Can You Age in Place?

Most people say that they want to stay in their homes as they age. But successful aging in place requires some careful planning--and it's not always the best choice. Issues to consider include the cost of maintaining your home, as well as proximity to healthcare, family, recreation, leisure activities, and transportation.

What's more, a quiet crisis is looming as we face a major gap in the availability of livable, age-friendly communities as the nation ages.

Research by the Joint Center for Housing Studies of Harvard University, or JCHS, illuminates the scope of this challenge. The number of households aged 75 to 79 will soar by 49% by 2028, and another 20% by 2038, to 10.7 million. The number of households aged 80 and over will grow even more quickly. At the same time, disparities in income and the gaps in home ownership among different demographic groups will add up to millions of older people without access to housing that is affordable, safe, and accessible.

Livability is the topic of a new report from the JCHS and the AARP Public Policy Institute. The report finds that most older adults don't reside in "livable" communities, as measured by the AARP Livability Index.

The AARP index is worth knowing about. It identifies attributes that contribute to community and individual well-being, and it's a useful online resource for evaluating any community in the United States (your own included) for livability as you age. You'll see a total score, and you can drill down for details on seven key measures. These include:

1. Housing: The physical accessibility of dwellings, their affordability, and presence of different housing types.
2. Neighborhood: The proximity to destinations, presence of mixed uses, and safety and quality.
3. Transportation: Convenience, cost, accessibility, and safety.
4. Environment: Water and air quality, energy efficiency, and resilience.
5. Health: Access to and quality of healthcare and healthy behaviors.
6. Engagement: Civic and social participation, equal rights, as well as Internet access.
7. Opportunity: Income equality, economic and educational opportunities, multigenerational communities, and local fiscal health.

The Harvard/AARP report points to significant differences in access to the country's most livable communities. Not surprisingly, these differences depend on whether the resident is a homeowner or renter, whether they have a disability, and what their races, ethnicities, and income levels are.

Renters and Asian older adults are more likely to live in high livability neighborhoods, while homeowners, middle-income households, older adults with disabilities, and white older adults are more often dwelling in places of low livability. Shares of Black and Hispanic older adults hold steady across neighborhoods of all levels of livability.

But overall, the report finds that most older adults do not live in livable communities. And, notably, livable neighborhoods don't always score highly for the same reasons. Some do well on transportation, for example, but may fall short on affordable housing.

Yet housing is among the most consistent factors determining livability, according to Jennifer Molinsky, who is a senior research associate at the JCHS and a co-author of the report.

"The highest livability neighborhoods tend to have more multifamily housing," she said during a recent webinar held to discuss the study findings. "The most livable places also have the oldest housing ... and they tend to have more renter occupied housing."

Public policy aimed at encouraging diversity in our housing stock would help create more livable options, what AARP Public Policy Institute vice president Rodney Harrell called "missing middle housing."

"The vast majority of neighborhoods only have single-family housing for various reasons, and if you can't afford a single-family house and a large lot, you can't live in that community," Harrell said during the webinar. "So, creating a range of housing types not only helps with affordability, but it also helps provide the options that people might need, particularly if you're aging and you might prefer an apartment or condo."

Do People Move? The simple reality is that most people don't move when they retire. And even among those who do, many move to locations close to their former residence. Doing so allows them to cut costs while staying near friends, cultural events, and familiar medical facilities.

Moreover, we're facing a gap in availability of age-appropriate housing that is affordable. Earlier Harvard research suggests that the affordability gap will be worse for people in their 50s now when they reach retirement, compared with today's seniors. The study points to a falling share of seniors who own their own homes--which means they will not be building wealth through home equity. It also notes a rising share of older households that are "cost-burdened," that is paying more than 30% of their income on housing. At the same time, development of age-appropriate housing has stalled.

"Affordability and the presence of housing stock that is suitable for older adults may be preventing many from moving to their more preferred and more livable settings," Molinsky said.

Forward Thinking and the Pandemic The Centers for Disease Control and Prevention 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."

Considering where to live, it's important to think forward and realize that your current needs likely will evolve--but your future needs can be tough to predict. For example, if the only problem you develop in later life is frailty, it may be more cost-efficient to age in place with someone coming into your home to provide assistance. Problems such as dementia, however, will require a great deal more help.

The pandemic will further complicate the outlook for housing and care. The cost of long-term care has continued to jump, fueled by a shortage of workers, higher demand, and higher mandated wages, according to Genworth, one of the largest underwriters of long-term-care insurance policies. The company recently issued its annual survey on the cost of care, which found increases ranging from 3% to 6% for services such as assisted living, homemaker services, and skilled nursing facilities.

That comes against a backdrop of disastrous levels of pandemic-driven death in nursing homes. COVID-19 has claimed the lives of more than 100,000 residents and staff members of nursing homes. Much reform will be needed in the years ahead, and one author argues that the pandemic highlights the need for a federal long-term-care insurance plan.

Taken together, all these trends point to the urgency of a rethink on making communities livable for an aging country. Change will come with some costs--but also some opportunities for employment and entrepreneurs in fields such as home remodeling, new housing construction, transportation, and home health technology.

As a society, we need to get after this as the pandemic recedes.

Resources Here are some resources I have found, along with the AARP Livability Index, that are useful for thinking through the issue of aging in place, moving, and age-friendly communities:

Aging in the Right Place, by gerontologist Stephen Golant, examines the relationship between location and aging successfully.

Partners for Livable Communities, a national nonprofit group, has developed a useful report card that can be used to evaluate your community.

Sperling's Best Places can help with data on comparative cost of living and lifestyle factors for locations across the U.S.

ConsumerAffairs offers a guide to the cost of remodeling to age in place.

Mark Miller is a journalist and author who writes about trends in retirement and aging. He is a columnist for Reuters and also contributes to WealthManagement.com and AARP The Magazine. He publishes a weekly newsletter on news and trends in the field at RetirementRevised. The views expressed in this column do not necessarily reflect the views of Morningstar.