Carrie Hawkins is an active and joyful older adult who cares for her grandchildren in her home. One day, she noticed leaks in the ceiling. "My roof was leaking everywhere in the house, and there was mold starting to grow,” Hawkins said.
Her utility bills were high due to air escaping through the damaged roof. And there were leaks and more damage under the sink. Rodents were beginning to be a problem.
"All of the issues in the home were making my granddaughter sick. She was having to miss weeks of school because of massive sinus issues,” said Hawkins.
“She's always been smart and made good grades, but if you can't see in class because your eyes are swollen or you can't breathe properly, you can't do what you need to do in school. I love cooking for us, but the lighting in my kitchen was so poor that I couldn't see anything."
On Hawkins’ limited income, she couldn’t make the critical home repairs or modifications to adapt and maintain her home.
Demographics Are A-Changin’
By 2038, it’s estimated that more than 10.1 million older adults will live alone, and of this group, households with people ages 80 and older will make up the fastest growing age group. As these individuals age, researchers find that housing cost burdens can increase, as can disabilities like loss of vision and troubles with balance. Activities of Daily Living (ADLs) such as toileting can become more difficult and even pose dangers. Deferred housing stock maintenance can impact individuals’ well-being, the cities in which they live and the healthcare industries that serve them.
How do roof leaks or inoperable HVAC systems impact respiratory health? Can water damaged floors increase the risk of falls? Will hospitals see an increase in preventable falls? What will neighborhoods look like if there is a premature exodus of older adults going into long-term care facilities because their homes are in such bad shape?
Addressing critical home repairs and adding accessibility modifications can provide what older adults, especially marginalized older adults, need to age in place healthfully, independently and equitably. These efforts can also help hospitals, healthcare payers and governments from incurring extra costs.
Memphis Habitat Responds to Older Homeowner Needs
Habitat for Humanity of Greater Memphis has since 1983 built more than 570 new homes for first-time homebuyers. Its well-known affordable mortgage program has improved homes for people from all cultural backgrounds, their families and children, and caused economic positive impacts throughout Memphis.
Aging in Place programs have provided more than 1,000 older adults with household repairs and modifications.
For the past six years, Memphis Habitat has responded to Memphis’ inadequate housing situation with its Aging In Place (AIP) program. This program provides critical home repairs and accessibility modifications that older Memphian homeowners need to remain independent, healthy, functional and happy in their homes and communities.
This successful program led to a Habitat-driven repair and retrofit effort in multiple Tennessee counties that provides equitable repairs and modifications for older homeowners in rural communities and cities. Over time, Memphis Habitat incorporated the medical sector into the AIP program by partnering with a local hospital, and with the Green & Healthy Homes Initiative (GHHI) on the Community Aging in Place-Advancing Better Living for Elders (CAPABLE) program out of Johns Hopkins University. CAPABLE combines allied health expertise, such as occupational therapy and nursing support, with client-focused repairs and modifications to create a holistic approach to aging in place.
Older Homeowner Outcomes
AIP programs have provided more than 1,000 older adults with household repairs and modifications locally and statewide. So what have been the outcomes associated with these repairs and modifications? Are the programs addressing inequities for the most vulnerable elders?
Memphis Habitat’s programming includes Quality of Life (QOL) and financial impact evaluations. These Institutional Review Board evaluations explore cost-savings, program efficacy and self-reported health changes rooted in evidence-based gerontology, anthropology and housing research. These evaluations further support collaborative policy recommendations, outreach and strategic partnerships among sectors that serve older adults.
Memphis Habitat’s applied anthropologists use qualitative methodologies such as one-on-one interviews, focus groups and longitudinal surveying to investigate AIP interventions as a response to social determinants of health for older adults. The evaluations blend quantitative and qualitative perspectives by incorporating an economist who measures the financial impacts of repairs and modifications for AIP clients, communities, the city and investment returns on this work.
‘I am more proud of my home, and my grands are not ashamed to bring their friends to the house.’
Evaluations also include the GHHI’s analyses of healthcare data, which explores feasibility and monetary value for payers. Supplementary statistical analyses have also included ADL measurements.
Results from these evaluations have evoked powerful images of what life is like for older homeowners before and after AIP:
- Roof, window, HVAC and plumbing repairs are preventing major water and air leaks, and saving on utility costs. These savings reserve older adult income for food and medications. Addressing leaks can prevent respiratory issues, sleeping issues and psychological discomfort.
- Grab bars, shower modifications, improved lighting and exterior handrails are preventing falls and improving ADLs. Both internal and external modifications encourage function and independence so that older adults can come and go freely to social functions, more easily access groceries, welcome visitors and attend doctor appointments.
- AIP’s impacts have generated:
- $19.7 million in savings for long-term care facilities;
- $1.4 million savings in falls that would have led to hospitalization;
- $11.7 million in blight and vacancy abatement costs;
- $0.8 million in client utility expenses; and
- $17.7 million in neighborhood appreciation values.
- Memphis Habitat has turned the original $8 million AIP investment into a $26 million cumulative benefit that helps older adults, raises home values, and saves money for medical entities and local Memphis government. That is a 3.3 multiplier return on investment.
"I'm on a limited income, and I had no other options for help. Habitat fixed the leaking roof, the hot water heater, and repaired the heating system. I didn't know they were in bad shape. It was immediately warmer for me, my grandchildren and great-grandchildren. I am more proud of my home, and my grands are not ashamed to bring their friends to the house. There's less controversy in the home,” said Hawkins.
“My granddaughter is an honor student majoring in accounting now. She has a 4.0 GPA. The repairs gave her a new lease on life that helped her to succeed. This program gave me and my grandchildren the ability to know that there are people who care about me, and I know that these repairs helped my granddaughter feel capable. She wants to do something to give back to this world, just like Habitat has.”
The need for Memphis Habitat to sustain and scale its AIP health and housing work is more important than ever as we anticipate a larger older adult populace. Incorporating robust sociomedical measurements inspires programming that will be particularly important to centering older adult narratives in this work.
"Nothing is more important than to feel that someone cares about you,” said Hawkins. … “Habitat brings us to the forefront and reminds us that we have a lot to offer when given the chance. And that chance is given to us in the most important place in an aging person's life, the home. … The program gave me a sense of control and dignity that money can't buy."
Chris Reeder Young, MA, is an applied anthropologist working as the senior research and evaluation manager at Habitat for Humanity of Greater Memphis.
Photo caption: Carrie Hawkins stands on her deck with her grands.
Photo credit: @2016 Habitat for Humanity International/Ezra Millstein