Growing old in the zoo has advantages. Our country's leading accredited zoos may serve as some of the best models for us to observe an optimal aging-in-place environment. In these peaceful zoo worlds of lush and sprawling landscapes, elderly animal residents are revered, not marginalized. These older animals are free from the human worries about Social Security, health care costs or being sent to the nursing home.
Ambika, the 70-year-old elephant aging in place at the Smithsonian’s National ZooInstead, geriatric zoo animals remain in their home, receiving top quality health care, nutrition planning, companionship, enrichment activities and more. An extensive team of zoo staff and veterinarians implement care of their geriatric animals in much the same way that we humans aspire to receive care from medical professionals and caregivers.
Here in Washington, D.C., I regularly visit the Smithsonian's National Zoo, one of the top zoos in the country. I call this place Utopia for zoo animals. My favorite older citizen resides at the Elephant Trail exhibit.
Top Notch Caregiving 
Meet Ambika, the 70-year-old female Asian elephant who is aging in place at the Smithsonian's National Zoo. Ambika has called the National Zoo home since 1961.
"She is one of the oldest animals in the National Zoo, and she is certainly the oldest elephant at this time at the National Zoo," said Tony Barthel, curator of the Elephant Trails and Cheetah Conservation Station. "She is one of the oldest [Asian] elephants in North America, one of the top three."
"She's a real sweetheart," added Barthel, who has been one of Ambika's chief caregivers for 15 years. "We all spoil her, dote on her, and she loves that."
According to Barthel, Ambika has been "a pretty healthy elephant throughout her life." He explained, "I tend to think of Ambika as that 100-year-old person who still drives around and maybe uses the internet."
However, Ambika has developed signs of aging. She has recently showed signs of arthritis and joint stiffness, and is now on her last set of teeth. (Elephants go through six sets of teeth in a lifetime.) For her arthritis, Barthel explained, Ambika receives foot soaks every couple of days and pedicures and trims almost every day. "We spend a lot of time and attention tracking the way she moves and the condition of her feet," he said.
Barthel has 10 staff members on his team to handle daily care for the elephants, plus other management; nutrition specialists to design and deliver the food and a large veterinary team.
For her teeth issues, Ambika now receives special pre-chipped hay. "It has made a huge difference in helping Ambika maintain a healthy weight and just eat normally," said Barthel.
When the elephant facility was modified, the zoo incorporated more natural substrates of soft sand and grass, and not a lot of concrete. Home modification is a major part of caring for zoo animals as they age in their home habitat. "We involve our whole zoo maintenance staff. With elephants, everything is big. We need things built," Barthel said.
Physical Therapy, Elephant Style 
Donald L. Neiffer, the chief veterinarian at the Smithsonian's National Zoo, said, "We all know the value of physical therapy, whether you are a human or a dog or an elephant. If you have arthritis and you choose, or are forced, to not move or to not use your legs or arms, the arthritis is just going to get worse."
Part of the treatment and preventive care for Ambika and Shanthi (the zoo's second oldest Asian elephant, who has severe arthritis) is to encourage mobility in the yard. With Shanthi, zoo staffers use wooden blocks to position her feet; this helps her take her ankles and wrists through different ranges of motion.
"The staff is interacting with her, training to have her move back and forth, and just go through the motions so she doesn't get stiff," said Neiffer of Shanthi's regimen.
Medication Management
As Neiffer explained the medications used to treat Ambika and Shanthi, it sounded like he was describing treatment for an elderly human patient: Anti-inflammatories, like ibuprofen; nutraceuticals to help with joint fluid replacement and other treatments through injections to counteract aging and joint disease.
Neiffer acknowledged the veterinary field has seen medical advances. However, he said, "A couple of things have happened. It's the same as in human medicine. We've become much more proficient about keeping people and animals alive longer, so that neither humans nor animals are dying as frequently from infectious disease or trauma or nutritional disorders. The downside of that positive trend is that we are now dying of end-stage organ failure and cancers."
"Zoo animals and domestic animals, they're living longer," he continued. "There's been a pressure, a need, and a desire to provide better care for these geriatric animal patients. We're doing a lot of things with treatments and preventive techniques and therapy for geriatric animals that has never been done before."
Zoo Wellness Programs 
According to Neiffer, the zoo has a preventive (or wellness) program, so all the animals are on some type of routine examination or evaluation schedule, either annually or every few years.
"It depends a lot on the species, some of the diseases they are prone to and some of the logistics involved with handling some of the animals," he said. "But within that group, we may have an animal that we see much more frequently because it has developed arthritis, or chronic ocular disease or cancer."
Innovative Treatments
The Smithsonian's National Zoo is one of a group of zoos promoting the use of different modalities to address medical problems, said Neiffer, adding they are using "the appropriate combination of Eastern and Western medicine, of traditional treatments and complementary therapy."
One example is the treatment for Shanthi's severe arthritis. "For Shanthi, we have done the intra-articular joint therapy, called IRAP. That's the treatment that's been used on humans, equine patients, probably on other domestic species," said Neiffer. "We are the first institution that ever tried it on an elephant."
According to Neiffer, the staff has been pleased with the novel treatment process. Down the road, he believes, it will benefit other elephants and large animals like rhinoceroses and hippopotamuses with similar problems.
Quality of Life Is a Priority at the Zoo
How does Ambika respond to her aging care? With patience and good humor, according to Barthel. "She doesn't like when we trim her cuticles, but she'll tolerate it. We trim the nails. We file the pads. We do the soaks."
Barthel commented, "You know, she can be mischievous sometimes. You often see Ambika standing in the tubs that we fill. As soon as we look away, she's got her foot somewhere else or she's got her trunk in the tub trying to do things."
If you're wondering how an elderly elephant likes to spend time: "Ambika's favorite thing in the whole world is just to stand and soak in the sun. She also likes being with the other elephants," said Barthel.
Birthday Party
Next year, the Smithsonian National Zoo plans to celebrate Ambika's 71 birthday. Working with the nutrition department, Barthel said there are "some really creative people on that team" who will recombine the usual ingredients from her diet into Ambika's cake, which they will also make easy to chew.
Barthel expects the zoo will have a little fanfare and attention: "We'll make a big deal for the public so they get to celebrate with us."


Aging in Place at the Zoo

Holly Lawrence

Surveys show that most people would prefer to grow older, and even die, in their own home. This desire isn't hard to understand.
While you may have already downsized to a more manageable home or condo, you won't have to move again, which is emotionally straining, physically taxing and can be financially cumbersome. Aging in place also lets you remain in your familiar surroundings, close to friends and possibly family. And there are other advantages.
But there's a flip side to aging in place that needs to be weighed:
You may have to move again if you can't be adequately cared for in your home, and it'll be much harder when you are older and in worse health.You can become isolated, especially if you can no longer drive.Caregiving help can get expensive and hard to find if you need it.If you have mobility problems, it's easy to be mostly confined to your home.Your home may become a burden, with its continual needs for maintenance and upkeep.It's easy to think that aging in place will be less costly than moving to a retirement community or assisted living. But this reasoning overlooks that your stay-in-home costs will increase, because you will need more care as you age.
You may also need to hire trusted advisers to help you find competent, responsible and honest caregivers and home contractors.
6 Potential Disadvantages of Aging in Place
Let me go into a little detail about some of the disadvantages of aging in place.
1. Handling sudden health declines. Your aging in place plan may be going swimmingly: you've made the appropriate home modifications, you're getting the help that you need and you're doing fine. Then something happens.
There's a tendency for your home to decline as you age in it.
Maybe you have a stroke, maybe you have a debilitating fall, maybe an accident, maybe a sudden onset illness — something occurs suddenly that means you need a significantly higher level of care.
Now — right now — you need a different living arrangement… and because of the event you haven't the time, energy or perhaps competence to manage the transition yourself.
Now you're at the mercy of whatever help family members may be able to provide. That help may not be much given your distance from them or your relationship with them; some may be too old or infirm themselves to help.
2. You'll miss needed repairs or won't have the money for them. We've all been in older people's homes that were in disrepair, even if they could afford to keep them up. Maybe they didn't notice the mold under the sink, smell the sewer backing up in the cellar, hear the mice in the walls eating the wiring, see the dirty toilet or note the roof deteriorating.
Some are unable to pay for these repairs or worry about tapping their savings to do so.
There's a tendency for your home to decline as you age in it.
If you plan to age in your home, you'll likely need modifications to accommodate or compensate for the inevitable physical limitations you'll accumulate. Everyone knows about installing shower grab bars and entrance ramps and eliminating slip and fall hazards. But less obvious things include installing lever-style doorknobs and more and brighter lighting.
The National Association of Home Builders has an Aging-in-Place certification, and there are other national organizations that certify and train people to advise you on these modifications, usually with comprehensive checklists of possible improvements.
An experienced adviser will suggest useful — often necessary — modifications.
3. You're dependent on your spouse or partner. If you are aging in place as a couple, you may depend on one of you to be more competent in a given area. One person may be good with repairs and cooking, the other with financial and medical issues. But when one half of an aging couple dies or declines significantly, the affairs they handled must be able to be picked up by the remaining partner.
Since that might not be possible, you need a plan in place  to backfill for the missing person's competence.
4. If you have spouse or partner, they may need basic nursing skills. Medical issues tend to increase as we age. So, at some point, you might need to assist with changing dressings, giving medications (perhaps shots), inserting suppositories, helping your partner with bathroom tasks and so on.
A lot of people are squeamish about, or unwilling, to do these things. You can get instruction and coaching on how to perform tasks from your medical providers, but you have to be willing to do them.
5. You may decline mentally. Mental and cognitive decline as we age is inevitable, although it will affect some severely and some not as much.
If you live alone, this kind of decline could become dangerous or unhealthy. You might not remember to take your meds or eat well. You might ignore problems with wiring or the gas line.
6. Fire hazards can increase. Older people are more likely than younger ones to forget to maintain (or replace) their fire, smoke and CO2 detectors. Because older people get colder more easily, they are big users of portable heaters, which have well-known fire hazards.
Hoarding is perhaps the biggest fire hazard older people face. As you age, you can lose the physical, mental and emotional energy necessary to get rid of stuff you don't need.
Advice for People in Their 60s
My advice: in your 60s, assess the probability of needing to make a residence change in the next five years.
If your situation, including your health and family health history, indicates you have a decent chance of needing assistance in that period, you might want to explore housing options in the area where you'd like to live. Or you could either make aging in place modifications to your home or research the kinds of in-home assistance available in your area.
If you believe the odds that you (and a spouse or partner if you have one) will be healthy and able in five years, then revisit the probabilities then.
But from age 65 or so, have a plan!
(This article is an excerpt from the new book, "The Senior Years Master Plan" by Ralph Mroz.)


The Disadvantages of Aging in Place

Ralph Mroz

Editor's note: This article is part of a year-long project about aging well, planning for the changes aging brings and shaping how society thinks about aging. 
It’s not just a house. It’s a home. Your parents raised a family there, tended the garden and mowed the lawn. They kept up with the neighbors and enjoyed many wonderful years in that house. Who can blame them for never wanting to leave?
(MORE: SPECIAL REPORT: Transforming Life as We Age)
Finding a Place for Forever  
No one lives forever, but people are living longer, and most American seniors desire to stay in their homes for the rest of their lives. A 2010 AARP survey found that 73 percent respondents 45 and over strongly agreed with the statement, “I’d like to stay in my current residence for as long as possible,” while an additional 13 percent in that age group somewhat agreed with the statement.
They can remain in their homes for as long they want, with some planning. The house itself may need to be customized for their increasing needs. Someone could come in to keep the house livable. And financial arrangements can make it all affordable.
(MORE: 3 Innovative Ways to Age in Place)
 Make House Feel Like Home
 Home modification doesn’t mean converting a house into a hospital. In addition to adding safety rails in the bathroom or a chair lift on the stairs, one floor of the home can be adapted for single-level living. Coming and going can take place through a doorway not connected to a stairway. Non-skid flooring, adjustable controls on light switches and programmable thermostats “senior proof” a home without making dramatic changes to the familiar environment.
 Affording a Home in Retirement  
A nest egg is for retirement years, and it can shrink quickly if costs for keeping a house or paying for help are too high. Reverse mortgages are loans that allow homeowners age 62 and over to convert home equity into cash while living at home for as long as they want. Unlike conventional mortgages, there are no income requirements for these loans and no monthly payments are required as long as the borrower continues to live in the home. When the last borrower moves out of the home or dies, the loan becomes due.
(MORE: Own Your Future)
“It opens up new options for people to think about in terms of how they tap their equity as a retirement resource,” said Barbara Stucki, vice president of home equity initiatives at the National Council on Aging.
When Your Loved Ones Can’t Do It Alone
There comes a time when it’s obvious that outside help is needed for an aging loved one. According to a fact sheet on hiring in-home help by the Family Caregiver Alliance, telltale signs include recognizing that constant supervision and/or assistance is needed with everyday activities. This is the time to talk to them about getting help and have discuss with other family members or friends in similar situations what has — or hasn’t—worked well for them.
The National Institute on Aging points out that paying for part of caregiving out of pocket can cost less than moving into an independent living, assisted living or long-term care center. And, your loved ones get their wish of staying in their own home.
There are plenty of places that help to ensure your lifelong stay at home is fulfilling:
The Eldercare Locator has information on many different services for older people.The Centers for Medicare and Medicaid Services offers suggestions to fit individual needs.The National Library of Medicine website has a section “home care services.”The National Institute on Aging publishes the Health and Aging Organizations Directory with names, addresses, phone numbers and websites for more than 260 government agencies, professional associations, and public and private groups offering information and assistance for older people. 


What It Takes to Age in Place

Aging in place is an appealing idea to many of us: the ability to continue living in the homes we cherish as we age into our 70s, 80s and 90s, rather than move. There are just two problems: many homes aren’t designed for health issues that can come with getting older and aging in place alone can be lonely. Have I got some ideas for you. Four, actually.
They’re the three winners and one honorable mention of the Innovation@Home contest for smart, effective age-friendly housing practices around the world. (The National Association of Area Agencies on Aging also recently honored 48 programs that help older adults age in place, with its 2019 Aging Achievement and Innovations Awards.)
The Innovation@Home competition was conducted jointly by Grantmakers in Aging (a group for philanthropies who aim to improve the experience of aging) and the World Health Organization Global Network for Age-Friendly Cities and Communities. It was funded by the Robert Wood Johnson Foundation.
"People don't want to be forced to go someplace they've never lived in their life," said John Feather, CEO of Grantmakers in Aging.
The Innovation@Home Competition
The idea: to find the best age-friendly housing innovations that could be implemented around the U.S. Clearly, there’s a huge interest — the Innovation@Home report was downloaded 1,200 times the first two weeks after it was released.
When the judges selected among aging in place entries from 15 countries, two winners came from Europe — the Home Refurbishment Program of Barcelona, Spain and the Aconchego home-matching program in Porto, Portugal. One winner, the No-Cost Building Permits program of Sausalito, Calif., and the honorable mention , CHORE Volunteer Handyman Service of Bergen County, N.J. are in the United States.
“People don’t want to be forced to go to someplace they’ve never lived in their life,” said John Feather, CEO of Grantmakers in Aging (and a 2016 Next Avenue Influencer in Aging). “And a lot of programs we saw emphasize that.”
Feather said he believes aging in place in the United States is developing rapidly around the world but added that “there’s still very far to go.” One reason: “Practically none of the people who do zoning have training in aspects of aging,” Feather said. “And traditionally, aging services agencies have not developed a willingness to talk to them on a systematic basis.”
Susan Mende, senior program officer at the Robert Wood Johnson Foundation, said the competition’s judges were “looking for approaches and programs that could be adapted and replicated somewhere else. The question they asked was: ‘Is this a one-off or can it go to scale?’”
Sausalito, Calif.Here’s a bit about the three Innovation@Home winners and the honorable mention:
Winner: No-Cost/Low-Cost Building Permit Program of Sausalito, Calif.
Sausalito is a gorgeous, quaint seaside community just over the Golden Gate Bridge from San Francisco; 34% of its residents are over 60. But since many Sausalito homes are multi-level and built on a steep hillside, they can be difficult for older inhabitants and can lead to falls.
So, Age Friendly Sausalito, a volunteer group of older residents, worked with municipal officials, to create The Age-Friendly Home Adaptation Grant program in 2018. It lets Sausalito homeowners age 60 and older (or younger ones with a disability) get free or reduced-cost building permits for projects of up to $10,000 to improve the safety and accessibility of their residences. The program has been so successful, all California cities and counties can now waive building permit fees for this purpose.
“For a $2,400 construction job putting in a ramp or a chairlift, you might save $800,” said Sybil Boutilier, chair of Age Friendly Sausalito. “One person said, ‘I was thinking I would have to leave. There are so many entry stairs in my home. I was able to put in a ramp and handrail and make my bathroom more accessible. It really made a huge difference.’”
Winner: Aconchego Home-Matching Program of Porto, Portugal
This program in the university town of Porto matches residents age 60 and older who have extra room in their homes with students ages 18 to 35 who need a place to live. The older people get
Porto, Portugalcompanionship; the students get free housing. Nearly 400 people have participated in the Aconchego Program since it was launched by Porto City Hall and the Academic Federation of Porto in 2004.
“Social isolation and loneliness is a very big issue for many older people around the world, including in the U.S., and it’s tied to ill health,” said Mende. “At the same time, housing can be expensive in university towns. Lots of students in Porto had trouble finding places they could afford.”
An added bonus: the Aconchego program helps prevent older people from spending time only with older people and younger ones from spending time only with younger ones.
Winner: Home Refurbishment Program of Barcelona, Spain
Here, the most vulnerable people age 65 and older in the Barcelona region (other than the city of Barcelona itself) can get non-structural home repairs, mostly in bathrooms and kitchens.
The Home Refurbishment Program, run by La Diputació de Barcelona, also improves home energy efficiency and provides technology like assistive devices to help residents have greater independence and a better quality of life.
The Barcelona County Council coordinates and finances projects and works with a private firm to manage the construction. Roughly 10,500 people have been helped since the program began in 2009.
“Sometimes, it’s just a question of getting someone in to fix that broken step or that cracked tile or that broken light that a person can’t reach,” said Mende. “That can make a big difference to being safe at home.”
Honorable Mention: CHORE Volunteer Handyman Service of Bergen County, N.J.
Bergen Volunteers’ CHORE helps residents age 60 and older in the 70-municipality northern New Jersey county (as well as people with disabilities) live safely in their homes by performing minor home repairs.
What’s more, most of the crew volunteers in this 42-year-old program are retirees. Some are skilled and a lot “are home tinkerers” said Lynne Algrant, CEO of Bergen Volunteers.
“There is something about seniors helping seniors that is very special about this program,” noted Algrant. “There’s a really charming sensitivity on the part of the volunteers about making a visit and puttering around and asking how folks are.”
CHORE charges clients for parts, if the residents can afford it, but not for labor.
“We’ve done a couple of thousand grab bars,” to help people maintain balance and grab onto in case of a fall, noted Michelle Ogden, CHORE’s director. “We can change light bulbs. We also do banisters and light electrical work and light plumbing work. It’s really a relief for seniors to get a service call. An electrician or plumber is outrageously expensive.”
CHORE estimates clients save an average of $500 by using the service.
Kimberly Malone, director of Bergen Volunteers, recalls a client who said CHORE had been coming to her home for 20 years. The woman said, “My children sometimes want me to transition [to another place], but this is my community, and this is what I know,” noted Malone.


Aging in Place Programs That Really Work

Richard Eisenberg

Shelter-in-place restrictions are being lifted and the country is beginning to open up, which means that more Americans will be eager to get out and explore, or rediscover, their downtowns. But some — particularly those whose vision or coordination isn't what it used to be — may find unexpected  difficulties.
Irma Sheppard, 80, knows a thing or two about that. She has lived in central Philadelphia for some 30 years and had been able to walk to most places she needed to go: the supermarket, CVS and her Silver Sneakers fitness class at a local gym. But Sheppard has recently noticed some lurking hazards. "The pavements are very bad here," Sheppard said of her neighborhood. "Some blocks, you have to be very careful when you're walking."
Uneven, steep and broken sidewalks; cracked or missing curb ramps at street crossings to let people wheelchairs cross; restaurant signs on sidewalks; outdoor tables and ever-present scaffolding are increasingly causing challenges to people who can't see well, walk with a cane or use a wheelchair.
A Growing Problem for Residents of Older Cities and Towns
It's a growing problem particularly in older, historic cities and towns with aging infrastructures and tight budgets.
"We take for granted our ability to go from one street to another, from one corner to another, and to do so safely."
And the COVID-19 pandemic is only straining already stressed municipal budgets nationwide. Philadelphia, for example, says it will have to scrap a $5.2 billion spending plan proposed in March as it now faces what the city calls "significant losses in revenue" due to the pandemic.
Philadelphia is being sued over its alleged failure to comply with a 1994 order to make sidewalks and curb cuts (ramps graded down from a sidewalk to a street) compliant with the Americans With Disabilities Act.
"Philadelphia's sidewalks are dilapidated, disintegrating, and teeming with obstructions, making everyday travel difficult and dangerous for the thousands of people with disabilities that call Philadelphia home," say the plaintiffs, which include individuals and groups like Liberty Resources, the Center for Independent Living for the Philadelphia area.
Other cities, including New York City, Portland, Ore.; Long Beach, Calif. and  Arlington, Texas have faced similar suits.
The Interest in Retiring Downtown
"These cases are important for thousands of people across the U.S.," said David Ferleger, a Philadelphia lawyer specializing in disability rights and an attorney representing the groups. "People who are able-bodied — we take for granted our ability to go from one street to another, from one corner to another, and to do so safely."
Philadelphia is seeking a partial dismissal of the case and the city's court filing says it's "moving ahead with planned accessibility upgrades to the best of its ability and remains committed to working with the disabled community as a partner in these efforts."
Boomers around the country have been eyeing city centers as potential places to live in retirement. Carl Dranoff, president and chief executive of Philadelphia-based Dranoff Properties, a developer of luxury apartments and condominiums, said his firm continues to see interest in a high rise it's building in the heart of the city's arts district.
Downtowns — with proximity to restaurants, cultural institutions, gyms and supermarkets — have also been drawing empty nesters who want to trade their suburban houses and cars for the convenience and vibrancy of big cities.
Other pre-retirees prefer to remain where they are as they get older, which includes urban areas. "There's a consistent desire for people to age in place no matter where they live," said Danielle Arigoni, director of AARP's Livable Communities program.  A 2018 AARP survey found that about three-quarters of people age 50 and older "want to be able to age in their community," she said.
What Boomers Want in Communities
That survey also found that well-maintained streets, particularly sidewalks, were among respondents' top priorities, Arigoni said.
But, she added, "there's a general perception that sidewalks aren't maintained, and buckling really does pose an impediment," especially in older, historic cities.
Even in tight financial circumstances like ones cities are experiencing these days, there are small, "really cost-effective ways" cities can fix problems such as loose bricks or buckled pavements, Arigoni said.
If an older adult wants to avoid steep hills, the app takes a flatter route.
An AARP community challenge grant has funded about $3.5 million in such projects over the last several years, Arigoni said. Projects funded in 2019 included walk audits and traffic calming in a Washington, D.C. neighborhood; the reactivation of a neglected alleyway in Newnan, Ga. and a collaboration with artists to repair potholes in Chicago.
"Using demonstration projects can be a really powerful way of encouraging the community to see sidewalks differently and build that political support," said Arigoni.
There's an App for That
PathVu, a startup in Pittsburgh that helps cities improve accessibility and walkability, is working on a potential solution. It's building an app to let users navigate walking routes and avoid potential hazards.
"For example, if an older adult wants to avoid steep hills, it takes a flatter route," alerting the user to "tripping hazards" as they come up, said co-founder Eric Sinagra.
The app's currently being tested in downtown Pittsburgh. "Our goal is to continue to grow to other cities across the country and across the world," Sinagra said.
Meanwhile, some cities are trying to keep pace with repairs.
Boston has set aside more than $1 billion over five years for improvements to sidewalks, roads and bridges, said Emily Shea, commissioner of the city's Age Strong Commission. "We have improved over four thousand curb cuts, replaced miles of sidewalk with age-friendly materials such as concrete and filled hundreds of tree pits to lessen tripping hazards," she said.
Well-maintained sidewalks are actually important to city dwellers of all ages, research shows.
"There's a lot of alignment between what older adults and millennials want," said AARP's Arigoni. "They want options on how they get around."


As Older Adults Prepare to Walk Around, Will Infrastructure Let Them?

Nora Macaluso

A modest home in the Memphis suburb of Raleigh — a vacant foreclosure — used to be dark inside, an interior that was frankly depressing, recalls David Brown, CEO of Home Matters, a nonprofit based in Washington, D.C., that's committed to increasing the country's affordable and accessible housing. Now, the Raleigh house has been remodeled based on a winning design concept from an AARP competition, Redefining Home: Home Today, Home Tomorrow. Sponsored by Home Matters and others, the aging in place competition took in entries and announced a winner last year.
The remodeled house features a no-step entry and an easily accessible wraparound porch. Inside, there's lots of light, and the hallways and doorways have been widened. Moveable walls can be used to alternately create a bedroom or a larger living room space for gathering family or friends.
There's one more important improvement, as the Memphis Commercial Appeal reported in February this year: the house is now occupied. After the rehab, it was donated to Walter Moody, a 54-year-old Army veteran. He moved in with his family, including his 77-year-old mother, Mary Moody, who, because of the design changes, is able to move easily from room to room with her walker and wheelchair.
An open floor plan makes it easier to maneuver with a walker or wheelchair.Redefining Home was aimed at the challenge of adapting the country's existing suburban housing stock to the needs people have as they age. A brief for architects and designers entering the competition asked them to create homes where people can stay "as they travel through various life stages."
Along with Home Matters, AARP and the AARP Foundation, sponsors of the competition included Wells Fargo, the Home Depot Foundation and Dwell magazine.
Just 1 Percent of Homes Are Conducive to Aging in Place
"This competition and one we did in 2015 asked designers and architects to redefine home and re-imagine the home of the future," Brown says. It's great to work on building more affordable housing, he says, but Redefining Home was about finding practical solutions to another of the nation's housing crises. There's a pressing need to remodel and retrofit homes like the one in Raleigh, Tenn.
There are more than 100 million homes in U.S. cities, suburbs and rural areas, yet only about 1 percent of them are conducive to aging in place, says Rodney Harrell, director of livability thought leadership for AARP, who serves as the organization's housing expert. Meanwhile, 10,000 Americans turn 65 every day, and more than 80 percent of those 65 and older say they want to stay in their homes.
"The housing stock right now is not meeting people's needs," says Harrell. Designs like those generated in the Redefining Home competition "serve as ways to create attractive housing that will meet those needs and at the same time be functional and beautiful."
Guided by Universal Design
The winning design in the competition came from the New York architectural firm IBI Group – Gruzen Samton. Like many of the entries, IBI's plans were influenced by a concept known as universal design.
It's not a new idea, but universal design is being "discovered" by more people because of what the approach has to offer to an aging population, says Richard Duncan, executive director of the R.L. Mace Universal Design Institute in Asheville, N.C., who served as a judge for Redefining Home. The Mace Institute describes universal design as "the design of products and environments to be usable by all people, to the greatest extent possible, without the need for specialized design."
The curbless shower is easy to step or roll into and features a bench for sitting.Principles of universal design focus on safety, ease of movement and attractive design for all ages and abilities, inside and outside, according to Home Matters. They can be applied to home building and remodeling, workplaces and public spaces such as parks, and community development.
Put another way, universal design is ageless design. "You can call it 8-to-80 or lifelong-living [design]" Duncan says. The point is to create an environment that "responds to people over their lifespan through all of life's changes, not just when older." That might mean installing sinks at different heights or using lever-style faucet and door handles because they're easier for anyone with painful joints or a weak grip to turn.
Universal design isn't all about function, however. It also focuses on aesthetics, moving beyond solutions that "look accessible" to a more standard appearance, Duncan says. "Regardless of features, people want regular-looking homes."
Beyond Grab Bars to Quality of Life
"The aging demographic is looming large," says Duncan. Age isn't the only reason to pursue more accessible design, but "it does add to the urgency to do it."
Proponents of universal design encourage young and middle-aged homeowners to think ahead and integrate age-friendly changes to homes as they remodel and update them through the years. It's more affordable to incorporate accessibility and ease of use as part of an already-planned renovation project than it is to apply universal design later on as its own separate round of remodeling.
Homeowners can also think about the meaning of universal design very broadly. In the Redefining Home competition, entrants were asked to develop solutions based on flexible, simple and intuitive use, and to make the home attractive, adaptable and affordable. They were encouraged to think not only about things like grab bars and specific functionalities, but to keep in mind quality of life, too.
At the Raleigh house, for example, new front-yard box gardens invite neighborly interaction, says Gabriel Espinoza, a member of IBI Group's winning design team.
"When you age, you want to stay connected with your neighbors to create a better community and better quality of life" for yourself, Espinoza says.
Ideas to Get You Started
Moody was chosen to receive the remodeled house in Raleigh, the Commercial Appeal reported, because of his military service, his desire to create a safe place to build his life and his interest in having his mother live there. "Aging in place will allow me to live in this home and grow old," he told the crowd at the ribbon-cutting ceremony in February. "Family will gather at my home during special holidays [creating] fond memories."
To make your home more amenable to a long-term vision like Moody's, think about how you can start adding features like these, suggested by the experts involved in the Redefining Home initiative:
Stairless entriesA gradual outdoor incline up to the entry instead of rampsLow or no thresholds at doorwaysDoorways wide enough to accommodate wheelchairs and walkersWidened hallwaysLever-style doorknobsLever-style faucet handlesShallower countertops to put items in easier reachCurbless shower stallsOpen-concept floor plans that provide better lighting, shorter hallways and easier movementSingle-floor living that includes a kitchen, bathroom, bedroom and laundry on the same floorFlexible living spaces that can change size or be used for more than one purposeSlip-resistant floors and lighter-color floors for greater visibilityLower placement of light switches and higher placement of electrical outletsMore windows for better indoor lightYou can learn more from the Home Today, Home Tomorrow design competition toolkit for homeowners that was released this spring.


Will Your Home Be Ready for Aging in Place?

Angelo Gentile

Although it's not news that the 78 million members of the baby boomer generation are expected to live longer than previous generations, consider how that breaks down: Of those who turned 65 last year, 20 percent will live to age 90, and 1 in every 50 boomer women will reach 100. The quality of their, and our, lives, and where we will all live as we age, are critical questions for our society. In an AARP survey, 90 percent of senior citizens said they wanted to stay in their homes as long as possible, but that puts a potential burden on the family members who will become responsible for managing their care.
The solution, for many, may be the Village Movement.
 
Why It Takes a Village
 
The principles of the Village Movement are simple: Instead of leaving their homes for senior housing or assisted living, a group of residents in a given community, typically age 50 and older, form a non-profit membership organization to provide access to services that support their goal of remaining at home as long as possible. A village can range from a few blocks in an urban or suburban neighborhood to a rural area with a 20-mile radius. Each is autonomous and its members determine which services it will offer. Typical offerings shared by all members include: home-safety modifications, transportation, meal delivery, dog walking, technology training and support, health and wellness programs, social activities, and the services of visiting nurses and care managers. Most villages hire an administrator, either paid or a volunteer, who can connect members with services as needed, as well as coordinate village-wide programs and activities. Many villages recruit and rely on local volunteers to help deliver services to its members as well. For example, if a member needs grab bars installed in a bathroom, he or she would contact the administrator, who might then order the bars from a vendor using the village's group discount (the member would have to pay for the goods) and arrange for installation, either by a volunteer contractor or one working at a discount.
(MORE: Henry Cisneros Wants to Design Cities for All Ages)
The first village was founded by a group of residents of the Beacon Hill neighborhood of Boston in 2001. Today, there are at least 89 villages in 36 states, with about 125 more in development. Most participate in the Village-to-Village (VTV) network, which helps them share best-practice advice for fundraising, establishing services and managing communities, as well as information about group discounts on goods and services. The VTV website also offers a national map of current and planned village sites.
Most villages have between 150 and 200 members. The average resident is a middle-class, 74-year-old woman. Each member pays an annual fee — the average is about $435, but can range from $50 to $1,500. All villages offer discounts or subsidies for lower-income residents, and most take part in fundraising efforts to support their communities.
Villages Benefit Caregivers, Too
 
More than 7 million of the 44 million Americans who act as family caregivers for someone over age 50 live at least an hour away from their loved one. These long-distance caregivers face constant worry about how their parents are faring each day, as well as guilt over not being there more often. The Village Movement can ease those concerns. "Baby Boomers are really driving the movement in two ways," says Candace Baldwin, who oversees the VTV Network for NCB Capital Impact, a national non-profit community development group that supports the village model. "First, they are purchasing the membership for their parents, which gives them peace of mind. Second, they believe this is the model they want for their future housing as they grow older and so they are starting that conversation in their own neighborhoods.”
Enrolling parents in a village can also help adult children ease future care transitions. "If you have a mom in a village who has progressive dementia," Baldwin says, "and it becomes apparent she may need to move to receive more specialized care, the care manager who has been part of the village services can facilitate that conversation more easily because they have known both you and your mom through your mom’s residency.”
(MORE: For Caregivers, New Tracking Technology Offers Peace of Mind)
As I see it, the Village Movement taps into essential boomer characteristics of independence and volunteerism. Village members have control over their lives — and many volunteer to help other village members. Many support family caregivers by checking up on neighbors on days an adult child cannot, but their support for each other can extend well beyond that. Up to 60 percent of residents volunteer or have embraced encore careers to aid their villages, Baldwin says. In one village, a retired lawyer provides pro bono counsel to neighbors; in another, a nurse volunteers to help older villagers with daily medications; in yet another, a retired executive offers tai chi lessons.
A Renaissance for Aging in Place?
 
In 15th-century Florence, the Medicis brought sculptors, poets, philosophers, painters and architects together, broke down barriers, and gave birth to the Renaissance that was the bridge between the Middle Ages and the modern era. Perhaps the Village Movement, as a solution for aging with a high quality of life, can bring us to a new age of enlightenment about where and how we should live until we breathe our last.
 
The goals that inspired the village model are not revolutionary. To live at home until our last days is a wish most of us share. But the movement does embrace innovation, combining the best new ideas in community-minded living, volunteerism, personal control and person-centered focus to create what Baldwin calls "the new face of aging."


The Village Movement: Redefining Aging in Place

Sherri Snelling

How will we access and pay for the support and services we’ll need as we grow older? There is a growing sense of urgency around that question, as more of us are determined to remain as independent as possible throughout our lives.
Many states are shifting away from requiring people who need long-term care to be in a nursing home in order to receive Medicaid. In Ohio, for example, nine out of 10 older people on Medicaid received long-term services in a nursing home in 1993; today, half that population receives such care at home, according to a study by the Scripps Gerontology Center at Miami University.
More Help Needed
While that trend is welcome news, professionals in the field of aging say our system needs a huge course correction in order to adequately meet older people’s desire to stay at home.
Supportive services, both volunteer and paid, need to be expanded. Payment must better align with the individual, both to give people what they want and to save the health care system money, according to a new report by the Long-Term Care Financing Collaborative, a group of experts and stakeholders.
In the past, “what we have had is what I and others call the over-medicalization of aging,” says Collaborative member Stuart Butler, senior fellow at the Brookings Institution. People often ended up in institutions regardless of their wishes, simply because they ran out of resources and Medicaid would only cover care in a nursing home. Other older people moved to more institutional settings rather than burden their families.
Nevertheless, family caregivers continue to provide the vast majority of long-term care. But turning to family members is less and less an option. A 2013 AARP study found that the ratio of family caregivers (aged 45 to 64) per older relative will decline from seven to one in 2010 to three to one in 2050, when the boomers are in their 80s.
“Comparatively speaking, we’ve had an abundance of potential family caregivers,” says independent consultant Don Redfoot, who co-authored the study and serves on the Collaborative. “But that dramatically changes over the next couple of decades.”
At the same time, few older people can afford much paid home care, which can easily cost $20 an hour.
Meeting the Caregiving Shortfall
To fill the gaps, community supports will increasingly be a critical piece of the long-term care puzzle, the report found. Although most volunteers can’t provide hands-on care, “There’s an awful lot they can do that may not prevent, but could delay, the time people have to go to an institution,” says Collaborative member Howard Gleckman, senior fellow of the Urban Institute and author of Caring for Our Parents.
“That in itself would be very important both for the person receiving care and the people worried about costs,” he says.
New models such as The Villages, a neighbors-helping-neighbors membership organization, are one way to deliver that support.  Among the other promising alternatives highlighted by the Collaborative:
Fraternal Organizations
Ohio Masonic Home is a nonprofit that serves older members of the Ohio Masons, a fraternal organization with 500 lodges and 90,000 members.
In addition to retirement communities, nursing home, assisted living, and a paid home care agency, the Ohio Masonic Home operates an 800-number call center. The center is staffed by “aging service representatives” who link older members or their widows to local resources of all kinds, including volunteer assistance.
Masons help their fellow members with anything from repairing a broken toilet to meal preparation or transportation.  The organization will also help with emergency funds for things like lapsed utility bills. In one case, a member needed a wheelchair ramp.  Volunteers built the ramp, and when the member could not afford to pay for the supplies, Ohio Masonic Home covered the cost.
“If you can’t get these things done, you run the risk of falls, of depression, of not eating well,” says CEO Tom Stofac. “Those kinds of issues start to escalate, and they might go to the hospital because they’re malnourished.  What we haven’t done a good job of in the aging field is to look upstream at these little things. That’s what I'm finding is really helpful.”
‘Grand-Aides’
A home care model that is spreading globally is called Grand-Aides, now operating at 20 sites in the U.S.
Grand-Aides, who are employed by health systems at no charge to patients, have the temperament of kindly grandparents and the skills of specially-trained certified nursing assistants, according to program founder Dr. Arthur (Tim) Garson.
Armed with computer tablets, Grand-Aides provide home care to people at risk of hospital admission or an emergency room visit.
“Everybody is pushing towards trying to manage patients with ‘apps,’” says Garson. “It turns out that some people just need people.”
A typical patient is someone discharged from the hospital with congestive heart failure. Such patients are most at risk of readmission within the first 30 days.
A Grand-Aide will visit the patient several times that first week. Using her computer tablet, she will video the patient and his medications, with a registered nurse on the other end viewing the encounter and double-checking the meds.
By troubleshooting problems and offering clear guidance and reassurance, Grand-Aides affordably provide home health care and may reduce readmissions, a major goal of hospitals and of Medicare.
Faith and Health
In Memphis, Tenn., Methodist Le Bonheur Healthcare partners with local churches, predominantly African-American, to promote wellness and manage chronic illness. Some 600 churches have forged a “covenant” relationship with the hospital system to promote good health in their congregations and surrounding neighborhoods.
Hospital navigators link to volunteer liaisons within the congregations. When church members are admitted to the hospital, the liaison alerts the navigator who looks out for the patient and, along with the church, makes discharge arrangements.
“We try to see what needs [the churches] can meet when they go back to their community,” says Rev. Dr. Harry Durbin, senior vice president for Faith and Health at the hospital. “Maybe transportation to visit their doctor, or someone who is a ‘pill pal’ to remind them about their medicine — any range of activity.”
The hospital also holds physician-led classes in the community for church members about prevention, wellness and chronic disease management, such as diabetes.
The health system invests $700,000 a year in the program.
“We think it’s consistent with our mission, which is to care for the whole community without ability to pay,” says Durbin. “If we’re going to be a health care organization committed to good health, we have to be in the community.”
And by helping attend to wellness and prevention, he adds, the hospital can better direct its resources to handling more acute and difficult illnesses.
Dr. Gary Gunderson, who founded the Memphis Model, is now at Wake Forest Baptist Medical Center. There, he leads a learning group of hospitals wanting to adapt and expand it.
“As we approach decades when there are more and more elders, we simply must work on building the broad community strengths to balance those in our more formal programs of government,” Gunderson says.
 


Will We Really Be Able to Age in Place?

Beth Baker

Last month, Next Avenue asked readers to share with us your questions about aging in place — being able to live where you want safely, independently and affordably as you grow older. For most people, that means staying in their own home.
The questions we received fell into three main categories:
How to find the services I will need, including housekeeping, medical and transportationHow to pay for those services, including whether, and to what extent, Medicare and Medicaid will cover themHow to evaluate home care providers for my parents in a different stateFor each of the areas, we offer suggestions and advice we’ve learned from experts. We’ll also point you to places you can go for more information.
How to Identify and Find Aging in Place Services
Even if you are currently in good health, you can probably guess what kinds of things you may need in the future. As one reader wrote, “I am 71 and still robust, but know I am facing declining mobility and vision.”
Many people are brought face-to-face with this reality for the first time when they experience a fall. A broken hip or wrist can severely hamper your ability to care for yourself — to get in and out of bed, go to the bathroom or fix meals. Other physical ailments like osteoarthritis, heart disease, macular degeneration (an eye disease) and incontinence are common as we age.
When health issues or lack of exercise lead to weakness, it can be difficult to get everyday household tasks done. You may need help with light housekeeping or home repairs. Your health may also impact your ability to drive safely.
With these in mind, assume that your future needs may fall into five areas: 1) health care, like assisting you with medications or home treatments; 2) personal care, like helping you get out of bed, get dressed or go to the bathroom (also known as custodial care); 3) transportation to medical visits and social outings; 4) nutrition, such as providing or helping you with meals and 5) house care, like cleaning and repairs.
A good resource for finding older adult and caregiver services in your local area is the Eldercare Locator. A service of the federal Department of Health and Human Services, it is both a website (where you can search by your ZIP code) and a telephone service, at 800-677-1116.
The Eldercare Locator will direct you to, among other things, the Area Agency on Aging (AAA) for your county or city. The AAA can provide leads on a broad range of resources near you, such as transportation options, Meals-on-Wheels and home health care.
How to Pay — and Will Medicare and Medicaid Help?
Medicare Part A and/or Part B covers 100 percent of the following in-home services, when you are homebound and when a doctor determines they are medically necessary, according to the Medicare website:
Intermittent skilled nursing care (defined as less than seven days a week or less than eight hours a day over a period of 21 days or fewer)Physical therapySpeech-language servicesOccupational servicesMedicare does not pay for:
24/7 careMeal deliveryHousekeeping servicesPersonal careMedicaid (which is available for low-income households) may cover in-home, long-term care services depending on which state you live in. Check with your state Medicaid office for details.
If you are a Medicare Advantage member, you may soon be eligible for other home services. (Medicare Advantage is coverage offered by private companies approved by Medicare.)
The new CHRONIC Care Act, which became law in February, gives Medicare Advantage plans more flexibility so they can now cover “non-medical” benefits like home bathroom grab bars and wheelchair ramps for the chronically ill. These benefits will begin in 2020.
That law also covers more telehealth services (providing health care remotely through electronic means) for people with Medicare Advantage plans, beginning in 2020.
In addition, Medicare Advantage plans will be able to offer services like home-delivered and medically tailored meals (now available only to people with a very small number of conditions) or home aides to help with daily activities. That’s according to a recent Next Avenue piece by elder advocates Bob Blancato and Meredith Ponder Whitmire.
“Such services will be crucial in allowing Medicare beneficiaries to stay in their homes as they age as opposed to requiring institutional care,” they wrote.
Since Medicare Advantage plans are private plans to supplement Original Medicare coverage, their benefits vary.
How Can I Evaluate Home Care Providers for My Parents?
If you need to line up help for your parents and live in a different state, there are tools that may help.
Home Health Compare is a national online ratings system that assigns stars to a home care agency based on a number of factors, including its patients’ experience. (Start by putting in your parents’ ZIP code, which will pull up a number of agencies in the area.)
See these tips from the National Association for Home Care & Hospice on selecting a home care agency.
In addition, check the Better Business Bureau to find out if there are complaints against a particular agency. Ask other trusted people in the area, such as your parents’ friends or religious leaders, for referrals.


Answers to Questions About Aging in Place

Emily Gurnon

After retiring, the chance to stay in the home where you’ve built up memories and grown comfortable may sound perfect. But to age in place well, you may need to do some renovations. The question is: Which ones are worth the cost?
“If you plan on aging in place, there are two things to keep in mind,” says Cristina Miguelez, a remodeling specialist at Fixr.com. “The first is what it is that you need to remain in your home. The second is that you need your home to maintain its value and salability regardless of what you do to it.”
As you look around your home, it may be helpful to draw up a list of potential renovation projects and then evaluate them based on what you think you’ll need in coming years.
You may want to arrange for a consultation with a home renovation pro to discuss possibilities. Due to growing numbers of people wanting to age in place, the Chubb insurance company just started offering its homeowner clients a free home accessibility risk consultation service.
6 Home Renovations Worth Their Cost
Here are six home renovation projects that experts say are worth their cost in retirement:
1. An Accessible Kitchen
“What modifications you actually do will be dependent on your needs,” Miguelez says. Putting in a pullout pantry and placing the microwave on a counter or below counter height might make the space easier to work in. Adding space and lowering counters could create a kitchen that would be wheelchair-friendly if you ever needed that option.
"Widening narrow doorways is one of those less glamorous, yet important renovations to make if you plan on aging at home after retirement."
A mid-range minor kitchen remodel in 2019 costs an estimated $22,507, according to Remodeling magazine's Cost Vs. Value Report.
You might spend more or less, depending on the adjustments you make.
2. A New Home Office
You may not head to work every day in retirement, but you might want a place to work part-time from home, as well as look over the bills. Designing a home office you love offers the opportunity to have a productive, comfortable area.
“Whether this means repurposing a current space or completing a small home addition, it’s definitely a good investment — not to mention it holds a solid ROI  (return on investment) when it comes time to resell,” says Kaitlin Martin, of Choice Windows, Doors & More, a home renovation company in Lancaster, Pa.
The cost of turning a room into a home office will depend on its size and your preferences. But Remodeling magazine says you can figure a home office remodel running about $187 a square foot.
3. An Easy Entrance
To make sure your home will be easy to get in and out of as you get older, make sure it has at least one exterior door with a flat entry or a ramp, rather than steps.
“Designs and materials today allow accessible ramps to be an integrated part of the finish and architectural design of the home,” says Jim Magliaro, vice president and risk consulting technical leader at Chubb Personal Risk Services.
If the interior has tight doorways, consider adding several inches to the frames. That will make it easier to get around in a wheelchair or a walker one day, if need be.
“Widening narrow doorways is one of those less glamorous, yet important renovations to make if you plan on aging at home after retirement,” Martin says. “This is a quick renovation for a contractor to do and typically only costs a few hundred dollars per doorway.”
4. A First-Floor Bedroom
While climbing stairs might seem effortless now, in the years ahead, a health condition or disability might make the trip difficult. If your home’s bedrooms are all located on an upper floor, consider putting in a sleeping and main living area on the ground floor.
“Open floor plans — especially flow in the kitchen, dining and living rooms areas — will allow you to make maximum use of the living space,” says Lukasz Kukwa, a real estate agent with Coldwell Banker Residential Brokerage in Westfield, N.J.
Try turning a room on the lower level into a bedroom or build a bedroom onto the main floor of the home. “If possible, adding or converting for a laundry room on the main floor is a desired feature future buyers are looking for,” Kukwa says.
5. Bathroom Modifications
A mid-range bathroom remodel (new fixtures, toilet, sink and counter and medicine cabinet plus a tile floor and wallpaper) could cost about $20,000, according to Remodeling.
If you focus on several low-cost modifications — like installing grab bars and rails — you can create an age-friendly space for less. These days, grab bars come in elegant styles to blend in with the bathroom design and avoid an institutional appearance.
Other suggestions: a no-threshold shower, so you won’t trip over the edge, and a higher toilet (perhaps 19 inches high) in case of potential mobility or balance issues someday.
Switching knob-style bathroom faucets to faucets with a lever-style handle is pretty inexpensive and could be helpful, too.
6. Proper Lighting
Go through each room of your home and take note of spots that could use extra lighting to prevent falls. An electrician can install fixtures in dark areas, such as a hallway or dining room. You might also put light strips on the stairs or a lamp in a living room corner.
When replacing bulbs, use LEDs, which have a longer life than incandescents and can reduce your energy bill each month.
Before starting any renovation project, talk to your homeowners' insurer to be sure you’ll have the proper coverage. You may even qualify for discounts if you make your home safer.


6 Home Renovations in Retirement That Are Worth the Cost

Rachel Hartman

The Retirement Gap is a real-life problem. Learn how to prepare for whatever retirement may look like for you.

Growing a business means managing change. Read how entrepreneurs like you have done just that and found resources to succeed.

Nationwide workshops and festivals offer community for aging artists

There is power in talking openly about mental health and mental illness. Featuring expert insight and personal stories, find support and resources on how to challenge stigma and rethink mental health as we age.

Perceptions on Wealth in Retirement

Navigating Change

Art + Aging in Community

Talking About It: Aging and Mental Health