Housing and Caring for an Aging Population

How do we house and care for an aging population?  

On Monday evening, over 50 attendees gathered at the Harvard Graduate School of Design to hear about one of the most urgent issues of the coming decades: Housing Policy in an Aging World. The panel discussion was convened by the Joint Center for Housing Studies, and panelists included current Loeb Fellow Emi Kiyota, professor of Urban Planning Ann Forsyth, and Ashish Jha, professor of International Health and director of the Harvard Global Health Institute. The panel was moderated by Jenn Molinsky, senior research associate at JCHS. These inspiring academics, designers, and health professionals offered their perspectives on what the aging demographic shift means for our society and how we can best address its challenges.

Molinsky began the evening with a series of sobering projections. JCHS’s recent report on housing and aging predicts that by 2035 in United States:

  • The population aged 65+ will increase from 48 million to 79 million
  • 1 out of every 3 households will be headed by an individual 65 years old or older
  • Very low income elderly households will rise from 4 million to 7.6 million
  • Most of these households will be individuals living alone or in couples

The report noted the 65+ population is more likely to be living with disabilities, lack resources to afford health and home care, and experience isolation. These issues converge in the lack of physically appropriate and financially accessible housing.

Recognizing there is no singular roadmap to address these issues, Molinsky invited discussants to offer their international perspectives on the problem at hand:

How do we ensure that older populations remain connected to their communities as they age, while also having access to the services and health supports they need?

Ann Forsyth offered an overview of environmental and service oriented solutions for housing and caring for older and frail people in her native Australia. As principal investigator with the Health and Places Initiative and daughter of an elderly Australian mother, Forsyth is uniquely qualified to comment.

Solutions for supporting older individuals generally fall into two categories, she explained: strengthening formal supports and increasing service opportunities. These include enriching service clusters in neighborhoods and creating opportunities for “linked housing,” such as accessory dwelling units and cohousing.

Forsyth identified the different scales at which innovations in supporting the elderly can occur. At a neighborhood level, we can ensure there are locally accessible services, health supports, and home care. On a house level, we can design flexibly to accommodate future accessibility needs. In Australia, the number of people living residential care facilities is declining. Recently, a series of bipartisan commissions collaborated to create a streamlined, government backed, national gateway for elderly services. This system connects services to people rather than people to nursing homes.

Emi Kiyota offered an optimistic perspective on redesigning the social models and physical spaces societies use to support our aging populations. Kiyota is the founding CEO of the international nonprofit Ibasho, and is a member of the current class of Loeb Fellows. Her presentation implored us to take a multigenerational view of community, and to view elders as assets.

She challenged the audience with the question, "Are you looking forward to old age?" If not, we should design more hospitable and dynamic spaces for the elderly. Our housing and community support models should improve quality of life for all members of society, rather than reproduce sterile or inaccessible environments that increase social isolation and poor health.

In Japan, there is more than enough housing, but not enough accessible housing. Elders are often dying alone on upper levels of apartment buildings. Although experiencing a declining population overall, the increasing elderly demographic in Japan demands additional senior housing be built.

Kiyota also described the international work of Ibasho, which directly challenges the ageism and social isolation that often characterizes the experience of aging. The organization partners with local organizations to design elder facilities that defy the sterility of traditional nursing homes. One facility evokes the feeling of a wooden sanctuary surrounded by luscious greenery; others have gardens and cooking facilities for peer to peer and multigenerational skill sharing programs. Ibasho puts elders at the center of its work, incorporating local knowledge into the heart of its designs.

Ashish Jha returned to the dire picture painted by the statistics on aging and housing and suggested that lack of safe, accessible, and appropriate housing was one of the most pressing issues affecting the health of the older population today. He explained that each day an elderly individual spends in the hospital adds another week to his or her recovery. Doctors understand this reality, but are often forced to keep elderly individuals in inpatient situations owing to homes that are not accessible or safe.

The inability of many individuals to remain safely at home as they age leads to more and longer hospital visits, longer recovery times, and higher health care bills. Although cultural relationships to aging vary around the globe, Jha stressed that overall the global health care systems are not prepared to handle pressures caused by extremely accelerated demographic shift towards an aging population. Increasing the availability of safe accessible housing for seniors, he argued, must be a top priority for the health of our society.

Where do we go from here?

 Despite the alarming projections, the tenor of the discussion remained hopeful, and the panelists’ collective expertise produced a number of actionable steps:

  • Challenge preconceived notions of what institutional care has to look like.
  • Use our positions as designers and planners to push society and clients to think further ahead. Rather than cut corners in the present, plan for the future of an aging population.
  • Leverage the untenable cost of health care to push for change in models of care and housing for the elderly.
  • Design across scales to integrate aging into our communities.
  • Remember that elders are valuable assets to our communities.
  • Capitalize on the breadth of multidisciplinary work happening at Harvard to develop innovative study and solutions.

The challenge goes out to all of us in the design, planning, and health care communities: are we up to the task of reimagining the place of aging in our societies?

Thank you to Emi Kiyota for the generous use of her photos.
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