Spring 2015

Inclusive Design and Elder Housing Solutions for the FutureBy Thomas Hall

I. THE AGING POPULATION ........................................................................................ II. VISITABILITY AND UNIVERSAL DESIGN ....................................................................

A. Visitability ....................................................................................................... 63B. Universal Design .............................................................................................. 64

III. WHY INCLUSIVE DESIGN? ....................................................................................... A. Many Single-Family Homes May Be Hazardous to Elderly People ................... 64B. Aging at Home Provides Multiple Emotional and Psychological Benefits ......... 65C. Inclusive Design Will Ultimately Lead to Savings ............................................ 66D. Current Housing Laws Do Not Go Far Enough .............................................. 67

IV. HOW INCLUSIVE DESIGN HAS BEEN IMPLEMENTED ................................................. A. Mandatory Programs ....................................................................................... 68B. Voluntary Programs ......................................................................................... 70C. Expanding These Programs .............................................................................. 71

V. CONCLUSION ..........................................................................................................

As the number of Americans age 65 and older rapidly grows, society faces the challenge of housing an aging population. Long-term care facilities and elderly-focused communities can provide the services and amenities necessary to age comfortably, but the large majority of older people in the United States prefer to remain in their own homes — a concept often referred to as “aging in place.”1

Policies that promote aging in place assert that older people benefit socially and finan-cially when they are able to age in their own homes, in familiar neighborhoods and com-munities.2 Unfortunately, older people with physical limitations face an additional barrier to aging in place: the structural design of the homes they inhabit. While several laws address accessibility issues for public areas and a small percentage of publicly subsidized housing, the vast majority of private housing is left without legally mandated accessibility standards.3

This article seeks to promote the development of standards for the inclusion of visitabil-ity and universal design principles in public housing, and incentivize their use in new private residential housing construction, furthering the ideal of aging in place. Such standards should expand the number of housing options available to the elderly, particularly those with physi-cal impairments, and support the strong preference of older people to age in their current homes and communities. Part I discusses the drastic demographic shift affecting the United

Thomas Hall is a third-year law student pursuing a JD Certificate in Elder Law at The John Marshall Law School. During his time as a law student, he has dedicated much of his efforts towards advocating for vulnerable individu-als in the areas of fair housing, criminal defense, and guardianship. As a lifelong resident of Chicago’s far South Side, he plans to focus his future practice on issues concerning his hometown’s large elderly and special needs community.

1 Teresa A. Keenan, Home and Community Preferences of the 45+ Population 4 (AARP; 2010); Jon Pynoos, et al., Aging in Place, Housing, and the Law, 16 Elder L.J. 77, 78 (2008)

2 Id.3 Jordana L. Maisel et al., Increasing Home Access: Designing for Visitability (AARP; 2008).

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States and the impact of that shift on housing. Part II explores two principles of inclusive design: visitability and universal design. Part III addresses the social and financial benefits of incorporating inclusive design features into private single-family homes during the design stage of construction. Finally, Part IV looks at how inclusive design principles have been incorporated into local, state, and federal laws.

I. THE AGING POPULATIONThe United States is in the midst a demographic shift unlike any our nation has ex-

perienced. Between 1990 and 2010, the number of Americans age 50 and older grew by 35 million, an increase of 55 percent.4 This translated into the total number of Americans age 65 and older swelling to more than 40 million in 2010,5 representing 13 percent of the total population.6 In 2011, the leading edge of the baby boomer generation reached age 65.7 Since January 1, 2011, and each day for the next 20 years, an estimated 10,000 Americans will celebrate their 65th birthdays.8 By 2030, when the last baby boomer turns 65, the U.S. Census Bureau estimates that the population age 65 and older will be more than 70 million.9

While the aging of our population has serious implications for virtually every aspect of American society, accessible housing is of particular concern, given the strong correlation between age and prevalence of disability. In 2006, about 22 million people age 65 and older reported having physical difficulties.10 Of that number, about 11.5 million reported having difficulty climbing 10 steps without resting.11 Many older people also have trouble complet-ing daily activities such as eating, dressing, and bathing, or completing household tasks such as cleaning, laundry, cooking, and using the telephone. In 2005, the AARP Public Policy Institute reported that 4.6 million, or 13 percent, of the older population, had difficulty with at least one daily activity.12 Furthermore, 25 percent of persons between the ages of 65 and 74 reported a limitation caused by one or more chronic conditions, while 44 percent of persons 75 years and older reported such limitations.13

The prevalence of disability in the older population underlines the need for develop-ment of safe and affordable housing options for the millions about to enter the ranks of the elderly. Every year, more and more people enter these ranks. Within the next two decades, around 75 million baby boomers will follow. As a result, people over age 65 are expected to account for 20 percent of the U.S. population by 2030.14 The sheer size of the soon-to-be

4 Harv. U. Jt. Ctr. For Hous. Stud., Housing America’s Older Adults: Meeting the Needs of an Aging Population 2 (2014).

5 Lindsay M. Howden & Julie A. Meyer, Age and Sex Composition: 2010, 2, 2010 Census Briefs, C2010BR-03, (2011).

6 Id.7 Ctrs. for Disease Control & Prevention, The State of Aging & Health in America 2013 1. U.S. Dept. of Health

& Human Servs.; 2013.8 Id.9 Harv. U. Jt. Ctr. For Hous. Stud., supra n.4.10 Maisel, et al., supra n. 3, at 2.11 Id. 12 AARP Public Policy Inst., The State of 50+ America 2005 (AARP; 2005)13 Id.14 Harv. U. Jt. Ctr. For Hous. Stud., supra n.4.

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senior population places an increasing urgency on the need to develop more housing units with inclusive design features.

II. VISITABILITY AND UNIVERSAL DESIGNVisitability and universal design are two related, yet distinct movements founded in a

civil rights approach to increasing the accessibility of our communities. While neither theory focuses exclusively on issues surrounding the elderly, their ability to provide socially and economically viable solutions to problems associated with housing an aging society cannot be ignored.

A. Visitability Visitability is a standard of home construction founded in the proposition that every

home should be visitable by every person in the community, especially those with wheel-chairs.15 As such, visitability requires basic accessibility in the entry and first floor of sin-gle-family homes.16 While a variety of features can be included in a visitable home, three minimum standards must be met to make a home visitable: 1) a zero-step entrance, 2) wider doorways on the main floor (32-inch minimum clearance), and 3) a half bath on the main floor with enough space to fit a wheelchair.17 Other visitability features include grab bars in the first-floor bathroom and lever-style door handles instead of doorknobs.18

The concept of visitability was introduced to the United States in 1987 by Concrete Change, an advocacy group for people with disabilities.19 Originally termed “basic home access,” the title was eventually changed to “visitability” to reflect the movement’s focus on community integration, as opposed to separate housing.20 Philosophically, visitability is not entirely centered on elderly housing, but rather on a civil rights approach to accessibility for the physically impaired. The immediate goal of visitability is to provide a few basic accessibil-ity features to ensure that a person with mobility limitations can use and visit the homes of friends and family.21 Over the long term, single-family homes designed with visitability in mind can reduce the number of barriers that interfere with adapting homes for long-term use by persons with mobility impairments.22

Many jurisdictions have adopted visitability standards. These laws vary significantly in scope of housing covered, features required, and enforcement.23 With respect to scope of housing covered, a common limitation in many of the existing laws is that many laws only

15 Id., at 95.16 Id. 17 Maisel, et al., supra n. 3 at 8.18 Robin Paul Malloy, Inclusion by Design: Accessible Housing and Mobility Impairment, 60 Hastings L.J. 699,

712 (2009).19 Maisel, et al., supra n.3.20 Id.21 Concrete Change, Visitability Defined, http://concretechange.org/ visitability/visitability-defined/ (accessed

July 24, 2014).22 Ctr. For Inclusive Design & Envtl. Access, Visitability: An Inclusive Design Approach for Housing http://www.

udeworld.com/visbooklet/visitibilitybooklet.pdf (accessed July 24, 2014).23 Stanley K. Smith, et al., Aging and Disability: Implications for the Housing Industry and Housing Policy in the

United States, 74 J. of Am. Plan. Assn. 289, 292 (2008).

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apply to a small percentage of single-family units constructed with public funds.24 With respect to enforcement, some programs are mandatory, with a law or ordinance requiring builders to include visitability features in new construction.25 Others are voluntary, offering tax incentives and expedited administrational processes in return for compliance.26

B. Universal DesignIn contrast to the intentionally minimal requirements of visitability, universal design

offers a comprehensive overhaul of the way single-family homes are planned and built. Uni-versal design suggests that everything within a structure should be designed in a way that is readily accessible to all persons regardless of age, size, or physical ability.27 Thus, universal design standards are more comprehensive than visitability standards and apply throughout the entire structure.

A home built using universal design would, at a minimum, include the types of features required in new multi-home complexes under the Fair Housing Act (accessible entrances, hallways, bathrooms and kitchens; raised electrical outlets; and wall supports in bathrooms for installing grab bars).28 A truly universal design home would go a step further to include the following: features to ensure accessibility of all entries, closets stacked on different floors to allow an elevator to be installed if needed, countertops installed at multiple heights, front-loading appliances such as washer and dryers raised off the floor, grab bars in all bathrooms, nonslip surfaces, at least one roll-in shower, doors with either lever handles or automatic openers, and a “livable” first floor.29

Universal design is particularly concerned with the aesthetic aspect of a home’s struc-tural features.30 Ultimately, the goal of the universal design movement is to encourage the design of products and environments that are usable by all people, to the greatest extent possible, without the need for adaption or specialized design.31 As such, it is important that designs be pleasing to the eye because design features that are identified solely with disability can stigmatize a home and make it unmarketable to the broader population.

III. WHY INCLUSIVE DESIGN?Mandating accessibility standards for a broader range of home construction projects in-

creases the inclusiveness and safety of our neighborhoods and homes. Though elderly persons would likely be the natural beneficiaries of such a transformation, the benefits that arise from expansion of inclusive design in construction will be far-reaching.

A. Many Single-Family Homes May Be Hazardous to Elderly PeopleWhile housing policy and principles of home design may not seem like a matter of life

24 See Natl. Council on Disability, The State of Housing in America in the 21st Century: A Disability Perspective, Table 10 (Jan. 19, 2010), http://www.ncd.gov/publications/2010/Jan192010.

25 See id.26 See id.27 Malloy, supra n. 18, at 711.28 Pynoos, et al., supra n. 1 at 98.29 Id.30 Leslie Mann, Universal Design Strikes a Balance Between Safety and Style, Chi. Trib. (June 28, 2012).31 Ctr. for Universal Design, The Principles of Universal Design, (version 2.0, N.C. St. U. 1997).

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and death, they often have a major impact on the health and safety of elderly homeowners. The barriers inherent in traditional home design can become serious hazards to the elderly and mobility impaired. For example, something as simple as a narrow doorway can become a serious obstacle for an elderly person who uses a wheelchair. Narrow bathroom doors may force people using walkers to maneuver sideways through the door, increasing the risk of falls. Narrow doors also may cause people who cannot walk to resort to unsafe strategies to enter the room such as lowering themselves out of wheelchairs to scoot across the floor or transfer-ring to dangerous alternatives such as a desk chair. For those with serious sensory or mobility impairments, safely navigating their homes can be a dangerous, and sometimes deadly, task.

Each year millions of elderly Americans age 65 and older suffer from a fall.32 In fact, one out of three elderly Americans experiences a fall each year,33 making falls the leading cause of both fatal and nonfatal injuries among that age group.34 In 2011, about 22,900 adults age 65 and older died from falls.35 While not every fall results in death, falls are the most common cause of traumatic brain injury.36

The unforgiving terrain of a home that is ill-equipped to house a person with mobility impairments can also become a hazard to caregivers. For example, it’s common for caregivers to suffer physical injuries as a result of lifting and handling the individuals for which they care.37 However, the health problems affecting caregivers are not limited to physical injuries. Psycho-logical health issues such as fatigue, anxiety, and depression are also common.38 In sum, the inability of a caregiver to easily navigate their surroundings when caring for a patient or family member can become a serious obstacle to delivering the quality care many elderly and disabled persons require.

B. Aging at Home Provides Multiple Emotional and Psychological Benefits. The overwhelming majority of persons 45 and older would strongly prefer to stay in

their current homes as they age.39 The fact that aging in a familiar and safe environment has been linked to numerous emotional and psychological benefits may help explain the strong desire among older people to age in place. For example, research shows that indepen-dent living promotes life satisfaction, health, and self-esteem, three keys to successful aging.40 Furthermore, older adults get a sense of familiarity, comfort, and meaning from their own homes. A 2004 AARP survey found that of those people living in homes they identify as meeting their needs very well or somewhat well, 95 percent reported being satisfied with their

32 According to the Centers for Disease Control and Prevention, 2.4 million nonfatal falls among elderly adults were treated in emergency departments in 2012. Ctrs. Disease Control & Prevention, Falls Among Older Adults: An Overview (last updated Sept. 22, 2014), http://www.cdc.gov/homeandrecreationalsafety/Falls/adultfalls.html (accessed Sept. 27, 2014).

33 Id.34 Id.35 Id.36 Id.37 Maisel, et al., supra n. 3, at 4.38 Id. 39 Keenan, supra n. 1.40 A. R. Herzog & J. S. House, Productive Activities and Aging Well, 1 Generations 15, 54. (1991).

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lives most of the time.41

Accordingly, policies that promote aging in place may have a significant impact on the emotional and psychological health of elderly individuals. By adopting inclusive design standards, governments will be actively promoting elderly independence by removing physi-cal barriers to the full use of one’s home before they even become obstacles. Additionally, comprehensive inclusive design standards enforced during the design stage of home construc-tion may also save future generations of American elderly from the emotional trepidation experienced by individuals forced to leave their long-occupied homes. In sum, by promoting independence among the elderly population, we can ensure that our older citizens get full enjoyment out of their later years

C. Inclusive Design Will Ultimately Lead to SavingsAlthough home modifications can be a viable option for financially secure older adults

looking to age at home, cost is a significant barrier to aging in place for many elderly people. In an AARP survey of persons age 50 and older with disabilities, cost was the most commonly cited reason they did not make needed home improvements.42 HomeAdvisor, a popular con-sumer information website with national membership, reports that nationwide its members paid $8,990 on average for disability accommodation remodeling, with most homeowners spending between $6,943 and $11,037.43 While the cost of individual projects can vary sig-nificantly based on the requested design features and the cost of materials on the local level, waiting to incorporate inclusive design features can drive remodeling costs into the tens of thousands of dollars.

By contrast, the cost of incorporating inclusive design features during initial home construction is often cheaper and more cost-effective than making extensive renovations.44 For example, the former executive director of the Home Builders Association of Georgia es-timated that when visitability features are planned, the typical added cost for a single-family detached home is “less than $100 for homes on concrete slabs, and $300 to 600 for homes with crawl spaces or basements.”45 Even high-end estimates that hover between $2,000 and $5,00046 are still lower than what most homeowners will pay in remodeling costs in later years.

Additionally, the cost of using inclusive design features in private residential homes pales in comparison to the cost of living in a nursing home or assisted living facility. In 2012, the average monthly base fee for an individual to live in an assisted living facility was $3,550, or $42,600 annually.47 Additionally, the average cost of a private room in a nursing home in 2012 was $2248 a day or $90,520 a year.48 Federal and state funds pay for a large portion

41 Ada-Helen Bayer Ph.D, & Leon Harper, Fixing to Stay: A National Survey of Housing and Home Modification Issues 32 (AARP 2000).

42 AARP, supra n. 12.43 HomeAdvisor, “How Much Does It Cost to Remodel for Disability Accommodation?” http://www.homeadvisior.

com/cost/environmental-safety/remodel-for-disability-accommodation (accessed Aug.26, 2014).44 Maisel, et al., supra n. 3 at 19.45 Id. 46 Mann, supra n. 30.47 MetLife, MetLife Market Survey of Long-Term Care Costs, (MetLife Mature Mkt. Inst. 2012).48 Id.

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of nursing home costs. For example, Medicaid spent $67 billion on long-term care in 2000, 75 percent of which paid for nursing home and institutional care.49 In many cases, elderly people who enter nursing homes exhaust their savings over time, and must turn to publicly funded government programs to help pay for care. Thus, helping people to remain in their homes during old age could lead to substantial savings for individuals and society as a whole.

Finally, homes constructed using inclusive design will reduce medical costs by de-creasing the likelihood and severity of falls. According to the Centers for Disease Control and Prevention, falls among older people resulted in $30 billion in direct medical costs in 2012.50 By 2020, the total annual cost of these injuries is expected to reach $67.7 billion.51 In 2002, Medicare paid, on average, between $13,797 and $20,450 per fall (figures adjusted for inflation).52 Expanding the use of inclusive design principles in new home construction can help reduce the number of falls experienced by elderly Americans by creating living condi-tions more suited to their needs. For example, including a first-floor bedroom and bathroom in a home can negate the need for an elderly person to make trips up hazardous stairways. Additionally, building reinforced walls to accommodate the easy installation of grab bars and installing no-step bathtubs can help prevent individuals from experiencing devastating falls in bathrooms.

D. Current Housing Laws Do Not Go Far EnoughOn the national level, several significant regulations affect building accessibility for a

number of types of property. Numerous ordinances on the state and local level also exist. Unfortunately, very few of these laws reach privately funded single-family housing.

The Architectural Barriers Act of 1968 (ABA) requires that buildings and facilities de-signed, constructed, altered, or leased with federal funds after September 1969 must be ac-cessible and usable by disabled persons.53 Private-sector construction of single-family housing is not covered by the ABA. Similarly, section 504 of the Rehabilitation Act of 1973 prohibits discrimination based on disability in any program or activity receiving federal financial as-sistance. Section 504, as it applies to housing, covers housing programs receiving federal funding, but not to privately funded single-family residential housing.54

The Fair Housing Amendments Act of 1988 applies to multifamily housing and outlaws discrimination against people with disabilities.55 It also provides mandates for all new multi-family housing to meet specific accessibility standards, including standards for entranceways, hallways, light switches, grab bars, spacing to accommodate use of a wheelchair, and other design elements.56 The inclusive design criteria, however, does not apply to single-family residential housing.

Perhaps one of the most well-known federal regulations protecting disabled persons is

49 Christy M. Nishita, et al., The Going Home Plus Project, 68 Hawaii Med. J. 156, 156 (2009).50 Ctrs. for Disease Control and Prevention, supra n. 32.51 Id. 52 Id. 53 Architectural Barriers Act of 1968, Pub. L. No. 90-480, 82 Stat. 718 (1968) (codified as amended at 42

U.S.C. §§ 4151-4157 (2006)).54 Rehabilitation Act of 1973, 29 U.S.C. § 794 (2006). 55 Fair Housing Amendments Act of 1988, 42 U.S.C. § 3601 (2006).56 Id.

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the Americans with Disabilities Act of 1990 (ADA). Title II of the Act prohibits discrimina-tion based on disability in programs, services, and activities provided or made available by public entities.57 The Department of Housing and Urban Development (HUD) enforces Title II when it relates to state and local public housing, housing assistance, and housing re-ferrals.58 Title II sets accessibility standards for public facilities and programs- not for private residential housing.59 Additionally, Title III of the ADA prohibits discrimination based on disability in the provision of goods, services, facilities, privileges, advantages, or accommoda-tions for any place of public accommodation by any person owning, leasing, or operating a place of public accommodation.60 Some examples of a place of public accommodation cov-ered by Title III includes hotels, restaurants, museums, and certain commercial facilities.61

The glaring limitation to these vitally important laws is that they do not cover private single-family housing. This is particularly troubling given that the vast majority of adults age 50 and older live in single-family homes they own.62 Furthermore, the percentage of publicly funded units covered is fairly small. For example, under HUD regulations, only 5 percent of qualifying public housing units must be accessible.63 This means that the HUD accessibility standard only applies to a small percentage of overall housing because it completely misses all privately owned single-family residential housing. Thus, to prepare for the eminent increase in the number of elderly Americans, we need to think in broader terms concerning the need for inclusive design housing, and we must recognize the public interest in both publicly and privately funded units.

IV. HOW INCLUSIVE DESIGN HAS BEEN IMPLEMENTEDRecognizing the coverage deficits of federal accessibility laws, many state and local

governments have enacted inclusive design standards. Each initiative varies in the features required and amount of housing covered. While participation is mandatory in some cases, others are entirely voluntary, offering benefits such as tax credits to encourage compliance. The programs described below are grouped according to this distinction. Despite the relative newness of these programs, each represents an important first step toward changing the face of our national housing stock.

A. Mandatory ProgramsSome local jurisdictions have implemented mandatory programs to encourage the use

of universal design and visitability principles in new home construction. In 1992, the na-tion’s first visitability ordinance was passed in Atlanta, Ga.,64 which, to date, is estimated to have resulted in the construction of between 700 and 1,000 visitable homes.65 The ordinance

57 Americans with Disabilities Act of 1990, Pub. L. No. 101-336, 104 Stat. 327, 337-353 (1990)(codified as amended at 42 U.S.C. §§12131-12161).

58 Id.59 Id.60 Id.61 Id.62 Harv. U. Jt. Ctr. For Hous. Stud., supra n. 4, at 20. 63 42 U.S.C. § 3601.64 Concrete Change, supra n. 21.65 U. at Buffalo IDeA (Ctr. For Inclusive Design & Envtl. Access) & AARP Publice Policy Inst., Local Visitabil-

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mandates that all builders of new single-family dwellings, duplexes, or triplexes that receive any financial benefit from or through the city must meet several basic access requirements.66 Those requirements include: one flat or sloped entrance, doors at least 32 inches wide, wall switches and outlets at reachable heights, and reinforced bathroom walls to allow for the installation of grab bars.67

The most effective of the local ordinances was passed in Pima County, Ariz., whose mandatory visitability ordinance resulted in the construction of more than 15,000 visitable homes as of 2009.68 In general, mandatory programs have enjoyed a moderate level of suc-cess nationwide. Thus, the second, third, and fourth largest supply of visitable homes can be found in cities with mandatory participation ordinances.69

State governments also have implemented laws requiring visitability in home construc-tion. In Minnesota, all new construction of single-family homes, duplexes, triplexes, and multilevel townhouses that are financed though the state Housing Finance Agency are re-quired to incorporate basic visitability principles into design and construction.70 The statute defines a visitable home as “a dwelling so that people with mobility impairments may enter and comfortably stay for a duration,”71 but limits the design features to “one no-step en-trance, 32-inch clear doorways throughout the dwelling, and a one-half bathroom on the main level.”72 This statute does not include expanded hallways, reinforced bathroom walls, and height requirements for light switches and environmental controls that are included in other state inclusive design statutes. Furthermore, a primary limitation of many accessibility laws is that if they reach residential construction, they require that only a small percentage of those homes constructed comply with the inclusive design standard. While the limited inclu-sive design features required by the Minnesota law leave something to be desired, the strength of the law lies in the fact that it applies to all housing construction funded in whole or in part by the state’s housing authority.73 Some jurisdictions mandate that builders provide informa-tion regarding universal design and visitability to consumers. For example, as part of Califor-nia’s Health and Safety Code, builders must provide a checklist of universal design “add-on options” to potential homebuyers, enabling buyers to choose accessibility features for their homes.74 This approach addresses the information gap between builders and homebuyers.

The push for federal leadership on the issue has led to the introduction of the Inclusive Home Design Act, which seeks to build on the accessibility requirements already in place

ity Initiatives & Policies; http://idea.ap.buffalo.edu//Visitability/reports/existingcitylaws.htm (updated Jan. 2014).

66 Id.67 Mike Ervin, NPR, Housing First: A Special Report, Visitability: A Concrete (and Brick, and Wood) Change

(2002), http://www.npr.org/news/specials/housingfirst/whoneeds/visitability.html (accessed on Nov. 6 2014).

68 Maisel, Jordana, et al., supra n. 3.69 See id. In 2008, San Antonio, Texas had more than 7,000 visitable homes; Bolingbrook, Illinois had more

than 3,500; and Austin, Texas, more than 3,000.70 Minn. Stat. Ann. § 462A.34 (West 2014).71 Id. 72 Id. 73 Id. 74 Emily Salomon, Expanding Implementation of Universal Design and Visitability Features in the Housing Stock.

(AARP, Public Policy Inst. Mar. 2010).

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through various statutes. Originally introduced in 2002 by Rep. Jan Schakowsky of Illinois,75 the bill died in committee but was reintroduced in mid-2013 as the Eleanor Smith Inclusive Home Design Act.76 The Act requires all newly constructed single-family houses and town houses funded with federal money to include at least one level that complies with visitability standards.77 The bill also permits private civil actions in federal district court or state court for violations of the Act.78 As evidenced by the prior failures of the bill in Congress, the Act does not have a strong chance of becoming law.

B. Voluntary ProgramsAs an alternative to laws that mandate the use of universal design and visitability fea-

tures, some jurisdictions have developed programs that offer financial incentives in exchange for homeowners and builders voluntarily incorporating universal design and visitability fea-tures into homes. At the local level, Freehold, N.J., passed an ordinance to waive build-ing permit fees for construction of universal design and visitability features in residential homes.79 While the ordinance does not clearly define what constitutes a qualifying accessibil-ity feature, the city has shown a willingness to waive fees for commonly recognized features such as ramps.80

Similar local incentive-based programs are designed to encourage builders to use univer-sal design and visitability principles in their residential developments. For example, in Austin, Texas, the Safe, Mixed-Income, Accessible, Reasonably Priced, Transit-Oriented (SMART) Housing Policy Initiative offers an expedited review process and fee waivers to encourage the construction of affordable housing.81 To participate in the SMART program, builders must construct homes that meet visitability standards put in place by an Austin city ordinance.82 The Austin ordinance is mandatory and applies to all new home construction that is funded with financial assistance from the city.83

At the state level, Pennsylvania’s Residential Visitability Design Tax Credit Act allows a local governing body to authorize, for any new or redeveloped housing that contains visit-ability features, either a tax credit of up to $2,500 or the amount the property tax will increase for the first five years after the visitability features are installed, whichever is less.84 Some qualifying visitability features include zero-step entryways, wider doorways and hallways, and entry-level bathrooms.85

Other states have offered more substantial incentives. In Virginia, the Virginia Livable Home Tax Credit program is designed to improve accessibility and visitability in Virginia’s

75 Inclusive Home Design Act, H.R. 5683, 107th Cong. (2002).76 Mann, supra n. 30.77 H.R. 5683, 107th Cong.78 Id.79 Andrew Kochera, Accessibility and Visitability Features in Single-Family Homes: A Review of State and Local

Activity 17 (AARP Mar. 2002).80 Id. 81 Salomon, supra n. 74.82 Id.83 Kochera, supra n. 79.84 Pa. Consol. Stat. Ann. tit. 72 P.S. § 4751-101 et seq. (2010).85 Id.

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residential units by providing state tax credits for the purchase or construction of new acces-sible housing units or the retrofitting of existing units.86 Tax credits are available for up to $5,000 for the purchase or construction of a new accessible residence and up to 50 percent of the cost of retrofitting existing units, not to exceed $5,000.87

Other states developed programs specifically for people with permanent disabilities. For example, Georgia offers a $500 tax credit to homeowners with disabilities to cover the costs of qualifying accessibility features.88 Qualified features include: one no-step entrance to the residence, interior passage doors providing at least a 32-inch wide opening, reinforced bath-room walls, and light switches and outlets placed in accessible locations.89 The program also provides a credit for the cost of retrofittingan existing single-family home with one or more of these features or $125, whichever is less.90

C. Expanding These ProgramsAs of 2014, 34 states91 and 59 local jurisdictions92 had implemented visitability criteria

or universal design standards. Despite notable successes, much work is left to be done. By using successful visitability and universal design initiatives as a model, jurisdictions that have yet to adopt comprehensive standards can take a major step toward ensuring that aging in place is a reality for millions of elderly Americans.

V. CONCLUSIONPreparing for the inevitable challenges that will accompany a growing elderly popula-

tion should be a priority at every level of government. With the rising cost of medical care and the challenges of a weakened economy, the traditional nursing home or long-term care facility will simply not be an option for many of the soon-to-be elderly. Aging at home is becoming an increasingly attractive option for many older individuals. Unfortunately, cur-rent home design standards do not provide comprehensive support for aging-in-place and in many cases serve as a source of physical and economic hardship for the elderly and their care-takers. Ensuring that the elderly population ages in safe and familiar housing that enriches and prolongs their lives will require bold solutions. Expanding current local, state, and federal laws to encourage the use of inclusive design principles in both public and private housing will provide a solid foundation for meeting these coming challenges.

86 Va. Dept. of Hous. & Dev., Livable Homes Tax Credit (LHTC), http://www.dhcd.virginia.gov/index.php/housing-programs-and-assistance/tax-credit-programs/livable-homes-tax-credit.html (accessed on Oct 12, 2014).

87 Id.88 Salomon, supra n. 74.89 Ga. Code Ann. § 48-7-29.1 (2014).90 Id.91 U. at Buffalo IDeA Ctr. & AARP Public Policy Inst. State Visitability Iniatives & Policies (updated Jan. 2014),

http://idea.ap.buffalo.edu//Visitability/reports/existingstatelaws.htm.92 U. at Buffalo IDeA Ctr. & AARP Public Policy Inst., supra n. 65.

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