Optimizing Housing for the Elderly

Homes Not Houses

Leon A Pastalan

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781135904890
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

Discover the diverse range of housing options available to the elderly population with this excellent new book. This timely volume addresses the public policy and design and development issues that must necessarily face those concerned with housing our steadily growing elderly population. The chapters cover a broad spectrum of populations including elderly people in "aging ghettoes" in suburbia, continuing care retirement community residents, full-time recreational vehicle travelers, and the homeless elderly. The authoritative contributors go beyond descriptions of wide-ranging elderly housing options and delve into the central themes that influence them all. Optimizing Housing for the Elderly explores some common considerations such as personal security, food and medical services, independence, and social interaction, that are important determining factors when selecting a style of housing, and addresses economic questions including advice on reducing costs in popular continuing care retirement communities, currently inaccessible to lower-income elderly people. Professionals involved in any aspect of housing for the elderly will benefit from the information in this insightful book.

Chapter 1

Introduction

Leon A. Pastalan

Any discussion of housing for older persons must begin with an understanding of how their housing needs differ from those of other age groups. Quite simply, it is the characteristics of this population and how they change over time that determine their special housing needs. With the knowledge that by the turn of the century there will be more than 30 million people in the United States 65 years of age or older has come the realization that there will be an increasing need for a vast array of different types of housing and living arrangements to accommodate older adults in the future. These considerations will play a part in the housing experience of older individuals since the ability of a person to function within any environmental setting depends on his/her capabilities, as well as the characteristics of the setting. Thus one of the difficulties of developing suitable housing solutions for the elderly is that the circumstances, situations, and the needs of this population vary greatly, and will be constantly undergoing a process of change over time.

Despite changing needs and circumstances there are some things that typify the aging process that do not change. One is that during the period of retirement the person will likely have a reduced income. The problem of low income is frequently compounded by health problems. Second, changes in household composition typically occur at one or more points in the aging process, for example, when a spouse dies, or suffers an incapacitating illness and alternative housing solutions must be found. Third, because the retirement period is long, for instance a person aged 65 today has an average life expectancy of 14 more years. The changes in economic circumstances, household composition and health place economic and psychosocial pressure on the household and frequently leads them to alter their housing situation several times between the onset of retirement and death.

These situations clearly impact strongly on the changing housing needs of the aged. Housing goes beyond the physical aspects of shelter and includes health, social and related services and amenities associated with any given dwelling.

Our concern in this volume is deliberately wide ranging in an effort to characterize the many and at times seemingly chaotic responses to housing needs. There is for instance an international treatment of needs by Professor Baker of the Canadian experience in Victoria, Canada. Hawkins makes an interesting comparison of American and British retirement homes by observing that English residents tend to be older and more feeble but more physically active, while the Americans tend to spend more money on services, are more age segregated, live in newer facilities and participate in more voluntary associations. Blandford and her colleagues on the other hand found in their study of Canadian housing alternatives that virtually no differences exist among the different types of elderly persons’ housing suggesting current distinctions among options within subsidized housing are not reflected among residents currently living in such situations. Bishop’s interest was in exploring ways to reduce costs of continuing care retirement communities. Continuing care retirement communities seem to be increasingly popular as a housing option among the more well to do retirees and certainly lower costs would make this option more accessible for those less well to do. Gonyea et al. have dealt with a very timely subject, that of aging in suburbia. What is occurring in many suburbs across the country is yesterday’s young couples with small children have been transformed into elderly couples whose children have long since grown and left home. Demographically speaking younger segments of the population are decreasing and the older segments are increasing creating aging ghettos. As a consequence basic shifts in the types of housing and services needed to support this changing population profile present major challenges to us as a society.

Kalymun has focused her energies on where on the continuum of care does assisted living fall and in fact asks a very basic question, “Just what exactly is assisted living?” Her treatment adds important insights to this housing alternative. Hartwigsen’s intriguing study of RV’s (recreational vehicles) as an alternative housing solution makes fascinating reading. She observes that living year-round in a recreational vehicle is an egalitarian housing and lifestyle option, it fits any age, income level and marital status. Finally Keigher’s work on the elderly homeless points out in bold relief the many basic issues of housing needs of those who have no housing in the traditional meaning of the term. Most of her informants lacked even the most rudimentary elements of shelter available to sustain life. The powerful point made by Dr. Keigher is one we frequently forget and that is there are many elderly people who have run out of housing options and face the unrelenting brutality of the street as their only alternative.

It was stated earlier on that the discussion in this volume would be expansive covering such diverse topics as international perspectives on housing needs to RV’s as a housing solution to homelessness. Despite these diverse topics there have been recurring themes which gives the discussion a necessary coherence. The themes by and large are concerned with housing needs and its quality; continued aging and its implications for supportive environmental, health and psychosocial services; economic and financial concerns; design and development issues; and community issues. Indeed the specific topics may be broad and ever changing, the core themes, however, remain remarkably constant and enduring.

Chapter 2

Supportive Housing Preferences Among the Elderly

Paul M. Baker

Michael J. Prince

Paul M. Baker is affiliated with the Department of Sociology and Michael J. Prince is affiliated with the Faculty of Human and Social Development at the University of Victoria, British Columbia.

SUMMARY. The living arrangements and preferences of older people are receiving increased attention from social scientists and planners, governments, and the housing industry. One segment of this area is “supportive housing,” in which individuals or couples live in self-contained apartments, but have access to certain services. Supportive housing has a long history in Britain, but is just appearing on the scene in Canada. A sample survey of 533 seniors aged 55 and over in Victoria, British Columbia, found a moderately high level of interest in three of the most important components of supportive housing: personal alarm systems, resident managers or caretakers, and meal services. This interest was greatest among those aged 75 and over who are living alone, and among the poor elderly.

The authors conclude it seems unlikely that extended family support systems will greatly reduce demands for formal community support services, especially among the “old-old.” Most seniors, if they could not look after themselves in later life, would prefer to either stay at home with assistance from community services or to move into some form of supportive housing. This type of housing may be a way to prevent undue use of long-term institutional care facilities. Future housing policy should address how to ensure supportive housing options are available, affordable and appropriate to the needs of Canada’s elderly.

INTRODUCTION

One of the most important issues in the area of housing for the elderly concerns the demand for, and availability of different types of family and community support. Most seniors who currently live independently say they would prefer to remain in their own homes as long as possible. Inevitable declines in mobility and health mean, however, that many of them must at some point obtain support to allow them to remain independent yet secure. Recent Canadian studies, reviewed below, reveal a range of living arrangement preferences among seniors should they no longer be able to live on their own. The interplay of different types of housing with different types of community outreach services makes the issue complex. We need more reliable empirical data to refine both our theoretical thinking and social policies. For example, “supportive housing” is a relatively novel form of social housing for seniors in Canada. What components of this new housing option are preferred by the current cohort of older individuals? What social and demographic factors moderate such preferences? These are the central research questions to be addressed in this article.¹

Supportive housing was first developed many years ago in Britain, where it is termed “sheltered housing.” There are three fundamental aspects of this type of housing:

a. the presence of a resident caretaker or house manager;

b. communal facilities for dining (and sometimes laundry and socializing); and,

c. an alarm system linking residents to the caretaker.

The dwelling units are self-contained suites, with private bathrooms, and often small kitchens as well with low-level equipment to allow use by people in wheelchairs. Sometimes the meal service is optional: residents may purchase all or none of their meals. The alarm system may be personal (with a “pager” worn by the resident), or several alarm buttons may be located within the dwelling unit.²

Around the world, there are many different labels for supportive housing. Gutman and Blackie (1985) and Novak (1988) provide good reviews of the terminology and the range of housing programs in Canada, as well as elsewhere. Gurewitsch (1984) used the term “protective housing” for a similar project in Switzerland. “Congregate housing” is the American equivalent to supportive housing as defined above, while in Britain, the terms “sheltered” or “grouped” housing and “Abbeyfield house” are the labels applied by voluntary agencies and public authorities. Abbeyfield housing is normally for very small numbers (8–12) and are more “homey” than the larger scale congregate housing projects in the United States. Although there are over 1000 Abbeyfield homes in Britain, founded in 1956 as an expression of Christian concern for the elderly, the first Canadian Abbeyfield home was only opened in 1987 in Sidney, British Columbia by St. Andrews Church. In Canada and the United States, however, such designs are still relatively scarce. Part of the reason for their scarcity is due to the limited funding provided for such schemes by government. As Lawton has noted:

The funds required for the congregate services to have a real impact are far greater than those now available. Congregate housing can function as a true alternative to institutionalization and thereby is likely to save substantial money that would otherwise have to be used to support the much more expensive institutional care. (1980:102)

The cost savings of congregate housing are still a matter of dispute: Ruchlin and Morris (1987) suggest that total costs of several housing and service options are approximately the same.

Since supportive housing in Canada is very recent, the current demand appears to be far greater than the supply. One of the major institutional reasons for such a lack is that public policy responsibility for housing and health care are normally under two separate governmental auspices. When better coordination develops, supporting housing will become an effective way to lessen the number of elderly who either remain too long at home, or who enter institutions too soon.

PREVIOUS RESEARCH

The major research activity in the area of supportive housing has been in Britain. Heumann and Boldy (1982) provide a systematic overview of the research and policy issues on this topic. They estimate that between 5 and 10 percent of the population aged 65 plus require supportive housing, under the most conservative assumptions of need. In the North American context (Canada and the US), this would translate into a possible population target group of between 1 and 2 million seniors. Reviewing empirical research in the United States and Britain, Heumann and Boldy conclude that there is a very high level of satisfaction with this type of housing, and that mortality, illness, and hospital utilization rates may be significantly lower than among comparable groups of seniors in independent housing.

In Canada research is scarce and regional in scope. For example, a recent large-scale survey on housing preferences among the elderly in Ontario was done by the United Senior Citizens of Ontario in 1985. That study surveyed 846 seniors aged 62 and up, in 5 urban and 6 rural communities. Eighty percent of their respondents were satisfied with their current housing situation. Only 5 percent said they had plans to move soon, and most of these said their homes were difficult to maintain or just too large. Fully 47 percent said they would be interested in supportive housing if they became unable to take care of their major needs.

Other Canadian research on housing for the elderly also suggests that there is a great need for a range of alternative forms of living arrangements. Gutman and Blackie (1985), Hodge (1987), and the Canada Council on Social Development (1976) all came to this conclusion. The work of Bùland (1984 and 1987) Shapiro and Tate (1985), and Wister (1985) all point to the need for some form of supportive housing for the aged. Bùland and Wister both argue that since preferences for privacy and independence are strong in North America, conventional nursing homes are not highly preferred among the elderly.

Connidis (1983) presented some more specific, qualitative data which showed a clear preference for living in a “facility” as opposed to living with one’s adult children, given a hypothetical situation in which the older parents could not look after themselves. This basic preference was explored in detail, and it was found that the preference for an institution was predicated on the assumption that adult children would be burdened by sharing their households with dependent aged parents. In other words, housing preferences are dependent upon levels of care needed, and older adults do not feel it is “fair” to expect their adult children to provide substantial care; institutions are seen as necessary evils, capable of providing care. Storm, Storm, and Strike-Thurman (1985) found similar beliefs about obligations for care in their study of a small sample of Canadian women aged 18 to 85 in a small town. Children were seen as having a obligation to organize care, or to provide for care, which might actually be provided by formal institutions.

In summary, the Canadian literature is consistent in showing the need for something other than a “Home” when the elderly can no longer cope for themselves in their own homes. Most seniors want to avoid being a “burden” on their family, and the relative abundance of long-term care facilities and relative scarcity of alternative housing schemes has made the former the only viable option. Home nursing and home care are becoming more popular, and more widely available, but supportive housing is a new option in Canada which deserves closer study. The close proximity of other seniors and availability of common rooms adds a beneficial social opportunity not found in home care. In addition, home nursing can be more effectively delivered to a number of seniors in a single supportive housing complex than in many individual homes. We will discuss further the benefits of support...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Chapter 1: Introduction
• Chapter 2: Supportive Housing Preferences Among the Elderly
• Chapter 3: Yanks vs. Brits: American Compared with English Retirement Homes
• Chapter 4: Can the Elderly Be Differentiated by Housing Alternatives?
• Chapter 5: Features of Lower-Cost Continuing Care Retirement Communities: Learning from Cost Analysis
• Chapter 6: Housing Preferences of Vulnerable Elders in Suburbia
• Chapter 7: Toward a Definition of Assisted-Living
• Chapter 8: Full-Timers: Who Are These Older People Who Are Living in Their RVs?
• Chapter 9: Personal Coping Strategies of the Elderly in Housing Emergencies: Clues to Interventions to Prevent Homelessness and Institutionalization