A Growing Need for Aging-in-Place Services in Suburbs and Rural Areas

A new report found that there are 4,764 census tracts where more than half the population is at least age 50.

A new report found that there are 4,764 census tracts where more than half the population is at least age 50. Shutterstock


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A new Harvard study found that the share of older adults living in low-density metro census tracts grew by more than 6 million people from 2000 to 2016.

A growing number of older people are living in suburban or rural areas that are less likely to have the kind of services needed to help people stay in their own homes as they age, a new report found.

The share of adults who are 65 or older living in low-density metro census tracts increased by more than 6 million people from 2000 to 2016, the study by the Joint Center for Housing Studies of Harvard University noted. That is about 15 million people, with another 8 million living in non-metropolitan area neighborhoods.

For many local governments, helping these residents age in place could mean a larger readjustment of community practices, such as changing zoning in suburban areas to not be so focused on single family housing, said Jennifer Molinsky, a senior research associate at the center.

“There is a lot to be done to increase housing options,” she said. “Especially in places that are lower density and primarily single family, it is often the case that people would like to stay in their community but perhaps not in a big, single-family house.”

Another consideration for policymakers is how to help with transportation as older people in rural areas—and even many suburban ones—stop driving.

“It doesn’t take too far out of a central city where transportation isn’t happening. The options to take a bus or anything else are pretty limited,” Molinsky noted.

For many communities, this is not just a looming problem to tackle in the years to come, but something that elected officials and agency heads should be thinking about right now. The center’s study noted that there are now 4,764 census tracts where more than half the population is at least age 50, up from 1,499 census tracts in 2000.

(Courtesy of the Joint Center for Housing Studies)

This is particularly a phenomenon away from dense, urban areas, in places like rural California, Michigan, Texas, Oregon and Washington state, the report found.

(Courtesy of the Joint Center for Housing Studies)

Molinsky said some states, local governments and non-profit groups are rolling out programs aimed at helping people live in their homes longer by modifying the spaces.

For example, the CAPABLE program developed by the Johns Hopkins School of Nursing is aimed at helping lower-income seniors age in place. The program teams up a nurse, occupational therapist and handyman, who make home visits over four months to figure out how people can safely remain in their own homes.

The program is now in 25 places in 12 states, said Sarah Szanton, who developed the program that started in 2009.

“This is particularly targeted at people who have some difficulty with any kind of activity of daily living,” Szanton said, giving the examples of bathing and feeding themselves. “The clinicians elicit people’s functional goals, like they would like to get in and out of the bath by themselves, instead of having their grandson pull them up out of it.”

The therapist and nurse then work with them on solutions for their difficulties. The handyman can tap a budget of $1,300 to make specific repairs or modifications, such as a grab bar in the shower or an extra bannister for the stairs, Szanton said. In some places, the programs are funded through Medicaid waivers, with the idea that keeping people in their homes longer will cut back on future nursing home or other long-term care costs, as well as hospitalizations.

The Harvard report pointed to a significant number of older people needing some kind of help, whether with their particular living situations or more generally. The study found that 9.7 million households of people age 65 and over spent more than 30 percent of their incomes on housing.

Older renters are more likely than homeowners to spend this large share of their income on housing, which Molinsky said shows the need for more federal rent support for this population. Only about a third of the older low-income people who qualify get rent subsidies, she noted.

Laura Maggi is Managing Editor of Route Fifty and based in Washington, D.C.

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