Citation
A Study of individual, public, and private sector factors affecting aging in place housing preparedness for older adults

Material Information

Title:
A Study of individual, public, and private sector factors affecting aging in place housing preparedness for older adults
Creator:
Delgado de León, Maria Alejandra
Place of Publication:
Denver, CO
Publisher:
University of Colorado Denver
Publication Date:
Language:
English

Thesis/Dissertation Information

Degree:
Doctorate ( Doctor of philosophy)
Degree Grantor:
University of Colorado Denver
Degree Divisions:
College of Architecture and Planning, CU Denver
Degree Disciplines:
Design and planning
Committee Chair:
Gallegos, Phillip
Committee Members:
Clevenger, Caroline
Makarewicz, Carrie
Johnson, Jennifer Steffel

Notes

Abstract:
Colorado is facing demographic changes as the senior share of the population rapidly increases. Simultaneously, Denver residents are not prepared to age in place. Their homes do not include accessible features, such as those incorporated into universal design or visitability standards, which support an individual’s ability to stay in the home as their capabilities decline over time. Furthermore, there are no legal requirements to provide accessible features in singlefamily homes to support residents aging in place. To investigate this problem, the study explored why Denver residents, along with design and construction professionals, are not adequately preparing homes for aging in place. The study assessed and compared levels of aging-in-place design feature awareness, implementation, knowledge of associated costs, and support for policies of the features in single-family homes from the perspective of the residents and professionals. The author administered two online surveys for Denver residents and design and construction professionals. The resident sample size was 177, a response rate of 15%. The professional sample size was 71, a response rate of 6%. The resident survey found 93% of the respondents wants to live independently, but only 33% of the residents were familiar with aging in place. The professional survey found 94% of the surveyed professionals recognize the importance of living independently, but only 46% of the professionals are extremely/very familiar with aging in place. Despite the lack of awareness, both groups expressed high levels of support for universal design and visitability features in new construction. Nearly 68% of the residents and 80% of the professionals support universal design in new construction homes. A bivariate regression analysis revealed there was a statistically significant relationship between the number of accessible features in the resident's home and the resident's satisfaction with his/her home as a place for older adults to live as they age. The researcher makes recommendations for the City and County of Denver in order to further integrate universal design and visitability in new construction and remodeled homes.

Record Information

Source Institution:
University of Colorado Denver
Holding Location:
Auraria Library
Rights Management:
Copyright Maria Alejandra Delgado de León. Permission granted to University of Colorado Denver to digitize and display this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.

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Full Text
A STUDY OF INDIVIDUAL, PUBLIC, AND PRIVATE SECTOR FACTORS AFFECTING
AGING IN PLACE HOUSING PREPAREDNESS FOR OLDER ADULTS
by
MARIA ALEJANDRA DELGADO DE LEON
B.S., Colorado State University, 2006
M.Arch., University of Colorado Denver, 2013
A dissertation submitted to the Faculty of the Graduate School of the University of Colorado in partial fulfillment of the requirements for the degree of Doctor of Philosophy Design and Planning
2018


©2018
MARIA ALEJANDRA DELGADO DE LEON ALL RIGHTS RESERVED
11


This dissertation for the Doctor of Philosophy degree by Maria Alejandra Delgado de Leon has been approved for the Design and Planning Program by
Phillip Gallegos, Advisor and Chair Caroline Clevenger Carrie Makarewicz Jennifer Steffel Johnson
Date: May 12, 2018
in


Delgado de Leon, Maria Alejandra (Ph.D., Design and Planning)
A STUDY OF INDIVIDUAL, PUBLIC, AND PRIVATE SECTOR FACTORS AFFECTING AGING IN PLACE HOUSING PREPAREDNESS FOR OLDER ADULTS
Dissertation directed by Associate Professor Phillip Gallegos
ABSTRACT
Colorado is facing demographic changes as the senior share of the population rapidly increases. Simultaneously, Denver residents are not prepared to age in place. Their homes do not include accessible features, such as those incorporated into universal design or visitability standards, which support an individual’s ability to stay in the home as their capabilities decline over time. Furthermore, there are no legal requirements to provide accessible features in singlefamily homes to support residents aging in place. To investigate this problem, the study explored why Denver residents, along with design and construction professionals, are not adequately preparing homes for aging in place. The study assessed and compared levels of aging-in-place design feature awareness, implementation, knowledge of associated costs, and support for policies of the features in single-family homes from the perspective of the residents and professionals. The author administered two online surveys for Denver residents and design and construction professionals. The resident sample size was 177, a response rate of 15%. The professional sample size was 71, a response rate of 6%. The resident survey found 93% of the respondents wants to live independently, but only 33% of the residents were familiar with aging in place. The professional survey found 94% of the surveyed professionals recognize the importance of living independently, but only 46% of the professionals are extremely/very familiar with aging in place. Despite the lack of awareness, both groups expressed high levels of
iv


support for universal design and visitability features in new construction. Nearly 68% of the residents and 80% of the professionals support universal design in new construction homes. A bivariate regression analysis revealed there was a statistically significant relationship between the number of accessible features in the resident's home and the resident's satisfaction with his/her home as a place for older adults to live as they age. The researcher makes recommendations for the City and County of Denver in order to further integrate universal design and visitability in new construction and remodeled homes.
The form and content of this abstract is approved. I recommend its publication.
Approved: Phillip Gallegos


DEDICATION
I dedicate my Ph.D. to my parents. Mom and Dad, I love you so much. I could not have done this without your support and I am so blessed to have you as parents. Thank you.
I also dedicate my Ph.D. to the special seniors that I have had throughout my life. My grandmother, Abuela Guicha, and to my late neighbor, Mr. Eugene Dalton, who are and were champions of aging in place.
vi


ACKNOWLEDGEMENTS
I want to thank the College of Architecture and Planning led by Dean Nan Ellin and the Design and Planning Department directed by Jody Beck at the University of Colorado Denver for funding my Ph.D. education and research.
I especially want to thank my Ph.D. Advisor, Phil Gallegos, for his endless support, encouragement, and direction throughout my scholarship. Additionally, I want to thank my committee members: Carrie Makarewicz, Jenny Steffel Johnson, and Caroline Clevenger. Throughout my Ph.D. journey, they all have contributed such high quality and unique talents that have shaped the writer and researcher I am today.
I would also like to thank the staff of the College of Architecture and Planning led by Leo Darnell who made certain I had the space and tools I needed in order to be productive and successful throughout the program. Additionally, a special thanks to Mike Harring for always making sure my computer was in the best condition.
Lastly, I want to thank my Ph.D. colleagues: Jenna McKnight, Nermeen Dalgamoni, Mohammed Bay, and Aziz Almutawa. It has been such an amazing adventure sharing an office full of genuine support, encouragement, and endless conversation splashed with so much laughter and positivity. Thank you all. ©
Vll


TABLE OF CONTENTS
I INTRODUCTION 1
City and State Demographics 4
Population Growth 4
State Capital - Denver population growth 6
State and local population growth implications on economy, households,
labor force 7
State Response 11
Background of the Problem 12
National Problem 12
Local Problem 14
Lack of Denver preparedness 14
Lack of systemic structure 18
Rationale and Purpose 18
Theoretical Framework 20
Research Problem 25
Hypothesis framework 25
Barriers related to residents’ support of aging in place 26
vm
Barriers related to professionals’ support of aging in place
26


Research Questions and Hypotheses
27
Survey 28
Framing the Research 28
Significance of the Study 28
Assumptions, Limitations, and Delimitations 29
Assumptions 29
Limitations 29
Delimitations 30
Organization of the Study 30
II LITERATURE REVIEW 32
Environmental Gerontology 32
Aging Attitudes 33
Learning Theory Model 33
Man-Environment Theories 35
Adaption Theory 35
Environment Congruence Model 35
Stress Theory 36
Residential Normalcy Theory 36
Accessibility Evolution 39
Accessibility Rights 39
IX


Visitability
44
Visitability cost and location 44
Visitability public laws 44
Universal Design 46
Universal design public and private laws 48
Opposition to Visitable and Universal Design Policy and Incentives 49
Opposition Concerns 49
Excessive government control 49
Cost concerns 50
Societal Costs of Not Integrating Features 51
Past Policy Tactics 52
Policy Promotion 52
Government policies to alleviate cost 52
States and municipalities promoting incentives 53
Mandatory Versus Voluntary Incentives 54
Accessory Dwelling Units as a Tool for Aging in Place 55
Accessory Dwelling Units 55
ADU History 55
ADUs and Older Adults 57
Benefits of ADUs for Seniors 58
x


Denver ADUs
59
Universal design, visitability and ADUs 61
Uack of Accessible Homes in Existing Housing Market 61
Action by Stakeholders To Create Potential Policy 63
Action by Professional Architects 63
Action by Professional Builders 64
Action by State and Uocal Government Officials 64
National legal action 64
State of Colorado legal action 65
Action by Non-govemment Officials 68
Conclusion 68
III METHODOUOGY 70
Participatory Observation 70
Survey 71
Survey Distribution and Collection 71
Postcard design 71
Online resident and professional survey links 71
Mailing list 73
Mailing 73
Direct email invitation from Qualtrics 73
xi


Email timeline
74
Response rates 75
Incentives for response rates 76
Survey Instruments 77
Resident surveys 77
Universal design survey questions 77
Statistical Analysis 81
Dependent Variables 81
Independent Variables 82
Quantitative Inferential Statistics 85
Qualitative Analysis 86
Qualitative resident survey question and codes 86
Qualitative professional survey question and codes 86
Conclusion 87
IV RESULTS 88
Descriptive Statistics 88
Public survey respondents 88
Professional survey respondents 89
House, Household, and Neighborhood Characteristics 91
Quantitative - Residents and Professional Results Organized by Survey Questions 94
xii


Awareness
94
Awareness independent sample t-test 95
Awareness multiple regression resident findings 96
Awareness multiple regression professional findings 96
Awareness cross tabulation comparison 97
Neighborhood awareness 98
Action 101
Action independent sample t-test 106
Action linear regression 107
Action multiple regression resident findings 108
Action cross tabulation comparison 110
Why residents integrate 111
Why professionals integrate 112
Why not integrate 113
Cost 116
Support 119
Policy 1 119
Policy 1 independent sample t-test 119
Multiple regression resident findings 120
xm
Multiple regression professional findings
120


Awareness cross tabulation comparison 121
Policy 2 123
Policy 2 independent sample t-test 124
Multiple regression professional findings 125
Resident preferences for incentive types 126
Professional preferences for incentive types 126
Policy 3 127
Policy 3 independent sample t-test 128
Multiple regression resident findings 129
Support (qualitative) 130
Awareness 130
Residents’ responses about awareness 130
Professionals’ responses about awareness 132
Action 133
Action from residents 133
Action from professionals 134
Cost 140
Cost information from residents 140
Cost information from professionals 143
Policy 143
xiv


Policy for residents
143
Policy for professionals 144
Hypothesis Testing Between the Groups (Residents and Professionals) 144
Results Overall 144
V CONCLUSION 146
Findings Overview 146
Findings Recommendations 150
Renovation - (past) 150
New Construction - (future: building codes) 152
Future Studies 155
Conclusion 156
REFERENCES 158
xv


LIST OF TABLES
Table 3.1 - Survey Timeline 75
Table 3.2 - Survey Response Rates Comparison: Emails Versus Postcards 76
Table 3.3 - Codes for Survey Question Dependent Variables 82
Table 3.4 - Codes for Survey Question Independent Variables 83
Table 4.1- Demographics Characteristics of Residents/Professionals 90
Table 4.2 - Length of Occupancy Comparison 92
Table 4.3 - Level of Satisfaction with Home and Neighborhood as a Place to Age in
Place 93
Table 4.4 - Comparison of Level of Familiarity with Aging in Place by Residents and Professionals 95
Table 4.5 - Results of Independent Sample /-tests by Residents and Professionals: How Familiar Are You with Aging in Place? 96
Table 4.6 - Multiple Regression of Joint Predictors (Age, Gender, Education, Employment, and Disability) on Familiarity with Aging in Place for Two Groups: Residents and Professionals
97
Table 4.7 - Level of Importance with Remaining in Your Neighborhood and Living Independently for Residents 99
Table 4.8 - Universal Design Features “Must Haves” Residents Versus Professionals 102
xvi


Table 4.9 - Universal Design Features Resident “Have” Versus “Must Have”
103
Table 4.10 - Comparison of Top Five Resident “Must Have” Universal Design
Features Versus “Have” Features 106
Table 4.11 - Results of Independent Sample /-tests by Residents and Professionals: Which of These Features Do You Feel a House Must Have in Order for a Senior to Age in Place in Their Home? 107
Table 4.12 - Regression for Level of Satisfaction and Number of Features 108
Table 4.13 - Multiple Regression of Joint Predictor (Age, Gender, Education, Employment, and Disability) on Number of Features a House “Must Have” in Order for Seniors to Age in Place for Two Groups: Residents and Professionals 109
Table 4.14 - Reasons for Residents Not Integrating Features into Home 114
Table 4.15 - Resident and Professional Cost Awareness of Universal Design Features Home Retrofit Cost Versus New Construction Cost 118
Table 4.16- Level of Support that Denver Residents and Professionals Have for Universal Design in New Construction Single-Family Homes: Would You Like to See More New Construction Homes in Denver that Include Universal Design Features? 119
Table 4.17 - Results of Independent Sample /-tests by Residents and Professionals: Would You Like To See More New Construction Homes in Denver that Include Universal Design
Features?
120


Table 4.18 - Multiple Regression of Joint Predictors (Age, Gender, Education, Employment, and Disability) on More New Construction Homes in Denver that Include Universal Design
Features. 121
Table 4.19 - Level of Interest that Denver Residents and Professionals Have for Integrating Universal Design in Single-Family Homes if the City Provides Incentives: If the City/State Provided Incentives, Would You Be Interested in Adding Any Universal Design Features to: (Residents) Your Current Home in the Future? (Professionals) Your Client’s New or Remodeled Home in the Future? 123
Table 4.20 - Results of Independent Sample /-tests by Residents and Professionals: If the City/State Provided Incentives, Would You Be Interested in Adding Any Universal Design Features to: (Residents) Your Current Home in the Future? (Professionals) Your Client’s New or Remodeled Home in the Future? 125
Table 4.21 - Multiple Regression of Joint Predictors (Age, Gender, Education, Employment, and Disability) on If the City/State Provided Incentives, Would You Be Interested in Adding Any Universal Design Features to: (Residents) Your Current Home in the Future? (Professionals) Your Client’s New or Remodeled Home in the Future? 125
Table 4.22 - Level of Interest that Denver Residents and Professionals Have for Learning More About Universal Design in Single-Family Homes: Do You Want To Learn More About Universal Design Features? 128
Table 4.23 - Results of Independent Sample /-tests by Residents and Professionals: Do You Want To Learn More About Universal Design Features? 129
xvm


Table 4.24 - Multiple Regression of Joint Predictors (Age, Gender, Education, Employment, and Disability) on Residents and Professionals Wanting To Learn More About Universal Design Features 129
Table 4.25 - Tax Rebates Available for Seniors in the City and County of Denver 141
XIX


LIST OF FIGURES
Figure 1.1a- Share of Colorado Population by Age Group 5
Figure 1.1b- Colorado Residents Age 65+ 2000-2030 6
Figure 1.2 - Denver Demographics, 2010-2015 7
Figure 1.3 - Colorado Persons 65+ Below Official Poverty Level 9
Figure 1.4 - The Elder Economic Security Standard Index for Denver County, CO 2015 10
Figure 1.5 - Housing Features of Importance to AARP Members in Denver 17
Figure 1,6a - Environmental Press Competence Model 22
Figure 1,6b - Reinterpretation of the Environmental Press Competence Model 23
Figure 2.1- Residential Normalcy Theory Constructs 37
Figure 2.2 - Accessibility Policy Timeline 40
Figure 2.3 - International Code Council 42
Figure 2.4 - ADUs in Denver 60
Figure 3.1- Design of Resident and Professional Postcards Produced by Researcher 72
Figure 3.2 - Process to Initiate Survey by Postcard (left) Versus Email Invitation (right) 74
Figure 4.1- Positive Directional Correlation of Jon Lang’s Lawton and Nahemow’s Environmental Press Competence Model and the Researcher’s Graph of Number of Features and Home Satisfaction 108
xx


Figure 4.2 - American Community Survey 2011-2015. Denver Age 65+ Distribution. Number of features by Neighborhood 112
XXI


CHAPTER I
INTRODUCTION
The World Health Organization (WHO) has defined eight domains that influence the health of older adults. These include outdoor spaces and buildings, transportation, housing, social participation, respect and social inclusion, civic participation and employment, communication and information, and community and health services. Housing is included as a domain to emphasize the vital role that living accommodations play in the life of an older adult. WHO states, “housing and the built environment has a profound impact on human health” and recognizes that unintentional home injustices are a serious public health problem (WHO, n.d.). Negative housing incidents, such as home barrier-related falls, contribute to the annual 34 million dollar medical costs of adults 65 years and older (CDC, 2013).
However, homes designed to be accessible through the application of universal design standards and visitability principles offer opportunities to maximize the safety of a home, thereby increasing the ability of a home’s design to support an individual to aging in place. The Center for Disease Control defines aging in place as “the ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level” (2009). Nearly 90% of seniors aged 65 years and older prefer to age in place (AARP, 2010, p.
13). Creating age-friendly environments is a responsibility from various stakeholders: residents, professionals, and governments (WHO, n.d.). Further encouraging the notion, in a 2014 study conducted by the American Association of Retired Persons (AARP), “What is Livable? Community Preferences of Older Adults,” key findings emphasize 87 % of United States adults 65+ want to stay in their home and community as they age (Harrell et al., 2014). However, living
1


autonomously in a non-accessible environment (both home and surrounding community) can become increasingly difficult for people with disabilities. Loss of physical function occurs with age (Manini, 2011). A study conducted by Staudinger, Smith, and Baltes, (1992) exploring age differences, found as early as 45 years, increased rates of the population begin to encounter physical limitation on daily activities. Staudinger et al. (1992) found at 65 years, 26.9% of the population note physical limitations and then at 75 years almost 45.3% of the population experience limitation in activities such as walking, lifting, writing, and more. Currently, in Colorado 34% of 65 years and older adults have a disability and the state projects 69% of 65 years old adults will have a disability (permanent or temporary) at some point (Garner, 2017, p. 33). Experts agree that society must prepare to support the aging population, especially as life expectancy continues to increase (WHO, 2011). The National Center for Health Statistics documents report that in the United States, life expectancy at birth has changed from 47.3 years in 1900 to 78.8 years in 2015 (NCHS, 2016).
A current gap exists in housing policy regarding accessible private residences. There are no legal requirements to provide accessible features in single-family homes or accessory dwelling units (ADUs) in many cities across the nation. As defined by the U.S. Department of Housing and Urban Development Office of Policy and Development Research, “Accessory dwelling units (ADUs) - also referred to as accessory apartments, second units, or granny flats -are additional living quarters on single-family lots that are independent of the primary dwelling units. The separate living spaces are equipped with kitchen and bathroom facilitates, and can be either attached or detached from the main residence” (HUD, 2008). Although, the Americans with Disabilities Act (ADA) imposes the provision of accessibility in public facilities and government-owned or funded multi-family housing, the ADA does not apply to private housing.
2


The researcher presents an extensive review of past policies in the literature review, but overall, some local cities have adopted ordinances and some U.S. states have adopted requirements over the years. However, currently, there are no existing federal requirements for private singlefamily housing to be accessible. In the absence of private home accessibility policies and regulations, professionals are designing millions of new homes in ways that will not safely support what is a large and growing segment of the population, the elderly.
Research on existing residential units suggest 87% of the U.S. single-family homes need extensive or substantial home modifications and repairs to be age friendly (Johnson & Appold, 2017, p. 6). Given this number, the importance of age-supportive housing features to elderly living is vital. Society needs policies that will educate, encourage, and incentivize developers, architects, and the public to equip single-family homes with designs that promote aging in place. One may conclude that without policies to educate, encourage, and incentivize developers, architects, and the public to equip single-family home designs that promote aging in place features, implementation of homes will not occur on a scale sufficient to support the forecasted 65+ population. The purpose of this study is to identify the level of aging in place awareness, application, financial knowledge and what types of polices, programs, or incentives are appropriate to address the lack of accessibility in single-family homes. The purpose of this dissertation is to test the level of implementation of these features and explore whether the public and professionals would be receptive to policies or other efforts that raise awareness, encourage, and/or require the residential construction and design industry and individuals to incorporate universal design and visitability principles in new construction homes.
Accessible housing can assist older adults to stay in their homes safely for as long as possible. Providing the market with homes where people can age in place could offset the future
3


burden of expensive home remodeling, expensive medical bills or life-threatening injuries, and reduce the need to build new specialized senior housing, while meeting the preferences of the majority of older adults who hope to age in place. On a grand scale, the changes could benefit the local economy in addition to the individual.
City and State Demographics
Population Growth
Currently, Colorado is experiencing a demographic shift as the population rapidly continues to age. According to the State Demographer’s Office, in 2016, Colorado’s population of 5.5 million is about 1.7% of the nation’s total population of 323.1 million. The State Demographer’s office projects by year 2050 Colorado’s population could increase to 2.1% of the country’s total population, with 8.7 million Coloradoans (DeGroen, 2017b, p. 4).
Of the 5.5 million Coloradoans today, 13.4% of the populations are seniors - an estimated 715,000 seniors. When compared to other states, that share is very low. In fact, it is the sixth lowest share of seniors in the United States (DeGroen, 2017a, p. 2). Figure 1.1a shows data obtained from the State Demographers Office on the past and projected age distributions from 1990 to 2050 in Colorado. The graph visually identifies the rapid expansion of the 65+ share group in Colorado.
4


40%
Share of Colorado Population by Age Group
25 to 44
30%
Figure 1.1a. Share of Colorado Population by Age Group. Source: DcGrocn. Cindy (2017). Population Estimates and Forecast Overview: The Population of Colorado p. 23. Retrieved from Colorado Department of Local Affairs State Demography Office. Website:
https ://demography. dola.colorado.gov/demography /publications-and-presentations/#publications-and-presentations
However, currently there are 1.3 million baby boomers (born between 1946 and 1964) who currently reside in Colorado (DeGroen, 2017a, p. 2). That means Colorado is rapidly aging. In fact, Colorado is the third fastest growing 65+ population in the United States (DeGroen, 2017a, p. 2). The majority of the rapid aging changes are occurring in this decade. According to projected growth rates, from 2010 to 2020, 155 Coloradans turn 65 daily, which will shift the median age from 36.4 in 2016 to 40.7 in 2050 (DeGroen, 2015). Figure 1.1b takes atargeted look by showing data obtained from the State Demographers Office on the past and projected
5


age distributions from 2000 to 2030 in Colorado. The graph visually identifies the rapid expansion of the 65+ share group in Colorado.
Figure 1.1b. Colorado Residents Age 65+ 2000-2030. Source: DeGroen, Cindy (2017). Population Estimates and Forecast Overview: Aging in Colorado and the Economic Impacts p. 5. Retrieved from Colorado Department of Local Affairs State Demography Office. Website:
https ://demography. dola.colorado.gov/demography /publications-and-presentations/#publications-and-presentations
State Capital - Denver population growth. The city and county of Denver are coterminous and serve as the capital city of Colorado. As reported by the Department of Local Affairs (DOLA), in 2016 Denver is the largest municipality in Colorado with a population of 693,292 (DeGroen, 2017b, pg. 12). In the regional reports created by DOLA, Denver (in region 3) had a 2010 census population of 600,158 people, which increased by 98,134 over six years (DOLA, 2017, p. 1). The Denver Regional Council of Governments (DRCOG) projects that Denver’s population of older adults will continue to increase over the coming decades. DRCOG
6


specifically highlights that “In 1990, on average, 10.4 % of the [Denver] region’s population was age 60 or older. By 2014, that share increased to 18.9 %, and by 2040 more than 24 % of the total population will be age 60 or older.” As shown in Figure 1.2, one in four Coloradoans will be 60+ by the year 2040 (DRCOG, 2018).
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Figure 1.2. Denver Demographics, 2010-2015 Denver Regional Council of Governments (2018). [Graph illustration on website March 2018], Aging Population by County. Retrieved from https://drcog.org/services-and-resomces/denver-regional-visual-resources/aging-population-by-county
State and local popidation growth implications on economy, households, labor force. Population growth has influenced Colorado’s and Denver’s construction industry, job market, and household income. First, the Colorado State Demographer’s Office reported that the construction industry was the state’s third-fastest growing sector at more than 8% in 2014 (Akers, 2015, p. 17). Denver’s construction industry has added a plethora of new apartment buildings to Denver’s skyline and neighborhoods. Second, the population growth has influenced
7


the job market. In 2015, the housing report by the Denver Office of Economic Development showed that Denver’s employment increased by 4.3% in one calendar year, adding 19,500 new jobs to the market. The construction boom has brought more jobs to Denver and subsequently there has been an increase in the median income. Specifically, in the same report, the American Community Survey estimated that by 2014, Denver’s median income had grown by 16% from 2011-2014. This rate is faster than the 11% Colorado median income growth and the 6% U.S. median income growth (OED, 2015, p. 6). Therefore, the rapid growth within three years implies that migration and a strong economy has raised the incomes of at least some of the population significantly in a short timeframe.
The strong economy has also influenced household trends. In 2016, the median household income in Denver increased to $56,258 (from $51,800 in 2015) and the 2016 average home value increased to $292,700 (from $257,500 in 2015) (DRCOG, 2016). In 2016, there were 281,072 occupied households in Denver, and of those households, just under 50%
(138,870) were owner-occupied housing (DRCOG, 2016). Colorado State Demography Office reports 38% of Colorado households over 65+ are comprised of individuals living alone, and of these households, single older women are at the greatest risk of living alone (Gamer, 2017, p.36). Denver is comprised of an estimated 41,179 females and 30,871 males in the 65+ population (DRCOG, 2016).
Figure 1.3 shows that over 50,000 65+ Coloradoans are living below the official poverty level (Gamer, 2017, pg. 39). In fact, the 2010-2014 American Community Survey 5-Year Estimates reveal that of the estimated 65+ seniors living in Denver, 11.8% are living below the poverty level. As seniors retire, they tend to live on a fixed income; therefore, understanding the cost of living of older adults is relevant to understanding the basic framework of the housing
8


market. As home values and incomes of the working-age population have accelerated at a rapid pace, rental prices have risen more quickly.
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Figure 1.3. Colorado Persons 65+ Below Official Poverty Level (Gamer, 2017,).
Aging in Colorado [PDF document]. Retrieved from Colorado Department of Local Affairs State Demography Office Website:
https://drive.google.coin/file/cl/OBvz6H4k4SESZGNXOG5YcOtOX2s/view
To understand better the cost of living for older adults, the Colorado Center on Law and Policy (CCLP) recently commissioned the creation of an Elder Economic Security Standard Index. Figure 1.4 provides the average cost of living for people 65 years and older in Colorado. The report on Denver City and County identifies the average cost of living for senior couples and individuals with or without mortgages. Figure 1.4 shows, in 2015, an individual senior house
9


mortgage payment can average $1,395 while an individual senior rent payment averages $803. To contextualize, in Denver, in 2016, median monthly owner costs were $1,324 and median monthly rent costs were $1,035 (DRCOG, 2016). The Elder Economic Security Standard Index suggests seniors are paying average for mortgage installments and below average for rent. These measures are imperative because they help estimate the amount of income that retired persons must have to meet their basic needs in Denver. As rent prices have increased with Colorado’s population growth, renters and homeowners with lower social economic status may not have the financial means to maintain their home and ability to age in place.
The Elder Economic Security Standard Index for Denver County, CO 2015 I
Elder Person Elder Couple
Owner Owner Owner Owner
w/o w/ w/o w/
Expenses Mortgage Renter Mortgage Mortgage Renter Mortgage
Housing $430 $803 $1,395 $430 $803 $1,395
Food $260 $260 $260 $476 $476 $476
Transportation $233 $233 $233 $360 $360 $360
Health Care $343 $343 $343 $686 $686 $686
Miscellaneous $253 $253 $253 $390 $390 $390
Elder Index per Month $1,519 $1,892 $2,484 $2,342 $2,715 $3,307
Elder Index per Year $18,228 $22,704 $29,808 $28,104 $32,580 $39,684
Figure 1.4. The Elder Economic Security Standard Index for Denver County, CO 2015 Website: http://cclponline.org/wp-content/uploads/2016/06/Denver.pdf
Colorado’s changing labor force will look quite different in the upcoming decades, which in turn will influence the economy. In 2010, baby boomers (persons born after World War II, 1946 to 1964) were 37% of the labor force. However, the State Demographer’s Office approximates that over the next 20 years, 1,000,000 workers will age out of the labor force (Garner, 2017, p. 31). As people retire, two main financial shifts occur in both revenue and
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expenditure habits. First, older adults experience occupational adjustments, which subjects their household income to downward pressure. In addition to generating less income, older adults’ purchasing needs change. Older adults tend to purchase more services when compared to younger families who tend to buy more goods. Therefore, seniors have reduced income tax and sales tax, as well as opportunities for property tax relief, while also placing increasing demand on healthcare services and Medicaid (Garner, 2017, pg. 40). Colorado’s society needs to prepare to balance these two identified aging concerns with the changing labor force because aging out of the labor force in combination with the average cost of living for seniors can determine whether older adults can continue to live autonomously. If they cannot, they will depend on family or the state to meet their housing needs.
State Response
As a response, city officials across Colorado have begun to explore solutions to address today’s housing problems of cost, unit shortages, and housing design. In 2015, Governor John Hickenlooper appointed 23 members to the Strategic Action Planning Group on Aging (SAPGA) to respond to the fast growth Colorado is experiencing. The goal of SAPGA is to confront challenges Colorado is facing and envision solutions by developing a “2030 and beyond” plan for the state (SAPGA, 2016, p. 12). The group has seven committees organized by issue: built environment, workforce development, health and wellness, supportive community, family economic security, outreach and community, public finance. The built environment committee explored a universal design ordinance. In November 2016, SAPGA released eight major goals for the state to facilitate age-friendly communities. Goal 1: Colorado seniors will be able to live andfully participate in their communities of choice for as long as possible. Outcome and strategies for consideration included:
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Building codes will meet the needs of an aging population, with universal design as the standard to (1) promote universal design standards and include them in local building codes; (2) educate the public on the benefits of universal design; (3) create incentives for developers and contractors to use universal design. (SAPGA, 2016, p.14)
The group also gave nine recommendations to the governor and state legislature. Recommendation 4 included supporting “efforts to create a Universal Design Certification program to encourage the inclusion of universal design elements in new and remodeled housing for seniors” (SAPGA, 2016, p.23). The next section elaborates on the ordinance notion by introducing the gap in the literature on accessible housing stock.
Background of the Problem
National Problem
The AARP Public Policy Institute in conjunction with the National Conference of State Legislatures published a research report entitled, “Aging in Place: A State Survey of Livability Policies and Practices,” which assesses policies and practices at the state level regarding aging in place (Farber, N., Shinkle, D., Lynott, J., Fox-Grage, W., & Harrell, R.). The report, issued in 2011, discusses building standards as a means to support aging in place. The report highlights the significant need to support single-family home occupants by implementing local and state building standards that encourage accessible single-family homes. The authors stress important reasons for supporting accessible single-family private residences. The primary reason is that most people with disabilities live in private housing. Therefore, the authors suggest private
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residential housing design should respond to the needs of older adults with disabilities living in their homes.
Accessible design has gained currency during the last 30 years. The “visitability” movement began to measure a building’s accessibility level. The National Council of Independent Living defines visitability as “single-family or owner-occupied housing designed in such a way that it can be lived in or visited by people who have trouble with steps or who use wheelchairs or walkers” (NCIL, 2018). To meet the three visitability requirements a house must have one zero-step entrance, doors with 32 inches of clear passage space, and one bathroom on the main floor you can get into in a wheelchair. Visitability is applicable to both public and private buildings. The objective of universal design (UD) is similar. Universal design is the provision of inclusive design for people of all ages, regardless of whether they are able-bodied or physically challenged. Universal design is the concept of “designing for all” and extends to not only the built environment, but also product design inside the house (Trachtman, L. H., Mace, R. L., Young, L. C., & Pace, R. J., 1999). The idea for accessible principles in housing grew from the recognition that most of the features utilized by people with disabilities were useful to others, so their inclusion in standard practice was justified (Mace, 1998). Universal design, like visitability, is applicable to both public and private buildings.
The U.S. Social Security Administration reported that more than one in four of today’s 20-year-olds will become physically challenged before the age of 67 (SSA, 2015). There is a documented correlation between aging and disability. As people age they are more likely to become disabled (Hansler and Glas, 2011). Because people are naturally susceptible to physical challenges (permanently or temporarily) at some point in their lifetime, accessible home design can help counterbalance the issue. In recent years, studies have shown an increased
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understanding that universal design and visitability practices influence the ability of an individual to age in place. Consequently, the author’s research investigates older adults in Denver to explore their views on universal design and visitability in housing.
Local Problem
The effects of Denver’s rapidly aging population has drawn the attention of researchers and policymakers to senior housing needs. The overarching problem is that the Denver population, as a whole, is not prepared to age in place. There are no policies, requirements, or incentives from the City to direct professionals to provide accessible design for residents in single-family homes. The next section will illustrate preliminary research in Denver that has investigated how equipped homes are to facilitate residences’ aging in place. Specifically, the section documents evidence of Denver homes lacking universal and visitability features to age in place.
Lack of Denver preparedness. Several studies have examined the views of older adults on universal design and visitability in Denver. The AARP Division of Research contracted GfK Marketing to conduct a questionnaire survey called “Home and Community Preferences of the 45+ Population. ” The objective of the questionnaire was to widen the understanding of the issues that influence older adults in their homes and communities. The telephone survey was conducted in July 2010 over a period of two weeks, and responses were collected from 985 individuals who were 45 years and older. The key findings from the questionnaire revealed that almost three-quarters (73%) of the respondents strongly agreed that they would like to live in their current residence as long as possible (Keenan, 2010, p. 3). Two-thirds of the respondents (64%) strongly agreed that they wanted to stay in their community. However, the telephone questionnaire revealed that fewer than 50% of the respondents had visitability and universal design elements in
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their homes. Specifically, the data showed the frequencies of the following features: a zero-step entrance (36%); lever door handles instead of knobs (34%); wide interior and exterior doorways (27%); and a half-bath on the main level (43%) (Keenan, 2010, p. 5). The cost section of the literature review will discuss in detail average pricing; however, overall, research shows that it is more expensive to remodel a home to include universal design and visitability features than to integrate these features into new construction (Kochera, 2002, p. 13). However, because most older adults do not want to move to a new home and want to stay in their home as long as possible, retrofitting their home is the only feasible means to achieve aging in place. Keenan’s Denver study showed that low-income households are particularly likely to have a bathroom on the main floor (Keenan, 2010, p. 6). Specifically, respondents with an income below $50,000 were more likely to have a full bath on the main level than were respondents in a higher income bracket, which alleviates the need for one of the most expensive universal design and visitability features. However, the respondents were more likely to have a half bath on the main floor and lever door handles (Keenan, 2010, p. 6).
Keenan’s survey found other disparities in respondents’ perspectives by gender and age. Gender differences revealed that women had a higher likelihood of having a bathroom on the main floor, but men had a higher likelihood of having a half-bathroom on the main floor. Regarding age differences, the respondents 50 years and older were more likely than the younger respondents to report that their home had a full bath on the main floor. The respondents 65 years and older had a higher likelihood of having a zero-step entrance and wider doorways compared to respondents from 50 to 64 years (Keenan, 2010, p. 6).
The National Research Center (NRC) conducted another study commissioned by the Denver Regional Council of Governments (DRCOG) in 2015. The “Community Assessment
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Survey for Older Adults” study was specific to Denver, Colorado (NRC, 2015). The study showed that 54% of AARP members 50 years and older had lived in Denver for over 20 years. Furthermore, 89% of Denverites (Denver residents) wanted to stay in their homes throughout retirement (NRC, 2015, p. 10). Another survey conducted in 2014 by AARP, “Creating an Age Friendly City: The 2014 Neighborhood Survey of AARP Members Age 50-plus in Denver, Colorado, ” revealed similar findings. The survey found that 52% of Denver AARP members had lived in Denver for the past 35 years, and 59% of that group had lived in the same neighborhood for at least 15 years. Sixty-six percent of the survey participants noted they were not likely to move after retirement (Binette, 2015, p. 3). However, the study revealed that among Denver AARP members, the primary contributing factor to relocating would be a home that would help them live independently as they aged (Binette, 2015, p. 5). The survey also identified the most important housing features for 50+AARP members in Denver. Survey participants determined that 89% of the group selected well-maintained homes as the highest priority (Binette, 2015, p.
7). The second priority of the population was that homes should be equipped with universal design features, such as no-step entrances, wide doorways, grab bars in bathrooms, and first-floor bedrooms and bathrooms. However, Figure 1.5 shows only 56% of AARP members living in Denver felt the features were extremely/very important. Twenty-eight percent indicated that universal design features were somewhat important, and 13% indicated they were not very/not at all important. These statistics present an opportunity to explore the reasons why nearly half of the Denver AARP members did not consider universal design principles extremely/very important. Understanding the reasons that people do not integrate universal design principles in their homes (i.e., lack of awareness/education, financial constraints, etc.) could contribute to the research on aging in place.
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Housing Features of Importance to AARP Members in Denver
(n=727)
Well-maintained homes and properties
Homes that are equipped with things like no step entrance, wide doorways, grab bars in bathrooms, and first floor bedrooms and bathrooms
Affordable housing options for adults of varying income levels
A home repair service for low-income and older adults that helps with things like roof or window repairs
Well-maintained and safe low-income housing
54% 28% 14%

52% 29% 15%
0% 20% 40% 60% 80% 100%
â–  Extremely/Very important
Somewhat important ■ Not very/Not at all important »No answer
* Percentages may not add up to 100 due to rounding.
•Percentages less than 5 percent are not shown.
Figure 1.5. Housing Features of Importance to AARP Members in Denver. Binette, Joanne (2015). Creating an Age Friendly City: The 2014 Neighborhood Survey of AARP Members Age 50-plus in Denver, Colorado [PDF document]. Retrieved from America Association of Retired Persons (AARP) Website: https://www.aarp.org/researcli/topics/coimnunity/info-2015/livable-communities-denver-colorado-aarp-members.html
No previous studies have investigated the reasons why people are not prepared to age in place. Is it a lack of awareness or another factor such as difficulty with action item implementation, misinformation of cost, or opposition to policy support? The present study will investigate the barriers that contribute to the lack of preparedness for aging in place. It will add research that considers both the needs of professionals and residents to understand the dialogue between the groups and its contribution to Denver’s lack of preparedness to age in place. For instance, residents may not understand how to retrofit their homes. Residents may also not understand the importance of modifying their homes in order to prepare to age in place. In some cases, professionals such as architects and developers may not have the expertise or may have a
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lack of interest in these design features. In other cases, professionals may have both the interest and expertise, but perceive there is a lack of demand for this work. By researching the reasons why Denver individuals are not prepared to age in place with respect to single-family homes from the perspectives of residents and professionals in the construction and design sector, we could better understand the interplay of the resident-professional supply-demand relationship.
Lack of systemic structure. The City and County of Denver adheres to the International Building Code (IBC) and references accessibility standards in the book Standardfor Accessible and Usable Buildings and Facilities ICC/ANSI A117.1 created by American National Standard Institute (ANSI). As noted in Title 9 Article 5 of the Colorado Statutes (COT9A5), a Type C visitable unit is referenced in ICC/ANSI A117.1 SECTION 1105 TYPE C (VISITABLE). However, Denver does not require a Type C unit in any design scenarios. Denver, via the IBC, ANSI, and COT9A5, requires Type A and/or B units in different designs. COT9A5 calls for visitable units in Denver, which is a Type B unit (not a Type C unit). The quantity of visitable units are defined in COT9A5 and reproduced in Denver Amendments Appendix R. As specified by COT9A5, residential projects are “assigned accessibility points base on the number of units contained within the project” (COT9A5, p.36). Development projects in Denver with six units or less are not required to have visitability. Furthermore, these accessibility points do not apply to single-family homes in Denver. Additionally, the city of Denver also does not enforce universal design provisions. Therefore, there is a lack of systemic accessibility structure in place for single-family homes in Denver.
Rationale and Purpose
The issue of preparing to age in place is very current in Denver’s population and the research could inform potential policymakers. The statewide Colorado Strategic Action Planning
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Group on Aging (SAPGA) is hoping to change this situation. They are collaborating with community organizations and public agencies to conjure their vision for Colorado to “be a place where all aging residents can maintain a healthy, mobile and vibrant life.” They are examining practical solutions at state levels (SAPGA, n.d.). The State is discussing the idea of having a policy that addresses the aging universal/visitability built environment issue. This research can provide insights that policymakers may find valuable in understanding what constituents and professionals believe to be an encouraging and appropriate dialogue regarding the need for universal design and visitability ordinances for aging in place. Therefore, there are two driving reasons to conduct this research. First, the study will fill a significant gap in the research on the issue of accessible housing for single-family homes. Second, currently, Denver does not have any policies for universal design or visitability.
The first aim of the research is to investigate the reasons why Denver is not preparing to age in place. This first aim has two objections. The first objective is to explore factors that are contributing to this lack of awareness, action, and cost misinformation among residents. The second objective is to explore factors that are contributing to this lack of awareness, action, and cost misinformation among professionals including contractors, architects, and aging specialists.
The second aim is to investigate Denver residents’ political perspective on potential ordinances and incentives regarding aging in place. This second aim has two objectives. The first objective is to explore the residents ’ e.g., voters or constituents’ perspectives on and support for potential policies regarding universal design, visitability, and accessory dwelling unit (ADU) ordinances in single-family homes. The second objective is to explore professionals' perspectives and policy support regarding potential universal design, visitability, and accessory dwelling units (ADU) ordinances in single-family homes.
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Theoretical Framework
The social psychologist Kurt Lewin studied the behavioral interaction of an individual and the environment known as the ecological model. The ecological model equation expresses behavior is the function of the person-environment relationship: B =/(P, E). Lewin published the equation in his book, Principles of Topological Psychology in 1936. Lewin stated the twofold relationship demonstrated that “every physiological event depends upon the state of the person and at the same time on the environment” (Lewin, p. 12, 1936). He described the “life space” as relationships between objects and surroundings. Other social psychologists developed theories building on Lewin’s model.
Environmental psychologist M. Powell Lawton utilized Lewin’s ecological principles to investigate the interaction of epidemiology and gerontology. In the 1960s, Lawton pioneered research on aging and recognized the significance of designing living environments for aging communities. He adapted Lewin’s ecological model to calculate both the environment and the individual who was susceptible to continual change by using the person-environment equation:
B =/(P, E, P x E). This innovation led to Lawton and Nahemow’s Environmental Press Competence Model, which focuses on an individual’s reaction or the ability to adapt to the physical environment (Lawton, 1973). The model specifically identifies a person’s sensory process, perception, and cognition as links to the ecological system. Unfortunately, a person’s mental and physical variable functions reduces over time; therefore, an individual’s environmental cognition becomes a vulnerable mediator between themselves and their environment. Lawton and Nahemow’s Environmental Press Competence Model further describes the “person-environment fit” or “adaptive” theory, which suggests environmental effects become more prominent as physical and cognitive aging occur.
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There are five main components to Lawton’s Environmental Press Competence Model (Figure 1.6a). The first component is degrees of individual competence. This component represents the individual’s abilities, including cognitive, physical, and physiological qualities.
The model recognizes the limits are specific to the individual over time. The second component is environmental press. Lawton credits Murray (1938) for originally defining environmental press as environmental forces that evoke individual response. Murray distinguished between alpha and beta press (p. 607), with alpha press being objectively discernable forces and beta press being subjectively discernable forces - otherwise known as the psychological environment. Adaptive behavior is the third component of the Environmental Press Competence Model. Lawton describes adaptive behavior as the “outer manifestation of [an] individual component”
(p. 659). Both social norms and self-actualization define adaptive behaviors. The fourth component of environmental press is affective responses. Affective responses are the individual’s emotional reactions that occur in human-environment transactions. The fifth and final component of the Environmental Press Competence Model is the adaption level. According to Helson (1964), the adaptation level is a person’s optimal level of behavior response to environmental stimuli. The next paragraph will further explain how the five components relate to each other.
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SOCIAL ENVIRONMENT OF AGING 661
Figure 1.6a. Environmental Press Competence Model. Lawton, M. P„ & Nahemow, L. (1973). The Psychology of Adult Development and Aging Ecology and the Aging Process. (619-674).
The x-axis represents the level of environmental stressors and the y-axis represents a person’s competence level. The dashed, diagonal adaptation level line is a theoretical mean for individuals with an average competence. The shaded area on either side of the adaption level line is the positive affect. The positive affect (shaded area) is when an individual is comfortable in their environment. Negative affect occurs further away from the adaption level. This could be due to an individual’s sensory deprivation making the surrounding environment less tolerable and seemingly more stressful. As a person’s competence declines, they have more environmental stresses and maladaptive behavior may become present. However, adaptive behavior can
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maintain a person’s affect in the positive region. Figure 1.6b is a reinterpretation of the model by
Jon Lang.
Figure 1.6b. Reinterpretation Environmental Press Competence Model. Lang, Jon (1994). Urban Design the American Experience, (p.32).
As detailed by Lawton and Nahemow (1973), the Environmental Press Competence Model shows seven phenomenon (p. 665):
1. As individual competence decreases, the area for maladaptive behavior and negative affect increases.
2. Negative outcomes are more likely with excessively strong than with weak environmental press.
3. Positive affect and adaptive behavior are positive only at relatively low levels of environmental demand for the person of low competence.
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4.
Small changes in level of environmental press in people of low competence may
evoke gross changes in quality of affect or behavior. This statement illustrates the environmental docility principle, contrasting the low-competence individual with the high-competence one, who may deal with major changes in press while still functioning adequately.
5. For every individual including those with low competence there is a band in which environmental press are associated with positive outcomes, and conversely, a band in which self-initiated or externally initiated action may increase or decrease the environmental demand in his behavioral world.
6. Both stimulus-seeking and self-initiated dependency striving may occur at low levels of competence as well as at high levels.
7. The amount of variation in press permitted around Z to raise adaption level and simultaneously level of competence is much smaller at the low-competence end of the scale than at the high-competence end.
Lawton and Nahemow (1973) defined the ecology of aging as a “system of continual adaptations in which both the organism and the environment change over time” (p. 621).
Lawton and Nahemow view the ecology of aging as humans continually adapting and alternating their environment in order to age independently - also known as the Adaptation Theory. This study will explore the person-environment relationship further by exploring the role that universal design and visitability can play in single-family homes and ADUs.
The Lawton and Nahemow model is the underlying framework for the present study. The diagram emphasizes that adaptation influences the person-environment relationship. Specifically, the components of the Environmental Press Competence Model form the basis of the study. First,
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the degree of individual competence component will assess the public’s current familiarity with aging in place and physical ability. Second, environmental press component will assess the public’s home stressors for aging in place via design feature responses. Third, adaptive behavior identifies whether the public is implementing universal and visitability measures. Fourth, affective responses measures the emotional reasons behind why residents did or did not implement accessible features in their home. Fifth, adaptation level component will assess the public’s satisfaction with their home as a mechanism for aging in place.
The study will also investigate four components from the perspective of design and construction professionals. First, the degree of individual competence component will assess professional’s current familiarity with aging in place and physical ability. Second, environmental press component will assess the perceived professional home stressors for aging in place via the professionals’ rating of each design feature importance. Third, adaptive behavior identifies whether professionals are implementing universal and visitability means. Fourth, affective responses measures the emotional reasons behind why professionals did or did not implement accessible features in their client’s home. The fifth component, adaptation level, assesses the optimal fit level of a person’s home satisfaction within their environment; therefore, it does not apply to professionals because the professional is not the end user. The next section will reveal the research questions and hypothesis.
Research Problem
Hypothesis framework. The City and County of Denver has a rapidly aging population but the city is not prepared to support the aging group. Resident homes are not suited for aging in place; construction professionals are not incorporating universal design and visitability designs into new construction; and there are no municipal policies, regulations, or incentives to require or
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encourage the integration of universal and visitable design principles in either new construction or existing construction.
Barriers related to residents ’ support of aging in place. Null (2003) has observed that despite the increased support of aging in place by seniors through the producer and consumer-based tax and fee incentives described in the literature, local consumers are still not prepared to age in place. Null attributed the situation to three factors identified by the National Home Modifications Action Coalition in 1997. The first was skewed demographics. Seniors represent a vast, diverse group of individuals where increasing physical and cognitive disability occurs. A single marketing design cannot address this heterogeneous group. Second, the denial of aging could impair decisions to obtain a universal design. The lack of emotional acceptance of the process of aging could delay the individual’s preparedness to fulfill his or her supportive environmental needs. Lastly, Null suggested that a lack of public awareness was a contributor to soft market demand. Seniors might not know where to seek resources, find expertise, or buy products that could enhance their independent living. The more information the consumer has, the better prepared they can become.
Barriers related to professionals ’ support of aging in place. Wolford (2000) conducted a study on single-family homes and universal design. She surveyed homebuilders to understand their thought on universal design in private homes. The study determined there was greater awareness of features than use of features. One of the largest barriers found was the cost associated with the notion of making universal design a part of the local building code. The study did not include an expanded group of professionals or integrate the perspectives of residents. Residents may have completely different outlooks on aging and aging barriers than
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professionals. Incentives can be an opportunity to encourage new behavior and should be further explored.
As Denver faces changing demographics, the research questions will be built on past literature, while study Denver specifically to understand how residents and professionals can cohesively interact to prepare to age in place.
Research Questions and Hypotheses Question 1:
Why are Denver construction/design professionals and residents not prepared to age in
place?
Hypothesis 1:
• Lack of awareness
• Lack of action (feature integration)
• Lack of, or misinformation of cost
Question 2:
Is there a statistically significant difference between Denver construction/design professionals’ and residents’ levels of age-in-place awareness, action, cost information, and policy support?
Hypothesis 2:
Null Hypothesis, Ho: There is no statistically significant difference between Denver construction/design professionals’ and residents’ levels of age-in-place awareness, action, cost information, and policy support.
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Alternative hypothesis, Ha: There is a statistically significant difference between Denver construction/design professionals’ and residents’ levels of age-in-place awareness, action, cost information, and policy support.
Question 3:
What could a potential Denver universal design policy include?
Survey
The author created two independent surveys to assess the research questions through both qualitative and quantitative questions. Chapter 4, Methodology, discusses in detail the populations surveyed as well as the design of the survey itself.
Framing the Research
The present study makes several important contributions to the body of knowledge in the field of aging in place. The first novel approach to the framing of the study is the author’s particular consideration to compare the residents and professionals. The literature review will show there have been many independent studies of consumers and producers. There is a gap in the literature comparing residents and professionals. The study will compare and contrast residents and professionals universal design/visitability consensus. Understanding both professional and residents’ sentiment will present a well-rounded understanding of why society as a whole is not prepared to age in place.
Significance of the Study
Beneficiaries of the research are older adult residents and relevant professionals because the research will assess aging in place specific to their Denver community. In Denver, 93% of respondents want to live independently yet the research revealed only 33% of residents are aware
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of aging in place. The researcher wants people to learn the impact that universal design and visitability can have on aging in place. First, the data shows there is a statistical significance with the number of features in a person’s home and their level of satisfaction with their home as a place to live as they age. Second, there is a desire from residents (46%) and professionals (46%) to learn more about aging in place. The researcher argues that more awareness, education, legislative change, and policy incentives can increase the implementation of universal design and visitability in Denver single-family homes. The study will add to the literature information about the impact of contributing factors listed above on universal design and visitability.
In addition, the research will benefit the City and County of Denver and the SAPGA with valuable information about how to allocate resources to prepare to age in place in Denver. The findings will help policymakers in considering the building codes and incentives that are the most appropriate for accessible single-family homes, which could influence both the design and construction professions and the residents.
Assumptions. Limitations, and Delimitations
Assumptions. The survey assumed people answered truthfully. The researcher assumed the reward of the iPad-motivated participants to take and complete the survey. The researcher assumed the mailing address purchased included accurate information of residents and construction professionals in Denver.
Limitations. A limitation to this study is the sample size. With the sample size of 111 residents and 71 professionals, the study does not fully reflect the population. In the professional group, a slight bias may exist because local Certified Aging in Place Specialists (CAPS) were invited to participate in the survey. CAPS are trained professionals who identify home
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modifications for the National Association of Home Builders (NAHB). Another limitation that could arise in the study relates to the self-reported data. The research used two online survey instruments and as with all survey-based research, selective memory or exaggeration could bias participant response. Additionally, because the administration of the survey occurred online, the online survey does not account for residents who do not have access to a computer or a smartphone. Finally, online collection of responses outside the coterminous boundary of The City and County of Denver occurred. Some of the professional respondents’ jobs tangentially related to the construction and design field. The respondents identified when they were not able to answer questions because they did not make that type of design decision. A potential limitation would be control of the survey web address. A participant could forward the address to an individual unbeknownst to the researcher.
Delimitations. The geographical region is a delimitation of the study. The results of the survey are generalized to residents and professionals who (a) are a resident of Denver, or (b) work, design, and/or build housing in the City and County of Denver in 2017.
Organization of the Study
Chapter 2 will present an in-depth review of the literature on universal design, visitability, and accessory dwelling units from the perspectives of history, research studies, and policy reviews. Chapter 3 will explain the methodology used in the study, specifically the data collection and analysis. The chapter will explain the specific techniques used to obtain outcomes. Chapter 4 will analyze the qualitative and quantitative survey results from the distinct perspectives of residents and professionals. The chapter will also compare and contrast the data collected from the two groups and present the results of the hypotheses test. Chapter 5 will discuss the key findings, recommendations, and suggestions for future research. Chapter 5
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concludes the study by assessing how the findings have contributed to a deeper understanding of the broader research problem.
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CHAPTER II
LITERATURE REVIEW
This chapter examines man-environment theories related to gerontology, the evolution of accessible design, and universal design laws and incentives. First, the chapter will present past literature of foundational person-environment theories. Then the chapter will review the ways in which visitability and universal design integrate into single-family units to support aging in place. The chapter will show how the movement towards a universal design policy can help to create an environment for aging in place and could potentially become a standard in Colorado to support healthy community living. As Colorado experiences the changing demographics, research suggests that policymakers, developers, architects, general contractors, and citizens need to consider new strategies that support older adults with housing.
Environmental Gerontology
Foundational definitions of aging help identify the aging process. According to Handler the definition of aging “is the deterioration of a mature organism resulting from time-dependent, essentially irreversible changes intrinsic to all members of a species, such that, with the passage of time they become increasing unable to cope with the stresses of environment, thereby increasing the probability of death.” (Handler, 1960, p. 200). Some psychologists perceived Handler’s definition to be too restrictive. According to Birren and Renner, their definition concentrates on the process of aging. The definition focuses on how behavioral differentiations occur over the aging process. The authors state, “Aging refers to the regular changes that occur in mature genetically representative organisms living under representative environmental conditions as they advance in chronological age” (Birren & Renner, 1977, p. 4). Birren and
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Renner detail three types of age: biological, psychological, and social. Biological age refers to the differentiation of organisms over time. Specially understanding that over one’s life span and biological age physical limits apply to the organ system. In addition to aging biologically, Birren and Renner suggest psychological age as a second type of age. Psychological age recognizes a person’s ability to adapt to the environment. A point of consideration with physiological age is that the person’s organ system is changing and therefore their environment surroundings are increasingly harder to navigate over time. Memory, learning, and motor performances change over time (Arenberg, 1977; Craik, 1977; Welford, 1977). Social age is the third type of aging defined by Birren and Renner. Social age reflects the social habits of a person in society. The authors argue a combination of both biological with psychological characteristic influence a person’s social norms.
Aging Attitudes
Learning Theory Model. Zubin discusses how the Learning Theory Model (1977) influences the etiology of aging. The Learning Theory Model applied to aging states people learn to be old by observation. Even when physiological decline occurs, people learn to adapt (Zubin, 1977, p. 6). If people are not able to adapt, the learning theory reverts to learning to correct negative behaviors and further emphasize new processes.
Attitudes toward aging influence older adults. Attitude, as defined by W. A. Scott, is “an enduring organization of motivational, emotional, perceptual and cognitive processes, with respect to some aspect of the individual’s world” (Bennett & Eckman, 1973, p.577). Bennett and Eckman investigate the relationship of attitudes toward aging on the aging experience. They suggest maladaptive behavior of aged individuals could result in premature death. Negative views on aging could contribute to an unwillingness to integrate coping mechanisms in one’s
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environment (Bennett & Eckman, 1973). Riegel and Riegel conducted a study that revealed older people have rigid views (1960). Therefore, the lack of flexibility in views could equate to unchanged attitudes. A study in 1984 researched 300 popular magazine article writings in the 1970s. The study reinforced consistently negative views toward aging (Nussbaum, J.
&Robinson, J.). A more recent study linked negative aging attitudes as a predictor to increased daily stressors in older adults (Bellingtier & Neupert, 2016). Forty-three adults participated in daily reporting of attitudes over a total of 380 days. Daily stressors affected people with negative attitudes on aging more than individuals with positive aging attitudes. Positive attitudes on aging may be a resource to mitigating reaction to daily stresses.
Over the years, attitudes of aging have changed. More recently, AARP research conducted a study regarding attitudes on aging. The study found that 59% of people feel that getting older is a positive experience. The study also found the biggest predictor of overall satisfaction with life is health. Individuals who rate their health “good” were twice as satisfied with life (84%) when compared to people with poor health (David, 2013). Literature shows there is a relationship of health to housing. A 30-year retrospective analysis studied this relationship. The authors analyzed the relationship between health status and housing quality from 1970-2000. The two datasets assessed were the National Health and Nutrition Examination Survey and the America Housing Surveys. The results showed “ecologic trends in childhood lead poisoning follow housing age, water leaks, and ventilation; asthma follows ventilation, windows, and age; overweight trends follow ventilation; blood pressure trends follow community measures”; therefore, they conclude “housing trends are consistent with certain health trends over time” (Jacobs, Wilson, Dixon, Smith & Evens, 2009).
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Man-Environment Theories
Adaption Theory. Through a review of the literature, three theories of the man-environment relationship in gerontology have become prevalent. The first theory, the Adaption Theory, previously discussed in the Chapter 1, was the framework for the research questions. As a review, the Adaptation Theory is the model of aging and adaptation developed by Lawton and Nahemow (1973). The theory suggests that adaptive behavior otherwise viewed as outer criterion relates to the inner criterion of a person, by either influencing positive or negative affection expression. The model suggests a person’s competence defined as both physical and mental adapt to the demand quality of the environmental press, which the author operationalizes as pressures such as architectural barriers that provide stress (Lawton, 1977). Lawton’s environmental docility hypothesis (1973) suggests older people with increased physical impairments are likelier to have their behaviors represented in their residential settings.
Environment Congruence Model. A second theory of man-environment relations, applied to gerontology, was the Person-Environment Congruence Model published by Kahana in 1975. Similar to Lawton’s hypothesis, Kahana illustrates congruence between the built environment and an aging person’s abilities to influence the well-being of their surroundings. The Congruence Model ascertains a best-fit line between the elderly individuals and the environment in order to understand the impact of a person’s well-being by the environment. Kahana argues that an individual’s preferences need to be congruent with an optimal environment setting. Therefore, she suggests that optimal environment be person-specific (Kahana, 1975). She measures congruence as an individual’s perceived well-being. The individual’s behavior adapts to the environment. Therefore, the environment must be maximized to make the individual most comfortable.
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Kahana argues behavior varies because of a person’s needs and environmental press. There are three possible target zones. First, is the Cumulative Difference Model. The model (also known as Zero Deviation) reflects an environment that has reached full optimization capability because the zone meets both the person’s and environmental press needs. The second model is the Critical-Difference Model. This model version states deviation can become non-optimal. The third is the Optimal Congruence Model. The Optical Congruence Model identifies no deviations and extreme deviations with negative outcomes. Therefore, between zero and extreme is a range of outcome options and optimization occurs in between the zero and extreme range.
Stress Theory. Schooler (1975) devised the Stress Theory to describe man-environment relations. The theory argues an exterior stimulus becomes a perceived threat. The threat can come in the form of biological, physiological, or social changes in older people. When there are no perceived threats, older adults continue normal behavior processes. If a perceived threat occurs, (a stimulus becomes a stressor) the individual responds by exuding coping mechanism behaviors. Schooler’s model is similar to the Adaptive Theory and the Person-Environment Model because it addresses psychological and sociological types of aging. Dissimilar to Lawton and Nahemow’s and Kahana’s theories, Schooler’s Stress Theory focuses more on the stressors than the environment. He focuses on what the individual perceives as stressors. Lawton & Nahemow and Kahana theories allow for interplay between external stimulus and internal response, suggesting physical barriers can influence behavior without perceived awareness (Lawton, 1977, p. 298).
Residential Normalcy Theory. Golant (2018) argues in his Residential Normalcy Theory that older people are “motivated to initiate coping actions when they feel out of their residential comfort” (Golant, 2018, p. 65). Golant recognizes Lawton’s and Nahemow and Kahan’s person-
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environment interaction theories and further builds on the fit-congruence environment model to understand why some older adults have more advanced coping repertoires and age more successfully. The Residential Normalcy Theory specifically focuses on how “older individuals differently coped with their incongruent residential environments” (Golant, 2018, p. 68). In Golant’s Residential Normalcy Theory, he suggests two main factors influence a person’s implantation of adaptive behavior. The first influence is an individual’s personal appraisement of unmet needs. The second influence on a person’s adaptive behavior is how that individual processes information (Golant 2014). He proposes constructs that influence coping behaviors. Below Golant identifies three factors in Residential Normalcy Theory constructs that influence coping repertoires of older adults (Figure 2.1).
Figure 2.1.Residential Normalcy Theory Constructs
1. Whether they have resilient characteristics;
2. Whether their current or alternative places or residence have
resilient environments based on objective indicators; and
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3. Whether they make decision of their own volition or if they have voluntarily delegated their decision-making authority to others.
These factors influence the enrichment level of coping repertoires for older adults. Golant argues object indicators can create resilient residential environments (2014). However, his overall argument is that different people can assess the same object differently; therefore, the coping strategies for people can become very individualized. Suggesting demographics and personalities, life history, and health status can all be predictive personal characteristics. The characteristics of the person influences how that person’s ability to house more effective problem solving/coping skills in search of creating a residential normalcy environment (Golant, 2014).
The present study will examine integration of universal design and visitability features as an action item of adaptation for single-family homes within the framework of the Adaptation Theory. The Adaptive Theory Model is the most relevant to the topic of study. The other models, (Environment Congruence Model, Stress Theory, and Residential Normalcy Theory) have been discarded because they are less relevant. This study will assess universal design and visitability awareness, action, features cost knowledge and policy. The means for assessment will be via a survey instrument. The survey (discussed in detail in Chapter 3, Methodology) will address questions of awareness, action, cost, and policy. The study will also gauge policy interest for integrating features in single-family homes. The next section will provide a historical overview of accessibility evolution for built environments in the United States.
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Accessibility Evolution
Accessibility Rights
At the end of the 1950s, the American Civil Rights Movement commenced a conversation about basic rights of accessibility for all Americans. Figure 2.2 shows the accessibility policy timeline. In 1961, the Veterans Administration (VA) became the first government agency to establish standards for building access. The VA rules, “Making Buildings Accessible to and Usable by the Physically Handicapped,” are not federal laws. Rather, they are enforceable only if municipal or state governments adopt them. Nevertheless, these government regulations established a movement to encourage individual independence and eliminate physical restrictions regarding building access. Building on the Veterans Administration initiative, Congress passed the Architectural Barriers Act (ABA) in 1968. It was the first legislation to mandate building access in any new structure, which was designed, built, remodeled, and/or leased with federal funds. The ABA also called for the immediate eradication of existing physical barriers that impeded a person’s ability to enter and exit a building. As inclusiveness became a legal right, conventional building design practices evolved to include the barrier-free requirement. Today, the United States Architectural and Transportation Barriers Compliance Board ensures that architects, engineers, designers, general contractors, building owners, and managers continue to comply with the ABA accessibility standards.
In the 1960s, more literature appeared linking the built environment and older individuals. The literatures emphasizes a connection between gerontologists to professionals such as architects, and planners. In 1974, Pastalan evaluated architecture student subjects’ responses to the environment after their sensory had been temporary altered to simulate modal
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impairment in an aging person. The students had difficulty with tactile fine muscle controls in their hands, increased inability to hear, visual impairments such as faded colors and glare issues. The sensory deprivation model created from the experiment informed professionals, at the time, of safety hazards. Since then, additional studies have influenced the evolution of accessible environments.
However, these previous Acts included public and private commercial buildings, not residences. Section 504 of the Rehabilitation Act (1973) was the first federal guideline for the accessibility to all government-subsidized buildings (including residential dwellings) (AARP, 2010, p. 3). The Act required multifamily projects to ensure that 5% of their housing units were accessible by people with mobility impairments (Kochera, 2002, p. 7). Examples of the architectural requirements were 32-inch door openings, one accessible entrance, and removable cabinets under the sink. These requirements allowed an individual wheelchair user to live in federally funded multifamily homes.
Figure 2.2 Accessibility Policy Timeline
Following Section 504, Congress passed the Fair Housing Amendment Act (FHAA) in
1988 to provide accessibility for multifamily buildings, regardless of federal funds. The FHAA Sec. 804. [42 U.S.C. 3604] Discrimination in sale or rental of housing and other prohibited
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practices prohibits housing discrimination based on several factors, one of which was disability. The Act covers private residences, government-built housing, and federal financial-assistance housing. The Fair Housing Amendment Act of 1988 requires that accessibility standards for new public or private multifamily dwellings with 4 or more units meet accessible standards. The act protects people from discriminatory housing practices through the following standards:
(a) To refuse to sell or rent after the making of a bona fide offer, or to refuse to negotiate for the sale or rental of, or otherwise make unavailable or deny, a dwelling to any person because of race, color, religion, sex, familial status, or national origin.
(i) The public use and common use portions of such dwellings are readily accessible to and usable by handicapped persons;
(ii) All doors designed to allow passage into and within all premises within such dwellings are sufficiently wide to allow passage by handicapped persons in wheelchairs; and
(iii) All premises within such dwellings contain the following features of adaptive design:
(I) An accessible route into and through the dwelling;
(II) Light switches, electrical outlets, thermostats, and other environmental controls in accessible locations;
(III) Reinforcements in bathroom walls to allow later installation of grab bars; and
(IV) Usable kitchens and bathrooms such that an individual in a wheelchair can maneuver about the space (USDJ, 2015, website).
Clause (III) Reinforcements in bathroom walls to allow later installation of grab bars is defined in the International Code Council (ICC) All 7.-2017 Standardfor Accessible and Usable Buildings and Facilitates American National Standardbook. Section 609 Grab Bars (p.87) details the grab bars in bathroom facilitates (Figure 2.3). The section identified requirements for cross section of grab bars, spacing, position on grab bars, position of children’s grab bars surface hazards, fitting grab bars, installing and configuring grab bars, and structural strength.
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SIZE OF GRAB BARS
FIGURE 609.3 SPACING OF GRAB BARS
Figure 2.3 International Code Council (ICC) A117.-2017 Standard for Accessible and Usable Buildings and Facilitates American National Standard
These clauses made it unlawful to discriminate against a disabled person when selling or renting a dwelling. Additionally, the law applies to other activities such as zoning practices and new construction design. The coverage of Section 504 and the FHAA made accessibility possible for people with disabilities living in multifamily homes. However, additional progress in addressing private single-family homes on local levels remains a need.
None of the newer and more stringent United States laws enacted during the late 1980s considered accessibility in single-family homes. However, this gap in the single-family home accessibility laws did not discourage public consideration. New programs for visitability and
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universal design simultaneously emerged in the 1980s through local advocacy and education centers.
The most comprehensive law to date for public accommodations is the Americans with Disabilities Act of 1990 (ADA), signed by President Bush, which drew the widest attention to the civil rights of people with disabilities. The law enforces accessibility in public accommodations such as hotels, restaurants, shopping centers, hospitals, and more. The law also applied to government-subsidized housing such as university housing. The law applies to public spaces in multi-family housing, but not inside the units. The law has five major sections. Specifically, the sections Title II - Public Services (State and Local Governments) and Title III -Public Accommodations (Commercial Facilitates) have greatly influenced the design of building access. This federal legislation mandated the removal of physical barriers that impeded access to state and local buildings as well as public accommodations, including privately owned facilities. The Department of Justice continues to regulate the compliance with ADA to ensure that the physical, built environment is accessible to all persons.
Demirkan (2007) reviewed the literature and her paper depicts three phases that led to widening ideology of housing design for the aging population. She organizes the evolution of home accessibility in three stages: individual, adaptable, and universal. First, Demirkan states housing design was “individual” and specific to the user with a disability. Then, individual housing design emerged into adaptable housing. Adaptable housing (adding grab bars and creating ramps) and customized home modifications began to evolve. Lastly, following individual and then adaptable design, universal design emerged. The housing ideology highlighted the “design for all” concept. The design-for-all concept expands home accessibility design for people of different ages “regard less of age or ability” (Demirkan, 2007, p. 35). All are
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effective means to revitalize homes to support aging in place, but the latter impacts more people because it is universal. The next two sections will discuss visitability and universal design.
Visitabilitv
Eleanor Smith and her Atlanta-based advocacy organization, Concrete Change, started the visitability movement in 1987. The group maintains that there are three essential features “that must become a default in home construction practices.” First, one zero-step entrance at the front, back or side of the house. Second, interior doors, including bathrooms, with 32 inches or more of clear passage space. Third, at least a half-bath, preferably a full bath, designed on the main floor (Concrete Change, 2016). The three visitable features listed above support the independence of homeowners and renters.
Visitability cost and location. The location of the zero-step entrance door could occur in the front door or through the garage. Different construction methods allow zero-step entrances to be feasible. Various methods to creating a zero-step entrance include slab-on-grade, earth berms, retaining walls, garage entrance, and ramps (Concrete Change, 2005; Visitability, n.d.). For all homes built on slab-on-grade there would be a charge of approximately $200 for a zero-step entrance. When considering the slab-on-grade zero-step entrance, the final detail to include is the threshold door connection. The most recommended threshold is a flush entry with an average cost under $50. Integrating a flush threshold that aligns with the ground providing a smooth, uninterrupted surface is a final detail consideration when constructing zero-step entrances.
Visitability public laws. In 1992, the city of Atlanta, Georgia approved the first visitability ordinance. The ordinance mandated that public homes would receive government grants in the forms of city loans, land grants, and tax incentives to integrate into their home
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designs with zero-step entrances, 32-inch doorways, reinforced bathroom walls, and electrical controls that are reachable from a wheelchair (Kochera, 2002, p.23). In 1998, Austin, Texas mimicked Atlanta’s initiative and adopted an ordinance applying to newly constructed, singlefamily homes that directly received funds from the city (Kochera, 2002, p.25). Austin, Texas also created the Safe, Mixed-Income, Accessible, Reasonably Priced, and Transit Oriented (S.M.A.R.T.) Housing Policy initiative, which provided fee waivers and faster processing of building permits for developers and builders of such units (Maisel, Smith, & Steinfeld, 2008).
Recently, however, there are instances where policy applies to private residences. According to Nikita (2007), both Pima County and Naperville in Arizona became the first to pass ordinances that applied to both publicly funded and private homes. In 2002, Pima County was the first to pass a visitability ordinance for publicly and privately funded homes. Specifically, the law called for visitability features to include a zero-step entry, wide doors and hallways, and reinforced bathroom walls (so walls can support grab bars). In addition, all outlets and light switches were reachable from a wheelchair level. After the creation of the visitability ordinance in Pima County, professionals introduced 15,000 visitable single-family homes into the housing market (JCHS, 2014, p. 23). Following Pima County, in 2002, Naperville, Arizona amended its building codes to introduce visitability guidelines (2002). However, Naperville stated that if the site grade reflected a dramatic change in elevation the no-step requirement was exempt. Several other localities have authorized similar ordinances: Urbana, Illinois (2000); San Antonio, Texas (2002); St. Petersburg, Florida (2004); Birmingham, Alabama (2007); and Pine Lake, Georgia (2007).
The state of Vermont required “any spec-built single-family or multifamily housing unit to adhere to a number of construction standards that closely follow the broad visitability
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legislation,” however, “unlike Georgia and Texas, the Vermont requirements extend to privately financed housing, making Vermont the first state to establish a set of visitability features for almost all housing” (Kochera, 2002, p. 14). Vermont passed the most comprehensive visitability law implemented at the state level. Since 1998, eight states have enacted legislation requiring visitability in state-funded housing: Georgia, Kansas, Kentucky, Michigan, Minnesota, Ohio, Oregon, and Texas. At a minimum, the laws mandate a no-step entrance, 32-inch interior doors, and a half-bath on the main level (Hayes, 2010). Shortly following the visitability movement, universal design came to the forefront. Forty-two states do not have visitability laws.
Universal Design
In 1989, the U.S. Department of Education funded the National Institute on Disability and Rehabilitation to support a group of architects, environmental designers, and engineers to address accessibility issues in buildings. Ron Mace at the Center for Universal Design led this group for Universal Design at North Carolina State University. He defined universal design as “the design of products and environments to be usable by people of all ages and abilities” (CUD, 2008). The application of universal design includes seven principles: equitable use, flexibility in use, simple and intuitive use, clear information, tolerance for error, low physical effort, and size and space for approach and use. The Center continues to reside in the College of Design at North Carolina State University and promotes the universal design philosophy of “design for all” through design development and research publications. These principles have led to a universal design checklist that helps in identifying new construction, remodeling, and modification options to support aging in place. As noted in aging research, the universal design philosophy may be the
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most desirable built environment design option because of its applicability to everyone (Carr, Weir, Azar, & Azar, 2013).
The book Residential Design for Aging in Place by Lawlor and Thomas synthesizes the definitions presented by The Center for Universal Design of each principle (2008).
Principles of Universal Design
Principle One: Equitable Use
This principle encourages designs that are functional with the same or equivalent means of use that appeals to a wide number of individuals.
Principle Two: Flexibility in Use
Designs following this principle feature a choice of preference and methods of use, including accommodating left- or right-handed operation while allowing for users’ precision, accuracy, and peace of work.
Principle Three: Simple and Intuitive Use
According to this principle, the design should be straightforward and consistent with the expectation and intuition of the user. Information should be presented based on its importance to accommodate a broad range of literacy and language skills. The design should give prompting and feedback during and after each use.
Principle Four: Perceptible Information
This design principle provides a product that gives appropriate information to the user by using different modes of redundant presentations (pictorial, verbal, and tactile) regardless of the ambient conditions or the user’s sensory abilities.
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Principle Five: Tolerance for Error
Designs should facilitate their safe use, be forgiving if errors occur, and minimize adverse and unintended consequences. Examples include providing warning or error alerts and discouraging unconscious actions in a task that require close attention to the use.
Principle Six: Low Physical Effort
This principle calls for designs that are efficient, comfortable, and require little effort to use. The design should allow the user to operate successfully without much force and without twisting, turning, or repetitive actions.
Principle Seven: Size and Space for Approach and Else
In this principle, spatial design creation is design appropriate for its size, by providing a clear line of sight and making it possible to reach whether seated or standing regardless of the user’s body size, posture, and mobility.
Universal design public and private laws. Currently in the United States, visitability ordinances exceed universal design ordinances. On 16 February 2010, the Community Development Department in the City of Sacramento passed the universal design ordinance NO. 2010-003, “A Proactive Effort to Create New Housing To Be Enjoyed by Everyone,” to accommodate the growing disabled and senior population. Developments containing 20 or more single-family houses in the Standard Single Family (R-l) Zone and Single-Family Alternative (Rl-A) Zone were required to construct one home that contains universal design features (grab bars, zero-step entries, and wider doorways) (City of Sacramento, 2010, p. 3). In the remaining homes in the subdivision, consumers had the option to integrate universal design features. Since
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then, Sacramento has continued to promote proactive universally designed residential development to support independent living.
To some people grab bars are unattractive and a sheer sign of aging, which may make people uncomfortable. The researcher recognizes it is not necessary for every home to have bathroom grab bars in place, however, integrating grab bar blocking design during the construction phase of a home is inexpensive, and not labor intensive. Locations of grab bar blocking could be included (a) adjacent to the toilet, above the toilet, and at the shower faucet (b) within the shower. Placing grab bar blocking in bathrooms to prepare to age in place minimizes the task of a full-scale bathroom remodel, which greatly benefits the homeowner. The public does not have to tear the entire wall out in order to include the grab bars. If professionals include grab bar blocking in new construction homes, the public can avoid expensive cost in the future.
Opposition to Visitable and Universal Design Policy and Incentives
Opposition Concerns
Excessive government control. Investigators claim conventional single-family units in the housing stock lack basic accessibility (Nishita, Liebig, Pynoos, Perelman, & Spegal, 2007). A case study assessing the diffusion patterns of visitability legislation aim to understand “spread of the visitability concept, the patterns of diffusion, the opposition’s main concerns, and the mechanisms by which advocates [for visitability] overcame opposition and facilitated passage” (Nishita, Liebig, Pynoos, Perelman, & Spegal, 2007, pg. 2). The authors describe how contractors reacted to the first visitability ordinance, championed by Eleanor Smith, in 1992, with much controversy and opposition because of their concern for government encroaching on private property and cost concerns.
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Concerns regarding both the increased costs of accessible features and governmental interference exist in the professional industry. The opponents of visitability argue the idea of government mandating ordinances in private residences encroaches on peoples’ rights. The notion is rooted in the fact that individual homeowners own the land and pay taxes on their land; therefore, they can decide what to do with their own private property. Some builders suggest no laws apply to private residences and that homeowners should be able to choose to obey them.
Cost concerns. Opponents also argued, in addition to government not encroaching on private residence, that the cost associated with universal design and visitability would “negatively impact the affordability of a home” (Nishita, Liebig, Pynoos, Perelman, & Spegal, 2007, pg. 10). However, the study revealed pricing for visitability was in fact inexpensive and that increased awareness of visitability pricing can help proponents of visitability policies further succeed in adding visitability in the U.S. housing stock. (Nishita, Liebig, Pynoos, Perelman, & Spegal, 2007). Furthermore, the study addressed a clear distinction associated with time of integration: concepts integrated “before” construction compared with homes retrofitted “after” construction had substantial cost differences. It is less expensive to include visitability in the initial design of a home then to retrofit a home after construction. The literature review will elaborate the study.
Previous studies found that original design and construction specifications of the materials and labor used in universal design and visitability are not outlandishly overpriced. Gobtop and Memken (2005) calculated that the value of using universal design to design a new home would raise the initial selling price by $3,700. They argued that paying a higher premium for a universal design home has long-term benefits because the features installed (a) support an individual to age in place, and (b) mitigate the need to retrofit the home in the future. In fact, this
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study estimated that remodeling a home to include universal design features would cost $50,000 to $66,000. It may not be feasible for an elderly individual to pay this cost in the latter stages of his or her life. Maisel (2007) validated this finding in a study that compared the cost of integrating a visitable design into the original design and construction in contrast to the cost of modifying a home for visitability. She found that the average new construction cost of installing visitability during construction was $200 for a zero-step entrance and $50 for interior doors. The values are less expensive than retrofitting. The average cost was $3,300 to add a safety zero-step entrance to an existing home and $700 to widen the interior doorways (Maisel, 2007). Therefore, the literature suggested that both universal design and visitability home modifications are significantly more cost effective when integrating the features in the initial design and construction phase. This research suggests the construction industry should consider the incorporation of universal design and visitability features within new construction.
Societal Costs of Not Integrating Features
The literature review also identified the cost associated with not utilizing accessibility features. As people age, falls become more prevalent. Unsafe physical barriers in homes can increase the chances of older adults falling, and an increase in the number of falls can lead to an increase in medical costs. The Center for Disease Control and Prevention reported that in 2013, the direct medical cost of falls by people aged 65 and older was 34 billion dollars (CDC, 2013). Barrier-related home falls are an important issue because these statistics are likely to rise as the U.S. population continues to age. These statistics set a precedent in the information on creating safe homes because a portion of such incidents occurs in homes.
In 2015, the National Council on Aging released the Falls Free: 2015 National Falls Prevention Action Plan. The plan includes a section on home safety strategies to create
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awareness of the need for consumers to adopt home modifications to prevent falls. They have designated two main goals. First, all older adults will have knowledge of and access to home security measures (including information, assessments, and home modifications) that reduce home hazards, improve independent functioning, and lower the risk of falls. Second, healthcare, the aging network, housing, and other service providers will become more aware of and promote home safety measures (including information, assessments, and adaptive equipment) that reduce home hazards, improve independent functioning, and lower the risk of falls (NCOA, 2016). Each goal has three to four specialized action steps, but the primary goal is to eliminate falls and increase home safety so that people can age in place safely.
Past Policy Tactics
Policy Promotion
Government policies to alleviate cost. As noted, the federal government has succeeded in creating accessibility in federally funded private apartments and public buildings, but has declined to create federal laws regulating accessibility in single-family homes. To date, there are no national accessibility, universal design or visitable requirements for single-family homes. However, the government has explored federal incentive programs. During the fiscal years 1999 to 2001, the U.S. Department of Housing and Urban Development (HUD) administered federal aid through the Super Notice of Funding Available (SuperNOFA) to incentivize developers to incorporate visitability and accessibility in subsidized single-family homes. The grant successfully encouraged developers to include grade entrances and 2-feet 10-inch passageways in single-family homes. Kochera (2002, p. 1) noted that although the incentives have been minimal at the federal level, exploration of incentive programs occurs at the state and local levels, which have led to a changing landscape of visitability and universal design incentives in
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single-family homes. Hartje (2004) agreed with Kochera, claiming that incentive programs can also “accelerate the adoption of universal design in housing, supporting the goal of transforming the real estate market into one in which universal design features and products are the standards for design and construction” (p. 195). In contrast to the federal government, the delivery of programs and incentives at state and local levels has driven new trends in passing legislation, which benefit both builders and homeowners.
States and municipalities promoting incentives. Several localities and states offer tax incentives to both producers and consumers to defray the costs associated with future accessibility laws (City of Austin, 2013). In 1998, the state of Georgia passed a law that gave single-family homeowners a tax credit of $500 if they incorporated accessibility features into their houses. The law also included a $125 tax credit for retrofitted existing homes; the credit could not exceed a total of $500 (Kochera, 2002, p. 17). The regulation was similar to the visitability law passed by Texas in 1999. Texas’s visitability law applied to single-family affordable housing constructed with federal funds. Although, the idea is to incentivize the production of universal design and visitability there are examples in both state laws that if the grading cost is unreasonably expensive, the visitability features may be waived (Pima County, 2001, p. 22). Neighboring states took note of the tactic to incentivize via political action. Both Virginia, in 1999, and Pennsylvania, in 2006, provided state ordinances that gave tax credit incentives to consumers (Maisel, Smith, & Steinfeld, 2008, pg. 33). Virginia and Ohio created a Livable Homes Tax Credit (LHTC) program, which allows both builders and homeowners to claim up to $5,000 to build accessible homes and for owners to upgrade their existing home (JCHS, 2014, p. 23; Virginia, 2018). In 2012, Ohio’s Injury Preservation Partnership campaign,
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an advocacy group, argued that home modifications could prevent falls and save lives because accessibility features promoted independent living to improve the quality of life for older adults.
Mandatory Versus Voluntary Incentives
Various localities and states have utilized several means for implementing visitability and universal design features in the existing housing stock. Local jurisdictions have waived construction permit fees, designated tax credits, deferred loans, and issued land grants to increase the number of single-family homes and townhomes with universal design and visitability features. Such solutions streamline the permit process and create a financial stimulus for the participants. These features improve the safety of housing by limiting the number of impediments in a home, thus supporting independent living for all (Salomon, 2010). However, not all programs mandate participation. The literature review revealed significant differences between mandated programs and volunteer programs. Pima County and Tucson in Arizona and Bolingbrook in Illinois have all passed visitability ordinances that apply to homes built using both public and private funds. Maisel (2008) compared the number of houses produced by the various programs to measure the effectiveness of the different strategies. In 2007, local municipalities combined reported 28,600 visitable homes resulting from the adoption of mandatory ordinances in various cities compared to 1,000 built by a volunteer program (p.21). The adopted laws achieved a higher response from society than the volunteer programs did. Hence, a greater number of cities are exploring mandatory programs because they want effective change.
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Accessory Dwelling Units as a Tool for Aging in Place
Accessory Dwelling Units
Accessory dwelling units (ADU) are separate housing units for one or more people on the same lot as the primary residential unit. ADUs either can attach or be detached to a single-family residence on the same parcel of land. To classify as a separate and independent housing/dwelling unit, ADUs need to have a kitchen and bathroom and (for attached units) an adjoining unit by a locked door to separate the spaces or (for detached units) must be physically separate. Additionally, some municipalities require separate utilities.
ADUs present an underutilized opportunity for aging in place and enabling people to remain in their single-family homes because they support homeowner independence. ADUs can either be a space where caring family members or nurses can live when assisting the elderly homeowner. Alternatively, ADUs can be a space where the homeowner can downsize into the ADU and rent their larger house for more income (Le. More specifically, ground level ADUs (attached or detached), which integrate universal design and visitability features are very conducive to individuals aging in place. ADU benefits include augmented homeowner income, as well as conveniently allowing the individual to continue to be a part of their neighborhood fabric. Currently, the City and County of Denver does not permit ADUs in all neighborhoods.
ADU History
In the early 20th century, single-family home construction often included accessible dwelling units. Homeowners would rent ADUs to non-family members to generate income or as servant quarters used for extended family. After World War II when an influx of men returned from the war, a G.I. bill called The Servicemen’s Readjustment Act of 1944 established grant
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money for educating and housing the returning soldiers. In response to the demand for housing, the Federal Housing Administration (FHA) increased the availability of FHA loans to stimulate development of housing in America’s suburbs. Land was less expensive in suburban areas. The mortgage subsidy reduced the need to have additional income-generating housing on the same lot as the primary single-family home. Additionally, the America Dream was evolving; the notion of an American home shifted from a dense urban pattern to a pastoral suburb. Post-World War II zoning created large houses with big lot sizes to support the men and their families. FHA guidelines gave birth to the suburbanization of the United States in low-density settlement patterns. Suburban sprawl became the spreading of housing developments in a rural area. The sprawling became a solution to the problem of the urban density at this time, but consequently, the use of ADUs significantly decreased. Throughout the 1950s and 1960s, as housing development concentrated on lower-density suburban districts, local jurisdictions began to adopt restrictive residential codes to prohibit ADU construction with the intention of preserving and protecting single-family neighborhoods (Katsuyama, 1995). Ironically, the adverse effects of suburban sprawl, such as traffic congestion and the lack of affordable housing, drew negative attention to suburban design among some urban researchers. The critique of suburbia motivated the practice of new design methods. To address the unfavorable post-war suburbanization, development patterns began to change in the 1990s to Smart Growth and New Urbanism. These new city planning ideologies promoted walkable neighborhoods and integrated a range of housing types. They promoted higher densities and a mix of uses instead of single use residential areas at lower densities. Subsequently, a growing number of municipalities began to lift the ban on ADUs and adopt new ADU zoning regulations. However, many of these new ADU ordinances are still restrictive in terms of design, size, and parking regulations (Pfeiffer D.,
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2015). Additionally, there is still the neighborhood phenomenon of NIMBY (not in my back yard) that can fuel community resistance (Farris J., 2001, p.23).
ADUs and Older Adults
The literature shows that there was a movement to encourage the expansion of ADUs. In 1992, Kelbaugh, Hinshaw, and Wright described the new meaning of ADUs in their book, Housing Affordability and Density: Regulatory Reform and Design Recommendations. First, Kelbaugh and colleagues identified the problem of older adult individuals who want to remain in their homes but have a surplus of space that they cannot maintain. Specifically, during the 1990s, 9% of the households in Washington State consisted of persons over 65, who were mainly women. In accordance with the Colorado State Demography Office data, this demographic trend was similar to that in Colorado during the same period. Kelbaugh suggested that ADUs could be an opportunity for aging homeowners to remain in a home, sometimes on their own property and in their community. Owners can downsize by moving into their own ADU. By moving into living quarters that are more manageable, owners do not have to relocate into a different neighborhood (Lehning, 2012, p. 347). Alternatively, they can stay in their homes and a caregiver can move into the ADU or, homeowners can move into the ADU themselves i.e., the “granny flat.” Other authors followed Kelbaugh’s suggestion to use ADUs as a solution to support aging at home. In the aging and social policy literature, Cobb and Dvorak (2000) argued that older adult consumers were displaying increased interest in ADUs. Cobb and Dvorak referenced a national survey that was conducted in 1997 by AARP, which revealed that 36 % of persons 50 years and older were receptive to building ADUs to assist them when they became elderly. Acknowledging the documented trend of the increasing interest in ADUs, identified by the literature, Liebig (2006) advocated that governments should participate in the advancement
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of ADUs. Liebig argued that both state and local governments have the responsibility to investigate ADUs and educate policymakers, developers, and consumers about the topic through marketing and media. Liebig suggested that localities could provide information about universal design features that ADUs can incorporate to enhance the support of older adults.
Benefits of ADUs for Seniors
ADUs have several benefits. First, they increase the housing supply in existing communities using existing infrastructure. ADUs encourage the use of the preexisting housing stock and infrastructure, and they help to increase the supply of housing without the need for government subsidies. Second, they financially assist homeowners by supplementing their income. The additional money gained from renting out an ADU or the primary residential unit can provide financial aid and stability to elderly homeowners who rely on a fixed income. In the case where a senior rents an ADU from someone else, the rent is likely more affordable than a single-family home mortgage. In the event the senior rents the ADU for income or a caregiver and stays in the main housing unit, the ADU provides an affordable rental option in an existing neighborhood where rentals are not otherwise being constructed. Third, ADUs are a convenient option for aging homeowners to transfer their living quarters if they want to downsize. ADUs can also support aging in place by providing a transitional period for homeowners to stay in their homes longer because caregivers, friends, and family members can live nearby to provide security and companionship. Fourth, ADUs can be a design opportunity to preserve characteristics of the home as an extension of the main house. Fifth, ADUs modestly increase the density of a neighborhood if enough are developed, and the additional density of households attract community services such as public transit frequency.
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Denver ADUs
Combining the concepts of universal design and visitability in ADUs creates a vast opportunity for homeowners who are considering building an ADU to support their aging in place. ADUs present an underutilized opportunity for Denver to combat their housing shortage. Following national trends, in 1956, the City and County of Denver halted further construction of detached homes. Fifty years would pass before the city reconsidered the topic. In 2006, Robert Sperling created the Friends of Granny organization, which lobbied for the legalization of ADUs. Consequently, in 2010, Denver’s zoning codes lifted the ban on ADUs. However, the lift only applied to about 10 % of Denver’s geography-specific neighborhoods. Subsequently, from 2010 - 2017 in Denver, the City has issued 156 ADU permits (Figure 2.4).
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hit City and County of Denver
DENVER
# Permits Issued For New Accessory Dwelling Units 2010 -2017
Issued by Year 2010 - 2 2011 - 6
2012 - 9
2013 - 20
2014- 12
2015- 19
2016- 44
2017- 44
Figure 2.4 ADUs in Denver. Source: City and County of Denver.
The sparse development raises both questions and possibilities regarding this untapped market. ADUs could provide an opportunity to increase housing density in Denver, and they could be an avenue for combating the housing shortage supporting a homeowner’s ability to age in place. Blueprint Denver is a transportation and land use plan produced by the City of Denver’s Community Planning and Development Department. In an updated Blueprint Denver version, the City will seek to allow construction of ADUs in more neighborhoods because of the tremendous benefits ADUs provide. The update to the Blueprint Denver plan is in process as of March 2018.
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Universal design, visitability andADUs. This previous section explored history and benefits of ADUs, particularly with regard to existing single-family homes in Denver. There is an opportunity for integration of visitability and universal design in ADUs in existing singlefamily residential lots to provide additional housing for the aging population in the current real estate market. However, if ADUs do not integrate universal design and visitability principles, future ADUs may not be supportive enough for older adults to occupy them safely. The remainder of this chapter will refer to new residential single-family home construction (without ADUs).
Lack of Accessible Homes in Existing Housing Market
Buildings have been subject to following similar standards for the last 30 years. According to the literature, home design can influence an individual’s ability to live independently. Therefore, as the demographics change, the improvement of design and construction must evolve. Currently, the ADA is unique to public buildings and publicly funded private buildings, and it is not mandatory for developers, architects, and contractors to consider in designing and constructing private homes. No federal laws exist that are specific to accessibility in single-family homes. This omission in ADA federal law is critical for two main reasons: first, society should respond to consumer preferences i.e., aging in place supports preparedness in existing homes and new homes; and second, there is a shortfall in the number of accessible homes.
In March 2015, the U.S. Department of Housing and Urban Development Office of Policy and Development and Research published “Accessibility of America’s Housing Stock: Analysis of the 2011 American Housing Survey (AHS).” The study concluded there are few
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accessible homes in the existing market. Their extensive analysis indicated, “fewer than two percent of housing units are accessible” (Bo’sher, Chan, Ellen, Karfunkel & Liao, 2015, p. 45).
The lack includes both old homes and new homes. The lack of attention to accessibility in single-family homes accentuates when recognizing that single-family homes are a substantial part of the new construction market today. The Highlights of the Annual 2014 Characteristics of New Housing revealed that of all the new homes built in 2014, 70% (620,000) were singlefamily dwellings. Not only are people unprepared, but they also do not have new housing options. Making aging in place a reality will occur through the continued evolution of housing design. Pynoos (2008) suggested that the housing movement is hindered by the unavailability of accessible and supportive housing, arguing “new policies are needed to provide help modifying existing housing, mandate the creation of housing based on principles of universal design, and provide a range of housing types in communities” (p. 78).
According to Maisel, Smith and Steinfeld (2008), in the majority of existing singlefamily homes, a homeowner must climb steps to enter the home, and the interior and/or exterior doorways are narrow. These home designs are unsafe spaces for residents of diverse ages who have disabilities. A study conducted by the Joint Center for Housing Studies of Harvard University also assessed the existing housing stock and agreed, stating that the nation’s supply of accessible housing is not equipped to meet the demand from baby-boomer consumers. The report revealed that nearly two-thirds of adults aged 50 to 64 years and nearly three-quarters of individuals aged 65 to 79 years are living in single-family homes, yet the majority of the home designs lack accessibility consideration. Therefore, there is a need to integrate programs and incentives in cities that target the new construction and modifications of single-family homes by raising the awareness of both consumers (residents) and producers (architects, builders, and
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developers). A study conducted by Memken and Earley (2007) reveals shortfalls in the number of accessible housing units across the country. The authors argued that the lower availability of accessible housing units could affect the ability of an elderly individual to age in place in the United States. This shortage in the market indicates the need to create more homes with accessibility. People living in older homes will need to make several modifications.
Discussing these issues will encourage solutions such as incentives; then, incentives can lead to increased public attention to advocate for aging in place, therefore motivating producers and consumers to take action (Maisel, 2008, p.21). Increased public awareness of universal design can foster initiatives and public incentives for campaign awareness in local cities. For example, Colorado is making progress in this direction by entertaining ordinances for visitability and universal design. Using a pragmatic approach, universal design requirements incorporated into new residential construction can create a home market of user-friendly environments for people of all ages to make up for resources that have been missing.
Action by Stakeholders To Create Potential Policy
Action by Professional Architects
The American Institute of Architects (AIA) is a national organization that registers licensed architects. The AIA advocates for professionals in the design and construction industry. The organization has existed for 150 years and today has over 88,000 members (AIA, 2018a). The organization has various committees that address different issues. The Government Affairs Committee is primarily involved in state legislative actions. The group educates legislators about issues that are important to architects. The committee supports legislation that could potentially affect the design and construction professions. In addition, the AIA’s Denver Housing
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Committee provides a forum where residential architects follow codes, government regulations, and technologies that influence the housing trends. Nationally, AIA hosts an online platform to discuss advocacy for architectural issues that are important to designers (AIA, 2018b). This platform is a means to educate people on current topics such as buildings codes and could eventually be a cyberspace to discuss the visitability and universal design issues that affect the aging population.
Action by Professional Builders
Builders have also responded to the cause. The National Association of Home Builders (NAHB) collaborated with AARP and the Home Innovation Research Labs to develop the Certified Aging-in-Place Specialist (CAPS) programs. CAPS are trained professionals who identify home modifications that support independent living by helping people to be safe in their homes. CAPS evolved in response to the growing demand for residential home modifications and assistance in creating public awareness about preparedness. By searching the NAHB website, the public can find out that currently there are 15 CAPS registered in Colorado, and 13 are in the Denver Metropolitan Area. The public lacks information about this resource option; there is a need to clarify the aging issues perceived by the government, professionals, and the public.
Action by State and Local Government Officials
National legal action. U.S. Representative Jan Schakowsky from the state of Illinois authored the first national attempt to bridge single-family homes and accessibility, the Eleanor Smith Inclusive Home Design Act. The federal bill (HR3260, 114th Congress, 2015-2016), introduced in the House of Representatives in July 28, 2015 assists in building a supply of
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accessible housing in today’s housing market. H.R. 3260 bill would require “all newly constructed, federally assisted, single-family houses and townhouses to meet minimum standards of visitability for persons with disabilities” (Congress.gov).
• Include at least one accessible (“zero-step”) entrance into the home.
• Ensure all doorways on the main floor have a minimum of 32 inches of clear passage space.
• Build at least one wheelchair-accessible bathroom on the main floor.
• Place electrical and climate controls (such as light switches and thermostats) at heights reachable from a wheelchair (Congress.gov).
The bill was referred to the House Committee on Financial Services. The bill reflects the current issue that is facing the design and construction industry, which could potentially have a great effect on the national housing market. The bill is undergoing the legislative process. The bill needs to pass the House, Senate, and President in order for it to become a national law.
Until the Inclusive Home Design Act passes at a national level, change must continue to occur at the state and municipal levels. In Colorado, local governments have begun to discuss incentives to promote universal design in single-family homes to understand how best to move forward. Society needs more research on community and professional perceptions of visitability and universal design to support aging in place.
State of Colorado legal action. The first Colorado state attempt to bridge the gap was in 2005, House Bill 05-1241, which was vetoed by Colorado Governor Owens. The division of housing created a pilot program that would require newly constructed housing units to have minimum visitability standards for persons with disability. On May 31, 2005, Governor Owens’
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Veto Letter Regarding HB 05-1241 justified his decision (Owen, 2005). He argued there was no market demand for this housing type. Owens also argued the bill “seems to micromanage the affordable housing market.” Owens did note that the Colorado Division of Housing might benefit from “voluntary criteria for visitability depending on the demonstration of an identified need through market analysis” (Owen, 2005). However, ten years later, the current literature and housing market data seems to support a need for visitability in single-family homes for older adults.
In response to the aging demographic, Governor Hickenlooper passed and signed Colorado House Bill HB15-1033 Strategic Planning Action Group on Aging (SPAGA). The group, appointed by the governor, studies a comprehensive range of issues that affect Colorado residents aged 50+ years to identify solutions. The SPAGA group address the major issues that affect Colorado’s current aging population. One subcommittee, the Physical Built Environment Community, aims to create awareness of all things related to housing and mobility. In response to the aging population, the subcommittee, focused on housing issues, described three primary outcomes of change in Colorado, two that directly relate to this research.
The first outcome concerns how building codes should evolve to meet the needs of an aging population. The objectives of the outcomes are to (a) promote universal design codes and (b) make universal design marketable and create incentives for developers and contractors to use universal design standards. To track the objective, performance measures for (a) would be to have 2% of new homes certified (UDC). The committee suggests tracking the objective (b) the performance measure should be to dedicate 5% of new housing construction to be universal design. Strategic strategies to obtain these measures for (a) are to create a Universal Design Certification (UDC). A strategic initiative for (b) is to create incentives for affordable housing to
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use universal design standards. Identifying and encouraging champions such as KB Homes, Richmond Homes, Housing Authorities, and architects, etc. to incorporate universal design in the homes could lead the housing changes. The second outcome the built environment committee addresses relates to the supply of accessible, affordable housing meeting the current and future needs of an aging population. Objective 4 of the group is to encourage a variety of innovative housing opportunities such as Accessory Dwelling Units (ADUs). The performance measure for this objective, determined by the committee, are to reduce barriers; increase awareness/understanding at municipal planning and community levels; ensure some new ADUs are accessible; and provide incentives for entrepreneurs to develop more of these options. The strategic initiative would be to encourage local zoning codes that allow for more housing arrangements.
The SAPGA physical built environment committee is at the forefront of finding solutions to support aging in place at a state level. Municipalities can follow in the steps and explore the integrating visitability, universal design and ADUs as a means to increase independent living longer. At a local level, progressive advancements are already documented through organizations such as the National Institute on Aging (NIA) and the Administration on Aging (AoA) whom have initiated grants to foster gerontology research on aging in local communities.
Unfortunately, at both Colorado State and the national level the gap still exists today. There are no visitability and/or universal design ordinances for new single-family home construction. The last section of the literature review will consider steps moving forward to creating ordinance awareness for citizens, private sector, and government officials.
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Action by Non-government Officials
A growing number of organizations are conducting research to integrate aging in place with housing standards. The Colorado Health Foundation (CHF) seeks to collaborate with individuals and organizations to improve the health of Coloradans by encouraging healthy lifestyle choices. Their vision is to become the healthiest state in the nation. To achieve this goal, they focus on three areas: healthy living, health coverage, and health care. The Health Coverage Agenda focuses on ensuring that Colorado health coverage is stable, affordable, and adequate. The measurable goal is that “by 2023, 95 percent of Coloradans will have health coverage, and the percentage of Coloradans who are underinsured is reduced to four percent.” To achieve this goal, The Colorado Health Foundation is seeking various avenues. They recognize the importance of aging in place and creating housing options, such as co-housing, Accessory Dwellings Units, Natural Occurring Retirement Communities (NOCRs), and enhanced supportive services. On 12 April 2016, the Colorado Health Foundation awarded Denver’s Office on Aging $60,000 in support of their efforts. The grant will assist the work of the Age Matters Needs Assessment to understand aging through the lens of the City and County of Denver. The larger vision includes best practices and recommendations in the rural areas of Colorado. The assessment of needs emphasizes the importance of aging in place and recognizes the demand for research to understand further aging in place in our community.
Conclusion
The 2016 Census Bureau’s Population Estimates Program Annual Estimates of Housing Units for the United States documented out of American’s 134 million total housing units, 60% are single-family detached structures (Census, 2016). The literature review revealed that baby boomers would rather age in place and prolong moving to a nursing home, but there are very few
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accessible homes in the market. The United States anticipates that as baby boomers age they do not want to move from their homes. It is clear that there is a shortage of accessible single-family homes prepared for their residents to age in place. Therefore, there is a dire need for accessible homes that incorporate visitability and universal design features. As the literature shows, it is more expensive to retrofit an existing home than to design and build a new home that includes these features. Developers, builders, contractors, and designers in the construction and design industry need to create designs that make these functions a part of the mainstream housing market. Previous studies in the literature indicate that groups respond when policies are in place. Therefore, to create this shift, state and local governments should consider implementing ordinances to elicit an immediate response from the single-family home design and construction industry. The review has shown that there is a critical need to create an avenue for educating the population about preparedness for aging. Various means can be used to raise consumers’ awareness of how to prepare for aging in place. The literature review revealed that a gap exists in research that compares the perspectives of government, residents, and professionals (design and construction) regarding universal design and visitability. The literature review also showed an opportunity to study the integration of visitability and universal design in accessory dwelling units. As the large population in Denver continues to age, more visitability and universal design research from diverse perspectives will help to inform the city, people, and professionals on how to best meet existing demands and prepare for future demands of aging in place through design and construction regulation implementation.
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CHAPTER III
METHODOLOGY
The purpose of this study was to research how prepared the residents and professionals of Denver are prepared to support residents’ aging in place. No previous studies have compared and contrasted the perspectives of the consumer and the professional regarding aging in place in Denver.
The researcher designed the study to investigate residential aging in place by older adults. A main goal steering the study was to uncover perspectives regarding future housing policies that would address aging in place. The research employs a mixed-methods approach. Two independent surveys gathered qualitative and quantitative information from the Denver,
Colorado older adult resident population and the professional design and construction population to gather qualitative and quantitative information. The researcher will discuss her participatory observation at the beginning of the dissertation that led to the forming of the project. The chapter will also describe the distribution and collection of the survey, the survey instruments, and the response rates and analysis of the survey. At the end of the chapter, the researcher will describe details on the qualitative data survey questions, and the coding associated with the questions.
Participatory Observation
Participatory observation was a part of the data collection. The researcher began with an internship at the Office on Aging in the City and County of Denver. The internship research connected her with the Office on Aging in Larimer County and the SAPGA. The researcher
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participated in observation at both of those aging committee meetings. First, in northern Colorado, the researcher attended the Larimer County Office on Aging Housing Priority Group meetings. These meetings facilitated discussions on means to support the large aging population in northern Colorado. The Office on Aging established the first Universal Design Charrette organized by Colorado State Universities Institute for the Built Environment. A total of $3,000 was fundraised to host the day’s event. A list of local professionals were invited to the Charrette: homebuilders, remodelers, residential developers, housing specialists, City and County code officials, architects, planners, landscape architects, realtors, and more. Second, the researcher attended the SAPGA committees in Denver. The committees have seating for the public. At each SAPGA meeting a different aging specialist was brought in to create a holist approach. In addition to presenting experts in the field, each monthly meeting would also recap the progress the subcommittees were accomplishing between the larger monthly meetings. The SAPGA was the first meeting where the researcher observed the state’s quest to explore universal design and visitability invitations.
Survey
Survey Distribution and Collection
Postcard design. The researcher used postcards as a means to invite both the residents and professionals to participate in the survey. In Adobe Illustrator, the researcher created the postcard design for both the residents and professionals. The two postcard designs parallel the University marketing material. The University of Colorado Denver communications department officially approved both the postcard design for the residents and the professionals (Figure 3.1).
Online resident and professional survey links. The postcards were a means to distribute the resident anonymous Qualtrics online survey link and the professional anonymous Qualtrics
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online survey link. Activating the anonymous link setting in the Qualtrics software disables respondents’ IP addresses. When Qualtrics originally generated the anonymous survey link for the online survey, the address was excessively long, so to increase site access a website called Bitly was used to shorten the URL address that was printed on the postcards. The resident postcards invited older adults interested in participating to visit the webpage: http://bitly/cudenver-age. The professional postcards invited older adults interested in participating to visit the webpage: http://bitly/CUDenverAge. Shortening the browser links unequivocally optimizes accuracy when participants enter the website address. The postcards also stated the iPad incentive. An internal University of Colorado Denver Grant, “One-time Opportunity Grant,” funded the printing and mailing of the postcards as well as the iPad gift. Respondents for the professionals needed to be 18+ in age and for residents 45+ in age.
AGING IN PLACE
Enter to win free IPAD prize!
AGING IN PLACE SURVEY"
Enter to win free IPAD prize!
Figure 3.1 Design of Resident and Professional Postcards Produced by Researcher.
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Mailing list. The researcher purchased a mailing list for both residents and professionals from the website Leadsplease.com to address the postcards for both the resident and professional. For the residents, specifications for the mailing list included adults living within the confines of Denver who were 45+ years of age. For the professionals, the list included design and construction professionals working in Denver. The original list purchased had 1401 resident addresses and 1401 professional addresses. Using the computer program Excel, the researcher generated a random list of 1,000 addresses for both sets (residents and professionals). With the =RAND() function, each individual address was given a random decimal number between 0 and 1. The researcher then sorted the newly randomized cell values from smallest to largest independently for both the resident and professional datasets.
Mailing. The researcher securely electronically transferred the 1000 resident and 1000 professional final mailing list and both the University approved postcard designs to the university printing services. The printing department printed, addressed, and mailed the Denver 1000 postcards for residents and 1000 for professionals. The printing department mailed and distributed the postcards on predetermined dates over a month-long period. A group of 1000 residents in Denver received mailing postcards directly to their home address and a group of 1000 professionals in Denver received mailing postcards directly to their employer address.
Once the postcard arrived to either the resident or professional, respondents could respond because each postcard had an anonymous online link printed on a postcard mailed from the printing services to either a residents’ home or professionals’ office.
Direct email invitation from Qualtrics. In addition to the anonymous link printed on a postcard, part of the survey methodology was to use the Qualtrics interface to email professional organization contacts directly. The researcher obtained the Registered Neighborhood
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Organization contacts from the City and County of Denver website. Successful emails were sent to Denver neighborhood representatives inviting locals to participate in the survey to expand survey participation. Additionally, the email distribution list included the 19 current members of the governor-formed Strategic Action Planning Group on Aging Built Environment Committee. Lastly, a contact at the Commission on Aging, Office on Aging, A Little Help, Denver City Council and Denver Regional Council of Governments (DRCOG), AIA Find and Architect (Residential Denver Architects), and Denver Certified Aging in Place Specialist all received invitations via email. Direct email invitations had eliminated a postcard step (Figure 3.2). Professionals and residents could directly click on the link after receiving the invitation in their mailbox.
Figure 3.2. Process to Initiate Survey by Postcard (left) Versus Email Invitation (right).
Email timeline. The timeline for both the public and professional surveys was a period of one month. The researcher distributed emails prior to the postcards for both the residents and professional surveys. Distribution of emails occurred over a period of four weeks. The first week’s email was an invitation to participate in the survey. The second week’s email was a reminder about participating. No emails were sent the third week. In the fourth week, the researcher sent a “last chance” email. Following the email invitations there was a three-week break. During this time, the researcher addressed technical issues that arose from the postcard
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method (Table 3.1). First, a preliminary postcard notified the prospective resident and professional participants of the survey. One week following the first mailed postcard, a second mailed postcard reminded households and professionals to complete the survey. The third week, residents and professionals did not receive postcards. The fourth week a final “last-ditch” postcard encouraged participants to complete the survey before the deadline. The email invitations followed the same process. Due to a technical glitch, the professional email invitations went out two days later than the public email invitations.
Response rates. To increase response rates, the Dillman Total Design Survey Method was adapted for the online and postcard survey (Hoddinott, S. N., & Bass, M. J., 1986). The sampled households and professional firms received three mailings (Table 3.1).
Table 3.1
Survey Timeline
Week Public Professional
Email Postcard Email Postcard
First 29-Mar-17 17-May-17 31-Mar-17 17-May-17
Second 5-Apr- 17 24-May-17 7-Apr- 17 24-May-17
Third None None None None
Fourth 21-Apr-17 7-Jul-17 21-Apr-17 7-Jul-17
Note: Professional emails in the first and second week sent two days after the public emails.
Qualtrics has the capability to track if respondents received the survey via the anonymous link printed on the postcards or the direct email invitation link via the Qualtrics interface (Table 3.2). Each individual respondent self-administered his or her survey.
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There were 177 resident responses received from email and postcard invitations. Out of the 177 survey responses recorded on Qualtrics, 138 resident respondents came from the anonymous links printed on postcards. There were 1000 residential postcards mailed out; therefore, resident response rates via postcards were 14%. The remaining 39 resident surveys (out of 177) were the Denver public that received an invitation via a direct Qualtrics email list. There were 217 emails sent via Qualtrics; therefore, public response rates via emails were 18%. For the design and construction professional, there were 71 total surveys completed via postcards and Qualtrics email invitations. Thirty-two professional surveys came from the anonymous link, so because there were 1000 professional postcards mailed out, the professional response rates via postcards were 3%. The remaining 39 professional surveys (out of 71) were the professionals that received an invitation via a direct Qualtrics email list (AIA residential list or the Certified Aging in Place list). There were 210 emails sent via Qualtrics; therefore, professional response rates via postcards were 19%.
Table 3.2
Survey Response Rates Comparison: Emails Versus Postcards
Residents Professionals
Emails 18% (39/217) 19% (39/210)
Postcards 14% (138/1000) 3% (32/1000)
Combined total 15% (177/1,217) 6% (71/1,210)
Note: Percentages rounded to closest whole number.
Incentives for response rates. Out of the 177 resident survey respondents, 148 (83%) entered the reward for the iPad gift. Out of the 71 professional survey respondents, 62 (87%) entered for the iPad gift. In order to enter for the iPad gift, a participant needed to complete the
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entire survey. The iPad gift was an incentive for participants. In addition to the iPad reward, another element that may have influenced higher email response rates may relate to the survey instrument process (Figure 3.2). The email process participants could directly click on the email and open the survey so it was a two-step process. The postcard was longer - it was a three-step process. Participants needed to find access computer or smartphone and then manually enter the postcard address into their web browser.
Survey Instruments
The questionnaires target older Denver residents and professionals working in the residential design and construction industry in Denver. A review of the literature, participant observation, professional experience, and past surveys conducted in the Denver area informed the survey questions. The researcher-generated instruments asked questions related to awareness and perceptions of accessible housing. The surveys were online and residents and professionals received invitations to participate via a postcard to their home (residents) or via a postcard to their office (professionals). Description of the sampling strategy, recruitment method, and other details are below.
Resident surveys. The resident survey has 43 questions. The researcher divided the survey instrument into three sections. The first addressed universal design (14 questions), the second focused on accessory dwelling units (5 questions), and the third section was the About Me section (24 questions).
Universal design survey questions. The first and second resident survey questions asked the residents how familiar they were with aging in place and how important it was for them to age in place. Questions 3 through 7 investigated resident knowledge of universal design principles. Specifically, residents identified which features they thought were important, what
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features were currently in their home, and explain why they did or did not incorporate the features in their homes. The questionnaire included the 25 features identified by Nunn as being those that “best embodied” the seven Principles for Universal Design set by the Center for Universal Design (Nunn, 2003, p. 48). The researcher notes, some furniture, fixtures, and equipment will have a performance specification by the architect; however, usually specific products will be submitted to the architect by the contractor for approval, e.g., handheld showerhead. Questions eight through ten asked residents about their cost awareness of universal design in retrofit versus new construction. Questions 10 through 15 investigated city policy regarding universal design. Specifically, the survey questions asked residents if City incentives would encourage them to add more universal design features and if so, what type of incentives would be most inviting. At the end of the survey, a final question asked whether residents were interested in learning more about universal design.
The next resident survey section contains ADU questions. The first two questions invited residents to respond if they had ever considered incorporating an ADU in their home currently or in the future. If a respondent stated they were interested in constructing an ADU at any moment in time, the survey directed the respondent to answer questions regarding the ADU purpose, rent cost, and integration of universal design features in the ADUs.
The About Me section of the resident survey examined respondents’ personal features as well as the contextual features of their home and neighborhood. The first two questions asked what city they lived in and length of residency. Questions three through six focused on the neighborhood scale asking respondents about their length of residency, satisfaction with the neighborhood, and their neighborhood’s name and zip code. Questions seven through 12 sought to understand characteristics about the respondent’s homes: length of residency, building
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structure type, ownership/rent status, square footage size, age of home, and the respondent’s satisfaction with livability in their home as they age. The last 11 questions of the resident survey addressed personal characteristics of the respondents including gender, age, household situation, marital status, education level, current employment, and income.
The professionals’ survey had 39 questions. The researcher divided the professional survey into the same three sections: universal design, accessory dwelling units, and an About Me section. The universal design section included 18 questions, the ADU section included five, and the About Me section included 13.
The first question asked the professionals which industry they were associated with: design or construction. There are intentional similarities between the public and professional survey questions. Questions 2 and 3 asked in the professional survey seek to understand how familiar professional respondents are with aging in place. Questions 4 through 7 ask professionals to identify what universal design features they feel a senior should have to age in place and whether they use certain they features in their designs. Specifically, the professional survey asked the respondents to select from among the exact 25 features displayed in the resident survey. The questions probe professionals to state why or why not they integrate the universal design features. Questions 8 through 10 are an opportunity for professionals to identify their knowledge of the financial cost of universal design features financial cost. The last four questions of the universal design section address professionals’ thoughts on potential universal design-related city policies and incentives. The last set of questions explore whether professionals would be inclined to add more features if the city provided incentives and why different types of incentives would be appropriate.
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A STUDY OF INDIVIDUAL, PUBLIC, AND PRIVATE SECTOR FACTORS AFFECTING AGING IN PLACE HOUSING PREP AREDNESS FOR OLDER ADULTS by MARIA ALEJANDRA DELGADO DE LEON B.S., Colorado State University, 2006 M.Arch., University of Colorado Denver, 2013 A dissertation submitted to the Faculty of the Graduate School of the University of Colorado in partial fulfillment of the requirements for the degree of Doctor of Philosophy Design and Planning 2018

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ii © 2018 MARIA ALEJANDRA DELGADO DE LEON ALL RIGHTS RESERVED

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iii This dissertation for the Do ctor of Philosophy degree by María Alejandra Delgado de León has been approved for the Design and Planning Program by Phillip Gallegos, Advisor and Chair Caroline Clevenger Carrie Makarewicz Jennifer Steffel Johnson Date: May 12, 2018

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iv Delgado de León, María Aleja ndra (Ph.D., Design and Planning) A STUDY OF INDIVIDUAL, PUBLIC, AND PRIVATE SECTOR FACTORS AFFECTING AGING IN PLACE HOUSING PREP AREDNESS FOR OLDER ADULTS Dissertation directed by Associ ate Professor Phillip Gallegos ABSTRACT Colorado is facing demographic changes as the senior share of the population rapidly increases. Simultaneously, Denver residents are not prepared to age in place. Their homes do not include accessible features, such as those incorporated into un iversal design or visitability standards, which support an individu al’s ability to stay in the home as their capabilities decline over time. Furthermore, there are no legal require ments to provide accessi ble features in singlefamily homes to support residents aging in place. To investigate this problem, the study explored why Denver residents, along with design and cons truction professionals, are not adequately preparing homes for aging in place. The study as sessed and compared levels of aging-in-place design feature awareness, implementation, knowle dge of associated costs, and support for policies of the features in single-family homes from the perspective of the residents and professionals. The author administered two on line surveys for Denver residents and design and construction professionals. The resident samp le size was 177, a response rate of 15%. The professional sample size was 71, a response rate of 6%. The resident survey found 93% of the respondents wants to live independently, but only 33% of the residents were familiar with aging in place. The professional survey found 94% of the surveyed profe ssionals recognize the importance of living independently, but only 46 % of the professionals are extremely/very familiar with aging in place. Despite the lack of awareness, both groups expressed high levels of

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v support for universal design and visitability feat ures in new constructi on. Nearly 68% of the residents and 80% of the profe ssionals support universal design in new construction homes. A bivariate regression analysis revealed there wa s a statistically significant relationship between the number of accessible features in the resident 's home and the resident's satisfaction with his/her home as a place for older adults to live as they age. The researcher makes recommendations for the City and County of De nver in order to further integrate universal design and visitability in new c onstruction and remodeled homes. The form and content of this abstract is approved. I recommend its publication. Approved: Phillip Gallegos

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vi DEDICATION I dedicate my Ph.D. to my parents. Mom a nd Dad, I love you so much. I could not have done this without your support and I am so blessed to have you as parents. Thank you. I also dedicate my Ph.D. to the special se niors that I have had throughout my life. My grandmother, Abuela Guicha, and to my late neighbor, Mr. Eugene Dalton, who are and were champions of aging in place.

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vii ACKNOWLEDGEMENTS I want to thank the College of Architectur e and Planning led by Dean Nan Ellin and the Design and Planning Department di rected by Jody Beck at the University of Colorado Denver for funding my Ph.D. edu cation and research. I especially want to thank my Ph.D. Advisor, Phil Galle gos, for his endless support, encouragement, and direction throughout my sc holarship. Additionally, I want to thank my committee members: Carrie Makarewicz, Jenny Steffel Johnson, and Caroline Clevenger. Throughout my Ph.D. journey, they all have contributed such high quality and unique talents that have shaped the writer and researcher I am today. I would also like to thank the staff of the College of Arch itecture and Planning led by Leo Darnell who made certain I had the space and tools I needed in order to be productive and successful throughout the program. Additionally, a special thanks to Mike Harring for always making sure my computer was in the best condition. Lastly, I want to thank my Ph.D. colleag ues: Jenna McKnight, Nermeen Dalgamoni, Mohammed Bay, and Aziz Almutawa. It has been such an amazing adventure sharing an office full of genuine support, encouragement, and en dless conversation spla shed with so much laughter and positivity. Thank you all.

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viii TABLE OF CONTENTS I INTRODUCTION 1 City and State Demographics 4 Population Growth 4 State Capital – Denver population growth 6 State and local population growth im plications on economy, households, labor force 7 State Response 11 Background of the Problem 12 National Problem 12 Local Problem 14 Lack of Denver preparedness 14 Lack of systemic structure 18 Rationale and Purpose 18 Theoretical Framework 20 Research Problem 25 Hypothesis framework 25 Barriers related to residents’ support of aging in place 26 Barriers related to professionals’ support of aging in place 26

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ix Research Questions and Hypotheses 27 Survey 28 Framing the Research 28 Significance of the Study 28 Assumptions, Limitations, a nd Delimitations 29 Assumptions 29 Limitations 29 Delimitations 30 Organization of the Study 30 II LITERATURE REVIEW 32 Environmental Gerontology 32 Aging Attitudes 33 Learning Theory Model 33 Man-Environment Theories 35 Adaption Theory 35 Environment Congruence Model 35 Stress Theory 36 Residential Normalcy Theory 36 Accessibility Evolution 39 Accessibility Rights 39

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x Visitability 44 Visitability cost and location 44 Visitability public laws 44 Universal Design 46 Universal design public and private laws 48 Opposition to Visitable and Universal Design Policy and Incentives 49 Opposition Concerns 49 Excessive government control 49 Cost concerns 50 Societal Costs of Not Integrating Features 51 Past Policy Tactics 52 Policy Promotion 52 Government policies to alleviate cost 52 States and municipalities promoting incentives 53 Mandatory Versus Voluntary Incentives 54 Accessory Dwelling Units as a Tool for Aging in Place 55 Accessory Dwelling Units 55 ADU History 55 ADUs and Older Adults 57 Benefits of ADUs for Seniors 58

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xi Denver ADUs 59 Universal design, visitability and ADUs 61 Lack of Accessible Homes in Existing Housing Market 61 Action by Stakeholders To Create Potential Policy 63 Action by Professional Architects 63 Action by Professional Builders 64 Action by State and Local Government Officials 64 National legal action 64 State of Colorado legal action 65 Action by Non-government Officials 68 Conclusion 68 III METHODOLOGY 70 Participatory Observation 70 Survey 71 Survey Distribution and Collection 71 Postcard design 71 Online resident and professional survey links 71 Mailing list 73 Mailing 73 Direct email invitation from Qualtrics 73

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xii Email timeline 74 Response rates 75 Incentives for response rates 76 Survey Instruments 77 Resident surveys 77 Universal design survey questions 77 Statistical Analysis 81 Dependent Variables 81 Independent Variables 82 Quantitative Inferential Statistics 85 Qualitative Analysis 86 Qualitative resident survey question and codes 86 Qualitative professional survey question and codes 86 Conclusion 87 IV RESULTS 88 Descriptive Statistics 88 Public survey respondents 88 Professional survey respondents 89 House, Household, and Neighborhood Characteristics 91 Quantitative Residents and Professional Resu lts Organized by Survey Questions 94

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xiii Awareness 94 Awareness independent sample t-test 95 Awareness multiple regression resident findings 96 Awareness multiple regression professional findings 96 Awareness cross tabulation comparison 97 Neighborhood awareness 98 Action 101 Action independent sample t-test 106 Action linear regression 107 Action multiple regression resident findings 108 Action cross tabulation comparison 110 Why residents integrate 111 Why professionals integrate 112 Why not integrate 113 Cost 116 Support 119 Policy 1 119 Policy 1 independent sample t-test 119 Multiple regression resident findings 120 Multiple regression professional findings 120

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xiv Awareness cross tabulation comparison 121 Policy 2 123 Policy 2 independent sample t-test 124 Multiple regression professional findings 125 Resident preferences for incentive types 126 Professional preferences for incentive types 126 Policy 3 127 Policy 3 independent sample t-test 128 Multiple regression resident findings 129 Support (qualitative) 130 Awareness 130 ResidentsÂ’ responses about awareness 130 ProfessionalsÂ’ responses about awareness 132 Action 133 Action from residents 133 Action from professionals 134 Cost 140 Cost information from residents 140 Cost information from professionals 143 Policy 143

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xv Policy for residents 143 Policy for professionals 144 Hypothesis Testing Between the Groups (Residents and Professionals) 144 Results Overall 144 V CONCLUSION 146 Findings Overview 146 Findings Recommendations 150 Renovation – (past) 150 New Construction – (future: building codes) 152 Future Studies 155 Conclusion 156 REFERENCES 158

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xvi LIST OF TABLES Table 3.1 – Survey Timeline 75 Table 3.2 – Survey Response Rates Comp arison: Emails Versus Postcards 76 Table 3.3 – Codes for Survey Qu estion Dependent Variables 82 Table 3.4 – Codes for Survey Question Independent Variables 83 Table 4.1 – Demographics Characterist ics of Residents/Professionals 90 Table 4.2 – Length of Occupancy Comparison 92 Table 4.3 – Level of Satisfaction with Home and Neighborhood as a Place to Age in Place 93 Table 4.4 – Comparison of Level of Familiar ity with Aging in Place by Residents and Professionals 95 Table 4.5 – Results of Independent Sample ttests by Residents and Professionals: How Familiar Are You with Aging in Place? 96 Table 4.6 – Multiple Regression of Joint Predicto rs (Age, Gender, Education, Employment, and Disability) on Familiarity with Aging in Place for Two Groups: Residents and Professionals 97 Table 4.7 – Level of Importance with Re maining in Your Neighborhood and Living Independently for Residents 99 Table 4.8 – Universal Design Features “Must Ha ves” Residents Versus Professionals 102

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xvii Table 4.9 – Universal Design Features Re sident “Have” Versus “Must Have” 103 Table 4.10 – Comparison of Top Five Resi dent “Must Have” Universal Design Features Versus “Have” Features 106 Table 4.11 – Results of Independent Sample ttests by Residents and Professionals: Which of These Features Do You Feel a House Must Have in Order for a Senior to Age in Place in Their Home? 107 Table 4.12 – Regression for Level of Satis faction and Number of Features 108 Table 4.13 – Multiple Regression of Joint Predic tor (Age, Gender, Education, Employment, and Disability) on Number of Featur es a House “Must Have” in Order for Seniors to Age in Place for Two Groups: Residents and Professionals 109 Table 4.14 – Reasons for Residents Not Integrating Features into Home 114 Table 4.15 – Resident and Professional Cost Awareness of Universal Design Features Home Retrofit Cost Versus New Construction Cost 118 Table 4.16 – Level of Support that Denver Reside nts and Professionals Have for Universal Design in New Construction Single-Family Ho mes: Would You Like to See More New Construction Homes in Denver that In clude Universal Design Features? 119 Table 4.17 – Results of Independent Sample ttests by Residents and Professionals: Would You Like To See More New Construction Homes in Denver that Include Universal Design Features? 120

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xviii Table 4.18 – Multiple Regression of Joint Predicto rs (Age, Gender, Education, Employment, and Disability) on More New Construction Homes in Denver that Include Universal Design Features. 121 Table 4.19 – Level of Interest that Denver Resi dents and Professionals Have for Integrating Universal Design in Single-Family Homes if th e City Provides Incentives: If the City/State Provided Incentives, Would You Be Interested in Adding Any Universal Design Features to: (Residents) Your Current Home in the Future? (Professionals) Your Client’s New or Remodeled Home in the Future? 123 Table 4.20 – Results of Independent Sample ttests by Residents and Professionals: If the City/State Provided Incentives, Would You Be Interested in Adding Any Universal Design Features to: (Residents) Your Current Home in the Future? (Professionals) Your Client’s New or Remodeled Home in the Future? 125 Table 4.21 – Multiple Regression of Joint Predicto rs (Age, Gender, Education, Employment, and Disability) on If the City/State Provided Incen tives, Would You Be Interested in Adding Any Universal Design Features to: (Residents) Your Current Home in the Future? (Professionals) Your Client’s New or Remodeled Home in the Future? 125 Table 4.22 – Level of Interest th at Denver Residents and Professi onals Have for Learning More About Universal Design in Single-Family Ho mes: Do You Want To Learn More About Universal Design Features? 128 Table 4.23 – Results of Independent Sample ttests by Residents and Professionals: Do You Want To Learn More About Universal Design Features? 129

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xix Table 4.24 – Multiple Regression of Joint Predicto rs (Age, Gender, Education, Employment, and Disability) on Residents and Professionals Wanting To Lear n More About Universal Design Features 129 Table 4.25 – Tax Rebates Available for Seni ors in the City an d County of Denver 141

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xx LIST OF FIGURES Figure 1.1a – Share of Colorado Population by Age Group 5 Figure 1.1b – Colorado Residents Age 65+ 2000-2030 6 Figure 1.2 – Denver Demographics, 2010-2015 7 Figure 1.3 – Colorado Persons 65+ Be low Official Poverty Level 9 Figure 1.4 – The Elder Economic Security St andard Index for Denver County, CO 2015 10 Figure 1.5 – Housing Features of Importance to AARP Members in Denver 17 Figure 1.6a – Environmental Press Competence Model 22 Figure 1.6b – Reinterpretation of the E nvironmental Press Competence Model 23 Figure 2.1 – Residential Normalcy Theory Constructs 37 Figure 2.2 – Accessibility Policy Timeline 40 Figure 2.3 – Internationa l Code Council 42 Figure 2.4 – ADUs in Denver 60 Figure 3.1 – Design of Resident and Professional Postcards Produced by Researcher 72 Figure 3.2 – Process to Initiate Survey by Postcar d (left) Versus Ema il Invitation (right) 74 Figure 4.1 – Positive Directional Correla tion of Jon Lang’s Lawton and Nahemow’s Environmental Press Competence Model and the Res earcher’s Graph of Numb er of Features and Home Satisfaction 108

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xxi Figure 4.2 – American Community Survey 20112015. Denver Age 65+ Dist ribution. Number of features by Neighborhood 112

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1 CHAPTER I INTRODUCTION The World Health Organization (WHO) has de fined eight domains that influence the health of older adults. These include outdoor sp aces and buildings, tran sportation, housing, social participation, respect and social inclusion, ci vic participation and em ployment, communication and information, and community and health se rvices. Housing is included as a domain to emphasize the vital role that living accommodations play in the life of an older adult. WHO states, “housing and the built environment has a profound impact on human health” and recognizes that unintentional home injustices ar e a serious public health problem (WHO, n.d.). Negative housing incidents, such as home barri er-related falls, contribute to the annual 34 million dollar medical costs of adults 65 years and older (CDC, 2013). However, homes designed to be accessible th rough the application of universal design standards and visitability principles offer opportunities to maximize the safety of a home, thereby increasing the ability of a home’s design to suppor t an individual to aging in place. The Center for Disease Control defines aging in place as “t he ability to live in one’s own home and community safely, independently, and comfortably, re gardless of age, income, or ability level” (2009). Nearly 90% of seniors aged 65 years a nd older prefer to age in place (AARP, 2010, p. 13). Creating age-friendly environm ents is a responsibility from va rious stakeholders: residents, professionals, and governments (WHO, n.d.). Furt her encouraging the notion, in a 2014 study conducted by the American Association of Re tired Persons (AARP), “What is Livable? Community Preferences of Older Adults,” key findings emphasize 87 % of United States adults 65+ want to stay in their home and community as they age (Harre ll et al., 2014). However, living

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2 autonomously in a non-accessible environment (both home and surrounding community) can become increasingly difficult for people with disa bilities. Loss of physical function occurs with age (Manini, 2011). A study conducted by Staudinge r, Smith, and Baltes, (1992) exploring age differences, found as early as 45 years, increa sed rates of the populati on begin to encounter physical limitation on daily activit ies. Staudinger et al. (1992) found at 65 years, 26.9% of the population note physical limitations and then at 75 years almost 45.3% of the population experience limitation in activities such as walking, lifting, writing, and more. Currently, in Colorado 34% of 65 years and older adults have a disability and the st ate projects 69% of 65 years old adults will have a di sability (permanent or temporar y) at some point (Garner, 2017, p. 33). Experts agree that society must prepare to support the aging population, especially as life expectancy continues to increase (WHO, 2011) . The National Center for Health Statistics documents report that in the United States, life ex pectancy at birth has changed from 47.3 years in 1900 to 78.8 years in 2015 (NCHS, 2016). A current gap exists in housing policy rega rding accessible private residences. There are no legal requirements to provide accessible f eatures in single-family homes or accessory dwelling units (ADUs) in many c ities across the nation. As define d by the U.S. Department of Housing and Urban Development Office of Po licy and Development Research, “Accessory dwelling units (ADUs) – also referre d to as accessory apartments, second units, or granny flats – are additional living quarters on single-family lots that are independent of the primary dwelling units. The separate living spaces are equipped with kitchen and bathroom facilitates, and can be either attached or detached from the main residence” (HUD, 2008). Although, the Americans with Disabilities Act (ADA) imposes the provis ion of accessibility in public facilities and government-owned or funded multi-family housing, the ADA does not apply to private housing.

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3 The researcher presents an extensive review of pa st policies in the literature review, but overall, some local cities have adopted ordinances and so me U.S. states have adopted requirements over the years. However, currently, there are no ex isting federal requirements for private singlefamily housing to be accessible. In the abse nce of private home acces sibility policies and regulations, professionals are de signing millions of new homes in ways that will not safely support what is a large and growing se gment of the population, the elderly. Research on existing residentia l units suggest 87% of the U. S. single-family homes need extensive or substantial home modifications and repairs to be age friendly (Johnson & Appold, 2017, p. 6). Given this number, the importance of age-supportive housing fe atures to elderly living is vital. Society needs policies that will educate, encourage, and incentivize developers, architects, and the public to equip single-family ho mes with designs that promote aging in place. One may conclude that without policies to educate, encourage, and incentivize developers, architects, and the public to equip single-fam ily home designs that promote aging in place features, implementation of homes will not occu r on a scale sufficient to support the forecasted 65+ population. The purpose of this study is to iden tify the level of aging in place awareness, application, financial knowledge and what t ypes of polices, programs, or incentives are appropriate to address the lack of accessibility in single-fam ily homes. The purpose of this dissertation is to test the level of implementati on of these features and explore whether the public and professionals would be receptive to policies or other efforts that raise awareness, encourage, and/or require the residential construction and design industry and indivi duals to incorporate universal design and visitability principles in new construction homes. Accessible housing can assist ol der adults to stay in their homes safely for as long as possible. Providing the market with homes where pe ople can age in place could offset the future

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4 burden of expensive home remodeling, expensive me dical bills or life-thre atening injuries, and reduce the need to build new specialized senior housing, while meeting the preferences of the majority of older adults who hope to age in place. On a grand scale, the changes could benefit the local economy in additi on to the individual. City and State Demographics Population Growth Currently, Colorado is experiencing a dem ographic shift as the population rapidly continues to age. According to the State De mographer’s Office, in 2016, Colorado’s population of 5.5 million is about 1.7% of the nation’ s total population of 323.1 million. The State Demographer’s office projects by year 2050 Colora do’s population could increase to 2.1% of the country’s total population, with 8.7 million Coloradoans (DeGroen, 2017b, p. 4). Of the 5.5 million Coloradoa ns today, 13.4% of the populations are seniors – an estimated 715,000 seniors. When compared to other stat es, that share is very low. In fact, it is the sixth lowest share of seniors in the United St ates (DeGroen, 2017a, p. 2) . Figure 1.1a shows data obtained from the State Demogra phers Office on the past and proj ected age distributions from 1990 to 2050 in Colorado. The graph visually iden tifies the rapid expans ion of the 65+ share group in Colorado.

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5 Figure 1.1a . Share of Colorado Population by Age Group. Source: DeGroen, Cindy (2017). Population Estimates and Forecast Overview: The Population of Colorado p. 23. Retrieved from Colorado Department of Local Affairs State Demography Office. Website: https://demography.dola.colorado.gov/demography/publications-and-presentations/#publications-andpresentations However, currently there are 1.3 million baby boomers (born between 1946 and 1964) who currently reside in Colorado (DeGroen, 2017a , p. 2). That means Colorado is rapidly aging. In fact, Colorado is the third fastest growing 65+ population in the United States (DeGroen, 2017a, p. 2). The majority of the rapid aging chan ges are occurring in this decade. According to projected growth rates, from 2010 to 2020, 155 Colo radans turn 65 daily, which will shift the median age from 36.4 in 2016 to 40.7 in 2050 (D eGroen, 2015). Figure 1.1b takes a targeted look by showing data obtained from the State Demographers Office on the past and projected

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6 age distributions from 2000 to 2030 in Colora do. The graph visually identifies the rapid expansion of the 65+ share group in Colorado. Figure 1.1b . Colorado Residents Age 65+ 2000-2030. Source: DeGroen, Cindy (2017). Population Estimates and Forecast Overview: Aging in Colorado and the Economic Impacts p. 5. Retrieved from Colorado Department of Local Affairs State Demography Office. Website: https://demography.dola.colorado.gov/demography/publications-and-presentations/#publications-andpresentations State Capital – Den ver population growth . The city and county of Denver are coterminous and serve as the capital city of Colorado. As reported by th e Department of Local Affairs (DOLA), in 2016 Denver is the largest municipa lity in Colorado with a population of 693,292 (DeGroen, 2017b, pg. 12). In the regi onal reports created by DOLA, De nver (in region 3) had a 2010 census population of 600,158 people, which in creased by 98,134 over six years (DOLA, 2017, p.1). The Denver Regional Council of Gove rnments (DRCOG) projects that Denver’s population of older adults will continue to increase over the coming decades. DRCOG

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7 specifically highlights that “In 1990, on average, 10.4 % of the [Denver] region’s population was age 60 or older. By 2014, that share increase d to 18.9 %, and by 2040 more than 24 % of the total population will be age 60 or older.” As shown in Figure 1.2, one in four Coloradoans will be 60+ by the year 2040 (DRCOG, 2018). Figure 1.2 . Denver Demographics, 2010-2015 Denver Regional Council of Governments (2018). [Graph illustration on website March 2018]. Aging Population by County. Retrieved from https://drcog.org/services-and-res ources/denver-regional-visual-resour ces/aging-population-by-county State and local population grow th implications on economy, households, labor force. Population growth has influenced Colorado’s and Denver’s constructi on industry, job market, and household income. First, the Colorado St ate Demographer’s Office reported that the construction industry was the stat e’s third-fastest growing sector at more than 8% in 2014 (Akers, 2015, p. 17). Denver’s construction indust ry has added a plethora of new apartment buildings to Denver’s skyline and neighborhoods. Second, the population growth has influenced

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8 the job market. In 2015, the housing report by the Denver Office of Economic Development showed that DenverÂ’s employment increased by 4.3% in one calendar year, adding 19,500 new jobs to the market. The construction boom has br ought more jobs to Denver and subsequently there has been an increase in the median income . Specifically, in the same report, the American Community Survey estimated that by 2014, Denve rÂ’s median income had grown by 16% from 2011-2014. This rate is faster than the 11% Colo rado median income growth and the 6% U.S. median income growth (OED, 2015, p. 6). Therefore, the rapid growth with in three years implies that migration and a strong economy has raised th e incomes of at least some of the population significantly in a short timeframe. The strong economy has also influenced household trends. In 2016, the median household income in Denver increased to $56,25 8 (from $51,800 in 2015) and the 2016 average home value increased to $292,700 (from $257,500 in 2015) (DRC OG, 2016). In 2016, there were 281,072 occupied households in Denver, and of those households, just under 50% (138,870) were owner-occupied housing (DRCOG, 2016). Colorado State Demography Office reports 38% of Colorado households over 65+ are comprised of indi viduals living alone, and of these households, single older women are at the greatest risk of living alone (Garner, 2017, p.36). Denver is comprised of an estimated 41,179 fe males and 30,871 males in the 65+ population (DRCOG, 2016). Figure 1.3 shows that over 50,000 65+ Coloradoans are living below the official poverty level (Garner, 2017, pg. 39). In fact, th e 2010-2014 American Community Survey 5-Year Estimates reveal that of the estimated 65+ senior s living in Denver, 11.8% are living below the poverty level. As seniors retire, they tend to live on a fixed income; therefore, understanding the cost of living of olde r adults is relevant to understandi ng the basic framework of the housing

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9 market. As home values and incomes of the wo rking-age population have accelerated at a rapid pace, rental prices have risen more quickly. Figure 1.3 . Colorado Persons 65+ Below Official Poverty Level (Garner, 2017, ). Aging in Colorado [PDF document]. Retrieved from Colorado Department of Local Affairs State Demography Office Website: https://drive.google.com/file/d/0 Bvz6H4k4SESZGNXOG5Yc0tOX2s/view To understand better the cost of living for older adults, th e Colorado Center on Law and Policy (CCLP) recently commissioned the creatio n of an Elder Economic Security Standard Index. Figure 1.4 provides the average cost of li ving for people 65 years and older in Colorado. The report on Denver City and Count y identifies the average cost of living for senior couples and individuals with or w ithout mortgages. Figure 1.4 shows, in 2015, an individual senior house

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10 mortgage payment can average $1,395 while an i ndividual senior rent payment averages $803. To contextualize, in Denver, in 2016, median monthly owner costs were $1,324 and median monthly rent costs were $1,035 (DRCOG, 2016). Th e Elder Economic Security Standard Index suggests seniors are paying average for mortgage installments and below average for rent. These measures are imperative because they help estimat e the amount of income that retired persons must have to meet their basic needs in Denver. As rent prices have increased with ColoradoÂ’s population growth, renters and homeowners with lo wer social economic status may not have the financial means to maintain their home and ability to age in place. Figure 1.4 . The Elder Economic Security Standard Index for Denver County, CO 2015 Website: http://cclponline.org/wp-content/uploads/2016/06/Denver.pdf ColoradoÂ’s changing labor force will look quite different in the upcoming decades, which in turn will influence the economy. In 2010, baby boomers (persons born after World War II, 1946 to 1964) were 37% of the labor force. However, the State DemographerÂ’s Office approximates that over the next 20 years, 1,000,000 workers will age out of the labor force (Garner, 2017, p. 31). As people retire, two main financial shifts occur in both revenue and

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11 expenditure habits. First, older adults experience occupationa l adjustments, which subjects their household income to downward pressure. In add ition to generating less income, older adults’ purchasing needs change. Older adults tend to purchase more services when compared to younger families who tend to buy more goods. Therefore, seniors have reduced income tax and sales tax, as well as opportunitie s for property tax relief, while also placing increasing demand on healthcare services and Medica id (Garner, 2017, pg. 40). Colorado’s society needs to prepare to balance these two identified aging concerns with the changing labor force because aging out of the labor force in combination with the av erage cost of living fo r seniors can determine whether older adults can conti nue to live autonomous ly. If they cannot, they will depend on family or the state to meet their housing needs. State Response As a response, city officials across Colorado have begun to explore solutions to address today’s housing problems of cost, unit shortage s, and housing design. In 2015, Governor John Hickenlooper appointed 23 members to the Stra tegic Action Planning Group on Aging (SAPGA) to respond to the fast growth Colorado is expe riencing. The goal of SAPGA is to confront challenges Colorado is facing and envision so lutions by developing a “2030 and beyond” plan for the state (SAPGA, 2016, p.12). The group has seven committees organized by issue: built environment, workforce development, health and wellness, supportive community, family economic security, outreach and community, public finance. The built environment committee explored a universal design ordinance. In N ovember 2016, SAPGA released eight major goals for the state to facilitate age-friendly communities. Goal 1: Colorado seniors will be able to live and fully participate in th eir communities of choice for as long as possible . Outcome and strategies for consideration included:

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12 Building codes will meet the needs of an aging population, with universal design as the standard to (1) promote universal design standards and include them in local building codes; (2) educate the public on the bene fits of universal design; (3) create incentives for developers and c ontractors to use universal design. (SAPGA, 2016, p.14) The group also gave nine recommendations to the governor and state legislature. Recommendation 4 included suppor ting “efforts to create a Un iversal Design Certification program to encourage the inclusion of universal design elements in new and remodeled housing for seniors” (SAPGA, 2016, p.23) . The next section elaborates on the ordinance notion by introducing the gap in the litera ture on accessible housing stock. Background of the Problem National Problem The AARP Public Policy Institute in conjuncti on with the National Conference of State Legislatures published a research report entitled, “Aging in Place: A State Survey of Livability Policies and Practices,” which asse sses policies and practices at th e state level regarding aging in place (Farber, N., Shinkle, D., Lynott, J., Fox-Gr age, W., & Harrell, R.). The report, issued in 2011, discusses building standards as a means to support aging in pl ace. The report highlights the significant need to support si ngle-family home occupants by implementing local and state building standards that encourage accessible sing le-family homes. The authors stress important reasons for supporting accessible si ngle-family private residences. The primary reason is that most people with disabilities liv e in private housing. Therefore, the authors suggest private

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13 residential housing design should respond to the n eeds of older adults with disabilities living in their homes. Accessible design has gained currency duri ng the last 30 years. The “visitability” movement began to measure a building’s acc essibility level. Th e National Council of Independent Living defines visita bility as “single-family or owner-occupied housing designed in such a way that it can be lived in or visited by people who have trouble with steps or who use wheelchairs or walkers” (NCIL, 2018). To meet the three visitab ility requirements a house must have one zero-step entrance, doors with 32 inches of clear passage space, and one bathroom on the main floor you can get into in a wheelchair. Visitability is applicable to both public and private buildings. The objective of universal desi gn (UD) is similar. Universal design is the provision of inclusive design for peop le of all ages, regardless of whether they are able-bodied or physically challenged. Universal de sign is the concept of “designi ng for all” and extends to not only the built environment, but also product desi gn inside the house (Trachtman, L. H., Mace, R. L., Young, L. C., & Pace, R. J., 1999). The idea fo r accessible principles in housing grew from the recognition that most of the f eatures utilized by people with disa bilities were useful to others, so their inclusion in standard practice wa s justified (Mace, 1998). Universal design, like visitability, is applicable to bot h public and private buildings. The U.S. Social Security Admi nistration reported that more th an one in four of today’s 20-year-olds will become physically challenged before the age of 67 (SSA, 2015). There is a documented correlation between agi ng and disability. As people age they are more likely to become disabled (Hansler and Glas, 2011). Becau se people are naturally susceptible to physical challenges (permanently or temporarily) at some point in their lifetime, accessible home design can help counterbalance the issue. In recen t years, studies have shown an increased

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14 understanding that universal desi gn and visitability practices influence the ability of an individual to age in place. Cons equently, the author’s research investigates older adults in Denver to explore their vi ews on universal design a nd visitability in housing. Local Problem The effects of Denver’s rapidly aging populatio n has drawn the attention of researchers and policymakers to senior housing needs. Th e overarching problem is that the Denver population, as a whole, is not prepared to age in place. There are no policies, requirements, or incentives from the City to direct professionals to provide accessible design for residents in single-family homes. The next section will illustrate preliminary research in Denver that has investigated how equipped homes are to facilita te residences’ aging in place. Specifically, the section documents evidence of Denver homes lacking universal and visitability features to age in place. Lack of Denver preparedness. Several studies have examined the views of older adults on universal design and visitability in Denver. Th e AARP Division of Research contracted GfK Marketing to conduct a questionnaire survey ca lled “Home and Community Preferences of the 45+ Population. ” The objective of the questionnaire was to widen the understand ing of the issues that influence older adults in their homes a nd communities. The telephone survey was conducted in July 2010 over a period of two weeks, and responses were collected from 985 individuals who were 45 years and older. The key findings from the questionnaire revealed that almost threequarters (73%) of the respondents strongly agreed that they would like to live in their current residence as long as possible (Keenan, 2010, p. 3). Two-thirds of the respondents (64%) strongly agreed that they wanted to stay in their community. However, the telephone questionnaire revealed that fewer than 50% of the respondents had visitability and universal design elements in

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15 their homes. Specifically, the data showed the fre quencies of the following features: a zero-step entrance (36%); leve r door handles instead of knobs (34%); wide interior and exterior doorways (27%); and a half-bath on the main level (4 3%) (Keenan, 2010, p. 5). The cost section of the literature review will discuss in detail average pric ing; however, overall, research shows that it is more expensive to remodel a home to include univer sal design and visitability features than to integrate these features into new constructi on (Kochera, 2002, p. 13). However, because most older adults do not want to move to a new home and want to st ay in their home as long as possible, retrofitting their home is the only feasible means to achie ve aging in place. Keenan’s Denver study showed that low-income households are particularly likely to have a bathroom on the main floor (Keenan, 2010, p. 6). Specifical ly, respondents with an income below $50,000 were more likely to have a full bath on the main level than were respondents in a higher income bracket, which alleviates the need for one of th e most expensive universal design and visitability features. However, the respondents were more likel y to have a half bath on the main floor and lever door handles (Keenan, 2010, p. 6). Keenan’s survey found other disparities in respondents’ perspectiv es by gender and age. Gender differences revealed that women had a higher likelihood of ha ving a bathroom on the main floor, but men had a higher likelihood of having a half-bathroom on the main floor. Regarding age differences, the respondents 50 ye ars and older were more likely than the younger respondents to report that their home had a full bath on the main floor. The respondents 65 years and older had a higher likelihood of having a ze ro-step entrance and wider doorways compared to respondents from 50 to 64 years (Keenan, 2010, p. 6). The National Research Center (NRC) conduc ted another study commissioned by the Denver Regional Council of Governments (D RCOG) in 2015. The “Community Assessment

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16 Survey for Older Adults ” study was specific to Denver, Colorado (NRC, 2015). The study showed that 54% of AARP members 50 years a nd older had lived in Denver for over 20 years. Furthermore, 89% of Denverites (Denver resident s) wanted to stay in their homes throughout retirement (NRC, 2015, p. 10). Anothe r survey conducted in 2014 by AARP, “ Creating an Age Friendly City: The 2014 Neighborhood Survey of AARP Members Age 50-plus in Denver, Colorado ,” revealed similar findings. The survey found that 52% of Denver AARP members had lived in Denver for the past 35 years, and 59% of that group had lived in the same neighborhood for at least 15 years. Sixty-six percent of the su rvey participants noted they were not likely to move after retirement (Binette, 2015, p. 3). Ho wever, the study revealed that among Denver AARP members, the primary contri buting factor to relocating woul d be a home that would help them live independently as they aged (Binette, 2015, p. 5). The surv ey also identified the most important housing features for 50+AARP members in Denver. Survey participants determined that 89% of the group selected well-maintained homes as the highest pr iority (Binette, 2015, p. 7). The second priority of the population was th at homes should be e quipped with universal design features, such as no-step entrances, wide doorways, grab bars in bathrooms, and firstfloor bedrooms and bathrooms. However, Fi gure 1.5 shows only 56% of AARP members living in Denver felt the features were extremely/very important. Twenty-eight percent indicated that universal design features were somewhat important , and 13% indicated they were not very/not at all important. These statistics present an opportunity to explore the reason s why nearly half of the Denver AARP members did not consider universal design principles extremely/very important. Understanding the reas ons that people do not integrate universal design principles in their homes (i.e., lack of awareness/education, fina ncial constraints, etc.) could contribute to the research on aging in place.

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17 Figure 1.5. Housing Features of Importance to AARP Members in Denver. Binette, Joanne (2015). Creating an Age Friendly City: The 2014 Neighborhood Survey of AARP Members Age 50-plus in Denver, Colorado [PDF document]. Retrieved from America Association of Retired Persons (AARP) Website: https://www .aarp.org/research/topics/community/info2015/livable-communities-denver-c olorado-aarp-members.html No previous studies have investigated the reasons why people are not prepared to age in place. Is it a lack of awareness or another factor such as difficulty with action item implementation, misinformation of cost , or opposition to policy support ? The present study will investigate the barriers that contribute to the l ack of preparedness for aging in place. It will add research that considers both th e needs of professionals and resi dents to understand the dialogue between the groups and its contribution to DenverÂ’s lack of preparedness to age in place. For instance, residents may not understand how to retrofit their homes. Residents may also not understand the importance of modifying their homes in order to prepare to age in place. In some cases, professionals such as architects and develo pers may not have the expertise or may have a

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18 lack of interest in these design features. In other cases, professi onals may have both the interest and expertise, but perceive ther e is a lack of demand for this work. By researching the reasons why Denver individuals are not prepared to age in place with respect to single-family homes from the perspectives of residents and professi onals in the constructi on and design sector, we could better understand the interplay of the re sident-professional suppl y-demand relationship. Lack of systemic structure . The City and County of Denver adheres to the International Building Code (IBC) and references accessibility standards in the book Standard for Accessible and Usable Buildings and Facilities ICC/ANSI A117.1 created by Am erican National Standard Institute (ANSI). As noted in Title 9 Article 5 of the Colorado Statutes (COT9A5), a Type C visitable unit is referenced in ICC/ ANSI A117.1 SECTION 1105 TYPE C (VISITABLE). However, Denver does not require a Type C unit in any design scenarios. Denver, via the IBC, ANSI, and COT9A5, requires Type A and/or B un its in different designs. COT9A5 calls for visitable units in Denver, which is a Type B un it (not a Type C unit). Th e quantity of visitable units are defined in COT9A5 and reproduced in Denver Amendments Appendix R. As specified by COT9A5, residential projects are “assigned accessibility points base on the number of units contained within the project” (COT9A5, p.36). Devel opment projects in Denver with six units or less are not required to have visitability. Furt hermore, these accessibility points do not apply to single-family homes in Denver. Additionally, the city of Denver also does not enforce universal design provisions. Therefore, there is a lack of systemic accessibility structure in place for single-family homes in Denver. Rationale and Purpose The issue of preparing to ag e in place is very current in Denver’s population and the research could inform potential policymakers. The statewide Colorado Strategic Action Planning

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19 Group on Aging (SAPGA) is hoping to change th is situation. They are collaborating with community organizations and public agencies to conjure their vision for Colorado to “be a place where all aging residents can maintain a healt hy, mobile and vibrant lif e.” They are examining practical solutions at state levels (SAPGA, n.d.) . The State is discussi ng the idea of having a policy that addresses the aging uni versal/visitability built environm ent issue. This research can provide insights that policymakers may find valu able in understanding what constituents and professionals believe to be an encouraging a nd appropriate dialogue re garding the need for universal design and visitability ordinances for ag ing in place. Therefore, there are two driving reasons to conduct this research. First, the study w ill fill a significant gap in the research on the issue of accessible housing for single-family homes. Second, currently, Denver does not have any policies for universal design or visitability. The first aim of the research is to investigate the reasons why Denver is not preparing to age in place. This first aim has two objections. The first objective is to explore factors that are contributing to this lack of awarene ss, action, and cost misinformation among residents . The second objective is to explore fact ors that are contributing to this lack of awareness, action, and cost misinformation among professionals including contractors, archit ects, and aging specialists. The second aim is to investigate Denver re sidents’ political pe rspective on potential ordinances and incentives regardi ng aging in place. This second aim has two objectives. The first objective is to explore the residents’ e.g., voters or constituents’ perspectives on and support for potential policies regarding universal design, visitability, and accesso ry dwelling unit (ADU) ordinances in single-family homes. The second objective is to explore professionals ’ perspectives and policy support regarding potenti al universal design, visi tability, and accessory dwelling units (ADU) ordinances in single-family homes.

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20 Theoretical Framework The social psychologist Kurt Le win studied the behavioral in teraction of an individual and the environment known as the ecological mo del. The ecological model equation expresses behavior is the function of the pe rson-environment relationship: B = f (P, E). Lewin published the equation in his book, Principles of Topological Psychologyin 1936. Lewin stated the twofold relationship demonstrated that “every physiolo gical event depends upon the state of the person and at the same time on the environment” (Lewin, p. 12, 1936). He described the “life space” as relationships between objects a nd surroundings. Other social psyc hologists developed theories building on Lewin’s model. Environmental psychologist M. Powell Lawton utilized Lewin’s ecological principles to investigate the interaction of epidemiology and gerontology. In the 1960s, Lawton pioneered research on aging and recognized the significance of designing living environments for aging communities. He adapted Lewin’s ecological model to calculate both the environment and the individual who was susceptible to continual change by using th e person–environment equation: B = f (P, E, P x E). This innovation led to La wton and Nahemow’s Environmental Press Competence Model, which focuses on an individual ’s reaction or the ability to adapt to the physical environment (Lawton, 1973). The mode l specifically identifies a person’s sensory process, perception , and cognition as links to the ecological sy stem. Unfortunately, a person’s mental and physical variable functions redu ces over time; therefore, an individual’s environmental cognition becomes a vulnerable mediator between themselves and their environment. Lawton and Nahemow’s Environmen tal Press Competence Model further describes the “person-environment fit” or “adaptive” theor y, which suggests environmental effects become more prominent as physical and cognitive aging occur.

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21 There are five main components to Lawt on’s Environmental Press Competence Model (Figure 1.6a). The first component is degrees of individual competence . This component represents the individual’s abilities, including cognitive, physical, and physiological qualities. The model recognizes the limits are specific to the individual over time. The second component is environmental press . Lawton credits Murray (1938) for originally defining environmental press as environmental forces that evoke indi vidual response. Murray distinguished between alpha and beta press (p. 607), with alpha pre ss being objectively discernable forces and beta press being subjectively discerna ble forces – otherwise known as the psychological environment. Adaptive behavior is the third component of the E nvironmental Press Competence Model. Lawton describes adaptive behavior as the “outer manifestation of [an] individual component” (p. 659). Both social norms and self-actualiza tion define adaptive behaviors. The fourth component of environmental press is affective responses . Affective responses are the individual’s emotional reactions that occur in human-environm ent transactions. The fifth and final component of the Environmental Press Competence Model is the adaption level . According to Helson (1964), the adaptation level is a person’s optimal level of behavi or response to environmental stimuli. The next paragraph will further explain how the five components relate to each other.

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22 Figure 1.6a. Environmental Press Competence Model. Lawton, M. P., & Nahemow, L. (1973). The Psychology of Adult Development and Aging Ecology and the Aging Process. (619-674). The x -axis represents the level of environmental stressors and the y -axis represents a personÂ’s competence level. The dashed, diagonal ad aptation level line is a theoretical mean for individuals with an average competence. The shad ed area on either side of the adaption level line is the positive affect. The positive affect (shaded area) is when an individual is comfortable in their environment. Negative affect occurs furthe r away from the adaption level. This could be due to an individualÂ’s sensor y deprivation making the surrou nding environment less tolerable and seemingly more stressful. As a personÂ’s comp etence declines, they have more environmental stresses and maladaptive behavior may become present. However, adaptive behavior can

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23 maintain a personÂ’s affect in the positive region. Figure 1.6b is a reinterpretation of the model by Jon Lang. Figure 1.6b . Reinterpretation Environmental Press Competence Model. Lang, Jon (1994). Urban Design the American Experience. (p.32). As detailed by Lawton and Nahemow ( 1973), the Environmental Press Competence Model shows seven phenomenon (p. 665): 1. As individual competence decreases, the area for maladaptive behavior and negative affect increases. 2. Negative outcomes are more likely with excessively strong than with weak environmental press. 3. Positive affect and adaptive behavior are pos itive only at relatively low levels of environmental demand for the person of low competence.

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24 4. Small changes in level of environmenta l press in people of low competence may evoke gross changes in quality of affect or behavior. This statement illustrates the environmental docility principle, contrasti ng the low-competence individual with the high-competence one, who may deal with majo r changes in press while still functioning adequately. 5. For every individual includi ng those with low competence there is a band in which environmental press are associated wi th positive outcomes, and conversely, a band in which self-initiated or externally in itiated action may increase or decrease the environmental demand in his behavioral world. 6. Both stimulus-seeking and self-initiated dependency striving may occur at low levels of competence as well as at high levels. 7. The amount of variation in press permitte d around Z to raise adaption level and simultaneously level of competence is much smaller at the low-competence end of the scale than at the high-competence end. Lawton and Nahemow (1973) defined the ecology of aging as a “system of continual adaptations in which both the organism and the environment change over time” (p. 621). Lawton and Nahemow view the ecology of aging as humans continually ad apting and alternating their environment in order to age independently – also known as the Adaptation Theory. This study will explore the person-en vironment relationship further by exploring the role that universal design and visitability can play in single-family homes and ADUs. The Lawton and Nahemow model is the underl ying framework for the present study. The diagram emphasizes that adaptati on influences the person-environm ent relationship. Specifically, the components of the Environmental Press Comp etence Model form the ba sis of the study. First,

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25 the degree of individual competence component will assess the public Â’s current familiarity with aging in place and physical ability. Second, environmental press component will assess the publicÂ’s home stressors for aging in place via design feature responses. Third, adaptive behavior identifies whether the public is implementi ng universal and visitability measures. Fourth, affective responses measures the emotional reasons be hind why residents did or did not implement accessible features in their home. Fifth, adaptation level component will assess the publicÂ’s satisfaction with their home as a mechanism for aging in place. The study will also investigate four compone nts from the perspective of design and construction professionals. First, the degree of individual competence component will assess professionalÂ’s current familiarity with aging in place and physical ability. Second, environmental press component will assess the perceived professi onal home stressors for aging in place via the professionalsÂ’ rating of each de sign feature importance. Third, adaptive behavior identifies whether professionals are implementing unive rsal and visitability means. Fourth, affective responses measures the emotional reasons behind w hy professionals did or did not implement accessible features in their clientÂ’s home. The fifth component, adaptation level, assesses the optimal fit level of a personÂ’s home satisfaction w ithin their environment; therefore, it does not apply to professionals because the professional is not the end user. The next section will reveal the research questions and hypothesis. Research Problem Hypothesis framework. The City and County of Denver has a rapidly aging population but the city is not prepared to support the aging group. Resident hom es are not suited for aging in place; construction professionals are not incorporating universal design and visitability designs into new construction; and there ar e no municipal policies, regulations , or incentives to require or

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26 encourage the integration of unive rsal and visitable design principl es in either new construction or existing construction. Barriers related to residentsÂ’ support of aging in place . Null (2003) has observed that despite the increased support of aging in place by seniors th rough the producer and consumerbased tax and fee incentives descri bed in the literature, local cons umers are still not prepared to age in place. Null attributed the situation to three factors identified by the National Home Modifications Action Coalition in 1997. The first was skewed demographics. Seniors represent a vast, diverse group of individuals where increasi ng physical and cognitive disability occurs. A single marketing design cannot address this hete rogeneous group. Second, the denial of aging could impair decisions to obtain a universal de sign. The lack of emotional acceptance of the process of aging could delay the individualÂ’s preparedness to fulfill his or her supportive environmental needs. Lastly, Null suggested that a lack of public awarene ss was a contributor to soft market demand. Seniors might not know wher e to seek resources, find expertise, or buy products that could enhance thei r independent living. The more information the consumer has, the better prepared they can become. Barriers related to professionalsÂ’ support of aging in place. Wolford (2000) conducted a study on single-family homes and universal desi gn. She surveyed homebuilders to understand their thought on universal design in private homes. The study de termined there was greater awareness of features than use of features. One of the largest barriers found was the cost associated with the notion of making universal de sign a part of the local building code. The study did not include an expanded group of professionals or integrate the perspe ctives of residents. Residents may have completely different outlooks on aging and aging barriers than

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27 professionals. Incentives can be an opportunity to encourage new behavior and should be further explored. As Denver faces changing demographics, the research questions will be built on past literature, while study Denver specifically to understand how residents and professionals can cohesively interact to pr epare to age in place. Research Questions and Hypotheses Question 1: Why are Denver construction/design professiona ls and residents not prepared to age in place? Hypothesis 1: Lack of awareness Lack of action (feat ure integration) Lack of, or misinformation of cost Question 2: Is there a statistically significant di fference between Denver construction/design professionalsÂ’ and residentsÂ’ levels of agein-place awareness, action, cost information, and policy support? Hypothesis 2: Null Hypothesis, H0: There is no statistically significant difference between Denver construction/design professionalsÂ’ and residentsÂ’ levels of ag e-in-place awareness, action, cost information, and policy support.

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28 Alternative hypothesis, Ha: There is a statistically significant difference between Denver construction/design professionalsÂ’ and residentsÂ’ levels of ag e-in-place awareness, action, cost information, and policy support. Question 3: What could a potential Denver uni versal design policy include? Survey The author created two independent surveys to assess the research questions through both qualitative and quantitative questions. Chap ter 4, Methodology, disc usses in detail the populations surveyed as well as th e design of the survey itself. Framing the Research The present study makes several important c ontributions to the body of knowledge in the field of aging in place. The fi rst novel approach to the framing of the study is the authorÂ’s particular consideration to compare the reside nts and professionals. The literature review will show there have been many independent studies of consumers and producers. There is a gap in the literature comparing residents and professionals. The study will compare and contrast residents and professionals uni versal design/visitability c onsensus. Understanding both professional and residentsÂ’ sentiment will pres ent a well-rounded understanding of why society as a whole is not prepared to age in place. Significance of the Study Beneficiaries of the research are older adult residents and relevant professionals because the research will assess aging in place specific to their Denver community. In Denver, 93% of respondents want to live independe ntly yet the research revealed only 33% of residents are aware

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29 of aging in place. The researcher wants people to learn the impact that universal design and visitability can have on aging in place. First, the data shows there is a stat istical significance with the number of features in a personÂ’s home and th eir level of satisfaction with their home as a place to live as they age. Second, there is a desi re from residents (46%) and professionals (46%) to learn more about aging in place. The rese archer argues that more awareness, education, legislative change, and policy incentives can incr ease the implementation of universal design and visitability in Denver single-family homes. The study will add to the liter ature information about the impact of contributing factors listed above on universal design and visitability. In addition, the research will benefit the City and County of Denver and the SAPGA with valuable information about how to allocate reso urces to prepare to age in place in Denver. The findings will help policymakers in considering the building codes and incentives that are the most appropriate for accessible single-family homes, which could influence both the design and construction professions and the residents. Assumptions, Limitations, and Delimitations Assumptions. The survey assumed people answered truthfully. The researcher assumed the reward of the iPad-motivated participants to take and complete the survey. The researcher assumed the mailing address purchased includ ed accurate information of residents and construction professionals in Denver. Limitations. A limitation to this study is the samp le size. With the sample size of 177 residents and 71 professionals, the study does not fully reflect the population. In the professional group, a slight bias may exist because local Cer tified Aging in Place Specialists (CAPS) were invited to participate in the survey. CAPS are trained professiona ls who identify home

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30 modifications for the National Association of Home Builders (NAHB). Another limitation that could arise in the study relates to the self-reported data. The re search used two online survey instruments and as with all survey-based resear ch, selective memory or exaggeration could bias participant response. Additionally, because the admi nistration of the survey occurred online, the online survey does not account for residents who do not have access to a computer or a smartphone. Finally, online collection of res ponses outside the coterminous boundary of The City and County of Denver occurred. Some of th e professional responden tsÂ’ jobs tangentially related to the construction and design field. The respondents identified when they were not able to answer questions because th ey did not make that type of design decision. A potential limitation would be control of the survey web addr ess. A participant could forward the address to an individual unbeknownst to the researcher. Delimitations. The geographical region is a delimita tion of the study. The results of the survey are generalized to residents and professi onals who (a) are a resident of Denver, or (b) work, design, and/or build housing in the City and County of Denver in 2017. Organization of the Study Chapter 2 will present an in-depth review of the literature on universal design, visitability, and accessory dwelling units from the pe rspectives of history, research studies, and policy reviews. Chapter 3 will explain the met hodology used in the study, specifically the data collection and analysis. The chapter will explain th e specific techniques used to obtain outcomes. Chapter 4 will analyze the qualitative and quan titative survey results from the distinct perspectives of residents and professionals. The chapter will also compare and contrast the data collected from the two groups and present the results of the hypotheses test. Chapter 5 will discuss the key findings, recommendations, and suggestions for future research. Chapter 5

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31 concludes the study by assessing how the findings ha ve contributed to a d eeper understanding of the broader research problem.

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32 CHAPTER II LITERATURE REVIEW This chapter examines man-environment theori es related to geront ology, the evolution of accessible design, and universal design laws and incen tives. First, the chapter will present past literature of foundational person-environment theori es. Then the chapter w ill review the ways in which visitability and universal design integrat e into single-family un its to support aging in place. The chapter will show how the movement towards a universal design policy can help to create an environment for aging in place and coul d potentially become a st andard in Colorado to support healthy community living. As Colora do experiences the changing demographics, research suggests that policymakers, developers , architects, general c ontractors, and citizens need to consider new strategies that support older adults with housing. Environmental Gerontology Foundational definitions of agi ng help identify the aging process. According to Handler the definition of aging “is the de terioration of a mature organism resulting from time-dependent, essentially irreversible changes intrinsic to all members of a species, such that, with the passage of time they become increasing unable to cope with the stresses of environment, thereby increasing the probability of death.” (Handler, 1960, p. 200). Some psychologists perceived Handler’s definition to be too restrictive. According to Birr en and Renner, their definition concentrates on the process of aging. The defi nition focuses on how behavioral differentiations occur over the aging process. The authors state, “Aging refers to the regul ar changes that occur in mature genetically representative organi sms living under representative environmental conditions as they advance in chronologica l age” (Birren & Renner, 1977, p. 4). Birren and

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33 Renner detail three types of age: biological, psychological, and social. Biological age refers to the differentiation of organisms over time. Specia lly understanding that over one’s life span and biological age physical limits apply to the organ system. In addition to aging biologically, Birren and Renner suggest psychological age as a second type of age. Psychological age recognizes a person’s ability to adapt to the environment. A point of consider ation with physiological age is that the person’s organ system is changing a nd therefore their envir onment surroundings are increasingly harder to naviga te over time. Memory, learning, and motor performances change over time (Arenberg, 1977; Craik, 1977; Welford, 1977). Social age is the third type of aging defined by Birren and Renner. Social age reflects the social habits of a person in society. The authors argue a combination of both biological w ith psychological charac teristic influence a person’s social norms. Aging Attitudes Learning Theory Model . Zubin discusses how the Learning Theory Model (1977) influences the etiology of aging. The Learning Theory Model applie d to aging states people learn to be old by observation. Even when physiologica l decline occurs, people learn to adapt (Zubin, 1977, p. 6). If people are not able to adapt, the learning theory reverts to learning to correct negative behaviors and further emphasize new processes. Attitudes toward aging influence older adults. Attitude, as defined by W.A. Scott, is “an enduring organization of motivational, emotiona l, perceptual and cognitive processes, with respect to some aspect of the individual’s world” (Bennett & Eckman, 1973, p.577). Bennett and Eckman investigate the relationship of attitude s toward aging on the aging experience. They suggest maladaptive behavior of aged individu als could result in premature death. Negative views on aging could contribute to an unwillingn ess to integrate coping mechanisms in one’s

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34 environment (Bennett & Eckman, 19 73). Riegel and Riegel conducte d a study that revealed older people have rigid views (1960). Therefore, the la ck of flexibility in views could equate to unchanged attitudes. A study in 1984 researched 3 00 popular magazine article writings in the 1970s. The study reinforced consistently nega tive views toward aging (Nussbaum, J. &Robinson, J.). A more recent study linked negative aging attitudes as a predictor to increased daily stressors in older adults (Bellingtier & Ne upert, 2016). Forty-three a dults participated in daily reporting of attitudes over a to tal of 380 days. Daily stressors affected people with negative attitudes on aging more than individuals with pos itive aging attitudes. Positive attitudes on aging may be a resource to mitigating reaction to daily stresses. Over the years, attitudes of aging ha ve changed. More recently, AARP research conducted a study regarding attitudes on aging. Th e study found that 59% of people feel that getting older is a positive expe rience. The study also found the biggest predictor of overall satisfaction with life is health. Individuals who rate their health “good” were twice as satisfied with life (84%) when compared to people with p oor health (David, 2013). Literature shows there is a relationship of hea lth to housing. A 30-year re trospective analysis st udied this relationship. The authors analyzed the relationship between health status and housing quality from 1970-2000. The two datasets assessed were the National He alth and Nutrition Examination Survey and the America Housing Surveys. The results showed “ecologic trends in childhood lead poisoning follow housing age, water leaks, and ventilation; asthma follows ventilation, windows, and age; overweight trends follow ventil ation; blood pressure trends follow community measures”; therefore, they conclude “housi ng trends are consistent with ce rtain health trends over time” (Jacobs, Wilson, Dixon, Smith & Evens, 2009).

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35 Man-Environment Theories Adaption Theory. Through a review of the literatur e, three theories of the manenvironment relationship in gerontology have be come prevalent. The first theory, the Adaption Theory, previously discussed in the Chapter 1, wa s the framework for the research questions. As a review, the Adaptation Theory is the model of aging and adaptation developed by Lawton and Nahemow (1973). The theory suggests that adaptive behavior otherwise view ed as outer criterion relates to the inner criterion of a person, by e ither influencing positive or negative affection expression. The model suggests a personÂ’s compet ence defined as both physical and mental adapt to the demand quality of the environmental press, which the author operationalizes as pressures such as architectural barriers that provide stress (Lawton, 1977). LawtonÂ’s environmental docility hypothesis (1973) sugge sts older people with increased physical impairments are likelier to have their behaviors represented in their residential settings. Environment Congruence Model. A second theory of man-envi ronment relations, applied to gerontology, was the Person-Environment Congruence Model published by Kahana in 1975. Similar to LawtonÂ’s hypothesis, Kahana illust rates congruence between the built environment and an aging personÂ’s abilities to influence th e well-being of their surroundings. The Congruence Model ascertains a best-fit line between the elde rly individuals and the environment in order to understand the impact of a personÂ’s well-being by the environment. Ka hana argues that an individualÂ’s preferences need to be congruent with an optimal environment setting. Therefore, she suggests that optimal environment be pe rson-specific (Kahana, 1975). She measures congruence as an individualÂ’s perceived well-being. The individua lÂ’s behavior adapts to the environment. Therefore, the environment must be maximized to make the individual most comfortable.

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36 Kahana argues behavior varies because of a person’s needs and environmental press. There are three possible target zones. First, is the Cumulative Difference Model. The model (also known as Zero Deviation) reflects an environmen t that has reached full optimization capability because the zone meets both the person’s and en vironmental press needs. The second model is the Critical-Difference Model. This model versi on states deviation can become non-optimal. The third is the Optimal Congruence Model. The Optical Congruence M odel identifies no deviations and extreme deviations with negative outcomes. Therefore, between zero and extreme is a range of outcome options and optimization occurs in between the zero and extreme range. Stress Theory . Schooler (1975) devised the Stress Theory to describe man-environment relations. The theory argues an exterior stimul us becomes a perceived threat. The threat can come in the form of biological, physiological, or social changes in older people. When there are no perceived threats, older adults continue normal behavior pro cesses. If a perceived threat occurs, (a stimulus becomes a stressor) the i ndividual responds by exuding coping mechanism behaviors. Schooler’s model is similar to th e Adaptive Theory and the Person-Environment Model because it addresses psychol ogical and sociological types of aging. Dissimilar to Lawton and Nahemow’s and Kahana’s theories, Schooler’s Stress Theory focuses more on the stressors than the environment. He focuses on what th e individual perceives as stressors. Lawton & Nahemow and Kahana theories allow for interp lay between external stimulus and internal response, suggesting physical barriers can in fluence behavior without perceived awareness (Lawton, 1977, p. 298). Residential Normalcy Theory. Golant (2018) argues in his Re sidential Normalcy Theory that older people are “motivated to initiate coping actions when they feel out of th eir residential comfort” (Golant, 2018, p. 65). Golant recogniz es Lawton’s and Nahemow and Kahan’s person-

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37 environment interaction theories and further bui lds on the fit-congruence environment model to understand why some older adults have more advanced coping repertoires and age more successfully. The Residential Normalcy Theory specifically focuses on how “older individuals differently coped with their incongruent reside ntial environments” (Golant, 2018, p. 68). In Golant’s Residential Normalcy Theory, he s uggests two main factors influence a person’s implantation of adaptive behavior. The first influe nce is an individual’s pe rsonal appraisement of unmet needs. The second influence on a person’ s adaptive behavior is how that individual processes information (Golant 2014). He proposes constructs that influence coping behaviors. Below Golant identifies three factors in Residential Normalcy Theory constructs that influence coping repertoires of olde r adults (Figure 2.1). Figure 2.1 .Residential Normalcy Theory Constructs 1. Whether they have resilient characteristics; 2. Whether their current or altern ative places or residence have resilient environments base d on objective indicators; and

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38 3. Whether they make decision of their own volition or if they have voluntarily delegated their decisi on-making authority to others. These factors influence the enri chment level of coping repertoires for older adults. Golant argues object indicators can crea te resilient residential envi ronments (2014). However, his overall argument is that differe nt people can assess the same object differently; therefore, the coping strategies for people can become very individualized. Suggesting demographics and personalities, life history, and h ealth status can all be predictiv e personal characteristics. The characteristics of the person influences how that personÂ’s ability to house more effective problem solving/coping skills in search of creating a residential normalcy environment (Golant, 2014). The present study will examine in tegration of universal design a nd visitability features as an action item of adaptation for single-family homes within the framework of the Adaptation Theory. The Adaptive Theory Model is the most re levant to the topic of study. The other models, (Environment Congruence Model, Stress Theory, a nd Residential Normalcy Theory) have been discarded because they are less relevant. This study will assess universal design and visitability awareness, action, features cost knowledge a nd policy. The means for assessment will be via a survey instrument. The survey (discussed in detail in Chapter 3, Met hodology) will address questions of awareness, action, cost, and policy. The study will also gauge policy interest for integrating features in single-family homes. Th e next section will provide a historical overview of accessibility evolution for built environments in the United States.

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39 Accessibility Evolution Accessibility Rights At the end of the 1950s, the American Civil Rights Movement commenced a conversation about basic rights of accessibility for all Americans. Figure 2.2 shows the accessibility policy timeline. In 1961, the Vete rans Administration (VA) became the first government agency to establish standards for building access. The VA rules, “Making Buildings Accessible to and Usable by the Physically Handi capped,” are not federal laws. Rather, they are enforceable only if municipal or state governme nts adopt them. Nevertheless, these government regulations established a movement to encourag e individual independence and eliminate physical restrictions regarding building access. Building on the Veterans Administration initiative, Congress passed the Architectural Barriers Act (A BA) in 1968. It was the first legislation to mandate building access in any new structure, which was designed, built, remodeled, and/or leased with federal funds. The ABA also calle d for the immediate er adication of existing physical barriers that impeded a person’s abilit y to enter and exit a bu ilding. As inclusiveness became a legal right, conventional building design practices evolved to in clude the barrier-free requirement. Today, the United States Architect ural and Transportation Barriers Compliance Board ensures that architects, engineers, desi gners, general contractors, building owners, and managers continue to comply with the ABA accessibility standards. In the 1960s, more literature appeared linking the built environment and older individuals. The literatures emphasizes a conne ction between gerontologi sts to professionals such as architects, and planners. In 1974, Past alan evaluated architec ture student subjects’ responses to the environment after their sensory had been temporary altered to simulate modal

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40 impairment in an aging person. The students had di fficulty with tactile fine muscle controls in their hands, increased inability to hear, visual im pairments such as faded colors and glare issues. The sensory deprivation model created from the e xperiment informed professionals, at the time, of safety hazards. Since then, additional stud ies have influenced the evolution of accessible environments. However, these previous Acts included public and private commercial buildings, not residences. Section 504 of the Re habilitation Act (1973) was the first federal guideline for the accessibility to all government-subsidized buildi ngs (including residential dwellings) (AARP, 2010, p. 3). The Act required multifamily projects to ensure that 5% of their housing units were accessible by people with mobility impairments (Kochera, 2002, p. 7). Examples of the architectural requirements were 32-inch door ope nings, one accessible entrance, and removable cabinets under the sink. These requirements allo wed an individual wheelchair user to live in federally funded multifamily homes. Figure 2.2 Accessibility Policy Timeline Following Section 504, Congress passed the Fair Housing Amendment Act (FHAA) in 1988 to provide accessibility for multifamily build ings, regardless of federal funds. The FHAA Sec. 804. [42 U.S.C. 3604] Discrimination in sale or rental of housing and other prohibited Americans with Disabilities Act (ADA) 1990 Fair Housing Amendment Act (FHAA) in 1988 Section 504 of the Rehabilitation Act 1973 Architectural Barriers Act (ABA) in 1968 Veterans Administration (VA) building standards 1961

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41 practices prohibits housing discrimination based on seve ral factors, one of which was disability. The Act covers private residences, government -built housing, and federal financial-assistance housing. The Fair Housing Amendment Act of 1988 re quires that accessibility standards for new public or private multifamily dwellings with 4 or more units meet accessible standards. The act protects people from discriminatory housing practices through the following standards: (a) To refuse to sell or rent after the making of a bona fide offer, or to refuse to negotiate for the sale or rental of, or otherwise make unavailable or deny, a dwelling to any person because of race, color, religion, sex, familial status, or national origin. (i) The public use and common use portions of such dwellings are readily accessible to and usable by handicapped persons; (ii) All doors designed to allow passage in to and within all premises within such dwellings are sufficiently wide to allow pa ssage by handicapped pers ons in wheelchairs; and (iii) All premises within such dwellings cont ain the following featur es of adaptive design: (I) An accessible route into and through the dwelling; (II) Light switches, electrical outlets , thermostats, and other environmental controls in accessible locations; (III) Reinforcements in bathroom walls to allow later installation of grab bars; and (IV) Usable kitchens and bathrooms such that an individual in a wheelchair can maneuver about the space (USDJ, 2015, website). Clause (III) Reinforcements in bathroom walls to allow later installation of grab bars is defined in the Internat ional Code Council (ICC) A117.-2017 Standard for Accessible and Usable Buildings and Facilitates American National Standard book. Section 609 Grab Bars (p.87) details the grab bars in bathroom facilitates (F igure 2.3). The section identified requirements for cross section of grab bars, spac ing, position on grab bars, position of childrenÂ’s grab bars surface hazards, fitting grab bars, installing and confi guring grab bars, and structural strength.

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42 Figure 2.3 International Code Council (ICC) A117.-2017 Standard for Accessible and Usable Buildings and Facilitates American National Standard These clauses made it unlawful to discriminate against a disabled person when selling or renting a dwelling. Additionally, the law applies to other activities such as zoning practices and new construction design. The coverage of Sec tion 504 and the FHAA made accessibility possible for people with disabilities living in multifam ily homes. However, additional progress in addressing private single-family homes on local levels remains a need. None of the newer and more stringent United States laws enacted during the late 1980s considered accessibility in single-family homes. However, this gap in the single-family home accessibility laws did not discourage public co nsideration. New programs for visitability and

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43 universal design simultaneously emerged in th e 1980s through local advocacy and education centers. The most comprehensive law to date for pub lic accommodations is the Americans with Disabilities Act of 1990 (ADA), si gned by President Bush, which dr ew the widest attention to the civil rights of people with disabilitie s. The law enforces accessibility in public accommodations such as hotels, restaurants, shop ping centers, hospitals, and more. The law also applied to government-subsidized housing such as university hous ing. The law applies to public spaces in multi-family housing, but not inside the units. The law has five major sections. Specifically, the sections Title II – Public Services (State and Local Governments) and Title III – Public Accommodations (Commercia l Facilitates) have greatly influenced the design of building access. This federal legislation mandated the rem oval of physical barriers that impeded access to state and local buildings as well as public a ccommodations, including privately owned facilities. The Department of Justice con tinues to regulate the complian ce with ADA to ensure that the physical, built environment is accessible to all persons. Demirkan (2007) reviewed the l iterature and her paper depict s three phases that led to widening ideology of housing design for the agin g population. She organizes the evolution of home accessibility in three stages : individual, adaptable, and unive rsal. First, Demirkan states housing design was “individual” a nd specific to the user with a disability. Then, individual housing design emerged into adaptable housing. Adaptable housing (adding grab bars and creating ramps) and customized home modifica tions began to evolve. Lastly, following individual and then adaptable design, uni versal design emerged. The housing ideology highlighted the “design for all” concept. The design-for-all concept expands home accessibility design for people of different ag es “regard less of age or abil ity” (Demirkan, 2007, p. 35). All are

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44 effective means to revitalize homes to support agi ng in place, but the latter impacts more people because it is universal. The next two sections will discuss visitability and universal design. Visitability Eleanor Smith and her Atlanta-based advocacy organization, Concrete Change, started the visitability movement in 1987. The group mainta ins that there are thre e essential features “that must become a default in home construction practices.” First, one zero-step entrance at the front, back or side of the house. Second, interior doors, including bathrooms, with 32 inches or more of clear passage space. Third, at least a half-bath, preferably a full bath, designed on the main floor (Concrete Change, 2016). The three visitable features listed above support the independence of homeowners and renters. Visitability cost and location . The location of the zero-step entrance door could occur in the front door or through the garage. Different construction methods allow zero-step entrances to be feasible. Various methods to creating a zero-s tep entrance include slab-on-grade, earth berms, retaining walls, garage entrance, and ramps (Con crete Change, 2005; Visita bility, n.d.). For all homes built on slab-on-grade there would be a charge of approximately $200 for a zero-step entrance. When considering the slab-on-grade zero-st ep entrance, the final detail to include is the threshold door connection. The mo st recommended threshold is a flush entry with an average cost under $50. Integrating a flush threshold that aligns with the ground providing a smooth, uninterrupted surface is a final detail consider ation when constructing zero-step entrances. Visitability public laws. In 1992, the city of Atlanta, Georgia approved the first visitability ordinance. The ordinance mandate d that public homes would receive government grants in the forms of city loans, land grants, and tax incentives to integrate into their home

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45 designs with zero-step entrances, 32-inch doorwa ys, reinforced bathroom walls, and electrical controls that are reachable from a wheelch air (Kochera, 2002, p.23). In 1998, Austin, Texas mimicked Atlanta’s initiative and adopted an or dinance applying to newl y constructed, singlefamily homes that directly received funds fr om the city (Kochera, 2002, p.25). Austin, Texas also created the Safe, Mixed-Income, Accessibl e, Reasonably Priced, and Transit Oriented (S.M.A.R.T.) Housing Policy init iative, which provided fee waiv ers and faster processing of building permits for developers and builders of such units (Maisel, Smith, & Steinfeld, 2008). Recently, however, there are instances wher e policy applies to private residences. According to Nikita (2007), both Pima County and Naperville in Arizona became the first to pass ordinances that applied to both publicly funde d and private homes. In 2002, Pima County was the first to pass a visitability ordinance for publicly and privately funded homes. Specifically, the law called for visitability featur es to include a zero-step entr y, wide doors and hallways, and reinforced bathroom walls (so walls can support grab bars). In addition, all outlets and light switches were reachable from a wheelchair level. After the creation of the visitability ordinance in Pima County, professionals introduced 15,000 visitable single-family homes into the housing market (JCHS, 2014, p. 23). Following Pima Count y, in 2002, Naperville, Arizona amended its building codes to introduce visitab ility guidelines (2002). However, Naperville stated that if the site grade reflected a dramatic change in elev ation the no-step requirement was exempt. Several other localities have authorized similar ordinances: Urbana, Il linois (2000); San Antonio, Texas (2002); St. Petersburg, Florida (2004); Birmi ngham, Alabama (2007); and Pine Lake, Georgia (2007). The state of Vermont required “any spec-bui lt single-family or multifamily housing unit to adhere to a number of construction standard s that closely follow the broad visitability

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46 legislation,” however, “unlike Ge orgia and Texas, the Vermont re quirements extend to privately financed housing, making Vermont the first state to establish a set of vis itability features for almost all housing” (Kochera, 2002, p. 14). Verm ont passed the most comprehensive visitability law implemented at the state level. Since 1998, ei ght states have enacte d legislation requiring visitability in state-funded hous ing: Georgia, Kansas, Kentuc ky, Michigan, Minnesota, Ohio, Oregon, and Texas. At a minimum, the laws mand ate a no-step entrance, 32-inch interior doors, and a half-bath on the main level (Hayes, 2010). Shortly following the vi sitability movement, universal design came to the forefront. Fortytwo states do not have visitability laws. Universal Design In 1989, the U.S. Department of Education f unded the National Institute on Disability and Rehabilitation to support a gr oup of architects, environmenta l designers, and engineers to address accessibility issues in buildings. Ron Mace at the Center for Universal Design led this group for Universal Design at North Carolina Stat e University. He define d universal design as “the design of products and enviro nments to be usable by people of all ages and abilities” (CUD, 2008). The application of universal design includes se ven principles: equitable use, flexibility in use, simple and intuitive use, clear information, tolerance for error, low physical effort, and size and space for approach and use. The Center continue s to reside in the College of Design at North Carolina State University and promotes the uni versal design philosophy of “design for all” through design development and research publications . These principles have led to a universal design checklist that helps in identifying new c onstruction, remodeling, and modification options to support aging in place. As noted in aging rese arch, the universal design philosophy may be the

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47 most desirable built environment design option becau se of its applicability to everyone (Carr, Weir, Azar, & Azar, 2013). The book Residential Design for Aging in Place by Lawlor and Thomas synthesizes the definitions presented by The Center for Un iversal Design of each principle (2008). Principles of Universal Design Principle One: Equitable Use This principle encourages designs that are f unctional with the same or equivalent means of use that appeals to a wi de number of individuals. Principle Two: Flexibility in Use Designs following this principle feature a choice of preference and methods of use, including accommodating leftor right-ha nded operation while allowing for usersÂ’ precision, accuracy, and peace of work. Principle Three: Simple and Intuitive Use According to this principle, the design should be straightforward and consistent with the expectation and intuition of the user. Info rmation should be presented based on its importance to accommodate a broad range of literacy and language skills. The design should give prompting and feedback during and after each use. Principle Four: Perceptible Information This design principle provides a product that gives appropriate information to the user by using different modes of redundant presentations (pictorial, verbal, and tactile) regardless of the ambient conditions or th e userÂ’s sensory abilities.

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48 Principle Five: Tolerance for Error Designs should facilitate thei r safe use, be forgiving if errors occur, and minimize adverse and unintended consequences. Exampl es include providi ng warning or error alerts and discouraging unconscious actions in a task that require close attention to the use. Principle Six: Low Physical Effort This principle calls for designs that are effici ent, comfortable, and re quire little effort to use. The design should allow the user to ope rate successfully without much force and without twisting, turning, or repetitive actions. Principle Seven: Size and Space for Approach and Use In this principle, spatial design creation is design appropriate for its size, by providing a clear line of sight and making it possible to r each whether seated or standing regardless of the user’s body size, posture, and mobility. Universal design public and private laws . Currently in the United States, visitability ordinances exceed universal design ordina nces. On 16 February 2010, the Community Development Department in the City of Sacram ento passed the universal design ordinance NO. 2010-003, “A Proactive Effort to Create New Housing To Be Enjoyed by Everyone,” to accommodate the growing disabled and senior po pulation. Developments containing 20 or more single-family houses in the Standard Single Fam ily (R-1) Zone and Single-Family Alternative (R1-A) Zone were required to construct one hom e that contains universal design features (grab bars, zero-step entries, and wi der doorways) (City of Sacramen to, 2010, p. 3). In the remaining homes in the subdivision, consumers had the opti on to integrate universal design features. Since

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49 then, Sacramento has continued to promote proactive universally designed residential development to support independent living. To some people grab bars ar e unattractive and a sheer si gn of aging, which may make people uncomfortable. The researcher recognizes it is not necessary for every home to have bathroom grab bars in place, however, integrating grab bar blocking design during the construction phase of a home is inexpensive, a nd not labor intensive. Locations of grab bar blocking could be included (a) adja cent to the toilet, above the toilet, and at th e shower faucet (b) within the shower. Placing grab bar blocking in bathrooms to prepare to age in place minimizes the task of a full-scale bathroom remodel, wh ich greatly benefits the homeowner. The public does not have to tear the entire wall out in order to include the grab bars. If professionals include grab bar blocking in new construction homes, the public can avoid expensive cost in the future. Opposition to Visitable and Univers al Design Policy and Incentives Opposition Concerns Excessive government control. Investigators claim conventiona l single-family units in the housing stock lack basic accessibility (Nishita, Liebig, Pynoos, Perelman, & Spegal, 2007). A case study assessing the diffusion patt erns of visitability legisla tion aim to understand “spread of the visitability concept, the patterns of di ffusion, the opposition’s main concerns, and the mechanisms by which advocates [for visitabili ty] overcame opposition and facilitated passage” (Nishita, Liebig, Pynoos, Perelman, & Speg al, 2007, pg. 2). The authors describe how contractors reacted to the first visitability ordinance, championed by Eleanor Smith, in 1992, with much controversy and opposition because of their concern for government encroaching on private property and cost concerns.

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50 Concerns regarding both the increased cost s of accessible features and governmental interference exist in the profe ssional industry. The opponents of visitability argue the idea of government mandating ordinances in private re sidences encroaches on peoples’ rights. The notion is rooted in the fact that individual hom eowners own the land and pa y taxes on their land; therefore, they can decide what to do with their own private property. Some builders suggest no laws apply to private residences and that homeowners should be ab le to choose to obey them. Cost concerns . Opponents also argued, in addition to government not encroaching on private residence, that the cost associated with universal design and visitability would “negatively impact the affordab ility of a home” (Nishita, Liebig, Pynoos, Perelman, & Spegal, 2007, pg. 10). However, the study revealed pricing fo r visitability was in fact inexpensive and that increased awareness of visitability pricing ca n help proponents of visitability policies further succeed in adding visitab ility in the U.S. housing stock. (N ishita, Liebig, Pynoos, Perelman, & Spegal, 2007). Furthermore, the study addressed a clear distinction asso ciated with time of integration: concepts integrated “before” constr uction compared with homes retrofitted “after” construction had substantial cost differences. It is less expensive to include visitability in the initial design of a home then to retrofit a hom e after construction. The literature review will elaborate the study. Previous studies found that original desi gn and construction specifications of the materials and labor used in universal design and visitability are not outlandishly overpriced. Gobtop and Memken (2005) calculated that the va lue of using universal design to design a new home would raise the initial se lling price by $3,700. They argued that paying a higher premium for a universal design home has long-term benefits because the features installed (a) support an individual to age in place, and (b) mitigate the need to retrofit the home in the future. In fact, this

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51 study estimated that remodeling a home to incl ude universal design features would cost $50,000 to $66,000. It may not be feasible for an elderly indi vidual to pay this cost in the latter stages of his or her life. Maisel (2007) validated this fi nding in a study that compared the cost of integrating a visitable design into the original de sign and construction in c ontrast to the cost of modifying a home for visitability. She found that the average new construction cost of installing visitability during construction was $200 for a zerostep entrance and $50 for interior doors. The values are less expensive than retrofitting. The average cost was $3,300 to add a safety zero-step entrance to an existing home and $700 to widen th e interior doorways (Mai sel, 2007). Therefore, the literature suggested that both universal design and visita bility home modifications are significantly more cost effective when integr ating the features in the initial design and construction phase. This research suggests th e construction industry should consider the incorporation of universal design and visita bility features within new construction. Societal Costs of Not Integrating Features The literature review also identified the co st associated with not utilizing accessibility features. As people age, falls become more prev alent. Unsafe physical barriers in homes can increase the chances of older adu lts falling, and an increase in the number of falls can lead to an increase in medical costs. The Center for Di sease Control and Prevention reported that in 2013, the direct medical cost of falls by people aged 65 and older was 34 billion dollars (CDC, 2013). Barrier-related home falls are an important issue b ecause these statistics are likely to rise as the U.S. population continues to age. These statistic s set a precedent in the information on creating safe homes because a portion of such incidents occurs in homes. In 2015, the National Council on Aging releas ed the Falls Free: 2015 National Falls Prevention Action Plan. The plan includes a s ection on home safety strategies to create

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52 awareness of the need for consumers to adopt ho me modifications to prevent falls. They have designated two main goals. First, all older adu lts will have knowledge of and access to home security measures (including information, asse ssments, and home modifications) that reduce home hazards, improve independent functioning, a nd lower the risk of falls. Second, healthcare, the aging network, housing, and other service prov iders will become more aware of and promote home safety measures (including information, as sessments, and adaptive equipment) that reduce home hazards, improve independent functioning, a nd lower the risk of falls (NCOA, 2016). Each goal has three to four specialized action steps, but the primary goal is to eliminate falls and increase home safety so that people can age in place safely. Past Policy Tactics Policy Promotion Government policies to alleviate cost . As noted, the federal government has succeeded in creating accessibility in federally funded priv ate apartments and public buildings, but has declined to create federal laws regulating accessib ility in single-family homes. To date, there are no national accessibility, universal design or visi table requirements for single-family homes. However, the government has explored federal incentive programs. During the fiscal years 1999 to 2001, the U.S. Department of Housing and Ur ban Development (HUD) administered federal aid through the Super Notice of Funding Availabl e (SuperNOFA) to incentivize developers to incorporate visitability and accessibility in subsidized single-family homes. The grant successfully encouraged developers to include grade entrances and 2-feet 10-inch passageways in single-family homes. Kochera (2002, p. 1) not ed that although the incentives have been minimal at the federal level, exploration of in centive programs occurs at the state and local levels, which have led to a cha nging landscape of visita bility and universal design incentives in

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53 single-family homes. Hartje ( 2004) agreed with Kochera, clai ming that incentive programs can also “accelerate the adoption of universal design in housing, supporting the goal of transforming the real estate market into one in which univers al design features and pr oducts are the standards for design and construction” (p. 195). In contra st to the federal government, the delivery of programs and incentives at state and local levels has driven new trends in passing legislation, which benefit both builders and homeowners.States and municipalities promoting incentives . Several localities and states offer tax incentives to both producers and consumers to defray the costs associated with future accessibility laws (City of Austin, 2013). In 1998, the state of Georgia passed a law that gave single-family homeowners a tax credit of $500 if they incorporated accessibility features into their houses. The law also included a $125 tax cred it for retrofitted existing homes; the credit could not exceed a total of $500 (Kochera, 2002, p. 17). The regulation was similar to the visitability law passed by Texas in 1999. Texas’ s visitability law app lied to single-family affordable housing constructed with federal funds. Although, the idea is to incentivize the production of universal design and vi sitability there are examples in both state laws that if the grading cost is unreasonably expensive, the visi tability features may be waived (Pima County, 2001, p. 22). Neighboring states took note of the tact ic to incentivize via political action. Both Virginia, in 1999, and Pennsylvania, in 2006, provid ed state ordinances th at gave tax credit incentives to consumers (Maisel, Smith, & Stei nfeld, 2008, pg. 33). Virginia and Ohio created a Livable Homes Tax Credit (LHTC) program, which allows both builders and homeowners to claim up to $5,000 to build accessible homes and for owners to upgrade their existing home (JCHS, 2014, p. 23; Virginia, 2018). In 2012, Ohio’s Injury Preservation Partnership campaign,

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54 an advocacy group, argued that home modifications could prevent falls and save lives because accessibility features promoted independent living to improve the quality of life for older adults. Mandatory Versus Voluntary Incentives Various localities and states have utilized several means for implementing visitability and universal design features in the existing housing stock. Local jurisdictions have waived construction permit fees, designated tax credits, defe rred loans, and issued land grants to increase the number of single-family homes and townhomes with universal design and visitability features. Such solutions streamline the permit pr ocess and create a financial stimulus for the participants. These features improve the safety of housing by limiting the number of impediments in a home, thus supporting indepe ndent living for all (Salomon, 2010). However, not all programs mandate particip ation. The literature review reve aled significant differences between mandated programs and volunteer program s. Pima County and Tucson in Arizona and Bolingbrook in Illinois have all passed visitability ordinances that appl y to homes built using both public and private funds. Ma isel (2008) compared the number of houses produced by the various programs to measure the effectiveness of the diffe rent strategies. In 2007, local municipalities combined reported 28,600 visita ble homes resulting from the adoption of mandatory ordinances in various cities comp ared to 1,000 built by a volunteer program (p.21). The adopted laws achieved a higher response fr om society than the volunteer programs did. Hence, a greater number of cities are exploring ma ndatory programs because they want effective change.

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55 Accessory Dwelling Units as a Tool for Aging in Place Accessory Dwelling Units Accessory dwelling units (ADU) are separate ho using units for one or more people on the same lot as the primary residential unit. ADUs either can attach or be detached to a single-family residence on the same parcel of land. To classi fy as a separate and i ndependent housing/dwelling unit, ADUs need to have a kitchen and bathroom and (for attached units ) an adjoining unit by a locked door to separate the spaces or (for detached units) must be physically separate. Additionally, some municipalities require separate utilities. ADUs present an underutilized opportunity fo r aging in place and enabling people to remain in their single-family homes because they support homeowner independence. ADUs can either be a space where caring family members or nurses can live when assisting the elderly homeowner. Alternatively, ADUs can be a space where the homeowner can downsize into the ADU and rent their larger house for more inco me (Le. More specifi cally, ground level ADUs (attached or detached), which integrate univers al design and visitabil ity features are very conducive to individuals aging in place. ADU be nefits include augmented homeowner income, as well as conveniently allowing the individual to continue to be a part of their neighborhood fabric. Currently, the City and County of De nver does not permit ADUs in all neighborhoods. ADU History In the early 20th century, single-family home cons truction often included accessible dwelling units. Homeowners would rent ADUs to non-family members to generate income or as servant quarters used for exte nded family. After World War II wh en an influx of men returned from the war, a G.I. bill called The Servicem enÂ’s Readjustment Act of 1944 established grant

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56 money for educating and housing the returning soldiers. In re sponse to the demand for housing, the Federal Housing Administration (FHA) increase d the availability of FHA loans to stimulate development of housing in AmericaÂ’s suburbs. La nd was less expensive in suburban areas. The mortgage subsidy reduced the need to have additional income-generating housing on the same lot as the primary single-family home. Add itionally, the America Dream was evolving; the notion of an American home shifted from a dense urban pattern to a pastor al suburb. Post-World War II zoning created large houses with big lot si zes to support the men and their families. FHA guidelines gave birth to the s uburbanization of the United States in low-density settlement patterns. Suburban sprawl became the spreading of housing developments in a rural area. The sprawling became a solution to the problem of the urban density at this time, but consequently, the use of ADUs significantly decreased. Throughout the 1950s and 1960s, as housing development concentrated on lower-density suburban districts, local jurisdictions began to adopt restrictive residential co des to prohibit ADU construction with the intention of preserving and protecting single-family neighborhoods (Katsuya ma, 1995). Ironically, the adverse effects of suburban sprawl, such as traffic congestion and the lack of affordable housing, drew negative attention to suburban design among some urban researchers. The cr itique of suburbia motivated the practice of new design methods. To addr ess the unfavorable post-war suburbanization, development patterns began to change in the 1990s to Smart Growth and New Urbanism. These new city planning ideologies promoted walkab le neighborhoods and in tegrated a range of housing types. They promoted higher densities and a mix of uses instead of single use residential areas at lower densities. Subse quently, a growing number of muni cipalities began to lift the ban on ADUs and adopt new ADU zoning regulatio ns. However, many of these new ADU ordinances are still restrictive in terms of design, size, and pa rking regulations (Pfeiffer D.,

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57 2015). Additionally, there is still the neighbor hood phenomenon of NIMBY (not in my back yard) that can fuel community resistance (Farris J., 2001, p.23). ADUs and Older Adults The literature shows that ther e was a movement to encourag e the expansion of ADUs. In 1992, Kelbaugh, Hinshaw, and Wright described the new meaning of ADUs in their book, Housing Affordability and Density: Re gulatory Reform and Design Recommendations . First, Kelbaugh and colleagues identified the problem of older adult individuals w ho want to remain in their homes but have a surplus of space that th ey cannot maintain. Specifically, during the 1990s, 9% of the households in Washington State co nsisted of persons over 65, who were mainly women. In accordance with the Colorado State De mography Office data, this demographic trend was similar to that in Colorado during the same period. Kelbaugh suggested that ADUs could be an opportunity for aging homeowners to remain in a home, sometimes on their own property and in their community. Owners can downsize by moving into their own ADU. By moving into living quarters that are more manageable, owne rs do not have to relocate into a different neighborhood (Lehning, 2012, p. 347). Alternatively, they can stay in their homes and a caregiver can move into the ADU or, homeowners can move into the ADU themselves i.e., the “granny flat.” Other authors followed Kelbaugh’ s suggestion to use ADUs as a solution to support aging at home. In the aging and social policy literature, Cobb and Dvorak (2000) argued that older adult consumers were displaying increased interest in ADUs. Cobb and Dvorak referenced a national survey that was conducte d in 1997 by AARP, which revealed that 36 % of persons 50 years and older were receptive to bui lding ADUs to assist them when they became elderly. Acknowledging the documented trend of the increasing interest in ADUs, identified by the literature, Liebig (2 006) advocated that governments s hould participate in the advancement

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58 of ADUs. Liebig argued that both state a nd local governments have the responsibility to investigate ADUs and educate po licymakers, developers, and c onsumers about the topic through marketing and media. Liebig suggested that loca lities could provide info rmation about universal design features that ADUs can incorporate to enhance the support of older adults. Benefits of ADUs for Seniors ADUs have several benefits . First, they increase th e housing supply in existing communities using existing infrastructure. ADUs encourage the use of the preexisting housing stock and infrastructure, and th ey help to increase the supply of housing without the need for government subsidies. Second, they financia lly assist homeowners by supplementing their income. The additional money gained from renti ng out an ADU or the primary residential unit can provide financial aid and stability to elderly homeowners who rely on a fixed income. In the case where a senior rents an ADU from someone else, the rent is likely more affordable than a single-family home mortgage. In the event the senior rents the ADU for income or a caregiver and stays in the main housing unit, the ADU provides an affordable rental option in an existing neighborhood where rentals are not otherwise be ing constructed. Third, ADUs are a convenient option for aging homeowners to transfer their living quarters if they want to downsize. ADUs can also support aging in place by providing a tran sitional period for homeowners to stay in their homes longer because caregivers, friends, and family members can live nearby to provide security and companionship. Fourth, ADUs can be a design opportunity to preserve characteristics of the home as an extension of th e main house. Fifth, ADUs modestly increase the density of a neighborhood if enough are develope d, and the additional density of households attract community services such as public transit frequency.

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59 Denver ADUs Combining the concepts of universal design and visitabi lity in ADUs creates a vast opportunity for homeowners who are considerin g building an ADU to support their aging in place. ADUs present an underutilized opportunity for Denver to combat their housing shortage. Following national trends, in 1956, the City and C ounty of Denver halted further construction of detached homes. Fifty years would pass before th e city reconsidered the topic. In 2006, Robert Sperling created the Friends of Granny organization, which lobbied for the legalization of ADUs. Consequently, in 2010, Denver’s zoning codes li fted the ban on ADUs. However, the lift only applied to about 10 % of Denver’s geographyspecific neighborhoods. Subsequently, from 2010 – 2017 in Denver, the City has i ssued 156 ADU permits (Figure 2.4).

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60 Figure 2.4 ADUs in Denver. Source: City and County of Denver. The sparse development raises both questions and possibilities regarding this untapped market. ADUs could provide an opportunity to increase housing density in Denver, and they could be an avenue for combating the housing sh ortage supporting a homeo wnerÂ’s ability to age in place. Blueprint Denver is a transportation and land use plan produced by the City of DenverÂ’s Community Planning and Developm ent Department. In an update d Blueprint Denver version, the City will seek to allow constr uction of ADUs in more neighb orhoods because of the tremendous benefits ADUs provide. The update to the Blueprin t Denver plan is in process as of March 2018.

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61 Universal design, visitability and ADUs . This previous secti on explored history and benefits of ADUs, particularly with regard to existing single-family homes in Denver. There is an opportunity for integration of visitability and universal design in ADUs in existing singlefamily residential lots to provide additional hous ing for the aging population in the current real estate market. However, if ADUs do not integrat e universal design and vi sitability principles, future ADUs may not be supportive enough for ol der adults to occupy them safely. The remainder of this chapter will refer to new resi dential single-family ho me construction (without ADUs). Lack of Accessible Homes in Existing Housing Market Buildings have been subject to following similar standards for the last 30 years. According to the literature, home design can influence an individual’s ability to live independently. Therefore, as the demographi cs change, the improvement of design and construction must evolve. Currently, the ADA is unique to public buildin gs and publicly funded private buildings, and it is not mandatory for deve lopers, architects, and co ntractors to consider in designing and constructing pr ivate homes. No federal laws exist that are specific to accessibility in single-family homes. This omissi on in ADA federal law is critical for two main reasons: first, society should re spond to consumer preferences i.e., aging in place supports preparedness in existing homes a nd new homes; and second, there is a shortfall in the number of accessible homes. In March 2015, the U.S. Department of H ousing and Urban Development Office of Policy and Development and Rese arch published “Accessibility of America’s Housing Stock: Analysis of the 2011 American Housing Survey (AHS).” The study concluded there are few

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62 accessible homes in the existing market. Their ex tensive analysis indicated, “fewer than two percent of housing units are ac cessible” (Bo’sher, Chan, Ellen, Karfunkel & Liao, 2015, p. 45). The lack includes both old homes and new homes. The lack of attention to accessibility in single-family homes accentuates when recognizi ng that single-family homes are a substantial part of the new construction market today. Th e Highlights of the Annual 2014 Characteristics of New Housing revealed that of all the new homes built in 2014, 70% (620,000) were singlefamily dwellings. Not only are people unprepar ed, but they also do not have new housing options. Making aging in place a reality will occur through the c ontinued evolution of housing design. Pynoos (2008) suggested th at the housing movement is hi ndered by the unava ilability of accessible and supportive housing, arguing “new policie s are needed to provide help modifying existing housing, mandate the creation of housing based on principles of universal design, and provide a range of housing type s in communities” (p. 78). According to Maisel, Smith and Steinfeld ( 2008), in the majority of existing singlefamily homes, a homeowner must climb steps to en ter the home, and the inte rior and/or exterior doorways are narrow. These home designs are unsa fe spaces for residents of diverse ages who have disabilities. A study conducted by the Jo int Center for Housing Studies of Harvard University also assessed the existing housing stock and agreed, stating that the nation’s supply of accessible housing is not equipped to meet the demand from baby-boomer consumers. The report revealed that nearly two-thirds of adults ag ed 50 to 64 years and nearly three-quarters of individuals aged 65 to 79 years are living in si ngle-family homes, yet the majority of the home designs lack accessibility consideration. Therefore, there is a need to integrate programs and incentives in cities that target the new constr uction and modifications of single-family homes by raising the awareness of both consumers (resident s) and producers (architects, builders, and

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63 developers). A study conducted by Memken and Earl ey (2007) reveals shor tfalls in the number of accessible housing units across the country. The authors argued that the lower availability of accessible housing units could affect the ability of an elderly individual to age in place in the United States. This shortage in the market i ndicates the need to create more homes with accessibility. People living in older homes will need to make several modifications. Discussing these issues will encourage soluti ons such as incentives; then, incentives can lead to increased public attenti on to advocate for aging in pla ce, therefore motivating producers and consumers to take action (Maisel, 2008, p.21) . Increased public awareness of universal design can foster initiatives and public incentiv es for campaign awarene ss in local cities. For example, Colorado is making progress in this dire ction by entertaining ordinances for visitability and universal design. Using a pragmatic approach , universal design requirements incorporated into new residential construction can create a home market of user-fri endly environments for people of all ages to make up for resources that have been missing. Action by Stakeholders To Create Potential Policy Action by Professional Architects The American Institute of Ar chitects (AIA) is a national organization that registers licensed architects. The AIA advocates for profe ssionals in the design and construction industry. The organization has existed for 150 years and today has over 88,000 members (AIA, 2018a). The organization has various comm ittees that address different i ssues. The Government Affairs Committee is primarily involved in state legislative actions. The group educates legislators about issues that are important to ar chitects. The committee supports le gislation that could potentially affect the design and construction professi ons. In addition, the AIAÂ’s Denver Housing

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64 Committee provides a forum where residential architects follow codes, government regulations, and technologies that influen ce the housing trends. Nationally, AI A hosts an online platform to discuss advocacy for architectural issues that are important to designers (AIA, 2018b). This platform is a means to educate people on curre nt topics such as buildings codes and could eventually be a cyberspace to discuss the visitabi lity and universal design issues that affect the aging population. Action by Professional Builders Builders have also responded to the cause. The National Association of Home Builders (NAHB) collaborated with AARP and the Home Innovation Research Labs to develop the Certified Aging-in-Place Specialist (CAPS) pr ograms. CAPS are trai ned professionals who identify home modifications that support independent living by helpi ng people to be safe in their homes. CAPS evolved in response to the grow ing demand for residentia l home modifications and assistance in creating public awareness about preparedness. By searching the NAHB website, the public can find out that currently th ere are 15 CAPS registered in Colorado, and 13 are in the Denver Metropolitan Area. The public lacks informati on about this resource option; there is a need to clar ify the aging issues perceived by th e government, professionals, and the public. Action by State and Local Government Officials National legal action . U.S. Representative Jan Schakowsky from the state of Illinois authored the first national attempt to bridge single-family homes and accessibility, the Eleanor Smith Inclusive Home Design Ac t. The federal bill (HR3260, 114th Congress, 2015-2016), introduced in the House of Representatives in July 28, 2015 assists in building a supply of

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65 accessible housing in today’s housing market . H.R. 3260 bill would require “all newly constructed, federally assisted, single-family houses and townhouses to meet minimum standards of visitability for persons w ith disabilities” (Congress.gov). • Include at least one accessible (“ze ro-step”) entrance into the home. • Ensure all doorways on the main floor have a minimum of 32 inches of clear passage space. • Build at least one wheelchair-accessi ble bathroom on the main floor. • Place electrical and climate controls (such as light switches and thermostats) at heights reachable from a wheelchair (Congress.gov). The bill was referred to the House Committee on Financial Services. The bill reflects the current issue that is facing th e design and construction industry, which could potentially have a great effect on the national housing market. The bill is undergoing the legi slative process. The bill needs to pass the House, Senate, and President in order for it to become a national law. Until the Inclusive Home Design Act passes at a national level, change must continue to occur at the state and municipal levels. In Co lorado, local governments have begun to discuss incentives to promote universal design in singl e-family homes to understand how best to move forward. Society needs more research on community and professional percep tions of visitability and universal design to support aging in place. State of Colorado legal action . The first Colorado state atte mpt to bridge the gap was in 2005, House Bill 05-1241, which was vetoed by Colorado Governor Owens. The division of housing created a pilot program that would requi re newly constructed housing units to have minimum visitability standards for persons w ith disability. On May 31, 2005, Governor Owens’

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66 Veto Letter Regarding HB 05-1241 justified hi s decision (Owen, 2005). He argued there was no market demand for this housing type. Owens also argued the bill “seems to micromanage the affordable housing market.” Owens did note that the Colorado Division of Housing might benefit from “voluntary criteria for vi sitability depending on the demons tration of an identified need through market analysis” (Owen, 2005). However, ten years later, the current literature and housing market data seems to support a need fo r visitability in single-family homes for older adults. In response to the aging demographic, Governor Hickenlooper passed and signed Colorado House Bill HB15-1033 Strategic Pl anning Action Group on Aging (SPAGA). The group, appointed by the governor, studies a comprehe nsive range of issues that affect Colorado residents aged 50+ years to identify solutions. The SPAGA group address the major issues that affect Colorado’s current aging population. One s ubcommittee, the Physical Built Environment Community, aims to create awareness of all thin gs related to housing and mobility. In response to the aging population, the subcommittee, focu sed on housing issues, de scribed three primary outcomes of change in Colorado, two that directly relate to this research. The first outcome concerns how building codes should evolve to meet the needs of an aging population. The objectives of the outcomes are to (a) promote unive rsal design codes and (b) make universal design marketable and create incentives for developers and contractors to use universal design standards. To track the objectiv e, performance measures for (a) would be to have 2% of new homes certified (UDC). The co mmittee suggests tracking the objective (b) the performance measure should be to dedicate 5% of new housing construction to be universal design. Strategic strategies to obtain these meas ures for (a) are to cr eate a Universal Design Certification (UDC). A strategic in itiative for (b) is to create in centives for affordable housing to

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67 use universal design standards. Identifying a nd encouraging champions such as KB Homes, Richmond Homes, Housing Authoritie s, and architects, etc. to inco rporate universal design in the homes could lead the housing changes. The second outcome the built environment committee addresses relates to the supply of accessible, affordable hous ing meeting the current and future needs of an aging population. Objective 4 of the group is to encourage a variety of innovative housing opportunities such as Accessory Dwellin g Units (ADUs). The performance measure for this objective, determined by the committ ee, are to reduce barriers; increase awareness/understanding at municipal planning and community levels; ensure some new ADUs are accessible; and provide incentives for entrep reneurs to develop more of these options. The strategic initiative would be to encourage lo cal zoning codes that allow for more housing arrangements. The SAPGA physical built environment committee is at the forefront of finding solutions to support aging in place at a state level. Muni cipalities can follow in th e steps and explore the integrating visitability, universal design and ADU s as a means to increase independent living longer. At a local level, progr essive advancements are alread y documented through organizations such as the National Institute on Aging (NIA ) and the Administration on Aging (AoA) whom have initiated grants to fo ster gerontology research on ag ing in local communities. Unfortunately, at both Colorado State and th e national level the gap still exists today. There are no visitability and/or universal design ordinances for new single-family home construction. The last section of the literature review will consider steps moving forward to creating ordinance awareness for citizens, pr ivate sector, and gove rnment officials.

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68 Action by Non-government Officials A growing number of organiza tions are conducting research to integrate aging in place with housing standards. The Colorado Health Foundation (CHF) seeks to collaborate with individuals and organizations to improve the health of Coloradans by encouraging healthy lifestyle choices. Their vision is to become the healthiest state in the nation. To achieve this goal, they focus on three areas: healthy living, health coverage, and health care. The Health Coverage Agenda focuses on ensuring that Colorado health coverage is stable, affordable, and adequate. The measurable goal is that “by 2023, 95 percent of Coloradans will have health coverage, and the percentage of Coloradans who are underinsured is reduced to four per cent.” To achieve this goal, The Colorado Health Foundation is seek ing various avenues. They recognize the importance of aging in place and creating housing options, such as co-housing, Accessory Dwellings Units, Natural Occurring Retiremen t Communities (NOCRs), and enhanced supportive services. On 12 April 2016, the Co lorado Health Foundation awarded Denver’s Office on Aging $60,000 in support of their efforts. The grant will assist the work of the Age Matters Needs Assessment to understand aging th rough the lens of the City and County of Denver. The larger vision incl udes best practices and recommenda tions in the rural areas of Colorado. The assessment of needs emphasizes th e importance of aging in place and recognizes the demand for research to understand fu rther aging in place in our community. Conclusion The 2016 Census Bureau’s Population Estimates Program Annual Estimates of Housing Units for the United States documented out of American’s 134 million total housing units, 60% are single-family detached structures (Census, 2016). The literature review revealed that baby boomers would rather age in pl ace and prolong moving to a nursing home, but there are very few

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69 accessible homes in the market. The United States anticipates that as baby boomers age they do not want to move from their homes. It is clear th at there is a shortage of accessible single-family homes prepared for their residents to age in place. Therefore, there is a dire need for accessible homes that incorporate visitability and universal design features. As the literature shows, it is more expensive to retrofit an existing home than to design and build a new home that includes these features. Developers, builders, contractor s, and designers in th e construction and design industry need to create designs that make thes e functions a part of the mainstream housing market. Previous studies in the literature indicate that groups res pond when policies are in place. Therefore, to create this sh ift, state and local governments should consider implementing ordinances to elicit an immediate response from the single-family home design and construction industry. The review has shown that there is a critical need to crea te an avenue for educating the population about preparedness for aging. Various means can be used to raise consumersÂ’ awareness of how to prepare for aging in place. The literature review revealed that a gap exists in research that compares the pers pectives of government, residents, and professionals (design and construction) regarding universal design and visitability. The liter ature review also showed an opportunity to study the integrati on of visitability and universal design in accessory dwelling units. As the large population in Denver continues to age, more visitability and universal design research from diverse perspectives will help to inform the city, people, and professionals on how to best meet existing demands and prepare for fu ture demands of aging in place through design and construction regulation implementation.

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70 CHAPTER III METHODOLOGY The purpose of this study was to research how prepared the residents and professionals of Denver are prepared to support resi dentsÂ’ aging in place. No prev ious studies have compared and contrasted the perspectives of the consumer a nd the professional regard ing aging in place in Denver. The researcher designed the st udy to investigate residential ag ing in place by older adults. A main goal steering the study was to uncover perspe ctives regarding future housing policies that would address aging in place. The research employs a mixed-methods approach. Two independent surveys gathered qualitative and quantitative information from the Denver, Colorado older adult resident population and the professional de sign and construction population to gather qualitative and quantitative informati on. The researcher will discuss her participatory observation at the beginning of the dissertation that led to th e forming of the project. The chapter will also describe the distribution and co llection of the survey, the survey instruments, and the response rates and analysis of the survey. At the end of th e chapter, the researcher will describe details on the qualitative data survey questions, and the codi ng associated with the questions. Participatory Observation Participatory observation was a part of the data collection. Th e researcher began with an internship at the Office on Aging in the City and County of Denver. Th e internship research connected her with the Office on Aging in La rimer County and the SAPGA. The researcher

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71 participated in observation at both of those aging committee meetings. First, in northern Colorado, the researcher attend ed the Larimer County Office on Aging Housing Priority Group meetings. These meetings facilitated discussi ons on means to support th e large aging population in northern Colorado. The Office on Aging estab lished the first Universal Design Charrette organized by Colorado State Universities Inst itute for the Built Environment. A total of $3,000 was fundraised to host the dayÂ’s even t. A list of local professionals were invited to the Charrette: homebuilders, remodelers, residential develope rs, housing specialists, City and County code officials, architects, planners, landscape architects, realtors, and more. Second, the researcher attended the SAPGA committees in Denver. The committees have seating for the public. At each SAPGA meeting a different agi ng specialist was brought in to create a holist approach. In addition to presenting experts in the field, each monthly meeting would also recap the progress the subcommittees were accomplishing between the larger monthly meetings. The SAPGA was the first meeting where the resear cher observed the stateÂ’s quest to explore universal design and visitability invitations. Survey Survey Distribution and Collection Postcard design. The researcher used postcards as a means to invite both the residents and professionals to participate in the survey. In Adobe Illustra tor, the researcher created the postcard design for both the resi dents and professionals. The tw o postcard designs parallel the University marketing material. The University of Colorado Denver communications department officially approved both the postcard design for th e residents and the prof essionals (Figure 3.1). Online resident and professional survey links . The postcards were a means to distribute the resident anonymous Qualtric s online survey link and the pr ofessional anonymous Qualtrics

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72 online survey link. Activating the anonymous link setting in the Qualtrics software disables respondents’ IP addresses. When Qualtrics orig inally generated the anonymous survey link for the online survey, the address was excessively lo ng, so to increase site access a website called Bitly was used to shorten the URL address th at was printed on the postcards. The resident postcards invited older adults interested in participating to visit the webpage: http://bitly/cudenver-age. The professional postcards invited older adults interested in participating to visit the we bpage: http://bitly/CUDenverAge . Shortening the browser links unequivocally optimizes accuracy when participan ts enter the website address. The postcards also stated the iPad incentive. An internal University of Colorado Denver Grant, “One-time Opportunity Grant,” funded the printing and mailing of the postcards as well as the iPad gift. Respondents for the professionals needed to be 18+ in age and for residents 45+ in age. Figure 3.1 Design of Resident and Professional Postcards Produced by Researcher.

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73 Mailing list. The researcher purchased a mailing list for both residents and professionals from the website Leadsplease.com to addre ss the postcards for bot h the resident and professional. For the residents, sp ecifications for the mailing list included adults living within the confines of Denver who were 45+ years of age. For the professionals, the list included design and construction professionals working in Denver. The original list purc hased had 1401 resident addresses and 1401 professional addresses. Using the computer program Ex cel, the researcher generated a random list of 1,000 addr esses for both sets (residents and professionals). With the =RAND( ) function, each individual address was given a random decimal number between 0 and 1. The researcher then sorted the newly random ized cell values from smallest to largest independently for both the resident and professional datasets. Mailing . The researcher securely electronically transferre d the 1000 resident and 1000 professional final mailing list and both the Un iversity approved postcard designs to the university printing services. Th e printing department printed, addressed, and mailed the Denver 1000 postcards for residents and 1000 for profe ssionals. The printing department mailed and distributed the postcards on predetermined dates over a month-long period. A group of 1000 residents in Denver received mailing postcards di rectly to their home address and a group of 1000 professionals in Denver received mailing post cards directly to their employer address. Once the postcard arrived to ei ther the resident or profe ssional, respondents could respond because each postcard had an anonymous onlin e link printed on a postcard mailed from the printing services to either a resident sÂ’ home or profe ssionalsÂ’ office. Direct email invitation from Qualtrics. In addition to the anonymous link printed on a postcard, part of the survey methodology was to use the Qualtrics interf ace to email professional organization contacts directly. The res earcher obtained the Registered Neighborhood

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74 Organization contacts from the City and County of Denver website. Successful emails were sent to Denver neighborhood representati ves inviting locals to participate in th e survey to expand survey participation. Additionally, the email dist ribution list included the 19 current members of the governor-formed Strategic Action Planni ng Group on Aging Built Environment Committee. Lastly, a contact at the Commi ssion on Aging, Office on Aging, A Little Help, Denver City Council and Denver Regional Council of Gove rnments (DRCOG), AIA Find and Architect (Residential Denver Architects), and Denver Certif ied Aging in Place Specialist all received invitations via email. Direct email invitations had eliminated a postcard step (Figure 3.2). Professionals and residents could directly click on the link after receiving the invitation in their mailbox. Figure 3.2. Process to Initiate Survey by Postcard (left) Versus Email Invitation (right). Email timeline . The timeline for both the public and pr ofessional surveys was a period of one month. The researcher distributed emails pr ior to the postcards for both the residents and professional surveys. Distribution of emails o ccurred over a period of four weeks. The first week’s email was an invitation to participate in the survey. The sec ond week’s email was a reminder about participating. No emails were sent the third week. In the fourth week, the researcher sent a “last chance” email. Following the email invitations there was a three-week break. During this time, the researcher addressed technical issues that arose from the postcard Click on Online Survey Manually enter Bitly Link Recieve Postcard Click on Online Survey Email Inbox

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75 method (Table 3.1). First, a preliminary postc ard notified the prospective resident and professional participants of th e survey. One week following the first mailed postcard, a second mailed postcard reminded households and professiona ls to complete the survey. The third week, residents and professionals did not receive post cards. The fourth week a final “last-ditch” postcard encouraged participants to complete the survey before the deadline. The email invitations followed the same process. Due to a technical glitch, the professional email invitations went out two days later than the public email invitations. Response rates . To increase response rates, the Dillman Total Design Survey Method was adapted for the online and postcar d survey (Hoddinott, S. N., & Bass, M. J., 1986). The sampled households and professional firms r eceived three mailings (Table 3.1). Table 3.1 Survey Timeline Week Public Professional Email Postcard Email Postcard First 29-Mar-17 17-May-17 31-Mar-17 17-May-17 Second 5-Apr17 24-May-17 7-Apr17 24-May-17 Third None None None None Fourth 21-Apr-17 7-Jul-17 21-Apr-17 7-Jul-17 Note: Professional emails in the first and second week sent two days after the public emails. Qualtrics has the capability to track if respondents received the survey via the anonymous link printed on the postcards or the direct email invitation link via the Qu altrics interface (Table 3.2). Each individual respondent self -administered his or her survey.

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76 There were 177 resident responses received fr om email and postcard invitations. Out of the 177 survey responses record ed on Qualtrics, 138 reside nt respondents came from the anonymous links printed on postcards. There were 1000 residential postcards mailed out; therefore, resident response rates via postcards were 14%. The remaining 39 resident surveys (out of 177) were the Denver public that received an invitation vi a a direct Qualtrics email list. There were 217 emails sent via Qualtrics; therefore, public re sponse rates via emails were 18%. For the design and construc tion professional, there were 71 total surveys completed via postcards and Qualtrics email invitations. Thirty-two professional surveys came from the anonymous link, so because there were 1000 professional postcards mailed out, the professional response rates via postcards were 3%. The remaining 39 professional surveys (out of 71) were the professionals th at received an invitati on via a direct Qualtr ics email list (AIA residential list or the Certified Aging in Place lis t). There were 210 emails sent via Qualtrics; therefore, professional response rates via postcards were 19%. Table 3.2 Survey Response Rates Comparison: Emails Versus Postcards Residents Professionals Emails 18% (39/217) 19% (39/210) Postcards 14% (138/1000) 3% (32/1000) Combined total 15% (177/1,217) 6% (71/1,210) Note: Percentages rounded to closest whole number. Incentives for response rates . Out of the 177 resident su rvey respondents, 148 (83%) entered the reward for the iPad gift. Out of th e 71 professional survey respondents, 62 (87%) entered for the iPad gift. In order to enter for th e iPad gift, a participant needed to complete the

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77 entire survey. The iPad gift was an incentive fo r participants. In addition to the iPad reward, another element that may have influenced higher email response rates may relate to the survey instrument process (Figure 3.2). The email process participants could dire ctly click on the email and open the survey so it was a two-step proce ss. The postcard was longer – it was a three-step process. Participants needed to find access com puter or smartphone and then manually enter the postcard address into their web browser. Survey Instruments The questionnaires target ol der Denver residents and professionals working in the residential design and constructi on industry in Denver. A review of the literature, participant observation, professional experience, and past surveys conducted in the Denver area informed the survey questions. The researcher-generated in struments asked questions related to awareness and perceptions of accessible housing. The surveys were online and residents and professionals received invitations to participate via a postcar d to their home (residents) or via a postcard to their office (professionals). Description of the sampling strategy, recruitm ent method, and other details are below. Resident surveys . The resident survey has 43 questions . The researcher divided the survey instrument into three sections. The first addr essed universal design ( 14 questions), the second focused on accessory dwelling units (5 questions ), and the third section was the About Me section (24 questions). Universal design survey questions . The first and second reside nt survey questions asked the residents how familiar they were with agi ng in place and how important it was for them to age in place. Questions 3 through 7 investigat ed resident knowledge of universal design principles. Specifically, residents identified whic h features they thought were important, what

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78 features were currently in their home, and e xplain why they did or did not incorporate the features in their homes. The questionnaire includ ed the 25 features identified by Nunn as being those that “best embodied” the seven Principles for Universal Design set by the Center for Universal Design (Nunn, 2003, p. 48). The research er notes, some furniture, fixtures, and equipment will have a performance specificatio n by the architect; however, usually specific products will be submitted to the architect by the contractor for approval, e.g., handheld showerhead. Questions eight through ten asked residents about thei r cost awareness of universal design in retrofit versus new construction. Questions 10 throu gh 15 investigated city policy regarding universal design. Specifi cally, the survey questions aske d residents if City incentives would encourage them to add more universal desi gn features and if so, wh at type of incentives would be most inviting. At the end of the survey , a final question asked whether residents were interested in learning more about universal design. The next resident survey s ection contains ADU questions. Th e first two questions invited residents to respond if they had ever considered incorporating an ADU in their home currently or in the future. If a respondent stated they were interested in construc ting an ADU at any moment in time, the survey directed th e respondent to answer questions regarding the ADU purpose, rent cost, and integration of universal design features in the ADUs. The About Me section of the resident survey examined respondents’ personal features as well as the contextual features of their home and neighborhood. The first two questions asked what city they lived in and length of residency. Questions three through six focused on the neighborhood scale asking responde nts about their length of re sidency, satisfaction with the neighborhood, and their neighborhood’s name and zip code. Questions seven through 12 sought to understand characteristics about the respondent’s homes: length of residency, building

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79 structure type, ownership/rent st atus, square footage size, age of home, and the respondentÂ’s satisfaction with livability in their home as they age. The last 11 questions of the resident survey addressed personal characteristics of the respond ents including gender, age, household situation, marital status, education level, current employment, and income. The professionalsÂ’ survey had 39 questions. The researcher divided the professional survey into the same three sections: universa l design, accessory dwelling units, and an About Me section. The universal design se ction included 18 questions, the ADU section included five, and the About Me section included 13. The first question asked the professionals wh ich industry they were associated with: design or construction. There ar e intentional similarities betw een the public and professional survey questions. Questions 2 and 3 asked in the professional survey seek to understand how familiar professional respondents are with aging in place. Questions 4 through 7 ask professionals to identify what unive rsal design features they feel a senior should have to age in place and whether they use certain they features in their designs. Specifically, the professional survey asked the respondents to select from amo ng the exact 25 features di splayed in the resident survey. The questions probe professionals to stat e why or why not they integrate the universal design features. Questions 8 through 10 are an o pportunity for professionals to identify their knowledge of the financial cost of universal de sign features financial cost. The last four questions of the universal design section addr ess professionalsÂ’ thoughts on potential universal design-related city policies a nd incentives. The last set of questions explore whether professionals would be inclined to add more f eatures if the city pr ovided incentives and why different types of incentives would be appropriate.

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80 The next section block in the professional su rvey contained five questions about ADUs. The first two questions asked if the professional currently inte grates ADUs in their clientsÂ’ homes. The next question sought to learn wh ether City ordinances permit ADUs in more neighborhoods, would the respondent be more likely to encourage their clie nts to build an ADU. The last three questions in the professional ADU section sought to discover the main reasons why clients of professionals build ADUs, the potential rent their clie nt could charge, and if their clients were asking to integrate uni versal design features in ADUs. The About Me section explored the professi onalsÂ’ company structure characteristics as well as their personal characterist ics. The survey inquired about em ployment status , role, history, company size, average home design size, age, an d cost. The survey also tracked respondent demographics including gender, age, di sabilities, and education level. The Qualtrics interface is a secure system that houses the collection and analysis of data online. The researcher used the UniversityÂ’s Qu altrics license to access the Qualtrics software system to create and distribute the surveys onl ine. The researcherÂ’s dissertation committee reviewed the surveys. Twenty-three individuals te sted the pilot survey: 10 homeowners tested the resident survey and 13 desi gn and professionals p iloted the profe ssional survey. The survey also presented the average cost of integrating th e visitability design features in homes to inquire if the public was aware of these costs as seen be low. The author obtained these numbers from the literature and tested them in the pilot study with current exis ting professionals to confirm relevance. In the pilot study 76.1% of professi onal respondents confirmed these costs were accurate. To increase clarity, both surveys were subject to modificati ons. The costs (selected from the research and affirmed/updated in the p ilot study) (Visitability, n. d.) used in the final survey were:

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81 In new construction , the cost of adding a: Zero-step entrance is an average of $200 wide interior doors ways is $50 full bathroom on the main floor is $10,000-$15,000 In retrofitting a home, the cost of adding a: zero-step entrance is an average of $3,000 wide interior doors ways is $700 full bathroom on the main floor is $25,000-$30,000 The researcher submitted both final survey instruments to the Colorado Multiple Institutional Review Board (COMI RB) and received full approval. Statistical Analysis The researcher analyzed the two survey data sets (residents and prof essionals) using the Statistical Package for the Social Sciences (SPSS) version 22. Dependent Variables The researcher measured four dependent vari ables. The first was the general level of awareness that the public and prof essionals had about in regards to aging in place. The second variable was the level of action the public and professionals are exerting towards aging in place preparations. The third variable was cost inform ation regarding preparing for aging in place. The fourth variable was the level of policy support fo r an ordinance relating to aging in place. Table 3.3 shows the codes for the dependent variables.

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82 Table 3.3 Codes for Survey Question Dependent Variables Dependent Variable Survey question Code Value Survey Awareness How familiar are you with aging in place? 1= Not at all familiar 2= Not very familiar 3= Somewhat familiar 4=Very familiar 5=Extremely familiar 1, 2 Action Which of these features do you feel a house must have in order for a senior to age in place in their home? Continuous; 0-25 1, 2 Cost Were you aware it is more expensive to retrofit a home to universal design standards than to buy a home that includes the universal design standards? 0= No 1= Yes 1, 2 Policy 1 Would you like to see more new construction homes in Denver that include universal design features? 0= No 1= Maybe 2= Yes 1, 2 Policy 2 Do you want to learn more about universal design features? 1= Definitely not 2= Probably not 3= Might or might not 4= Probably yes 5= Definitely yes 1, 2 Policy 3 If the city/state provided incentives, would you be interested in adding any universal design features to: (residents) your current home in the future? (professionals) your clientÂ’s new or remodeled home in the future? 0= No 1= Maybe 2= Yes 1, 2 Note: Survey 1= Resident 2= Professional Independent Variables Various independent variables helped to pr ovide a comprehensive overview of the public and professionalsÂ’ understanding of aging in place given other char acteristics. The questions in the residential public survey address specific resi dent characteristics: indi vidual characteristics, house, household, and neighborhood. The individual ch aracteristics questions included variables such as age, gender, education level, employ ment, and disability. The house characteristics

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83 questions included length of occ upancy, homeowner satisfaction, owne rship of home, and size of structure. The household characteristic que stions included total household income. The neighborhood characteristics in cluded variables such as neighborhood name, length of occupancy, neighborhood satisfaction, and zip code. Table 3.4 show s the codes for the independent resident variables. The questions in the professional survey addr ess specific worker characteristics: personal and company. The personal characteristics included variables that identified the professionalÂ’s age, gender, educational level, employment stat us, and disability. The company characteristics included variables that identified the professi onalÂ’s company size, position in company, and years of experience. Table 3.4 shows the codes fo r the independent profes sional variables. The following detailed tables visually organize how the identified va riables were coded. Table 3.4 Codes for Survey Question Independent Variables Independent Variable Survey question Code Value Survey Age What is your age? 1= 18-24 2= 25-34 3= 35-44 4= 45-54 5= 55-64 6= 65-74 7= 75-84 8= 85-94 9=95-104 10= 105 or older 1, 2 Gender What is your gender? 1= Male 2= Female 1, 2

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84 Table 3.4 continued Education What is the highest level of education you have completed? 1= Less than high school degree 2= High school degree or equivalent (e.g., GED) 3= Some college but no degree 4= Associates degree 5= BachelorÂ’s degree 6= Graduate degree 1, 2 Employment Which best de scribes your employment status? 0=Retired 1= Employed part-time 2= Employed full-time 1, 2 Disability Do you have a disability that limits physical activities such as walking, climbing stairs, reaching, lifting, or carrying? 0= No 1= Yes 1, 2 Income What is your approximate annual household income (from all sources)? 1= $0-$24,999 2= $25,000-$49,999 3= $50,000-$74,999 4= $75,000-$99,999 5= $100,000-$124,999 6= $125,000-$149,999 7= $150,000-$174,999 8= $175,000-$199,999 9= $200,000 and up 1 Own/Rent Do you rent or own where you live? 0= Rent 1= Own 1 Aging-inplace Home Satisfaction How would you rate your home as a place for older adults to live as they age? 1= Very poor 2= Poor 3= Average 4= Good 5= Excellent 1 Aging-inplace Neighborhood Satisfaction How would you rate your neighborhood as a place for older adults to live as they age? 1= Very poor 2= Poor 3= Average 4= Good 5= Excellent 1 Company Size What is the size of your company? 1= 1-10 2= 11-50 3= 51-100 4= 101-200 5= 201-500 6= 500+ 2

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85 Table 3.4 continued Position in Company What is your role in th e company? 1= Employee 2= Manager 3= Partner/Owner 2 Years of experience How long have you been practicing in your field? 1= 0-4 years 2= 5-9 years 3= 10-19 years 4= 20-29 years 5= 30+ years 2 Note: Survey, 1= resident 2= professional Quantitative Inferential Statistics In addition to descriptive statistics and cross tabulations , the researcher performed inferential statistical analysis to determine if th ere was any statistical sign ificant to the research questions. Three types of statistical models were used. The first was independent sample t -test. The t -test was used to understand if there was a statistically si gnificant difference between the means of the resident group versus the professi onal group based on level of awareness of aging in place, action (number of universal design and visitability features), cost (awareness with universal design and visitability feature prices) and policy support. The second test performed by the researcher was multiple regression analysis. The researcher conducted the inferential procedure in order to assess five (independent) variables simultane ously in order to predict the (dependent) single outcome variable. Simultaneous entry regression was used; therefore, all predictors were entered at once. The method fo r choosing the variables used was “enter.” The researcher wanted to learn if age, gender, educ ation, employment, and disa bility (separately and combined) predicted the level of awareness, number of features integrated, cost knowledge, and support for policies among resi dents and professionals.

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86 Qualitative Analysis Qualitative resident survey question and codes . The majority of the qualitative comments came from an open-ended question asking resident s to elaborate on what they would like a universal design and visitability ordinance to include. The researcher coded the open-ended questions into four categories: awareness, action, finance, and support. Awareness is associated with education or knowledge remarks. With in the awareness section, comments were subcategorized into: education and list of city approved professionals. Acti on is associated with comments regarding physical features. Within th e action section, comments were subcategorized into: incentives, requirements, ac tivities, and transportation comment s. Cost is associated with monetary policy responses. Within the cost section, comments were subcategorized into: tax, accountability, affordability, and fees. Policy sup port is associated with incentives and clear statements that either oppose or encourage support of a unive rsal design policy. Within the policy support section, comments we re subcategorized into: “yes” (for) or “no” (opposed). The researcher describes the patterns within the categories in the next chapter. Qualitative professional survey question and codes . Just like the residents, the majority of the qualitative comments came from an open-ende d question asking professionals to elaborate on what they would like a universal design and visita bility ordinance to include. The researcher coded the professional open-ended questions into four categories: awaren ess, action, cost, and support for the professionals. The code definiti ons for awareness, action, cost, and policy support are consistent with the definitions given a bove. Within the professional awareness section, comments were subcategorized into: educati on and guidelines. With in the action section, comments were subcategorized in to: time, incentives, requirement s, planning, and transportation comments. Within the cost section, comments were subcategorized into: tax. Within the policy

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87 support section, comments were subcategorized into: “yes” (for) or “no” (opposed). The researcher describes the patterns within the categories in the next chapter. Conclusion In conclusion, the research should improve our understanding of the aging population’s level of preparedness to age in place, while also gauging the perspe ctives of support for universal design and visitability policies to allow for aging in place. This dataset could inform the need to require universal design and visitability in single-family homes and ADUs. The knowledge acquired from the survey would develop ordinances and incentives that influence Denver’s aging in place population. In the futu re, if the city implemented a new design policy, Denver’s aging population could experience the benefits of impr oved, accessible housing and have an increased chance of aging in place successfully. The next chap ter discusses the findings and results of the study.

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88 CHAPTER IV RESULTS The result of the research assesses aging in plac e as it pertains to Denve r. First, the author will present the demographics about the sample for the public (personal, house, household, and neighborhood) and for professionals (personal, work experience). Second, this chapter will describe the results of the main variable categor ies for the public and professionals (awareness, action, finance, and support) regarding the universal design features. To define overall awareness, the author merges level of awareness, number of features the public and professionals have actively integrated in their homes, and informational knowledge about product cost. To define support, the author assesses the public and professional support/opposition for a universal design ordinance notion. Additionally, the author analyzes the types of incentives that can potentially incentivize both public and profession als to integrate univer sal design features. Descriptive Statistics Public survey respondents. The public survey targeted local Denver residents. There were 177 responses generated from the online public survey. The respondents were 55.6% female and 44.3% male. With 33.1 %, the largest age group represented in the survey was 65 to 74. The second largest group to take the survey was 55 to 64 year olds, who represented 29.7% of respondents. Therefore, over 60% of the res pondents were between 55 and 74 years old. A combined 78.9% of the population reported living by themselves ( 25%) or with one other person (53.98%). The survey group was mostly individual s who lived with a person or alone. 65.5% of the respondent group is married. A combined 29.3% self-identified as eith er divorced (13.7%) or never married (15.5%). The majority of the group, specifically 85.2%, self-identified as not

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89 having a physical disability, while 14.77% of the group reported they do ha ve a disability that limits their ability to walk, climb stai rs, reach and lift or carry objects. The sample group is highly educated: 79.5% ha ve obtained an undergraduate or graduate degree. Specifically, 30.6% gradua ted with a bachelor’s degree and 48.8% completed a graduate degree. 20.4% of the entire sa mple group either received a GED, acquired an Associate’s degree, or attended college but did not gradua te with a degree. The sample group was selfdescribed as retired (41.6%), or employed working full-time (41.0%). Similarly, employed working part-time (12.7%), disabled and not able to work (1%), not employed looking for work (2%), or not employed not looking for work (2%). Even though the population was mostly retired or employed full-time (82.6%), the annu al household income varied drastically. The largest income range for the group was $75,000 $99,999 totaling 18.7%. Two different income groups were the second largest: 14.3% of respon dents were in the income range of $100,000 $124,999. The percentage of respondents who re ported the income range $50,000 $74,999 was 14.3%. The survey found 20.0% of respondents earned less than $50,000 while 32.5% make over $125,000 annual income. When asked if the participan ts considered themse lves well off, 60.1% of the population self-declared “yes” while 39.8% of the population selected “no.” Professional survey respondents. Nearly half of the res pondents to the professional survey were in the design pr ofessions (49.3%) such as archit ects, certified aging-in-place specialist, etc. The second-largest industry represented in the survey was the construction industry (25.3%). The number of respondents who categorized themselves in both the design and construction industry totaled 18.3%. Less than 10% (7.04%) of participants labeled themselves as “other.”

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90 The majority of the survey respondents are male at (59.1%) and females at (40.8%). The sampleÂ’s largest age group was 55 to 64 years old (28.1%) of respondents. The second-largest age group was 45-54 years old (21.1%). The thir d-largest age group was 34 to 44 years old (16.9%). With respect to mobility, 94.3% of the part icipants did not have a disability that limited their daily activities. Acco rding to the data set, 4% of the group had a high school education and 15.7% obtained some college education but no degree. Overall, the professional survey respondents are highly educated (e ither college or graduate). For instance, over three-quarters of the sample group have higher education. In fact, 80 % of the groups obtained at least a bachelorÂ’s degree. Furthermore, 42.8% of the group completed a graduate degree. Over 50% of the graduate degrees were Masters of Architecture degrees. There were 94.3% full-time employees. The remaining respondents identified themselves as employed, part-time, or retired. Overall, 30.9% of the professionals have over 30 yearsÂ’ work experience. Of the professionals, 78.9% had at least 10 + years practicing in their industry (Table 4.1). Table 4.1 Demographics Characteristics of Residents/Professionals Descriptive Statistics Variable Residents Professionals Gender n % n % Male 78 44% 42 59% Female 98 56% 29 41% Education level Less than high school degree 0 0% 0 0% High school degree or equivalent (e.g., GED) 4 2% 3 4% Some college but no degree 25 14% 11 16% AssociateÂ’s degree 7 4% 0 0% BachelorÂ’s degree 54 31% 26 37% Graduate degree 86 49% 30 43%

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91 Table 4.1 continued Marital Status Never married 27 16% N/A N/A Not married, living with partner 2 1% N/A N/A Married 114 66% N/A N/A Separated 0 0% N/A N/A Divorced 24 14% N/A N/A Widowed 7 4% N/A N/A Mobility Impairment Impaired 26 15% 4 6% Not Impaired 150 85% 67 94% Employment Employed, working full-time 71 41% 67 94% Employed, working part-time 22 13% 2 3% Not employed, looking for work 4 2% 0 0% Not employed, not looking for work 3 2% 1 1% Retired 72 42% 1 1% Disabled, not able to work 1 1% 0 0% Age 18 to 24 N/A N/A 2 3% 25 to 34 N/A N/A 11 15% 35 to 44 N/A N/A 12 17% 45 to 54 45 26% 15 21% 55 to 64 52 30% 20 28% 65 to 74 58 33% 10 14% 75 to 84 18 10% 1 1% 85 to 94 1 1% 0 0% 95 to 104 1 1% 0 0% 105 or older 0 0% 0 0% Note: No participants were over 105 years old. House, Household, and Ne ighborhood Characteristics Length of occupancy varied among the survey groups (Table 4.2). On a macro scale, a large percentage of the group (38%) have lived in the city of Denver for more than 35 years. On a mezzo scale, 27% of the group have lived in their current neighborhood between 5 to 15 years. On a micro scale, the majority of the group, 30%, have lived in thei r home for more than 5 years, but less than 15 years. The second largest group (23 %) have lived in their home for more than 15

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92 years, but less than 35. More re sidents have spent the longest duration in the city, the second longest duration in their ne ighborhood, and the shortest dur ation in their homes. Table 4.2 Length of Occupancy Comparison Years Home Neighborhood City n % n % n % Less than 1 year 5 3% 5 3% 1 1% More than 1 year but less than 5 years 32 18% 30 17% 21 12% More than 5 years but less than 15 years 52 30% 47 27% 33 19% More than 15 years but less th an 25 years 40 23% 44 25% 29 16% More than 25 years but less than 35 28 16% 25 14% 26 15% 35 years or more 19 11% 25 14% 66 38% Total 176 100% 176 100% 176 100% Note. Missing one respondent response. The survey asked residents to rank their le vel of satisfaction w ith their homes and neighborhoods as a means to aging in place. On a s cale of 1 to 5, with 1 be ing the lowest level of satisfaction and 5 being the highe st. RespondentsÂ’ average level of satisfaction with their home was 2.92 with a standard deviation of 1.11. Their average satisfaction with their neighborhoods was 3.59 with a standard deviation of .99. The num bers suggest that respondents have a higher potential level of satisfaction with their ability to age in place in their neighborhoods than in their specific homes (Table 4.3).

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93 Table 4.3 Level of Satisfaction with Home and Neighborhood as a Place to Age in Place Level of satisfaction Type n M SD Home “age in place” 171 2.92 1.11 Neighborhood 168 3.59 0.99 Note. Minimum and maximum ranking scale: 1-5. The next section in this chapter will a ssess the results of both the resident and professional surveys regarding respondents’ awaren ess, action, cost, and policy support for aging in place. Together, these responses will he lp explain why Denver’s construction/design professionals and residents are no t prepared (or preparing) to ag e in place. The sections below will thoroughly detail the results of survey questions and further address to what extend does the level of awareness, action, cost , and policy support contribute to the lack of preparedness. As coded by the researcher in SPSS, the researcher a ssessed universal design and visitability level of awareness (AWARENESS), integrat ion of features (ACTION), perceived cost (COST), and policy support (SUPPORT) to inform the overall main research question: Why are Denver construction/design professionals and reside nts not prepared to age in place? The author uses the policy-related questions to assess the level of support for po licies expressed by the public and professionals.

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94 Quantitative – Residents and Professional Results Organized by Survey Questions Awareness The first research question is: Is there a statistically significant difference between Denver construction/design professionals’ and resi dents’ levels of awareness regarding aging in place? The awareness section below will analyze the data to discuss how levels of awareness of universal design and visitability differ in Denver’s professionals and resident groups. The section will also compare resident and professional sentiment regarding how important it is to maintain in ones’ neighborhood and live indepe ndently. After, the author will discuss the extent to which the level of awareness contribu tes to the lack of preparedness facing Denver’s aging population. To gauge level of awareness among the public , the survey asked Denver residents to describe their level of familiarity with aging in place. The survey also asked residents to describe how important they felt living independently was and how important they considered it was to remain in their neighborhood as they age. The survey used a Like rt scale where “not at all” represented lowest values and “ex tremely” reflected highest values. The first questions in the survey asked the public to identif y how familiar they are with th e aging in place topic. Out of 177 total responses, a combined 33.4 % consider ed themselves very familiar (19.8%) or extremely familiar (13.6 %). Another 32.8 % of the group determined they considered themselves “somewhat” familiar with aging in pl ace. Ten percent stated, they were “not very familiar” and the remaining 23.7% of the group identif ied themselves as “not at all familiar” with aging in place. Therefore, only one-third of the population considers themselves comfortably familiar with aging in place (Table 4.4).

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95 Table 4.4 Comparison of Level of Familia rity with Aging in Place by Residents and Professionals Residents Professionals Level of Familiarity n n Extremely 24 21 Very 35 9 Somewhat 58 28 Not Very 18 9 Not at all 42 4 Total 177 71 Awareness independent sample t-test . Since both residents and professionals were asked, “How familiar are you with aging in place?” an independent sample t -test was conducted testing the Null Hypothesis, H0: There is no statistically signifi cant difference between level of awareness that Denver residents an d professionals have for aging in place in single-family homes (Table 4.5). The results indicated we can re ject the null hypothesis because there was a significant difference between resi dent and professional groups, t (246) = 3.21, p<.01. (The assumption of homogeneity of variance was assume d and Levine’s Test of Equality of Variances was used.) The results mean there were signifi cantly lower levels of awareness among residents (2.89), compared to professionals (3.48). Although these results are specific to this study and cannot necessarily be generalized to other cities, they are wo rth considering in terms of implications for targeting awareness and educat ion campaigns. Professionals may be more aware because their professional communities are discu ssing these issues, especially the ones in this group who were certified on aging in place. Re sidents do not have the same types of associations, but cities may want to target residents through other ch annels where they do participate.

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96 Table 4.5 Results of Independent Sample t-tests by Re sidents and Professionals: How Familiar Are You with Aging in Place? Outcome Group 95% Confidence Interval of the Mean Difference Resident Professionals M SD n M SD n t df Aware 2.89 1.34 177 3.48 1.21 71 .23, .95 3.21* 246 Note: * p < .05. Likert scale was minimum 1ma ximum 5 (not familiar, extremely familiar) To further understand the differences between the resident and the professional groups, a multiple regression inferential procedure was conducted by the researcher to assess five (independent) variables. Awareness multiple regression resident findings. The SPSS model summary showed R was .210 so R2 = .044. The collection of the predicti ng variables (age, gender, education, employment, disability) for residents accounted for 4.4% of the variance in the outcome of resident familiarity with univers al design. There was a statistically significant value with age in years. The older the person was the hi gher level of awareness they had. Awareness multiple regression professional findings. The SPSS model summary showed R was .364 so R2 = .133. Meaning, the joint in fluence of the variables (age, gender, education, employment, disability) predicted for the single outcome (awareness) accounted for 13.3% of the variance in the outcome of level of professiona l familiarity with universal design (Table 4.6). Again, there was a statistically si gnificant value with age in ye ars. The older the professional was, the higher the level of awareness for universal design.

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97 Table 4.6 Multiple Regression of Joint Predictors (Age, Gender, Education, Employment, and Disability) on Familiarity with Aging in Pla ce for Two Groups: Resi dents and Professionals. Variable B Std. Error t Sig. Residents Age .240 .113 .185 2.12 .036* Gender .280 .208 .104 1.34 .182 Education .071 .090 .060 .786 .433 Employment .114 .161 .059 .706 .481 Disability .120 .305 .032 .395 .694 Professionals Age .224 .111 .271 2.208 .047* Gender .195 .298 .082 .652 .517 Education -.186 .119 -.191 -1.562 .123 Employment -.173 .386 -.051 -.447 .656 Disability .052 .697 .009 .075 .940 Note: *p<.05. Residents df=164, professionals df= 64. Likert scale was minimum 1maximum 5 (Not familiar, extremely familiar) Awareness cross tabulation comparison . The researcher also c onducted a cross tabulation analysis to explore th e differences between age and awareness . As we learned from Table 4.4, the majority of the residents (66%) were between somewhat familiar with aging in place or not at all. Cross tabulation analysis of age and awareness for the reside nts show 44% were 65 and older and 56% were between the ages of 45-64 meani ng the major share of residents were younger older adults. Within the 65 plus groups, 29% were between somewhat familiar with aging in

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98 place or not at all familiar while only 15% we re very, extremely familiar. In the 45-64 age groups, 38% were between somewhat familiar with aging in place or not at all and 18% were very, extremely familiar. Therefore, the data demonstrates the largest share of residents unfamiliar with aging in place are adults in the 45-64 age groups. The cross tabulation directly reemphasizes the previous multiple regression analysis that found older adults are more familiar with aging in place. The researcher notes a nega tively skewed distribution exists because both the residents and professionals in this sample were of older ag e groups. The results may be due to the uneven sample and are not generalizable to the general population. On the other hand, it is logical that younger adults are less familiar with ag ing in place because they mostly likely have not yet encountered age-re lated disabilities or lim itations and have not been forced to learn about aging in place issues. Since preparedness for aging in place takes time and can be more costly to implement in older homes or as remodels, th ese younger adults should be targeted with information about the importanc e of planning in advance. Neighborhood awareness . The first and second question in the public survey asked respondents to identify how importa nt it was to: remain in their neighborhood as they age and be able to live independently in their home as they age. Table 4.7 shows a comparison of the resident averages. Nearly 64% reported it wa s extremely/very importa nt to live in their neighborhoods as they age. The survey elicited an even higher response for living independently in oneÂ’s home as one ages. Nearly all of th e public (93%) reported it was extremely/very important to live independently in their home as they age. Even though the majority of the public acknowledges the importance of remaining in their neighborhood and living independently in their home as they age, as discussed in the pr ior paragraph, only one-third of the group (33%) stated they were extremely/very familiar with aging in place.

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99 The residents have a clear desire to live inde pendently in their homes as they age. Aging in place is a means for resident s to maintain their autonomy. Th e lack of awareness regarding aging in place is contributing to the lack of preparedness for residents. If residents are not familiar with how to age in place, they cannot prep are to age in place. La ter in this section, the author will discuss barriers be tween wanting to live indepe ndently and aging in place. Table 4.7 Level of Importance with Remaining in Your Neighborhood and Living Independently for Residents Neighborhood Live independently Level of importance n % n % Extremely 47 27% 98 55% Very 66 37% 67 38% Somewhat 42 24% 9 5% Not very 16 9% 2 1% Not at all 6 3% 1 1% Total 177 100% 177 100% The researcher posed the same question of familiarity with aging in place to the professionals and the residents. The data shows 42% of professionals ar e “extremely/very” aware of aging in place, which is a significantly larg er portion than the public, of whom 33% reported being “extremely/very” aware. Professionals have more expertise, so it is expected for them to be more informed than the public. However, with le ss than 50% of professionals familiar with aging in place, there is an opportunity for more professionals to be e ducated on aging in place. With respect to living independently, pr ofessional responses parallel public sentiment. The majority of the public (93%) and professiona ls (94%) felt it was “extremel y/very” important to live independently. Therefore, the data found the same disconnect between “importance” and

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100 “familiarity” in both the public and professionals . The majority of professionals feel living independently is important, yet less than 50% are familiar with aging in place. The survey also asked participants how important they felt it is for them to remain in their neighborhood as they age. Similarly, the prof essional survey asked them to specify their perception of how important they perceive it is for a senior to remain in their neighborhood. Although, aging in place includes supports for people’s needs to bot h live independently and stay in their home/neighborhood as long as possible, these two factors were not weighted the same by the public or professionals survey groups. The results show that overall both the public and professionals felt it was slightly more important for a senior to liv e independently than remain in their neighborhood. Furthermore, specifically 81% of professiona l respondents found it “extremely/very” important while only 63.8% of professionals found it “extremely/very” important to remain in one’s neighborhood as people age. Since more than 90% of the respondents to both surveys felt it was “extremely/ very” important for indi viduals to remain in their home, remaining in one’s ne ighborhood is clearly a lower prio rity for residents as well as professionals. Yet, residential respondents were more satisfied with their neighborhoods than their homes, so these results indicate satisfaction with ne ighborhood does not necessarily indicate the location where a reside nt would want to age in place. Overall, awareness with aging in place is low among residents a nd professionals, but significantly lower in younger olde r adults. This lack of aging in place awareness, by both residents and the professionals (who would be hired to help residents) is infiltrating future new construction home designs, contributes to the reside nt’s lack of preparedne ss to age in place. If residents becomes more aware of aging in place, they can start to prepare their homes. If more professionals become familiar with aging in plac e, the knowledge of professional expertise could

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101 potentially be transmitted to their clients. As we know from Lawton’s Environmental Press Competence Model (1973), livi ng independently is a direct outcome of the surrounding environment; therefore, increasing awareness of ag ing in place to prepare residents to age in place could potentially lead to more preparatio ns in an individual’s environment and positively support the ability of peopl e to live independently. In the last chapter, the author will discuss opportunities to educate the public and professionals. Action The second research question is: Is there a statistically significant difference between Denver construction/design professionals’ and re sidents’ levels of ac tion for aging in place (integration of features)? The action section will identify the integration of universal design and visitability features for both residents and profe ssionals, and then discuss the extent to which the level of action contributes to Denver’s lack of preparedness for the agi ng population. In order to do so, the author will identify the top five most important universal design features for both the public and private. The author will also identi fy motives/intensions as to why or why not the features were integrated. This section addresses the act ions of integrating universa l design features in homes. Bothe the residents’ and the prof essionals’ surveys asked the part icipants to identify universal design features that they feel are “must haves” to age in place (Table 4.8). On the residents’ survey, the subsequent questions asked respondent s to identify which f eatures they currently “have” in their homes (Table 4.9). Succeeding these questions, the author inquired as to why or why not the participants had take n that course of action. Understa nding the actual integration of features helps the author assess what actions peop le have taken to prepare to age in place. This section presents the most common features in respondents’ homes and discusses what the

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102 barriers are leading to lack of ac tion to integrate these features in homes today. This information will reveal overall how prepared respondents’ ho mes are to enable them to age in place. Survey questions assessed home integration of universal desi gn and visitability features by the public respondents. In the self-administere d survey, the public iden tified which features they felt a senior “must have” in order to age in place. Each respondent indicated whether the feature was present or not present in their home. During statistical analysis, for each independent 25 items, the absence of a feature was coded “0” versus the presence of a feature, which was coded “1.” The coding system mi mics Nunn’s strategy of dependent variables. The researcher organized the 25 mean scores from highest to lowest. Table 4.8 Universal Design Features “Must Ha ves” Residents Versus Professionals Resident “Must Haves” Professionals “Must Haves” Features Mean SD Mean SD Grab bars in the tub/shower 0.88 0.331 0.9 0.3 One bedroom and full bath on the main floor 0.86 0.349 0.87 0.335 Stair handrails on both sides of the stairs 0.61 0.489 0.72 0.453 One entrance with no steps 0.56 0.497 0.85 0.364 Handheld shower head 0.56 0.498 0.62 0.489 Raised toilet seat 0.55 0.499 0.48 0.503 Lever door hardware 0.53 0.5 0.73 0.446 Under cabinet task lighting 0.49 0.501 0.48 0.503 34” or wider interior doors 0.47 0.501 0.73 0.446 Base cabinets with pull-out shelves 0.46 0.5 0.54 0.502 Microwave oven at counter height 0.46 0.5 0.61 0.492 Lever controls on faucets 0.46 0.5 0.66 0.476 Sink with lever faucet 0.44 0.497 0.63 0.485 Shower with a minimum of 3 × 5 space 0.41 0.493 0.58 0.497 Base cabinets with ‘Lazy-Susan’ shelves 0.39 0.489 0.21 0.411 Adjustable closet rods and shelves 0.37 0.485 0.28 0.453 Anti-scald device on water controls 0.37 0.483 0.54 0.502

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103 Table 4.8 continued Adjustable shelves in wall cabinets 0.36 0.482 0.37 0.485 Rocker light switches 0.33 0.471 0.39 0.492 Light switches 36–44” from floor 0.32 0.466 0.34 0.476 Electrical outlets 18” from floor 0.31 0.464 0.31 0.466 Countertops of varying heights 0.28 0.449 0.34 0.476 Dishwasher elevated off of the floor 0.21 0.412 0.13 0.335 Open-front space below sink 0.2 0.399 0.15 0.364 Removable base cabinets 0.11 0.31 0.17 0.377 Total N=177 N=177 Note: Some furniture, fixtures, and equipment will have a performance specification by the architect, but the contractor can submit speci fic products to the ar chitect for approval. Table 4.9 Universal Design Features Reside nt “Have” Versus “Must Have” Resident “Have” “Must Have” Features Mean SD Mean SD Grab bars in the tub/shower 0.60 0.492 0.86 0.349 One bedroom and full bath on the main floor 0.56 0.498 0.44 0.497 Stair handrails on both sides of the stairs 0.51 0.501 0.46 0.5 One entrance with no steps 0.46 0.5 0.56 0.498 Handheld shower head 0.42 0.496 0.53 0.5 Raised toilet seat 0.38 0.487 0.36 0.482 Lever door hardware 0.38 0.486 0.49 0.501 Under cabinet task lighting 0.36 0.48 0.46 0.5 34” or wider interior doors 0.32 0.469 0.41 0.493 Base cabinets with pull-out shelves 0.32 0.469 0.47 0.501 Microwave oven at counter height 0.32 0.466 0.39 0.489 Lever controls on faucets 0.29 0.457 0.36 0.482 Sink with lever faucet 0.29 0.454 0.32 0.466 Shower with a minimum of 3 × 5 space 0.24 0.43 0.46 0.5 Base cabinets with ‘Lazy-Susan’ shelves 0.24 0.43 0.37 0.485 Adjustable closet rods and shelves 0.22 0.416 0.88 0.331 Anti-scald device on water controls 0.20 0.404 0.55 0.499 Adjustable shelves in wall cabinets 0.18 0.386 0.56 0.497 Rocker light switches 0.15 0.355 0.31 0.464 Light switches 36–44” from floor 0.13 0.337 0.37 0.483 Electrical outlets 18” from floor 0.10 0.295 0.28 0.449

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104 Table 4.9 continued Countertops of varying heights 0.09 0.288 0.2 0.399 Dishwasher elevated off of the floor 0.08 0.279 0.21 0.412 Open-front space below sink 0.08 0.279 0.61 0.489 Removable base cabinets 0.03 0.181 0.11 0.31 Total n=177 n=177 Note: Some furniture, fixtures, and equipment will have a performance specification by the architect, but the contractor can submit speci fic products to the ar chitect for approval. The “must have” items with the top five mean scores ranked by the public were: (1) one bedroom and full bathroom on the main floor; (2) sink with lever faucet; (3) lever door hardware; (4) handheld shower head; (5) rock er light switches. It is notab le that minimum visitability requirements include 32” doorway clearance, a zero-step entrance, and bedroom/bathroom on main floor, yet the residents did not select either one entrance with no steps or 32” doorway clearance as most important f eatures for aging in place. Professionals’ ranking of the top five “mus t have” features for aging in place is significantly different from the residents. The items with the top five means scores ranked by professionals were: (1) grab bars in the tub/s hower; (2) one entrance with no steps; (3) one bedroom and full bathroom on the main floor; (4) lever door hardware; (5) 34” or wider interior doors. Three out of the top five features do ma tch the minimum visitability requirements (32” doorway clearance, zero-step entr ance, and bedroom/bathroom on ma in floor). Thus, the survey informs us that professionals ar e generally aware of the accessibili ty features that are vital to aging in place and the residents may not be aware of these features given their low rankings. Following the “must have” universal design feature question, the survey asked the residents to note which of the 25 universal design and visitability features they currently “have” in their home. Again, the data was coded “0” for the absence of a feature and “1” if the feature was present. The top results were: (1) grab bars in the tub/shower; (2) one bedroom and full bath

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105 on the main floor; (3) stair handrails on both sides of the stairs; (4) one entrance with no steps; (5) handheld showerhead. Table 4.10 compares the public’s top five “must have” universal design and visitability features items for a senior to age in place with the top five “have” universal design and visitability features items re sidents currently has in their homes. The results varied. The two features identi fied on both lists were one bedroom and full bath on the main floor and a handheld showerhead. There were three universal design items that the public deemed “must haves” to age in place yet freque ntly did not “have” in their home. Those items were: (1) grab bars in the tub/shower; (2) stairs handrails on both sides of the stairs; (3) one entrance with no steps. One entrance with no step s is one of the three necessary features to achieve visitability; however, it currently is no t present at most existing public homes. Based on the statistics, the researcher notes grab bars , stair handrails, and one -step entrances are all deemed important for seniors to age in place yet are not pres ent in the sample groups’ homes. This mismatch between features considered “must have” and the physical pres ence of features in homes suggests there may need to be a public polic y or program that encourages the installation of these “must have” features, especially becaus e these features reduce falls and injuries. Since all three of these items are aimed at trip-pre vention (to minimize broken bones among seniors, and other injuries that can remove them from their homes in the short or long term), the researcher recommends the city consider in centives for supporting resi dents to acquire the features. The City might also de velop a list of contra ctors who can install these features where these items can be purchased.

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106 Table 4.10 Comparison of Top Five Resident “Must Have” Universal Design Features Versus “Have” Features Public Feature rank “Must have” n “Have” n 1 – Grab bars in the tub/shower 155 43* 2 – One bedroom and full bath on main floor 152 112 3 – Stair handrails on both sides of the stairs 108 19* 4 – One entrance with no steps 100 35* 5 – Handheld shower head 99 84 Notes: *Not in the top ten “haves.” Action independent sample t-test. Both residents and prof essionals were asked, “ Which of these features do you feel a house must have in orde r for a senior to age in place in their home?” to help determine whether the lack of acti on was more on resident demand or professional personal knowledge and/or advisement of their c lients. To test the difference between groups, an independent sample ttest was conducted. The Null Hypothesis, H0: There is no statistically significant difference between the universal design and visitability featur es Denver residents and professionals determine as “must haves” for agi ng in place in single-family homes. The results indicated we can reject the null hypothesis b ecause there was a significant difference with resident and professional groups, t (151.371) = 2.87, p<.01, with the num ber of features residents and professionals felt a home must have in order for a senior to age in place (Table 4.11). The assumption of homogeneity of variance was not assumed and Levine’s Test of Equality of Variances was not used because Question 2 had si gnificantly different variances (std. deviation professionals=5.9; std. deviation residents=7.02). Therefore, because the group means were not spread out approximately the same amount, the re searcher did not assume homogeneity and used the ttest with a fractional degree of freedom. Th e adjusted 151.37 degrees of freedom was used. With a higher mean (13.72) professionals found a higher amount of features were critical for a

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107 senior to age in place than residents with a mean of (11.17). This is important because the dataset shows resident “must have” beliefs are less in tense than professional beliefs. There is an opportunity to educate resident s on the importance of these f eatures to age in place. Table 4.11 Results of Independent Sample t-tests by Resi dents and Professionals: Wh ich of These Features Do You Feel a House Must Have in Order for a Senior to Age in Place in Their Home? Outcome Group 95% Confidence Interval of the Mean Difference Resident Professionals M SD n M SD n t df Action** 11.17 7.02 177 13.72 5.96 71 .80, 4.27 2.87* 151.37 Note: * p < .05. Continuous scale. **Action variable, equal variances not assumed. Used ttest with adjusted degrees of freedom. Action linear regression. In addition to the independent sample ttest a linear regression analysis was conducted to understand whether the number of features in a home predicted the level of satisfaction of a home as a place to ag e in place. The coefficients show there was a statistical significance with a num ber of features and level of satisfaction (Table 4.12). The results of the regression indica ted the predictor (number of f eatures) explained 16.5% of the variance (R2=.165, F=(1,169)=33.456, p<.001). It was f ound that the number of features significantly predicts the level of satisfaction as a resident home to age in place. The researcher compared the Regression for level of satis faction and number of features graph with Jon Lang’s interpretation of Lawton and Nahemow’s Envi ronmental – Press Competence Model shown in Figure 4.1 in order to highlight the directional association expressed wi thin both graphs. The positive linear graphs for both measures indicates higher numbers of adaptive features increases home satisfaction and is associ ated with higher levels of user competence while reducing

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108 environmental press stressors. As a personÂ’s home environment improves for seniors due to the presence of more aging in place features, the pe rson rates their home as more favorable for aging individuals. The favorable rating indicates they feel supported by the environment and, possibly, more competent. Table 4.12 Regression for Level of Satisfaction and Number of Features Variable B Std. Error t Sig. (p) .099 .017 .407 5.784 p<.001* Note: p<.001 Figure 4.1. Positive Directional Correlation of Jon LangÂ’s Lawton and NahemowÂ’s Environmental Press Competence Model and the Research erÂ’s Graph of Number of Feat ures and Home Satisfaction. Action multiple regression resident findings. Following the linear regression analysis, a multiple regression analysis was conducted ne xt. The SPSS model summary showed R was .328

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109 so R2 = .107. For residents, the collection of the va riables (age, gender, education, employment, disability) predicted 10.7% of the variance in the outcome on the number of features a house “must have” in order age in place (Table 4.13) . There was a statistically significant value difference with gender for residents. For gender, female residents identified higher number of “must have” features in a house than males.The researcher notes, this statistic relates back to the Colorado State Demography Office, which identifi ed households at risk to be single women (Garner, 2017, p.36). Therefore, it is interesting to note that female s are integrating more features than other individuals are. For ability, the presence or lack ther eof of a disability also was statistically significant. The ol der the person was, the more features that person deemed necessary for a home to have in order to suppor t aging in place. Residents with disabilities identified higher number of “must have” features in a house in order for a se nior to age in place in their home than abled-bodies residents. Fo r residents overall, 15 % of respondents had a disability compared to 85% who were able-bodied. Table 4.13 Multiple Regression of Joint Predictor (Age, Gender, Education, Employment, and Disability) on Number of Features a House “Must Have” in Order for Seniors to Age in Place for Two Groups: Residents and Professionals. Variable B Std. Error t Sig. Residents Age -.498 .568 -.074 -.876 .382 Gender 3.476 1.043 .251 3.333 .001* Education -.077 .449 -.013 -.173 .863 Employment .359 .807 .036 .445 .657 Disability 3.643 1.527 .187 2.386 .018*

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110 Table 4.13 continued Professionals Age .500 .589 .118 .849 .399 Gender 1.081 1.571 .090 .688 .494 Education -.630 .630 -.127 -1.001 .320 Employment 2.125 1.963 .137 1.082 .283 Disability -3.069 3.708 -.104 -.828 .411 Note : * p<.05. Residents df=164, profe ssionals df=65. Continuous scale. Action cross tabulation comparison. The researcher ran a cross tabulation analysis to analyze the differences between males and females and the number of features identified. As the demographics previously stated, for the reside nts, 44% were male a nd 56% were females. Female residents identified four times higher number of “must have” features in a house in order for a senior to age in place in their home than males did. More males id entified a fewer number of “must have” features in a house in order for a senior to age in place in their home than males. The researcher theorizes this could also be due to the gender gap in life expectance because females live longer than males (Ginter & Simko, 2013). There was also a statistical significant difference between disability impairments predicting which universal design features a resident perceived to be the most important for seniors to age in place. There were 85% of re sident respondents who did not have a disability while, 15% of resident respondents identified ha ving a disability. Of the 26 residents with disabilities, 53% had 15 or more f eatures in their home, while 46% had 14 features or less. When these numbers were compared with the 150 ab le-bodied resident respondents, 28% had 15 features and up while 72% able -bodied respondents had 14 featur es or less. Based on the

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111 statistics, disabled residents identified a higher number of “must have” features in a house in order for a senior to age in place in their home than abled-bodied residents. Based on the statistics, more abled-bodied residents identifie d a fewer number of “must have” features in a house in order for a senior to age in place in th eir home than males. Based on the statistics, the researcher notes that both disabled and ablebodied individuals incor porate universal design features. As the State Demogr aphy Office projects, an estima ted three-quart ers (69%) of Coloradoans will have a disability (permeant or temporary) at some point (Garner, 2017a, p. 33). Therefore, the researcher recommends increase d education for both able-bodied and disabled individuals. Why residents integrate . Following the inferential statis tics about the universal design and visitability features in their home, the su rvey asked the residents respondents to describe why they chose to integrate those features in to their home. Respondents listed convenience, safety, and independence to be the driving fact ors of universal design feature integration in homes. Specifically, the results showed 27.2% of resident survey respondents cited the number one reason why they have incorporated universal design and visitability features into their home is “for convenience.” The sec ond reason reported is to increase safety (16%). The third mostcommon (15%) reason given for integrating univers al design and visitability is to increase independence. Figure 4.2 shows the distribution of 65+ year olds in Denver. The grey dots on the map show the number of universal design featur es respondents have in their homes, designated by neighborhoods. The map does not take into account other factors such as the year the house was built. It is notable that the majority of th e design features are located in neighborhoods with greater senior population. It is not clear from this study why seniors who live in communities with higher shares of seniors te nd to have more features, but it could be that they are sharing

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112 information with their neighbors, who are also seni ors. This potential asso ciation is a topic for further research. Alternatively, they could ha ve bought homes from other seniors who had already installed these features. Figure 4.2. American Community Survey 2011-2015. Denver Ag e 65+ Distribution. Number of features by neighborhood. Map made possible using CARTO – a Location Intelligence Software. Why professionals integrate . Mimicking the public survey, the professional survey also asked professionals to describe why they integrat e universal design and vis itability features in their client’s homes. The result s show the number one reason prof essionals integrate the features is to increase safety (67.6%) for their clients. The second and third reason s are to increase client independence (66.2%) and for clients to age in place longer (64.8%). The fourth reason is for

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113 convenience (50%) and the fifth r eason is that “my clients request ed” (38%) the se rvice. The low demand from the residents further identified by the professionals fu rther enhances the data that only 33% of the public feel “extremely/very” fa miliar with aging in place. The conclusion section will further address this topic. Why not integrate . In addition to identifying the reside nts’ and profession als’ reasons for integrating universal design and visi tability features in their (and their clients’) homes, the survey also provides insight into why th e residents and professionals did not integrate features in their homes/clients’ homes. As reported by the resi dent survey, the top three reasons for not integrating universal design features in their homes are lack of need, expensive costs, and lack of awareness (Table 4.14). The first reason identifi ed by 50.71% of the residents was a perceived lack of need for universal design and visitabi lity features. The majority of the residents respondents stated that they are ab le-bodied and do not need the feat ures. This leads the author to ask if the public is not prepared to age in place largely because they do not perceive themselves to be aging. The second reason gi ven is that 14.18% of the resi dent respondents deemed the features too expensive. The thir d reason is that 11.35% of the pub lic was not aware of universal design. Lastly, 7% of the survey sample group st ated they did not want to include universal design and visitability features in their home in order to avoid changing their home’s appearance. Overall, the results show the majority of peopl e are not including universal design features in their homes because they believe they are “not needed” or “too expensive.” The researcher views these reasons as potential barriers to integrati ng universal design features in homes. Further, because the topics are different, the information needs to be tailored to each reason. Both require more education, but in some cases, the City may n eed to take steps to help lower or subsidize costs.

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114 Table 4.14 Reasons for Residents Not Inte grating Features into Home Public Barrier Reasons n % I am able-bodied and don’t n eed the features now 143 51% It is too expensive 40 14% I am not aware of universal design 32 11% Other 26 9% I don't want to change my home appearance 21 7% I am not interested 18 6% I have a misconception of the cost 2 1% Total 282 100% Comments of “other” included some responde nts who further described limitations. The first imitation described was re nting. Two comments related to rent. “I do not own my home,” and “I rent!” Another limitation was lack of opt ions. One resident stated, “Features not offered when we built our home.” Another comment further elaborated on the cost issues. “Many of these items cannot be added inexpensively afte r construction has stopped, including electrical upgrades and door widths and shower sizing.” One resident stated some items are “too expensive” and another “unable to afford the cost of the changes at this time.” A linear regression analysis was conducted to understand if reside nt rent/ownership predicted the number of f eatures in a resident’s home. Ninety-two percent of the residents own their own homes, while 7.9% re nt. The results of the regression indicated the predictor (rent/own) explained 1.3 % of the variance (R2=.013, F= (1,175)= 2.33, sign .129). Although not statistically significant at a .1 leve l, the results at .129 are close. Based on the statistics for this survey, no statistical si gnificance was found with the (predict or) rent/own and the (dependent variable) number of features in a resident’s home. The survey sample size was small and more research should be conducted with a larger sa mple size to re-investig ate this relationship.

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115 The professionals who do not integrate the un iversal design features in their clientsÂ’ homes selected three main reasons that parallel with the resident Â’s lack of feature integration. The first reason selected by 5% of professionals (explaining why th eir clients are not interested in integrating features) is that their clients are able-bodied an d do not need the features. The second reason selected by 5% of pr ofessionals (explaining why their clients are not interested in the features) is that their clients lack interest. Lack of interest from the residents to integrate universal design and visitability features in their homes may be related to the lack of resident familiarity regarding universal design previously found in the data. The third reason 2% of professionals feel their clientsÂ’ do not integrate universal design or visitability features in their homes is because the features are too expensive. The conclusion chapter will discuss the need for professionals to educate the re sidents on the benefits of unive rsal design and visitability to support aging in place. A linear regression analysis was conducted to understand if ye ars of professional experience predicted the number of features in a residentÂ’s home . Average years of experience of professionals was in the range of 10-19 years. The results of the regression indicated the predictor (years of e xperience) explained 3.3% of the variance (R2=.013, F=(1,69)= 2.34, sign .129). No statistical significance was found with the (predictor) ye ars of professional experience and the (dependent variable) number of features in a residentÂ’s home. Overall, the survey data presents two ways action differs between residents and professionals. Based on the survey results, action differs between the residents and professionals for integrating features by importance and intentions . First, professionals ar e well aware that the visitability features are important because they address the primary issue of access. Access into the home is critical -a zero-step entrance can prevent falls. However, the residents did not

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116 include visitability features in th eir top five features, which indicat es to the researcher there is a need to educate the public on the importance of the visitability features. Th e data shows residents and professionals differ regarding action because their intentions are different. The public wants to take action and integrate features because features are convenient, while the number one reason professionals integrate un iversal design features is beca use of safety. However, even though there is a difference in reasons for implementing universal de sign between the residents and professionals, both groups iden tified the same reasons for not integrating features in their or their client homes: they are able-bodied so th e features are not needed. The notion of “not needing” the features is directly contributing to the lack of prep aredness to age in place. The idea relates to the attitudes previously discussed in the literature that ne gative views on aging can contribute to an unwillingness to integrate adaptive behaviors in an individual’s environment (Bennett & Eckman, 1973). The stat istics suggest the residents a nd professionals are satisfied with residents’ abled-bodied cu rrent situation and not taking acti on to prepare their homes to age in place. The questions asked and methods used in this study does not provide enough information on the other unmeasured factors, su ch as number of people living in the home, age of home, etc. that could have pl ayed a role into why features ar e or are not being integrated.. The conclusion chapter will recommend when people shoul d start to prepare to age in place and why. Cost The third research question is: Is there a statistically si gnificant difference between Denver construction/design professi onals’ and residents’ levels of cost information for aging in place? The cost section below will analyze how in formed the residents and professionals are regarding cost associated with new construction and remodels. Afte r, the author will address the extent that cost contributes to the lack of preparedness f acing Denver’s aging population.

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117 The survey further investigated the residentÂ’s awareness of the visitability features (e.g., one zero-step entrance, doors with 32 inches of clear passage space, and bathroom and bedroom on the main floor). The main three universal de sign features known as visitability include the main zero-step entrance, wide interior doorwa ys, and full bathroom on main floor. Kochera determined it is more expensive to retrofit hom es to visitability standards than create new construction homes with visitability included (20 02, p.13). The survey asked residents if, overall, they were aware that retrofitting was more expe nsive than new constructi on. More than half of the resident respondents (68.4%) stated they were aware it is more expensive to retrofit a home to include visitability than purchase a newly constructed home with visitability. A higher percentage of professionals are aware of the cost when compared to the public. Slightly less than 87.3% of professional respondents reported stated th at they are aware of the cost. Again, we see that more professionals are awar e of cost than the public. This comes as no surprise because professionals have more expertise. Over half of both the residents and th e professionals in this survey are aware that it is more expensive to retrofit homes than in itially purchasing a new construction with integrated features. As discussed in the methodology, in the pilo t study, 76.1% of prof essional respondents confirmed the visitability cost used in the survey were accurate. In the survey, professionals were 89% aware of cost and the resident survey results show that 68% of the re sidents are aware of the average cost comparison (Table 4.15). Based on th e statistics, we can de termine the public is aware that it is more expensive to retrofit a home versus purchasing a newly constructed home. However, the survey did not ask specific ques tions about the prices of individual features. Therefore, the research cannot determine from th e survey how informed the public is with the average cost of adding visitabil ity features. More research in the future could communicate the

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118 cost of individual features to the survey responde nts to determine how actual cost information (of specific features) may change their responses. In this case, their responses for or against installing features could be due to an under or over estimate of what respondents think the costs actually are. The responses in this survey we re not constrained by (specific universal design item) costs or budgets. Moreover, as noted above, resident responde ntsÂ’ second-most often-stated barrier to having universal design features is the expe nse; 14% of the resi dents state that the features are too expensive. No t understanding the true cost can misinform the publicÂ’s decisionmaking on aging in place. The research suggests the public is in need of visitability cost education. Table 4.15 Resident and Professional Cost Awareness of Universal Design Features Home Retrofit Cost Versus New Construction Cost Residents Professionals Cost Aware n % n % Yes 121 68% 62 89% No 56 32% 8 11% Total 177 100 70 100 Based on the statistics, this means professionals have a sl ightly higher cost awareness than residents. Regardless of the differences f ound in the survey, both groups are well-informed about the big concept of retrofit versus new construction. These results do not mean that residents are well-informed about the specific cost of items. In f act, as identified earlier in the Action section, the second determined barrier for aging in place for the residents is because of expenses. The idea that aging in place is expensiv e may be slightly contributing to peopleÂ’s lack of preparedness. The researcher recommends more research to be conducted to determine how informed residents are about the individual cost of items.

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119 Support The fourth research question is: Is there a statistically si gnificant difference between Denver construction/design professionals’ and resi dents’ levels of policy support for aging in place?The section below discusses policy suppor t from the resident and professional perspective. The survey dedicate d five questions to exploring pot ential universal design policy content, incentives, and overall interest. After, the author addresses the extent that support contributes to the lack of preparedness f acing Denver’s aging population. The survey also included both quantitative and qualitative questions to capture a comprehensive overview of public and professional opinion that the author will discuss in the following section. Policy 1. Following the cost-related finance questions presented above, the professionals’ survey gauged professional interest regarding un iversal design features in new construction and existing homes in Denver. To begin, 80.3% of professionals support more integration of universal design features in new construction homes (Table 4.16). Table 4.16 Level of Support that Denver Residents and Professionals Have for Universal Design in New Construction Single-Family Homes: Woul d You Like to See More New Construction Homes in Denver that Include Universal Design Features? Residents Professionals Support n n Total No 11 1 12 Maybe 45 13 58 Yes 121 57 178 Total 171 71 248 Policy 1 independent sample t-test . Both residents and prof essionals were asked: “ Would you like to see more new construction homes in De nver that include univ ersal design features?” An independent sample t -test was conducted testing the Null Hypothesis, H0: There is no statistically significant differen ce between the level of support (see more) that Denver residents

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120 and professionals have for univers al design in new construction si ngle-family homes. The results indicated we can reject the null hypothesis b ecause there was a significant difference with resident and professional groups, t (246) = 2.12, p<.05. Based on th e statistics, although both groups are supportive, mo re professionals ( M =1.79) want to see more new construction homes in Denver that include universal de sign features than residents ( M =1.62) (Table 4.17). The assumption of homogeneity of variance was assume d and LevineÂ’s Test of Equality of Variances was used. Table 4.17 Results of Independent Sample t-tests by Re sidents and Professionals: Would You Like To See More New Construction Homes in Denver that Include Universal Design Features? Outcome Group 95% Confidence Interval of the Mean Difference Resident Professionals M SD n M SD n t df Policy: see more 1.62 .60 177 1.79 .46 71 .01, .32 2.12* 246 Note: * p < .05. Responses: no/maybe/yes (low to high). Multiple regression resident findings. The model summary showed R was .303 so R2 = .092. The joint variables accounted for 9.2% of the variance in the outcome of residents wanting to see more new construction homes in Denver th at include universal design features. Based on the statistics from this survey sample, there is a statistically significant difference with gender and level of support for universal design in new construction homes in Denver for residents. Multiple regression professional findings . The same outcome was found for professionals. The model summary showed R was .329 so R2 = .109. The joint variables accounted for 10.9% of the variance in the outcom e of professionals wanting to see more new

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121 construction homes in Denver that include unive rsal design features (T able 4.18). Again, there was a statistically significant value with gender. Based on the statistics from this survey sample, there is a statistically significant difference wi th gender and level of s upport for universal design in new construction homes in Denver for professionals. Table 4.18 Multiple Regression of Joint Predictors (Age, Gender, Education, Employment, and Disability) on More New Construction Homes in Denver that Include Universal Design Features. Variable B Std. Error t Sig. Residents Age .094 .050 .159 1.860 .065 Gender .335 .092 .276 3.631 .000** Education .030 .040 .057 .766 .445 Employment .013 .071 .015 .177 .860 Disability .019 .135 .011 .141 .888 Professionals Age .025 .043 .078 .575 .567 Gender .283 .115 .314 2.458 .017* Education -.042 .046 -.115 -.928 .357 Employment .061 .149 .051 .410 .683 Disability .159 .269 .072 .590 .557 Note : p < .05*, p < .001** Residents df=164, profe ssionals df= 64. Responses: No/Maybe/Yes (Low to high). Awareness cross tabulation comparison. There was a statistical significant difference between gender predicting level of universa l design support for new construction homes. The

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122 researcher ran a cross tabulati on analysis to further understand the differences between males and females support and opposition. For the residents, 4% of females and 9% of males stated opposition for universal design features in ne w construction. However, regarding “maybe” responses versus “yes” respons es the percentages were more unbalanced between the groups. More males were indecisive with their decisi on at 36% nearly doubling the 16% of females in the “maybe” category. Regarding the full support “yes” category, 80% of women support new construction homes in Denver that include universal design features, which is significantly larger than the males at 55%. A statistical significance was found also with gender in pr ofessionals for integrating more universal design features in new construction ho mes. Opposition was very low with two percent of men opposed while 0 percent of females we re opposed. Similar to the resident gender percentages again, more males were indecisive wi th their decision at 26% more than tripling the 7% of females in the “maybe” category. When it came to support, 93% of female professionals supported more new construction homes with univers al design features compared to the 71% of males who stated “yes.” Based on the statis tics from the survey sample, the researcher recommends gender be a point of considerati on for marketing awareness to residents and professionals. Gender was significan t on research question two as we ll. It is unclear from this study why females were more supportive. It may be due to the reason previously discussed regarding female awareness of living longer, et c. However, there may be other reasons that should be explored. Even though the data shows, residents a nd professionals are op en to supporting a universal design policy for new construction homes, th e survey did not inquire at what price. For example, the survey did not measure what moneta ry value would people be willing to pay for a

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123 universal design policy. Similar to the discus sion on costs above: respondents may respond positively to a survey question when the actual (u niversal design item) cost is not revealed, but change their opinion when they are shown the act ual cost. Further resear ch should be conducted to explore how much people would be willing to pay. Policy 2 . Furthermore, if the City provided in centives, 73.2% of professionals stated “yes” and 23.9% “maybe” that they would be mo re interested in integrating universal design features in a client’s new or existing home (Table 4.19). The data shows there is demand from the professionals to integrate un iversal design features in newl y constructed homes. The results were different when assessing personal resident homes. Table 4.19 Level of Interest that Denver Residents and Professionals Have for Integrating Universal Design in Single-Family Homes if the City Provides Incentives: If the City/State Provided Incentives, Would You Be Interested in Adding Any Universal Design Features to: (Residents) Your Current Home in the Futu re? (Professionals) Your Client's New or Remodeled Home in the Future? Residents Professionals Integration n n Total No 16 2 18 Maybe 82 17 99 Yes 79 52 131 Total 177 71 248 As previously noted, when assessing the residents, nearly 70% of the respondents (68.4%) stated they would like to see more inte gration of universal de sign features in new construction (Table 4.16). However, the data show s there is less demand from the same resident respondents to integrate universal design in their existing personal homes than in new construction homes. Even with the notion of c ity-provided incentives, onl y 44.6% of the resident respondents responded “yes” to adding the features to their existing homes ; 46.3% residents were

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124 indecisive “maybe” concerning th eir personal home property (Table 4.19). Ninety percent of the population would “yes/maybe” consider adding unive rsal design features in their current home. Resident opposition to universal design feature integration is lo w -less than 10% (9.04%) for both new construction and existi ng homes were opposed to addi ng the features (Table 4.19). There is an opportunity for prof essionals to educate and inform the 46.4% of “maybes” in the public through public awareness ca mpaigns to educate people on th e topic (Maisel, J., Smith, E., & Steinfeld, E., 2008, p. 26). An increase in aw areness or education may potentially sway resident opinion to hold more deci sive “yes” or “no” responses. In total, there is more public hesitation of universal design inte gration in a resident’s personal home than in a random newly constructed home. The residents’ weariness could be contributi ng to the lack of preparedness Denver is experiencing. Policy 2 independent sample t-test . Both residents and prof essionals were asked “ If the city/state provided in centives, would you be interested in adding any universal design features to: (residents) your current home in the future? (professionals) your client's new or remodeled home in the future?” To test for differences in their responses, an independent sample t -test was conducted to test theNull Hypothesis, H0: There is no statistically significant difference between the level of interest for adding features that Denver residents and professionals have for integrating universal design in single-family home s if the city provides incentives. (Table 4.20). Based on the statistics, the researcher can re ject the null hypothesis because there was a significant difference with resi dent and professional groups, t (246) = 4.07, p<.001; more professionals were motivated by incentives than residents were. The a ssumption of homogeneity of variance was assumed and Levine’s Test of Equality of Variances was used.

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125 Table 4.20 Results of Independent Sample t-tests by Reside nts and Professionals: If th e City/State Provided Incentives, Would You Be Interested in Adding Any Universal Design Features to: (Residents) Your Current Home in the Future? (Professionals) Your Client's New or Remodeled Home in the Future? Outcome Group 95% Confidence Interval of the Mean Difference Resident Professionals M SD n M SD n t df Policy: incentive 1.36 .64 177 1.70 .518 71 .18, .51 4.07* 246 Note: * p < .001. Responses: No/Maybe/Yes (Low to high). Multiple regression professional findings. The model summary showed R was .172 so R2 = .030. Altogether, the joint vari ables accounted for 3% of the variance in the outcome of professionals being incentivized to add more universal design feat ures in their client’s new or remodeled home in the future (Table 4.21). A cross tabulation analys is revealed of the professionals, 73% were working full-time and fr om the full-time group, 98% selected “yes” for incentives. Table 4.21 Multiple Regression of Joint Predictors (Age, Gender, Education, Employment, and Disability) on If the City/State Provided Incen tives, Would You Be Interested in Adding Any Universal Design Features to: (Residents) Your Current Home in the Future? (Professionals) Your Client's New or Remodeled Home in the Future? Variable B Std. Error t Sig. Residents Age -.047 .055 -.076 -.857 .393 Gender .154 .101 .120 1.530 .128 Education -.019 .043 -.034 -.445 .657

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126 Table 4.21 continued Employment -.05 .078 -.006 .069 .945 Disability .175 .147 .097 1.190 .236 Professionals Age -.029 .049 -.079 -.597 .553 Gender .158 .131 .151 1.209 .231 Education -.002 .052 -.006 -.046 .963 Employment .379 .169 .270 2.241 .028* Disability .319 .306 .125 1.044 .301 Note: p < .05*, p < .001** Residents df=164, profe ssionals df= 64. Responses: no/maybe/yes (low to high). Resident preferences for incentive types . Next in the section, the researcher will present the types of universal design incentives preferred by the residents. Listed in order of frequency are the residentsÂ’ preferred incentives: cash rebates, tax credit, streamlined permitting, fee waivers, and universal design building certi fication. The number one supported resident incentive was cash rebates (64.9%), while the second most popular incentive was tax credits (58.7%). Both top priorities are associated with monetary values. Streamline permitting was the third most popular item with 50% of the resident sÂ’ interest. The streamline permitting incentive is associated with time. The last priority determined by the public was a universal design building certification. Professional preferences for incentive types. The resident incentives described above almost identically matched the professionalÂ’s incentive order. The first incentive desired by 57.7% of professionals was tax credit. The second incentive de sired by 53.5% of professionals

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127 was cash rebates. The third incentive desire d by 53.5% of professi onals was streamline permitting. All top three favored incentives relate to money and time. The least favored incentives designated by professionals are f ee waivers (45.1%) and universal design building certifications (38%). Based on the statistics, both the residents and professionals place high importance on monetary incentives. It is more im portant for both the resi dent and professionals to have tax credits or cash rebates versus a universal design build certificate for the project. Professionals may prefer the tax credit since it w ould not have tax implications as a cash rebate may. However, the tax credit may not be useful fo r someone who is retired, unless it might be a property tax credit. Understanding both the resident and professi onal primary incentive interest helps to inform potential city/state policy content in the future. Policy 3 . Overall, resident interest to learn more about accessi ble housing is evident. The survey determined a combined population of 46.3% of the public populati on is interested in learning more about universal design features in the future (Table 4.22). Additionally, 29.4% of the public is also “maybe” interested in learni ng more. Based on the stat istics, there is demand from the residents to learn more about universal design. Professionals’ inte rest in learning more are slightly stronger than the public’s inte rest. Fifty-nine percent of professionals “definitely/probably” want to l earn more about universal desig n, while another 21% are “maybe” interested in learning more. As the data demons trates, there is an openne ss from professionals and the residents to learn more about universal design and specifi cally explore integrating more universal design features in newly constructed ho mes. The next chapter will address avenues for educating the public to increase universal desi gn education from an action, cost, and policy support perspective.

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128 Table 4.22 Level of Interest that Denver Residents and Professionals Have for Learning More About Universal Design in Single-Family Homes: Do You Want To Learn More About Universal Design Features? Residents Professionals Level of interest n n Total Definitely note 9 2 11 Probably not 34 12 46 Might or might not 52 15 67 Probably yes 53 15 68 Definitely yes 29 27 56 Total 177 71 248 Policy 3 independent sample t-test . Both residents and prof essionals were asked, “ Do you want to learn more about universal design features?” An independent sample t -test was conducted to test the Null Hypothesis, H0: There is no statistically significant difference between the level of interest that Denver re sidents and professionals have for learning more about universal design in single-family homes. (Table 4.23). Based on the statistic s, we can reject the null hypothesis because there was a significant diffe rence with resident and professional groups, t (246) = 2.57, p<.01. More professionals ( M =3.75) want to learn mo re about universal design features in single-family homes than do residents ( M =3.33).The mean for both groups was higher than the median, which suggest most responde nts want to learn more The assumption of homogeneity of variance was assumed and Levine ’s Test of Equality of Variances was used.

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129 Table 4.23 Results of Independent Sample t-tests by Resi dents and Professionals: Do You Want To Learn More About Universal Design Features? Outcome Group 95% Confidence Interval of the Mean Difference Resident Professionals M SD n M SD n t df Policy: learn 3.33 1.11 177 3.75 1.22 71 .09, .73 2.57* 246 Note: * p < .05. Likert scale was mini mum 1-maximum 5 (low to high). Multiple regression resident findings. The model summary showed R was .262 so R2 = .069. The joint variables predicted 6. 9% of the variance in the out come of residents wanting to learn more about universal design features. A cross-tabulation analys is revealed of the residents, 100% of the individuals with disabilities want to learn mo re, while 75% of able-bodied individuals want to learn more (Table 4.24). Motivation is importa nt for a desire to learn. For professionals, it may be so that they can please thei r clients, or gain more clients, and thus more revenue. For persons with disabilities, it may be so that they can improve their quality of life and their physical competence while in their home. Respondents are motivated for different reasons, but the majority want to collectively learn more. Table 4.24 Multiple Regression of Joint Predictors (Age, Gender, Education, Employment, and Disability) on Residents and Professionals Wan ting To Learn More About Universal Design Features. Variable B Std. Error t Sig. Residents Age .052 .094 .048 .556 .579 Gender .226 .172 .102 1.317 .190

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130 Table 4.24 continued Education .031 .074 .032 .416 .678 Employment .126 .133 .079 .950 .343 Disability .623 .251 .200 2.477 .014* Professionals Age .085 .118 .100 .722 .473 Gender .549 .319 .224 1.719 .090 Education -.122 .127 -.122 -.962 .339 Employment .392 .413 .120 .949 .346 Disability -.310 .746 .-052 -.416 .679 Note : p < .05*, p < .001** Residents df=164, profe ssionals df= 64. Responses: no/maybe/yes (low to high). In addition to residents and professionals identifying their policy support and preferred incentives, the survey asked residents to detail additional elements they would like a city/state universal design policy to include. The next se ction will discuss in detail what survey participates described as possible content to include in a universal design policy in the future. Support (qualitative) In this section, the researcher will present th e content of the reside ntsÂ’ responses to the question: What could a potential Denver universal design policy include? Awareness ResidentsÂ’ responses about awareness . The first section is awareness. Within the awareness category for the residents, there were two large patterns: education and informing the public services via authorized item lists. An ove rwhelming portion of the residents emphasized a

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131 need to educate city resident s about universal design overall.The first large pattern discovered in the awareness category was the need for educati on. There were nine comments that related to education. There is a clear call from the resident s to inform and educate the city residents on universal design. The residents suggest some sort of awareness program that can identify specific examples. One respondent stated, “the most productive would be an awareness program, especially for new homes and communities. With Colorado’s population increasingly aging, financial aid for retrofitting homes for low income seniors will definitely be needed.” Another resident suggested using “publicity for succes sful examples of universal design. Include information about how the owner’s life is and w ill be different because of universal design, i.e., stay out of assisted liv ing and its exorbitant costs, lack of privacy, etc.” to educate homeowners on benefits to live in their home longer. Anothe r comment related to e ducation suggests an increase in “education on how to do it and potent ial return on invest.” The residents desire educational information explaining the impact of universal design on homes. One resident respondent’s comment suggests, “might consid er having ‘navigators’ – who are educated, licensed, bonded, etc. to assist se niors in the process. It is ch allenging and intimidating to know what, how, and fair market cost to do any remode l, especially for senior s and/or singles.” The idea of “navigators” licensed individuals could rea lly help educate seniors. Currently, there are in fact aging-in-place specialists from the National Association of Home Builders (NAHB). There is a clear need to inform the city resident s of the aging-in-place specialist programs. The second large pattern discovered in the awareness category was the need for an approved “list.” Nine resident comments rela ted to generated lists as a source to find information. The resident respondent s suggest there could be a vetti ng process in place to inform citizens of reputable contractor referrals. Specif ically stating “perhaps referrals for contractors

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132 who have passed some sort of vetting requirement s and continue recertification.” The residents suggest the “list” could distingu ish not only contractors but also products that the public can choose from to help guide thei r process of integrating universal design. One comment stated a “list of approved products and designs and pric e ranges from which to choose" would help because it would “eliminate the need to do a lo t of footwork to check out the products at numerous locations.” Another comment suggested “a list of approved cont ractors that meet the city/state requirements for installation” because “as we age more people tend to take advantage of us.” There is a fear from the resident responden ts that professionals wi ll try to take advantage of seniors. There is a clear need from the reside nt respondents to have id entified contractors that are already certified or approved by an established organization or program. The notion from the residents is that a list can help to identify a pproved contractors that will perform efficiently and be cost effective. Professionals’ responses about awareness . Professionals too encouraged the need of more awareness regarding universal design. Ther e were six comments re garding education and two comments suggesting educatio n guidelines for professionals. One professional’s comment on education suggested “information sessions fo r homebuyers and homebuilders to inform the public of the benefits.” The potential strategy could increase education within both parties. Another professional commented about educatio n and supported the need to educate both the public and professionals. The comment suggested , “the universal design city policy should include instructional/informationa l seminars and resources to he lp educate the industry and the public about the benefits of universal design. This information should also pay special attention to interior materials – including how they can help prevent slip/fall injuries, assist visually impaired individuals with depth perception and na vigation etc.” to help educate the industry and

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133 the public about the benefits of universal de sign. Another comment suggested, “increased education and awareness, incl uding testimonials that woul d help convince clients of marketability.” Another professional comment encouraged “adequate education material available for client education.” Two comments directly discuss a universal policy should have more “design guidelines and suggestions” and a second suggested “guidance on features to add which are prioritized.” There is a need to disperse material to both profes sionals and residents to share knowledge regarding universal design. As th e qualitative information demonstrates, there is a demand for more education for both the professional and the resi dents about universal design. The conclusion section will discuss avenues to determine what content could be shared and by whom. Action Action from residents . The second coded section was action. Within the action category for residents, there were two s ubcategories: incentives and requi rements. Two comments related to incentives for policies shows support from resi dents for builders to re ceive incentives to incorporate the universal design policy in new residential cons truction. One comment specially encourages that professionals are incentivized to become universal design specialists to increase the customer confidence in the legitimacy of the universal design process. Residents positively responded to the notion of professionals having incentives to integrate universal design and visitability features in single-family homes. Re sidents also encourage the universal design policy to have clear requirements. In total, there were four comments about requirements. One comment suggests a form of enforcing the universal design policy is by “incorporati ng [it] into base code for new buildings.” If the city incorporates a universal design po licy into the base code for new buildings, the city could verify that contractor meets the cr iterion for universal design with

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134 licensure. Another resident comment suggests defining a “basic minimum universal design on all new homes.” Another resident comments that a potential policy should “clearly state requirements/guidelines with a summary of list fo r quick reference.” Three incentives comments related to action were code d supporting incentives. One comment suggested, “provide developers, builders, realtors with incentives to become aging-in-place/universal design specialists. The idea would be to provide clients/customers with confidence in design, building, retrofitting, and associated costs.” Another co mment suggested the incentives should go to “builders/developers to incor porate in new residential constr uction.” Residents also included examples of features that should be inco rporated in a universal design policy. Action from professionals . Within the professional ac tion category, there were three subcategories: time, requirements, and incentives. In the action subcategory for the professionals, there were three comments associated with universal design policy and time. A professional survey respondent suggested ha ving a universal design policy that allowed for “faster approval” processes. Faster approval proc esses could be used as motivation to integrate more universal design features. Another professional’s comment suggested, “design a gu ideline checklist to qualify for streamlined permitting; ‘point system’ similar to LEED (so hopefully we don’t have to do multi-height counters in every house).” The researcher found a guideline checklist already exist for neighborhood development planning. The respondent referenced a “point system” similar to Leadership in Energy and Environmen tal Design (LEED). In fact, there is a point credit on the latest version of LEED, but it is specific to de velopers building neighborhoods. The intent of the credit is to “i ncrease the proportion of areas usab le by a wide spectrum of people, regardless of age or ability” (LEED, 2018, p. 48). The program was introduced in 2007 in the Pilot Version for LEED for the Neighborhood Development Rating System. Recently, on

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135 January 5, 2018 the version was updated. As it stands , developers can obtain a project point with new dwellings when they: design a minimum of 20% of new dwelling units (but not less than one dwelling unit per type)in accordance w ith ICC A117.1 Type C, Visitable Unit, for each of the following residential building types: detached single-dwel ling units buildings; attached single-dwelling unit buildings; a nd buildings with two or three dwelling units.(p. 48) According to the requirements, each unit must have a kitchen, living area, bedroom, and full bath on an accessible level. Developers also have a chance to integrate universal design and visitability “for multiunit buildings with four or more dwelling units. Developers must “design a minimum of 20% of the units (but not less than one) to meet the requirements of one of the following options. This category includes mixeduse buildings with dw elling units” (p. 48). The Neighborhood Plan Development credit fo r visitability and universal design is structured by universal desi gn features integrations in the home, kitchen, bedroom, and bathroom. In order to obtain a point for Option 1) Universal Design Features Throughout the Home , the developer must include: throughout the home, at least five of the following universal design features (p. 48): • easy-to-grip level door handles; • easy-to-grip cabinet a nd drawer loop handles; • easy-to-grip locking mechanisms on doors and windows; • easy-to-grip single-le ver faucet handles; • easy-touch rocker or hands-free switches;

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136 • motion-detector lighting at en trance, in hallways and st airwells, and in closets; and motion-detector light switches in garages, utility spaces, and basements; • large, high-contrast print for controls , signals, and the house or unit numbers; • a built-in shelf, bench, or table with kn ee space below, located outside the entry door with weather protection overhead, such as porch or stoop with roof, awning, or other overhead covering; • a minimum 32-inch (80-centimeter) clear door opening width for all doorways; • tread at the entrance, on stairs, and othe r areas where slipping is common, with color contrast difference between stair treads and risers; and • interior floor surfaces (e.g., low-pile carpe ts, hard-surface flooring) that provide easy passage for a wheelchair or walker, with color contrast between floor surfaces and trim; no carpet is permitted in a kitchen, bathroom, or other wet areas of the dwelling unit. In order to obtain a point for Option 2) Kitchen Features, the developer must include (on the main floor of the home or any another floor, if an elevator or stair lift is provided), a kitchen with hard-surface flooring, plumbing with singlelevel controls, a 5-foot (1.5 meter) turning radius, and at least four of the follo wing universal design features (p.48): • variable-height (28-to 42-inch [70-to 110-centimeter]) or adjustable work surfaces, such as countertops, sinks, and cooktops; • clear knee space under sink and cooktops (this requirement can be met by installing removable base cabinets or fo ld-back or self-storing doors), cooktops

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137 and ranges with front or side-mounted controls, and wall-mounted ovens at a height to accommodate a seated adult; • a toe kick area at the base of lower cabi nets with a minimum height of 9 inches (23 centimeters), and full-extension draw ers and shelves in at least half (by volume) of the cabinets; • contrasting color treatm ent between countertops, front edges, and floor; • adjustable-height shelves in wall cabin ets; and glare-free task lighting. In order to obtain a point for Option 3) Bedroom and Bathroom Features, the developer must include on the main floor of the building (or on another floor, if an elevator or stair lift is provided, all the following (p. 48): In at least one accessible bedroom, • Size the room to accommodate a twin bed w ith a 5-foot (1.5 meter) turning radius around the bed. • Install a clothes closet with a 32-inch (80-centimet er) clear opening with adjustable-height closet rod and shelves (p. 49). In at least one full bathroom on the same floor as the bedroom: • Provide adequate maneuvering space with a 30-by-48 inch (75-by-120 centimeter) clear floor space at each fixture. • Center the toilet 18 inches ( 45 centimeters) from any side wall, cabinet, or tub, and allow a 3-foot (90-centimer ter) clear space in front. • Install broad blocking in walls around toilet, tub and/or shower for future placement and relocation of grab bars.

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138 • Provide knee space under the lavatory (this requirement many be met by installing removable base cabinets or fold -back or self-storing doors). • Install a long mirror whose bottom is no more than 36 inches (90 centimeters) above the finished floor and whose t op is at least 72 inches (180) high. In addition, all bathrooms must have hard-s urface flooring, all pl umbing fixtures must have single-lever controls, and tubs or shower must have handheld showerheads (p. 49). The requirements for the visitability and universal design LEED is a great resource for current examples of desired content that could go in a potential Denver or Colorado universal design visitability ordinance. Another respondent describes aging in place as a process that “can allow for similar changes over time.” The respondent provided an example that demonstrates “proper blocking can allow for easy future installation.” For in stance, installing blocking (wood pieces installed between wall studs to provide support for mount ed attachments) in new construction bathrooms would be a fast and easy solution to prepari ng for residents to age in place. Blocking would allow for easier remodeling in bathrooms to integr ate grab bars. The upfront cost with material, labor and time to the contactor is not significant and the benefits to the resident down the road are significant. The conclusion section w ill further discuss the topic of blocking. The second action subcategory for the profe ssionals was requirem ents. Just like the residents, professionals want to see clear requirements. Seve n comments addressed universal design policy requirements. These professionals wanted to see “clear standards on what constitutes a universal design residential bu ilding.” Specifically, two comments address individual units. One respondent identified having mandatory visitability minimums for dwelling units. Another comment suggests there could be set “percentages of units to be required” in the

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139 universal design policy for professional project s, e.g., 5% (1 out of 20 homes) will include universal design visitability features. Ther e were two comments that addressed where responsibility for the requirements should lie. One-comment states there should be “requirement for certified age-in-place c ontractors to remodel/retrofit existing homes.” While another comment suggested “only use Certified Aging in Place Professionals or Certified Living in Place Professionals in [the] design pr ocess.” A professional survey re spondent suggested there could be a “general description of specifications th at meet Universal design requirements.” That specific individual further suggests there could be a “designation that could be attached to the property or to a deed” if the home meets the unive rsal design requirements as a means to identify the home. Property deeds are legal instruments that can transfer a person’s estate to another party. The researcher suggests attaching unive rsal design to a property deed may not be appropriate because if the home design was altered in any form it would not be reflected in the deed. The comments from both the professionals and the public reveal there is a strong desire to have clear requirements regardi ng any universal design certifi cate. The author will propose requirements and responsibil ity in the conclusion. Two comments in the action section referen ced incentives. One prof essional respondent suggested, “dropping ADA visitability rules and opt for a program to reward builders for age-inplace design.” Another comment encour aged “ADA compliance incentives, as ADA accommodations are common with many aging in place accommodations.” It is important to note, ADA regulations are part of our United Stat es national laws so a ll public buildings and privately funded buildings must abide by them. Th ere is a need to educate both the public and professionals on accessibility laws, as well as their limitations since they do not apply to residential single-family homes. Starting with a strong foundation of knowledge will allow for a

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140 clear distinction betw een what is law and what could become future laws or incentives regarding universal design. Cost Cost information from residents . Cost is the third coded category in the qualitative responses. The researcher discovered four overarc hing patterns in the finance section: taxes, accountability, affordability, and fees based on 12 resident comments within the survey. Regarding taxes, four separate comments showed there were three schools of thought supporting new taxes, opposing new taxes, and reevaluating existing taxes. One resident comment suggested there should be “no additional taxes” associated with this program. One resident comment encouraged “tax credits or re bates for kitchen redesigns.” An other notion in support of taxes suggests a “reduction in taxes for those who need it” specifically suggesting a “sliding pay scale” tax system. Lastly, one public comment suggest s reevaluating current tax exemptions. The respondent’s comment referenced Denver’s propert y tax exemption for citizens who are 65 years or older. The Senior Citizen Tax Exemption is av ailable to people 65 and older who have lived in their home at least 10 years prior to applying. Fr om their point of view , the tax “discourages people from any type of move, even to a mo re accessible living situation by only giving a tax break if you lived in your home at least 10 year s.” The resident’s comment suggests a change could encourage people to be in the place that best meets their needs as they age. There are actually four existing property tax exemptions for older ad ults in Denver (Table 4.25). Understanding the requirements of each tax is important so the public fully understands their options. There was only one open-ended prof essional comment regarding finances. A professional suggests allowing “a tax credit for remodeling.” A tax credit for professionals to

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141 remodel homes to include universal design coul d encourage more profe ssionals to support the aging population. Table 4.25 Tax Rebates Available for Seniors in the City and County of Denver Tax Name Tax Description Property Tax/Rent/Heat Credit This rebate assists with property tax, rent, or heat expenses for elderly or people with disabilities who are Colorado renters and home owners who meet the following criteria: Colorado residents; and have total income of less than $12,953 (or $17,460 for a couple); and age 65 or older; surviving spouse at least 58 years old; disabled of any age receiving benefits for the full year. Senior and Disabled Veterans Property Tax Exemptions A property tax exemption is available for seniors who: Have owned their home and occupied the property as their primary residence for the last 10 consecutive years or more; and are age 65 or older (or are a su rviving spouse of a previously qualified senior) Refunds to Denver Seniors/People with Disabilities A partial refund of property taxes, or the equivalent in rent, is available to Denver home owners who: Reside in the City and County of Denver and own his/her home and pay property taxes or rent on his/her home; a nd age 65 or older or a person with a disabili ty; and have total income of $15,900 or less ($23,000 for couples).

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142 Table 4.25 continued Property Tax Deferral for Seniors/Active Military Personnel This program helps military personnel and seniors afford to live in their home by deferring the payment of their property taxes: Colorado resident who has owned his/her home and whose property taxes from previous years are paid in full; and age 65 or older; and if the property has a mortgage, the mortgage lender must agree to place the State of Colorado in first position on the lien. Note: Information retrieved from Denver’s Office on Aging Another coded cost subcategory was acc ountability (three comments). The survey respondents revealed they would like to see more builder accountability. One comment specifically suggested that builder s be financially accountable for the “quality of the home for at least 10 years.” Another comment suggested, “fines [be] accessed by the City for those contractors who violate safety c odes and do shoddy work.” As it stands now, if a contractor does not pass an inspection, they would have to pay a re-inspection fee. As noted by the City and County of Denver, building code associated f ees are typically “$100.00 per hour of inspection” with minimum of two hours. (CPD, 2017, p.3) The last comments suggested “mechanisms for pre and post construction verifica tions [so] the contactor and work meet the criterion for Universal Design, is licensed a nd bonded.” Therefore, some resi dents suggest potentially fining contractors and holding them to a higher financial accountability to deter construction mistakes. In addition to cost accountability, cost affo rdability was another category the residents determined should be a consideration for a universal design policy. The finance section subcategorized four comments regarding affo rdability. One comment proposes, “low interest loans for seniors.” Low-interest loans may encour age more seniors to purchase homes; therefore, there should be future studies of senior lowinterest loans. Another comment suggested ranch homes to be reasonably priced. Both new construction and existi ng ranch style homes include all

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143 essential living necessitates on the main floor and are ideal settings for seniors to age in place. The third comment encouraged cheaper “home retro” options. Making home renovations more affordable for seniors would encourage seniors to age in their homes as l ong as possible. The last comment states the government c ould set up “housing that is affo rdable for the seniors” with hospice so seniors can feel like they are “home a nd not in a nursing home.” All comments relate to cost affordability policy considerations. Cost information from professionals. There was a professional comment that spoke on cost issues. The respondent suggested a potential universal design and visitability ordinance to “allow a tax credit for remodeling.” Policy Policy for residents . Policy was the last coded cate gory reviewed in the qualitative question. Four comments clearly stated if they were opposed or supporti ve of universal design policies. One survey response stated they had a clear statement in support of universal design. There were three comments that advocated against universal design becoming a city policy. The statements specifically stated they would not like to see universal design mandates from government. It is important to note, although there were three qualitative resident comments not in support of the ordinance, the qua ntitative questions in the survey showed 68% of the residents stated they wanted to see more new constructio n homes in Denver with universal design features. Additionally, 90% of reside nts stated if the city provided incen tives, they would be interested in adding features to their current home.

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144 Policy for professionals . There were four comments rela ted to policy support. All four comments were opposed to the notion. The first comment suggested to “let the market drive universal design. City needs to focus on other mo re important policy issues.” A second comment doubted the policy need stating, “I don’t know that there should be such a policy, I’d rather have universal design presented as a best proactive or something like th at. I say this because it’s hard enough obtaining building permits and getting insp ections as it is.” The third comment noted, “these are good ideas” but suggested to “encour age the builder community to offer them as options.” The last comment suggested not manda ting universal design on “all new development.” It is important to note, although there were f our qualitative professional comments not in support of the ordinance, the quantitative questions in the survey showed 80% of the professionals stated they wanted to see more new construction homes in Denver with universal design features. Additionally, 97% of professionals stated if the city provided incentives, they would add features to their client’s new or remodeled home design. Hypothesis Testing Between the Gro ups (Residents and Professionals) Results Overall Why are Denver construction/design professiona ls and residents not prepared to age in place? Is there a statistically significant difference between Denver construction/design professionals’ and residents’ levels of agingin-place awareness, action, cost information, and policy support? What could a potential Denver universal design policy include? Research into the questions above found ther e was a lack of resident and professional awareness and action that is c ontributing to Denver not being prepared to age in place.Based on Lawton and Nahemow's ecological model, the res earcher asserts that the low levels in the

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145 outcome variables (awareness and action) lead to a decrease in preparedness. The researcher found there is support from residents and professi onals to create univers al design policy. More research should be done to determine at what cost would the public and pr ivate sectors be willing to support a policy. Chapter 5, Conclusion, will make recommendations to the SAPGA with respect to new construction home policy and po licies applied to remodeling existing homes.

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146 CHAPTER V CONCLUSION There are three sections within the conclusi on chapter. The first section will summarize main points identified in the results chapter. Th e main points are associated with the awareness, action, cost, and policy support categories. Th e second section will propose recommendation considerations as a direct response to the main points. The author will propose final building code and policy recommendations for both exis ting remodels and new construction. Education and marketing is a blanket recommendation that covers both home remodel and new construction strategies to increase awareness. In the third section, the author will present possibilities for expanding the future research of universal design. Findings Overview When reassessing the original research que stions: (a) why are Denver residents and construction/design professionals not prepared to age in place; (b) is there a statistically significant difference between Denver construction/d esign professionalsÂ’ and residentsÂ’ levels of aging-in-place awareness, action, and cost information; and (c ) what could a potential Denver universal design policy include; the study has pr ovided enlightening information on DenverÂ’s current state regarding aging in place. In the resident group, the researcher surveyed a diverse group of resi dents with different age, gender, education, employment status, and abilities/ disabilities. Additiona lly, the researcher surveyed professionals who work in home cons truction and are competent about varying trends affecting their consumer base, e.g., aging. Docu menting the statistically significant differences between the resident and professional groups is important for informing policy. The

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147 professionals seem knowledgeable and willing but may need more prompts and incentives to integrate universal design and visitability feat ures, while the residents are slightly/moderately informed but need more information, educati on, and advice so they can physically (and mentally) prepare to age in place. This dic hotomy also suggests some home improvements may need to be regulated since the residents may not pay for them ot herwise. The resident results showed larger hesitation with modifying their own homes; therefore, it would be best to construct the features into new construction now, e.g., the bathroom backing for grab bars and zero-step entrances. The professional results showed professionals support incentive policy programs for universal design and visitability in new construction homes. Yet, as previously noted, the research did not measure at what co st professionals would support a tax increase to fund a policy e.g. how much money would they be willing to pay for a universal design policy. The support for aging in place by Colorado citizen s in new construction homes validates the need to establish regulations. This study realized the established framewo rk of Lawton and Nahemow’s Environmental Press Competence Model described the “person-e nvironment fit” or “adaptive” theory, as the process of environmental effects becoming more prominent and difficult for an individual to control as their physical and cogni tive abilities decline due to ag ing. The model stated there was a best line of fit where the zones of maximu m comfort and performance potential occur. A person adapting their environment maintains th eir autonomy and comfort. The survey data showed this model to be true. The regression model in Table 4.11 te sted the association of level of satisfaction of the home as a place to age in pl ace and the number of feat ures in the home. The predictor variable (number of f eatures) was statistically significan t to the outcome (level of a satisfaction of the residents’ home to age in place) emphasizing the eco logy of aging model.

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148 Based on the statistical outcome, this directly reemphasizes the theory of the Environmental Press Competence Model. The lack of awareness, action, cost, and policy is contributing to DenverÂ’s current lack of preparedness by way of residents not preparing their homes to be age-ready and professionals not encouraging or inserting age in place ready homes in the market. Po licy can create structure and incentives to establish and regulate change within Denver. As demonstrated in the results chapter, the surveys brings to light many insightf ul points regarding aging in place in Denver. In this section, the author will highlight key factors within each category. The first category was awareness. In the aw areness category, the researcher learned the majority of residents and professionals find it critically important to live independently. The researcher also learned less than 50% of professi onals and the residents are familiar with aging in place. The literature tells us aging in place s upports living independently. Therefore, in Denver we can see there is a clear disconnect; if people l ack knowledge to age in place, they are not fully preparing to live independently. The second main point found in the research is related to the action category. Residents and professionals identified what actions they we re taking to prepare to age in place. Both residents and professionals detail ed what features they integrat ed in their homes. The groups ranked the top features that were most important. In doing so, the su rvey revealed critical insight with the outcome. We now know professionals designate visitability features as highly important. The residents, however, did not. Visitabili ty features are critical because they provide safe access in and around the home, which s upports home autonomy. More awareness of visitability specifically is crucial. The number one recommendation is to integrate visitability

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149 requirements into new construction homes. The researcher will further discuss the recommendation later in the chapter. The researcher notes both the residents and professionals supported universal design feature requirements in new construction homes. However, they were wary when it came to remodeling their own homes. The research sugg ests the number one reason for hesitation to aging in place on behalf of the residents is b ecause they considered themselves “able-bodied” and did not need the features yet. The “not needed” mentality is preventing people from beginning the aging in place process. A solution is needed to educat e people about the benefits of aging in place little by little. The earlier an indi vidual starts, the more prepared they will be. If the goal is to live in their home as long as po ssible, starting the universal process early will benefit all people living in the home during any ph ase of their life. Recommendation number two is to develop a campaign to educate the public on aging in place preparations. The campaign will empower the public and begin aging in pl ace dialogue. The researcher will discuss recommendation two later in the chapter. Cost misinformation was the third key tak eaway from the survey. The cost section clarifies overall resident and pr ofessional knowledge rega rding cost of aging in place. The data shows both the residents and professionals are aware it is more expensive to retrofit a home than to design and build a new construction home with integrated unive rsal design features. Professionals are aware of cost associated with visitability to age in place. While, the residents determined the second barrier to aging in place is price. The residents stat ed the features are “too expensive.” The researcher recommends future studi es include the cost asso ciated with specific items to help understand what cost informati on the residents have on specific items and how their answers may change gi ve the actual costs.

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150 Findings Recommendations In the previous section, the re searcher listed three recommen dations as a response to the main findings: (a) increase preparation knowledge; (b) integrate visitability; (c) increase cost knowledge. In the follow section, strategized recommendations for executing an awareness education campaign for home re novations and a policy ordinance for new construction homes is detailed. Awareness is a means to increase public and professional knowledge on preparing existing homes to age in place. The awareness campaign can operate through the lens of education (increase information) and as a conduit to connect people to services either digitally online or physically in person. In addition to an education campaign, the researcher suggests consideration of a new construc tion policy such as zero-step en trances and bathroom blocking. A policy focused on new construction homes can secure a future home market with homes prepared to age in place. Renovation – (past) The first recommendation is an education campaign. The campaign can materialize in several forms. The first can be an online campaign. There is a clear desire for residents to have a list of city-approved contractors to contact for aging in place se rvices and features. A website specific to Denver and aging in place would solve this issue and benefit the aging population. On Denver’s Office of Aging website, an existing Older Adults Resource Directory includes a document developed by The Denver Commission on Aging, which specifies a list of companies to contact regarding aging issues. The docum ent is comprehensive and includes contacts regarding several aging issues su ch as nutrition and meals, tran sportation, healthcare, and many more topics. The document has a very small “R epairs & Maintenance” section. The document includes six company names and phone numbers of businesses that can perform repair and

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151 maintenance. The researcher commends the inte ntion behind the document. The list responds to the qualitative survey comments s uggesting a list. However, the re searcher recommends there be a more high-profile list. The reside nts in the survey were not aware there is already a list of this nature. The list should be in a live format with active online links and on its own dedicated website so it will be easier to find. A live docum ent would ensure the presentation of the most accurate information presented. As more comp anies develop, the Denver Commission on Aging could vet and update the list. Within the time in which this study was c onducted, a website specifi cally addressing this notion emerged. The platform stems from Denver City Council and Denv er Regional Council of GovernmentsÂ’ (DRCOG) Area Agency on Agi ng, the federally designated Area Agency on Aging for a portion of the Denver metro region (DRCOG, 2018), DRCOG has a newly developed, in-depth live network of care website. The website successfully details home repairs, modifications and accessibility issues. Company contact information is on the website with active links connecting residents to the professionalsÂ’ individu al websites. The Office on Aging could link to the DRCOGÂ’s new Network of Care . DRCOG launched the in ternet-based Network of Care in 2009 as a community resource for seni ors. Trilogy, a company based in California, runs the software. The site www.networkofcare .org shows various module options for cities, states, and countries to utili ze. The site has real-time live updates. There is an e-library, education tool and a service directory that pr ovides senior information on assistive devices, health care, disability resources, accessible hom e construction and much more. Both education and a directory are the demands that the resident s were commenting about in their responses. The problem is people do not know of the resource. Not once were these resources mentioned in the survey. The residents were not aware of the ne w resource and direct e fforts should promote the

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152 internet engine. To promote the online platform, other form s of advertising should be utilized/established/etc. The education campaign can operate via social media, local advertising commercials, and ads in local print magazines. The researcher recommends the education campaign should be targeted to platforms people in the target age range use. Increased awareness of the resource efforts would help direct users to the local site. A website that is easily accessible or city hosted information sessions in local municipal buildings such as neighborhood libra ries can begin to educate resi dents on how they can prepare. Home improvement retail stores such as Ho me Depot may even consider hosting Saturday morning informational sessions on aging in place to help residents iden tify what product will best support aging in place. Additio nally, the city and local stores could jointly create events to educate the residents of short-term improve ments and more long-term permanent ones. New Construction – (fut ure: building codes) A new construction policy related to unive rsal design building codes can implement home design and construction changes in the fu ture. The section below will suggest key points for a potential policy. The comments of both profe ssionals and the public ha ve helped to identify the key points, but both were mixed or hesitant on having a regulation or strict policy because of property rights, government interventions, costs, etc. The section will also recommend the organization best fit to advocate the tasks. The re searcher will also address issues on marketing and education with respec t to new construction. At the root of aging in place is aging. Respondents need to understand why these features are essential and how the features will support th eir aging. The researcher recommends the City provide education on overall aging in additi on to universal design feature information.

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153 Understanding the impact and importance of the uni versal design features on aging will then lead people to care more about how and where th ey can obtain universal design features. The majority of both professionals and th e residents are open to a new construction policy for aging in place. As discussed in the qualitative policy support se ction for both residents and professionals, there is str ong support to integrate universa l design in newly constructed homes. As noted in the previous section, near ly 70% of the population (68.4%) would like to see more new construction homes with universal design features. Add itionally, 80% of the professionals support adding universal design in new construction homes. There was little opposition to the notion. Less than 10% of both the residents and professionals opposed the concept. However, the city should conduct a full investigation and analysis of past policies to identify various options for them. If a policy we re drafted feedback from both the residents and professionals emphasized the need to be very cl ear about the requirements. The researcher notes it is very important to distinguish between unive rsal design and visitabilit y. The researcher also recommends, based on the resident and profession al feedback, a new cons truction policy must be very clear with requirements. The policy could integrate both universal design and visitability aspects. Below are the features that both the re sidents and professionals identified as import to age in place. These features can become requireme nts for in a future universal design policy. The researcher suggests the requirements in a policy can include the top features determined by both residents and professionals: zero-step entrance bedroom and bathroom on main floor grab bars level door hardware

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154 stair handrails on both sides handheld shower A future policy could include the six items above as potential requirements. The number one feature on both the resident s and professionals was grab bars. Although a vital safety features, there are esthetic and emotional reserva tions to implementing grab bars that can deter residents from wanting to place them in their home s. This explains why the residents listed them as the most important; however, when asked if th ey were installed in peopleÂ’s homes, grab bars did not even make the top 10 lis t. As a solution, at a minimum, I recommend that grab bar blocking be a requirement for all single-family home bathrooms. Proper blocking (constructed behind the walls and unnoticed to users) allows for future easier , faster grab bar installments. Architecture firms are only required to include grab bars for multi-family homes under the guidelines of ANSI and ADA. Typically, firms are including the grab bars if the clients have accessibility issues and make the request to their architect. In addition to grab bars, there is a clear de mand from the residents to integrate zero-step entrance homes in new construction. In fact, integration of one zero-step entrances into a new construction home was one of the top three items for both residents and professionals (behind grab bars, and a bedroom and bathroom on main floor). The researcher recommends a policy for homes to have at least one zero-step entrance in to the home. In conclusion, the public supports a universal design policy that encourages developers , architects, and contra ctors to invest, design, and build universal design featur es in new construction homes. To summarize, at a minimum, the researcher recommends all new single-family homes to integrate grab blocking in all bathrooms and a minimum of one zero-ste p entrance into the home. If the city imposes a policy for

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155 developers, architects, and cont ractors to include homes with new features, it will begin to change the options in the housing market for homebuyers. Future Studies Future studies can build on the knowledge obtained in this dissertation. There are opportunities to conduct more research in seve ral areas. The residents are encouraging a universal design policy for new construction. A policy would dire ctly influence professionals. There is an opportunity to interv iew professionals to obtain a more in-depth perception of their thoughts on a universal design policy. The interview could discuss if professionals have more detailed preferences for policy re quirements. That would allow pr ofessionals to identify further what would be the impact (posi tive or negative) if they were required to implement a policy. The researcher did not conduct in-p erson interviews or focus groups with the professionals or the residents. Second, the researcher collected all an alysis by way of online survey response to the open-ended and closed-ended quest ions. The interview and the in terviewer can establish rapport to make the interviewers feel at ease. In-per son interviews and focus groups would allow the interviewer to ask follow-up questions to th e interviewee. This would provide further clarification on the subject matter. Additionally, with regard to demographics, future studies can target a larger sample size in order to explore different population groupsÂ’ preferences. For instance, single female homeowners with a permanent or temporary disa bility who are living in their home longer may have a higher level of awarene ss of accessibility concepts th an do males and women who have never experienced a disability. A future finding could be that female level of awareness may increase when they deal with a past or current disability or outlive their male partners. These participants may also have a higher standard of awareness of the build ing costs and time. The

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156 study may show that individuals with a higher understanding of accessibility may be more willing to support universal design and visitability policies than others are. Or, more research may show that residents with a higher level of awareness may be more willing to integrate universal design features in thei r home if the city provides in centives to do so. They may be aware of the concepts but need support and encouragement to comm it to the installation of such features. Conclusion The researcher circles back to The Stra tegic Action Planning Group on Aging (SAPGA), which continues to have conversations about the needs of Colorado’s aging population. SAPGA invites the public to “Conversations on Aging” m eetings and sends out ne wsletters to recap and promote progress. As previously detailed, during th e time the researcher did the current research, the group determined eight major goals for the state. Goal 1 is that Colorado seniors will be able to live and fully participate in their commun ities of choice for as long as possible . Under the goal, there are seven specific outcomes and sp ecifications. One of the seven outcomes under consideration is that: Building codes will meet the needs of an aging population, with universal design as the standard to: (1) pr omote universal design standa rds and include them in local building codes; (2) educate the public on the bene fits of universal design; (3) create incentives for developers and c ontractors to use universal design. (SAPGA, 2016, p.14) The SAPGA group held their first legisla tive caucus on aging in January 2018. The results of this survey respond to the outcomes identified by SAPGA. Based on the findings of

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157 this survey, Denver can better understand the current state of universal design research of residents and professionals. Th e SAPGA group should look into the results of this study to help inform their future decisions. Overall, whether it be preparing an old home or focusing on new homes, there are a myriad of opportunities to integrate aging in place within our Denver communities. By minimizing barriers and constraints, the physical anatomy of built environments can offer spaces that are more congruent for i ndividuals (Denhardt & Denhardt, 2010). Education and marketing influences mindset, which is vital to creating change. The public needs to understand aging in place so they can make decisions on what level th ey would like to engage. If the public demands aging in place, that will put pr essure on professionals to underst and and supply the market with homes that have the features.

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