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• Dementia Innovations, a nonprofit started in Sheboygan County, is developing what it describes as the first U.S. village where people diagnosed with dementia will live and own homes.
• Unlike a traditional risk-averse memory care facility with locked doors, homeowners at Livasu, short for “living as usual,”  will be free to navigate the village with support from staff.
• It’s similar to a European model. Experts say the village care model is difficult to replicate in the litigious U.S., but Livasu’s founders hope the village will show it can work in Wisconsin and other states.
• To limit costs, the village is using manufactured homes, a more affordable alternative to site-built options.

A row of footprints followed John and Terri Cooper, both 70, as they carefully navigated an icy road near Sheboygan, Wisconsin. They stopped at a row of concrete slabs. 

“This is our house,” John said, waving at the first snow-covered block.

“It’s pretty big,” Terri added while standing on the foundation.

As they do every Sunday, the Coopers had driven around 20 miles from their independent living community to the construction site of their soon-to-be home. John flies a drone over the neighborhood taking shape around it, which will include a grocery store, a spa and a gym. He photographs progress on the 45-acre development designed specifically for people like Terri, who has Alzheimer’s disease.

The couple has moved a lot during their 50-year marriage. But this summer’s move will be different from all the others.

Dementia Innovations, a nonprofit started in Sheboygan County, is developing what it describes as the first U.S. village where people diagnosed with dementia will live and own homes. It’s similar to a European model that encourages people with memory loss to remain more independent. The Sheboygan County village, Livasu, short for “living as usual,” will allow people with dementia to live alone or with loved ones and continue typical routines from their homes as their disease progresses.

Applauded for years in other countries, experts say the village care model is difficult to replicate in the U.S. Livasu’s founders hope the estimated $14 million village will show it can work in Wisconsin and other states.

To limit costs, the village is using manufactured homes, a more affordable alternative to site-built options. People will buy their home and set hours of caregiving, depending on their level of need.

Unlike a traditional risk-averse memory care facility with locked doors, homeowners will be free to travel throughout the village with support from staff.

“We all take risks every day, but as we age, and especially as we age with dementia, there’s a safety-at-all-cost approach,” said Livasu’s project lead, Mary Pitsch. “That cost is actually a loss of personhood.” 

Rather than a fence surrounding the village or automatically locking doors, landscaping will direct people from their home toward the community’s “downtown.” People living in the village’s 124 houses will have access to a lodge with support staff and a place to eat meals with neighbors and to watch the Packers, Pitsch said.

The village will eventually feature a public grocery store and a restaurant.

“We are changing the way we are thinking about care and support,” Pitsch said.

Aging at home — together

The Coopers met in college. 

“I picked Terri out almost immediately. It took me some months to convince her that I was the right guy,” John joked.

“Thankfully,” Terri chimed in with a laugh.

As the couple raised two daughters, John worked different technology jobs and photographed sporting events like triathlons on the weekends. Terri was a structural steel detailer. 

After watching her mother battle Alzheimer’s, Terri made sure to eat healthy and exercise to prevent herself from getting the same disease. But in 2019, John started noticing changes. Two years later, Terri was officially diagnosed. 

“I mean right now,” she asked John outside of the Livasu construction site,  “I think I’m OK, right?” 

“Yeah, you’re great!” he responded emphatically, prompting another round of laughs.

Terri shook her head.

“This is what I live with,” she said.

The couple moved into an independent living center over a year ago after John was diagnosed with two forms of cancer that are now in remission.

“We wanted to be someplace where, if I was gone, Terri could live and have people take care of her,” John said. “That’s still the goal.”

Unlike institutional settings, Livasu will allow them to age in their home together.

Manufactured housing brings savings 

The Coopers are excited to again own a home, even if it’s smaller than they’re used to.

First they left their 2,400 square foot home in Neenah for a 1,500 square foot duplex. Their future manufactured home in Livasu measures just 1,140 square feet, John said. But unlike the independent living duplex they rented, they are purchasing this home.

Home prices in Livasu currently range between $95,000 and $175,000 — less than traditional site-built houses. 

Like with any manufactured homes, savings come from finding scale in mass production, with factories buying materials in bulk and cutting down material waste through computer design. 

The Livasu homes are built off-site, limiting construction time and noise as people move in at different times, Pitsch said. The homes have a title, similar to a car, instead of a traditional deed. That will make transferring the homes between owners easier.

Terri Cooper lived in a mobile home during one year at college, John recalled. But today’s manufactured homes are higher quality, he said. 

“They’re actually built pretty nice,” he said.

Every detail is designed for someone aging with dementia, Pitsch explained while walking through a model home placed outside the Livasu construction zone. 

More lights in each house help aging eyes. Dark door handles contrast to lightly painted doors. The homes feature safer electric stoves instead of gas.

While homes in most manufactured housing communities — traditionally called “mobile home parks” — have stairs,  Livasus will place homes at ground level.

Bedrooms will have a direct line of sight to the toilet, which can help prevent incontinence.

“The shower was a big discussion. Do you have glass doors? Do you have a shower curtain?” Pitsch remembered debating with the other designers. 

“Lots of conversations about some things that would seem really simple, were long conversations,” she said, “and we made the best decisions we could.”

Dignity in dementia care

Pitsch, a social worker, developed her passion for this work while working with older adults. She has run an at-home care company with her husband for close to 20 years. She learned Sheboygan-area law enforcement often responded to emergencies involving people with dementia. 

She and other community members started a task force to evaluate the county’s response to residents with dementia. That prompted changes in the county’s emergency protocols and the creation of Dementia Innovations.

“I’m kind of one of those people that if it’s not me, then who’s going to do it?” Pitsch said.

Pitsch and others started planning a way to better care for people with dementia and to prevent emergency situations in the first place. They learned about Hogeweyk, the world’s first dementia village in the Netherlands.

“We are far behind other countries in a better, humanistic way of providing care for those with dementia,” Pitsch said.

Dementia care in the U.S. tends to prioritize safety above all else, said Emily Roberts, an associate professor at Oklahoma State University who researches the connection between older adults and their physical environment. 

Creating environments where people can make choices and take risks can be expensive, especially in a litigious country like the U.S., she said.

Support staff in Livasu will regularly monitor the grounds. Cameras can alert them if someone walks in or out of the village through an unexpected area.

Creating a home-like environment also prevents people from wanting to leave, Roberts said. As the number of people with dementia continues to grow, the country will need more environments that support people with dementia, she said. That’s especially true in aging Wisconsin.

A private room in a nursing home cost $127,750 on average in the U.S., according to the Alzheimer’s Association — more than a smaller home at Livasu. Village residents will pay for care as they need it, similar to at-home care, and potential homeowners discuss their finances with Livasu volunteers, Pitsch said. 

Livasu raised more than $8 million for the first phase of construction. It still needs to raise around $6 million more to complete the entire village, but the first houses are already waiting to get placed on foundations.

Pitsch recently watched as a construction crew drove excavators and bulldozers over the giant field where a restaurant, post office and ice cream shop will eventually go. 

“I pinch myself,” Pisch said. “It gets pretty emotional actually, to see that it’s actually happening,” 

‘Wherever she goes, I go’

When the Coopers move in, they don’t expect to need any caretaking. They still make weekly visits to see their grandkids and take weeks-long hiking, camping and cycling excursions.

“Wherever I go, she goes, wherever she goes, I go. Except in the women’s bathroom,” John said, eliciting more laughs from Terri.

“We kind of like each other, so that’s OK.” 

As the couple finished checking in on construction of their future community, they carefully walked back to their car — holding hands the entire way.

‘Living as usual’: A new village in Sheboygan County reimagines life with dementia is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

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• Free clinics like Bread of Healing in Milwaukee and Open Arms Free Clinic in Walworth County serve as a final safety net for community members who can’t afford health care.

• They are bracing for higher demand as more residents are expected to forgo insurance as a crucial tax credit is set to expire and premiums spike.

• Clinic staff say they may need more resources to meet demand. 

• The U.S. Senate on Thursday rejected dueling plans related to helping people pay for plans on the federal marketplace.

Editor’s note: This story has been updated to note the U.S. Senate’s rejection on Thursday of legislation to address the expected rise in health care premiums.

Cars filled the small parking lot outside of Milwaukee’s Cross Lutheran Church on a recent Monday afternoon. The church’s pews sat empty, but downstairs visitors waited around folding tables. Not to hear a sermon, but to see a volunteer physician. 

Staff and volunteers walked patients past a row of dividers used to separate the “waiting room” from the folding tables where doctors and counselors filled out paperwork. 

In front of the free health clinic’s four exam rooms, two phones rang. 

“This is the Bread of Healing Clinic. Can you hold for a moment?” asked Diane Hill Horton, the free health clinic’s assistant.

Across from Hill Horton, another staff member scheduled an appointment in Spanish. 

On a typical Monday, the clinic sees up to 30 patients. Bread of Healing treated 2,400 patients in 2024 across three clinics it runs in Milwaukee. Patients typically lack any health coverage and aren’t asked to pay for their visits.

“We don’t turn anyone away,” Hill Horton said.

But without action from lawmakers in Washington, clinic staff worry that it will become harder to answer every call.

Free clinics like Bread of Healing serve as a final safety net for community members who can’t afford health care. They are bracing for higher demand as more residents are expected to forgo insurance as a crucial tax credit is set to expire and premiums spike.

Affordable Care Act premiums in Wisconsin will increase on average by 17.4% next year, a previous Wisconsin Watch analysis showed, with wide variation depending on age, income, family status and geography. Meanwhile, experts estimate more than 270,000 Wisconsinites rely on the enhanced premium tax credit to make insurance more affordable. It will expire at the end of the month without intervention. 

People without insurance are less likely to get preventative care. Bread of Healing focuses on treating chronic conditions to prevent people from overwhelming emergency rooms, said Executive Director Erica Wright.

“If we don’t try our best to move with that demand, we’re not going to be able to see as many people, and there’s going to be a lot of folks falling through the cracks,” she said.

Wright oversees all three Bread of Healing locations. While the clinics have some room to take on more patients right now, she wants to significantly increase their capacity over the next year — adding money and volunteers to serve a possible “monsoon” of demand.

“We’re never going to be able to serve everybody, we know that,” Wright said. “But I don’t want it to be where our phones are ringing off the hook and we just can’t meet at least a good chunk of the demand.”

Higher premiums and shrinking options

Ashley Bratz paid about $545 a month for a low-deductible marketplace plan this year. That same plan cost over $700 when she went to sign up for 2026.

Even with her job at Open Arms Free Clinic in Walworth County covering a portion of her health care costs, the only option in Bratz’s price range had deductibles higher than what she expects to spend.

 “It’s supposed to be reasonable, and this is not reasonable,” Bratz said.

Bratz, who works as the nurse clinic coordinator, said she did not receive enhanced marketplace subsidies this year. Those who did will face a particular shock as the tax credit expires — while also confronting rising prices and shrinking options.

The income-based tax credits have lowered some marketplace enrollees’ monthly premium payments since they became available in 2014.

In 2021, the federal government expanded those subsidies, further bringing costs down for lower-income enrollees and extending smaller subsidies to people making over four times the  federal poverty level — $62,600 a year for one person in 2025.

Without an extension, monthly premiums are expected to more than double on average nationally for subsidized enrollees, according to KFF, an independent source for health policy research.

A quarter of enrollees surveyed by KFF said they were “very likely” to go without insurance if their premiums doubled.

The U.S. Senate on Thursday rejected a Democratic plan to extend marketplace subsidies. Republicans, who have long criticized the Affordable Care Act (ACA), have instead called for a broader overhaul. The Senate also rejected a Republican plan that would have expanded access to high-deductible insurance plans and deposit $1,000 to $1,500 in enrollees’ health savings accounts — without renewing enhanced subsidies.

Sara Nichols, Open Arms Clinic executive director, is forging ahead regardless. When Bratz told her about her shrinking affordable coverage options, Nichols started working with an insurance broker to find a new plan for the clinic’s small team of paid staff.

“We cannot have health care workers not have health insurance,” Nichols said.

The move left Bratz relieved. Now she’s preparing to help more clients who can’t afford coverage or just need help navigating the complicated system.

They face challenges beyond lost subsidies and premium hikes. President Donald Trump’s “big” bill-turned law included additional changes to Medicaid funding and the ACA that are expected to increase the number of people without insurance by 10 million over the next decade, according to the Congressional Budget Office.

“We always take what is thrown at us and we figure out how to handle it,” Bratz said. “Do I think we could also use more help? Yes.”

Resources needed to meet demand

Open Arms Free Clinic is already seeing higher demand, Nichols said. 

It operates a dental clinic five days a week, and she’s considering whether further demand would require opening its medical clinic for an additional day.

That would take more volunteers and money. 

While the Legislature sent state dollars to free clinics in its latest budget, private grants and donations have been harder to secure this year, Nichols said. She expects the clinic will have to get even leaner next year.

But she won’t start turning patients away.

The clinic provides dental, medical and behavioral health to low-income people who live and work in Walworth County. Its 250 volunteers help with things like translating, nursing, greeting patients and connecting people to the clinic. They also provide vision and pharmacy services.

“I know that we have enough smart people and kind people that we’re going to come up with a solution to anything that comes up,” Nichols said.

This is far from the first time Wisconsin’s free clinics have faced big changes, said Dennis Skrajewski, the executive director of the Wisconsin Association of Free and Charitable Clinics. 

Free clinics adapted to the COVID-19 pandemic, operating with fewer volunteers and switching to telehealth services and opening vaccine programs, Skrajewski said. Then clinics prepped for increased demand in 2023 after Medicaid unwinding.

“We’re used to waking up and the world changed yesterday, so we’ll adjust,” Skrajewski said.

Wisconsin’s free and charitable clinic association is collaborating with other safety net health providers as part of the Wisconsin Owns Wellbeing initiative, which will host statewide planning meetings to strengthen the state’s safety net services. 

Clinic co-founder: ‘I just wish it weren’t needed’ 

Rick Cesar started working as a parish nurse at Cross Lutheran Church in the 1990s. He took people’s blood pressure at a weekly food pantry and ran an HIV testing site and needle exchange out of the church’s basement.

He helped co-found the Bread of Healing Clinic in 2000, a decade before the ACA passed. 

“There were so many people that had no coverage,” Cesar said.

Demand for free services persisted even after more people enrolled in marketplace plans. The clinic expanded to two other locations and hired paid staff. Cesar retired from nursing in 2019 but still regularly volunteers. He feels proud watching the clinic grow.

“I just wish it weren’t needed,” he said.

The clinic is adaptable, Cesar said, whether it’s responding to a pandemic with vaccine drives or helping clients navigate ACA changes.

“We’re going to be here and do as much as we can,” Cesar said. “But those resources, you never know how long they are going to last when the demand is so great.”

‘We don’t turn anyone away’: Wisconsin’s free clinics fill gaps as thousands expected to go uninsured is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

Reading Time: 2 minutes

Last winter, I got an intriguing story tip: Many Wisconsin manufactured home communities were operating with expired licenses. 

I didn’t initially know much about these communities, often called mobile home parks, where residents own their homes but rent the land they sit on. I quickly learned they provide a critical source of affordable housing in Wisconsin and beyond — the country’s largest portion of unsubsidized low-income housing. 

Housing experts and advocates told me private equity’s growing interest in the model threatens to change that. My reporting found that Wisconsin’s government is failing to enforce basic protections for owners. Still, some residents and groups see pathways for safe, affordable manufactured home ownership as a solution during an affordability crisis. 

That required talking to owners of manufactured homes across the state, starting with a February drive from Wisconsin Watch’s Madison newsroom to snowy La Crosse. There I met with a couple who moved into their manufactured home more than a decade ago. That meeting led to a months-long tour of similar communities. 

A Cumberland couple showed me their favorite part of their manufactured home, the fireplace. I passed out flyers in Richland Center and Spring Green, chatting with a surprising number of people who answered their doors.

As the weather warmed, I walked up to chatty neighbors sitting on porches in Wisconsin Dells. Menomonie residents stopped their yard work to talk. I left a set of Fond du Lac park interviews sunburned after standing on a porch for too long as residents lent me their time and perspectives. 

Not every homeowner’s experience made it into our “Forgotten homes” series, named after a lawmaker’s reference to the homes as “a forgotten segment of real estate.” But they often shared a lot of similarities. Here are some of my takeaways:

1. Park ownership is changing. While some residents said they know the person who owns their park, others were paying rent to out-of-state companies. Some mentioned concerns about what would happen to their homes once their local owner decides to sell. 

2. Residents don’t always know where to turn when conditions deteriorate. Wisconsin uses a patchwork of state and local agencies to monitor different aspects of manufactured home communities. That leaves residents unsure of where to complain about issues or unaware they have that option. 

3. People want to stay in their homes. Even as some residents face surging monthly payments, they struggle with the idea of giving up the space, independence and yards.

4. Owning a manufactured home outside of a park can be complicated. Wisconsin Habitat for Humanity affiliates are developing factory-built housing in residential neighborhoods. But local zoning can block certain homes from residential neighborhoods. And other park residents mentioned needing more money to purchase land themselves.

5. Manufactured homeowners often face stigma but are proud of their homes. Residents showed me carefully decorated lawns, peaceful walking routes through parks, kitchens with custom cabinets and the homes of their longtime neighbors and friends. 

Wisconsin’s forgotten homes: Takeaways from investigating manufactured housing is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.