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Harvard: 4 Aging in Place Challenges the U.S. Can’t Ignore

Portrait of smiling senior couple by house

One in five Americans—nearly 80 million people—will be older than age 65 within the next 20 years, and they will want to continue living in their current homes for as long as possible. Despite these desires, the reality is that the U.S. is ill-equipped to currently provide the accessible housing units and supportive services needed to accommodate these aging in place demands, research shows.

In fact, there are four distinct challenges to meeting the aging in place needs of the impending senior population, according to “Projections and Implications for Housing a Growing Population,” a recent report from the Joint Center for Housing Studies at Harvard University.

Such challenges include addressing the majority of U.S. homes that are not accessible for older people with limited mobility; expensive costs of using long-term care to live at home; housing costs that become unaffordable later in life; and reducing isolation of elderly adults living at home.

Accessible housing

The Joint Center for Housing Studies (JCHS), which has suggested reverse mortgages can be financially feasible options to helping older homeowners comfortably age in place, projects that the share of households headed by someone over 65 will grow from 29.9 million today to 50 million in 2035.

Of this group, the JCHS projects that 17 million older households will include at least one person with a mobility disability for whom stairs, traditional bathroom layouts and narrow doors and corridors may pose challenges, a 77% increase from today, says Jennifer Molinsky, senior research associate at the JCHS.

Yet, only 3.5% of U.S. housing units offer a zero-step entrance into the home, single-floor living and wide doorways and hallways that can accommodate someone in a wheelchair.

“Preparing ahead, at a time when no one in the household has limited mobility disabilities, can help lower the financial and emotional cost of these changes—for example, during a bathroom remodel, adding reinforced walls can make the later addition of grab bars much simpler, while choosing a walk-in shower can eliminate the need to add one later,” Molinsky says.

The costs to make such age friendly improvements are a hurdle for some older homeowners, nearly 10% of whom have less than $50,000 in total assets including the value of their homes, according to the JCHS. Excluding home value, 39% of older homeowner households have less than $50,000.

“Going forward, trends in income, wealth, and debt suggest that older adults may have even fewer assets in the future,” Molinsky says. “Helping older adults with limited means finance modifications through tax credits, low- or no-interest loans, grants, or expanded Medicaid waivers for needed modifications will be important.”

Long-term care

By 2035, the JCHS projects the number of older adult households in which at least one person has a self-care disability will reach 12 million. If these people wish to age in place, they will require daily assistance and personal care to help them do so.

But while trends in health care have seen nursing home usage decline in recent years, in favor of less costly at-home care, such assistance is still currently expensive. The median monthly cost for home health aide services is $3,813, according to the 2016 Genworth Cost of Care Survey, the latest data available.

For an aging population that may no longer be in the workforce, affording such care servicers will be difficult to achieve on one’s own. Fortunately for some living today this care is provided by family members, including spouses. But it will not always be this way.

“In the future, fewer family members will be available to the next generation of older adults, because the number of households with few or no children, as well as single-person households, will rise,” Molinsky says. “For individuals, factoring in the potential costs of paying for in-home support and care is an important part of planning for aging in place, but policy has a role as well in encouraging innovation of cost-effective care delivery in the home.”

Housing affordability

Housing costs are likely to remain a significant obstacle to aging in place. In 2014, the JCHS notes that 31% of older households were cost-burdened, meaning they spent more than 30% of their income on housing. Projecting ahead, the JCHS anticipates 17.1 million older households will be burdened by housing costs, and 8.5 million of these households will be spending more than 50% of their income on housing expenses.

Homeowners comprise the majority of cost-burdened older households, especially owners who carry mortgage debt into older ages—a trend that has increased over the past 20 years, Molinsky says.

“For homeowners, the challenge of high housing costs might be met with prudent and early financial planning, reverse mortgages or refinancing, relief from property taxes, or help increasing home energy efficiency and lowering utility costs,” Molinsky says.

Reducing isolation

Ensuring older households are able to connect with their neighbors and access services in their communities is as critical to aging in place as preparing one’s home and finances, Molinsky says. Isolation is not just an issue for older adults living in rural areas, but for those living in cities, too.

Just under half of older households are located in areas of metro regions with less than one housing unit per square acre, or outside metro regions entirely, according to the JCHS report. This isolation is further exacerbated when older adults give up driving—a share that exceeds 50% of those in their mid-80s and above.

“Alternative transportation, such as paratransit or car-share services, as well as technology that enables virtual medical appointments and social interaction, will be key,” Molinsky says. “But individuals in these lower density areas, and the organizations and governments that serve them, will need to consider how to expand programs to ensure older adults can access services and remain engaged in their communities.”

While reducing isolation and addressing these other three challenges do not mean that aging in place is an “impractical” or an “unworthy” goal, Molinsky says, the evidence of these obstacles means there is much more planning to be done at both the individual and societal levels.

“Educating households about the financial and physical challenges they might face if they remain in their current home and the options available to address them is an important first step,” she says. “So is ensuring that local governments understand and plan for the challenges their older residents will likely face.”

For more information about aging in place, contact us here.