| From Vision to Urgency

| Observations of a Newly Minted Older Person
| Louis Tenenbaum

| Sixteen years ago, I wrote a white paper published by the MetLife Mature Market Institute describing a future in which housing, technology, caregiving, medical services, transportation, and community supports would work together as a single, coordinated system for older Americans who wanted to remain in their own homes. It was called Aging in Place 2.0: Rethinking Solutions to the Home Care Challenge. The vision was ambitious and urgently needed.

The good news is that the vision holds up. The bad news is that it is still mostly a vision. Aging in place services still operate in silos. The system has not been built. Needless to say, writing about it did not make it happen. I was naïve. It is still urgently needed.

Two Things Have Changed Since Then

The first is technology. Remote monitoring, passive sensors, AI-assisted pattern recognition, telehealth platforms, smart home systems, and a growing list of other tools are now available and far more sophisticated than I imagined when I wrote the original paper. Age Tech investment is robust. The problem is that most of these tools still operate inside the same old silos. They are smarter than before, which is helpful, but still not coordinated.

The second change is that the situation has become more grave. 

• The older population has increased dramatically. 
• The number of people living with dementia has grown. 
• The ratio of caregivers to older adults has fallen sharply. 
• The cost of medical care and institutional senior housing has risen beyond what most middle-income families can afford. Those now described as the “Forgotten Middle” are in particularly serious trouble: too asset-rich for Medicaid, too cash-poor for private care, and at real risk of spending down into dual eligibility, which only adds to pressure on public funds. 

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Fiscal pressure on public programs has intensified to the point where continued inefficiency is not viable. The worse the situation becomes, the more urgent the need for a real system. And the larger the opportunity.

The Silo Problem

What do we mean by silos? Picture different businesses, different industries, different regulations, and different funding streams. Medical care, home modification, meal delivery, transportation, home health aides, telehealth, medical equipment, medications, and community programs each operate in their own lanes. The task of coordinating them is treated as yet another lane, and a mostly unpaid one at that. Care coordination is compensated only in limited post-acute situations, and usually only for a short time. Paying out of pocket is expensive and, when time frames and prognoses are unknown, becomes a worrisome expense.

The difficulty with care coordination comes from a simple fact: aging health is dynamic. Just when everything seems settled, it changes, and the work of assembling services starts again. New needs mean new research, new providers, new arrangements, and new gaps to fill. This is an extraordinarily difficult job. And, almost absurdly, overwhelmed and undertrained families are expected to perform it. 

Coordinating fragmented providers around constantly changing needs is not a family function. It is a system function. And we still do not have a system.

Aging in Place 2.5: Technology Plus Coordination

Now picture connective tissue that can turn housing, caregiving, healthcare, transportation, and community supports into a functioning system. Because the needs of older adults are dynamic and continually changing, this function is built into the system itself rather than offered as a separate silo. Technology can strengthen that effort by helping monitor needs, anticipate changes, and manage the distribution of resources and services, but technology alone is not enough. What is needed is an operational model in which technology and coordination work together to produce something none of the silos can achieve alone. I refer to this update to Aging in Place 2.0 as Aging in Place 2.5.

The move from 2.0 to 2.5 requires acknowledging something the field has never formally accepted: care coordination is not a luxury service for families who can afford a geriatric care manager; nor is it a job that should fall by default to an exhausted adult child or aging spouse. It is itself a core function. If aging in place is going to work at scale, care coordination must be recognized, supported, and funded as essential infrastructure; not underpaid, not outsourced to families, and not treated as just one more silo.

What Is Required Now

In 2010, Aging in Place 2.0 was a vision. In 2026, the demographic pressure is no longer a projection. It is the daily reality of millions of families, thousands of strained providers, and a public system with very little room left for inefficiency.

The silos will not dissolve on their own. The connective tissue will not appear by magic. Creating Aging in Place 2.5 requires a shared decision to build an actual system. Providers, payers, policymakers, communities, and families must get behind deliberate policy and investment. What is required now is collective action.

Making aging in place affordable and possible is not just a social good. It is a scalable, investable strategy for economic growth and system sustainability. The path from 2.0 to 2.5 is not a path of new ideas. It is a path of finally acting on the right ones, together.

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.