International Encyclopedia of Rehabilitation


Jordana L. Maisel

A disconnect exists between seniors' housing preferences and their ability to fulfill this desire. A lack of accessible, affordable, and adequate housing currently prevents many seniors and people with disabilities from remaining in their own homes, despite their overwhelming desire to do so (Mathew Greenwald & Associates, Inc. 2003). Many homes are inaccessible to a large part of the population; homes are built with barriers like steps at entrances and narrow doorways that reduce individuals' autonomy and do not support declines in physical health.

Many forces are joining together to further complicate and intensify the housing problem in the United States. For example, America's changing demographic composition further contributes to the growing housing problem. Researchers and policymakers expect housing problems to worsen in the next few decades as the country's population experiences a major demographic transformation, with a growing share of the population above the age of 65. Demographic trends, including the aging of the Baby Boomer generation, lower birth rates, and longer life spans are combining to create this changing demographic structure. Projections based on U.S. Census Bureau data indicate that the number of persons age 65 and older will grow to almost 40 million by the year 2010 and 70 million by 2030 (U.S. Census Bureau 2004). Along with a growing number of older adults, advancements in medicine and technology have also resulted in millions of Americans with disabilities that impair their mobility. The U.S. Census estimates that 21% (58.8 million) of the population had some form of legally defined disability in 2000 (U.S. Census Bureau 2003). Approximately five million persons 65-74 and almost eight million persons 75 and older reported having physical difficulties in 2004 (National Health Interview Survey 2006). The growing number of people with disabilities will put an even greater strain on the current housing problem.

Federal legislation also threatens seniors' ability to fulfill their desire to age in place. While tremendous strides in accessibility legislation have taken place over the past few decades, there is still much room for improvement. Section 504 of The Rehabilitation Act of 1973 specifies that programs supported by federal funds shall not discriminate against people with disabilities, including seniors, and it provides governmental authority to ban federal funds from discriminating agencies and entities. Although Section 504 requires accessibility features in at least five percent of dwelling units in newly constructed multifamily projects (containing five or more dwelling units), it does not cover private single-family homes. According to the 2005 American Housing Survey, approximately 70% of the population lived in single-family housing (U.S. Census 2005). Therefore, a large segment of the housing stock remains unaffected by the legislation.

Despite existing legislations' limitations, new strategies to incorporate accessibility in single-family housing projects are emerging and gaining recognition. Incorporating more innovative and cost effective design practices into the new housing stock helps create a larger supply of homes that support seniors' housing preferences. Visitability is an affordable, sustainable, and inclusive design approach for integrating basic accessibility features as a routine construction practice into all newly built homes. Based on the principle that inclusion of basic architectural access features in all new homes is a civil and human right, the visitability movement strives to improve livability for all (Truesdale and Steinfeld 2002). Started in the U.S. by Eleanor Smith and her group Concrete Change in 1986, visitability seeks to make homes more accessible by having them meet only three conditions: one zero-step entrance at the front, side or rear of the home, 32 inch wide clearances at doorways and hallways with at least 36 inches of clear width, and at least a half bath on the main floor.

Visitability provides benefits to a wide range of users, including those with disabilities, their nuclear family, friends, and other relatives who may, from time to time, need to use wheelchairs or other adaptive equipment. Consequently, rather than remain isolated and confined to their personal surroundings, as a result of visitability, individuals with a variety of abilities can interact with each other and participate in community activities outside of their homes.

Recognizing the benefits and growing need for more accessible housing, many state and local jurisdictions have joined the visitability movement. In fact, several municipalities and states across the country have already formalized and enacted visitability programs. Despite their common goal of increasing the supply of accessible housing, these visitability programs vary significantly. The three primary ways they tend to differ are the geographic regions they cover, the scope of features they include, and the strategy by which they are implemented and enforced. For instance, some visitability programs cover housing within an entire state, while others only have jurisdiction over cities and/or counties. In addition, some programs strictly adhere to the three basic accessible features (step-less entrance, wider doorways and hallways, and a half bathroom on the main floor), while others include additional architectural elements such as lever handles, blocking for grab bars in bathroom walls, and accessible environmental controls. Visitability programs also vary in how they are enforced. While some initiatives are mandatory, with a law or an ordinance requiring builders to include the visitable features during new construction, others are voluntary. With regard to scope, some ordinances cover only houses constructed with some form of government assistance such as tax breaks, reduction of fees, or down-payment assistance, whereas a few ordinances cover every new house built.

As of June 2008, there were 57 visitability programs across the U.S., with 33 mandatory ordinances and 24 voluntary programs (Maisel, Smith, and Steinfeld 2008). While Atlanta, GA passed the first ordinance in 1992 that required basic visitability features in single family homes or duplexes built with any type of subsidy from the city, Pine Lake, GA and Tucson, AZ were the latest municipalities to pass initiatives. However, the Tucson ordinance goes even farther and covers every new home, both publicly and privately financed. In addition to local and state efforts, a federal initiative is underway. A Federal Bill: The Inclusive Home Design Act was first introduced by Rep. Jan Schakowsky (D. Ill.) in 2003 and reintroduced on November 15, 2007, as H.R. 4202. If passed, the legislation would cover all single-family homes that receive assistance from the federal government, including construction funding and tax credits.

Figure 1

Figure 1. A graph showing the cumulative number of visitability initiatives from 1989-2007.

An explanation of figure 1 is available.

Measuring the effectiveness of visitability proves quite challenging because very few municipalities actually track the number of visitable homes that are built as a result of new legislation. However, some programs do formally track results, and even with limited data available, local government officials report that about 30,000 visitable homes have been built as a result of mandatory ordinances. Compared with this estimate, fewer than 1,300 visitable houses have been built under identified voluntary programs (Maisel et al. 2008). The data available on visitability therefore suggests that mandatory programs generally yield better results.

Despite its rise in popularity and widespread diffusion, visitability continues to face some challenges and controversies. Questions regarding the legality of local ordinances, the cost effectiveness of programs, and the feasibility of implementation have loomed since the philosophy emerged. While supporting efforts by builders "to develop voluntary programs promoting accessible design features for single-family construction and remodeling," in 2007, the National Association of Home Builders (NAHB) reaffirmed a policy opposing mandatory visitability laws (NAHB n.d.). In response to legislation that affects both publicly and privately financed housing, the Pima County, AZ and Naperville, IL local chapters of the National Association of Homebuilders (NAHB) immediately took aim at the law's constitutionality. Arguing that the ordinance deprived homeowners and builders of the fundamental right to design private homes, the Southern Arizona Home Builders Association (SAHBA) eventually took their case to the Arizona Court of Appeals. In its verdict, the Court of Appeals unanimously ruled in favor of the county (Lawlor 2004).

Besides infringing on homeowners' "rights", many visitability critics also argue that inclusive design costs too much and negatively affects the aesthetic quality of homes. While cost studies are somewhat limited, researchers and professionals continue to affirm the minimal cost of visitability, if the features are planned and incorporated before construction (Smith 2004; Smith and Pace, 2007). Critics also argue that visitability features are obtrusive and unappealing which will deter many homebuilders and homeowners from including them in their plans. In many cases, however, visitable homes remain indistinguishable from conventional designs. Visitability features, such as a step-less entrance and a ramp, can be successfully incorporated into a home's design without sacrificing visual appeal.

Recognizing the growing need for accessible housing and the need to win over skeptics, innovative strategies for incorporating accessibility features are emerging. Drafting new codes, bundling innovations, and increasing public awareness are all strategies to further increase the spread and adoption of visitability. For example, the ICC/ANSI A117.1 standard for accessible design, the national consensus standard referenced by most building codes in the country, recently adopted a new section with technical design criteria for visitability. The standard can now be referenced by visitability laws and programs, thus promoting uniformity in applications and aiding in their interpretation and widespread implementation. Bundling visitability with other innovative housing concepts is another strategy that is supported by research in diffusion of innovation (Rogers 2003). By coupling the visitability requirement with sustainability, affordability, mixed-income development, and safety, each goal gets a boost from the other.

Bundling with related concepts increases the constituency for each innovation and develops and expands awareness and knowledge of each innovation faster. Finally, visitability supporters must continue to draw awareness to the visitability movement by attracting media outlets, influential leaders, and policymakers to the cause. The movement could be further strengthened by advocates targeting additional social networks such as professional organizations, real estate development interests, and organizations serving older people and broader-based disability organizations, and by these groups reaching out to join forces with advocates.

International Perspective

International efforts are also addressing the lack of suitable housing for disability and aging. In the United Kingdom, the Joseph Rowntree Foundation developed the Lifetime Homes program in 1993 that contained 16 design features that ensure a new house or flat will meet the needs of most households. The Foundation's efforts also led to the revision of Part M of the British Building Regulations. This section of the building code requires homebuilders to construct new housing to standards that permit people with disabilities, particularly wheelchair users and those with mobility or ambulant impairments, to visit a house and have access to at least a common space and toilet on the main floor. Wales, Scotland, and Northern Ireland have developed and adopted similar regulations.

Many English builders take the same position on visitability as their American counterparts. They argue that Part M adds to development costs, but few are able to quantify the additional costs. Experience with Part M has demonstrated that variable and inconsistent interpretation of Part M among building control officers leads to a range of different design mandates. Despite these challenges, Part M has led to a growing number of accessible homes. Research studies estimate that between October 1999 and December 2002, builders incorporated Part M of the building regulations into 68% (105,790 dwellings) of all new builds (Imrie 2003).

Additional efforts to increase the supply of accessible homes are underway in The Netherlands. Over the past 20 years, local councils and housing associations have encouraged the development of new dwellings designed on adaptable housing principles. There are five criteria for "adaptable housing," including threshold heights, space reserved for lifts, turning space clearances, wider hallways, and a larger bathroom. By 1996, 44% of new social housing in Amsterdam was adaptable, as well as 60% of all new housing in The Hague (Herd et al. 2003). In 1997, the requirements for adaptable housing were included in the Dutch National Building Code.

Housing initiatives across Australia have been much more varied, and, as a result, several different initiatives have emerged. The State of Victoria implemented ResCode in August 2001 as a statewide planning policy. The intent was to encourage the consideration of the needs of people with limited mobility in the design of multi-unit developments. However, enforcement is discretionary; and council planners can decide how stringently to apply the guidelines depending on the particular context of the site, amenity considerations, and local municipal policies. New South Wales has two State Environmental Planning Policies (SEPP 5 and 65) related to housing for older people and for people with disabilities, while South Australia has a requirement for one Class 1 building (house) or Class 2 (apartment) to be accessible if a group of 20 or more are being built (Herd et al. 2003).

Recently, The Australian Network for Universal Housing Design (ANUHD) was formed to support a more uniform and simplified set of guidelines for accessible housing across Australia. This group is working to obtain access requirements for housing in the Building Code of Australia for all new and extensively modified housing.

The Nordic countries also have adopted accessible housing policies that apply to all new housing, including single-family housing. Sweden has a long history of developing accessibility legislation. Legislation for the building sector adopted in the 1960s was extended to cover work spaces and housing in 1977. Accessibility legislation is integrated into the Swedish National Building Code. The main rule regarding accessibility states that "Buildings containing housing, work space and facilities for public use, must be designed and constructed in such a way that they are accessible and usable by persons with limitations of mobility or orientation capabilities" (BVF 1994, §12).

Sweden is also leading the way towards full community-wide accessibility. In 2000, the country adopted a "National Action Plan for Handicap Policy." The campaign extends beyond housing, with a goal of incorporating full accessibility across all policy areas by 2010. Besides increasing employment for people with disabilities and identifying and removing existing obstacles to participation in working life, additional efforts apply to public transport and easily remedied obstacles in buildings and public places.

As the population ages and the current lack of accessible housing and neighborhoods becomes an even greater problem, visitability represents one possible strategy to help increase the supply of accessible and usable dwellings. Visitability not only addresses the need for more accessible housing, but it also recognizes that this need extends beyond the multifamily housing market; individuals who prefer to live in single family homes express a need and desire for accessible housing as well. Visitability ultimately provides an innovative, cost effective, and viable strategy for transforming and improving the nation's housing supply and meeting the needs of a changing population.


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Further reading

Related encyclopedia entries: Universal Design

CIRRIE article citations: Housing, Universal design

Rehabdata article citations: Housing, Universal design

ICF codes: e155 (Design, construction and building products and technology of buildings for private use), e515 (Architecture and construction services, systems and policies)

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Cite this article

Maisel JL. 2010. Visitability. In: JH Stone, M Blouin, editors. International Encyclopedia of Rehabilitation. Available online:


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