Our homes watch over us as we age. They see everything from birth to death and in between—a child’s first steps, a beloved pet’s last breaths, from marriage to divorce, adolescence to infirmity—and through it all, they change as we change. From the decorations on the wall to the etchings on the floor, they are the unwritten diary of our lives.

Or, at least, they used to be. Today, many Americans at the end of their lives find themselves not in the homes they love, but rather in institutions they dread—assisted-living facilities, nursing homes, hospitals—and we have accepted this outcome as a fair accomplishment. We are unwitting captives in a prison of our own design.

In part, this is a result of our own success. Modern medicine has made spectacular gains. Today, the average life expectancy is nearly 80, more than double the life expectancy for most of human history. This extended lease brings new demands on the society that sustains us. And the housing sector has not kept pace.

Older homeowners typically live on fixed incomes. As a result, they spend less on maintenance and often have less access to credit. Without upkeep, their housing will deteriorate as they age. This is both dangerous and demoralizing.When these homes lose value, their owners lose wealth. On a fixed income, wealth matters. According to one recent study, when the elderly lose housing wealth, their health worsens and their likelihood of disability increases. In fact, for older populations, housing assets account for more than 90 percent of socioeconomic inequality and over half of disability inequality.

Further, with aging comes a decline in mobility. It’s harder to walk, drive, and navigate the environment. Most homes and neighborhoods aren’t equipped for this stage of life. They lack ramps, wide doorways, and bathroom grab bars. Public transit is inaccessible and inhospitable. Healthy food stores and affordable medical centers are too far away. Sidewalks are uneven and poorly lit, if they exist at all.

Faced with these obstacles, many older Americans have to choose between sedentary isolation and premature institutionalization—both of which are associated with worse health outcomes. The longer a person stays in their own home and the more space they occupy, the longer they tend to live and the less they tend to experience stress, anxiety, and depression.

In the research for his recent book Being Mortal, Atul Gawande was shocked to discover how simple changes could make such a big difference. His surgeon training told him to focus on expensive tests and medications—in short, how to stop aging—but palliative care specialists took a different approach. They prescribed better shoes to prevent falling. (Hundreds of thousands of Americans fall and break a hip every year. Almost half of them wind up in a nursing home. A fifth will never walk again.) They tried to eliminate medications that reduced the patient’s quality of life. They altered diets and routines. In short, they aimed to manage aging.

We can learn a lot from these experts. They have spent their lives thinking about an inevitability that most of us would rather ignore until it’s upon us. But by then it’s too late. And for those among us who are already facing this final hurdle—a group that will only continue to expand as the Baby Boomers retire—it is incumbent on a humane society to give them all the help and support we can. After all, we would not be here without them.

Midway through the book, Gawande tells the story of Bill Thomas, a young physician who had the radical idea to fill his nursing home with dogs and cats and birds and plants, completely outside the box that his profession had created for end-of-life care. When he ordered hundreds of parakeets, they thought he was crazy. It was a recipe for chaos.

What happened next was remarkable. “People who we had believed weren’t able to speak started speaking,” he recalls. “People who had been completely withdrawn and nonambulatory started coming to the nurses’ station and saying, ‘I’ll take the dog for a walk.’” One by one, the residents adopted the pets, and it gave them a renewed sense of purpose. They laughed and played and cared for their new animal friends.

They felt alive again.

Bill Thomas put the home in nursing home. He understood what Home Matters is all about: Our housing may change, but it should always remain a home, a place where people feel warm, safe, and valued until their very last day.

Prolonging life is one of the great accomplishments of the modern era. We need to make sure that our housing adapts to better serve prolonged lives.  

If we started designing homes with an age-in-place sensibility that allows for both aesthetics and adaptability, we would get to raise our children, become empty nesters, perhaps become widowers and mobility-challenged, yet still stay rooted to our precious memories, aging with grace, in our own home.  All the energy and investment we put into adding years to our lives is only worth it if we marshal the same effort to make those years enjoyable and fulfilling. The difference between surviving and thriving is the difference between shelter and home. For it’s only when we’re truly home that we feel that treasured presence, watching over us, sharing our journey, for as long as it’s able.