Healthy Aging in Place

By Scott Watkins, MPP/MBA 2016

Source: Scott Watkins

Source: Scott Watkins

Of Americans over the age of 65, 21 percent do not drive. Commonly cited reasons include lack of access to a car, declining health, and safety concerns.[1] Furthermore, over 50 percent of non-drivers do not leave home most days, partly due to a lack of transportation.[2]

Communities that center exclusively on driving a car have a direct and debilitating impact on our elders by creating social isolation. When addressing the problem of social isolation, we begin to see the separation of housing from community services no longer makes sense. A more comprehensive strategy is needed to integrate housing options with services, businesses, and other programs. In turn, this strategy would make it possible for older adults to remain in their homes, in close proximity to these services, and thereby preserve their independence, dignity, and social connections with the community.

By encouraging the restructuring of zoning codes, we can create a safe, secure, and supportive community that enhances personal independence, allows residents to age in place, and fosters residents’ engagement in their community’s civic, economic, and social life.

During our lifetimes, we develop deep connections with our communities. We form relationships with our barista, hair stylist, sandwich artist, and neighbors, and we develop familiarity with the neighborhood and larger community, the concerts in the town square, the parklet where community members dine on Sunday afternoon.  These connections cannot be seamlessly replicated when people are abruptly forced to move into a new environment. Life’s little patterns, and the relationships we foster along the way, are the essence of living and aging gracefully.

According to the AARP, nearly 90 percent of the population over the age of 65 indicates that they want to stay in their homes as long as possible,[3] and four of five people in the 65-and-older population believe their current home is where they will always live.[4] The degree to which they are able to actively participate in their communities will be determined by how well they are able to access services, businesses, and community assets in close proximity.

Currently, the population of citizens over the age of 65 is approximately 40.3 million, accounting for 13 percent of the US population. [5]  The 65-and-older population jumped 15.1 percent between 2000 and 2010, compared with a 9.7 percent increase for the total U.S. population. By 2040, 80 million Americans will be 65 and over.[6] The rapid growth of the 65-and-over population in America is related to decreased morbidity and mortality rates, leading to longer average life expectancy.

With the rapidly changing nature of health care, and a paradigm shift away from high-priced facilities (the average cost of a nursing home was $75,000 in 2005, and is expected to triple by 2025),[7] a growing movement has taken root, resulting in more of our elders wishing to continue living in their own homes and communities, aging in place.  But zoning policies that limit options for neighborhood development make it difficult for seniors to continue living in their communities as they age.

The greatest area of opportunity for integrating services and existing housing is at the local level. Localities have insight into the existing fabric of their communities along with a well-developed sense of what’s missing. Additionally, localities are best equipped to evaluate optimal sites for weaving critical services into their own communities.

Ultimately, cash is what drives change, and many communities lack the financial and administrative tools to carry out far reaching policy change.  Many believe that the California state government, perhaps through the state mandated General Plan guidelines, currently being updated and released during the summer of 2014, is best equipped to address the rewriting of local zoning policy. Along with the new state mandated guidelines, communities need access to funding to implement change.

Two innovative funding solutions for improving communities throughout the state of California are being examined.

Currently, the Strategic Growth Council and their partners[8] are beginning to fund the Sustainable Communities Planning Grant and Incentives Program that seeks to create healthy and sustainable spaces our aging population need within existing communities.

A Social Impact Bond is another innovative funding mechanism that is expected to shape our existing communities in the near term. While Social Impact Bonds are currently being used to solve complex social problems like reducing prison recidivism in New York City,[9] other cities are beginning to investigate how Social Impact Bonds can help reshape the built environment.[10]

Investing in active transportation and infrastructure that serves the needs of our aging population[11] ought to be made a high priority. With thoughtful evaluation and improvement of local policies covering the planning and development of the suburban built environment, we can encourage a safe, secure, and supportive community that enhances personal independence, allows residents to age in place, and foster residents’ engagement in the community’s civic, economic, and social life.

 

[1] Linda Bailey, Aging Americans: Stranded Without Options (Washington, D.C.: Surface Transportation Policy Project, 2004),
[2] Linda Bailey, Aging Americans: Stranded Without Options (Washington, D.C.: Surface Transportation Policy Project, 2004),
[3]Nicholas Farber, Douglas Shinkle (2011) Aging in Place: A State Survey of Livability Policies and Practices. A report by the National Conference of State Legislatures & Public Policy Institute http://assets.aarp.org/rgcenter/ppi/liv-com/aging-in-place-2011-full.pdf
[4]Nicholas Farber, Douglas Shinkle (2011) Aging in Place: A State Survey of Livability Policies and Practices. A report by the National Conference of State Legislatures & Public Policy Institute http://assets.aarp.org/rgcenter/ppi/liv-com/aging-in-place-2011-full.pdf
[5] U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2011
[6] Guo, K. L. (2008). Aging of the U.S. population and its impact on the health care system. The Business Review, Cambridge, 9(2), 246–252
[7] Feldstein, P.J. (2007). Health Policy Issues; An Economic Perspective (4th ed.) Chicago, IL: Health Administration Press
[8] “The Strategic Growth Council partners with other state agencies and departments within Business, Consumer Services and Housing, Transportation, Natural Resources, Health and Human Services, Food and Agriculture, and Environmental Protection, with the Governor’s Office of Planning and Research to coordinate activities that support sustainable communities emphasizing strong economies, social equity and environmental stewardship.” Accessed (March, 2014) http://sgc.ca.gov/
[9] New York City: Incarcerated Youth Case Study Social Finance, accessed (March 2014) http://www.socialfinanceus.org/social-impact-financing/case-studies
[10] Anderson, Barbara (2013) Fresno is site of first-ever health care ‘bond’ project. The Sacramento Bee. Accessed (March 2014) http://www.fresnobee.com/2013/11/20/3622136/fresno-is-site-of-first-ever-health.html
[11] Route design resources, Sustrans 2014 http://www.sustrans.org.uk/our-services/infrastructure/route-design-resources
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