Academic journal article Generations

Retrofitting Homes and Buildings: Improving Sites for Long-Term-Care Delivery

Academic journal article Generations

Retrofitting Homes and Buildings: Improving Sites for Long-Term-Care Delivery

Article excerpt

A revised goal: Away from the old 'continuum' toward more integrated living.

Athough the aging of the population is by now a commonly accepted fact of life, the aging of the housing stock is an issue that requires more attention. The existing housing stock in the U-nited States is inadequate to meet the demands of a population with increasing needs for assistance with daily living and for healthcare and long-term care. Building new housing and long-term-care facilities is often not the best answer because it is a slow and expensive process compared to retrofitting and modifying the existing housing stock.

Retrofitting is defined as modernizing or adapting a home or building to improve its accessibility and capacity to support frail older adults. This option benefits older adults living in existing homes as well as residents aging in government-subsidized senior housing projects. Retrofitting of the housing stock can also enable service providers and caregivers to provide assistance more effectively. All in all, retrofitting creates a supportive long-term-care delivery site that is more cost-effective than institutional alternatives. Retrofitting can make living environments more accessible, accommodating, and affordable sites for longterm care.

THE CONTINUUM OF HOUSING: CHANGING THE PARADIGM

A long-standing assumption has been that older adults move along a housing continuum from one setting to another as they become more frail. Along this continuum is a range of housing options, such as single-family homes, apartments, congregate living, assisted living, and board-and-care homes, with the end point most frequently identified as a nursing home (Pynoos and Nishita, 20053). Although the continuum of housing contains a range of housing types, there is increasing recognition that frail older people do not necessarily have to relocate, even if they become more frail. Semi-dependent or dependent older people can live in their own homes and apartments if the physical setting is retrofitted to be more supportive, accessible, and accommodative of services. Because of this recognition, a revised framework that emphasizes the elasticity of the conventional housing stock to accommodate a wide spectrum of frail older adults and younger people with disabilities has emerged.

The revised framework is well aligned with the Olmstead decision of 1999, by which the Supreme Court determined that unnecessary institurionalization violated the Americans with Disabilities Act (Williams, 2000). As a remedy, public entities must now administer programs in the most integrated setting appropriate to the needs of qualified handicapped people (Rosenbaum, 2000). The Olmstead decision suggests that older adults should reside in the setting that has the lowest appropriate level of care, including the possibility of their own homes. Retrofitting existing structures would support this goal, but housing-related legislation impedes progress in this direction.

BARRIERS TO RETROFITTING HOUSING

Barriers to retrofitting housing exist in the form of legislation, programming, and funding. Legislation that supports the retrofitting of conventional housing has been slow to evolve. The Fair Housing Amendments Act of 1988, the major piece of federal legislation that requires physically accessible housing settings, applies only to buildings of four or more dwelling units, leaving out entirely single-family houses and smaller housing complexes, including most townhouses. The section of the bill that refers to retrofitting existing multiunit dwellings calls for "reasonable accommodations" for people with disabilities and allows tenants to make adaptations, but the bill is vague on the responsibility of the owner to pay for changes, even in the common areas.

Programs that provide funds enabling elderly people who live in their own homes to retrofit the physical environment are few and far between, supported primarily by programs such as Community Development Block Grants, which was created in 1974, and the Older Americans Act of 1965, neither of which provides substantial resources to solve these problems. …

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