Housing first: paradigm or program?

Sobriety, treatment compliance and celibacy have traditionally been behavioral requirements for housing persons who are homeless, regardless of the circumstances leading to loss of home. This remnant of the British Poor Laws is based on the premise that personal and behavioral flaws lead to housing loss and must be remediated before a person can live in permanent housing. A recent approach has reversed this logic and predicates the ability to change based on first providing stable and long-term housing. Termed “housing first,” it is both a housing philosophy or paradigm that everyone deserves a home of their own, regardless of personal circumstances, prior to engaging in any rehabilitative efforts, it also describes specific program models. A review of the research indicates that the success of “housing first” relies more on political support than wide-spread scientific evidence of “best practices”. This report examines the development and scientific evidence for “housing first” programs in North America and suggests that future housing first research examine modifications necessary for distinct geographies and groups of homeless persons.     

Health and Aging-in-Place: Implications for Community Practice

ABSTRACT

There is increasing interest in helping elders to remain independent in their homes. As the nation experiences the unprecedented growth among its oldest residents, public and private efforts are emerging to facilitate aging-in-place. However older people, particularly the oldest old, experience a myriad of issues impacting their health and ability to remain at home. This article presents the findings from a needs assessment of a Naturally Occurring Retirement Community (NORC) (n?=?114) that revealed multiple health-related issues among older people residing in high-need neighborhoods. The study utilized a holistic perspective of health to measure physical, mental, and social well-being among the older residents. Implications for community-based health interventions to enhance aging-in-place are discussed.     

Local Environment of Neighborhood Naturally Occurring Retirement Communities (NORCs) in a Mid-Sized U.S. City

As the U.S. population ages, almost half of elderly householders have lived in their current home for more than 20 years, and a significant majority wish to remain in their current residence or community for as long as possible as they age. Concern with how communities will cope with these trends has led to a growing interest in naturally occurring retirement communities (NORCs), which are neighborhoods or housing complexes that house a concentration of older adults, and their potential to enhance efforts to support aging-in-place. In this article, we examine the local built and social environment of neighborhood NORCs in Tallahassee, Florida, a low-density mid-sized city. We found that a large proportion of NORCs are located in neighborhoods with an urban form, or physical design, that is presumed to be less supportive of active aging, and associated with poor access to amenities, such as grocery stores, pharmacies, and parks. Another substantial portion of NORCs are located in neighborhoods with some aspects of a supportive urban form. We also found that NORCs are over-represented in neighborhoods featuring low residential turnover and above average homeownership rates. This suggests a potential for collective action to facilitate aging-in-place, even in neighborhoods thought not to have supportive physical environments.     

Older Adults’ Use of Adaptable Design Features in Housing Units: An Exploratory Study

In 1997, the city of North Vancouver, British Columbia developed Adaptable Design Guidelines for housing to support aging-in-place for older tenants. This article reports the first qualitative evaluation of those adaptable design features since those guidelines were implemented. The study used a qualitative methodology to explore the elderly tenants’ use and satisfaction of the adaptable design features in the housing units and environmental changes made by those tenants. Key qualitative categories that emerged from the interviews were design preferences and environmental modifications. Findings from this study can inform future revisions of the guidelines and demonstrate what needs to be done in environmental design of seniors’ housing that can foster functional independence.     

Physical Home Environment as a Determinant of Aging in Place for Different Types of Elderly Households

The aim of this research was to investigate the relationship between physical housing features and home modifications to aging in place or precipitating a housing transition among elderly households. Data was taken from two waves (1998 and 2000) of the Health and Retirement Survey. Univariate, bivariate, and multivariate analyses were performed. Residing in a multi-family home without an elevator was a predictor for housing transition for couple households, while residing in a home with small interior modifications was a predictor for remaining in place for single households. Implications for policy makers, health care providers, housing industry and elderly are discussed.     

Housing Cost Burden and Marital Satisfaction

This study assessed the relationship between housing burden ratios and marital satisfaction. We also examined whether economic pressure might mediate this association and whether housing satisfaction would moderate it. Using existing data from the National Survey of Families and Households (n = 5,109 participants), results suggested that participants' housing burden ratio was negatively associated with marital satisfaction. Among homeowners, having a paid-off home mortgage was positively associated with marital satisfaction. These relationships were fully mediated by feelings of economic pressure. Although housing satisfaction was positively associated with marital satisfaction, it did not mediate the association between participants' housing burden ratio and their reported marital satisfaction.     

A Model for Aging in Place in Apartment Communities

The purpose of this article is to introduce a theoretical model for an aging-in-place housing specialist for those living in congregate housing facilities. A “needs assessment” tool is outlined to help facilitate the successful implementation of a Health and Aging Residential Service Coordinator (HARSC), both from a research perspective and from implementation of training curriculum for this specialized population. A model that provides both on- and off-site services is hypothesized to be most effective.     

Young,anchored and free? Examining the dynamics of early housing pathways in Australia

Young people are remaining in the parental home for longer, and returning there more often, before attaining residential independence. In Australia, these patterns have prompted concerns about a ‘boomerang generation’ whose housing aspirations and decisions have either been directly questioned, or viewed as symptomatic of broader affordability issues. Employing a longitudinal perspective, we argue that early residential pathways reflect a mix of stable and dynamic influences involving individuals, their families, and their broader relationships. Using data from a large cohort (n = 2082) of young Australians participating in the ‘Our Lives’ research project, we examine housing pathway formation between the ages of 12/13 and 21/22. Events such as parental union dissolution or partnership formation were found to encourage home leaving, whilst being employed at a younger age and having grown up rurally predicted both leaving and remaining out of home. Close, supportive relationships with family and friends served to ‘anchor’ respondents at home for longer, and parental socioeconomic resources enabled respondents to leave home and return if needed. The findings suggest that early residential independence reflects various factors, not all of which are in young people’s control, and some of which may hinder the longer term sustainability of their living arrangements.     

Aging in Place at Home Through Environmental Support of Physical Activity: An Interdisciplinary Conceptual Framework and Analysis

This article presents a conceptual framework to link issues of health, services, physical activity, and environment to help older adults age in place in their own homes, which may reduce the demands on society to provide institutional long-term care. Using environments to promote physical activity has received attention by researchers, but its impact on aging-in-place at home has been largely ignored. This article interprets and synthesizes existing studies on aging-in-place in relation to health and services, contributions of physical activity to health and service accessibility, and environmental support of physical activity. The conceptual framework can serve as the core construct to address gaps in previous research and as a tool to refine practical targets for policies and interventions aimed at promoting healthy aging.     

Meaning of Home in Later Life as a Concept to Understand Older Adults’ Housing Needs: Results from the 7 Age-Friendly Cities Pilot Project in Québec

To support older adults’ desire to age in place, their housing needs must be well understood. However, little research has explored housing needs from older adults’ point of view. This article, based on the results of 49 focus groups (n = 392) and one case study from the Age-Friendly Cities Project in Québec, Canada, uses the concept of meaning of home in later life to explore older adults’ housing needs. An overview presents how older adults express meaning of home and what their needs are regarding housing and relocation. Finally, the implications for decision makers and stakeholders are discussed.     

Housing Conditions and Risk: Reporting on a European Study of Housing Quality and Risk of Accidents for Older People

The declining capacities in older people often lead to limitations in activities of daily living and a simultaneous rising demand for care services. Many of these limitations in daily activities are to a varying degree caused, enhanced or facilitated by disadvantageous housing and environmental conditions. Home modifications have been credited as an important part of the solution, allowing for an extended and safer use of the home. In order to examine this issue in more detail, this paper provides empirical evidence on the type and extent of risks associated with accidents around the home. It reports on findings from a European case study on the difficulties using the home and risks of accidents which may lead to injury. It is argued that healthy housing conditions for older persons are important to maximize the supportive capacity of one's home, to stimulate an active and healthy lifestyle, and to avoid unnecessary institutionalization.     

The Internet and Demystifying Power Differentials

Abstract

Over the course of the past three years, a group of women residents of a forty-five-year-old public housing project have struggled with the housing authority to participate in the revitalization of that project. This article examines the emergence of a “critical consciousness” and action on the part of these women as a consequence of their going on-line on the Internet with their own home page. This article also looks at the historical and social context of their relationship with the local community and the housing authority as well as the women's ultimate challenge to the housing authority's sense of “exclusive” possession and use of information and data.     

Accessibility Improvement Models for Typical Flats: Mass-Customizable Design for Individual Circumstances

ABSTRACT

Elderly housing policies in Finland emphasize aging in place and preparing the existing housing stock for the predicted increase in the aged population. Timely home modifications that enhance mobile accessibility are a focal target for these policies. This article introduces the idea of mass-customizable architectural accessibility improvement models (AIMs) that have been developed for typical Finnish flats. The applicability and generalizability of an AIM designed for an archetypal two-room flat is tested by applying it to nine case buildings in the city of Tampere. The model was found to be beneficial for 42 of the 45 rooms in the research material.     

Environmental Evaluations and Modifications to Support Aging at Home With a Developmental Disability

ABSTRACT

Increasing numbers of people with developmental disabilities are living into old age and are now residing in community-based housing, largely due to the deinstitutionalization movement. The overlay of age-related impairments onto pre-existing, lifelong disabilities puts this population at a magnified risk for premature behavioral limitations and loss of independence. This article describes a demonstration project designed to enable people with developmental disabilities to age in place. Interviews and observational assessments with 45 older adults with developmental disabilities were conducted in their community-based homes to identify potential barriers to aging in place. An Individualized Environmental Intervention Plan was developed for each study participant, recommending ways to solve problems and eliminate potential barriers. Individualized Environmental Intervention Plans were implemented to the extent possible through home modifications and assistive technology. Pre- and post-modification task performance and self-report revealed the positive impact that home modifications and assistive technology can have. The study demonstrates the need for ongoing evaluation and assessment sensitive to the needs of people with developmental disabilities and the unique characteristics of supported living settings.     

Housing Governance and Senses of Home in Older Age: The Provider Scale

Extensive research examines senses of home in aging, focusing on built and care environments. In parallel, a body of work examines housing governance, reviewing degrees of resident satisfaction. However, there is little crossover between this work, with governance research only rarely considering senses of home. This article argues for attention to the interconnections between provider-scale housing governance and senses of home in older age, arguing that governance mechanisms structure the housing context and provide the framework through which home is experienced and lived. Through a case study of a small, affordable housing community in Sydney, Australia, it shows that housing governance can profoundly shape senses of home in aging, both contributing to and diminishing senses of home. Further, it points to a connection between housing governance and housing design with different housing typologies associated with different aging bodies and forms of management practice, with profound implications for residents' senses of home.     

Marriage and the housing careers of naval wives

The analysis of female biography is problematic, straddling as it does the public world of work and the private domain of home. In recent years the development of life course analysis has encouraged a greater awareness of the variability and complexity of most women's lives. Within this context discussions of the home have centred on domestic relationships, on marriage and parenting. Less discussed have been the implications of tenure and accommodation for domestic responsibility and domestic labour. The home is an arena for family life. Housing is the basis of home-making and many of the responsibilities of housework and maintenance devolve on women as home-makers. The interrelationship between housing and the domestic relationships of women was explored in a research project concerned with the wives of Royal Navy personnel. The marriage patterns and housing careers of these women revealed a biographical pattern that was distinctive and largely uniform. This pattern was the product of an occupationally-related structure of housing options and the wider pressures towards home-ownership. This pattern shaped the domestic responsibilities of the naval wives and their relationships with husbands and children and had implications for their patterns of employment and family formation.     

Moving Past Picket Fences: The Meaning of “Home” for Public Housing Residents

The literature on the meaning of “home” has generally focused on creating lists without giving much attention to the context that shapes meanings. Recently, scholars have argued that to understand “home” it is important to know the range of meanings that different people in different contexts give it. In this article, we focus on the meaning of “home” for public housing residents and consider how they construct the meaning of “home” and if they find that meaning in public housing. Our findings suggest that respondents consider their public housing residences to be “home,” and they construct this meaning using the dimensions of home identified in the literature. However, how respondents used these dimensions were, in some ways, different because of the context of living in public housing. Respondents emphasized the social dimension, and this dimension appeared to organize the other dimensions. As such, our findings support arguments that context matters to the meaning of “home.” They also suggest that policymakers need to broaden their understandings of public housing, as places that can be “home,” and use this understanding when making decisions about housing transformations.     

The Role of Design Factors of the Residential Environment in the Physical and Mental Health of the Elderly

This study examined the relationship between selected dimensions of architectural design and measures of physical and mental health and morale among 171 elderly residents of congregate public housing and private housing. Several indices of social interaction were also investigated as possible mediators of the effects of the design factors on health. Design factors included congregate public housing versus private housing; high-rise versus low-rise; floor level; position on corridor; length of corridor; distance from elevator; number of bedrooms; and home ownership versus renting. Residents of congregate housing, high-rise buildings and those living at the end sections of corridors were found to be significantly higher in morale, but not in physical or mental health. Social interaction was not found to contribute significantly to this relationship.     

Paternal Incarceration and the Housing Security of Urban Mothers

High rates of imprisonment among American fathers have motivated an ongoing examination of incarceration's role in family life. A growing literature suggests that incarceration creates material and socioemotional challenges not only for prisoners and former prisoners but also for their families and communities. The authors examined the relationship between fathers' incarceration and one such challenge: the housing insecurity of the mothers of their children. Using data from the Fragile Families and Child Wellbeing Study (N = 4,125) and a series of longitudinal regression models, they found that mothers' housing security was compromised following their partners' incarceration, an association likely driven in part, but not entirely, by financial challenges following his time in prison or jail. Given the importance of stable housing for the continuity of adult employment, children's schooling, and other inputs to healthy child development, the findings suggest a grave threat to the well‐being of children with incarcerated fathers.