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Cypress Glen

100 Hickory Street Greenville, N.C. 27858

919-830-0036

16 May, 1990

Rep. Robert W. Kastenmeier
US House Representatives
Washington, DC 20515

Dear Rep. Kastenmeier:

I am writing in hopes that you will have the bills S.1157 and H.R.3158
(Videocassette Copyright Legislation) set for hearing. I cannot understand
why health care and housing facilities need to be licensed. This is the
residents' home. What is the difference if I invite twenty friends over
to my house and we watch a video? No admission fee is charged.

Viewing movies is a popular and therapeutic activity for residents.
Residents can socialize with each other and they can stay abreast of the
types of films enjoyed by others outside communal settings. The films
enhance the residents' quality of life, a goal shared by residents, their
families, advocates, providers, legislators and regulators.

The motion picture industry wants to charge these organizations, claiming
that they are due royalties in the form of per-bed or per-unit licensing
fees before residents can see these films. Mainly nursing homes have
been threatened with lawsuits by licensing organizations which insist
that these viewings are public performances, which require annual license
fees.

I believe this is wrong, and the residents should be able to view these
films in the health care or housing facilities.

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Copyright 1983 by

The Gerontological Society of America

The health and well-being of 494 residents living in five federally assisted housing projects for the elderly were assessed 12 to 14 years after a similar sample of original occupants of the five projects were studied. A decline in functioning was more notable in psychological than in health domains. All five environments had accommodated such declines by developing different clusters of services delivered by community agencies, and this “patchwork of services" was working reasonably well. Key Words: Housing, Environment, Well-being, Patchwork of services

The Changing Service Needs of Older
Tenants in Planned Housing'

M. Powell Lawton, PhD,2 Miriam Moss, MA, and
Miriam Grimes, BA2

Despite a long history of resistance in federal pclicy to the idea of providing supportive services in housing for the elderly, services have become a fact. Thus there is no longer any point in asking, "Should we have services?" The appropriate question has changed to a series of questions that, if answered, would specify the number, types, locations, and sponsorship of services and the people to be served.

This report summarizes a longitudinal research project whose purpose was to answer three general questions: how tenant populations in planned housing have changed over time, the extent of tenants' current service needs, and the responses of the housing environments in meeting these needs. The answers to these questions should be relevant both to the administration and service planning of housing for older people and to the policy directing future efforts to serve older people in planned housing.

Services in Planned Housing

Most planned housing was built to provide shelter for older people who wished both to improve their housing and to satisfy social needs in addition to the need for shelter alone. An important variation in planned housing is the intensity of supportive services offered in addition to the basic shelter package. Although federal policy in the past discouraged the production of service-rich housing, some sponsors succeeding in building environments that included one or more of a wide array of services for which some need might be anticipated. Service-rich housing became known as "congregate housing," as contrasted with the traditional "independent" or ser

'The research reported here was supported by Grant No. 90-AR-0006 from the Administration on Aging.

"Director of Research Research Associate, and Research Associate, respectively: Philadelphia Geriatric Center, 5301 Old York Road, Philadelphia, PA 19141.

vice-sparse housing. At the present time nominal federal support for congregate housing exists in the form of two demonstration programs currently in progress supported by the U.S. Department of Housing and Urban Development and the Farmers Home Administration. The great bulk of existing congregate housing, however has been developed and supported either through subsidies provided by nonprofit housing sponsors or by services provided at full market rates in projects populated by relatively affluent older tenants (see Regnier, 1975; Urban Systems, 1976). A mix of congregate and independent housing fulfills the overall intent of the planned housing network: to match the level of support offered to the tenants' level of independence. Ideally, congruent matches should provide few services for the independent and many services for the less independent.

The major factor disturbing this neat matching of person and environment is change of both the former and the latter over time. The direction of change in people over a period of years is regrettably downhill. Although chronological aging by no means necessarily implies poor health, the probability that one will develop many chronic illnesses increases with age. By definition a housing environment's original healthy tenant population grows a year older every year. What happens to tenants and to the entire character of the housing environment as both age? What service needs predominate in these "aged" environments?

In a study of two housing environments over a 15and 20-year period, respectively, Lawton, Greenbaum and Liebowitz (1980) found that these projects had progressively added services over the years, in concert with the general decrease in health of both original tenants and new tenants. They suggested that these two projects typified the "accommodating model" of housing - that is, the housing environment as a whole made accommodations to enable

more intensive services to be delivered as tenants' competence decreased. These authors contrasted the accommodating model with the "constant model," which attempts to maintain the character of the original population by three mechanisms. First, stringent medical and behavioral standards for admission are maintained. Second, the competence of tenants is monitored carefully and termination of tenure is initiated as impairment becomes evident. Finally, new services are not added, and incentives are offered to encourage continued independent behavior.

The two models are ideal and do not occur in life in such a highly contrasted fashion. For example, Ehrlich, Ehrlich, & Woehlke (1982) defined an intermediate form called a "balanced model" involving continuity of tenant independence with integration of limited tenant-environment changes, which characterized the housing they studied better than did either the constant or accommodating models. Nonetheless, sponsor and management have considerable control over how much accommodation occurs. A rational congregate housing policy demands greater knowledge of what, in fact, does happen to ordinary housing over time.

The study by Lawton et al. (1980) was conducted at the authors' own facility and of course cannot be considered representative of all housing. More information is clearly needed to describe change under differing conditions. An opportunity to test further the generality of such changes arose from the existence of an earlier study of the original occupants of five housing environments (Lawton, 1980; Lawton & Cohen, 1974). The present research constituted a followup study of these five projects 12 to 14 years after initial occupancy (referred to hereafter, for convenience, as the 12-year followup).

The Research

In 1966 and 1968 approximately 100 randomly selected original tenants in each of five federally-assisted age-segregated housing environments were interviewed immediately prior to and 1 year after their move into the new facilities. The interviews covered a variety of aspects of the tenants' present lives, their perceived well-being, and their expectations and evaluations regarding their housing.

The research sites (fictitious names)

Blueberry Acres is a 156-unit public housing site in a poor but stable neighborhood in a large city. Initially no on-site services were offered.

President Towers is a 143-unit public housing site in an urban-renewal, multiethnic area of a small city, located a 15-minute walk from the central shopping section of town. No on-site services were offered.

Golden Years is a 208-unit Jewish-sponsored Section 202 project one block from the boardwalk of a seaside resort. Initially built in an urban renewal area, by 1980 it was in the heart of the burgeoning casino area.

Ebenezer Towers is a 140-unit Section 202 project situated in a distressed black working-class area on the grounds of a progressive black geriatric center in a large

[blocks in formation]

city. However, no services were originally offered to tenants.

Sholom Aleichem House, snonsored by a jewish fraternal lodge, is a 390-unit 202 project in a strong upper-middle class large-urban neighborhood. Built expressly as a congregate housing facility, it offered daily dinner, maid service, and a medical office for community physicians' use.

Procedure

In 1980. a new representative sample of 100 tenants from each of the projects was interviewed to obtain a long-term, longitudinal picture of tenant characteristics. Six hundred sixty-five tenants were sampled from complete lists of apartments, of whom 87 were not contacted due to death, disability, vacancy, being under 65, and other reasons. The successful completion rate was 74% of all sampled but 85% of all contacted. Ratings were obtained from management on all tenants sampled. Regular and significant differences appeared between those interviewed and those not interviewed, with the latter group always showing lower well-being. Including the non-interviewed tenants, however, would have changed the overall sample characteristic by no more than 3 or 4 percentage points. Thus, although this consistent underestimation of disability must be recognized at every point, the necessary correction would always amount to a very small figure.

The interview content represents the major domains of behavioral competence as they appear in the hierarchy proposed by Lawton (1972): the Rosow & Breslau (1966) Functional Health Status Index (6 items), reported difficulty in performing three activities of daily living (ADL), number of days in hospital, local motility (6 items), and two indices of time use (3 passive activity items and 11 active activity items). The social domain included a number of indicators of family and friends' interaction (both within and outside the building). Perceived quality of life was measured in three ways. First, a series of 15 items comparing current perceived state of well-being to that a year ago comprised a change for the better index. Housing satisfaction (14 items) was a second perceived quality of life measure, and the third was one question as to whether enough activities were offered in the building. Psychological well-being was measured by a 9-item version of the Philadelphia Geriatric Center Morale Scale (Lawton, 1975). Three questions were asked regarding the wish for more services in the housing (checking, activity organization, and help for tenants with personal problems). In addition, a variety of questions were asked to determine whether help was received by the tenant in a number of areas, who gave the help, and whether more help was needed. Managers of the housing made ratings on five aspects of well-being and on whether tenants were in need of 10 different types of services.

Finally, open-ended interviews were held with management, other on-site personnel, local serviceagency staff, and local planning and coordinating bodies in order to learn what services were delivered

and as much as possible about the mechanisms of
service organization and its problems.

A very large amount of information was generated.
The present report necessarily must deal in rather
summary fashion with many of the details in order to
present in an integrated fashion the high points of
data regarding an important service and policy issue.
The results are presented here as answers to the
three basic questions stated above.

How Tenant Populations Change Over Time

Original tenants

One major component of the aging of an environ-
ment is the subgroup of tenants who age in place. Of
the 494 tenants interviewed in 1980, 61 or 12% were
original tenants who had been interviewed in 1966-
1968. These subsequent “survivors" were elite at that
time, compared to all tenants who were interviewed
when the building opened. They were significantly
younger, in better functional health, and more mo-

bile; participated in more activities; and were higher
in morale but not in social interaction (data not pre-
sented here). By 1980, these survivors had, not sur-
prisingly, declined significantly by almost every in-
dex. Thus, long-term residents contributed a
substantially negative trend to the aggregate differ-
ences between the tenant population in 1980 and at
occupancy.

The aggregate tenant environments

The overall change in tenant characteristics over 12
years is the question of major interest. Average age
had increased from 72.8 in 1966 to 77.7 in 1980.
Whereas 25.2% were married among the original
populations, only 7.9% were married in 1980. Simi-
larly, the mean number of living children per tenant
decreased very significantly from 2.1 to 1.6.

Perhaps the most interesting finding is that a rela-
tively small number of changes in competence ap-
peared systematically in every site. Therefore it is
important to show findings both by sites and in the
aggregate, as in Table 1. Because such a small pro-

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*Means coded so that higher score signifies "better" or "more frequent,” except "days in hospital," where high code means more days.
Differences between 1968 and 1980 tested by t for uncorrelated proportions, d.f. = 930.

*p < .05.

**p < .01.

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