The Wisdom of Non-Heterosexually Based Senior Housing and Related Services

Abstract

Understanding the housing needs of non-heterosexual seniors will improve the delivery of social services to more than 3 million gay, lesbian, bisexual and transgender seniors in the United States and aid in the development of new service-enriched housing models for the benefit of all service dependent populations. The feasibility and demand for non-heterosexually based senior housing and related services, however, has received negligible attention. This study is a first step and San Francisco is an ideal place to begin because of the community of non-heterosexual seniors, the City's housing market, the social service resources available to seniors, in general, and the social service delivery technology evolving in response to the AIDS crisis.     

Homes of Choice

Abstract

State policymakers increasingly recognize that housing is not only an important shelter resource for older persons, but also a key element of community-based care. Over the last two decades, significant state and local activity has led to an increase in service-enriched housing for older persons. Service-enriched housing refers to living arrangements that include health and/or social services in an accessible, supportive environment. Emerging forces are leading to increased pressure for the expansion of service-enriched housing. These forces include: a growing and diverse population of older renters; older adults' preferences to age in place; the increasing frailty of subsidized housing residents; the development of assisted living (AL); the enactment of Medicaid waivers; and implementation of the Olmstead decision. Although studies have not included cost-analysis, available research demonstrates that service-enriched housing promotes resident satisfaction, successfully provides services to frail populations, and supports aging in place.

Given both limited resources and research, this article addresses how states can adequately respond to and capitalize on these forces in order to best meet the long-term needs of older adults.     

The Life Course of Leisure-Oriented Retirement Communities

Abstract

Leisure-oriented retirement communities (LORCs) are specifically designed to meet the housing needs of a small but important sector of older population. This research involved informal follow-up site visits to seven LORCs that were the focus of previous research in the 1980s. In general, the communities were found to have remained viable by adjusting to changes in both the housing market and the needs and preferences of residents. Interviews with key informants at each site suggest that, despite economic and social pressures, the viability of these communities has been characterized by the autonomy and stability of community organization and quality of life, as indicated through amenities packages.     

Resource Accessibility and Walkability Among Older Adults in Extended-Stay Hotels

Older adults represent a large and growing population group in the United States. This population cohort is projected to grow to 72.1 million, or 19% of the total population, by 2030, up from 40 million in 2010 (Administration on Aging, 2011; Federal Interagency Forum on Aging-Related Statistics, 2012). Despite reported decreases in the proportion of older adults living in poverty in recent years, inequities prevail. Approximately 40% of older American households reported housing cost burdens¹Cost burdens are expenditures on housing and utilities that exceed 30% of household income. (Federal Interagency Forum on Aging-Related Statistics, 2012). Many of these low-income older adults live in socially and economically marginalized positions, and housing them remains a major challenge complicated by (a) limited affordable housing options and (b) chronic health conditions that seriously undermine long-term health and mobility. In a study on the impacts of public housing transformation in Atlanta, Oakley, Reid, & Ruel (2011) reported that 26% of seniors entered public housing because of a health condition or disability. According to Smith (2006), seniors in public housing are in worse health than other older Americans, even other poor older Americans suffering from such chronic health conditions as hypertension, diabetes, arthritis, and asthma. Despite these realities, Ball (2012) has noted that older adults receive little attention in comprehensive development planning beyond specialized age-segregated retirement and care communities. Salkin (2009) echoes similar concerns about the tendency toward housing initiatives and designs for more affluent older adults. She commented that most states have focused attention on programs that are best suited for seniors who do not have the same income limitations as those who are truly on fixed incomes and living close to the poverty level (Salkin, 2009). While public housing remains the predominant affordable housing option for low-income older adults, such housing is out of reach for many low-income older adults who find themselves displaced and homeless. As a result, some of these adults move into extended-stay hotels to remain sheltered.     

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.     

Targeting Services to Those Most at Risk

Abstract

The budget crises facing many state Medicaid programs have increased interest in the goal of linking services and housing as a way to provide more options to people with disabilities at less cost than institutional care. This article examines some of the premises underlying this interest, especially with respect to linking supportive services and federally subsidized housing for older persons. The first section provides a brief history of the activity in this area. The second section examines the risk factors associated with nursing home admission and how those factors match the characteristics of renters receiving subsidies. The third section focuses specifically on the likelihood that subsidized renters will also become eligible for Medicaid. The fourth section explores the capacity of housing programs to meet the challenges associated with service delivery. Finally, the conclusion examines the implications for public policy decision-makers interested in linking services and housing in order to address the long-term care (LTC) needs of older persons with modest incomes.     

A Comparison of Spanish and American Housing Policy Frameworks Addressing Housing for the Elderly

Abstract

Housing policies in Spain and die United States have important similarities and dissimilarities mat affect housing for the elderly. Spain, even more so than me United States, promotes homeownership. Bom countries face significant challenges in addressing the housing needs of the elderly, particularly those challenges associated wim aging in place. The paper reviews me broader housing policy frameworks in bom countries in order to understand me context for elderly housing policy. The paper identifies lessons from the American experience mat can expand housing policies in Spain.     

Building Affordable Rental Housing for Seniors: Policy Insights From Canada

ABSTRACT

In the context of healthy aging, we explore newly constructed, unassisted affordable rental housing with respect to design, location, and the involvement of seniors in decision making. We do so from the perspectives of seniors and project sponsors. Overall, the themes that emerged from these two groups of participants diverge. Seniors spoke about the importance of shared space, design-related barriers to aging in place, and problems accessing transportation. They also expressed a range of views regarding participation in decision making, from conveying it was not necessary to requesting resident involvement. Project sponsors spoke about cost, feasibility, and, in certain cases, learning how to build housing; they also evinced disparate views about the nature of the housing they were providing and the importance of seniors' involvement. Recommendations include linking housing to health and social policy, implementing guidelines for sponsors related to design and location, and providing increased funding to offset new costs.     

The Impact of Economic,Demographic, and Cultural Changes on Preferences for Independent Living Arrangements and Seniors Housing in South Korea

Abstract

Asian countries are experiencing demographic, economic, and cultural changes that are altering housing and living arrangements. Many South Korean baby boomers will enter retirement with sufficient financial resources to live independently of their children if they choose to do so. Using a derivation of push-pull and life-course movement models, regression analysis results indicate that preference for both independent living arrangements and seniors housing is related to availability of pension resources, sex, presence of a son, and attitudes about intergenerational living, in-home care, and seniors housing. Pensions are an enabling factor; however, the cultural expectation of the eldest son providing housing for his aging parents may continue to moderate the demand for seniors housing developments. [Article copies available for a fee from The Haworth Document Delivery Service:     

Housing Concepts For and By the Elderly: From Subjects of Design to a Design Resource

ABSTRACT

The perception of elderly residents as a homogeneous group is challenged by the diversification of lifestyles and emphasis on individuality in housing. Recently, there has been a rise in Finland in housing projects initiated by groups of elderly people, where the seniors themselves are seeking to fill in qualitative gaps in the offering of housing. This article presents a comparative analysis of four senior housing concepts that represent both a producer-driven (“for the elderly”) and a resident-driven (“by the elderly”) approach. The study shows that elderly people can be a resource for residential development and that this necessitates a different “design logic” than in conventional senior housing.     

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.     

Implementing Multidisciplinary Wellness Programs in Subsidized Housing: University–Community Partnerships

University–community partnerships (UCPs) are an important avenue for providing wellness services to seniors in subsidized housing, but there is sparse literature on this topic. The goals of this article are to (a) describe our UCP, which was unique in involving ethnically diverse older adults, and (b) discuss findings of an integrative literature review of UCP examples in subsidized housing. Results showed that UCPs typically received funding for program development and implementation; used multidisciplinary approaches to needs assessment and programming; and reported positive outcomes such as improvement in self-rated health or participant endorsements. This article provides insights and guidance for future UCPs that are much needed in subsidized housing.     

Long-Term Care Preferences Among Older Adults: A Moving Target?

ABSTRACT

This study investigates long-term care preferences across three hypothetical scenarios and over one year of time among a sample of disabled older women receiving informal care (n?=?420). Unpaid or paid help in one's home was preferred, given scenarios of instrumental activities of daily living (IADL) and activities of daily living (ADL) needs; nursing home care was most preferred for dementia care. While aggregate preferences for long-term care were relatively stable, there was considerable fluctuation in individuals' preferences over time, with just 52.5%, 44.4%, and 44.6% of participants retaining their initial first choice across IADL, ADL, and dementia scenarios, respectively. Implications of study findings are discussed.     

Assisted Living for Lower-Income and Frail Older Persons from the Housing and Built Environment Perspective

Abstract

This paper examines the linkages between housing and supportive services from the built environmental perspective. When it comes to linking supportive services, it is usually true that the wealthier an individual is the more private resources he or she has available to define a personal support system at every step in the aging process; the poorer the individual is, the fewer choices she or he has and the successful linkages of government subsidized housing, health and supportive services become more important to successful aging of that person. Low-income and aging individuals are the real testing ground for whether current policy allows holistic support linkages to occur and whether programs are available in both the quantity and quality to empower low-income older persons with options and support choices.

The discussion that follows is limited to supportive services and aging in place in conventional housing and affordable purpose built assisted living programs and facilities; it omits institutional living. For low-income older persons, institutional care provides few if any housing choices or individual power to control support delivery, and thus linkages between cooperating support professionals and programs becomes increasingly moot.     

Senior Housing in Sweden—A Question of Class Differences and Collective Aging

Abstract

Private senior housing in Sweden has become an alternative to accommodation for elderly in the public welfare system. In the study presented here, the aim was to elucidate this senior housing from the perspective of the residents. The questions that were asked were: (1) Why have the residents chosen senior housing? (2) What are the differences between residents in rental apartments and tenant-owned housing cooperatives? (3) What advantages and disadvantages do the residents think that senior housing has? The interviews showed that: (1) The seniors have chosen the housing for reasons other than its being senior housing; (2) the residents in rental apartments come from the working class and socialize in collective forms, while the residents in cooperatives come from the middle class and socialize through individual initiatives; and (3) the advantages they experience in senior housing are that it involves activities and community. The disadvantages derive from the architectural planning. When the building has a communal yard or entrance, integrity can be threatened and the sense of collective aging can be a Strain.     

Service Enriched Housing and the Senior Living Enhancement Program

ABSTRACT

The Senior Living Enhancement Program was an initiative designed to provide selected services to seniors, including nursing and health promotion, social service coordination, and social and recreational opportunities. The seniors were located at 12 high-rise buildings for the elderly. The main goal of the initiative was to improve the health of seniors in 10 areas called the 10-Keys to Healthy Aging. In general, the 10-Keys to Healthy Aging are strategies aimed at reducing preventable risk factors in the aging population. Over a period of 2 years, seniors showed improvements in a majority of the 10-Keys to Healthy Aging and, therefore, proved the health benefits for elders coming from this service-enriched housing initiative.     

An Assessment of Sheltered Housing Design in Belfast,Northern Ireland

This article presents a UK-based research that has studied the existing sheltered or assisted living housing population and its future housing options and preferences. This meets an identified need to know and understand users' needs and requirements in much more detail that outlines what is liked and disliked by older people about sheltered housing, so that those who plan and design such housing can be aware of their views. The study also sought to understand the architects' challenges in designing and adapting this type of housing. The sheltered housing managed by housing associations in Belfast, Northern Ireland, was assessed through a series of site visits, structured interviews, and a focus group with stakeholders. Findings revealed older users' keen interest in participating in their housing needs assessment, identified building design concerns and provided recommendations for potential design guidelines.     

Local Housing and Service Decisions

Abstract

The purpose of this research was to identify factors associated with local housing and service decisions that support aging adults in rural communities. These decisions represent de factostrategies that affect the quality of life of older residents and their ability to age in place. Data were collected from 951 informants in 134 Midwest rural communities. Analyses were undertaken to identify the role of community characteristics in predicting the availability of a group of housing options and support services. Findings support the notion that the community context is important to the delivery of key housing and service needs. Population size, proportion of community residents 65 years and older, and housing planning processes promoted gains in housing and services.     

Meeting the Needs of Visually Impaired People Living in Lifetime Homes

ABSTRACT

This article explores perceptions on the suitability and effectiveness of Lifetime Homes standards (LTHS) for those with visual impairment in Northern Ireland. LTHS are a series of mandatory United Kingdom public-sector housing design interventions, providing a model for ensuring accessible and adaptable homes throughout an occupant's life span. An aging demographic with increasing incidence of diabetes has led to rising numbers of elderly, visually impaired people wanting to remain in their homes for longer. Qualitative semi-structured interviews were conducted with 13 key stakeholders and thematically analyzed. Although findings show that employing LTHS offers benefits to visually impaired residents, shortcomings were also identified. Evidence indicates a need for policy makers, health-care professionals, and housing associations to modify practices to better meet the housing needs of visually impaired people. Findings may also be applicable to those with other impairments and disabilities in relation to housing for elderly residents.     

Chapter 2. Housing and Household Movement in Later Life

ABSTRACT

In most developed countries housing policies are focusing on enabling elderly and very elderly people to remain in their own homes. Attention is also turning to people in the Third Age to see how their housing needs to be different from earlier stages of their lives but also as a preparation for old age. This paper presents evidence from the United Kingdom (UK) about choices and policies at different stages of middle and old age and on the developing range of housing options to meet these needs.