Bioethics Forum Essay
Housing an Aging Society: Five Priorities
While home and neighborhood environments matter to all people, older age brings particular considerations related to housing cost, safety and accessibility, neighborhood livability, links between the home and supportive services, and the increasing prevalence of home as the site of health care delivery. Recognizing the need for housing solutions to support the growing number of older adults in the United States, my colleagues and I at the Joint Center for Housing Studies at Harvard recently launched the Housing an Aging Society (HAS) Program. Building on research we’ve conducted on housing and aging over the past eight years, the program will examine the diverse needs of U.S. households headed by someone older than 65, a group that will make up about a third of all U.S. households by 2038.
The HAS program will deepen an examination of themes we’ve explored in our previous work, with a particular focus on deep inequities in access to safe and affordable housing, livable neighborhoods, and affordable housing, livable neighborhoods, and services that help older people thrive. As we launch the new program, there are five research priorities for our work:
- Housing affordability and stability. Before the pandemic, roughly a quarter of all households headed by someone age 65 and over—about 10 million households—were paying more than 30% of their income for housing, and over five million of these households spent over half their income for shelter. The fallout of the pandemic for older adults is just beginning to come into focus. Older adults with housing cost burdens may be faced with unwanted moves or have to cut back on other necessities such as food and health care. Indeed, a paper we released last fall finds that spending on prescription medications increased after pre-retirement-aged older adults paid off their mortgages. New research underway at the Center examines the relationships between household composition, housing stability, and physical and financial well-being.
- Safety and accessibility. Our work has shown that only a tiny percentage of America’s housing is accessible to those who have ambulatory difficulties—a challenge reported by 19% of those aged 65-79 and 39% of those 80 and over. Inaccessible housing can limit independence, heighten risk of injury and, for those with difficulty getting in and out of their homes, impede engagement in the community. We presented new research about the accessibility of older adult homes in a recent webinar and will publish a paper about the findings in the coming weeks.
- Neighborhood livability. While the cost and physical attributes of housing matter, so too does location. Safe streets, public transportation, parks, opportunities for engagement, access to services, and a healthy environment contribute to quality of life for all people. Yet many older adults live in places that lack these, as underscored by a report we published in conjunction with AARP in 2020. Going forward, our work will continue to explore the role of neighborhood and community setting in older adults’ wellbeing.
- Housing, supportive services, and health care. Policymakers and housing providers are increasingly focused on the importance of services delivered in the home, such as personal care or assistance with home upkeep. In late 2020, we conducted a survey of service coordinators—professionals who help residents access needed services and benefits—that revealed the broad scale and critical role of their work supporting older adults living in publicly-assisted housing during the pandemic. We will soon release results of a follow-up survey fielded last fall. We’re also examining how advances in digital technology mean the home is increasingly a location for the delivery of health care, which can have implications for those without stable, accessible housing, and/or without access to technology, given the deep digital divide among older adults. We’ll be among the presenters at a Joint Center symposium this spring on housing and digitalization.
- Housing options. A goal for the HAS program is to identify policy and design solutions that address challenges with affordability, accessibility, location, and service delivery. The older population is diverse—in life stage, life experiences, resources and supports, and preferences—and one housing typology will not serve all. For some, deep inequities in access to jobs, homeownership, and other opportunities through their lifetimes have limited their housing options in older age. Even those who have resources may find it difficult to remain in their communities given few housing alternatives to single family homes and high costs for services. At the same time, interest is growing in alternative living arrangements such as shared housing, multigenerational households, and intentional communities (something we are examining in a project this year; look for our report at the end of 2022).
One ongoing study that touches on multiple themes is the COVID-19 RECAPP (Review of Equitable Community-based Aging Policies and Practices) project, on which we are collaborating with The Hastings Center. The goal of RECAPP is to identify promising ideas developed during the pandemic that support vulnerable populations of community-dwelling older adults. Please visit the RECAPP section of our website to share your examples of promising policies and programs, and look for our report in the summer of 2022.
The challenges of housing an aging population are broad and cannot be solved by those in the housing field alone. For this reason, we’re building partnerships with colleagues in public health, policy, ethics, design, and international research organizations. Together, and with my colleagues in the HAS program, we look forward to continuing our work exploring the critical role housing plays in older adults’ wellbeing and bringing to the fore a range of creative solutions to address today’s challenges and inequities.
Jennifer Molinsky, PhD, (@jenmonlisky) is project director of the Housing an Aging Society Program and a lecturer at Harvard’s Graduate School of Design. A version of this essay originally appeared in Housing Perspectives, the Harvard Joint Center for Housing Studies blog.