The Silver Tsunami

Older Americans are driving the need for housing to age in place.

The concepts of aging in place and universal design — that is flexible, durable design that is comfortable and accessible to all, including people with disabilities — are not some fancy flavor-of-the-month. They are essential needs backed by countless demographic studies by respected institutions.

By 2030, all baby boomers will be older than age 65 — meaning one in five U.S. residents will be retirement age. U.S. Census numbers show that by 2034, there will be 77 million people over 65, compared to 76.5 million under 18 — a first in history that there are more elderly than youth. Centers for Disease Control numbers show that one in five people will experience some degree of disability in their lifetime.

The need for strategies to make housing age-friendly and barrier-free has never been greater.

Rodney Harrell — AARP’s vice president for Family, Home and Community — said housing can no longer be built in a conventional way — that it must be more flexible, diverse and accommodating.
“More than 80 percent of people over 50 want to stay in their homes and age in place — but only a portion of that housing stock is built in a way or in a location that supports that desire,” he said.

AARP created the Home Fit Guide featuring smart ways to make a home comfortable, safe and a great fit for older adults — and people of all ages and abilities. Featuring many elements of universal design, it is in many languages at: https://www.aarp.org/livable-communities/housing/info-2020/homefit-guide.html.

The NATIONAL ASSOCIATION OF REALTORS® and AARP teamed up this year to integrate AARP’s Livability Index scores across the REALTORS® Property Resource® platform. The index, created in 2015, measures how a neighborhood serves people of all abilities, incomes and ages.

“People are seeing how walkability to parks, grocery stores, and amenities serves them, and REALTORS® are learning about this,” said Harrell, noting that the site has been visited nearly 2.5 million times and more than half a million reports have been created.

“Every community and every location have trade-offs. The urban area might be closer to a grocery store and more accessible to walkability. The rural area might be more affordable,” he said. “It’s very hard to see all the tradeoffs. We created a guide to pull 40 indexes and 20 public policies. This allows you to put in your priorities, create a report and see a quick score that takes a deep dive and gives you comparisons at a quick glance.”

The tool, which allows weighting for priorities such as proximity of transit or good schools, is at https://www.aarp.org/livabilityindex.

To allow aging in place, Harrell called for a uniform code that addresses Accessory Dwelling Units (ADUs) — housing on a single-family lot that is smaller than the main house and is allowed to be occupied by someone other than the owner of the lot.

“Zoning varies from community to community across the country — you may have to go through an expensive permitting process with an architect and attorney. This makes it hard to finance ADUs. They are excellent ways of providing flexibility for the homeowner. They can help pay for repairs and modifications for their home through ADU rent. They can have an on-site caregiver staying in the ADU for free or reduced rent,” he said, noting that the community benefits by bringing young, bright medical, nursing, physical therapy, occupational therapy and other students into a more vibrant neighborhood.

Harrell said in 80 percent of American neighborhoods, single-family housing is the only option, which is not affordable for tens of millions. AARP and many planning leaders advocate for doubles, triplexes, low-rise condos and similar housing in areas zoned for only single-family housing.

“You can buy a new tooth brush in a second; housing is a hard thing to change,” he said. “City planners and builders should be thinking about the future and designing for more accessibility and options — this is going to need an all-hands-on-deck approach. There are great examples of beautiful universal design options that make a home appealing to a wide audience. Making things pretty and useful — that’s where the magic is.”

Patricia Will, founder and CEO of Belmont Senior Living, has been addressing the rise in seniors seeking amenity-rich, universally accessible housing for a quarter of a century. Belmont has created more than 30 high-end senior communities with more than 4,000 residents.

Will believes in building communities that are connected to transit, shopping, medical and other activities. She is a leader in developing in urban areas and as part of mixed-used development. Her project in Coral Gables, a Miami suburb, is a partnership with Baptist Health — the region’s leader in hospital and wellness facilities. Will also is a huge advocate of universal design and inclusion for people with disabilities.

“We believe in creating communities within very active areas. The idea that someone gets removed from life because they are aging is absolutely antithetical to what we see as a very full and engaging life for the elderly,” she said.

Will said more cities recognize that including senior housing enhances the quality and value of a mixed-use project and the surrounding neighborhood.

“It used to be a hard sell to include senior housing. People felt it was a detriment to the retail and restaurant vibe,” she said, noting that zoning needs to be more inclusive in allowing different senior housing options. “It’s the opposite. Senior housing raises sales for retail and restaurants — not only from the residents but from their family. There’s a multiplier effect.”

As an advocate for universal design, Will is amazed that some people see an assistive mobility device, or walk/roll-in shower as a negative.

“It was controversial over 20 years ago when we created development in San Diego that had common dining, gym, therapy and other areas for both independent living and assisted living. People told me it would never work, because the so-called independent people would not tolerate seeing anything that portrayed frailty in their eyes,” she said, noting that not only was the project very successful, but the units with tub-showers for independent residents were torn out and replaced with walk/roll-in showers by popular demand. “Inclusion is part of the DNA at Belmont. If someone needs a walker for mobility, if they are more secure by having a caregiver standby when they take a shower, how does that diminish them?”

The National Association of Home Builders (NAHB) created the Certified Aging-in-Place Specialist (CAPS) program to teach residential remodelers home modifications for the aging-in-place.
 
“Some of the simple and easy fixes are things such as: adding safety bars to an existing shower or tub area, changing light switches from toggle to paddle switches, exchanging door knobs with level door handles, adding a removable shower seat to your existing shower/tub area or even installing a comfort height toilet to your bathroom,” said Steve Cunningham, CAPS, CGP — 2021 NAHB Remodelers Chair and owner of Williamsburg, Va.,-based Cunningham Contracting.

Modifications also enhance visitability — accommodating family members and visitors who require level entrances, wider doorways and a ground floor accessible restroom.

“The importance of the CAPS program to aging-in-place is that it allows homeowners to live in their home more confidently and independently, as well as safely with the modifications that a CAPS remodel allows. It also lengthens the amount of time in which one can stay in their home rather than going to an assisted living facility without a CAPS home/renovation,” Cunningham said. “With the modifications that are available during a simple renovation and at a minimal cost, they not only add a monetary value, but add a personal sense of security and well-being.”
 
Maximum Accessible Housing of Ohio (MAHO) serves greater Cleveland with assisted living units for people with disabilities. It also has a demonstration unit filled with universal design ideas simple to incorporate and it provides in-home accessibility assessments free to county residents who make within 120 percent of median income.

“We always say a 20-dollar grab bar can save a fall that can break a hip that can lead to a long hospitalization, loss of home or even death,” said Beth Glas, executive vice president of MAHO and director of its Anderson Center for Accessible Living.

Greater Cleveland, carved by glaciers and very hilly, provides challenges for ramps and creative use of topography to create one level entrance into a home. The old city also has a lot of duplexes, with aging owners who live upstairs desiring to make the ground floor unit accessible so they can move into that space while continuing to earn rental income from the upstairs unit.

“Sometimes the fixes are fairly easy. If there’s an existing shower on the main level, a fixed roll-down seat or portable bath bench can add a lot of safety and accessibility for a low price,” Glas said. “Because converting to a roll-in shower can be expensive, we want to make sure we educate people on how to do it the right way. You cannot assume your architect or contractor knows how to modify for accessibility. There are so many creative, low-cost options that your contractor probably doesn’t know about.”

Jennifer Molinsky, a senior research associate at the Joint Center for Housing Studies of Harvard University said different people have different ideas about aging in place. For some, it means they will never move out of their house. For others, it means they want to stay in the same community and for others it means moving anywhere, so long as it is not a nursing home.

“We think of housing as a platform for wellbeing. Housing affordability matters to financial security and capacity to meet other needs besides shelter, such as for food and out-of-pocket medical costs,” she said. “The accessibility and safety of the home matters to our ability to live independently.”

Even though accessibility is key to living independently, Molinksy said even minimal access — wide doorways and hallways, a bedroom and bath on the ground floor — exists in barely 3.5 percent of housing. She said this must change. She said it is why several advocacy groups are lobbying for federal, state and local tax credits to support retrofits for aging in place and expanding access for people with disabilities.

“Ann Forsyth says ‘the suburbs are not a terrible place to live if you can drive. If you can’t, that’s a problem,’” said Molinksy, quoting the professor of Urban Planning at Harvard University and her co-author of What Is Aging in Place? Confusions and Contradictions. “I’m a big proponent of housing options — ADUS, triplexes, small apartments — there is a lot of potential to build up the suburbs into walkable neighborhoods.”

Valerie Novack, a fellow with the Disability Justice Initiative at the Center for American Progress and a Ph.D. candidate in Land Use and Planning at Utah State University, supports retrofitting but pushes for more universal design in new construction. She is frustrated with the stigma attached to accessibility.

“I have an old book from the 1980s on retrofitting San Francisco homes for accessibility. There is a picture of accessible doorways and the caption is very negative, saying it is unattractive and people don’t like it,” she said. “It’s a barn door style. These are all the rage for bedrooms, bathrooms kitchens — they are in designer homes now.”

Novack’s message is that accessibility and flexibility add value, which busts the myth that universal design is ugly and kills resale value.

“People like big bathrooms, they like something they can grab in the shower even if they are not a fall risk. Those are accessibility features,” she said. “People pay for the convenience of a bathroom on first floor or an extra room that can be an office and eventually a bedroom on the first floor — that’s universal design.”

Jay Woolford, executive director of Senior Housing Assistance Group (SHAG) in greater Seattle, is concerned about the lack of affordable and accessible housing. SHAG builds affordable senior housing units, but even in the highest income counties in the state, many people have difficulty affording rent.

“There needs to be bonus density for senior housing, programs are needed to create more affordability,” he said. If the land is cheap, you’re in an urban desert. If the land is amenity rich, with proximity to daily needs — it is expensive.”

SHAG sets aside 20 percent of the units in each of its complexes for people with disabilities, who are eligible at age 55 — younger than the typical senior. He said even more accessible/affordable housing is needed.

“We’ve done a very good job of creating affordable housing, but what we haven’t figured out is how to keep it affordable,” he said. “People increasingly don’t have pensions and social security cost-of-living increases are not going up enough to match the cost of housing. Someone might enter one of our communities in sound financial shape, but 10 years later they are severely rent burdened. We have to fill up the donut hole for people who make too much to get Medicaid or other support, but too little to afford to private pay for care and housing.”

With the rapid graying of America, Wolford said public policy must shift to supporting more intergenerational communities, more buildings like SHAG’s that have ground-level retail, restaurants and wellness centers open to the general public.

“I think there are inherent problems with aging in your own home. A lot of housing stock is not appropriate for aging in place. A lot of houses are split levels or only have an upstairs bath,” he said. “It gets harder to live there and to get out and do things. That leads to social isolation. I believe in the ability to age in the same community, but with housing options that are more accessible and affordable.”

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