This article is part of the Under the Lens series
Top Takeaways
The well-known definition of “aging in place” is unrealistic given rampant housing instability and the fact that homes and communities no longer support older adults’ needs.
The focus shouldn’t be on keeping older people in their homes at all costs, but rather on supporting them to remain in—and part of—their communities. This includes environments that guarantee a high quality of life and a high quality of care.
The changing mindset reflects ideas that housing, disability, and community development advocates have raised for years: that a person’s health and well-being are shaped not only by medical care but also by whether they have safe and stable housing, reliable transportation, accessible social amenities, walkable communities, and support for caregivers.
Americans are living longer than ever, prompting a growing rethinking of what it means to age in place—and what kinds of housing, services, and community supports that requires.
“Aging in place” is an unofficial phrase, loosely defined by the National Institute on Aging as “staying in your own home as you get older.” But as the baby-boomer generation (born between 1946 and 1964) enters older adulthood, they’re finding that the homes they’ve lived in for decades don’t accommodate their evolving needs. Many older adults on fixed incomes are seeking more accessible and affordable accommodations—an emotional challenge unto itself, without having to compete for the same limited housing stock as everyone else.
For the millions of older adults who rent, deciding where to age in place when they don’t own their homes is especially fraught. They’re often beholden to landlords who may choose not to make repairs, never mind modify units to meet their aging tenants’ needs.
“Aging in place,” as it is popularly understood, is too limiting to reflect the reality that today’s older adults face, which in turn constrains how policymakers, service providers, and even seniors themselves can address their needs.
In less than a decade, more Americans will be 65 and older than under 18, according to the U.S. Census Bureau. This means that for the first time in U.S. history, older adults will outnumber children. As America’s population ages, housing and aging advocates say more creative solutions are needed, beginning with a more expansive definition of what it means to age in place.
Finding Flexibility
“When people hear the phrase ‘age in place,’ they think of staying in your home no matter what,” says Rodney Harrell, vice president of family, home, and community for AARP, the country’s largest advocacy organization for older adults. “If the only choice I can conceive of is either my house or a nursing home, I will choose my house.”
But as housing instability has come to define mainstream American life, that narrow definition is no longer sufficient—or realistic.
“We’re assuming that folks who are aging in place are aging in place with their family members, in a stable home, and with stable income,” says AmyLinda Nevarez of Strategic Actions for a Just Economy (SAJE), an economic justice advocacy group in Los Angeles, where older adults are also the fastest-growing age demographic. “Those are assumptions that we just can’t make right now.”
Nevarez is the director of organizing and advocacy for SAJE’s Stay Housed LA program, which provides tenant education workshops and clinics for Angelenos at risk of eviction. Most of SAJE’s members are older adults, many of whom have lived in rent-stabilized housing for years. Consequently, she says, their ability to age in place at home depends entirely on their landlords’ willingness—or lack thereof—to address issues such as out-of-service elevators.
Those accommodations are also hard to come by: According to the U.S. Census Bureau, less than half of U.S. homes have even the most basic “aging-ready” features. This includes a step-free entryway into the home and a bedroom and full bathroom on the first floor.
“Many of our systems—the way we build homes, the way we design communities and transportation systems—have not been designed with aging in mind,” says Harrell.
Take Dominick Calsolaro’s three-bedroom, two-story home in Albany, New York. Calsolaro and his family lived there for nearly 40 years before he became disabled in 2023 at age 68. Because all the bedrooms were on the second floor, the home wasn’t adaptable to his new needs, including wheelchair access.
The cost of modifying the home was more than the family could afford, so Calsolaro and his wife moved into a rental apartment across town, where he could still access his care network and community. Eventually, after a rent increase, they moved into a condo in a neighboring state where they could be closer to their children and grandchildren.
“It’s a hard decision to move out of a place in your neighborhood that you lived in [for] most of your life, and [that] your children [were] raised [in],” says Calsolaro, who’s now 71.
Many other older adults will eventually be forced to make similar life changes. For those whose homes no longer support them as they age, the idea of aging in place must change.
“As the population is aging, we are recognizing and seeing that this one-size-fits all approach doesn’t really work,” says Trista Bercarich, founder and CEO of the Age-Friendly Policy and Program Institute, a consultancy on implementing age-friendly programming.
There’s opportunity in the challenge, too, says Harrell, such as widening the term to encompass as many interpretations as possible. “We want to widen the range of options that people have,” he says. “The more options we have, the better off we are.”
What a Widened Lens Looks Like
“I like to think of it as having the freedom to stay in your home or community—if that’s what you want to do—and not being forced to move into an institutional situation or somewhere that you don’t want to move,” says Harrell. “To me, aging in place is about a freedom that is given to the individual, to stay safely [and] healthfully and [to] be able to thrive where they are.”
Whether that’s in their current home, another home in the same neighborhood, or even a home across town or across the country, says Harrell, the most important consideration is the rest of the ecosystem: “Whether you’re in a small town, a suburb, or a big city, it’s ideal to have a home in a location that has multiple transportation choices—whether you drive or not—[and] that’s near parks and libraries and grocery stores so that you can be healthy and connected.”
I like to think of it as having the freedom to stay in your home or community—if that’s what you want to do—and not being forced to move into an institutional situation or somewhere that you don’t want to move.”
Rodney Harrell, vice president of family, home, and community for AARP
Advocates for older adults largely agree with this interpretation.
“Our term is ‘aging well at home,’” says Sandy Markwood, CEO of USAging, a national advocacy organization and member association of older adult service providers. “There’s the housing component, and then there’s the services and community support component. On the housing side, does [the] house meet their needs? … Does it need modification? Does it need repair? How can you make it meet their needs? [And] then on the other side of it, how can you marry the housing supports with the services that an older adult may need over their journey of aging so that they can remain safely and independently living there? It sounds like a simple concept, but there’s multiple complexities to it.”
The stress, Markwood says, should not be on keeping older adults in their homes at all costs, but rather on supporting them to remain in—and part of—their communities, which could include providing chore services, medical transportation services, home-delivered meals and medications, social engagement activities in the community, or even lifelong learning options.
“The goal is to help older adults live well at home and in the community, with dignity, independence, safety, and purpose—to age as well as they can with the support that they need to do that. That’s where we’re coming from: It’s supporting people’s health, but [it’s] also supporting their well-being,” says Markwood.
The ideal, then, is to provide older adults with as much agency as possible for as long as possible. But that looks different across this vast and diverse segment of the aging population, given people’s varied needs, expectations, socioeconomic and cultural factors, and community infrastructure.
The older adult tenants Nevarez serves in Los Angeles, for example, cannot be treated as a monolith, but they do have one thing in common. “Not all of them are on [a] fixed income [or] are dealing with costly medical issues,” she says, “but they are all worried about what will happen when they get to that point, because stable housing is not, in fact, the reality for them.”
“Stable” is also the operative word for aging advocates. Bercarich defines aging in place as any stable housing situation that keeps older adults connected to their community and to what’s familiar to them. “For me, [it] means maintaining those comforts,” she says.
As a consultant for aging service programming, Bercarich prioritizes keeping patients in their homes, but that raises ethical and practical issues as older adults age out of independence.
“That’s something that people leave out,” she says. “It’s like, ‘I want to make Mom and Dad happy. I want them to age in place.’ OK, but what does that look like? In reality, are you guys able to step into that caregiver role and meet the needs of [your parents] in the home? It’s a nice want, and it’s a nice definition, but in reality, what does that look like?”
Not all of them are on [a] fixed income [or] are dealing with costly medical issues, but they are all worried about what will happen when they get to that point, because stable housing is not, in fact, the reality for them.”
AmyLinda Nevarez of Strategic Actions for a Just Economy (SAJE)
“There’s still a huge burden that falls on family and friends to do this care,” says David Grabowski, a professor of healthcare policy at Harvard Medical School who researches long-term and post-acute care—particularly nursing homes. “Although that care is free from a healthcare perspective, it’s not free from a family perspective. If I’m caring for my loved one, I’m not working or earning money, and so there’s a tension there.”
That’s assuming older adults have family nearby to support them, says Nevarez. Many of SAJE’s older adult members live alone and must advocate for themselves. But even for those who do have family nearby, the question of long-term care isn’t an easy one. Nevarez herself is a renter, and among her peers, few believe they are stable enough to be caregivers. “Are they going to move in with us? Are we going to now enter the housing market and try to find a house to buy? That’s out of the question for a lot of us, especially in Los Angeles,” she says. “It’s just not feasible.”
“We want people to age in place, but we also want to give them the supports to age in place,” says Grabowski.
For older adults with intensive care needs, Grabowski doesn’t want to entirely discount institutional care as an aging-in-place option.
“Researchers have done surveys, [and] most people say they’d rather be dead than be in a nursing home,” he says. “Nobody wants to go to a nursing home; we all want to stay in our homes. And I, like everyone else, agree with that.”
Still, he says, “The dichotomy shouldn’t be, ‘My home where I have a high quality of life’ versus an ‘institution’ that is not associated with a higher quality of life.”
For him, aging in place means aging in whatever environment guarantees a high quality of life and a high quality of care—and that shouldn’t rule out care facilities. “All of us want to stay out of nursing homes, but we want to give people the long-term care supports to do that, and we should also invest in making nursing homes more home-like, such that it isn’t, ‘I’ll do anything to stay out of there,’ but rather, ‘If my care needs evolve to the point where I’d be best served in a nursing home, it is in a place that feels like my home.’”
Admittedly, Grabowski says, dominant nursing home models—which still draw from their hospital-style roots to mirror a clinical setting—aren’t “consumer directed,” meaning their design and operations meet the needs of the institution, not the needs of the resident. But other models exist, he says, pointing to the Green House model, a “person-centered” care model featuring small, residential‐style houses located in community neighborhoods and staffed with caregivers, where residents can dictate their own daily schedules, activities, and meals.
Alternative models like this are rare and seldom covered by Medicare, but it’s one example that extends the idea of aging in place beyond the family home. Importantly, this model doesn’t isolate older adults from the community and incorporates their agency.
“To me, aging in place means aging in a home-like environment where I feel safe and well supported, and [where] I’m able to do all the things that make life worth living,” says Grabowski. Otherwise, he says, “What does it mean for me to age in place in my house or my apartment if I’m isolated and lonely and don’t have supports or caregiving? Is that really the ‘right’ place for me?”
Investing in the Future
Only 21 percent of older adults surveyed by the Pew Research Center have long-term care insurance that would help cover the costs of in-home care or care in an assisted living setting. This is why Markwood believes the smarter investment is in community infrastructure.
“From an economics perspective, the cost of home- and community-based services—if you were getting multiple services— is $40,000 a year, compared to the price of a nursing home, which is $110,000 and up. It’s not only what people want, [but] it’s also the right thing to do economically.”
[RELATED ARTICLE: Massachusetts Advocates Push for Medicaid-Funded Assisted Living]
But such an investment requires political will to influence policy, which Markwood identifies as a persistent challenge. “From a policy perspective, we’re not supporting older adults to live well at home, and [we’re] also not supporting their caregivers, who are the backbone of the long-term care system in this country,” she says.
Nevarez is seeing similar political inertia on the housing front. “I feel like I’m running around in a burning building, saying, ‘Everybody, the building is burning!’ and everyone says, ‘We’ve got some time, we don’t want to leave the building right now.’”
She suspects ageism is at play, a stubborn culprit that advocates of older adults have long identified—even among older adults. “Everybody wants to live a long life,” says Markwood, “but nobody wants to age.”
Grabowski also points to ageism as a reason the issue of threadbare care infrastructure hasn’t penetrated national policy conversations. “Every family has dealt with these issues, but for whatever reason, it never rises to a major political issue,” he says. “It’s never raised in presidential debates. It very rarely comes up in a State of the Union address. There are a few bills in Congress every cycle, but there’s never a ton of momentum around them. By and large, long-term care just goes under the radar.”
From a policy perspective, we’re not supporting older adults to live well at home, and [we’re] also not supporting their caregivers, who are the backbone of the long-term care system in this country.”
Sandy Markwood, CEO of USAging
Part of that reason, says Bercarich, is that older adults aren’t as visible in society to advocate for their needs—and, in turn, to prompt policymakers to address them. “It’s out of sight, out of mind,” says Bercarich. “When you have a frail older adult, and you don’t see them in the community, it’s really easy to forget about them. There’s been a really big loss of the human element [in] so many things.”
That’s why community-based services are so essential, Markwood reiterates: to keep older adults integrated into their communities. “By keeping older adults at home and in the community, you’re enriching the fabric of the community based on the time, talents, contributions, and wisdom of a major portion of your population.”
When asked whether he plans to age in place in his current condo in Massachusetts, Calsolaro replies, “I hope so.” He doesn’t plan to move again, but he leaves the door open to the possibility as life changes.
“It’s hard to predict the future,” he says. “My advice would be for people to look around and start doing things a little bit ahead of time.” This includes assessing whether one’s home is accessible as is or requires modifications—or, in Calsolaro’s case, finding a more accessible home elsewhere.
Advocates for older adults echo this sentiment, lamenting that Americans are not better prepared for this part of their future.
“We don’t plan for aging. We don’t even discuss aging until it’s a crisis, and that’s the worst time to ever intervene,” says Markwood. “People just don’t have a clue about planning for their own aging. And because of that, they’re just not valuing [it]. I hope that we start looking at aging as [part of] the fabric of life, instead of a throwaway time period at the end.”
When you have a frail older adult, and you don’t see them in the community, it’s really easy to forget about them.”
Trista Bercarich, founder and CEO of the Age-Friendly Policy and Program Institute
That shift may already be underway as questions about how to support the aging baby-boom generation moves to the forefront. Harrell of AARP spoke with Shelterforce fromthe American Planning Association Conference in Detroit, where he was heartened to hear how many urban planners, mayors, and policymakers brought up aging. “They’re thinking more about aging and how to make their communities work for people of all ages,” he says.
In many ways, the conversation reflects ideas that housing, disability, and community development advocates have raised for decades: that a person’s health and well-being are shaped not only by medical care, but by whether they have safe and stable housing, reliable transportation, accessible social amenities, walkable communities, and support for caregivers.
“Aging is really a story about the future, about [whether] things that work for folks today will work for folks tomorrow,” says Harrell. “If we put aging in as part of our future-oriented mindset, we’ll do a better job of meeting everybody’s needs.”
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