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Regional Keys

Making the Region a Livable Community

What are the keys to making this region a place where senior citizens and adults with disabilities will desire to “age in place”? What are the keys to making this region a “livable community”? These are the questions considered by the Hampton Roads Regional Lifelong Planning Partnership (LLPP) over the past 18 months through surveys, focus groups, and steering committee meetings.

In a follow-up to our 2008 Regional Snapshot, we asked survey participants to list the top three characteristics that make this region an ideal community for seniors. Here are the top three responses:

  1. Ability to age in place (community based services to help people stay in their homes)
  2. Public awareness of availability of services
  3. Housing that is both accessible and affordable

“Today seniors do not necessarily want to move in with someone else or be institutionalized. If given a choice, most seniors want to stay in their own homes and age in place. Aging in place services refer to the concept of helping seniors resolve whatever problems, be they housing, healthcare, home care, home repairs, nutritional services, etc., that might affect that individual’s ability to maintain his or her current living arrangement for as long as possible.” (Mulroy, Tull, Bloom & Karnas, 2007)

The top three responses clearly echo this “aging in place” phenomenon and direct us to four keys that are essential to making this region a livable community:

First Key

Improved Regional Transportation Services Community-based services are “services designed to help people remain independent and in their own homes; [and] include[s] transportation, delivered meals or congregate meals site, visiting nurses or home health aides, adult day care, and homemaker services.” “Mobility is a crucial component of everyone’s quality of life. Affordable, easy-to-use, and flexible transportation options are essential for accessing health care services, establishing and maintaining social and family contacts, and preserving independence and general well-being.” (Leary, 2007) Whether a community meets the test of livability “depends in part on multiple mobility options that allow residents of all ages [and abilities]…to connect with their communities…transportation is the means by which they physically reach other people and activities in their community.” (AARP, Beyond 50.05, 2010)

Transportation is the most critical type of community-based service, and is key to providing access to other types of community based services. Transportation includes the following:

  • Public transit
  • Privately owned and operated transit
  • Personal vehicles

“Safe and appropriate pedestrian and bicycle facilities (complete streets) and paratransit, which provides complete needs of all individuals participating within the community.” (Community Integration Implementation Team and the Community Integration Advisory Commission, 2009)

“Nationally, the greatest change in trip-making does not occur as we age [but rather] when we stop driving… nondrivers make half as many trips as drivers. Many older people see mobility as inextricably linked to personal image, dignity, and well-being. Most adults equate mobility with the ability to drive; the loss of driving is seen as a handicap, which results in, at best, a change in lifestyle and, at worst, the end of life as they know it.” (Hampton Roads 2030 Regional Transportation Plan – Elderly & Handicapped Transportation Plan: Part I)

Mobility options for non-driving seniors and people with disabilities are a factor of the community in which the individual resides. Both groups “find it difficult…to stay in the community due to the lack of affordable, accessible housing and transportation.” Money Follows the Person Demonstration annual housing and transportation action plan”, 2008. Studies show that people living in densely populated areas are more mobile than their rural counterparts. “One in three older non-drivers walks on a given day in denser areas, as compared to 1 in 14 in more spreadout areas. [Also,] more than half of older non-drivers use public transportation occasionally in denser areas, as compared to 1 in 20 in more spread-out areas” (Improving the Competitiveness of Hampton Roads, Report No. 1: How the Region Works, Hampton Roads Regional Structure Project, 2005)

The studies support several conclusions. First, the key to keeping seniors mobile is to keep them driving as long as possible. Second, once seniors stop driving, their mobility is impacted by two critical factors: whether they live in a densely populated area and whether they have access to public transportation and accessible sidewalks and curb-cuts. Our public transportation provider, Hampton Roads Transit (HRT), targets most of its resources in densely populated areas as indicated by its routes and schedule. ( The addition of the Norfolk-based light rail service will enhance the mobility of all people, including seniors. However, while there is hope for a regional light rail plan, no such plan has been developed. In the interim the Commonwealth Transportation Board recently “approved $93 million to re-establish passenger rail in South Hampton Roads... In three years, travelers will be able to board an Amtrak train at Harbor Park in Norfolk and ride to Richmond and beyond for the first time in more than three decades.” (The Virginian-Pilot, Norfolk, Va., June 17, 2010)

The mobility demands of rural commuters and those residing in HRT underserved areas have been supplied principally by independent providers such as Senior Services of Southeastern Virginia (Senior Services) operates “I-Ride”, a public fee paying bus service with scheduled routes serving Franklin, Isle of Wight, Courtland, and Southampton County. In addition to “I-Ride” Senior Services recently received foundation grant funding to provide shuttles from Franklin to the Western Tidewater Free Clinic as well a public “wellness shuttle” in the City of Norfolk.16 Senior Services also received a Senior Transportation Grant from the Virginia Department of Rail and Public Transportation (VDRPT) to subcontract with private vendors for night and week-end services for Franklin and South Hampton County. Additionally, Senior Services provided critical support to assist in the award of a $70,000 VDRPT grant to Southampton County. This latest initiative underscores Senior Services’ value as a collaborative
partner with VDRPT and HRT.

Finally, according to a national transportation study “by 2020, culturally and ethnically diverse elders will comprise 23.6% of the total older population in the U.S. Culturally and ethnically diverse elders face a number of mobility challenges that are distinctly their own. For instance, approximately 21% of all American elders do not drive. However, when the data is analyzed by culture and ethnicity, close to 40% of each group – African-American, Hispanic and Asian elders – do not drive [versus] 16% of Caucasian older adults.” (National Center on Senior Transportation, 2009)18 Given this study, our regional transportation solution must be sensitive to the fact that 31% of our senior population is comprised of minorities. Based on these numbers, we estimate that 32,200 minority elderly populations will not be driving in 2020, in addition to 28,700 non-minority drivers in the South Hampton Roads area.

The key to ensuring access to community based services for seniors and people with disabilities is to improve regional transportation services by the following:

  1. Developing a comprehensive approach to ensure that seniors continue to drive as long as possible
  2. Enhancing our public transit capacity by increasing available routes in rural and underserved areas
  3. Providing an incentive for our regional transit provider to work collaboratively with the private sector in expanding transportation options
  4. Developing a regional transportation plan to ensure that all municipalities are sensitive to and appreciate the needs of non-drivers, including accessible sidewalks; and, other modes of transportation that are user-friendly
  5. Encouraging a regional transportation plan to “go beyond” Americans with Disabilities Act (ADA) standards for paratransit services for people with disabilities

Second Key: Improved Access to Services

The second key is to provide public awareness of available services. How do we get out the word to insure that people know what services are available to make seniors’ lives livable? Simply stated “…access to aged care services can sometimes be complicated when people do not understand what is available or how to access services.” In a nationwide effort to simplify access and to provide a single point of entry into the longterm supports and services system for seniors and adults with disabilities the Administration on Aging and the Centers for Medicare & Medicaid Services funded 43 states and territories to develop Aging and Disability Resource Center programs between 2003 and 2005.

“Aging and Disability Resource Centers (ADRCs) serve as single points of entry into the long-term supports and services system for older adults and people with disabilities. Sometimes referred to as one stop shops or No Wrong Door systems, ADRCs address many of the frustrations consumers and their families experience when trying to find needed information, services and supports. Through integration or coordination of existing aging and disability service systems, ADRC programs raise visibility about the full range of options that are available, provide objective information, advice, counseling and assistance, empower people to make informed decisions about their long term supports, and help people more easily access public and private long term supports and services programs.”

There are numerous examples of highly effective ADRCs. The Atlanta Regional Commission’s (ARC) strategy to provide access to services and resources through education of seniors and caregivers and improving linkages among community-based services is a nationally recognized example. The ARC has achieved success in involving corporate, medical and human service organizations in implementing the following strategies:

1. Educate seniors, adults with disabilities and caregivers about services by doing the following:

a. streamlining information and access to services and promoting the services
b. partnering with local employers to promote retirement planning among employees of all ages
c. educating adults of all ages about long-term care insurance
d. educating adults of all ages about end-of-life issues including advance directives and wills
e. expanding Information and Assistance (I&A) networks; f. providing education and support for adult children caring for seniors; and g. conducting outreach to underserved seniors.

2. Improve linkages among community-based service providers and connect community-based services with hospitals and rehabilitation centers by doing the following:

a. promoting formal and informal linkages between community organizations that serve seniors and other targeted populations (communication, cross-training,
b. promoting partnerships between community organizations
within and outside the aging network and
c. educating local policy makers about the needs of seniors

Also, Wisconsin has demonstrated national leadership. In order to access public benefits in their state, “…a consumer must meet certain functional criteria.” ADRC workers collect information on the target group, Activities of Daily Living (ADL), and a person’s need for health services. They assess whether or not that level of care is equal to that paid for in a nursing facility. If a person meets the functional criteria, they then must qualify for Medicaid. After meeting the financial criteria for Medicaid eligibility, a consumer will choose to be in the managed care program (FamilyCare) or not. Someone who does not opt into managed care can enter a nursing facility, enroll in Medicaid fee-for-service or use informal supports to remain in their home. There is a higher income limit for Medicaid if a consumer is functionally eligible due to a waiver
being in place in the state program. “Throughout these steps a consumer is engaged in the options counseling process with an ADRC worker, receiving comprehensive information about choices and resources. The evaluators constantly refer to the concept of minimizing the number of hoops that a consumer has to jump through to access services.”

Since 2000, the Endependence Center, Inc., the region’s Center for Independent Living (CIL), has received grants from the Virginia Board for People with Disabilities to provide information about Virginia Medicaid Home and CommunityBased Waiver services. Through this statewide project, the Medicaid Waiver Technical Assistance Center (MWTAC) was established. Waiver materials, workshops and information are available from 20 advocates connected to disability organizations who have participated in an eight-month training program conducted by the Endependence Center and the Department of Medical Assistance Services. The resources available through the MWTAC at the Endependence Center are accessed by seniors and adults with disabilities to assist them in learning about eligibility and services.

Community Resource Connections for Aging and Disabilities (CRC) “…is North Carolina’s implementation of the federal Aging and Disability Resource Center initiative. North Carolina’s brand reflects one of the main goals of this initiative, community collaboration. Through this collaboration, agencies and organizations within the community work together to provide information and assistance with access to services for individuals who are aging or have a disability. “Resource Connections denotes that individuals will be connected to resources for long-term services and supports and, for Aging and Disabilities, identifies the individuals to be served through the CRC.”

The ADRC models described above have many of the same components found in this region’s ADRC, Senior Services of Southeastern Virginia. In 2007, the Virginia Department for the Aging selected Senior Services as a No Wrong Door site for the ADRC statewide initiative. No Wrong Door, a “…virtual single point of entry system [is] designed to enable individuals to access long-term and supportive services through any agency or organization using one system. No Wrong Door creates a single, coordinated system of information and access for all persons seeking long-term support; minimizes confusion; enhances individual choice and supports informed decisionmaking.” Although this is a pilot program, “… the vision is to have ADRCs in every community serving as highly visible and trusted places where individuals can turn for information on the full range of long-term support options and entry to public long-term support programs and benefits.” In order to realize this vision and to provide public awareness of services for seniors, it is imperative that the following goals are met:

  1. Ensure that each municipality supports a regional ADRC
  2. Educate seniors, adults with disabilities and caregivers
    about services
  3. Improve linkages among community-based service

Third Key: Increased Workforce Capacity

The third key to making the region a livable community is to increase our community-based workforce capacity. Some experts assert that “…community-based service is a broad term that refers to all of the long-term care services provided to an individual in their home and community… includ[ing] home care... (State of Home Care and Hospice Services in Virginia, 2009). A community’s ability to deliver “home care” is dependent upon its workforce capacity. “Given the pressures that will be exerted on our workforce due to …the increased number of seniors and with that overall number the aggregate of those needing some form of care will also increase.” (Mulroy, Tull, Bloom & Karnas, 2007).

Over the next 10 years, the number of seniors residing in South Hampton Roads will increase by nearly 30%, from 200,000 to 260,000 by 2020.30 Therefore it is not surprising that seniors in South Hampton Roads are concerned with the availability of community-based services that include a workforce of sufficient capacity to service the growing population.

An individual’s ability to live independently is affected by their health. As the individual ages so does the need for care. A 2005 study in the health care journal Inquiry indicated that 69% of people over age 65 eventually would require some kind of long-term care. As the number of people needing care increases, the need for more professional and paraprofessional caregivers will as well. Direct Support Professionals play key roles in the health care delivery system for elderly adults and adults with disabilities. These are Certified Nursing Assistants (CNA), orderlies, home health aides and others who attend to seniors in long-term health care settings. In 2002, the statewide vacancy rate for CNA’s was 8.2% and there was a turnover rate of over 73%. (Roadmap for Virginia’s Health: A Report of the Governor’s Health Reform Commission, 2007).

Studies throughout the Commonwealth of Virginia indicate that the number of health care professionals and paraprofessionals will not keep pace with the increased number of seniors needing their services. It is estimated that by 2020 there will be a shortage of approximately 1,500 physicians in Virginia. (Roadmap for Virginia’s Health: A Report of the Governor’s Health Reform Commission, 2007)33 Physician retention is the primary issue in Virginia. Virginia educates medical students at the national average. However, only 36% of Virginia medical students stay in the state to practice. (Roadmap for Virginia’s Health: A Report of the Governor’s Health Reform Commission, 2007).

By 2020 there is a projected shortage of 22,600 registered nurses in addition to a physician shortage. (Roadmap for Virginia’s Health: A Report of the Governor’s Health Reform Commission, 2007)35 Not only is there a shortfall between the supply and demand of nurses, but there is also a shortfall in the number of students that Virginia can currently educate due to a shortage of educators and facilities. In 2003, Virginia programs turned away more than 1,300 qualified applicants. (Roadmap for Virginia’s Health: A Report of the Governor’s Health Reform Commission, 2007).

“Research on the benefits of home care indicates that home care may prevent or postpone unnecessary institutionalization. A recent report to Congress by the Medicare Payment Advisory Commission concluded that older adults who do not have help with ADL are more likely to be hospitalized for acute illness than adults who receive the help that they need.” Virginia Commonwealth University, Department of Gerontology (2010) In an effort to prevent the projected shortages in the health care workforce, both the federal government and the Commonwealth of Virginia have enacted several laws.

At the federal level, “…[t]he Workforce Investment Act of 1998 (WIA) replaced the Federal Job Training Partnership Act, with the goals of increasing the employment, retention and earnings of participants in Department of Labor (DOL) employment and training programs, largely by increasing the occupational skills of participants…. WIA mandates that states and local government carry out workforce planning in partnership with business, elected officials, labor and other key stakeholders through Workforce Investment Boards (WIBs). Every state must be subdivided into workforce development areas, and direct services to clients are delivered through “One-Stop” centers in each of these areas…. When WIA was implemented, beginning in 1999, shortages were or emerging among many health workforce professions, and even greater shortages were being projected for the next several decades.”

As early as the 1970’s, the Commonwealth of Virginia expressed concerns with the shortage of health care professionals. This trend continued with several other initiatives. In accordance with the Federal Workforce Investment Act’s guidance that “…[e]very state [ ] be subdivided into workforce development areas”, Virginia created sixteen local Workforce Development Boards. Opportunity Inc. is “…[t]he Hampton Roads Workforce Development Board… responsible for developing policy and overseeing local workforce development initiatives in partnership with local elected officials.” Opportunity Inc. provides client services through strategically located one-stop career centers. The Commonwealth’s concern with health care workforce capacity culminated in July 2010 with the creation of the Virginia Health Workforce Development Authority “…to facilitate the development of a statewide health professions pipeline that identifies, educates, recruits and retains a diverse, appropriately geographically distributed and culturally competent quality workforce.” (Code of Virginia § 32.1-122.7)

One of the critical success factors outlined in Virginia’s Comprehensive Cross-Governmental Strategic Plan is for persons with disabilities to be able to choose quality community providers and direct support professionals. To help ensure this outcome, the Plan recommended increased pay rates, an adequate network of personal care attendants for consumerdirected personal care and employee training and certification opportunities to ensure quality and professional services. (Code of Virginia § 32.1-122.7)

In 2000, the University of North Carolina at Chapel Hill introduced a practical interdisciplinary medical learning model known as Beyond Clinic Walls. Recently, Eastern Virginia Medical School introduced this model in their curriculum to help “… determine whether participation in a student-run, service-learning organization can positively affect student attitudes towards older adults, increase knowledge of geriatrics and increase interest in geriatrics-related fields.” This program provides both an assessment of medical students’ interests in pursuing geriatrics careers and a model for increasing the number of geriatric medical professionals in the region’s workforce.

In order to increase the regional workforce capacity, a strategy must be developed with the following objectives:

  1. Increase focus on the health care needs of seniors and adults with disabilities are represented on regional boards addressing workforce capacity
  2. Provide ongoing data analysis and policy recommendations to the existing state and regional workforce organizations
  3. Encourage programs such as Beyond Clinic Walls to incorporate the needs of people with disabilities in its program model

Fourth Key: Increased Stock of Accessible and Affordable Housing

The fourth key is to ensure that there is an increased stock of accessible and affordable housing. Seniors in our region rank the availability and affordability of accessible housing as their most pressing need. Some experts assert that “seniors need to continue to live in and be a part of their community and that a comprehensive linkage between housing and services would facilitate such aging in place. The aging in place process refers to seniors who, as their needs change, receive services in the same place. These include seniors who live independently in their own homes, in senior housing and in their communities with supportive services provided by outside agencies. “The housing emphasis is on personal residential choice including: remaining where they live (with modifications and services), house sharing, granny flats, foster care and small group homes. Supportive housing can be substituted for nursing homes and, by restricting the building of nursing home or converting existing nursing homes into residential settings that promote more privacy and autonomy, seniors could in fact have a housing choice.” (Cohen, Mulroy, Tull, Bloom & F. Karnas (2007) Other options include local zoning laws which permit accessory dwelling units and the development of cohousing communities. Having options to live independently, in integrated housing, with access to supportive services is critical to adults with disabilities as well. “A large majority of adults with disabilities needs supportive housing. Most people needing supportive housing are able and prefer to reside in affordable community housing serving the general population – not in special housing set aside for people with disabilities.” (Report on Housing Opportunities for Persons with Disabilities in Virginia, House Document No. 86, 2005)49 Integrated housing is “strongly preferred in order to reduce stigma and facilitate community integration.” (O’Hara & Day, 2001)

The lack of adequate housing that is affordable to adults with disabilities has moved to the forefront of identified barriers to independent living. There is still a shortage of affordable barrierfree and accessible units for rent and for sale.

The affordable and accessible housing concerns of seniors and people with disabilities reflect an issue of national importance. In a joint effort, the Department of Housing and Urban Development, the Department of Transportation and the Environmental Protection Agency recently “announced a new partnership to help American families gain better access to affordable housing, more transportation options, and lower transportation costs. The average working American family spends nearly 60 percent of its budget on housing and transportation costs, making these two areas the largest expenses for American families. The aforementioned agencies want to seek ways to cut these costs by focusing their efforts on creating affordable, sustainable communities.”

“The generally accepted definition of affordability is for a household to pay no more than 30 percent of its annual income on housing. Families who pay more than 30 percent of their income for housing are considered cost burdened and may have difficulty affording necessities such as food, clothing, transportation and medical care.” (Study of Funding for Housing Serving People with Disabilities, 2000) In the Commonwealth of Virginia “affordable housing means, as a guideline, housing that is affordable to households with incomes at or below the area median income, provided that the occupant pays no more than 30 percent of his gross income for gross housing costs, including utilities…” For the purpose of administering affordable dwelling unit ordinances authorized by this chapter, local governments may establish individual definitions of affordable and affordable dwelling units, including determination of the appropriate percent of area median income and percent of gross income to be devoted to housing costs.

A review of selected affordable dwelling unit ordinances administered by localities in South Hampton Roads revealed that they generally identify dwelling units occupied by persons with household incomes at or below the area median income.

According to the Virginia Housing Development Authority (VHDA), “there were 41 publicly-assisted senior apartments for every 1,000 elderly headed household in 2000.” In response to this need many cities have taken steps to increase the stock of affordable housing units. In Williamsburg, “the city council voted to increase the occupancy limit of homes within the city’s rental inspection districts from three unrelated tenants to four. Those petitioning to allow a property to house four unrelated people must obtain permission from the city of Williamsburg, pending several inspections.” In Atlanta, Georgia, the (ARC) has identified the following accessible/affordable housing solutions for their seniors who provide for the inclusion of senior housing needs in the overall planning and policy processes:

  • Develop affordable housing with services targeted to seniors
  • Expand home repair and modification programs for older adults (ranging from contractor matching services to low interest loans to grants for low-income home owners)
  • Develop energy efficiency repair and modification programs to assist older home owners
  • Educate older adults about reverse mortgages

In 1999 the U.S. Supreme Court determined that “…it is a violation of the Americans with Disabilities Act for states to discriminate against people with disabilities by providing services in institutions when the individual could be served more appropriately in a community-based setting." In response to this decision, Virginia instituted the Money Follows the Person Demonstration Project which provides funding to seniors and people with disabilities seeking to transition out of institutions. According to the most recent data, 1075 nursing home residents in the region have indicated a desire to return to the community. (CMS, MDS Q1a Report, 2nd quarter 2010)

Recently, the Virginia General Assembly passed legislation“…that supersedes local zoning laws in the state and allows families to install [a MEDcottage] on their property with a doctor’s order” (Virginian- Pilot, May 16, 2010) According to its inventor, Rev. Kenneth Dupin, the MEDcottage is “a portable high-tech dwelling that could be trucked to a family’s backyard and used to shelter a loved one in need of special care…As America grows older, its aging adults could avoid a jarring move to the nursing home by living in [these] temporary shelters close to relatives.”(Virginian-Pilot, May 16, 2010) This “portable 12-by-24-foot high–tech hut [is composed of] living quarters and a system to transmit an occupant’s vital health information to offsite caregiver.” (AARP Bulletin, Vol. 51, No. 6, July-August 2010) In addition to this bill, the legislature adopted a separate measure which expands telemedicine coverage. These legislative measures provide a perfect setting for people to remain in their communities without being concerned with whether their insurer will cover the telemedicine services. However, it is well-recognized that “…a comprehensive linkage between housing and services would facilitate such aging in place.” (Cohen, Mulroy, Tull, Bloom & Karnas 2007). Virginia legislative studies indicate that “in addition to the lack of affordable housing…there is a lack of housing combined with supportive services…[such as] assistance with food preparation, laundry, personal and health care, transportation, shopping, bill paying and socialization.”

In addition to the availability of support services for seniors and people with disabilities to age in place, housing must be accessible. There is no universal definition of accessible housing. The internationally recognized universal design approach “assumes that the range of human ability is ordinary, not special.” (Ostroff, 2001) Simply stated, universal design is an approach to design that incorporates products as well as building features which, to the greatest extent possible, can be used by everyone.” (Ostroff, 2001)

While this design approach “benefit[s] everyone across the lifespan, persons with disabilities and older persons with limited functioning benefit the most, as a properly designed environment can actually delay or prevent institutionalization… Universal design has led to legislation that mandates accessibility, specifically through the Fair Housing Amendments Act of 1988 and the Americans with Disabilities Act of 1990. These efforts have brought us to the relatively new concept and movement of Visitability, which proposes that all new residential construction meet minimum levels of accessibility to eliminate the social isolation which persons with disabilities experience when the homes of friends and relatives prevent them from visiting. Features of a visitable home include: one zero-step entry; a clear, accessible 36 inch path through the ground floor, with 32-inch wide doorways; and, one accessible half-bath on the ground floor. It is more environmentally sound to build for minimum levels of accessibility and future adaptability than to undertake substantial renovations later on, which result in discarding viable building components in landfills.” (Forsyth, Greenhouse, Wells, Maxwell, Laquatra, Kay & Tiffany 2008)

The federal Fair Housing Amendments Act of 1988 requires newly-constructed multi-family housing to follow certain design and construction requirements. These requirements such as the maneuvering space allowable in kitchens and bathrooms are not adequate for many people with mobility disabilities. This dilemma further demonstrates the need for universal design. Universal design include 5 foot turning diameter or t-turns in kitchens, full access tubs or roll-in showers, 5 foot turning diameters and safety grab bars in bathrooms, and lever handles on doors and faucets. Universal design increases housing choices in market rate housing as well as in assisted housing, where the federal 5% minimum requirement for accessible units is not adequate in many communities.

Low-income seniors and people with disabilities cannot afford to make accessibility modifications, which enable individuals to age in place, ensure safety and independence, gain full use and enjoyment of their home, and be afforded the freedom to enter and exit their own homes. “Home modifications can prevent accidents, facilitate care giving, make it easier to carry out tasks such as cooking and cleaning, engage in major life activities, and even minimize the need for costly personal care services or institutional care. Unfortunately, the growing number of older adults and younger persons with disabilities who would benefit from home modifications has not yet been matched by a delivery system capable of responding to their needs.” (Home Modification Capacity Building: Strategies from Programs in Action, Overton, J. in Maximizing Human Potential, Winter (1998), 3-5)

The 1995 American Housing Survey (AHS) supplement asked renters and home owners who had a physical impairment whether they had an unmet need for a specific home modification. Most households reported that they needed grab bars. The next common need was modifications for entrances and bathrooms. (Home Modifications Among Households With Physical Activity Limitations)

Senior Services of Southeastern Virginia, in collaboration with other partners, is spearheading a movement to introduce a mixed-use self contained model that provides affordable and accessible senior housing units with support services. This mixed use development has been designed with the intent of replicating the concept throughout the region thus increasing the stock of such needed housing for seniors in this region.

As regional leaders, agencies and organizations seeking to meet the demand for affordable and accessible housing in this region must develop a plan to realize the following objectives:

  1. Ensure that every municipality defines affordable housing consistent with HUD’s guidelines
  2. Integrate older adults and people with disabilities into local land use and community planning processes to ensure that universal design is incorporated in publicly funded single family and multi-family developments
  3. Develop policy to promote housing options for older adults and people with disabilities
  4. Place a priority for people with disabilities to access rental assistance resources


Based upon the anticipated demands of our growing senior population, it is imperative that regional leaders and existing organizations with regional authority develop a comprehensive livable communities regional plan of action. In order for this to be effective, it must come from the cooperative efforts of our regional leaders: including the region’s mayors; Hampton Roads Planning District Commission; Hampton Roads Partnership; Hampton Roads Transit; Hampton Roads Transportation Planning Organization and Hampton Roads Chamber of Commerce. Instead of engaging in regional coordination and a common economic strategy, local governments tend to be “pitted against each other in a zero-sum game” to attract tax-generating development with little or no consideration of the impact that the development will have on residents’ quality of life. (Orfield, 2003) “Competition among communities for tax revenue frequently results in sprawling shopping malls, auto dealerships and big-box retailers – not exactly the kind of development that leads to livable communities.” (AARP, Opportunities for Creating Livable Communities, 2008) Once these groups begin working collaboratively to make the region a place where people of all ages will desire to live, the ideas promoted by this study will become an integral part of such a plan.

This publication was made possible by a grant from the Obici Healthcare Foundation and support from the Norfolk Department of Human Services.
Author: William H. Wade, Esq., a graduate of Vassar College and Cleveland Marshall College of Law, is Long-Term Care Capacity Planner at Senior Services of Southeastern Virginia.

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