News (June 2005)

Name of Event: Partnerships for Aging in Place – A Morton Kesten Summit

Date of Event: June 6-7, 2005
Location of Event: Washington, D.C.
Number of Persons Attending: 55 participants

Sponsoring Organizations:

AARP
Home Safety Council
National Association of Home Builders
Rebuilding Together
National Aging in Place Council
National Home Modification Action Coalition, Inc.
University of Southern California – National Resource Center on Supportive Housing and Home Modification

Contact Name: Jon Pynoos, Ph.D., Leon Harper

Telephone Number: 213-740-1364
Email: JPynoos@aol.com, Leonudharper@aol.com

Priority Issue #1

Need to reduce health and long term care costs through home modifications, visitability, and universal design.

Home modifications (HM), visitabilty and universal design (UD) save health and long term care expenditures by helping older people age in place and stay out of costly long term care facilities.  HMs are adaptations to existing housing (e.g., grab bars, hand rails, ramps) that increase safety, promote independent functioning, and make caregiving easier. Visitability refers to a small number of accessibility features on the first floor of a house (e.g., stepless entrance, wide doorways and hallways, access to at least a half bath).UD, intended to be usable by people regardless of age, ability or size, includes basic visitable requirements and a broader range of other features (e.g., fully accessible bathrooms and kitchens, easy to use controls, variable height counters) that are integrated ‘invisibly’ into the overall design of new housing.

Barriers

• Inadequate attention to housing in planning for long term care.
• An existing housing stock that is inaccessible and unsupportive of the needs of frail elderly and persons aging with a disability.
• Insufficient funding for home modifications in housing, health and long term care programs.
• The benefits of home modifications, visitability, and universal design are not yet widely appreciated by consumers, builders, and policy makers.
• Building codes for single family housing that have few requirements for accessibility and supportiveness.

Proposed Solutions

Solution 1a

Insure that affordable, accessible, and supportive living arrangements are an integral part of all long term care planning.

Solution 1b

Expand reimbursement for home assessments and home modifications in programs such as Medicaid (including Waiver programs) and HUD Community Development Block Grants.

Solution 1c

Provide tax incentives for builders and consumers who incorporate universal design and “visitable” housing features into new housing.

Solution 1d

Encourage marketplace competition in accessible design features.

Solution 1e

Support federal legislation such as the Inclusive Home Design Act that would require universal design features in federally subsidized housing.

Solution 1f

Conduct additional cost benefit studies of home modifications / universal design and widely disseminate their findings.

Priority Issue #2

Need to increase housing choices for aging in place by 2010

Older Americans want the ability to remain in their own homes and the availability of other affordable, accessible, and supportive housing options.  These preferences are especially strong among the next cohort of older Americans, and necessary components of plans to implement the Olmstead Decision and New Freedom Initiative.

Barriers

• A lack of stable funding sources for affordable, accessible and supportive housing.
• Restrictive zoning codes and policies that limit housing choices in most communities.
• Medicaid requirements and policies that favor institutional care.

Proposed Solutions

Solution 2a

Promote the development of financial mechanisms such as housing trust funds and tax credits that will increase the supply of affordable, accessible housing.

Solution 2b

Stimulate technology innovation and available products for consumers that will foster aging in place.

Solution 2c

Develop new models of housing (e.g., mixed use and mixed income developments, intergenerational housing, second units, co-location of programs and services, ‘visitable’ housing and elderly co-housing that increase choices and maximize independence.

Solution 2d

Promote greater collaboration between service provider systems and the housing industry.

Priority Issue #3

Need to create livable communities that maintain involvement and insure safety/security throughout the lifespan.

Livable communities, based on the principles of universal design, provide settings that promote involvement and interaction. They allow older persons to age with dignity and purpose. In contrast to many suburban areas, livable communities provide a range of housing options within single neighborhoods so that if older persons need to move, they can stay in the same community. Livable communities pay attention to location of housing, provide services, and contain facilities (e.g., senior centers) that encourage independence and contribution of older people.

Barriers

• Large distances and limited transportation/ mobility options (e.g., paratransit) in suburban and rural areas make it difficult to access shopping, recreation, cultural, medical, and other services and activities.
• Naturally occurring retirement communities (NORCs) that contain large concentrations of older persons in neighborhoods not planned for them, lack services and infrastructure to help them age in place.
• Retrofitting the infrastructure, existing subdivisions and public rights-of-way is expensive and subject to policy and zoning constraints.
• Current zoning practices, reinforced by federal mortgage interest tax deduction,

encourage dispersed and single use development patterns.

• Although alternate development schemes rapidly gaining popularity (e.g., traditional neighborhood design, new urbanism designs, SMART growth) have significant positive infrastructure advantages, they often overlook the importance of affordable, accessible and supportive housing.

Proposed Solutions

Solution 3a

HUD should use its Consolidated Plan process and programs (e.g., urban renewal,
HOME, CDBG) to encourage livable communities based on principles of
universal design.

Solution 3b
The Department of Transportation should develop comprehensive community mobility solutions including exploring ITS (intelligent transportation systems) and pedestrian friendly use of public rights of way, especially for street crossings and roundabouts.

Solution 3c
Better utilize home-based technology services (e.g., grocery delivery, tele-health, GPS and home monitoring).

Solution 3d

Take advantage of the economies of scale in NORCs by adding services, improving the infrastructure, and modifying housing so that residents can continue to age in place.

Priority Issue #4

Need to coordinate housing and related programs/services so that senior citizens can age in place and have access to the programs/services.

Barriers

• Aging in place requires accessing services from a variety of programs that are embedded in different agencies of the federal government.
• Current programs and services are spread across numerous federal agencies, making it difficult for seniors to understand and access needed services.
• Federal agencies and programs often have different eligibility requirements, benefits, caps on expenditures, and time horizons.
• Because of lack of coordination, programs sometimes work at cross purposes and significant gaps exist..

Proposed Solutions

Solution 4a

Create an Interagency Council comprised of executive representatives (or designees) of the following agencies:

HUD, HHS, DOT, Agriculture, Treasury, Labor, Veterans Affairs, the Social Security Administration, the Centers for Medicare and Medicaid Services,   the Administrator of the Administration on Aging and other federal agencies selected by the Council. The Council will also include consumer representatives of the elderly and persons with disabilities.

Solution 4b

Appoint an executive director of the Interagency Council with authority to undertake the following activities:

• Recommend ways that the federal government should streamline and consolidate its programs and services for seniors.
• Coordinate all aspects of housing and services programs for seniors.
• Conduct a thorough review of all federal programs and services designed to facilitate aging in place of seniors.
• Reduce duplications and coordinate programs and services.
• Collect and disseminate data and information on seniors and their needs.
• Maintain an updated website with information on how seniors can access housing and services that fit their needs.
• Work with states to coordinate programs and services at the state and local level.