Rethinking Housing and Aging in Place

By Athan Bezaitis on June 23, 2009 1:27 PM

Combining home modifications with the Obama administration’s plan to retrofit dwellings throughout the country for energy conservation could help millions of older adults to age in place.

So would the adaptation of safer building codes and the development of age-friendly communities, according to a recent article by USC Davis School of Gerontology elder-housing advocates Jon Pynoos and Caroline Cicero.

Their recommendations appear as the cover story of the recently released Winter 2009 Public Policy & Aging Report, a publication of the National Academy on an Aging Society.

“Policy responses to support aging in place have been piecemeal and fragmented, leaving many older people in homes that are unsupportive and in communities that offer them few housing options,” said Pynoos, the UPS Foundation Professor of Gerontology, Policy, Planning and Development. “Even worse, we continue to build new homes that lack the features to help the next generation of older persons.”

Although research shows the many benefits of home modifications, which range from inexpensive fixes such as grab bars and handrails to more costly repairs such as ramps, stair glides and walk-in showers, more than 1 million older adults report a need for home improvement, according to the article.

Pynoos and Cicero proposed the Obama administration’s plan to weatherize 2 million homes as part of its economic stimulus package could be an opportunity to implement home modifications in units occupied by low-income seniors. “The timing is right, especially considering current efforts to promote energy efficiency,” said Cicero, a doctoral candidate in gerontology.

The article also suggested that home modification initiatives can capitalize on pending health care reform.

“Recognizing the role repairs around the home can play in fall prevention has a direct effect on the ability to carry out activities of daily living and caregiving,” Cicero said.

Two current bills that will enable Medicare to play a greater role in the physical safety of elders aging in place are The Independence at Home Act and the Geriatric Assessment and Chronic Care Coordination Act. “Both aim to increase the home safety of older adults while meeting health care needs and reducing Medicare costs,” Pynoos said.

In the absence of effective federal laws that make the construction of new homes favorable to aging in place, the authors see hope in two movements that have gained traction on the state and local levels: visitability and universal design.

“Visitability provides basic accessibility on the first floor of a home for its residents and makes it possible for persons with a disability to visit other people’s homes,” Cicero said. Its four main components include a zero step entrance, interior doors with a minimum width of 32 inches, an accessible route inside the house and a half bathroom on the first floor.

As of 2007, the article reported, the visitability movement resulted in building code changes in 17 states and 30 cities, affecting 30,000 homes.

Based on the principle of equity for persons of all ages, sizes and abilities, universal design is another promising design concept for elder housing advocates.

A universally designed home has features such as accessible entries, variable height countertops, front-loading appliances that include washers and dryers raised off the floor, doors with either lever handles or automatic openers and “livable” first floors.

“Supporters of universal design suggest that many of its features add minimal extra cost and that housing designed better for older and disabled people enhances the lives of everyone,” Pynoos said.

Calling for a “lifespan perspective” in building housing and planning for communities, Pynoos and Cicero wrote, “By 2030, there are likely to be more than 28 million adults over the age of 65 with disabilities. Universal design prevents the need for major remodeling, retrofitting and modifying and fits with the greater overall movement of sustainability.”

Outside of the home, aging-friendly cities provide features such as usable transportation, well-maintained sidewalks, accessible retailers, social services and health care.

“When local governments plan neighborhood improvements offering mixed uses and walkable streets that are less car-dependent, they call it ‘smart growth.’ This recent trend in planning provides design that is by nature beneficial to people across all stages of the lifespan,” Cicero said. “Aging advocates need to take advantage of the public debate about smart growth and consider it an opportunity for educating local communities.”

In single-family suburbs, the authors support the development of infill housing such as accessory dwelling units (ADUs) on traditional single-family lots.

“ADU’s can provide benefits for local governments through increases in property tax bases and expansion in the supply of affordable housing,” Pynoos said. “They help delay the need for nursing home care and provide the possibility for intergenerational intentional communities in which people of all ages care for each other.”

Pynoos should know: He developed a completely accessible accessory dwelling unit for his father-in-law, who came to live with him in his mid-70s and included features such as a walk-in shower, an emergency response button near the bed, enhanced lighting and non-scald valves in the shower and sink. The unit made an enormous difference in his life, Pynoos said, as it improved his independence and helped prevent falls.

In spite of the economic climate, the article urges aging policy wonks to lobby municipal governments and to encourage the development of features that make local communities safer and more enriching for people of all ages.

“With baby boomers on the brink of becoming senior citizens, the opportune time to make aging in place a priority is now,” Cicero said.

TAGS: aging, research

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