Aging in San Diego

Aging in San Diego

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Executive Summary

San Diego’s population is aging. This trend mirrors the national growth of the senior population in the United States. While approximately 45 million Americans are currently 65 or older, that number will reach 73 million Americans by 2030. AARP and the World Health Organization have partnered to help cities prepare for the aging population through their program called Age-Friendly Communities (AFCs).

To become an AFC, a jurisdiction must plan for both the built and social environment that supports its aging population. To achieve great communities for seniors, and residents of all ages, many communities pursuing the AFC designation utilize the Eight Domains of Livability framework developed by the World Health Organization. The following Eight Domains of Livability are incorporated into required Action Plans, which serve as the guiding document for creating an AFC:

Domain 1: Outdoor Spaces and Buildings

Domain 2: Transportation

Domain 3: Respect and Social Inclusion

Domain 4: Housing

Domain 5: Communication and Information

Domain 6: Civic Participation and Employment

Domain 7: Community Support and Health Services

Domain 8: Social Participation

In addition, Dementia-Friendly Communities is frequently added as a ninth Domain. Dementia-Friendly communities provide the support needed for those living with dementia to help them live as independently as possible. Jurisdictions pursuing AFC designation may incorporate areas outside of the Eight Domains of Livability that address their unique situation.

San Diego’s senior population is growing rapidly. The population of San Diegans 55 and older is expected to grow by 194 percent from 2012 to 2035 to a population of over a million. Motor vehicle collisions are a leading health issue impacting older adults. So are issues of homelessness and displacement. The cost of living in San Diego poses a large threat for seniors, who largely live on fixed incomes. Seniors are also negatively impacted by poverty and social isolation with about a quarter of seniors living alone or below 200 percent of the Federal Poverty Line.

This report explains the steps and commitments needed for a city to become an Age-Friendly Community to be able to address the many issues that impact the quality of life for older adults in San Diego County. This report also shares the benefits of joining the Age-Friendly Network through a review of best practices from across the country in each of the Eight Domains of Livability.

Introduction: Age-Friendly Communities

American communities are on the precipice of enormous change, but it is not a change that should catch anyone by surprise. We are all, of course, aging. And right now, approximately 45 million Americans are age 65 or older. By 2030, that number will reach 73 million Americans. At that point, one in five Americans will be older than 65. But the real moment of change will take place just a few years later. By 2035, the United States will — for the first time ever — be a country comprised of more older adults than of children. The U.S. Census Bureau projects there will be 78 million people age 65 and over compared to 76.4 million under the age of 18.^[1]

The AARP Network of Age-Friendly Communities (AFC) is an affiliate of the World Health Organization’s Age-Friendly Cities and Communities Program, an international effort launched in 2006 to help cities prepare for rapid population aging and the parallel trend of urbanization. The program has participating communities in more than 20 nations, as well as 10 affiliates representing more than 1,000 communities. AARP works with local officials and partner organizations around the country to identify communities for membership in the Age-Friendly Network. The program emphasizes both the built and the social environment, and helps refine what it means for AARP to have a community presence. The AARP Network of AFCs program is a tool that can be used by AARP staff and others to help local leaders prepare and ultimately adapt their communities to become great places for everyone to live.^[2]

Circulate San Diego has teamed with San Diego State University’s Social Policy Institute and The San Diego Foundation to help San Diego lead as an Age-Friendly region and prepare for these inevitable changes. The AFC program is not a new concept to the region. The City of Chula Vista and the County of San Diego have both joined the AFC network and written implementable Action Plans. Most recently, Circulate San Diego, San Diego State University’s Social Policy Institute, and a team of experts have come together to support the City of La Mesa in becoming the third jurisdiction in the region to join the AFC. Even with three AFCs in San Diego, many other cities and communities remain without thoughtful planning for the growth in older adults. It is important to reflect on the processes and experiences from the first three AFC jurisdictions to support other cities in the region to become more age-friendly. Due to the strong precedent set by the County and the cities of Chula Vista and La Mesa, The City of San Diego will soon join the AFC network as the fourth Age-Friendly jurisdiction in the region. San Diego can build on the AFC work already done in the region’s other AFC jurisdictions and best practices nationally.

San Diego jurisdictions are in a position to take action and create a plan with implementable steps for our region to prepare for and adapt to these oncoming changes. This report serves as a summary of the AFC process and visits how other communities have gone about designing a program that is suitable to their specific population and the fabric of their community. This report will be focusing on the characteristics of San Diego and how approaches from other jurisdictions may be applied. This report should leave the reader with three lessons:

• What are AFCs and the Eight Domains of Livability;
• Changes in the San Diego region and how jurisdictions may benefit from an Action Plan to prepare and support San Diego’s aging society; and
• Benefits of joining the Age-Friendly Network as demonstrated in best practices outlined below.

Age-Friendly Network through a review of best practices from across the country in each of the Eight Domains of Livability.

According to SANDAG’s 2050 Regional Growth Forecast, the total population of people aged 55 and older in San Diego County was 577,750 persons in 2012. This population of older adults is projected to grow by 194 percent, resulting in a population of 1,121,358 persons by the year 2035.^[3]

Motor vehicle collisions are one of the leading health conditions impacting older adults in San Diego County. Between 2016 and 2017, there were a total of 3,965 motor vehicle collisions involving adults over 55 years old, with a total of 6,152 injuries and 85 fatalities.^[4] In the same year, older females also suffered from more motor vehicle occupant deaths compared to their male counterparts.^[5] Moreover, collisions and injuries involving motor vehicles and seniors are projected to only increase by 2030.^[6]

Older adults also face significant problems related to homelessness and displacement. In 2018, 35 percent of homeless individuals in San Diego were aged 55 and older.^[7] Further, the cost of living in San Diego poses a large threat for seniors, as the growing aging population will ultimately result in more people living on fixed incomes and Social Security. Senior households in San Diego are not all homeowners, 25 percent are renters. The highest numbers of senior renters reside in National City, with 56 percent of San Diego’s rented senior households, followed by Central San Diego and Mid-City at 51.1 percent and 45.6 percent respectively.^[8] For elder adults who reside in assisted living and long-term care facilities, the amount spent on housing is over three times the average monthly housing cost for seniors in San Diego County.^[9] As rents continue to rise, seniors living in the sub-regions mentioned above, as well as those who require assisted and long-term care, such as those with dementia, will be disproportionately impacted.

Seniors are also negatively impacted by poverty and lack of social participation. About 23.3 percent of seniors were living alone in 2016, with older females more likely to live alone than older males. Among seniors, only 17.4 percent participate actively in the labor force, and 25.2 percent of senior households in San Diego County are dependent solely on Social Security as their primary source of income. In 2016, 9.1 percent of seniors were living below 100 percent of the Federal Poverty Line. During that same year the percentage of seniors living below 200 percent of the Federal Poverty Line was 26.1 percent.^[10] Because of the increasing cost of living, an increasing number of older adults can no longer afford basic costs, greatly increasing the risk for homelessness, food insecurity, and social isolation.

While older adults can face housing and income hardships, it is important to note the economic contributions of seniors. Consumer spending by households headed by people 50 years old or older is called the “Longevity Economy”, and has demonstrated to be an outsized positive impact on California. The Longevity Economy accounted for 47 percent of California’s GDP and supported 11 million jobs in the state in 2015. In addition, 65 percent of 50-64-year-olds are employed and people 50 years old and older represent 31 percent of California’s workforce. ^[11]

AARP Age-Friendly Network

Phase 1: Getting Started

In order to begin the process of receiving recognition as an AFC, the community must demonstrate its commitment to continuously improving itself for the sake of its older adult population. This means that the jurisdiction’s decisionmakers (usually a city council), must pledge in writing its commitment, alongside an application that is sent to the appropriate AARP representative. It may be that the City Council brought this idea forward itself, or that community members worked to get their representatives to make the commitment, but ultimately the first step is a pledge from the decisionmakers.

The jurisdiction should engage stakeholders such as relevant non-profits, governmental agencies, and older adults at this stage to support the AFC process and ultimately conduct assessments of the community’s needs. AARP has developed assessments that can be adapted to any community to help in this stage. These assessments help the jurisdiction see how it performs in the Eight Domains of Livability, which will frame the work ahead in partnership with an advisory committee formed for the AFC process.

The Eight Domains of Livability

Many communities pursuing AFC designation utilize the Eight Domains of Livability framework developed by the World Health Organization to organize their Action Plans.^[12] The Eight Domains reflect the combination of built and social environmental domains that influence the livability of communities for people of all ages. These Domains are helpful in the creation of Action Plans as a starting point. Many communities adapt, combine, or add new domains to fit the needs of their communities.

Below are the Eight Domains of Livability and a brief summary explaining what communities frequently cover within each Domain. Dementia Friendly Communities is also included, since it is one of the more frequently added Domain in AFC Action Plans and was included as one of five domains in San Diego County’s AFC Action Plan.

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  Domain 1: Outdoor Spaces & Buildings

  People need places to gather — indoors and out. Parks, sidewalks, safe streets, outdoor seating and accessible buildings (elevators, stairs with railing, etc.) can be used and enjoyed by people of all ages.^[13]

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  Domain 2: Transportation

  Driving should not be the only way to get around. Public transit options can be as expansive as a train system or as targeted as a taxi service that provides non-drivers with rides to and from a doctor’s office.

• 

  Domain 3: Respect & Social Inclusion

  Intergenerational activities are a great way for young and old to learn from one another, honor what each has to offer and, at the same time, feel good about themselves.

• 

  Domain 4: Housing

  Most older adults want to age in place. Doing so is possible if homes are appropriately designed or modified — and if a community includes affordable housing options for varying life stages. Currently less than 4 percent of housing stock offer critical accessibility features needed to age in place.^[14]

• 

  Domain 5: Communication & Information

  Age-friendly communities recognize that not everyone has a smartphone or Internet access and that information needs to be disseminated through a variety of means. At the same time, technology can be used to share information and improve quality of life for older adults through smart phone apps and other means.

• 

  Domain 6: Civic Participation & Employment

  An age-friendly community provides ways older people can, if they choose to, work for pay, volunteer their skills, and be actively engaged in community life. In fact, volunteerism is of great interest to older adults: a quarter of Americans aged 55 and older do volunteer work.^[15]

• 

  Domain 7: Community Support & Health Services

  At some point, everyone gets hurt, becomes ill, or simply needs a bit of help. While it is important that care be available nearby, it is essential that residents are able to access and afford the services required. In San Diego, the County Health and Human Services operates health services, however cities have the opportunity to develop partnerships to bolster health services for seniors in their jurisdictions.

• 

  Domain 8: Social Participation

  Regardless of one’s age, loneliness negatively affects a person’s health and sense of wellbeing. Isolation can be combatted by the availability of accessible, affordable, and fun social activities.

Dementia Friendly Communities^[16]

The Age Well San Diego Action Plan for the County of San Diego defines a Dementia-Friendly Community as a community which “provides appropriate support to individuals living with dementia so they can live as independently as possible. People with dementia are encouraged and welcomed to participate in community life and are supported by neighbors, businesses, faith communities, and the healthcare system.”^[17] While Dementia-Friendly Communities is not one of the Eight Domains of Livability, it demonstrates the type of issues that can be addressed as decided by each jurisdiction.

Phase 2: Action Planning

Once a jurisdiction has successfully formed an advisory committee and conducted assessments of the social and built environments, it is time to start planning. The key component to becoming an AFC is the development of a three-year action plan that builds on assessments and feedback from the advisory committee and older adults. This is typically where the Eight Domains of Livability are put to use as a framework for the goals set in the action plan.^[18]

Best Practices

This section looks at how other communities, outside of San Diego, have approached the AFCs planning process and provides best practices for joining the Age-Friendly Network. These best practices illustrate what AFCs and the Eight Domains of Livability are, how jurisdictions may benefit from an Action Plan to prepare and support San Diego’s aging society, and the benefits of joining the Age-Friendly Network.

As more communities in San Diego explore joining AFC, they should build off the previous work and successful models that preceded them. San Diego communities can and should apply solutions that cater to every jurisdictions unique needs and qualities. AFC exists because there is a greater, overarching mission to make more livable communities for everyone. There are multiple paths to take as communities work towards a healthier, more supportive way of life.

Miami-Dade

Domain 1: Outdoor Spaces & Buildings

In the Action Plan for an Age-Friendly Miami-Dade^[19], Miami-Dade County broke down the Eight Domains into two sections: the built environment and the social environment; however the built environment is their main focus. The three domains that are included in the built environment section are outdoor spaces and buildings, transportation, and housing. Each of the three domains is then broken down into an additional three strategies for the community.

Miami-Dade proposed the creation of an Age-Friendly Park designation, along with criteria needed to receive the designation. The County developed a self-directed walking program, began with 13 pilot park sites, and evaluated those sites with an equity access criteria. Using that criteria, they were able to identify barriers and opportunities for accessibility in and around the parks.^[20]

City of Auburn Hills, Michigan

Domain 2: Transportation

The City of Auburn Hills outlined seven domains in its City of Auburn Hills Age-Friendly 2015 Action Plan.^[21] Each domain breaks down the timespan, parties responsible, potential barriers, and metrics.

Auburn Hills has outlined transportation as a top concern, as do many other AFCs. The action plan has outlined several actions that can help create awareness and raise funding to improve transportation options for older adults. They propose creating partnerships with private companies to utilize their vehicles, exploring the possibility of billing insurance companies for transportation service options for medical arrangements and visits and providing information regarding transportation services for medical appointments. The action plan also stated a need to build awareness of affordable means of transportation. These outlined actions include a timespan for completion and resources and support that are available. The obstacles are funding, time, and manpower.

Denver, Colorado

Domain 4: Housing

Denver put forth social health as their biggest challenge and goal. They conducted a survey for residents and social health was voted by the majority of the public to be the biggest focus area. The housing domain outlined tangible goals to insure people would be able to age in place, such as tax breaks, emergency preparedness, and more. The action plan states that almost 90 percent of seniors wish to stay in their own houses as they age.

Boulder County

Domain 3: Respect & Inclusion,
Domain 5: Communication & Information,
Domain 6: Civic Participation & Employment, and
Domain 8: Social Participation

Boulder County’s Age Well Boulder County Strategic Plan - 2015^[22], is a second version of the Boulder County Area Agency on Aging’s original 2006 strategic plan. It focuses on just four Priority Areas: basic needs, personal connections and community involvement, health and wellness, and aging in community.

Within the personal connections and community involvement Priority Area, the Strategic Plan lays out several goals that overlap with both Domains 5 and 6. These include:

• Everyone in the community feels connected to others;
• People of all ages participate in social, civic, cultural, educational, and recreational activities;
• Opportunities exist for meaningful volunteer work; and
• Promote positive images of aging

These goals focus on the diversity of older adults and pay special attention to the social needs of homeless, Latinos, and LGBT seniors. San Diego’s diversity should also be included in any AFC planning as well.

West Sacramento

Domain 5: Communication and Information

The West Sacramento Age-Friendly Action Plan heavily focuses on actions for the city to take. In fact, it’s organized by 20 “Implementation Items”, not by domains. One of their implementation items is to increase awareness among older residents of the City’s Code Enforcement Services.”^[23]

This item is relevant to cities in San Diego where housing is expensive and many people may live in substandard housing due to their relative affordability. West Sacramento’s campaign relating to Communications and Information is to increase awareness of resources available to older adults that can assist in improving their quality of life, whether they are a tenant or renter.

City of Austin, Texas

Domain 7: Community Support & Health Services

Austin adopted the Eight Domains of Livability in their Building an Age-friendly Austin action plan.^[24] The greatest concern for elderly citizens is health care and navigating the complex needs of each individual. The action plan outlines community support and health services into a table with goals, partners, strategies, and potential actions.

There are four major goals for the Community Support and Health Services domain: Sustain and enhance investment in affordable, accessible, and holistic care that will build a vibrant and productive senior community; ensure access to proper support services, community resources and information for successful aging environment; provide information, education and training to ensure the safety, wellness, and readiness of seniors in emergency situations; and prevent financial exploitation, neglect and the physical, sexual, and emotional abuse of seniors.

Conclusion

Age-Friendly Communities are communities that are livable and increase quality of life for people of all ages. Thanks to the generosity of The San Diego Foundation, Circulate San Diego, San Diego State University’s Social Policy Institute, and a team of experts researched the best practices of Age-Friendly Communities that any jurisdiction in the San Diego region can put to use.

Resources are available to make becoming an AFC a smooth and fruitful process. The best practices above are a fraction of the number of Action Plans that have already been adopted across the country. These best practices and other resources should serve as a stepping stone for San Diego communities wishing to join AFC. They are foundational but show the ability to adapt the framework of the Eight Domains of Livability to each community as they saw fit.

Resources

Many resources are available for a jurisdiction interested in pursuing AFC. A good place to look for more resources is the AARP website on AFCs.^[25] There are also many local experts who were involved in the development of this report who can provide support:

• The San Diego Foundation
• AARP
• City of La Mesa
• Circulate San Diego
• SDSU SPI
• County of San Diego LiveWell

Acknowledgments

Author Maya Rosas Director of Policy, Circulate San Diego

Maya Rosas serves as Circulate San Diego’s Director of Policy, where she leads Circulate’s efforts on Vision Zero, Community Planning Group reform, and other campaigns. She has worked in safe streets advocacy, land use planning, and housing in both the non-profit and private sectors in San Diego since 2012. Maya is the author or co-author of numerous reports on topics including aging in place, Vision Zero, and affordable housing opportunities. Previously, Maya worked as a land use consultant for Atlantis Group, where she helped see development projects through all phases of the entitlement process and learned how homes get built.

Maya is a leader in San Diego’s YIMBY movement, a member of the San Diego Housing Federation’s Policy Committee, and serves on the City of San Diego’s Mobility Board. She is a graduate of the San Diego State University Master in City Planning program.

Special Thanks

Thanks to Catherine Thibault and Kaela Chavez for editing the report and Jana Schwartz for designing and formatting the report. Thanks to The San Diego Foundation and San Diego State University’s Social Policy Institute for their valuable feedback on the development of this report, and special thanks to the following individuals for providing extra input and expertise:

• Peggy Pico
• Susan Richardson
• Megan Howell
• Misty Thompson
• Lori Clark
• Steve Hornberger
• Tessa Cross
• Bob Prath
• Zachary Hansen

This program is funded by The San Diego Foundation and supported by AARP, the City of La Mesa, SDSU’s Social Policy Institute, community residents, local experts, and County and Chula Vista representatives.