Workshop Video: Housing Design

Rodney Harrell, AARP: Welcome back, everyone. I hope you're as inspired as I am about seeing some of that fantastic work that's happening from across the country. That was really great. But now we're about to hear from another great group of panelists on the topic of housing design. Our panelists today will discuss efforts to design housing for people of all ages and all ability levels, especially for older adults and residents with disabilities.

Now this is always an important conversation, but it's even more timely now because this is National Falls Prevention Awareness Week. So before we dive into that conversation, let's get to our next quiz.

At this point you should see on your screen a Slido question. Now visitability is an approach to housing that requires that homes have a few key features that enable anyone to visit a home. Three of these answers are correct. But which of the following characteristics is not a requirement for a home to be visitable by all people, regardless of those physical abilities? First, it is entirely free of stairs. Second, it has a zero-step entrance. Next, ground-floor doorways provide at least 32 inches of clear passage space, or finally, a bathroom is accessible by someone using a wheelchair. It's a tough question, but we're trying to pick the one that's not right. So Mike, what are we seeing out there?

Mike Watson, AARP: Well Rodney, looking at this now, we have had a pretty resounding answer. Folks are pretty clearly saying that a home, it does not require that a home be entirely free of stairs for it to be visitable. About 80 percent of folks are saying that. Another 10 percent are saying a zero-step entrance. Five percent are talking about bathrooms that are accessible by someone using a wheelchair, and another 4 percent are noting that ground-floor doorways are providing at least 32 inches of clear passage space. So again, very clear resounding answer, up to 81 percent on being entirely free of stairs.

Rodney Harrell: You know what, Mike, I try my best to trick, everyone. It didn't work. If you're all in my class, you would have gotten an A here. The correct answer is that it is not required to have a home entirely free of stairs. The idea is that visitabilty includes an entrance without steps, but it largely pertains to the main living area, which is usually the first floor, where visitors can use common areas and a bathroom, but visitable areas of visitable homes may have some stairs as well. So they just need to worry about getting into the house and being able to use the house, but not necessarily living in the home. That's a different set of accessibility features.

So with all of our all-star listeners here, I'm glad to hear that you've gotten that right, but let's go to our next panel discussion. Now remember, to ask questions of the panel, go ahead and start entering them in Slido in the Q&A tab at any point.

And now, it's my great pleasure to introduce our next moderator. Bandana Shrestha, who's our state director of AARP Oregon, and will moderate our next panel discussion. Bandana, welcome. 

Bandana Shrestha: Well, thank you so much, Rodney, it's so great to be here. I'm so excited, it's been a great day already, and I'm excited about our panel here. Housing design is such a critical aspect of meeting the changing housing needs of our communities, and I'm very thrilled that we have two experts who I'm looking forward to introducing. I'll just get started and get started with our panelists.

So Jennifer Molinsky is project director of the Housing and Aging Society program at the Joint Center for Housing Studies. Hi, Jen. It's nice to see you.

Jennifer Molinsky: Hi.

Bandana Shrestha: She leads the research on housing challenges facing an aging population.

And then Cynthia Shonaiya — Cindy is an architect with 30 years of professional experience spanning three continents. Hi, Cindy. She is senior market sector leader at the design firm Hord Coplan and Macht.

So it's so great to see you both. Thank you so much for being here. I'm excited to hear from our panelists, but before we move forward, it would be great if we could do a Slido poll. So everybody be sure to have your devices ready and submit your question to my, to answer to my question I should say.

Here's some background. While we talk about housing accessibility in the context of older adults, it benefits people of all ages and abilities and is, in fact, crucial to the majority of Americans who say they want to be able to remain in their own home as they grow older. Yet many homes are not accessible. We heard from some of the other folks who just talked about preventing falls and making a home accessible and livable for a lifetime. Estimates are that the population of older adults will increase from 40 million to 89 million between 2010 and 2050. That means they will go from making up 13 percent of the population to 20 percent of the estimated population. As a result, demand for more accessible housing that's suitable for older adults is expected to increase.

So here's my question to you. What type of program and policies has your community put in place to address that challenge? So you should see Slido pop up for you. What type of programs and policies has your community put in place to address this challenge? And your choices are policies, one, is policies that impact new construction, secondly, home modification programs, third, home repair and maintenance programs. Fourth is other, and fifth is none of the above.

So, oh my goodness. Let's see, what type of programs and policies has your community put into place to address this challenge? I see the ... I'm going to be very curious to your answers here because the availability of housing that's accessible is such a growing issue for our communities. Wonderful. Home repair and maintenance programs looks like is winning now.

Okay, I'd love to bring our panelists back and get their responses. So it looked like the one that won the day was home modification programs, if I'm correct. Panelists, what are your reactions to the result of the poll that you just saw? Are you surprised by what you saw? At first, I was a little alarmed because it seemed like people said, "None of the above" for policies that have been implemented, but it sounded like home modification programs was the one that won the day. So let's start with you, Cindy, what was your reaction?

Cynthia Shonaiya: I'm actually not surprised. As an architect, I am more involved in projects that are more involved with new construction or actually modification of buildings, your existing homes. But if you look at the scale of these type of changes to affect the environment, home modification or maintenance and repairs of your existing home are the lowest barrier and therefore probably more accessible to more people. What I would love to see is more programs that provides affordable housing and housing for seniors in communities, as well as things that cost a little bit more, which may be modification of your existing home. But it's not surprising to me that that was more available, just maintenance of existing homes.

Bandana Shrestha: Well, thank you so much. What about you, Jen. What was your reaction when you saw the response there, and what won out?

Jennifer Molinsky: I suppose a little alarmed that there was a fairly high share with "none of the above." But I guess I would say that the programs that people selected really reflects two separate issues. I think one, we have an issue in that many people lack homes that match their immediate needs. On a report that we released [last] winter shows, the share of those having difficulty entering, navigating, using their homes rises with age and quite dramatically over the age of 80. So we clearly need programs that help people modify their homes to meet their individual needs and keep them safe.

But we also have the second challenge, which is so little of our housing stock offers universal design features, that it could be difficult for people moving, who are seeking accessibility for themselves or for their friends and relatives who want to visit, as Rodney was just talking about, to find what they need. And estimates that less than 1 percent of the U.S. stock is wheelchair accessible, and less than 4 percent could be entered and navigated without steps, and that have wide enough hallways and doorways that you could use a wheelchair or a walker.

So a second set of programs relates to that new construction, and sometimes too, rehabilitating housing, the visibility ordinances fall into these categories, and we really need both, I think, to speak to the immediate personal need and those that encourage our housing stock to incorporate more accessibility over time.

Bandana Shrestha: Yeah, I think that's absolutely right. You know we may not have the policies yet, but at least it's good that there are home modification programs that are available. So I'd like to start with a question for you, Jen. So recognizing the needs for housing solutions to support the growing number of older adults in the U.S., the Joint Center for Housing Studies of Harvard recently launched the Housing and Aging Society Program, which you're a part of, of building on the research that you've conducted on housing and aging over the past 8 years. The program examines the diverse needs of U.S. households headed by someone older than 65, a group that we've talked about, that will make up about a third of U.S. households by 2038. Can you share with us, Jen, how your thinking has evolved around the critical role housing plays in older adults' well-being and the types of creative solutions that address today's challenges and inequities, and particularly addressing the issues of safety and accessibility.

Jennifer Molinsky: Sure, so at the center, we understand housing comprehensively as a platform for well-being, and this is true, of course, for people of all ages, but in some particular ways for older adults. Housing affordability is fundamental to financial security, and we have growing awareness of its relationship to well-being because unaffordable housing means people cut back on food and medication. Housing expenses can also make it hard to maintain and modify one's home, which goes right into accessibility and safety, which are integral to independent living and health. And finally, housing's location is really important because it relates to access of services, amenities, and opportunities for social engagement.

In my time working on these issues, I've seen a deeper understanding of the role that housing plays in health and aging, and with this, some encouraging collaboration between agencies focused on housing and health. I've also seen organizations like Habitat for Humanity and Rebuilding Together and Capable in this space addressing accessibility and safety so that people can remain in their homes. But I think we still have a lot of work to do.

For one, I think we need a more expansive notion of accessibility. Aging in place, whether in a long-time home or another home in the community, requires more than the physical design features. It also often means services and supports, like help with homemaking and personal care. But access to these can be difficult. Access to housing assistance, and access to supportive services, flow through different channels. Government programs in both arenas are going to have different eligibility criteria, so it could be hard to secure the housing and services that people need to remain in their homes. And this includes millions of middle-income older adults who don't qualify for these programs.

Another issue is that we're seeing more and more interest in putting technology in the home to support health —  from monitors for falls, to programs that provide acute hospital-level care at home rather than in a hospital setting. But to do this well, I think we need to make sure that we're attending to the house. Does it make sense to provide acute care in a home that lacks basic accessibility features or safety features, or is in a stable living situation? So in my mind, we don't give up on those ideas. It's just more impetus to make sure that more people understand the gaps in our system of housing, and have the impetus to address them.

And last, I'll just say, I think we need to rethink what our houses should provide in 2022. I would definitely say that broadband access is an accessibility feature now because it enables people to access programs and social supports and even apply for benefits. There are other elements we might add to this list too, but I think that expansive notion of accessibility is really important.

Bandana Shrestha: I love that. I think that's so great because otherwise we think so narrowly about the little-step entry or the handle to get in there, but you're really talking about expanding that notion. Of course, we do have to start with those no-step entries, but I think in today's world, you're absolutely right. Thank you so much for that response.

So next, let me ask Cindy. Cindy, in your architectural practice, you've designed senior living communities of all types for over 20 years, and throughout that time you've become a strong advocate for intergenerational living opportunities that keep older adults integrated into their communities and with their families. How has a shift in demand, particularly among current generation of older adults, influenced your approach to housing design? And, also, what type of engagement have you done to better understand the housing needs, the changing housing needs of people, and what has been the impact of those built environment choices?

Cynthia Shonaiya: Thank you, Bandana. As you said, I've been practicing in this space now for over 20 years, almost 25 years. And I would say that going back to the beginning of my practice for senior living communities, a lot of our communities were located in the suburbs, where the idea of retirement was, you know, you move away from the community, and you're moving to a senior living campus where everybody is the same age and has the same outlook, but in more recent times, what we're seeing is that, really, older adults want to remain [video freezes].

Bandana Shrestha: Oh no.

Cynthia Shonaiya: ... have, we're seeing more multigenerational and intergenerational communities here.

Bandana Shrestha: Okay. I do hear Cindy, but I'm hearing that maybe other people can't hear Cindy or see her? Is that right? Oh, go ahead, Cindy.

Cynthia Shonaiya: Okay, I hope you can hear me now. Okay. So what I was saying is that in more recent time, our focus and our practice has been in providing more integrated communities, more multigenerational and intergenerational communities, and locating them in areas where older adults can remain active, vibrant parts of the rest of society. So for example, we have projects where they're not just age-restricted, but really are both multifamily, as well as for older adults, we are seeing locations that [video freezes].

Bandana Shrestha: I definitely think this time that Cindy has, we've lost her connection. That's too bad. I love what, Cindy, you were saying about really thinking about more expansive, like Jen was starting to say about where these housing units that are developing are, and all that, but let me ask the question of Jen. Jen, what are some ways that we've been talking about design, and we've been talking about how your thoughts have changed, and hopefully Cindy can join us, but what are some ways that we can influence policymakers and local leaders to increase the number of accessible housing units in communities? Obviously, let's start out with the aspect of universal design. But what do you think about that? Can you respond to that question?

Jennifer Molinsky: Sure. You know, I think we need to increase both the fit between people, individuals and their homes, and the availability of housing that is accessible. So both of those branches, I guess, that I was talking about before. And I think that there are excellent programs out there that do both of these from no-interest loans for home modification that are available, often at the local and state level, to visitability ordinances that require new construction to have accessibility, and here we have them at the local, the county, even the state of Vermont has visitability ordinances. And, of course, those excellent nonprofit programs dedicated to helping people age safely in their homes, but I guess the question I come back to is why are these not more widespread?

And there are likely many reasons, but I think part of it is that we don't sufficiently appreciate the need for these programs yet. Accessible housing is simply not the priority that it needs to be, and a society that will see a double of its population 80 and over within the next 20 years. It may also be something that we personally don't want to think about, because it means reckoning with our own evolving needs or something that calls to mind institutional design, which is something that Cindy could talk to and tell you that is a false association. But for whatever the reason, I think if we really want to support people who wish to remain in their homes and communities, we need advocacy from individuals, from age-focused organizations, from the housing community. Education is a big part of this, and here I'll put on the hat of someone who teaches in an urban planning program. I think we need to educate tomorrow's professionals in the planning and design fields about housing gaps and solutions like visitability and universal design.

I think if you're an elected official, it's the time think about enacting ordinances and setting aside the funding for needs that are only going to grow. So we need to put some, I think, funds and teeth behind the idea of aging in place.

And lastly, I just want to give a nod to the previous panel and note that housing options are really important because accessory dwelling units are often just single-floor living, multifamily buildings with elevators often have single-floor living, no steps, and these can also provide greater accessibility, so I think it ties in with what that panel was saying.

Bandana Shrestha: Thank you so much, Cindy, and I know that thank you for being ... Jen, I'm glad to see, Cindy, you're back. Now I'm just going to go to my last question, which is a rapid fire question here. So throughout this workshop we want to equip participants with tools and resources and strategies for getting work done in communities. With that in mind, what should we each be ready to do differently as a result of this panel? Let's start with you, Cindy.

Cynthia Shonaiya: Well, one of the things that we can all do is within our homes, even if we're not able to effect policy, and it would take a while for more senior living communities to come online, we can still look within our homes. And I know some of the earlier panels looked at some of these items. As an architect, there's certain things that I always design. And it benefits everybody. You know, in kitchens and bathrooms, instead of having closed cabinets, think about glass front cabinets, open shelves, key hooks, charger stations, levers and not knobs. These are little adjustments that can be made to make aging in place easier for everybody. Bathrooms, showers and not bathtubs. Towel bars that are grab bars. Things like this, and using technology — Alexa, Google, Siri — all of these can help as we think about aging in place.

Bandana Shrestha: Thank you so much, Cindy. Jen?

Jennifer Molinsky: I guess I'd just add to those fantastic suggestions. We need to remember that there are a lot of inequities in people's access to safe and accessible housing. We need to address the needs of people who rent as well as owners of single-family homes. Remember that millions struggle to afford their housing, let alone pay for modifications. I guess that's not what we will do differently, but hopefully what we'll be remembering as we go forward.

Bandana Shrestha: Well, thank you, both. I know this has been a very short conversation, and I'm sorry, Cindy, we missed you a little bit, but keeping things moving along, I just want to say thank you for sharing your insights. We really appreciate that. Housing design is such an important part of really making sure that we are able to meet the housing needs of our changing society, and this has been a great conversation. Thank you both, and I'm going to turn it back to our emcees.

Mike Watson, AARP: Thank you, Bandana, and thank you, Cindy, and thank you, Jen, for that panel. That was really a fantastic discussion to really ground us in the conversation around housing design. And now, it's your chance to ask your questions of our panelists on that very topic. Remember, if you'd like to ask a question, please use the Slido Q&A function. We were looking at it earlier and we already have a few great ones coming in from our viewers, so I'm going to go ahead and jump right in.

This question is going to be for both of you. And it involves kinds of policies. Can you share a little bit about the types of policies that are going to more positively impact new construction for accessible housing? Cindy, let's start with you and then go to Jen.

Cynthia Shonaiya: [inaudible] that has always benefited senior living in communities is the fact that older adults have less impact on public schools and on the transportation system. And the more that we can have public officials realize that having seniors in the community, creating that full-time vibrancy, is a benefit. I think that is one of the policies that the more we talk about that, then I think incorporating older adults into communities will continue to happen.

Mike Watson: Very well said, Cindy. Jen, do you have anything you'd like to add to that?

Jennifer Molinsky: Yeah, I would think in terms of new construction. That's where visitability becomes really important, and these are policies that requires that new construction have some basic features or that they are creating housing that's adaptable later on. So, for instance, some ordinances require that the blocking be in the walls in the bathrooms, so that grab bars can be added later. They may not be added right at the outset, but they'll be easier to add later, so that you don't have to open up the whole walls of the bathroom to do it. So I would go to visitability for new construction.

Mike Watson: Great answer, and I think, Cindy, I want to pick up on a point you made around engagement, listening to older adults. As I mentioned earlier, there are folks from across the country who are representatives of communities that are part of the AARP Network of Age-Friendly States and Communities, and I want to underscore that these communities are starting with that listening, it's starting with that engagement, and we've seen some great policy solutions there. So I really want to commend those communities to underscore the point that you just made, Cindy.

And on that, I want to pick up on something else you said, Cindy, which was kind of a notion around schools and youth, and we're seeing a lot of questions here around intergenerational housing. Can you each share a few thoughts and guidance for communities tuning in today, how they should think about intergenerational housing that is accessible and built for the kind of needs of all ages and all abilities. Jen, let's start with you and then go to Cindy.

Jennifer Molinsky: We hear about this all the time, and I think there's a growing number of households that are living intergenerationally, so with relatives, grandparents, adult children, grandchildren. We also hear about intentional communities where people of all ages wish to live together. They may not be related and [they] maintain their own apartments, but have common spaces. I think in all of those, we have an important need for flexible space, we have an important need for accessibility, the needs of sightlines so that people can see each other and watch kids while also having a safe and accessible house. So I think we are seeing all of these things.

We're also, I think, seeing some impediments, which can be related to zoning, and finding the opportunity to create the site for these maybe bigger communities and more flexible housing spaces.

Mike Watson: Very well said, that was a great big picture there, Jen. Cindy, do you want to add anything to that?

Cynthia Shonaiya: Yes, I do. We do put a lot of emphasis on jurisdictions and planners and so on, but I also want to mention some movements that we're seeing in the private sector that is also encouraging intergenerational, multigenerational communities. A lot of universities, for example, are really zoning in on that desire for lifelong learning, and creating senior living communities on college campuses. We have a couple of projects now where seniors are being encouraged to move onto campus. We're creating senior living communities, people are taking classes. Students have this opportunity then to interact with older adults, and thereby create another sort of intergenerational community. We're seeing this also even [in] theme parks. Disney is coming up with a Storyliving by Disney, which is a senior living community located very close to Disney World in California. We all know that children love Disney World, but people of all ages do too.

So I'm just thinking about expanding, how do we create these intentional or unintentional multigenerational, intergenerational communities, and I think it's the job of everybody, all kinds of organizations, to look for that aspect that seniors are, and bring them really back into the rest of the community. The idea of separating seniors and putting them into the suburbs, I think may appeal to some, but more people want to remain integrated with their families and with their neighborhoods, and there are different ways of making that happen.

Mike Watson: Very well said, Cindy. That's what we see and hear from older adults across the country as well, almost 8 in 10 folks say that they want to remain in their same home and their same community as they age. And with that, one of the questions that we're seeing in the chat, and kind of building off something that we asked about earlier, we asked a little bit about new construction. Now I want to follow up, and Cindy, you also mentioned a kind of the multisector approach here. So I want to follow up with a question on what folks can do if they're in an existing home. What are the resources that are available to them broadly, and also locally, to help them retrofit their homes and ensure that they can have a place that is livable for them and their family for a lifetime? Cindy, let's start with you and then go to Jen.

Cynthia Shonaiya: I think what's available to older adults differs from community to community, and I would say definitely reach out to your local jurisdiction to see what funds are available. And the impact that you can have, we can start from the lower level, very simple things that you can do to adjust your living environment, just to make it more easy to navigate through. Some things require more funds. If we're talking about adding a chair lift, modifying a bathroom, that may be something that requires more funding, but if we're talking about utilizing some of the technology that's out there, it may not cost much to get, if you have broadband, of course, to have some of the sensors that are available or maybe to open up some of your cabinets, have lighting that is on sensors so that you have night lighting, you have less ability to fall at night. And so modifications that you can make depend upon the funds that are available and, unfortunately still, that depends on where you're located in the country.

Mike Watson: Very well said, Cindy. Jen, do you have anything you'd like to add to that?

Jennifer Molinsky: Yeah, I think Cindy is exactly right, that the resources vary by location. There is a website called HomeMods.org, which can help you find, if you page down, there's a directory by location that can help point people to programs in their area. And I guess just also to go back to something that Cindy said before. I think it can sometimes be hard to see our own homes with fresh eyes, so it can be helpful to have someone come in and evaluate a home with you before you make a decision about what modifications are needed. We tend to adapt and start looking past certain things that maybe we might want to address. So that's just something that I have learned in my own life, so I just wanted to pass that on.

Mike Watson: Appreciate that. I think the lessons you learn in your own life often apply to your academic research and policy work as well. So really appreciate that. As Rodney shared earlier, I think we're all experiencing this on a day to day basis.

So with that, we're seeing a lot of questions here around, kind of, some of these, what I would describe as maybe unde-resourced communities and how can we do some smaller, quicker, faster changes that don't require huge investment or funding from the state or federal government. We've talked about a bunch of those today. If you don't mind, can you take a quick minute or two and just share with us the one or two things you think that a community could or should do that can kind of have a quick on-ramp and quickly impact residents as well. Jen, let's start with you and then go to Cindy. And this is going to be our last question.

Jennifer Molinsky: I think there are programs across the country, like the Capable Program out of Johns Hopkins, which has shown that with a relatively targeted investment of $5,000 or so, you could really do a lot to help someone remain in their home. That comes with a consult with an occupational therapist who helps you adapt to your home as needed. Other programs are similarly small in scope, but are just about the modification and safety. I think that we need to investigate and build on those more. They may not solve the issue of adding a bathroom to a first floor, but they can really make a difference in terms of helping people, sometimes all it is a ramp or the railing on a stair so that you can stay in that house. So we need to pay attention to those fixes.

Mike Watson: Thanks, Jen, that was really good guidance. Cindy, what would you like to add to that?

Cynthia Shonaiya: Yeah, part of our practice deals with modifying affordable homes. A lot of these programs are funded by low-income housing tax credits with a local or state jurisdiction. And some of the light sort of modifications that we do when we go into these homes include things like modifying the lighting so that, you know, once you have better lighting, then you eliminate, or you reduce, the number of falls and trips and things like that. Adding grab bars to bathrooms, so that if your towel bar, for example, if you grab your towel bar, you may trip and fall but if your towel bar is reinforced and your toilet roll holder is reinforced, it can also help to eliminate and reduce falls. Things like modifying handles from knobs to levers make it easier also for older adults to remain in their homes. So there are, you know, even flooring, eliminating trip hazards by making sure the thresholds are flatter.

And so a number of little things that don't cost a lot of money can make a large impact on residents. And we haven't spoken about it yet, but even things like more efficient HVAC, more efficient lighting, heating, hot water, can free up more funds, so that less of your funds are going toward your utility bills, and therefore you have more available funds, which will allow you to stay within your home also. So sustainability, energy efficiency, all of those types of upgrades are important.

Mike Watson: Thank you, Cindy, and thank you so much, Jen. That was really wonderful. I think you gave us a great picture from the top at the kind of federal level and big picture programs down to the nitty-gritty of what are things that folks can do in their homes. So really appreciate you joining us, and also want to thank Bandana who was with us earlier to moderate this panel discussion. So thank you so much.

Jennifer Molinsky: Thank you.

Cynthia Shonaiya: You're welcome.

Mike Watson: Now we just heard a great conversation about housing design and what communities can do. Now to bring that concept to life, we're going to show a few videos focused on two local solutions. The first, in Rogue Valley, Oregon, and also in Minneapolis, Minnesota. These videos are going to last about 10 minutes, and when we come back, we'll kick off our final panel discussion of the day focused on how state leaders are taking action.