| Observations of a Newly Minted Older Person
| Louis Tenenbaum

| Part 4 of a 4-part series: The Only Test That Matters  

A home that works is worth having whether you stay 2 years or 20

The same issue has come up twice recently, from very different directions. It’s a basic one — and persistent. This four-column series is my attempt to clarify it.

The problem is that we approach building backwards. We wait for a diagnosis, an injury, or a moment of crisis — and then we respond. Since remodeling takes time to be done well, urgency undermines the functional process.

And all along, we celebrate aging in place while continuing to design and build homes that fall short in the critical details. They work right up to the moment they’re needed. That’s when the details start to matter.

Timed for the 2026 American Society on Aging and National Aging in Place Council meetings, this series looks at that gap — and what we may do to fill it.

Read part 1
Read part 2
Read part 3

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This series has described a gap between what a longevity society needs and the failure of a medicalized approach to meet that need. There is another way to look at this — not as a design problem, or a health services problem, but as a market opportunity.

Adults over 55 account for roughly a third of a $470 billion remodeling market. That is an enormous volume of work, in homes where functional design decisions will matter — but as described above, that is not happening. People who are already remodeling, when the walls are already open and the budget is committed, are the prime opportunity to influence better design. 

None of this requires inventing new knowledge. Wider clearances, better placement of controls, layouts that function when circumstances change, features installed where they actually help — these are easily made design decisions. As a contractor, I can assure you: none of this is rocket science. It is just common techniques and materials used in slightly unusual ways.

Healthcare-at-home and aging services represent large and faster-growing sectors that should understand this math, even if they haven’t yet acted on it. A single fall resulting in a hip fracture can cost well over $30,000 in acute care alone, before rehabilitation, before any long-term implications. Long-term care insurers, health plans, and managed care organizations absorb those costs routinely — with no thought to a remodeling project that could have changed the outcome. The downstream spend is enormous. The clinical evidence for prevention is strong. The financial case is clear. Yet the upstream investment remains unmade.

Which raises a simple question: why are we waiting for the downstream spend?

The current model — intervening after an event — is both clinically and financially inefficient. Long-term care insurers, health plans, and managed care organizations have direct financial incentives to support design decisions that prevent the costly events they will otherwise pay for.  Every fall that happens in a bathroom that could have been made safer represents a failure of timing and motivation. Few recognize this. 

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The problem is framing. “Because you’re getting older” is a non-starter. A different framing gets different results. A tax credit, an insurance discount, a state or federal program that offsets part of the cost of better design at the moment of remodeling changes the entire conversation. The contractor doesn’t need to raise the subject of aging. The homeowner doesn’t need to confront what might happen someday. The decision gets made for entirely ordinary reasons: it costs less to do it right.

That is how durable behavior change works at scale. Homeowners didn’t insulate their attics because they were persuaded to care about energy policy. They did it because the incentive made it the financially obvious choice. The same mechanism is available here — and the return on investment is, if anything, more compelling. A modest incentive at the remodeling moment captures savings that are multiples of its cost, distributed across insurers, health systems, and public programs that are currently paying for outcomes that better design would have prevented.

Nobody in that chain had to say the word aging.

Policymakers have the tools: tax credits, state incentive programs, Medicaid waiver authorities. Insurers and health plans have the data, the financial stake, and their own paths to provide incentives. What has been missing is the recognition that the intervention point isn’t the hospital, the rehabilitation facility, or the moment of crisis. It is the remodel — years earlier, when the cost is low, the disruption is minimal, and the decision is still easy to make.

We’ve been relying on the wrong incentives for too long, and waiting until the crises are too profound. Shifting to the right incentives and the right timing could make a huge difference.

The moment is already there, happening every day in homes across the country, where contractors and clients are making decisions that will last for decades. All we need is to organize the collective will to make it happen.

Louis Tenenbaum is a longtime advocate for aging in place, co-founder of the HomesRenewed™ Coalition, the HomesRenewed™ Resource Center, and HomesRenewed Ventures, LLC and a nationally recognized expert on home modifications that support independent living. Discover more columns in this series.