Small Houses, Big Impact: Rethinking Senior Care

At The Forest at Duke, innovation is personal. Our drive to set the highest possible standard for senior living and health care comes from a desire to create the best possible experience for our residents. With the opening of our Cohen Center for Health in February 2023, we realized a forward-thinking vision of care, one that challenges the traditional, institutional model and replaces it with something much more familiar: home.

The new chapter of senior care centers on the “Small House” concept, where residents receive personalized support in a thoughtfully designed, household-like environment that fosters a sense of autonomy, connection, and comfort. Daily life in our Small Houses is welcoming and vibrant, characterized by meaningful activities and close-knit care teams who know each resident as an individual.

Philosophy of care

The Small House model is influenced by the philosophy of The Eden Alternative, a culture change movement in long-term care. The Eden Alternative is a person-centered philosophy of aging that seeks to replace institutional models of care with environments rooted in dignity, autonomy, and meaningful connection. It challenges the traditional experience of long-term care by addressing what it identifies as the “three plagues” of aging—loneliness, helplessness, and boredom—through relationship-based care and daily engagement.

At its core, the Eden Alternative empowers older adults to direct their own lives, encouraging choice, purpose, and participation while fostering a true sense of home. The power of choice, in particular, makes a big impact on the everyday lives of our residents. Caregivers at The Forest have found that, with more control over their daily routines, residents tend to eat better, participate in activities more frequently, and spend more time out of their rooms engaging socially with others.

Levels of care included in the small house concept

Within the Cohen Center for Health at The Forest at Duke are nine unique Small Houses designed to support varying levels of care: Assisted Living, Memory Care, and Skilled Nursing. Each of the nine small houses includes a kitchen, dining room, den, living room, a screened-in porch, and ten private resident rooms.

The Cohen Center also includes special amenities to enhance the quality of everyday life for residents. For example, the secure Memory Care household includes an outdoor garden to promote meaningful wandering and interaction with nature. The art studio and community room, used by all the households, are the site of daily activities and events, from ballroom dancing to painting.

The human impact

We talked to Jennifer Kea, Assisted Living Manager at The Forest at Duke, about the human impact of the Small House model. “Before transitioning to the Small House model,  we had a resident who rarely participated in programs and spent most of his time in his room,” she said. “After moving into the Small House setting, he began spending time in the shared living area, where he enjoyed bantering with staff and watching shows in the living room. He also took part in more daily activities than he did previously.”

The impact of small houses extends to the family of residents as well. “Families especially enjoy the screened porches,” Kea shared. “They often share that it feels like their loved ones are truly part of a household, rather than living in a facility.”

Essentially, the Small House model redefines what senior care looks and feels like. Guided by person-centered principles, this approach shows that quality care doesn’t have to feel clinical or impersonal—rather, it can be warm and empowering for residents, families, and caregivers alike. In rethinking what senior living can look like, The Forest at Duke is proving that even in a comprehensive continuum of care, smaller spaces can have a profoundly bigger impact.