One major aspect missing from recent health care reform conversations is housing, especially with regard to the aging population of the United States, according to three University of Arkansas researchers who have collaborated on a new book: Just Below the Line: Disability, Housing, and Equity in the South.
Problems in housing will become increasingly evident as the first wave of baby-boomers enters retirement over the next few years. In the United States, about 40 million residents are age 65 and older. That number is expected to double in the next three decades. The number of people with disabilities will also double during that time.
Post-World War II housing no longer fits the current baby-boomer lifestyle. It was designed for young, working families, not for an older population. Not only will those born in the surge following World War II likely live longer than previous generations after retirement, they’ll also demand more independent residential living than traditional nursing homes or assisted living facilities.
Yet, the amount of government funds spent on health care versus housing is a 15-to-1 ratio.
The University of Arkansas researchers — Korydon Smith, Jennifer Webb and Brent Williams — realized it would take the combination of their fields to address the social disparities in housing. In their new book, Just Below the Line (spiral-bound hardback, $49.95), they redefine conventional concepts of aging, disability and housing and offer ideas that could lead to nationwide change, with Arkansas serving as a model.
Smith, an associate professor of architecture in the Fay Jones School of Architecture, is the book’s lead author. Smith coauthored the book with Webb and Williams, associate professors of interior design and rehabilitation, respectively.
This is the first book released under the new collaborative publication venture between the Fay Jones School of Architecture and the University of Arkansas Press.
The authors started their focused research on aging, disability and housing in 2004 through a statewide survey, with funding from three state agencies. They discovered many misperceptions about what disability actually is and the role that design plays. They found that “well over 90 percent of Arkansans believe they will maintain their independence as they age, though 81 percent believe their health will decline. Fewer than half of these folks, however, believe that the design of their neighborhood will affect their ability to live independently.”
“We need to be thinking about how we design housing to meet the variety of needs of the current population,” Smith said.
Disability should be redefined “as a normal part of human existence, that it exists along a continuum,” Williams said. People move in and out of a variety of levels of functioning throughout the course of their lives — whether they have a cold or a car accident.
“We just don’t understand the sheer number of people that struggle with some kind of disability, either daily or for a period of their life,” Webb said.
Nevertheless, functioning is often determined not by the health or abilities of the individual, but by design. Design can enable or disable daily functioning. Out-of-date housing is one of those hurdles, particularly in the South, where reverence for tradition makes change difficult and slow.
The researchers chose to focus on the South, and specifically Arkansas, for several reasons. The South has the largest overall population of the four regions defined by the U.S. Census. This region also contains the largest number of older adults and people with disabilities, as well as the largest and fastest-growing retiree population.
Smith said much of today’s housing, produced during the housing boom of the mid-1900s, “was designed for a young, active, employed, traditional family structure, not for single parents, not for grandparent-run households, not for widows and widowers living by themselves. So the current housing that we have in this country is seriously out of date in terms of the way it was designed and also in terms of disrepair.”
Those houses had a “non-open floor plan, cellular organization, and each function had its own room,” he said. Main entries were inaccessible, with steps leading to front porches, and bathrooms and kitchens were small.
The one place people should be most comfortable is their own home, where they can create and express their identity. Inadequate housing, however, leads to isolation and decreased independence. Good housing design addresses the needs of all people, even as people’s needs, preferences and abilities evolve.
“If you’re designing well, what you’re designing should work for the largest number of people on that continuum,” Williams said.
Housing solutions outlined in this book include prototypes that maximize adaptability and efficiency, with three specific case studies in distinct regions of Arkansas. Features include a service core, which holds the main plumbing and electrical functions, and minimal interior structural walls, which allows for the reconfiguration of room spaces with movable storage cabinets. Though they are smaller than most two- to three-bedroom homes, they are less expensive to build and their open floor plans make them feel bigger and help with mobility.
Concerns about equality drove this research.
“Though gender and racial inequality have held a long history in the South, age and disability inequality is, in our opinion, the most significant prejudice that exists in housing today,” Smith said.
This book is intended as a reference for policymakers, designers, builders, consumers and others. In their conclusion, the authors offer 10 recommendations for changes in mindset, policy and practice.
“If we continue to ignore housing, we’re going to end up with a great deal of public spending in other areas, especially in the health care arena,” Smith said. “Many issues that are housing problems are currently being solved by the health care world.”
Their research found that every $1 spent on housing is equivalent to a savings of $1.20 in health care costs. Improved housing conditions allow people to live in their homes longer and avoid pricey hospital stays and nursing home care.
These housing solutions could reduce the more than $150 billion per year spent by taxpayers on nursing home care by providing more accessible retirement living options.
“When you’re talking about $60,000 to $100,000 a year — half the cost of a house — times millions of people, that’s significant,” Smith said.
Ultimately, housing should be designed with everyone in mind. “Disability is something that we all experience; it’s time to design houses that reflect that,” Williams said. “It sounds like a simple thing, but that’s a big deal.”
Research for this book was sponsored by Arkansas Rehabilitation Services, the Arkansas Department of Human Services and the University of Arkansas for Medical Sciences Partners for Inclusive Communities.
Just Below the Line is available for $49.95 at the University of Arkansas Bookstore and can be ordered through the University of Arkansas Press.