If there is one thing Americans can agree on, it’s that they do not want to end their life living in a nursing home.
In fact, about 77% of older adults say that they want to “age in place,” remaining in their communities surrounded by the places, people, and things they love. For some this means continuing to live in their current home. For others this might include living in the home of a relative, or other community-based housing options such as a senior community. In any case, aging in place is not just about personal planning. It requires an infrastructure that is prepared to meet the needs of the growing population of older adults and their families.
The Benefits of Aging in Place
Over the past 20 years, the number of community-dwelling older adults has grown while those living in nursing homes has declined. Aging in place has numerous mental, emotional, and physical health benefits for individuals including a higher quality of life, stronger sense of identity and self-esteem, reduced social isolation, and avoidance of adverse health effects associated with institutional long-term-care such as infection, pressure sores, falls, and medication mismanagement. Data also shows that aging in place is more affordable than institutional care, which benefits older adults, their families, governments, and the healthcare system overall.
Affordable Housing: A Key to Independence
In order to successfully age in place, older adults and people with disabilities must have affordable and accessible housing options. Anyone spending more than 30% of their income on housing is considered housing cost burdened. One in four adults age 65 or older is housing cost burdened and at risk of facing difficult choices between paying for housing versus other necessities like food and medicine. Affordable housing options for older adults are severely limited. Of the approximately 5 million federally-subsidized housing units nationwide, about 700,000 (14%) are targeted to older adults. Meanwhile, approximately 4 million older adult renters are spending more than 30% of their income on housing. More affordable housing options are required to enable all older adults who want to remain living in the community to do so.
Healthcare at Home and in the Community
Access to affordable health care options, particularly home- and community-based services such as personal care, home health care, and adult day care, is another key to aging in place. Nearby health systems, hospitals, and emergency departments with age-friendly certification and providers trained in geriatrics can be helpful in promoting wellness and preventing institutionalization.
Home health care is also essential, with Americans paying more than $8 billion out of pocket for home health care for adults age 65 and older in 2020. Personal assistance services in the form of home care or homemaker services that help with bathing, dressing, and getting around can be accessed by people with the lowest incomes in most states through Medicaid waiver programs, but the waitlists can be long and are not available for most older adults who don’t quality for Medicaid.
With insufficient access to paid caregiving, many older adults rely on the support of informal caregivers in the form of friends or relatives who can step in and lend a hand in the event of an illness or injury. Access to this kind of unpaid help can be essential to prevent the need for a prolonged stay in a nursing home.
Approximately 20% of all adults are providing care to a family or friend with a health problem or disability. Providing this care can be stressful financially, physically, and emotionally. Increasing access to paid caregiving and access to respite care for unpaid caregivers can make aging in place more feasible and result in better outcomes for all.
Reliable Transportation: A Lifeline to Community and Health
Safe and reliable transportation is a third essential ingredient to aging in place. Lack of reliable transportation can result in missed medical appointments, fewer social engagements, and less community access and involvement, leading to poor physical and mental health outcomes.
Many older adults and people with disabilities cannot rely on a personal vehicle for transportation as they either cannot safely drive themselves or do not have access to a vehicle. Notably, older adults who live alone are less likely to have reliable access to a vehicle than other older adults and cannot rely on a live-in companion for transportation.
The number of older adults who live alone is increasing, with women being more likely to live alone than men. Lower-income households are also less likely to have access to a vehicle (American Community Survey). This issue is especially prominent in rural areas, with over one third of State Offices of Rural Health identifying transportation as the biggest barrier to aging in place.
Therefore, community-based transportation options are key to enabling all adults to safely age in place. In a 2021 survey, 84% of caregivers indicated that it would be difficult to find alternative transportation for the people they care for, whether due to lack of knowledge or lack of available options.
Public transportation can fill some gaps, but is often unavailable, insufficient due to fixed routes and schedules, or inaccessible due to the infrastructure of the transit system. Programs tailored to older adults and people with disabilities can fill the remaining gaps if they are sufficiently designed, funded, and managed.
Steps to Improve Transportation for Aging in Place
There are a variety of approaches that governments, health systems, and social service providers can implement to help improve the array of available transportation services:
Conduct an inventory of current available services to identify gaps and unmet needs. Identify programs to implement or expand such as Para-Transit, volunteer and assisted transportation programs, and transportation options counseling to fill these gaps.
Dedicate funding at the federal, state, and local level for the implementation or expansion of transportation programs (as the Federal Trade Commission’s Enhanced Mobility of Seniors & Individuals with Disabilities program did in 2022).
Ensure transportation services are affordable and accessible for all older adults. Public transportation systems can offer reduced fares for older adults and people with disabilities, ensure public transportation infrastructure is disability- and senior-friendly, and ensure that sidewalks and roads are safe for people of all ages and abilities.
Cover or provide transportation to and from medical appointments as a benefit for eligible individuals in Medicaid, Medicare, or other health plans.
Increase awareness about programs like Meals on Wheels that can reduce the need for older adults to rely on transportation for essentials like food.
A Cross-Sector Approach for Lasting Change
Taking a cross-sector systems approach can help to ensure alignment of housing, health care, and transportation efforts to support aging in place initiatives within a community or a state. For example, more than half of the communities enrolled in AARP’s Age-Friendly Network are working on age-friendly transportation programs and services, and at least 11 states are developing Multisector Plans for Aging with transportation as a key domain of focus.
These approaches create communities that not only allow older adults and people with disabilities to thrive, but allow people of all ages to reap the benefits of inter-generational living.