America’s demographics are changing. Currently, about 13 percent of the population is over 65, and, due to increasing longevity, 18 percent are expected to be 65+ by 2030, according to the Pew Research Center. Meantime, the general population is swelling, as the birth rate has hit its highest level in 45 years.
So how will communities address the housing needs of a population growing at both ends of the spectrum?
The Intersection of Health and Housing
To answer that question, The Stories at Congressional Plaza — a boutique apartment community in Montgomery County’s Rockville, Md. created by Federal Realty Investment Trust and my residential community development company, Smart Living 360 — recently hosted a panel on the subject. The answers, which explored the challenges and innovations shaping the nexus of health and housing, were fascinating.
The Future of Housing for Grown-Ups: A National and Local Perspective featured a discussion with Debra Whitman, AARP’s chief public policy officer; Dr. Anand Parekh, senior adviser at the Bipartisan Policy Center and Leslie Marks, a senior fellow at the Montgomery County (Md.) Department of Housing and Community Affairs. Bill Novelli, a distinguished professor at Georgetown University and former CEO of AARP, moderated the panel.
I’m quickly realizing that housing is in many ways is health. It’s a very important determinant of health.
— Dr. Anand Parekh, Bipartisan Policy Center
The experts spoke about three major trends driving the future of housing: changing demographics and related psychographics, a shift in health care from fee-for-service to more values-based models and accelerating advances in technology. Working in tandem, these trends could lead to new housing models that may unlock opportunities for better, and more cost-effective, living options for a wide range of people, the experts said.
Parekh’s Bipartisan Policy Center last year launched a task force on senior housing and health that will present recommendations to Congress this summer. “I’m quickly realizing that housing is in many ways is health,’ said Parekh, a physician and former deputy assistant secretary at the U.S. Department of Health and Human Services. “It’s a very important determinant of health.”
For example, Parekh noted that one in three older individuals falls every year and that falls are the leading cause of injury and injury-related death for seniors. What’s more, he added, falls cost Medicare $34 billion, “so modifications in the home are very important to improve health.”
Among the areas that need more study and collaboration, he said, is identifying and scaling models that integrate health, housing and long-term services and supports.
“The idea of bringing health care services to the home is extremely important and in many ways I think that’s the future of outpatient health care,” said Parekh. He thinks that “instead of the individual going to a health care practitioner, having the health care practitioner coming to congregate settings” will let us see how that model improves health outcomes.
Marks noted that all six hospitals in Montgomery County — a Washington, D.C. suburban area — have teamed up to form the Nexus Montgomery group and applied for a state pilot program loan to address affordable housing to deliver health care services. “There will be a discharge social worker when someone comes out of the hospital, there will be somebody to help them look at their house to see what they can do about falls,” she said.
Options for an Aging Population
Whitman cited an AARP survey saying that the vast majority of people want to age in their home — not a nursing home or a place where they can lose control of their independence.
“So the shift in housing is also going to mirror our demographics,” she said. “Realtors and home builders and communities need to look at this change of an aging population and provide options for them — affordable, yes, but a range of options so that they have a place that has health and exercise equipment downstairs so you can stay healthy. A place that can be adapted for your needs as you age because the doors are already structured a little bigger or the walls are developed for handrails.”
Most U.S. homes, Parekh said, “are not designed for the needs of seniors. If you take a look at five common features of universal design (standards to make homes usable for people of all ages), it’s estimated that only 50 percent of homes have only one of those five.”
Whitman also said “We need to be thinking about ways to redesign our communities.” Last year, AARP launched its Livability Index, which scores communities in categories including housing, neighborhood, transportation, environment, health, engagement and opportunity.
What Montgomery County, Md. Is Doing
Montgomery County, where The Stories at Congressional Plaza is located, scores relatively high in the AARP Livability Index, though the area’s high housing costs an preponderance of housing units with low accessibility give it a low housing score.
But Montgomery County is at the forefront of encouraging livable communities for all ages, noted Marks. It’s part of the World Health Organization’s Global Network of Age-friendly Cities and Communities and has been effective in helping create more affordable housing by implementing local incentives to attract developers.
“In Montgomery County, home builders collaborated with the county and legislation was passed that provides tax credits to both the buyer and the builder if they put universal design features in new construction,” she said, noting that there are also credits for modifying existing construction.
Bringing Together Strange Bedfellows
Parekh said a major challenge is finding ways to incentivize the private sector to create new housing with an eye toward overall well-being and longevity. Novelli talked about the importance of getting assorted forces in housing and health to work together.
Diane Ty, a Georgetown colleague of Novelli’s, described one such effort underway called the AgingWell Hub. “It’s about bringing together strange bedfellows, folks from the nonprofit, academic, government and corporate sectors to really tackle tough aging issues,” she said. Philips, Merck, MedStar Health, MIT Age Lab, AARP and Smart Living 360, among others, are part of the AgingWellHub and housing is one of their key areas of focus. It’s building a model showcase home in the Chicago suburb of Lake Zurich.
The panelists also talked about the importance of intergenerational living, rather than communities only for people over a certain age. As we’ve been building Smart Living 360, we’ve found some people who loved the concept but couldn’t get over the stigma associated with an age-restricted building.
The discussion closed with panelists agreeing that housing that works for grown-ups works well for everybody. Whitman said that accessible housing designs “are good for me as a parent, good for me when grandparents come to visit and good for me if I never need it myself.”