Mimi Kirk is a contributing writer to CityLab covering education, youth, and aging. Her writing has also appeared in The Washington Post, Foreign Policy, and Smithsonian.
A recent report outlines a number of challenges to aging in place.
The Harvard Joint Center for Housing Studies recently published a report with stunning statistics on housing and aging. By 2035, one in three U.S. households, versus today’s one in five, will be headed by someone 65 or older. This will also mean an American population with one in five people over 65—almost 80 million people—up from one in seven today. That’s an increase of more than 30 million people over the next 20 years.
Many of these Baby Boomers, the report notes, intend to “age in place,” or stay in their homes or communities. This is where the report sounds an alarm: In many ways, we’re just not ready. For example, only 1 percent of housing stock is currently equipped with no-step entrances, single-floor living, wide halls and doorways to allow a wheelchair, electrical controls reachable from a wheelchair, and lever-style handles on faucets and doors—“universal design” elements that help occupants age in their homes. The report highlights accessibility challenges, as well as other hurdles for an aging population: affordability, the need for in-home care, and the potential for isolation.
The growth in the older population will mean an increase in the number of low-income adults. By and large, members of the Boomer generation own their homes, but the report’s lead author Jennifer Molinsky notes that they may have mortgages, and are thus not exempt from financial constraints. The population increase will also result in more older renters and single heads of household, who are even more likely to need financial assistance. Millions will find it difficult to afford changes to their homes to enhance accessibility—or even to stay in them. “Homeowners with limited means will likely face challenges affording needed modifications,” says Molinsky. “Meanwhile, renters may lack both financial resources and control over their units to make those changes.”
With options of in-home care expanding over the past 20 years, nursing home use has declined, even as the older population has grown. The need for in-home care will only increase. By 2035, the number of households with a person with a disability will reach more than 31 million—an increase of 76 percent over current numbers. Twelve million of these households will have someone who needs help with self-care, such as bathing and eating, and another 27 million will have an occupant who has limitations when it comes to household activities such as driving, cooking, and cleaning. “To age in their homes, many people with disabilities will need some form of assistance, whether a home health aide or weekly help with housekeeping,” says Molinsky. “Expense is also a challenge here, as supports in the home can be costly.”
Finally, nearly half of all adults will age in low-density places, which may lack public transport or nearby neighbors and services. “Even though many people express a desire to age in place, doing so can be isolating without ways to connect with the surrounding community,” Molinsky says.
A few programs are working to meet these challenges. Johns Hopkins University’s Community Aging in Place–Advancing Better Living for Elders (CAPABLE) five-month research study, for instance, helped Baltimore residents on Medicare or Medicaid stay in their homes more comfortably and safely by assigning them a nurse, an occupational therapist, and a handyman to make adjustments, such as installing handrails. Close to 80 percent of participants improved their self-care and, thus, their independence. CAPABLE is now expanding to Michigan, where it could ultimately be integrated into the Michigan Medicaid waiver program.
Rodney Harrell, an expert on housing at AARP, notes that his organization is spurring interest in home design for older residents through such initiatives as design competitions. The 2016 Redefining Home: Home Today, Home Tomorrow contest challenged architects to take $75,000 and alter an existing house in Memphis to make it more conducive to aging in place. The New York City firm that won used much of the funds to widen hallways and remodel the bathroom and kitchen, but it also created an open, light-filled space in front of the house to serve as a meeting area for neighbors. “It’s a way to fight isolation,” says Harrell.
State and federal tax credits can help older residents make adjustments to their homes. So far, Virginia and at least three U.S. counties have approved such credits. A federal tax credit through the Senior Accessible Housing Act has also been introduced to Congress.
For housing yet to be built, residential building codes that mandate features such as wider hallways and no-step entryways can aid future occupants. Currently, a few areas, such as Pima County, Arizona, and Bolingbrook, Illinois, require these standards. Sally Abrahms, an expert on Baby Boomers, also notes that some developers are building multigenerational homes, in which aging parents live in a first-floor space and their adult child and their family live in a larger, connected two-floor space. This trend of different generations living together, particularly among Asian and Hispanic immigrants, can bring relief from loneliness and supply built-in care.
Molinsky says that constructing new housing in more central areas, such as in downtown suburban centers, could also help with isolation. “With better housing options that are more accessible and lower cost, we might see that people are more willing to move than current surveys indicate,” she says.
There’s a good bit individuals can do to prepare to age in place. If you’re remodeling a home you own, for instance, it’s easy to preemptively install a walk-in shower or grab bars. “A lot of people wait until there’s a crisis,” says Molinsky. “It can be more emotional and expensive to do it later.”
But at the end of the day, individuals can only do so much. “The public, nonprofit, and private sectors will be key to increasing the housing options and health and supportive services that enable people to live a high quality of life at older ages, particularly for the millions who will have low incomes and little wealth,” says Molinsky.