Some Varieties of Structural Lag: Housing for Older People

              Some Varieties of Structural Lag: Housing for Older People M. Powell Lawton Philadelphia Geriatric Center It is a great pleasure to be stimulated to re-examine some older research and its conceptual base in terms of some newcentury ideas formulated in the aging and society paradigm. Specifically, I've spent several decades working with the concept of "person-environment congruence" but just this year have had the good fortune to be introduced to the concept of "structural lag." This construct shows promise of adding a richer dynamic and perhaps explanatory quality to our understanding of how people lead their lives in their external worlds. I shall use the instance of planned housing for older people to suggest that is is worthwhile to think in terms of a hierarchy of structures across which lag can occur, arranged in terms of the elasticity they afford people in accomplishing their life goals. First, the concrete environmental focus of these thoughts is all housing designated for or occupied by older people. This class includes all unplanned housing (where about 87% of all elders live), retirement communities of both the purchase type (for example, Sun City) and life-care, and especially the almost one million units designated for older people of limited incomes, located in projects subsidized with public funds. Draft presentation for M. W. & J. Riley (organizers) Age and Structural Lag, Panel Discussion, American Sociological Association annual meeting, Washington DC, August 19, 1995. Within this context I shall examine older individuals and their structural context, as conceptualized in age and society terms. However, I shall begin by relating their concepts to a much earlier set of distinctions among 3 types of environment, which I made from the point of view of an environmental psychologist. First was the physical environment, as defined in Second was an aspect that I I suggested that the centimeters, grams, and seconds. called the "suprapersonal environment." dominant observable characteristics of people in close proximity to the person, and the target person's location within the aggregate, would constitute an important stimulus context for the individual, independent of any person-to-person interaction. One can see the relationship of this concept to Merton's concept of personal homophily. Another environmental facet I referred to as I refer to this now with the "megasocial" environment. apologies, having assumed that all that was not the individual, the collective, or the physical environment -- that is, everything considered useful by sociology, anthropology, economics, and political science could be placed in this single category! Let me hasten now to substitute "social structure," as best a psychologist can understand that term, for this aspect of the environment relevant to today's discussion. For that discussion, the 3 environmental facets may all be viewed as highly salient aspects of the structure of housing for older people, the planned aspect of which began in the late 1950s, as follows. The social structural component originated in a philosophy of housing that aimed to foster the maintenance or growth of independence in older people. The physical component consisted of clean, efficient housing providing improved, lowcost shelter of a type diametrically opposed to the home for the aged or nursing home. The tenants populations i (suprapersonal environment) were selected to be as healthy in both physical and mental terms as possible. Together, these 3 facets of the housing environment represent related aspects of structure, but they have the potential for change in ways that are not always parallel. This brings us to the individual, and the inevitable phenomenon of aging in place. Research that assessed tenants in 5 housing sites prior to entry, 12 months later, and 11 years later was able to test 61 people on all 3 occasions. Not surprisingly, on all of about 15 indicators of well-being, these tenants declined significantly. A s in the aging and society paradigm, aging in place requires complementary changes in supportive social structures if lag is to be avoided and positive outcomes are to be maximized. What happened in the large planned housing stock? There was great reluctance among planners and administrators to revise the goal of "independent housing for independent people." Most such housing had been built with minimum common spaces, certainly with little ability to accommodate on-site meals and other supportive services. In the suprapersonal realm, aging in place of the individual had its analogous effect: The tenant population as a whole aged and exhibited aggregate decline. The dynamic interplay between person and structure was clearest in my data depicting the annual changes in the ages of cohorts of new tenants. The suprapersonal age (and frailty) environment, to which each individual contributes in reciprocal fashion, influences the decisions of each new potential applicant regarding whether this environment is suitable for her. The implication of these findings is that as tenants in older housing become older and more frail in the aggregate, this changing suprapersonal structure in turn not only helps to recruit older and more frail replacement occupants but also contributes to 2 types of lag. The lag between the less frail and the more frail The aggregate compromises quality of life of the less frail. continuing decline of the aggregate further accentuates the asynchrony between the nonsupportive structure of the housing and the needs of the majority. Our research on the developmental history of such housing documented a lagging attempt to modify the physical environment in response to tenant population change. Sometimes additional space is built, a social room is converted to a dining room, or other space is converted into staff offices. Change in "soft services," where local agencies target resources to bring in services to needy tenants, often occur in unplanned fashion to create what I called a "pathwork of services." substitutes for a more desirable The patchwork planned service program whose establishment would require a basic structural change in the model of housing services. Such planful service coordination can originate only in the highest structural level that subsumes the specifics of a service-providing philosophy: Recognition of the reality of health decline; foreseeing the needs of the future for a variety of housing/service options; acceptance of a political philosophy of social interdependence; decision-makers' willingness to initiate change in proximal social structures such as neighborhood attitude, zoning, building codes, profit vs. nonprofit sector competition, tax issues, regulatory issues, and economically-driven political interests, I've thus hypothesized that the hierarchy of structural flexibility versus rigidity begins with the person as most flexible, followed in order by the aggregate of individuals, the physical environment, and the megasocial environment. The aging and society concept of lag or asynchrony would become even more complicated if we tried to examine separately each of the components of social structure as they differ in content, in periodicity, and in their amount and direction of influence on one another. I suggest that thinking in terms of hierarchically interrelated structures will add to our ability to understand both individual lives and social structures. The outcomes of imbalances between lives and structures in planned housing may be examined in terms of 2 ideal housing types, the "constant" and the "accommodating" environment, where goals, programs, physical environment, current tenants and replacement tenants are controlled to maintain the original character of the housing. The tenant whose independence declines is the big loser here; in order to maintain constancy, administrative action is used to terminate frail elders7 tenure. The "accommodating" model ideally retains tenants as they become more frail. The risk is that minor alterations in the structures can go only so far in serving both the individual and the aggregate. The individual may experience unmet needs and the research-documented decline of the health and morale of the aggregate may threaten the viability of the entire system. A more positive model of "primary prevention" of these types of imbalance has been accomplished primarily in the private housing sector serving affluent older people. The life-care, or continuing care retirement community (CCRC) has the luxury of representing a continuum of housing types that range from the fully independent through "assisted living" and on to the nursing home. Physical relocations may be delayed because of the proximity and orderly organization of supportive services. Negative outcomes of relocation within the community are softened because of the continuity of the administrative and social network in the CCRC model. By now it will have become obvious that I have neglected the model of the country's major housing type: scattered, individually-chosen dwelling units that are likely to have been occupied long before the trajectory of decline begins. This type of housing is age-integrated, which brings us to the Riley's third and perhaps crucial principle: Can the cure for structural lag come through age integration in the structure of society? As far as housing goes, this is a very complex issue. I can only give my personal reading of the data at hand, which is that the majority of older people choose and thrive in ordinary housing that is age-integrated; further, that the overwhelming desire of elders is to remain in these familiar residences. Nonetheless, the fact is that structural lag is extremely problematic when the community residence built for a robust person means inaccessibility to enriching resources and supportive services for the frail. Let me conclude by suggesting applications of the age integration principle at each structural level. At the physical environmental level, the outcome of the efforts of the behavioral design microdiscipline has been the discovery that most design improvements turn out to be good not only for the specific user group but for people generally (the tub grab bar, for example). The same principle on a neighborhood level would improve pedestrian access to shopping and securitypromoting surveillance opportunities -- for elders only? Clearly, it would be to the advantage of all. On the suprapersonal level, age-segregated housing constitutes a means for reducing some type of structural imbalance. There is very strong evidence that those who live in age-segregated housing have usually chosen it actively and thrive in it. As Matilda Riley put it, "Would (age integration) prevent the comfort of homophily and the self-esteem engendered by having age peers as reference points?" I think it would, for those who have made the move to age-segregated housing. On the megasocial level an alternative to the lag inherent in overdifferentiated structures is possible. One possible outcome of the social change envisioned by the aging and society paradigm might be that the age integration of social structures surrounding housing and community planning, education, work, and leisure might actually support the greater ability of individuals to choose housing most consistent with their personal needs and preferences, as these preferences apply to such options as the service package or the age mix. var-lag.hsg (manuscr3) 9/8/95 (xix) HOUSING DYNAMICS AT FOUR STRUCTURAL LEVELS Table 3 Hierarchy of Structure The person Dynamic Process Costs of Asynchrony Unmet need The Constant Environment Early involuntary relocation Retain character of original population Periodic refurbishment The Accommodating Environment Age in place Aging in place The suprapersonal environment Replacement Low morale Generalized increase in frailty Patchwork accommodation The physical environment Constancy or decline A "sick" physical environment Social and political devaluation The megasocial structure Inflexibility Constancy of service goal Internal dissonances among elements M. Powell Lawton, Philadelphia Geriatric Center For Panel discussion, Aging and Structural Lag American Sociological Association, Washington DC, August 19, 1995 HOUSING DYNAMICS AT FOUR STRUCTURAL LEVELS Table 3 Hierarchy of Structure The person Dynamic Process Costs of Asynchrony Unmet need The Constant Environment Early involuntary relocation Retain character of original population Periodic refurbishment The Accommodating Environment Age in place Aging in place The suprapersonal environment Replacement Low morale Generalized increase in frailty Patchwork accommodation The physical environment Constancy or decline A "sick" physical environment Social and political devaluation The megasocial structure Inflexibility Constancy of service goal Internal dissonances among elements M. Powell Lawton, Philadelphia Geriatric Center For Panel discussion, Aging and Structural Lag American Sociological Association, Washington DC, August 19, 1995