Everyone Supports Aging in Place. But Can We Actually Deliver It?

This article was originally published on Shelterforce.

Three-quarters of older adults in the United States want to remain in their homes or communities as they age, according to national surveys by AARP. While the desire to live at home collides with numerous challenges—from worsening health conditions and mobility impairments that make navigating a home difficult to the financial toll of necessary home repairs, rising property taxes, and in-home help—there is a range of local, state, and national supports that can help older adults live where they please.

But experts say the policies and programs designed to support aging in place are often inconsistent, disconnected, and underfunded.

“We have a wealth of wonderful programs … and really dedicated workers who try to meet all the older people’s needs—but they’re operating in a fragmented, [uncoordinated] system,” says Jennifer Molinsky, director of the Housing an Aging Society Program at the Joint Center for Housing Studies (JCHS) at Harvard University, which researches the needs of older adults.

What could help people achieve their goal of staying home—or at least nearby—and spending their later years as they wish? Shelterforce spoke with experts and service providers about which programs and policies are effective and where service and coordination gaps remain.

Programs That Keep Homes Livable

Research by JCHS has highlighted that adults over 65 tend to live in larger, older homes, and that housing repairs and upkeep can be especially burdensome for older adults on fixed incomes.

Without home modifications, many older adults become vulnerable to falls, the leading cause of injuries among those 65 and older and a major factor in moves to nursing homes. Without modifications, they’re also less likely to independently manage daily living tasks such as cooking, bathing, and laundry.

For cash-strapped older homeowners, the inability to afford repairs, maintenance, or accessibility modifications can dash hopes of aging in place. Programs that offer free or low-cost home repairs and modifications—from fixing roofs to installing grab bars, handrails, and ramps—can be a game changer.

At the national level, Habitat for Humanity is one of the most prominent nonprofit providers of free home repairs and accessibility accommodations, offered to lower-income older adults through its Aging in Place program. The program operates through a network of local affiliates across the U.S., using a mix of contractors and volunteers to complete repairs.

Adrienne Goolsby, Habitat for Humanity’s senior vice president for the U.S. and Canada, says that the program, with its Housing Plus model, serves 11,000 households annually and has helped more than 50,000 older homeowners remain in their homes.

Key to the model’s effectiveness, Goolsby says, is its two-step assessment for each household. To start, a health or human services professional meets with the homeowner and their family members to understand their daily activities and movements.

“They get an understanding of things like how they do meal prep [and] what things they do outside and inside the home and in the backyard,” she says. “That gives us a pretty comprehensive picture of the priorities [for] repairs or modifications that need to be made.”

After that initial step, a repair team assesses the work to be done. The program is modeled after CAPABLE (Community Aging in Place: Advancing Better Living for Elders), developed by the Johns Hopkins School of Nursing. In its pure form, CAPABLE calls for integrating the services of an occupational therapist, a registered nurse, and a repair worker to assess and recommend changes that best ensure a home’s safety and livability for a particular household.

The National Council on Aging (NCOA) has approved CAPABLE as an evidence-based aging-in-place program. The program has been shown to improve residents’ self-care and their ability to grocery shop and manage medications, while also reducing depression symptoms and reducing the length of hospital stays. Each $3,000 in program costs saves an estimated $30,000 in medical costs, the CAPABLE program reports.

Home repair programs also operate locally, often as partnerships between state or local governments and community organizations.

For instance, the Comfortably Home program in Bath, Maine, is managed by the local public housing agency but offers repairs at no cost to lower-income senior homeowners. The program is the brainchild of Bath Housing Executive Director Debora Keller. When she took the reins 10 years ago, Keller says she learned that many people in Bath’s public housing were living there because their former homes could no longer accommodate them.

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