THE CONCEPT AND ROLE

OF CONGREGATE HOUSING FOR
OLDER PEOPLE

Frances M. Carp

Congregate housing is "officially" defined in the 1970 Housing and Urban Development Act and in the 1974 Housing and Community Development Act as low-cost housing in which some or all dwelling units have no kitchens and in which there is a central dining facility. In implementing the program, the U.S. Department of Housing and Urban Development (HUD) has tended to interpret the legislative language as restrictive to food service. Other definitions and different names for the basic concept have been suggested, all deriving from some dissatisfaction with the legislative language and/or HUD's interpretation of it.

What is the source of this unease? Generally, dissatisfaction arises either from some discontinuity between expectation and reality-some gap between problem and proffered solution-or from some ambiguity. Both may be involved in the present instance. Some ambiguities in the terminology will be considered later in this paper, but first let us examine the malaise that seems to stem from the definition. The question then becomes: What is the problem that congregate housing is intended to alleviate?

Housing's Role in Attaining Societal Goals for the Elderly

With regard to older citizens, society has established certain goals which may be summarized as "good quality of life." Dignity, independence, and the exercise of options are among the common descriptors of life quality; to achieve them, programs have been devised to help provide the elderly with adequate income, good living environments, nutritious food, and access to other people and to needed services (health, recreational, cultural, religious, and social).

Housing has been a major focus of efforts to achieve these goals. A large number and some variety of housing facilities for the elderly have been erected, and other types of housing have been made available to them through various programs. Many national and international meetings have been organized around the subject of housing the elderly. There also has

been clear documentation in several research studies that the living environments of older people have decisive impact upon aspects of their life styles and well-being which are reasonably subsumed under "quality of life."

One of the most impressive occurrences in this country in the past 15 years has been the construction of housing which benefits the elderly. These programs were initiated more on faith than on anything else, on the conviction that good housing would be beneficial. There were those who thought that older people would be unable to adapt and that relocating them would be hazardous. And there were those who thought it would make no difference.

Many Federally-funded housing programs affect the elderly, directly.or indirectly. Those that have had the most impact upon poor and moderate income elderly are public housing, Section 202, Section 236, and rent supplement programs. Section 231 housing has touched those who are relatively affluent. Currently, attention is turning to the need to more actively involve the private as well as the public sector in improving housing for the elderly. This urgent need was stressed at the 1973 International Symposium on Housing and Environmental Design for Older Adults:

One of the principal objectives of the Symposium was to encourage increased investment of untapped private capital in housing for older people with an economic return satisfying to investors. 2

Under its various programs HUD has re-housed approximately 750,000 older people, and today about 600,000 of them live in special housing for the elderly. On the basis of this rather impressive amount of re-housing, what can be said about the impact of living environments upon the wellbeing of older people and, in particular, what are the implications of this experience for congregate housing? Despite the impressive number of older people re-housed, the larger figure (750,000) represents only about three percent of the total elderly population. Those persons re-housed probably are a select segment of this population, rather than representative of their age peers in general. Therefore, our knowledge is of limited generalizability with regard to "older people." However, for those who have been re-housed and for others like them, it is instructive to ask: What have we learned about the importance of housing, and how can this information enlighten our work with congregate housing?

Is Housing Important to Older People?

Does improving the housing of older people really help? Benefits following a move to an apartment house which was built under the Section 202 program (and included some respondents who received rent supplements) were reported by Donahue.3 Similarly, beneficial effects following a move to a retirement community for the relatively well-to-do

were reported by Hamovitch.4 Since neither study included non-movers for comparison purposes, the capacity to generalize their findings is limited.

Studies using comparison groups found associations between moving to a better housing situation and various indexes of well-being. 5.6.7 Even these studies are not conclusive. They compared movers with non-movers, but not across time, and, therefore, do not speak definitely about change due to re-housing.

A longitudinal study that compared movers and non-movers in relation to public housing for the elderly reported a similarly favorable impact of improved housing over the first year of tenancy. This finding has been cross-validated in five different housing environments over a similar oneyear interval. With the exception of functional health, the results are consistent with earlier findings, confirming the beneficial effects of good housing, at least over the short run.

Obviously, reactions at the end of one year may represent a "honeymoon" response. Unless benefits are lasting, the investment is questionable. The longitudinal study cited previously has been "validated across time."10 Data from this eight-year follow-up study support the early favorable conclusions. In addition to the "softer" indexes of life satisfaction, well-being, and desired life style, it is now apparent that death and institutionalization rates are lower. Not only has better housing increased the length of life, but also it has increased the quality of the added years. The feasibility of attaining societal goals for older citizens through the medium of housing seems now to be well documented.

Implications of Research Studies

for Congregate Housing

Studies to date justify concluding that: (1) low-cost housing for the elderly is beneficial to competent older people who select it; (2) retirement communities can be beneficial, at least over the short run, to those financially and otherwise privileged persons who choose them; and (3) the elderly who have been studied have not included those most in need of services as well as shelter. Because of the eligibility requirement of "wellness," these elderly have been explicitly or implicitly excluded from rehousing projects (and consequently from the research), either by not being admitted or by having to move out when it became impossible to sustain independent living because the requisite supporting services were not available.

It is clear that improved housing with limited services has positive effects on the physical and socio-psychological health of the elderly. There exists, however, a large but relatively unknown group of older persons whose ability to function independently and to enjoy life is dependent upon the receipt of one or more services. These individuals may be physically impaired or socially deprived, or both, but their needs would not be well met in a nursing home or a "bed care" environment. On the basis of need

estimates made nationally by the Urban Institute, Washington, D.C., there are 2.4 million persons age 65 and older who do not need institutionalization but do need appropriate shelter and services in order to remain outside of institutions. The estimates suggest that 1.1 million of them need congregate housing."I

In applying to congregate housing any wisdom acquired through experience with earlier housing concepts, it is important to keep in mind that the "independent living" environments which have been created and studied are, for the most part, far more than simply shelter. Lurie Terrace, the project studied by Donahue, had a dining room in which one meal a day was served as well as a number of recreation areas in which community groups provided various services and activities. The retirement community studied by Hamovitch advertised its "country club" life style with all manner of services and amenities. Victoria Plaza in San Antonio, Texas (a study of whose residents is referenced in footnotes 6 and 8) included, on the ground floor, the first senior center in the country to be located in a public housing project. Housing for the elderly is not now and never has been viewed as shelter in isolation from other aspects of the surrounding environment. The concept of congregate housing is the newest development in the respected tradition of viewing housing for the elderly within the context of the broader environment and of interpreting housing for independent living to include shelter plus other service elements necessary to support dignified lives of good quality.12

What is new is the recognition that the service components in earlier housing programs are still insufficient to enable an important segment of the older population to maintain or return to highly valued independent living and to relieve society of the financial burden of their unnecessary institutionalization. The success of the more limited early models of congregate housing justifies the expectation that provision of appropriate and adequate services will assist in achieving these vital individual and societal goals. The service provision aspect for the congregate housing program is different from previous programs in that it permits services to be funded together with shelter, acknowledging the central importance of services, in conjunction with shelter, to prolong independent living and to support life quality.

Questions in Defining Congregate Housing

What is to be congregated-living units? old people? services? Congregate housing-taken literally, gathering housing units into close proximity is not novel and is far from unique to the elderly. The decline of free-standing individual family residences and the rise of dwelling units "congregated" into apartment houses, multiplexes, and condominiums are widespread for all age groups, due to population growth, urbanization, land values, and building costs. The overriding advantage is economy in

providing living units. In its literal sense, congregate housing is simply descriptive of a national trend for people of all ages.

Another interpretation of the term is that old people are to be gathered together for residential purposes. Such age clustering may have significant advantages for sociability and mutual assistance. 13 It is efficient for service delivery; obviously, it is in many ways easier to provide services to a concentrated and homogeneous population with similar needs and life styles.14 However, there is evidence that not all older people desire or benefit from age-homogeneous living environments, and that congregating deprived people of any type may impede rather than facilitate societal attention to their needs.15

This leads to the third possibility, that the essential “congregating" is that of services rather than either living units or old people. The scattering of services needed by the elderly and the imperfect efforts to coordinate them are continuing problems. Concentration of services within a residential setting is one way of focusing relevant services and making them available to residents. It is not the only viable model for meeting shelter and service needs nor the best one for all situations. It is of central importance and yet cannot solve the entire problem.

Let us consider the working definition of congregate housing prepared for this conference:

Congregate housing is an assisted independent group living environment that offers the elderly who are functionally impaired or socially deprived, but otherwise in good health, the residential accommodations and supporting services they need to maintain or return to a semi-independent life style and prevent premature or unnecessary institutionalization as they grow older.

I propose that this definition be altered somewhat and be reformulated as a broad societal objective, in the pursuit of which "congregate housing" is one vastly important model for assisting independent living. This subordination is not intended to be demeaning, but rather to further the progress of congregate housing by setting realistic goals. As a background to this proposal, let us examine the major terms in the proposed definition.

What is "Assisted Independent Living"?

Independent living is widely accepted as a central goal among older people and as a major goal for society with regard to the elderly. As people age, their maintenance of independent living becomes more dependent upon environmental supports and upon easy access to more services more frequently. Some portion of the older population seems capable of fending, each for himself, with no special provisions or considerations other than those available to persons of all ages. At the opposite end of the spectrum there is a relatively small proportion of persons who are unable to live independently even with maximal supports, including appropriate services, but who instead need care. The size of this latter group remains indefinite,