In mid-March of last year, after the pandemic first began, I was talking shit with a close friend about college students who prioritized partying over public health. My friend made a point that ejected me off my high horse: she reminded me that as a white boy born, raised, and socialized with wealth in the U.S., I am not so distant from many of my “reckless, partying” peers. She said that collectively, young people in this country don’t seem to care much about the lives of the elderly, unlike communities in much of the rest of the world. Although it was a generalization, her reminder has lingered with me since. I began analyzing my relationship with elderly people—or lack thereof.
Growing up, I only really had meaningful interactions with elderly people on special occasions like B’nai mitzvahs and weddings. I did, however, have a lot of contact with my maternal grandparents, who moved to an assisted living facility near my house when they began their respective losing battles with dementia and Alzheimer’s. During that period of my life, I visited them every week and interacted with many older people. Before my grandparents passed away, I was able to catch a glimpse of what my life might look like one day if I reached old age. I tasted the meals that might be carted out to me. I listened to the classical music that might play while I rest in an electric reclining chair. I observed the people who might live down the hall from me. In many ways, their wealth afforded them a comfortable environment to undergo such debilitating diseases and live out the end of their days. During my visits, I still found myself wondering if this was how I wanted to age. Would I feel comfortable living and dying in a place like this?
These questions have led me to considerations that go beyond the relative ease that my grandparents’ assisted living facility afforded them. Instead, I am drawn to thinking about the spaces in the U.S. where elderly people frequently end up, the physical space that seems to separate them from much of society, and the implications that this has on collective understandings of community.
Although the sheer volume of congregate care (i.e. nursing homes, assisted living facilities, retirement communities, etc.) advertising makes it seem that these places are the most common housing destinations for elderly people, in 2010, “only 4.5% (about 1.5 million) of older adults [lived] in nursing homes and 2% (1 million) in assisted living facilities.” Contrarily, 93.5%, or 33.4 million elderly people live in their community, with nearly 40% (mostly women) living alone.
A 2014 AARP study draws attention to the housing desires of aging people, which are crucial for a better understanding of why elderly people might continue to live where they currently do. 78% of respondents “somewhat or strongly [agreed]” that they would prefer to stay in their current house for as long as possible. Approximately the same percentage declared they would like to remain in their local community for as long as possible, pushing against the idea that it is preferable to move to congregate care. Furthermore, while two-thirds of respondents agreed that they “want to stay home because [they] like what [their] community has to offer,” more than one quarter claimed that they “want to stay home because [they] cannot afford to move.” These responses indicate that people are primarily drawn to aging-in-place because of community attachments and/or financial reasons. Not only does aging-in-place deliver these particular benefits, but it also “promotes life satisfaction, health, and self-esteem, three keys to successful aging.” Being able to age in their own homes could allow elderly people more control over their future, and thus, the ability to feel more comfortable, while also positively impacting their health and aging processes.
On average, assisted living facilities cost $42,600 annually and nursing homes cost around $90,520, as recorded in 2010. Due to these high expenses, many “elderly people who enter nursing homes exhaust their savings over time, and must turn to publicly funded government programs to help pay for care.” Moving to a congregate care setting typically does not reduce financial burden, but instead may exacerbate it. In fact, in a Canadian study, researchers found that “when only formal costs are considered, home-care costs are, on average, 50% or less of the costs of residential care.” Since people often cannot afford to move into care facilities, many end up staying in their private homes, which are seldom held to adequate standards of accessibility and are thus unsafe.
After my grandparents passed away, I stopped visiting their assisted living facility. My life has become almost entirely devoid of interactions with elderly people. From my personal observations, this is a common experience amongst many young people I know in the U.S. Without meaning to generalize an entire generation—because I know this by no means represents everyone’s experience—I would like to talk about why I might have observed this phenomenon and what I find some of its implications to be.
It feels important to first recognize that congregate care is essential for many people’s aging processes. I am not advocating to put an end to this type of assisted care living. Many people whose parents/elders need increasing care as they age cannot afford to devote the time required for their care due to the demanding hours of many peoples’ work days. I believe being forced to decide between supporting one’s family monetarily or tending to their elders renders visible a national prioritization of values that puts aging and the elderly toward the bottom. People are forced to sacrifice their wellbeing in order to attend to the capitalist and individualist demands of meeting material needs. How are these demands impacting the collective prioritization of certain bodies? How does this impact our ability to age and die on our own terms?
In order to truly remedy this devaluation of the elderly, I believe that there needs to be a large-scale radical reevaluation and re-prioritization, as well as a major shift in resource allocation in this country. However, until this shift occurs, I want to advocate for a society whose architecture and infrastructure facilitates more intergenerational exchange. I believe that the physical distance that separates and isolates older people from middle-aged and younger people disrupts the existence of intergenerational politics of care and community. Additionally, I believe that all young people should be taught to value relationship building with people of all ages from their youth. If these conditions could be implemented, not only might people be more thoughtful and caring in their decisions and actions, but we might be able to live out our lives in a way that is more conducive to self curation through our final moments of life.
These two ideas seem to seep into one another in addressing my primary observation: there seems to be a disjointedness in who we recognize as part of our regular community throughout life. As a young person in a college environment, I feel that aside from my family, my community is almost entirely comprised of other young people. How would my life be different if my community was equally composed of children, people my age, middle-aged adults, and elderly people? I know that in my grandparents’ final stage of life, seeing young people like myself gave them a strong sense of purpose and joy. Perhaps it was because it allowed them to be part of the larger intergenerational community that they once had. I wish that it had been easier for them to have felt this sense of community on a daily basis.
I have been lucky to experience an exception to this observation, which has given me a splendid taste of what life might be more like if people of all ages lived, moved, grew, and died closer together. Her name is Mere, and she is a gentle, fiercely caring, badass, spitfire-of-a-person. Mere is my close childhood friend’s grandmother and she has lived in my friend’s basement since we were in middle school. As a result, she has been an important figure to my friends and me. Just the other day, I was on a walk and called a friend from home and our conversation naturally drifted to Mere. We wondered if she had seen her hilarious hairdresser recently, if she had been up to any puzzles (one of my favorite memories with her), and we contemplated how she might be feeling as a member of one of the most vulnerable groups of people living through this deadly pandemic. In retrospect, I’ve been able to realize how meaningful the relationship we all share with her is and how she has become an important presence in our community. We think about her and talk about her and miss her. And respectively, she lights up when talking with her granddaughter about how we are all doing. The gratitude I hold for Mere occupying this space in my life makes me all the more inclined to advocate for a more intergenerational existence.
I have a deep admiration for the researchers, architects, and designers that are already at work in creating housing complexes and community spaces that are intended to be occupied by people of all ages. I also hold immense respect for those who build and maintain friendships that transcend their age category as much as possible. I think these people are able to learn important lessons that can lead to a life of increased fulfillment. I hope that one day it becomes commonplace for these relationships to exist in communities like mine, and the means by which this can be achieved are plentiful. In doing so, I think people of all ages could experience the benefits of more inclusive networks of care and community.
Researchers have proposed two processes that should be at the core of creating spaces for elderly people: “experience-driven belonging and behavior-driven agency.” This framework suggests that a sense of belonging and agency positively influences the health and wellbeing of aging people. It also provides reinforcement for the study mentioned earlier, that the majority of elderly people wanted to stay in their own homes as long as possible (agency) and remain a part of their community (belonging).
The article “Inclusive Design and Elder Housing Solutions for the Future” proposes two metrics for how to assess (or construct) spaces for elderly people: Visitability and Universal Design. Visitability describes the ability of everyone in the community to visit the space, particularly those in wheelchairs. Within this term there are three standards that must be met: “1) a zero-step entrance, 2) wider doorways on the main floor (32-inch minimum clearance), and 3) a half bath on the main floor with enough space to fit a wheelchair.” Although increasing Visitability in housing would reduce some safety threats commonly found in U.S. households, this standard is not enough to make a space ideal for elderly people. For even better safety precautions, Universal Design is an optimal solution, which is a standard that ensures that everything in a structure is accessible to everyone of all abilities, ages, and sizes. More specifically, it requires accessible entryways (easy for people in wheelchairs to move through), closets stacked on different floors (allowing for an elevator to be installed if need be), countertops at multiple heights (enabling people both sitting and standing to access), front-loading appliances including washer and dryers raised off the floor (reducing the amount of mobility often required to do laundry), grab bars in all bathrooms (making it easier for people to stand up and sit down unassisted), non-slip surfaces (reducing the risk of falling), at least one roll-in shower, doors with either lever handles or automatic openers (making it easier for people to open and close doors with limited hand-wrist motor abilities), abundant light (increasing visibility), and a “liveable” first floor (allowing people who cannot move up and down stairs to eat, use the bathroom, sleep, and rest comfortably). Universal Design is a powerful model for how architecture in the U.S. can begin to prepare for a more sustainable nationwide aging process by addressing the accessibility needs of everyone from the beginning of designing a home.. If this design strategy became commonplace, it could maximize safety in a way that makes aging-in-place a much more viable option, and thus could allow people to better control their own processes of aging.
Another possible solution for elderly housing that architects and designers have been working on is intergenerational spaces. These spaces can “nurture or even ‘provoke’ new forms of belonging” through relationship building and increased stimulation (i.e. watching, listening, and interacting with children). The “Journal of Architectural Planning and Research: Volume 36, Number 1” shares a diagram showing how intergenerational space can connect the young and old and curate healthy and engaged living environments for people across generations. This visual highlights how designers and architects can approach creating spaces sociologically, using the tenets of personhood and contact theory (which suggest fundamental requirements that can improve the quality of human life) in order to best account for the needs of the future occupants. By using this model to critically plan, evaluate, design, build, and reevaluate, housing for the elderly can be more intentionally programmed in order to facilitate healthier aging processes, and maximize comfort and happiness.
Bill Thomas is a designer who has already been working to try addressing the shortage of safe and accessible housing for elderly people through an aging-in-place model. Thomas is a “towering figure in the world of nursing homes … who has spent his life trying to make nursing homes better … and now he’s decided he wants to destroy them all”. He has imagined an alternative to nursing homes called the Minka, a modular tiny home designed to be built in people’s backyards (or on most small lots) in order to allow elderly and terminally ill people to live in their community, close to family, etc. This design is “what many people would recognize as a studio apartment. But instead of it being a studio apartment, it’s your house. And you can ... live where you want.” Thomas designed this house to be 3D printed so it is able to be mass-produced, which speaks to the urgency for housing an increasing population of elderly people. The Minka meets Universal Design standards, and thus is a space that accommodates people of all ages, abilities, and sizes. Some specific design features of the Minka include: a single-floor plan, non-step thresholds, grab bars and a roll-in shower, and large windows for abundant light. Thomas has commented that this design is merely an attempt at beginning a movement of “many better options.” Of course, the Minka is still relatively inaccessible in that it requires people to own their homes and have a backyard, but this idea of integrated modular housing is a step in the right direction. The Minka will hopefully draw architects and designers into the conversation of creating age-accessible housing and push the design world to become more engaged in addressing this nation-wide issue.
Sharon and Howard Johnson, two National Association of Home Builders Certified Aging-In-Place Specialists (CAPS), have also been working to increase accessibility for aging-in-place living. They design “lifelong housing”—a model that accommodates people in all stages of life. Similar to the Minka, “lifelong housing” meets Universal Design standards. Some of these features can be seen in Images 5-9 including: a spacious floor plan, widened doorways, non-step thresholds, easy-to-reach cabinetry, roll-in shower, lever door knobs, and ADA-compliant kitchen appliances.
The Johnsons advise that it is time “to be thinking about retirement options and what type of living situation they want later in life” in peoples’ mid-50s because they have found that very few aging adults plan to live in nursing homes. For those looking to remodel or newly construct age-friendly housing, they recommend using the Rogue Valley Council of Governments’ Senior and Disability Services’ “Lifelong Housing Certification Standard,” which “covers exterior entrances, doorways, lighting, bathrooms, kitchens … and identifies 37 individual requirements for certification.” This list of standards can serve as a checklist for designers and architects to ensure that their work is accommodating the needs of elderly people of all abilities.
Fostering an intergenerational community would benefit people of all ages. Younger people could have more folks to look up to and learn from, as well as more people caring for them. Older people would be more often able to live in places they prefer occupying and would be better looked after by those who are able-bodied. Perhaps the dynamics in my communities would look different during a deadly pandemic, and observing people making decisions without considering those most vulnerable would become rare.
These cultural shifts could be greatly assisted by the designers and architects who create the spaces we, as a country, occupy. Housing could become more accessible for people of all ages, and could thus assist neighborhoods and communities to better facilitate intergenerational community bonds. Perhaps with increased awareness about the work of designers like Bill Thomas and Sharon and Howard Johnson, not only would other architects and designers follow their lead in designing for aging-in-place, but more people would pay attention to and benefit from intergenerational networks of care and community.