“I did [home] alarm sales before I came here,” says Chris McKee, a Sellwood sales manager. “It’s kind of the same thing here. You sell yourself to a certain degree. Is somebody willing to trust you with the care of their parent? Are they comfortable with you? I think about those things when somebody comes in the door, but no more so than if you’re selling a car.”

What he’s saying is, you buy things from people you trust.

Elder care is a business. And that’s OK. But if the past few months have taught us anything, it’s that any publicly held company is fair game in a recession.

A 2001 report from the National Health Policy Forum hailed Oregon as a national model for its long-term-care system, which emphasizes home- and community-based care. But recent history—at least the history played out in the court of public opinion—has not been kind. And not just in high-profile cases like that of the Pearl at Kruse Way, in Lake Oswego, which was sued by the family of 86-year-old Elvera Stephan. In May, Stephan, who suffered from dementia, was handcuffed and restrained by police who were called to the scene, while nurses and attendants did nothing. The family won a $904,200 judgment.

A recent analysis by the New York Times showed that nursing homes delivered substantially worse care to residents after being bought by a corporation, findings two Harvard Medical School professors refuted last year in Health Affairs, a peer-reviewed national medical journal.

Locally, a recent analysis of Oregon senior-care organizations by the Pamplin Media Group showed that for-profit care ventures in Oregon are cited for injuries and violations more frequently than are their nonprofit counterparts. Earlier this year, the Oregon Department of Human Services even tried and failed to get the Legislature to raise penalties and licensing fees—which would have funded training for caregivers—with the hope that the number of violations could be curbed. Both measures may appear on the legislative calendar in 2009.

The decision between breaking the bank on a high-rise retirement facility or taking chances on a for-profit home has helped create what Mary Shortall, who heads the Multnomah County Aging and Disability Services division, calls the “sandwich generation”—people who suddenly find themselves in the challenging position of caring for their aging parents as well as their growing children.

“It’s forcing us to start thinking about long-term insurance at a younger age,” Shortall says. “People need to plan for aging now: what your life might look like, your housing, your transportation, your finances. And not just your own, but how you might handle having to take care of your parents.”

The lack of a plan is why some people end up in Rebecca Childs’s office. As housing program manager for the Northwest Pilot Project, an agency that helps low-income seniors find a place to live, she’s often the last hope for those who are struggling just to get by.

“Some have been stable for a long time, but then they have a health crisis that creates the loss of their longtime home and all their stuff,” Childs says. “And suddenly they’re looking for a place to live. It’s an emotional process, and we have to work on readjusting their expectations.”

Childs says she sees nearly 1,700 low-income elderly people a year. Because of waiting lists for public and other subsidized housing—some senior citizens wait as long as two years—she’s able to place fewer than 500 people each year.

She insists she’s glad a place like Terwilliger exists, yet she can’t help offering up a sigh at the thought of four-course meals and massages.

“It’s great to have a range of options if you can afford it,” she says, “but I really want to see us as a city take care of the people who don’t have those types of resources.”