Zelda and Bill Gamson are leaving Martha’s Vineyard after 35 years. Like many other seniors on the Island, they had found themselves at a crossroads when they needed to sell their house. The only suitable alternative was off-Island.

“The market has changed drastically in the time that I have lived here,” Mrs. Gamson told the Gazette recently. Taking advice from their children, the Gamsons turned their attention from buying to renting, but that path also led nowhere.

“There is no place to go if you are a senior, or even if you are not a senior,” said Mrs. Gamson, who spent years serving on boards and committees to help provide more year-round housing for Islanders.

Senior living on the Island takes many forms, including in-home care, residential communities, assisted living and nursing homes. But as many have learned, the doors are often closed.

Obstacles include both cost and availability. The Island has no traditional continuing care facilities, where elders can progress through various stages of assisted living. Island Elderly Housing, which provides low-income residential housing, has a seven-year waiting list. And the several options that offer more care for elders are either too expensive or may not provide the type of environment people desire. While Windemere has earned top ratings from the Centers for Medicare and Medicaid Services, for example, many elders seek to avoid such institutional settings.

Senior living takes many forms, but doors are often closed. — Jeanna Shepard

An announcement two weeks ago that the Martha’s Vineyard Hospital would begin the process of closing Wildflower Court, a 13-room wing at the Windemere Nursing and Rehabilitation Center, came as a surprise to many, and has shined a light on the broader need for elder living options on the Vineyard. The hospital has suspended admissions as it considers its next steps for the facility, which many also were surprised to learn is half-empty and costing the hospital about $1 million a year.

The announcement happened to follow a series of state-certified housing production plans, drafted in January, which aim to dramatically increase the Island’s affordable housing stock by 2035. The plans note, among other things, a total of 1,100 elder families currently paying unaffordable rents or mortgages on the Island, including 585 families that earn more than the area median income (about $65,500 for Dukes County).

Peter Temple, a longtime housing advocate and consultant for Healthy Aging Martha’s Vineyard, which is exploring options for elder living on the Island, including services for patients with dementia, said most seniors want to stay at home. But those seeking to downsize or receive daily care may find themselves out of luck.

Simone DeSorcy, president of the board of directors at Island Elderly Housing, which offers 165 low-income apartments for elder or disabled residents on the Island, pointed out that with rising property values, elders on fixed incomes increasingly struggle to pay their bills. And unlike the younger generations, she said, elders can’t simply get a second job. Many elders on the Island could afford (and would prefer) to sell their homes and move into a community where they don’t have to worry about maintenance, she said, but they don’t have the option.

Wildflower Court, which offers private rooms and some basic services, illustrates the complexity of elder living options in general, where distinctions have become fuzzier as healthcare providers expand their services. The facility is often billed as offering an independent living arrangement, but is licensed as a level four nursing facility or rest home, which allows for a higher level of care.

“Calling that independent living is not using that term the same way it is being used in the rest of the world,” Mr. Temple said. “There is no independent living that I know of on the Island.”

Wildflower Court residents pay between $210 and $270 per day, with Medicaid covering 50 per cent, which is more than they would pay in a typical market-rate assisted living facility, even on the Island.

To most people, independent living would suggest private apartments with emergency call systems, along with the availability of basic services such as meals and housekeeping, and a degree of communal living. In contrast, assisted living facilities, which may include independent living arrangements, provide a wider range of services, including assistance with daily tasks like washing and dressing. But both options stop short of skilled medical care.

The Island has six age-restricted housing developments that are considered affordable, with most being limited to low-income residents. Four of the developments are managed by the nonprofit Island Elderly Housing (Woodside Village and Aidylberg in Oak Bluffs, and Hillside and Love House in Vineyard Haven). The other two are the Greenough Housing Project and Havenside Apartments in Vineyard Haven. All have long wait lists, including more than seven years for Island Elderly Housing.

The Island has two assisted living facilities, the Henrietta Brewer House in Tisbury, and Long Hill Assisted Living in Edgartown, which provide a total of 24 market-rate units, with monthly rents ranging from $180 to $220 a day at Henrietta Brewer, and $5,500 per month at Long Hill.

According to Healthy Aging Martha’s Vineyard, there are no new senior housing or care projects planned for the Vineyard, although increasing the elder housing stock remains a primary goal of Island Elderly Housing.

Ms. DeSorcy said state and federal funding for elder housing construction has dwindled since the 1980s, creating a major obstacle to development. “I know we could fundraise enough to build, and we have property,” she said. “But that’s just the tip of the fundraising iceberg. It’s the monthly subsidies to each resident that’s our problem.”

Many residents in Island Elderly Housing have visiting nurse assistants, and a professional coordinator helps them find the services they need. But unlike many nursing homes and assisted living facilities, Island Elderly Housing does not receive any Medicare or Medicaid reimbursements. The same is true of the Island’s two assisted living facilities.

Falmouth has four assisted living facilities — at Atria Woodbriar Place and Terrace, Cape Cod Senior Residents at Pocasset, Royal Megansett Nursing and Retirement Home, and Heritage at Falmouth — with half the cost of assisted living at Cape Cod Senior Residences covered by Medicaid.

Healthy Aging has pointed out that when residents in assisted living need help beyond what is covered in their rent, those added costs can be significant. Base rates at Heritage in Falmouth, for example, range from around $5,000 to $6,000 per month, but jump to between around $8,000 and $9,000 with three hours of assistance a day.

One benefit for residents at Wildflower Court has been that Medicaid covers half their rent. But qualifying for Medicaid often requires applicants to sell their homes or other assets. Windemere’s other nursing facilities, which provide higher levels of care, cost between $380 and $420 per day, with Medicare and Medicaid covering 90 per cent — a higher reimbursement rate than in Falmouth, although the Falmouth nursing homes also have dedicated memory units for people with dementia. Windemere has one unit that serves primarily dementia patients, but the Island has no dedicated memory care facility.

According to Healthy Aging, a significant number of people from the Island have resided at nursing homes on the Cape — for either long-term care or short-term rehabilitation — over the course of a year. Some also moved to the Cape from out of state to be closer to family on the Island.

Given the uphill battle for aging on the Vineyard, some Islanders are taking matters into their own hands. Anna Edey, an alternative living advocate and author of Green Light at the End of the Tunnel, realized during a harsh winter two years ago that she too would soon be looking for elder housing. She began designing what she calls An Elder Community of Our Dreams, with private cottages, community buildings, a special needs home, an organic farm and renewable energy production. According to her calculations, monthly rents would not exceed the state average of about $5,250 per month for assisted living, thanks to savings associated with the onsite farm, energy generation and staff housing.

And unlike many other elder living situations, Ms. Edey’s would specifically exclude federal subsidies. “It would be an endless amount of strings attached,” she said. “I know from experience from schools, libraries, town halls — when there are government funds involved, you don’t get any of the solar-green stuff,” she added. “It all just becomes token solar, token green. And that’s not what we want.”

The estimated $15 million cost of land and infrastructure would eventually provide a return on investment, Ms. Edey said, adding that land was less of an issue than the need for investors. Investors have yet to step up, although Ms. Edey is undaunted. Following a brief hiatus from the efforts, she planned to pick up again in the near future.

“It’s absolutely possible to do,” she said.