11 Fixable Things that Make Life Harder for the Elderly, the Sick, and the Poor

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11 Fixable Things that Make Life Harder for the Elderly, the Sick, and the Poor<br>Making it cheaper to be old, sick, or fragile in America. An abundance playbook.

Abi Olvera<br>Mar 18, 2026

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No one plans to become fragile. You get in a car crash and can’t walk. A virus leaves your brain foggy. You start getting seizures and can’t drive. You turn 75 and the stairs become difficult.<br>Some of the rules we’ve built have made it harder for people to seek care and live independently. Here are some things we could change, most of which require no new spending.<br>I plan to keep updating this list.

1. Make it legal to rent out a lockable bedroom in a shared building

This is illegal in most cities.<br>Single Room Occupancy hotels, which are a private bedroom and shared bathrooms, housed millions of low-income Americans for most of the 20th century. In 1950, SRO units were 10% of all rental units in some major cities.<br>Elderly people were as much as half of SRO tenants. However, most cities outlawed them in the 1980s. This made the lives of the elderly and poor more precarious. Pew notes this increased homelessness:<br>As the nation’s least expensive source of housing disappeared, homelessness soared in major cities across the United States. In New York City, for example, the number of homeless residents increased from a barely visible population to almost 30,000 by 1987. About half of men entering homeless shelters in the city in 1980 reported they had previously lived in SROs.

Seniors are the fastest growing group experiencing homeless.<br>2. Let families build a room on their own property for a struggling loved one

In much of Japan, you can build things on your lot like a studio or sleeping quarters for a relative. Most of America is zoned single-family only. You usually can’t add a backyard room for an aging parent.<br>Backyard units used to be how people with less money lived near family. It also was a source of modest passive income for the families who built them.<br>Accessory Dwelling Units (ADUs) are an attempt to bring these back, but most jurisdictions make them difficult to build. For example, with “temporary use” permits that expire when the senior dies, “removability” requirements that conflict with building codes demanding permanent foundations, sunsetting clauses that make them bad investments.<br>3. Treat manufactured homes the same as any other home in zoning law

A manufactured home or a “mobile home” costs roughly half what a site-built home does. People over 60 are a third of adults living in them. It’s one of America’s largest sources of affordable senior housing.

Manufactured homes are cheaper and can provide better energy efficiency than conventional construction. Image source: Lincoln Institute.<br>Many jurisdictions ban them outright, require large minimum lot sizes, prohibit replacing a unit when someone moves out, or segregate communities far from doctors, transit, and groceries. Vermont and Maine effectively legalized these homes: no zoning regulation can exclude manufactured homes except on the same terms as conventional housing.<br>4. Let small groups of people share a home and a caregiver

Four to six seniors sharing a house and a caregiver is effectively illegal. Three barriers stop it. Many zoning codes cap unrelated persons at four. Medicaid allocates aide hours per individual with no way to pool them, even though one aide under one roof is more efficient than four aides visiting four homes. And the moment seniors share a caregiver, many states classify it as an assisted living facility requiring fire codes, staffing ratios, commercial inspections designed for a 100-bed building.<br>These regulations and licensing requirements work well for protecting people in institutions. However, requiring commercial kitchen inspections for a house with four seniors and a caregiver stops people from forming tiny community-centered solutions.<br>The fix: create a regulatory category between “person alone at home” and “licensed facility” e.g. a small shared care home with proportionate safety rules.<br>5. Stop requiring government permission to add nursing home beds

NIMBY blocks some nursing homes, but another barrier is that 34 states require a Certificate of Need just to add nursing home beds. You need state approval to build supply. Sixteen states go further with outright construction moratoria.<br>These laws were designed to prevent overbuilding and control Medicaid costs. In practice, they protect existing facilities from competition and keep supply artificially low. Repealing CON for nursing homes and classifying small care homes as a permitted residential use by right would expand options.<br>6. Remove the legal ambiguity around homesharing

Homesharing matches older homeowners — property-rich, cash-poor, often isolated — with people who need a room to live in and are willing to help in the home for...