Click for next page ( 27


The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page 26
Proposals for Policy and Further Research When the housing problems of older people first arose as a matter of public concern during the late 1950s, the direction of policy and the programs to implement it were relatively clear: to build good-quaTity shelter for the large number of older people who were relatively self-supporting but who were limited by income in their ability to find decent housing on the open mar- ket. New housing production was one way to provide economic relief for the poorer elderly. At about the same time, methods were also under consideration for providing economic relief in Tong-term health care for the elderly. Two strategies that were implemented were the redefinition of the home for the aged and federal facilitation of nursing home development. Simply stated, then, the federal government wanted to elevate the quality of life for the Tow-income independent older person through improved housing; it wanted to do the same for the Tow- income disabled older person through nursing home care. Yet these intended policies did not readily accommodate subsequent changes in American society in general and in the elderly pop- ulation in particular. First, the income of older people improved measurably, shrink- ing the size of the financially indigent population. Second, the distinction between independent and dependent elderly persons became blurred: an elderly person's health status could vary, and there were often unequal rates of change among older resi 26

OCR for page 26
PROPOSALS FOR POLICY AND FURTHER RESEARCH 27 dents clustered in the new housing of the 1960s. Third, the OlderAmericans Act, the Social Security Act, and Medicare es- tablished the concept of chronological age as a basis for entitle- ment to national programs. In housing and health programs, it became recognized that prospective clients were not dichotomously healthy or unhealthy but could exhibit health conditions of any stage in between. Thus, the nation saw the development of intermediate residen- tial models-housing for the elderly that fell somewhere be- tween their own residences and the total care provided by nurs- ing homes as well as the emergence of local, home-delivered services that came to be known as community-based long-term care. All of these developments seemed to be going in the "right" direction that is, working toward a greater ability to match the characteristics of environments and services to the varied needs of elderly people. But expectations about the country's ability to produce enough housing units, enough varieties of residences, and the right mix of services were diminished by the economic downturn of the late 1970s. At this writing (1987), all federally assisted new housing con- struction programs have been terminated except for the Section 202 program, which survives on a year-by-year basis over the recurring objections of the national administration. Nursing home construction with the aid of public funds has been greatly reduced. Experimentation with locally provided community- based Tong-term care continues in spite of reduced public fund- ing fueled by private sector innovations and a demand by elderly clients. Although the present may be a time for the consolidation of these efforts, it may also be an appropriate time to identify objectives in environmental policy for the future. This chapter discusses four policy areas: age and disability, environmental services and the well-being of older people, person and environ- ment in life-span perspective, and self-determination in environ- mental decision making. AGE AND DISABILITY Neugarten (1982) and Binstock (1983) have suggested that there should be no ambiguity in an elderly person's eligibility for services and programs. One form of eligibility may be chron- ological age; another is need as defined by levels of disability or

OCR for page 26
28 COMMITTEE ON AN AGING SOCIETY poverty. As some gerontologists have warned might happen, the United States is currently in the midst of a disruptive quarrel over "age equity" (Kingston et al., 1986; Preston, 1984), a quar- rel fed by the resentments of people who believe that benefits are going disproportionately to older people who are not neces- sarily in economic need. Thus, a first question is whether na- tional housing policies have emphasized chronological age in their definition of entitlement in a way that undermines the credibility of the policies. In general, they have not. There was a time when substantial federal support went into mortgage insurance and low-interest loans to housing or nursing homes that served older people who had incomes well above the poverty level, but those subsidies have for the most part ended. The attention of national housing policy is now focused on Tow-in come persons. Another complaint that is sometimes made is that the new construction of public programs became concentrated on older income-eligible clients, some believe to the neglect of younger families. This trend can be seen in the high proportion of public housing and Section ~ units that were provided for elderly per- sons in the 1970s. Thus, age can be said to have been an advan- tage in the distribution of scarce national housing resources. Currently, there is concern that almost no new housing for low-income people is being built to replace units being lost through the normal processes of housing turnover. However one may applaud programs to conserve and rehabilitate older hous- ing, it ought not to occur at the expense of the program that has produced 800,000 or so new units over the years. Moreover, in the process of modifying the original objectives of federal hous- ing policy and defining its target group more carefully, in addi- tion to income the age criterion must be redefined to recognize the housing needs of people of all ages. It is possible that limiting high-expense programs to the most financially needy may require the introduction of an added cri- terion in addition to age and income. Some discussion is needed to develop a consensus about whether less expensive forms of assistance should be substituted for new dwelling units for poor older people, reserving the more expensive programs for poor older Americans who are also disabled. A question that is often raised is the issue of what minimal level of quality is everyone's right. Having been guided so strongly and for so long by the

OCR for page 26
PROPOSALS FOR POLICY AND FURTHER RESEARCH 29 simple view that our national programs could provide quality housing for all, insufficient attention has been paid to specifying the minimum right versus the purchasable options. Whether health should be an additional eligibility criterion introduces a second major policy issue: that of the relationship between the environment of the elderly and their health and social services. ENVIRONMENTAL SERVICES AND THE WELL-BEING OF OLDER PEOPLE The demographic and health data presented in this volume (see the eight commissioned papers) quite effectively portray the size of the "vulnerable" population as a minority of all aged persons. Yet what must also be considered is that elderly persons who are vulnerable by reason of health deficits are likely to be vulnerable in other ways. Historically, federal housing programs housed older tenants who grew less independent with the years, creating a growing group of disabled people who required something more than mere shelter. The congregate housing model that is, a facility with supportive services that is clearly a housing unit and not an institution became firmly established during the one phase of housing development for the elderly (although never as ubiq- uitously as is sometimes presumed). For a time, it seemed as if three models of residence would serve most elderly people's housing needs: independent housing, congregate housing, and nursing homes. The reluctance of society to support these three housing mod- els financially forced us to search for alternatives to these rela- tively expensive physical facilities. Social gerontologists were probably late in recognizing the strength of older people's wishes to remain in their own homes in the community. Indeed, there may be a ceiling in terms of the proportion of older people who may be candidates for planned housing, given improvements in the access of older people to good supportive services that would enable them to remain in their own homes. An apparent failure to pool housing-related resources at the federal level may be traced to an attempt to maintain separate programs by the U.S. Department of Housing and Urban Devel- opment (HUD) and the U.S. Department of Health and Human Services (HHS). This lack of integration of related services was

OCR for page 26
30 COMMITTEE ON AN AGING SOCIETY extended to the local level, and as a result, opportunities to develop integrated services were missed. Such opportunities in- cluded planned small-scale equivalents of congregate housing, (Lawson et al., 1985), supportive small-scale housing alterna- tives for the marginally independent, and the incorporation of a strong housing-quality component in local community-based long-term care programs. The papers by Soldo and Longino and by Struyk in this volume discuss the importance of a health component in housing pro- grams and the connections between housing, health, and social service programs. As these authors point out, major policy issues remain. For instance, where does the responsibility lie for facil- itating, by a policy of housing maintenance, the continued resi- dence of older people in homes of their own choice? On balance, it is clearly more cost effective to subsidize the maintenance of the usual older existing home rather than pay the costs of re- placing it with a new home. Yet the problem confronting policy- makers is the large backlog of potential clients and the high administrative costs of a centralized small-repair and mainte- nance program for older homes (Struyk, 19851. In attempting to delimit the scope of public responsibility and establish priorities for housing assistance, it may be necessary to exclude health and disability criteria to qualify for federal assistance in home adaptation. Soldo and Longino (in this vol- ume), Newman (1985), and others have demonstrated that mul- tiple deprivations tend to occur in the same people, who then exhibit a combination of unmet needs: insufficient income, poor housing, ill health, and apparent social needs. More specifically, the impaired elderly who are now being served by subsidized in- home service programs may well constitute a pool of possible candidates for home repair and home adaptation services. Such services might make the critical difference that would enable these people to remain at home instead of moving to a more . expensive rest .ence. One value issue, then, is whether the nation (like some other countries that assist the elderly in maintaining their independ- ent living) is prepared to pay for additional services that may reduce the necessity for the institutionalization of older persons. A policy dilemma that must also be faced is the failure to ad- dress quality-of-life issues for healthy but low-income elderly

OCR for page 26
PROPOSALS FOR POLICY AND FURTHER RESEARCH 31 who live in deficient housing. Does one approach take prece- dence over the other? The first two policy areas reviewed in this section have in- volved vulnerable older people who constitute a high-priority group even though they may be a minority of older people. Needy as this group may be in terms of policy attention, the field of person-environment relationships has much to offer in improv- ing the quality of life for all older people. Two further policy- relevant areas suggested by the papers presented in this volume are the life-span view of person-environment transactions and the issue of self-determination in environmental decision making. PERSON AND ENVIRONMENT IN LIFE-SPAN PERSPECTIVE Although the authors of papers in this report were not asked specifically to address life-span issues, any broad approach to housing policy must place some of the major policy issues within the context of the life-span perspective. One proposal made ear- lier suggests that the needs of the [Larger society require that some measure of equity be established regarding the housing needs of people of different ages. An important moderator of concern about age equity, however, is the realization that the beneficiaries are seldom restricted to one specific age group: benefits for one generation often produce benefits for other gen- erations. For example, housing subsidies for older people in the form of planned housing developments are likely to remove fi- nancial burdens from younger wage earners, allow more dwell- ing-unit space for growing children, and diminish the intrafam- ily conflict that is often associated with involuntary home sharing by adult children and their elders. Yet what is equally important is to conceptualize a person's life as an "environmental career," a notion that introduces basic theories of persons in environments with each person shoulder- ing the task of maximizing the gains and minimizing the stresses of the various environments inhabited over the course of one's lifetime. If we agree with Campbell et al. (1976) that people make a continuing series of choices and engage in active behaviors that lead to their successful approximation of an ideal

OCR for page 26
32 COMMITTEE ON AN AGING SOCIETY environment, it is not surprising to find that older people are more satisfied with their ultimate housing, their neighborhoods, and other facets of their environments than are people of younger ages. One line of reasoning suggests that planning for one's housing environment in old age should be a lifelong process. This ap- proach may be intuitive for many older people for despite the problems of nonliquidity, some 75 percent of all elderly in the United States own their own homes. Buying a home is only one of a variety of "housing adjustments" (in Struyk's terms) that a person is required to make. If we enlarge the foregoing concept to "environmental adjustments," it is possible to identify a large category of tasks and decisions that extend across the life span and for which there is need for intervention. The promotion of national policy to direct such interventions is urgently needed. The concept of environmental adjustments clearly includes the transportation concerns expressed in this volume by Wachs, the specific housing interventions discussed by Regnier, and the rad- ical readjustment proposed by Morgan, together with the out- come of "quality-years" cited by Kane. Perhaps the most useful general policy directive emerging from a proposed life-span view is that priority should be given to interventions whose benefits are germane to multiple age groups. Indeed, any proposed program should be analyzed for its contemporary effects on multiple generations in addition to its probable effects on recipients at later stages of their lives. To reiterate, one principle that ought to guide policy develop- ment in the environmental area is that what is found to be useful for older people is likely to be useful for people of any age as well as for disabled persons. Contributions to the improve- ment of housing, neighborhoods, and consumer products for most people may begin in a search for user-friendly designs specific to the elderly; yet many of the design adaptations discussed by Regnier have the capacity to enhance the quality of residential life for people at any stage of life. There are many implied policy proposals contained in the pa- pers included in this volume. For example, Struyk's plea for enlarging the opportunities for timely modification of older per- sons' housing might well influence the building of age-irreve- lant housing with features that increase the adaptiveness of the residence to the changing needs of its occupants over time. Wachs

OCR for page 26
PROPOSALS FOR POLICY AND FURTHER RESEARCH 33 has noted that security is a major need for older people as they traverse their neighborhoods or use local transportation. Im- proving security for them will improve the quality of life for all transit users. And as Kane suggests, the processes of teaching and establishing an older person's familiarity with new housing- relevant technologies will reveal useful methods that may apply to younger users as well. (This principle applies despite a mis- taken assumption that user-friendly technology is not relevant to the young.) In summary, the life-span conception of an environmental ca- reer leads the process of policy formulation toward a broader conception of the common good in the realization that there are few environmental benefits for one group that cannot be made to work to the advantage of people of any age. This broad con- ception argues against the idea of age-targeted environmental designs. In contrast to this point of view, however, is the notion of disability-oriented or deprivation-targeted housing design. SELF-DETERMINATION IN ENVIRONMENTAL DECISION MAKING There are a number of particular ways in which the varying needs, preferences, personalities, competencies, and disabilities of a person influence his or her use of the environment. The personal factor in environmental interactions should be ad- dressed to give adequate recognition to individual needs and the ability of older people to shape their own living environments, both as individuals and as a group. The environmental career of a person is determined in part by the nature of the environment into which the person is thrust and partly by the active choices the person makes in the selec- tion of environments and in the shaping of either the given or the chosen environment. It may be useful to think of the way people interact with allotted or chosen environments as a ten- sion between reactivity and inactivity. In addition to this behav- ioral dialectic, there is a conflict-laden need between the wish to be challenged and the wish to be secure. National housing policies for the elderly tend to assume that old age is only a time of reactivity and a striving for security. The wish to remain in one's own home is but one instance of the preference in the elderly for autonomy within the limits of

OCR for page 26
34 COMMITTEE ON AN AGING SOCIETY a person's physical, mental, and economic capabilities. Yet how can housing policies be modified to facilitate such active choices as proposed by several authors in this volume? Community- based services for elderly persons in congregate housing and in other housing alternatives can extend the period of community residence. Although neighborhood dynamics were not originally to be part of this volume's scope, Wachs' underlining of how a lack of physical security may limit personal autonomy com- mands attention. Other forms of neighborhood-wide interven- tions that help people form at least preliminary relationships with one another need to be supported by policies affirming the worth of neighborhood preservation. An important feature of Sweden's in-home services for the elderly, as described by Sven Thiberg (in this volume), is the assistance given by close neighbors, stimulated by small organ- izational and financial incentives providLed by the federal gov- ernment. Such an approach has the advantage of enabling active roles for neighbors who are prepared to help the less independ ent in their vicinity. There are few older people who are so impaired that some degree of choice or autonomy is not within personal range. Our policies regarding institutional care, as Regnier noted, however, have supported many regulations that work against preserving even limited independence for people who must live in a partic- ular setting. Institutional regulations that import rules from acute care hospitals or that place an undue premium on the maintenance of rigidities and internal order defeat the provision of a flexible living environment for residents. In practice, in such a situation, few independent behaviors are rewarded. The performance of instrumental roles such as the making of one's bed or the assumption of responsibility for one's small living area is discouraged in the name of conforming to internal regulations. In practice, there are few incentives for designers, sponsors, or administrators to attempt innovative efforts in providing envi- ronments that maximize choice. For example, consider the small manufactured home and its relative, the "granny flat." Current technology can produce such units at reasonable cost to accom- modate a person's changing needs, but local zoning, land use restrictions, and building codes have hindered the implementa- tion of this approach. Some of the authors of the papers in this volume emphasize

OCR for page 26
PROPOSALS FOR POLICY AND FURTHER RESEARCH 35 the importance of consumer preferences in giving direction to technological developments in housing. Certainly, demographic projections support the idea that an unprecedented number of older individuals will be financially and intellectually capable of expressing and acting on personal preferences in the open economic market. At the same time, consideration must also be given to raising the quality of housing for the segment of the older population that is not financially solvent or knowledgeable enough to participate fully in the market economy. One way to achieve this goal is to target life-enriching programs more to- ward the poor older person. Such publicly subsidized programs as senior activity centers, transportation, and educational activ- ities are likely to elevate the quality of life, but a substantial proportion of these resources tend to be consumed by people who may not require subsidizing. On the other hand, targeting such programs only to the poor may mean they are politically less viable and poor in quality. In any case, a policy that leads to creative efforts to design aspects of the physical and social en- vironment that challenge and engage healthy but economically deprived older persons should be a priority. To sum up, the prevalence of a proportion of elderly persons with poor health and economic deprivation identifies one target group of older people on whom it is appropriate to focus as subjects for environmentally significant subsidy programs. Yet the majority of older people are healthy when they enter old age, and they may remain in good health for most of their lives; in such cases, their relationship to the environment is a contin- uous process of active choices and self-determinative behavior. Therefore, each proposed housing policy must consider carefully its effect on the use of the environment in bolstering the quality of a person's life. From this perspective, policies are not age specific but contribute to the autonomy and well-being of people of all ages. RESEARCH AND POLICY NEEDS An important function of the papers prepared for this volume was to point to research needs whose implementation might lead to better theory, policy, services, and design of the social and built environment of an aging society. Yet the concept of person- in-environment is by its nature quite broad because it must integrate discrete elements that are usually treated separately

OCR for page 26
36 COMMITTEE ON AN AGING SOCIETY for convenience: that is, the person, the small group, larger aggregates of people, social institutions, culture, values, and the physical environment. To achieve an integrated policy and re- search product requires a multidisciplinary array of partici- pants that includes but is not limited to physicians, psycholo- gists, sociologists, anthropologists, policymakers, architects, and planners. Precisely because the field of person-environment relation- ships is so wide-ranging, it requires a special category of re- search to address the knowledge-implementation process. It is not accidental that specific attention to these special research needs was cited in the papers in this volume by the two archi- tects in the group, Regnier and Thiberg. The "doers" those who actually design our physical and to some extent our social envi- ronments and the risks of such housing are at the far end of the chain of knowledge generation that begins with theoretical biology, psychology, and other academic disciplines. Although some designers active in the investigation or exploration of per- son-environment relationships are themselves researchers or are research oriented, the majority of their peers are not. The latter group depends on socially determined channels of com- munication for their knowledge, a process strewn with many barriers, as documented by Regnier and Thiberg. Thus, one major research need is for a focused inquiry into the life course of design-relevant ideas: the multiplicity of sources of the idea such as the potential user, the scientist, and the profes- sional; the way the idea is subjected to verification; the multiple modes of transmission of the information; and the determinants of the extent and manner of its adoption, both informally in common practice and formally in regulations, housing codes, law, and broad special policy. The knowledge-implementation process is a special research need and is therefore given special priority in this section. Yet there are also other research needs that have been suggested in the papers included in this volume and in discussion on the topics that follow. Population Issues The many compositional changes that have already occurred within the aging population and future projections of coming change (see Serow and Sly, in this volume) constitute an essen

OCR for page 26
PROPOSALS FOR POLICY AND FUR TRIER RESEARCH 37 tial aspect of the social environment of older Americans. Re- search is needed to study the effects of such changes on the aging individual at the micro end of the scale and on the total society at the macro end. One poorly understood determinant of the behavior of the elderly is the effect on an older person of having aggregates of people in close physical proximity or within the person's subjective awareness what may be called the su- prapersonal environment. Thus, as older people migrate from one location to another, differing mixes of individuals in terms of age, health, condition, ethnicity, and other characteristics- are available with which the older person may interact. The effects of comparative changes in the educational and income levels of aging cohorts on their social attitudes is an- other phenomenon requiring study. For example, will the greater numbers of the old old reinforce the social stereotype of age as a period of disability? How much will the growing affluence of new young old cohorts counteract any negative social valuation of the broad category of older persons? In fact, what will the economic status of future cohorts of older persons be, given the shifts now occurring in the economy (from industrial to service jobs, earlier retirement, etc.? How will all of these trends affect housing policy? Researchable questions also arise regarding the effects of the migration of older people into an existing community, including the net effect on demands for local services and amenities, as well as their integration with the nonmigrant population. Housing Programs Housing adjustments within a life-span perspective are a pri- mary focus for research because they allow the study of the process by which changing needs, social conditions, and family status interact with housing and other environmental attri- butes. The manner in which residential decisions are made and the nature of the barriers and facilitators what Struyk calls timely adjustments are areas about which too little is known. Research is also needed on the multigenerational effects of hous- ing services directed toward older people. There is a need to document more thoroughly the indirect benefits to adult chil- dren and to grandchildren of the economics of housing assis- tance and the social consequences of separate living arrangements.

OCR for page 26
38 COMMITTEE ON AN AGING SOCIETY The conditions under which alternative housing is acceptable to older individuals is an area that requires further research, including community-level studies of how such enterprises as shared housing, match-up services, and other housing forms get started and under which conditions they succeed or fail. In ad- dition, the last word on congregate housing for older people has not been written. One of the messages from HUD is that better targeting of services for older persons and the adjustment of services to local needs would work in the interest of improved efficiency and cost-effectiveness. A series of variations on the basic model of housing for older persons should be implemented and evaluated. For example, the service block concept used in Sweden is one of many forms evolving outside the United States that could be tested experimentally in this country. Congregate housing service programs could be effectively concentrated in housing sites that will give preference to elderly persons. Finally, research and demonstration efforts could be directed toward identifying a feasible way to introduce a modest home repair/maintenance/home adaptation program into local com- munities. The administrative overhead costs seem to preclude the establishment of such a program in a centralized form, but there are excellent models currently working at local levels in cities such as Everett, Washington. Another promising demon- stration project idea would be to train social- or health-oriented in-home workers in basic skills that could then be transmitted to newly impaired older residents to make their current home functionally usable. Technology The interaction between the elderly and technology is just beginning to receive research attention. A somewhat abstract question raised by Kane deserves attention: how to introduce and measure the benefits or other effects of technology on the quality of an older person's life. A general recommendation might be that every attempt to assess the economic effect of a new technology be expanded to include its psychological and social impact on the user. Finally, on the macrosocial level, research is needed on the way political decisions that control the accessibility of various

OCR for page 26
PROPOSALS FOR POLICY AND FURTHER RESEARCH 39 innovations are conditioned by community attitudes and value judgments regarding the aging. Productivity and New Environmental Forms The massive field trial proposed by Morgan on the pooling of resources is an appropriately researchable idea on the productiv- ity of older people. What is needed is to determine the limits of older people's abilities to "bank" the services they give and to accept an economy based on the exchange of services rather than on money or the use of volunteers. In addition, another issue is raised by a proposal of this kind. Morgan, as does Regnier, poses a clear trade-off between the need for privacy and individuality on the one hand and for sociability and integration on the other. Research on this issue, both at the level of the individual home and at the level of group housing environments, is recommended. The Vulnerable Aged In portraying some of the current approaches to the problems of the vulnerable aged, Soldo and Longino raise many as yet unanswered questions about the alternative pathways to care by household members versus nonhousehold members and to care by family versus formal organizations. For example, would it be helpful to know what personal characteristics of an im- paired person generate the desire to continue to live alone and retain autonomy? What is the best route toward achieving changes in the physical configuration of the home to support independence? What kinds of compromises are involved for var- ious family and household members when an impaired older person is maintained at home? Related to the concept of the environmental career that sub- sumes a [Lifetime of housing adjustments, a more limited "care- giving/care-receiving career" is also deserving of study. In addi- tion, the course of beginning impairments and the overlay of multiple impairments, other issues raised by Soldo and Longino, require study in relation to residential decision making. Finally, a careful analysis needs to be made of the environmen- tal behavior of cohorts of affluent older persons as they move into old age. Their choices and preferences will provide prelimi- nary information on the consumer preferences of larger num

OCR for page 26
40 COMMITTEE ON AN AGING SOCIETY hers of older people in the future. It is also possible to use and adapt such knowledge in planning for the needs of the poor and the near-poor elderly, the groups identified by Soldo and Lon- gino as the most likely to be deprived of adequate housing. Transportation The specific ideas on research in Wachs' paper in this volume recognize the importance of differences in types of neighbor- hoods in planning services for the older person. It seems clear that the effects of differing physical and social forces at the neighborhood and community levels are poorly understood in addressing the environment of aging persons. Although Wachs points out that transportation is primarily an instrumental activity rather than a goal in and of itself, this very observation raises the question of identifying the condi- tions under which transportation per se may be a primary goal. Is it possible to walk, drive, or ride public transportation for sheer enjoyment? Is such transportation behavior likely to be attractive to older people? Can research on this topic lead us to a broader repertoire of life-enriching experiences in an aging society? Concern about the possible restrictions of experience engen- dered by the inaccessibility of transportation has engendered questions about the processes by which a person's "social space" becomes restricted. Growing disability may lead to a diminish- ment in the geographic extensiveness of activity patterns; an- other possibility is that an involuntarily imposed restricted range of transportation alternatives may blunt the desire for new experiences. These several aspects of the mobility of older persons deserve study. A host of cost and cost-benefit issues are raised by Wachs including the dichotomy of mainstreaming versus tailored spe- cialized transportation services. Wachs' identification of such factors as institutional resistance to resource pooling and the incentives to potential fraud in the voucher approach illustrate the multiplicity of unanswered questions still remaining after years of demonstration transportation projects. There is a clear need for more disciplined research in evaluating contrasting approaches to satisfying the mobility needs of an aging population.

OCR for page 26
PROPOSALS FOR POLICY AND FURTHER RESEARCH CONCLUSION 41 Although the researchable issues articulated in the preceding pages were implicitly or explicitly suggested by the authors of the papers in this volume, the issues proposed for study tend to exhibit a bias toward the individual in relation to the larger environment. Yet there is also great richness in terms of policy implications and research needs in the macrosocial and eco- nomic areas that were not covered in this review. Similarly, there are many important environmental topics that simply could not be addressed within the limits of the resources availa- ble for this project. Some of the missing topics include such areas as rural aging; neighborhood and community planning; the per- formance of nursing homes, acute hospitals, mental hospitals, and nonresidential facilities; the role of the family; the ethical underpinnings and values to be achieved; and the cultural as- pects of person-environment interactions. Additionally, re- sources limited a consideration of how data and policies in other countries (beyond Sweden) can enrich and inform our policies. A complete agenda for future policy consideration should include these areas. REFERENCES Binstock, R. H. 1983. "The Aged as Scapegoat." The Gerontologist 23:136-143. Campbell, A., P. G. Converse, and W. Rodgers. 1976. The Quality of American Life. New York: Russell Sage Foundation. Kingston, E. R., B. A. Hirshorn, and J. M. Cornman. 1986. Ties That Bind: Interdict penitence of Generations. Washington, D.C.: Seven Locks Press. Lawton, M. P., M. Moss, and M. Grimes. 1985. "The Changing Service Needs of Older Tenants in Planned Housing." The Gerontologist 25:258-264. Neugarten, B. L., ed. 1982. Age or Need? Beverly Hills, Calif.: Sage. Newman, S. J. 1985. "Housing and Long-Term Care: The Suitability of the Elderly's Housing to the Provision of In-Home Services." The Gerontologist 25:35-40. Preston, S. H. 1984. "Children and the Elderly in the U.S." Scientific American 25:44-49. Struyk, R. J. 1985. "Future Housing Assistance Policy for the Elderly." The Geron- tologist 25:41-46.