This article brings into focus three emerging problems facing our aging urban population:
1. The struggle that frail elderly and their family caregivers have making a decision about where loved ones can live with self-respect and care in their later years;
2. The growing gap between the cost of housing and the income levels of care providers and cared-for;
3. The disconnect between existing housing design options and housing design options appropriate to home-based caregiving.
The authors propose that long-term care managers, executives, and investors work with teams of professionals and community representatives to create residences conducive to home-based businesses for caregivers who choose to live in the same home or in the same community as their loved ones. To address the caregivers' housing crisis, a group decision-making process is presented and recommendations are provided for constructing residences that are designed to support caregivers' needs for affordable home-based businesses.
Why Are New Housing Options Needed? The need for new housing options that are appropriate to home-based caregivers is urgent since the incidence of home- based caregiving is increasing dramatically. In the United States today, driven by economic and societal forces, the need for housing and caregiving have reached a crisis point for many urban families.
A 2003 study shows that 20% of U.S. households provided care to relatives and friends. Of this population, 70% lived in the home or nearby (National Alliance for Caregiving St AARP, 2004). With one in three households expected to provide caregiving by 2020 (McQueen, 2006), the question is not if, but where and how, caregiving support will be provided.
What concerns us is what the research (and our own experience) shows regarding obstacles to those who would like to provide in-home caregiving. One survey conducted in 2003 by the National Association for Caregiving asked, "Have you made modifications in the house or apartment where your (charge) lives to make things easier for your (charge)?" Survey responses indicate that 39% of the caregivers had made such modifications (National Association of Caregivers Survey, 2003). Many caregivers, in our experience, cannot afford to make desired changes (i.e., in bathrooms or kitchens) and instead simply make the best of a poor environment. Today's workers have the problem of both how to adapt housing for aging loved ones and how to find affordable housing for caregiving.
History of Caregiving
In the first half of the 20th century, most families and communities took care of their elderly. Frail older adults would live with members of their own families or with other relatives. The authors grew up in the mid1950s, an era when many families "lived above the store." The family business would house multigenerations in a single (affordable) structure.
One of the author's grandfather lived with her aunt's family in Massachusetts after his wife died. Grandpa was the primary caregiver for his grandson during the day, preparing his lunch and watching over him after school while the boy's mother worked as an elementary school teacher, until he passed away in his mid 80s.
The other author grew up across the country in San Francisco. He recalls children playing in the shop or in the kitchen. As with his East Coast colleague, he experienced aging parents caring for young children and being cared for by their adult children. Communication technology was simple. "No cell phones or pagers," he recalls, "we just shouted out the window or down the stairs for immediate results." It was not perfect, but based on the caregiving options of the time, the available live-work options made economic sense.
For those who live in extended families, relationships can become complex. The old style of caregiving described above is not always possible. …