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The Relation of Housing and living Arrangements to the Productivity of Older People James N. Morgan The relevant literature on the relation of housing and living arrangements to the productivity of the elderly is diverse and often only marginally on target. A few items will be discussed, but a more extensive bibliography is provided at the end of this paper in which the titles are usually adequate for sorting. There is a large economics literature on the decision to retire from paid market work. In that area, the facts are gradually defeat- ing the stereotypes, showing that retirement is both desired by most people and good for them. Most people retire as soon as they can afford to or when poor health or job obsolescence forces them to (Barfield and Morgan, 1969; Morgan, 1981a; Palmore? 1985, Parnes, 1981; Streib and Schneider, 19711. If there is to be an increase in productive activity by older people, it seems likely that it will not occur through a later retirement from regular jobs. A second, much thinner stream deals with unpaid work vol- unteer work or helping others in which the evidence is that although people expect to do more of it when they retire, they do not report, after they retire, that they are doing more of it (Barfield and Morgan, 19691. James N. Morgan is program director and professor of economics, Institute for Social Research, University of Michigan. 250
THE RELATION OF HOUSING TO PRODUCTIVITY 251 The stereotype that it is bad for older people to be "segre- gated" in communities of older people, like the stereotype that retirement is bad for people, has persisted in the face of contra- dictory evidence. One might discount the expressed attitudes or argue that the same stereotype affects the attitudes of older people when they opt for heterogeneous communities. Yet the data on activity and satisfaction levels of older people in various types of communities are also in favor of the age-homogeneous areas and are more convincing. They might, of course, exagger- ate the difference because of selection biases that is, if those who move to such communities do so because they expect to like them and be active in them. At a minimum, as Lawton has suggested, there is a substantial fraction of older people who would like to be in age-uniform communities (Lawson et al., 1984; Lawton et al., 1980; Rosow, 19671. Research and designs for environments for the frail elderly or for communities of the elderly have been extensively covered and summarized by M. Powell Lawton (Canter and Canter, 1979; Kasl, 1977; Koncelik, 1976; Lawton, various). A burgeoning attention to care-giving, both institutional and by family or friends, reflects the nursing home crisis and the explosion of actual and threatened medical costs. It tends to focus on assessing the strain on people who provide care and on the relation of that strain to the decision to send the frail into nursing homes or other institutional care (Morycz, 1985; Silver- stone, 19851. The finding that women care-givers report more strain than men may be another example of selection bias if women are more likely than men to be forced into such roles by the expectations and rules of society and the demographic facts of life. Interestingly enough, it is difficult to find in the studies of strain any attention to what apparently is the fact that many elderly with mental problems provide more difficulties for their spouses than for anyone else. Finally, there is research on the design of the physical environ- ment, which focuses almost entirely on increasing the efficiency and capacity for self-care or for professional care and not on the encouragement of care-giving by other older people (Koncelik, 1976; National Policy Center, no date). If one asks about environments that might encourage produc- tive activity on the part of older people, much of the literature does not appear relevant because it focuses productivity discus
252 JAMES N. MORGAN signs on paid market work; the rest of the literature focuses attention on the delivery of services to the elderly or at most on facilitating more self-care. Surprisingly, this lack of breadth oc- curs at a time when we have a growing group of elderly, many of whom are reasonably fit, and yet the care of those who are not is provided either by one long-suffering, underrewarded spouse or by expensive professionals in expensive surroundings who provide many unnecessary services. PRODUCTIVITY BROADLY CONSIDERED We must expand our concept of productivity to include any- thing that produces goods or services. They need not be market- able, so Tong as they reduce the demand on goods or services produced by others. Even self-care is productive if the person might otherwise have required someone to provide that care. The potential for productive activities outside the usual paid employment by older people is both relatively and absolutely important. The productivity of older people is a large and growing issue because the sheer number of relatively healthy older people is growing, and there is no evidence that they really want to stay longer in the paid labor force or that the younger workers want them there. Indeed, retirement from regular jobs is widely de- sired and enjoyed. Economists have recently discovered that it is not Social Security that induces early retirement but company pension schemes and the giving out of people's health or their jobs. Yet other kinds of productive activity, more flexibly sched- uTed and more discretionary, are a real possibility. The inequal- ity among people in each generation increases as they age, leav- ing some hate and hearty and others in poor health. It is the potential demand of some older people for labor-intensive serv- ices, including nursing, that raises the question of whether or not others of them could provide many of those services. (Cur- rently, unduly burdensome demands are often placed on spouses.) Economists state that all issues of economic policy contain considerations of efficiency (resource allocation) and equity (fair- ness or redistributional effects). We must be careful in talking about increasing the productivity of older people to ask whether we are also increasing transfers to them by subsidizing activi- ties or whether we are reducing their relative well-being by
THE RELATION OF NO USING TO PRODUCTIVITY 253 expecting them to do things without adequate compensation. Some older people do volunteer work, but coerced unpaid work is a form of taxation. Hence, we seek neutral policies that nei- ther tax nor subsidize but that open up new options or opportu- nities and remove barriers. There are three kinds of barriers that inhibit the productive activity of older people: (1) economic and legal, (2) social and organizational, and (3) environmental. I intend to discuss the third, namely, the effect of the built environment, housing and neighborhood, on the productivity of older people. But I must preface that discussion with a few words about the other two areas because we are talking about potentially substantial changes in people's behavior. It is well known that changing behavior requires multiple and powerful motivations, particu- larly among older people who have had a lifetime to become "set in their ways." We senior types have difficulty making up our minds, much less changing our way of life. On the other hand, we have fewer liquidity constraints. I know some people in Sun City West who are building a church with loans of $10,000 from each of the prospective new members. Indeed, there is some urgency in developing better designs for living arrangements for older people because many of them right now are committing themselves to investments in communities that, at least from the point of view of encouraging productive activities, are very badly designed. What little research has been done has tended to follow the usual scientific paradigms of varying one thing at a time or at the least varying a few things in some kind of experimental design that is orthogonal so that the manipulated variables are uncorrelated. Yet if one sees real results only when all of the multiple motivations are in place and all of the major barriers are reduced, then such experimentation is a formula for failure, or at least for "proving" that each component does no good. The suggestions provided later in this paper may seem grandiose, but this may well be an area in which one must "think big" or fail. Furthermore, we live in a changing and complicated world, and people are complex organisms. Hence, the success of any new physical or social or economic arrangements depends on their flexibility and on their capacity to adapt and solve the many unexpected problems that will arise. Our tradition of sci
254 JAMES N. MORGAN entific experimentation must give way to trials not of rigidly predefined inputs but of problem-solving mechanisms. There are additional persuasive reasons for this approach. It is an insult to any group of people to experiment on them, but it is a compli- ment to provide new options and encourage them to get together and work out optimum new arrangements. There is very con- vincing research to show that offering older people more control over their environment and more opportunities will increase their activity level and even their indicators of health. We shall end by proposing a meta-experiment, trying out whole new fIex- ible, self-regulated communities so that if some succeed we shall know what kind of living, problem-solving mechanisms show promise and not just what particular set of solutions worked in one situation. It is our conviction that, to attract people to new opportunities, it may be necessary to change their social or organizational environment, their economic arrangements, and their physical or built environment. Each of the three depends on the others for its success. Consequently, let me postpone a discussion of the physical environment for just a little longer and briefly describe the economic and social structures or arrangements that ~ be- lieve would have to accompany the better built environment if it were to work. ~ shall also indicate what those optimal arrange- ments imply about the required physical environment. THE ECONOMIC ENVIRONMENT We need economic arrangements that provide incentives and rewards for productive activities but that (lo not produce further inequities among a group that is experiencing widely diverging economic paths in any case. Inequality increases with age- inequaTity in income, wealth, and health. Hence, substantial economic incentives for those who are able to take advantage of them can seem like punishment to those who cannot. Most peo- ple in paid employment are relatively overpaid in their later years, and employers want to replace them with younger people with more energy and flexibility and Tower salaries. Indeed, another of the stereotypes that is only slowly being dispelled by the facts is that Social Security encourages early retirement. In fact, it is the private pension plans that are twisted to reward those who retire early and punish those who stay on; Social
THE RELATION OF IIO USING TO PRODUCTIVITY 255 Security, particularly after the 1984 amendments, is actuarially unfair to those who retire early and provides undue rewards to those who keep working. This situation occurs despite the fact that many who retire early do so unavoidably because their health gives out or their job skills become obsolete, whereas many who continue to work are in pleasant, well-paid jobs they enjoy (Maxfield, 1985; Packard, 1985; Sherman, 19851. ~ should propose for communities of older people a new alter- nate currency to be used for facilitating exchanges of services and helping each other. It is well known among economists that money (currency) facilitates exchange as well as providing a store of value that can be saved. It frees us from the constraints of barter, which would require us to stay in bilateral balance with each other individual. It facilitates the development and publication of market-clearing prices that can themselves re- duce haggling and exploitation. It reveals real needs while dis- couraging undue demands. Many baby-sitting cooperatives use paper money to avoid the need to pay a secretary to make calls and keep the books. All one needs in such a group is a list of the members and rules against accumulating too much of the cur- rency. Such cooperatives easily develop special prices in their currency for extra children in the house or for sitting after 11 p.m. in the evening. Because the currency is good for hours and not dollars, it does not depreciate. ("Prices" would, of course, be adjusted according to the amount of skill the help required.) Finally, by giving everyone an initial stock of the alternative currency, a certain initial equality is introduced even among people with wide differences in wealth and money income. There is then an easy set of subsequent improvements: first, to have a small community tax in such currency so people can be paid for doing things for the community; then an insurance arrangement by which for an annual payment one can have emergency needs covered without running out of the currency; and finally, an annuity arrangement by which larger, early an- nual payments build a reserve to pay for the greater needs when one is very old. Why not use ordinary money? Because it is taxable, because the "wages" in the new currency will be different, because a measure of altruism is involved, and because everyone starts out with the same initial stock of the new currency, reducing in- equaTities. As the currency is in units of hours of work adjusted
256 JAMES N. MORGAN for skill levels, it does not depreciate indeed, its value goes up as real wages go up. Why any currency? Because it allows mul- tilateral exchange one need not stay in a balance of services given and received with each other individual. Others have dis- cussed coordinating arrangements, and barter, and even a helper bank or "skills bank" (Goodman, 1984; Noberini and Berman, 1983; Pynoos, 19841. There has even been discussion of insurance arrangements, although not of an actual currency (Goodman, 19841. There is some research on attribution, which argues that rewards for good deeds erode the sense of altruism one attributes to oneself, but partial recognition in a new form should serve as an added incentive, and the increased sense of equity and bal- ance are surely desirable. Indeed, there is now some research indicating that the opportunity to reciprocate encourages help- seeking behavior (Nadler et al., 19851. If a community is to rely on its own internal markets to set prices for various productive activities, then there would have to be some system for keeping track of the prices being paid. Thus, at the beginning, it would be useful to start with some initial levels of those prices from which departures could be made. Services performed for others or for the community might ini- tially be considered worth one "&" (if that is what we decide to call the new shadow currencyJ per quarter hour of unskilled time, plus a fourth of an "&" per mile driven transporting some- one or running errands. Another aspect of such economic arrangements would be a flexible choice as to how much money each individual invests in the community. Those with available assets and a desire to keep the tax advantages designed for home owners could make con- dominium-like arrangements with a large investment, taking tax deductions for their share of interest and taxes and achiev- ing tax-free rent savings and a low monthly rental fee. Others might have almost nothing to invest and pay a high rental. And it should be possible to allow those with investments to consume them gradually by paying a Tower rental, essentially by convert- ing the investment into an annuity. There would, however, have to be a substantial flexible umbrella mortgage because most people could not invest much in the new community until they had sold their homes and moved. The amount of the mortgage would be large, at least temporarily, but the risk would be small
THE RELATION OF HOUSING TO PRODUCTIVITY 257 because such a development would be attractive solely as a con- dominium project, even without the organization and other fea- tures designed to encourage productive activity. In all of this, of course, an essential ingredient is flexibility, the capacity to change and adapt, and the involvement of the members in problem solving and managing. Indeed, a major productive activity for some members would be their contribu- tion of time, energy, and expertise to solving the unpredictable problems that are bound to arise. Some of these problems would be legal as well as economic such as securing the right to re- ceive government payments for home nursing care, for example, and assuring favorable tax treatment of investments and of "earnings" from helping one another or the community. Finally, if the shadow currency were to be used to tax members and pay for community services, and also to set up insurance and annuity arrangements allowing scheduled payments to cover unavoidable needs and heavier needs at older ages, then expert actuarial help would be needed, as well as clearance with the insurance regulations of the state. Note that an annuity-type arrangement would require a lump sum payment from new members who were joining at older ages because they would not have made the usual surplus payments in their earlier years that allow a flat set of payments to cover the higher risks later. Such a system would dramatize and quantify the need to main- tain an age balance by starting with a wide age spread and then recruiting mostly young replacements. It should be noted that these economic arrangements would only work well in cases in which there was excellent communi- cation and an organizational structure to develop the rules, post the going prices, set up the pseudo insurance-annuity company, arrange the financing, and so forth. In addition, the economic exchanges of services surely require easy access access to any other member of the group in a few minutes and without going outside in the cold or rain. THE SOCIAL-ORGANIZATIONAL ENVIRONMENT We need social-organizational arrangements because many of the productive activities that are most likely to result are serv- ices to the community or to other individuals, both of which
258 JAMES N. MORGAN require information, communication, and social support mech- anisms. People need to know one another, to make new friends as the old ones die off, to be able to provide the kind of wise help only a friend can provide. And in starting any new activity indeed, even in joining a new community-people need direct, personal encouragement and help. Transitions are difficult, par- ticularly if they involve moving from the old family home and neighborhood, however inappropriate they were and however few friends remained there. The socialization of new members into such a community would involve more than simply helping them make the trau- matic move and adjust to a new set of norms and relationships. Such new members would also need training in providing social support for others and in certain skills such as nursing care, which are sure to be in demand in such a community. Indeed a major advantage of this type of community would be the poten- tial for spreading the burden of care among many people rather than concentrating it on a single spouse or close relative. The gerontological literature is full of studies of the strain of care- giving and the resulting demand for nursing home care merely to relieve the strain and not because highly skilled nursing is needed (Morycz, 1985; Silverstone, 19851. Providing social sup- port also requires skills most of us must acquire. Social support means more than just affective support and friendship; it also means an affirmation of the worth of the other person and aid tailored to the person's needs. Developing new friendships is increasingly difficult as one gets older, and one cannot expect to like everyone in any community. But the focus on doing things for others, and being rewarded with both thanks and payments so that no one feels in debt, would help. In addition, the variety of jobs organizing and keeping track of such activities and arrang- ing deals would itself facilitate getting to know and like people. Many of the services members would do for each other are currently provided either by professionals (although most of what is done even in a nursing home is not highly skilled) or by spouses. The economic advantage of reducing the use of highly paid (insurance-bloated) professionals on the one hand and the psychic advantage of reducing the excess burden on spouses on the other should be clear. Again, it is necessary to stress the need for flexibility and
THE RELATION OF HOUSING TO PRODUCTIVITY 259 problem solving as such a community develops. The history of most successful institutions and communities is a history of the smart solving of a variety of unpredictable problems and emer- gencies. It would probably be ideal to start with a number of two-generation pairs of member families, one in their sixties and one or more of their parents in their eighties or nineties, with separate dwellings but able to share burdens. (It is often easier to deal with helping a nonrelative, particularly in more extreme situations such as memory loss.) Should the same eco- nomic arrangements and "prices" apply to the two-generational helping relationships? The answer is probably yes. How much recor~keeping and monitoring of prices is needed to ensure convergence on market clearing norms? ~ feel sure the community would be able to work such things out. It is likely, however, that there would have to be at least 200 people involved in order to have a variety of skills, needs, time schedules, and enough transactions to establish norms ("prices"~. There are many issues to be decided: for example, what about visitors, who will range from friends to relatives to noisy grandchildren to nosy observers of this new experiment? The community itself will have to decide how to protect itself from excessive costs in disruption and perhaps excessive self-consciousness that might come from becoming a news item. Although the community would want to keep some intimate connections with the larger surrounding community, it would also want protection and pri- vacy, particularly from the more noxious aspects of society. Surely it would appear useful to have barriers to keep burglars out and keep some forgetful members from wandering off. In- deed, the best protection against unwanted intruders may well be the development of a community in which everyone knows everyone else well and even recognizes their neighbors' family, friends, and visitors. As with the social-organizational environment, these eco- nomic arrangements might be possible among a set of dispersed families, but they would surely be more likely to succeed if people were in easy contact, had regular, casual interactions with others, shared some space and equipment, and could easily keep up with everything that was going on. Thus, the built environment may be a crucial element in facilitating the produc- tive activity of older people.
260 JAMES N. MORGAN THE BUILT ENVIRONMENT Finally, then, we come to the built environment. If the eco- nomic and social arrangements of the aging are to be improved, what is there about the physical environment that matters? It seems obvious that a major barrier to most of the productive activities ~ have been talking about, except perhaps some gar- dening and home maintenance, is remaining in an isolated sin- gle-family home. It reduces communication and contact and makes giving or receiving help difficult because it requires transportation and communication. It is also wasteful of re- sources to have very large homes occupied by one or two people, even if they only heat part of them in the winter. Yet the famil- iar is difficult to give up, even if the economic arrangements in a new environment could mimic those to be had with single- famiTy homes. In a design workshop with students given an assignment to design such a physical environment, it took a quantum change in their orientation (away from a focus on auto traffic and park- ing and the aesthetic aspects of design) before they could achieve success. They were not used to asking what would facilitate each person's access to others or reduce barriers to potentially produc- tive activities. There was some uncertainty about whether peo- ple would respond favorably to such notions as clothes washers and dryers shared by a few nearby units-to facilitate friendly, casual meetings and the making of friends as well as doing a neighbor's wash when he or she was ill because we are all so used to total access and no sharing of such equipment. Similar issues will arise with any shared equipment or shared space. In terms of shared space, economists believe that putting prices on things helps allocate them fairly and efficiently. Thus, as an example, groups could get together and rent space for their meetings. Only experience would tell whether such tests of need were necessary to avoid conflict. A major issue is the relative amount of space devoted to com- mon or group use. Clearly, in a community of several hundred units, every square foot of private space given up by each family frees up several hundred square feet of common space. Decisions would have to be made about how to divide the common space among subgroups defined physically (one wing) or by interests (garden space, swimming pool).
THE RELATION OF HOUSING TO PRODUCTIVITY 261 Another issue is the paradox of privacy versus encouraging and facilitating interaction with and easy access to one another. Television monitors and other electronic gadgets are always a possibility, but there are advantages to easy visibility in some areas (so that any one of a number of others can be sure that a person is all right) that can be closed off when privacy is wanted. Some hospitals have begun putting windows in rooms that look into halls or common spaces the windows have curtains that can be drawn. Some community members will want easy access to their cars; others will use public transport, taxis, or rides provided by other members and will need sheltered pick-up space. Casual contacts during the day would surely facilitate arranging for helping activities. What should be available is access to the rest of the community through a private door or garage for those who want it but, more importantly, access to everyone in the group through inside corridors or space, without stairs or other barriers. There are many small mechanical "fixes," ranging from emer- gency signaling systems (usually with cords reaching to the floor) to elaborate monitoring from central stations. There are stoves that turn themselves off and ways of converting beds to the needs of the handicapped. What ~ see little of is designs that make it easy for a not-very-strong older person to do things to help others. (My grandfather cared for my grandmother, who was paralyzed on one entire side, in an isolated farmhouse in southern Indiana for many years, using some ingenious aids like a pulley-hoist to get her up onto a wheelchair or toilet and a party-line telephone so she could be the communication link for the whole community.) Sequential changes along these lines may be required, although initial pretesting pays off. Experience in designing the new University of Michigan hospital revealed that only going through actual procedures in mocked-up rooms un- covered many of the problems. Substantial changes could thus be made before construction took place in things like door widths and room dimensions that would have been difficult to change later. There has been a great deal of work on design to facilitate caring for older people, and some has even been devoted to mak- ing it easier for them to care for themselves. What we have not had the imagination to discuss yet is design that will help older people care for each other and do things for their community.
262 JAMES N. MORGAN Instead of more studies of the strain of care-giving when it is concentrated on one spouse, we need designs that allow the burden to be spread. And we also need to make these new envi- ronments so attractive that people will want to move to them before any of them are desperate or frail, committing themselves to provide some support for whoever becomes frail in return for a promise that others will support them if they need help with some compensation, of course. Such a community would be ideal for two-generation families, with separate housing units for the very old and for their old children but easy monitoring, contact, and care when needed. What characteristics would we seek in an optimal housing and community layout, optimal including the facilitating of produc- tive activities, including the organizing and problem solving that is in itself a productive activity? The following seven seem desirable: 1. Autonomy and self-determination. This characteristic is an- other reason for insisting that such new communities be self- supporting without either subsidies or taxes or the expectation of unpaid work for the larger community, which is itself a kind of extra tax. However, because not all of its members will want to invest in the community (not unlike the situation in a condo- minium) and because many of them will not have the funds until they cell their present homes, some interim financing will be essential. A flexible mortgage that can be rapidly reduced as members move their investment from some minimum to a full share or more would be required. Perhaps temporary mortgages on present homes could be used, mortgages that would be trans- ferable to an investment in the community when people can actually sell their homes and move. 2. Privacy and individual freedom, combined somehow with easy access to others to give and receive social support and vari- ous kinds of help. Students in a design seminar at the University of Michigan worked on such a project, and they found it quite challenging. It was necessary, however, to keep reminding them of the criteria; otherwise, they tended to revert to lovely designs that restricted access to others or focused on cars and parking. It seems likely that the best design might be one that allowed a great deal of change and adjustment by the members of the community as experience and preferences dictated. Ideally, a
THE RELATION OF HOUSING TO PRODUCTIVITY 263 founders group could give advice on basic issues of layout before the project started building. It is quite unlikely that telephones and computers can over- come distance and the lack of regular, casual contact in stimu- lating mutual help patterns or community help activities. At best, it seems probable that various bulletin boards, secretaries, central offices, or other devices would facilitate and encourage cooperative exchanges. Economic arrangements can ensure eq- uity and incentives, and social-organizational arrangements can provide the norm and the emotional support that should go along with the productive activities. Yet seeing others regularly, and being able to get to their living quarters without going out in the rain (or up and down stairs) would seem to be extremely important. Of all the discussion and writing on better physical environments for the aged, almost none focuses on the activities of the aged, except perhaps in terms of their improved capacity to care for themselves requiring alarm systems, hand-rails, stoves that shut off, chairs it is easier to get out of, and the like. The ideal way to arrange helping is during regular or even casual meetings at meals, the laundry, or in shared spaces rather than formally, through an exchange center (however much com- puters may facilitate such "markets"~. Access to the wi(ler community is also important, ideally with the new community within the service area of public transpor- tation. Perhaps some members of the community might provide child care for children of the area while their parents are at work, all day or just after school. 3. Reasonable homogeneity of status to facilitate everything but embedded in a larger community to allow interactions with other age groups and other economic levels. There is much discussion about "age ghettos," but many old people prefer to be able to get away from the noise and confusion of modern life. Most like occasional contact with their own grandchildren. (Some might want to run a day-care nursery, but again, the emphasis must be on self-determination, not predetermination.) The basic de- sign tends to determine some general level of cost, however, and hence of the affluence of the average member. ~ would personally opt for a level that is sufficiently modest so that middle-income children with dependent parents would be willing to pay to house them there. 4. A maintained age spread, which means starting with an
264 JAMES N. MORGAN even distribution from age 55 up but then encouraging mostly the younger old to join so that there are always younger people providing more of the services and building up their community credit for when they may need more help than they can give. Two-generation families would also be welcome, however. A ma- jor reason for insisting that all features must be attractive is that otherwise people will not move to the community until they become desperate, and it could become one more dismal nursing home, assembling all those who need help. 5. A size sufficient to allow a real community to develop, di- verse talents to be shared, and "markets" to set the "wages" for services to others and to the community in the new currency. The perils of the too-small community were dramatically described by Nathaniel Hawthorne after his brief experience at Brook Farm: "an unfriendly state of feeling could not occur between any two members, without the whole society being more or less commoted and made uncomfortable thereby . . ." (The BZithd~ale Romance, 18521. There need to be at least several hundred people in such a community, but there is also an upper limit beyond which it is difficult to develop warm friendship groups, even subgroups, or for the community to govern itself. 6. Homelike living quarters, but with the capacity to introduce special equipment to facilitate remaining there even when dis- abledt or ill. A combination of equipment for self-care and easy communication and accessibility for calling for help is obviously needed. Home health care is generally a myth for those living alone, even in apartments, because although they need care only occasionally, it is economically and physically inefficient to pro- vide it. Often, simple emergency help for a few minutes is all that is needed, and such help can be easily provided by someone close at hand, often requiring little skill. Having people nearby without the developed networks and support arrangements, helps little. Having emergency call systems (as in retirement homes) without the social and economic arrangements leads to expensive professional services andJor inhibitions against ask- ing for help. A recent study of the impact of the ending of a home help service indicated little effect, prompting the conclu- sion that the service had not provided the personal care that is the most burdensome and most time-specific (Hooyman, 19851. 7. The crucial qualities of pexibiZity and adaptabiZity, particu .. . . . ~. ~ . .,
THE RELATION OF HOUSING TO PRODUCTIVITY 265 larly to minimize the need to move again. Each living unit should have wide doors and be capable of having hoists added to facilitate getting into and out of a bed or a wheelchair, ways of allowing the visual monitoring of activities when necessary through windows or by TV, and the delivery of meals. It should be possible to advertise that people would never have to move again (studies in England have shown that is what happens even when different levels of care are provided for in different projects). There are some requirements that make it unlikely that the easy conversion of older structures would suffice. Overall, it would be difficult to provide hierarchies of shared space for example, some shared locally by 4 to 12 families, some by larger groups or the whole community, and some by smaller groups from the whole community. It would be difficult to provide both privacy and access to the outside and one's car and also easy access (without going out in the wind and rain and cold) to most of the other members of the community. In addition, common space that is protected from outsiders but easily visible by insid- ers (so that those who need it could be kept under observation without that burden falling on one person) is impossible in older areas of either low or high density. At the level of design of individual spaces, ceilings strong enough to allow the installation of pulleys (so that people can be moved between bed and wheelchair and toilet without much main strength) and doorways and spaces that allow such maneu- vering could be designed inexpensively in new areas, but they would be very difficult to install in older ones. In particular, to avoid the need for moving to other quarters, one would want the capability of space adaptation without the investment of fitting out every space for every contingency. There is ample evidence that moving is difficult for the elderly and will be resisted and that providing several stages of residence does not work people tend to stay wherever they first move. Furthermore, it seems likely that friendship groups will develop, and people may want to live near their friends (sharing the small-group spaces with them), rather then near others with the same level of handicaps. There may, of course, be some who require a kind of segregation to avoid disturbing others, and the community would have to solve such problems as they arose.
266 JAMES N. MORGAN There can also be shared equipment, including not just wheel- chairs and hospital beds and pulleys but such items as tools, videotapes, and sports equipment. Here, again, many problems may arise (as anyone knows who has tried to share woodworking tools with people who never sharpen anything); but again, one of the productive activities such communities would induce is the solving of this kind of problem. There are, after all, real economies in sharing things that are used only occasionally and advantages in specialization "paying" skilled perfectionists who will keep the planes sharp in the woodworking shop. Is there no way we can make do with arrangements that allow people to stay where they are? Or could we start with existing retirement communities and attempt to work just on the eco- nomic and organizational arrangements? I do not believe there is much promise in the first of these alternatives, however ap- pealing it may seem. The problems of communication and trans- portation are just too great to overcome. We might consider, in a few of the more appropriate places in which older people are concentrated, trying the other environmental changes, particu- larly the economic ones. Indeed, newspapers have reported some attempts at recognizing community services with credits that can be used to purchase other needed services. Finally, in line with my general insistence that the people involved should make as many of their own decisions as possible, we need designs that are flexible and that allow each unique group with its back- wrn~,nd.~ preferences. and experiences to adapt the physical en c~ ~ ~ ~ ~ ~ 1 vironment to its own needs. Do we need more studies of existing situations to seek out approaches that work or to know what modes of reciprocity and patterns of time use prevail in existing communities? I suspect that what we would learn would be that existing communities have various barriers that prevent any but the most limited patterns of mutual help or other productive activities. Perhaps cataloging all of the possible barriers in their diversity would help prove our contention that we need built environments that solve all the problems at once, rather than more experiments that would continue to show that partial solutions are not much use. It is important to keep certain distinctions in mind. Efficiency must be gained without destroying equity, which means provid- ing for reciprocity among members and self-sufficiency for the
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