The Social and Built Environment in an Older Society (1988) / Chapter Skim
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CURRENT AND EMERGING ISSUES IN HOUSING
CURRENT AND EMERGING ISSUES IN HOUSING
Pages 134-168
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From page 134... ...
Two attributes in particular should affect the way we think about housing interventions for the elderly population. First, as people reach retirement age, they experience numerous changes, sometimes in rapid succession: incomes fall from preretirement levels, children leave home, health problems and activity limitations emerge, a spouse requires institutionalization or dies.
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From page 135... ...
The second section reviews current federal housing assistance programs for the elderly; the third presents a framework for thinking about housing policy that goes considerably beyond the present programmatic structure. The fourth section describes three specific federal housing interventions that could meet the requirement of being an element in a long-term care system.
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From page 136... ...
Dwelling-specific Needs Our focus in this section is on the incidence of physical deficiencies and excessive housing expenditure burdens in 19792 (Table 11. Moreover, we limit the population considered to those households that in 1979 were not participating in federal or state housing programs some 14 million elder-headed households.
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From page 137... ...
CThese figures are only for households headed by elderly persons. SOURCE: Struyk and Turner (1984)
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From page 138... ...
Finally, although it is not shown in the table, it is worth noting that there is little difference in the rate of deficiencies among the elderly aged 65-74 and those 75 years of age and older (Struyk and Soldo, 1980, Table 3-6~. To summarize, in 1979 there were about 1.61 million elderheaded households in dwellings that would be characterized as physically deficient and about 2.58 million households spending an excessive share of income on housings Because only about 340,000 of the households have these problems in commonmeaning that many are spending a large fraction of their incomes to live in decent housing a total of about 3.85 million, or 28 percent of all elder-headed households, have a dwelling-specific housing problem.
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From page 139... ...
Nationally, about 25 percent of the elderly who report a functional limitation are receiving formal services. Applying this rate to the 2 million households noted in the earlier paragraph yields about 500,000 households who require support services provided by a formal agency.
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From page 140... ...
Public policy should be so structured as to complement informal services rather than replace them. It is also important to note that, when we examine the determinants of the likelihood of a person receiving formal supportive services, the dominant factors are the extent of the person's disability and the absence of informal services.
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From page 141... ...
Note that this rate is substantially higher than the 10 percent rate for elder-headed households with no members with such limitations, suggesting that households with an impaired member have greater difficulty maintaining or affording decent housing.5 This rate implies that in 1979 there were some 340,000 households in the group with both dwelling deficiencies and dwelling-use problems. Similar calculations can be performed for the overlap between those households with excessive housing expenditures and those with a member with an activity limitation.
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From page 142... ...
Percentages Dwelling specific Deficient dwelling Excessive housing expenditures Dwelling use Supportive services Generous estimate Stringent estimate Dwelling modifications Including those needing supportive servicesstringent definition Excluding those needing supportive servicesstringent definition Overlap between dwelling-specific and dwellinguse problems Supportive services (generous definition) and: Deficient dwelling Excessive housing expenditures Supportive services (stringent definition)
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From page 143... ...
and a lack of programs to help with dwelling modifications related to activity limitations. Likewise, the targeting of resources to Tower income groups is mixed; it is probably good in the housing area and much weaker in the area of support services.7 In short, the present system is a patchwork and one that only infrequently provides the right aid to persons who need both housing assistance and supportive services.
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From page 145... ...
Aid has also been provided to households through rental assistance programs, most notably Section 8, Existing, and the new housing voucher program. Federal housing programs per se have been directed toward renters; yet elderly homeowners have received substantial onetime aid in repairing and rehabilitating their homes through locally operated programs funded under the federal community development block program (CDBP)
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From page 146... ...
Currently Eligible for and Receiving Federal Housing Assistance and Expected Participation in an Open-Enrollment Housing Voucher Program Elder-headed Nonelder-headed Households Households Owners Renters Owners Renters Total Participation Eligible to receive housing assistance (1981) ~ Currently receiving assistance (1985)
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From page 147... ...
There is no systematic information on the extent to which arrangements of this kind have been made. However, the data that have been gathered on the services available at a large sample of elderly-only public housing and Section 202 projectsi° as part of the evaluation of the demonstration congregate housing services program would suggest that such arrangements are fairly common.
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From page 148... ...
In addition, "drawing down" assets to pay medical bills or to support formal care expenses will lower incomes, possibly to the point at which housing expenditures become "excessive." We have also seen that current housing assistance deals only minimally with the nexus of housing and dwelling-use problems. The challenge is to design a programmatic response that is flexible enough to deal with the variety of need mixes and ability-to-pay circumstances that will be encountered.
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From page 149... ...
The latter strongly affects the efficiency with which many support services can be provided, and tenure affects the range of options available for coping with dwelling deficiencies and excessive housing expenditures. Figure 2 summarizes some of the public interventions that might be appropriate for households in differing circumstances.
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From page 152... ...
(Note that "congregate services" is shorthand for a variety of supportive community housing environments.) For example, for households needing extensive support services, a voucher for a congregate housing program (described later)
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From page 153... ...
In particular, the following question is considered: Should the federal government now sponsor more demonstrations and evaluations, or should it begin to encourage such approaches by making them eligible for voucher recipients, by providing direct support or mortgage insurance, or through other means? Congregate Housing We may define a congregate housing facility as a rental housing complex in which households have separate units that include kitchens and bathrooms; the complex includes public
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From page 154... ...
Congregate housing is seen as a vehicle of great potential for the elderly and as a cost-effective alternative to institutionaTization; that is, it is viewed as a way to permit persons who would otherwise be in institutions to remain in a more stimulating and less expensive community setting. If such an approach can be proven to be cost effective, federal assistance for residences (in lieu of Medicare payments for institutional care)
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From page 155... ...
On the basis of these findings, it would certainly be difficult to argue for the enactment of a major congregate housing program. Still, there were several problems with the program that was demonstrated and with the evaluation that need to be considered in reaching a balanced judgment about congregate housing.
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From page 156... ...
Dwelling Modifications The alteration of the features of a dwelling to make it easier for a person with a physical impairment to use is a logical response to the onset of activity limitations. Some have thought that the installation of appropriate modifications to dwellings occupied by elderly homeowning households that have an impaired member, through public programs if necessary, could be cost effective in terms of helping sustain the person in the community.
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From page 157... ...
Three other adjustments include changing the use of rooms (often in response to the activity limitations of a household member) ; taking in a roomer or boarder to generate additional income or for the companionship and help they might provide; and changing (typically, Towering)
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From page 158... ...
These rates can be put into perspective by noting that about 3.3 percent of elderly homeowners and 13 percent of nonelderly homeowners adjust their housing circumstances by changing residence each year. As a result, the rates of in-place adjustments for the elderly are at least double those achieved by relocating.~3 A better idea of the national incidence of dwelling modifications is available from data gathered by a special supplement to the 1978 annual housing survey (AHS)
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From page 159... ...
~ · if- 1 · · ~ 1 ~ 1 1 1 __ 1_ _ _ _1 households make unit mocl~cat~ons, lit tells us norn~ng about the effectiveness of such changes in delaying institutionalization. Some research on this topic using the 1982 Tong-term care and annual housing survey data sets is just now getting under way.
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From page 160... ...
Another survey of such living arrangements (van Dyke and Bresiow of the Jewish Council for Aging of Greater Washington, reported in National Policy Center on Housing and Living Arrangements for Older Americans, 1983, pp.
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From page 161... ...
We will also use Heumann's (1985) estimate that equivalent services for those needing less than nursing home care can be provided in a congregate setting for about one-third less cost than in the long-term care facilities.
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From page 162... ...
, then for a system of congregate facilities and Tong-term care facilities to operate with the same resources as the present arrangement would require that no more than half of the households in congregate facilities be without a member who would otherwise have been in an institution. Of course, if the households would have purchased some of the supportive services in other environments, then a higher share of congregate housing occupants could be those who would have been in community housing.
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From page 163... ...
Excessive Housing Expenditures Here we follow HUD's lead so that our results will be consistent with other tabulations. Excessive burden is defined separately for renters and homeowners.
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From page 164... ...
, Based on Annual Housing Survey Items and a Revised Definition (1981) Type of Deficiency Description Plumbing 1.
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From page 165... ...
2. Since 1979 we know, in general, from annual housing survey data that the share of households with "excessive" housing expenditures has increased, whereas the share living in dwellings with deficiencies has decreased slightly.
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From page 166... ...
11. For a discussion of a congregate housing voucher program for low-income households, see Struyk (1984b)
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From page 167... ...
1985. Final Report of the Evaluation of Congregate Housing Services Program.
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From page 168... ...
Washington, D.C.: U.S. Department of Housing and Urban Development.
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