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Living at home
Americans, we’re told, want to “age in place,” as proven by repeated survey data.
And most of us probably think we know what it means — staying put in the home we raised our children in as we age: “the only way I’ll leave this house is feet first,” as my own father used to say.
But it turns out, it hasn’t always meant this, there is no single official definition, and not all experts even use what we might think is its straightforward meaning.
The CDC definition
At first glance, the term looks obvious: a google search turns up repeated references (for example, at the Rural Health Information Hub, Harvard Health Publishing, and the AARP) to a definition by the Centers for Disease Control:
“The ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level.”
But it’s not that simple.
This definition was not a part of some sort of Aging-in-Place research project at the CDC. It does not come out of a larger discussion of the topic. Instead, that definition comes from a web page called Healthy Places Terminology, and, what’s more, the page itself is stated by the CDC to be inactive, part of the Healthy Community Design Initiative, “no longer a funded program.” In fact, the page was last reviewed on October 15, 2009, and, according to the Internet Archive/Wayback Machine, that page first appeared in 2004, but the Aging in Place definition was not added until the end of 2008, and a broader review of the Healthy Places initiate indicates that the project was concerned not with aging but with community design to encourage physical activity, for example, encouraging sidewalks so that it’s easier to walk to get to places.
And, in fact, if you think about it, this definition of “aging in place” doesn’t really make much sense: what defines being in your “own home” vs. some other living arrangement? If you move to an apartment or a retirement community or an assisted living facility, is your unit still your “own home”? And why does the definition state that “aging in place” is about living “safely, independently, and comfortably”? Don’t plenty of people “age in place,” that is, live in their longtime homes by themselves, without safety, independence, or comfort, when they are homebound and dependent on others?
The AARP, on the other hand, has conducted a number of surveys in which a definition of Aging in Place is implied, if not directly stated: to stay in one’s current home forever, or for as long as possible. The first survey, “Beyond 50.05; A Report to the Nation Livable Communities: Creating Environments for Successful Aging,” dates to 2005 (seemingly; it is undated) based on 2004 survey data, and reports that 84% of those 50 and older, and 91% of those 65 – 74 and 95% of those older than 75, somewhat or strongly agree that they want “to stay in my current residence for as long as possible.” In December 2011, they sponsored a similar survey, “Aging in Place: A State Survey of Livability Policies and Practices,” which addressed a variety of issues related to housing and aging, similarly reports that “According to a 2010 AARP survey, nearly 90 percent of those over age 65 want to stay in their residence for as long as possible, and 80 percent believe their current residence is where they will always live.” In 2018, AARP updated their survey, reporting that 76% of those aged 50 and older and 86% of those 65 or older wanted to stay in their own home. And in another survey in 2021, they asked similar questions, though with fewer age bands, and less detail in reporting, stating again only that over 75% of those over age 50 wanted to stay in their current home.
In all these cases, the AARP makes it clear that to age in place is to remain in one’s home, with the title of the webpage featuring the latest data proclaiming, “Despite Pandemic, Percentage of Older Adults Who Want to Age in Place Stays Steady.” And in all these cases, the reports offer an explicit agenda: government agencies, nonprofits, and adults planning for future aging should all direct their efforts towards making this possible and providing more support for in-place agers.
A generation ago
It also turns out that, going back further (though early studies are hard to find), “aging in place” did not have this meaning at all. For example, in “Changing Concentrations of Older Americans,” an October 1978 article by Thomas O. Graff and Robert F. Wiseman at The Geographical Review, “aging-in-place” was used to describe not a housing decision but the process, at a broader, regional level, that caused a disproportionate share of older persons in certain regions of the country due to the out-migration of younger people for economic opportunity while their parents stayed put, as opposed to regions where the share of older adults was disproportionately large due to their in-migration.
And when Aging in Place was used specifically of housing choices, it did not have the positive framing of the CDC, but was considered to be a negative.
For example, a 1982 dissertation, “Aging in Place: An Investigation of the Housing Consumption and Residential Mobility of the Elderly,” by James David Reschovsky, considers the stability of the elderly, that is, their tendency not to move even when it would be beneficial for them, to be a problem that reduces welfare, or at least an economic puzzle that requires modeling and empirical explanation. Unlike current proposals in support of Aging in Place, Reschovsky’s policy proposals include assistance to elderly households to ease their search for more appropriate housing. Strikingly, he writes, “It may well be that what has been assumed to be a strong attachment for the current home by elderly homeowners is in fact more of a strong attachment to homeownership, and the pride and security attached to it,” and continues,
“The other area where individual counseling and assistance may be appropriate is in helping the elderly household decide whether a move is in its best interests. Many households may need some encouragement and support to make a move, particularly those mentally or physically frail” (p. 175 – 176).
The scholarly literature
Finally, in current academic journals, “aging in place” gets a pretty expansive re-definition.
For example, in “The quality of life of older people aging in place: a literature review,” in 2017, authors Patricia Vanleerberghe et al., write that
“Aging in place used to refer to individuals growing old in their own homes, but lately the idea has broadened to remaining in the current community and living in the residence of one’s choice. Indeed . . . the World Health Organization Centre for Health Development defines the concept broader as: ‘Meeting the desire and ability of people, through the provision of appropriate services and assistance, to remain living relatively independently in the community in his or her current home or an appropriate level of housing. Aging in place is designed to prevent or delay more traumatic moves to a dependent facility, such as a nursing home.’”
Indeed, the authors later claim that Aging in Place is so broad as to include assisted living facilities, which they identify as “a type of supportive senior housing.” As it turns out, these facilities are actually classified by the US federal government as a type of nursing home, or at any rate they have the same “long-term care facility” classification that meant that they had the same Covid lockdowns for their residents every bit as much as for actual nursing homes.
And what’s the point of this redefinition into meaninglessness?
My best guess is that Aging in Place has been determined by the AARP and other “aging experts” to be the right, acceptable way of living as one ages, and has become the unquestioned national or international policy objective. As a result, anyone who might wish to discuss alternatives that are not the very clear “stay in the family home” meaning, feels obliged to stretch the meaning of that term so that they can claim that their alternative is also a form of “aging in place.”
But this clever redefinition has not actually helped experts or government officials figure out the best sort of policies or programs to help the elderly as they begin to have physical or cognitive impairments. In fact (stay tuned . . . ), it’s probably made it harder because “aging in place” has become a party-line that one contradicts at one’s peril!