This chapter provides insights into different policy dimensions necessary to promote ageing at home. It first describes how countries are ensuring that housing remains affordable for older people and whether there is sufficient help for adapting housing when people develop mobility limitations. It also focusses on the broader environment where people live, highlighting necessary changes to enable more age‑friendly communities that provide access to services and promote participation. Finally, the chapter looks at the comprehensiveness and affordability of home care services.
The Economic Benefit of Promoting Healthy Ageing and Community Care
Abstract
Current living environments do not always promote ageing at home. The current housing stock is not always affordable or well-adapted for older people to remain at home as they age, and public funding for housing adaptation is often insufficient. In the United States and Europe, home modifications that make housing more accessible are in place in less than 20% of homes. Essential services and green spaces are not always readily accessible to older people. In cities, on average, a person has access to only 0.2 green areas and only 0.5 hospitals within 15 minutes’ walking time. Public transport does not yet fully meet the needs of older people in accessing services. Among 27 OECD countries with available information, only 16 countries reported that public transportation is easy to access for people with mobility limitations and affordable for older people.
Home and community care provision remains limited, presenting challenges in ensuring access and meeting current needs. Currently, 40% of countries impose a limit on the hours of care, while care for instrumental activities of daily living is not always covered in 20% of those cases. Continuous LTC support at home is available in only 30% of countries across the OECD. Gaps in the public provision of home care leave vulnerable people with severe needs and low income at the risk of unmet needs or high out-of-pocket costs, incentivising the use of institutional care.
Policy options
Support people in making their houses age‑friendly. Home modifications are associated with a lower likelihood of being admitted to nursing homes and a lower need for help with activities of daily living. Simplifying the process for housing adaptation and ensuring that it is generous enough to cover modifications would be needed to better promote ageing in place. Currently, out-of-pocket payments are required in one‑third of countries to cover the cost of housing adaptations. Countries like France have simplified access to such support for older people who need housing adaptations by creating a financial aid programme, MaPrimeAdapt’. In several countries like the Netherlands, Sweden and Norway, municipalities provide consultation on housing adaptation with an occupational therapist who assesses needs and subsidise providers upon request once the adaptation is in place.
Adapt communities to an ageing population. Environments which encourage accessibility help to promote independence for older adults, especially for people with dementia. Health services in rural areas where there are more older people could also be enhanced by innovative solutions to strengthen health professionals, as in France and Norway. Public transportation that is accessible and affordable to older people fights social isolation and maintains functional capacities. Countries like Australia and Japan have looked at flexible transport models for older people while Austria has promoted concessionary fares. An offer of activities to enhance social participation is also important: In Japan, municipalities have implemented salons for older people on educational programmes and social activities, which have halved the incidence of long-term care (LTC) needs.
Make home care services more comprehensive. Enhancing the hours and services for home care, while seeking innovative solutions, can incentivise people to stay at home longer. Personal budgets, as in England and the Netherlands, could provide flexibility to users in deciding the home care services that they need. Spain in 2022 changed the limit on the hours available for the highest grade of LTC to cater for more home care for those who have more severe needs. Digital technologies, as implemented in Nordic countries and Japan, can help contain the costs of monitoring and free workers’ time for providing other types of care to older people. In addition, where unit costs of home care services are lower than those of institutional care, countries could consider expanding the hours and piloting 24‑hour care options.
Older people across OECD countries prefer to age at home and in their community. According to evidence from the United States, 77% of adults aged 50 and above wish to age at home (Binette and Farago, 2021[1]). With an ageing population and a growing burden of chronic conditions leading to an increasing demand for long-term care, allowing people to age in place is gaining importance. Many OECD countries have developed services to support home‑based care for older adults. Between 2011 and 2021, the proportion of long-term care recipients who received care at home increased slightly, from 67% to 69%. However, having more older people living at home is not without its own challenges.
Although a majority of older adults in OECD countries are homeowners, housing affordability is declining, and the proportion of older people owning homes is expected to shrink as younger generations grow older. Additionally, many older adults experience reduced incomes, making it increasingly difficult to afford rent and cover essential living expenses. Policies aimed at enabling individuals to age in place and remain in their own homes for as long as possible should address the challenge of ensuring suitable housing that supports independent living in later years.
5.2.1. Decreasing homeownership is likely to pose a challenge to older people in the coming decades
Among OECD countries, the majority of people in older ages own their homes, but housing affordability is decreasing. Homeownership is an important asset for older people for several reasons. In most countries, a home is the biggest financial asset that people own, representing more than 70% of total wealth in European households (Vignoli, Tanturri and Acciai, 2016[2]) and acquiring a house is associated with better mental health in old age (Courtin, Dowd and Avendano, 2017[3]). The share of homeowners, as well as housing tenure, has been declining for the overall population across OECD countries. This is driven by several factors. Housing affordability (i.e. housing price to income ratio) has decreased since 2017 in OECD countries (OECD, 2023[4]). Today, families pay considerably more to buy a flat than previous generations. The years of annual income needed to buy a 60 square‑metre flat in the country’s capital city or financial centre, for a median income couple with two children, grew from 6.8 years in 1985 to 10.2 years in 2015, based on data from 16 OECD countries (OECD, 2019[5]). Moreover, between 2020 and 2022, the housing cost overburden rate has been growing considerably for people aged 65 or older, moving from 7.8 in 2020 to 9.7 in 2022 on average in the EU (Figure 5.1).
Percentage of the population living in a household where the total housing costs (net of housing allowances) represent more than 40% of the total disposable household income (net of housing allowances), by age groups
Note: Data includes 27 EU countries.
Source: Eurostat (2024[6]), “Housing cost overburden rate by age group – EU SILC survey”, https://ec.europa.eu/eurostat/databrowser/view/tessi161__custom_10348800/default/table?lang=en.
As home ownership becomes increasingly unaffordable, a growing share of older people are expected to become renters in the coming years and need additional support to ensure affordable housing. Older renters are often faced with the challenge of rent overburden and difficulty making ends meet due to decreasing incomes at older ages.1 Poverty rates for older people are higher than for the total population in two‑thirds of OECD countries and increase with age, limiting the capacity of older people to pay rent in tight housing markets (OECD, 2023[7]). Research has highlighted growing housing insecurity and rent unaffordability, together with lower quality of housing among older people, particularly affecting women and minorities, partly contributing to a growing number of people becoming homeless at the age of 50 or older (Bates et al., 2019[8]; Bates et al., 2019[9]; Cram and Munro, 2020[10]; Waldron, 2021[11]; Petersen and Aplin, 2021[12]; Airgood-Obrycki, Hermann and Wedeen, 2022[13]). The precarity caused by renting at older ages poses additional challenges and can compromise older people’s well-being (Bates et al., 2019[9]; Bates et al., 2019[8]; Mawhorter, Crimmins and Ailshire, 2021[14]).
Several countries are supporting people in securing stable housing through policies that aim to either improve the supply of affordable rental and homeownership opportunities or support housing-related costs, such as rental costs. Across OECD countries that replied to the OECD Questionnaire on Healthy Ageing and Community Care, 73% (16 out of 22) of countries reported the existence of programmes to increase the supply of affordable rental and homeownership opportunities among older adults, and 68% (15 out of 22) of countries reported the existence of subsidies for rental programmes with services for low-income older people (Figure 5.2). In most cases, the programmes and subsidies are not exclusively dedicated to older people. However, in some cases, access is subject to age requirements. Furthermore, two‑thirds of the countries reported that when programmes to promote ageing in place existed, they offered care services at home, in addition to affordable housing options (OECD questionnaire, 2023).
Number of programmes by type and availability at the national or subnational level
Note: N=19. Measures for affordable housing that do not specifically target older adults are not considered.
Source: OECD questionnaire (2023).
However, more demand and enhanced public support for housing on the supply side are necessary. Government investment in housing development has been declining in recent years (OECD, 2021[15]), leading to a decline in social rental dwellings available in the past decade, as a share of the total housing stock, in several OECD countries (Cournède and Plouin, 2023[16]). The type of housing affordability support needs to be carefully designed, taking into consideration its possible negative spillovers and balancing costs and benefits to support people in ageing in place.
5.2.2. Incentivising supply is important to have sufficient affordable housing for older people in the face of demand changes
Some countries have public-private partnerships aiming at supporting private companies to increase the supply of affordable housing. In Canada, the previous Investment in Affordable Housing (IAH) programme established partnerships with the private sector and community organisations to increase the availability of affordable housing while a new programme has affordable loans (Affordable Housing Fund). The programme offers forgivable loans to for-profit, not-for-profit and co‑operative organisations to build housing opportunities that are rented at affordable prices for a minimum period of time. Access to such housing is available for people who are eligible for social housing, while some projects can also target specific subgroups, such as low-income seniors (Leviten-Reid and Lake, 2016[17]). In Switzerland, the federal government supports private entities developing new housing that is barrier-free, particularly those that follow the LEA (Living Every Age) label. Even though this programme does not exclusively target older people, the latter are likely to benefit from a growing number of affordable and accessible – barrier-free – housing options (OECD questionnaire, 2023).
In other countries, there is public support in the form of subsidies to build affordable housing opportunities. In the Netherlands, any legal entity involved in creating social housing can apply for public subsidies. This is part of the incentive scheme for building meeting spaces in housing for older people (called Stimuleringsregeling Ontmoetingsruimte voor Ouderenhuisvesting, SOO). This incentive scheme aims at increasing the availability of spaces where older people can meet and support each other. At least 50% of the residents who can benefit from the meeting spaces must be over the age of 55 (Dutch Government, 2023[18]). Furthermore, to ensure the affordability of social housing in the Netherlands, the “Passend Toewijzen” (“appropriate allocation”) programme ensures that people living in social housing pay a rent that is adequate to their income level (Dutch Government, 2023[19]). In Spain, the Spanish Government has approved the State Plan for access to housing 2022-2025, which provides government contributions for the promotion of newly built or rehabilitated residential buildings that are accessible and affordable for people with limitations and older people. The design of the buildings must guarantee accessibility and adequacy for people with disabilities and older people to live as independently as possible. Furthermore, the accommodations financed through this subsidy must be rented or transferred for use to people aged 65 or older or to people with disabilities, subject to means testing of the beneficiaries. The persons or entities promoting the accommodation or homes, even from their rehabilitation, may obtain direct aid, proportional to the useful surface of each accommodation or home, of up to a maximum of EUR 700 per square metre of said useful surface (Agencia Estatal Boletín Oficial del Estado, 2022[20]). In England, private housing providers can receive subsidies through the Affordable Homes Programme (AHP) and the Care and Support Specialised Housing Fund (CASSH). The programmes aim at incentivising the availability of affordable housing for older people. In 2021, the Secretary of State for Health and Social Care presented to Parliament the white paper on Adult Social Care Reform, highlighting the commitment to continued investment in the CASSH fund, forecasting a GBP 70 million investment per year until 2026 (Department of Health and Social Care, 2021[21]).
In New Zealand, the Ministry of Housing and Urban Development (HUD) has started a number of programmes to improve the availability of affordable housing for both buyers and renters. The Affordable Rental Pathway (ARP) offers grant funding to not-for-profit organisations to build new affordable housing to rent. The first round of the programme received USD 50 million; the second round, USD 100 million. Housing targets people with low income, but also households (whānau) who cannot access public housing but cannot afford market rent either. Such a programme does not specifically target older people (OECD questionnaire, 2023).
In other countries, affordable housing is funded and supplied by public authorities. For instance, in Slovenia, the Pension Real Estate Fund and the Housing Fund of the Republic of Slovenia provide affordable rental housing targeting older people (OECD questionnaire, 2023). In the United States, the Housing Opportunities for People Everywhere( HOPE), which was replaced by the Choice Neighbourhoods Initiative, programme has provided funding to Public Housing Authorities that have severely distressed public housing since 1993. The programme supports the construction and rehabilitation of social housing, as well as the demolition of severely distressed public housing (US Department of Housing and Urban Development, 2023[22]). Studies have found that residents of housing within the previous programme (HOPE IV) reported higher scores on mental health, social functioning and vitality, but results are mixed when looking at physical health outcomes (Spillman, Biess and MacDonald, 2012[23]). In Australia, the state of Victoria funded the Big Housing Initiative, while New South Wales announced in 2020 an increase of AUD 900 million investment for the construction of 1 300 new social dwellings (OECD, 2021[15]).
5.2.3. Providing financial support and social housing would help to make housing more affordable for older people
Some countries have social housing options with services to support older people with low income to live at home as independently as possible. In the Netherlands, there are examples of multigenerational social housing, where older people and young students live in the same social housing buildings, to support each other and allow each other to be independent (International Observatory on Social Housing, 2023[24]). In Switzerland, similar programmes for older people exist at the local level. For instance, in the City of Zurich, the SAW Foundation (Stiftung Alterswohnungen) offers apartments for older people at affordable rents. The apartments also include a wide range of services, such as move‑in assistance, laundry, emergency telephone, house maintenance, courses, and social events and common areas (OECD questionnaire, 2023).
Other countries have subsidies to support older people to pay rent or buy a house. Some recent evidence also shows that older renters living in subsidised housing are less likely to develop activity limitations compared to unsubsidised older renters (Jenkins Morales and Robert, 2023[25]). Some studies on the effectiveness of subsidised housing have shown positive results of such programmes on the mental health of beneficiaries, with mixed results on physical health (Spillman, Biess and MacDonald, 2012[23]). In France, older people can receive financial support to pay for their rent (i.e. the Aide Personnalisée au Logement or the Allocation de Logement Social) (French government, 2023[26]). In New Zealand, Superannuation and Veterans’ Pension recipients are entitled to the weekly Accommodation Supplement to help with rent or the cost of owning a home. Furthermore, the Progressive Home Ownership Fund (PHO Fund) supports people in buying a house by offering options such as the rent-to-buy arrangements, shared ownership or leasehold schemes (OECD questionnaire, 2023). For older people who are planning to become homeowners, the United Kingdom has the Older Persons Shared Ownership (OPSO) initiative, a form of shared ownership for people aged 55 or older, who do not own a home, with a gross annual household income equal to or less than GBP 80 000 (or 90 000 in London). The OPSO initiative allows people to buy a share of a home – between 10% and 75% of its market value – and to pay rent on the remaining share (Own Your Home - UK government, 2024[27]). Furthermore, older people can be eligible for a housing benefit to support renters who have reached the state pension age (or older) have a low income and less than GBP 16 000 of savings. The amount of the support depends on the income and savings of the renter, as well as the amount of rent to be paid, the size of the home and whether the person already receives other benefits (e.g. the carer’s allowance, or disability allowances) (Age UK, 2024[28]).
In a number of countries, subsidies are usually not targeted at older people, but older people with low income can benefit from them. For instance, in Canada, a one‑year programme was in place and those who paid rent in 2022 corresponding to at least 30% of their net family income received a one‑time top-up of CAD 500 to the Canada Housing Benefit. The benefit is application-based, non-taxable and can be received by pensioners (OECD, 2023[7]). Colombia has a subsidy for households from vulnerable populations to support them to buy or rent a house, while Costa Rica has subsidies to support housing improvements, repairs and maintenance for people with lower socio-economic status (Government of Colombia, 2023[29]) (IMAS, 2023[30]). Latvia passed a law in 2004 to support people with different types of housing assistance, including renting out social housing, financial support to cover rent, and allowances to renovate residential space. The support does not target older people specifically, but is rather referred to people with low incomes, without age restrictions (Law 22 December 2004 on Assistance in Solving Apartment Matters). In Luxembourg, the Affordable Housing Act (2023) promotes equitable access to housing through financial participation from the state, tailored rent calculations, and a dedicated allocation process for people aged 60 and over, ensuring their affordability and social inclusion (Gouvernement du Grand-Duché de Luxembourg, 2023[31]; Gouvernement du Grand-Duché de Luxembourg, 2023[32]). In the Netherlands, the “Passend Toewijzen” (“appropriate allocation”) programme ensures that people living in social housing pay a rent that is adequate to their income level (Dutch Government, 2023[19]). The United Kingdom has a number of initiatives to support people to pay their rent or become homeowners. People can receive support for the payment of mortgage interest (the SMI – Support for Mortgage Interest). The initiative provides people with a loan to support them in paying for mortgage interests or for some home improvements. In the United States, people who are unable to pay the rent can apply for rent relief resources (US Department of Housing and Urban Development, 2023[33]).
In addition, previous OECD work has highlighted the importance of broader governmental investments in social housing to improve the quality of existing housing and the development of new social housing that is environmentally sustainable (OECD, 2021[15]). Studies have found that when social housing is available, it is often tailored for younger families and poses accessibility challenges for older people (Bogataj, Bogataj and Drobne, 2023[34]). Housing that is accessible and facilitates the independence of people with physical and/or mental limitations, as well as being environmentally sustainable and adapted to changes in temperature and weather, is vital for populations with more precarious health status, including older populations with care needs.
Living in a housing environment tailored to individuals’ needs and conducive to their independence and well-being is another crucial factor for policymakers to consider when crafting policies to promote ageing in place. As people age, moving around the house, taking the stairs and living in a place that is not adapted to people with physical limitations can lead to fear of falling and to increased risk of falls and injuries (Chen et al., 2023[35]; Braubach, 2011[36]). Facilitating independent living at home involves enabling people to make necessary housing modifications and promoting the building of new accessible housing environments. While for new residential construction, accessibility requirements can be implemented, the current housing stock also needs adaptations and residential renovations to ensure a minimum level of accessibility.
5.3.1. Housing affects older people’s ability to live independently and is not always accessible
The current housing stock across many countries does not adequately meet the needs of older people, leaving many of them in unsuitable housing conditions. Data from the American Housing Survey shows that only 40% of homes had the most basic features to be considered ageing-ready, such as a step-free entryway into the home with a bedroom and a full bathroom on the entry level floor (Davis, Clark and Vespa, 2023[37]). In the United Kingdom, only 12% of older people had level access to the entrance of their building, while less than half had a bathroom on the entry level (Older People’s Housing Taskforce, 2024[38]). In France, only 6% of housing was considered adapted to older people’s needs in 2013 (CNAV, 2013[39]). In Spain, a recent survey highlighted that eight out of ten dwellings were not adapted to older people’s needs (CGATE, 2023[40]).
Housing adaptations friendly for ageing are still uncommon, and they vary significantly across the OECD. Only 15.8% of households in the European Union (EU) and the United States had special features for increased accessibility and independence as of 2022 (Figure 5.3). The share of households living in housing with any accessibility features was highest in Israel (39.4%) and lowest in Bulgaria (2.2%). Bathroom and toilet modifications, such as grab bars or shower seats, were most common (9.8%) in the United States. In EU countries, rails were also common (8.0%), as well as bathroom and toilet modifications. Housing equipped with ramps or alerting devices was relatively uncommon, with fewer than 3.5% of properties featuring these features across the countries. The overall low prevalence of housing adaptations and the limited modifications to the most basic features are likely due to the tendency for people to postpone introducing these special features until they reach the age of 80, which is often linked to cost constraints (Wu, Fu and Yang, 2022[41]).
Share of households living at home with any special features for older people or people with physical impairments, 2022
Note: Data for Europe and the United States are based on SHARE Wave 9 (2021-2022) and HRS 2022, respectively. The OECD average includes only the values of OECD Member countries.
Source: Survey of Health, Ageing and Retirement in Europe (European Union and Israel) and Health and Retirement Study (United States).
In addition to housing adaptations, several items can support people’s autonomy at home. Among OECD countries for which data is available, the most common items that people use to move and perform basic activities of daily living in autonomy are canes and walkers (20% of respondents on average in 13 OECD countries), incontinence pads (7%) and personal alarms such as alarms used to make emergency calls after falls (5%). Other items like wheelchairs, buggies and special eating utensils are much less common among older people living at home (less than 5%).
There has recently been a lot of discussion about the potential of new technologies to improve the conditions of care recipients and prevent additional interventions by caregivers. Technological solutions can facilitate active ageing and social participation of older people, reducing loneliness and facilitating social inclusion via participation in virtual activities. For example, in Denmark, a digital training tool for physical activities at home (called “DigiRehab”) contributed not only to efficiently monitoring care recipients’ physical ability but also to reducing their need for home care (Healthcare Denmark, 2019[42]). In Canada, the Canada’s Aging in Place Challenge programme focusses on improving the quality of life of older adults and their personal caregivers through technology and innovation for safe and healthy ageing. A few studies have emphasised effects on improved communication, family interactions, a better sense of safety and participation in health decisions (Moreno et al., 2024[43]). Wearable devices or smart home and monitoring technology increase older people’s independence and mobility. At the same time, current evidence on the effectiveness of technological devices remains scarce. A review identified that a number of wearable devices, such as a pedometer, a biofeedback device and an online video platform, can indeed facilitate ageing in place (Ollevier et al., 2020[44]). Challenges in using technology and privacy concerns are also preventing the wider use of such devices.
Housing adaptations can support people’s autonomy at home
According to several studies, accessible housing design has a positive impact on the ability of older people to live independently, resulting in lower health-related outcomes, such as fewer falls, and delayed nursing home admissions. Studies have found that home modifications that make housing more accessible are associated with a lower likelihood of being admitted to nursing homes, lower needs for help with activities of daily living such as bathing, lower levels of functional decline and carers’ better outcomes (Spillman, Biess and MacDonald, 2012[23]; WHO Europe and European Commission, 2017[45]; Petersen and Aplin, 2021[12]). Some studies in the past decade found that the impact of accessible housing on specific outcomes such as preventing falls is less clear, with studies finding contrasting results when analysing the effect of installing supportive features such as grab bars and railings, together with healthcare workers’ visits at home (Chase et al., 2012[46]; Spillman, Biess and MacDonald, 2012[23]; Leviten-Reid and Lake, 2016[17]). Nevertheless, a recent Cochrane review including 22 studies in 10 countries found that home fall-hazard interventions reduce the rate of falls by 26% overall, with greater reductions for people with a high risk of falls (38%) (Clemson et al., 2023[47]). Previous analysis based on England has also found that unhealthy housing impacts health outcomes of older people, producing GBP 1.4 billion of health expenditure per year, while home adaptations could bring potential savings of GBP 1.5 billion a year due to lower health costs as a result of falls or reduced residential care costs (Garrett and Burris, 2015[48]; Centre for Ageing Better, 2024[49]).
The housing space can also impact the ability of older people to build and maintain social ties, while the housing location can influence older people’s choice to remain in their homes or to relocate to different areas. For instance, in Canada, balconies and common areas such as lobbies and common rooms have been found to boost relationships among neighbours. Studies have also shown that housing located in rural communities can hamper older people’s ability to live in their homes, particularly if adequate public transportation is missing (Leviten-Reid and Lake, 2016[17]).
The impact of housing adaptation is still rarely measured. Only six OECD countries perform evaluations of the effects of housing adaptations on the outcomes, and three conduct evaluations of the economic impact. France, Japan and Portugal report evaluations focussing only on the effects on the outcomes, while the Slovak Republic, Sweden, and the United States perform evaluations of both the impact on outcomes and the economic impact of housing adaptations. Latvia reported that the measurement of effects depends on the municipal level and may vary across the country (OECD questionnaire, 2023).
5.3.2. Financial support for housing adaptations focusses on more basic equipment, while the application process and out-of-pocket costs limit user access
Given that for a substantial number of older people, their current living environment is unsuitable and that they might not have the means to finance the adaptation of their dwellings to their functional possibilities, governments would need to consider subsidising housing adaptation in addition to stimulating accessible design for new homes.
Public funding for home adaptations is available across the OECD. Among 22 OECD countries that responded to the OECD Questionnaire on Healthy Ageing and Community Care, more than 60% of countries reported funding handrails (78%), stair lifts and ramps (72%), toilet replacement, fall sensors, lighting improvements and rails and seats in bathrooms (61%). On the other end, assistive technology is the least publicly funded. Only around one‑third of countries reported that intercom systems and smart home technology can be covered through public funds (Figure 5.4).
Limited financial support for assistive technology may result in a lower availability of technologically advanced housing adaptations, such as smart home technology. In fact, only 10 out of 28 responding countries have reported that public funding is available to cover digital tools that can support ageing in place, a result that shows that the availability of digital technologies might vary across countries. Seven responding countries have reported that remote rehabilitation or exercise and medication dispensers for people living at home can be covered by public funding. Norway, the Slovak Republic and Sweden also cover location trackers with public funding. Other examples of digital tools for people living at home that can be publicly funded are home security alerts and remote monitoring, which are available in Canada (New Brunswick), Luxembourg and New Zealand (OECD questionnaire, 2023).
Percentage of countries that reported that public funding can be used to cover specific housing adaptations, by type of housing adaptation
Note: N=22.
Source: OECD questionnaire (2023).
In half of the countries for which information is available, people who need to perform housing adaptations to allow them to live independently at home will need to contract out the adaptation work before receiving partial or total reimbursement of expenses (OECD questionnaire, 2023). It is therefore important to have clear information available to support people in navigating the housing adaptation process. Among the 28 countries that responded to the questionnaire, only 10 reported the existence of an entity providing advice on housing adaptation.
In some countries, there are specific agencies that people can refer to when looking for information on housing adaptation, while in other countries, this role is held by local authorities. For instance, France has designated information centres, the centres d’information et de conseil sur les aides techniques (CICAT), which provide information to professionals, older people or other people with limitations in need of housing adaptation, as well as their families and informal caregivers. The centres can provide information and allow people to test the available housing adaptation options to choose the most suitable solution for their needs. In Luxembourg, ADAPTH is a consultancy office that provides support to both building companies and individuals with limitations who need housing adaptation. ProSenectute in Switzerland also has a similar role. Ireland operates the Healthy Age Friendly Homes Programme by appointing a local co‑ordinator in all local authorities, who performs home‑based assessment, identifies and designs supports for independent living. Meanwhile, the municipality is responsible for providing information on housing adaptation in Latvia, the Netherlands, Norway and Portugal. In most cases, occupational therapists are responsible for providing information on housing adaptation options (in 8 countries out of 10 that reported this information), followed by social workers (5 countries) (OECD questionnaire, 2023). In Sweden, a health professional can also initiate the process of housing adaptation, and, in most cases, an occupational therapist inspects the home to assess environmental barriers and the extent of people’s limitations and identify needs.
Most OECD countries that answered the questionnaire reported supporting housing adaptation with public funding, but public support is usually means-tested. The national level funds such measures in 74% of countries that replied to the OECD Questionnaire on Healthy Ageing and Community Care and by the local level in 48% of countries. Private out-of-pocket contributions also seem to play a significant role, with one‑third of countries reporting that private out-of-pocket contributions are required to fund housing adaptations (Figure 5.5, OECD questionnaire, 2023). Data from Europe shows that people delay the introduction of housing adaptation often until they are at least 80 years old and such modifications tend to be limited, focussing on the most necessary modifications because of affordability constraints (Wu, Fu and Yang, 2022[41]). In Sweden, on the contrary, the grants for housing adaptation do not depend on the financial situation and, after the application is accepted, the invoice is sent to the local authority so that older people do not need to advance the funds.
Share of countries by the source of funding for housing adaptations
Note: N=23.
Source: OECD questionnaire (2023).
5.3.3. Public subsidies and tax credits for older people to adapt their housing remain limited
Public subsidies are the most common form of support, available in 12 countries (Austria, Canada, Colombia, France, Iceland, Ireland, New Zealand, Portugal, the Slovak Republic, Spain, Sweden, the United States), followed by grants and long-term care insurance funds, tax credits and loans (OECD questionnaire, 2023). The generosity of these types of support varies across countries. For instance, in Austria, the city of Vienna covers up to 35% of the cost of housing adaptation for up to EUR 4 200. Sweden allocates a total of SEK 1 billion annually for housing adaptations, with 70% spent on older people and approximately 74 000 projects undertaken each year (Slaug, Granbom and Iwarsson, 2020[50]). Starting from January 2024, France merged three forms of financial support available to cover housing adaptations into one financial aid: people with physical limitations who require housing adaptations2 will be able to apply to MaPrimeAdapt’ to receive financial support equal to 50% or 70% of the adaptations up to a maximum amount of EUR 22 000 (French government, 2023[51]).
Public subsidies might fall short to help people with limited means and major needs. Studies on the costs of housing adaptations suggest that such costs are sizeable. A study from the United Kingdom suggests that the costs of major adaptations represent on average more than GBP 16 000, ranging from GBP 2 500 to GBP 36 681 (Curtis and Beecham, 2018[52]). In Ireland, older people (65 or older) living in poor housing conditions can receive the housing aid for older people grant to make improvements or repairs such as replacing windows and doors, heating, and sanitary facilities. The grant can cover up to 95% of the cost for a maximum amount of EUR 8 000 and is means-tested. The grant is financed by the Department of Housing, Local Government and Heritage (80%) and the local authorities (20%) (OECD questionnaire, 2023). A review of the grant advised nonetheless to increase the size of the grants and the threshold limits to obtain them (Department of Housing, Local Government and Heritage of Ireland, 2024[53]).
Grants for providers are available in a number of countries. In Australia, 232 service providers receive grants to deliver home modifications, with a total public funding of USD 70.8 million in 2023‑2024. Furthermore, people living in social housing receive support for home modifications through the local government (OECD questionnaire, 2023). In Poland, under the Za życiem (For Life) programme, communities, social care organisations, and NGOs can apply for non-repayable financial support of up to 80% of investment costs for the development of protected housing for persons with disabilities, including assisted and training units, as well as for upgrading the existing housing. Furthermore, the TERMO programme allows owners and managers of multi-family buildings to apply for funding to cover the cost of the thermal modernisation of buildings, up to a maximum of 90% of the total cost (OECD questionnaire, 2023). In the United Kingdom, the Department of Health and Social Care and the Department for Levelling Up, Housing and Communities deliver annual grants to local authorities to support home adaptations for people with disabilities and limitations. Since 2010, almost half a million housing adaptations have been covered by public funding, for a total of GBP 573 million. In September 2023, an additional GBP 50 million has been granted to local authorities. Further grants are foreseen, for a total of GBP 102 million over two years (UK government, 2023[54]).
Tax credits are much less common as a measure to support housing adaptations. Across the OECD, tax credits for such scope are available in France, the Netherlands, Switzerland and the United States and are sometimes set at the local level. For instance, Switzerland foresees tax credits to cover the cost of housing adaptations for people with low income or above the retirement age. The amount of the credits is set by the cantonal law (OECD questionnaire, 2023).
5.3.4. Developing guidance on public housing design is important for future housing
Developing guidance for the design of housing represents another way for governments to support better accessibility and climate resilience of housing, adapted to the needs of older people. Guidance for housing design adapted to older people can include: housing adaptation to facilitate moving around with or without a wheelchair and performing daily activities; balconies and common areas to facilitate social relationships; green areas with benches available around the housing space to support people to take a walk around the housing space; energy efficiency and sustainability of housing design to support resilience to climate change. Examples of guidelines for housing design adapted to older people’s needs are available in Canada, Poland, New Zealand, and the United Kingdom, among others.
In New Zealand, the government has developed a public housing design guidance which includes a specific chapter focussed on the needs of older people. It provides guidance on the basic requirements to make housing accessible, to allow for sufficient car parking spaces for family, friends, whanau or other informal carers to visit older people, as well as to facilitate older people’s participation in social life by including shared outdoor and indoor common spaces with seating available and balconies overlooking common spaces (Ministry of Housing and Urban Development, 2022[55]).
In the United Kingdom, the Homes and Communities Agency set up the Housing our Ageing Population Panel for Innovation (HAPPI), an initiative established in 2009 to address the challenges posed by an ageing population in relation to housing. HAPPI promotes innovative housing solutions that are adapted to older people’s needs to allow them to live independently in their homes and to foster community engagement, social interaction, and accessibility (The Housing our Ageing Population Panel for Innovation, 2009[56]). The Ministry of Housing, Communities and Local Government in the United Kingdom has also published national design guidelines for public spaces, which take into consideration the needs of older people and people with disabilities (The Ministry of Housing, Communities and Local Government, 2021[57]). Furthermore, the City of Cambridge developed a design guide for sustainable housing, including explicit mentions of the needs of older people and people with limitations. The guidelines include social inclusiveness among the requirements for sustainable housing, as well as adequacy to the HAPPI principles (Cambridge city council, 2021[58]).
In Canada, the Affordable Housing Office of the City of Toronto has developed design guidelines for affordable housing design to make sure that housing with affordable rental is physically accessible for people with all needs, including people with disabilities and older people. The guidelines explicitly mention the need for housing and external areas to be accessible to older people with limitations (City of Toronto, 2017[59]).
In Poland, as part of the National Housing Programme, the integrated programme of social support for rental housing co-finances the construction of apartments accessible to older people and people with limitations, along with additional features such as recreation rooms in common areas and/or day care centres. Furthermore, newly constructed residential buildings are required to have an elevator in the case of a project consisting of the construction of a residential building with three or more above‑ground floors, together with barrier-free spaces and colourful arrangements to facilitate orientation when moving within the building (OECD questionnaire, 2023).
Shaping communities in an accessible way for older people has obtained growing priority on the policy agenda, from the international to the local level, leading to the shaping of the concept of age‑friendly communities (WHO, 2024[60]). Supporting independent living requires access to services and activities located within a convenient distance or reachable through affordable, accessible public transport. Urban infrastructure, such as traffic lights, benches, and green spaces, should also be designed with an age‑friendly perspective to further promote independence for older adults. Age‑friendly environments should incorporate an ageing lens with barrier-free physical features into urban planning, making services and activities available at an easily accessible distance or accessible via public transportation.
At the national and local level, examples of age‑friendly communities are arising across OECD countries with the scope of rethinking urban planning and community life in view of ageing populations. In some cases, the national government actively promotes the creation of age‑friendly communities. For instance, in Canada, since 2008 the Public Health Agency of Canada has convened the Pan-Canadian age‑friendly communities Reference Group, which meets monthly to discuss important issues related to age‑friendly communities across the country and exchange knowledge, resources, and best practices. This group includes provincial/territorial/municipal representatives, non-profit organisations, older adults, and academics. As of 2024, ten provinces and one territory are promoting age‑friendly community initiatives in Canada, although the uptake of the age‑friendly communities model varies within the country (OECD questionnaire, 2023). Chile has 209 of its 346 municipalities enrolled as part of the Age‑friendly World network and its public service entity in charge of older people (Servicio Nacional del Adulto Mayor, SENAMA) has a specific programme aiming to reduce environmental barriers for older people. Municipalities commit to performing a participatory assessment and designing an action plan. However, as this is a recent initiative, only 11 municipalities have performed the diagnostic, and 21 have an action plan (https://www.ciudadesamigables.cl/sobre‑el-proyecto/programa‑adulto-mejor/). New Zealand has a national Age‑friendly programme by the Office for Seniors, and funding is available for projects (based in the Ministry of Social Development) supported by the Better Later Life strategy and action plan. Furthermore, New Zealand has established a Network of Age friendly cities and communities, which counted 29 members as of 31 July 2023. In other countries, subnational organisations promote the creation and spreading of age‑friendly communities. In Norway, the Norwegian Association of Local and Regional Authorities (kommunesektorens organisasjon, KS), the organisation representing all local governments in Norway, published a handbook on age‑friendly communities, which includes guidelines on how to design age‑friendly communities, including through public transport, housing and social participation (OECD questionnaire, 2023). In the United States, there are organisations (e.g. USAging) and local agencies (e.g. Area Agencies on Aging) planning liveable communities for people of all ages (OECD questionnaire, 2023).
5.4.1. Urban planning can have an impact on the safety of older people
Previous studies have highlighted the importance of urban planning features for older people to feel safe walking independently in their community. Being able to walk regularly in a safe way contributes to older people’s health. Existing literature indicates that 60 minutes of walking time during the day is desirable for older adults to maintain and improve their health (Ihara et al., 2022[61]). Walkable paths and public facilities improve the cognitive function of older people (Gan et al., 2021[62]). Environmental barriers near the person’s home can influence the ability of older adults to walk outdoors and to reach services and activities within walking distance. Furthermore, environmental barriers and facilitators also influence the development of physical limitations. A study from Germany highlighted that study participants who were asked about urban features necessary to feel safe while moving around reported surface quality (71% of participants), good lighting (71% of participants), and crossings (68% of participants) as the most essential features. Barrier-free paths and space to walk were rated as important by around 60% of all older adults in the study (Brüchert, Baumgart and Bolte, 2022[63]). Similar results have also been found in a previous study from Belgium (Van Cauwenberg et al., 2012[64]). The physical space and social connections are important elements of age‑friendly environment, while well-maintained and safe footpaths are critical to mobility and walkability. In Spain (the Basque Country), the Ttipi-ttapa programme was launched to revitalise walking routes and a strategy to promote community health initially targeting older and vulnerable people (OECD, forthcoming[65]).
A majority of countries have age‑friendly pedestrian crossings, but adequate pavement is less widespread. Across 27 OECD countries with available information, 18 reported the availability of seating outdoors and in public spaces, and 17 reported the availability of pedestrian crossing lights with audio signals and/or long enough to allow older people to traverse (Figure 5.6). A lower number of OECD countries (13 out of 27) reported well-maintained pavements and adequate public toilets. The availability of seating areas and shelters at bus, tram and metro stops, and the availability of information on public transportation times in analogic form (e.g. through timetables at bus and metro stops can all support older people to move around in a safe and independent way.
Number of countries that reported the following age‑friendly features
Note: N=27.
Source: OECD questionnaire (2023).
Safety for older adults, as well as exposure to noise and pollution, could be improved. Despite government efforts to improve community environments, a significant number of older people lose their lives while walking down the street. In Korea, the fatality rate of pedestrian accidents is 7.7 per 100 000 older people, the highest among OECD countries (Kim, Choi and Kim, 2025[66]). In Europe, approximately 10‑16% of older households consistently live in poor-quality neighbourhoods, exposed to noise, pollution, and crime (Figure 5.7).
Policies to implement age‑friendly features in urban planning are in place in a number of countries, making cities more accessible for older people or people with physical or mental limitations. For instance, in Colombia, architectural standards have been introduced in urban planning. Such standards include: i) universal accessibility for all people, favouring those with difficulties in their displacements and in their bodily mobility that require support of technological elements, such as wheelchairs, elevators, special visual or sound signalling, among others, and ii) local, regional and national standards that affect the way in which infrastructures such as pedestrian bridges should be designed, built and maintained (OECD questionnaire, 2023). Furthermore, in New Zealand, work is underway on the Accessibility for New Zealanders Bill, aiming to accelerate progress toward a fully accessible New Zealand through the identification, removal and prevention of accessibility barriers. Key areas of focus include public spaces and transport, information and communication, and housing. The National Policy Statement on Urban Development (NPS-UD) aims to make sure New Zealand’s towns and cities are well-functioning urban environments that meet the changing needs of diverse communities (OECD questionnaire, 2023). In the United States, the Americans with Disabilities Act requires cities to have pedestrian crossing lights with audio signals and/or with longer times to accommodate older people or those with physical limitations in crossing. The act is overseen by the United States Access Board (OECD questionnaire, 2023).
Percentage of problems in the neighbourhood of the usual dwellings of households with people aged 65+, 2012-2023
Note: Single‑person households consist of one adult aged 65 or older, and two‑person households include two people, with at least one adult aged 65 or older. Noise refers to whether the neighbourhood of the older household has noise problems from neighbours or from the street; pollution refers to whether the neighbourhood has problems with pollution, grime, or other environmental issues; crime refers to whether the neighbourhood has problems with crime, violence, or vandalism in the area. Data in 2012-2019 is based on EU 28 while data in 2020 and 2023 is based on EU 27.
Source: Eurostat (2025[67]), “Environment of the dwelling (ilc_mddw)”, https://ec.europa.eu/eurostat/databrowser/explore/all/popul?lang=en&subtheme=livcon.ilc.ilc_md.ilc_mddw&display=list&sort=category&extractionId=ilc_mddw01.
5.4.2. Accessibility of services is important for the autonomy of older people
The distribution of services and green spaces can have an important influence on many factors affecting older people’s health and well-being. The distribution of residential spaces and services across the cities, for instance, influences the time a person spends commuting to go to work, visit a loved one to provide care and support, and reach services and social activities. Furthermore, the availability of urban green spaces can improve the health and well-being of older people (Ali, Rahaman and Hossain, 2022[68]). Existing literature has indicated that parks and green areas in cities are the most common environmental facilitators reported by older people as enabling them to go out independently and walk to access main activities and services (Eronen et al., 2014[69]; Rantakokko et al., 2015[70]). Having key destinations such as shops and amenities within a 20‑minute walking distance can encourage older people to walk to reach such places (Hasselder et al., 2022[71]).
Enhancing the accessibility to food and recreational services for older people requires careful urban planning (OECD, 2020[72]). Available evidence suggests a great variation in accessibility to amenities within a short walking distance. Across OECD countries, the number of places that are reachable within a 15‑minute walk varies widely depending on the type of services and the size and structure of the city. Data from a selection of 121 cities in 30 OECD and EU countries show that food shops and restaurants are the most available services in cities, followed by schools and recreational activities. Green spaces are much more sparse and hardly reachable within a 15‑minute walk. In fact, on average, a person can reach 16 food shops and 34 restaurants by walking 15 minutes in some of the major cities across 30 OECD and EU countries, yet only 0.2 green areas are available within the same distance (Figure 5.8). The distribution and accessibility of such services and amenities vary across Europe, with restaurants and food shops most widely reachable within a 15‑minute walk in southern European countries, particularly in Spain, and green spaces more concentrated and accessible in Northern European countries. Countries need to balance ensuring a sufficient level of density to make the most of the agglomeration benefits, while building pedestrian-friendly areas to improve connectivity and increasing green spaces within walking distance (OECD, 2020[72]).
Average number of services available within a 15‑minute walk in selected major cities across 30 OECD and EU countries
Note: The data are collected from 121 cities across 30 OECD and EU countries. Spain has 176 restaurants.
Source: OECD (2024[73]), “Urban access framework”, https://data-explorer.oecd.org/s/2vt.
Healthcare services are harder to reach compared to other public services and amenities, calling for innovative solutions. As the health status is likely to decline while chronic conditions increase in older age, having healthcare services easily reachable and accessible may influence the choice of where to live in older age. Across a selection of 121 cities in 30 OECD and EU countries, hospitals are among the services that are scarcer within a 15‑minute walking distance. On average, only 0.5 hospitals are reachable within that walking time, ranging from 0.1 in Northern European countries to almost one among Central and Eastern European countries and reaching 2.7 in Greece (Figure 5.9).
Rural areas face additional challenges in accessibility due to population ageing. First, rural areas tend to have more older people: remote regions have the highest dependency ratios and have experienced the highest increase in such ratios (OECD, 2020[74]). Second, accessibility to some essential services is lower in rural areas. While schools, banks and pharmacies are relatively common in settlements of all types, including villages, as they need to be used often, this is less the case for health services (OECD, 2024[75]). In 11 out of 19 countries with available data, hospital bed rates are lower in rural regions compared to metropolitan areas. The number of active physicians per 1 000 inhabitants was lower in rural areas than metropolitan areas in 12 out of 14 OECD countries (OECD, 2021[76]).
Countries are designing integrated services and promoting financial incentives to attract health workers to rural areas as well as finding other innovative solutions. France has introduced the communautés professionnelles territoriales de santé in rural areas, which bring health professionals (general practitioners and specialists, pharmacists, nurses, physiotherapists, etc.) to work together in response to identified health needs in the same area. At the same time, maisons de santé group different doctors and have a guaranteed income in the first two years after practice opening, with add-on payments for practising in rural hospitals, the training of trainees, and lump-sum payments upon opening a practice. In Norway, municipalities are required to set up municipal emergency beds or other supplemented primary healthcare units in order to strengthen healthcare in primary care settings and to promote the efficient utilisation of health resources (OECD, 2014[77]). In Australia, people living in rural and remote areas need to travel hundreds of kilometres for healthcare service: the Royal Flying Doctor Service connects people to primary and specialised care (Gardiner et al., 2019[78]). Expanding the use of teleconsultations could also be considered. This is an area which has expanded since the COVID‑19 pandemic, where the use of teleconsultations per patient per year almost doubled from 0.6 in 2019 to 1.4 in 2021, but where previous research has highlighted that older people face greater challenges in its usage (Keelara, Sutherland and Almyranti, 2024[79]).
Average number of hospitals available within a 15‑minute walk in selected major cities across 30 OECD and EU countries
Note: The data are collected from 119 cities across 29 OECD and EU countries.
Source: OECD (2024[73]) “Urban access framework”, https://data-explorer.oecd.org/s/2vt.
5.4.3. Public transport and safe public spaces are needed for older people to age in place
There are inequalities in access to public transport across countries. Across 27 OECD countries with available information, 16 countries reported that public transportation is easy to access for people with mobility limitations and affordable for older people, 15 countries reported that public transportation is widely available, and it connects key destinations, while in 14 countries it is widely available and connects urban and rural areas (OECD questionnaire, 2023). On average, 83% of the urban population across the OECD’s cities can access a bus stop and 31% a metro or tram stop within a 10‑minute walk. Although buses provide better coverage across a city transport network, their frequency tends to be more variable, and their speed is lower than that of metros. Promoting mobility and accessibility for peri‑urban and non-urban populations requires alternatives to individual cars and going beyond incentives to cycle and walk with a sizeable investment in public peri‑urban and inter-urban transportation (OECD, 2024[80]).
A number of OECD countries have implemented policies to make public transportation more accessible and affordable for older people. For instance, in Austria, action has been taken throughout the Austrian Länder, by implementing measures such as concessionary fares for older persons. Vienna has also taken a number of measures to enhance and maintain the accessibility of local public transport facilities. At present, all of Vienna’s 109 underground stations and more than 95% of tram and bus stops are built to barrier-free standards (OECD questionnaire, 2023). In Colombia, the Ministry of Transportation has advanced preferential rates for older people to access public transportation, in order to promote access, accessibility and safety for older people and people with reduced mobility (OECD questionnaire, 2023). Furthermore, the Colombian Ministry of Transport, through the Sustainable Urban Mobility Unit, seeks to guarantee accessibility to all users, promoting the public transport infrastructure as a tool allowing for the circulation of users with the greatest autonomy and ease of movement (OECD questionnaire, 2023). In the United Kingdom, in England and in Wales, older people can ask for a pass for public transportation once they reach retirement age (UK Government, 2024[81]).
While a number of measures and policies are in place to improve accessibility and affordability of public transportation, more can be done. Some countries, such as Australia, Japan and the United Kingdom, have looked at flexible transport systems, which are based on demand or do not have a fixed route, or subsidised taxis as an alternative to expanding public transport by bus (Lin and Cui, 2021[82]). In Norway, the Norwegian National Transport Plan (NTP) has an overall objective of developing an efficient, environmentally friendly and safe transport system by 2050. Local programmes are also available in Norway, such as the “Ruter age‑friendly transport (RAT)”, the “AtB 67 plus” and the “Pick me up!”, which are services of shared door-to-door transport that older people can book online and access at the cost of a public transport (OECD questionnaire, 2023).
5.4.4. A true participation of older people in the communities requires adequate cultural features
Making ageing in place possible also entails allowing older people to contribute to society and be active members of the community, supporting them to perform activities in the community outside of their home, offering older people opportunities for social participation, entertainment, volunteering, or employment, to reduce isolation and facilitate active ageing. Recent studies show that loneliness is common among older people, with 30‑55% of older people in Central and Eastern Europe and 10‑20% in Northwestern Europe feeling lonely (Vozikaki et al., 2018[83]). In the United States, 37% of older adults (aged 50‑80 years) experienced loneliness and 34% reported feeling socially isolated (Gerlach, Solway and PN, 2024[84]). In Canada, Data from the Canadian Community Health Survey shows that almost one in five Canadians aged 65 and over reported experiencing loneliness in 2019 and 2020.3 Social participation contributes by three percentage points (p.p.) to the increase in the share of individuals reporting good or very good health on average (Sirven and Debrand, 2008[85]). Existing evidence has shown that older adults who actively participate in social activities are more likely to maintain or increase physical activity than those without social participation (Kikuchi et al., 2017[86]; Nemoto et al., 2021[87]; Ihara et al., 2022[61]). Evidence from Japan has also shown that social participation of older people through participation in clubs for hobbies, sports or volunteering is associated with lower cost of long-term care services (Saito et al., 2019[88]). Furthermore, studies analysing the effects of dementia friendly initiatives on people living with dementia and informal carers have highlighted that dementia friendly initiatives can improve social contacts and enjoyment and can decrease stress (Thijssen et al., 2021[89]). At the same time, social participation is also influenced by close proximity to resources, recreational facilities, neighbourhood security and transport options (Levasseur, Généreux and al., 2015[90]). Finally, older people who participate in social activities regularly are more likely to maintain or increase physical activity than those without social participation, further highlighting the importance of the accessibility of social activities and services near where people live (Ihara et al., 2022[61]; Nemoto et al., 2021[87]).
Some initiatives have promoted raising awareness of the importance of involving older people in the community, in some cases by offering intergenerational activities. In Poland, initiatives by Klub Seniora (Seniors Club), such as the “Seniors forward! – education for the body, health and spirit” and “The computer is a friend of the senior” in Wrocław, represent campaigns to highlight the importance of older people’s participation in activities to promote intergenerational integration (Wroclaw Senior Center, 2024[91]). In Norway, the “buddy intergenerational meeting – Samnager” are held in schools every Wednesday, offering meals, extracurricular activities and games that involve students, adults and older adults. Furthermore, both in Norway and Ireland, there are intergenerational choirs. Such choirs represent an occasion for different generations to meet and share activities. In most cases, in fact, the choir also organises trips, excursions and different activities involving people of all ages (Norwegian Association of Local and Regional Authorities, 2020[92]).
A number of initiatives to involve older people in the community have also been put in place across the OECD. Most initiatives are developed and implemented at the local level to involve older people in volunteering or other activities. For instance, Poland developed a number of initiatives with this scope. The FIO project “Professional Senior – Volunteer in Non-Governmental Organizations” in the municipality of Wrocław consists of an initiative to encourage older people to participate in activities such as volunteering in non-governmental organisations. The project aims to improve the process through which organisations find volunteers with unique competencies that can increase the effectiveness of NGOs. Furthermore, the Academy of Active Senior Volunteers aims to keep older people active and combat social exclusion. To reach this goal, the “Active Senior” Foundation offers educational and sports activities for older people (Wroclaw Senior Center, 2024[91]). Japan has implemented local initiatives to involve older people in social interactions through the organisation of gathering salons called ikoino saron. The salons are managed by local volunteers and are open to all older adults aged 65 or older. The salons are occasions for participants to meet and interact through relaxing and/or educational programmes. In 2017, almost 87% of Japanese municipalities had implemented the salons, which have positive results. Participating in the salons has in fact resulted in a halved incidence of long-term care needs and about a one‑third reduction in the risk of dementia onset (Saito et al., 2019[93]). Norway also has several activities organised for older people, with the aim of offering activities that are accessible and enjoyable for older people. For instance, the “Grannehjelpa” walking club offers walking tours of different types, which are accessible for older people with various levels of physical conditions. Furthermore, some Norwegian municipalities have home library services for older people who have difficulty accessing a library. The library employee communicates with borrowers over the phone and delivers books and audiobooks directly to the person’s home (Norwegian Association of Local and Regional Authorities, 2020[92]).
5.5.1. Coverage of home care services is not always sufficient
The availability of benefits and services for long-term care currently falls short of demand. On average, public formal care systems provide benefits and services to 29% of those with long-term care needs (Figure 5.10). While previous OECD work highlighted that approximately half of individuals with needs require care for less than 6.5 hours per week (OECD, 2024[94])and such individuals might rely on informal care, which can lead to higher social costs in terms of informal carers reducing their employment, hours worked or worse health. If public long-term care is insufficient, there is also a risk that people face high out-of-pocket costs, that needs go unmet, or that the pressure on the general health system increases in terms of higher hospital admission rates or longer stays in hospital beds for those who cannot afford to pay for LTC (Costa-Font, Jimenez-Martin and Vilaplana, 2018[95]; ESRI et al., 2019[96]). Across European countries, it was estimated that one‑quarter receive neither formal nor family care (OECD, 2023[97]). The OECD estimates suggest that if countries aim to expand the availability of LTC by increasing the coverage to meet the growing demand due to ageing, to the extent that 60% of people with care needs receive benefits and services, the OECD would result in a 45% increase from the level of LTC expenditures in 2022 (OECD, 2024[94]).
Public coverage of long-term care benefits as a share of individuals reporting low, moderate and severe needs
Note: Low, moderate, and severe needs correspond to 6.5, 22.5 and 41.25 hours of care per week, respectively. An older person with severe needs receiving LTC at home is assumed to live with a spouse who can provide 24‑hour supervision, help with taking medicines, and manage the finances, but cannot provide any other ADL/IADL care.
Source: OECD analyses based on the Long-Term Care Social Protection questionnaire and the OECD Health Database.
Low access is related to a variety of factors. First, individuals are not always aware of their rights and do not apply. They might be discouraged by a variety of barriers, such as the administrative requirements and the needs assessments. One‑stop shops at the local level can help users to overcome such barriers. In Greece, community centres in municipalities can advise older people about home care and help them with the application process for home care, particularly with the paperwork required. Similarly, in the Netherlands, Care offices (Zorgkantoren) in regions help people find care that is appropriate to them. Second, tight eligibility criteria also limit the number of people who can access the system and the rate of rejections for applications varies widely across countries. Means-testing systems also limit the amount that individuals receive and how much they need to pay out-of-pocket and certain individuals who have a median or high income might be discouraged from applying. In six countries (Croatia, Greece, Japan, Latvia, New Zealand, the Slovak Republic) access to long-term care depends on whether people have an informal carer, while in Canada and Portugal, the provision of formal care is complementary to the care provided by an informal carer. In New Zealand, all district healthcare boards were required to adopt a new interRAI assessment that includes checks for the presence of an informal caregiver to determine eligibility. This change is attributed to the decrease in the share of LTC recipients (OECD, 2021[98]). In Croatia, the home assistance programme and publicly financed nursing homes are not provided if there is an informal caregiver, although Croatia is introducing recent changes into its long-term care system. Finally, in several countries, even if individuals are eligible for benefits and services, there are waiting lists for assessment and then, once assessed, to access long-term care support.
Currently, just over half of the countries do not have any guidelines on waiting lists, while five additional countries do have guidelines to limit waiting times, but they do not appear to be enforced (Figure 5.11). In Australia, for instance, while individuals with high priority may be expected to receive their home care package within a month, those with medium priority may have to wait between 3 and 15 months (Australian Government, n.d.[99]). In Spain, with waiting lists for benefits or services being monitored, the percentage of people on waiting lists improved from 17% in 2020 to 9% (IMSERSO, 2024[100]). In the United Kingdom, there were more than 400 000 people waiting for an assessment, care or direct payments to begin or a review of their care plan (Associations of Directors of Adult Social Services, 2023[101]). Germany has a requirement to notify the applicant about the result of the needs assessment and the decision on the granting of aid within a maximum of 25 working days. In Sweden, services should be provided within three months.
Number of countries by type of policy on waiting lists for long-term care
Note: Canada is based on the data from New Brunswick.
Source: OECD questionnaire (2023).
5.5.2. Insufficient home care hours and funding for services hamper ageing in place
More than 40% of countries have limits on the number of hours provided for home care. In Slovenia, there is currently a weekly limit of 20 hours of care, although this is likely to change with the progressive introduction of the new system following the Adoption of the Long-term Care Act in 2023. Luxembourg offers 3.5 to 36 hours (210 to 2 171 minutes) per week, depending on the assessed level of care needed, along with an additional three hours of housework assistance. Japan has a maximum monthly service which differs by category of need (Gouvernement du Grand-Duché de Luxembourg, 2005[102]). Similarly, in Israel, the limit on hours of care which individuals are entitled to varies according to the degree of dependency, but ranges from a maximum of 5.5 hours per week for the lowest level to 30 hours per week for the highest level. In France, the financial assistance for hiring a personal care worker at home cannot be more than 30 hours per week for a single person or 48 hours if a couple is entitled to such assistance. Iceland also has a limit of 60 hours per month for social home care services.
Several countries have taken steps to enhance the hours and services for home care, while seeking innovative solutions. In 2023, Spain changed the limit on the hours available for all levels of need, moving from 20 hours per month for grade I to between 20 and 37 hours, from 21‑45 hours to 38‑64 hours for grade II and from 46‑74 hours to 65‑94 hours for grade III (Ministerio de Sanidad, Servicios Sociales e Igualdad, 2023[103]). Personal budgets, as introduced in England and the Netherlands, could provide flexibility to users in deciding the home care services that they need.
In particular, provision of 24‑hour long-term care services at home is limited to one‑third of the countries and is not always well covered in countries where such services are available. According to OECD calculations, the share of older people requiring care is expected to rise across all analysed countries by 30% by 2050 and it is expected that higher life expectancy may extend the period of living with severe needs (OECD, 2024[94]). In England, for instance, a study estimated that the number of people aged 85 and over needing 24‑hour care is set to double (Kingston, Comas-Herrera and Jagger, 2018[104]). In a number of countries, 24‑hour care is available but still sometimes falls short of public financing or availability. Austria, for instance, has offered the possibility since 2007 of financial support for 24‑hour care at home. The benefit is means-tested and granted to people with a monthly income lower than EUR 2 500 and requires a minimum level of dependence (care level 3). This can be used to employ caregivers who are either family members, self-employed or from non-profit agencies. While the benefit is meant for 24‑hour care and is more generous than the regular benefit, it falls short of covering all costs, as it constitutes a maximum of EUR 800 per month. In the United States, Medicaid can offer 24‑hour care under exceptional circumstances through home and community-based services (HCBS) waivers in some states 52% of waivers serving include round-the‑clock services as a benefit for the population with intellectual development disabilities (Watts, Musumec and , 2022[105]). In the Netherlands, individuals are eligible for 24‑hour care at home under the 2015 Long Term Care Act (Wet langdurige zorg – WLZ). A report from the inspection service highlighted that such services are not always appropriate and depend on the provider. For certain providers, a district nurse monitors the care quality and provides care available 24 hours a day if needed, including through alarms and digital aids, while for many small providers, those services are unavailable for 24 hours or not at the level of expertise needed.4 Finland has embarked on an ambitious reform since 2023 of abolishing institutional care by 2027 and increasing home care and is planning to address worker shortages, house calls and self-management in order to ensure the provision of around the clock home care, if needed. For this, it also includes provisions of data privacy for the use of technology at home and care alarms.5
Some countries do not adequately provide financial support for instrumental activities of daily living and social needs. The public social protection system does not fully cover the costs of help with all or certain instrumental activities and requires either partial or complete out-of-pocket payment by the care recipient. While most countries provided support with household activities such as meal preparation, laundry and cleaning, support with grocery shopping or support to go to appointments and administration were available to a limited extent, as this was available in 20 and 18 countries, respectively (Figure 5.12). In Ireland, the costs of help with laundry and shopping are not covered by the public social protection system. In an effort to reduce social isolation, since 2024, France has included the option to add a maximum of nine hours per month, covered by the public purse, for those receiving the home care allowance. Such hours can be used for cultural activities, outdoor activities, leisure and well-being. In Australia, home care packages include providing a companion to assist with making in-home or telephone‑based social calls or arranging social activities and providing or co‑ordinating transport to social events.
Countries by type of funded home care services
Source: OECD questionnaire (2023).
A number of countries would need to find efficiency gains in providing care at home for people with severe needs, as population ageing and people’s preferences press for more people to age at home. Currently, in the majority of OECD countries, the cost of home care is higher than the cost of staying in a nursing home for an older person with severe needs: this is the case for 17 countries, while in 10 countries, the reverse is true (OECD, 2024[94]). Formal home care can thus be very expensive when needs are severe and involve many hours of care each week. Professional carers must travel between care recipients’ homes, which in some countries can take significant amounts of time during which they are not providing care. This limits the number of older people they can care for at any given time.
Technology has the potential to improve worker productivity, promote efficiency and potentially reduce the costs of long-term care at home. Digital technologies such as sensors and tablets can streamline administrative tasks, co‑ordination, monitoring, and transportation, thereby maximising the time workers can spend on direct caregiving. Moreover, new technologies could improve the conditions of care recipients and prevent additional interventions by caregivers. In Denmark, a digital training tool for physical activities at home (called “DigiRehab”) contributed to not only efficiently monitoring care recipients’ physical ability but also reducing their need for home care (Healthcare Denmark, 2019[42]). Similarly, in Finland, the telecare scheme called “Remote Care” helped long-term care workers reduce travel time (OECD, 2023[97]). Furthermore, Artificial Intelligence (AI)-enhanced tools can facilitate independent living for older people, reducing the need for constant supervision, such as by managing medication regimens and systematically monitoring and recording the health status of care recipients (Eurocarers, 2024[106]).In Japan, AI software is increasingly accepted to help long-term care workers smoothly optimise travel and avoid preventable harms in long-term care settings. There is a case like Japan where the AI detection of falls helped reduce the burden on monitoring by long-term care workers (OECD, 2023[97]). However, the overall evidence surrounding the effectiveness of AI (e.g. wearables) on avoiding falls is inconclusive at present and further development is to be expected (O’Connor et al., 2022[107]).
5.5.3. Improving the affordability of home care services would strengthen ageing in place
In several countries, limited public financial support and tight eligibility criteria pose challenges to the affordability of long-term care (Oliveira Hashiguchi and Llena-Nozal, 2020[108]). This section discusses current gaps in the affordability of users, which can prevent them from ageing in place. It draws on the analysis of public social protection systems, which highlight how much of the costs are covered by the public purse and the degree of out-of-pocket costs (OECD, 2024[94]). Out-of-pocket expenses are high in a majority of countries for individuals with severe needs at home and for moderate needs in some countries. In 16 countries and subnational regions, out-of-pocket costs exceed 50% of median income, while they are above median income itself in seven countries and subnational regions. For individuals with moderate needs, in 11 countries, out-of-pocket costs would be at least 50% of the median income (i.e. relative poverty line). Given that the median income of older people is generally lower than that of working-age individuals, it is unlikely that they can afford these basic living costs after spending a significant part of their income on long-term care. The median income is taken as a benchmark because, if costs are higher, this would mean that the remaining disposable income left might not be enough to cover basic living costs such as rent or utilities, food, or clothing. Despite higher incomes having less public protection, out-of-pocket costs remain high for those with low income in a number of countries: out-of-pocket costs for low-income earners exceed 50% in seven out of 32 OECD and EU countries and subnational areas.
While, on average, the generosity of public benefits is greater for care provided at home, certain countries are more generous for institutional care, which could discourage ageing in place (Figure 5.13). Around 65% of home care costs are covered in the OECD, while the average covered cost of institutional care is 10 p.p. lower. By contrast, the share of costs covered by public long-term care systems is higher for institutional care in Estonia, Portugal, Czechia, the United States (California and Illinois), Korea, Croatia, Italy, Germany and France. The public social protection for institutional care is the highest in Sweden, France and Ireland. At the other end of the scale, there is no public social protection for institutional care for a person with a median income in Poland and Greece. The support is also very limited (below 20%) for older people in the Slovak Republic, Slovenia and Spain. This significant difference is partly due to the design of the long-term care systems, some of which aim at covering all costs, while others are designed to provide partial support with the expectation that older people will organise most of their support themselves.
Percentage of total costs covered by public funding by country, 2022
Note: Severe needs correspond to 41.25 hours of care per week. An older person with severe needs receiving LTC at home is assumed to live with a spouse who can provide 24‑hour supervision, help with taking medicines, and manage the finances, but cannot provide any other ADL/IADL care. Data for Poland in institutional care corresponds to the social care sector.
Source: OECD analyses based on the Long-Term Care Social Protection questionnaire, the OECD Income Distribution Database, and the OECD Wealth Distribution Database.
Designing effective public support needs to take into account the generosity of the system. Across the OECD, countries are likely to seek additional sources to fund long-term care, but options to manoeuvre are tight. Countries should investigate policy options that promote efficiency and help contain the costs of long-term care. Slovenia has launched a wider reform to introduce long-term care insurance and make the range of long-term care services more generous to users but also promote a rehabilitation-first approach to bring costs down. In addition to these two options, given the current gaps for vulnerable people, countries could better target their existing long-term care funds towards those most in need, that is, those with higher needs and lower income. Estonia has recently started a reform to reduce the out-of-pocket costs for users. Countries might consider introducing progressive income‑testing, such as in Lithuania, as the degree of cost-sharing increases progressively along the income distribution. They could also have wealth-testing to better target the most vulnerable older people with needs and to discourage strategic behaviour around wealth thresholds. For example, Spain has implemented a system where 5% of the value of wealth (excluding the primary residence) is added to the income to determine the level of public support for long-term care.
5.5.4. Public financial support for the provision of informal care can be further expanded
While many people prefer to be cared for by their family members or have to rely on them because of insufficient formal care, this can create poverty risk for such households. Informal care is widespread in many countries: among OECD countries for which data is available, about 60% of older people reported receiving only informal care (Rocard and Llena-Nozal, 2022[109]). Public social protection for the provision of informal care is limited, especially compared with formal care and tends to be low (Figure 5.14). In nearly half of the countries, an adult child providing 22.5 hours of care to an older parent would receive no allowance, even though the adult child would have to reduce working hours or even resign from work to provide care. Even some countries with generous social protection for formal care, like Iceland and Sweden, do not provide benefits for informal carers. On average, only 14% of the costs of care are covered in case of informal care compared with just over 60% for formal care.
As discussed in previous OECD work (OECD, 2024[94]), countries need to balance the level of financial support for informal carers with financial constraints and the risk of informal caregivers becoming long-term caregivers. The level of compensation for informal carers is often a recognition that providing care involves costs for carers and for the opportunity costs of providing care – that is, for lower incomes caused by reduced working hours. At the same time, low allowance levels for informal carers are often driven by the risk that high compensation could trap carers in a role that is comparatively low paid. At the same time, countries should consider the potential risk of future shortages of informal carers and their concerns regarding livelihoods, and therefore, explore ways to support and address these issues. Broader public policies for these informal carers, such as psychological support, adequate training and work-life, are also important (Rocard and Llena-Nozal, 2022[109]). This can provide win-win options for countries as people prefer being cared for by their relatives and a reasonable allowance for informal carers can be beneficial for families while limiting the costs to the system in terms of avoiding hospitalisations or using formal care which is likely to be of a higher cost.
Public support for formal and informal home care as a share of total formal home care costs for older people with moderate needs, median income and zero wealth
Note: Moderate needs correspond to 22.5 hours of care per week. Median income refers to the country’s disposable median income of older people. The care is provided by an adult child who earns the country’s median income for the entire population. Detailed descriptions of care recipients’ needs and the informal carer’s characteristics are available in Annex A (OECD, 2024[94]).
Source: OECD analyses based on the OECD Long-Term Care Social Protection questionnaire, the OECD Income Distribution Database and the OECD Wealth Distribution Database.
References
[28] Age UK (2024), Housing benefit, https://www.ageuk.org.uk/information-advice/money-legal/benefits-entitlements/housing-benefit/.
[20] Agencia Estatal Boletín Oficial del Estado (2022), Royal Decree 42/2022, of January 18, which regulates the Young Rental Bonus and the State Plan for access to housing 2022-2025., https://www.boe.es/buscar/act.php?id=BOE-A-2022-802.
[13] Airgood-Obrycki, W., A. Hermann and S. Wedeen (2022), ““The Rent Eats First”: Rental Housing Unaffordability in the United States”, Housing Policy Debate, Vol. 33/6, pp. 1272-1292, https://doi.org/10.1080/10511482.2021.2020866.
[68] Ali, M., M. Rahaman and S. Hossain (2022), “Urban green spaces for elderly human health: A planning model for healthy city living”, Land Use Policy, Vol. 114, p. 105970, https://doi.org/10.1016/j.landusepol.2021.105970.
[101] Associations of Directors of Adult Social Services (2023), Adult Social Care budgets and Waiting Times. Autumn Survey Report.
[99] Australian Government (n.d.), What happens after assessment, https://www.myagedcare.gov.au/assessment/what-happens-after-assessment.
[8] Bates, L. et al. (2019), “‘You can’t put your roots down’: housing pathways, rental tenure and precarity in older age”, Housing Studies, Vol. 35/8, pp. 1442-1467, https://doi.org/10.1080/02673037.2019.1673323.
[9] Bates, L. et al. (2019), “Precariously placed: Home, housing and wellbeing for older renters”, Health & Place, Vol. 58, p. 102152, https://doi.org/10.1016/j.healthplace.2019.102152.
[1] Binette, J. and A. Farago (2021), Home and Community Preference Survey: A National Survey of Adults Age 18-Plus., AARP Research.
[34] Bogataj, M., D. Bogataj and S. Drobne (2023), “Planning and managing public housing stock in the silver economy”, International Journal of Production Economics, Vol. 260, p. 108848, https://doi.org/10.1016/j.ijpe.2023.108848.
[36] Braubach, M. (2011), “Key challenges of housing and health from WHO perspective”, International Journal of Public Health, Vol. 56/6, pp. 579-580, https://doi.org/10.1007/s00038-011-0296-y.
[63] Brüchert, T., S. Baumgart and G. Bolte (2022), “Social determinants of older adults’ urban design preference: a cross-sectional study”, Cities & Health, Vol. 6/2, pp. 360-374, https://doi.org/10.1080/23748834.2020.1870845.
[58] Cambridge city council (2021), Sustainable Housing Design Guide 2021, https://www.cambridge.gov.uk/media/1503/cambridge-sustainable-housing-design-guide.pdf.
[49] Centre for Ageing Better (2024), Counting the Cost: The case for making older people’s homes safe.
[40] CGATE (2023), La vivienda en España.
[46] Chase, C. et al. (2012), “Systematic review of the effect of home modification and fall prevention programs on falls and the performance of community-dwelling older adults”, The American Journal of Occupational Therapy, Vol. 66/3, pp. 284-291, https://doi.org/10.5014/ajot.2012.005017.
[35] Chen, L. et al. (2023), “Community-dwelling older adults’ experiences and perceptions of needs for home modification in Shanghai”, Ageing and Society, pp. 1-21, https://doi.org/10.1017/s0144686x22001313.
[59] City of Toronto (2017), Affordable rental housing design guidelines, https://www.toronto.ca/wp-content/uploads/2017/11/8fea-AFFORDABLE-HOUSING-DESIGN-GUIDELINES.FINAL_.07.06.2017.pdf.
[47] Clemson, L. et al. (2023), “Environmental interventions for preventing falls in older people living in the community”, Cochrane Database of Systematic Reviews, Vol. 2023/3, p. CD013258, https://doi.org/10.1002/14651858.cd013258.pub2.
[39] CNAV (2013), Adaptatio du logement à l’autonomie des personnes âgées.
[95] Costa-Font, J., S. Jimenez-Martin and C. Vilaplana (2018), “Does long-term care subsidization reduce hospital admissions and utilization?”, Journal of Health Economics, Vol. 58, pp. 43-66, https://doi.org/10.1016/j.jhealeco.2018.01.002.
[16] Cournède, B. and M. Plouin (2023), No home for the young? Stylised facts and policy challenges, OECD Publishing, Paris, https://doi.org/10.1787/adbee321-en.
[3] Courtin, E., J. Dowd and M. Avendano (2017), “The mental health benefits of acquiring a home in older age: A fixed-effects analysis of older US adults”, American Journal of Epidemiology, Vol. 187/3, pp. 465-473, https://doi.org/10.1093/aje/kwx278.
[10] Cram, F. and M. Munro (2020), “Life when renting for older Māori”, AlterNative: An International Journal of Indigenous Peoples, Vol. 16/1, pp. 64-75, https://doi.org/10.1177/1177180120903504.
[52] Curtis, L. and J. Beecham (2018), “A survey of local authorities and Home Improvement Agencies: Identifying the hidden costs of providing a home adaptations service”, British Journal of Occupational Therapy, Vol. 81/11, pp. 633-640, https://doi.org/10.1177/0308022618771534.
[37] Davis, S., A. Clark and J. Vespa (2023), Aging-Ready Homes in the United States—Perception Versus Reality of Aging-Accessibility Needs: 2019.
[21] Department of Health and Social Care (2021), People at the heart of care, https://assets.publishing.service.gov.uk/media/6234b0c48fa8f540f21fdd8d/people-at-the-heart-of-care_asc-form-print-ready-with-correction-slip.pdf.
[53] Department of Housing, Local Government and Heritage of Ireland (2024), Report on the Review of the Housing Adaptation Grants for Older People and People with Disability.
[19] Dutch Government (2023), Housing allocation file, https://www.volkshuisvestingnederland.nl/onderwerpen/dossier-woningtoewijzing.
[18] Dutch Government (2023), Incentive scheme for meeting spaces in elderly housing (SOO), https://www.rvo.nl/subsidies-financiering/soo.
[69] Eronen, J. et al. (2014), “Environmental facilitators for outdoor walking and development of walking difficulty in community-dwelling older adults”, European Journal of Ageing, Vol. 11/1, pp. 67-75, https://doi.org/10.1007/s10433-013-0283-7.
[96] ESRI et al. (2019), An analysis of the effects on Irish hospital care of the supply of care inside and outside the hospital, ESRI, https://doi.org/10.26504/rs91.pdf.
[106] Eurocarers (2024), Integrating artificial intelligence within informal care and long-term care: enhancing opportunities while mitigating threats, Eurocarers, Brussels, https://eurocarers.org/wp-content/uploads/2024/07/Eurocarers-AI_pp.pdf.
[67] Eurostat (2025), Environment of the dwelling (ilc_mddw), https://ec.europa.eu/eurostat/databrowser/explore/all/popul?lang=en&subtheme=livcon.ilc.ilc_md.ilc_mddw&display=list&sort=category&extractionId=ilc_mddw01 (accessed on 9 July 2025).
[6] Eurostat (2024), Housing cost overburden rate by age group - EU SILC survey, https://ec.europa.eu/eurostat/databrowser/view/tessi161__custom_10348800/default/table?lang=en (accessed on 2024).
[26] French government (2023), Les aides au logement en établissement, https://www.pour-les-personnes-agees.gouv.fr/vivre-dans-un-ehpad/aides-financieres-en-ehpad/les-aides-au-logement-en-etablissement.
[51] French government (2023), MaPrimeAdapt’, une nouvelle aide unique pour aménager son logement, https://www.pour-les-personnes-agees.gouv.fr/actualites/maprimeadapt-une-nouvelle-aide-unique-pour-amenager-son-logement.
[62] Gan, D. et al. (2021), “Dementia-friendly neighborhood and the built environment: A scoping review”, The Gerontologist, Vol. 62/6, pp. e340-e356, https://doi.org/10.1093/geront/gnab019.
[78] Gardiner, F. et al. (2019), “Health care for older people in rural and remote Australia: challenges for service provision”, Medical Journal of Australia, Vol. 11 (8), pp. 363-364.
[48] Garrett, H. and S. Burris (2015), Homes and Ageing in England, Public Health England, https://essenceproject.uk/evidence/homes-and-ageing-in-england-briefing-paper/.
[84] Gerlach, L., E. Solway and M. PN (2024), “Social isolation and loneliness in older adults”, JAMA, Vol. 331/23, p. 2058, https://doi.org/10.1001/jama.2024.3456.
[32] Gouvernement du Grand-Duché de Luxembourg (2023), La nouvelle loi relative au logement abordable, logement.lu, https://logement.public.lu//fr/politique/logabo.html (accessed on 3 September 2025).
[31] Gouvernement du Grand-Duché de Luxembourg (2023), Loi relative au logement abordable, https://legilux.public.lu/eli/etat/leg/loi/2023/08/07/a611/jo (accessed on 3 September 2025).
[102] Gouvernement du Grand-Duché de Luxembourg (2005), Long-term Care Insurance Act, https://www.secu.lu/assurance-dependance/livre-v/chapitre-i-objet-de-lassurance/ (accessed on 3 September 2025).
[29] Government of Colombia (2023), Family housing subsidy, https://www.minvivienda.gov.co/viceministerio-de-vivienda/subsidio-familiar-de-vivienda.
[71] Hasselder, P. et al. (2022), “Destinations fostering older adults’ walking for transport: a cross-sectional study from Germany”, BMC Geriatrics, Vol. 22/1, https://doi.org/10.1186/s12877-022-02896-w.
[42] Healthcare Denmark (2019), A dignified elderly care in Denmark, Healthcare Denmark, https://healthcaredenmark.dk/media/tmkhokaf/white-paper-dignified-elderly-care-pdf-uk.pdf.
[61] Ihara, S. et al. (2022), “Social participation and change in walking time among older adults: a 3-year longitudinal study from the JAGES”, BMC Geriatrics, Vol. 22/1, https://doi.org/10.1186/s12877-022-02874-2.
[30] IMAS (2023), Home improvement, https://www.imas.go.cr/es/beneficios/mejoramiento-de-vivienda-0.
[100] IMSERSO (2024), Evolucion de los principales indicadores de la gestion del SAAD. Informe mensual.
[24] International Observatory on Social Housing (2023), How the Dutch Lead the Way in Senior Housing Innovation, https://internationalsocialhousing.org/2017/05/29/learning-best-practices-in-housing-for-the-elderly-from-the-dutch/.
[25] Jenkins Morales, M. and S. Robert (2023), “Does subsidized housing prevent health decline and 2-year mortality among low-income older renters?”, The Gerontologist, Vol. 64/5, p. gnad121, https://doi.org/10.1093/geront/gnad121.
[79] Keelara, R., E. Sutherland and M. Almyranti (2024), Leading practices for the future of telemedicine: Implementing telemedicine postpandemic.
[86] Kikuchi, H. et al. (2017), “Social participation among older adults not engaged in full‐ or part‐time work is associated with more physical activity and less sedentary time”, Geriatrics & Gerontology International, Vol. 17/11, pp. 1921-1927, https://doi.org/10.1111/ggi.12995.
[66] Kim, S., S. Choi and B. Kim (2025), “Analysis of factors affecting pedestrian safety for the elderly and identification of vulnerable areas in Seoul”, Accident Analysis & Prevention, Vol. 211, p. 107878, https://doi.org/10.1016/j.aap.2024.107878.
[104] Kingston, A., A. Comas-Herrera and C. Jagger (2018), “Forecasting the care needs of the older population in England over the next 20 years: estimates from the Population Ageing and Care Simulation (PACSim) modelling study”, Lancet Public Health, Vol. 3, pp. 447–455.
[90] Levasseur, M., M. Généreux and J. al. (2015), “Importance of proximity to resources, social support, transportation and neighborhood security for mobility and social participation in older adults: results from a scoping study.”, BMC Public Health, Vol. 15, p. 503.
[17] Leviten-Reid, C. and A. Lake (2016), “Building affordable rental housing for seniors: Policy insights from Canada”, Journal of Housing For the Elderly, Vol. 30/3, pp. 253-270, https://doi.org/10.1080/02763893.2016.1198738.
[82] Lin, D. and J. Cui (2021), “Transport and mobility needs for an ageing society from a policy perspective: Review and implications”, Int J Environ Res Public Health, Vol. 18/22.
[14] Mawhorter, S., E. Crimmins and J. Ailshire (2021), “Housing and cardiometabolic risk among older renters and homeowners”, Housing Studies, Vol. 38/7, pp. 1342-1364, https://doi.org/10.1080/02673037.2021.1941792.
[103] Ministerio de Sanidad, Servicios Sociales e Igualdad (2023), Real Decreto 675/2023, de 18 de julio por el que se modifica el Real Decreto 1051/2013, de 27 de diciembre, por el que se regulan las prestaciones del Sistema para la Autonomía y Atención a la Dependencia, establecidas en la Ley 39/2006, de 14 de diciembr.
[55] Ministry of Housing and Urban Development (2022), Public Housing Design Guidance for community housing providers and developers, https://www.hud.govt.nz/assets/Uploads/Documents/Public-Housing-Design-Guidance.pdf.
[43] Moreno, A. et al. (2024), “A systematic review of gerontechnologies to support aging in place among community-dwelling older adults and their family caregivers”, Frontiers in Psychology, Vol. 14, https://doi.org/10.3389/fpsyg.2023.1237694.
[87] Nemoto, Y. et al. (2021), “Longitudinal associations of social group engagement with physical activity among Japanese older adults”, Archives of Gerontology and Geriatrics, Vol. 92, p. 104259, https://doi.org/10.1016/j.archger.2020.104259.
[92] Norwegian Association of Local and Regional Authorities (2020), Handbook for Age-Friendly Communities.
[107] O’Connor, S. et al. (2022), “Artificial intelligence for falls management in older adult care: A scoping review of nurses’ role”, Journal of Nursing Management, Vol. 30/8, pp. 3787-3801, https://doi.org/10.1111/jonm.13853.
[80] OECD (2024), “Cities turning crisis into change: Post-pandemic pathways to resilience in complex times”, OECD Regional Development Papers, No. 94, OECD Publishing, Paris, https://doi.org/10.1787/05c005d5-en.
[75] OECD (2024), Getting to Services in Towns and Villages: Preparing Regions for Demographic Change, OECD Rural Studies, OECD Publishing, Paris, https://doi.org/10.1787/df1e9b88-en.
[94] OECD (2024), Is Care Affordable for Older People?, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/450ea778-en.
[73] OECD (2024), Urban access framework, https://data-explorer.oecd.org/s/2vt.
[4] OECD (2023), Analytical house prices indicators, https://data-explorer.oecd.org/s/2vu.
[97] OECD (2023), Beyond Applause? Improving Working Conditions in Long-Term Care, OECD Publishing, Paris, https://doi.org/10.1787/27d33ab3-en.
[7] OECD (2023), Pensions at a Glance 2023: OECD and G20 Indicators, OECD Publishing, Paris, https://doi.org/10.1787/678055dd-en.
[15] OECD (2021), Building for a better tomorrow: Policies to make housing more affordable, OECD Publishing, Paris, https://doi.org/10.1787/5d9127d4-en.
[76] OECD (2021), Delivering Quality Education and Health Care to All: Preparing Regions for Demographic Change, OECD Rural Studies, OECD Publishing, Paris, https://doi.org/10.1787/83025c02-en.
[98] OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.
[72] OECD (2020), Improving Transport Planning for Accessible Cities, OECD Urban Studies, OECD Publishing, Paris, https://doi.org/10.1787/fcb2eae0-en.
[74] OECD (2020), Rural Well-being: Geography of Opportunities, OECD Rural Studies, OECD Publishing, Paris, https://doi.org/10.1787/d25cef80-en.
[5] OECD (2019), Under Pressure: The Squeezed Middle Class, OECD Publishing, Paris, https://doi.org/10.1787/689afed1-en.
[77] OECD (2014), OECD Reviews of Health Care Quality: Norway 2014: Raising Standards, OECD Reviews of Health Care Quality, OECD Publishing, Paris, https://doi.org/10.1787/9789264208469-en.
[65] OECD (forthcoming), Promoting Community Action for Health in the Basque Country, OECD Publishing, Paris.
[38] Older People’s Housing Taskforce (2024), Our Future Homes: Housing that promotes wellbeing and community for an ageing population, Open Government Licence.
[108] Oliveira Hashiguchi, T. and A. Llena-Nozal (2020), “The effectiveness of social protection for long-term care in old age: Is social protection reducing the risk of poverty associated with care needs?”, OECD Health Working Papers, No. 117, OECD Publishing, Paris, https://doi.org/10.1787/2592f06e-en.
[44] Ollevier, A. et al. (2020), “How can technology support ageing in place in healthy older adults? A systematic review”, Public Health Rev, Vol. 41, https://doi.org/10.1186/s40985-020-00143-4.
[27] Own Your Home - UK government (2024), Older persons shared ownership, https://www.ownyourhome.gov.uk/scheme/opso/.
[12] Petersen, M. and T. Aplin (2021), “Exploring Older Tenants’ Healthy Ageing in Privately Rented Homes”, Australian Social Work, Vol. 76/1, pp. 100-112, https://doi.org/10.1080/0312407x.2021.1970783.
[70] Rantakokko, M. et al. (2015), “Associations between environmental characteristics and life-space mobility in community-dwelling older people”, Journal of Aging and Health, Vol. 27/4, pp. 606-621, https://doi.org/10.1177/0898264314555328.
[109] Rocard, E. and A. Llena-Nozal (2022), “Supporting informal carers of older people: Policies to leave no carer behind”, OECD Health Working Papers, No. 140, OECD Publishing, Paris, https://doi.org/10.1787/0f0c0d52-en.
[93] Saito, J. et al. (2019), “Community-based care for healthy ageing: lessons from Japan”, Bulletin of the World Health Organization, Vol. 97/8, pp. 570-574, https://doi.org/10.2471/blt.18.223057.
[88] Saito, M. et al. (2019), “Reduced long-term care cost by social participation among older Japanese adults: a prospective follow-up study in JAGES”, BMJ Open, Vol. 9/3, p. e024439, https://doi.org/10.1136/bmjopen-2018-024439.
[85] Sirven, N. and T. Debrand (2008), “Social participation and healthy ageing: An international comparison using SHARE data”, Social Science and Medicine, Vol. 67/12, https://doi.org/10.1016/j.socscimed.2008.09.056.
[50] Slaug, B., M. Granbom and S. Iwarsson (2020), “An aging population and an aging housing stock – housing accessibility problems in typical Swedish dwellings”, Journal of Aging and Environment,, Vol. 34/2, pp. 156–174, https://doi.org/10.1080/26892618.2020.1743515.
[23] Spillman, B., J. Biess and G. MacDonald (2012), Housing as a Platform for improving outcomes for older renters, Urban Institute, https://www.urban.org/research/publication/housing-platform-improving-outcomes-older-renters.
[56] The Housing our Ageing Population Panel for Innovation (2009), The Housing our Ageing Population Panel for Innovation (HAPPI) Report (2009), https://www.housinglin.org.uk/Topics/type/The-Housing-our-Ageing-Population-Panel-for-Innovation-HAPPI-Report-2009/ (accessed on 2024).
[57] The Ministry of Housing, Communities and Local Government (2021), National Design Guide, https://assets.publishing.service.gov.uk/media/602cef1d8fa8f5038595091b/National_design_guide.pdf (accessed on 2024).
[89] Thijssen, M. et al. (2021), “How do community based dementia friendly initiatives work for people with dementia and their caregivers, and why? A rapid realist review”, International Journal of Geriatric Psychiatry, Vol. 37/2, https://doi.org/10.1002/gps.5662.
[81] UK Government (2024), Apply for an older person’s bus pass, https://www.gov.uk/apply-for-elderly-person-bus-pass.
[54] UK government (2023), Government delivers extra 50 million home adaptation funding, https://www.gov.uk/government/news/government-delivers-extra-50-million-home-adaptation-funding.
[22] US Department of Housing and Urban Development (2023), , https://www.hud.gov/program_offices/public_indian_housing/programs/ph/hope6/about.
[33] US Department of Housing and Urban Development (2023), , https://www.hud.gov/rent_relief.
[64] Van Cauwenberg, J. et al. (2012), “Physical environmental factors related to walking and cycling in older adults: the Belgian aging studies”, BMC Public Health, Vol. 12/1, p. 142, https://doi.org/10.1186/1471-2458-12-142.
[2] Vignoli, D., M. Tanturri and F. Acciai (2016), “Home bitter home? Gender, living arrangements, and the exclusion from homeownership among older Europeans”, Genus, Vol. 72/1, https://doi.org/10.1186/s41118-016-0014-y.
[83] Vozikaki, M. et al. (2018), “Loneliness among older European adults: results from the survey of health, aging and retirement in Europe”, Journal of Public Health, Vol. 26/6, pp. 613-24, https://doi.org/10.1007/s10389-018-0916-6.
[11] Waldron, R. (2021), “Generation Rent and housing precarity in ‘post crisis’ Ireland”, Housing Studies, Vol. 38/2, pp. 181-205, https://doi.org/10.1080/02673037.2021.1879998.
[105] Watts, M., M. Musumec and A. (2022), State Policy Choices About Medicaid Home and Community-Based Services Amid the Pandemic.
[60] WHO (2024), Creating age friendly cities and communities, https://www.who.int/activities/creating-age-friendly-cities-and-communities.
[45] WHO Europe and European Commission (2017), Age-friendly environments in Europe: A handbook of domains for policy action, WHO Regional Office for Europe, Copenhagen, https://iris.who.int/bitstream/handle/10665/334251/9789289052887-eng.pdf.
[91] Wroclaw Senior Center (2024), Wroclaw Senior Center, https://www.seniorzy.wroclaw.pl/wroclaw-w-who.
[41] Wu, S., Y. Fu and Z. Yang (2022), “Housing condition, health status, and age-friendly housing modification in Europe: The last resort?”, Building and Environment, Vol. 215.
← 1. Average incomes usually decline after retirement. The income of people aged 65 or older in 2020 amounted to 88% of the overall average population incomes on average across OECD countries. Older people are often more likely to live alone, which exacerbates declines in disposable income. This phenomenon impacts women to a larger extent, due to longer life expectancy (OECD, 2023[7]).
← 2. The support is accessible for: i) older people aged 70 years or older, ii) older people between the age of 60 and 69 with physical limitations, iii) people with disabilities of any age. An assessment of means is also performed to declare accessibility to this form of financial support. Means assessment is performed by the National Housing Agency (ANAH).