Former HUD Secretary Henry Cisneros and a team of experts on aging, architecture, construction, health, finance, and politics offer the first comprehensive overview of the possibilities and challenges in helping seniors live independently to a very old age.
Do you want to age independently in your own home and neighborhood? Staying home, aging in place, is most people's preference, but most American housing and communities are not adapted to the needs of older people. And with the fastest population growth among people over 65, finding solutions for successful aging is important not only for individual families, but for our whole society. In Independent for Life, former HUD Secretary Henry Cisneros and a team of experts on aging, architecture, construction, health, finance, and politics assess the current state of housing and present new possibilities that realistically address the interrelated issues of housing, communities, services, and financial concerns.
Independent for Life covers a wide range of smart solutions, including remodeling current housing and building new homes for accessibility and safety, retrofitting existing neighborhoods to connect needed services and amenities, and planning new communities that work well for people of all ages. Case studies show how the proposals can be implemented. The authors offer action plans for working with policy makers at local, state, and national levels to address the larger issues of aging in place, including family financial security, real estate markets, and the limitations of public support. Lists of essential resources, including a detailed "to do" list of aging in place priorities and an individual home assessment, complete the volume.
- Title Page
- Table of Contents
- Foreword by John W. Rowe
- Section I, Introduction: Independent/Successful Longevity
1. New Visions for Aging in Place, Henry Cisneros
2. A Hopeful Future, Laura Carstensen
- Section II: Demographics and Challenges
3. Changing Demographic Realities, Adele Hayutin
4. Future Social and Economic Changes, Anthony Downs
- Section III:Housing and Services
5. From Home to Hospice: The Range of Housing Alternatives, Elinor Ginzler
6. Community Services, Jennie Chin Hansen and Andrew Scharlach
- Section IV: Homes
7. The Home Environment and Aging, Esther Greenhouse
8. Technology Solutions, Eric Dishman
9. A Contractor’s Perspective, Greg Miedema
10. A Case Study: Interior Design for Aging in Place, M. Robbins Black
11. Multifamily Housing, Hipolito Roldan
12. A Case Study: The Freedom Home, Keith Collins
- Section V: Neighborhoods
13. Healthy Communities, Lawrence D. Frank
14. How to Get Started - Local Community Action, Ron Littlefield and Robert H. McNulty
15. Retrofitting Suburbs, Ellen Dunham-Jones and June Williamson
16. Longevity and Urbanism, Scott Ball and Elizabeth Plater-Zyberk
17. Neighborhood Development, Christopher B. Leinberger and Michael Glynn
- Section VI: Strategies for Change
18. Vulnerable Populations, Fernando Torres-Gil and Brian Hofland
19. Housing Finance, Richard K. Green and Gary D. Painter
20. A Political Strategy, Shirley Franklin and Jane Hickie
According to a recent report issued by the MacArthur Network on an Aging Society, an aging society is one in which people over sixty outnumber those under fifteen. The MacArthur Network, an interdisciplinary group of experts on longevity, conducts analyses and proposes public policies relevant to the challenges and opportunities of an aging society. The Network has pointed out that inevitable demographic shifts mean that our country will become increasingly older in coming decades. We are woefully unprepared to deal with the myriad consequences of this impending reality, nor have we challenged ourselves to imagine the opportunities that an aging America will present.
The aging of our society is not merely a possibility, contingent on future increases in life expectancy. It is a certainty driven by well-defined factors, including the aging of the baby boom generation, dramatic increases in life expectancy that occurred in the 20th century and the more recent compression of morbidity. Compression of morbidity means that many more of us will live disease and illness free right up until the end of our lives. These forces, despite sustained fertility rates and continued immigration, will result in an America populated by increasing numbers and percentages of older people.
As we enter these uncharted waters, the greatest unknowns relate to the future behavior of the baby boom generation. How will they work, save, spend, study, help others and vote? How and when will they retire? As they withdraw from paid employment, how will they cope with their lack of engagement and control? Will the innovative and entrepreneurial spirit that has characterized this generation endure? What new ideas will they pursue? And, as investigated in detail in this volume, where and how will they live?
Considerable analysis and much political discussion have focused on the future of the U.S. health care system and the solvency and sustainability of the Social Security and Medicare Trust Funds. There has been much less focus on the realities of life in an aging America. We are entering a period of rapid change in many of our society’s key institutions including housing, retirement, labor markets, education, transportation, religious communities, neighborhoods, political parties, national defense and the family itself. To cope with an aging population, these institutions must adapt to emerging structural and cultural changes. We also need to develop policies and strategies at the local, state and national levels that will optimize opportunities for all age groups. Our whole society needs to think creatively about how to best support people to a very old age.
The future design, structure and function of our housing, neighborhoods and communities are central issues as we try to come to grips with an aging America. One important strategy will be to develop healthy communities that engage all residents and foster intergenerational experiences. Former U.S. Secretary of Housing and Urban Development, the Honorable Henry Cisneros, joined with the Stanford Center on Longevity (SCL) to produce this volume, Independent for Life: Homes and Neighborhoods for an Aging America. The basic premise of this book is that Americans are aging in traditional homes, age-segregated neighborhoods and communities that are designed for yesterday’s demographic realities. Future demographic changes demand transformative efforts for successful aging in place. As Professor Andrew Scharlach says, “The ultimate goal of aging in place efforts is true choice in housing; the ability to live wherever you want regardless of age or ability.”
This important and timely volume is an edited work from an interdisciplinary group of architects, urban planners, gerontologists, economists, civic leaders, elected officials, developers and builders. It represents a very important contribution to the national discourse on strategies to assure the emergence of a productive and equitable aging America.
Independent for Life has been funded with generous grants from The Home Depot Foundation, the MetLife Foundation and the Federal Home Loan Mortgage Corporation (Freddie Mac). Lead funding has been provided by the MacArthur Foundation Research Network on an Aging Society.
It is our hope that this book will stimulate thinking about how we can change the culture of our society to support successful aging in place. We are aware that the challenges are great and that the opportunities are real.
John W.Rowe is a professor in the Department of Health Policy and Management at the Columbia University Mailman School of Public Health. Previously, he served as chairman and CEO of Aetna Inc., one of the nation’s leading health care and related benefits organizations, from 2000-2006. He is former president and CEO of Mount Sinai NYU Health; prior to the Mount Sinai-NYU Health merger, he was president of the Mount Sinai Hospital and the Mount Sinai School of Medicine in New York City. He was a professor of medicine and founding director of the Division on Aging at the Harvard Medical School, as well as Chief of Gerontology at Boston’s Beth Israel Hospital.
Currently, he leads the MacArthur Foundation’s Initiative on An Aging Society and chairs the Institute of Medicine’s Committee on the Future Health Care Workforce for Older Americans. He serves on the Board of Trustees of the Rockefeller Foundation and is a former member of the Medicare Payment Advisory Commission. He chairs the Board of Trustees at the University of Connecticut and the Marine Biological Laboratory in Woods Hole, MA. He received an MD from the University of Rochester School of Medicine and Dentistry and BS from Canisius College.
In order to remodel and rebuild communities to support aging in place, we need to understand the history of longevity and the physical and cognitive realities of normal aging. The evidence is abundant from studies of history and science that Americans can live for many more years without the painful, costly, dispiriting effects of debilitating diseases.
Older Americans can continue to contribute and can remain self-reliant for longer, able to articulate their own priorities. We can find solutions to the problems that old people identify only if we fully appreciate the importance of their concerns.
“Aging in place,” as we discuss it in this book, refers to a range of housing and services, a continuum of options, that together support older people as they age and change. Older people can age in place well in assisted living or age poorly in a single-family home in a traditional neighborhood. The goal is to find the balance of housing and care that offers the right environmental, emotional, and economic fit.
A central purpose of our society should be to change our culture to support both old and young people so that very long lives are lived well.
New Visions for Aging in Place
My Family Experience
My mother, Elvira Cisneros, is eighty-five years old and lives independently. She lives in the home in the West Side neighborhood of San Antonio, Texas, that she and my father, George, bought as newlyweds in 1945, across the alley from the home of her mother and father, my grandparents, where she grew up. Most rooms of my mother’s home, a 1920s bungalow, are exactly as I remember them my entire life, down to the placement of the furniture in the rooms and the figurines on the shelves. I am the oldest of five siblings and will always remember a home that was a nurturing place full of encouragement, ambition, and pride in our Latino heritage. The neighborhood around us was supportive and active; every house on the block belonged to a hard-working, lower-middle-class Latino family with multiple children. I have often described it as a block that could well have been lifted from a Norman Rockwell painting, except that all of the faces would have been brown.
Over the years, some exterior modifications were made to the home to accommodate the realities of debilitation and aging. My father suffered a stroke at age fifty-nine in 1976 while on Army Reserve duty and lost full use of his left arm and left leg. Though some doctors advised that the stroke would accelerate the aging process and that he would likely live only another few years, owing to his disciplined commitment to therapy and exercise and to my mother’s care in their home, my dad lived thirty years after his stroke. He died at age eighty-nine in 2006. To help him remain as active as his disabilities allowed—which included founding the San Antonio Stroke Club and creating a one-arm golf tournament—the house was modified to include a ramp along one side, a deck connected to the ramp to eliminate steep back-door steps, and a metal handrail leading up to the front porch. Inside, bathroom modifications, including lowered fixtures and a roll-in shower, made possible my dad’s use of a wheelchair in his late years.
Only in the last two years has my mom begun to visibly slow down and show some frailty herself. She hurt her knee rushing into the passenger seat of a car on a rainy day in 2009, and from the knee trauma came foot, ankle, and hip pain that lasted months. Pushed by her strong character, she worked hard to remain mobile and the earlier home modifications helped. She loves being in her home full of memories and has never for an instant considered moving to senior housing. She recognizes that she is slower and that organizing complex family events in her traditional manner is beyond her, so she now accepts that Christmas dinner can be at my home instead of stubbornly insisting that her home must be the holiday gathering place for my brothers and sisters and their families. I noticed recently that she wrote instructions to herself for operating the kitchen oven in large letters on masking tape and affixed them to the handles of a new stove. She accepted the installation of a security alarm system one Christmas and a Life Alert personal communications device the next year. By making these concessions, she contends that she can live in her beloved home for years to come.
Her attitude is mirrored by other seniors in this neighborhood that has itself aged, both in the longevity of the residents and in the physical attributes of the housing stock. Stella Tenorio, the ninety-four-year-old next-door neighbor who never married, keeps an immaculate house and mows her own yard with a manual reel mower. About ten years ago, she repelled a violent intruder by sliding under her bed and biting him when he reached for her. Rebecca Gonzalez, the neighbor on the other side, lived in her home until her nineties, and Lydia Mass across the street was at home until she died at age ninety-seven.
Many other older people in the innermost circle of my life have demonstrated similar attachments to their homes over the years. My wife’s father, Porfirio Perez, lived at home and worked with his wife, Annie, in the store they owned adjacent to their home until 2000, when he went to the hospital and passed away a few weeks later at age ninety-two. And Mrs. Perez died in her bed at home six years later at age ninety. My maternal grandfather, Romulo Munguia, worked in the print shop he founded and operated with a son until the day before he died at age ninety-three. He and my grandmother lived independently in the home that my wife and I later remodeled in that central city neighborhood and in which we raised our family.
It may seem from these examples that the older people in my life are all unusually long-lived and have particularly strong attachments to their homes. I do believe that Latinos develop intense love for their homes as places that evoke the memories of large extended families and years of lively social gatherings. But Latinos are by no means unique in their desire to be as independent as possible and to live in familiar surroundings for as long as they can. I cite the experiences of my family and neighbors only because they are personally vivid examples of the following themes that are becoming more important in our country:
- The reality that large numbers of Americans will be living into their eighties and beyond
- The desire of many older Americans to live in their homes for as long as they can
- The fact that existing neighborhoods all across the nation will increasingly comprise aging residents
- The awareness that homes and communities and services will have to be adapted, or new ones built, to accommodate older Americans who want to function actively, even though they may slow down a step in their pace, lose some acuity of vision, or function with slightly less upper body strength
The aging attributes of the Latino neighborhood I have described in San Antonio could just as easily be a Polish American parish in Chicago, Illinois; an African American community of row houses in Washington, DC; a Chinese American neighborhood in San Francisco, California; or a small town of German American heritage in Nebraska. The same ripples are spreading out across the nation: the growth of the aged population, the desire or need of older people to stay at home, and the imperative to engage family and community resources to create living settings that will enable people to live with dignity and to manage the process of aging supported by the comforting familiarity of the homes and communities in which they live.
The Focus of This Book
As former secretary of the US Department of Housing and Urban Development (HUD) and mayor of San Antonio and in my current role as a home-building executive, I have long been interested in housing and communities. With the sweeping demographic changes that are facing our nation, the ways our communities function must change. We, as a nation, must examine ways to support aging in place for the unprecedented numbers of older Americans seeking to live healthy and contributing lives in communities that serve all ages. Americans are aging in traditional homes, neighborhoods, and communities that were designed for yesterday’s demographic realities, not those of today or the future. The sheer size of the baby boom generation guarantees that, as the health and mobility of so many begins to deteriorate, communities could be saddled with an enormous burden. What can be done quickly and affordably to support successful aging in communities throughout the United States? What will be our plan for supporting the oldest of the old among us?
Fast-arriving changes in age, race, and ethnic composition of the population will have significant consequences for the creation of what have been called livable communities. Large segments of the population are at risk for health, social, and economic hardship. Suburbs, where most of the growth in the senior population will occur, create dependency on the automobile, with many homes being distant from jobs, services, and amenities. Rural communities struggle with transportation and service delivery issues. We can change our communities so that people living very long lives can live well. These changes must be made soon.
As we age, our needs and interests evolve and change, so our choices of housing should be wide ranging, as should be the spectrum of activities and services. There are a number of proven, affordable models that enhance independent living. Homes can be retrofitted, new age-appropriate homes built, existing neighborhoods reconnected, and new communities planned.
The enormity and complexity of such change is daunting. Financial strategies must adapt to new needs and opportunities. Public opinion must be better aligned with the values of accessibility, affordability, connectivity, and diversity. All levels of government must address these challenges with bold solutions.
During the years that I served as the mayor of San Antonio and spent many evenings listening to residents in neighborhood meetings across the city, I noticed repeated development patterns related to aging. In the same neighborhoods in which the population was aging, the housing stock was deteriorating and social needs were intensifying. As I listened to the older residents of those neighborhoods, I did not know then that those patterns were the local manifestations of what we now know to be the national forces of aging demographics, of physical isolation experienced by many older people, of unaffordable housing, and of diminishing social services funding. Over all these years, the frightened faces and plaintive voices of those older residents have stayed with me and spurred this search for public and private answers.
For this book, we have brought together experts in aging, architecture, construction, health, finance, and politics. We have asked experts on home renovation, urban design, community services, and finance to apply their professional knowledge to the needs of older Americans. Although diverse in expertise, they share a sense of urgency and determination to describe a new vision for aging in place and for living well at all ages.
The number of Americans who will make up the population over age sixty-five is growing rapidly. When the first baby boomers, one of the largest cohorts of people in American history, reach sixty-five in 2011, the older population will explode. The US Census Bureau projects that the over-sixty-five population in the United States will grow from thirty-five million in 2000 to seventy-two million in 2030 to eighty-nine million in 2050. The number of people eighty-five and over will grow from 4.2 million in 2000 to 9 million in 2030 to 19 million in 2050. Dr. Sherwin Nuland tells us in his book, The Art of Aging, that today 64 percent of Americans can expect to live to seventy-five and 35 percent should plan to reach eighty-five.
The rate of growth in the numbers of older Americans has implications for numerous dimensions of American life, from consumer products to finances to living arrangements. The relative percentage of older Americans in the population is also larger, so there will be changes in the ratios of workers to retirees and of schoolchildren to elderly people. The US Census Bureau projects that the ratio of working-age people (those aged fifteen to sixty-four) to retirement-age people (those aged sixty-five plus) will drop from 5.2 in 2010 to 3.0 in 2050. This change will occur not because we will have fewer workers or children but because we will have so many more retirees. These retirees may not be able to rely on Social Security to the same degree that their parents could, but will instead need to work longer and draw upon other personal resources to fund their retirement.
The evidence is abundant that many Americans can live for many more years without the painful, costly, dispiriting effects of debilitating diseases. Others may not be so fortunate. Many older Americans can continue to contribute and can remain self-reliant for longer, pushing serious debilitation until the very end of life. One of the central purposes of our society should be to change our culture to support both old and young people so that very long lives are lived well.
Compression of Morbidity and the Longevity Dividend
Dr. James Fries of Stanford University articulated the idea of “compression of morbidity” in 1980. In The Art of Aging, Dr. Sherwin Nuland provides a clear description of the concept:
Fries hypothesized that measures could be taken to change the long, gradually drooping arc [of aging decline] with a pattern that more resembled a relatively horizontal line ending in a rapid drop-off shortly before death. If this was accomplished, he pointed out, “then lifetime disability could be compressed into a shorter average period and cumulative lifetime disability could be reduced.” In other words, instead of a long period of worsening frailty and illness, our bodies would stay relatively intact and then give out much closer to the time of eventual demise.
When I visit my mother in her home and see her neighbors—like Stella Tenorio next door trimming her roses at age ninety-four—I am struck by evidence of how important compression of morbidity is as I see its benefits in the people I love. It is a walking, talking, living reality that goes far beyond an interesting concept and has everything to do with dignity in people’s older years. It is my strong conviction that the physical environment in which older people live—with the security, stability, comfort, and psychological nurturing it offers—has a lot to do with staying healthy and independent longer.
A metric has been devised to bring solidity to the concept. It is referred to as ALE, or active life expectancy, and it quantifies the number of years that people can expect to live without disability. It is indicative of our hopeful standards of quality of life that we, as a society, are now measuring, not simply years of longevity but also the number of those years in which longer life can be of high quality: healthy, active, and free of impairment.
The benefits to individuals of being alert and involved in activities with colleagues, friends, and family are clear. There are also benefits for caregivers, for younger family members, for networks of friends, for employers, and for the recipients of volunteer time. Preventive measures, such as establishing activity centers and supporting wellness programs, are valuable investments. Everyone benefits by reducing expenditures for costly medical interventions and emergency responses due to diabetes, stroke, and heart attack. The costs of Medicare and Medicaid might be reduced if individuals used the most expensive long-term institutional and end-of-life care less.
The late Dr. Robert Butler, former president and CEO of the International Longevity Center in New York City, explicitly extended the idea of compression of morbidity for individuals to a benefit, or “longevity dividend,” for society at large. If compression of morbidity for individuals and a longevity dividend for society are worthy goals, then it is important to consider ways in which they can be achieved. Among the elements of a strategy to reach those goals are continued progress in medical research and care, increased accessibility to health care, governmental attention to solvency of the key health insurance and finance systems, wellness education, nutritional improvements, and disincentives to use cigarettes, alcohol, and other harmful products. Increasingly, health and aging experts are adding another set of societal actions to the compression of morbidity agenda—that is, the redesign of physical environments to facilitate wellness, healthy activity, social engagement, and self-reliance. A place to live that is physically manageable and emotionally uplifting is connected with independence, peace of mind, and self-improvement. Services designed particularly for the needs of seniors are essential. Support systems can be added to existing homes or can be built into new homes to help people remain safe, mobile, self-reliant, fit, and strong.
The central assertion of this book is that we, as a nation, need to find ways to modify or build homes and communities to support aging in place for those unprecedented numbers of Americans seeking to live healthy lives in their own homes. These changes will enable older Americans to make even greater contributions to their communities, thereby strengthening our society as a whole.
Transforming Existing Homes into “Lifelong” Homes
Why should we pay attention to housing with respect to aging? It is estimated that 70 percent of Americans aged sixty-five and older live in single-family detached homes, and at least 89 percent intend to remain permanently in their homes. The normal process of aging imposes infirmities that can create hardships in homes if these environments are designed only for younger people. Some of the hardships are easy to address. Declining eyesight, for example, can be aided by simple interventions based on knowledge about aging, such as brighter lightbulbs, better locations for light sources, accessible controls, guide lights for nighttime, and contrasting colors on the edges of furniture or steps.
But many homes need more significant modifications to support healthy living, and older Americans may ignore necessary changes until there is a crisis. Renovations and necessary maintenance can be expensive, there may be a fear of becoming victimized by predatory elements of the home-remodeling industries, and there may be challenges in managing major repair projects.
For years, city officials and remodeling contractors have organized and certified packages of home renovations for energy efficiency and savings in order to weatherize homes. I was a city councilman in the 1970s and a mayor in the 1980s when the concept of weatherization of homes was first advanced on a large scale. The concept went from general awareness of the energy losses from poorly insulated homes and from recognition of the financial burdens of utility costs to action on pilot projects and then widespread national action. It is now time to follow that path from awareness to action concerning the modification of existing homes to meet the needs of aging Americans. The need for an affordable and effective package of modifications and regular maintenance to make existing homes more suitable for older people should be organized as a renovation package to create homes that could be used for a lifetime. A certified renovation package for aging in place could include roll-under kitchen and bathroom sinks, grab bars, curbless showers, lever faucets and door handles, a zero-step entrance, and wider doors and hallways. In multifamily homes, adding elevators may be the key for aging in place.
New Homes for Aging in Place
A 2002 report published by the National Association of Home Builders indicates that 31 percent of homebuyers aged fifty-five and older would seriously consider buying townhomes, duplexes, and multifamily condo units, but only 15 percent of homeowners aged fifty-five and older live in such housing. As a society, we need to be producing more housing that is of smaller scale, affordably priced, suitable for multifamily use, located in walkable communities, and close to amenities, commercial districts, health facilities, and public transit. The goal should be to support communities in which older people can choose from a variety of types of homes: single-family and multifamily units, rentals and owner-occupied homes.
New forms of supportive housing are being developed that enable older residents to live independently with assistive services. Cohousing is a residential model that locates individual dwelling units around common spaces, often including dining facilities and a great room, and incorporates accessible design. Accessory dwelling units (ADUs) located on the same lot as a primary home may be ideal for multigenerational families. Because of their physical proximity, they provide the added advantage of enabling the younger generation to look in on older residents. Some cities promote the building of ADUs on single-family lots to expand the supply of affordable housing on more dense, transit-accessible infill sites. Other cities are revising zoning policies to encourage more compact and affordable housing types in areas where the population is aging.
Another housing innovation for older people who wish to continue working in a small, self-employed setting is the live/work flex house, a dwelling that includes a workspace. It might be a row house in which the living space is typically above the business use, or a loft/studio in which the office or shop is on the same level as the living area. These “mixed uses” create settings where older people can comfortably pursue careers. Some of these configurations evolve naturally in existing homes and neighborhoods; in newly constructed communities, their inclusion can create a diversity of uses that is ideal for all ages.
Adapting Existing Communities for Aging Populations
In addition to individual homes that support aging in place, we need thoughtfully created communities—both existing and new neighborhoods—that feature safe streets, usable sidewalks, stores offering groceries and pharmaceuticals, public parks, churches, and services. All across America, neighborhoods such as the one where my mother lives are aging. Planners have given them a name: naturally occurring retirement communities (NORCs). As a councilman and mayor, I advanced ideas on a piecemeal basis when I saw the pattern of older residents left behind in increasingly concentrated pockets. I suggested, with some success, to our police department, for example, that we use crime data to identify those concentrations of aging citizens victimized by local thugs in order to patrol those neighborhoods in different ways, such as on foot or in teams capable of doing spot checks by knocking on seniors’ doors. I have visited more than two hundred American cities as secretary of HUD and in my private community-building work, and I have come to believe that we should go beyond piecemeal ideas and create more comprehensive municipal responses to aging that can include the following elements:
- Supporting certified home renovation programs
- Establishing accessible senior nutrition and fitness programs
- Providing utility assistance
- Arranging health consultations and interventions
- Offering special programs at branch libraries and literacy centers
- Extending appropriate transportation programs
- Training and deploying aging specialists
- Developing the capabilities among those specialists to help seniors with daily activities such as preparing meals, cleaning, and bathing
- Tailoring community policing to special needs
- Designing local senior services based on statistical evidence and on advice from community-based organizations about elderly population needs
In this way, an existing neighborhood can overcome the seemingly immutable physical features that otherwise render it socially disconnected, geographically isolated, underprotected, and underserved. Such seemingly unchangeable barriers as the street layout, distance from necessary stores and services, and even criminal incidence can be overcome with an intentionally designed overlay of community services that pull together a cohesive NORC. Also, organizations such as the Village to Village Network offer new ways to weave together a fabric of unifying services to overcome the barriers that isolate residents in an existing NORC.
Planning New Communities to Age in Place
Admittedly, it can be difficult to place new communities of significant scale, including homes for older people, in already dense, built-up urban environments, although the recycling of obsolete urban areas through clearance and restoration is an attractive option in many cities. But there are abundant opportunities for newly designed communities in the less dense first-ring suburbs and in the green-grass exurbs. In such places, there is physical space to build entirely new concepts of communities, as well as homes of various sizes, price points, and configurations, designed for young singles, families, and people seeking to age in place. This mix of ages and homes can be consciously woven together as communities of cohesion and mutual support. The suburbs are where the fastest growth of the older populations will occur. The Brookings Institution draws the following conclusion about the “graying of suburbia”:
In 2008, 71 percent of pre-seniors lived in suburbs, and their numbers (as well as those of seniors) grew faster in suburbs than in cities during the 2000s. This reflects boomers’ status as America’s “first suburban generation,” and signals their likelihood to remain in these communities as they grow older.
The work of the New Urbanists has advanced smart growth principles, which are highly applicable to the creation of communities suitable for Americans of all ages. New Urbanist principles provide a guide for community building that stair-steps through levels of urban geography: from the regional level to the neighborhood to the specific street to the individual building or dwelling unit. These principles can be applied when a failed retail center in an inner suburb is cleared and a new neighborhood is put in its place or when an open tract of land adjacent to an edge city farther out from the urban core is linked to mass transportation and planned as an urban village. These concepts and models are useful in examining and assessing the characteristics of existing as well as new communities. The challenge is to finance and otherwise enable this type of change to occur across the country.
Listening to Older People
Listening carefully to the concerns of older people about their present living arrangements is an important way to identify what should be done to make their lives better. At an AARP-sponsored town hall meeting, at which I presented aging-in-place ideas, older residents described their concerns and fears, the things that made life difficult for them in their present homes. Among the concerns they listed were the following:
- Frustration at being immobile and being dependent on others to run errands and drive them to appointments
- Deterioration of their homes
- High utility costs, particularly for heating and cooling
- Fear of crime, including assaults on the street or burglaries of their homes
- Debilitating effects of major impairments and serious frailties
- Loneliness as a result of isolation from friends and family
- Fear of falling, getting hurt, becoming ill, and not being able to communicate
- Pain or feelings of inadequacy in managing the activities of daily living
- Lack of money for home improvements or maintenance
- Fear of high volumes of fast-moving traffic on neighborhood streets
- Danger of misusing appliances such as a stove or oven
Clearly, not all of these concerns can be addressed by reshaping the physical environment, but a number of features in homes and communities can help. Services to support people in their communities and homes are essential and need to be well coordinated. Table 1.1 sets forth responses for addressing specific concerns.
Paying for Aging in Place
No consideration of preparing our homes and communities for the surge of older Americans who wish to age in place can be complete without exploration of the economic resources needed for home maintenance, retrofitting, new construction, and the integrated delivery of services. To list useful renovations and products without regard to how individuals or society are going to pay for them is not likely to result in progress.
There are resources that can be prioritized, including personal savings, retirement earnings, and state and local tax relief measures, that would be helpful for wealthier families. Social services and federal housing and income security programs are important for those with fewer resources. It is important to remember that modest expenditures to extend the years of aging in place can save money for individuals, for families, and for society. The interplay of personal savings and retirement earnings with governmental grants, loans, tax relief, and incentives is complex. It is important for leaders to create age-appropriate homes available within the price ranges of people who need them. It is particularly important to consider the ways in which scarce resources can be brought to bear in assisting the frail elderly who are poor.
As our country recognizes the growth in the number of older people, it is important that we mobilize our resources to enhance the quality of life for our aging population. We can support the vitality of older people, enhancing their independence, supporting their mobility, and sustaining their dignity. By doing this, we will reap the benefits of the wisdom and experience of seniors at a time when our society needs every citizen to be productive. We can help transform individual lives from dependence and decline to lives of purpose and involvement by being attentive to the ways that we build homes and communities.
To date, these concepts have been applied principally to senior facilities of a specialized character, affordable to people with substantial retirement resources in resort-like settings. But the population of older people in our country is now becoming so large that strategies of improving existing homes, of incorporating universally useful features in new homes, of building thoughtful new communities, and of retooling existing neighborhoods must be broadly integrated into our community-building strategies at the local level across the United States. This initiative is not a matter of creating homes for seniors as acts of obligation, although, as a nation, we certainly owe a debt of gratitude that would make obligation reason enough. Rather, it is in the interest of our nation that we all benefit from the longevity dividend, that we secure the best quality of life for all our citizens, and that we live up to the ideal that every single person can contribute to the nation’s well-being over the span of an entire lifetime.
I have seen with my own eyes how a safe, decent, and financially secure place to live can add vitality to a person’s older years. I know that my mother’s ability to live in the cherished home she shared with my father and in the rooms where she raised her children is a big part of the life force that enables her to stay active, involved, upbeat, and determined to make the most of each day. She knows her way around the house and knows every creak and crack after sixty-five years there. She is deeply rooted in the neighborhood and follows the goings-on among the younger generations. She gains energy from the warm sun and the breeze as she tends her potted plants and fruit trees. In short, she loves her home—it is part of her, intellectually and spiritually.
She and we, her family, are living proof of the wisdom of Winston Churchill’s observation: “We shape our buildings; thereafter they shape us.” In the case of the Cisneros family, it is fitting to take license with the great statesman’s idea: We spend sixty-five years lovingly shaping a home and all the while it is shaping us. After all, that home is the place where my brothers, sisters, and I learned about family loyalty, about social justice, about patriotism, about faith, about responsibility, about diversity, and about striving against adversity.
Not everyone can live in a home with as much tenure or memory as my mother’s. But I have a deep conviction that a safe and decent home is a great boon in every person’s life. We need to make sure that every American—especially those whose older age makes the quest for stability and peace of mind more urgent—has a safe and decent place to call home.