but evidence suggests that it is not as large as the number of elderly persons now in institutions. Between these two extremes lie the majority of older persons at any one time and the majority of years of "old age" for an individual. The more appropriately the living environment supports the capabilities and meets the needs of this majority of older persons, the longer will be the period during which they can maintain autonomous lives, and the better will be the quality of their living during that span.

Who Are the Elderly Who Are "Impaired"

But Otherwise in Good Health?

In this context, illness or the absence of "good health" refers not to a temporary condition, but to chronic incapacitation for the autonomous conduct of the routines of everyday life. We are not charged with designing convalescent centers but with describing living conditions for persons during relatively stable periods of health. But what is the meaning of "impaired"? In some sense, probably every person past any given age in later years is "impaired" in one or more ways, compared to his previous condition. Almost uniformly, the senses become less acute and motor responses slower. Old friends and family members die, and people are increasingly alone. Income is reduced. Drivers' licenses are not renewed. All these things and more occur, in addition to the increasing incidence of various disease processes, some of them entailing cognitive loss. But the vast majority of older people, despite physical and other problems, prefer and manage to carry out normal routines of daily life on their own.16 The cost of such efforts is not known.

What are the "Residential Accommodations and Supporting Services Needed"?

In implementing programs to enable people to “maintain or return to" independent living, both the characteristics of persons and of environments must be specified. The domain covers a wide range of life styles which lie between a total lack of need for any special assistance and an absolute need for total care in an institutional setting where occupancy is defined in terms of "beds" rather than "living units." The problem is complicated by the fact that the person and his environment interact. An appropriately supportive and stimulating environment can improve competency, while an overly supportive one can lead to deterioration.

Although much lip-service has been paid to the participation of older people in the design of living environments, in actuality they have been given almost no voice. There is now considerable evidence that the user or potential user may have quite a different viewpoint from the expert.17 Shelter and service programs have traditionally been designed by the experts. Older people should be asked to define what is meant by

"residential accommodations and supporting services" for a variety of subgroups and stages of aging.

What are "Assisted Independent Living" and a "Semi-Independent Life Style"?

Clearly implied in both terms is that each is not any form of institutionalization. Surely another implicit descriptor is adequate quality of life. The old person who lived alone, died alone, and whose body was found a week later by a delivery man is hardly our goal model, despite his "independence."

To look at the issue from another perspective, can we identify any other age group that carries on quality living with no societal assistance? School children have hot lunch programs, counselors, nurses, sometimes physicians and social workers. Employers usually provide a meals service, often medical care, and sometimes types of counseling. Our major transportation systems are designed to ensure that the labor force can get to work.

We live in an interdependent society, and many of our major services are delivered through institutions that exclude the elderly. The absolutely independent life style, if it ever existed, rarely does so today for persons of any age. Some of the "impairment" of older people stems from the fact that they do not have access to the societal supports which enable people in other age groups to "live independently." For example, one problem in assessing the impact of retirement upon physical health is that some people see a physician less often after retirement, not because they have fewer symptoms or feel better but because they no longer have access to the "company doctor."18

As people age, they tend to need more services, it is true; but they should suffer no unusual onus over an inability to live in total "independence." Some need only the types of societal assistance ordinarily available to younger persons; others need more. "Assisted independent living" in the present instance means a need for something more than is currently available to the old person. That, obviously, will depend not only upon his abilities to cope but also upon what is available in the community and upon his access to it.

The general issue with regard to the maintenance of independence among the elderly concerns the degree of "fit" or congruence between people's needs and abilities, on the one hand, and the demands, supports, and opportunities within their environments, on the other. For some persons the "fit" of competence and need in relation to environment is adequate, but evidence suggests that they are the minority. The task is to modify environments for better congruence with human capabilities and needs. This is the basic problem to which congregate housing and other

programs for the elderly are addressed. In this light I propose that the conference definition be slightly amended as follows:

Assisted independent group living is made possible by a residential environment which incorporates shelter and services needed by the impaired or socially deprived (but not ill) elderly to maintain or return to a semiindependent life style and to avoid premature institutionalization as they grow older.

There is not going to be one or even one best solution. A variety of models must be developed to meet the needs created by the diversity of persons and situations. One major "model" for meeting the needs of elderly people for shelter plus other services is to incorporate services within shelter. I propose that this is the appropriate concept and role of congregate housing.

Building for the Future

Because the construction of physical facilities is involved, it is wise to include some consideration of future as well as current needs in any decision making process for the development of congregate housing arrangements.

Aging of Tenants

Facilities designed to meet the needs of applicants are soon "outgrown" as the original occupants age and as the age structure of the tenant group skews upward. This has proved true both in retirement communities for the relatively affluent and in public housing for the elderly.

The aging of the tenant population might be slowed or stabilized by a gradual, rather than an immediate, filling of units in a new facility and by selection of replacements on the basis of age rather than time on the waiting list. Simulation studies could estimate the effects of such strategies. However, even if they were favorable with regard to age structure, serious problems would remain in terms of the equity of public funds involved and in terms of early cash flow and later public image for private developers. Alternatively, the metamorphosis of the resident group suggests the possibility of "add on" architectural design and program planning, not unlike that for family homes designed for newlyweds who intend to add bedrooms and bathrooms for a growing family as well as recreation spaces and facilities for children, then teenagers, then young adults. In congregate housing for the elderly, "add on" or expansion features might be services related to health, nutrition, housecleaning, and personal hygiene.

1) Extended and Augmented Health Services. After eight years in residence, nearly a quarter of the residents of Victoria Plaza (23 percent) wanted more complete medical and health services, but non-intrusiveness was important. They wanted additional health services on-site, but they did not want them to intrude into everyday activities and, particularly, not into

the social center. The need for augmenting health services with the passage of time is not unique to public housing but is currently recognized in private retirement communities for the relatively well-to-do.

This suggests that future projects should make provision for later expansion of health services. This "add on" approach would be costeffective by avoiding the premature provision of unneeded services and space for them. It would also help achieve social and personal goals for the elderly, since over-protective environments lead to loss of function. Innovation in the design of facilities is needed, accompanied by careful long-term study of the resulting "natural experiments," in order to determine the appropriate role and form of health services in congregate housing for the elderly. This highly controversial topic urgently needs factual enlightenment.

2) Food Service. The other striking change over time among Victoria Plaza residents was a dramatic increase in their desire for a food service, for some place to buy a meal. After eight years, 79 percent of the residents spoke of this need. It has been assumed that cooking for oneself is a major support of self-esteem and a sign of independence, particularly for women, but recent research findings call into question the universality of this assumption. Surveys in some retirement communities point to the importance of dining facilities; others adhere to a policy of no food service. Conclusive evidence is lacking. Here again, we need innovation on the part of designers and developers, coupled with well-conducted evaluations, in order to determine the relative merits of kitchens, a food service, and combinations of the two for various population subgroups.

3) Cleaning Services. As people age, diminution in strength, agility, and visual acuity, as well as the increment of physical ailments such as arthritis, increase the burden involved in housecleaning. Long before any form of institutionalization is appropriate, assistance with heavier housecleaning tasks would be helpful both in maintaining independence and in safeguarding property. Such services need not be automatic for every resident and may not be necessary for any at the project's initiation; however, as tenants age, these services will become increasingly needed to support independent living.

4) Personal Hygiene. Grooming is an important element in self-esteem; even impoverished men and women desire the services of beauty and barber shops, and these are increasingly important on-site as, with age, the "life space" diminishes in size. 19 As people grow older, the routine tasks of caring for hair, skin, and feet, in particular, become difficult. Unfortunately, relevant services tend to be available only to the wealthy and the institutionalized. Again, innovative solutions should be found to provide these basic aids in congregate housing.

Changes in the Older Population

The elderly who will replace the original residents may be different in many respects from those for whom the facilities were planned. A building

is relatively static for the 30 or 40 years during which it stands, but the characteristics of the older population will be quite different that many years in the future. "We are not only talking about improving the lot of those who are already in their later years; we are talking about ourselves."20 And we might add, in connection with buildings, that we are constructing even for our children's old age.

Some projections for the future can be made with relative safety. There will be more old people, both absolutely and relative to the rest of the population, and this will be particularly striking in regard to the "older old." One clear implication is that there will be more people to shelter and serve over longer periods. Other implications are not so clear. Can we project service needs on the basis of the characteristics of today's old people at the same ages? Probably not.

Tomorrow's old will be chronologically older, but will this be true on functional indexes? This will depend partly upon lifelong nutrition and health care and partly upon the nature of anticipated medical research advances. For example, what will be the environmental design implications of "payoffs" from the current large investments in research on cancer and cardiovascular diseases, and from the progress in organ transplantation as it moves from experimental to technique-refinement stages? As the "killers" in later life are eliminated and their usual victims survive, how will shelter and service needs be affected? What if these "killers" are conquered earlier than the "cripplers"? For example, arthritis and related disorders appear to be highly resistant to treatment or prevention. Today, for a small number of people, someone to "do the buttons" and "cut the toenails" provides the single additional service which allows them to maintain independent living in a setting where basic housework and cooking are provided. This small extra service stands between these individuals and institutionalization, which is totally inappropriate. How many more of them will there be in the years ahead?

As the "killers" and "cripplers" of the later years are brought under management, we will recognize more clearly our need for understanding intrinsically age-related changes in order to plan congregate housing appropriately. It appears that we need not prepare for a great increase in the number of cognitively defective persons as a consequence of the changing age distribution. But to what extent are sensory-motor changes essentially a matter of years since birth? Losses in sensory acuity after about age 70 seem to be so regular as to appear inevitable, as do losses in the speed and agility of motor response, and particularly in perceptualmotor speed, even before age 70.21

Lifelong experience and ingrained habits will differ also among tomorrow's old. They will have had more formal education and probably better retirement incomes. Both suggest higher levels of expectation regarding living environments, and more aggressiveness and competence in demanding what they consider their due. This tendency will be supported