Illustration: Sarah Grillo/Axios

Nursing homes have been the epicenter of the coronavirus outbreak, prompting more urgent discussions about alternative housing situations for elderly Americans.

Why it matters: Deaths in nursing homes and residential care facilities account for 45% of COVID-19 related deaths, per the Foundation for Research on Equal Opportunity — but there are few other viable housing options for seniors.

  • COVID-19 illness severity and mortality rates have been highest among older adults — a fast-growing segment of the U.S. population as Baby Boomers age.

The alternatives that are available are getting a closer look. Here are the ones that are growing in popularity:

"Granny flats" — or small units built in backyards, above garages or in basements — are seeing the biggest surge in interest, experts say, because they are often easiest to tack onto existing structures and get less resistance from the NIMBY crowd.

  • They allow aging parents and grandparents to live near caregivers and can offset living costs for homeowners.
  • Some cities are trying to make them easier to build. Most recently, the Austin city council in April directed staff to find funding for low-cost loans and streamlining the permitting process in a push to increase the use of secondary units (or accessory dwelling units) in the city.

Multigenerational living has increased over the past decade, with 9.3 million people over 65 living with grown children or grandchildren in 2017.

  • As the trend picks up, housing design will have to follow suit, according to Jennifer Molinsky, senior researcher at the Joint Center and lecturer in urban planning and design at Harvard. That means houses built with two master suites, an in-law suite or other flexible space.
  • In a recent AARP survey, 52% said the benefits of living in an intergenerational home outweigh the disadvantages and risks posed by COVID-19. But ages 50-59 are most likely to see those benefits, with older age brackets more heavily weighing the downsides.

Co-living — or living with roommates and sharing common areas a la "The Golden Girls" — is still relatively small among the the 65 and older camp, but the rise of services that match older roommates like Nesterly and SilverNest has boosted interest.

  • With "homesharing," older adults with extra room can take on a tenant to help pay bills and decrease loneliness, allowing them to stay in their house for years longer.
  • "It's logical to conclude that with extended periods of isolation that interest could increase," said Danielle Arigoni, Director of AARP Livable Communities. "But on the flip side, it may be that people are more afraid of having a roommate right now."

By the numbers: The number of households aged 75-79 will rise 49% between 2018 and 2028, while those age 80 and over will account for 12% of all households by 2038, per Harvard's Joint Center for Housing Studies.

  • More than half of individuals in this age range live alone.
  • And in many metro areas, more than a third of older households are cost-burdened, meaning they pay more than 30% of their income for housing.

The big picture: Most communities do not have the housing that will be needed as their residents age.

  • Many older adults either can't afford to downsize as the nation's housing stock has grown bigger and more expensive, or they don't have enough savings or retirement funds to keep paying a mortgage or the rent for pricey long-term care centers.
  • A growing number of older adults live in low-density areas filled mostly with single-family homes and requiring cars to get around. That's problematic both for seniors looking to downsize and for those who can no longer drive themselves.
  • "To the extent people want to stay in communities where they've been living, we'll absolutely need more housing options, such as apartments and denser more walkable solutions that are lower cost," Molinsky said

Between the lines: Even with new options for semi-independent living situations and increased concerns around nursing homes, service-rich residential housing that provides meals, transportation and medical care will still play a large role as we live longer and require more around-the-clock attention.

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