Conchy Bretos

Ashoka Fellow
Miami, United States
Fellow Since 2009
My work: creating a new norm for elderly people to stay in their homes rather than move to nursing homes
Related TopicsHealth & Fitness, Aging


This profile was prepared when Conchy Bretos was elected to the Ashoka Fellowship in 2009.
The New Idea
In response to the deplorable public housing conditions that she witnessed as Florida’s Secretary for Aging and Adult Services in the mid 1990s, Conchy created a new model for providing basic care services to the elderly while allowing them to stay in their own homes. Although private assisted living facilities (ALFs) have long existed for senior citizens who are able to pay hefty monthly fees, low-income and disabled senior citizens—many of whom live in public housing— are largely unattended by the market. Conchy’s model makes ALFs affordable for these seniors by retrofitting existing public housing buildings to comply with ALF regulations and by leveraging state Medicaid waiver funding to finance the ALFs’ start-up operations. Not only do these affordable ALFs allow the elderly to continue living with relative independence and dignity in their own homes, but they also generate employment for single minority mothers in the daily care of the residents and the maintenance of the facilities, often leading to a gradual revitalization of the frequently derelict or decaying urban neighborhoods where these ALFs are located.

Preliminary studies of the results of Conchy’s model have shown that residents’ physical and cognitive health actually improves significantly in these affordable ALFs as compared to traditional nursing homes. As hospitalizations, emergency calls, and dependence on medications drop, so does the financial burden on the Medicaid program, which often ends up covering the medical expenses of low-income and disabled seniors. Consequently, Conchy’s model not only helps the elderly stay in their own homes with basic services, but it also helps cut Medicaid costs at a time when both state and federal government budgets are becoming increasingly overwhelmed by public spending.

Conchy has already replicated her model in 40 ALF projects that serve approximately 5,000 seniors in 23 states through MIA Consulting, the for-profit group she founded in 1995 to help public housing authorities (PHAs) across the country adopt versions of her affordable ALF model. MIA Consulting works directly with interested PHAs to conduct feasibility studies, retrofit buildings to meet ALF standards, recruit residents and staff, manage day-to-day operations in the start-up phase, and conduct performance and impact evaluations. After an initial three- to five-year period of intensive involvement, MIA Consulting hands over the management of facilities to the local PHAs themselves. MIA Consulting is funded by contractor fees from PHAs and non-profit organizations that want to implement an affordable ALF model; all profits beyond the salaries of MIA Consulting’s two principals (the CEO and COO) are reinvested in the organization to help subsidize low-cost and pro bono consulting services.
The Problem
The Strategy
The Person

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