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Research Applied to Congregate Housing M. Powell Lawton, Ph. D. Philadelphia Geriatric Center Although congregate housing is not a new phenomenon, there has been relatively little research devoted to housing of this type, as compared to the more usual housing for the elderly with minimal services. By far the greatest proportion of all senior-citizen housing was designed for original occupants who were still relatively independent. This planning decision necessarily dictated certain physical design features that may he uncongenial to the later addition of some kinds of services. Yet, the original population of independent tenants does age, and over a period of years the characteristics of new occupants may also change. Thus, what may originally have been an appropriate environment for the original occupants may, ten years later, be less appropriate. The 1970 Housing Act also at least legitimated the building of new housing environments of the congregate type. The need to re-think the suitability of older housing and to plan prospective designs for new construction makes it mandatory that we become aware of existing knowledge about the service needs of people in traditional housing, and how present-day congregate housing works. This paper will discuss a series of Issues in these areas, referring wherever possible to research done at the Philadelphia Geriatric Center over a period of years. The topics to be covered are: 1. The expressed service needs of elderly tenants. 2. The characteristics of people who choose congregate and traditional housing. 3. The frequency of different service programs in federally assisted housing. 4. The use of services by tenants. 5. The impact of services on tenants. 6. Environmental design considerations appropriate to congregate housing. 7. Management requirements for congregate housing. The expressed service needs of older people. As might be expected, it makes a great deal of difference whether a person is a community resident, an applicant for housing, or a tenant when one tries to determine his perceived need for the kind of services that might be offered within congregate housing. An even stronger determinant of perceived need is whether the person is actually receiving the service at the time the question is asked. As we all know, older people of todayfs generation have a strong tendency to evaluate positively their current situation unless it is incredibly bad, so that we need to take this current situation into account when ttying to estimate actual need. In two major research projects done at the Philadelphia Geriatric Center we were able to obtain some information relevant to older people's wish for services. One project was an intensive study of about 1700 older people who lived in 12 different age-segregated public housing and 202 projects or in scattered private residences in the community. Some of the housing tenants were interviewed before they moved in and again a year after occupancy, In the second study, a national probability sample of 103 public 202 sites was studied, as well as a sample of 3500 tenants housing sites and 50 currently living in those sites. One of the goals of both studies was to learn about as many of the issues associated with services as possible. Generalizing from the results of both studies, the most striking finding was the very high level of expressed need for some kind of regular on-site medical services among community residents, housing applicants, and tenants who did not currently live in housing that provided them. Almost two-thirds of all tenants expressed such a need, which is especially notable because such a lopsided proportion runs counter to the general tendency to express satisfaction with whatever one has. Conversely, only 3 percent o? tenants in several environments that did have medical services indicated any wish that there not be such services within their housing. It is more difficult to generalize about the type of services wished. critical point is the feeling of security that is conveyed by knowing that assistance is quickly available if one needs it; Therefore, the most generally approved form was an on~site medical clinic, with regular physician houss and with a nurse readily available. There was less general approval of more clearly The hospital-like facilities such as an infirmary or a semi-permanent special-care area within the housing. However, it should be noted that such "heavy" medical services become more acceptable as the health of the housing population declines. In such a case we have a clear instance of a tradeoff situation, where a minority-somewhere between one-fifth and one-third - of tenants express some discomfort at the idea of having visibly sick or disabled people living in close physical proximity to them. Yet, in more extended interviews with some of these people, the idea was communicated that the security of knowing that a service that they themselves might someday need was available was frequently important enough to outweigh the anxiety caused by the presence of a medical service or of visibly frail fellow-tenants. Thus, we concluded that some kind of arrangement whereby a physician could hold regular office hours, and where a nurse could be present for some period every day and on call for emergencies (i.e., a live-in nurse) would be extremely desirable. An infirmary or special-care area is probably best reserved for congregate housing that has both substantial financial resources and also a policy of accepting and maintaining people whose level of functioning ability is considerably lower than those who ordinarily live in housing without services. A very high level of approval was also expressed by tenants for the idea of having personal care services such as help with cooking, housekeeping, and -3- bathing available for tenants who might need them, ? This wish clearly represented \ a security-building mechanism, since relatively few tenants mentioned a current need for such services. With the exception of lilirtTniiMliilfI that explicitly cater to the marginally independent tenant, these services are probably beat provided on call for individual tenants in need, rather than across the board. It is, of course, very important that if personal care is announced as being available that it actually be deliverable. Transportation is, as we know, a vital link to almost all other need satisfactions. While one's own car rides from a family member, and walking account for the majority of most tenants' trip behavior, other transportation can make the critical difference in the case of individual tenants with disability, those without access to a car, those who wish to enrich their lives by utilising distant facilities, and those located In resource-poor or dangerous neighborhoods, Sini it is not surprising that half of our tenants felt that they would be willing to spend some part of a small increase in inconie to pay ; ; for bus service that would connect them with a shopping or business center. About four years separated the times of gathering data from our two research projects. This lapse of time was prabably quite significant in explaining the only major disagreement between the two studies in the estimation of a service need. Around 1967 we found that aiiacst one*third of community residents and applicants to housing (prior to occupancyx felt that they would like to have some on~site meal services when or if they moved into housing for the elderly. Y e t , the same applicants, after they had lived in housing without meal services for a year, as well as tenants who had been there an even longer time, ware notably less anxious to have this services provided--about 20 percent. W e interpreted this to mean that some confirmation of the person's ability to live a satisfyingly independent life was given by the year's experience in the n e w housing, so that the perceived need decreased. By contrast in 1971, a larger percentage, almost half, of our tenants expressed a need for some kind of on-site prepared meals. Since both of our samples were very large, it seemed that this change since 1967 reflected some real overall change in need. We can only speculate that part of the increased need may have been due to a possible overall aging of the population, and part of it to tenants1 increased awareness of the realistic possibility that such a program exists, through their knowledge of other housing with meals, the increasing incidence of nutrition programs, and so on. Thus, in the case of meals, we can say that not all tenants need or desire them, but that enough do to warrant serious consideration of modes by which those who wish seals oan have them, hopefully without demanding that everyone be forced to do so. There are, of course, serious economic problems associated with optional meals, a subject that I am not equipped to deal with. However, modes to achieve the ideal situation of individual choice ought to be vigorously pursued. The characteristics of people who choose congregate and traditional housing. All too often, the older person has little choice about where she will live. Seventy percent of the households maintained by older people are occupant-owned and therefore profide the lowest-cost housing possible. For many who would like to move because of the deterioration of their homes*the decline of their neighborhoods, or failure of the energy necessary to maintain a home built for an entire family, there is no housing alternative available within economic reach, and they are forced to remain in a less-than-ideal situation. For the minority who are fortunate enough to have access to purpose-built housing for the elderly - ? I estimate this number to constitute no more than 3 percent of * the older population -- simply having a decent shelter at a modest cost overThus, a person with a housing need may be rides every other consideration. -5- likely to accept the first opportunity afforded to move into any housing environment for the elderly, regardless of whether the non-shelter aspects of the housing suit her or not. Given these major restrictions on choosing what is right for oneself, one can sometimes find a small residue of older people who have the kind of new housing into which they move. some choice as to Looking at the choices made by people in moderate to higher income ranges may tell us something about the bases that the larger group might use if they had the option. Our research addressed this issue in a way that allowed us to compare moderate**income older people who chose congregate housing with those who chose traditional housing for the elderly. The sites that we studied in depth included three whose original occupants were almost entirely Jewish and had lived most of their lives in urban Eastern areas. Two of these sites had central dining rooms and some form of on-site medical services, thus having some characteristics of congregate housing. The third site had neither of these services; it therefore represented the traditional type of housing. We asked the specific question, fiAre the tenants who initially occupied the congregate housing measurably different from those who moved into the traditional housing?11 Our hypothesis was that the service-rich environments In fact, we found that would appeal to those in greater need of such services. those who moved into the congregate housing were, before moving in, significantly older, in poorer functional health, less active in organisations, less mobile, and less happy than those who moved into the traditional housing. I consider these findings exfjremely important for two reasons. First, they indicate that when given 1 choice older people? like the rest of us, assess their 1 needs realistically and choose an environment that has the best probability of meeting their need, The service-poor environment required its te&ants to do all their own shopping, food preparation, housekeeping and to travel to receive medical care. These tenants1 better physical, social, and psychological status -6- presumably would enable them to cope adequately with such demands* The second point to be emphasized is that the sponsorfs original &!?ntiin& ?f the level o F services to be offered seamed t? determine the char act er Is tic s of the j . tenants who would choose to apply. Tt is, of course, possible for a sponsor to apply either rigid or relaxed health standards for acceptance of a tenant's application. Our congregate housing sponsors probably could have excluded the least independent applicants had they tried hard to do so. However* they did not, and the result was that the combination of selective appeal to different ' kinds of people and of differing sponsor admission standards led to measureably different tenant populations, These findings thus demonstrate rather clearly that a range of alternatives is required in order to serve people with differing needs. They also indicate that a sponsor needs to be aware of the implications of Its early planning decisions. The sponsor of a service-rich housing environment might well have difficulty finding tenants should it insist on very high health standards. Even if such people did fill the building^the sponsor might in actuality be forcing the exclusion of those who can benefit most from the services. The frequency of service programs In federally-assisted housing, The Philadelphia Geriatric Center's survey was based on a national sample of 103 public housing and 50 202 projects and thus afforded &n estimate of the frequency of services in these kinds of housing throughout the country. Every 202 and 92 percent of the public housing sites conducted some kind of activity program. Thus3 organised activities are part and parcel of planned housing and thus not In any way specific to congregate housing. The situation is totally different with respect to other types of services. Slightly less than one-quarter of both 202 and public housing sites had any kind of medical services available on the site for its tenants. AMttg this minority of sites, very few had either physicians or nurses who were actually -7.
Object Description
Title | Research Applied to Congregate Housing |
Subject | housing; congregate housing; older people; Philadelphia Geriatric Center; environmental psychology; aging; housing for the elderly; aged; environment |
Subject Keyword | housing |
Subject LCSH | congregate housing; older people; Philadelphia Geriatric Center; environmental psychology; aging |
Subject MeSH | housing for the elderly; aged; environment |
Description | Conference on Congregate Housing (December 1975 : Washington D.C.) |
Abstract | Prior to evaluating the suitability of elderly housing and planning designs for future construction, researchers need to be aware of the service needs of the elderly in traditional housing and the experiences of those living in congregate housing, housing with a high level of supportive services. In this presentation, Dr. Lawton discusses the most important topics related to this issue, including: expressed needs of elderly tenants, characteristics of people who choose congregate and traditional housing, frequency of different service programs in federally assisted housing, use of services by tenants, impact of services on tenants, environmental design considerations appropriate to congregate housing, and management requirements for congregate housing. While a number of research projects conducted by the Philadelphia Geriatric Center deal with these topics, much more is needed in the future. // Missing references. --AJL |
Creator | Lawton, M. Powell, 1923-2001 |
Publisher | Polisher Research Institute |
Contributors Principal Investigators | Rachel R. Resnick |
Contributors Research Assistants | Karen C. Kohn; Nicole Snyder; Amanda J. Lehning; Arthur Shum |
Contributors Reviewers | Philip D. Sloane; Maggie Calkins; Laura Gitlin; Jeanne Teresi; Patricia Parmelee |
Physical Description | 21 p. |
Date | 1975 |
Type | Text |
Original Format | Publications |
Digital Format | application/pdf |
Class Number LCC | HD7287.92.U5 |
Class Number NLMC | WT 145 |
Class Number DDC | 155.9084 |
Language | English |
Relation | Lawton, M.P. (1975). Planning and managing housing for the elderly. New York: Wiley-Interscience. // Lawton, M.P. (1980). Social and medical services in housing for the elderly. National Institute of Mental Health. Washington, DC: U.S. Government Printing Office. // Newcomer, R.J., Lawton, M.P., & Byerts, T.O. (Eds.). (1986). Housing an Aging Society. New York: Van Nostrand Reinhold. // Lawton, M.P., & Simon, B. (1968). The ecology of social interaction in housing for the elderly. The Gerontologist, 8, 108-115. // Lawton, M.P. (1969). Supportive services in housing for the elderly. The Gerontologist, 9, 15-19. // Lawton, M.P. (1970). Planners notebook: Planning environments for older people. Journal of the American Institue of Planners, 36, 124-129. // Lawton, M.P., Nahemow, L., & Teaff, J. (1975). Housing characteristics and the wellbeing of elderly tenants in federally assisted housing. Journal of Gerontology, 30, 601-607. // Lawton, M.P. (1976). The relative impact of congregate and traditional housing on elderly tenants. The Gerontologist, 16, 237-242. // Lawton, M.P. (1977). An ecological theory of aging applied to elderly housing. Journal of Architectural Education, 31, 8-10. // Lawton, M.P. (1977). Environments for older people. The Humanist, 20-24. // Lawton, M.P., & Nahemow, L. (1979). Social areas and the wellbeing of tenants in housing for the elderly. Multivariate Behavioral Research, 14, 463-484. // Lawton, M.P. (1979). Social science methods for evaluating housing quality for older people. Journal of Architectural Research, 7, 5-11. // Lawton, M.P. (1980). Housing the elderly: Residential quality and residential satisfaction among the elderly. Research on Aging, 2, 309-328. // Lawton, M.P. (1981). An ecological view of living arrangements, The Gerontologist, 21, 59-66. // Lawton, M.P. (1985). Environment and its relationship to well-being. Pride Institute Journal, 4, 5-11. // Saperstein, A., Lawton, M.P., Cherkas, L., Moleski, W., & Sharp, A. (1985). Determining housing quality: A guide for home health care. Pride Institute Journal, 4, 41-51. // Lawton, M.P. (1987). Strategies in planning environments for the elderly. Journal of Independent Living, 1, 1-14. // Lawton, M.P. (1991). A future agenda for congregate housing research. Journal of Housing for the Elderly, 9, 167-182. |
Rights | http://rightsstatements.org/vocab/InC/1.0/ |
Contributing Institution | Polisher Research Institute |
Sponsorship | This Digital Object is provided in a collection that is included in POWER Library: Pennsylvania Photos and Documents, which is funded by the Office of Commonwealth Libraries of Pennsylvania/Pennsylvania Department of Education. |
Full Text | Research Applied to Congregate Housing M. Powell Lawton, Ph. D. Philadelphia Geriatric Center Although congregate housing is not a new phenomenon, there has been relatively little research devoted to housing of this type, as compared to the more usual housing for the elderly with minimal services. By far the greatest proportion of all senior-citizen housing was designed for original occupants who were still relatively independent. This planning decision necessarily dictated certain physical design features that may he uncongenial to the later addition of some kinds of services. Yet, the original population of independent tenants does age, and over a period of years the characteristics of new occupants may also change. Thus, what may originally have been an appropriate environment for the original occupants may, ten years later, be less appropriate. The 1970 Housing Act also at least legitimated the building of new housing environments of the congregate type. The need to re-think the suitability of older housing and to plan prospective designs for new construction makes it mandatory that we become aware of existing knowledge about the service needs of people in traditional housing, and how present-day congregate housing works. This paper will discuss a series of Issues in these areas, referring wherever possible to research done at the Philadelphia Geriatric Center over a period of years. The topics to be covered are: 1. The expressed service needs of elderly tenants. 2. The characteristics of people who choose congregate and traditional housing. 3. The frequency of different service programs in federally assisted housing. 4. The use of services by tenants. 5. The impact of services on tenants. 6. Environmental design considerations appropriate to congregate housing. 7. Management requirements for congregate housing. The expressed service needs of older people. As might be expected, it makes a great deal of difference whether a person is a community resident, an applicant for housing, or a tenant when one tries to determine his perceived need for the kind of services that might be offered within congregate housing. An even stronger determinant of perceived need is whether the person is actually receiving the service at the time the question is asked. As we all know, older people of todayfs generation have a strong tendency to evaluate positively their current situation unless it is incredibly bad, so that we need to take this current situation into account when ttying to estimate actual need. In two major research projects done at the Philadelphia Geriatric Center we were able to obtain some information relevant to older people's wish for services. One project was an intensive study of about 1700 older people who lived in 12 different age-segregated public housing and 202 projects or in scattered private residences in the community. Some of the housing tenants were interviewed before they moved in and again a year after occupancy, In the second study, a national probability sample of 103 public 202 sites was studied, as well as a sample of 3500 tenants housing sites and 50 currently living in those sites. One of the goals of both studies was to learn about as many of the issues associated with services as possible. Generalizing from the results of both studies, the most striking finding was the very high level of expressed need for some kind of regular on-site medical services among community residents, housing applicants, and tenants who did not currently live in housing that provided them. Almost two-thirds of all tenants expressed such a need, which is especially notable because such a lopsided proportion runs counter to the general tendency to express satisfaction with whatever one has. Conversely, only 3 percent o? tenants in several environments that did have medical services indicated any wish that there not be such services within their housing. It is more difficult to generalize about the type of services wished. critical point is the feeling of security that is conveyed by knowing that assistance is quickly available if one needs it; Therefore, the most generally approved form was an on~site medical clinic, with regular physician houss and with a nurse readily available. There was less general approval of more clearly The hospital-like facilities such as an infirmary or a semi-permanent special-care area within the housing. However, it should be noted that such "heavy" medical services become more acceptable as the health of the housing population declines. In such a case we have a clear instance of a tradeoff situation, where a minority-somewhere between one-fifth and one-third - of tenants express some discomfort at the idea of having visibly sick or disabled people living in close physical proximity to them. Yet, in more extended interviews with some of these people, the idea was communicated that the security of knowing that a service that they themselves might someday need was available was frequently important enough to outweigh the anxiety caused by the presence of a medical service or of visibly frail fellow-tenants. Thus, we concluded that some kind of arrangement whereby a physician could hold regular office hours, and where a nurse could be present for some period every day and on call for emergencies (i.e., a live-in nurse) would be extremely desirable. An infirmary or special-care area is probably best reserved for congregate housing that has both substantial financial resources and also a policy of accepting and maintaining people whose level of functioning ability is considerably lower than those who ordinarily live in housing without services. A very high level of approval was also expressed by tenants for the idea of having personal care services such as help with cooking, housekeeping, and -3- bathing available for tenants who might need them, ? This wish clearly represented \ a security-building mechanism, since relatively few tenants mentioned a current need for such services. With the exception of lilirtTniiMliilfI that explicitly cater to the marginally independent tenant, these services are probably beat provided on call for individual tenants in need, rather than across the board. It is, of course, very important that if personal care is announced as being available that it actually be deliverable. Transportation is, as we know, a vital link to almost all other need satisfactions. While one's own car rides from a family member, and walking account for the majority of most tenants' trip behavior, other transportation can make the critical difference in the case of individual tenants with disability, those without access to a car, those who wish to enrich their lives by utilising distant facilities, and those located In resource-poor or dangerous neighborhoods, Sini it is not surprising that half of our tenants felt that they would be willing to spend some part of a small increase in inconie to pay ; ; for bus service that would connect them with a shopping or business center. About four years separated the times of gathering data from our two research projects. This lapse of time was prabably quite significant in explaining the only major disagreement between the two studies in the estimation of a service need. Around 1967 we found that aiiacst one*third of community residents and applicants to housing (prior to occupancyx felt that they would like to have some on~site meal services when or if they moved into housing for the elderly. Y e t , the same applicants, after they had lived in housing without meal services for a year, as well as tenants who had been there an even longer time, ware notably less anxious to have this services provided--about 20 percent. W e interpreted this to mean that some confirmation of the person's ability to live a satisfyingly independent life was given by the year's experience in the n e w housing, so that the perceived need decreased. By contrast in 1971, a larger percentage, almost half, of our tenants expressed a need for some kind of on-site prepared meals. Since both of our samples were very large, it seemed that this change since 1967 reflected some real overall change in need. We can only speculate that part of the increased need may have been due to a possible overall aging of the population, and part of it to tenants1 increased awareness of the realistic possibility that such a program exists, through their knowledge of other housing with meals, the increasing incidence of nutrition programs, and so on. Thus, in the case of meals, we can say that not all tenants need or desire them, but that enough do to warrant serious consideration of modes by which those who wish seals oan have them, hopefully without demanding that everyone be forced to do so. There are, of course, serious economic problems associated with optional meals, a subject that I am not equipped to deal with. However, modes to achieve the ideal situation of individual choice ought to be vigorously pursued. The characteristics of people who choose congregate and traditional housing. All too often, the older person has little choice about where she will live. Seventy percent of the households maintained by older people are occupant-owned and therefore profide the lowest-cost housing possible. For many who would like to move because of the deterioration of their homes*the decline of their neighborhoods, or failure of the energy necessary to maintain a home built for an entire family, there is no housing alternative available within economic reach, and they are forced to remain in a less-than-ideal situation. For the minority who are fortunate enough to have access to purpose-built housing for the elderly - ? I estimate this number to constitute no more than 3 percent of * the older population -- simply having a decent shelter at a modest cost overThus, a person with a housing need may be rides every other consideration. -5- likely to accept the first opportunity afforded to move into any housing environment for the elderly, regardless of whether the non-shelter aspects of the housing suit her or not. Given these major restrictions on choosing what is right for oneself, one can sometimes find a small residue of older people who have the kind of new housing into which they move. some choice as to Looking at the choices made by people in moderate to higher income ranges may tell us something about the bases that the larger group might use if they had the option. Our research addressed this issue in a way that allowed us to compare moderate**income older people who chose congregate housing with those who chose traditional housing for the elderly. The sites that we studied in depth included three whose original occupants were almost entirely Jewish and had lived most of their lives in urban Eastern areas. Two of these sites had central dining rooms and some form of on-site medical services, thus having some characteristics of congregate housing. The third site had neither of these services; it therefore represented the traditional type of housing. We asked the specific question, fiAre the tenants who initially occupied the congregate housing measurably different from those who moved into the traditional housing?11 Our hypothesis was that the service-rich environments In fact, we found that would appeal to those in greater need of such services. those who moved into the congregate housing were, before moving in, significantly older, in poorer functional health, less active in organisations, less mobile, and less happy than those who moved into the traditional housing. I consider these findings exfjremely important for two reasons. First, they indicate that when given 1 choice older people? like the rest of us, assess their 1 needs realistically and choose an environment that has the best probability of meeting their need, The service-poor environment required its te&ants to do all their own shopping, food preparation, housekeeping and to travel to receive medical care. These tenants1 better physical, social, and psychological status -6- presumably would enable them to cope adequately with such demands* The second point to be emphasized is that the sponsorfs original &!?ntiin& ?f the level o F services to be offered seamed t? determine the char act er Is tic s of the j . tenants who would choose to apply. Tt is, of course, possible for a sponsor to apply either rigid or relaxed health standards for acceptance of a tenant's application. Our congregate housing sponsors probably could have excluded the least independent applicants had they tried hard to do so. However* they did not, and the result was that the combination of selective appeal to different ' kinds of people and of differing sponsor admission standards led to measureably different tenant populations, These findings thus demonstrate rather clearly that a range of alternatives is required in order to serve people with differing needs. They also indicate that a sponsor needs to be aware of the implications of Its early planning decisions. The sponsor of a service-rich housing environment might well have difficulty finding tenants should it insist on very high health standards. Even if such people did fill the building^the sponsor might in actuality be forcing the exclusion of those who can benefit most from the services. The frequency of service programs In federally-assisted housing, The Philadelphia Geriatric Center's survey was based on a national sample of 103 public housing and 50 202 projects and thus afforded &n estimate of the frequency of services in these kinds of housing throughout the country. Every 202 and 92 percent of the public housing sites conducted some kind of activity program. Thus3 organised activities are part and parcel of planned housing and thus not In any way specific to congregate housing. The situation is totally different with respect to other types of services. Slightly less than one-quarter of both 202 and public housing sites had any kind of medical services available on the site for its tenants. AMttg this minority of sites, very few had either physicians or nurses who were actually -7. employed by the sponsor or who provided any extensive coverage over the full week. Most were employed by outside agencies such as a local hospital, a city health department, or a Visiting Nurse Association to render occasional services when needed. In addition, about two-thirds offered only diagnostic and referral Thus, it seems clear that medical services, as contrasted to direct treatment. coverage is very poorf especially when contrasted with the high level of ex~ pressed need documented earlier in this report. In 1971 the gap between public housing and 202's was most marked In the area of meal services* Considering the administrative barriers to the provision of on-site food service* it was truly astounding that three-quarters of the 202fs had found some way to provide on-site meals. In most instances, this service was 1 minimal (one to four meals per week), but almost one-quarter provided all meals in a common dining room and the average number of meals per week over all 50 202 sites was 9. By contrast, only 18 percent pf public housing sites provided \ any such service then, and over all 103 sites the average number per week was just one.* Almost all meal services in public housing were limited to a one to five day-per-week luncheon organized by some outside group, sometimes with the assistance of tenants. While this proportion has surely grown as the Administration on Aging's nutrition program has matured, there is undoubtedly a far greater demand for meals than has yet been met. situation does, of course, change rapidly, and our 1971 estimates probably are no longer accurate. A substantial increase since then in the number of sites where some meals are served has no doubt occurred because of the growth of the Title VII nutrition programs, which are frequently based in the community rooms of housing for the elderly. -8- Transportation services explicitly provided for elderly tenants have also been augmented since our 1971 survey. As of that time, some kind of assistance was provided by about 60 percent of 202 sites and 30 percent of public housing sites* Again, few of these sites provided frequently-operating or regularly- scheduled transportation to any variety of local resources. Most often such assistance was arranged by appointment for medical purposes, or a on$e~weekly shopping trip conducted by a local community service agency. Through the local housing authority or a community agency, social services were provided on the premises of the residential building or another authority building in more than one-third of the public housing sites* While such formal services were less often available in 202fs? the difference is more than made up by the tendency for 202fs to have full-time administrators with training in social work, the ministry, or other human-service fields. Of course, many sites reporting none of these types of service were not totally without means to serve tenants1 needs in these areas. They often knew about and helped to arrange contacts with local resources when the need arose. However, the latter mode was usually unsatisfactory, considering the general shortage of community services, the sometimes ageistic attitude of agencies toward elderly clients, and the general slippage involved in such indirect channels of access. Considering our estimates of tenant need and the number of services actually provided, the proportion of unmet need Is estimated as being from 65 to 90 percent. The use of services by tenants As we have seen, there is no such thing as standardization of the service package offered by those housing environments where anything beyond an activity program is offered - a fact for which, at this stage of our knowledge, at least, we can be grateful, for it is only through experience in trying many different approaches to the same goal that we can learn. A consequence of this variety is that, with one exception, we are quite unable to proffer usable information regarding the likelihood that a generically-defined service will be utilized if it is provided. Variation in amount of use among different tenant popula- tions is very likely to be explainable on tha basis of unique features of the service at a given site* such as the characteristics of the tenants, the availability of other alternatives, the cost, quality, frequency, and dependability of the service, and so on. Given these limitations on our ability to generalise* however,,some trends may nonetheless be discerned. The obvious exception to the unpredictability of use is the site where a service is made mandatory by charging for it as a part of a single monthly fee* Thus, where meals are prepaid, tenants will In one site where clinic- choose to cook their own relatively infrequently. type medical services were given in the building and included as part of the monthly fee* 90 percent of all tenants used the house physician, rather than one not associated with the housing. There can be much debate about the The loss of freedom of choice desirability of structuring services so rigidly. must be balanced against the general economy of mandatory services$ which allows such services to be made available to those who need and wish them, where they might otherwise be prohibitive in cost* In several of the public housing sites where a voluntary, moderately high level of clinic-type medical and nursing services were provided at no or nominal cost* proportions of the tenant population varying from 40 to 63 percent utilised them. The low figure was found in a clinic for tenants of all ages located in a different building from the one where tenants resided, while the higher figure was from a site where the clinic was for elderly tenants only and located on the residential building's ground floor. While we do not have such specific data for other sites, informal observation of many sites suggests that limitations imposed on the scope of services offered will grossly reduce use -? infrequent hours, undependable scheduling, restriction to diagnostic services, etc. ?10- A different kind of question is whether easy access to medical services generates additional use beyond a level that is appropriate, i.e., are resources thus wasted or is the *fsick role" fostered? In each of 4 sites with good medical clinic services, median annual use (6 visits per year) was almost exactly that indicated by the National Health Survey for people 63 and over throughout the USA. It is of interest also that tenants in the site offering the package-price medical treatment tnade slightly fewer visits per year than did others. Evidence from other research indicates that while soma social and personality factors are associated with amount of use, the extent of diagnosed illness is the strongest determinant of use. Thus, there is nothing to support the idea that too-easy access leads to over-use. Our data on actual use of on~sit@ meal facilities are very sketchy, and our best data are frora 1967*1968# so they must be viewed with caution. In three public housing sites that served weekday hot lunches for m nominal price, just over 10 percent used this service regularl}^ While two-thirds rarely or never did. In one other site with a completely optional but m&re elaborate GtiMl service, only one-third of its tenants never ate in the common dining room. With the better funding and organization that has followed the major increase in federal programming during the past 8 years9 it is likaly that participation has increased. However, it is vary doubtful that all of the nearly 50 percent who expressed a wish for meal services in our survey would ba regulat customers in an optional meal program under the best of circumstances. The relatively low utilization rate for optional dining room/cafeteria service tells us very clearly that in most situations the usual preference of the older person is to be able to continue cooking her own meals at her own schedule. Making meals mandatory changes the situation, of course. My own conviction ? is that such an arrangement will screen out many relatively healthy people, thus contributing to the tendency for congregate housing to attract the less independent. I would conclude that the minimal voluntary lunch program would be -11- a good addition to many traditional housing environments because it server* the minority who need or wish th4s service in a relatively economical manner without forcing conformity from other tenants * More elaborate stid^ . f necessary, if mandatory, meal service*? shou*?* be reserved for true congregate settings which plan other servieor in addition to meals so as to serve the semi-independent. In one of our sites we asked a research question about the kinds of individuals vfoa participated in a voluntary lunch program3 in an attempt to learn something tbottt the notivation for such behavior. By gathering the names of \ all those eating lunches over a five-week period we were able to determine that those tenants who were rated by the manager as being relatively active socially were more likely to participate than those who were not. When rated for general level of independence, participating tenants were likely to be either high or low in independence, while tjpse who were average in this respect participated less. These findings allow us to suggest that a lunch program serves two kinds of needs: the need for social contact and the need for support in the case of failing capacity. The impact of congregate touting on. the older person The most serious of all questions in this area is the consideration that was foremost in the minds of the planners of all federal housing programs: Does the I on-Bite service decrease the vllllttgAftsa and the ability of the older tenant to continue his involvement with the larger society9 Out research enlarged this question somewhat so as to ask more generally whether tbere were gains or losses in a number of areas that might be attributed to the provision of on-site services. This Is a good example of the kind of question that is very difficult There are so many sources of error in measuring At for the social sciences to answer. that one must be very emitious in interpreting the results of any one study. the very least, such a question ought to be asked by a number cf investigators, each approaching it in his own way, with a tentative verdict being reached only if most of the results converge on the same answer* To date, our research is the only attempt to test this vital question, so please add appropriate caution to the interpretation at any point where I fail to do so. The strategy used to answer this question has been described above. That isf the pair of projects (one congregate and one traditional) that appeared to be serving roughly similar populations was studied before occupancy and again after occupancy. It may be recalled that there were, in factf major differences in the initial characteristics of the original tenants, such that those choosing traditional housing had more vitality in many ways than those choosing congregate housing. With this initial difference being so obvious, we clearly could not attribute any lower level of independence in congregate tenants a year later to the fact of their having been exposed to the congregate setting. Thus, we had to use statistical means to equate the two groups of tenants on their initial status for each indicator of wellbeing. follows: 1. On six measures of wellbeing, changes over the course of the year did The findings were as not differ in the two kinds of housing. 2. Tenants in congregate housing declined more (or improved less) than tenants in traditional housing in behavior reflecting active use of the larger community, including organisational participation. 3* Tenants in congregate housing declined less (or improved more) than tenants in traditional housing in general outlook on life, satisfaction with their housing, and their proximate social relationships. Thus, the overall differences were not major. However, there was consistency in the pattern of differences. It appears that other things being equal, there was a reduction in the range and intensity of activities of the congregate~housing tenant together with a comparative improvement in general life satisfaction and small-scale social relationships. I have described this elsewhere as a net increase in "passive contentment11 for the congregate-housing tenant. Despite the before~and-after study of the tenants in these two types of housing, it is possible that our statistical attempt to equate the groups in Initial status did not completely obliterate other differences. Even if they were equated as of the time of the preoccupancy measure, it could still be possible that those moving into congregate housing had experienced a decline in energy well before the time of occupancy, so that their social range decreased more steeply than would have been true for the traditional housing tenants during the first year of occupancy. The prospective congregate housing tenants may have recognized in themselves this vulnerability and therefore sought out the added services. In other words, even though their status at t the time of occupancy was statistically equate! the rajbe of natural decline of the congregate housing tenants was greater in far-ranging social behavior and could not be counteracted by the housing environment. If true, this could suggest that it was not the increased level of service that brought about decline in community activity but, rather, a personal decline that would have been at least as evident in any other setting as well. Their relative improvement in outlook, on the other hand, would in this case be much more likely to be attributable to the sense of security and easily available social relationships afforded in the service^dense housing environment. If such findings are replicated in future studies $ how might we interpret them in evaluating the desirability of the congregate housing model? First, our findings do not dispense with the concern planners have had about the possible erosion of independent behavior by the easy availability of services. Neighborhood mobility, organizational memberships and activity did decrease more in congregate housing tenants; other things being equal, this is an undesirable effect. However, as discussed above, there may be other explanations as to why this relatively greater decline occurred. this question, remains unanswered. Thus, until further study enlightens us, Second, the finding that outlook on life, housing satisfaction, and local friendships increased suggests that, with respect to their beginning point, tenants in congregate housing experienced a favorable impact. It would seam that this favorable change clearly constitutes a potent argument for congregate housing to serve older people who are no longer as independent as the average traditional housing tenant* Thus, it seems logical to suggest that first preference in congregate housing be given to people who have some mild disability in locomotion* capacity to perform everyday tasks, and social resources. The course cf action to be taken when a highly independent person applies for an existing vacancy in congregate housing is less clear;' I do not feel that the evidence from our study is strong enough to recommend that the application be rejected on the grounds that her dependence might be unnecessarily increased. At this point it might suffice for the tenant to b i allowed to move in if the manager is prepared to be vigilant in encouraging * her to maintain her outside activities and associations. One further cautionary note might be added in relation to the difficulties of measuring the impact of congregate housing, The only way to measure impact is to follow the same individuals over a period of time, preferably beginning with their initial occupancy of the housing ("longitudinal11 method). Any attempt to assess impact by correlating measurements on individuals with the kind of environments they inhabit at a single point in time (flcross-secIionalH method) can give only suggestive information on impact, and even this information risks much error in interpretation. Thus the only trustworthy future information will be that gained by using the much more costly and painstaking longitudinal method. Environmental design and congregate housing In distinction to ail of the above research-based discussion* a good bit of what we can say about designing congregate housing is based on informal, nonquantitative research done through extensive interviews of tenants and administrators and the direct observation of life in many different types of housing environments* It is very difficult to establish a direct quant*dative relationship between a specific aspect of physical design and the behavior of the people living in that environment. The major exception to this disclaimer is the explicit research dealing with the relationship between distance to a resource and the amount of use it receives, Research by Robert Newcomer has shown roost clearly that use of such resources as a laundromat, a grocery store, a b&rber/beautician, a senior ? centert or a snack bar was most frequent when the facility was located on the ? housing site. In addition,, use of a neighborhood facility decreased sharply \ as the distance from the facility to the housing site increased. The decision as to whether to have such a facility on the site must be made partly in relation to other considerations, however. The cost of the service, the quality of service that can be offered, the off-site alternatives to an- on?site service, and the possible desirability of forcing tenants to utilize off-site facilities in the interests of function na&intenance are examples of other factors that may influence the decision. All the basic services offered by congregate housing we assuroe should be either in a main building or a connected separate structure: activity center, kitchen and dining room, laundro- mat, and professional medical and social-service offices? Beyond the basic package, however, the primary consideration is whether the necessary services are already available nearby. Other things being equal (&.g., quality, cost), it seems more desirable for tenants to exercise their physical and social skills by utilising a neighborhood grocery store, drug store, beauty/ barber shop, and other less obligator}7 facilities provided they are within a three-block radius with safe access? When the immediate site neighborhood does -It- not contain such facilities, the housing sponsor should consider providing them on the premises. The selection of a site for building involves similar considerations. The choice of a site far removed from normal neighborhood facilities puts a great burden on the sponsor. He must be prepared to furnish all of the facilities previously mentioned, as well as post-office and banking services, facilities for religious services, library, snack counter and/or bar, and some form of transportation to a distant shopping and transportation center. All of these are expensive, and if their quality is to be sufficient to maintain tenant morale, almost by definition the tenant population must be, an upper-income group. There are a few examples of isolated retirement communities with substandard on-site facilities; nothing can be so demoralizing. While Sun City is a genuinely complete city that does fit the needs of many of its inhabitants and is certainly not a deprived environment, by most standards, the cost of this completeness is a kind of segregation that many of us feel may not be in the best Interest of the larger society. Thus, the attractiveness of a low-cost land parcel that produces such segregation may be strongly counteracted by its tenants1 loss of contact with younger people and the mainstream of life. v In a relatively central location the sponsor will have fewer problems, but it must be emphasized that every block of distance and every barrier (such as a steep grade, heavy traffic crossing, icy sidewalk^ or crime risk) will reduce use of a neighborhood facility. Even in the best of locations there will be a need for some kind of sponsor-provided transportation system to serve those too frail to use public transportation. Unfortunately the fear of crime has surfaced during the past decade as a major consideration in the selection of a housing site, a concern that is understandably more characteristic of older people than of younger people. Especially for congregate housing no site should be considered that tff is not widely received -17- as safe at least during the daytime* Architectural design can contribute much to making the housing premises themselves safe from intruders, but the design problems of attaining security in the neighborhood are far more difficult. In general, it is undesirable to locate housing near a junior or senior high school or in walking pathways to such schools unless the neighborhood is generally safe* Parks bordering on a prospective site may be very desirable if they contain safe seating areas, but are an obvious liability if they do not* Congregate housing will require more attention to outdoor spaces than traditional housing because these may be the only kind of outdoor exposure that some tenants will experience. As with all housing, these spaces should be located so as to allow choices between sun and shade, breeze and protection from breeze, views of street activity and of traffic entering and leaving the building, and where needed, protection from the unwanted intrusion of outsiders? Congregate housing can expect to have a greater proportion of tenants whose enjoyment involves watching, rather than active participation. Given adequate control over access to lfoutdoorfl seating areas and the right kind of pedestrians, moderate to high levels of pedestrian traffic are desirable, both from the point of view of providing some spontaneous monitoring of behavior by passerby and also for the interest such traffic provides for the older onlooker. Much has been written about building design for older people and I shall not attempt to recapitulate this literature. vail for congregate housing. In general, similar considerations pre- Some of the unique aspects of congregate housing Since more services are provided, more design may be of interest, however. spaces for these services will be necessary and the competition for centrality of location of common spaces thereby increased. A general design principle is that spaces whose use is desirable to maximize should be located as close as possible to the main entrance and elevators. Every housing environment should have an entrance lobby with much seating, at least one staff office, the elevators, and the mall area (if any) In this favored location. Most housing can also arrange to have a general-purpose community room close to this core also* If an activity is both regularly scheduled and obligatory it need not take place in a centrally located spot; people will come to meals, to a physician's office,or to very desirable large-audience events even if they are located on a second floor or at the end of a wing. There is a limit, of course, to the distances that marginally competent people should have to walk, but thi would be expressed in such decisions as limiting the total length of hallways, or putting service facilities in a main building rather than % outlying one. Much of this discussion has seemed to assume a high-rise building, which, of course, is not intended. However, one needs to be particularly conservative about the amount of physical dispersion of structures that can be tolerated by people whose mobility Is limited* Such a consideration also limits the total It is number of units that are functional for a low-rise congregate setting. also mandatory to have weather^protected walkways between units and buildings in all but the most felicitous climates, A critical issue in congregate housing is that of whether to Include individual kitchen facilities in housing where congregate meals are also provided. regulations clearly state that such units may be omitted. To my mind the The presence of a kitchen Is the feature that makes the clearest distinction between housing and an institution. Without unit kitchens, the tenant has no option at all in the way he eats. With kitchens, every option is available: one, two, or three mandatory meals a day, some tenants with all congregate meals and others with some or none, an occasional self-cooked meal, oversleeping without penalty, and so on. There is room for creativity in designingfcrerysmall combination kitchen units that allow such options within relatively moderate cost limits. Unlike the kitchen vs. no-kitchen problem, there is, no answer to the old tub-vs.-shower problem. People perversely split down the middle in such a Unquestionably the safest choice is a shower choice? sometimes vociferously. with adequately sloped floor (e.g.* no rim), flexible hose, and a firm seat. Very reluctantly I suggest this option, knowing that the absence of a tub will frustrate many people and deprive those who are capable of negotiating it* I would urge strongly that regulation furnishings be avoided, despite the administrative headaches that may arise from clutter, dirty% or unsafe belong- ings . At the most, one might insist on sponsor-purchased mattresses and bed linen* but other furniture and possessions are too critical to the sense of self and one's continuity with the past to be replaced with standard furnishings? Much more extended discussion of siting and design probletns may be found in my book, Planning and Managing Housing; for the Elderly (Wiley-Interscience* 1975). Management requireraants for congregate housing Our research has inquired rather deeply into management as an element in the wellbeing of tenants but has produced relatively little to date in firm findings of the kind that have been mentioned above in connection with other questions. Overall we have found few managerial characteristics or attitudes It is possible that housing management as a that relate to tenants1 wellbeing, profession is too new and has too insubstantial a technological base to show the strong direct relationships to tenants' personal outlook, social behavior, or activity level that we might expect. We unquestionably have good administrators and poor administrators, but such people have great diversity of education and experience, attitudes that range from authoritarian to laissez-faire, and goals for their housing that range from the moat business-oriented to the -20- most strongly socio-emotional. It aakes good sense that those people responsible for more vulnerable tenants should have more specific training and sensitization to their needs than the minimum required for traditionalT In fact, this is one of the relationships shown by our d,?ta: Administrators of housing with services were more likely to show a nurturing attitude toward tenants and to be more tolerant of dependency on the part of tenants. Going beyond the data, one would hope that the time is near when not only specialized training in the management of housing for the elderly is mandatory, but also specialized training for those who manage congregate i \ I housing. Their everyday roles will require counseling, social intervention, and decision-making based on a better than average knowledge of such areas as gerontology, social medicine, and the legal system. In addition, the fiscal management of the added services will require a different kind of expertise that is surely capable of being taught. The time has passed when such expertise can be picked up through experience alone. While recruitment for congregate housing management should certainly take advantage of those administrators who have proved themselves through their performance, this process should constitute only the first step, to be followed by explicit advanced training. In summary, research has some good information to offer in a few disparate areas. This review of what is known should make it glaringly obvious how much more there is yet to learn. It is to be hoped that the momentum / among doers created by this first conference on congregate housing will have the parallel function of stimulating both those who fund research and those who do research to continue the search for better research-based guidelines. |
Contributors Authors | M. Powell Lawton |
Access Rights | fair use rights |
Description
Title | Research Applied to Congregate Housing (pages 1-7) |
Subject | housing; congregate housing; older people; Philadelphia Geriatric Center; environmental psychology; aging; housing for the elderly; aged; environment |
Subject Keyword | housing |
Subject LCSH | congregate housing; older people; Philadelphia Geriatric Center; environmental psychology; aging |
Subject MeSH | housing for the elderly; aged; environment |
Description | Conference on Congregate Housing (December 1975 : Washington D.C.) |
Abstract | Prior to evaluating the suitability of elderly housing and planning designs for future construction, researchers need to be aware of the service needs of the elderly in traditional housing and the experiences of those living in congregate housing, housing with a high level of supportive services. In this presentation, Dr. Lawton discusses the most important topics related to this issue, including: expressed needs of elderly tenants, characteristics of people who choose congregate and traditional housing, frequency of different service programs in federally assisted housing, use of services by tenants, impact of services on tenants, environmental design considerations appropriate to congregate housing, and management requirements for congregate housing. While a number of research projects conducted by the Philadelphia Geriatric Center deal with these topics, much more is needed in the future. // Missing references. --AJL |
Creator | Lawton, M. Powell, 1923-2001 |
Publisher | Polisher Research Institute |
Contributors Principal Investigators | Rachel R. Resnick |
Contributors Research Assistants | Karen C. Kohn; Nicole Snyder; Amanda J. Lehning; Arthur Shum |
Contributors Reviewers | Philip D. Sloane; Maggie Calkins; Laura Gitlin; Jeanne Teresi; Patricia Parmelee |
Physical Description | 7 p. |
Date | 1975 |
Type | Text |
Original Format | Publications |
Digital Format | application/pdf |
Identifier | 1975ResApp1.pdf |
Class Number LCC | HD7287.92.U5 |
Class Number NLMC | WT 145 |
Class Number DDC | 155.9084 |
Language | English |
Relation | Lawton, M.P. (1975). Planning and managing housing for the elderly. New York: Wiley-Interscience. // Lawton, M.P. (1980). Social and medical services in housing for the elderly. National Institute of Mental Health. Washington, DC: U.S. Government Printing Office. // Newcomer, R.J., Lawton, M.P., & Byerts, T.O. (Eds.). (1986). Housing an Aging Society. New York: Van Nostrand Reinhold. // Lawton, M.P., & Simon, B. (1968). The ecology of social interaction in housing for the elderly. The Gerontologist, 8, 108-115. // Lawton, M.P. (1969). Supportive services in housing for the elderly. The Gerontologist, 9, 15-19. // Lawton, M.P. (1970). Planners notebook: Planning environments for older people. Journal of the American Institue of Planners, 36, 124-129. // Lawton, M.P., Nahemow, L., & Teaff, J. (1975). Housing characteristics and the wellbeing of elderly tenants in federally assisted housing. Journal of Gerontology, 30, 601-607. // Lawton, M.P. (1976). The relative impact of congregate and traditional housing on elderly tenants. The Gerontologist, 16, 237-242. // Lawton, M.P. (1977). An ecological theory of aging applied to elderly housing. Journal of Architectural Education, 31, 8-10. // Lawton, M.P. (1977). Environments for older people. The Humanist, 20-24. // Lawton, M.P., & Nahemow, L. (1979). Social areas and the wellbeing of tenants in housing for the elderly. Multivariate Behavioral Research, 14, 463-484. // Lawton, M.P. (1979). Social science methods for evaluating housing quality for older people. Journal of Architectural Research, 7, 5-11. // Lawton, M.P. (1980). Housing the elderly: Residential quality and residential satisfaction among the elderly. Research on Aging, 2, 309-328. // Lawton, M.P. (1981). An ecological view of living arrangements, The Gerontologist, 21, 59-66. // Lawton, M.P. (1985). Environment and its relationship to well-being. Pride Institute Journal, 4, 5-11. // Saperstein, A., Lawton, M.P., Cherkas, L., Moleski, W., & Sharp, A. (1985). Determining housing quality: A guide for home health care. Pride Institute Journal, 4, 41-51. // Lawton, M.P. (1987). Strategies in planning environments for the elderly. Journal of Independent Living, 1, 1-14. // Lawton, M.P. (1991). A future agenda for congregate housing research. Journal of Housing for the Elderly, 9, 167-182. |
Rights | http://rightsstatements.org/vocab/InC/1.0/ |
Contributing Institution | Polisher Research Institute |
Sponsorship | This Digital Object is provided in a collection that is included in POWER Library: Pennsylvania Photos and Documents, which is funded by the Office of Commonwealth Libraries of Pennsylvania/Pennsylvania Department of Education. |
Full Text | Research Applied to Congregate Housing M. Powell Lawton, Ph. D. Philadelphia Geriatric Center Although congregate housing is not a new phenomenon, there has been relatively little research devoted to housing of this type, as compared to the more usual housing for the elderly with minimal services. By far the greatest proportion of all senior-citizen housing was designed for original occupants who were still relatively independent. This planning decision necessarily dictated certain physical design features that may he uncongenial to the later addition of some kinds of services. Yet, the original population of independent tenants does age, and over a period of years the characteristics of new occupants may also change. Thus, what may originally have been an appropriate environment for the original occupants may, ten years later, be less appropriate. The 1970 Housing Act also at least legitimated the building of new housing environments of the congregate type. The need to re-think the suitability of older housing and to plan prospective designs for new construction makes it mandatory that we become aware of existing knowledge about the service needs of people in traditional housing, and how present-day congregate housing works. This paper will discuss a series of Issues in these areas, referring wherever possible to research done at the Philadelphia Geriatric Center over a period of years. The topics to be covered are: 1. The expressed service needs of elderly tenants. 2. The characteristics of people who choose congregate and traditional housing. 3. The frequency of different service programs in federally assisted housing. 4. The use of services by tenants. 5. The impact of services on tenants. 6. Environmental design considerations appropriate to congregate housing. 7. Management requirements for congregate housing. The expressed service needs of older people. As might be expected, it makes a great deal of difference whether a person is a community resident, an applicant for housing, or a tenant when one tries to determine his perceived need for the kind of services that might be offered within congregate housing. An even stronger determinant of perceived need is whether the person is actually receiving the service at the time the question is asked. As we all know, older people of todayfs generation have a strong tendency to evaluate positively their current situation unless it is incredibly bad, so that we need to take this current situation into account when ttying to estimate actual need. In two major research projects done at the Philadelphia Geriatric Center we were able to obtain some information relevant to older people's wish for services. One project was an intensive study of about 1700 older people who lived in 12 different age-segregated public housing and 202 projects or in scattered private residences in the community. Some of the housing tenants were interviewed before they moved in and again a year after occupancy, In the second study, a national probability sample of 103 public 202 sites was studied, as well as a sample of 3500 tenants housing sites and 50 currently living in those sites. One of the goals of both studies was to learn about as many of the issues associated with services as possible. Generalizing from the results of both studies, the most striking finding was the very high level of expressed need for some kind of regular on-site medical services among community residents, housing applicants, and tenants who did not currently live in housing that provided them. Almost two-thirds of all tenants expressed such a need, which is especially notable because such a lopsided proportion runs counter to the general tendency to express satisfaction with whatever one has. Conversely, only 3 percent o? tenants in several environments that did have medical services indicated any wish that there not be such services within their housing. It is more difficult to generalize about the type of services wished. critical point is the feeling of security that is conveyed by knowing that assistance is quickly available if one needs it; Therefore, the most generally approved form was an on~site medical clinic, with regular physician houss and with a nurse readily available. There was less general approval of more clearly The hospital-like facilities such as an infirmary or a semi-permanent special-care area within the housing. However, it should be noted that such "heavy" medical services become more acceptable as the health of the housing population declines. In such a case we have a clear instance of a tradeoff situation, where a minority-somewhere between one-fifth and one-third - of tenants express some discomfort at the idea of having visibly sick or disabled people living in close physical proximity to them. Yet, in more extended interviews with some of these people, the idea was communicated that the security of knowing that a service that they themselves might someday need was available was frequently important enough to outweigh the anxiety caused by the presence of a medical service or of visibly frail fellow-tenants. Thus, we concluded that some kind of arrangement whereby a physician could hold regular office hours, and where a nurse could be present for some period every day and on call for emergencies (i.e., a live-in nurse) would be extremely desirable. An infirmary or special-care area is probably best reserved for congregate housing that has both substantial financial resources and also a policy of accepting and maintaining people whose level of functioning ability is considerably lower than those who ordinarily live in housing without services. A very high level of approval was also expressed by tenants for the idea of having personal care services such as help with cooking, housekeeping, and -3- bathing available for tenants who might need them, ? This wish clearly represented \ a security-building mechanism, since relatively few tenants mentioned a current need for such services. With the exception of lilirtTniiMliilfI that explicitly cater to the marginally independent tenant, these services are probably beat provided on call for individual tenants in need, rather than across the board. It is, of course, very important that if personal care is announced as being available that it actually be deliverable. Transportation is, as we know, a vital link to almost all other need satisfactions. While one's own car rides from a family member, and walking account for the majority of most tenants' trip behavior, other transportation can make the critical difference in the case of individual tenants with disability, those without access to a car, those who wish to enrich their lives by utilising distant facilities, and those located In resource-poor or dangerous neighborhoods, Sini it is not surprising that half of our tenants felt that they would be willing to spend some part of a small increase in inconie to pay ; ; for bus service that would connect them with a shopping or business center. About four years separated the times of gathering data from our two research projects. This lapse of time was prabably quite significant in explaining the only major disagreement between the two studies in the estimation of a service need. Around 1967 we found that aiiacst one*third of community residents and applicants to housing (prior to occupancyx felt that they would like to have some on~site meal services when or if they moved into housing for the elderly. Y e t , the same applicants, after they had lived in housing without meal services for a year, as well as tenants who had been there an even longer time, ware notably less anxious to have this services provided--about 20 percent. W e interpreted this to mean that some confirmation of the person's ability to live a satisfyingly independent life was given by the year's experience in the n e w housing, so that the perceived need decreased. By contrast in 1971, a larger percentage, almost half, of our tenants expressed a need for some kind of on-site prepared meals. Since both of our samples were very large, it seemed that this change since 1967 reflected some real overall change in need. We can only speculate that part of the increased need may have been due to a possible overall aging of the population, and part of it to tenants1 increased awareness of the realistic possibility that such a program exists, through their knowledge of other housing with meals, the increasing incidence of nutrition programs, and so on. Thus, in the case of meals, we can say that not all tenants need or desire them, but that enough do to warrant serious consideration of modes by which those who wish seals oan have them, hopefully without demanding that everyone be forced to do so. There are, of course, serious economic problems associated with optional meals, a subject that I am not equipped to deal with. However, modes to achieve the ideal situation of individual choice ought to be vigorously pursued. The characteristics of people who choose congregate and traditional housing. All too often, the older person has little choice about where she will live. Seventy percent of the households maintained by older people are occupant-owned and therefore profide the lowest-cost housing possible. For many who would like to move because of the deterioration of their homes*the decline of their neighborhoods, or failure of the energy necessary to maintain a home built for an entire family, there is no housing alternative available within economic reach, and they are forced to remain in a less-than-ideal situation. For the minority who are fortunate enough to have access to purpose-built housing for the elderly - ? I estimate this number to constitute no more than 3 percent of * the older population -- simply having a decent shelter at a modest cost overThus, a person with a housing need may be rides every other consideration. -5- likely to accept the first opportunity afforded to move into any housing environment for the elderly, regardless of whether the non-shelter aspects of the housing suit her or not. Given these major restrictions on choosing what is right for oneself, one can sometimes find a small residue of older people who have the kind of new housing into which they move. some choice as to Looking at the choices made by people in moderate to higher income ranges may tell us something about the bases that the larger group might use if they had the option. Our research addressed this issue in a way that allowed us to compare moderate**income older people who chose congregate housing with those who chose traditional housing for the elderly. The sites that we studied in depth included three whose original occupants were almost entirely Jewish and had lived most of their lives in urban Eastern areas. Two of these sites had central dining rooms and some form of on-site medical services, thus having some characteristics of congregate housing. The third site had neither of these services; it therefore represented the traditional type of housing. We asked the specific question, fiAre the tenants who initially occupied the congregate housing measurably different from those who moved into the traditional housing?11 Our hypothesis was that the service-rich environments In fact, we found that would appeal to those in greater need of such services. those who moved into the congregate housing were, before moving in, significantly older, in poorer functional health, less active in organisations, less mobile, and less happy than those who moved into the traditional housing. I consider these findings exfjremely important for two reasons. First, they indicate that when given 1 choice older people? like the rest of us, assess their 1 needs realistically and choose an environment that has the best probability of meeting their need, The service-poor environment required its te&ants to do all their own shopping, food preparation, housekeeping and to travel to receive medical care. These tenants1 better physical, social, and psychological status -6- presumably would enable them to cope adequately with such demands* The second point to be emphasized is that the sponsorfs original &!?ntiin& ?f the level o F services to be offered seamed t? determine the char act er Is tic s of the j . tenants who would choose to apply. Tt is, of course, possible for a sponsor to apply either rigid or relaxed health standards for acceptance of a tenant's application. Our congregate housing sponsors probably could have excluded the least independent applicants had they tried hard to do so. However* they did not, and the result was that the combination of selective appeal to different ' kinds of people and of differing sponsor admission standards led to measureably different tenant populations, These findings thus demonstrate rather clearly that a range of alternatives is required in order to serve people with differing needs. They also indicate that a sponsor needs to be aware of the implications of Its early planning decisions. The sponsor of a service-rich housing environment might well have difficulty finding tenants should it insist on very high health standards. Even if such people did fill the building^the sponsor might in actuality be forcing the exclusion of those who can benefit most from the services. The frequency of service programs In federally-assisted housing, The Philadelphia Geriatric Center's survey was based on a national sample of 103 public housing and 50 202 projects and thus afforded &n estimate of the frequency of services in these kinds of housing throughout the country. Every 202 and 92 percent of the public housing sites conducted some kind of activity program. Thus3 organised activities are part and parcel of planned housing and thus not In any way specific to congregate housing. The situation is totally different with respect to other types of services. Slightly less than one-quarter of both 202 and public housing sites had any kind of medical services available on the site for its tenants. AMttg this minority of sites, very few had either physicians or nurses who were actually -7. |
Contributors Authors | M. Powell Lawton |
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