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Fall 2010

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By the year 2030, nearly one out of four San Mateo County residents will be over the age of 65.1

The number of adults over age 65 in the county will increase by 72%; and the number of people over the age of 85 will increase to two and a half times the current number. This is mirrored across the United States with the aging of the baby boomer generation (people born between 1946 and 1964). Locally, San Mateo County will have a greater proportion of older adults than the state average. 2

Unless we make signi� cant changes, this population will need healthcare and community-based services far beyond what our public and private systems can provide. According to the San Mateo County Projection Model, if we do nothing, by the year 2030, the county will experience a:

• 50% increase in demand for physicians, and as great as an 108% increase in demand for treatment in various sub-specialty areas

• 34% increase in acute hospital days among older adults3

• 59% increase in demand for hospital beds4

These projections are driven by an increase in the number of older adults, coupled with high rates of chronic diseases and cognitive impairments among aging baby boomers. Combined, these factors will result in a dramatic increase in demand for services.

By 2030: • 60% of baby boomers nationally will have more than one chronic disease,

nearly 1/3 will be obese, and 25% will have diabetes.5

• Approximately 23,300 older adults in San Mateo County will have developed Alzheimer’s Disease, a 70% increase from current numbers.6

• 1 out of 5 people over the age of 65 in San Mateo County will have a physical or mental disability, and some communities will face an even greater prevalence of these conditions.

San Mateo County Projection Model: Better Planning for Tomorrow

E� ective planning for tomorrow’s older adult population requires that we uncover the di� erences between the older adults of today and tomorrow. If we merely plan for an increase in older adults without recognizing the generational di� erences in their preferences, needs and opportunities, we will not plan appropriately.

To e� ectively plan for the aging of baby boomers, the San Mateo County Health System, Department of Housing, Transit District, the Commission on Aging, and Health Plan of San Mateo collaborated to create a demographic projection model that looks at the characteristics of older adults in San Mateo County for the years 2020 and 2030.

This model, with supplemental survey results, is a unique tool that provides local leaders and decision-makers with new data and qualitative � ndings to inform planning in healthcare, community design, public transit and other areas. For additional briefs based on the San Mateo County Projection Model, visit www.smhealth.org/hpp.

Communities that prevent disease are those that:

• Make it easy for everyone to walk, bike, ride public transit and engage in everyday physical activity

• Are aff ordable, allowing families and friends to remain in close proximity to provide ongoing support and reduce social isolation

• Prioritize public gathering places that enhance a sense of community and facilitate social connections

• Keep watch over neighborhood streets and have street designs that are safe and inviting for pedestrians

• Make aff ordable, fresh and healthy food accessible

Communities that support healthy older adults are those that:

• Place neighborhood services and retail near housing to allow for an easy walk between home and everyday destinations

• Are connected by reliable, frequent and safe forms of public transit so people can get around without a car

• Provide housing across generations and adopt universal design* so that older adults can age in place

• Facilitate volunteerism and opportunities to maintain social connections in order to reduce the risk of social isolation

• Off er an array of supports as alternatives to institutional care

Maintaining the Health of an Aging San Mateo County 3

* Universal design is a set of building and design standards that make it easy for someone of any age to occupy a housing unit.

We must prepare for the aging baby boomer population by developing communities that prevent diseases today and support healthy aging for tomorrow. These are communities where people of all ages have the ability to thrive, including the older adults of today and tomorrow.

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The 8–80 Rule

The 8–80 rule was coined by the Canadian based nonpro� t organization 8–80 Cities, an organization dedicated to supporting the creation of healthy communities and vibrant cities to enable residents to live healthier and happier lives.

The 8–80 rules asks us to envision a local street or sidewalk, then to think of two loved ones: a child who is approximately 8 years old and an adult who is approximately 80 years old. Next, ask if you would send those loved ones on a walk or a bike ride along the sidewalk, or across the street. If you would, then you can consider the street or sidewalk to be safe. If you would not, the street or sidewalk is not considered safe.

Using this rule, most cycling and pedestrian infrastructures in San Mateo County are not suitable for both an 8 year old and an 80 year old. As a county, we have lots of work to do to better support our children and our growing population of older adults.

In October 2009, Gil Peñalosa, Founding Executive Director of 8–80 Cities, visited San Mateo County and spoke to more than 100 elected o� cials and community members at the � rst Active Public Spaces Convening. His call to action inspired the Streets Alive movement across the county and moved us one step closer to preparing for healthy aging. For more information, visit www.streetsalivesmc.org.

4 Maintaining the Health of an Aging San Mateo County

In San Mateo County, getting around without a car is challenging. Today, 93% of baby boomers drive alone in a personal car to meet daily needs, and only 2% of baby boomers walk to complete these same activities.1 Most housing in San Mateo County is located far from shopping and services, and in many neighborhoods, there are too few riders to support public transportation. There are also several residential neighborhoods located on hills and in canyons, which also make it di� cult to provide transit service.

It is more healthy and less dangerous for older adults to walk and take public transportation than drive. Driving becomes less safe as individuals age; and getting around on foot, bike and transit can keep people healthier longer. Routine walking is an important strategy for preventing many chronic diseases and falls among older adults. Every transit trip starts and ends with some kind of a walk or ride, and public transit riders are far more likely to get routine physical activity than non-transit riders.7

San Mateo County baby boomers are demanding environments that promote their health. About half of survey respondents in San Mateo County reported that as they age, they plan to rely on public transit as their primary mode of transportation when they are no longer able to drive. These preferences indicate signi� cant demand for housing near reliable public transit. Similarly, most baby boomers report that they “want to enjoy cultural activities, shopping, and restaurants,” or simply be “able to visit their medical provider without driving.”1

Meeting this opportunity will require San Mateo County cities and regional planning agencies to:

Prioritize the development of housing in transit-rich centers. This requires mixed-use development near BART stations, Caltrain and along the El Camino Real corridor. If all cities prioritize development along just one quarter of El Camino at a density of 40 units

Older adults must be able to get around without driving

Maintaining the Health of an Aging San Mateo County 5

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San Mateo County Senior Mobility Initiative

Maintaining the Health of an Aging San Mateo County 5

Funded by a Caltrans Statewide Planning grant, the San Mateo County Transit District (SamTrans) organized a steering committee of 35 representatives from local public and private organizations and advocacy groups

to implement priority strategies from the 2006 Senior Mobility Action Plan. Key strategies, many of which are advanced in this brief, include providing community shuttles, taxicabs and community-based transportation services, o� ering safe driver courses, and encouraging

walking and using public transit by providing information and assistance. The plan can be found at www.peninsularides.org. For more information, visit www.seniormobility.org.

per acre (corridor study8), the county will meet its necessary housing development at a density that supports transit. Increasing the density along El Camino Real will create the opportunity to institute Bus Rapid Transit (BRT). Santa Clara County, through the Grand Boulevard Initiative, is currently planning for Bus Rapid Transit. This may also be possible in San Mateo County with community-based support and a commitment to mixed-use development.

Expand public transportation connections. San Mateo County is served by three major transit service providers: SamTrans, BART and Caltrain. Planning is underway to add a new high-speed rail system between San Francisco and Los Angeles, with 1 or 2 stations slated for San Mateo County.9 Regionally, proposed transportation plans include the revival of the Dumbarton Rail Line between Fremont and North Fair Oaks/Redwood City, which would add a new east/west rail system through communities that are currently underserved by public transit, and the addition of Bus Rapid Transit along El Camino Real from northern San Mateo County through Santa Clara County. Implementation of these projects provides the opportunity to increase the number of transit connections available for riders and the number of areas served by transit in San Mateo County, however, these expansions will require su� cient demand to ensure continuous service.

Increase the number of neighborhood destinations that can be reached on foot and bike. It is most feasible for older adults to walk for daily trips under 1/4 mile. Neighborhood centers and transit hubs with a diversity of retail outlets, services and housing create an environment inclusive of many daily destinations and allow older adults to remain active, independent and connected.

Implement street designs that are safe and inviting. Street design can support or inhibit walking and biking. Most people won’t walk to a destination, even within a few blocks, if it requires crossing a large intersection, walking on a narrow or uneven sidewalk, or walking along a busy, congested road. In order to make streets safe for older adults, crosswalk signals must allow su� cient time to cross safely at a slower pace, sidewalks must be well maintained to prevent falls and allow for the use of walking-aids, and signage must be clear and consistent to avoid cognitive confusion.

6 Maintaining the Health of an Aging San Mateo County

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Today, 77% of baby boomers own a single family home, and many (23%) own their homes without a mortgage. Homeownership contributes to the � nancial security of many baby boomers, but single family homes rarely support healthy aging. They are often further from transit hubs than multi-family housing, require the use of stairs and demand ongoing maintenance that can be costly and physically challenging for aging adults. The location of single family homes can contribute to social isolation, and the design of a single family home can inhibit older adults’ mobility and put them at risk of falling.

Few baby boomer homeowners have made modi� cations to prepare for limited mobility or cognitive impairments. Only 4% of baby boomers have installed grab bars in their homes, and even fewer have added ramps. Retro� tting baby boomers’ current homes would be quite costly; and when older adults were asked if they had the assets to make these changes, more than one quarter of survey respondents (28%) said they would need loans or other � nancial assistance to make their home safe as they age.1

For many San Mateo County residents, renting or living with family is the only � nancially viable option. For example, 72% of Asian focus group participants say they reside with their children for cultural and � nancial reasons; and 35% of African-American survey respondents, and 18% of Latino respondents in the County are renters, even though they make up 4% and 11% of County population, respectively.1 Making improvements to rental housing or � nding new rental housing that supports aging at an a� ordable price can be challenging for older adults.

San Mateo County baby boomers are demanding environments that promote their health. Nearly 50% report that they would be willing and interested in moving closer to public transportation, even when this would require selling their current home. In addition, most express that “it is not important to live near people their own age; but it is important to live near a diversity of ages.” This is a signi� cant shift from today’s older adults who have predominantly preferred age-speci� c communities. As baby boomers age, they see themselves living in multi-unit, multigenerational housing in transit-oriented environments.

Meeting this opportunity will require San Mateo County cities and developers to:

Prioritize a� ordable housing for both renters and homeowners. Baby boomers must be able to a� ord housing that is suitable for aging in place. This requires the development of a diversity of housing options, including below market rate units in residential developments and mixed-use projects; small condominiums, apartments and townhouses; and co-housing arrangements where common spaces are shared to reduce costs. To facilitate this development, it may be necessary to reduce parking requirements to lower development costs, since older adults have far lower rates of car ownership than working adults.

Increase the stock of transit-oriented housing units. From 2000 to 2030, the demand for housing near transit is expected to increase by 25% across San Mateo County10; and baby boomers are only one group demanding this housing. To meet the demand, developers and cities will have to prioritize Transit-Oriented Development (TOD). The San Mateo County 21 Elements initiative encouraged cities across the county to create housing policies that focus on TOD to preserve open spaces and

Older adults need accessible homes in accessible places

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San Mateo County Department of Housing

The San Mateo County Department of Housing published the booklet Building for the Boom: Creating Communities that Work for All Generations in the spring of 2009 as a resource for people working to meet the housing needs of the older adults of today and tomorrow. This booklet provides practical recommendations for increasing the stock of older adult-friendly housing in cities across San Mateo County, including recommendations for building the menu of housing options, prioritizing a� ordability, establishing livable communities, and incorporating universal design principles. To view this booklet, visit www.smchousing.org.

Maintaining the Health of an Aging San Mateo County 7

respect established single family neighborhoods; and the City and County Association of Governments (CCAG) of San Mateo County recently instituted a TOD incentive program to subsidize the cost of building TOD housing. These two programs can make this development a reality in the next 10 to 20 years.

Implement Universal Design Standards. Universal design describes building standards that make communities, buildings and homes equally accessible to people of varying abilities. Neighborhoods that meet this standard o� er businesses and other services within walking distance of housing; and homes that meet universal design standards may be required to have ground � oor access, reinforced bathroom walls that make it easy to add grab bars in the future, doorways and hallways that are wide enough to allow wheelchair access, color coding and labeling to reduce cognitive confusion, and lighting that accommodates visual impairments.

8 Maintaining the Health of an Aging San Mateo County

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Older adults must remain socially connected to friends, family and ongoing activitiesMany older adults experience social isolation and have feelings of loneliness, often as a result of reduced interactions with family and friends and withdrawal from social contact. Social isolation makes older adults more susceptible to physical and � nancial abuse. Today, many baby boomers in San Mateo County feel very connected to their communities. More than 70% report that they have someone to talk to regularly, and more than 75% report that they have lived in San Mateo County for 14 years or more. To maintain these connections, baby boomers must be able to age in their communities, retain independence to be able to meet daily needs, and take up new activities, such as group programs and volunteer projects.

Those who report needing to leave San Mateo County as they age cite that the primary reason “would be to move closer to family for help with daily activities,” and housing experts cite the high cost of living as a reason why many younger family members have left the county.1

San Mateo County baby boomers are demanding environments that promote their health. They intend to remain connected, or in many cases increase connections, to their communities as they age. Many have ambitious plans to volunteer and work part time well after their o� cial “retirement.” On average, most intend to work longer than today’s older adults, and many say they would like to stay in their current communities. By 2030, almost 50 percent of older adults will be foreign-born, which shows that even baby boomers born in other countries plan to stay in their current communities in the United States as they age. The foreign-born population is one factor contributing to the racial and ethnic diversi� cation

of tomorrow’s older adult population. This diversity is a key factor to consider when developing programs to encourage civic engagement and maintain community among older adults.1

Meeting this opportunity will require San Mateo County cities and community-based organizations to:

Increase the number of public gathering places. Public places that promote social connections can be spaces that serve a diversity of ages, including community centers, libraries, community gardens, cafés, parks and other public spaces.

Organize volunteer opportunities. Creating and structuring opportunities for baby boomers to volunteer at community-based organizations, religious institutions, local government o� ces, and schools will be valuable for the community and help increase a sense of social connection for the growing population of older adults.

Maintaining the Health of an Aging San Mateo County 9

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Engage the local community in conceiving new mobility options. There are numerous non-pro� t and private organizations that provide older adults with an array of � exible local options to meet their mobility needs. Emerging practices that could o� er new transportation alternatives for older adults include: volunteer driver programs, more accessible taxi service, better information and assistance for seniors to access and utilize transportation options. The partners in the San Mateo County Senior Mobility Initiative are working to bring this array of options to older adults throughout the County so that they can stay active in civic and volunteer organizations.

Reinvent the traditional “senior center.” Already, “senior centers” are changing their names and the types of services they provide. Gyms, cyber cafés and social networks are growing in popularity among aging adults, and may hold particular appeal for baby boomers who are wary of becoming “seniors.” Yet the social interaction and the connection to services and resources that the traditional senior centers provide are critical to alleviating social isolation. Many cities in San Mateo County, including the City of San Mateo’s Aging Well Initiative, have developed strategic plans for reinventing the delivery and marketing of services to older adults.

Support community capacity that assists older adults in maintaining health. Non-pro� t and faith-based organizations often provide services that help older adults maintain their health. It will be imperative to explore services and programs that go beyond health education, which will require working across non-traditional sectors. Examples include expanded transportation options, opportunities for social engagement, and access to a� ordable housing, which all promote healthy living for older adults.

10 Maintaining the Health of an Aging San Mateo County

Unless we make signi� cant changes, tomorrow’s older adults will need healthcare and community-based services far beyond what our public and private systems can provide. We can take action and change this.

Goal: Older adults must be able to get around without driving Recommendations for City & Regional Planning Agencies

Strategy Supporting Resources

Prioritize the development of housing in transit-rich centers

Policylinkwww.policylink.org

Expand public transit connections Senior Mobility Guidecip.plsinfo.org/SMAP_Guide_English_0309.PDF

National Complete Streets Coalitionwww.completestreets.org

Increase the number of neighborhood destinations that can be reached on foot and bike

Grand Boulevard Initiativewww.grandboulevard.net

National Complete Streets Coalitionwww.completestreets.org

Implement street designs that are safe and inviting

Public Health Law and Policywww.phlpnet.org

Goal: Older adults need accessible homes in accessible places Recommendations for Cities and Developers

Strategy Supporting Resources

Prioritize a� ordable housing for both renters and homeowners; Increase the stock of transit-oriented housing units

21 Elements San Mateo Countywww.21elements.com

Implement universal design standards Concrete Changewww.concretechange.org

Baby Boomers Get Smart: Local and State Strategies to Prepare for the Aging Populationwww.epa.gov/agingepa/resources/presentations/2008_ 0208_smart-growth-conference-markwood.pdf

Maintaining the Health of an Aging San Mateo County 11

Goal: Older adults must remain socially connected to friends, family & ongoing activities Recommendations for Cities and Community-Based Organizations Strategy Supporting Resources

Increase the number of public gathering places

Grand Boulevard Initiative www.grandboulevard.net

Project for Public Placeswww.pps.org

Growing Smarter, Living Healthier: A Guide to Smart Growth and Active Agingwww.epa.gov/aging/bhc/guide/index.html

Organize volunteer opportunities Portland Parks & Recreation and Bureau of Transportation, Oregon11

www.epa.gov/aging

Engage the local community in conceiving new mobility options

Environmental & Policy Change for Healthy Aging www.agingfriendly.org

NACCHO, Community Design/Land Use Planningwww.naccho.org/topics/environmental/landuseplanning/index.cfm

Reinvent the traditional “senior center” Lesley Senior Communities, Half Moon Bay11

www.epa.gov/aging

Support community capacity that assists older adults in maintaining health

AARP (formerly American Association of Retired People)www.aarp.org

San Mateo County Aging and Adult Services, Network of Caresanmateo.networkofcare.org/aging/home/index.cfm

Department of Health and Human Services, Eldercare Locatorwww.eldercare.gov

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1 San Mateo County Health Policy and Planning division. San Mateo County Projection Model. (2008). Accessed 8/30/2010: www.smhealth.org/hpp

2 California HealthCare Foundation. Beds for Boomers: Will Hospitals Have Enough?(September 2008). Accessed 8/30/2010: www.chcf.org/publications/2008/09/snapshot-beds-for-boomers-will-hospitals-have-enough

3 By 2030, the 65+ group is projected to use more than half (51%) of the state’s acute care days, despite representing only 18% of the population. The same ratio was applied to the future San Mateo County population to derive the % increase in acute hospital days noted.

4 Increase in demand does not indicate an increased need for hospital bed supply. In fact, given demand projections, no new supply is needed.

5 American Hospital Association. When I am 64: How Boomers Will Change Health Care. (May 2007). Accessed 8/30/2010: www.aha.org/aha/content/2007/pdf/070508-boomerreport.pdf

6 Alzheimer’s Association. California Alzheimer’s Disease Data Report. (2008). Accessed 8/30/2010: www.alz.org/cadata/CAALZ_County_Data.pdf

7 Besser L.M., Dannenberg A.L. Walking to public transit: steps to help meet physical activity recommendations. (2005). American Journal of Preventive Medicine, 29 (4), 273-280.

8 U. LaChapelle and L. D. Frank. Transit and Health: Mode of Transport, Employer-Sponsored Public Transit Pass Programs, and Physical Activity. (2009). Journal of Public Health Policy. Accessed 8/30/2010: www.palgrave-journals.com/jphp/journal/v30/nS1/pdf/jphp200852a.pdf

9 Greenbelt Alliance. Grow Smart Bay Area.(May 2009). Accessed 8/30/2010: www.growsmartbayarea.org/downloads/GSBA%20brochure.pdf

10 California High-Speed Rail Authority. Project Environmental Impact Report/ Environmental Impact Statement, Preliminary Alternatives Analysis Report for the San Francisco to San Jose Section. (April 2010). Accessed 8/30/2010: www.cahighspeedrail.ca.gov/images/chsr/20100408092523_SF-SJ%20Preliminary%20Alternatives%20Analysis%20Report.pdf

11 Center for Transit-Oriented Development, Strategic Economics, Transit-Oriented Development Demand Analysis. (July 2005). Commissioned by the San Francisco Bay Area Metropolitan Transportation Commission. Accessed 8/30/2010: www.mtc.ca.gov/planning/smart_growth/tod/deliverables/4d.pdf

12 United States Environmental Protection Agency. Building Healthy Communities for Active Aging Awards. (2009). Accessed 8/30/2010: www.epa.gov/aging/bhc/awards/2009/index.html

Questions? Comments?San Mateo Health SystemHealth Policy and Planning225 37th AvenueSan Mateo, CA 94403

www.smhealth.org/hpp

Phone: 650-573-2398Email: HPP@co.sanmateo.ca.us

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©2010 San Mateo County Health System

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