Abstract
In this timely and comprehensive volume, Golant questions a belief that has become sacrosanct in many circles and among older people themselves—that aging-in-place is the best and most desired residential setting for later life. What is important, he argues, is to live in a place that is compatible with their lifestyles and capabilities, that is, a setting “that allows them to cope with their aging bodies” (viii). Golant would certainly agree that this may mean remaining in their current home. For a variety of reasons, however, many older adults find themselves in places that make it difficult for them to cope with the challenges they face, and yet they do not relocate.
In this book, Golant “seeks to be as critical as possible of the residential and long-term solutions adopted by older people” (20). He argues that neither aging in place nor moving strategies are perfect pathways to aging successfully. There are “many environmental pathways for older people to achieve the good life and to receive competent and compassionate care” (8). And there are many reasons why older adults and their families may be frustrated in their ability to find the “right place.” Golant skillfully synthesizes extensive evidence in support of his assessment, including his own impressive scholarship on related topics over his long and distinguished career.
The book is written for the range of stakeholders who influence whether older people successfully cope with their housing and care deficiencies. Planners working in local government, nongovernmental organizations, and the private sector are among these stakeholders. In the book, Golant offers a critical perspective that is often missing in the rush to embrace the oft-repeated message advocating aging-in-place. In addition, he provides valuable insight into the viewpoint of older people as consumers, citizens, and recipients of care, a perspective that is often overlooked in planning discourse and practice. This is particularly important given that experts and older people often do not agree about what constitutes great places to live.
Golant provides a clear and content-rich explanation of the strong pulls that keep people in their current home or apartment and make them feel they are in that “sweet spot to live” (chapter 3). This may be a result of residential inertia, a tendency to do nothing even when faced with signs that all is not well. Or it may be because a lack of desirable and affordable housing alternatives leaves older people “stuck in place.”
Furthermore, Golant provides extensive evidence to show that all is not necessarily well with those aging in place: unaffordable housing; physically inadequate dwellings; unmet needs for long-term services, supports, and care for chronic health conditions; social isolation and loneliness; unsafe or inhospitable neighborhoods and communities; and limited or unsafe transportation options (chapter 4). He suggests that it often takes a dramatic and stressful episode to push older people and/or their families to begin questioning what he calls the “groupthink”: a fall, a traffic crash, an emergency room visit, or unexpected wandering behavior. And it takes proactive older people to take steps to change their undesirable housing or care circumstances, and to intentionally make things happen around them. Golant shows that unsurprisingly, overall those with “enriched coping repertoires” do better (chapter 5).
A substantial part of the book provides a systematic and comprehensive description of the wide range of residential options that are available to today’s older people, how stakeholders from all sectors of American society influence the extent to which older people effectively cope with their housing and care deficiencies, and the decisions they make regarding staying versus moving.
In my view, one of Golant’s most important contributions to planning scholarship and education is to critique residential options for older people from a preventive health perspective, that is, one that considers the extent to which residential options can help prevent disease and injury, facilitate early detection of health and functioning problems, and help manage chronic disease symptoms or functional limitations and avoid further complications. The way he conceives of the different residential options is consistent with this approach. They include combinations of housing alternatives and the complementary strategies such as family caregiving, paid help, assistive devices, home modifications, and technologically modified dwellings that make it easier for older people to remain in their current homes and cope effectively with undesirable housing or care circumstances. These combinations are evident in many communities today. Golant believes that the range of options will only increase, and that the barriers between community-dwelling older people and housing options, such as continuing care retirement communities (CCRCs) (chapter 12), independent living communities, and assisted living facilities (chapter 11), are likely to become more porous as CCRCs become service and product providers to older people and their families living in the surrounding community.
Golant’s discussion of the residential options is organized around the four advantages that he believes give older people the best chances of remaining in their homes despite physical and cognitive limitations: dwellings that can be retrofitted or redesigned; at least one compassionate family member committed to providing care; places where they can afford, or can negotiate public assistance for, community-based long-term services and support; and buildings, neighborhoods, and communities that are more compatible with the lifestyles and capabilities of older people.
The first advantage consists of having a dwelling that can be physically retrofitted and redesigned (e.g., grab bars, improved lighting, accessibility modifications) and equipped with the smart home technologies that many experts think will be key going forward (chapter 6). This will increase older people’s chances of coping effectively while remaining in their current home. Golant contends, however, that experts believe the human element—family caregivers—will remain “the backbone of our long-term care solutions” (145) at least for now.
The second and related advantage entails having at least one committed and compassionate family member to assist them full-time, ideally around the clock (chapter 7). This increases older people’s chances of coping effectively in their current home despite physical and cognitive limitations. Having a family member who is the primary caregiver is particularly important in an era when the duties expected of caregivers are increasingly complex. This person may live with them, or nearby. Golant stresses the importance of respite care, provided by the range of adult day services for example, to relieve family caregivers temporarily of their caregiving responsibilities.
The third advantage comes when older people occupy places where they can afford the paid services offered by the private or public sectors to assist older people in managing their health problems, mobility limitations, and cognitive declines. The advantage also accrues to those who have very low incomes and few assets, and are eligible for publicly funded and community-based long-term services and supports (chapter 8). Golant’s assessment of what it takes for older people to secure the necessary help, however, is sobering. A complex array of programs, providers, and funding sources needs to be negotiated to come up with the appropriate package of services. Even resilient older people may not know whom to call, or how to explain what assistance they need. Often, family members are not much better informed or prepared than their elders.
The challenge of obtaining an appropriate package of services is made even greater by the shortage of professional care workers willing to serve older people in community settings: physicians, nurses, social workers, and other health care professionals, particularly those who can provide mental health services (178). Furthermore, direct care workers are more easily available in some areas than others; many are foreign born. Long-term care experts are very concerned about the future of immigration policies and the resulting inadequate direct care workforce to meet the needs of older people in the long term.
The fourth advantage comes when people occupy “age-friendly” or “healthy aging” buildings, neighborhoods, or communities, that is, ones that are more compatible with the lifestyles and capabilities of older people. Golant’s assessment of the strengths and downsides for older people of “age-friendly” initiatives is enhanced by his rich discussion of the consumer perspective. “Age-friendly” initiatives run the gamut from transportation alternatives to the promise and pitfalls of New Urbanism. Initiatives seeking to make communities more age-friendly also include residential options that are often overlooked: clustered housing where concentrations of older people can be a ready market for long-term and supportive services (chapter 9); affordable rental properties and “housing-care” solutions; “Villages” that offer another way to organize housing, neighborhood, and long-term and supportive services for older adults; and age-segregated residential options provided by private developers (chapter 10).
Overall, I found the book well organized, well supported, and highly readable. It is an excellent reference for scholars and professionals who are interested in the implications for US cities and counties of a growing proportion of older people. It would also be an excellent choice for both undergraduate and graduate courses in Planning and Aging Populations. I wish the book had been available when I was designing a graduate course along these lines! The book is easily accessible for students, and would be a valuable complement to a book like Planning Aging-Supportive Communities by Winick and Jaffe (2015).
The book may be disappointing to those looking for specific guidance on what cities and counties should do to prepare for increasing numbers of people aging-in-place. That is not its purpose. I believe that together with a book such as Planning Aging-Supportive Communities, however, Aging in the Right Place gives planners what they need to move ahead with initiatives that consider the views of both experts and older people themselves. The book provides valuable background and substantive material that can help planners ask better questions, consider a broader range of options, and talk with a wider spectrum of people than they might otherwise.