Opinion: Building for Health

By Stefanie F. Seldin 

In 2003, Felicia Coward became a homeowner and quickly developed deep bonds with her neighbors. Over time, the home needed critical repairs. The third-floor skylights that had made her fall in love with the house began to leak and the ceiling was crumbling under the weight of a roof with too many layers of rubber. As is the case for many older homeowners, the need for repairs coincided with Coward’s retirement and a decrease in income. 

This story is not unique. The median age of a Philadelphia home is 93 years old, significantly higher than the national average. Old rowhomes were simply not designed with accessibility in mind. They often suffer from water infiltration, and need plumbing or roof repairs. Left unfixed, water infiltration will cause mold and long-term health problems. Philadelphia’s old rowhomes were also built with scant insulation, making them uncomfortable and expensive to heat and cool.   

Making all of these upgrades is cost prohibitive. Rebuilding Together Philadelphia (RTP), a nonprofit that provides free home repairs to income-eligible homeowners, helped Coward with several critical fixes, including a new roof; skylight, roof and ceiling repairs; and aging-in-place modifications such as grab bars and a new comfort-height toilet. RTP families live in homes that threaten their health through poor indoor air quality, endanger their safety through inaccessibility, and drain their finances through energy inefficiency. 

RTP repairs 150 homes a year and has completed 2,468 renovations for low-income families since its inception in 1988. Older adults comprise over half of the homeowners served; nearly half of homes have at least one resident with a respiratory condition. With a focus on improving health, safety, and energy efficiency, RTP’s work is not just about fixing structures — it’s about helping families and older adults thrive. The hope is that all design professionals adopt the lens of healthy housing in their work.   

Aging in Place 

The AARP’s 2024 Home and Community Preferences Survey found that 75 percent of adults aged 50 and older want to remain in their home as they age. Yet our infrastructure doesn’t match these aspirations.  Ensuring that homes are accessible as physical and cognitive limitations increase is a major challenge to aging in place — research consistently shows that only 10 percent of U.S. homes are designed for older adults to live in safely. According to the American Academy of Orthopedic Surgeons, most hip fractures occur as a result of a fall, and most falls and injuries occur in the home. Within a year of breaking a hip, one in four people will die.  

RTP has a long-established collaboration with occupational therapists who evaluate homes and recommend modifications, including grab bars in bathrooms, anti-slip tape on stairs, lever-style door handles, a second handrail, hand-held showers, comfort-height toilets, and more. RTP’s limited per-house budget (about $20,000) often cannot cover the most requested modifications (main floor bathrooms, main floor bedrooms, wider doorways, entrances with no stairs), but all architects and designers should talk to their clients about incorporating them into designs. When you help someone age safely in place, you prevent debilitating (and expensive) hospital visits, you reduce the need for institutional care, and you keep families in their communities. 

Breathing Easier 

The science is clear: Home materials and systems directly impact our clients’ ability to breathe. Interventions to improve respiratory health include remediating and preventing mold (fixing roof and plumbing leaks; installing dehumidifiers and exhaust fans); ensuring comfortable indoor temperatures (HVAC repairs); pest management (sealing all exterior gaps and providing pest management); and carpet removal.  

Carpeting presents a significant challenge for families with respiratory issues. The pile traps pollutants such as dust mites, pet dander, pest allergens, and mold spores, all triggers for asthma and other respiratory conditions. The American Lung Association recommends that families choose hard-surfaced flooring instead of carpets. Before recommending carpets, design professionals should ask clients if they or their family members have breathing difficulties. 

Twenty-five percent of children living in Philadelphia’s poor neighborhoods have asthma, and forty percent of asthma episodes are due to triggers in the home. In 2018, RTP began working with the Children’s Hospital of Philadelphia to reduce those triggers in the homes of children with severe asthma. In November 2021, the results of the collaboration were published in the Journal of Allergy and Clinical Immunology. A year after repairs, participants experienced an approximately 50 percent reduction in nighttime symptoms, 40 percent reduction in rescue medication use, and a 60 percent reduction in missed school days. All of these are indicators of better asthma control. Incredibly, there was also a 40 percent reduction in hospital utilization and a 69 percent reduction in emergency room visits.  

Small Cost, Big Impact 

Energy efficiency improvements make homes more comfortable, healthier and more affordable. This is hardly a new concept for architects. While the energy-efficiency repairs that RTP focuses on aren’t as sexy as passive house design, basement air sealing and attic insulation (costing about $5,000) provide a high return on investment. Air leaks in basements and attics account for significant energy loss. 

Air sealing also prevents moisture infiltration and stabilizes indoor temperatures, crucial for respiratory health. RTP often encounters families forced to use dangerous heating sources such as space heaters or gas stoves due to poorly insulated, drafty homes. A small investment in energy-efficiency modifications improves indoor air quality, prevents the use of dangerous heating alternatives, and reduces energy costs.  

Scaling Through Partnership  

Home repairs prevent falls that would end independence, eliminate energy burdens that force families to make impossible choices, and create indoor environments that support, rather than undermine, health. The scale of the need in the Philadelphia area and nationwide still far exceeds available resources. The Federal Reserve Bank of Philadelphia estimated the cost of addressing physical housing deficiencies nationwide at $149.3 billion. Repair needs were concentrated among lower-income households, which accounted for an estimated $57.1 billion of that total. 

For architecture firms in Pennsylvania, the Neighborhood Assistance Program (NAP) presents a unique opportunity to partner with nonprofits like RTP while receiving significant tax benefits. Through NAP’s Special Program Priorities (SPP) component, businesses can receive up to a 90 percent tax credit. For example, a $50,000 investment equals $5,000 of cash expense and $45,000 in tax credits. Let’s create built environments where vulnerable populations can truly flourish.  

Design matters. New homes and sensible retrofits can make a big difference to clients’ well-being. Let’s ensure the homes we create and repair provide safe, healthy, and efficient environments that support families through all stages of life. 

Stefanie F. Seldin is President and CEO of Rebuilding Together Philadelphia. She joined Rebuilding Together Philadelphia in 2013 after 18 years as a public interest attorney, with the last decade focused on housing preservation.