Surveys show aging in place is the preference of most people, but the options for doing so vary greatly. A recent study shows that even those with middle-incomes will not have the resources to maintain their homes and access services needed to remain in them. Income inequalities persist throughout the life span, however, which make aging in place much more challenging for those with fewer resources.
According to the 2016 report of Joint Center for Housing Studies of Harvard University (JCHS), Over the next twenty years, the population aged 65 and over is expected to grow from 48 million to 79 million. By 2035, one in three households will be headed by someone over age 65. In the coming decades, many of these older households will have the financial resources to secure housing and supportive services needed as they age. “Over the same period, however, millions of low-income older households will struggle to pay for appropriate housing and necessary supportive services. For these households, basic housing costs will drain resources needed to pay for home modifications or in-home services, and may force reductions in spending on critical needs like food and healthcare.”
Using data from the 2014 Health and Retirement Study (HRS), JCHS reports that 41% of older adults between 65-79 have at least one self-care (e.g., eating, dressing), household activity (e.g. driving, housework, money management), or mobility disability, and for those 80 and over, this percentage rises to nearly 71 percent. Disability rates, however, are highest among those with low-incomes, or limited educational attainment, among Hispanics and non-Hispanic blacks, and among the unmarried.
The expansive growth of single-persons households is especially of concern. JCHS estimates that by 2035, “there will be 9.3 million on-person households aged 80 and over, representing 57% of households in that age group.” Living alone in old age is correlated with lower incomes, higher rates of disabilities, and the need for finding services and supports outside of the home. These services and supports must be paid for even as these households rely on more limited incomes.
Yet, most homes are not suited to increasing levels of disability. Herbert and Molinsky (2019) report, “Only 3.5 percent of US housing stock offers three basic features of accessibility: no-step entry, single-floor living, and wide hallways and doorways that can accommodate a wheelchair. Making modifications to a home can be expensive, particularly if extensive changes such as widening doors, installing ramps or chairlifts, or lowering cabinets are needed.” But even simple home and yard maintenance, grab bars, and other low-cost modifications are often lacking, due to few community resources and lack of knowledge among older residents of services available.
Additionally, homes aren’t just isolated units; neighborhoods play an essential part in supporting (or not) aging in place. In 2018, the Urban Institute’s Housing Matters Initiative indicated the “evidence suggests that low-income older adults and older adults of color are more likely to live in neighborhoods with economic, social and physical conditions that are detrimental to their health.” Residents of these neighborhoods are more likely to suffer from chronic diseases, cognitive impairment, and accelerated biological aging than those living in more economically prosperous neighborhoods. So, even if these older adults want to age in familiar neighborhoods, clearly the policy call is to improve neighborhood quality – from reducing crime and increasing social cohesion, to improving housing stock, fixing the built environment (sidewalks, transportation), and enhancing local services and supports.
So, while many older adults with financial means can make choices to maintain and modify their homes or move to other supportive housing options in their communities as they age and their needs change. But a significant and growing number of low-, moderate- and middle- income older adults do not have these options. They may already live in unaffordable or deteriorating houses and neighborhoods, and do not have the resources to modify their residences and get supports needed to aging in their community. This trend is expected to continue, exacerbated by current income and wealth inequalities. Fewer and fewer older people will have the option to age in the place of their choice. Not only is the value of aging in place important, but increasingly the home is the setting for the delivery of long-term care, another trend expected to continue as millions more aging adults want to remain in their current dwellings while dealing with disabilities and health issues.
The policy call: Communities can engage in age-friendly initiatives, to enhance mobility, community design, engagement, access to services and other factors important for health and well-being. Visibility initiatives which require new home design to include basic accessibility features or be easily modified later. Tax credits and federal programs for home improvements and repairs all play a vital role, but must be expanded if we are to meet the growing need. Local volunteer efforts are essential to fill the gaps, especially given the limited resources in existing public programs. Expansion of rental assistance programs is critical to meet the demand for affordable housing for low-income older adults. Other options such as shared housing, multigenerational housing such a villages and co-housing, and formal and informal in-home care and support programs are all needed if we are to increase the opportunities for older adults to remain in their communities. Of utmost importance is that these efforts become part of a coordinated community response focused on helping older adults remain vital and engaged residents in the housing option of their choice that best meets their changing needs.
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