In the village area on Lopez Island in the San Juans, the Lopez Hamlet, a community of houses for independently living seniors, sits between the post office and the community center.

Embedded in Lopez Hamlet is a rarity: Hamlet House, the only assisted-living, senior nursing care facility in the Whatcom-Skagit-Island-San Juan region whose costs, above and beyond room rental, are totally supported by donations and grants. With the mission of “maintaining connection and relationships benefits everyone through the lifespan,” it exists because the Lopez community chose to meet the challenge of helping its seniors age and die in place.

In Washington, designated Adult Family Homes (AFHs) are residential homes licensed to care for up to six nonrelated residents, providing room, board, laundry, necessary supervision and necessary help with activities of daily living, personal care, and social services.

Of the 26 AFHs in the Whatcom, Skagit, Island and San Juan county region, Hamlet House is one of only two nonprofits, the other being Sean Humphrey House in Bellingham which serves adults living with HIV. 

The not-for-profit, community-supported model is extremely uncommon among AFHs. 

 “I know of 20 or so nonprofit Adult Family Homes in the Seattle-Tacoma area, maybe a handful more … but that’s out of 4,012 statewide,” noted John Ficker, executive director of the Washington Adult Family Home Council.

Individuality and community

Lopez Island resident Gale McCallum, who helped plan and build Lopez Hamlet and died in 2019 at the age of 95, is remembered by her daughter Barbara Orcutt as exhorting the planners to hurry up so the residences were available to her before she died. “She would not choose to be anywhere else,” said Orcutt.

Retired vicar Murray Trelease, who first voiced the need for an aging-in-place facility on Lopez, summed up McCallum’s role as being “the Hamlet’s ‘poster girl’.”

Despite the challenges of the pandemic, Hamlet House continues to be a model for communities striving to keep families together as they age.

The six Hamlet House residents enjoy individual rooms furnished and decorated with personal belongings, plus a comfortable common and dining area. A staff of five, including a resident manager with emergency medical certification and a nurse who visits weekly, provide meals and round-the-clock care. 

Hamlet House’s blend of individuality and community distinguishes it from other AFHs. It was intentionally built adjacent to the cottages of the Lopez Hamlet’s independently living seniors, as part of its community. Hamlet House is situated in the very center — the heart of Lopez Village. 

McCallum and the original board members planned the Lopez Hamlet’s layout to embody its values. A rectangle of green reminiscent of a college quad is lined by cottages, seven to a side, painted in ochres, greens and blues. Half are two-bedroom cottages rented at market rate; the others are one-bedroom cottages with subsidized rents, per “federal and county affordable housing requirements,” said Hamlet director Heather Harrison. Cottage interiors and front-and-back gardens reflect individual tastes. 

At one end of the green rectangle is the Gathering Place, with fireplace, piano, kitchen and rooms for meetings, exercise or any kind of communal activity. Hamlet House’s assisted-living residents reside “among friends,” as Lopez Hamlet resident and board member Ed Sheridan puts it. Cottage residents like himself might move into Hamlet House when they need more help, Sheridan said, but “they are still welcomed wholeheartedly to attend special lectures or enjoy parties at the Gathering Place.”

Peggy Means, a former board member and health care administrator, helped her father, Bob Means, move into a cottage in 2016. She appreciates the “facing in and facing out” design. “If you feel like visiting with the neighbors, you can walk on the inner path and stop by to chat. If you’re in a hurry to go somewhere, you walk on the street side.” The central location is vital, Means said. “You can walk or ride your cart to the post office, grocery stores, community center, the library, even the dentist and the clinic.”  

Limitations of island life

In the early 2000s, Trelease began to worry about the lack of places for seniors no longer able to maintain their homes. “There wasn’t such a critter anywhere on the island,” he said. He consulted with his friend Rip Van Camp, a retired corporate executive with extensive planning experience.

With other concerned Lopezians, they assessed options to meet the island’s care needs, but quickly found that “there was no model like this anywhere,” Trelease said. “We were told we couldn’t do anything feasible for less than 40 residences” — far too large for little Lopez. 

But the group secured land at a “decent rate” from a fellow islander and, with plans drawn up, they were successful in getting a grant from the Robert Woods Johnson Foundation and a million-dollar loan from the U.S. Department of Agriculture’s Rural Development program. Hamlet treasurer Rebecca Chao said that the total cost of building Hamlet House, the cottages and the Gathering Place came to $4,711,500. The USDA grant is still being paid back, according to Hamlet director Harrison, “little by little each month.”

Van Camp, who served 12 years as board chair, believes that the project’s success stemmed largely from its bold inception. Other AFHs they visited “were converted houses, mostly without good lighting. They lacked the functionality,” he said.

Hamlet House has an extra-large living room and kitchen; a central bathroom with safe, walk-in tub available with assistance; and skylights for atmosphere. “We were able to offer an Adult Family Home with all those features built in,” he said. 

Former board member Robin Van Hyning, a registered nurse and administrator with 37 years of experience in long-term care — including running her own AFH in Friday Harbor for eight years — emphasized Hamlet House’s “large open common area that still feels cozy like a living room, an open dining area [and a] kitchen designed to cook for a large family.” 

“Of all the settings I have worked in, if a person is unable to remain in their own home … I would choose an AFH,” she said.

Funders, too, agreed, and Hamlet House opened in 2008, and McCallum moved into the first cottage soon after.

Choices at Hamlet House 

Phyllis Nansen, a former opera singer and music director who moved from a Lopez Hamlet cottage into Hamlet House after a medical emergency, can be found cuddling with her black-and-white cat, Sweet Boy Kitty, in her vibrant, art-filled room.

“I must say, this is a really fine place,” said Nansen. “I’m kind of a loner. I socialize at mealtimes, but basically, I am happy to read.” While she keeps up with her Seattle book club, Sweet Boy Kitty can be found curled on various laps in the living room. 

“The staff responds to people’s individual interests,” Means said, describing how the sound system was improved after a fundraiser to allow opera lovers to gather on Saturdays to enjoy live Metropolitan Opera broadcasts. “And someone else loved bingo, so bingo happened.”

Lopez is an island, and Hamlet House represents the only means for families “to keep generations and families intact” when the need for care increases, said board member Nancy Wynen. She sees Hamlet House as “integral to the whole Lopez life cycle. Being isolated from the mainland, we [share] a communal desire to do that.” 

Nancy Fay, a 93-year-old former social worker and a resident since February, agreed: “My children love that I am safe here, and nearby.”

Passion for making a difference

That sense of security derives from a staff that is, in the words of resident manager Alex Davis, “passionate” about helping people. Davis, a community EMT and firefighter with 10 years’ medical experience, moved to Lopez in the spring of 2021 in search of more meaningful care work. 

Davis came from a background of large, for-profit care institutions, “where people are just a Medicaid number,” he said. “I wanted to be more direct with the families. I get to spend more time in direct care here, in making a difference in their lives.”

Davis and his partner, Mary Worthy, who cooks the meals, share the Hamlet’s upstairs residence — a job perk of arguable value, given the limited privacy — and their Labradoodle, Luna, roams the premises with Sweet Boy Kitty. But the stresses of the past two years, familiar to care- and nursing-staffing shortages nationwide, have taken a toll on the couple, and Davis hopes to hand the reins to a new resident manager soon. Despite the challenge, Davis has valued the work: “I wouldn’t take a single hour back.” 

The same factors that weigh on Davis and Worthy affect the Lopez Hamlet, especially staffing and fundraising. Board member and nurse Karen Gilbert joined with several Lopezians and former board members including Wendy McClure to form an advisory group in 2022 to help the board “stabilize the facility” while a new resident manager is found to replace Davis. 

A resident manager vacancy is a problem, advisory group member Van Hyning said, because no one on the board is qualified to step in as interim manager with the required credentials to manage day-to-day operations. The group is actively seeking applicants, making it clear that the board is aware of the stresses. “We cannot continue to offer the job the way [Davis has] been forced to do it. But a job share is possible,” Gilbert said

There are also expenses and a need for fundraising. 

“We’ve been less expensive than a typical for-profit AFH,” said director Harrison, but there’s an estimated $108,000 shortfall due to rising costs in 2022 that will require a rent hike. Hamlet House rents cover staffing, food and medical supplies, according to treasurer Chao, while the USDA loan payment, utilities, insurance, license fees, annual maintenance and incidentals are covered by donations designated specifically to Hamlet House. The Lopez Hamlet has its own set of books and its own donors, though both facilities share undesignated donations.

A model for the future

To Gilbert — and everyone — interviewed, Lopez Hamlet and Hamlet House are “unique and amazing, a community gem” that could be replicated elsewhere.

“The whole community benefits when our elders are able to remain on island and share their wisdom and experience, children especially,” said Means. “The Lopez community … demonstrates that, with ongoing fundraising and volunteer support, it is possible to provide quality services in a nonprofit, rural setting.” 

Cofounder Van Camp encouraged others to try the Hamlet model: “Now you have an example, a success story, [with] 15 years of operation.” 

“Interest in the aging and housing situation is much higher than when we started,” he said. “There are parts of government dedicated to this. Foundations would have even more interest than when we started,” especially “in dealing with the unserved, rural segment of the population.” He encouraged interested communities to “survey the funding field,” but with a plan, “not just, ‘What if we build something for seniors?’ [but], ‘What if we build this?’” 

“This” — Hamlet House — needs to find staff as dedicated and caring as those currently working there. And, resident manager Davis noted, “Health care workers in general are pretty burnt out,” so working at Hamlet House has to be worthwhile financially. For Gilbert, those who work at Hamlet House need to be part of the community of care and Hamlet stakeholders need to ensure their workers will feel that level of support.

John Ficker of the AFH Council said he is excited about the model and would love to see more of it statewide. He said he is encouraged that the legislature will be taking up a bill in January to use property tax exemptions to offer as an incentive to any individual or community looking to open their own Adult Family Home.

— Reported by Gretchen K. Wing

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