Many older adults living in apartment communities or housing cooperatives enjoy a high degree of self-reliance, low cost of living, and enhanced quality of life. Even those who cope with multiple chronic conditions often find reassurance in having a reliable network of other resident members to depend upon for help. So the benefits to seniors of vesting in one of these co-ops are many—even for individuals who have a relatively low income level. But there is another side to this kind of self-reliant lifestyle we don’t often talk about, though it may become critical to the health and safety of everyone residing in one of these communities: how to monitor residents for dementia, when to intervene medically or with social services, and when to insist that a member move on to a more appropriate setting.

I recently heard stories about three older adults that really brought this issue home. The first was an older woman, a PhD psychologist deteriorating with Alzheimer’s disease, who left the water running in her bathtub and flooded out the apartment below. The second was an elderly man with dementia who was boiling water for coffee in the morning and ended up severely burning himself. He died several months later. The third, an eighty-year-old medical school professor living alone, repeatedly fell in his apartment, causing serious bruises and broken bones. These individuals were a danger to themselves or to others. Obviously, they should have had skilled professionals looking after them, but who was accountable to make that decision? They were incapable of making it themselves, and there may have been no relatives to do it for them. So did the responsibility, either ethically or legally, fall to the co-op? Whatever the answer, many of these communities are choosing to do whatever they can to help remedy this problem.

Some newer housing cooperatives, organized around the needs of senior residents and managed by licensed long-term-care administrators, are better equipped to deal with these situations. Many of the older ones, however, are not. In fact, a substantial number that initially housed mostly young residents have transformed into de facto senior co-ops as their populations have aged. They now face challenges they never anticipated. These places are called “naturally occurring retirement communities” or NORCs, a term that originated in New York City in the 1980s. Fortunately, a model of providing social services to their seniors, called NORC social services programs (SSPs), have been drawn from the experience of several larger NORCs and can help give smaller co-ops direction—not only in how to put a program in place, but also in how to fund it.

But medical and social services are not, in themselves, a complete solution, though they may require a substantial commitment of time, money, and human resources. (According to the Alzheimer’s Association, proper dementia care should consider food and fluid consumption; issues surrounding toileting, bathing, and other activities of daily living; social engagement; wandering; and falls, among other issues.) Perhaps even more importantly, each co-op needs to determine its policies toward residents with dementia ahead of time, clearly articulate those policies in understandable language, and make certain that every resident knows about and has agreed to accept them. What kinds of services will the co-op provide? Who will assume the financial burden of those services? And at what point will it consider removing a resident to a facility with more specialized care?

Answering questions such as these can go a long way in helping cooperative housing communities determine what their capabilities are when dealing with the difficult problem of handling residents with dementia. But perhaps just as critical is bringing this issue to a public forum for discussion and to help determine who should, ethically and legally, assume ultimate responsibility in managing these cases.