Four Challenges to Aging in Place

by Jennifer Molinsky
Senior Research Associate

Within 20 years, one in five Americans—almost 80 million people—will be older than 65 and, surveys indicate, they will want to remain in the current homes for as long as possible. However, the country currently lacks the accessible housing units and supportive social services needed to accommodate these desires.

Four challenges are particularly noteworthy, according to Projections and Implications for Housing a Growing Older Population, a recent Joint Center report which also projected that the share of households headed by someone over 65 will grow from 29.9 million today to 50 million in 2035. In particular:

• Most U.S. homes are not accessible for older people with limited mobility
• Many older Americans living at home will need long-term care, which is expensive
• Millions of older adults cannot afford their current housing units
• Older adults who live at home are often isolated

Challenge #1: Making Housing Accessible

A growing older population will mean greater numbers of households that include someone with a disability (Figure 1). Indeed, the Joint Center projects that by 2035, 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 percent increase from today. Yet only 3.5 percent of US housing units offer a zero-step entrance into the home, single-floor living, and wide doorways and hallways that accommodate someone in a wheelchair.

Notes: Mobility disability is defined as difficulty walking, getting in and out of bed, and climbing one flight of stairs; self-care disability as difficulty eating, dressing, toileting, and bathing; and household activity disability as difficulty with meal preparation, food shopping, using the telephone, taking medication, money management, housework, and driving.
Source: JCHS tabulations of University of Michigan, 2014 Health and Retirement Survey.

The costs of improving safety and accessibility range from free (e.g. removing throw rugs) to costly (e.g. a new addition to enable single-floor living). Preparing ahead, at a time when the 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. For some, merely identifying modification needs and finding a contractor or handyman to make changes can be daunting. Consequently, resources that can connect people to trustworthy sources to assess the home and find capable workers will be an important part of any efforts to support aging in place.

However, a sizeable share of homeowners will need financial assistance to make these changes. Today nearly 10 percent of all older homeowner households have less than $50,000 in total assets including the value of their homes. (Excluding the value of the home, 39 percent 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. 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.

Renters, particularly those living in older, less accessible units, may be in more difficult straits. Even though federal law generally requires that landlords allow tenants with disabilities to make necessary changes to their units, renters—whose median wealth is only $6,000—typically must do so at their own expense. Furthermore, landlords may require the modifications be removed at renters’ expense upon leaving.

Challenge #2: Providing Long-Term Care 

The Joint Center projects that the number of older adult households in which at least one person has a self-care disability will reach 12 million by 2035; many of these households will require daily assistance with personal care if they are to stay in their homes. (This is consistent with an often-cited 2005 study by Peter Kemper, Harriet L. Komisar and Lisa Alecxih estimating that nearly 70 percent of adults who reach the age of 65 will need some form of long-term care later in life.) Indeed, this type of care is increasingly being offered in people’s homes. Nursing home usage has declined in the past two decades, a trend likely to continue as health and housing partners build partnerships to deliver care at lower cost to private residences. In addition to assistance with personal care, by 2035, we project that 27 million older Americans will need help with other household tasks such as shopping, housework, or paying bills.

Yet long-term care currently is expensive. The median monthly cost for a home health aide working five days per week is $3,813. The typical older renter could afford just two months of these services before exhausting their savings. While the median older homeowner is better situated, many have limited resources—and as noted above may need these to make modifications to their homes.

Today most assistance is provided by family members, including spouses, at least in part because of high costs. However, 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. 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.

Challenge #3: Ensuring that Housing is Affordable 

Affordability is and is likely to remain a significant obstacle to aging in place. In 2014, 31 percent of older households were cost-burdened (i.e. they spent more than 30 of their income on housing). Holding cost-burdened shares by age, race/ethnicity, and tenure constant, the Joint Center projects that by 2035, 17.1 million older households will be housing cost-burdened, and 8.5 million of these households will be spending more than 50 percent of their income on housing.

Given lower incomes, older renters are more likely to be cost-burdened. However, with a homeownership rate approaching 80 percent for older households, owners are more numerous and make up the majority of cost-burdened older households. In particular, owners who carry mortgages into older ages—a trend that has increased over the past 20 years—are at higher risk of experiencing unaffordable housing costs. Households that are housing cost-burdened typically cope by cutting back on other necessities, such as food, healthcare, or transportation. These tradeoffs put older adults’ health at risk and limit their opportunities to engage in their communities and access needed services.

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. Renters have fewer options, as rental subsidies are in short supply. By 2035 the Joint Center projects that the number of older adults eligible for rental housing subsidies will grow to 7.6 million from just under 4 million today. Currently the nation provides subsidies to only about one-third of those eligible; simply maintaining this level for seniors in 2035 would require providing subsidies to an additional 1.3 million households, which would more than double the number of older people who are being assisted today.

Challenge #4: Reducing Isolation

Ensuring older households are able to connect with their neighbors and access services in their communities and beyond is as critical to aging in place as preparing one’s home and finances. One can be isolated anywhere, even in a city if streets are perceived as unsafe, or if friends or needed services are not nearby. There are, however, ways to capitalize on a localized population of older adults to deliver services, through organizations like “villages” or those that serve naturally occurring retirement communities (NORCs), such as large apartment complexes that are home to significant numbers of older people.

Isolation is a particular concern for those aging in low-density and rural locales. The new study found that that just under half of older households are located in areas of metro regions with less than one housing unit per acre, or outside metro regions entirely (Figure 2). When older adults curtail or give up driving—a share that exceeds 50 percent for those in their mid-80s and above—people living in these locations can be particularly isolated.

Notes: Areas are defined as census tracts. High-density metro areas have at least 2028 housing units per square mile; medium-density metro areas have between 644 and 2028 housing units per square mile; and low-density metro areas have less than 644 housing units per square mile. Connected and isolated non-metro areas are defined using USDA Rural-Urban Commuting Area codes.
Source: JCHS tabulations of 2010-2014 American Community Survey 5-Year Estimates and USDA Rural-Urban Commuting Area codes.

Alternative transportation, such as paratransit or car-share services, as well as technology that enables virtual medical appointments and social interaction, will be key. 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.

Moving Forward

These challenges do not mean that aging in place is an impractical or an unworthy goal, but rather that there is much planning to be done at both the individual and societal level. 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. So is ensuring that local governments understand and plan for the challenges their older residents will likely face.

For some, though, alternatives to a current residence may prove to offer a higher quality of life. Therefore, we also need to create new housing options that offer accessibility features, are located near to shopping and services (or in a multifamily building that provides services), offer flexible space (perhaps including space that can be occupied by caregivers if needed), and are aimed at a people with range of incomes, including low-income renters. Developing housing with these features in the centers or downtowns of small towns and suburbs where older adults already live can provide alternatives that allow longtime residents to maintain ties to their communities. Since one in three US households will be headed by an older adult within 20 years (up from one in five today), we need to start taking these and other steps as soon as possible.

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Jennifer Molinsky will be a panelist at our March 6 event Housing and Policy in an Aging America. This event will be free and open to the public.

Bipartisan Policy Center Task Force Recommends Integrating Health and Housing to Support Aging in Place

by Jennifer Molinsky
Senior Research Associate

The Bipartisan Policy Center’s Senior Health and Housing Task Force recently released Healthy Aging Begins at Home, a report and set of policy recommendations centered on integrating health care, supportive services, and housing to support the nation’s rapidly expanding older population. As the 65 and over population is projected to soar from 48 to 74 million over the next fifteen years, the report brings into focus some core challenges.

Surveys show that most older adults prefer to age in place; indeed, a 2014 AARP survey found that nearly 90 percent of those 65 and older agree or strongly agree that they would like to remain in their current homes for as long as possible. Yet as the incidence of mobility and other disabilities rises with age, only 1 percent of existing housing units have five key universal design features (no-step entry, single-floor living, lever-style handles on doors and faucets, wide halls and doorways, and accessible electrical controls) that can allow those with disabilities to live safely at home. Millions will also need support with homemaking and personal care, but costs of in-home assistance can be substantial. 

Indeed, the Joint Center’s Housing America’s Older Adults report has shown that the typical renter 65 and over can afford just 2 months of homemaker or home health aides before depleting all assets. And while the physical and financial barriers to aging in place are high, the nation will also have to contend with rising Medicare and Medicaid expenditures.

The crux of Healthy Aging Begins at Home is that the challenges of aging in place, as well as rising health care costs, can both be moderated by better integration of health care and housing. For example, relatively small investments in grab bars, lighting, and other modifications can help avert falls among older adults that can end or severely impair an individual’s independence, and that cost an estimated $34 billion in health care costs annually. Helping older adults modify their homes for safety and accessibility can help them remain independent in their own homes longer, precluding moves to more costly congregate care. Similarly, the task force's report finds Medicare, Medicaid, and hospitals should look to homes as a site for preventive health care as well as supports and services that help older adults age in place while also reducing costs. Among a number of examples, the report points to the Independence at Home Demonstration program, created under the Affordable Care Act, which uses home-based primary care for Medicare holders with multiple chronic conditions, saving over $25 million in the program’s first year.

While healthy aging indeed does begin at home, for a host of reasons the best home may not be the current home. As the BPC report notes, “[I]t may be the case that living alone, socially isolated, in a single-family home is not the most appropriate or healthiest living situation, particularly for a frail senior. America needs a broader perspective: the aspiration should be to help seniors not just to age in place but to age with options.” In a recent report from the Milken Institute on The Future of Aging, Joint Center Managing Director Chris Herbert echoes this point, noting the importance of aging “in the right place.” This may mean a home that is smaller, more physically accessible, more affordable, or less isolated. Since one size will not fit all, a range of housing choices is needed, including in older adults’ existing communities, which would allow for a move but help people retain social and family ties. With three-quarters of older adults residing outside of central cities, this means new options in suburbs, small towns, and rural areas.

We particularly need options for the millions who pay too much for inadequate, inaccessible, or otherwise unsuitable housing. Recent Joint Center analysis shows that older adults aged 75 and over have the highest incidence of all ages of severe cost burdens, paying more than 50 percent of their income for housing. While there’s a higher incidence of cost burdens among older renters, with the older population's high homeownership rate and low incomes, greater numbers of older owner households face severe burdens (Figure 1). Unfortunately, we expect cost burdens among older adults to worsen as the population grows: a recent report by the Joint Center and Enterprise Community Partners projects that severe burdens are expected to rise by 39 percent among those aged 75 and over and 42 percent among those aged 65-74 by 2025. 

Notes: Cost burdens are defined as housing costs more than 50% of household income. 

JCHS tabulations of US Census Bureau, American Community Surveys. 

Indeed, while Healthy Aging Begins at Home calls for integrating health care, supportive services, and housing, it makes the compelling argument that this is not possible without housing that is affordable: 

One thing is clear: all bets are off in bridging the health-housing divide if seniors lack access to affordable housing. Affordable housing is the glue that holds everything together: without access to such housing and the stability it provides, it becomes increasingly difficult, if not impossible, to introduce a system of home- and community-based supports that can enable successful aging.

Toward this end, Healthy Aging Begins at Home calls for the expansion of the Low Income Housing Tax Credit program to finance and preserve affordable rental housing, including units for low-income older adults. In close alignment with this recommendation, on May 19, Senator Maria Cantwell and Chairman Orrin Hatch of the Senate Finance Committee introduced a bill, the Affordable Housing Credit Improvement Act (S 2962), to increase support for LIHTC by 50 percent. The report also recommends a host of other policy changes including support for senior supportive housing through the US Department of Housing and Urban Development's Section 202 and new programming, coordination of federal resources for home modifications, expansion and creation of new state and local efforts to support the financing of home modifications, integration of health care and long term services and supports for Medicare beneficiaries who live in publicly-assisted housing, a focus on fall prevention within Medicare and other federal programs, and greater reimbursement of telehealth and other technologies that make it easier to monitor and coordinate care for people living independently. Some of these policies require additional investments but have longer-term payoffs in terms of reduced health care costs.

The Joint Center’s own Housing America’s Older Adults report concludes that though the challenges are vast, the largest impacts on healthcare and housing are still a decade away, giving the nation time to begin to make needed changes to our housing stock, communities, and health care systems. That too was the message at the release of Healthy Aging Begins at Home: with so much at stake, the time to act is now. 

Disability Housing - Best Practices and New Solutions

Micaela Connery
2015 Research Fellow

This summer I’m moving. Again. It will be my sixth “residence” since graduating college. Over the last seven years, home has included a three bedroom apartment in Somerville, my parent’s basement (Cellar Dwellers Unite!), a grad school dorm where adults regress to freshman status, full-size bunk beds on the Lower East Side (full-size bunk beds are a real thing), and a bedroom that was actually a closet found somewhere deep in a Brooklyn craigslist. Despite all the quirks that came with each dwelling place—communal showers, head whacks on the top bunk, et cetera—each one was home in some special way.

But, for many adults with disabilities, a suitable home is hard—sometimes almost impossible—to come by. In the time that I moved five times, hundreds of thousands of individuals with disabilities across the U.S. have sat on housing waitlists. They’re waiting, often many years, to make just one crucial move, the move out of their parent’s home into community or independent living. The United States spends over $77 billion dollars annually on special education, often working to prepare individuals with disabilities to be successful, independent, and included. Yet those opportunities for independence inclusion are almost non-existent after exiting the school system. We spend billions in public funds preparing individuals with disabilities for opportunities they may never be able to have.

The most obvious issue here is funding and availability of housing offerings. Most state agencies who are on the front lines of addressing this need are finding there simply isn’t enough public funding to support placements and support services for the high number of individuals with disabilities who need it. As state developmental services budgets are cut and numbers of adults with disabilities increase, the challenge is only growing over time.

While increasing funding (or at least preventing budget cuts) is a key part of the solution, it will only incrementally address the growing waitlists for housing services. Absent an increase in the supply of suitable housing options, funding alone won’t likely fix the problem. Many providers, families, and organizations have taken it upon themselves to innovate new solutions to housing placements; experimenting with different operational structures, engaging private funders, rallying parent support, and innovating new housing models. By understanding what makes these innovative models effective, and where they face challenges, policymakers can better support new solutions for the disability housing crisis. With support from the Joint Center, I spent last summer examining a few of these approaches and what we can learn from them, and have reported my findings in the paper “Disability Housing: What’s happening? What’s challenging? What’s needed?”.

Perhaps the most obvious finding from spending time with consumers and providers is that one size does not fit all. While there are some common best practices—engaging families, supporting choice, linking to employment and transit, and retaining quality staff—there is not one single housing type or model that is right for all people with disabilities. As for people without disabilities, what people want their home to look like varies greatly. Some people desire an apartment in a city while other prefer a house with lots of land in a more rural neighborhood. Some people want to live alone and other want to be surrounded by lots of friends, family, and activity. Policies must support a range of options and choices for individuals with disabilities.

The second key issue in finding housing solutions is the right to risk, meaning that housing options shouldn’t be unduly constrained by concerns about residents safety. A right to risk would bring a willingness to innovate and provide support for experimenting with new models. Policymakers and regulators, perhaps wary of litigation, seem to be resistant to anything that may lead to failure or risk. They want to protect people with disabilities, sometimes at any cost. But people with disabilities should be allowed to take risks themselves and providers should be supported to innovate with new approaches. While we should protect people as best we can, we can’t let protection stifle new ideas. The only way disability housing can improve is if we give it space to innovate, and even make mistakes.

While providing housing and adult services for people with disabilities presents challenges, it’s also full of opportunities. It’s an opportunity to better integrate our communities. Thinking about these issues helps us reexamine what it means to support quality and affordable housing for all populations, not just those with disabilities. It’s an opportunity to re-evaluate and innovate around how we create communities, connect with our neighbors, and age within our homes. With the right program design and service delivery, we can start to change the predominant concerns of parents of children with disabilities. No longer will they worry, “Where will my child live after I die?” or “Who will care for my child?” Instead, they can wonder: “Which housing option is right for my child?” And most of all: “What community will be lucky enough to have my child as a member?”

Individuals with disabilities and advocates have been fighting for thoughtful supports, inclusion in communities, and independent living since the 1960s. The challenge isn’t new, but the solutions will need to be.

Micaela Connery was a summer research fellow for the Joint Center for Housing Studies. She is an MPP Candidate at Harvard Kennedy School focusing on disability, inclusion, and community development. She is a member of the inaugural class of New World Social Enterprise Fellows at the Center for Public Leadership at Harvard. She will continue with her studies as a Mitchell Scholar in the Fall of 2016, pursuing her MBA at the Smurfit School at University College Dublin.

She is presenting a Housing Studies Seminar on this topic at noon on Friday, April 27, 2016 at the Joint Center offices. See our calendar listing for more information.

The Future of Renting Among Older Adults

Jennifer Molinsky
Senior Research Associate

Since 2005, the number of renter households aged 50 and over has increased dramatically, jumping from 10 to nearly 15 million, and accounting for more than half of all renter growth over the past decade, as my colleague Dan McCue pointed out in a recent post. This is not just a result of the large baby boom cohort passing age 50, but is also a distinct increase in the rate at which older adults are renting. As these trends are likely to continue, it’s concerning that the nation’s current supply of rental housing suitable to the needs and preferences of older renters is insufficient, particularly in relation to affordability and physical accessibility.

The baby boom cohort, now aged 50-69, is responsible for most of the increase in older renters. In the last decade, the boomer generation fully passed into the 50+ category, and going forward, this cohort will continue to drive up the number of renters in their 70s and beyond (Figure 1).

Notes: Projected renter growth assumes constant homeownership rates by age, race, and household type.  Constant rates are the average of rates from 2014 and 2015. Historical growth uses 3-year trailing annual averages to reduce volatility.
Sources: JCHS tabulations of US Census Bureau, Current Population Surveys and 2013 JCHS household growth projections.

However a growing older population is only part of the story: more than half the growth in older renters stems from a decline in homeownership and subsequent increase in the share of those 50 and over who rent, a legacy of the foreclosure crisis and recession. As our 2014 report on housing for older adults noted, the homeownership rate for 50-64 year olds slipped 5 percentage points between 2005 and 2013—a larger drop than in the nation’s overall homeownership rate over that period. For these owners-turned-renters, transitioning back to homeownership can be especially difficult as retirement approaches: the imperative to save for retirement may take precedence over saving for a downpayment, while weak credit may make it difficult to obtain a mortgage. Though some may make their way back to homeownership despite these challenges, it is likely that the higher rentership rates among the boomer cohort will persist as the group ages.

While the recession pushed many into renting, other older homeowners are transitioning to renting as a choice. For these owners, rentals may offer a smaller, more cost-effective option that demands less time, physical effort, and money to maintain. As mobility limitations increase with age, older owners also turn to renting to obtain more accessible housing, with features like single-floor living, no-step entries into the unit, walk-in showers, and other universal design elements. As the large baby boom population enters the 70-plus age range in the next decade, we can expect a swell in the number of older renters seeking accessibility features that can enhance safety in the home, independence, and quality of life.

It remains to be seen whether baby boomers will elect to make these moves earlier than their predecessors. With growing interest in walkable communities, proximity to transit, and back-to-the-cities living, we may see earlier turns to renting as a choice. But even if not, the sheer growth in older households and the falloff in owning compared to previous generations at the same age indicates strong growth in older renter households going forward, even absent further declines in homeownership.

The question then is whether the nation’s supply of rental units is suited to the needs and preferences of older renters. Like renters in general, older renters have lower median incomes than their home-owning counterparts. But since incomes decline in retirement, older renters also have lower median incomes than renters in general (Figure 2). Lower incomes leave a significant share of older renters vulnerable to housing cost burdens. Indeed, 55 percent of renters aged 65 and over are cost burdened, spending more than 30 percent of their income on housing, including 30 percent who spend more than half their income on housing. Older cost-burdened renters typically spend less on food, healthcare, and transportation – and for those in their 50s and early 60s, save less for retirement, threatening financial security down the road.

Notes: Real Median Incomes are as of 2014 and have been adjusted for inflation using the CPI-U for all items.

Source: JCHS tabulations of US Census Bureau, 2015 Current Population Survey.

As noted below, older renters are more likely to have disabilities than younger renters, as well as homeowners of the same age (Figure 3). Yet the supply of accessible units is limited; less than 1 percent of US rentals include five basic universal design features (a no-step entry, single-floor living, wide hallways and doors, electrical controls reachable from wheelchair height, and lever-style handles on doors and faucets). Units in newer, larger buildings are apt to offer more, yet still, just 6 percent of units in buildings constructed 2003 and later, and 11 percent of units in larger apartment buildings with 20 or more units, offer all five of these features. And newer rentals tend to command higher rents, leaving them out of reach to lower-income households with disabilities.

Notes: For individuals age 15 and older, a disability is defined as a hearing, vision, cognitive, ambulatory, self-care, or independent living difficulty. White households are non-Hispanic. Includes non-group quarters population only.

Source: JCHS tabulations of US Census Bureau, 2012 American Community Survey.

Indeed, older adults seeking housing that is both affordable and accessible face particular challenges. The current affordable stock tends to be older and located in smaller multifamily buildings that are the least likely of any rentals to offer accessibility features. Two-fifths of renter households in their 50s and 60s live in apartments in small buildings with 2-9 units (Figure 4), which are among the oldest and least accessible units in the entire rental stock. Meanwhile, over a third live in single-family rentals whose accessibility varies widely by region, with renters in the Northeast and Midwest at particular disadvantage for single-floor living.

Source: JCHS tabulations of 2013 American Housing Survey, US Department of Housing and Urban Development

In addition to lower-cost and more accessible rentals, we will likely see an increase in demand for rentals with services that enhance older adults’ quality of life. Many older adults are not in need of assisted living or skilled nursing care, but could benefit from services such as transportation, laundry, or housekeeping that can support independent living into older ages. For lower-income adults, service-enhanced housing, where services are provided onsite, or service networks that support older renters scattered in multiple locations, can fill a role that their higher income peers can obtain through “village” membership organizations or the more independent portions of continuing care retirement communities.

With renters 50 and over now comprising a third of the renter population – and renters 40 and over representing fully half – now is the time to consider the suitability of the nation’s rental stock for older renters and begin to address its shortfalls in accessibility and affordability. There is an urgent need to create more accessible units, through new construction or retrofit, suitable and affordable to older adults. This is particularly true for the oldest cohort, which has both the lowest median income of all renters and the highest rate of disability, and which will grow in size as the baby boomer generation ages into their 70s. Meanwhile, service-enhanced rental housing can play a critical role in extending independence and quality of life for those lower-income renters who do not need skilled nursing care or assisted living, but who could benefit from services that support independent living. 

Aging Society and Inaccessible Housing Stock Suggest Growing Need for Remodeling

by Abbe Will
Research Analyst

Over the coming decades, the number and share of U.S. households age 65 and over will rise dramatically as the oldest members of the baby-boom generation reach retirement age. Inevitably, with increasing age comes the growing presence of disability and problems using components of the home without assistance. Surely, some aging households will look to move into homes that are better suited to their changing needs, but the majority of older households continue to plan to “age in place.” Since much of the housing stock is currently ill-equipped with even basic accessibility features, older homeowners aging in place will need to invest in retrofitting their homes in order to age comfortably and safely. New research released by the Joint Center sheds light on the implications of an aging society for the home improvement market by analyzing the remodeling activity by older owners and estimating the projected demand for and supply of homes with basic accessibility features in the near future.

Older homeowners have already been exerting significant influence on the home remodeling market due to changing trends in longevity, mobility, wealth, homeownership rates, and labor force participation. Since 2007, the share of total market spending for home improvements by owners age 55 and over has increased considerably, from less than a third to nearly a half by 2013. Reaching $90 billion in 2013, spending by older owners was just 6 percent less than during the last market peak in 2007 and for the first time surpassed the share and level of spending by middle-age homeowners. Combining historical spending data from the American Housing Survey with recent consumer housing survey data of expected spending from the Demand Institute suggests that total improvement expenditure by older homeowners could surge by an additional $17 billion annually over the next three years.

The Joint Center estimates that of the over 25 million households age 65 and over today, 44 percent have some need for home accessibility features due to disability or difficulty using components of the home, such as kitchen or bathroom facilities, without assistance (Figure 1). And yet the current housing stock is not especially equipped to meet the accessibility needs of an aging nation, as not even a third of homes have what could be considered basic accessibility features, such as a no-step entry and bedroom and full bathroom on the entry level (Figure 2). Although 45 percent of older homeowners plan to undertake improvement projects in the next several years with the intent of making their homes easier to live in as they age, surprisingly few owners are focused on home accessibility as part of aging in place comfortably and safely. Given the attitudes of today’s older homeowners, the remodeling industry will need to bridge a substantial mismatch between owners’ wanting to age in place and their actually being able to do so safely with appropriate accessibility features.

Note: Households with accessibility need are defined as those with a disabled member or members with serious difficulties using components of the home without assistance. For more detail, see Appendix A in Abbe Will, Aging in Place: Implications for Remodeling, JCHS Working Paper, July 2015. Source: JCHS tabulations of HUD, American Housing Survey.

Note: Basic accessibility features are defined as a no-step entry and bedroom and full bathroom on the entry level of the home. Source: JCHS tabulations of HUD, American Housing Survey.

As the number and share of older households rise sharply over the coming decade, construction of new housing with basic accessibility features is projected to fall considerably short of increased demand in the Northeast and Midwest regions of the country. Fully 40 percent of the net gain in households age 65 and older with accessibility needs in these regions is projected to have unmet demand, suggesting the need for significant retrofit spending on existing homes to narrow this supply-demand gap (Figure 3). Older households in the South and West regions of the country are already better accommodated for aging in place, with relatively more homes in these regions having basic accessibility features, and this trend is not expected to change over the coming decade. Ultimately, the dramatically rising number of older households aging in place, strong and growing home improvement spending by older owners, and the unsuitability of the current housing stock for safely and comfortably aging in place all support the expectation for substantial growth in demand for homes with accessibility features moving forward.

Note: Basic accessibility features include a no-step entry and bedroom and full bathroom on the entry level of the home. Source: Abbe Will, Aging in Place: Implications for Remodeling, JCHS Working Paper, July 2015.

The Rise of the Single-Person Household

by George Masnick
Senior Research Fellow

Perhaps nothing speaks greater volume about changes in modern American life than the rise of the single-person household. A recent paper authored by Census Bureau researchers shows that a hundred years ago, fewer than six percent of all households consisted of people who lived alone. By 1940, that share had only inched upward to 7.8 percent. By 2013, at 28 percent of all households, it is now the second most common household type just behind married couples without minor children (29 percent), and well ahead of marrieds with minor children in the household (19 percent). In the 19^th and early 20^th centuries, single-person households consisted mostly of men, but the greatest gains in living alone during the past 50 years have been among women. Today, women head 54 percent of all single-person households. In the past, when living alone might have been a short-term condition, for many it is now a long-term situation, the result of a number of broad demographic and economic forces at work over the past half century: greater affluence, longer lives, later ages of marriage, higher divorce, smaller family sizes, greater labor force participation and financial independence of women, and stronger government safety nets across a wide spectrum of social programs.

In parts of the country the share living alone is much higher than the national average. In many counties in the nation’s mid-section, where outmigration of young adults have led to older populations, between 30 and 40 percent of all households are single person. In large cities, single person occupancy can account for 45 percent of all households. A Pew Research Center study of single-person households reports that in some neighborhoods in Manhattan and DC, the share of single-person households approaches two thirds. 

According to the 2013 American Housing Survey, single-person households are spread across all ages. About 28 percent of all single person households are under the age of 45, another 36 percent between the ages of 45 and 64, and 36 percent are over the age of 65. Among the elderly, the older the household head, the higher the percentage that live alone. Fully 43 percent of households headed by those over the age of 65 are single-person, with 65-69 year old heads having 34 percent, 70-74 year olds at 37 percent, and 75+ registering 52 percent. Aging baby boomers will drive the share of over-65 year olds living in single-person households even higher over the next two decades. 

As recently as 1940, 61 percent of single-person households consisted of renters, but today owners are in the majority, with the 2013 American Housing Survey reporting that 54 percent of single person households were owner-occupied. Between 2003 and 2013, owners accounted for 55 percent of the growth in single person households. Among single-person households under the age of 45, two thirds are renters, but among single-person households over the age of 65, owners are a strong 70 percent majority (Figure 1).

Source: Joint Center tabulation of 2013 American Housing Survey

Single-person owners and renters are markedly different in terms of the type of housing they occupy. Fully three quarters of single-person renters live in multi-family housing, but among single-person owners almost three quarters live in single-family detached units, and another 8 percent in single-family attached structures. Single-person owners also live in larger units, with 63 percent in homes with 3+ bedrooms. This compares to only 12 percent of single-person renters living in large units (Figure 2).

Source: Joint Center tabulation of 2013 American Housing Survey

The reason that more single-person owners live in larger units compared to single-person renters is that many widows and divorcees remain in their homes after life-course events have left them living alone. Almost three-quarters of single-person owners have been in their homes for 10 or more years, including 40 percent who have been there for 20 or more. This compares to only 16 percent of single-person renters having lived in their homes for 10 or more years. Among single-person owners over the age of 65, 59 percent have been in their home for 20 or more years and another 21 percent for 10-19 years. 

Of course, not all single-person owners have lived alone the entire time in the home they now occupy. While for many, living alone might be a relatively recent event; for others it has become a long-term situation. When becoming single in late middle-age, such as when adult children of divorcees leave home, or when a spouse dies at a relatively young age, staying put has many advantages - including a neighborhood support network, familiar routines, and an overwhelming need for some stability in at least this one dimension of a life that has been turned upside down. But for many, the longer one lives alone and the older one gets, the more difficult it becomes to make a housing adjustment that might make sense across a wide spectrum of criteria.

Because young and middle-aged adults who live alone are more likely to be renters and to have lived in their homes for shorter periods of time, they are most likely to have chosen a house or apartment that best meets their current needs - in location, tenure, size, and cost.  This could also be said of elderly renters who are more mobile than elderly owners.  Elderly owners, however, who have lived in their homes for many years, are more likely to be living in places that were more suitable to when they were married or had young children. A recent Joint Center report highlights housing issues faced by many older adults as they age in place, including housing cost burdens and a lack of accessibility features in homes that are increasingly important as they faces health and mobility issues. While that report did not focus on older single-person households in particular, many of the concerns that were raised for all elderly are magnified for this group as they lack a partner or companion who can help both financially and physically.

In general, housing markets in this country respond fairly quickly to changes in demand. The upturn in multi-family construction following the Great Recession is a case in point.  However, one area where housing markets have been slow to respond is to fill the demand for smaller, affordable single-family owned units that are geared to the older homeowner in communities where the elderly now live. Land cost and availability, regulatory constraints, high property tax rates, proximity to shopping and services, and difficulties accessing public transportation are all obstacles to building such housing where many elderly now live and wish to continue to live. Unless these obstacles can be overcome, aging in place will continue to increase the number of elderly who live alone in homes that are too large and costly to maintain, requiring being able to drive to shop and get to necessary services, and perhaps unsafe and difficult to navigate when health and mobility begins to deteriorate.

Older Homeowners Want to Age in Place but Aren't Focused on Accessibility

by Abbe Will
Research Analyst

With many baby boomers reaching retirement age this decade, a major shift in the age distribution of U.S. households is underway. According to recent Joint Center projections, the number of householders age 65 and over is set to increase by 9 million from 2010 to 2020. Many of these older adults will choose to remain in their current homes and “age in place” while others will look to move into homes that are better suited to their changing needs. New survey data from The Demand Institute—a joint venture between The Conference Board and Nielsen—sheds light on homeowner attitudes toward aging in place and accessibility needs, including major motivations for upcoming remodeling projects. This extensive survey, fielded in the summer of 2013, asked households about their housing attitudes, household finances, major household purchases, community and commuting, future moving intentions, housing and neighborhood needs, and home improvement plans and motivations.

A preliminary analysis of the Demand Institute’s consumer housing survey data indicates that older homeowners do not consider aging in place and home accessibility as going hand in hand. Although the vast majority of homeowners age 50 and over report that being able stay in their home as they age is very important (88 percent ranked this statement 8, 9, or 10 on a scale of 1 to 10, where 10 is extremely important), less than 35 percent of older owners place the same level of importance on having a home that is accessible to persons with special health needs or disabilities.

Indeed, 7 out of 10 older homeowners do not have any plans to move in the future, meaning they intend to age in place. But even among those who do plan to move at some time in their later years, only 36 percent cite accessibility as an important characteristic of their next home. This is a meaningful statistic given that the 2011 American Housing Survey estimates that almost 30 percent of older homeowners have a disability or significant difficulties doing typical activities around the home without assistance, which would indicate some need for home accessibility features. The share of homeowners with disability or impairments rises dramatically with age to 46.4 percent of homeowners age 70 or older.

Unfortunately, older homeowners are largely not focused on accessibility needs as part of aging in place. While 45 percent of older owners report being somewhat or very likely to do a major remodeling project (costing $2,000 or more) on their primary home in the next three years, few of them are likely to list “accommodating health needs” or “making the home easier to live in as they age” as major reasons for their next renovations. Only 8.0 percent of homeowners age 50 and over who plan to do a major remodeling project in the next three years plan to do so to accommodate the health needs of someone in the household, and only 15.3 percent want to renovate specifically to make their home easier to live in as they age. Even those older owners reporting that accessibility is important to them are not much more likely to cite accessibility (16.0 percent) and aging in place (23.4 percent) as major reasons for upcoming remodels.

Notes: Major renovations are defined here as costing $2,000 or more.  Homeowners placing high importance on accessibility ranked having a home that is accessible for people with special health needs or disabilities as 8, 9, or 10 on a scale of 1 to 10 where 10 is “extremely important.” Source: JCHS tabulations of the Demand Institute’s 2013 consumer housing survey data.

Certainly as the number and share of older households increase significantly in the coming decades, the demand for homes with accessibility features for safely aging in place will also grow substantially. Yet, given the attitudes of today’s older homeowners, the remodeling industry will need to bridge a significant gap between owners wanting to age in place and being able to do so safely with appropriate accessibility features.

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On Tuesday, September 2, the Harvard Joint Center for Housing Studies and AARP Foundation will release a new report, Housing America's Older Adults—Meeting the Needs of An Aging Population, which will look at these and other issues affecting America's aging population.

Join us for the live webcast at 11:00 a.m. (Eastern) on September 2, and follow the conversation on Twitter with #housing50.

The Active Process of Aging in Place

by Jen Molinsky
Research Associate

America’s older population is poised for unprecedented growth. The youngest members of the baby boom population, born 1946-1964, have turned 50, while the oldest boomers have crossed the 65 threshold. Growth among 65-74 year olds is set to soar, climbing from 22 million in 2010 to an estimated 39 million by 2030, a 78 percent jump. By 2040, there will be an estimated 30 million 75-84 year olds, and another 14 million people 85 or over.

The vast majority of older adults currently live independently. This is true even among the oldest group: of those aged 85 and above, 72 percent live by themselves or with a spouse/partner in their own homes, according to the 2012 American Community Survey. With evidence that Americans of all ages are moving less, and given health care improvements that have delayed moves to institutional care, the trend toward independent living in older age is very likely to continue.

Indeed, surveys show that most people want to live independently in their current homes and communities as they age—a preference popularly called “aging in place.” In a 2010 survey of 1,600 people over aged 45, AARP found that 86 percent somewhat or strongly agreed with the statement “What I’d really like to do is stay in my current residence for as long as possible,” while 85 percent somewhat or strongly agreed “What I’d really like to do is remain in my local community for as long as possible.” A 2014 online poll by the American Planning Association found that 69 percent of 50-65 year old respondents with at least two years of college reported that staying in their homes as they got older was somewhat, very, or extremely important.

The Center for Disease Control defines aging in place as “the ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level.” The CDC’s focus on aging in place as an “ability” is on point: because abilities may change over time, the definition hints at the dynamic nature of aging in place, rather than the absence of action and change regarding one’s living environment. The reality is that, for many, aging in place is a deliberate and dynamic process, one best undertaken with preparation including adaptations of physical space, modes of transportation, or other facets of life in advance of physical or cognitive need to do so. For some, it may even involve moving in order to set the stage to live independently for as long as possible, relocating to a new home that is more comfortable, safe, affordable, and/or convenient. Moves may be within the current community – preserving existing social connections – or outside to locations where changing needs can be better accommodated either because of more community resources or proximity to family.

And even with preparation, aging in place is an ongoing process (as literature from the field of gerontology recognizes) in which older residents renegotiate how, and indeed if, they continue to stay in their current home as their preferences and circumstances (health, finances, relationships and family and social supports) shift over time.

The CDC mentions the ability to remain in one’s community as well, and indeed a critical part of aging in place is the setting in which it occurs. Many researchers, advocates, and commentators point to the same list of elements needed to make communities more livable for all ages, including older adults: affordable, secure, and physically accessible housing; and affordable, safe, and reliable transportation alternatives for those who are unable or choose not to drive (such as mass transit, paratransit, and safe and desirable walking routes to services and amenities). Opportunities for older residents to engage with their communities in recreational, learning, cultural, volunteering, and/or social experiences, and options for in-home health care and/or assistance with activities of daily life as circumstances change are also critical.

Yet there are tremendous challenges in ensuring that our houses and communities are ready to support a high quality of life for older adults aging in place now, and the growing numbers of those who will do so in the future. Needs include more accessible housing units for those with ambulatory difficulties; a larger range of housing options for those seeking smaller, more affordable units; improved infrastructure to promote pedestrian safety; transportation alternatives to private cars;  and local services to assist older adults with home maintenance, care, and meals. The federal government has a role too, in providing financing options to help homeowners and renters modify their homes to improve safety and accessibility, supporting the growing number of low-income senior renters, and in improving collaboration between health and housing programs to ensure they are mutually supportive of aging in place.

There is much to be done to provide the needed supports for today’s older population and the coming waves of older adults engaged in the dynamic process of aging in place. A first step is for individuals to recognize the value of planning in anticipation of future needs, and for government at all levels to recognize the magnitude and importance of the challenges and opportunities associated with an aging population seeking to age in their communities. The next step is to take stock of what we already know about the best way to support aging in place and to consider how the public, nonprofit, and private sectors can innovate and bring solutions to scale. 

To help spur and inform this important discussion, the Joint Center for Housing Studies and the AARP Foundation will release a comprehensive report on this topic this fall. Housing America's Older Adults: Meeting the Needs of an Aging Population will be released at an event in Washington, DC on September 2, 2014.  Join our mailing list to receive more information this summer.

Crossing the Threshold: Problems and Prospects for Accessible Housing Design

by Wanda Katja Liebermann
Meyer Fellow

America is at the confluence of two opposing demographic tides. Land use law scholar Daniel Mandelker has called the movement of people with disabilities out of state institutions into communities, in the last few decades, “one of the great migrations in recent history.” At the same time, aging baby boomers, many of whom are gradually becoming disabled in housing inadequate to their changing needs, portend a national “forced migration” in the reverse direction—into nursing homes and retirement enclaves. 

As I write in my recent working paper, our aging population is increasingly the focus of new planning and policy initiatives. Their unprecedented numbers—by 2030 the population of people 65 and over will top 20 percent—and political influence create new concerns as well as opportunities to rethink the physical, social, and legal landscape of housing, infrastructure, and service provision. Because people are much more likely to develop physical and mental disabilities as they age, the visibility of the boomer generation is helping to draw attention to the fact that, according to the 2010 National Council on Disability report, 35 million households in the US in 2007 had one or more people with some kind of disability, representing 32 percent of all American households. Because elderly and disabled people share a number of these needs, concerns long considered the marginalized province of the disabled are expanding. 

Both the disabled and elderly overwhelmingly want to live in homes in “mainstream” neighborhoods, but the ability to participate in the community depends on how well the physical environment can accommodate them. A number of legal protections developed in the last few decades have shaped the possibilities for that. The most comprehensive, the Americans with Disabilities Act (ADA), covers primarily public accommodations, leaving the bulk of housing unregulated. As AARP has shown, most people with disabilities, including older adults, live in private single-family residences, the largest sector of the housing market. Yet except for a small amount of federally-funded units, single-family housing is not covered by disabled access regulations. This creates a big gap between the supply and demand for accessible housing of various kinds. 

The left shows a metal ramp kit retrofitted to a public building entrance—an example of unintegrated thinking about access. The right is an ADA-compliant hotel room bathroom, featuring the standard “beige melamine” of mass manufactured accessible components.

Sources: http://www.portawalk.com/
http://www.sleepinn.com/media/eBrochure/ebrochure/AZ/AZ805/AZ805B8.JPG

Partly because it is not regulated by the ADA, private single-family housing is an area where states and local municipalities are experimenting with policy and design approaches to create more accessible options. Without building code prescriptions for specific access requirements, programs based on ideas like visitability and universal design are cropping up around the country. Universal design is especially appealing because its approach differs from ADA-based building codes by not singling out the disabled in design but by making better functioning spaces and objects through a broader reconsideration of good design practice—“design for all.” A classic example of this is the curb-ramp, originally developed for wheelchairs, which benefits parents with strollers, travelers with luggage and delivery people. Local initiatives are becoming laboratories for developing strategies with broader application.

The curb ramp is considered a classic example of universal design: developed for wheelchairs but so practical for many other uses that it seems incredible that it wasn’t thought of earlier. 

Sources: http://wwbpa.org/2009/09/ http://www.fhwa.dot.gov/publications/research/safety/pedbike/05085/chapt8.cfm

While planners and policy makers are recognizing the important role that housing, including the private single-family home, plays in public health, homebuilders have been much slower to adopt accessibility. The history of bad design for disability, among other factors, has meant that developers and homebuyers don’t yet see the benefits of accessible features, like a no-step entry. The common belief is that accessible design is ugly, diminishes the visual appeal of homes, and is only targeted at a small, specialized segment of the market. Nevertheless, some homebuilders are recognizing the looming demand for “aging in place” and “flexible” residential design. Eskaton Livable Design, one of the most ambitious of the commercial projects, is a third-party certification system, similar to LEED (Leadership in Energy and Environment Design) for sustainable design, which packages accessible features as part of an overall practical and aesthetically appealing design. 

On the left is the Livable Design model home, built in Roseville, California, developed by Eskaton to accommodate a range of abilities associated with multi-generational households. On the right sits Mr. Blundell, who commissioned this residence built with the LifeMark certification system, developed by the New Zealand government to create new access standards for the national housing market. 

Sources: http://www.livabledesign.com/livable-design-tour/
http://www.lifemark.co.nz/the-lifemark/case-studies/case-study-blundell.aspx

There are still a number of obstacles to widespread acceptance of accessible design in housing. The current political climate makes consumer demand central to both regulatory and market reform. Yet, consumer resistance persists because of the negative perception of accessible design related to the continuing stigmatization of disability—a mutually reinforcing dynamic. While more creative and flexible approaches to improving the accessibility of housing may appeal to both homebuilders and designers, their very open-endedness may pose difficulties for implementation at a wider scale. 

And indeed, as some of the commercial initiatives evolve, they show signs of requiring similar levels of compliance with prescribed standards for certification. Real change, including the capacity to deal with the complexities of interpreting and evaluating more variable design solutions, will require a new mindset. Public officials, architects, builders, and consumers need to develop a more critical understanding of design and accessibility, away from the compliance-only approach.