Aging in Place—or Trapped in Place?

By Stephen M. Golant

As older adults age into later life, they often face disruptive changes that make their dwell­ings, neighborhoods and communities seem less appealing. When they retire and seek new leisure, volunteer or career activities, they may be disappointed by what is available nearby. After their children depart, older adults may feel that their homes are uncomfortably large, and utility costs, property taxes and mortgage payments are overly high. The smaller income stream in retirement can mean that such home expenses become financially burdensome. About 54 percent of ages 65 and older renters and 26 percent of older homeowners are cost-burdened, paying more than 30 percent of their monthly income for housing.

Because these dwellings also are aging, they typically require constant repairs and upgrades, and may pose fall risks due to stairs that are expensive to modify. Only about 15 percent of house­holds with moderate mobility difficulties occupy dwellings that are accessible.

Often, older adults must weather loneliness and depression from the deaths of a spouse or friends. And as neigh­­borhoods evolve, chances for social isolation can increase if surroundings no longer seem safe or socially compatible. Nationally, among people ages 65 to 69 and ages 70 and older, 36 percent and 24 percent felt lonely, respectively.

As health conditions, mobility limi­tations and mental declines occur, activities such as residen­tial upkeep, self-care, medication management and getting around become challenging. Low-den­sity suburbs in particular present trans­portation barriers when elders give up driving. About one-third of older persons have unmet travel needs.

Despite these factors, older people find that moving is an unwelcome way to change their im­perfect worlds. In most years, only about 2 percent of homeowners ages 65 and older, and 10 per­cent of the same-age-cohort of renters, change their addresses—rates of moving that are much lower than for any other age group.

Older Adults Are Not Leaving Home

Strong magnetic attractions keep older persons from moving. They are emotionally attached to their dwellings and possessions, which they treat as untouchable archeological evidence of their interesting and successful pasts. Also sacred are ritualistic everyday activities—weekend dinners with friends, movie nights, club activities or neighborhood walks. Elders cringe at the prospect of relocating and having to find new doctors, restaurants, stores and recreational opportunities. They worry about living in a place where nobody knows their name and having to find new friendships and trusted neighbors. By remaining in familiar places, they feel engaged, competent and in con­trol, despite other uncertainties in their lives.

Also, older adults’ family relationships can account for an unwillingness to move. Larger houses can accommodate visits or the return of grown children who, saddled with debt, may seek to save on housing expenses. The dwelling equity of older homeowners—often their primary source of wealth—can be preserved as an inheritance for loved ones.

So how do aging-in-place older adults cope with their incongruent worlds? They play mind games, rationalizing the failings of where they live. More constructively, they take on more debt or cut back on other expenses. They make only essential home modifications and avoid difficult-to-use areas in their dwellings. They look for alternative social relationships or become more seden­tary. They become car passengers rather than drivers, or depend upon door-to-door van services. They cling to independence by depending on families for assistance. To a lesser extent, they secure paid or publicly supported in-home supportive services.

Caveat lector: Some older persons age in place not because they choose to, but because they must. The elders with the most limited options—the poorest, oldest, least educated, unmarried women and minorities—are best characterized as trapped in place. They want to move, but cannot find decent and affordable housing—either to own or to rent—in what they consider appropriate neighborhoods or communities.

Some of the usually mentioned housing options are not realistic. Even if older adults have fam­ily members willing and able to accommodate them in their homes—which many don’t—they fear losing privacy and independence. Also, they view as too extreme the downsizing required by living in an accessory dwelling unit or spare bedroom. Senior care facilities, such as assisted living, which might accommodate their vulnerabilities, are, for other reasons, not an option. Older adults often object to living with other frail older people, or simply cannot afford to. Only about 17 percent of available units now accommodate older persons who are dependent upon Medicaid.

Can It Be Easier to Age in Place?

Given these downsides, it might appear counterintuitive to argue that it is becoming easier to age in place. But surprisingly, today’s older adults have more ways to connect to their activities, people, goods and services and care in their communities. Why? Consider the following:
•  Higher percentages of older women now drive; and new technologies are making vehicles easier and safer to operate, plus the advent of self-driving cars is on the horizon.
•  Ride-sharing apps such as Uber and Lyft have increased travel options. Such companies also col­laborate with homecare agencies and medical facilities to make it easier for older clients to reach ser­vices.
•  Vendors and service providers deliver goods and services to an increasing number of neigh­borhoods mainly occupied by elders (known as naturally occurring retirement communities). These enclaves also offer social opportunities to combat loneliness.
•  With the growth of e-commerce, older persons can access prescriptions, banking services, gro­ceries, meals and more without leaving their homes, and apps like TaskRabbit can provide labor for home upkeep or organizational tasks.
•  Comprehensive health and care services delivered to older adults’ homes speed hospital-stay recuperation and assist with self-care activities. And physician house calls are on the upswing.
•  Internet connectivity allows online entertainment, distance learning and self-help and vir­tual reality experiences. Texting, Skype and FaceTime can enable “intimacy-at-a-distance” social relationships. And emotionally responsive robotic pets can be fill-in social companions.
•  Smart home sensor-based technologies—monitoring and responding to problems—enable older persons to live independently for longer. And home telehealth and telemedicine allow older persons to receive medical assessments and care management once only available in clinical settings.

Can Aging-in-Place Elders Weather the Headwinds?

A cautionary note, however, is in order. There are four reasons why in the future older people may have more difficulty remaining in their familiar abodes.

First, elders may reject the new ways of connecting with their communities because they resist adopting innovations and worry about privacy violations. Older adults may view sensor technolo­gies and telehealth services as impersonal and dehumanizing options that eliminate face-to-face human contacts.

Second, caregiving assistance will become less available, as demographic projections show that the ratio of family members to mobility-limited older persons declines over the next two decades; and the current shortage of paid home­care workers will worsen.

Third, paid in-home care, home modifications, assisted living residences and technological so­lutions will become prohibitively costly, making these options unaffordable to all but those elders with higher incomes. Two uncertainties—the extent to which federal programs and insurance companies will defray costs and whether middle-income elders, who are ineligible for most gov­ernment assistance, can pay for these alternatives.

And fourth, over the next three decades, the elder population will become top-heavy with indi­viduals in their mid-80s and older—an age cohort that has the most difficulty living independently because of their very low incomes, high disability rates and more serious chronic illnesses.

The bottom line is this: It will become more likely that older persons who age in place will not be aging in the right place.

Stephen M. Golant, Ph.D., is a speaker, author and researcher on the housing, mobility, transporta­tion and long-term-care needs of older adult populations. He is a Fellow of the Gerontological Society of America, a Fulbright Senior Scholar and professor emeritus at the University of Florida, in Gaines­ville. Golant is the author of Aging in the Right Place (Baltimore: Health Professions Press, 2015). He can be contacted at golant@ufl.edu.

https://www.asaging.org/blog/aging-place-or-trapped-place