"In spite of illness, in spite even of the archenemy sorrow, one can remain alive long past the usual date of disintegration if one is unafraid of change, insatiable in intellectual curiosity, interested in big things, and happy in a small way."

—EDITH WHARTON (1862-1937), AMERICAN NOVELIST, POET, AND DESIGNER

According to projections from the US Census Bureau, by the year 2030, people 65 and older will make up 20% of the population. As the out-of-pocket costs of assisted living facilities and nursing homes continue to soar, it would appear that most individuals will not experience a comfortable old age without a lifetime of sensible planning, or generous financial resources (the National Institute on Aging estimates the cost of eldercare at about $60 billion a year). How will we care for our aging citizens?

Fortunately, from the beginning, Americans have been trendsetters. So, it should be no surprise that as more of us move through middle age into our senior years, we show little interest in the prospect of expensive nursing homes and assisted living facilities, and are planning to live out our lives on our own terms—as independently as possible—at home. Considering new philosophies in aging and recent advancements in technology and health care, this is not an unreasonable expectation.

As the awareness of senior care issues grows, we are considering such concepts as establishing senior villages, retirement communities, intergenerational living spaces, and community groups to provide support for those who are experiencing the inevitable course of age: the loss of family, friends, and independence, as well as the physical limitations of growing older. These environments also offer those living within them a network of caregivers and friends to provide activities, classes, socialization, as well as a ride to the market or the doctor.

In addition, universal design and accessible home environments are also becoming major solutions for aging Americans with a desire to remain at home. With their comprehensive knowledge of understanding a person's physical needs, skilled rehabilitation specialists, such as occupational therapists, physical therapists, and certified aging-in-place specialists, play an important role in overseeing home modification evaluations, tailoring them to an individual's specific needs. In addition, they can provide aging clients with customized regimens—including strength building, gait and balance evaluations, nutritional tips, and brain and agility training—to improve their physical well-being and continued independence.

—Rogena Schuyler Silverman