Given a choice, most people prefer to "age in place" in their homes, but the healthcare system is now largely organized to provide services at clinics and hospitals, a system which is likely to evolve as the population gets older.

Aging in place -- retiring to existing homes where they have lived for many, as most homeowners wish to do -- is best both for an aging person's health and housing needs. That's because aging in place maximizes an individual's independence and capacity for self-help and maintains a senior's social and economic contributions.

According to the study Aging in Place: Coordinating Housing and Health Care Provisions for America's Growing Elderly Population," by Atlanta-based Kathryn M. Lawler, a fellow in the Emerging Leaders in Community and Economic Development at the Joint Center for Housing Studies at Harvard University, health care and housing are increasingly impacted by an aging population.

"The ratio of working Americans to retired Americans will drop from 5 to 1, to 2 to 1 over the next fifty years. Today, the most current connections between elderly health and housing are tenuous at best. As a result, the most desirable and most cost-effective methods of aging -- aging in place -- is difficult, even under the most ideal conditions," says Lawler, whose report echo's another Joint Center study, "Housing America's Seniors. "

Lawler says the services from the current systems of health and housing delivery are not connected enough to meet the needs of aging Americans when they most need them to deliver.

"Health concerns can create or compound the problems of an aging housing stock, and housing concerns can create or compound health problems for aging individuals. When a living environment is affordable and appropriate, an aging individual is more likely to remain healthy and independent. When an individual maintains good health, he or she is more able to keep up with the maintenance of his or her living environment," says Lawler.

To develop more efficient health and housing services, the long-term care system should reflect the interrelationship between health and housing, but instead the long-term care system typically provides too much care or not enough.

"A customized model of care avoids the inefficiencies of over care and under-care by matching services and facilities to an individual's need rather than matching an individual to an existing service or facility," says Lawler, who recommends the following changes.

• Reduce federal, state bureaucracy. Rather than deliver federal funds through separate channels to separate state and local agencies with different jurisdictions, the current isolated budgeting systems should merge in a local or state level agency. This agency would then be responsible for contracting with local or state private or public providers to deliver comprehensive and coordinated health and housing services, eliminating the need for providers to navigate their own way through the separate systems.

• Include housing in revamped care systems. Each state is in the process of examining and restructuring its current community-based term care system as a result of the 1999 Supreme Court Olmstead ruling. The restructuring includes Medicaid and other services but not housing -- a critical component of community-based care. State and local housing providers should be included in the planning process to meet the mandates of the Supreme Court.

• Local, community-based nonprofit organizations should play a pivotal role in developing aging-in-place programs. Because of their front-line community networks and revitalization programs, community organizations can help employ the para-professionals needed for a range of health and housing services from handymen to personal care assistants. They also can be instrumental in injecting aging into the local community planning process by helping the powers that be recognize the benefits of the economic and social contributions of older Americans.

"In over 60 interviews between June and August 2001, with health and housing providers, nonprofits and for-profits, health and housing trade associations and academics, all participants not only discussed their work and expertise in the field of aging, but articulated the story of their aging parents or in-laws, aunts, uncles or neighbors," said Lawler.

They all spoke of the difficulty they experienced navigating the separate systems of health and housing services and the challenges this separation presented to maintaining quality care for their relatives as they continued to age. The public systems of housing and health care do not reflect the interrelationship of health and housing, causing frustration and incurring greater expense for the country as a whole," she added.

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