Aging in Place: Housing, Supports, Safety
Our rapidly aging population demands a fundamental shift in planning to minimize the economic, social, and health challenges that will otherwise overwhelm communities. Many communities, however, have had difficulty bringing planners and aging professionals together to plan livable communities for all ages.
At the America Society on Aging's 2017 Aging in America conference, over 250 planners and aging professionals did just that — and started a conversation that has continued in many communities and at the national level — including the APA webinar Planning Livable Communities for All Ages.
More than 80 percent of adults 45 and older say they want to age in place or age in community, yet physical and non-physical barriers may make it a poor option or even impossible.
Whether or not an older adult relocates, does the housing stock in your municipality support needs and abilities across the lifespan? Planners have the ability to minimize or eliminate these barriers and create housing options that enable citizens to be independent and to thrive at all ages.
During the roundtable discussions at the first ASA/APA/AARP Livable Communities Summit, both aging services professionals and planners identified key housing-related issues in their communities.
Housing issues are not limited to the built environment of the home itself, but are interdependent with neighborhood and community design, access to food and transportation, affordability, and safety. Housing is a variable in social interaction, a complex, multifaceted issue that requires interdisciplinary approaches to create successful solutions.
The design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design.
—Ron Mace, one of the founders of Universal Design
Design of the Home
If all housing were designed according to the principles of Universal Design, we would be meeting the behavioral needs of the majority of the population in our society, across the range of ages and abilities.
Our current standards for design are not inclusive of the broad range of ages, abilities, heights, and senses of our people, resulting in spaces that unnecessarily disable many. These man-made barriers can be avoided by designing out traditional barriers such as steps (when a universal feature is an option), too narrow doorways, and bathrooms accessed only by stairs.
This approach to incorporating Universal Design features has been formalized in visitability ordinances and policy mechanisms that promote housing features such as zero-step entries, no threshold showers, a bathroom on the first floor, and 36-inch wide doorways.
These are known entities and have been successfully been built in all housing types in every climate in our nation.
Design of the Neighborhood
Housing does not exist in isolation. The physical design of the neighborhood is a key component.
In 2007, the World Health Organization began to shift the world's focus to address this interrelationship by creating the Age-Friendly Cities program. WHO said that simple resources like benches and shade can be the difference between dependence and isolation or mobility, engagement, and independence for many seniors (and others who may not drive). Likewise, supportive services to address gaps caused by youth-centric built environments and lack of informal supports from family are part of the program.
In this country, AARP is leading the effort with its Livable Communities for All Ages initiative. Planners are familiar with resources that are important to this approach including walkability, connectivity, and Complete Streets. Making sure these are integrated and implemented is a means to creating communities which work for everyone.
Social Interaction and Supports
While aging in place and aging in community may have advantages of familiarity and maintaining one's connections, it may also set older adults up for social isolation, particularly if they have limited mobility or access to other people. Social isolation and loneliness have been shown to have negative effects on health and well-being.
Density does not automatically ensure social interaction, as evidenced by the multi-decade demand for programs to address this in one of the world's most densely populated cities: New York City.
Long before the internet, DOROT's programs kept home-bound seniors intellectually stimulated and engaged through phone-in programs, since expanded to online programs as well. Dialogue and collaboration between aging services and planning can be a vehicle for creating and expanding such programs. Broadband access can support online programs.
Can a senior get to a senior center or other place for interaction? Get to medical services? Can an aide take a bus to serve a senior at home? Understanding transportation issues from varied perspectives will assist municipalities with addressing these and creating housing options which work for citizen's needs.
Creating programs to address a lack of market rate affordable housing is an undertaking in many communities across the nation from Ithaca, New York, to Jackson Hole, Wyoming. Three crucial issues regarding housing affordability must be considered:
- Cost to Build and Develop. Land, development fees, costs for well and septic (in rural areas) all can make it difficult to offer good quality housing options to persons who do not qualify for subsidized housing.
- Indirect Impact on Service Costs. When accessing housing one can afford, it may be substandard housing which can result in higher expenditure on energy costs, as well as negatively impact health and well-being (Ball, M.S. "Aging in Place: A Toolkit for Local Governments").
- "Drive to Qualify". Barriers to accessing support services are created when one is no longer able to drive to a town or a node or afford to own a vehicle. This may also be an obstacle to receiving services at home, regardless of whether one rents or owns.
Housing that is not designed to meet people's needs across the continuums of age and ability increases the risk of accidents because of the gap between what the built environment demands and a resident's abilities.
Falls are the leading cause of injury and death for older adults and have a direct cost to society of over $30 billion annually. Falls and other safety concerns can be addressed by known design features such as a zero-step entry into the home, a zero-step shower, non-skid flooring, high lighting with low glare, grab bars, and a clear and accessible path.
On the macro scale of a development or a neighborhood, safety includes benches to enable walking, shade and shelter for refuge from weather, smooth and well-maintained sidewalks year-round, good lighting, orientations that encourage informal surveillance and social interactions, human-scale design, layers of public versus private space that support territoriality, and a lack of dark nooks to give shelter to possible predators.
Further Dialogue for Success
2017's premiere Livable Communities Summit is being replicated this year at the 2018 Aging in America conference. On the local level, it can be a replicable model for planners to create their own opportunities for dialogue, particularly if the age-friendly movement is active in their community.
Collaboration between aging service professionals and planners is a positive vehicle for developing ideas for housing options that allow citizens across the lifespan to thrive.
For more on universal design, visitability, and the impact of the built environment, see "Challenging the Status Quo" in the upcoming February 2018 issue of Planning.
Ball, M.S. 2004. "Aging in Place: A Toolkit for Local Governments." Atlanta Regional Commission. www.aarp.org/content/dam/aarp/livable-communities/plan/planning/aging-in-place-a-toolkit-for-local-governments-aarp.pdf
Bayer, A. 2000. "Fixing to Stay: A National Survey on Housing and Home Modification Issues." AARP www.aarp.org/home-garden/housing/info-2000/aresearch-import-783.html.
"Costs of Falls Among Older Adults," www.cdc.gov/homeandrecreationalsafety/falls/fallcost.html
Firestone, S.K., Keyes, L., and E.S. Greenhouse. 2018. "Planners and aging professionals collaborate for livable communities," Working with Older People. https://doi.org/10.1108/WWOP-12-2017-0035
Hawkley, L.C., and J.T. Cacioppo. 2010. "Loneliness Matters: A Theoretical and Empirical Review of Consequences and Mechanisms," Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine, 40(2), 10.1007/s12160–010–9210–8. http://doi.org/10.1007/s12160-010-9210-8 Free online access at: www.ncbi.nlm.nih.gov/pmc/articles/PMC3874845/#
Top image: A bermed walkway, covered entry, and a zero-step entry are good design for all ages, abilities, and activities — for all who visit and for all who live there — over the lifespan of the residents, and the lifetime of the home. Photo courtesy Esther Greenhouse.