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Local and Regional Governments and Age-Friendly Communities: A Case Study of the San Francisco Bay Area Amanda J. Lehning PhD
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University of Maryland , Baltimore , Maryland , USA Accepted author version posted online: 22 Nov 2013.Published online: 27 Jan 2014.
To cite this article: Amanda J. Lehning PhD (2014) Local and Regional Governments and Age-Friendly Communities: A Case Study of the San Francisco Bay Area, Journal of Aging & Social Policy, 26:1-2, 102-116, DOI: 10.1080/08959420.2014.854140 To link to this article: http://dx.doi.org/10.1080/08959420.2014.854140
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Journal of Aging & Social Policy, 26:102–116, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 0895-9420 print/1545-0821 online DOI: 10.1080/08959420.2014.854140
Local and Regional Governments and Age-Friendly Communities: A Case Study of the San Francisco Bay Area AMANDA J. LEHNING, PhD Downloaded by [Umeå University Library] at 02:57 13 November 2014
Assistant Professor, University of Maryland, Baltimore, Maryland, USA
The purpose of this study was to assess the extent to which cities, county departments of adult and aging services, county transportation authorities, and public transit agencies in the San Francisco Bay Area have in place age-friendly policies, programs, and infrastructure in the areas of community design, housing, transportation, health care and supportive services, and opportunities for community engagement. The most common age-friendly features include those that target alternative forms of mobility (for example, incentives for mixed-use neighborhoods and changes to improve the accessibility of public transit), while the least common policies and programs are those that aim to help older adults continue driving, such as driver education programs, driver assessment programs, and slow-moving vehicle ordinances. The article concludes with policy and research implications of these findings. KEYWORDS aging in place, local government, social policy
INTRODUCTION In recent years, a number of initiatives, including the World Health Organization’s (WHO) Global Network of Age-Friendly Cities and Communities program, AARP’s Livable Communities Initiative, and the U.S. Environmental Protection Agency’s (EPA) Smart Growth and Active Aging (for more information about the EPA’s initiative see Sykes and Robinson, in this issue), have started working to make communities throughout the world Received November 29, 2011; revised May 15, 2012; accepted June 12, 2013. Address correspondence to Amanda J. Lehning, PhD, University of Maryland, 525 West Redwood St., Baltimore, MD 21201, USA. E-mail: [email protected] 102
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more age-friendly to improve the health and well-being of older adults and help them age in place. This interest in changing communities’ physical and social environments is a reaction to several factors, including population aging, a projected increase in disability and chronic disease in future cohorts of older adults, and inadequate long-term care systems. Age-friendly communities share three characteristics: (1) individuals can continue to pursue and enjoy activities and interests; (2) supports are available so those with functional disabilities can meet their basic health and social needs; and (3) older adults can develop new sources of fulfillment and engagement (Lehning, Chun, & Scharlach, 2007). Recent surveys by AARP’s Public Policy Institute (2005b) and the National Association of Area Agencies on Aging (N4A) and Partners for Livable Communities (2005), as well as the key components identified by such organizations as the WHO, suggest there is an emerging consensus on the components of an age-friendly community. These components include (1) community design, (2) housing, (3) transportation and mobility, (4) health and supportive services, and (5) community engagement. Local and regional governments in the United States can make valuable contributions toward making communities more age-friendly, yet there is little research regarding whether they have done so. This article presents descriptive data from a case study of the San Francisco Bay Area examining whether city and county governments in this region have policies, programs, and infrastructure in place that address these five components of age-friendly communities.
BACKGROUND AND CONTEXT There is growing evidence that community design, housing, transportation, health and supportive services, and community engagement can have a positive impact on elder health, well-being, and the ability to age in place (see Introduction, in this issue). Aspects of each of these domains fall under the purview of local and regional governments, including city planning departments, county aging services, county transportation authorities, and public transit agencies.
Community Design Age-friendly community design includes mixed-use and walkable neighborhoods. Mixed-use neighborhoods allow alternative development, including higher than usual densities, a variety of housing types, and easy access to destinations (Inam, Levin, & Werbel, 2002). Cities can have zoning policies and incentives for mixed-use development to promote physical activity and potentially reduce rates of chronic conditions (e.g., obesity, diabetes, and chronic heart disease) that pose the greatest public health
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risks and restrict the independence of elders (Satariano, 1997). Furthermore, cities can ensure that infrastructure supports walkability through sidewalk repair, widened sidewalks to improve accessibility for those who use wheelchairs, improved street lighting (Heath, 2006), and traffic-calming measures (e.g., narrowing lanes, raising crosswalks; Retting, Ferguson, & McCartt, 2003).
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Housing Age-friendly features in the area of housing include accessory dwelling units, senior housing, new housing with universal design features, and assistance to seniors in making home modifications. An accessory dwelling unit (ADU) is an attached or detached unit located on the same lot as a single-family home (Pynoos, Nishita, Cicero, & Caraviello, 2008). ADUs can provide an alternative form of housing for older adults who need to downsize or be a rental unit or living space for a caregiver (Pynoos et al., 2008). Some cities have fostered the development of senior housing through federal (e.g., the Section 202 housing program) and state programs. Based on focus groups with older adults, accessibility features in new housing include parking spaces immediately outside the home, full bathrooms and bedrooms on the main level, wide doorways, and entrances without steps (AARP Public Policy Institute, 2005b). For existing housing, older adults report that high costs are one of the top barriers to incorporating accessibility features (Bayer & Harper, 2000), and home modification assistance may help them make adaptations.
Transportation and Mobility Age-friendly features that help older adults maintain their mobility independence include driver education, driver assessment, road improvements, and slow-moving vehicle ordinances. Older adults endorse the development of driver education and assessment programs to help ensure they can operate their vehicles in a safe manner (Adler & Rottunda, 2006), so cities and counties can supplement courses offered by organizations such as AARP. Cities can also adapt recommendations from the Federal Highway Administration’s Older Driver Highway Design Handbook (1997) to local streets where they have jurisdiction, including improving the visibility of road markings, increasing the size of letters on signs, and simplifying intersections (Herbel, Rosenbloom, Stutts, & Welch, 2006). For older adults who cannot continue driving a car, one alternative is to operate slower-moving vehicles (e.g., golf carts) on roads. Several cities in the United States have passed ordinances that would permit slower-moving vehicles on roadways, albeit with restrictions (e.g., only on streets with speed limits at or below 30 miles per hour; Bryce, 2006).
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Alternative modes of transportation, including supplemental transportation services, mobility management, accessible public transit, and discounted public transit, can also improve mobility. Supplemental transportation serves those whose mobility needs are not being met by existing public transportation (Nelson\Nygaard Consulting Associates, 2002). These services also address some of the limitations of paratransit, including limited evening and weekend service (Burkhardt, McGavock, & Nelson, 2002). Local government subsidies for taxis or shuttles to medical appointments, shopping centers, senior centers, and other destinations frequented by older adults can also facilitate access. Mobility management involves coordinating and brokering all types of transportation services available in a community, such as paratransit services, buses, and volunteers (Sterns, Antenucci, Nelson, & Glasgow, 2003). Improved accessibility for public transit involves providing buses with a first step three inches from the curb; benches and protective covering at bus stops; training drivers to be aware of the needs of individuals with disabilities; and providing large-print schedules and maps (Burkahardt et al., 2002). Public transportation providers could increase affordability of buses and trains by extending the 50% discount during off-peak hours mandated by federal law to peak hours.
Health and Supportive Services Age-friendly features in the area of health and supportive services include information directories, home- and community-based services, fitness programs, and preventive health programs. Counties may provide an information directory in either a telephone, online, or printed format. Counties may offer services such as nutrition programs, legal services, dementia day health programs, adult day health programs, medication management, volunteer companions, mental health services, and in-home services (e.g., home health aides; N4A and Partners for Livable Communities, 2005). Counties may offer fitness programs targeted specifically to older adults (N4A and Partners for Livable Communities, 2005). In focus groups, older adults have expressed a need for preventive health programs, such as immunizations (AARP Public Policy Institute, 2005a).
Community Engagement Age-friendly features that offer opportunities for community engagement for older residents include education programs, senior centers, intergenerational programs, and improvements in volunteer and work opportunities. Local or regional governments may supply funding for discounted or free educational programs at community colleges, senior centers, and community-based organizations. Many senior centers rely on local government financial support to supplement federal and state funding and help them adequately serve
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vulnerable elders who require assistance (Turner, 2004). Intergenerational programs can be part of senior center activities (Turner, 2004), adult education or co-learning programs, and community service programs (Manheimer, 1998). Advocates of intergenerational programs believe these interactions benefit older adults by increasing feelings of belonging to the community (Manheimer, 1998). To increase participation in volunteer activities, local and regional governments may fund public awareness campaigns on options for volunteering, offer programs matching the skills of older adults with available volunteer opportunities (Smith & Gay, 2005), or supply funding to programs that target elder volunteers.
PURPOSE OF THE STUDY The purpose of this study is to examine whether local governments in the San Francisco Bay Area have age-friendly features in place. The specific features included in this study were selected based on (1) a review of the empirical literature on community characteristics that could have beneficial effects on older adults and (2) brief interviews with local government experts in the state of California regarding the appropriate role of different types of local governments within each of the five age-friendly domains. Because there is variation across states in terms of the way local and regional governments are organized, the degree to which local and regional governments have jurisdiction over the features detailed below also varies. Furthermore, local governments do not bear the sole responsibility for making communities more age-friendly, but instead can supplement or complement the efforts of other entities, including state governments, the federal government, foundations, nonprofit organizations, and businesses. Finally, although the term “age-friendly” is new, some age-friendly features have been in place in some communities for a long time. This study was concerned with the features in place at the time of the survey and not with the time frame in which they were introduced.
METHODS The present study was part of a larger mixed-methods study that examined the facilitators and barriers to local government adoption of age-friendly features (see Lehning, 2012). The University of California, Berkeley, Committee for the Protection of Human Subjects, classified this study as exempt from institutional review board approval. This larger study used a sequential mixed-methods design, with a quantitative study followed by a smaller qualitative study (Creswell & Plano Clark, 2007). Findings reported here are primarily from the quantitative phase
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of data collection and analysis. In qualitative interviews with 27 survey respondents, key informants clarified survey responses and provided more details regarding the age-friendly features that had been adopted by their local or regional government, and I present some of these findings in the Discussion section of the present article.
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Sample and Data Collection Procedures This study used a 100% sample of the 101 cities, 9 county adult and aging services departments, 9 county transportation authorities, and 18 public transportation agencies in the San Francisco Bay Area. Since the key components of an age-friendly community are determined by policies, programs, and infrastructure within the jurisdiction of different levels of government, it was necessary to collect data from multiple sources. In the state of California, city governments have jurisdiction over the use of land and very rarely offer any health or human services to their residents (Feldstein, 2007). Cities, therefore, may have adopted age-friendly features that fall under the domains of community design, housing, and transportation. Departments or divisions of adult and aging services offer programs that “promote the quality of life and independence of disabled and older adults” (County of Marin Division of Aging and Adult Services, 2010). In terms of age-friendly features, county departments of adult and aging services may provide programs within the areas of transportation, health and supportive services, and opportunities for community engagement. All nine Bay Area counties have a transportation authority, an entity created by county-specific voter-approved sales tax dedicated to transportation projects and programs. A county transportation authority engages in planning and allocates funding for public transit, infrastructure maintenance, and other transportation services. County transportation authorities and public transportation agencies may provide features and programs within transportation. Primary data were collected via online surveys developed by the author. Survey data collection took place between March and August of 2009. Response rates were as follows: 62 of 101 (61.4%) cities, 9 of 9 (100%) county adult and aging services, 5 of 9 (55.5%) county transportation authorities, and 8 of 18 (44%) public transit agencies.
Measures The outcome variables of interest were each of the 22 age-friendly features listed in Tables 1 through 5. For each of these features, respondents were given a checklist of policies, programs, and infrastructure relevant to that particular feature. For example, in the area of community design, city planners were asked “Does your city government provide any of the following incentives to encourage the development of mixed-use neighborhoods?”
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TABLE 1 Community Design Features
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Cities (n = 62) Freq (%) Any incentives for mixed-use Parking waivers/reductions Subsidization or provision of infrastructure for the project Fast-track permitting Increase densities Waiver/reduction of permit fees Local tax subsidies Other Any changes in infrastructure to improve walkability Sidewalk repair New pedestrian pathways Traffic calming measures Improved street lighting Wider sidewalks Other
42 33 10 9 7 6 1 12 55 45 39 36 32 27 10
(67.7) (53.2) (16.1) (14.5) (11.3) (9.7) (1.6) (19.3) (88.7) (72.6) (62.9) (58.1) (51.6) (43.5) (16.1)
TABLE 2 Housing Features Cities (n = 62) Freq (%) Accessory dwelling unit/second unit ordinance Detached unit permitted Incentives for developers who guarantee 50% or more units for seniors Increased densities Fast-track permitting Subsidization or provision of infrastructure for the project Waiver of permit fees Local tax subsidies Other Any incentives to developers to make new housing accessible Loans Grants Tax credits Other Any assistance to homeowners to modify existing homes Loans Grants Tax credits Other
62 57 30 27 5 5 3 1 5 24 15 8 4 8 33 23 18 1 9
(100) (91.9) (48.4) (43.5) (8.1) (8.1) (4.8) (1.6) (8.1) (38.7) (24.2) (12.9) (6.5) (12.9) (53.2) (37.1) (29) (1.6) (14.5)
This was followed by a checklist that included parking waivers, fast-track permitting, subsidization or provision of infrastructure for the project, local tax subsidies, and waiver of permits.
Analysis Plan Data analysis consisted of calculating the frequency and percent for each binary response. All data analysis was conducted using Stata Statistical Software: Release 11.
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Educational programs for older drivers Assessment programs for older drivers Allows slow-moving vehicles on public right-of-ways Any changes in infrastructure to improve older driver safety More visible road markings More visible street signs Added left turn lanes Simplified intersections Other Any alternative transportation services for those who cannot use public transportation Paratransit services above those required by ADA Shuttle service to senior centers, shopping Shuttle service to medical appointments Taxi subsidies/scrip Other Mobility management/coordination of volunteer drivers Any measures to increase transit accessibility Low-floor buses Bus/train stop amenities Driver sensitivity training Frequent service Large-print schedules and maps Travel training Any discounted fares beyond those required by ADA Discounted fares at all times
TABLE 3 Transportation Features
23 22 11 4 4
5 1 8 37 29 23 17 14 7 36 (37.1) (35.5) (17.7) (6.5) (6.5)
(8.1) (1.6) (12.9) (59.7) (46.8) (37.1) (27.4) (22.6) (11.3) (58.1)
Cities (n = 62) Freq (%)
4 (44.4)
4 (44.4) 2 (22.2)
County Aging (n = 9) Freq (%)
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5 5 5 4 4 4 1 3 3
3 2 1 3 3
(100) (100) (100) (80) (80) (80) (20) (60) (60)
(60) (40) (20) (60) (60)
4 (80)
County Trans (n = 5) Freq (%)
8 6 6 7 4 2 1 7 7
(100) (75) (75) (87.5) (50) (25) (12.5) (87.5) (87.5)
Public Transit (n = 8) Freq (%)
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TABLE 4 Health and Supportive Services Features
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County Aging (n = 9) Freq (%) Information hotline or directory Telephone hotline Online directory Printed directory Other (walk in for face to face) Any home and community-based services beyond those funded by the Older Americans Act Home delivered or congregate meals Care management Legal services Dementia day health Medication management/assistance Adult day health Volunteer senior companion Home health aides Homemaker services Mental health Other Fitness programs for older adults Fitness component to fall prevention/injury prevention program Preventive health programs Immunizations Free/discounted checkups in community clinics Other
9 8 6 4 1 9
(100) (88.9) (66.7) (44.4) (11.1) (100)
7 7 6 5 4 4 4 3 3 2 2 4 3 5 4 3 1
(77.8) (77.8) (66.7) (55.6) (44.4) (44.4) (44.4) (33.3) (33.3) (22.2) (22.2) (44.4) (33.3) (55.6) (44.4) (33.3) (11.1)
TABLE 5 Community Engagement Features County Aging (n = 9) Freq (%)
Community Engagement Innovations Education programs for older adults Continuing education in senior/community centers Discount at community colleges Senior centers/community centers with programs for older adults Intergenerational programs Efforts to improve volunteer opportunities for older adults Programs to match skills of older adults and needs of organizations Funding for volunteer programs geared towards older adults Employment placement program for older adults Other
4 4 1 6 4 7 3 2 1 2
(44.4) (44.4) (11.1) (66.7) (44.4) (77.8) (33.3) (22.2) (11.1) (22.2)
RESULTS Tables 1 through 5 present the frequency and percent of local and regional governments in the San Francisco Bay Area who adopted each of the 22 agefriendly features.
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DISCUSSION Findings of this study revealed that local governments in the Bay Area offer a substantial number of age-friendly features. The features most often in place included incentives for mixed-use development and infrastructure changes to improve walkability, accessory dwelling unit ordinances, measures to increase the accessibility of public transit, discounted fares for seniors on public transit, information hotlines for supportive services, and efforts to improve volunteer opportunities. Less common were incentives to incorporate accessibility features into new housing, elder driver education and assessment, slow-moving vehicle ordinances, fitness programs, lifelong learning programs, and intergenerational programs. It appears, therefore, that many local and regional governments in the Bay Area have features in place that make communities age-friendly, particularly in terms of alternative forms of mobility (e.g., walking and public transportation). Many of these features may be aimed toward other goals, such as encouraging business development or promoting sustainable environmental practices, but previous studies suggest that they could improve health and well-being and help seniors age in place. Research indicates that more mixed-use, walkable neighborhoods positively impact older adults by increasing their levels of physical activity (Berke, Koepsell, Moudon, Hoskins, & Larson, 2007) and decreasing the risk of functional limitations (Freedman, Grafova, Schoeni, & Rogowski, 2008). These community design features, along with accessibility on public transit buses and trains, may also alleviate negative effects of driving cessation, such as decreased wellbeing (Siren, Hakamies-Blomquist, & Lindeman, 2004) and reduced social integration (Mezuk & Rebok, 2008). While almost 60% of cities in this sample have infrastructure in place that could help older drivers remain safely on the road, only a small minority have driver education or assessment programs and a slow-moving vehicle ordinance. Local governments may perceive older driver safety as the responsibility of others, such as the department of motor vehicles or AARP. Alternatively, local and regional government employees may believe that older adults are incapable of operating their own vehicle. For example, one county transportation employee who participated in the open-ended interviews stated, “[older adults] have two cars in their garages, and it’s scary.” Across the United States, 80% of states have invested little to no resources in older driver safety projects (Lynott et al., 2009), and the National Highway Traffic Safety Administration has not yet issued guidelines to assist localities as they develop slower-moving vehicle ordinances (Suen & Sen, 2004). Older adults, however, want to keep driving for as long as possible (Rudman, Friedland, Chipman, & Sciortino, 2006). In 2003, 29 million adults aged 65 and older in the United States were drivers, making up 14.6% of licensed drivers (Herbel et al., 2006). In the Bay Area, 22% of women and 55% of men aged 85 and
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older still have a driver’s license (Nelson\Nygaard Consulting Associates, 2002). Public transportation cannot address the mobility needs of all seniors. In the Bay Area, for example, in 2002 53% of older adults lived in areas without public transit services (Nelson\Nygaard Consulting Associates, 2002). Less than 39% of cities in this sample offer incentives to incorporate accessibility features, including wide doorways and entrances without steps, into new housing. The Fair Housing Amendments Act of 1988 requires that new buildings with at least four units include basic accessibility features such as an accessible route into the units, but the majority of multifamily buildings were built before this went into effect (Pynoos et al., 2008) and single-family dwellings and smaller buildings are exempt (American Planning Association, 2006). At least 39 cities across the United States have adopted visitability codes to remove barriers that prevent individuals with disabilities from entering homes, but the federal Inclusive Home Design Act, which would mandate visitability throughout the United States, has never made it out of subcommittee in Congress (Pynoos et al., 2008). Since the majority of new homes that include visitability provisions have been built in areas where the provisions are legally mandated, it appears that local laws and incentives facilitate the development of more accessible housing (Pynoos et al., 2008). In addition, it is more cost-effective to incorporate accessibility features into new housing than to retrofit existing homes (Smith, Rayer, & Smith, 2008). Findings in the areas of health and supportive services and community engagement potentially reflect local and regional governments’ available resources and perceptions about their appropriate role. As an example of limited resources, while all of the county aging services in this sample offer supportive services beyond those funded through the Older Americans Act and Area Agencies on Aging, they primarily provide meals and care management, and few offer other services such as home health or homemaker services. As one county aging services administrator explained, “Funding is a major issue. We have spent years building up programs to help older adults, but now they are being cut.” In addition, a minority of counties in this sample offers or promotes continuing education programs. This may be because most counties view such programs as a responsibility of colleges, universities, and adult education providers. Results raise several important questions related to the provision of age-friendly features by local governments. First, why are local governments engaging in these activities? Second, why are some features more likely to be offered than others? Third, to what extent are local governments engaged in concerted efforts to make their communities more age friendly? Partial answers to these questions can be found in a recent article from the same sample examining the facilitators and barriers to age-friendly feature adoption at the city government level (Lehning, 2012). Briefly, this study found that advocacy, both externally from city residents and internally from policy entrepreneurs (e.g., elected officials), contributes to adoption of age-friendly
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features. Furthermore, cities with a larger percentage of the adult population with a disability have more features in place. Future research should take into account the influence of factors not examined in this larger study, including funding (or lack thereof) from state and federal government sources and the role of nonprofit organizations, including initiatives attempting to coordinate age-friendly efforts across different sectors. Findings from the current study should be interpreted in light of its limitations, including non-response error and self-reported data. In addition, this study did not collect information regarding when these features were adopted. Future research on this topic should distinguish between features that have been place for long periods of time and relatively new features. Moreover, this study examined the existence of only these 22 features and did not collect information regarding their scope. For example, future research might examine the percentage of sidewalks being repaired or replaced each year and not only whether a sidewalk repair program is in place. Fifth, results may not be generalizable outside of the San Francisco Bay Area because of its unique characteristics, including higher population income and education and rapid population growth at the end of the twentieth century (Kawabata & Shen, 2007). As noted earlier, the organization of local and regional governments in the United States differs depending on the state. It is difficult to determine whether these findings are typical of local governments across the United States because this study is one of the first to examine whether different levels of local governments have age-friendly features in place. In 2005, N4A and Partners for Livable Communities conducted a similar nationwide survey of cities, towns, townships, villages, and boroughs with a population of 2,500 or more. However, their survey did not include public transit agencies, county transportation agencies, or county aging services and did not ask about some of the age-friendly features included in the present study. Where results are comparable, the national survey often found fewer features in place than the present study. It is possible that the San Francisco Bay Area is ahead of the curve in terms of offering age-friendly features, particularly as it is located in a state that has historically offered extensive public services to groups such as those with disabilities (Skotch, 1989). It is also possible that these differences reflect changes over time, since data collection for the present study occurred 4 years after data collection for the national survey. Qualitative interviews revealed a number of age-friendly features to include in future studies on this topic. A number of city departments of parks and recreation, for example, run senior centers and other programs designed to keep elders connected to their communities. Public safety also came up in some city interviews, and future studies could ask about policies and programs within this domain, such as the existence of an evacuation plan for older residents, emergency energy assistance, and neighborhood watch programs (N4A and Partners for Livable Communities,
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2005). Some cities also offer housing programs that were not a part of the current study. One city is considering a program that would facilitate shared housing arrangements for older adults through a roommate referral service, and another offers waivers to allow higher densities without affordability requirements to assisted living facilities.
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CONCLUSIONS In recent years there has been a growing interest in making communities age-friendly by insuring that physical and social environment features are in place that can improve the health and well-being of older adults and help them age in place. Surveys completed by city planners, county aging services directors, county transportation authority employees, and public transit employees showed that local and regional governments in the San Francisco Bay Area offer a number of age-friendly features, particularly those that target alternative forms of mobility, including incentives for mixed-use neighborhoods, infrastructure features to support walkability, discounted public transportation fares, and features to strengthen the accessibility of public transit. However, few local governments in this sample have features in place that aim to help older adults continue driving, including driver education programs, driver assessment programs, and slow-moving vehicle ordinances. Local and regional governments do not bear the sole responsibility for offering age-friendly features. However, local and regional government policies, programs, and infrastructure can complement or supplement the efforts of other entities, including state and federal governments, nonprofit organizations, and businesses. Future research should seek to understand the appropriate roles of local and regional governments in making communities more age friendly.
REFERENCES AARP Public Policy Institute. (2005a). Beyond 50.05: A report to the nation on livable communities: Creating environments for successful aging. Retrieved from http://www.aarp.org/research/housing-mobility/indliving/beyond_50_ communities.html AARP Public Policy Institute. (2005b). Livable communities: An evaluation guide. Washington, DC: AARP. Retrieved from http://assets.aarp.org/rgcenter/ il/d18311_communities.pdf Adler, G., & Rottunda, S. (2006). Older adults’ perspectives on driving cessation. Journal of Aging Studies, 20, 227–235. doi:10.1016/j.jaging.2005.09.003 American Planning Association. (2006). Policy guide on housing. Policy adopted by American Planning Association (APA) Board of Directors. Retrieved from http://www.planning.org/policy/guides/pdf/housing.pdf
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Bayer, A., & Harper, L. (2000). Fixing to stay: A national survey on housing and home modification issues. Washington, DC: AARP Research Group and AARP Programs. Berke, E. M., Koepsell, T. D., Moudon, A. V., Hoskins, R. E., & Larson, E. B. (2007). Association of the built environment with physical activity and obesity in older persons. American Journal of Public Health, 97, 486–492. doi:10.2105/AJPH.2006.085837 Bryce, E. (2006). Golf carts could take to the streets. Herald Tribune. Retrieved from http://www.heraldtribune.com/apps/pbcs.dll/article?AID=/20060915/NEWS/60 9150407 Burkhardt, J. E., McGavock, A. T., & Nelson, C. A. (2002). TCRP report 82: Improving public transit options for older persons. Washington, DC: Transportation Research Board. County of Marin Division of Aging and Adult Services. (2010). Health and Human Services–Division of Aging and Adult Services. Retrieved from http://www.co. marin.ca.us/aging/ Creswell, J. W., & Plano Clark, V. L. (2007). Designing and conducting mixed methods research. Thousand Oaks, CA: Sage Publications. Feldstein, L. M. (2007). General plans and zoning: A toolkit on land use and health. Sacramento, CA: California Department of Health Services. Retrieved from http://www.phlpnet.org/healthy-planning/products/general-plans-and-zoning Freedman, V. A., Grafova, I. B., Schoeni, R. F., & Rogowski, J. (2008). Neighborhoods and disability in later life. Social Science & Medicine, 66, 2253–2267. doi:10.1016/j.socscimed.2008.01.013 Heath, G. W. (2006). The effectiveness of urban design and land use and transport policies and practices to increase physical activity: A systematic review. Journal of Physical Activity and Health, 3, 55–76. Herbel, S. B., Rosenbloom, S., Stutts, J., & Welch, T. (2006). The impact of an aging population on systems planning and investment policies. Research for the American Association of State Highway and Transportation Officials Standing Committee on Planning. Washington, DC: AASHTO, National Cooperative Highway Research Program Project 9-36, Task 50. Retrieved from http://www. statewideplanning.org/_resources/59_NCHRP8-36-50.pdf Inam, A., Levin, J., & Werbel, R. (2002). Developer-planner interaction in transportation and land-use sustainability. Mineta Transportation Institute Report, San Jose State University. Retrieved from http://www.transweb.sjsu.edu/mtiportal/ research/publications/documents/01-21.pdf Kawabata, M., & Shen, Q. (2007). Commuting inequality between cars and public transit: The case of the San Francisco Bay Area, 1990–2000. Urban Studies, 44, 1759–1780. doi:10.1080/00420980701426616 Lehning, A. J. (2012). City governments and aging in place: Community design, housing, and transportation innovation adoption. The Gerontologist, 52, 345–356. Lehning, A., Chun, Y., & Scharlach, A. (2007). Structural barriers to developing “aging-friendly” communities. Public Policy & Aging Report, 17, 15–20. Lynott, J., Haase, J., Nelson, K., Taylor, A., Twaddell, H., Ulmer, J., . . . Stollof, E. R. (2009). Planning complete streets for an aging America. Washington, DC: AARP Public Policy Institute.
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Manheimer, R. J. (1998). The promise and politics of older adult education. Research on Aging, 20, 391–414. doi:10.1177/0164027598204002 Mezuk, B., & Rebok, G. W. (2008). Social integration and social support among older adults following driving cessation. Journal of Gerontology: Social Sciences, 63B, S298–S303. National Association of Area Agencies on Aging (N4A) and Partners for Livable Communities. (2005). The maturing of America: Getting communities on track for an aging population. Retrieved from http://www.n4a.org/pdf/ MOAFinalReport.pdf Nelson\Nygaard Consulting Associates. (2002). Older adults transportation study for the Metropolitan Transportation Commission final report. San Francisco, CA: Author. Pynoos, J., Nishita, C., Cicero, C., & Caraviello, R. (2008). Aging in place, housing, and the law. University of Illinois Elder Law Journal, 16, 77–107. Retting, R. A., Ferguson, S. A., & McCartt, A. T. (2003). A review of evidencebased traffic engineering measures designed to reduce pedestrian-motor vehicle crashes. American Journal of Public Health, 93, 1456–1463. Rudman, D. L., Friedland, J., Chipman, M., & Sciortino, P. (2006). Holding on and letting go: The perspectives of pre-seniors and seniors on driving self-regulation in later life. Canadian Journal on Aging, 25, 65–76. doi:10.1353/cja.2006.0031 Satariano, W. A. (1997). The disabilities of aging—looking to the physical environment. American Journal of Public Health, 87, 331–332. Siren, A., Hakamies-Blomqvist, L., & Lindeman, M. (2004). Driving cessation and health in older women. Journal of Applied Gerontology, 23, 58–69. doi:10.1177/0733464804263129 Skotch, R. K. (1989). Politics and policy in the history of the disability rights movement. The Milbank Quarterly, 67, 380–400. Smith, J. D., & Gay, P. (2005). Active ageing in active communities: Volunteering and the transition to retirement. Bristol, United Kingdom: Joseph Rowntree Foundation by the Policy Press. Smith, S., Rayer, S., & Smith, E. (2008). Aging and disability: Implications for the housing industry and housing policy in the United States. Journal of the American Planning Association, 18, 289–306. doi:10.1080/01944360802197132 Sterns, R., Antenucci, V., Nelson, C., & Glasgow, N. (2003). Public transportation: Options to maintain mobility for life. Generations, 27, 14–19. Suen, S., & Sen, L. (2004). Mobility options for seniors. In Transportation in an Ageing Society: A Decade of Experience (pp. 97–113). Washington, DC: Transportation Research Board. Turner, K. W. (2004). Senior citizens centers: What they offer, who participates, what they gain. Journal of Gerontological Social Work, 43, 37–47.
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Local and Regional Governments and Age-Friendly Communities: A Case Study of the San Francisco Bay Area Amanda J. Lehning PhD
a
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University of Maryland , Baltimore , Maryland , USA Accepted author version posted online: 22 Nov 2013.Published online: 27 Jan 2014.
To cite this article: Amanda J. Lehning PhD (2014) Local and Regional Governments and Age-Friendly Communities: A Case Study of the San Francisco Bay Area, Journal of Aging & Social Policy, 26:1-2, 102-116, DOI: 10.1080/08959420.2014.854140 To link to this article: http://dx.doi.org/10.1080/08959420.2014.854140
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Journal of Aging & Social Policy, 26:102–116, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 0895-9420 print/1545-0821 online DOI: 10.1080/08959420.2014.854140
Local and Regional Governments and Age-Friendly Communities: A Case Study of the San Francisco Bay Area AMANDA J. LEHNING, PhD Downloaded by [Umeå University Library] at 02:57 13 November 2014
Assistant Professor, University of Maryland, Baltimore, Maryland, USA
The purpose of this study was to assess the extent to which cities, county departments of adult and aging services, county transportation authorities, and public transit agencies in the San Francisco Bay Area have in place age-friendly policies, programs, and infrastructure in the areas of community design, housing, transportation, health care and supportive services, and opportunities for community engagement. The most common age-friendly features include those that target alternative forms of mobility (for example, incentives for mixed-use neighborhoods and changes to improve the accessibility of public transit), while the least common policies and programs are those that aim to help older adults continue driving, such as driver education programs, driver assessment programs, and slow-moving vehicle ordinances. The article concludes with policy and research implications of these findings. KEYWORDS aging in place, local government, social policy
INTRODUCTION In recent years, a number of initiatives, including the World Health Organization’s (WHO) Global Network of Age-Friendly Cities and Communities program, AARP’s Livable Communities Initiative, and the U.S. Environmental Protection Agency’s (EPA) Smart Growth and Active Aging (for more information about the EPA’s initiative see Sykes and Robinson, in this issue), have started working to make communities throughout the world Received November 29, 2011; revised May 15, 2012; accepted June 12, 2013. Address correspondence to Amanda J. Lehning, PhD, University of Maryland, 525 West Redwood St., Baltimore, MD 21201, USA. E-mail: [email protected] 102
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more age-friendly to improve the health and well-being of older adults and help them age in place. This interest in changing communities’ physical and social environments is a reaction to several factors, including population aging, a projected increase in disability and chronic disease in future cohorts of older adults, and inadequate long-term care systems. Age-friendly communities share three characteristics: (1) individuals can continue to pursue and enjoy activities and interests; (2) supports are available so those with functional disabilities can meet their basic health and social needs; and (3) older adults can develop new sources of fulfillment and engagement (Lehning, Chun, & Scharlach, 2007). Recent surveys by AARP’s Public Policy Institute (2005b) and the National Association of Area Agencies on Aging (N4A) and Partners for Livable Communities (2005), as well as the key components identified by such organizations as the WHO, suggest there is an emerging consensus on the components of an age-friendly community. These components include (1) community design, (2) housing, (3) transportation and mobility, (4) health and supportive services, and (5) community engagement. Local and regional governments in the United States can make valuable contributions toward making communities more age-friendly, yet there is little research regarding whether they have done so. This article presents descriptive data from a case study of the San Francisco Bay Area examining whether city and county governments in this region have policies, programs, and infrastructure in place that address these five components of age-friendly communities.
BACKGROUND AND CONTEXT There is growing evidence that community design, housing, transportation, health and supportive services, and community engagement can have a positive impact on elder health, well-being, and the ability to age in place (see Introduction, in this issue). Aspects of each of these domains fall under the purview of local and regional governments, including city planning departments, county aging services, county transportation authorities, and public transit agencies.
Community Design Age-friendly community design includes mixed-use and walkable neighborhoods. Mixed-use neighborhoods allow alternative development, including higher than usual densities, a variety of housing types, and easy access to destinations (Inam, Levin, & Werbel, 2002). Cities can have zoning policies and incentives for mixed-use development to promote physical activity and potentially reduce rates of chronic conditions (e.g., obesity, diabetes, and chronic heart disease) that pose the greatest public health
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risks and restrict the independence of elders (Satariano, 1997). Furthermore, cities can ensure that infrastructure supports walkability through sidewalk repair, widened sidewalks to improve accessibility for those who use wheelchairs, improved street lighting (Heath, 2006), and traffic-calming measures (e.g., narrowing lanes, raising crosswalks; Retting, Ferguson, & McCartt, 2003).
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Housing Age-friendly features in the area of housing include accessory dwelling units, senior housing, new housing with universal design features, and assistance to seniors in making home modifications. An accessory dwelling unit (ADU) is an attached or detached unit located on the same lot as a single-family home (Pynoos, Nishita, Cicero, & Caraviello, 2008). ADUs can provide an alternative form of housing for older adults who need to downsize or be a rental unit or living space for a caregiver (Pynoos et al., 2008). Some cities have fostered the development of senior housing through federal (e.g., the Section 202 housing program) and state programs. Based on focus groups with older adults, accessibility features in new housing include parking spaces immediately outside the home, full bathrooms and bedrooms on the main level, wide doorways, and entrances without steps (AARP Public Policy Institute, 2005b). For existing housing, older adults report that high costs are one of the top barriers to incorporating accessibility features (Bayer & Harper, 2000), and home modification assistance may help them make adaptations.
Transportation and Mobility Age-friendly features that help older adults maintain their mobility independence include driver education, driver assessment, road improvements, and slow-moving vehicle ordinances. Older adults endorse the development of driver education and assessment programs to help ensure they can operate their vehicles in a safe manner (Adler & Rottunda, 2006), so cities and counties can supplement courses offered by organizations such as AARP. Cities can also adapt recommendations from the Federal Highway Administration’s Older Driver Highway Design Handbook (1997) to local streets where they have jurisdiction, including improving the visibility of road markings, increasing the size of letters on signs, and simplifying intersections (Herbel, Rosenbloom, Stutts, & Welch, 2006). For older adults who cannot continue driving a car, one alternative is to operate slower-moving vehicles (e.g., golf carts) on roads. Several cities in the United States have passed ordinances that would permit slower-moving vehicles on roadways, albeit with restrictions (e.g., only on streets with speed limits at or below 30 miles per hour; Bryce, 2006).
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Alternative modes of transportation, including supplemental transportation services, mobility management, accessible public transit, and discounted public transit, can also improve mobility. Supplemental transportation serves those whose mobility needs are not being met by existing public transportation (Nelson\Nygaard Consulting Associates, 2002). These services also address some of the limitations of paratransit, including limited evening and weekend service (Burkhardt, McGavock, & Nelson, 2002). Local government subsidies for taxis or shuttles to medical appointments, shopping centers, senior centers, and other destinations frequented by older adults can also facilitate access. Mobility management involves coordinating and brokering all types of transportation services available in a community, such as paratransit services, buses, and volunteers (Sterns, Antenucci, Nelson, & Glasgow, 2003). Improved accessibility for public transit involves providing buses with a first step three inches from the curb; benches and protective covering at bus stops; training drivers to be aware of the needs of individuals with disabilities; and providing large-print schedules and maps (Burkahardt et al., 2002). Public transportation providers could increase affordability of buses and trains by extending the 50% discount during off-peak hours mandated by federal law to peak hours.
Health and Supportive Services Age-friendly features in the area of health and supportive services include information directories, home- and community-based services, fitness programs, and preventive health programs. Counties may provide an information directory in either a telephone, online, or printed format. Counties may offer services such as nutrition programs, legal services, dementia day health programs, adult day health programs, medication management, volunteer companions, mental health services, and in-home services (e.g., home health aides; N4A and Partners for Livable Communities, 2005). Counties may offer fitness programs targeted specifically to older adults (N4A and Partners for Livable Communities, 2005). In focus groups, older adults have expressed a need for preventive health programs, such as immunizations (AARP Public Policy Institute, 2005a).
Community Engagement Age-friendly features that offer opportunities for community engagement for older residents include education programs, senior centers, intergenerational programs, and improvements in volunteer and work opportunities. Local or regional governments may supply funding for discounted or free educational programs at community colleges, senior centers, and community-based organizations. Many senior centers rely on local government financial support to supplement federal and state funding and help them adequately serve
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vulnerable elders who require assistance (Turner, 2004). Intergenerational programs can be part of senior center activities (Turner, 2004), adult education or co-learning programs, and community service programs (Manheimer, 1998). Advocates of intergenerational programs believe these interactions benefit older adults by increasing feelings of belonging to the community (Manheimer, 1998). To increase participation in volunteer activities, local and regional governments may fund public awareness campaigns on options for volunteering, offer programs matching the skills of older adults with available volunteer opportunities (Smith & Gay, 2005), or supply funding to programs that target elder volunteers.
PURPOSE OF THE STUDY The purpose of this study is to examine whether local governments in the San Francisco Bay Area have age-friendly features in place. The specific features included in this study were selected based on (1) a review of the empirical literature on community characteristics that could have beneficial effects on older adults and (2) brief interviews with local government experts in the state of California regarding the appropriate role of different types of local governments within each of the five age-friendly domains. Because there is variation across states in terms of the way local and regional governments are organized, the degree to which local and regional governments have jurisdiction over the features detailed below also varies. Furthermore, local governments do not bear the sole responsibility for making communities more age-friendly, but instead can supplement or complement the efforts of other entities, including state governments, the federal government, foundations, nonprofit organizations, and businesses. Finally, although the term “age-friendly” is new, some age-friendly features have been in place in some communities for a long time. This study was concerned with the features in place at the time of the survey and not with the time frame in which they were introduced.
METHODS The present study was part of a larger mixed-methods study that examined the facilitators and barriers to local government adoption of age-friendly features (see Lehning, 2012). The University of California, Berkeley, Committee for the Protection of Human Subjects, classified this study as exempt from institutional review board approval. This larger study used a sequential mixed-methods design, with a quantitative study followed by a smaller qualitative study (Creswell & Plano Clark, 2007). Findings reported here are primarily from the quantitative phase
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of data collection and analysis. In qualitative interviews with 27 survey respondents, key informants clarified survey responses and provided more details regarding the age-friendly features that had been adopted by their local or regional government, and I present some of these findings in the Discussion section of the present article.
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Sample and Data Collection Procedures This study used a 100% sample of the 101 cities, 9 county adult and aging services departments, 9 county transportation authorities, and 18 public transportation agencies in the San Francisco Bay Area. Since the key components of an age-friendly community are determined by policies, programs, and infrastructure within the jurisdiction of different levels of government, it was necessary to collect data from multiple sources. In the state of California, city governments have jurisdiction over the use of land and very rarely offer any health or human services to their residents (Feldstein, 2007). Cities, therefore, may have adopted age-friendly features that fall under the domains of community design, housing, and transportation. Departments or divisions of adult and aging services offer programs that “promote the quality of life and independence of disabled and older adults” (County of Marin Division of Aging and Adult Services, 2010). In terms of age-friendly features, county departments of adult and aging services may provide programs within the areas of transportation, health and supportive services, and opportunities for community engagement. All nine Bay Area counties have a transportation authority, an entity created by county-specific voter-approved sales tax dedicated to transportation projects and programs. A county transportation authority engages in planning and allocates funding for public transit, infrastructure maintenance, and other transportation services. County transportation authorities and public transportation agencies may provide features and programs within transportation. Primary data were collected via online surveys developed by the author. Survey data collection took place between March and August of 2009. Response rates were as follows: 62 of 101 (61.4%) cities, 9 of 9 (100%) county adult and aging services, 5 of 9 (55.5%) county transportation authorities, and 8 of 18 (44%) public transit agencies.
Measures The outcome variables of interest were each of the 22 age-friendly features listed in Tables 1 through 5. For each of these features, respondents were given a checklist of policies, programs, and infrastructure relevant to that particular feature. For example, in the area of community design, city planners were asked “Does your city government provide any of the following incentives to encourage the development of mixed-use neighborhoods?”
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TABLE 1 Community Design Features
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Cities (n = 62) Freq (%) Any incentives for mixed-use Parking waivers/reductions Subsidization or provision of infrastructure for the project Fast-track permitting Increase densities Waiver/reduction of permit fees Local tax subsidies Other Any changes in infrastructure to improve walkability Sidewalk repair New pedestrian pathways Traffic calming measures Improved street lighting Wider sidewalks Other
42 33 10 9 7 6 1 12 55 45 39 36 32 27 10
(67.7) (53.2) (16.1) (14.5) (11.3) (9.7) (1.6) (19.3) (88.7) (72.6) (62.9) (58.1) (51.6) (43.5) (16.1)
TABLE 2 Housing Features Cities (n = 62) Freq (%) Accessory dwelling unit/second unit ordinance Detached unit permitted Incentives for developers who guarantee 50% or more units for seniors Increased densities Fast-track permitting Subsidization or provision of infrastructure for the project Waiver of permit fees Local tax subsidies Other Any incentives to developers to make new housing accessible Loans Grants Tax credits Other Any assistance to homeowners to modify existing homes Loans Grants Tax credits Other
62 57 30 27 5 5 3 1 5 24 15 8 4 8 33 23 18 1 9
(100) (91.9) (48.4) (43.5) (8.1) (8.1) (4.8) (1.6) (8.1) (38.7) (24.2) (12.9) (6.5) (12.9) (53.2) (37.1) (29) (1.6) (14.5)
This was followed by a checklist that included parking waivers, fast-track permitting, subsidization or provision of infrastructure for the project, local tax subsidies, and waiver of permits.
Analysis Plan Data analysis consisted of calculating the frequency and percent for each binary response. All data analysis was conducted using Stata Statistical Software: Release 11.
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Educational programs for older drivers Assessment programs for older drivers Allows slow-moving vehicles on public right-of-ways Any changes in infrastructure to improve older driver safety More visible road markings More visible street signs Added left turn lanes Simplified intersections Other Any alternative transportation services for those who cannot use public transportation Paratransit services above those required by ADA Shuttle service to senior centers, shopping Shuttle service to medical appointments Taxi subsidies/scrip Other Mobility management/coordination of volunteer drivers Any measures to increase transit accessibility Low-floor buses Bus/train stop amenities Driver sensitivity training Frequent service Large-print schedules and maps Travel training Any discounted fares beyond those required by ADA Discounted fares at all times
TABLE 3 Transportation Features
23 22 11 4 4
5 1 8 37 29 23 17 14 7 36 (37.1) (35.5) (17.7) (6.5) (6.5)
(8.1) (1.6) (12.9) (59.7) (46.8) (37.1) (27.4) (22.6) (11.3) (58.1)
Cities (n = 62) Freq (%)
4 (44.4)
4 (44.4) 2 (22.2)
County Aging (n = 9) Freq (%)
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5 5 5 4 4 4 1 3 3
3 2 1 3 3
(100) (100) (100) (80) (80) (80) (20) (60) (60)
(60) (40) (20) (60) (60)
4 (80)
County Trans (n = 5) Freq (%)
8 6 6 7 4 2 1 7 7
(100) (75) (75) (87.5) (50) (25) (12.5) (87.5) (87.5)
Public Transit (n = 8) Freq (%)
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TABLE 4 Health and Supportive Services Features
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County Aging (n = 9) Freq (%) Information hotline or directory Telephone hotline Online directory Printed directory Other (walk in for face to face) Any home and community-based services beyond those funded by the Older Americans Act Home delivered or congregate meals Care management Legal services Dementia day health Medication management/assistance Adult day health Volunteer senior companion Home health aides Homemaker services Mental health Other Fitness programs for older adults Fitness component to fall prevention/injury prevention program Preventive health programs Immunizations Free/discounted checkups in community clinics Other
9 8 6 4 1 9
(100) (88.9) (66.7) (44.4) (11.1) (100)
7 7 6 5 4 4 4 3 3 2 2 4 3 5 4 3 1
(77.8) (77.8) (66.7) (55.6) (44.4) (44.4) (44.4) (33.3) (33.3) (22.2) (22.2) (44.4) (33.3) (55.6) (44.4) (33.3) (11.1)
TABLE 5 Community Engagement Features County Aging (n = 9) Freq (%)
Community Engagement Innovations Education programs for older adults Continuing education in senior/community centers Discount at community colleges Senior centers/community centers with programs for older adults Intergenerational programs Efforts to improve volunteer opportunities for older adults Programs to match skills of older adults and needs of organizations Funding for volunteer programs geared towards older adults Employment placement program for older adults Other
4 4 1 6 4 7 3 2 1 2
(44.4) (44.4) (11.1) (66.7) (44.4) (77.8) (33.3) (22.2) (11.1) (22.2)
RESULTS Tables 1 through 5 present the frequency and percent of local and regional governments in the San Francisco Bay Area who adopted each of the 22 agefriendly features.
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DISCUSSION Findings of this study revealed that local governments in the Bay Area offer a substantial number of age-friendly features. The features most often in place included incentives for mixed-use development and infrastructure changes to improve walkability, accessory dwelling unit ordinances, measures to increase the accessibility of public transit, discounted fares for seniors on public transit, information hotlines for supportive services, and efforts to improve volunteer opportunities. Less common were incentives to incorporate accessibility features into new housing, elder driver education and assessment, slow-moving vehicle ordinances, fitness programs, lifelong learning programs, and intergenerational programs. It appears, therefore, that many local and regional governments in the Bay Area have features in place that make communities age-friendly, particularly in terms of alternative forms of mobility (e.g., walking and public transportation). Many of these features may be aimed toward other goals, such as encouraging business development or promoting sustainable environmental practices, but previous studies suggest that they could improve health and well-being and help seniors age in place. Research indicates that more mixed-use, walkable neighborhoods positively impact older adults by increasing their levels of physical activity (Berke, Koepsell, Moudon, Hoskins, & Larson, 2007) and decreasing the risk of functional limitations (Freedman, Grafova, Schoeni, & Rogowski, 2008). These community design features, along with accessibility on public transit buses and trains, may also alleviate negative effects of driving cessation, such as decreased wellbeing (Siren, Hakamies-Blomquist, & Lindeman, 2004) and reduced social integration (Mezuk & Rebok, 2008). While almost 60% of cities in this sample have infrastructure in place that could help older drivers remain safely on the road, only a small minority have driver education or assessment programs and a slow-moving vehicle ordinance. Local governments may perceive older driver safety as the responsibility of others, such as the department of motor vehicles or AARP. Alternatively, local and regional government employees may believe that older adults are incapable of operating their own vehicle. For example, one county transportation employee who participated in the open-ended interviews stated, “[older adults] have two cars in their garages, and it’s scary.” Across the United States, 80% of states have invested little to no resources in older driver safety projects (Lynott et al., 2009), and the National Highway Traffic Safety Administration has not yet issued guidelines to assist localities as they develop slower-moving vehicle ordinances (Suen & Sen, 2004). Older adults, however, want to keep driving for as long as possible (Rudman, Friedland, Chipman, & Sciortino, 2006). In 2003, 29 million adults aged 65 and older in the United States were drivers, making up 14.6% of licensed drivers (Herbel et al., 2006). In the Bay Area, 22% of women and 55% of men aged 85 and
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older still have a driver’s license (Nelson\Nygaard Consulting Associates, 2002). Public transportation cannot address the mobility needs of all seniors. In the Bay Area, for example, in 2002 53% of older adults lived in areas without public transit services (Nelson\Nygaard Consulting Associates, 2002). Less than 39% of cities in this sample offer incentives to incorporate accessibility features, including wide doorways and entrances without steps, into new housing. The Fair Housing Amendments Act of 1988 requires that new buildings with at least four units include basic accessibility features such as an accessible route into the units, but the majority of multifamily buildings were built before this went into effect (Pynoos et al., 2008) and single-family dwellings and smaller buildings are exempt (American Planning Association, 2006). At least 39 cities across the United States have adopted visitability codes to remove barriers that prevent individuals with disabilities from entering homes, but the federal Inclusive Home Design Act, which would mandate visitability throughout the United States, has never made it out of subcommittee in Congress (Pynoos et al., 2008). Since the majority of new homes that include visitability provisions have been built in areas where the provisions are legally mandated, it appears that local laws and incentives facilitate the development of more accessible housing (Pynoos et al., 2008). In addition, it is more cost-effective to incorporate accessibility features into new housing than to retrofit existing homes (Smith, Rayer, & Smith, 2008). Findings in the areas of health and supportive services and community engagement potentially reflect local and regional governments’ available resources and perceptions about their appropriate role. As an example of limited resources, while all of the county aging services in this sample offer supportive services beyond those funded through the Older Americans Act and Area Agencies on Aging, they primarily provide meals and care management, and few offer other services such as home health or homemaker services. As one county aging services administrator explained, “Funding is a major issue. We have spent years building up programs to help older adults, but now they are being cut.” In addition, a minority of counties in this sample offers or promotes continuing education programs. This may be because most counties view such programs as a responsibility of colleges, universities, and adult education providers. Results raise several important questions related to the provision of age-friendly features by local governments. First, why are local governments engaging in these activities? Second, why are some features more likely to be offered than others? Third, to what extent are local governments engaged in concerted efforts to make their communities more age friendly? Partial answers to these questions can be found in a recent article from the same sample examining the facilitators and barriers to age-friendly feature adoption at the city government level (Lehning, 2012). Briefly, this study found that advocacy, both externally from city residents and internally from policy entrepreneurs (e.g., elected officials), contributes to adoption of age-friendly
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features. Furthermore, cities with a larger percentage of the adult population with a disability have more features in place. Future research should take into account the influence of factors not examined in this larger study, including funding (or lack thereof) from state and federal government sources and the role of nonprofit organizations, including initiatives attempting to coordinate age-friendly efforts across different sectors. Findings from the current study should be interpreted in light of its limitations, including non-response error and self-reported data. In addition, this study did not collect information regarding when these features were adopted. Future research on this topic should distinguish between features that have been place for long periods of time and relatively new features. Moreover, this study examined the existence of only these 22 features and did not collect information regarding their scope. For example, future research might examine the percentage of sidewalks being repaired or replaced each year and not only whether a sidewalk repair program is in place. Fifth, results may not be generalizable outside of the San Francisco Bay Area because of its unique characteristics, including higher population income and education and rapid population growth at the end of the twentieth century (Kawabata & Shen, 2007). As noted earlier, the organization of local and regional governments in the United States differs depending on the state. It is difficult to determine whether these findings are typical of local governments across the United States because this study is one of the first to examine whether different levels of local governments have age-friendly features in place. In 2005, N4A and Partners for Livable Communities conducted a similar nationwide survey of cities, towns, townships, villages, and boroughs with a population of 2,500 or more. However, their survey did not include public transit agencies, county transportation agencies, or county aging services and did not ask about some of the age-friendly features included in the present study. Where results are comparable, the national survey often found fewer features in place than the present study. It is possible that the San Francisco Bay Area is ahead of the curve in terms of offering age-friendly features, particularly as it is located in a state that has historically offered extensive public services to groups such as those with disabilities (Skotch, 1989). It is also possible that these differences reflect changes over time, since data collection for the present study occurred 4 years after data collection for the national survey. Qualitative interviews revealed a number of age-friendly features to include in future studies on this topic. A number of city departments of parks and recreation, for example, run senior centers and other programs designed to keep elders connected to their communities. Public safety also came up in some city interviews, and future studies could ask about policies and programs within this domain, such as the existence of an evacuation plan for older residents, emergency energy assistance, and neighborhood watch programs (N4A and Partners for Livable Communities,
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2005). Some cities also offer housing programs that were not a part of the current study. One city is considering a program that would facilitate shared housing arrangements for older adults through a roommate referral service, and another offers waivers to allow higher densities without affordability requirements to assisted living facilities.
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CONCLUSIONS In recent years there has been a growing interest in making communities age-friendly by insuring that physical and social environment features are in place that can improve the health and well-being of older adults and help them age in place. Surveys completed by city planners, county aging services directors, county transportation authority employees, and public transit employees showed that local and regional governments in the San Francisco Bay Area offer a number of age-friendly features, particularly those that target alternative forms of mobility, including incentives for mixed-use neighborhoods, infrastructure features to support walkability, discounted public transportation fares, and features to strengthen the accessibility of public transit. However, few local governments in this sample have features in place that aim to help older adults continue driving, including driver education programs, driver assessment programs, and slow-moving vehicle ordinances. Local and regional governments do not bear the sole responsibility for offering age-friendly features. However, local and regional government policies, programs, and infrastructure can complement or supplement the efforts of other entities, including state and federal governments, nonprofit organizations, and businesses. Future research should seek to understand the appropriate roles of local and regional governments in making communities more age friendly.
REFERENCES AARP Public Policy Institute. (2005a). Beyond 50.05: A report to the nation on livable communities: Creating environments for successful aging. Retrieved from http://www.aarp.org/research/housing-mobility/indliving/beyond_50_ communities.html AARP Public Policy Institute. (2005b). Livable communities: An evaluation guide. Washington, DC: AARP. Retrieved from http://assets.aarp.org/rgcenter/ il/d18311_communities.pdf Adler, G., & Rottunda, S. (2006). Older adults’ perspectives on driving cessation. Journal of Aging Studies, 20, 227–235. doi:10.1016/j.jaging.2005.09.003 American Planning Association. (2006). Policy guide on housing. Policy adopted by American Planning Association (APA) Board of Directors. Retrieved from http://www.planning.org/policy/guides/pdf/housing.pdf
Downloaded by [Umeå University Library] at 02:57 13 November 2014
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Bayer, A., & Harper, L. (2000). Fixing to stay: A national survey on housing and home modification issues. Washington, DC: AARP Research Group and AARP Programs. Berke, E. M., Koepsell, T. D., Moudon, A. V., Hoskins, R. E., & Larson, E. B. (2007). Association of the built environment with physical activity and obesity in older persons. American Journal of Public Health, 97, 486–492. doi:10.2105/AJPH.2006.085837 Bryce, E. (2006). Golf carts could take to the streets. Herald Tribune. Retrieved from http://www.heraldtribune.com/apps/pbcs.dll/article?AID=/20060915/NEWS/60 9150407 Burkhardt, J. E., McGavock, A. T., & Nelson, C. A. (2002). TCRP report 82: Improving public transit options for older persons. Washington, DC: Transportation Research Board. County of Marin Division of Aging and Adult Services. (2010). Health and Human Services–Division of Aging and Adult Services. Retrieved from http://www.co. marin.ca.us/aging/ Creswell, J. W., & Plano Clark, V. L. (2007). Designing and conducting mixed methods research. Thousand Oaks, CA: Sage Publications. Feldstein, L. M. (2007). General plans and zoning: A toolkit on land use and health. Sacramento, CA: California Department of Health Services. Retrieved from http://www.phlpnet.org/healthy-planning/products/general-plans-and-zoning Freedman, V. A., Grafova, I. B., Schoeni, R. F., & Rogowski, J. (2008). Neighborhoods and disability in later life. Social Science & Medicine, 66, 2253–2267. doi:10.1016/j.socscimed.2008.01.013 Heath, G. W. (2006). The effectiveness of urban design and land use and transport policies and practices to increase physical activity: A systematic review. Journal of Physical Activity and Health, 3, 55–76. Herbel, S. B., Rosenbloom, S., Stutts, J., & Welch, T. (2006). The impact of an aging population on systems planning and investment policies. Research for the American Association of State Highway and Transportation Officials Standing Committee on Planning. Washington, DC: AASHTO, National Cooperative Highway Research Program Project 9-36, Task 50. Retrieved from http://www. statewideplanning.org/_resources/59_NCHRP8-36-50.pdf Inam, A., Levin, J., & Werbel, R. (2002). Developer-planner interaction in transportation and land-use sustainability. Mineta Transportation Institute Report, San Jose State University. Retrieved from http://www.transweb.sjsu.edu/mtiportal/ research/publications/documents/01-21.pdf Kawabata, M., & Shen, Q. (2007). Commuting inequality between cars and public transit: The case of the San Francisco Bay Area, 1990–2000. Urban Studies, 44, 1759–1780. doi:10.1080/00420980701426616 Lehning, A. J. (2012). City governments and aging in place: Community design, housing, and transportation innovation adoption. The Gerontologist, 52, 345–356. Lehning, A., Chun, Y., & Scharlach, A. (2007). Structural barriers to developing “aging-friendly” communities. Public Policy & Aging Report, 17, 15–20. Lynott, J., Haase, J., Nelson, K., Taylor, A., Twaddell, H., Ulmer, J., . . . Stollof, E. R. (2009). Planning complete streets for an aging America. Washington, DC: AARP Public Policy Institute.
Downloaded by [Umeå University Library] at 02:57 13 November 2014
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Manheimer, R. J. (1998). The promise and politics of older adult education. Research on Aging, 20, 391–414. doi:10.1177/0164027598204002 Mezuk, B., & Rebok, G. W. (2008). Social integration and social support among older adults following driving cessation. Journal of Gerontology: Social Sciences, 63B, S298–S303. National Association of Area Agencies on Aging (N4A) and Partners for Livable Communities. (2005). The maturing of America: Getting communities on track for an aging population. Retrieved from http://www.n4a.org/pdf/ MOAFinalReport.pdf Nelson\Nygaard Consulting Associates. (2002). Older adults transportation study for the Metropolitan Transportation Commission final report. San Francisco, CA: Author. Pynoos, J., Nishita, C., Cicero, C., & Caraviello, R. (2008). Aging in place, housing, and the law. University of Illinois Elder Law Journal, 16, 77–107. Retting, R. A., Ferguson, S. A., & McCartt, A. T. (2003). A review of evidencebased traffic engineering measures designed to reduce pedestrian-motor vehicle crashes. American Journal of Public Health, 93, 1456–1463. Rudman, D. L., Friedland, J., Chipman, M., & Sciortino, P. (2006). Holding on and letting go: The perspectives of pre-seniors and seniors on driving self-regulation in later life. Canadian Journal on Aging, 25, 65–76. doi:10.1353/cja.2006.0031 Satariano, W. A. (1997). The disabilities of aging—looking to the physical environment. American Journal of Public Health, 87, 331–332. Siren, A., Hakamies-Blomqvist, L., & Lindeman, M. (2004). Driving cessation and health in older women. Journal of Applied Gerontology, 23, 58–69. doi:10.1177/0733464804263129 Skotch, R. K. (1989). Politics and policy in the history of the disability rights movement. The Milbank Quarterly, 67, 380–400. Smith, J. D., & Gay, P. (2005). Active ageing in active communities: Volunteering and the transition to retirement. Bristol, United Kingdom: Joseph Rowntree Foundation by the Policy Press. Smith, S., Rayer, S., & Smith, E. (2008). Aging and disability: Implications for the housing industry and housing policy in the United States. Journal of the American Planning Association, 18, 289–306. doi:10.1080/01944360802197132 Sterns, R., Antenucci, V., Nelson, C., & Glasgow, N. (2003). Public transportation: Options to maintain mobility for life. Generations, 27, 14–19. Suen, S., & Sen, L. (2004). Mobility options for seniors. In Transportation in an Ageing Society: A Decade of Experience (pp. 97–113). Washington, DC: Transportation Research Board. Turner, K. W. (2004). Senior citizens centers: What they offer, who participates, what they gain. Journal of Gerontological Social Work, 43, 37–47.
