What makes a good life in late life? And what role might housing and the built environment play in efforts to help older people have that life?
Over the past two years, I have had a unique opportunity to discuss these questions with experts in medicine, gerontology, public health, planning, philosophy, and other fields brought together by the Hastings Center, an interdisciplinary research center focused on bioethics. As part of that initiative, the Hastings Center recently released What Makes a Good Life in Late Life? Citizenship and Justice in Aging Societies, a special report featuring essays by many of those experts, including one that I co-authored with Ann Forsyth, a professor of urban planning at the Harvard Graduate School of Design.
The report, which explores the ethical dimensions of an aging society, starts from the premise that important ethical considerations for older populations are not limited to those involving medical treatment and end of life care, but include broader enquiries into society’s role in supporting a good life for older people, even in advanced age and with its associated frailties and conditions. Understanding that our homes and neighborhoods help shape older adults’ chances for health and fulfillment, the initiative’s organizers asked Ann and me to participate in the convenings and contribute a chapter on “Housing, the Built Environment, and the Good Life.”
As we note in our chapter, affordable housing located close to needed services, employment, and social connections is fundamental to physical health, emotional wellbeing, and participation in society and the economy for people of all ages. But these can be particularly important for older adults, a majority of whom spend most of their time in their homes. Disabilities and frailties arising with age underscore older adults’ need for accessible and safe housing, while falling incomes in retirement can exacerbate the already great affordability problems experienced by many older Americans. Moreover, for many older adults, their current home is not only a platform for daily life but an important repository of family memories.
Well designed and well planned neighborhoods are also important, though in the public realm, streets, parks, and transit must meet the needs of all ages and abilities, including those across the spectrum of older adults. This can be challenging, but ensuring that even those with frailties and disabilities are welcomed into public spaces is an important aspect of a good life and a just society. Adding further to the challenge of ensuring our communities are supportive of older adults is that fact that in the US, over half of those 65 and over live in what we consider low-density locations, which pose greater challenges for service delivery and for those who have curtailed their driving. Loneliness, which is itself a health risk, is a significant concern for all older adults and, while this risk is not limited to those in low-density locations, it can be exacerbated in these settings.
The conversations and other essays in the new Hastings report highlight the need for diverse fields to work together to ensure a good life for our growing older population. As an example, as the home increasingly becomes the site of long-term care delivery – and at times the delivery of medical care itself – there is an imperative for housing and medical communities to understand the challenges and policies that drive each field, as well as the field-specific terminology and acronyms that otherwise inhibit communication. Those of us thinking about housing for older adults and how to prolong independent living at home also need to consider where caregivers live, particularly those who are paid little and have few housing and transportation options themselves.
Perhaps most importantly, the Hastings report and the conversations leading up to it remind us of our ethical obligation to ensure that older adults (and people of all ages) have safe, affordable housing because doing so is part of a just and moral society. Understandably, “good” housing is often understood in terms of economics; for example, in analyses showing that it is generally less expensive to provide suitable housing than to support those without it, or the argument that suitable and affordable housing often provides a base from which people can participate in and contribute to the economy.
But if we rely too much on economic arguments, we can lose sight of the ethical dimensions of providing appropriate housing and creating healthy neighborhoods. As our communities age, this is a time to reflect and act upon the extent to which we support housing choice, quality design for people of all life stages, affordability, neighborhood infrastructure, and local supports and services – all in the service of a more equitable and just society, where housing need not be a barrier to the good life but an integral part of it.
On November 14, 2018, the Joint Center will release a new report: Housing America’s Older Adults 2018.