36 years after the ADA, accessibility advocates turn their attention to the home 

Ramps, curb cuts, accessible parking spaces, and automatic doors have become standard features of American public life since President George H.W. Bush signed the Americans with Disabilities Act on July 26, 1990. As the law nears its 36th anniversary, a parallel shift is underway in a space the ADA never regulated: the home. Three-quarters of adults age 50 and older say they want to remain in their current home for as long as possible, according to AARP's 2024 Home and Community Preferences Survey, which polled more than 3,000 U.S. adults between June and July of that year. Seventy-three percent said the same about staying in their current community.

QMedic, a national medical alert and remote monitoring provider, examines how aging in place, fall risk, and changing accessibility needs are reshaping the home for older adults. 

The survey, fielded through NORC's AmeriSpeak and Cint panels, found that nearly two-thirds of respondents aged 50 and older expect they will need a medical alert system to support independent living as they age. That figure marks a change from how researchers have historically framed this issue. Housing surveys in past decades tended to ask whether older adults wanted to stay home; the 2024 survey instead asked what tools they believed they would need to do it, and found 44% anticipating a need for smart home security features, 72% expecting bathroom modifications such as grab bars, and 71% expecting entryway changes such as ramps or wider doorways.

"Most older adults want to stay in their homes, yet rising housing costs and limited options create serious barriers," Rodney Harrell, AARP's vice president of family, home, and community, said in a statement accompanying the survey's release. AARP has cited affordable housing stock and accessible design as ongoing constraints on that preference, separate from the technology question. Falls remain the leading cause of both fatal and nonfatal injury among adults 65 and older, according to the Centers for Disease Control and Prevention. More than 14 million people in that age group, about 1 in 4, report falling each year, and the CDC estimates that 37% of those falls cause an injury serious enough to require medical treatment or restrict daily activity for at least a day. 

The National Council on Aging's Falls Prevention Resource Center puts the annual healthcare cost of nonfatal falls at roughly $80 billion, up from $50 billion in 2015, with costs projected to top $101 billion by 2030. Medical alert devices have changed accordingly. Where earlier systems relied on a wearable pendant that a user had to press manually, current products combine automatic fall detection, GPS tracking, two-way communication, and caregiver notifications into a single device or app. Brooke Miller, QMedic's vice president of sales, said the shift reflects what families are asking for. "Families are looking for ways to support independence, not replace it," Miller said, adding that the goal of newer systems is to operate passively in the background rather than requiring the user to initiate contact during an emergency. 

Falls are not the only reason families call, according to AARP's caregiving research. A recurring theme in that data is burnout among adult children managing a parent's care from another state, along with missed medications and stretches of isolation that don't show up in a fall report. Chronic illness is part of why no single device covers every household: 93% of adults 65 and older live with at least one chronic condition, and close to 79% live with two or more, according to NCOA. Federal law does not currently set accessibility requirements for private homes the way the ADA does for public buildings and transit systems, and the growth in this market so far has been driven by consumer demand rather than regulation. As the U.S. population ages, AARP expects demand for tools that support independent living at home to grow.