Home Modification Resources

Frail Elders and the Suburbs

By Patrick H. Hare

Single family homes and neighborhoods are the dominant theme of this article. Most people who age in the suburbs do so in single family homes, and that is where most of them at least start to grow frail.

Other suburban issues are also discussed, including transportation and how to make civic or homeowners associations more responsive.

The article's italicized assertions are not gospel. The increase in frail elderly people in suburban areas raises too many issues for certainty, and certainty is dangerous -- in land use planning, anyway. It should also be noted that low-income frail elders in suburban areas have special needs that go beyond those discussed in this article.

A wave of frail elderly people will follow the waves of postwar development out from core cities. After World War II, growth in suburban areas was fed by young households from urban and rural areas. A person who moved to the suburbs in 1950 at a ge 30 will be 75 years old in 1995. The frail elderly population is not uniformly distributed throughout the United States. It is located in large part in the homes that were built 30 or 40 years earlier. Right now, these are the immediate postwar suburbs .

Figure 1 Percent of population over age 75, by planning along 1-270, in Montgomery County, Maryland A wave of frail elderly people aging in place will move through single family areas surrounding older cities. The wave will follow the timing of development, just as a previous wave of school closings did.

An example can be seen along Interstate 270, which runs northwest out of Washington, D.C., like a spoke from a hub. Here are some aging statistics for the communities along that spoke. In 1990, people over 75 made up 6.4% of the population in Bethesda, an immediate postwar suburb, adjacent to the District line. Next is North Bethesda. Four percent of the population of North Bethesda were over 75 in 1990; 3.8% were over 75 in Rockville, 1.4% in Gaithersburg, and 0.3% in Germantown (Roman, 1990).

The figures cited probably do not even show the peak of the wave. In Bethesda, the 6.4 percent figure for persons over 75 in 1990 was followed by 11.3 percent in the age group 65-74 (Roman, 1990).

Suburban single family housing is "Peter Pan" housing, designed for people who will never grow old. To be able to age in place in comfort in an older single family home, a person typically has to be able to go up and down stairs, do simple home maintenance, contract for major home maintenance, drive a car, and enjoy living alone. Most of us will lose one or more of those physical abilities before we die, and probably few of us ever really like living alone.

Alone or not, it appears that medical technology and other factors will keep most of us alive until we have one or more disabilities. A Canadian study, apparently the only one of its kind, indicated that life expectancy for Canadians increased by six years over the period between 1951 and 1978. The punch line is that over 80 percent of the increase, or 4.7 years, was in disabled life expectancy (Soldo and Agree, 1988). Disabilities typically mean home modifications.

The remodeling industry is almost as important to the quality of life of frail elderly homeowners as the healthcare industry. Seventy-five percent of those 65 and older live in single family homes to stay in their present home and never move" (AARP, 1990b). If it is accepted, based on these facts, that single family housing is a very common form of elderly housing, then it follows that the remodeling and home maintenance industry is of critical importance to the quality of life of older people.

Frail homeowners will need assistance with major and minor repairs, with routine chores such as changing fight bulbs and putting up storm windows, and with installation of ramps, grab bars, and counters for use by people in wheelchairs. In addition, as reported in many studies, older people, not surprisingly, tend to live in older homes. Older homes often require not only more maintenance but also replacement of major items like roofs, furnaces, and hot water heaters (see, for example, Struyk and Soldo, 1980).

Finally, the baby boom has been followed by an empty-nester boom. Our single family housing stock is dramatically underutilized. One-third of the nation's single family homes have enough surplus space to install a complete separate apartment (Hare, 1990). In addition to providing housing for others, the owners of homes with accessory units will also get some combination of added income, security, companionship, and services. To get these benefits, older homeowners will need the assistance of a remodel er.

Choosing to age in place in a single family home has a dear implication: Your remodeler may be almost as important to you as your doctor. The relationship between the frail elderly and the remodeling industry is not an easy one. To begin with, most older homes are a maze of unpleasant pipes and wires and wood. As a result, it is difficult to know whether or not to trust a remodeler. Suppose you hire one to fix a roof, and after starting the job, he or she says, "Well, water got to some of those areas and rotted them, so we'd better fix them while we're at it." How do you know if they are rotted if you cannot get up there to see them? At the same time, many remodelers feel that older people are not good clients -- they will take too long to make up their minds, for example, and even if they do decide to hire the remodeler, they will be in the house all day, supervising.

In summary, it is not news that many older people do not trust the remodeling industry and that many remodelers do not want to work with the elderly, particularly the frail elderly. Given that most elderly people want to age in place in single family homes, this mismatch is a little like the dating game from hell.

Three proposals seem worth considering. First, the development of maintenance contracts for homes, much like property management contracts that are used for beach homes and other rental property, would help. They would allow an older homeowner to project maintenance costs and to know that small problems would not become big ones. Second, an independent advisory service is needed to help people select remodelers, draw up contracts, and check for quality of work before making payments. This service exists in Montgomery County (Maryland) and other jurisdictions, but only as a service for low-income people getting subsidized loans for the work. Third, a voluntary neighborhood remodeling committee could help. Made up of retired people who have done remodeling themselves, such a committee would help people find remodelers, prepare contracts, and check quality.

It is possible that one or all of these services already exist. Remodeling for the elderly is only beginning to emerge as a field with its own literature.

Driving should be considered an "activity of daily living," because it is critical to daily living in suburban areas. If they were affordable, chauffeurs would rank next in importance to doctors and remodelers. In most suburban single family homes, driving is critical. Some planners say that Henry Ford not only invented the affordable car, he also invented the single family neighborhood.

Driving should be considered an "activity of daily living," since without it there is no reasonable way to cover the distances created by suburban development patterns. A car and the ability to drive are needed to get to doctors, friends, shops, and almost anything, or anywhere but the local elementary school.

Studies that collect data on activities of daily living, should include driving. They should probably ask not only if an individual has a driver's license and a car available, but also if he or she feels able to drive without fear on major roads at rush hour, since some metropolitan areas, following the trend of Los Angeles, are approaching close to continuous rush hour conditions. The words "able to drive without fear" are in the question because there are many anecdotes about people who drive despite frailties that limit their driving ability -- they simple have no alternative. It should also be noted that most suburban auto trips involve segments on freeways that assume and require excellent eyesight, hearing, judgment, and response time.

Bus and light rail are not good alternatives for the frail elderly paratransit (special transportation for frail elderly or people with disabilities) which is too expensive for more than the most critical trips, and scheduling tips to avoid the rush hour will be increasingly difficult. There are no generally recognized strategies for providing affordable alternatives to the private automobile. Local governments generally cannot provide high quality high transit for more than the most critical trips to doctors.

It should also be noted that the bus is not a good option for most people, particularly frail people. The average speed of a local bus is about 7 miles an hour, as opposed to 28 miles an hour for the car. The walk, wait, and walk times that are involved in a bus trip lower the speed to about 7 miles per hour. Buses also typically involve the possibility of difficult steps, exposure to bad weather, and delays from traffic congestion (Reno, 1988, Hare 1991a). In addition, Lynn Chaiowitz, an elderly housing consultant, points out that the time between losing a license because of frailty and being too frail to take a bus is short; in fact, many frail elderly people can probably drive long after they lose the ability and patience to take a bus (Chaitowitz, 1988).

Nor is suburban light rail a solution. As one pundit said, "Mass transit does not work in the suburbs because there is no mass." Suburban densities are so low that most people, including most frail elders, cannot get to stations without a car. Stories about the legendary congestion of Los Angeles and other cities underline most people's assumption that given a reasonable government and a little planning, congestion should disappear. In practice, transportation planners and community planners may be coming to the conclusion that there is not enough land for the huge roads that will be needed, or enough people willing to have those roads next door to their homes. This is not a politically popular conclusion, but it may be forced to the surface by the Clean Air Act of 1991. If the language of the act is enforced, it may end up being more aptly titled the Transportation Planning Act because of its focus on reducing auto use.

The future of transportation in the suburbs is unclear, but dramatic change will probably be part of it, and that change may help the frail elderly. One of the emerging strategies is HOV lanes, lanes that can be used only by high occupancy vehicles, for example, cars with three or more passengers, van pools, buses. These lanes offer time saving because they are seldom congested. An interesting by-product of this strategy is that as the savings in time or money from using HOV lanes increase, passengers become a highly sought after commodity.

The HOV concept is also beginning to be applied to parking. Either the best spaces or free parking, or both, are given to cars that enter or leave the lot with passengers. It is possible that broad application of the HOV concept to both roads and parking may create a situation in which many cars become free taxis looking for passengers. This is already occurring near HOV facilities in Washington, D.C., in the San Francisco Bay Area, and probably in other regions (Reno, 1988; Hare and Honig, 1990). Free taxis looking for passengers would be of enormous benefit to those, like some frail elderly, who are unable to drive. An interesting application of the HOV idea should be to reserve some of the best parking spots at senior centers for cars that come in with three or more passengers.

However, whether or not the HOV concept can increase mobility for the frail elderly is not yet a serious issue. The concept of free taxis looking for passengers is still a long way from reality for the frail elderly or anyone else, except in a few areas. Nevertheless, the concept illustrates the scale of change that may be coming for many people in suburban areas, including the elderly. "Traffic calming" is needed for roads, streets, and intersections designed with little consideration for any pedestrian, let alone the frail elderly. Walking is a highly recommended exercise for older people. For those who cannot drive, wall may not only be good exercise but the only way to get to shops, religious services, and friends. It sounds good, except for one problem. People who cannot drive usually cannot walk long distances, and in most suburban areas, distances are long. Few services are within walking distance, even for a healthy person. In addition, there are few sidewalks, crossing lights, and safety islands for pedestrians, and few shops close enough to get to by walking.

Europeans have coined the term "traffic calming" to cover a variety of means to give more priority to pedestrians. "Traffic calming," however, tends to run counter to the goals of the traffic engineer, whose job for years has been to get as many cars through a given intersection in as short a time as possible. That focus has been fueled by years of complaints about congestion and years of almost no complaints about pedestrian convenience or safety. Concern about congestion has led to storage lanes for lefthand turns at the expense of median safety islands. Safety islands have been thinned to the point where they are more akin to safety razors. Similarly, the timing of "walk" phases on traffic fights seems based on the assumption that there is no one who walks slowly. Changing the low priority given to pedestrians has become a priority of many transit, bicycle, pedestrian, environmental, and other groups. All are natural allies for aging organizations.

Creating a good environment for pedestrians, particularly those who are frail and old, requires a wide variety of traffic calming devices and many other improvements such as separate pedestrian and bike paths in some locations. A quiet bike creeping up behind anyone at 15 miles an hour is unnerving. It is also frightening to most frail elderly people and can provoke instant rage from parents with toddlers.

All this implies reweaving fine, human-scale threads into a coarse fabric of roads and parking lots developed when the car was king. And as if changing the marching order of traffic engineers was not difficult enough, it will also be necessary to convince an endless number of motorists who have strong opinions about bike paths, reducing turning lanes, or waiting in traffic for a longer walk signal.

Many people think of planning as an exercise in subdividing cow pastures. While cows are not good at articulating their concerns, there are many articulate people in suburban areas who are genuinely concerned about any change in their neighborhoods. Getting involved in traffic calming or other planning issues in suburban communities is like being in an endless soap opera that is only very occasionally successful.

There is, however, some good news. Aging advocates concerned about traffic calming will be welcomed by a large number of allies in the groups mentioned earlier. The welcome will be particularly enthusiastic if the aging advocates make known the number of votes they bring with them.

To reduce isolation in single family neighborhoods, local ordinances or state laws should permit mom and pop shops when owned or sponsored by or situated in buildings leased from homeowner or civic associations. Convenience retail is needed in single family neighborhoods, but it has no chance of being permitted under most existing zoning regulations. George Liebmann, a Baltimore land use attorney, has proposed that zoning should permit convenience retail stores in single family zones when they are sponsored by or owned by civic or homeowners' associations (Liebmann, 1990). Management practices such as hours of operation and the number of cars attracted can then be controlled in ways that satisfy the neighbors.

The Town Center in Garrett park In Garrett Park, Maryland, the situation proposed by Liebmann is a reality. The town owns the building in which the town offices, the post office, a store and deli, a beauty salon, and other small convenience retail establishments are located (see photo). The town controls management practices through the leases. It also, at times, has reduced rent to help businesses it feels are important to the community. The town has also fought tenaciously against home delivery of mail, on the grounds that coming to the Town Center to pick up mail brings the town together as a community. The real estate agent says that the building and its businesses are "the soul of the town". Conversations with the owner of the town store and cafe suggest that this is true. Among other anecdotes about knowing people, she talks about a very frail older woman who lives by herself and comes in for milk. The owner has helped the older woman with her clothes and convinced her that she should not try to carry a full gallon of milk home.

The Town Center is a place where people meet, as is obvious from the numbers meeting inside and outside the businesses on any given day. Unlike the customers at typical convenience retail strip stores, these people all know each other. That, as much as anything to do with convenience, is a way in which older people would benefit from property controlled convenience centers in existing suburban single family neighborhoods (Hare, 1991b).

As it is in most single family neighborhoods, there is no place where you meet neighbors. Neighborhoods, in the sense used by Sesame Street said Mr. Rogers, are not common in the suburbs, except on television. The suburban frail elderly probably suffer as much as any group from not being part of real neighborhoods. The clerk in the supermarket express lane may smile, or be clean, or fresh, or live up to whatever slogan management is marketing, for the year, but he or she is unlikely, to become a friend who asks how your grandchildren are.

Many of the changes in the suburban areas that will improve life for the frail elderly will also improve it for everybody else. Universal design is as applicable to community planning as it is to buildings. The changes in suburban fabric needed by the frail elderly will also make life better for many others. Aging advocates, however, can play the leadership role in reshaping suburban areas. Many of the other advocates of change represent groups that by themselves do not influence many votes.

To make change easier aging agencies and commissions should ask all home-owners associations to appoint a representative for the frail elderly. At the grass roots of suburbia -- in the civic associations and homeowners' groups -- the voting power of the elderly is ignored. Typically advocates for the elderly are organized townwide or countywide but have no voice in the neighborhood civic associations. And when an elderly housing project comes up for approval, or when there is a battle over zoning for accessory apartments or over getting a bus route through a neighborhood, it is the civic associations that the elected officials listen to. There may be elderly members who are active in civic associations, but usually they are the healthy elderly, with little feeling for, and perhaps even an unconscious blindness to, the problems of frailty.

In many cases, the first step in starting to improve community planning for the frail elderly should be to have the aging commission ask every civic association to name a representative on elderly issues. It is not a threatening request. It would also be good for aging commissions to suggest that sister commissions and advocacy groups representing the disabled, single parents, and others make similar requests. These groups often have joint interests in things like pedestrian safety, neighborhood sense of community, and stores you can get to without a car. They also have a similar interest in damping the nay-saying of civic associations that may be dominated by healthy empty-nesters with little understanding of the needs of others.


It is simple to say that change is needed. It is also easy to conclude from an article of this nature that our suburbs are curb-to-curb problems and chancing them will involve lifetimes of endless and bitter struggle. The suburbs have problems, but the challenges are likely to be easy victories, or sure defeats. In fact, from the perspective of an advocate for the elderly, the challenge of weaving human scale and contact into the auto-dominated fabric of the suburbs should be attractive. Aging advocates who want to improve suburban communities are in an enviable position. They have a constituency group, the elderly, that is likely to understand very rapidly the ways to improve suburban areas for people of all ages. They can add that constituency to the articulate frustration of environmental groups and others that are beginning to question the highway lifestyle of the suburbs. The votes of the elderly could easy be added to the logic and research of environmental groups and the new generation of transportation planners. If that occurs, there will be few limits to how much finer the fabric of suburban communities can become.

Patrick H. Hare is a Washington, D.C. land use and transportation planner whose firm, Hare Planning and Design, specializes in accessory apartments. He is also a consultant to the National Eldercare Institute on Housing and Social Services. This article is based on a longer study available from Hare's firm.


AARP, 1990a. "A Profile of Older Americans." Washington, D.C.: American Association of Retired Persons.

AARP, 1990b. "Understanding Senior Housing for the 1990s: An American Association of Retired Persons Survey of Consumer Preferences, Concerns, and Needs." Washington, D.C.

Chaitowitz, L., 1988. Personal conversations with the author.

Hare, P. H., 1989. "Planning for the Frail Elderly in Postwar Suburbs." Public Management, July 1989.

Hare, P. H., 1990. "Installations of Accessory Units in Communities Where They Are Legal," Washington, D.C.: Patrick H. Hare Planning and Design.

Hare, P. H., 1991a. Unpublished work based on 1983 National Personal Transportation Survey data.

Hare, P. H., 1991b. Unpublished paper, "A Lesson in the Politics of Getting Convenience Retail Accepted in Single Family Neighborhoods." Garrett Park, Md.

Hare, P. H. and Honig, C., with others, 1990. "Trip Reduction and Affordable Housing." Maryland National Capital Park and Planning Commission, Montgomery County, Md.

Liebmann, G. W., 1990. "Suburban Zoning -- Two Modest Proposals." Real Property Probate and Trust Journal 25(1, Spring): 1-16.

Reno, A., 1988. "Personal Mobility in the United States," in A Look Ahead: Year 2020. Washington, D.C.: Transportation Research Board, National Research Council.

Roman, S., 1990. "Demographic Characteristics of Older Residents of Single-Family Homes (in Montgomery County, Md.)." Prepared for the Second Conference on People in Need, December 13, 1990, Montgomery County Planning Department

Soldo, B. J. and Agree, E. M., 1988. "America's Elderly." Population Bulletin 43(3, Sept). A publication of the Population Reference Bureau, Inc.

Struyk, R. J. and Soldo, B., 1980. Improving the Elderly's Housing: A Key to Preserving the Nation's Housing Stock and Neighborhoods. Lexington, Mass.: Ballinger.

Reprinted with permission from Generations, Journal of the American Society on Aging, Spring 1992, pp. 35-39. Copyright ASA.


A project of the National Resource Center on Supportive Housing and Home Modification,
in affiliation with the Fall Prevention Center of Excellence, funded by the Archstone Foundation.
Located at the University of Southern California Andrus Gerontology Center, Los Angeles, California 90089-0191 (213) 740-1364.