This article is the third in our series on the future of aging: interviews with people who are experts in their fields and are also visionaries. We’re asking them to talk about what they believe will happen in the years ahead to change the experience of aging.
Henry Cisneros, former US secretary of housing and urban development, believes that in the future, our homes, neighborhoods and cities will be easier for older people to navigate. People will be able to remain in their homes longer—healthier and happier than generations before.
For years, Henry Cisneros watched his father, George, live an active life with limited mobility. A stroke at the age of 59 had left the elder Cisneros without the use of his left arm and left leg. But parts of his house were modified to accommodate his limited mobility. He was able to live there, with his wife, Elvira, in the home and close-knit neighborhood where they’d raised their children, until two years before he died in 2006 at age 89.
We’re living ever longer, but today’s houses, neighborhoods and cities haven’t caught up with that.
Elvira Cisneros continued living by herself in that home until a few months before she died in 2014 at the age of 90.
Cisneros had witnessed his parents attain a modern American dream: living independently in your own home as you grow older—even with reduced mobility. It’s called aging in place. Like most dreams, however, this one often doesn’t come true.
Though life expectancy has increased, today’s houses, neighborhoods and cities haven’t caught up with the times. Even when older homeowners can remodel their houses for changing mobility needs, as Cisneros’ parents did, they still need age-friendly neighborhoods, transportation and services to make aging in place work well. Much of today’s world just isn’t built for the modern old age. So, many people have to move to a retirement or assisted living community.
Cisneros believes this can change—in fact, it must if we want to avoid “disaster” as the percentage of older people in our country continues to grow. That’s because home means more than memories. It means independence, and it fosters mental and physical health.
Cisneros has some specific ideas on how neighborhoods must be different in the future to accommodate all ages. And he feels optimistic that they will. In fact, he says, change has already begun.
The New Dream for a New Old Age
Cisneros, a grandson of immigrants from Mexico, has long been passionate about helping immigrants and people with modest incomes achieve traditional American dreams—things like economic success and home ownership. He served as the US secretary of housing and urban development from 1993 to 1997 under President Bill Clinton. He’s the founder of CityView, a real estate investment firm that focuses on helping build homes for the workforce. And he created the Cisneros Center for New Americans, which trains young people so that they can help immigrants integrate and gain economic achievement in the United States.
But it was as the mayor of San Antonio (1981 to 1989) that he started to become keenly aware of the challenges older Americans in particular faced in modern America. In Independent for Life (2012), a book he coedited that proposes ideas for creating age-friendly homes and neighborhoods, he wrote:
During the years that I served as the mayor of San Antonio and spent many evenings listening to residents in neighborhood meetings across the city, I noticed repeated development patterns related to aging. In the same neighborhoods in which the population was aging, the housing stock was deteriorating and social needs were intensifying. As I listened to the older residents of those neighborhoods, I did not know then that those patterns were local manifestations of what we now know to be the national forces of aging demographics, of physical isolation experienced by many older people, of unaffordable housing, and of diminishing social services funding. Over all these years, the frightened faces and plaintive voices of those older residents have stayed with me and spurred this search for public and private answers.
Three Components of an Age-Friendly Society
Eighty-seven percent of people 65 and older want to stay in their current homes as they age, according to a 2014 AARP Public Policy Institute survey of 4,500 people.
There are some challenges to accomplishing this dream though. After all, old age often brings with it mobility issues. So first, you need a home that’s easy to navigate no matter your abilities. Most aren’t. There are stairs, high cabinets, deep tubs to step over and narrow doorways to maneuver walkers and wheelchairs through.
“… if we can keep people in their homes for longer, they’re happier, and the society saves money.”
–Henry Cisneros
Aging in place also requires a safe, walkable neighborhood or door-to-door services that make up for the lack thereof. Somehow you have to buy groceries, get to doctor appointments and make social connections—even if you can no longer drive.
Beyond the neighborhood, certain other services and amenities can help facilitate independent living. These include nutrition, activity and exercise centers (though you must be able to get to them).
Older people can sometimes address these needs themselves—if they have enough money. Houses can be retrofitted. Drivers and delivery services can be hired. But often elders don’t have the money, or there are other practical concerns, so they must move from the home and the neighborhood they love.
On the Cusp of Triumph (or Disaster)
Federal and city governments (along with businesses and nonprofits) could knock down many barriers to aging in place, and they needn’t do so out of purely altruistic motives. Cisneros argues that by helping older people remain independent longer, the government would save money in the long run. Medicare and Medicaid expenditures on emergency services, medical interventions, facility care and long end-of-life care would decrease, because aging in place would result in a concept called compression of morbidity: staying healthy for a longer portion of your life and then having a briefer period of sharp decline.
“It is my strong conviction,” Cisneros wrote in Independent for Life, “that the physical environment in which older people live—with the security, stability, comfort and psychological nurturing it offers—has a lot to do with staying healthy and independent longer.”
We talked with Cisneros about the changes he believes need to happen to make his vision of an age-friendly society come true.
SCF: When did aging in place become a passion for you, and why? Or is that your passion?
HC: What makes me most personally passionate is the thought of people being able to live with a good quality of life for as long as they can. That’s one thing that moves me a great deal.
The other is the importance of all this to our country. We have the opportunity to create a society in which people, as they age, are treated with dignity. They have a place in the society. They’re rewarded for the contributions they made in their time. And [creating this society] will be hugely important. Otherwise, I see a chaotic world out there where everybody suffers because of the costs associated with aging to the general society, and because the failure to have a robust economy will make certain that elderly people do not have the resources they need to live in dignity. It’s a formula for disaster.
SCF: Already, there are some neighborhoods full of people who are aging in place. Can you tell us about them?
HC: There are a couple of concepts. One of them is what are called existing communities. In the urban planning field, they’re referred to as NORCs—naturally occurring retirement communities—which means neighborhoods where everyone is getting older at the same time.
We see entire communities in the Midwest—in farming communities, in Kansas and Nebraska and Iowa—where the population is aging quite dramatically. We also see it in the core cities across the country as the young people move out—seek a different kind of housing—and the people who are left behind tend to be older.
So that is an absolutely implacable reality for city officials. They have to figure out ways to address that with better policing services and with different approaches to health care outreach—and with aging specialists from the city looking in on people, and nutrition centers, and parks-and-recreation offerings that relate to advancing age. So that’s one reality.
What we need to do, really, is articulate a conception of the city as a city for people of all ages, so we’re thinking not only of children and adolescents and creating a city that is safe and uplifting for them, but a city for older populations as well.
And I’m pleased to say that I see the evidence that cities across the country are thinking about this—foresighted places like Chattanooga and New York City, for example, and multiple cities in the Midwest like Des Moines.
SCF: What do you believe the government needs to do to help your vision of an age-friendly society come to pass?
HC: I’ve done some town hall meetings with older Americans, in neighborhoods and cities across the country, and I’ve heard what they say themselves. They feel that they are disconnected and lonely as they give up the car and can’t travel as easily, and they’re relying on other people to pick them up. And people are busy and don’t come by. People then become a little disoriented, and then they make mistakes about medicines or about forgetting food or just become depressed.
So the kinds of things that local governments can do relate to transportation access—good transportation systems. And not just buses but vans and shared rides and so forth. We can foster the development of things like virtual villages that connect people so they can trade services and help each other out.
[Also, we should be] working on retrofitting some of our neighborhoods so that we have sidewalks that are walkable and parks that have some amenities for older people like exercise equipment. [We should make sure older people are] safe—they don’t get knocked over or assaulted.
We need to be thinking about things like policing that relate to the special needs of older populations, where policemen walking the block will stop and help older people, looking in on them. Cincinnati undertook an initiative like that related to some senior complexes that were the targets of assaults. New York City has some special districts that they’re actually zoning as districts with specialized senior services.
I think, in due course, city governments will have to think about things like retrofitting existing homes so that they are more user friendly, eliminating stairs, and putting in security lighting, and zero-[step] entrances, and lower kitchen cabinets, and more accessible bathroom fixtures, and security communications equipment that seniors can use to access police or ambulance help if they need it.
SCF: When the next generation starts to age in place, do you think these retrofitted houses will be more readily available?
HC: I’m hopeful that we, as a country, will do for senior housing what we did to respond to the energy crisis a few years ago, when we weatherized millions of homes across the country—caulking and sealing and window work and basically making them more energy efficient. I hope we do the same with a package of renovations that will create what [my colleagues and I] have called the life-span home—the home that’s accessible to people for an entire lifetime.
So this is a way the government can help—and, by the way, probably save money for the country in the long run, because the most expensive care is institutional care, and if we can keep people in their homes for longer, they’re happier, and the society saves money.
SCF: What is so important about a house?
HC: Well, that’s a profound question. I think people are surrounded by the memories of the best years of their lives. Literally, the walls are repositories of memories: their children growing up, social events that have been held there, the family gatherings, the good days—baptism and Mother’s Day—the sad days—wakes and sickness. But it’s home. There’s deeply rooted psychological value in being home.
SCF: Looking forward, say, 20 years in the future, will your ideal vision for an age-friendly society be a reality?
HC: As Americans, we tend to be, on the whole, a compassionate people, who are going to understand sooner or later that people do slow down a step as they age. They do become more frail as they age. They may have less income as they age. And we can’t leave people destitute and helpless. We can’t leave people lonely and unconnected. So I do see that many cities across the country will understand this and take appropriate steps.
SCF: It’s interesting that when you talk about creating an age-friendly society, you seem to talk more about entire cities rather than focusing on individual neighborhoods. Is that correct? Is that how you think of it?
HC: No, I think the unit that we relate to most after our own home is the neighborhood. The immediate block, the next-door neighbor, the people across the street, the people who looked in on you, the people who you can trust to keep an eye on your house, the people who you would call if they needed immediate help. The neighborhood is very, very important.
SCF: So, to build this future, do you picture going neighborhood by neighborhood?
HC: When they talk about naturally occurring retirement communities, they’re really talking about a smaller subset than even a region of the city. We’re talking about the neighborhood level.
Nowadays with GPS and statistical methods, you can identify where the groupings of people who are older and need help are. Instead of talking about some artificial neighborhood boundaries on a map that were drawn there a hundred years ago, let’s reconfigure our services around naturally occurring pockets where we see concentrations of population that need help.
SCF: What’s the biggest challenge faced when trying to get cities and towns to do things like allocate monies to retrofit homes, build accessible parks or provide transportation services for older people? Do cities accommodate young families and children more than older people? Does ageism play a role here?
HC: I think there’s two barriers. The first is all cities are strapped for revenue. So budgets are tight, and it’s very difficult to do all of the things that are desirable and necessary. There’s a constant battle of priorities.
Number two, the field of preparing public facilities for an aging population is relatively new. The concept of “cities for all ages,” which I think is going to be a very viable concept going forward, is relatively new in terms of its practical application. So at this point no one is really advancing the concepts. It’s not that there is a tilt toward younger. It’s just that nobody has really acknowledged the possibility, the technology, the creativity, the designs that would allow older people to enjoy parks, walking trails, walkable sidewalks, transit systems that have them in mind.
Now that’s going to become much more common going forward. I think we’re right at the point where people are beginning to think creatively about that, and this concept that I mentioned, cities for all ages, is gaining traction.
SCF: We’ve talked about government’s role. Are you looking forward to or hoping for any innovations from the private sector?
HC: Oh, yeah. When you talk about the private sector, that normally is intended to mean business, but I would mean it to include nonprofits and newly formed virtual organizations like [the villages] that I referred to earlier. [They] started in Beacon Hill [Massachusetts]; there’s now more than 200 across the country—people who are coming together to offer rides, to help with needs in the home, run errands, pick up groceries, pharmaceuticals, etc. All that is private.
Church-based organizations are hugely important. There’s nutrition centers as focal points for gathering. Those are private.
And then, of course, the private sector as we think of it—business—as well: the local grocery store becoming more age appropriate, the pharmacy, the bank and other services—everything from cosmetics and hair styling to workout facilities, understanding the demographics are changing.
SCF: Once you get an aging-in-place community going, what are the biggest challenges to sustaining it?
HC: Well, as with everything else in life, people have to be involved and help keep it going, but I would say that, if we do this in partnership with the local government, we can institutionalize some of these things, and then someone is responsible for them, like the parks or the transportation systems, and they cannot be withdrawn easily. Partnerships will make that possible. Permanent funding streams will make that possible. Local government involvement will make that possible.
SCF: What’s the likelihood that cities will do the things you believe they need to do?
HC: I think there’s going to be some cities that set the pace for the country. And by the way, I want to compliment the Milken Institute. They did a report [last] year on best cities to age [in]. I was a member of the advisory committee to that. And there’s some wonderful examples in there of places that are taking steps in every one of these realms that we’ve talked about.
So I think the odds are very good. I’m very positive about the ability of Americans to respond when they see the need, and the need here is becoming every day more clear.
SCF: You’ve seen that in your own life.
HC: My mother—we lost her in November [2014] at 90 years of age, and she lived in her home by herself until end of July of last year. She had a relatively short span of August, September, October and November in various hospitals and nursing homes after she had fallen. But she was in command of her destiny, fully aware, engaged in her community—loved her home, loved her yard, loved her plants, loved her neighbors. And I think it added immensely to her quality of life.
This interview was edited for clarity and length.
Leigh Ann Hubbard is a professional freelance journalist who specializes in health, aging, the American South and Alaska. Prior to her full-time freelance career, Leigh Ann worked at CNN and served as managing editor for a national health magazine. A proud aunt, Leigh Ann splits her time between Mississippi and Alaska.
