What will it take for Americans to age successfully in place, rather than have to bounce from home to assisted living to nursing home and so on? This question has immediate importance for policymakers and families as an estimated 10,000 baby boomers turn 65 every day.
It’s the subject of a new book, Independent for Life: Homes and Neighborhoods for an Aging America, (University of Texas Press) authored by more than a dozen leading experts in aging and housing and co-edited by Henry Cisneros, a four-term mayor of San Antonio and former of the U.S. Secretary of Housing and Urban Development.
Cisneros, who now runs a company specializing in urban real estate, spent an hour discussing his thoughts about aging in place with Kaiser News Service reporter Judith Graham. That interview has been edited for length and clarity.
Q: You start this book talking about your elderly mother. Tell me about her.
Henry Cisneros: My Mom and Dad bought the home across the alley from her mother’s home in 1945. It was a lower-middle-class neighborhood of civil service workers -- all Latinos. It had the feeling of a Norman Rockwell picture, only all the faces were brown.
My Dad passed away in 2006 at age 89, having had a stroke some years before. But my Mom, 87, lives there still. The house is essentially the same as it was, with some adjustments. We put a ramp on the side of the house leading to a deck. We raised the toilet, lowered the sinks, created a walk-in shower. Changed the lighting in the den so my Dad could read. Put in window guards, an alarm and outdoor lighting for my Mom because the neighborhood is somewhat in decline.
Q. Do you see her often?
Henry Cisneros: I try to visit her about every second or third day, but I talk to her every day by phone. She is a classic case of a person aging in place. She’s a healthy, lanky, tall woman who’s always been physically strong. But in recent years she’s started to slow down. She manages all her own affairs. I don’t think there’s a tractor strong enough to pull her from that house.
Until recently, on three sides, all her neighbors were her age or older. The lady to the left died this year at 97. The lady to the right went to a nursing home and died in her late 80s. And the lady across the street died at 90-plus. All stayed in their homes until very late. Aging in place in that neighborhood means older women living on their own.
Q. What lessons do you take from your mom's experience?
H.C.: Seniors fear being unable to communicate, being lonely, feeling insecure. Especially people who all their lives have had other people around them -- family, neighbors -- and now they go entire days and never see anybody.
Imagine being older, a step slower, a bit more fragile. Add to that being lonely, edging to depression and unsure about how you’re going to get everything done that you used to do--but wanting above all to stay in your own home and keep on being independent. That’s hard.
Q. What kinds of policies do you think are needed?
H.C.: First, I’d like to see us commit as a nation to creating lifelong homes. Only 4 percent of the 65-plus population goes to a nursing home. Most are at home for a long, long time. We should make this a priority, just as we did with creating more energy-efficient homes.
This could involve certifying a package of age-related home improvements -- the kinds of things we did for my parents -- and coming up with public and private strategies for financial support.
Second, we ought to be thinking about how we accessorize communities for an aging population. Today, we build parks for children. Imagine a park where older people would have stations for exercise. Think about age-appropriate recreation facilities. Think about how we make transit available, so people who no longer drive can get to the doctor.
As we build new communities we should focus on walkability -- making sure that older people can walk to facilities they need, like groceries and pharmacies.
Q. Can you point to examples?
H.C.: There are communities that are now rethinking zoning policies so that granny flats can be built on the same lots as larger size homes. Davis, Calif., has rethought its zoning codes with that in mind.
There are places using the high school library as the community library. So, elderly people can work there or volunteer there and interface with the next generation.
I think we’ll be recycling older communities in many parts of the U.S. -- clearing away obsolete buildings and reconfiguring them as elderly housing. The recession has created a lot of sites that are no longer economically viable. Strip centers, even regional malls are being remade with housing for the elderly in mind.
We also need to generate prototypes for new age appropriate homes for people who are leaving McMansions and looking for a smaller home.
Q. What about affordable housing?
H.C.: We need to double down on very successful programs that have produced affordable housing for the elderly. Low-income housing tax credits -- we need more. And HUD’s Section 202 (supportive housing for the elderly) program -- we need more of that. In some respects, this is the least problematic area because we know what to do -- we just need to do more of it.
What we don't know how to do very well is help people who are middle-class, but who are about to fall off the dual cliff of aging and frailty while living on fixed incomes and aging in place.
Q. Yet, this is an era of budget cuts. How do you make the case for more financial assistance for programs of this kind?
H.C.: As a country, we owe it to our seniors. It's the right thing to do. It is unacceptable to leave a large segment of the population on their own at the most frail time of their lives. I also think we can make the case that cost savings can be achieved by keeping people living independently as long as possible instead of going to assisted-living or nursing home facilities.
Q. What about the suburbs?
H.C.: The baby boomers are the first American suburban generation. But the suburbs are the worst place to age because they're so unwalkable and totally dependent on the automobile. Living in a cul de sac is really hard when you lose access to your car. So these communities have to think of new strategies.
Q. One of the authors in your book writes about his personal longevity plan. Do you have one?
H.C.: I turned 65 this year and I do have a plan that involves daily exercise and fitness. My personal role models are people who don’t think about retirement but have created either businesses or activities that will allow them to be active until the very end.
I will always be based in San Antonio. I live in my grandfather's old house, which I refurbished, one mile away from where I grew up and one block away from our neighborhood church. When you give this much to a place it becomes part of you and there are a lot of things you don't want to abandon.