Relationships between housing and health for older private renters: evidence from a pilot study in Australia

Increasing numbers of older people seek to age at home in their community in western countries including Australia. Whilst this aligns with community aged care policy, the nature and suitability of their housing to enable ageing in place, receives less policy attention. The increasing representation of older tenants in the private rental market, with limited resources and precarious tenure highlights the need to understand ageing in place in a privately rented home. This study aimed to explore the relationships between housing accessibility, financial status, health, and independence for older Australians renting privately. Home visits were conducted with 27 older adults, where the SF8, ADL Staircase, the Housing Enabler, the Financial Capability Questionnaire, and the 30:40 indicator of housing stress were completed. This preliminary research found that older private renters lived in inaccessible homes, with high scores on the Housing Enabler (mean = 185) indicating poor access. Inaccessible housing was correlated with worse physical health, lower perceived independence, less independence in instrumental activities of daily living, and activities of daily living being difficult to perform. Older tenants living with higher levels of financial disadvantage were also found to be less independent and have poorer mental health. The research reveals important policy implications for community aged care, housing, and social security, including removing barriers to enable free and easy access to home modifications for older renters experiencing financial disadvantage. Future research should examine a nationally representative, diverse sample of owners, private renters, and social housing tenants to further understand the influence of the home environment, including tenure, on the health and well-being of older adults as they age in place.


Introduction
This paper reports on quantitative data from a mixed methods pilot study with a group of older people who rent privately in Australia. As with many developed countries, Australia's aged care policy emphasises ageing in place and in the context of demographic changes older people's homes are increasingly the site where individuals and families manage health, independence and in some cases care (Hokenstad & Restorik Roberts, 2011). However, there is growing concern about how older people who rent privately can manage their health and well-being in a space they do not control with insecure tenure and limited resources (Morris, 2018;Taylor et al., 2019).
The experience of ageing in place for older private renters has largely been absent in policy and research (Wiles et al., 2012). This is of concern given the projected increases in older people renting privately in Australia (Commonwealth of Australia, 2020), and greater attention internationally to precarity and widening inequality in later life (Grenier et al., 2021). There has been extensive research examining the relationships between older adults' home environment, their health, and well-being thereby providing valuable insights for the design and operation of aged care and health policy (Garin et al., 2014;Oswald et al., 2007;Trecartin & Cummings, 2018;Werngren-Elgström et al., 2009). However, our understanding of the suitability of older people's dwellings for ageing in place is mostly drawn from research with older adults who own their homes and often from European contexts where private and social renting are structured differently to Australia. This paper provides analysis of the relationships between housing and health for older private renters in Australia to help understand how their dwelling supports ageing in place.

Understanding tenancy, health, and ageing
Older people in Australia who rely on the aged pension and reside in private rental housing are a disadvantaged group (Morris, 2018). Significant numbers of older private renters' face poverty and risk of homelessness largely due to high housing costs (Commonwealth of Australia, 2020;Petersen & Parsell, 2015). This financial stress in turn limits their capacity to afford the fees associated with aged and health care including home modifications and home care which although federally funded require co-payments (Commonwealth of Australia, 2020; Jones et al., 2008).
In Australia, government policy to support healthy ageing including housing, welfare, and aged care policy is structured on the premise that older adults will own their home by retirement (Power, 2017). For example, the aged pension rate assumes most Australians will retire as outright homeowners with no mortgage or rental payments (Yates, 2015). High levels of home ownership traditionally enabled aged pensioners to lead a decent life (Ong et al., 2019). However, major changes occurring in Australia's housing sector has resulted in increasing numbers of older people renting privately (Commonwealth of Australia, 2020). It is predicted that by 2031 adults aged 65 years and over with a mortgage will increase by 139% and those renting by 95% (Ong et al., 2019). A recent Australian audit found only 0.8% of rental properties were suitable for a single person on the aged pension (Anglicare, 2020). Using national data, approximately 7.3% of older people are private renters with over 40% subject to housing stress, that is housing costs exceed 30% of gross household income (Productivity Commission, 2015). In Australia, and in many other countries including Ireland, New Zealand, the United Kingdom, and the United States of America, the private rental sector is expanding at a faster rate than the overall stock of occupied dwellings (Pawson et al., 2020). Importantly in the Australian context, social housing is rarely an alternative as it is a residual form of housing allocated only to those with the highest health and psychosocial need, and stock has hardly increased over the last decade (Ong et al., 2019;Pawson et al., 2012). Currently, only 3% of Australians live in social housing (Pawson et al., 2020).
International research highlights the importance of housing policy on the lives of older adults. This was highlighted in a recent European study on housing quality, where being a renter was found to be negatively related to well-being, with less impact in countries with accessible and well-regulated rental markets (Herbers & Mulder, 2017). This finding was also evident in the longitudinal Whitehall II study in England conducted over 24 years showing inequality, housing quality, and ability to manage financial difficulties become increasingly important as participants aged (Howden-Chapman et al., 2011). Tenancy laws in Australia differ markedly from most developed European countries as tenancy laws are within the jurisdiction of States and Territories, and regulation largely prioritises property owners (Easthope, 2014;Pawson et al., 2020). Renters generally have limited control over their rented dwelling, as approval is needed for physical changes to their home, and they have limited security of tenure. In Australia, leases are commonly six months or one year, rarely longer. On expiration of a lease, rent can be increased with written notice, and a termination notice can be served on the tenant. This notice to vacate does not require a reason. As a result, older tenants experience ongoing stress associated with the lack of certainty attached to their private rental housing tenure, constant fear of being given a notice to vacate, and rises in rent (Morris, 2018;Petersen & Parsell, 2015).

Appropriateness of rental housing to support ageing in place
Functional abilities can decline with age. In the Australian context, 38% of people aged 65 years and over require assistance with core activities due to illness or disability (Australian Bureau of Statistics, 2019). However, even as functional ability declines, most older people prefer to age at home and in their neighbourhood (Productivity Commission, 2015). This is reflected in population data, with almost all (98.6%) older adults aged 65 to 79 years living in private dwellings (Australian Bureau of Statistics, 2019). Although this decreases with age, with 14.3% of those over 80 living in care accommodation, the majority remain living in the community (Australian Bureau of Statistics, 2019). Both Australian and international policy aligns with older people's preference to age in place. The Aged Care Act (1997) in Australia promotes "ageing in place through the linking of care and support services to the places where older people prefer to live" (Aged Care Act (Aus), 1997, s. 2.1.1j) and the World Health Organisation Centre for Health Development (2004, p. 9) outlines ageing in place as "meeting the desire and ability of people, through the provision of appropriate services and assistance to remain living relatively independently in the community in his or her current home or an appropriate level of housing".
To assist older people to remain in their own homes as their functional abilities decline there is a focus on the quality of the environment, in particular the physical characteristics of home, as well as the provision of support services. In the Australian context, community aged care provides support services, such as assistance with daily living activities including shopping, showering, and cleaning, along with modifications to the physical home environment to enable older people to manage their functional limitations in their home, and age in place. These support services are provided under two main schemes in Australia, the Commonwealth Home Support Program and Home Care Packages, with the latter providing a higher level of support (Australian Government, 2020).
While there are services to support ageing in place several critical issues exist for the growing number of older adults renting. First, some rental properties do not support ageing in place. Second, barriers exist for older private renters to access support services. There is growing evidence that the quality and design of rented homes influence a tenants' physical health and independence (Baker et al., 2014). Australian research has highlighted occasions of older people unable to be discharged from hospital due to their rented home being inaccessible (Petersen & Parsell, 2015). Further, older people face hazards living in substandard housing such as caravans and old farmhouses (Petersen, 2021). Contributing to the lack of appropriate housing for older private renters are the barriers they face in accessing home modifications. With housing clearly recognised as a social determinant of health (Marmot & Wilkinson, 2006) and the accessibility of the dwelling playing a key role in the health, well-being, and independence of older people, it is important to understand access to home modifications.
In Australia, landlords must approve modifications, and this results in some older tenants not having modifications installed due to refusal (Jones et al., 2008). Once installed, the onus is on the renter to remove modifications on departure. There is evidence that some older renters do not seek or decline modifications due to the cost and fear that raising a request may jeopardise their tenure (Jones et al., 2008). Further, an Australian Government inquiry indicated that private landlords have little incentive to modify properties to suit the needs of older tenants (Productivity Commission, 2015). This limited access to home modifications to assist with safety and well-being raises concern over the appropriateness of older renters' home as the site for ageing in place. Given the limited empirical evidence, there is clearly a need to understand the appropriateness of privately rented housing as a home environment that facilitates health and independence as older people's needs change.
To do so, we draw on the concept of person-environment fit.

Theoretical and conceptual framework
The relationship between the environment and older people's functioning and health is the focus of a number of models in gerontology and disability scholarship. In this study we draw on Lawton and Nahemov's ecological model of ageing (Lawton & Nahemow, 1973) and the concept of person-environment fit to explore the relationships between housing accessibility, financial status, health, and independence. The press-competence model within Lawton and Nahemov's ecological model of ageing discusses person-environment fit, where an older persons' competence (the abilities residing within the individual) interacts with the environment to result in the behaviour and affect of the older person, or how they function and feel (Lawton, 1982;Lawton & Nahemow, 1973). Person-environment fit provides a model to understand how well the environment supports an individual to be comfortable, healthy, and able to carry out day to day activities easily. Person-environment fit models include broad physical and social elements of the environment, such as cultural, socio-economic, and intuitional elements along with social norms and values (Lawton, 1982;Shalinsky, 1986). While there is this broad consideration of the environment in models of person-environment fit, much of the research seeking to understand the fit for older adults in their homes, and how this relationship between the person and their home influences their health and behaviour, has been limited to the measurement of the physical environment. Extensive literature, largely from Europe, uses an environmental gerontology perspective to examine the relationship between health and homes for people experiencing functional limitations (Garin et al., 2014;Iwarsson, 2005;Oswald et al., 2007;Trecartin & Cummings, 2018;Werngren-Elgström et al., 2009). This scholarship has not extensively considered social aspects of the environment, such as the tenure of the home environment, and how it influences health in combination with the physical home environment.
The present study draws on Lawton and Nahemov's press competence model of personenvironment fit (Lawton & Nahemow, 1973) to explore the home environment of older private renters in Australia. Given the lack of research to date on older private renters' homes as sites of ageing, this paper reports on the influence of both the physical and social elements of the environment on the health and independence of older people privately renting. This study seeks to answer the research question: What is the relationship between older renters' home environment and their health and independence?

Research design
The data for this paper was drawn from a mixed methods pilot study comprising in-depth interviews with older private renters, and the administration of standardised instruments to assess their health, independence, financial status, and accessibility of their home. This paper reports on the quantitative results of the study to explore how the home environment of older private renters influences the health and independence of older adults. An earlier paper reports on the qualitative results of the study (Petersen & Aplin, 2021). Ethical Approval was obtained from the University of Queensland's Human Research Ethics Committee (Approval number: 2017000438).
The study examines two aspects of person-environment fit to explore the relationship between older renters' home environment and their health and independence, as  Fig. 1. First, person-environment fit is explored from the perspective of housing accessibility, which describes how well the physical home environment ensures day to day activities are manageable for an individual. The second aspect explored is financial status, measured using two tools, financial capability, and housing affordability. Financial capability is representative of the fit between the person's financial resources and living expenses, and the broad social environment. The social environment encompasses the social security, housing and health policies which influence the socio-economic status of individuals. Housing affordability represents the fit between the person's financial resources and the social environmental factor of rental costs.

Procedure and recruitment
Home visits were conducted with 27 older people renting privately in southeast Queensland, Australia, including two couples. Participants responded to an invitation to participate through their aged care provider acting as gatekeeper. Potential participants received a participant information sheet outlining the criteria including aged 65 years or over, renting privately, and receipt of the aged pension as their main source of income. If interested, the participants rang the researchers. During this phone call, screening to check eligibility was conducted and the study was explained including the nature of the home visit, the completion of measures, and remuneration of $50. If eligible and on receipt of verbal consent a home visit was organised. People unable to provide informed consent were excluded from the study. Participants provided written consent at the commencement of the home visit. Both authors interviewed the participants and completed independence, health, financial, and environment measures over a period of one to two hours. The first author completed an environmental assessment of the home, and the second author conducted an in-depth interview focused on the participant's housing history and current circumstances. Photographs of the home environment were taken with permission from participants as part of the environmental assessment. The photographs were then available as a reference to assist in data analysis.

Measures
To explore the relationships between person-environment fit, health, and independence demonstrated in Fig. 1, five measures were completed. Two measures examined health. The Short-Form Health Status Questionnaire (SF-8) (Ware et al., 2001), a measure of health-related quality of life; and the ADL Staircase (Iwarsson & Slaug, 2010), a measure of independence in activities of daily living (ADL) were utilised. Person-environment fit was evaluated using three measures. Accessibility of the home environment (a measure of person and physical environment fit) was evaluated using the Housing Enabler (Iwarsson & Slaug, 2010); the financial status of participants (a measure of person and social environment fit) was assessed using the Financial Capability Questionnaire (Zaidi, 2011); and housing affordability was calculated from participants source of income and rent paid.

Health and independence measures
The Short-form Health Status Questionnaire (SF-8) (Ware et al., 2001) is a widely used instrument for measuring health-related quality of life. The subjective measure includes eight items, each scored on five-point Likert scales. For example, "During the past 4 weeks, how much did your physical health or emotional problems limit your usual social activities with family or friends", scored on a scale from "not at all" to "could not do any social activities". The SF-8 has been shown to be valid and reliable (Quality Metric, 2011;Turner-Bowker et al., 2003;Ware et al., 2001). It generates Physical Component Summary (PCS) and Mental Component Summary (MCS) weighted T-scores ranging from 0 to 100 with higher scores indicating better health (Quality Metric, 2011).
The ADL Staircase (Sonn, 1996;Sonn & Hulter Åsberg, 1991) is an objective measure of independence in activities of daily living. The nine items include five personal activities of daily living (PADL); feeding, transferring, going to the toilet, dressing, and bathing, and four instrumental activities of daily living (IADL); cooking, shopping, cleaning, and using transport (Oswald et al., 2007). Items are rated on a three-point scale of independent, partly dependent, and dependent. Each item rated independent is then given a difficulty rating, of completed with or without difficulty. The ADL staircase was unable to be scored using the method outlined by Sonn and Hulter Åsberg (1991), where grades are calculated based on responses to different items, as more than 5% of the participants fit into the 'other' category of scoring which has no grade. As such, a sum score for independence was calculated by the scoring: independent (0), partly dependent (1) and dependent (2) as outlined by Fänge et al. (2005) as an acceptable method of scoring to elicit adequate statistical power. An overall ten-point subjective scale of independence is also included in the ADL staircase, with zero indicating complete dependence and 10 indicating complete independence.

Housing accessibility measure
The home environment was assessed using the Housing Enabler (Iwarsson & Slaug, 2010), an objective measure of accessibility which involves three steps. The steps include, 1) the identification of functional limitations and use of mobility devices (14 items), 2) the identification of environmental barriers in the home (87 items), and 3) the calculation of an accessibility score based on predefined severity ratings (scored 1-4), which quantify the magnitude of the accessibility problem given the environmental barrier in the home and the persons' functional limitations (Iwarsson & Slaug, 2010;Oswald et al., 2007). The sum of the accessibility scores indicates the accessibility problems for the person in their home, with higher ratings indicating poorer accessibility or poor person-environment fit (Iwarsson & Slaug, 2010). The environmental barriers which cause the most accessibility problems (highest scores) are called weighted environmental barriers (Iwarsson & Slaug, 2010).

Measures of financial status
Two measures were used to examine financial status, Financial Capability and the 30:40 indicator of housing affordability stress. The subjective measure, Financial Capability (Zaidi, 2011) focuses on how people manage on the resources available to them. The first four questions are scored as yes/no responses. These include, 1) capacity to afford paying for one week's annual holiday away from home 2) capacity to afford a meal with meat, chicken, fish (or vegetarian equivalent) every second day 3) capacity to face unexpected financial expenses by paying through the household's own resources and 4) ability to keep the home adequately warm (or cool). These were scored as 1 (yes) or 0 (no). The fifth question, 5) the household's ability to make ends meet is scored on a six-point scale, ranging from 1 (with great difficulty) to 6 (very easily); the answers can manage fairly easily, easily, and very easily were coded 0; and with great difficulty, with difficulty, and with some difficulty, were coded as 1. The resulting score represents how often a participant is deprived out of a possible maximum of five. The higher the score the greater the lack of financial capability.
Housing affordability was measured using the 30:40 indicator. This indicator identifies households as being in housing stress, when more than 30% of household income is spent on housing costs and the household is in the lowest 40% of income distribution (Australian Housing & Urban Research Institute, 2019). All participants in this study had an income below Australia's 40% lowest income, which in 2017 at the time of data collection was $737 AUD per week.

Data analysis
All quantitative analysis was conducted using IBM SPSS ® Statistics for Windows version 24. Given the small sample size, n = 27, and the variables being not normally distributed, descriptive, and non-parametric statistical analysis were undertaken. Spearman's Rho, a non-parametric test to examine the strength and direction of a relationship between two variables (Pallant, 2016), was used to explore the relationships between the home environment, health, and independence, where an r value between 0.1 and 0.29 indicates a small relationship, r = 0.30-0.49 a medium relationship and r = 0.5-1.0 a strong relationship (Pallant, 2016).

Participant demographics
The participant group comprised 17 females and 10 males, with a mean age of 77 years (range = 65-90 years). Participants had lived in their current home for 6 months to 18 years, with the average being 6.4 years. More than half of the participants were divorced (n = 14, 52%) and the majority of participants were educated at a high school level (n = 16, 59%) or had trade qualifications (n = 4, 15%). Most participants (n = 20, 74%) had received community aged services including a minor home modification such as a grab rail or domestic assistance. Table 1 outlines further demographic information.

Health and independence
The participants were a group of older adults whose independence and health were beginning to decline, with most (n = 21, 78%) having three or more functional limitations and starting to show dependence in instrumental activities of daily living such as cleaning, showering and transport as shown in Table 2, with 89% of participants showing some dependence in their instrumental activities of daily living. Although the participants overall were independent in their personal activities of daily living such as showering and toileting with 85% being independent in all personal activities of daily living, 65% (n = 18) reported difficulty with at least one activity, most commonly transfers (n = 13), dressing (n = 10) and bathing (n = 7). Participants however rated their independence highly, with a mean of 8.1 (SD = 1.5), ranging from four to ten, with a median of eight. The most common functional limitations were poor balance (n = 22, 82%), limitations of stamina (n = 21, 78%) and reduced spine or lower extremity function (n = 20, 74%) as Table 2 indicates. Of the 27 participants, a little more than 50% used a walking aid (n = 15, 56%). Participants' self-rated health related quality of life was a mean of 45.35 (median = 46.13, range = 26.82-58.83) for physical health and 42.95 (median = 43.35, range = 25.31-61.22) for mental health. This represents a group of older adults with average to below average physical health with a norm for older adults aged 65-69 of 47.13 and decreasing in older age for those aged 75 and older to 45.46 (Ware et al., 2001). The participants mental health in comparison was well below norms, with a mean of 42.95, compared to norms for older adults aged 65 above ranging from 52.33 for 65-69 year-olds to 51.98 for older adults aged 75 and above (Ware et al., 2001).

Housing accessibility
Participants lived in a range of housing which presented accessibility challenges, most commonly an older brick apartment. Table 1 provides further information on housing and the top ten most common weighted environmental barriers are shown in Table 3. The mean magnitude of accessibility problems (sum score of the accessibility scores) was 185 (SD = 116, range = 0-417) and the mean number of home environment barriers was 55 (SD = 8.6, range = 35-72). These results demonstrate that renters' homes had multiple physical barriers that presented high levels of problems in their daily life. The average sum accessibility score of 185 is a high score with any score above zero indicating problems in the home and higher scores markers for worse accessibility problems (Iwarsson & Slaug, 2010).

Housing costs and financial capability
Participants average weekly rent was $272 (SD = $96, range = $100-$440). This weekly rent was found to result in a mean housing affordability of 53% (SD = 17%, range = 24-86%) with all but three participants under housing stress according to the 30:40 rule (Australian Housing & Urban Research Institute, 2019). The financial capability of participants was low, with 67% (n = 18) of participants finding it difficult to make ends meet. Further details are provided in Table 4.

Relationship between the home environment, health, and independence
To explore the relationship between the physical home environment, health, and independence for older private renters we measured the magnitude of accessibility barriers and examined their relationship to heath and independence variables. The participant's perceived or subjective rating of independence showed a strong relationship (r = − 0.604, p = 0.002) with accessibility problems in the home, indicating that participants with more accessibility problems in their home report being more dependent in activities of daily living. It is also evident, as seen in Table 5, that instrumental activities of daily living and reported difficulty with all activities were also strongly correlated with housing accessibility problems, while personal activities of daily living were not correlated with housing accessibility. However, with 85% (n = 23) of participants independent in all personal activities of daily living results may be skewed. Health related quality of life was also shown to be significantly related to housing accessibility, with physical health (r = − 0.474, p = 0.01) showing a negative medium relationship with housing accessibility. The negative relationship indicates when physical health decreases, housing accessibility problems increase. No relationship was indicated between housing accessibility and the mental component of the SF8.   To understand the relationship between health and the home environment further, the relationship between the number of environmental barriers identified in the Housing Enabler and the health and independence variables was examined. As can be seen in Table 5, no relationships were found between any of the variables for the total number of environmental barriers in the home. These results indicate that the number of environmental barriers in the home does not appear to influence health or independence, rather it is barriers relevant to the persons' functional limitations (the person-environment fit) that influence health and independence.

Relationship between financial status, health, and independence
To understand the influence of the social environment of the home for older private renters, we explored the relationship between financial status, health, and independence. We observed a medium relationship existed between financial capability and mental health (r = 0.489, p = 0.01). Further, participants perceived independence was correlated with financial capability, whereby those who are more financially disadvantaged reported being less independent (r = − 0.427, p = 0.029). Financial capability was not found to be related to physical health, or objective ratings of independence (refer Table 5). Housing affordability was also found to be unrelated to any of the health and independence variables as shown in Table 5.

Discussion
This paper aimed to explore the relationships between older renter's home environment and their health and independence. While a pilot study, the results indicate that understanding how the home environment supports the activities of older adults or the fit between the person and their physical home environment is critical in supporting the physical health and independence of older private renters. This was evidenced by the finding that participants living in less accessible rented homes were significantly more likely to have greater levels of dependence in instrumental activities of daily living and report greater dependence. While older renters' physical health was shown to be correlated with the accessibility of their home, their homes accessibility appeared not to impact their mental health. What appears to be important in mental health is financial disadvantage, with those reporting decreased financial capability more likely to report decreased mental health along with decreased perceived independence.
The findings support previous research showing strong relationships between housing accessibility and older adults' independence and participation in daily living activities (Garin et al., 2014;Iwarsson, 2005;Oswald et al., 2007;Werngren-Elgström et al., 2009;). In contrast, the relationship between housing accessibility, and self-perceived  and physical health (Werngren-Elgström et al., 2009) has received limited attention. Our Australian study extends European research, with preliminary evidence showing that older renters' housing accessibility is related to physical health along with independence in activities of daily living.
The importance of understanding the fit between older adults' and their home environment is reinforced in this study, with the number of environmental barriers in the home environment unrelated to health and independence outcomes. This supports outcomes from the European Enable Age study (Iwarsson et al., 2004) with data from older renters highlighting it is not the number of environmental barriers in the home, but accessibility, or the fit between a person and their home environment that is important for independence and well-being (Oswald et al., 2007). This points to the importance of collaborating with older people in relation to the provision of modifications, so their specific needs are addressed. While 74% of renters in this study had modifications installed, a large need was evident given the high number of accessibility problems, and participants reporting need for modifications (Petersen & Aplin, 2021). However, home modifications are often out of reach for older private renters with numerous barriers preventing installation. These barriers include the costs of installation and removal, refusal by some landlords to install modifications, time delays in approving modifications, and reluctance from older tenants to request modifications for fear of rent increases, eviction, and homelessness (Jones et al., 2008;Petersen & Aplin, 2021;Petersen & Parsell, 2015). These barriers place older renters at increased risk of poor health outcomes, as they live in home environments that do not allow them to carry out their daily activities. With recognition in the Royal Commission into Aged Care Quality and Safety (2021) of older people living in unsuitable housing facing greater risk of falls, injury, immobility and increasing likelihood of premature entry into aged care, coordinated intergovernmental policy, planning and action for older Australian's housing is advocated.
One important change to assist older renters in accessing the community care integral to their health and independence is less restrictive access to modifications. Key interventions would include fully funded modifications for older private renters, along with changes to tenancy law. Whilst there has been recognition of private renters' rights to modifications when assessed by an occupational therapist in Victoria (Residential Tenancies Act, 1997, s. 64), comparative laws do not exist in other states and territories. There is a need in other Australian state jurisdictions for legislation permitting modifications that support a tenant's health and independence. This legislation should ensure modifications can occur without landlord approval and tenants should not be required to fund the removal of the modification on vacating. An added benefit of these changes would be an increase in the accessibility of current Australian housing stock. Advocacy groups in Australia and the United Kingdom have long advocated for houses to be more versatile, and better meet the changing needs of occupants over their lifetime with liveability for young families, people with disability and their families, and seniors (Australian Network for Universal Housing Design, n.d; Equality & Human Rights Commission, 2018). There have been sustained advocacy efforts to legislate minimum accessibility features in all newly built homes in Australia. In 2021, there was recognition of the Liveable Housing Guidelines (Livable Housing Australia, 2017) in the National Construction Code by the Commonwealth, state, and territory Building Ministers for all newly built homes (Australian Government, 2021). However, given the recognition of these accessibility standards will only assist a small number of private renters in the future who live in homes built after 2021, home modifications remain a critical support for older renters.
The importance of the physical home environment and modifications in supporting older adults ageing in place was a key finding of this study. Another important finding was the impact of financial hardship for older private renters. These findings reinforce our understanding of the financial and psychosocial stress older private renter's experience (Morris, 2018), with participants' mental health below norms and related to financial disadvantage. Further, financial disadvantage was shown to have a negative relationship with perceived independence, likely a result of having less autonomy and freedom in daily life choices due to limited income. These experiences of disadvantage and stress for older renters has led to widespread calls to reform welfare and housing policy to provide more financial support to older adults privately renting (Commonwealth of Australia, 2020). This includes increasing the rate of aged pension and rent assistance provided to older renters so that they can achieve a minimum standard of living in line with community standards (Smith & Hetherington, 2016).
Along with increasing financial support, greater security of tenure is important for older private renters (Petersen & Aplin, 2021). Renters in this study lived in their homes for an average of 6.4 years, with six living in their home for 10 to 20 years. This is in stark contrast to the majority (94%) of private renters in Australia who have lease agreements of 12 months or less (Power, 2020). If Australia is to continue to rely on the private rental market to supply housing for increasing numbers of older Australians (Ong et al., 2019), there is a need to reform tenancy laws. Calls to reform tenancy laws in Australia are longstanding highlighting the lack of security in comparison with international best practice (Hulse et al., 2011). Key changes to support security of tenure worthy of consideration include the removal of the no-grounds eviction, longer term leases, and limiting the size and number of rent increases (Pawson et al., 2020;Power, 2020). However, there is resistance in Australia to increased security for tenants, as most owners are small holding individuals seeking to realise asset value appreciation, tax minimisation, and capital gains at their convenience (Hulse et al., 2018;Pawson et al., 2020). While changes to tenancy law will help to improve security of tenure for some older renters, the financial stress experienced by this group maintains the need for secure, lower cost housing. Greater social housing is therefore required to provide security of tenure for older adults living on the aged pension, particularly single older women (Power, 2020).

Limitations
The data collected for this study was limited to 27 participants in the environs of one Australian city. However, older private renters are a vulnerable and challenging population to recruit. Given the small sample, the findings may not apply to other locales in Australia or internationally. Further, rates of aged pension, housing costs, and community aged care policy vary across countries resulting in different impacts on tenants' health. However, in-depth interviews alongside validated measures provides rich data on the relationship between housing and health for older private renters and provides clarity on the barriers they face to age in place. Further research is needed to confirm our results that the physical health and independence of older renters is influenced by the accessibility of the home environment, while mental health is influenced by financial disadvantage. Research exploring a national and more diverse sample of owners, private renters and social housing tenants is warranted to further understand the influence of the home environment, including tenure on the health and well-being of older adults as they age in place.

Conclusion
This study sought to explore the relationships between older renters' home environment and their health and independence. The findings provide two key contributions to the international housing literature. Firstly, this study contributes new understandings of personenvironment fit for older people by examining both the social and physical influence of the environment on older renter's health and independence. This study found that accessibility of the home environment is important in influencing the physical health and independence of older private renters, with participants homes found to have numerous barriers that challenged their independence in daily life. Financial disadvantage was found to be more important in influencing mental health, with participants mental health well below norms for their age group, the majority experiencing housing stress, and more than half finding it difficult to make ends meet. The second major contribution to housing knowledge was the study's focus on the experience of older adults who privately rent. This group has received limited research and policy attention in Australia, despite their experience of disadvantage. This study found that living with limited financial capability influenced the participant's mental health and perceived independence. The study findings reveal important policy implications to support ageing in place for the rising number of older private renters in Australia. These include the need to reduce barriers to the installation of home modifications by fully funding modifications for older private renters experiencing financial disadvantage, removing the requirement of landlord approval for modifications that promote health and well-being, and ensuring older renters are under no obligation to remove these modifications. Further financial support is also required for older private renters to achieve a decent standard of living, the findings support increasing advocacy calls to increase the aged pension and rent assistance for older private renters. Finally, the study findings of a mean length of tenure of over six years and desire of older private renters to age in place confirms a need for increased security of tenure. Understanding how older people manage their health and independence in their privately rented homes is increasingly important. To inform housing, social security and aged care policy future research should seek to extend these results nationally with a more diverse sample of owners, private renters, and social housing tenants to further understand the influence of the home environment, including tenure on the health and well-being of older adults as they age in place.