The Commission on Affordable Housing and Health Facility
Needs for Seniors in the 21st Century
November 7, 2001
Dr. Jon Pynoos
It's a pleasure to be here and to see so many friends and colleagues. I especially want to acknowledge my colleague from USC, Phoebe Leibig (ph) who's worked with me in preparing these remarks.
I'd like to focus on the part of the housing stock where the largest segment of older persons live: single-family housing and apartments.
I will propose three initiatives to approach such housing: modify existing housing so it better meets the needs of its residents -- that's number one; two, modernize and modify multi-unit housing, which you just heard some remarks about; and third, building housing correctly in the first place so we avoid the kinds of problems that we're now encountering.
A few well-known facts to set the stage. As has been mentioned earlier, approximately 70 percent of older persons live in their own homes, primarily single-family dwellings, and 20 percent live in apartments.
These residents express a very strong preference to age in place.
An AARP study finds that over 80 percent indicate that they would like to stay in their current dwellings and never move. This is in table 1, page 4 of my handout.
As you have doubtless heard before, much of this stock can best be described as Peter Pan housing, housing designed for persons who are never going to grow old. It presents hazards and lacks the features to help people age in place.
The three biggest problems older persons encounter are: getting in and out of the house, up and down stairs, and safely using the bathroom. These problems are compounded because older persons live in the oldest part of the housing stock.
In 1995, nearly one half of all elderly homeowners lived in homes that they had remained in for over 25 years. Many in HUD buildings have lived in them for a long time as well.
There are many benefits of home modifications. It can promote independence by making it easier to perform tasks. My own father-in-law, Harry, lived in a unit I renovated for him, a guest house in the back with a curbless shower. It allowed him to bathe himself, even though he had cancer, fed himself through a tube, and otherwise was fairly incapacitated.
So they can promote independence, help people do things that otherwise they would rely on others to carry out.
They can facilitate care-giving. Having enough space in a bathroom can help someone else provide care.
Home modifications can help reduce accidents; they can enable older adults to engage in major life activities, whether it's sewing, reading, getting out.
And, finally, they can reduce health care costs and delay institutionalization.
In spite of these benefits, a lot of older persons live in housing without supportive features. Over five million older households have one member with a functional limitation. Over one million of these households report needing modifications. These are primarily old, old persons.
The most frequently needed modifications are faucet and cabinet adaptations, elevators or stair lifts, bathroom access and ramps. They might also benefit from curbless or walk-in showers, as I mentioned.
What are the barriers to home modifications? Why do people not have enough of these? One is affordability. Something like a curbless shower, a stair lift can cost $2,500 or more.
Second is the patchwork of funding sources and providers, most of whom don't cover large items, and as was mentioned earlier, it is difficult to organize different funding sources if you need more than one modification.
Third is lack of awareness of the problems and benefits by both older persons and service providers. Service providers often find it easier to arrange for personal care than they do for modifying homes.
Fourth is the reluctance of landlords to make reasonable accommodations for people who live in their buildings who have disabilities.
The Fair Housing Amendments Act calls for reasonable accommodations. Landlords for the most part don't pay attention to it.
Fifth, you've heard slow government response to modernize subsidized housing, and sixth is inadequate laws and codes.
The major law that we have that relates to accessibility in housing is the Fair Housing Amendments Act. It only applies to housing with more than four units. It doesn't apply to single-family housing of which makes up the major part of our housing stock.
What can we do? We propose an aging-in-place initiative that would increase the availability of home modifications, retrofit existing multi-unit housing, and facilitate the building of housing -- suitable housing in the first place.
Very briefly, a few examples. Making home modifications more available -- we could have a national campaign similar to HUD's healthy home campaign that addressed lead paint, was on television frequently, that addresses how to age in place through modifying your home.
Enhanced planning and coordination efforts -- we should require HUD's consolidated plans, housing elements and master plans by Area Agencies on Aging to address the needs for home modifications and retrofitting multi-unit housing.
Third, increase funding for home modifications. I know Jim is looking for ways that we don't have to pay for things --
But if we can reform Medicare and Medicaid which do not pay for home modifications at all -- to consider it -- you could end up coming home from a hospital to your own house with a wheelchair and not be able to get up or down the stairs or through the hallways. This is a tragedy.
Third, we can include home modifications in community-based waiver programs including those intended to implement the very important Ohmstead decision.
We can change IRS and state income tax rules to more easily allow home modifications as a deductible expense or provide a tax credit.
Second, retrofitting existing multi-unit housing by increasing the funds for the modernization of older, federally assisted housing stock with an emphasis on creating a supportive environment for frail, older persons.
In terms of the private multi-unit stock, we should think about providing incentives to owners and sponsors of apartment buildings to modify their buildings to meet the needs of persons with disabilities.
And third, suitable housing can be facilitated through implementing some of the suggestions of visitability and universal design. Visitability calls for first unit of any housing building to offer basic accessibility so a person can get in and out of the house, use the hallways, and find accessibility to the bathroom.
This is very important because we are building more and more two-unit housing -- two-level housing that people won't be able to age in place in.
We are compounding our problems for the future baby-boom generation and those that follow.
In conclusion, more attention needs to be paid to how to adapt housing to the needs of an aging society and how to build it better in the first place.
We've made some progress, but we have a long way to go. We could do much to help older persons successfully age in place by creating a three-pronged initiative that makes home modifications more available, modernizes and modifies multi-unit housing, and builds more suitable housing in the first place.
I hope that the commission will include these recommendations in its final report in advocacy. Thank you very much.