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Rural Health Information Hub
Rural Health Information Hub

Housing Models for Rural Healthy Aging

Safe and affordable housing supports healthy aging in rural communities. There are promising program models to support safe and affordable housing for older adults in rural communities. Many older adults prefer to stay in their homes; however, many factors, including access, safety, and affordability make it more difficult for older adults to age in their home. As an alternative to aging in place, some older adults move to senior residential communities and long-term care facilities, such as nursing homes and assisted living facilities. For more information, see the Rural Long-Term Care Facilities topic guide.

Housing is the largest item in most household budgets, and many older adults struggle with housing costs. In addition to affordability, the location of housing is an important consideration for people in rural communities. Living near family and friends, transportation, shopping, recreation, and other services can help older adults to remain actively engaged in their communities.

Older adults also need access to safe housing. Rural residents are more likely to have a disability than urban residents. However, most housing units in the U.S. are not designed to meet the needs of people with physical disabilities or mobility impairments. Modifying existing housing can be cost-prohibitive. Rural areas have a higher rate of substandard housing units, making it even more important to focus on housing safety for older adults.

Older adults may experience difficulties getting in and out of and moving around their homes as well. Common issues include:

  • Difficulty getting in and out of their house safely, using stairs, or accessing the toilet or shower safely
  • Navigating through doorways and hallways
  • Moving around kitchens and other rooms that do not have space for a wheelchair
  • Accessing cabinets that are out of reach

Promising aging in place models include home modifications, senior cohousing, intergenerational housing, naturally-occurring retirement communities, villages, and affordable housing.

Home Modifications can make homes safer and help older adults remain in their homes as they age. They can reduce risk of falls and injury and may include inexpensive and easy-to-install additions such as adding lighting to halls and stairways, placing a bench near entryways, and installing lever-style door handles. More intensive modifications may include installing a chairlift, stairlift, platform lift, curbless or no-step shower entry, grab bars, ramps, or nonslip flooring. The United States Department of Agriculture (USDA) provides grants or loans to fund home modifications. It is important to evaluate whether a building can be remodeled and to monitor any modifications made to the home. Specific considerations might include design features to promote safety and prevent falls, adequacy of lighting, and space to maneuver a wheelchair. Housing should reflect the older adult's health status and needs.

  • Community Aging in Place Advancing Better Living for Elders (CAPABLE) is approved by the National Council on Aging as an evidence-based fall prevention program. CAPABLE is a home-based program that offers services from an occupational therapist, registered nurse, and handy person who work with an older adult to set goals and create plans that change behaviors to improve health, independence, and safety at home. There are currently 45 CAPABLE sites across the country, 22 of which are in rural communities.
  • The Home Modification Service-Delivery Model was developed by the subcommittee of the National Home Safety and Home Modification Work Group led by the National Council on Aging and the University of Southern California. This program incorporates evidence-based and best practices to expand access to home modification programs for older adults and people with disabilities. This model uses a transdisciplinary team approach (healthcare providers, occupational therapists, contractor/handy persons) to conduct intake and an assessment, modify the home, and follow-up with participants.
  • USDA Rural Development offers loans and grants to help rural residents buy or rent safe, affordable housing and make health and safety repairs to their homes. For instance, Multifamily Housing Direct Loans and Single Family Housing Repair Loans & Grants provide financial assistance for affordable rental housing in rural areas, with a focus on low-income homeowners, older adults, and people with disabilities.

Senior Cohousing is a model where older adults live together in independent housing units to foster social interaction, improved quality of life, and community engagement. The cohousing model may be effective in improving older adults' overall health and well-being.

Intergenerational Housing is a dynamic where generations live together in a shared or connected space. This model can include having extended families living together or seniors and young adults sharing a home. This arrangement can foster connection across a range of age groups and may improve the quality of life of older adults. Bryan College of Health Science's Sage Living is an intergenerational living development formed in partnership with Tabitha Health. This community includes Bryan College students and active adults aged 55+ and is designed to reduce loneliness, promote sharing wisdom and knowledge, and enhance lives across multiple generations.

Naturally Occurring Retirement Communities (NORCs) are communities or geographic areas that have a naturally higher concentration of older adults. This presents an opportunity to provide services to meet the needs of older adults aging in place. Neighborhoods with high concentrations of older adults can make it easier to seek peer social support and offer economies of scale to providers serving older adults. As a greater portion of older adults age, NORCs will continue to increase across the United States. For instance, NORCs in Pennsylvania have increased between 2010 and 2020, with the most growth in rural areas (74 rural NORCs in 2010 and 465 in 2020).

Villages, as defined by the Village Movement California, are grassroots organizations funded by member fees that offer older adults' programs and affordable services in their community to meet their daily, social, and recreational needs. Many villages are also age-friendly communities that provide community support, outdoor spaces, and transportation. This model also helps older adults remain socially connected.

Affordable Housing provides a promising pathway to economic freedom for older adults to age in place. Rural older adults are facing affordable housing shortages, which may increase as people continue to retire.

  • USDA provides financial assistance for affordable rental housing in rural areas specifically for older adults and people with disabilities.
  • Support and Services at Home (SASH) is a nationally recognized, team-based care coordination program operating across 140 affordable-housing communities in Vermont. SASH can improve population health, reduce Medicare spending, and help people remain in their home. SASH partners with over 70 organizations and supports 5,000 older adults and people with disabilities.

Considerations for Implementation

Housing models for older adults are part of a spectrum and some may overlap. For example, intergenerational housing may be compatible with senior co-housing models. The built environment in the community is an important factor to consider for housing models. Models like villages or Naturally Occurring Retirement Communities that depend on proximity to essential services, like grocery stores, banks, and doctor offices, may not be suitable for some rural communities where such services are located far apart from each other.

Financial resources are needed for many housing models. Specifically, some models assume that that older adults have the means to purchase, rent, or remain in their homes. Villages may require older adults to have significant financial resources. Affordable housing and home modifications can help older adults with limited financial resources.

Resources to Learn More

Helping Older Adults Age Safely in Place: What Multifamily Owners Need to Know About Home Modifications
Document
Discusses strategies, relevant resources, and funding opportunities to help make homes more accessible, specifically for older adults living in HUD-assisted housing,
Organization(s): U.S. Department of Housing and Urban Development
Date: 7/2020

The Home Modification Service-Delivery Model: A Transdisciplinary Team Approach
Document
Describes a transdisciplinary approach to home modifications in which healthcare providers, nonprofit organizations, contractors, and other professionals can collaborate throughout the home modification process. Includes information related to intake, assessment of specific needs, completing the modifications, follow up, and impacts.
Organization(s): National Council on Aging
Date: 11/2024

Single Family Housing Repair Loans & Grants Fact Sheet
Website
Shares an overview of the Section 504 Home Repair program that offers loans to help low-income homeowners modify their homes, and grants to help older adults and low-income homeowners improve the safety of their home environment.
Organization(s): Rural Development U.S. Department of Agriculture