Jane Louise Nichols, PhD, High Point University, High Point, NC

Abstract

The influence of the American Association of Retired Persons (AARP) continues to evolve, from a mission to adequately house struggling retired teachers in 1958, to directing legislation for the Older American’s Act in the 1960’s, to leading a multi-phase national initiative to create more Livable Communities globally. Decades of research and activities of AARP’s Public Policy Institute informed and guided these efforts. Understanding the origins and ultimate destination of these endeavors is imperative to benchmarking and assessing our progress in housing, quality of community life for the elderly, and forging new pathways to the future.

AARP turned 60 this year. In 2012 it joined the World Health Organization (WHO) Global Network for Age-friendly Cities and Communities “to meet the needs of older residents… and promote health and active ageing”. The national nonprofit, nonpartisan, social welfare organization demonstrates a progression from local, grass-root human issues to universal solutions for effectively housing humans. AARP partnered with WHO through its’ Network of Age-Friendly States and Communities (NAFSC). The national network has since enlisted 3 states and 305 communities in the “Livable Communities” movement. The WHO Global Network connects 1000 cities and 39 countries, affecting over 200 million people worldwide. AARP has incrementally advanced policy that improves the lives of older persons, beginning with the work of one teacher in California, and now operating on a global scale.

The author explores the eight domains of AARP’s Livable Communities and identifies the top-ranked communities. Readers discover how the AARP Livability Index assesses strengths, weaknesses and opportunities to strategize for community livability improvements. An Action and Implementation Plan for a diverse region of 140,000 residents in North Carolina outlines how the AARP Livable Communities framework translated to the 2017-2022 Orange County Department on Aging’s Master Aging Plan. The work of the AARP between 1958 and 2018 is celebrated for its contribution to improved quality in housing and civic life for elderly persons in America.

Introduction

As the Environmental Design Research Association (EDRA) turns 50, this year the American Association of Retired Persons (AARP) turns 60!And just as EDRA’s mission begins to transform for its next half-century, the influence of the American Association of Retired Persons continues to transmigrate, from a mission to adequately house retired teachers in 1958, to directing legislation for the Older American’s Act in the 1960’s (www.aarp.org ‘j’, 2019), to leading a multi-phase national initiative to create more Livable Communities (www.aarp.org’k’, 2019). AARP has embarked on efforts to make our environment more livable for ages 8 to 80. In 2012, the AARP, a nonprofit, nonpartisan social welfare organization joined the World Health Organization (WHO) Global Network for Age-friendly Cities and Communities (NAFSC) “to meet the needs of older residents… and promote health and active ageing”(www.who, 2019). The evolution of this organization demonstrates a progression from local, grass-root human issues to universal solutions for effectively housing humans. The WHO seeks to inspire and support communities in identifying and implementing evidence-based solutions to the built environment. The Global Network connects 1000 cities and 39 countries, affecting over 200 million people worldwide. Domestically, the AARP Network has enlisted 3 states and 305 communities in a Livable Communities movement that is shifting the paradigm for housing in America. AARP has incrementally advanced policy that improves the lives of older persons, beginning with the work of one teacher, and now on a global scale.

Origins

In 1947, Dr. Ethel Percy Andrus was appointed to the California Retired Teachers Association (CRTA) ‘committee on retired teachers’ welfare’. On a cold, rainy day, Dr. Andrus was contacted by a neighborhood shopkeeper who had read about her committee appointment and thought Dr. Andrus ought to check up on a woman in his neighborhood who may need food, eyeglasses and teeth. Andrus discovered the elderly woman living-not in the well-kept bungalow at the address that was posted, but rather in a chicken-coop shed behind it. The retired teacher living in the dark, sagging wet shack didn’t invite the Doctor in but rather suggested they sit and chat in Ethel’s dry car. The conversation described a thrifty teacher who saved her earnings to buy land to later build on with her $40 per month teacher retirement funds. But destructive flooding and the Depression washed away her opportunity and her home. She had to make do with what she had, but did so with grit and determination. This chance meeting was a catalyst for Dr. Andrus to learn all that she could about the hardships and challenges of aging, and how we could help others maintain dignity, comfort and security as they age (www.aarp.org ‘d’, 2019). She envisioned older Americans leading independent, purpose-driven lives, and she championed for older persons’ rights through financial security and adequate housing. To achieve these goals, Dr. Andrus used her persuasive and grassroots organizing skills to unite independent state organizations across the US, and founded the National Retirement Teachers Association (NRTA) in 1957, to tackle the challenges of health insurance and economic difficulties for aging people. Dr. Andrus testified before the House Ways and Means Committee in 1953, stating that the income taxes paid by retired teachers left many of them indigent and hopeless. Congress passed the NRTA supported bill (www.aarp.org ‘e’, 2019) that shielded up to $1200 of retirement pay from federal income tax for those retirees not receiving Social Security.

Ethel’s vision for a national retirement home for teachers manifested 80 miles from Los Angeles in 1954, through Andrus’s dedication and passion, as a new model of communal living, “for the creation of new days, new futures and the expansion of old enthusiasms” (www.aarp.org ‘f’, 2019). Grey Gables, built in Ojai, served as a dynamic prototype for the ‘last third’ of life, and was highly differentiated from an ‘old folks’ rest home’. At Grey Gables, no one would live in isolation, be lonely or feel that their life was over. They would continue to engage with community through the arts, theater, historical and cultural lectures and business and local Ojai political organizations. Residents would take or teach classes at the community center, using their experience and knowledge in outreach to the community and its churches, schools, libraries and museums. Grey Gables would not be subsidized by the government, but would be financed and managed by the retired people living there. Grey Gardens contained 75 residential units across 14 mostly one-story buildings. A 25-bed nursing home was built to accommodate Grey Gables residents, and in 1967 fifty independent-living apartments were added, including studios, and one and two-bedroom units. The linkage in resident-type was a forerunner to the continuum of care models seen in assisted living today. There were also common spaces where residents shared family-style meals, and recreational buildings with hobby and game rooms, as well as outdoor shuffleboard courts, a heated swimming pool, and connections to nearby nature walks, bike paths, and numerous outdoor and indoor activities, all within in easy reach. Grey Gables, in many ways, was an early, uniquely American version of the Danish cohousing model bofaellsskaber(Mccamant & Durrett, 2011).The costs of Grey Gables were subsidized by Dr. Andrus’ generosity and made possible by low interest rates during the 1950’s. An entrance fee of $5000-7500 was linked to a “life care: contract at a permanently fixed monthly fee of $135. The majority of residents were women, and the quality of the environment and connections to others resulted in longer life expectancies, until the rate of inflation eroded the ability of the facility to maintain the low residential payments, leading to the sale of the property just to cover expenses. “Grey Gables helped change the very image of retirement years and became a model for future retirement communities nationwide” (aarp.org ‘f’, 2019).

Driving policy

Older Americans prior to 1965 were not entitled to Medicare or other health insurance programs, with many insurance companies denying coverage based on the increased health risks associated with aging. So concurrent with launching Grey Gables, Ethel Percy Andrus was beating the pavement to negotiate with insurance companies who would offer affordable health care insurance for people over 65. Forty-two companies declined to offer the low rates she insisted on for this population that was considered high-risk. A courageous agent at Continental Casualty Company named Leonard Davis decided to play the odds, and they set up a pilot program for New York members of NRTA. The successful $5.00 per month plan that took effect in July of 1956 was the first nationwide health plan for a large group of retired people, enrolling 5000 members in its first year. When hundreds of letters from non-educators seeking affordable health insurance flooded in, Andrus told Davis she wondered if they could create an organization for all retired people in California. Davis asked, “Why not think about doing it on a nationwide basis?” (aarp.org ‘c’, 2019). Andrus and the NFRT leadership moved forward with plans to create an organization open to all Americans over 55 years, and the American Association for Retired Persons was incorporated on July 1, 1958 with a new purpose.

Themission of the newly transpired national AARP was to “enhance the quality of life for older persons; promote independence, dignity and purpose for older persons; lead in determining the role and place of older persons in society, and, improve the image of aging” (www.aarp.org ‘i’, 2019). Dues for membership in AARP in 1958 was $2.00. That fall, AARP published its first magazine called Modern Maturity.What Dr. Andrus and her colleagues at AARP came to realize was that critical to the security and quality of life desired for all retired persons was a regular income that could pull older people out of poverty. Simultaneously in 1952, the ideas for health insurance for SS beneficiaries were a point of serious discussions in Congress. In 1957 Ms. Aime Forand, democratic congressional representative from Rhode Island, introduced a bill that would provide hospital insurance. Congress held hearings in 1958 and 1959, but met with strong opposition and made no legislative progress. With the organization of the AARP behind Dr. Andrus, she again presented to the House Ways and Means Committee with a compromise to the Forand bill-AARP’s proposal. The revised bill offered broader coverage and answered the objections that had been posed by private industry and medical professionals. However, it was also defeated. It again was introduced, argued and defeated in 1960. ButDemocratic Senator John F. Kennedy of Massachusetts used a program of hospital insurance for the elderly, called “Medicare” as a key issue in his campaign bid for US President. President-elect Kennedy closed his first White House Conference on Aging speech with an ask for support for Medicare. Medicare was introduced in Congress the next month. Between 1961 and 1965 bills were introduced and reintroduced, and hearings held. AARP testified at these hearings, but political gridlock still blocked progress toward passing the bills. When Lyndon Johnson was elected in 1965, the path had been paved for Medicare’s passage. AARP recommended revisions that made Medicare fairer and stronger, and lobbied to ensure coverage for all older persons, not just social security beneficiaries. AARP also demanded that Medicare be administered through the Social Security administration(www.aarp.org‘i’, 2019). AARP remains one of Medicare’s staunchest supporters, advocating for the affordable coverage that American seniors have come to rely on.

Leadership

While the 1960’s were a time of political muscle-building by the AARP, it was also exploring housing and the daily-life challenges the elderly faced in their current homes, even as these seniors willfully determined to age in place. To educate the public and to bring this issue to a dialogue occurring at the highest levelof government administration, in 1961 AARP built a show-house in Washington, D.C. It provided options for safety and style and incorporated principles of universal design throughout. The house included grab bars in bathrooms, non-slip floors, wider hallways and other options appropriate for seniors, and served as a showcase to delegates of the first White House Conference on Aging. The “House of Freedom” was so named because of its capacity to free residents from “household drudgery, from poor lighting, from dangerously slick floors or stairways, [and] from expensive housing expense” (Quote from show-house builder, www.aarp.org ‘g’, 2019). Some of the Freedom House features included: Zero-step entrances, electrical outlets at 18” above the floor, a dressing seat next to the bathtub, pull-down light fixtures, lowered upper cabinets and sink, perimeter heating for floors and a wide roof overhang for rain protection. The Freedom House presented an early model of universal and inclusive design for aging in place, and brought the issues of appropriate housing to the forefront of public policy in a visual and hands-on way that supplemented AARP’s extensive data and statistics (www.aarp.org ‘l’, 2019).

Throughout the 1960’s and ‘70’s, the AARP expanded its reach and leadership in this country. The AARP Institute for Lifelong Learning was launched in 1963 to provide a variety of educational options for seniors in Washington, D.C., from secretarial skills, English and speech to photographic arts and crafts and international relations (ww.aarp.org ‘h’, 2019). The program, considered by Dr. Andrus a “great experiment”, was so widely embraced it soon expanded from California to Florida. The 1964 New York World’s Fair hosted the first pavilion dedicated to vibrant healthy aging, and named the exhibit Dynamic Maturity(www.aarp.org ‘b’, 2019). The entrance to the building proposed a vision of agelessness via a twenty-foot diameter sun dial sculpture designed by Herbert Feuerlicht. Landmark legislation was signed on December 15^th, 1967, as President Lyndon B. Johnson autographed the Age Discrimination in Employment Act (ADEA), which received significant backing from AARP, repositioning a national culture from turning 55+ persons away from applying for jobs to honoring the experience senior workers can bring to employers. The Act banned all age-based discrimination against persons 40-65 years old in hiring, wages, promotions and layoffs (www.org ‘e’, 2019).

One of the most lasting and expansive initiatives that materialized from the educational leadership and comprehensive literature that AARP produced through their research on aging was the birth of the first school for gerontology formed at the University of Southern California. The Ethel Percy Andrus Gerontology Center was converted to the Leonard Davis School of Gerontology. “The USC Leonard Davis School was established in 1975 through a gift from Leonard Davis, a pioneer in the development of insurance for older Americans” and a cofounder of AARP (USC, 2019). The USC Davis School’s mission of “innovation in research, education and practice” continues today, as they host an annual conference on aging, and recently launched the Morton Kesten Universal Design student competition(http://gero.usc.edu/udcompetition, 2019).The membership age for AARP was dropped in 1984 from 55 to 50, but the core mission remains: “to empower people to choose how they live as they age” (ww.aarp.org‘h’, 2019). The bimonthly magazine, published since 1958, was renamed from Modern Maturity to AARP The Magazine in 2003. As of 2018, the AARP has 38 million members, and continues to grow.

Expanded horizons

Since AARP joined the World Health Organization (WHO) Global Network for Age-friendly Cities and Communities (GNAFCC) in 2012, they have forged pathways to develop age-friendly cities, towns, counties and states, concentrating on the factors that impact health and well-being of seniors. Social, economic, environmental and public policy factors have been the core of AARP’s drive toward better quality of life for older adults. Personal isolation has been identified as a social determinant of health, and the places where we live our lives can enable our connections with others, or can inhibit social interaction.

The not-too-distant 2008 housing crash decreased many seniors home equity, and the wait to sell a home while holding out for the value to return can hamper an older person’s or couple’s ability to downsize. Additionally, many seniors with flat retirement incomes and increasing health care costs use more than half of their income, primarily from Social Security, to pay down debt load. The number of retires who file for personal bankruptcy is growing (Greenhalgh-Stanley and Rohlin, 2019). The current housing retirees live in may also be ill-suited for mobility, require burdensome maintenance and be far too expensive for them (Brinig and Garnett, 2013).

Adults living alone in the US account for nearly 30% of households, but the housing stock has not responded to a changing demographic and provides few affordable alternatives for seniors. While survey after survey have concluded that older adults prefer to age in place in their homes, living alone may actually be less desirable than it is a default scenario. Paul Luken and Susan Vaughan, (2003) posit that the national discourse of how elderly women speak of their housing situation and their preference for independence through living alone may in fact be impacted by how capitalist institutions have defined traditional roles for women by their relationships (as wives or widows, mothers or grandmothers), rather than a reflective assessment of their housing options. These women proudly declare living alone as a symbol of their independence, but may in fact prefer living among others-but without the traditional burdens of family obligations and demands. Their preference for ‘living alone’ is restricted by their limited perceptions of what housing alternatives exist, and what has become ‘normalized’ for elderly women; either living alone to age in place (alone) or move to a congregate care facility. Growing old alone in the single-family home has become the socially accepted default. However, clustered housing in multifamily homes, particularly well-suited for paring with home-care, is a practical response to the aging-in-place demands of the elderly, allowing low-income and moderate-income individuals, even those with frailties, to maintain their health and independence (Prosper, 2004). Shared housing is yet another alternative that is being explored now more than ever, as aging residents seek to share living spaces, amenities, household duties and expenses. They often form lasting friendships and co-caring through home-sharing, an added boost to their personal wellness (Airbnb.com Report, 2016).

Based on AARP’s national surveys of older citizens (1989, 1992), original multifamily buildings designed for people of all ages, have in fact morphed to include large proportions of residents 60 and older, creating Naturally Occurring Retirement Communities (NORC’s). The substantial number of older persons who have elected to remain in multifamily developments provides evidence of a growing preference to age in place with multiple age groups. This is a housing choice being made with frequency, and may motivate housing researchers, policy-makers and developers to explore multi-family housing as a viable alternative to senior-restricted housing for the many elderly who lack significant financial resources, either as renters or homeowners (Prosper, 2004).

By 2035, the United States will be a country comprised of more adults than children. According to the U.S. Census Bureau, there will be 78 million people 65 and over, with 76 million under 18 years old (http://factfinder2.cecsus.gov/March 2017). Since 1950, the development paradigm has favored families with children, as the baby-boom drove the housing need and dictated our zoning frameworks and building regulations. The market became dominated by single-family detached homes dependent upon the auto and freeway systems to transport workers from residential zones to commercial or industrial zones. For older adults who wish to age in place in their existing homes, the reliance on driving or being driven is a detriment to an independent, affordable lifestyle, and often results in social isolation. The aforementioned communal living typologies can enhance independence and shared care-giving and are emerging as popular alternatives, even though these are not new.

Livable communities

While the AARP today will not be investing in Grey Gables across the USA, it is compelled to help communities “assess their residents needs through an age-friendly lens” (www.aarp.org ‘f’, 2019). As of April 27, 2019, 4 states and 363 communities nationwide are members of the AARP Network of Age-Friendly States and Communities. Communities commit to a five-year planning and implementation process, culminating in an action plan to address eight Domains of Livability (www.aarp.org ‘a’, 2019).

• Outdoor Spaces and Buildings: Provide people with gathering spaces indoors and out, as well as safe streets, parks and sidewalks with outdoor seating and accessible buildings.

• Transportation: Public transportation options from train to bus to targeted taxi that can supplement or replace driving.

• Housing: Diversity in housing at different life stages, affordable options and homes that are appropriately designed or modified to enable aging in place.

• Social Participation: Affordable, accessible, interesting social activities can counter loneliness and encourage social interaction, known to improve a person’s health and wellbeing.

• Respect and Social Inclusion: Intergenerational activities and spaces that honor all ages and enable each to learn from and enjoy one another.

• Civic Participation and Employment: An age-friendly community offers active engagement opportunities in the community, through work, volunteerism and civic engagement.

• Communication and Information: Information needs to be disseminated and delivered via a variety of means for those without internet access or smart phones.

• Community and Health Services: Nearby care that is accessible and affordable is essential to residents facing declining health.

One of the features that makes a community livable is housing alternatives that meet the changing needs of residents as they age. AARP’s efforts assist communities in diversifying their housing stock, through sharing information and technical support, lobbying legislators, working with public policy makers and encouraging civic engagement. But livability is multi-faceted. Convenient transportation, walkability and safe streets, accessible nearby amenities and healthy food choices, and opportunities for employment and education are some of the elements that comprise livability. The AARP Public Policy Institute developed the Livability Index (www.aarp.org ‘m’, 2019), utilizing the Domains of Livability and the indicators of the GNAFCC to establish measurements of livability for American communities across seven categories: Housing; Neighborhood; Transportation; Environment; Health; Engagement, and Opportunity. The web-based tool and the Livability Index website provides resources for community residents, organizers and leaders to assess livability for a neighborhood, city, county or state. It is an instrument with which to gather data, stimulate dialogue, catalyze agendas and create action plans to improve livability for communities.

The Livable Communities Index uniquely represents AARP’s missionWhile livability is important to all ages, older adults are more keenly impacted by their communities for a variety of reasons. Mobility challenges necessitate accessible transportation and homes, seniors on fixed incomes require affordable and diverse housing options, they also benefit from nearby senior centers, doctors and stores. Many older residents want to engage with and continue to contribute to their communities as they age. The Livability Index was created using over fifty sources of data. Forty metrics and twenty policies are at the index’s core. Twenty-three metrics assess livability at the neighborhood scale (block, tract or high school district), with the others rely on data from higher geographic levels (city, county or metro region). The scoring is built from the neighborhood level up, with a perfect score (not likely achievable) of 100. Scoring across categories demonstrates the actualities of the built environment, for example, a transit-rich neighborhood will score high in transportation, but gentrification near the transit stations may drive up real estate prices, making housing less affordable. To achieve a better balance that nets a higher livability score, the community would need to increase affordable housing near public transit.

There is a Roadmap to Livability that outlines the steps to achievement (www.aarp.org ‘m’, 2019). After assembling a team, invite stakeholders, gather information and identify priorities. Then write the Action Plan’s mission, values and goals, and develop the Plan’s strategies and tactics. Determine the evaluation process, and launch. The data gathering stage begins with a livability assessment. In addition to secondary data, the community is surveyed using the Livable Community Asset Inventory. For the purposes of this paper, we will briefly examine the efforts of two states toward Livable Communities; New York and North Carolina. New York is a member state of the network since 2017. Nine counties have signed on, as well as 13 towns and cities. About half of these have completed the assessment and have created Action Plans. Several are in Implementation stages and several have published Progress Reports. North Carolina is not a member state. Two towns, one city and seven counties are members, joining between 2016 and 2019. Matthews and Orange County have both completed assessments and Action Plans. The Action Plan of Orange County, where the City of Durham is located, will be scrutinized in detail. AARP provides a data-driven score that reveals how livable an area is across more than 60 indicators related to housing, transportation, health and the environment. The score is a great conversation starter on how and where a community can begin to take action to become more age-friendly and more livable.

A comparison of New York City andDurham, North Carolina(www.aarp.org‘m’, 2019):

47 Housing: Affordability and access 56 Housing

82 Neighborhood: Access to life, work and play 51 Neighborhood

91 Transportation: Safe and convenient options 55 Transportation

53 Environment: Clean air and water 64 Environment

50 Health: Prevention, access and quality 60 Health

45 Engagement: Civic and social involvement 58 Engagement

38 Opportunity: Inclusion and possibilities 56 Opportunity

58 Total Livability Score - NYC 57 Total Livability Score - Durham

While the Total Livability Scores are nearly identical, the scores are highly differentiated per category for the two cities. While New York City gets high points for Neighborhood and Transportation, Durham, a city in the ‘Research Triangle’ Combined Statistical Area of Raleigh, Durham and Chapel Hill, is a nuanced balance of scores. Environment, Health and Engagement have a stronger showing, which may reflect the geography and the presence of three major universities in a small area that is driven by health sciences and engineering innovation. However, Durham’s Neighborhood and Transportation scores are over 30 points lower than NYC. There is no mass transit, only a bus system, and the area is served by major interstates and state highways.Durham covers 108 square miles and is the core of the Durham-Chapel Hill Metropolitan area (www.wikipedia, 20190, with a population of 542,710 as of the U.S. Census in 2014, while the Research Trianglecovers 7000 acres and has a population of 2,037,430. This makes for a significant travel commute for many who live and work in the Triangle.

Orange County is included in the NC Metropolitan Statistical Area. In 2017, Orange County completed a Master Aging Plan (MAP) after four cycles of strategic planning for the county’s Department on Aging (OCDOA, 2017). This is the first MAP the county created that was based on the AARP Framework of Age-Friendly Community (AFC). The Master Aging Plan for 2017-2022 references the 8 Domains of Livability determined by AARP to impact older adults’ quality of life: outdoor spaces and buildings, transportation, housing, social participation, respect and social inclusion, civic participation and employment, communication and information, and community and health services.The Orange County Department on Aging conducted their MAP Community Needs Assessment from May through September of 2016. Community residents shared their vision for aging in Orange County over the next five years. Sixty-three community members participated in thirteen focus groups held across the townships of Orange County, in English, Spanish and Mandarin. An electronic survey was mailed to all Orange County government employees and a 2000-person listserv provided by the senior centers, with a total of 860 respondents. Guiding questions were: 1) What are you worried about when you thinking about aging? 2) What is Orange County already doing well? and 3) What would you like to see happen? What are some "magic wand" ideas you have? Over the summer of 2016, the OCDOA conducted 34 key informant interviews in 26 agencies across Orange County. Interviews were conducted with stakeholders in county and town government, healthcare, faith-based organizations, and community services. The interviews were intended to ascertain issues concerning the aging residents across various agencies in the county. Work groups were organized around the topics identified from the assessment. Forums included Outdoor Spaces and Buildings and Transportation, Housing, Social Participation and Inclusion, Civic Participation and Employment, and Community Supports and Health Services. Communication and Information, Domain #8, was one that crosscut all the work groups. Groups met between January and March of 2017. An OCDOA staff member of volunteer led each work group consisting of 20-30 community members, sometimes splitting off into smaller subgroups to tackle specific concerns. The work groups researched the topic area, identified the associated problems in Orange County, and formulated objectives and strategies to address the problem and then produced a list. UNC graduate and undergraduate students assisted with note-taking and meeting facilitation during group discussions. Below is a transcript summary of the first three main discussion points of each of the MAP Work Groups (OCDOA, 2017):

Outdoor Spaces and Buildings:• Involvement in planning processes and public schedules • Maintenance of public areas and addition of benches, public restrooms, etc. • Accessibility of sidewalks, especially in rural areas. • Spaces oriented to the needs to older adults Transportation:• Volunteer driving program • Access to transportation outside of Chapel Hill/Carrboro • Coordination between transportation agencies, both public and private, in the Triangle • Planning processes include older adults and their needs • Easy to understand and accessible information about transportation options Housing: • Housing policies and their impact on senior housing • Information for older adults about their options • Long-term care facilities and housing with services • Housing repair and maintenance services for older adults • Affordable and quality housing. Cross-Cutting Issues Addressed by All Work GroupsIn addition to domain-specific issues, each work group was instructed to address four crosscutting issues in its discussion and recommendations. These crosscutting issues included: 1. Communication and information 2. Diversity of the older adult population 3. Intergenerational opportunities 4. Including older adults in solutions.

The Orange County DOA MAP developers explored and defined how they wanted to serve their older adult population, and set Goals and Objectives.

Goals and Objectives The following goals are Orange County’s guiding principles in serving our older adult population. The first three include:

Goal 1 – Outdoor Spaces & Buildings: Optimize usability of outdoor spaces and buildings for older adults; Goal 2 – Transportation: Expand services and improve infrastructure for safe, accessible, and affordable travel within the community, and Goal 3 – Housing: Improve choice, quality, and affordability of housing, including housing with services and long-term care options.

Over the next five years, as Orange County’s Department on Aging implements their goals and recommendations, they will monitor the success of these within each category. For the purpose of this paper, the plan’s reported strategies and indicators shown will only include the domain of Housing. The AARP Age-Friendly Network recognizes that housing is central to livability, and demonstrates that people have different housing needs based on income, mobility and physical abilities. It is noted that while cities are often correlated with high housing costs, the prevalence of subsidized and multifamily dwelling units available to older adults may offset those costs with cheaper housing in rural areas, but with far fewer alternatives and much lower density.

The OCDOA MAP presents strategies for achieving the Goals and Objectives set forth for Goal 3: Housing, and provides Indicators. The Reportalso includes Responsible Agencies (not shown).

DOMAIN: Housing is an important part of safe and comfortable aging in communities.

MAP Goal 3 Housing: Improve choice, quality, and affordability of housing, including housing with services and long-term care options.

Objective 3.1:Modify, eliminate, or create policies that result in full realization of the MAP housing goal.Strategy 3.1.1: Create an inter-governmental Senior Housing Workgroup to study and recommend changes to relevant local and state housing policies, especially during times of key policy reviews. INDICATORS 3.1.1a. A Housing Task Force is developed. 3.1.1b. A list of state and local polices to target is created and changes are recommended.

Objective 3.2: Develop new affordable senior housing (rental and ownership, including supported housing). Strategy 3.2.1: Advocate for incentives and financing that encourages affordable and age-friendly housing development, both conventional and innovative. INDICATORS 3.2.1a. Additional public-private partnerships are developed to increase affordable housing options for older adults. 3.2.1b. Support is provided for senior housing proposals for County Bond funding, if appropriate. 3.2.1c. A pilot project focused on shared, supportive housing models is created. 3.2.1d. One site for development of age-friendly housing is identified in each of the Orange County jurisdictions: Carrboro, Chapel Hill, Hillsborough, and the county. 3.2.1e. Tax incentives are created that encourage accessible housing design and repair. 2017-2022 Orange County Master Aging Plan 25 3.2.1f. OCDOA is consulted with by developers and financers at the conceptual stage to ensure home and neighborhood designs are age-friendly. 3.2.1g. The number of units built that are targeted to older adults is increased by at least 20%. 3.2.1h. The number of age-friendly units built within larger mixed income developments is increased.

Objective 3.3: Modify and repair existing housing for safety and accessibility. Strategy 3.3.1: Increase and expedite repairs and modifications of existing housing. INDICATORS 3.3.1a. The public bidding process for the County Urgent Repair Program is replaced with a newly created and vetted list of approved contractors. 3.3.1b. New pathways for project permitting are developed through collaboration by regulatory organizations. 3.3.1c. Jobs are completed faster for clients in the Urgent Home Repair Program. 3.3.1d. Wait times are decreased for residents needing urgent home repairs. 3.3.1e. Number of accessibility repairs performed is increased. 3.3.1f. Skilled workers who can provide home repair/remodels for community members are identified by Local Fire Districts. 3.3.1g. Managers of existing senior housing developments consult with OCDOA about accessible repairs and modifications.

Objective 3.4: Educate the public about housing options in later life, emphasizing the importance of accessibility, safety, and maintenance. Strategy 3.4.1: Offer community events and educational materials to assist residents and family members in planning for their housing needs in later life. INDICATORS 3.4.1a. Aging in Community series is continued to educate the public about age-friendly housing models, especially “missing middle” housing (i.e., duplexes and small-scale apartments with courtyards). 3.4.1b. Aging Readiness Campaign is created with yard signs, interactive websites, and resources that 2017-2022 Orange County Master Aging Plan 26 can help older adults and family members plan for their future housing needs. 3.4.1c. Residents are educated on how to prevent future need for repairs and modifications, and connected to appropriate organizations and services. RESPONSIBLE AGENCIES: OCDOA, Orange County and Town of Chapel Hill Housing Departments Strategy 3.4.2: Create opportunities to improve relationships between residents, inspectors, and planning officials. INDICATORS 3.4.2a. Orange County Planning Department website is updated to include frequently asked questions. 3.4.2b. Programs are developed to make information about inspections available and decrease misconceptions. 3.4.2c. Programs are developed to decrease misconceptions about partial repairs.

Objective 3.5:Activate the community to support and improve quality of life for older adults living in long-term care settings.Strategy 3.5.1: Engage community volunteers in long-term care facilities and home care services. INDICATORS 3.5.1a. Volunteer Connect 55+ (VC55+) utilized as a clearinghouse of volunteer opportunities for people who are interested in enriching the lives of residents receiving long-term care services. 3.5.1b. Opportunities are created for long-term care residents to get out into the community, with the help of volunteers. 3.5.1c. Nursing Home and Adult Care Home Advisory Committee members promote activities that support resident/staff well-being and that reduce social isolation. 3.5.1d. Community mental health services provided to long-term care facilities are expanded.

Objective 3.6: Support Orange County residents to age in community. Strategy 3.6.1: Create and fund a new OCDOA housing specialist position to educate, activate, and coordinate the community in achieving MAP housing goals. 2017-2022 Orange County Master Aging Plan 27 INDICATORS 3.6.1a. Position is created and filled with support from housing agency partners. 3.6.1b. Older adults are connected to and supported to live in housing options of their choice. Strategy 3.6.2: Collaborate across repair/remodel organizations to better communicate, share cases, and refer to specialized services. INDICATORS 3.6.2a. Network of repair/remodel organizations is developed. 3.6.2b. Collaboration coordinator is selected. 3.6.2c. Representative from each organization is designated to network. 3.6.2d. Referrals are increased across organizations. 3.6.2e. Multiple repairs are provided by multiple organizations through use of coordinated repair network. 3.6.2f. More comprehensive repairs are provided to residents. 3.6.2g. Data are collected and shared regarding safety and well-being of residents who receive home repairs or modifications. 3.6.2h. Funding is increased for repairs and remodels that partially, but not entirely, bring a home up to code. 3.6.2i. Training is developed for OCDOA employees and others who make home visits regarding home safety resources and services.

Orange County expects its population, like the rest of the U.S, to grow and age during its implementation of the 2017-2022 MAP, stretching county services further each year. The OCDOA has committed to actively execute the strategies set forth in the MAP and to enhance the quality of life for its older residents and its families. The DOA suggests that collaboration between agencies and community organizations will be essential to the successful implementation of the MAP, and recommends mechanisms to enable that cooperation. The County DOA also stresses the importance of ensuring that older adults’ voices are heard with respect to all 8 domains, and is critical to fulfilling the MAP goals report (OCDOA, 2017). “With the voice and leadership of older adults in the community, the vision of Orange County as an age-friendly community can become a reality.”

The Master Aging Plan developed by Orange County is a clear blueprint for how to become a livable community, and the detailed Housing Doman portion of the OCDOA’s MAP reflects the vision of Dr. Ethyl Andrus when she championed for older persons’ adequate housing and a secure income back in the early 1950’s. As well, it aligns with the World Health Organization’s Global Network for Age-friendly Cities and Communities’ mission of meeting the needs of older adults by providing adequate housing. Since its inception, AARP has responded to societal change while adhering to its founding principles of enhancing quality of life for older persons. As our population ages and the ways of aging become redefined, the AARP continues to provide leadership, direction and inspiration in reimagining housing to meet the changing needs of older adults and the increasing demands upon cities and communities. This pursuit perfectly aligns with EDRA’s mission “toward improving an understanding of relationships among people, their built environments, and natural eco-systems” (www.edra.org, 2019).

We anticipate the best in research, policy and practice from EDRA and AARP over the next fifty years.

References

AARP.org. ‘a’ (2019). Age-Friendly Network. Retrieved fromhttps://www.aarp.org/livable-communities/network-age-friendly-communities/

AARP.org. ‘b’ (2019). History-1964 World’s Fair. Retrieved from https://www.aarp.org/about-aarp/history/aarp-1964-worlds-fair/#

AARP.org. ‘c’ (2019). History-AARP helps shape Medicare. Retrieved from https://www.aarp.org/about-aarp/history/aarp-helps-shape-medicare/

AARP.org. ‘d’ (2019). History-Chicken Coop. Retrieved from https://www.aarp.org/about-aarp/history/chicken-coop-inspires-mission/#

AARP.org. ‘e’ (2019). History-Founding Days. Retrieved from https://www.aarp.org/about-aarp/history/aarp-founding-days/

AARP.org. ‘f’ (2019). History-Grey Gables Retirement Community. Retrieved from https://www.aarp.org/about-aarp/history/grey-gables-retirement-community/

AARP.org. ‘g’ (2019). History-House of Freedom. Retrieved from https://www.aarp.org/about-aarp/history/house-of-freedom/

AARP.org. ‘h’ (2019). History-Institute of lifelong learning. Retrieved from https://www.aarp.org/about-aarp/history/aarp-institute-of-lifelong-learning/

AARP.org. ‘i’ (2019). History-Modern Maturity. Retrieved from https://www.aarp.org/about-aarp/history/modern-maturity-aarp-the-magazine/

AARP.org. ‘j’ (2019). History-Older Americans Act of 1965. Retrieved from https://www.aarp.org/about-aarp/history/older-americans-act-1965/#

AARP.org. ‘k’ (2019). Livable Communities. Retrieved from https://www.aarp.org/livable-communities/

AARP.org. ‘l’ (2019). Making Room. Retrieved fromhttps://www.aarp.org/content/dam/aarp/livable-communities/livable-documents/documents-2019/making-room-web-spreads-010819.pdf

AARP.org. ‘m’ (2019). Livability Index. Retrieved from https://livindexhub.aarp.org/?cmp=LVABLIDX_MAR25_015

Airbnb.com. (2016) Report:Home Sharing: A Powerful Option to Help Older Americans Stay in Their Homes. November 21, 2016.

Brinig, M.F. and Garnett, N.S. (2013). A room of one’s own? Accessory dwelling unit reforms and local parochialism. The Urban Lawyer, 45(3), 519-569.

Environmental Design Research Association. (2019). EDRA’s Mission. Retrieved from https://www.edra.org/page/missionvaluehistory

Greenhalgh-Stanley, N. and Rohlin, S. (2019). How does bankruptcy law impact the elderly’s business and housing decisions? The Journal of Law and Economics, 56(2), 417-451.

Golant, S.M., Parsons, P. and Boling, P.A. (2010). Assessing the quality of care found in affordable clustered housing-care arrangements: Key to informing public policy. Cityscape, 12(2), 5-29.

Luken, P. and Vaughan, S. (2003). Living alone in old age: Institutional discourse and women’s knowledge. The Sociological Quarterly, 44(1), 109-131.

Mccamant, K.M. and Durrett, C. (2011). Creating Cohousing: Building Sustainable Communities. Gabriola Island, BC, Canada: New Society Publishing

Orange County Department on Aging. (2017-2022). Master Aging Plan.Orange County Department of Aging: Janice Tyler-Director & Mary Fraser-MAP Committee Chair. UNC Bachelor of Public Health Capstone Team. UNC Graduate School of Social Work: Melissa Hunter-Intern.

Prosper, V. (2004). Aging in place in multifamily housing. Cityscape, 7(1) 88-106.

USC University of Southern California. (2019). The Leonard Davis School of Gerontology. Retrieved from https://gero.usc.edu/about/the-school/.

USC University of Southern California. (2019). The Morton Kesten Universal Design Competition. Retrieved from http://gero.usc.edu/udcompetition/.

U.S Census Bureau. (2017). Population 65 years and over in the United States, 2011-2015 American Community Survey 5-year estimates for Orange County, North Carolina. American FactFinder. Retrieved from http://factfinder2.census.gov/. Accessed 30 March 2017.

Wikipedia. (2019). City of Durham, North Carolina. Retrieved from https://en.wikipedia.org/wiki/Durham%2C_North_Carolina

World Health Organization (WHO) Global Network of Age-friendly Cities and Communities (GNAFCC). (2019). Retrieved from https://www.who.int/ageing/projects/age_friendly_cities_network/en/