Salem pastor's MEDCottage aims to offer comfort & care

BLACKSBURG - As part of his pastoral duties, the Rev. Kenneth Dupin often visits the old, the ill and the frail.

"I never visited anyone who said they wanted to be in a nursing home," Dupin recalled recently. "I said to myself, 'Why are they?' It basically comes down to there not being many options."

So the pastor of Salem Wesleyan Church came up with an option - a 12-by-24-foot modular home designed for a back yard in lieu of a nursing home - only to discover that the intersection of ministering and health care is more complicated than he first thought.

Six years after he came up with his "MEDCottage" idea, Dupin is still tweaking a business plan to make and sell the homes nationwide.

Although sales are significantly less than projected, he remains confident that the concept will catch on.

Enthusiastic debut

In a venture that is part entrepreneurial, part humanitarian and part ministerial, Dupin formed a company called N2Care in 2009 and began pitching a product that will allow the ill and the elderly to continue living independently, but within a few safe feet of where their family or caregiver resides.

The typical MEDCottage offers both home comforts and institutional-like care: shock-absorbent floors that give safe landing to falls, video cameras mounted ankle-high in the walls that can spot a prone body while preserving the resident's privacy, and an automatic medicine dispenser that delivers a recorded reminder when it's time for the next pill.

"Independence has never been so easy," the MEDCottage's website proclaims.

When Dupin launched his business plan in 2009, the response was both fast and favorable. The Washington Post, CBS News and other national media did stories. People called from as far away as San Francisco and London. Everyone, it seemed, wanted a MEDCottage.

Then came a dose of reality. After discovering that the logistics of placing a modular home in a back yard were more complicated than first thought - not to mention their added cost to the home's $75,000 price tag - Dupin had to readjust his business plan.

"Our issue is not with interest," he said. "We have huge interest. Our issue is with placement. Whether you can place it in your yard is the big monster for us."

Assuming the MEDCottage will fit in a caregiver's back yard, there's still the need for a general contractor to help hook into the main house's electrical, water and sewer systems.

And while a state law passed in 2010 allowed the structures to be placed without a special use permit required by many zoning ordinances, there's still the matter of getting a building permit and other logistical hassles.

"Right now, it's a lot like building another house as far as the utilities," Dupin said.

At N2Care headquarters at the Virginia Tech Corporate Research Center in Blacksburg, officials have just completed a new MEDCottage model that can be parked and plugged in, much like a Winnebago when it arrives at an RV park.

"What we started with and what we're doing today is about 50 percent different," Dupin said.

In the meantime, sales are chugging along. Five of the homes have been sold, including one to a Botetourt County family who wanted it so much they bought a model that had been sitting along Electric Road next to LewisGale Medical Center.

The first MEDCottage sold went to a family in Fairfax County last year. Others are in Hampton and Hanover County. (The family in Botetourt County declined to be interviewed.)

Another three deals are in the works, Dupin said.

Although sales are not as brisk as Dupin had hoped originally, he remains confident - perhaps because his vision of success comes more from the preacher than the business man.

"It has to have an economic engine," he conceded. "But my passion is in the whole business of families partnering" at a time when an aging loved one might be feeling isolated and forgotten.

Respecting elders

Dupin describes the idea as more of an evolution than an "A-ha" moment.

He was traveling across the globe, working on his doctorate in international development, when he was struck by how other countries care for their aging parents, grandparents and friends.

Nursing homes are less common abroad, he said, and the elderly there seem less afraid of being abandoned to an institution.

In other cultures, he said, "they celebrate the fact that people have lived so long."

Dupin is convinced that can happen here, too, in part through what he calls his "American solution" to a problem that will only get bigger.

By 2030, about one in four residents in the Roanoke Valley-Alleghany Planning District will be 65 or older, according to projections by the Weldon Cooper Center for Public Service. In the New River Valley, about one in six will be senior citizens by then.

Many of those people, no doubt, will eventually wind up in nursing homes.

Keeping an elderly person mobile (the MEDCottage has a ceiling-mounted suspension system and numerous handrails to help the infirm move around its 300 square feet) and independent-minded will help keep him or her out of an institution, Dupin said.

It's not that nursing homes are bad, he said. Sooner or later, an elderly person might need the level of skilled care they offer.

"Obviously, in a nursing home you've got nurses available 24 hours a day within 20 steps from your room, which may not be the situation in your home," said Stephen Morrisette, president of the Virginia Health Care Association, which represents nursing homes and independent living centers.

For those who can purchase a MEDCottage, Morrisette said, "we don't see it as competition as much as another alternative."

"The demand for long-term care services is going to be there, and if we just depended on nursing homes, we wouldn't have the capacity."

Several other companies are also in the business of making and selling what's known in the industry as auxiliary dwelling units, or ADUs.

But it's not yet a booming industry, which does not surprise Howard Gleckman, a resident fellow at the Urban Institute and the author of the book "Caring for Our Parents."

"This is a very interesting idea. It has a lot of potential for some people," Gleckman said. "But the market is going to be relatively limited."

Going beyond basics

On a recent June morning, Dupin unlocked the door to a prototype MEDCottage that sits in a parking lot near his Blacksburg office. With beige vinyl siding and white trim, it has the look of an upscale mobile home.

Dupin stepped into a living area that is about the size of a master bedroom. On one end was the bathroom. In the middle was a hospital bed and room for a few pieces of furniture. On the other end was a kitchen sink and counter with space nearby for a small refrigerator and washer-dryer unit.

Those are the basics. Here, Dupin pointed out, are some of the extras:

n A computerized system that records the resident's health conditions - blood pressure, pulse, weight, sugar level and the like - and feeds it into a dashboard that the caregiver can monitor online.

n Walls lined with foam core on the inside, part of a pressurized ventilation system that can block outside air if the occupant has a compromised immune system.

n A lift, attached to a built-in track in the ceiling, that allows the occupant to move around the cottage.

n And a sample of the special Satech padded floor that is designed to reduce the force of a fall by 38 percent.

Part of the company's sales pitch includes the statement that an egg will not break when dropped on the floor. Dupin says he's done it dozens of times at trade shows and demonstrations.

On this day, he placed the egg in a zip-top plastic bag - "just to be safe" - before dropping it onto the floor sample. The egg cracked open.

Dupin joked that the test subject, provided by a reporter, was a "bad egg." But he welcomed the experiment, saying the company should be held accountable to its promises.

Adjusting expectations

Answering the phone at N2Care can be a full-time job.

Dupin estimated the company has received 4,000 to 5,000 inquiries about the MEDCottage since the first of the year. The calls have come from across the United States and more than 60 countries.

In an effort to covert more of those calls to sales, the company has been working not just to simplify the installation of the home, but to make it more affordable.

Initial plans had a unit retailing at $75,000; the cost is now between $40,000 and $70,000. While that may still sound like a lot for a temporary home, Dupin said the cost of a nursing home - up to $6,000 a month - makes the MEDCottage a good investment that can be resold when it's no longer needed.

Plans to lease the units have yet to be finalized.

"It's harder to make the numbers work short-term," Dupin said.

Since starting his company three years ago, Dupin has enlisted the help of others, including engineers at Virginia Tech and builders in Martinsville and Charlotte County, where the cottages are manufactured.

"It's now a composite of about 20 people's ideas," he said.

Several years ago, the goal was to sell 100 MEDCottages a year. That's been scaled back to 20 or 30 units this year. About 80 of the homes must be sold before the company becomes profitable, Dupin said.

N2Care currently has 41 investors, with hopes of raising $10 million for a national rollout of the plan.

Dupin, who entered the ADU business with idealistic notions, has come to view the nation's $2.8 trillion-a-year health care industry in a different light.

"There's no other industry where the vulnerability of people sets the margins," he said. "It makes me angry."

Dupin is looking forward to the day when his company can afford to hire a CEO and he can go back to preaching full-time.

"Health care is a nasty, dirty business because of the margins involved," he said. "And it's just not where I want to spend my life."

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