we a oy, <* - - £ re. - _ua® = A wn Q 1 25 an JK 2D Xe [SR Se 3 = = oR = E cc LQ ay Fi on oO oR , National Institute of Mental Health Social and Medical Services in Housing for the Aged Sr By M. Powell, Lawton, Ph.D. Philadelphia Geriatric Center DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Alcohol, Drug Abuse and Mental Health Administration 5600 Fishers Lane Rockville, Maryland 20857 JL 7 /7 7 / # 7 4 r yo \ A XY \ This publication was written under contract No. PLD-8793-77 SH of the National Institute of Mental Health and developed from the final report of an NIMH-supported research pro- ject, No. ROI MH 14923. Both contracts were awarded by NIMH’s Center for Studies of the Mental Health of the Aging. Marie Blank served as the project officer for the writing contract and Thomas Anderson for the research project contract. The National Institute of Mental Health has obtained permission from the copyright holders to reproduce chapters 2, 3, and 6. Further reproduction of these copyrighted materials is prohibited without specific permission of the copyright holders. All other material contained in the volume, except quoted passages from copyrighted sources, is in the public domain and may be used and reprinted without permission of the author or the National Institute of Mental Health. Citation of the source is appreciated. DHHS Publication No. (ADM) 80-861 Printed 1980 I'or sale by the Superintendent of Documents, U.S. Government Printing Office Washington, D.C. 20402 FOREWORD Fortunately, society is finally beginning to recognize that the more than 20 million people over age 65 in this country cannot be talked about as if they are a single typical older person. The elderly are as diverse as any other age group—diverse in their needs, problems, strengths, and choices of places to live. Any comprehensive planning effort, national or local, must keep this fact in mind when addressing service issues that relate to the mental and physical health of older persons. In this context, housing specifically planned for the aged is a growing national phe- nomenon. At least for a certain segment of the older population, “Senior Housing” is an important option among the many places where one can reside in later life. As a result, there is a need to better understand housing for the elderly—who seeks it, who is selected, the experience of living in such settings, the problems and possibilities that emerge for the residents, the place of social and medical services at these sites. In the text that follows, many of these issues are explored with depth and sensi- tivity. Service, research, and social policy considerations are delineated. This work should be a valuable resource to planners, practitioners, social scientists, and policymakers alike. Gene D. Cohen, M.D. Chief, Center for Studies of the Mental Health of the Aging Division of Special Mental Health Programs National Institute of Mental Health iii 20596 ACKNOWLEDGMENTS This research project began with the creative ideas and innovative actions of Arthur Waldman, former Executive Vice President of the Phila- delphia Geriatric Center. The planning and occupancy of his second housing venture at the Philadelphia Geriatric Center, York House South, was the occasion for a preliminary study of housing for the elderly. Throughout the conduct of the preliminary study and the larger one re- ported here, Mr. Waldman’s active participation in thinking through the research problems, organizing the study, and analyzing the results made it all stay together. The original co-principal investigator was Ira deA. Reid, who was just then retiring from Haverford College after a lifetime of accomplish- ment in urban sociology. Dr. Reid’s contributions to the planning of the study and to the definition of issues to be researched were inestimable. It was a great loss to the project that he did not live long enough to see it completed. A number of research staff members contributed significantly to the project. In addition to the interviewers, the personnel included: Jacob Cohen, New York University, consultant in statistics and design; George Nash and Patricia Nash, staff sociologists; Bonnie Simon, Silvia Yaffe, Miriam Grimes, and Jeanne Bader, research associates; Diane Carlson, programmer; and Maurice Singer and Susan Singer, research assistants. Much formal and informal consultation and assistance was given by colleagues with substantial accomplishments of their own in areas related to this research: Kermit Schooler, Ruth Bennett, Leon Pastalan, Louis Gelwicks, Daniel Wilner, Frances Carp, Elaine Brody, Maurice Greenbaum, and Marie McGuire Thompson. Finally, a large number of professionals in the housing field helped educate the entire staff. Special thanks are due the sponsors, housing au- thorities, administrators, and tenants of the housing who made the project possible. iv CONTENTS Foreword Acknowledgments Introduction Chapter 1. Purpose and Design of the Study enn: 1 Chapter 2. The Impact of Rehousing 11 Chapter 3. Supportive Services in the Context of the Housing Environment 16 Chapter 4. Selective Factors in Recruiting Tenants 30 Chapter 5. The Prediction of Well-Being as a Response to the First Year of Housing 35 Chapter 6. Public Behavior and the Use of Space ....rennn. 39 Chapter 7. Site Differences: Relationship to Well-Being 48 Chapter 8. Physical and Social Aspects of the Living Environment 55 Chapter 9. The Manager 67 Chapter 10. Research Conclusions 80 Chapter 11. A Current Look at Housing Policy Issues: 1979 ... 84 References 93 Appendix 95 Index 107 P.O. 3758—JACKET 281-267—PROGRAM 358-m INTRODUCTION The data reported in this book were gathered between 1966 and 1968. While most of the findings are relevant in 1980, a number of changes in the national picture have occurred since then. These are noted and dis- cussed in the final chapter. This volume’s intent is to report a large set of research findings in a way that is clear to both research workers, on one hand, and to policy- makers and service providers, on the other. Some of the findings already have been reported to these groups of consumers in their own languages. Several chapters in this volume were adapted from articles published in scientific journals, with all their statistical trappings, while a manual for design, policy, and service-delivery personnel written totally without ref- erence to the basic data (Lawton 1975) has seen wide use by those con- cerned only with application. Neither of these vehicles was capable of telling the complete story of the research. Inevitably, a great deal had to be omitted from both the scientific and the applied-sector publications. To present all the results in the most understandable way to the largest number, certain guidelines were followed: First, complex statistical techniques were described only briefly, with the text concentrating on meaning rather than method. Second, the most complex tables were included in the appendix, and yet another set of tables is available only in the final report submitted to NIMH. Third, tables that present descriptive material only (percentages or averages) and a few that show simple correlations were included with the text. Finally, most of the finer points of research design and statistical analysis were omitted. However, no discussions or interpretations were made unless backed up by significant statistical tests. It is hoped that this presentation will be meaningful to a wide audience of people concerned with housing for the elderly. M. Powell Lawton, Ph.D. Philadelphia Geriatric Center vii Chapter 1 Purpose and Design of the Study Federal and private nonprofit agencies have supported a tremendous growth in housing for elderly individuals. Policies gov- erning the type of environments to be built necessarily have been formulated before data from social science on which to base such decisions have been collected. Since the need for such housing undoubtedly will increase along with the expected growth of the elderly population, the study of existing and already planned housing should provide guidance for the future. The aims of this study were: 1. To measure the impact of a move from dispersed housing in the community to planned housing for the elderly— changes in morale, voluntary activity, social interaction, physical health, physical mobility, and competence in self-mainténance. 2. To predict positive and negative changes in the above-mentioned areas from characteristics determinable prior to occupancy. 3. To determine the selective factors that distinguish those who move into hous- ing for the elderly from those who do not apply for this housing. 4. To determine which personal character- istics are associated with the desire for and the use of supportive services within a housing situation, and to de- termine the effect offering supportive services has on change in criterion characteristics. 5. To study the differential effects of housing environments, their adminis- trators, and the services offered in the environments on tenants, as a function of tenants’ preoccupancy characteris- ties. 6. To develop a conceptual framework, supported by data analysis, for the study of man-environment relation- ships, using the elderly person in the housing environment as the specific instance. Impact of Housing Moving from dispersed housing to planned housing is not an isolated act whose impact can be measured through change on various criterion variables. Rather, such a move in- volves a complex of changes in environment, in interpersonal associations, in social struec- ture, in personality, and possibly in health, and we must refer to this whole complex when we speak of change in residence. Such new environments have been spoken of as offering change for the better in personal ad- justment, meaningful activity, associations with other people, energy level, and inde- pendence. This study aimed at one level to study the gross changes in these major cri- terion variables during the first year of occu- pancy of housing sites for the elderly. It also examined in more detail those aspects of change that appeared to be more closely re- lated to criterion changes. Both Lipman (1968) and Carp (1966) measured impact at single public housing sites. This study in- cluded a wide range of housing types whose differential impacts could be studied. Prediction of Individual Change Carp (1966) addressed the question of prediction and found that single items and combinations of items from interviews and application forms could predict change in the individual during the first year. Again, pre- dictors of change in criterion variables in a variety of social-background, attitudinal, bio- 1 2 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED graphical, and personal characteristics were sought. Characteristics of Those Who Choose Planned Housing Both Carp and Lipman were able to de- scribe variables that distinguished successful from unsuccessful applicants for housing for the elderly. However, there is virtually no in- formation about who is more likely to want this kind of housing. That is, in what way do those who apply differ from those with similar backgrounds who do not apply for planned housing? Services Within the Housing Situation It is a moot question in social planning for the elderly to ask to what extent means by which other basic needs may be satisfied should be built into the housing situation. Originally, Federal policy was that federally assisted housing should be for physically well and relatively independent older persons. This policy made a sharp distinction between the institution, which provides life-sustain- ing services, and the housing environment, which is free of institutional qualities and puts a premium on self-maintenance and continuation of life as it always was, with the exception of the age-segregated inter- personal environment. Those who support this policy believe that too-easy access to meal, medical, housekeeping, and social serv- ices erodes the sense of independence of healthy older persons and, therefore, that such services should be limited to true in- stitutions, thereby segregating independent and dependent older people. Those favoring the inclusion of such serv- ices within the housing environment believe that the period of relative independence may be extended by offering some supportive services for marginal people whose welfare may suffer without the services. They point out that it has yet to be demonstrated that physical accessibility to such services causes people to be less independent. In recent years, support for offering services within the housing environment has grown, cul- minating in the congregate housing provi- sions of the 1970 Housing and Community Development Act. Psychology of Man-Environment Relationships The conceptual basis of this research lay in the wish to explore the relationships be- tween the individual and the environment. The investigator (Lawton 1970a) has de- scribed the ecosystem as consisting of the individual, the physical structures, the supra- personal environment (the modal character- istics of the older people in the immediate spatially and psychologically defined environ- ment), and the social environment. The phys- ical environment has been given the least at- tention by behavioral scientists, and study of the suprapersonal environment in relation to other determinants of behavior has been inadequate. METHOD The basic method of this study was the longitudinal control-group method: Subjects were seen twice, once before assuming resi- dence in planned group housing and again after one year. Direct observations of the housing settings and the social behavior of the individuals were made, for the purpose of characterizing differences in milieu among settings. Other representative housing sites were studied on a single occasion. SITES STUDIED Since a major focus of the study was the effect of services on individual health and adjustment, sites were selected to represent a variety of such services and a range of their availability. The ideal procedure would have been to select a universe of individuals with known characteristics and randomly as- sign them to housing settings identical except for the independent variable. Since such ex- perimental control was impossible, it was necessary to choose existing or planned sites that represented as wide an array of services or lack of services as possible. A description of all the major Federal housing programs for the elderly appears in chapter 11. In the PURPOSE AND DESIGN OF THE STUDY 3 present study, only low rent public housing, the lower middle-income section 202 housing, and the nonsubsidized (and therefore not in- come limited) section 231 housing, were represented. The original aim was to study pairs of housing sites similar in the background char- acteristics of occupants but different in the onsite supportive services offered. Prospec- tive sites were chosen with knowledge of the projected building schedules of a number of low-income public housing and lower middle- income nonprofit housing (202) sites. How- ever, most of these building schedules were overoptimistic. In a few cases, cooperation, originally promised with the research proj- ect, was not forthcoming. Twelve sites finally were chosen for full study, and three others received limited study. In addition, five groups of older people in scattered housing in various communities were interviewed for comparison purposes. In the descriptions that follow, the names of the sites are thinly disguised. Sites Studied in Full e Blueberry Acres, which opened in July 1966, provides low-income housing in a poor but “respectable” location in Jersey City. While predominantly Catholic, particularly Irish, the group of occupants was heteroge- neous and included a small number of blacks. “The two buildings comprising Blueberry Acres are two blocks apart; they share a very committed manager, a senior-citizen club, and a fairly active activity program. e (Golden Years, which opened in June 1966, was built under the 202 direct loan pro- gram. It is sponsored by two synagogues and a Jewish Community Center, but the popula- tion is not entirely Jewish. Although it is in an urban renewal area, Golden Years is in a very desirable location, just one block from the boardwalk in Atlantic City, New Jersey. No services are offered, but some assistance is given to an activity program. eo Sholom Aleichem House, which opened in June 1968 in Philadelphia, is sponsored by a fraternal organization. Its population is predominantly Jewish. It is a 202 project but a noonday dinner is included in its basic fee. It is a highly desirable upper middle- class location, but its occupants are of lower middle income because of the 202 program’s upper limit on tenants’ incomes. e Metropole Center provides public hous- ing in a complex of other public housing on the South Side of Chicago. It was built in an experimental circular form and is deliber- ately maintained with a racially balanced population, in contrast to its twin, which is almost 100 percent black. A senior center run by a large social agency connects the two buildings and serves hot lunches. A highly organized network of community services is ready to serve the occupants. eo Samuel Gompers Gardens, a 202 project in Philadelphia sponsored by the Amalga- mated Clothing Workers, opened in Septem- ber 1968 with a majority of union retirees, both Jewish and Italian, as occupants. It is in a very desirable center-city location, close to a flourishing union senior center and medical center. While it offers no onsite services, the activity and health services of the union are available only a couple of blocks away. eo President House, a public housing site in a low-income area of Reading, Pa., opened in July 1966. Many occupants are ‘“Pennsyl- vania Dutch,” but others are of various eth- nic strains. No services were offered, but a community senior citizen club operated there once a week at the time. The manager serves several buildings but maintains a close rela- tionship with most tenants. eo Yishay Apartments was built under the New York Mitchell-Lama direct-loan pro- gram by an organization assisting refugees from Nazi Germany. It is located in a mid- dle-class area of Queens, and its population is Jewish. An optional meal service is pro- vided, and it is next door to an active senior center which serves both the apartment building and the community. The manager and staff are close to the occupants, but a particularly strong effort at maintaining an atmosphere of freedom and independence is evident. eo Flower Tower is in lower Manhattan, among the mass of high rise buildings bor- dering the East Side from 34th Street on downtown. Its occupants are ethnically het- 4 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED erogeneous. A senior center operates on the premises, but it has no residential manager. o Ebenezer Towers, a 202 project in a somewhat substandard black neighborhood, is sponsored by perhaps the most progressive black home for the aged in the country. The 100-unit building opened in the summer of 1968, but had considerable initial diffi- culty renting despite the allocation of 10 percent of the units to a rent supplementa- tion program and 25 percent to Philadelphia Housing Authority clients. e Riverlake is located in a depressed black neighborhood in Cleveland near, but spa- tially separate from, family public housing. Its occupants are both white and nonwhite. It has a model health clinic sponsored by a nearby hospital and a senior center serving hot lunches sponsored by the city of Cleve- land. eo Van Winkle Houses are in a complex of public housing in the extremely depressed Brownsville section of Brooklyn. The build- ing is limited to the elderly and has a hetero- geneous group of occupants, including Jew- ish, black, and others. There is no resident manager, but a senior center is staffed by people from the City Department of Social Services; a hot lunch is served daily. e Old Gotham House, which opened in 1960 in Philadelphia, has an almost totally Jewish population. It offers two meals a day, medical service, housekeeping, and lim- ited assistance for both activity and social service needs. It is located in an urban middle-class area, and its occupants are of lower middle and middle socioeconomic status. Sites Receiving Limited Study eo Luther Lodge is a church-sponsored project in Atlanta located proximate to a long-term care facility. Its architecture is quite innovative, and it offers many active programs in addition to onsite meal services. eo New Gotham House is a sister project of, and is located next door to, Old Gotham House. It was built in 1965. The one major difference between the two sites is that the newer building has a floor with 24-hour medical, nursing, and personal care services, though an attempt is made to preserve the noninstitutional atmosphere. eo Northbridge is an age-integrated pub- lic housing project in Philadelphia, nega- tively famed for the architectural and social difficulties it offers the elderly tenant. Older and younger people live on the same floors, and crime is a major problem. Comparison Groups For comparison purposes, four groups of older people living in scattered housing in the community were interviewed: eo Jersey City residents—100 white and 101 black older people—were identified from household samples in census tracts from which large numbers of tenants of the Jersey City project came. o Philadelphia residents A were age- and sex-matched friends of tenants of Ebenezer House in Philadelphia. o Philadelphia residents B came from a random sample of the retired community- resident members of a Philadelphia trade union whose retired members constituted a large percentage of the population of Sam- uel Gompers Gardens. o Philadelphia residents C were Jewish community residents recruited from senior centers in Philadelphia to participate in a health maintenance research project at the Philadelphia Geriatric Center. Some basic background characteristics of the subject groups are shown in table 1, and some characteristics of the housing sites are given in table 2. DATA GATHERING In the first months of the study the proj- ect directors, the senior sociologists, and the associate psychologists produced an inter- view schedule designed to cover the basic areas under study. New Gotham House, which had been studied at the time of its activation under a National Institute of Men- tal Health small grant (MH 11053), was used as a pilot study site. During the course of the study, some alterations were made in the interview schedules for each new site, mainly in order to investigate aspects unique to each site. PURPOSE AND DESIGN OF THE STUDY 5 Site Preparation Typically, the feasibility of using a site was explored by one or several senior staff members through personal visits to housing authorities, sponsoring organizations, boards of directors meetings, and administrators. One site, the Normandie Hotel in Philadel- phia, did not wish to participate. All others were enthusiastic, and many have repeatedly requested followup visits and interpretations of some of our early findings to administra- tive and community groups. Just before in- terviewing began, sites were visited to ob- tain lists of applicants or tenants and floor plans of tenants in the buildings. Interviews Interviewing was done by undergraduate and graduate psychology and sociology stu- dents and by a few full-time staff. Inter- viewers were trained either by staff at the Philadelphia Geriatric Center (PGC) or by senior sociologists at the Bureau of Applied Social Research at Columbia University. Training included extensive study of the content and format of the schedules and spe- cial instruction manuals, role playing, ob- servation of senior people interviewing, and observations by senior people of trainee in- terviews, in addition to instruction in gen- eral interview techniques. PROCEDURE All subjects associated with housing sites first were sent a letter explaining briefly the purpose and sponsorship of the study. A time for the interview was scheduled, and subjects were seen in their current domi- ciles. Because interviews were done about a month before people were to move in, some changes occurred, and about 4 percent of those originally interviewed did not, in fact, move in. Procedures for selecting subjects to be interviewed varied with the total population of the site. Our aim was to obtain about 120 preoccupancy interviews at each new site, or 100 at ongoing sites. We began by choos- ing every nth name from the list in such a way as to yield the desired number. When the interview was not completed for the name drawn, the immediately preceding un- designated name was drawn. The noninter- view rate (including those who could not be located) varied somewhat among sites, but averaged around 14 percent at new sites. In the case of couples, one member of the Table 1. Background characteristics of subject groups Mean Mean % % % % Mean Monthly Occup. Median Fe- U.S. % Mar- Jew- % % Group Age income Level * Educ. male born White ried ish Prot. Cath. Blueberry Acres 71.4 $192 3.1 8.2 70 76 97 44 7 23 70 Ebenezer Towers 72.0 130 1.7 8.5 78 95 1 12 1 91 8 Flower Tower 70.6 132 2.6 8.0 78 33 86 27 54 20 26 Golden Years 73.4 198 4.2 9.8 80 33 100 35 96 0 4 Metropole Center 70.5 131 2.4 8.3 74 88 42 23 1 69 30 Old Gotham House 79.7 212 4.7 6.8 73 24 100 33 99 1 0 President House 72.9 89 2.6 8.1 82 91 99 12 1 72 27 Riverlake 73.7 117 3.0 9.5 80 67 79 29 36 51 13 Samuel Gompers Gardens 69.1 206 1.8 5.6 66 20 96 25 82 5 13 Sholom Aleichem House 74.5 233 4.2 — 74 18 100 18 99 1 0 Van Winkle Houses 71.4 132 2.2 8.1 78 38 70 32 54 37 9 Yishay Apartments 73.1 227 4.3 12.0 72 0 100 51 100 0 0 Jersey City White 71.5 250 3.0 8.4 57 67 100 45 9 25 66 Black 72.2 164 1.7 6.8 61 100 0 42 0 93 7 Philadelphia A 69.0 ee 2.6 4.5 81 98 0 31 0 100 0 Philadelphia B 70.0 230 1.8 5.1 48 23 100 57 19 6 75 Philadelphia C 77.0 153 2.5 4.0 71 9 100 30 100 0 0 a From Duncan Occupational Prestige Scale (Reiss et al. 1961). Table 2. Characteristics of housing sites Race/religion, socioecon. Loca- Type of Type of Type of No. of No. of No. of Services status Site tion Location Neighborhood * housing ” units tenants floors provided © of tenants Blueberry Acres NE City W, m-c, r PH 156 210 13 None W, w-c Ebenezer Towers NE Large city B, low/m-c/w-c, r 202 140 155 1 Med. B, m-c/w-c Flower Tower NE Large city B/PR, w-c, r PH 160 210 16 SC, lunch Mixed, w-c Golden Years NE Resort city Boardwalk area 202 208 280 14 None Jewish, m-c Luther Lodge South Large city Suburb, up/m-c, r 202 202 200 13 Med., meals Prot., m-c Metropole Center MW Large city B/W, w-c, r PH 175 200 14 SC, lunch WB/, w-c New Gotham House NE Large city W, m-c, r 231 240 251 12 Med., meals Jewish, m-c Old Gotham House NE Large city W, m-c, r 231 220 264 11 Med., meals Jewish, m-c President House NE Small city W, w-c, r PH 143 160 8 None Prot., w-c Riverlake MW Large city B, w-c, r PH 247 319 16 SC, lunch, med. Mixed, w-c Samuel Gompers NE Large city Center city, bus 202 278 308 17 SC, med. W, w-c/m-c Gardens Sholom Aleichem NE Large city W, up/m-c, r 202 310 350 11 Meals, nurse Jewish, m-c ouse Van Winkle Houses NE Large city B/PR, w-c, r PH 112 167 14 SC, lunch Mixed, w-c Yishay Apartments NE Large city W, m-c, r M-L(NY) 134 224 12 SC, meals Jewish, m-c a W = white; B = black; PR = Puerto Rican up = upper; m-c = middle-class; w-c = working-class r = residential; bus = business ? PH = public housing; M-L(NY) = New York Mitchell-Lama direct loan program < SC = senior center; Med. — medical ADV HHL 904 DNISNOH NI SHDIAYHES TVOIAAIN ANV 'TVIDOS PURPOSE AND DESIGN OF THE STUDY 7 couple was designated the subject, and every effort was made to recruit that person. On occasion, despite the efforts of the inter- viewer, the spouse of the subject insisted on answering. In these instances, the inter- viewer was allowed to substitute the spouse of the initial subject. Thus, the total sample at each site may be biased somewhat in favor of (a) the cooperative tenant, (b) the available tenant, and (¢) the dominant mem- ber of the married couple. Three of our samples were not interviewed by project staff. For the Jersey City com- munity resident comparison groups, the household samples of white and black elderly ‘persons living in the census tracts where the majority of the public housing tenants resided prior to their move were drawn and interviewed under contract with National Analysts of Philadelphia. Similarly, the Na- tional Opinion Research Center of Chicago was engaged to interview tenants at Metro- pole Center. THE INTERVIEW SCHEDULE The interview schedules were designed to gain information about the attitudes and be- havior most relevant to evaluating the suc- cess of a living environment. Areas ques- tioned included: e Background characteristics e Preoccupancy characteristics and the de- cision to move Expectations about the new building Family relationships Friends and peer relationships Organizational activities Life-sustaining (instrumental) activities Life-enriching activities Self-rated health Morale and life satisfaction Housing satisfaction Response to interviewer Most of the questions were asked identi- cally in pre- and postoccupancy interviews and in interviews of subjects questioned only once. Whenever possible, previously standardized measures such as the Rosow Health Scale (Rosow and Breslau 1966), the Philadelphia Geriatric Center Morale Scale (Lawton 1972), and the VIRO Scale (Kastenbaum and Sherwood 1972) were in- corporated in the interview schedule. In addition to the standard questions, al- most every site or subject group was asked some questions unique to its particular situa- tion. For example, community residents were questioned about their wishes to move, and tenants in sites with services were asked about their use and evaluation of the serv- ices. Some questions were unsuccessful with one group and were dropped from future schedules. Sociometric Surveys At some sites a complete sociometric sur- vey was done, i.e., all tenants, whether in the study sample or not, were asked to name their three best friends and tell where they live. From this information, measures of frequency of choosing and of being chosen (popularity) could be obtained. At the ma- jority of sites, only the study sample was surveyed. Two sites were surveyed at both 3 and 12 months after initial occupancy so temporal changes in friendship choices could be studied. Behavior Mapping A formalized scheme for the behavior of people in the public areas of the housing sites was devised. The schedule was set up so observations could be made at six speci- fied times of day and evening on five differ- ent weekdays, but observations were not made on all occasions at each site. The ob- server was required to traverse all halls, public rooms, and outdoor areas, tallying the number of people in each area and noting whether they were engaged in social behav- ior and whether they were tenants or non- residents. Open apartment doors were also counted. Each tour took about one-half hour. Medical Examinations Applicants to Golden Years and Ebenezer Towers were examined by local physicians recruited for the purpose, using the Phila- 8 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED delphia Geriatric Center’s standard physical examination form and functional Physical Classification Scale (Waldman and Fryman 1964). Golden Years tenants also were ex- amined after a year of occupancy. We origi- nally envisioned performing medical exam- inations on other tenant groups, but the data coming from the necessarily short ex- aminations did not appear sensitive enough to warrant the relatively high expense of gathering the information. Administrator Ratings Administrators were asked to rate tenants on scales measuring General Deterioration, Relationships with Other Tenants, Social Activity Participation, General Happiness, and Independence. Researcher Ratings The investigator and one senior sociolo- gist, on the basis of all knowledge available after the sites had been studied, ranked the sites on each of the dimensions listed below. Differences were resolved through discus- sion, resulting in revised consensus rankings. e Total amount of common space e Architectural quality of the building from the point of view of function, social facili- tation, and aesthetics eo Extensiveness of the activity program o Life-sustaining quality (an index of in- tensity of supportive services) eo Neighborhood resources (richness of shop- ping, transportation, entertainment, serv- ices, and other facilities) e Safety of neighborhood from crime e Amount of managing (the degree of ac- tivity of the manager’s style) e Quality of management (an overall evalu- ative judgment) Qualitative Observations Senior investigators and research assist- ants spent considerable time informally observing life at the housing sites, and con- versing with administrators, housing au- thority staff, other personnel, and tenants. Separate examinations of this qualitative ma- terial, not included in this report, were done on New Gotham House, Golden Years, Van Winkle Houses, and Metropole Center. DATA ANALYSIS The total amount of data gathered was enormous: a conservative estimate would put the total number of variables measured in one or more subject groups in the neigh- borhood of 800. Order was built into this mass of data by the definition of five of the six major objectives of the investigation: (a) study of the impact of new housing, (b) prediction of favorable response to new housing, (c) definition of selective factors associated with a person’s applying for new housing, (d) study of the impact of hous- ing offering services and other aspects re- lated to the onsite delivery of services, and. (e) study of the differential impact of differ- ent housing sites on well-being. For these five major project objectives, the variables whose effect was to be studied were very clear: Objective Variable(s) to be compared Rehousing vs. contin- ued community residence Demographic char- acteristics and initial status Housing impact Predictors of positive response Self-selective factors in choice Service-package impact Differential environ- mental impact Rehousing vs. contin- ued community residence Onsite services vs. no services Five different hous- ing sites The outcome variables were numerous. Many of them were included as indices of behavior or attitudes that were expected to reflect the tenant’s sense of well-being—Ilife satisfaction, morale, functional health, social adequacy, and so on. Others could not be characterized so clearly as measures of well- being, but expressed the tenant’s position on a number of issues of intrinsic interest to planners and administrators of housing PURPOSE AND DESIGN OF THE STUDY 9 for the elderly—reasons for wishing to move, expectations about the new environ- ment, attitude toward age-segregated living, preferences for housing types, evaluations of structural characteristics of buildings, and so on. Although several previously standardized scales were used, the psychometric proper- ties of many items were unknown. The choice of method of analysis was dictated by both the need to reduce the total num- ber of variables and the wish to heighten the reliability of the critical dependent vari- ables. Thus, the factor-analytic approach to data reduction was chosen. From the total array of variables, 334 were chosen that seemed to be (a) particularly important to the well-being of old people, (b) of in- trinsic interest on their own account, (c) important personal background characteris- tics, (d) relatively nonredundant with other variables, and (e) measured on most sub- ject groups. Thus, the data-reduction task began with individual interview and data items, even if an existing scale had been represented by a group of items. The statistical technique of factor analysis was used to define a small number of higher order measures of well-being. Each of these dimensions was used in a number of data analyses to be described later (see appendix table 1 for complete lists of factors, items, and loadings). These dimensions were: 1. Functional Health is one of the largest and strongest of the factors and clearly re- fers to the frequency and vigor with which the person performs various tasks. All six of the Rosow and Breslau (1966) health scale items appear on this scale, as do sev- “eral self-perceived health items. 2. Social Stimulus Value includes 13 of the 14 rating scales of the VIR (Vigor, Inter- action, Response) portion of the VIRO Scale (Kastenbaum and Sherwood 1972). This scale’s items are meant to capture the be- havior and affective response of the indi- vidual during the interview. Other items are based on four other interviewer ratings and two characteristics rated by a person un- familiar with the research procedure, the housing manager. 3. Middle-Class Leisure Pattern is defined particularly by such typically middle-class behaviors as organizational activity, joining, and having upward-mobile children and relatively high occupational prestige them- selves, as well as a variety of other appar- ently class-related characteristics. Many of the items in the factor refer primarily to planned housing, so that the factor is not useful for longitudinal or control-group com- parisons. 4. Morale consists of 12 items from the PGC Morale Scale (Lawton 1972). The items in this factor include most PGC items that refer to neurotic and depressive symp- toms, but they also include four items intro- duced to represent the inner aspect of dis- engagement (Cumming and Henry 1961) : eo As you get older, do you care less what other people think of you? e Do you sometimes enjoy just doing noth- ing? e Now that you are older, do you do as you please more than you use to? eo Are friends more important for younger people than for older people? The fact that these four items are closely related to other indicators of low morale, among other things, argues against the idea that increased detachment and feelings of inferiority are appropriate reactions to growing old and indicate positive adjust- ment. 5. Change for the Better consists of 21 items, 18 of which contain a time compari- son allowing people to say whether their current state of well-being is better or worse than at some earlier period of life. Eleven items were phrased in successive format (e.g., In the last year would you say that . . . you are more (active), less (active), or about the same?). Five PGC Morale Scale (Lawton 1972) items are also in the factor, most of them involving time comparison and all expressing satisfaction or dissatis- faction with some facet of the tenant’s daily life; these are clearly ideological, in contrast to the symptom items of the Morale factor. 6. Female Role contains items indicative of the frequency and ease with which “feminine” instrumental activities—cooking, 10 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED housecleaning, and laundry—are performed; owning a car is negatively loaded. This fac- tor is useful in differentiating among the competences of women and in measuring the extent to which men perform these roles. A high score indicates a high level of female role performance. 7. Loner Status in its negative direction describes people who have few familial and peer relationships and who interact on few occasions. Although this factor seems less than ideally useful because it mixes three separate aspects of the social networks of older people—presence of family, interac- tion level with family, and interaction level with peers—the items do fall together em- pirically. 8. Orientation to Children contains items related explicitly to children, as contrasted with Loner Status. Several of the behavioral items implicitly relate to activities with children (e.g., cooking for visitors, visiting the previous Sunday, going to church, and taking trips). 9. Housing Satisfaction contains a diverse set of items with the common thread of both a positive evaluation of the residential set- ting and the possession of the basic ameni- ties necessary to a well-equipped household. 10. Sociability is explicit to level of social interaction in the planned housing environ- ment: number of friends named, number of times chosen, frequency of visiting, nam- ing a “best friend” or being able to name a leader, and so on. Since this factor does not appear for the community comparison groups, it is used only for the housing groups. 11. Need for Services contains items re- lating to the wish for services among ten- ants in housing projects. 12. External Involvement is defined by a relatively few items whose common thread is the investment of time in activities that maintain a tenant’s link to the world outside, whether that be watching TV, keeping up with the news, going outdoors, or becoming involved in organizational activities. An in- teresting “extra” item concerns feeling safer during the past year; safeness may be per- ceived as facilitating involvement with the external environment. 13. Continued Breadth of Activity is de- fined by a small number of loosely related items indicating good functional health, though reasons for its independence from the Functional Health factor are unclear. 14. Satisfaction with the Status Quo con- tains five items different in content but simi- lar in that all express a tendency to like whatever one has today. One item (a per- son should live for today and not worry about tomorrow) is from the Cumming and Henry (1961) Morale Scale, and all items express a philosophy similar to Cumming’s and Henry’s concept of high morale in the ideally disengaged person. 15. Deprivation is composed of items that express at least the feeling, if not the reality, that one has been deprived in terms of fam- ily contact, social life, quality of domicile, health, finances, or proximity to facilities. The following chapters present the major analytic findings of the study: the impact of housing, services in housing, selective factors in recruitment, the prediction of well-being, the use of public space, and site differences in tenant well-being. Finally, findings that are more descriptive than ana- lytic are presented in chapters on environ- mental preferences and evaluations, and on the manager. Chapter 2 The Impact of Rehousing The basic question asked by the research was, “Does new housing help?’ This proj- ect came several years after Carp’s (1966) study of a successful project lit by the fire of an extremely gifted team that included architect, housing authority director, admin- istrative and social service personnel, and a research staff intimately associated with the housing. Was the success story of Vie- toria Plaza the one-occasion result of an unduplicatable team, or is there reason to feel that the basic idea lends itself to replica- tion by other teams? Five housing sites—Golden Years, Presi- dent House, Blueberry Acres, Ebenezer Tow- ers, and Sholom Aleichem House—were as- sessed in terms of their impact on tenants. Tenants were interviewed during the month prior to moving from their scattered homes in the community into new age-segregated high rise housing built especially for the Portions of this chapter were published in Law- ton and Cohen (1974). Copyright 1974 by Journal of Gerontology. Reproduced with permission. elderly and handicapped and again 12 months after the move. Change in these rehoused individuals was compared to change among elderly community dwellers who did not change residence during a similar 12- month period. Table 3 shows the numbers of subjects and their status at the two evaluation times. The original housing group subjects were selected by sampling a list made available by management about 6 weeks before each. building’s opening; the sampling interval was adjusted to yield 100 to 120 names. However, it proved impossible to maintain the sample in its original form: some appli- cants withdrew and were replaced by new prospective tenants, and, in the case of the three 202 sites, some applicants lived in other cities and could not be interviewed, while others could not be located or sched- uled for appointments. As table 3 indicates, among those available for interview the num- ber of refusals was relatively small. While we cannot claim to have utilized a random Table 3. Subject groups assessed for impact study First interview 12-month followup interview Names Inter- Did not Inter- Group drawn viewed move in viewed Moved Deceased Refused Other Housing sites Golden Years 182 143 1 113 2 1 4 12 President House 130 123 9 91 6 1 2 14 Blueberry Acres 139 119 3 97 4 2 3 10 Ebenezer Towers 105 100 1 78 9 6 2 4 Sholom Aleichem House 110 89 0 64 9 3 10 3 Totals 666 574 24 443 30 13 21 43 Community residents Jersey City (white) 128 100 ns 51 6 3 27 13 Jersey City (black) 112 101 i 69 12 4 8 8 Philadelphia A 84 66 er 28 9 4 8 17 Totals 324 267 Ri 148 27 1 43 38 11 12 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED sample of all tenants, neither is there rea- son to believe that the original sample was systematically biased. Followup interviewing at the housing sites was very successful, with an overall re-interview rate of 83 percent. Both man- agement and tenants were extremely helpful and eager to participate on both occasions. The community-resident groups were con- stituted in different ways. One housing site was located in Jersey City, and it was pos- sible to draw a block sample of community- resident elderly from the census tracts that furnished the largest number of tenants to that particular housing project. A private research firm, National Analysts of Phila- delphia, conducted the survey. Equal-sized samples of white and black elderly were sought, but residential segregation patterns made it impossible to find 100 black elderly in the originally specified census tracts. Therefore, adjacent tracts were added to increase the total pool. It was planned that the Philadelphia group (Philadelphia A) would match the tenants of Ebenezer Towers. However, since a fair number of the tenants had above- average incomes, locating a predominantly black comparison group through any kind of household sampling method would have been prohibitively expensive. Therefore, each interviewed applicant was told of our wish to compare movers with nonmovers and was asked to suggest three friends of his/her own sex and approximate age who did not want to move, for possible interview. Such a method presents many opportunities for biased selection, but some other factors may have been equalized through the tendency of people to name friends of similar status, background, and interests. This procedure yielded relatively few subjects at the initial interview: many interviewees refused to give names, and many people named were unreachable or refused to be interviewed. At followup time, the research project was operating under major budgetary re- strictions. While contact with all originally interviewed community subjects was at- tempted, callbacks and other time-consum- ing means of scheduling appointments were severely curtailed. This unavoidable attri- tion of community-resident subjects further diminished whatever comparability the com- parison groups originally had. The tech- nique used for data analysis, multiple re- gression analysis, was chosen partly because it is ideally suited for comparing groups that are not equated on background vari- ables. Details of the data are not presented here. However, appendix table 2 shows the char- acteristics of the tenants and table 3, the results of the statistical analysis. The analy- sis allowed comparison of the amount of change over one year among rehoused ten- ants with the amount of change over one year in the community comparison group, taking into account initial differences Dbe- tween these two groups in many background characteristics and generalized well-being. THE IMPACT OF REHOUSING: HIGHLY FAVORABLE After one year in the new housing, the rehoused were: e Significantly poorer in functional health than the community comparison subjects. e Significantly higher in morale, perceived more change for the better, and were more satisfied with their housing, more involved in external activities, and more satisfied with the status quo than were the community-comparison residents. There were no significant differences in Loner Status, Orientation to Children, or Continued Breadth of Activity between the rehoused and the community-comparison residents. With such a relatively large number of subjects, the size of the effect required for statistical significance is quite small. Meth- odologists have argued that relatively large samples such as the current one can be ex- pected to yield many small relationships that are statistically significant but that should be ignored. This argument is misapplied to the problem at hand, however. The task is not predicting, but rather identifying con- ditions that can improve the life styles of THE IMPACT OF REHOUSING 13 individuals over and above the effects of other, perhaps more potent, influences. We did not intend to measure the variables most likely to maximize prediction of followup status. Had we done this, we would have in- cluded measures of personality, attitudes, past medical and psychiatric status, and life experiences before the move. These dimen- sions, after all, pretty much constitute what a person is, and they would be expected to contribute most to the measures of morale, activity, and social participation a year later. These variables were not measured in the present study, but it is hoped they were randomized throughout the rehoused and comparison groups. Information on the rela- tively stable demographic statuses (age, sex, marital status, religion, and income) was controlled, and the sometimes very signifi- cant variance associated with these statuses was separated from the experimental effect. Viewed in this perspective, the housing change is seen as truly only one small com- ponent in and of itself. The fact of being rehoused would be expected to be related more to some of the criteria than to others. The point is that we must be humble in our expectations about the impact a change in housing may have. Generally, a person’s given biological, psychological, and social characteristics endure. Environment’s in- fluence lies in its potential for changing role functions and the degree of satisfaction an individual takes in performing these roles. As stated in more detail elsewhere (Law- ton 1970a; Lawton and Nahemow 1973), older people, particularly older people who have housing and possibly other problems, are likely to be more vulnerable to environ- mental influences than people in general. Therefore, we do have some hope that a favorable effect on well-being might occur. The favorable effect has been confirmed, in the face of the large number of other and more powerful factors that might influence well-being. The magnitude of the effect is in line with what might be reasonably ex- pected. Because of the methods used, the criteria are relatively reliable, and the inde- pendent regression effect therefore may be expected to be quite stable. Since physical health is typically so strongly related to all types of well-being, another set of analyses of change in well- being was done so as to equate all subjects on health prior to testing the effect of re- housing on well-being (a functional health variable, Pre-Long Functional Health In- dex). With the addition of preoccupancy health status as a control variable, the effect of rehousing on morale dropped below the level of statistical significance. The magni- tude of the favorable effect of housing on all other factors increased after the control for health. Some implications of the findings are: 1. Positive advantage can be expected from rehousing elderly persons, especially when the older person is given the response set to evaluate his/her current condition as it may have changed over the past year. This kind of evaluation is likely to be posi- tive partly because there is some adjustive value in the respondent’s simply saying he/she is better off this year than last. That the rehoused say this more frequently than do comparisons is not difficult to accept, since they no doubt need to make their evalu- ations consonant with the fact of having a new residence. Undoubtedly there also is some tendency to be afraid of responding in other than a positive way—a not uncom- mon suspicion that one may be asked to move if one says anything negative about the authorities. 2. Self-perceived Change for the Better is the most marked indicator of a positive housing effect, but not the only one. The items in the Morale factor inquired about similar feelings at two points in time, but did not offer the time span as a frame of reference for making the judgment. The Sat- isfaction with Status Quo factor is of simi- lar meaning, as is Housing Satisfaction. Each is a different aspect of expressed life satisfaction and all are in the direction of increased satisfaction among the rehoused. 3. Involvement in the activities of the ex- ternal world was greater among the re- housed, though not in all the ways this behavior could have been measured. That is, the External Involvement factor scores were 14 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED significantly higher, but other kinds of in- volvement, as shown in the Loner Status, Continued Breadth of Activity, or Orienta- tion to Children scores, did not reflect this change. Since social and planned activities are of particular interest in evaluating the success of housing for the elderly, later dis- cussion examines some of the separate as- pects of activity participation. 4. The relative decline in Functional Health among the rehoused is substantial and needs explanation, inasmuch as this finding runs counter to the general improve- ment in well-being found elsewhere. Several explanations are possible. It may be that in spite of the statistically achieved equivalence of the Pre-Long Functional Health scores of the rehoused and compari- son groups, those recruited by the new housing were physically more vulnerable. The critical test of this hypothesis would require assessment of health at a time prior to our preoccupancy measure, so that differ- ences in the slopes of the health-vs.-time curves of the rehoused and comparison groups could be tested, as in figure 1. The author has suggested elsewhere (Lawton 1969) that people tend to assess potential environmental situations in terms of whether those situations are likely to be consonant with their assets and liabilities. The hous- ing applicants may have perceived a physi- cal vulnerability in themselves that led them to apply for planned housing, unquestion- ably a more protected environment. This is purely a hypothesis for later testing. (To) GOOD — — a Comparison HEALTH POOR TIME Figure 1.—Hypothetical slopes of changes in rehoused and comparison groups It is equally possible that the new environ- ment actually curtailed the tenants’ func- tional capacity. Some items included in the Functional Health measure do decline sig- nificantly more in the rehoused than in the comparisons and may be essential aspects of the new living situation: frequency of leaving the housing site and frequency of leaving the neighborhood. Frequency of climbing steps naturally would decrease with a move into an elevator building. However, other items represent subjective estimates of the difficulty or ease with which physical energy is expanded; the criterion thus seems to be a self-estimated functional health index. It is also possible that the “protected en- vironment” of housing for the elderly dis- courages striving. Rosow (1967) has hy- pothesized that the greater the number of facilities provided within a housing site, the greater the tendency of tenants to withdraw from the community. A reduction of energy expenditure would be implied here. If fur- ther research, including a study of the form illustrated in figure 1, reveals that func- tional health does erode as the result of a move into new housing, it would seem par- ticularly important to attempt to predict which people might be more vulnerable to this erosion—the dependent? the psychiatri- cally disturbed? the deprived? Particular vigilance would be required, and counterac- tive measures to stimulate continued per- formance of instrumental tasks, geographic movement, and even prescribed exercise would need to be developed. Regardless of the reason for the decline in health, if health declines, all previous research on aging should lead us to expect a concomitant decrease in other forms of well-being. Nothing is more regular than the correlation between health and morale, health and social behavior, or health and leisure-time activity. Yet, in this study, while health declined more among the rehoused than among the controls, the net change in several other indices of well-being favored the rehoused. This suggests that the total impact of the new housing was to buffer the individual against a decline in health, so that attitudes, affect, and even some forms THE IMPACT OF REHOUSING 15 of social involvement, could remain at rela- tively favorable levels. In conclusion, it is not difficult to make a strong case for the overall favorable impact of new housing on elderly tenants. This conclusion must be tempered by the concur- rent greater decline in Functional Health among the rehoused than among controls, as well as by the failure to demonstrate clear superiority of new housing in affecting some social and activity criteria. Also the settings and subjects studied are by no means representative either of Federal hous- ing in general or even of high rise or age- segregated Federal housing. Finally, the major reservation that must be voiced con- cerns the magnitude of the favorable effect: small. Field research that depends primarily on older people’s overt responses to a struc- tured questionnaire has a large amount of built-in error, so the size of the effect is probably underestimated. Even so, it should be clear that new housing cannot be ex- pected to transform totally the lives of older people. They remain bound to their lifelong personalities, their problems, their capabili- ties. Most of the constraints our society offers them remain in spite of new housing, and much may be lost in the move. Thus, the expectations of planners, sponsors, and professionals must be tempered with accept- ance of the realistic limits to which a new environment can affect most tenants’ well- being. In light of subsequent research done at the Philadelphia Geriatric Center (Law- ton and Nahemow 1975), a couple of the five sites studied here seem to have some extraordinarily favorable features, but they include neither the best nor the worst ex- amples of this genre. Thus, there is reason to expect that improvement in design, in services offered, or in management can ex- tend the favorable impact we have docu- mented. But those who despite their best efforts fail to provide a total Shangri-La should not feel frustrated or defeated. SUMMARY This chapter has detailed the method by which the impact of new housing on the well-being of elderly tenants during their first year as tenants was tested. A positive impact of housing was measured in indices of Morale, perceived Change for the Better, Housing Satisfaction, External Involvement, and Satisfaction with the Status Quo, as compared with change over one year in a group of older people remaining in their homes in the community. A decline in Func- tional Health was associated with the new housing, and there was no effect on indices measuring Loner Status, Orientation to Chil- dren, or Continued Breadth of Activity. Rea- sons for the decline in health are obscure, but it is possible that the new housing under- mines the tenants’ energy expenditure. The relative improvement (or lesser decline) in other criteria despite the decline in health, however, points to a buffering effect of the housing environments in keeping tenants’ psychological state buoyed up. The size of the favorable effect is relatively small, how- ever, and caution is advised in the extent to which even the best housing environment can be expected to solve lifelong or current problems of the tenants. Chapter 3 Supportive Services in the Context of the Housing Environment The major questions addressed in this project’s inquiry into supportive services were: 1. What is the perceived need for services among community residents, applicants, and tenants? 2. By whom are services actually utilized? 3. Are tenants recruited selectively into projects that offer services as compared with projects that offer primarily housing ? Definitive answers to these questions will have to come slowly as findings from many different research projects are integrated. This research was the first to be reported in this area. Our inquiries were limited in scope, and our choice of sites had to be based more on their availability at the time of study than on their suitability for care- fully controlled experimentation. Therefore, the findings reported in this chapter should be viewed as exploratory and as bases for future hypothesis testing. Originally, we had planned to compare pairs of new sites that recruited similar populations of tenants, with one member of the pair having onsite services and the other member not having such services. However, new sites with services were almost non- existent during the 1966-69 period, and we were able to locate only one within an area where study was feasible—Sholom Aleichem House. For the study of the impact of serv- ices, then, only one pair was available (Golden Years being the nonservice paired Portions of this chapter were published in Law- ton (1969) and in Greenbaum et al. (1970). Copy- right 1969 and 1970 by Gerontologist and Journal of Aging and Human Development. Reprinted with per- mission. 16 member). However, two years previously a pilot study had studied New Gotham House, which also offered many services and had a population very similar to the other two. Thus, for a few comparisons where similar data were available, the service-site sample is augmented with data from New Gotham House. Since we were unable to compare matched pairs of new sites, we took the next-best approach—studying established sites that already had one or more services in opera- tion. At these sites it was not possible to study impact of services because the pro- grams were already underway and new tenants did not enter at a rapid enough rate to obtain enough new subjects for a longitu- dinal study. However, we were able to look at other features, such as utilization, atti- tudes toward the different varieties of serv- ices, and so on. TYPES OF SERVICES For easy reference, table 4 shows the types of services offered at the different sites. Every site had some kind of activity program, so routine activities are not listed. The presence of a senior center indicates a major activity program, usually involving more than one staff member. At the time of study medical services were relatively un- usual in federally assisted housing for the elderly; an exception was housing operating under the high-income 231 program (see chapter 11), where a full range of housing, infirmary, and nursing-care accommoda- tion frequently was provided. A number of totally privately financed (usually church- sponsored) retirement centers also offer this SUPPORTIVE SERVICES IN THE HOUSING ENVIRONMENT 17 Table 4. Services offered by the housing sites Services offered Senior Site Medical Food center Other Blueberry Acres None None Yes None Golden Years None None No None Sholom Aleichem House Physician’s office Noonday dinner Yes None Metropole Center None Hot lunch Yes Transportation/ Homemaker Samuel Gompers Gardens Clinic for union members None onsite Yes None President House None None Yes None Yishay Apartments None Optional lunch Yes None & dinner Flower Tower Onsite clinic None Yes None Ebenezer Towers Nursing home nearby None No None Riverlake Onsite clinic Lunch Yes None Van Winkle Houses None Lunch Yes None Old Gotham House Onsite clinic Lunch & dinner No Weekly housekeeping Luther Lodge Nursing home nearby All meals Yes None New Gotham House Onsite clinic & special- Lunch & dinner No Weekly care floor housekeeping Northbridge Diagnostic clinic None Yes None full spectrum of medical care. Since this study was done, “congregate housing” with a much broader array of services has been facilitated, especially under the 202 program. Unquestionably, full service is a major attraction for many older people, if they can afford it. Tenants seem to feel more secure when they know that all their medical needs can be met easily and that they won’t have to worry about where to go should their health decline. New Gotham was one of the few housing sites that at that time offered comprehen- sive services. Although New Gotham is a 231 project, it operated so that its total monthly cost at the time of the survey ($200 per month) for efficiency apartment, lunch, dinner, housekeeping, activity, and full out- patient onsite clinic and medications was still within range of the lower middle income tenant. Medical Services New Gotham House and Old Gotham House share one full-time physician who has an office and a treatment room in each build- ing. Both have a full-time day nurse and 24-hour coverage on call by live-in nurses. In addition, New Gotham House has a spe- cial-care floor, built like other floors with regular apartments but with an unobtrusive nurses’ station and food-serving station. Twenty-four hour nursing coverage is of- fered, as well as rounds by the physician, daily housekeeping, personal care, and meal service in apartments if needed. Tenants in these 32 units are people whose physical (or sometimes mental) condition is too poor for them to remain in the other areas of the Gotham House; without the special care they would have to go to a nursing home or back to their families. (Cost of care on this floor is higher—$345 per month in 1966.) Riverlake and Flower Tower were the only other sites in the sample with fully operating onsite clinics. Riverlake main- tained a suite of rooms for a clinic physician, nurse, and specialists. A physician was on the site for only a few hours each week, on several different days, but a nurse worked there full time and was available for regu- lar nursing dispensary duties. The housing was only one block from a full-service hos- pital. Nominal charges were made for the services, which were subsidized by the hos- pital and further aided by public funds from several sources. Flower Tower's clinic served a large group of housing projects composed of families as well as elderly. 18 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED Approximately 50 percent of the tenants of Samuel Gompers Gardens were retired members of the union that sponsored the housing. These people had ready access to the excellent full health services offered by the union health center about three blocks away in the center of Philadelphia. Sholom Aleichem House provided no medi- cal services for tenants but did have an office where a local physician (along with an attending nurse) held office hours on a regu- lar basis. A great many tenants continued to obtain treatment from their own physi- cians. Ebenezer Towers and Luther Lodge are representative of a substantial number of housing environments built close to existing homes for the aged. In neither case, how- ever, was the medical or nursing staff of the long-term care institution available to tenants of the housing sites—in one case because the staff’s time was too limited, and in the other because the administrator was anxious not to “infect” his tenants with exposure to the health-care atmosphere. Most of the other sites displayed cards listing local physicians’ phone numbers, ad- dresses, and office hours, or otherwise pro- vided this information. In a couple of in- stances, regular contact was maintained between the administration and a physician who agreed to make house calls and to come in emergencies. Meal Services Full meal service frequently is provided in private retirement centers and 231 proj- ects. On the other hand, at the time of study only a few 202 projects provided these serv- ices because, most frequently, Federal funds could not be used for construction of com- mon dining rooms and kitchens. The Hous- ing Act of 1970 explicitly authorized such use of funds for the first time in the “con- gregate housing” provisions. Funds are in- cluded in loans for middle- and low-income housing for construction (but not for oper- ation) of common kitchen and dining facili- ties. It is hoped that this will help meet the needs of people whose independence may be extended by personal care short of full insti- tutional medical care. Except in three or four small and very un- usual instances low-rent public housing, at the time of the study, only occasionally had small-scale lunch programs sponsored and subsidized by local organizations. Nutrition programs under the Older Americans Act have since been established in many public housing sites. We deliberately sought housing environ- ments that offered different types of eating arrangements. Thus, our site sample grossly overrepresents the frequency of onsite meals in the country as a whole at the time. The most extensive meal services were provided by Old and New Gotham Houses, which served lunch and dinner cooked in a kosher kitchen to almost all tenants. The cost of these meals was included in the overall cost mentioned earlier. Tenants had the op- tion to decline all meal service in return for a reduced monthly fee, but they could not choose to eat some meals and obtain a rebate for meals not taken. Sholom Aleichem House had a similar arrangement for noonday dinner. On the other hand, Yishay Apart- ments made its meals optional and purchas- able individually. Their food service chroni- cally lost money but slowly gained some financial stability by building up a service that put on dinners for local groups. All other meal services were limited to lunches served in an all-purpose room in public housing projects—Metropole Center, Riverlake, and Van Winkle Houses. Each of these was. part of a formalized senior center activity program on the housing site, run either by a private nonprofit agency with city funds (Metropole) or by the city (Riverlake and Van Winkle). Such services are not unusual at public housing sites, and became - easier to handle financially and therefore more common with the expanding, federally supported Title VII nutrition pro- gram. Nominal charges (e.g., 50¢ for soup, coffee, and salad plate or sandwich) were made for the meal, generally served to whomever shows up at the right time. Other types of food service are offered in other housing not included in this study. SUPPORTIVE SERVICES IN THE HOUSING ENVIRONMENT 19 In some housing the apartments do not have kitchens and all meals are served. At other sites tenants must pay for a minimum num- ber of meals each month but may choose which meals they take. This procedure, and even more so the completely optional meal arrangement, inevitably creates problems in maintaining financial stability. Activity Programs There is wide variation in the amount of activity provided at a site. Many housing environments designate their activity pro- grams ‘‘senior centers” or have Golden Age Clubs meeting on their premises. In general, these designations do not constitute an accu- rate guide to the range or intensity of the activity program. The presence of a paid activity worker to some extent ensures a minimal level of activity. However, this may mean the physical presence of a group for two hours one afternoon a week. Other housing with no paid worker may have a much more frequent and varied program run by tenants only. The most extensive programs in our sam- ple were those in large cities operating as formally designated centers, with substan- tial outside financial support—Metropole, Riverlake, and Gompers Gardens. High ac- tivity levels were also maintained through the efforts of tenants, management, and the sponsoring organization at Old Gotham, Yishay, Sholom Aleichem House, and Luther Lodge. Golden Year’s environment also was active, but its organized activity ceased during the summer ; the “boardwalk culture” totally and creatively supplanted the onsite program for four months of the year. All sites had some form of organized activity, with varying mixes of tenant involvement and managerial and outside contribution. The most deprived appeared to be public housing sites with part-time management and limited city resources. Under these cir- cumstances, and especially without a budget, it seems almost impossible for a tenant group to do an adequate job on its own. Social Services Caseworkers and other social work per- sonnel are sometimes normal components of the staff of large public housing authorities. Smaller authorities call on local agencies for the same services to tenants. Nonprofit spon- sors may have such personnel if the housing is part of a larger institution, but generally they rely on management or referral to local agencies; very few actually employ a social worker. A few of the private nonprofit sites studied were administered by people who had training in social work, the ministry, or social administration. Housekeeping Services Housekeeping services may be either a luxury or one of the personal care services provided for the marginally able. Actually, both purposes were served at the only sites in our sample where this service was pro- vided—the Gotham Houses. All apartments received a major cleaning once a week, while tenants themselves did the daily chores. In the special-care area of the New Gotham House, daily cleaning was provided. The service was mandatory and included in the single overall charge. Other Services Theoretically, other community-based serv- ices are available on order to older peo- ple, whether they live in planned housing or are dispersed in the community. However, additional assistance from management or a local agency usually is required to encour- age any substantial use of such services. Both Riverlake and Metropole are located in high-crime areas and at some distance from supermarkets. Both provided regularly scheduled minibus transportation. Metropole also had access to a homemaker service sponsored by the same agency that operated its senior center. Most sites had occasion to call on visiting nurse services periodically. Again, in the years since this study was done, these community home-delivered services have become more widely available to elderly tenants in planned housing. 20 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED PERCEIVED NEED FOR SERVICES Obviously, a person’s current situation af- fects his/her expressed need for services. The subjects in this study were applicants, non- applicants, and tenants. The groups were asked different questions. It was necessary for applicants to answer hypothetically about both the service itself and the hypothetical housing issue; for example, one question was phrased: “There are some apartment houses for older people being built where a medical clinic with doctors and nurses is provided. Would you like to live in a place like that, even if the medical services might cost more?” Medical Services Table 5 shows the percentages wishing medical services. By sheer numbers, the ma- jority—whether they were applicants who knew they were about to move into new housing that lacked medical facilities or community residents answering hypotheti- cally—expressed a desire for such services. Furthermore, the percentage of tenants wishing the service was significantly higher than the percentage of nontenants. Overall, 32 percent expressed no wish for medical services in general terms. Tenants who had been in residence one year expressed some- what less need for services than tenants who had lived in established housing for a considerably longer time (60 percent com- pared with 68 percent). Turning the question around, tenants at the four sites that provided some medical services were asked if they would prefer Table 5. Percentages of interviewees wishing onsite medica! services in apartment houses Wish medical Non- services? applicants Applicants Tenants Yes 599%, 549, 649, No 34 40 25 Don’t know/Other 7 6 11 Total 100% 1009, 100%, Number interviewed (418) (437) (593) Table 6. Percentage of tenants wishing various onsite medical services Tenants Tenants at sites at sites without with Service ‘services services First-aid station only 5% 5% Clinic with physician and nurse 40 54 Infirmary for temporary care 21 18 Other type of service 12 19 None 12 3 Not certain 10 0 Total 100%, 99% Number interviewed (669) (195) that there be no such service (table 6). Less than 3 percent expressed such extreme dis- pleasure with the existence of the service. When asked about specific types of medical services, very few tenants in housing either with or without existing services rejected all types of medical services. As might be expected, tenants having a clinic were more disposed to choose what they had, the clinic, and less disposed to reject all forms of onsite medical facilities. Also, tenants overall made a clear distinction between the kind of service normally healthy people might need (a clinic) and one more suggestive of real illness or disability (an infirmary), with only 20 percent choosing the latter. On the other hand, in another study (Greenbaum et al. 1970) a small sam- ple of tenants in New Gotham House, where the special-care area was located, approved both the idea of an infirmary (73 percent, N = 51), and the special-care area (71 per- cent, N =72). One would think that in addition to the tendency to like what one has there might be a general trend toward higher acceptance of a medically oriented environment as one’s potential need for it becomes greater, as this high level of accept- ance at New Gotham suggests. In any case, the need for onsite medical assistance administered in a clearly struc- tured and familiar manner obviously is far greater than our lower cost federally as- sisted housing programs have provided thus far. However, it frequently has been re- ported that tenants are made very anxious SUPPORTIVE SERVICES IN THE HOUSING ENVIRONMENT 21 Table 7. Tenants’ responses to question: Are there too many sick people in this building? Tenants Tenants at sites at sites with without Response services services Yes 319% 249, No 50 55 Can't say 19 21 Total 100% 100% Number interviewed (357) (301) by the visibility of sick people in their en- © vironment. It is not uncommon for a newly arrived tenant in her late eighties, barely able to get around with a cane, to look around and exclaim, “I didn’t know there were going to be all these old people here!” Relatively late in the conduct of the study, a specific question was added to the inter- view to explore this issue (table 7). New Gotham House was not included in these totals. There does seem to be a slight tendency for people living at sites that provide more services to express more displeasure at the presence of people whom they perceive to be “sick.” This negative evaluation may be more widespread among healthier tenants of a given building, but our data do not allow such a conclusion. In any case, it does seem that an increase in the number of vis- ibly disabled persons may increase anxiety among other tenants. In the study comparing Old and New Gotham Houses (Greenbaum et al. 1970), tenants of both sites tended to be able to identify correctly the overall difference in health between the two tenant groups. An effort was made to compare tenant well- being in the non-special-care areas of the two Houses as a rough indication of whether there was any gross decrement in well- being among the healthy tenants of New Gotham House attributable to the presence of less healthy tenants housed in the special- care area. Only one out of ten such measures gave any indication that tenants in the building with the special-care area differed appreciably from those in the building with- out the care area (see appendix table 4). We cannot, of course, rule out the possibility that there may be a more subtle effect not discerned in this rough analysis in which so many other effects are not controlled. Let us suppose that some negative effect eventually is detected. One might even say that the 31 percent objecting to “sick” peo- ple (table 7) is, in fact, evidence of such a phenomenon. The housing sponsor must still determine whether the magnitude of such an effect is great enough to warrant the decision not to provide such services for those who need them. (The sponsor would, of course, figure on attracting less-sick peo- ple to begin with, by not offering the serv- ices; see later section in this chapter on selective recruitment in projects with serv- ices.) As tenants of New Gotham House elaborated on their thoughts about the spe- cial-care area, they expressed some conflict- ing feelings: They didn’t like the ambience of sickness associated with it, but they also gained a feeling of security from the knowl- edge that there was a resource for them should their condition decline. Meal Services The situation is very different in regard to meal services. Table 8 gives responses to the following question, phrased appropri- ately for the three groups: “Some apart- ment houses being built for older people serve meals in a common dining room. Would you like to live in a place like that, even if it would cost more ?” People not living in housing for the elderly did not differ significantly in their expressed Table 8. Responses to question: Would you like to live in an apartment house for older people that serves meals in a common dining room, even if it would cost more? Non- Ten- Response applicants Applicants ants Yes 329, 27%, 17% No 56 64 79 Don’t know/Other 12 9 4 Total 100% 100% 1009, Number interviewed (435) (445) (651) 22 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED wish for onsite meals—not quite one-third thought this would be a good idea. On the other hand, once people had lived in housing that lacked meal services, their desire for such services decreased significantly (to 17 percent). One may speculate that the need for medi- cal services is much more basic than the desire for meal service. It is possible that before occupancy some people wish for on- site meals as an expression of anxiety about their ability to deal with this self-maintain- ing need. After living successfully in the new housing, their anxiety diminishes, leav- ing a small number who wish meal service either for social reasons or because they genuinely have trouble shopping and cooking for themselves. Tenants of several housing sites that did not offer food service were asked whether they would like inexpensive hot lunches to be served. Almost half said they would. Among those sites offering some meals, wide variation was found in how strongly tenants valued the meal service. Table 9 shows three 202 sites separately and the three public housing sites together (they did not differ appreciably). Tenants of 202 sites also were asked if they would prefer that meals not be provided; only a sprin- kling wished that there were no meal services. The wide variation in perceived impor- tance of meal services shown in table 9 is particularly interesting because the contrast between Sholom Aleichem and Old Gotham, on the one hand, and Yishay and three pub- lic housing sites, on the other, exactly par- Table 9. Percentage of tenants who would have moved to new housing even if no meal service had been provided 3 public Sholom old housing Response Aleichem Gotham Yishay sites Would have moved anyway 169, 119% 90% 92% Would not have moved 68 71 7 4 Not certain 16 17 3 4 Total 100% 999%, 100% 1009, allels the compulsory nature of the meals: One must take meals in the former environ- ment, while they are optional in the latter. However, this is not the only difference. The level of independence of the tenants also parallels the contrast in the critical nature of meal services: The tenants of Yishay and the public housing sites were more independ- ent by a number of measures than were those of Sholom Aleichem and New Gotham. The possible meaning of this greater inde- pendence among tenants at sites where serv- ices were not an essential part of the housing package will be discussed later in terms of a possible recruitment differential. Other Services More cursory inquiries were made about other services—social worker, activity worker, and maid service—among tenants only, at a limited number of sites where the services were not formally available (see table 10). A somewhat larger number of “don’t know” responses were given to these questions, and the expressed need for the services was relatively low. Among the 456 tenants at sites where some formalized ac- cess to counseling /social work services was maintained, 21 percent reported that they actually had discussed a problem with such a person on the staff. Thus, the level of ex- pressed need is almost exactly in line with our best estimate of actual use, though the conditions among the different housing en- vironments vary so widely as to require cau- tion in accepting this figure as a firm esti- mate of probable need. Table 10. Percentage of tenants wishing social worker, activity worker, and maid service Social Activity Maid Response worker worker service Wish the service 289, 219, 17% Do not wish the service 44 55 78 Don’t know 28 24 5 Total 100% 100% 100%, Number interviewed (433) (373) (461) SUPPORTIVE SERVICES IN THE HOUSING ENVIRONMENT 23 ACTUAL USE OF SERVICES Information on which to base estimates of probable use of facilities is very helpful to planners of housing. The consumer pref- erence survey attempted to gather this kind of information. However, it is well known that people’s estimates of their probable use of facilities are notoriously unreliable. It would have been ideal to compare appli- cants’ preoccupancy estimates with records of actual use after occupancy. The five hous- ing projects studied before and after occu- pancy had no elective services; therefore, it was impossible to compare actual use with estimated prospective use. Thus, informa- tion on use of services in the established sites that have elective services will be pre- sented as a preliminary guide to planning, in the hope that it will be augmented by more data from other projects. Medical Services The question, “Where do you go when you need a doctor?’ was asked at three sites where medical services were provided (table 11). Since cost of onsite service was not a significant factor at any of the sites, its lesser accessibility at Flower Tower may ex- plain its lower utilization rate. The clinic there was not located in the residential build- ing and was not open as many hours as Old Gotham’s. Actually, according to the records at Old Gotham House, 68 percent is an un- Table 11. Responses of tenants at sites providing medical services to question: Where do you go when you need a doctor? Source of Flower old River- treatment Tower Gotham lake Onsite clinic 40% 68% 63% Hospital outpatient service 20 2 7 Other clinic 10 2 2 Local private physician 22 17 19 Other 3 9 6 None 5 2 3 Total 100% 100% 100%, Number interviewed (85) (100) (100) Table 12. Number of times per year tenants of sites providing medical services visit physician Flower Tower & No. of River- Gompers Sholom old visits lake Gardens Aleichem Gotham None 17% 10% 3% 109%, 1-5 31 23 46 44 6-10 21 19 17 21 11-20 24 19 24 20 21 or more 7% 299% 10% 5% Median number of visits per year 6 9 7 5 Number inter- viewed (191) (88) (63) (102) Note: Columns are arranged in presumed order of in- ceasing availability of services (i.e., services are more avail- able at Samuel Gompers Gardens than at Flower Tower and Riverlake, etc.). derestimate of use; the administrator esti- mated that 90 percent of the tenants used the house physician at least some of the time. It is possible that some respondents incor- rectly named the source of treatment, not only at Old Gotham but at other sites. Table 12 shows the self-reported number of physician visits for the sites with medical services, with the columns arranged in the presumed order of increasing availability of service. There is no apparent relationship between availability and frequency of use. Clearly, medical services were most available at Old Gotham House, but reported use was about equal to use at the two sites where services were least available (Flower Tower and Riverlake). Tenants of Gompers Gardens had to walk several blocks to the union health center which provided their medical services, but their use was by far the great- est. Of course, as indicated in table 12, not all reported use refers to onsite services. However these data do suggest that easy availability by no means leads automatically to increased use. Meal Service Information was also obtained on fre- quency of use of meal services at four sites 24 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED Table 13. Frequency of eating optional meals on site Metropole, Van Winkle, and Frequency Riverlake Yishay Every day 5% 6% 2-5 times a week 6 15 Once a week 12 25 1-3 times a week 8 20 Almost never or never 69 34 Total 100% 100% Number interviewed (328) (71) where meals were optional, as shown in table 13. The three public housing sites where lunch was served as part of the activities program did not differ, and figures for these locations were pooled. The implication seems reasonably clear: the appeal of an optional program is relatively low. The higher rate of participation at Yishay, where only one- third of the tenants almost never used the service, may be attributable to many things: the nature of the population (Western Euro- pean Jewish immigrants, mostly refugees of the World War II era), the fact that meals were served in a setting purposely built as a dining room, availability of both lunch and dinner, or other unknown factors. The situation at the public housing sites is prob- ably typical; however, the involvement of only one-third of the tenant population in the lunch program seems very much in line with the utilization rate observed in many other lunch-time programs. Experimentation with this kind of service is very new, however, and these preliminary figures should not be taken as firm indicators of potential use. Many combinations of tenant groups and meal service organization must be studied before firm projections about probable utili- zation rates can be made. It would be desir- able to obtain updated information from housing sites where Title VII nutrition pro- grams have become firmly established. The relatively small amount of informa- tion gained on attitude toward medical and meal services must be interpreted, as in the case of all evaluational attitude data, in the Table 14. Evaluations of meal quality Yishay, Metropole, Sholom Van Winkle, Aleichem, and and Old Evaluation Riverlake * Gotham ® Very good 56% 209% Fair 21 59 Not so good 5 14 Don’t know/Other 18 7 Total 100%, 100%, Number (201) (216) a Offered lunch only. b Offered meal cervice beyond lunch. light of the strong tendency of elderly ten- ants to approve any aspect of their living conditions. Table 14 shows tenants’ evalua- tions of meals; responses of those offered lunch only (first column) are grouped sepa- rately from those offered more extensive services (second column). It is interesting to note that more than twice as many were willing to express an opinion on the quality of the food than the number who reported using the meal service once a month or more (table 13). If we are to take the responses at face value, it seems as if satisfaction is far greater among the group that uses the facilities the least! However, many factors are involved, one of them being the fact that the socioeconomic level of the lunch-program tenants is far lower than that of the other group. Are people accustomed to “having” more likely to be more discriminating? Or simply more critical? Or does familiarity (i.e., more frequent use) breed contempt? Or, finally, do those with least power (the public housing tenants with the lesser pro- grams) fear most evaluating an aspect of their housing environment frankly? The relative importance of these possible factors cannot be determined from the data. Among those who had some choice, rela- tively small percentages said they would buy communal meals more often if the prices were lower (11 percent) or the food were better (8 percent). Our hypothesis is that utilization has a great deal to do with both previous life style and current need; this is discussed in the next section. SUPPORTIVE SERVICES IN THE HOUSING ENVIRONMENT 25 WHO USES THE SERVICES? One would expect that medical services would be used more often by those whose health is poorer. The manager of Riverlake furnished a set of health, social, and psy- chological ratings of his tenants, which were compared to the health clinic utilization rate tenants reported for the past year. Tenants who were rated low in general adjustment, less happy, and more dependent used medi- cal services significantly more. Utilization was not related to the manager’s judgment of amount of social activity or quality of relationships with other tenants. At the same site, a tenant was employed to record, over a 5-week period, the names of all tenants who actually bought meals in the lunch program conducted in the senior center on the premises. Frequent purchase of lunches was associated with the manager’s rating of high level of social activity, but not with happiness, deterioration, or quality of social relationships. Use of the meal serv- ice was also associated in an unusual fashion with the manager’s rating of independence. Those rated as most independent took occa- sional meals during that time period, but those rated as relatively dependent tended to take either no meals at all or many meals. This finding suggests the interesting possi- bility that those in most need vary, accord- ing to their past experience, current situa- tion, or lifelong personalities, in the kind of responses they make to an available oppor- tunity such as a meal program. Some ap- pear to respond nonadaptively, that is, by avoiding a service that might bolster their marginal competence. Clearly, further ex- ploration is needed to answer such interest- ing questions as whether the gregarious eat- ing situation discourages some in need, whether it is a simple matter of outreach required to bring more into the program, or whether some marginally adequate people experience a net gain in self-image by avoid- ing such a service, and so on. Further work on the present data and on the same problem in other settings is neces- sary to determine whether there are other predictors of service utilization that may be helpful in planning onsite services. There is reason to think that the same service may serve different needs in different people. Thus, it is of interest to note that the Need for Services factor (chapter 1) did not in- clude the simple wish for medical services. Judging by other items related to the wish for meals, housekeeping activity, and social- work programs, these wishes characterize people with relatively middle-class life styles. These services make it possible to live in relative ease and comfort, and they also foster the social relationships seen to be par- ticularly important to the utilizers of the lunch program. Thus, it may well be that medical services are valued by all people be- cause they see them as either presently or potentially critical to the maintenance of life. On the other hand, other services are seen as optional at best and are rejected by the majority for whom they are (realistically) deemed either too expensive or inconsistent with their preferred independent life styles. SELECTIVE RECRUITMENT IN PROJECTS WITH SERVICES Prospective tenants, particularly those with the economic and personal resources necessary to give them a wide range of choice in type of housing, generally are rela- tively well informed about the housing en- vironment into which they are deciding whether to move. Persons whose options are narrower, such as low-income elderly in ur- ban renewal areas, may be so relieved to be offered a public housing vacancy that they do not explore adequately the new hous- ing environment’s characteristics in terms of its suitability to their needs. However, we suggest that, other things being equal, people tend to match their own capabilities to those of the new environment into which they move. Choice may be limited by many factors. For example, home ownership may make it difficult for an older person to move out of a bad situation in a high-crime neigh- borhood (Lawton et al. 1973), or poor health or personal maladjustment may induce pas- sivity in the face of demands by families, social agencies, or the political establish- 26 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED ment for change to a new environment. We believe that some considerable amount of the “resistance to change” many old peo- ple display in response to efforts of fam- ily and professionals to induce them to move actually represents this tendency to optimize the congruity between personal needs and the environment. The possibility that this apparent “resistance” is well con- sidered is strongly suggested by the great amount of evidence now coming in to sug- gest that involuntary relocation is life threatening (Blenkner 1967). If this ‘“congruity optimization hypothe- sis” is correct, one ought to find that appli- cants to projects with services would differ systematically from applicants to projects without services. Specifically, it seemed to us that people who were less competent should seek out environments where sup- portive services would help compensate for their lack of competence. Data for testing this hypothesis came from the service’ no-service site pair (Sholom Aleichem and Golden Years, respectively) and in some in- stances from another full-service site used as a pilot study (New Gotham House), where some measuring tools identical to those utilized in the latter pair were used. The preoccupancy characteristics of ten- ants going into sites with services were com- pared to those of tenants going into sites without services. Incoming tenants at all three sites had enough personal or family income to allow them some freedom of choice in deciding where to live. They also were relatively similar in such important back- ground characteristics as income, sex dis- tribution, religious background (Jewish), and urban life experience. The following characteristics were meas- ured at time of application for 89 tenants of Sholom Aleichem House, 75 of New Gotham, and 120 of Golden Years (see ap- pendix table 5) : Age Functional health Number of organizational memberships Number of organizational meetings at- tended Self-rated happiness Frequency of leaving the residence Voted in the 1964 elections Frequency of leaving the neighborhood Complexity of most frequent leisure ac- tivity e Number of friends reported Six of the 10 comparisons revealed sup- port for the hypothesis. That is, applicants to the site without services were younger, in better health according to medical ex- amination, belonged to and attended more organizational meetings during the past year, considered themselves happier, and left their residences more frequently. They did not differ in having voted in the last presiden- tial election, frequency of leaving the neigh- borhood, complexity of their most frequent leisure-time activity, or number of friends reported. Thus, while the hypothesis was not supported in every instance, the weight of the evidence strongly supported the idea that offering a service has major conse- quences for the kind of person who will ap- ply for a housing environment. The implications of this finding for plan- ning housing are major. It would be possi- ble for a sponsor to insist on screening applicants so that this self-sorting does not occur. However, in the instances tested here, there had to be a mutual concordance be- tween the sponsor’s admission standards and the choices of applicants. It seems that this procedure is highly desirable, its result be- ing that environments like Sholom Aleichem or New Gotham House serve a segment of the elderly population that would not be served in the usual housing built for the maximally independent. A sponsor must take this fact into account and realize that ac- cepting the less well and caring for their needs is a snowballing process. Such a hous- ing project becomes known for serving the less competent segment, and more compe- tent people may not apply for admission. A sponsor not ready to assume increasing responsibility for its tenants should not build large numbers of services into the site pro- gram. This research did not deal with another major aspect of the onsite service program, the long term change over time in the ori- SUPPORTIVE SERVICES IN THE HOUSING ENVIRONMENT 27 ginal tenant population. It is not yet known how change occurs (that is, the extent to which replacements are similar to or differ- ent from the original tenant population) and the changes in the tenants who remain. It is probable that most housing environ- ments will “age,” that is, that tenants in them will come to require services not nec- essary when the housing first opened. Fur- ther research will be necessary to provide guidance for sponsors about optimal ways of providing services for a changing tenant population and of anticipating such future needs by long range planning of space for such additions to the service package. IMPACT OF SERVICES ON TENANTS Our test of service impact requires par- ticular caution in interpretation because it is a quasi-experiment using two naturally occurring environments in different cities (Sholom Aleichem in Philadelphia, Golden Years in Atlantic City) whose tenants dif- fered in important ways before they came to their new housing. The tenants were alike in being Jewish, with a large propor- tion having come to the United States from Eastern European countries. Either the ten- ants themselves or their children had moved significantly upward in the social scale, since the minimum annual income required for rental plus other living expenses was sig- nificantly above the national average for older people. Almost all had lived most of their adult lives in metropolitan areas, New York and Philadelphia especially. Despite these similarities, the groups also differed in some important ways. Many of the At- lantic City group already had experienced one major relocation, usually coming at the time of retirement from a business followed by a move to Atlantic City. Another sizable group had been longtime residents of At- lantic City. Noteworthy differences between the two groups, discussed earlier, indicated that those applying to Golden Years were more competent. Thus, the method used to measure and compare change in the two groups took into account these and other preexisting differences between them, Strongly positive net effects on two meas- ures of activity, Middle-Class Leisure Pat- tern and External Involvement, were asso- ciated with the housing environment that did not offer any services (i.e., Golden Years). On the other hand, smaller but sig- nificant gains in well-being of other types were associated with living in the environ- ment with services (Sholom Aleichem): Morale, Loner Status, and Housing Satisfac- tion. No significant differences emerged on the other five criteria (see appendix table 6). Thus, there was no clear overall effect of the kind found when assessing the impact of rehousing. By two measures of activity, the effects of services appear to be nega- tive. Yet two of the other measures (Morale and Housing Satisfaction) measure inner responses whose net effect in the housing with services was positive. The other well- being factor that improved in the housing with services, Loner Status, may be thought of as a relatively static measure of size of social network, as contrasted with the more dynamic social interaction factors, Orienta- tion to Children or Sociability. Why this factor should change is not clear. Supportive evidence for these findings is provided by examining the changes in two single interview items relating to Functional Health, frequency of leaving the dwelling unit and the neighborhood. Sholom Aleichem tenants became less mobile over the first year, or gained less in this respect, than did Golden Years residents. Some important site differences which may have influenced these results should be noted. The proximity of Golden Years to the boardwalk undoubtedly was a strong in- centive for leaving the housing environment to walk, sit, watch, or participate in other recreation elsewhere. Yet Sholom Aleichem is situated in an area that is attractive and safe for walking or sitting and has relatively good access (with use of public transporta- tion) to shopping and entertainment facili- ties. In addition, residents at Sholom Alei- chem were closer to families and therefore had more opportunity for help in getting away from the site. A factor that should have operated in a direction opposite to the findings was the 28 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED presence at Sholom Aleichem of much more common space, more staff, and more in- volved management, all of which might have been thought to stimulate activities. Golden Years had less common space and its organ- ized activity program was totally in the hands of tenants, yet its tenants were more active. The combination of decreased activity plus slightly improved level of satisfaction does convey something like ‘passive content- ment.” Decreased willingness to become in- volved in activities, while maintaining high morale, is extremely reminiscent of Cum- ming’s and Henry’s (1961) classic descrip- tion of optimal aging in their disengagement theory. Thus, in some small way, these data do support the fears of those originally op- posed to the idea of installing supportive services in the housing environment, to the effect that too easy access to services en- courages dependence and diminishes motiva- tion to keep striving. In the theoretical man- environment paradigm of Nahemow and Lawton (1973), the service-oriented housing environment lies in the “zone of maximum contentment” rather than in the “zone of maximum performance potential.” This conclusion must be advanced with the greatest caution, however. We presented evidence in the preceding section of this chapter showing that less independent peo- ple apply to housing that offers services and have suggested that this represents adaptive behavior by an older person to match his competence to the demands of the environ- ment. Further, those who choose housing with services may not only begin at a lower level of competence than others, but their vulnerability may lead them to a more pre- cipitous rate of decline. This point was illus- trated and discussed in relation to figure 1 of chapter 2. Three measurements of well- being, with the first (T, in figure 1) pre- ceding the immediately-before-occupancy measure (T.), are necessary to determine whether the slope of change is constant, or whether becoming a tenant immediately after T, precipitated a negative acceleration of competence. Since our current data do not provide an answer to this question, the best conclusion seems to be that there is an initial process of self-matching and environ- mental effect such that 1. The most competent both choose the most demanding environments and maintain higher levels of activity, without necessarily showing higher contentment, and 2. The least competent choose the less de- manding environment and follow a course best characterized as “contented disengage- ment.” Clearly, our data leave wholly unresolved the issue of whether the move to the differ- ent types of service environments produced the observed changes, whether the changes are attributable to intra-individual selective factors, or whether they result from environ- mental or personal factors that were uncon- trolled by the experimental design. CONCLUSION The best advice to planning groups is still that they must be very aware of the risks that seem inherent in the decision to pro- vide a major service package. In addition to realizing that they will get a less compe- tent tenant group, they should, on the basis of the results presented in this chapter, be especially alert to the possibility that their tenants are more vulnerable to passivity and the relinquishment of competence-maintain- ing behavior than are those in housing ori- ented more toward shelter. Finally, the very important distinction must be made between the major and the minor service package. This research has tested the effect of the major package only. The lunch program and the part-time medi- cal clinic have not been evaluated here. The universality of the wish for some kind of onsite medical facility gives reason to think that it is possible to provide this service without creating an atmosphere of depend- ence. Full dining-room and mandatory meal service may be the key to the creation of the atmosphere of dependence. One of the key indicators of Kleemeier’s (1959) ‘“‘con- gregate” institutional dimension was the programing of eating by all members at the same time and place. The relatively low SUPPORTIVE SERVICES IN THE HOUSING ENVIRONMENT 29 frequency of use when meal programs are voluntary suggests that this arrangement may be ideal, one allowing several options for the more independent who are disposed to- ward meals as a social occasion, who like the ease of quasi-restaurant service, or who do not always have the energy to prepare their own meals. Thus, our advice to the planner of hous- ing for the most independent is to provide an operating subsidy, if possible, to allow one or two optional daily meals. Planners who wish to provide mandatory full meal service should then tailor the rest of the environ- ment to accommodate the more dependent tenants they likely will attract, by offering greater medical coverage, including guaran- teed ease of obtaining long term nursing care when needed, and more carefully pro- gramed social activities. Chapter 4 Selective Factors in Recruiting Tenants The major question addressed in this chap- ter concerns the characteristics of tenants in planned age-segregated housing. Are they representative of the older population of the country at large, or do they differ system- atically from their age peers who do not apply for such housing ? This issue is impor- tant to planners who wish to tailor housing to the needs of prospective tenants and to administrators who need to identify trends in the characteristics of applicants. In the early years of housing for the elderly pressure was strong to build the image of senior housing as serving the healthy and independent individual whose needs, with the exception of their explicit housing need, were no different from the needs of others. Planners and those in Government were understandably anxious to avoid any asso- ciation of their projects with dependency, sickness, or institutionalization. Despite this effort, some housing that offered services beyond physical shelter did get built. The question naturally arose as to whether the people who applied for this somewhat more supportive housing had the same capabilities as those who did not apply or those who applied to housing that did not offer such services (see chapter 3). If there were systematic differences be- tween tenants and nontenants, the selectivity involved to produce these differences might be imposed either by the tenants themselves or by those responsible for tenant selection. The suggestion has been made (Lawton 1969) that, given the opportunity, people choose environments that are consonant with their needs. Thus, if planned housing offers some particularly unique avenues toward need satisfaction, it is reasonable to think that people who have such unsatisfied needs 30 will selectively apply to that housing. Simi- larly, they will attempt to match their own competence with the perceived level of de- mands that the housing environment makes of them. However, successful matching is highly dependent on two factors—adequate knowledge of the prospective environment and possession of the resources that enable them to exercise freedom of choice. These two conditions are very important and fre- quently not present. Therefore, even if there were some ‘‘pull” to produce individual- environment congruity, it would become very diluted because some people (or their fami- lies or social agencies for them) would de- cide to apply to a particular housing environ- ment either without knowing much about it or by making psychodynamically deter- mined decisions that denied the reality of important needs in themselves. A far greater disruption of the self-selective process occurs simply because many applicants have only one option, that of moving to the environ- ment in question. The supply of adequate housing is very low and the proportion of elderly people affluent enough to pay for it is very small. Thus, we have to assume that a certain proportion of any site’s tenant population has arrived there by random rather than systematic choice. Almost all housing authorities or spon- sors have policies determining whom they will admit to tenancy. In the types of hous- ing studied here, federally established poli- cies are very strict in insisting that one member of a household be either 62 or older or handicapped and that children of tenants be allowed in the project only if they meet the criterion themselves, or are physically or mentally dependent on the aged tenant; very rarely, a younger person needed to care SELECTIVE FACTORS IN RECRUITING TENANTS 31 for an elderly tenant who otherwise is accept- able is allowed. Income limitations are also relatively strict, varying with local economic condi- tions and type of family. For the most part the public housing sites in our sample also observed limitations on assets, but the 202 sites were not required either to inquire about or screen out people on any basis other than regular income. At the time of study, a minimum income of at least $3,000-$3,500 would have been required to live in the 202 projects, while the maximum allowable in- come was in the neighborhood of $4,000- $4,500 for a single person. With one excep- tion (a project that clearly had an inordinate number of retired local and county employ- ees) the public housing sites seemed to serve all types of people, granted their poverty level. The 202 sites, on the other hand, just as clearly recruited selectively. All of them were, of course, sponsored by nonprofit orga- nizations, which frequently determined some characteristics of the tenants. Four were sponsored by Jewish organizations and, overall, 99 percent of their applicants and tenants were Jewish. A project sponsored by a black organization had less than 10 percent white tenants. Half of a union-spon- sored project’s tenants were retired union members, but 80 percent were Jewish—a phenomenon to be discussed later. Finally, one of the sites not studied in depth (Luther Lodge), sponsored by a Protestant church, had a substantial population of former mini- sters, missionaries, and religious workers. Overall, compared with public housing ten- ants, the 202 tenants were clearly more middle class and exceedingly more homoge- neous within sites. Thus, mutual self-selec- tion and management selection by salient background characteristic are evident among 202 sites. Carp (1966) and Jackson (1972) have provided some data on the selective process of public housing authorities choosing white and black applicants, respectively. The large amount of information Carp obtained on the 204 successful and 148 unsuccessful appli- cants to Victoria Plaza revealed relatively few differences, but those that appeared did suggest that those chosen as tenants were slightly more competent and socially ade- quate and exhibited a greater need for hous- ing than did rejected applicants. Jackson’s study of 47 successful and 51 unsuccessful applicants showed more differ- ences but a less consistent pattern. One striking contrast to Carp’s findings was that successful black applicants seemed to have less housing need than those who were not accepted. Since several of Jackson’s other findings agreed with Carp’s in showing a higher degree of social competence among those accepted, it does appear that there was some tendency to choose the more “ac- ceptable” black at the expense of not giving housing service where it was most needed. These two studies afforded an opportunity to test administrative selectivity as a factor in determining who will become a tenant. Both began with a pool of people who were similar to begin with, at least in the respect that they all wished to move into the project for the elderly. The administrative decision alone determined who was and who was not to be a tenant. Unfortunately, no comparably “clean” design is easily available to test the self-selectivity hypothesis or even the joint self- and management-selectivity hypothesis because it is very difficult to define or assem- ble a universe of community-resident eligi- bles and then assess the characteristics of those who apply and those who do not apply. This research project had what seemed to be a unique and exciting opportunity to approach this ideal. A local union announced a project to be built in a highly desirable downtown location. Furthermore, this par- ticular union already had sponsored for some time a flourishing program for retired members, including a formal organization of retirees, a senior center, and a medical center. Therefore, unlike most 202’s, it seemed to stand a good chance of recruiting a substantial number of its own members as tenants. Unfortunately, this was one of the few instances in which it was difficult to obtain management’s permission to use the project as a research site. Three separate, extended formal requests went to their board of directors, and permission was not granted until the project had already been occupied for two months. Other research had con- 32 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED vinced us that requests for retrospective in- formation about some of the major variables of interest were not likely to yield trust- worthy information for comparison to cur- rent status. For example, the question “How often do you see X (a previously named friend) ?” is likely to elicit a fairly reliable estimate of frequency. But to ask “During the year before you moved into Gompers Gardens how often did you see X77 is to invite an answer distorted by selective mem- ory or by the implied comparison to the present. Thus, for this particular site it was pos- sible to draw a random sample of nonappli- cants from the universe of local-resident retired members and a sample of the mem- bers who had moved into Gompers Gardens, but testing of the differences between ten- ants and nontenants had to be restricted, for this purpose, to such relatively invariant statuses as age, sex, and religion. The figures on which these background comparisons were based are given in chap- ter 1, table 1. Those who chose the new housing (Gompers Gardens) were similar to those who did not wish to move (Phila- delphia B) in age, education, foreign birth, and color. They differed considerably in pro- portion who were female: 66 percent of the rehoused, compared with 48 percent of those staying in the community. This basic sex difference probably accounts for the higher income and higher proportion of presently married people among the community group —3$230 per month and 57 percent compared with $206 per month and 25 percent among the rehoused. The most striking difference was in religion. The tenants of Gompers Gardens were 82 percent Jewish, 5 percent Protestant, and 13 percent Catholic. By con- trast, the random sample of nonapplicant union members was 19 percent Jewish, 6 percent Protestant, and 75 percent Catholic, almost all of the latter being of Italian ori- gin. The universe of about 1,100 retired union members was, of course, significantly reduced in proportion of Jews because a large number had moved into Gompers Gar- dens and thus were not eligible to be drawn. Therefore, the latter figures do not repre- sent a reliable estimate of the characteristics of the retired union membership; nonethe- less they show very clearly that the Jewish retirees are grossly overrepresented and Ital- ian retirees just as grossly underrepresented at Gompers Gardens. With this striking fact in hand, a survey of several other 202 projects for the elderly in Philadelphia turned up another equally striking fact. The only other high rise 202 project in the city’s center was sponsored by the Sons of Italy, an ethnic community organization. This project’s tenant popula- tion was 90 percent Jewish. Another 202 project sponsored by a union whose mem- bership is very diverse had an 82 percent Jewish population. Finally, yet another proj- ect sponsored by a coalition of unions was 55 percent Jewish. At the time, the only other 202’s in the city were Sholom Aleichem (Jewish), Ebenezer Towers (black), and a smaller Quaker-related project that had a small proportion of Jews. The evidence is clear that at least in this one city, specially built housing had an extremely powerful attraction for the Jewish elderly. Jewish people typically (perhaps stereotypically) have been portrayed as inveterate urbanites, a picture certainly consistent with the con- centration at the center-city sites, but less so with Jewish overrepresentation in more outlying projects, as several were. Some have suggested that the enforced conviviality of stoop-sitting in crowded tenement areas where immigrants lived may have condi- tioned this group toward greater enjoyment of group living. But what about the Italian immigrants? Homeownership was less frequent among housing applicants, but whether the elderly Jewish population of Philadelphia had a lower ownership rate than other groups is not known. Similarly unknown is whether the same tendency would be found in other cities or other regions or among public housing tenants. In any case, a planner at- tempting to forecast the possible recruit- ment potential of a site in a given area might take the presence of a sizeable Jewish popu- lation as one positive indicator. Comparable information exists on only a few other scattered characteristics. Perhaps one of the most important differences is that SELECTIVE FACTORS IN RECRUITING TENANTS 33 nonapplicants had a markedly larger num- ber of children: 51 percent of nonapplicants, but only 28 percent of tenants, had four or more children. One-third of all nonappli- cants actually lived in the same household with one or more children. While similar information was not obtained from Gompers Gardens tenants, only 11 percent of the more than 500 tenants in all longitudinal sites were living with a child before the move. Twenty-four percent of the Gompers Gar- dens tenants still held paid or volunteer jobs, compared with 10 percent of the com- munity residents. The two groups did not differ in the number of times they had vis- ited a physician during the past year. How- ever, those entering Gompers Gardens were far more active in organizations: 55 per- cent belonged to two or more organizations, compared with only 18 percent of the com- munity residents. Aside from the demo- graphic characteristics, there is really not enough information to answer questions re- garding the selective appeal of the planned housing. Thus, those moving tended to have fewer close family ties, whether to spouse or chil- dren, but were at the same time more in- volved in activity outside the family. Because information in this area is so lacking, we also sought other, admittedly less satisfactory, approaches to the question of who becomes a tenant. 1. Comparison of a rehoused group with a sample of older people living in the com- munity.—The next best source of informa- tion on systematic applicant-nonapplicant differences would be a comparison of the rehoused with a group of community resi- dents as similar to them as possible. The Blueberry Acres site was chosen, primarily because it was the first large-city site to be studied and came at a time when it was pos- sible to recruit and interview a community sample. We determined that 4 census tracts had furnished about 40 percent of the resi- dents of Blueberry Acres and used a prob- ability sample of people 62 years and over still living in these tracts as a comparison group. 2. Comparison of a rehoused group with a group of community residents matched through the process of referral.—Another comparison group was formed on the as- sumption that a person’s friends are likely to be similar in background, social, and possibly psychological characteristics. The procedure was to ask the potential tenant of Ebenezer Towers to suggest a friend who might be willing to be interviewed and who (a) did not wish to move into similar hous- ing, (b) was within five years of the sub- ject’s age, (¢) was the same race, and (d) was the same sex. 3. The aggregate group of rehoused and community-based groups.—Finally, the en- tire set of subject groups consisted of five separate applicant groups who were inter- viewed while still living in their homes in the community (applicants to Golden Years, President House, Blueberry Acres, Ebenezer Towers, and Sholom Aleichem House) and three groups of variously selected commu- nity residents who had signified, by virtue of not applying for tenancy, that they did not wish to live in planned housing (sepa- rate samples of 100 black and 100 white Jer- sey City residents and the Philadelphia nomi- nated-friend sample). The aggregate of these groups represents a convenience sam- ple, but it offers the advantage of a rela- tively large size. The statistical analysis attempted to de- termine the characteristics that distinguished applicants from nonapplicants, exclusive of the background characteristics of age, sex, marital status, race, and income. For the most part, the results across all three comparisons were relatively consist- ent: e Housing applicants were less active prior to occupancy, as measured by the Middle-Class Leisure Pattern factor. e Not unexpectedly, housing applicants were less satisfied with their prior housing. eo Less expectedly, community residents expressed a greater Need for Services than did housing applicants. o Community residents exhibited greater Continued Breadth of Activity than did housing applicants. e Housing applicants perceived less favor- able recent Change for the Better in their 34 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED well-being than did the community group. Somewhat less consistently these differ- ences appeared: eo Housing applicants were in better health than were community dwellers. e Applicants generally had a smaller so- cial network (i.e., they scored higher in the Loner Status factor) than did nonapplicants. e Despite having a smaller available net- work of relatives and friends, applicants were more likely to be oriented toward chil- dren in their recent activity. The greater need for services expressed by community residents may represent their greater distance from the reality of group housing. Given hypothetical questions relat- ing to facilities that are generally thought of as “good for your welfare,” nonapplicants may have felt free to indicate their accept- ance of these value judgments without seri- ously considering their suitability for them- selves. They also may have made the judgments in terms of what they thought might be desirable for others. The applicants, on the other hand, already had committed themselves to a new home where they knew these services would not be available. They may have been using the well-known adap- tive mechanism of trying to be satisfied with what one has and thus were less likely to wish very hard for something they knew they would not have. (However, as noted in the chapter on services, the perceived need for medical services was stronger than the tendency to be satisfied with what one has; this wish did not even appear in the same factor with the need for other types of services.) For the other selective recruitment fac- tors, the picture seems quite clear: People who seek out housing participate in less or- ganized leisure-time activity and self-suffi- cient activity than do people who do not seek new housing. Strong supportive evidence for this conclusion is found in responses to the question, “Would you like to see more of other people?’ Of 424 housing applicants 54 percent responded “Yes,” compared with only 25 percent of 241 community residents. Even more striking is the overwhelming prevalence of not-presently-married persons in our sample as well as in planned housing for the elderly in general. It seems a reason- able conclusion, then, that applicants are seeking some amplification of their activity, particularly their social interaction level. Just as clearly, on the other hand, the housing-applicant group appeared not to dif- fer in other areas of basic competence from those who stayed in the community. Overall, the groups were similar in physical health and psychological well-being (Morale) as well as other factors less central to well- being. SUMMARY In a rather consistent fashion, housing applicants were less socially active and ex- pressed greater social needs than did non- applicants. With this important exception, however, no other substantial reasons were found in this study to suggest that housing applicants are self-selected in terms of lower general competence. Such lower competence as is exhibited is limited to certain types of activity, where the disability may well be in society rather than in the individual. The one exception is in the comparison made earlier between applicants to sites with serv- ices and applicants to a site without services. In the latter instance, lowered competence seems to have led to the search for greater protection. Housing for the elderly as repre- sented by our five sites, however, does not seem to be perceived as a refuge for the infirm. Again, caution must be exercised in extending this generalization. Neither our sites nor our community residents were rep- resentative. Therefore, repeated examination of this same question with other populations is in order. Chapter 5 The Prediction of Well-Being as a Response to the First Year of Housing One of the more important sections of Carp’s (1966) study was devoted to the pre- diction of adjustment after one year in Vie- toria Plaza. Her study yielded much valuable data on how information gathered at the time of application could be used as a basis for estimating the person’s status after ac- tually becoming a tenant. One of Carp’s in- terests was in maximizing the efficiency of prediction by using information that was rel- atively easy to obtain, as contrasted with in- formation available only from extended interviews or questionnaires or from ex- pensive professional ratings; for that reason she estimated the amount of prediction of adjustment to Victoria Plaza. Adjustment was assessed by (a) tenants’ self-rating of happiness, (b) sociometric popularity, (c) administrator ratings of adjustments, and (d) interviewer ratings of adjustment. The predictors consisted of three types of infor- mation gathered at the time of application: e Application blank information, presum- ably the easiest to obtain—age, education, marital status, income, and occupational level of the head of household. e Interview and questionnaire items—12 items reported by the subject about his/her current and past life, such as number of friends, activities, and neurotic problems. This information is easily obtained from applicants but requires interview time be- cause information given on self-adminis- tered application forms tends to be less reliable. e Interviewer ratings on confusion, dis- ability, senility, disengagement, and desir- ability as a tenant—this information is the most difficult to obtain because reliable rat- ing requires specialized training. Carp found that adjustment one year later could be predicted by this information gained at the time of application. The interview and questionnaire items were the best pre- dictors; the other two sets were consistently poorer. It should be possible, using Carp’s results, to construct shorter versions of a screening instrument that would enable a housing au- thority or sponsor to choose applicants who would be most likely to “succeed” in one or more of the criteria for adjustment. Whether such screening is desirable, or even legal, is another matter. This question is beyond the scope of this research, but is discussed in detail elsewhere (Lawton 1975). The present project approached the pre- diction problem somewhat differently, by measuring similar characteristics before subjects moved into the new housing and after they had lived there for one year. On both occasions most of the information was given by the subjects themselves. A rela- tively small amount of the data consisted of observations and ratings by the interviewer. The manager provided five ratings of each tenant after a year of occupancy. The questions addressed by this research were: e (Can a tenant’s well-being after one year in planned housing be predicted by well- being at the time of application? e Can well-being after one year in planned housing be predicted by the tenant’s back- ground characteristics? The results showed that in almost all in- stances, well-being at the time of applica- tion was the best predictor of well-being one year later. The amount of predictability af- forded by the combination of preoccupancy 35 36 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED demographic characteristics and well-being measures found here was just slightly below the level reported by Carp. The most consistent before-and-after meas- ures were Functional Health, Continued Breadth of Activity, Housing Satisfaction, and Morale. Among the background characteristics, religion was by far the best predictor of well-being one year later. However, in our particular sample religion was grossly con- founded with site: Sholom Aleichem was Jewish, Blueberry Acres was Catholic, and President House and Ebenezer Towers were Protestant. Therefore, we may well have at least two mutually interacting variables. In any case, after one year Jewish tenants were in poorer health, perceived themselves as changing for the worse over their first year, and were less satisfied with the status quo, but were more active in organizations and had wider social networks. By contrast, Catholics tended to decline more in morale, but paradoxically perceived themselves to have changed more for the better during the first year, became less active in typically middle-class activities, but became involved in more passive-solitary activities, and had a low need for services. Income was the next-best predictor, high income before occupancy being independ- ently associated with higher activity of all kinds at followup—middle-class leisure ac- tivities, breadth of activity, and activities in relation to children. At followup, greater age was associated with poorer health, hav- ing a larger social network, and being satis- fied with one’s housing. In general, once the preoccupancy score on the particular measure of well-being and the background factors were accounted for, the other indices of well-being as measured at baseline added relatively little to the pre- diction of postoccupancy well-being. Specific preoccupancy predictors of these followup indices of well-being were as follows: e Low preoccupancy Continued Breadth of Activity was associated with low Loner Status 12 months after occupancy. The ra- tionale for this seemingly paradoxical find- ing is that Continued Breadth of Activity connotes a high level of independence in such activities as working and traveling about by oneself. Apparently those who were not independent in these ways were apt to have larger networks of family and friends, pos- sibly in direct response to their lesser inde- pendence. eo Low preoccupancy Orientation to Chil- dren was also associated with more marked Loner Status. This finding seems self-evi- dent: Activity related to children is less likely when the social network is smaller. e Perceived recent Change for the Better before occupancy was associated with a high level of Orientation to Children after occu- pancy, as well as with higher postoccupancy level of Satisfaction with the Status Quo. eo High preoccupancy Housing Satisfac- tion predicted a high postoccupancy Orienta- tion to Children. The meaning of this rela- tionship is not clear. One could speculate on many dynamisms to explain it, such as whether children of parents who moved into new housing in spite of being relatively sat- isfied with their old housing were more likely to extend themselves in mutual activity after the move (guilt over the move?). eo A high preoccupancy level of External Involvement predicted narrow postoccupancy Continued Breadth of Activity. Again, an explanation may be found in the fact that the behaviors included in the External In- volvement factor (following the news, watch- ing TV, spending time outdoors) may be relatively passive and time consuming and therefore to some extent mutually exclusive with the active and independent activities of the Continued Breadth of Activity factor. Another approach to prediction was the use of the housing administrator ratings of tenants after one year of occupancy as cri- teria; ratings were made on five character- istics: General Deterioration, General Hap- piness, Independence, amount of onsite Social Activity Participation, and quality of Relationships with Other Tenants. The rat- ing scales are shown in table 15. Managers were given the following instructions: “Please think of each tenant in terms of the five characteristics listed below. Please rate each one in terms of your best knowl- THE PREDICTION OF WELL-BEING 37 — TT ~~ Table 15. Managers’ rating scales A. General Deterioration ~~ 1 The tenant's ability to take care of himself has noticeably improved. 2 The tenant's ability to take care of himself has not changed since he came to [site]. 3 The tenant's ability to take care of himself in a socially acceptable manner appears to have declined since he moved to [site]. B. General Happiness 1 The tenant always seems happy. 2 The tenant is average in happiness. 3 The tenant is somewhat less happy than average. 4 The tenant frequently or always seems unhappy. C. Independence 1 The tenant always seems to be seeking support from other people or to need help for mental, physical, or self-care problems. 2 The tenant seems to seek more than average support, or more help than average, for mental, physical, or self-care problems. 3 The tenant is average in need for support. 4 The tenant is outstanding in needing significantly /ess support than others. D. Social Activity 1 Little or no participation in formal or informal social life. 2 Average amount of participation. 3 Conspicuously high amount of participation. E. Relationships with Other Tenants 1 Relationships are mostly positive and friendly. 2 Relationships with other tenants are either neutral, or as frequently negative as positive. 3 Relationships with other tenants are frequently negative, contentious, critical, demanding, etc. edge. If you do not know the tenant well enough to rate him, we should appreciate your asking the opinion of someone who may know him better, such as an activities worker, receptionist, or clerical worker. Otherwise, please omit the rating for that tenant. The first scale, General Deteriora- tion, asks you to think about how the tenant has changed since he moved in. All others ask you to judge how he is now.” The analyses examined the extent to which background characteristics and preoccu- pancy scores on well-being measures were related to the ratings. Only for the Inde- pendence rating did the set of background characteristics contribute a significant amount of variance. People who were older at the first interview were more likely to be judged as more deteriorated and less in- dependent after one year of occupancy. Overall, significant prediction of postoccu- pancy status by preoccupancy scores in well- being was observed only for General De- terioration, Independence, and General Happiness. These three ratings may be thought of as indicating functional compe- tence, as contrasted with the other two, more social, administrator ratings. Thus, functional competence was forecast better by characteristics measured before occu- pancy. This might mean that competence variables operate in more predictable ways or that the criteria for judging deteriora- tion, independence, and happiness were clearer to the raters, or it might reflect dif- ferential reliability attributable to other sources. Deterioration and dependence were greater after a year for those who were initially less healthy, less closely oriented to children, more dissatisfied with their hous- ing, and more restricted in their range of activity. Those who were more alert and responsive during the preoccupancy inter- view were judged by administrators one year later to be happier and more independ- ent. Finally, the tenant’s positive judgment of recent change for the better and high involvement in the external world were as- sociated with the administrator’s judgment of happiness a year later. Thus, in summary, the most efficient way to predict applicant well-being one year later is to measure at the time of application the 38 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED characteristic we are interested in. The con- tinuity of an individual’s previous character- istics overrides other related predictors. Some additional predictability is gained by considering the applicant’s age, income, sex, and religion, though the significance of the latter is greatly limited by the design of this part of the study, since religion was not randomized through the four sites studied. Finally, preoccupancy factors other than the criterion of well-being added only limited and spotty amounts of predictability. Looking at the total array of results from the attempts to predict postoccupancy status as judged by both the tenant and the admin- istrator, one is not particularly impressed with the amount of assistance such screen- ing might give an administrator who wished to choose applicants who would be independ- ent, happy, and socially alive. By choosing those who were younger, in better health, happier, more satisfied with their original housing, and more active and who made a better impression on the interviewer, the manager theoretically could “improve” the likelihood that tenants would be better off a year later. The usefulness of this conclu- sion is limited by two considerations. First, it is not terribly different from saying that better applicants make better tenants, or that gifted children likely will become gifted adults. The consistency demonstrated over time and with the use of criteria derived from tenants and administrators is comfort- ing, but one still must acknowledge that all such findings are consistent with what one might expect. Second, the perils of attempting to select tenants whose well-being will be high after becoming a tenant should be obvious. Even for the most efficient of the predicted in- dices of well-being, Functional Health, a limited amount of predictability is possible on the basis of information gained before occupancy. Using such information as a basis for choice undoubtedly would result in a large number of errors, both in admit- ting people whose health would decline and especially in refusing people whose health would be relatively good after a year. Thus, while we have gained useful information regarding some of the factors that lead to favorable outcomes on the average, our level of reliable prediction is far too low to use in making decisions regarding particular individuals. Finally, we must acknowledge that a ma- jor purpose of planned housing is caring for the needs of people who have some personal, social, or health problems. If we exclude these people because they are less likely to be high in well-being than applicants who began with a higher level of well-being, we clearly will not be serving those in greatest need. Chapter 6 Public Behavior and the Use of Space One major focus of the present concern with the environment is the establishment of links betwen the structure of the physical environment and the behavior of individuals within it. Even with this surge of interest in environment and behavior, productions in the new field have been high in thought content, perhaps, but low in empirical data. The present report sits in the middle ground between pure thought and pure empiricism. The situation is somewhat analogous to the clinical psychologist’s personality test assess- ment, which is based on data but is inter- preted freely with the aid of nontest data from the clinician’s previous experience. Briefly, the ecological transactions between older people and their congregate housing environments were observed. Differences among environments in the behavior of their occupants were considered in the light of structural and social characteristics of the environments. While the data are objective, the patterns of association between behavior and environment are frequently too complex to allow statistical treatment with a total of only 12 environments. A major source of data for these analyses was the “behavior map,” a term applied by Ittelson et al. (1970) to their method of charting the location in which a limited number of behaviors of mental hospital pa- tients occurred. The data were obtained by a trained observer during tours of all the halls and indoor and outdoor common spaces of 12 housing environments. From 10 to 27 tours (median = 21) were made in each building, representing times of day propor- tionately (8:00-10:00 a.m.; 10:00 a.m.-12 noon; 12 noon-2:00 p.m.; 2:00-4:00 p.m.; Most of this chapter was published in Lawton (1970b). Copyright 1970 by Environmental Design Research Association. Reprinted with permission. 4:00-6:00 p.m., 6:00-9:00 p.m.), and inso- far as possible an equal sampling of days of the week. An effort was made to ob- serve only when the weather was suitable for sitting outdoors, but that was not always possible; in the latter instances, account of this fact is taken in the interpretation. The observer’s task was to count the num- ber of people (tenants, employees, and visi- tors) in a given area and note briefly their behavior at a given moment. This method can be compared to a motion picture cam- era’s moving steadily from place to place, lingering on a given area (or person) only long enough to register it. Specifically, the following were recorded: eo The number of people in the hall on each floor (including those standing in their apartment threshold, but not those standing further back in their apartments) e Brief words or phrases noting the be- havior of those counted e The number of tenants conversing or appearing to be in a group where either conversation or a mutually dependent activ- ity was in progress (‘social behavior’) eo The room numbers of apartments with doors open or ajar but not on chain latch (“open door”) eo The number of people, and their be- havior, in the following common spaces: —Lobby (the area into which the main entrance led, including the front desk) —Functional spaces (areas by elevators, mailboxes, laundry rooms, clinics, offices, stores, and beauty parlors) —Activity spaces (any room for tenant use that is neither lobby nor functional space) —Outdoor space (usually limited to the area clearly on the property of the housing site; in some multibuilding 39 40 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED projects arbitrary borders were drawn between buildings to delineate the rele- vant area) Behavior maps were not charted at Metro- pole Center or Yishay Apartments, but were drawn at Luther Lodge and New Gotham House. Inasmuch as other data were not gathered as systematically in the latter two sites, a few of the results reported were based on ten environments. Since the number of tenants in each build- ing was different, and the number of obser- vation tours varied, the data were reduced to the same base by (a) obtaining a mean number of people observed in each location in each building (over the maps done on all days of week and times of day) and (b) ex- pressing the mean number observed as a percentage of all tenants living in the build- ing (occupancy percentages). Another index of interest, the distribution percentage, uses as a base the mean total number of people observed in common spaces per tour in each building, and calculates how this number is distributed over the major common space categories for that building. Appendix table 7 shows these values for all housing sites. RESULTS All Common Spaces There seems to be rather wide variation in the occupancy percentages for all com- mon spaces, the most general indicator of total visibility of a building’s tenants. Al- most 18 percent of the Van Winkle popula- tion, but less than 3 percent of the Golden Years population, was visible during the average tour. In overall terms, there was no relationship between the total amount of common space available in each building and the occupancy percentage of all common spaces. Thus, within the size of buildings we have studied (all large) it seems to make no difference whether there is a single area for gathering or whether there are many; the probability of pulling tenants into some common space is the same. Golden Years is located one block from the boardwalk of a populous resort; clearly the center of the summer’s social life is the boardwalk. Informal observation also made it clear that the situation is completely dif- ferent in the winter, when the building teems with activity. Thus, one may suggest that the pull of nearby competing spaces is one major determinant of space utilization. A similar phenomenon is illustrated by the low all-spaces occupancy rate at Samuel Gom- pers Gardens (7 percent). This site is the only one with a near-ideal center-city loca- tion; in addition, it is only a couple of blocks from the health center and senior adult center operated by the union that sponsors the project. It is easy to speculate that the combined pull of nearby urban resources and centers of activity visited before occu- pancy lessens the tendency of occupants to use the within-site common space areas. The relatively high visibility of Riverlake (15 percent) and Van Winkle (18 percent) tenants is partially attributable to the exist- ence of onsite senior centers, staffed by sev- eral salaried workers. Tenants of both Gotham Houses also had relatively high total visibility (15 percent and 14 percent). Other work has indicated that people with limited physical capacity tend to sit in public places to watch ongoing activity more than do the physically able. This may have been the situ- ation in the Gotham Houses, whose popula- tions are in somewhat poorer health than others. For the 11 sites on which health data were available (see chapter 7) the cor- relation between mean tenant health status and all common-space occupancy percentage was —.60; the less healthy the tenant popu- lation, the greater the proportion of tenants occupying common spaces. One may infer that adequate provision of common space becomes increasingly important as the pop- ulation to be housed becomes less physically well. Halls Institutions for the elderly are noted for the high number of residents in hallways. Chairs are frequently located there and staff often find it more convenient to have resi- dents visible there rather than in their less readily observable rooms, The situation is PUBLIC BEHAVIOR AND THE USE OF SPACE 41 quite different in these housing projects for the elderly, where the health of tenants is relatively good and the atmosphere is much less institutional. It was rare to see anyone in the hall for any purpose other than to go somewhere. About one-third of all people observed in halls were conversing, but these conversations usually were between people who were passing each other or walking to or from the elevator. Nevertheless, struc- tural features might explain the relatively high hall occupancy percentages at two sites. Riverlake was the only site that had an exterior gallery serving as hallway (for one wing, or about half the apartments in the building). The building was not air-condi- tioned, and many people sat on the gallery, although they could choose to sit behind locked screen doors in their apartments, with almost equal cooling effect. The mapping data distinguished between the behavior of those in the outdoor single-loaded (door on one side) corridor and those in the enclosed double-loaded corridor part of the building. More than half of all those observed in the galleries were engaged in social interaction, as contrasted to the one-third so engaged (in halls) over all sites. Another high hall- occupancy site, Luther Lodge, is built in a circular cross section with an unobstructed central hall area (elevators and utilities are in a stack that is located outside the central section). Staff corroborate the impression that there tends to be much incidental con- versation as people pass through the halls. Certainly the open circular pattern is ‘“soci- opetal” (Osmond 1957), that is, it is a spatial arrangement that induces the clustering of people so as to encourage social interaction. What is particularly interesting, however, is that all these central areas at Luther Lodge have chairs and other homelike fur- nishings. They were designed as they were partly in the hope that they would serve as small social centers for the occupants of the floor or as small party areas for occupant’s family or friends. Despite the physical adaptability of the space for these purposes, 132 visits to these central spaces revealed not one instance of people sitting there to converse. Despite the space’s general esthetic appeal, it is socially unfriendly because of the ring of doors around the circumference and the low proportion of wall space as compared to door space. Thus, its social suc- cess lies in the way it brings people together and encourages visual contact among resi- dents on their way to some place rather than in its sustained social use as a sitting area. Three of the four buildings where hall occupancy was lowest are public housing sites; and three of the same four are located in slum neighborhoods. There may be some tendency for people in slum-neighborhood buildings to use hallways infrequently, as a matter of safety. However, the hall occu- pancy percentage was not associated with research workers’ ratings of the safety of the neighborhoods. Lobby In our experience, the lobby is one of the most important areas of housing for the elderly. One lobby we studied is open to the sidewalk and to whatever malevolent wind, temperature, or person crosses the threshold. There is no place to sit, to talk, or to watch from, and there is no monitoring of access to the apartment floors. Needless to say, people spend as little time as possible there. Our housing varied widely in the extent and type of lobbies provided. All 12 sites had an entrance space beyond the front door, from which staff offices and elevators opened. However, four of the five sites with lowest lobby occupancy percentage had no chairs or benches, though there was ample space for furniture; the only people counted in these lobbies were those passing through, waiting for someone, or choosing to stand. We have found a great aversion among ger- ontologists, housing managers, policy mak- ers, and people in general to the sight of old people “just sitting.” The thought of inactivity seems to make active people very anxious; the intensity of this kind of reac- tion goes far beyond a reasonable wish to provide activity for those who wish it. Thus, our ‘space managers,” to use Sommer’s (1970) term, have at least passively toler- ated the absence of seating in the potentially busiest area of the building, and in a number 42 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED of cases have actively forbidden tenants to place their own portable chairs in the lobby. The six sites with relatively high lobby occupancy percentages have hotel-style lob- bies with comfortable seating where traffic is highly visible. The importance of both seating and traffic functions is underlined by contrasting the entrance lobby occupancy of these six buildings with the occupancy of other comfortably furnished, but periph- erally located, sitting rooms in the same buildings. For all six, buildings combined, the mean number of people observed in the entrance lobbies was almost five times greater than the mean number in the pe- ripheral sitting rooms. The halls are usually also devoid of action to watch, as compared to the coming and going of insiders and out- siders in the lobby—perhaps the most im- portant reason for people’s being uninter- ested in sitting in the halls. Activity Space The category of activity space is not as clearly homogeneous as are other spaces. Three of the sites with seatless lobbies used a general-purpose room in lieu of a lobby. At other sites there were as many as seven separate rooms in addition to the lobby. Thus, the three highest activity room occu- pancy rates were in public housing sites with minimal lobbies (Riverlake, Van Win- kle, and President House). The first two contained senior centers that were open most of the time. The activity room at Presi- dent House was the single most populated room among our 12 sites. While comfortably furnished, it had the disadvantage of hav- ing no visual connection with the lobby and only two small doors leading to the main- floor hall. Its one great advantage, however, was a wall of windows looking onto the main outdoor entrance to the building and, beyond that, to a moderately busy small city street. This opportunity to sit and watch was used lavishly by a regular contingent who were both very sociable with one an- other and greatly interested in who came and went. The fact that this activity room was both isolated from the usual business of the lobby, but at the same time a center for minding one’s brother’s affairs, seemed to encourage clique formation among the users and to cause a certain amount of re- sentment of the users’ nosiness among other tenants. All of the noncentral activity areas con- trasted in the section above with lobby oc- cupancy were included in the total measure of activity space. Only three sites that have ample lobby plus other activity space (the Gotham Houses and Sholom Aleichem House) attain even an average of 1 percent of its occupants using these auxiliary spaces. Most such use reflected in our observations was informal use by individual tenants for unplanned activities. On the other hand, al- most all the activity areas enjoy heavy use at certain, though relatively infrequent, times: An auditorium may be used twice a week, with a large proportion of the build- ing population attending at these times. Functional Space Every housing site contained an elevator area, mailbox area, and laundry area. Not all had an administrative office within the par- ticular building—from our point of view a very bad omission, though we cannot back up this assertion with data. Other funec- tional spaces included medical clinic, hair- dresser, store, and soda fountain. (Dining rooms were not included because by admin- istrative decision they involved almost all tenants and therefore would not reflect vari- ation in tenant behavior.) The occupancy percentage in functional spaces was a direct function of the total amount of common space in the building, which in turn was a function of the number of functional spaces. Provision of space for performing functional roles probably has some value in maintain- ing meaningful behavior. Therefore, this statistical relationship suggests that to some extent the provision of resources for instru- mental behaviors within the housing environ- ment can heighten the probability of effec- tive role maintenance. Outdoor Space The outdoor spaces of these housing en- vironments frequently seem so bad as to PUBLIC BEHAVIOR AND THE USE OF SPACE 43 defy any probability of their having simply occurred by chance. One site has a formal paved rectangle facing the blank side of the building, with a wall to an adjoining prop- erty on the opposite side of the rectangle. The only seats are regularly spaced, fixed, flat concrete benches with no backs. Thus, there is nothing to look at, no conversational grouping is possible, and use of the benches involves actual physical discomfort. Another building has an ample grassy area planted with attractive fruit trees, but the one out- door bench is rarely used because it stands in the path of a shortcut used by neighbor- hood children. The best sitting area we ob- served was a resort boardwalk. Variation in use of outdoor space among sites was relatively wide, the two lowest being a site that had no outdoor seats and a center-city site that had no street-side sit- ting. The next lowest was at a site in a very hot climate (Luther Lodge), and at the next lowest (Golden Years) the boardwalk si- phoned off potential users. The highest use occurred, surprisingly, in the building lo- cated in the worst neighborhood, a building for the elderly in a large complex of other high rise buildings for families (Van Win- kle). Factors working in favor of these ten- ants’ using their outdoor space included: (a) the space’s having the protection of two right-angled sides of the building; (b) the staff’s opportunity to monitor the behavior of outsiders through the windows of the senior center and fairly easy access from the center to the sitting area; (¢) the opportun- ity to choose between right-angle-oriented conversational groups or street-oriented watching; and (d) the existence of a bound- ary divider that separates the space from nonproject pedestrian areas and is not too much like a prison fence. Another major fac- tor in this high use of outdoor space may have been the direct negative result of the slum neighborhood: Van Winkle tenants had no other way of experiencing the outdoors. The Van Winkle tenants showed the lowest rates of offsite activity and of neighborhood and city mobility ; they may feel safe moving around only very close to home, and thus their utilization of the outdoors may be com- pensatory. To a lesser extent, many of these features characterize the sitting area at Riverlake, also. Blueberry Acres showed a different type of compensatory use of the outdoors. This site has no seats in the lobby, and during the summer we were there the only activity room frequently was locked during the day. Thus these tenants literally had no place to go. There were a few seats near the clothes- lines in back of the buildings, where women gathered to talk; the men congregated in front of the building, commanding an inter- esting view of a working-class white neigh- borhood and small business district. Seating was very limited, but a number of tenants interacted while standing. The Gotham Houses, where use of the outdoors was rela- tively high, have some of the best all-around outdoor seating. Their grounds are ample, the neighborhood is middle class, and a large number of employees and visitors constantly traverse the grounds; there are many benches, and one group of benches is ar- ranged in a circular form to facilitate con- versation while still affording a view of activity in a relatively wide area. Social Interaction At any given time, one can expect to find somewhat less than 6 percent of a building’s population interacting socially within the common spaces of the buildings. On the other hand, of all those observed in the common spaces of the buildings, about 55 percent will be interacting. Comparing the percent- age of population observed in all common spaces with the percentage of building popu- lation observed interacting socially, we see that common-space occupancy implies inter- action; the correlation between the two is .96. Despite the clarity of the relationship on an individual level, being visible promotes social interaction. However, on the building level, the proportion who were visible was independent of the proportion engaging in social interaction. Statistically, the correla- tion between the percentage of building pop- ulation observed in common spaces and the percentage of observed common space occu- pants who are interacting is .08. The mean- ing of this set of findings is that common- 44 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED space occupants of some buildings are more likely to sit or go about the building with- out interacting than are occupants of other buildings. Further, this relative proportion >f involvement-noninvolvement is independ- ent of the actual percentage of the buildings’ populations observed using the common spaces. Conversely, however, an increment in the number who are visible produces more who interact, even though the proportion of in- teractors so recruited varies widely among buildings. Does the amount of common space avail- able determine the amount of interaction? At first glance there seems to be a negative relationship; a large amount of common space was associated with a lower propor- tion of interactors among the occupants of common spaces (rr = —.62). However, small amounts of common space occur primarily in public housing. When 202 and public housing sites were analyzed separately, in- teraction was greater in public housing. Thus we can state two alternative hypothe- ses: (a) Small amounts of common space result in greater density of individuals and therefore a high proportion of interactors; or (b) The lower the socioeconomic level of people using common spaces, the more likely they are to interact socially. Certainly our data cannot choose between these ex- planations, nor can they in either case offer support for a causal relationship. However, the results do suggest that it may be worth- while to investigate more thoroughly, in an experimental manner, whether there is a point beyond which the provision of extra common space actually reduces the proba- bility of a social interchange. Looking at the individual sites, one sees that Van Winkle had both the highest pro- portion of its population in observable inter- action and also the highest rate of interac- tion among common-space occupants. The favorably located outdoor space and the or- ganized senior center no doubt brought peo- ple out; either the spatial factors or personal characteristics of the tenants led them, once exposed to each other, to interact rather than to remain isolated. A very low per- centage of Ebenezer Towers’ population en- gaged in social behavior and a very low proportion of visible occupants interacted. This adds up to a characterization of this environment as relatively impoverished so- cially, with no apparent structural explana- tion. It was the only environment sponsored by a black group, and it housed a mixture of middle-class, financially self-sufficient ten- ants and a group of tenants from the welfare rolls. Whether this socioeconomic mix was related to the tendency of tenants to stay out of common spaces is uncertain. Open Doors We have presented extensive material elsewhere on the meaning and empirical cor- relates of leaving one’s apartment door open (Lawton and Simon 1968) and suggested that one meaning of the open door is to announce one’s availability for social inter- action. In the present study, there was no relationship between the percentage of open doors and the presence of air-conditioning. The relationship between percentage of open doors in each building and percentage of all tenants in that building observed in social interaction was .54. In addition, the incidence of open doors was positively associated with the mean number of within-building friends named by tenants (» = .72). Further, the occupancy percentage in halls was highly correlated with percentage of open doors (rr = .76), and the correlation of hall occu- pancy with number of within-building friends just missed significance (rr = .53). Thus, social interaction within the building, and particularly on one’s own floor, is par- tially indexed by occupancy of hall space and leaving an apartment door open. Security considerations probably under- lay the low incidence of open doors at Flower Tower and Van Winkle, though the neigh- borhood of Riverlake was equally crime ridden. The low number of open doors at Golden Years and Samuel Gompers prob- ably reflects, among other things, the fact that many tenants were out of the building during the day. The very high number at Riverlake and in President House reflects the open social attitude at these two sites. Riverlake was an active community in every PUBLIC BEHAVIOR AND THE USE OF SPACE 45 way; President House occupants were less active than other groups generally, but they maintained a high concentration of social relationships on their own building floors (Lawton and Simon 1968). WHAT IS MEANINGFUL PUBLIC BEHAVIOR? The fact that space population, social in- teraction, and open doors are easy to count certainly is no guarantee that they will be the best indicators of differential behavioral effects of the physical environment. However, they do provide baseline indicators for a more searching look at how environments work. Acknowledging the usefulness of such bread-and-butter kinds of data, let us con- sider what a more refined look at behavior in public places might indicate about the human use of the physical environment. The function of visual scanning for older people has not been studied empirically. The prevalence of what I have called the “sitting and watching syndrome” (Lawton 1970a) is well known. Most of us, anxiously deny- ing the possibility that we too may age, look upon lobby-sitting as the zero point of be- havior. It is clear, however, that watching the ongoing scene represents something very active for many older people, perhaps the most active substitute for physical exertion some people can manage. We have vague knowledge that activity in parks, or the com- ing and going of people in building lobbies, attracts elderly watchers, but we have no idea exactly which activities, under what conditions, in what physical settings, evoke greater or lesser interest. It is possible to take a close look at the facial and postural indicators of interest as unobtrusively as we did in our gross observations; the orienta- tion of the body and head, the length of time a general area is fixated, the content of activity that makes a person redirect his/ her gaze—all are suitable for objective nota- tion. Unlike many other indicators of reac- tion to space and structure, visual scanning behavior is amenable to experimental inves- tigation rather than limited to naturalistic observation. It is possible to put older peo- ple in different physical locations or at dif- ferent distances or to vary the activity being observed. A related question would be the activity or passivity of behavior occurring as a func- tion of the surroundings. Some aspects of this question would be self-evident: Activity is probably greatest in the halls of apart- ment buildings, since they are used mainly for transit. The importance of the setting is underlined by the previous observation that the same is not necessarily true of the halls in homes for the aged. Sufficient attention to these relationships might eventually provide a basis for guidelines for the design of rooms, or room interrelationships, that maxi- mize, minimize, or optimize the amount of energy expenditure demanded of the user. Microsocial behavior as it occurs natur- ally or in response to an experimentally ar- ranged environment shows great promise of revealing individual-environment transac- tions. Ample evidence is at hand to indicate that chair arrangement and body orienta- tion influence the content of social behavior and that the perceived social demands of the situation in turn influence the arrange- ment of people in space (Hall 1966; Som- mer 1970). Only in the unusual situation of the mental hospital ward have such vari- ables been formally studied among older people (Sommer and Ross 1958). Observa- tion of the extent to which older people sitting side-by-side (the way most seating in public places is arranged) turn to orient themselves to each other and the effect of varied seating orientations on the frequency and content of social interaction would be worthy of study. Somewhat more difficult to deal with unobtrusively, but still pos- sible, are such variables as interaction dis- tance, touching, eye contact, and approach- avoidance orientations of the body to an individual as indicators of differential reac- tion to the physical environment. The differential environmental pull of par- ticular structures on particular individuals is a very accessible area of study, provided the situation is one in which it is possible to identify the users and their characteris- tics. Important questions involving mixed- age, mixed-sex, or mixed-race interaction 46 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED can be answered even without more intimate knowledge of the people involved. Beyond that, there is every reason to think that decor, structure, siting, or neighborhood would appeal differently to people with dif- ferent backgrounds or attitudes. The best index of this appeal would be their use of the area under conditions of free choice. Finally, a different look at behavior would be obtained from observing the stream of behavior rather than the discrete events focused on in our camera-eye view. Barker (1965) has made much of the idea that the meaning of behavior and interaction with the environment can be investigated only in a complete time dimension, not in terms of behavior “tesserae,” (that is, time sam- plings of discrete events). We have done some of this at the Philadelphia Geriatric Center by mapping the entire day of sev- eral residents. Certainly, this day-long ob- servation has revealed more starkly than the behavior tesserae method could how grossly impoverished the environment is for these people. Observing the same person over long periods as he/she goes from set- ting to setting is necessary to give a com- plete picture of a living person. However, these kinds of data are much more expensive to gather and difficult to treat empirically and certainly would have to be obtained on fewer people and in fewer environments than our method allows. SUMMARY The results of many hours’ observation of many older people behaving in 12 hous- ing environments for the elderly have been reported. The data on occupancy of differ- ent types of space, the frequency of social interaction, and the incidence of open doors should be useful as baselines of ecological transactions, in the same way that basic demographic information is useful in the design of any program for people. Beyond this point, we hope that the sys- tematic, though basically qualitative, look at congregate housing for the elderly in action may provide some ideas for future empirical testing. Some of the more promis- ing ideas are: eo The degree to which activities are cen- tered within a building varies with the build- ing’s proximity to resources in the larger environment within which the building is located. oe Within-building centeredness of life is also a function of the types of spaces avail- able within the housing environment and the activities conducted within those spaces. e Use of common space increases up to a point as the average health of a building’s tenants becomes poorer. e Halls are primarily transit spaces, though structural variations and the char- acteristics of the users may modify this use to a certain extent. eo Safety from intrusion by outsiders is a major determinant of the population of many common spaces, but this factor may be greatly moderated by proper environmen- tal and administrative engineering. oe The entrance lobby is the most impor- tant common space. At its best (roomy, at- tractive, ample seating) it serves as a social, traffic, and visual-stimulation center. e Common spaces located away from the center of activity serve a real social purpose for a small number of people but are grossly underused. Adequate use of these areas de- pends on their housing organized activities at scheduled times. Further investigation of the positive and negative feaures of all- purpose rooms is indicated. e Provision of spaces where functional activities can be maintained (laundry, stores, hairdresser, soda fountain) may result in better exercise and preservation of the older person’s competence and may afford oppor- tunities for social interaction as well. e Ideal outdoor space demands adequate seating, physical protection, visibility by behavior-monitoring personnel, and a view of ongoing action. eo The greater the population of common spaces, the more likely is social interaction. However, many factors may determine the proportion of a building’s common-space PUBLIC BEHAVIOR AND THE USE OF SPACE 47 occupants who interact. Possible determi- eo The incidence of open doors is related nants of high interaction rate are low socio- to the amount of social life in a building. economic level of tenants or small amount An open door is, among other things, a social of common space. invitation. Chapter 7 Site Differences: Relationship to Well-Being The five sites included in the longitudinal study—Golden Years, President House, Blue- berry Acres, Ebenezer Towers, and Sholom Aleichem House—varied widely in their characteristics. Three were 202 and two were public housing sites. Two were pri- marily Jewish, one was white Protestant, another black Protestant, and the fifth Cath- olic. Three were in urban centers, one in a resort city, and the other in a small rural- county city. One provided many services, while the others did not. Managers varied in amount of education, personality, and personal investment in the role of adminis- trator. Among the entire set of 12 sites, these and other characteristics were even more varied. Assessing tenants before and after occu- pancy is, to be sure, the only way of meas- uring genuine impact. Making similar as- sessments of people currently residing in different housing environments at only one point in time confounds impact with length of residence and selection factors, both self- selection and sponsor selection. However, there is so little information in this area that it seems worthwhile to look at the cross sectional findings that are available. Hamovitch et al. (1969) compared sam- ples of elderly residents living in a high- income retirement community, a hotel popu- lated only by the elderly, and a trailer park. Trailer park residents were much younger than other groups, and their current socio- economic status was between that of the retirement community and the low-income hotel residents. Trailer park residents tended to be least satisfied, and retirement com- munity residents most satisfied, with the locational and social aspects of their housing. Despite these relative differences, two-thirds or more of each group expressed a high 48 degree of satisfaction with all aspects of their housing. Sherman et al. (1968) studied tenants in six different housing situations chosen to represent most of the options then available to the California elderly. In general, the degree of tenant morale or housing satisfac- tion showed a roughly direct relationship to cost. A similar pattern was found for the number of activities offered at the different sites and the actual amount of participation by tenants. As part of the same research Sherman (1973) reported on the same sub- jects at two points in time (two years apart) after they had moved into their housing environments. More notable than the dif- ferences among the sites was the clear gain in activity participation level of the surviv- ing tenants over that two-year period as compared with older people living in scat- tered housing in the community. Mangum (1971) used Sherman et als data from the retirement housing sites to look at the relationships between formal site characteristics—the “congregate,” ‘“segre- gate,” and “institutional” qualities noted by Kleemeier (1959)—and the adjustment of tenants. Personal adjustment was not related in any simple form to the characteristics of the housing environments, though some com- binations of person and environment seemed to elicit differing amounts of activity. How- ever, in general, the environmental differ- ences predicted adjustment better in lower class than in higher social-class tenants. METHODS OF ANALYSIS In this chapter site differences are con- sidered in two ways: 1. An analysis of change in tenant well- SITE DIFFERENCES: RELATIONSHIP TO WELL-BEING 49 being at the five longitudinal sites as a func- tion of the particular housing environment. 2. A cross sectional analysis of tenant well-being at 12 sites as well-being varies across the sites. CHANGE IN WELL-BEING ACROSS FIVE LONGITUDINAL SITES As in the other analyses, the dependent variables were tenant factor scores of post- occupancy well-being. The analyses were performed so as to compare the five sites independent of their tenants’ preoccupancy well-being scores or the tenants’ background characteristics. Tenant well-being after 12 months’ occu- pancy was predicted significantly in every instance. Preoccupancy scores usually accounted for the greatest proportion of variance in final state of well-being: People are consistent and their states of well-being have continuity in time. Demographic characteristics as a group contributed to a considerably lesser degree, but the contribution was still sig- nificant except in the cases of Morale, Orien- tation to Children, Need for Services, Ex- ternal Involvement, and Satisfaction with the Status Quo. The increments associated with site mem- bership were significant in 9 of the 12 in- dices of well-being, the exceptions being Functional Health, Change for the Better, and Housing Satisfaction. The latter two indices were among those that showed the greatest favorable effect attributable to re- housing. Therefore, it may be that the strong overall tendency of all tenants to see im- provement in their housing situations (and consequently in their well-being when the question was framed in terms of change over the past year) masked any possible site differences in these respects. In summary, these analyses suggest strongly that the housing sites were not equal in their impacts on different aspects of well-being. Naturally, the amount of im- pact varied according to the index. Of those that showed significant site differences, by far the greatest impact was in Middle-Class Leisure Pattern and in Social Stimulus Value. Site differences, assessed informally through direct observation, seemed most marked in the activities conducted on the site and the orientations of tenants to leisure- time use. Therefore, it is not surprising that the sites differed so much in their effects on these behaviors. Effects of Specific Sites A variety of specific favorable and un- favorable effects of different sites on change in well-being was observed (see appendix table 8). Interpretation of these differences becomes largely a matter of trying to char- acterize each site in terms of its positives and negatives and then, in a post hoc man- ner, attempting to account for these constel- lations of “traits” in terms of other facts about the sites. This is clearly an intuitive, almost clinical, rather than empirical proc- ess similar to giving a name to a factor. Presented below are brief profiles of the sites in terms of this analysis, together with a discussion of how these profiles are related to other known facts about the sites. Golden Years Golden Years tenants experienced the curious combination of a greater-than-aver- age increase in Middle-Class Leisure Pat- tern and External Involvement, together with a decrease in Orientation to Children, Morale, and Satisfaction with the Status Quo; their internal state did not reflect their rise in social involvement. While the social environment at Golden Years was very ac- tive, enough tenants moved farther away from their families to result in a decrease in Orientation to Children. Why did their Morale decrease—or not increase—in com- parison with tenants at other sites? It may be that the tenants at other sites experi- enced a stronger favorable contrast effect between their former living situation and the new housing, while Golden Years ten- ants, being relatively privileged before mov- ing, were either impervious to such far- reaching effects or were more willing to criticize their new situation openly. An im- portant item in the Satisfaction with the 50 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED Status Quo factor is one’s evaluation of the adequacy of his/her financial situation. Since many Golden Years tenants moved from very low-rent dwelling units to higher rent units, they had some reason to feel less satisfied with this aspect of the new housing. President House Relative changes among President House tenants are also not all in the same direc- tion, but they are easier to understand than those at Golden Years. The one area of de- cline was in Middle-Class Leisure Pattern. While as a group Golden Years tenants were less active than average to begin with, many came from relatively close-knit social back- grounds and a number had moved a rela- tively great distance to the new housing. The activity program at President House was minimal during the first year, consist- ing primarily of a weekly Golden Age Club meeting, a Salvation Army religious pro- gram Sunday evening, and several evening social occasions during the year. Thus, the decline in organized activity may accurately reflect the environmental offerings in the old and new residences. The relative in- crease in Continued Breadth of Activity reflects personal, rather than organized, activity and undoubtedly was affected by the necessity of traveling farther to maintain relationships with family and friends. Fi- nally, the favorable change in Satisfaction with the Status Quo probably reflects par- tially the lower cost of public housing. Blueberry Acres The tenants of Blueberry Acres, having begun as a highly independent group and perhaps finding that their new housing stim- ulated them to increased expenditure of energy, experienced a relative increase in Functional Health. In line with this success- ful empirical test of their own competence, their expressed need for services also de- creased. They also increased their activity level in relation to children. On the other hand, their Middle-Class Leisure Pattern scores decreased, again probably related to the relatively low level of organized activity available to them: The senior activity center serving tenants in their building was lo- cated in a twin building a few blocks away, which no doubt constituted a barrier to full utilization. Ebenezer Towers Ebenezer Towers tenants changed in both positive and negative ways. Their social lives before occupancy tended to be restricted to family and close neighbors, and the move occasioned considerable increase in organized activity (Middle-Class Leisure Pattern) and Continued Breadth of Activity, but also in- creased their Loner Status as a consequence of leaving their previously close-knit social situations. The net result seems to have been positive, as indicated by the relative increase in Morale. Sholom Aleichem House Both Functional Health and External In- volvement declined among Sholom Aleichem tenants, by comparison with other sites. Actual negative change in physical health might have occasioned such decline, but a general confinement of behavior to the site itself and a relinquishing of responsibility in the very supportive environment could have added a strong psychological element to the decline. The one positive change (Loner Status) is difficult to interpret since this factor refers to the existence of a rela- tively stable social network and does not assess actual amount of contact. SUMMARY In summary, while sites differed in the extent to which specific changes were posi- tive or negative, there were few clear-cut overall site differences in quality as reflected in the net ledger of change. Environmental factors such as the amount of onsite orga- nized activity did seem to be reflected in tenant well-being, and the decrements asso- ciated with provision of services at Sholom Aleichem House noted in chapter 3 also were seen in these site-by-site analyses. Finally, the pattern of results showed no necessary concordance between inner state and activity. SITE DIFFERENCES: RELATIONSHIP TO WELL-BEING 51 CROSS-SECTIONAL ANALYSIS OF WELL-BEING Another look at differences among sites is available from the examination of data gathered at the site level, in combination with individual tenant data aggregated at the site level. Such an analysis is limited by both the small number of sites—10 or 12, depending on whether behavior maps are involved—and the fact that the data are purely correlational and cross sectional. However, 10 sites are more than have been studied in other research, and a brief and conservative effort at examining the correla- tions among the variables might yield find- ings that would lead to other, more refined research. Variable sets included in the analysis were: eo Input variables, that is, aggregated tenant background characteristics, expressed as means or percentages of all tenants at the site—‘“suprapersonal” site characteristics (Lawton 1970a) Religion (percent Jewish, Catholic, and Protestant) Age Sex Race Marital status (percentage currently mar- ried) Education (head of household) Income Occupational prestige rating eo Behavioral process variables, that is, some of the directly observed behaviors and counts of space use derived from the behavior maps Tenant population Number of common spaces Percentage of tenants in common spaces Percentage in halls Percentage in lobby Percentage in activity areas Percentage in functional spaces Percentage outdoors Percentage in social spaces Percentage of those observed who were engaged in social interaction Percentage of units having doors open eo Site quality process variables, that is, rankings of the sites on eight presumed indicators of quality, plus the summed total of the eight rankings. (The author and the project sociologist ranked the sites inde- pendently, and then agreed on a single ranking.) Total amount of common space Architectural quality of the building in terms of function, social facilitation, and aesthetics Extensiveness of the activity program Life-sustaining quality (an index of in- tensity of supportive services) Neighborhood resources (richness of shop- ping, transportation, entertainment, services, and other facilities) Safety of neighborhood from crime Amount of managing (degree of activity of the manager’s style) Quality of management (an overall evalu- ative judgment) eo Ultimate criteria, consisting of four ten- ant factor scores of well-being, expressed as site means (only the four most reliable factors where data were available on most sites were used), and the administrator’s rating of tenant happiness Functional Health Change for the Better Housing Satisfaction Morale Happiness Also included in the correlation matrix was the dichotomy 202 vs. public housing. Thus, conclusions regarding specific sites were not sought in this analysis; rather, over all 10 or 12 sites, the following correla- tional relationships were tested: eo Housing type (202 vs. public housing) and the input, process, and ultimate cri- terion varibles e Input variables (suprapersonal character- istics) with ultimate criteria (tenant well- being) e Process variables (behavioral map obser- vations) and site quality ratings with ultimate criteria (tenant well-being) e Interrelationships between input variables and process variables 52 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED Housing Type and Its Relationship to Input, Process, and Criterion Variables Table 16 lists the correlations between the 202 vs. public housing dichotomy and the other variables analyzed in this section. Since the program under which the housing was financed determined many other char- acteristics of the housing and the tenants, it is important to consider these relation- ships before the other three described above; many of the latter correlations may relate more to the type of housing program than to essential relationships among input, proc- ess, and criterion variables. By definition, 202 projects serve higher income elderly than do public housing proj- ects. From other data (Lawton and Krassen 1973) it is known that the 202 program grossly underserves blacks (about 4 percent are black), while public housing overrepre- sents the black elderly (28 percent nation- ally). (Note that only 8 percent of the U.S. elderly population is black.) The tendency for Jews to be located in 202 housing and Protestants in public housing may be an Table 16. Significant correlations between housing type and input, process, and ultimate criterion variables Correlation Site characteristic with 202 * Input characteristics (N=12) Higher Jewish population in 202 .67 Higher Protestant population in PH —.62 Higher black population in PH .53 Higher income in 202 .62 Quality process variables (N=12) More common space in 202 —.58 Better architectural quality in 202 —.72 Better neighborhood resources in 202 —.63 Safer neighborhood in 202 —.68 Better total quality in 202 —.62 Behavior process variables (N=10) Higher 9% population in lobby in 202 .65 Higher 9% population in activity areas in PH —.60 Higher 9% engaged in social interaction among all those observed in PH —.58 Higher 9 of open doors in PH —.79 Ultimate criterion variables (N=12) Housing satisfaction greater in 202 .80 * Coded so that high score indicates 202 housing type (i.e., 1=202, O=PH). artifact of the specific sites selected for study. However, since these relationships are so marked, other relationships between religion and tenant well-being must be inter- preted with knowledge that the strong hous- ing program-religion correlation may par- tially explain the relationships. The quality process variables also reflect the differential socioeconomic levels of the housing types: 202 housing was better lo- cated, had more common space, and was judged to be of better quality both archi- tecturally and in general. The behavior process variables, unlike the other characteristics discussed, have no such clear face relationships to housing type. These directly observed data portrayed pub- lic housing as having high concentrations of tenants in activity areas, relatively few in lobbies, and a relatively high level of explicit (percentage of tenants in social interaction) and implicit (percentage of open doors) tenant social orientation. Public housing frequently has a small lobby and that lobby may be less likely to contain fur- niture. Thus, other activity spaces tend to be where tenants congregate, and these are occasionally major senior centers with high activity level. In contrast, 202’s have more different kinds of space, and thus tenants may be dispersed over wider areas, with the exception of the lobby, which tends to be the showcase high-use area. The open door has an obvious analog in stoop-sitting in the urban ethnic areas. On the other hand, since people in the public spaces of 202 hous- ing are apt to be more widely dispersed (because of the greater number of public spaces), the smaller actual percentage of all tenants who were observed interacting socially may have been simply a matter of the lesser availability of clusters of tenants available for such contact (see chapter 6). Finally, the only public housing-202 differ- ence in ultimate criteria was in Housing Satisfaction: 202 residents were more satis- fied. This finding is consistent with the judged higher quality of 202 housing but still could be partially a function of the socioeconomic differences between the two tenant groups. SITE DIFFERENCES: RELATIONSHIP TO WELL-BEING 53 Suprapersonal Site Characteristics and Ultimate Criteria Sites with a higher Jewish population tended to be higher in Housing Satisfaction but lower in Morale, while sites with a high Catholic population were higher in mean Happiness and Protestant sites were lower in Housing Satisfaction (see appendix table 9). Since Jews tended to live in 202 sites and Protestants in public housing, these re- lationships between religious background and Housing Satisfaction were to be ex- pected. However, the tendency of Jews to be lower in Morale and Catholics to be hap- pier is suggestive of stylistic differences in outlook attributable to cultural background. One at least wonders whether there is a greater willingness among the Jewish groups to admit negative feelings. The other cor- relations conform with other commonly re- ported results from gerontological research: Older populations are less happy, and those with lower income or occupational back- ground are both less happy and less satisfied with their housing. Behavior Process Variables and Ultimate Criteria Sites where mean level of tenant health was poor tended to have a greater propor- tion of people observed in common spaces, in outdoor spaces, and in social spaces (see appendix table 10). These findings are most significant in suggesting that these presum- ably less mobile tenants compensated for their losses (which limit them more to the bounds of their housing) by seeking public spaces where they could either interact more with others or observe ongoing activity— the “sitting-and-watching syndrome” de- scribed by Lawton (1969). The few other significant correlations in this set were scat- tered and not easily interpreted. Quality Process Variables and Ultimate Criteria Poor health was associated with a rating of poor neighborhood security and with a minimal time and effort investment in man- aging (appendix table 11). While public housing tended to be located in high-crime neighborhoods and to have fewer full-time administrators, the housing program type itself was not significantly related to aver- age tenant health ; thus housing type does not seem a sufficient explanation of these cor- relations. One may wonder whether there is some tendency for the less healthy to have fewer options and therefore to be willing to accept less favorable placements, whether older housing sites had both less healthy tenants, less favorable location, and less committed managers, or whether bad neigh- borhood and laissez-faire management actu- ally affect health (especially mobility). Rated happiness clearly was associated with a variety of aspects of housing quality. Since happiness was not related to the pub- lic housing-202 dimension, there is some sup- port for the idea that the happiness meas- ure may have an intrinsic relationship to housing quality. Housing Satisfaction, on the other hand, shows exactly the same relation- ships with the indicators of housing quality as those seen for the public housing-202 dimension. Thus, Housing Satisfaction, 202 residence, and some types of housing quality seem to form a cluster of significant rela- tionships suggesting that 202 housing has achieved better quality and at the same time has tenants who are better satisfied. Suprapersonal Characteristics and Behavior Process Characteristics Tenants at large sites tended to be Jew- ish, white, and of higher income—undoubt- edly an artifact of the particular sites chosen (appendix table 12). The space-population data indicate that housing with older and less educated tenants showed a greater pro- portion in the lobby, that low-income hous- ing showed more people in activity areas, that sites with fewer females showed higher proportions observed in functonal areas, and that sites with more married couples had greater proportions sitting out- doors. 54 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED Behavior Process Variables and Quality Process Variables Correlations between size and number of common spaces and the quality process vari- ables (appendix table 13) were largely what one would expect on the basis of the differ- ences between 202 and public housing sites. A number of other behavior process vari- ables showed only occasional associations with quality process variables and are not discussed individually. Sites with a high percentage of tenants observed in functional spaces tended to be rated as architecturally superior and to offer many life-sustaining services. While these were usually 202 sites, it may be of interest that such locations do encourage clustering of people. Such areas include laundry rooms, mailbox areas, man- agement offices, and stores. It may be that housing planners should be encouraged to capitalize on such areas for incidental social interaction by building more of them, locat- ing them favorably, and humanizing their furnishings and decor. The percentage of all those counted who actually were engaged in social interaction was highest at sites rated as lower in five of the measures of quality. Again, these tended to be public housing sites, and there is no reason to suggest that poor quality produces much interaction! However, this very consistent finding suggests that reasons for the high interaction rate in public hous- ing should be sought and that, if possible, suggestions should be offered to planners of housing for middle-income elderly for the enhancement of this kind of behavior. One clue is found in there being a higher pro- portion socially involved in housing with fewer common social spaces. It may be that there is such a thing as too much dispersion of tenants as the result of providing too many different places for congregating. A minimum critical mass of individuals is nec- essary for social behavior to occur at all, and a space-rich environment may discour- age, rather than facilitate, this desirable grouping of people. SUMMARY This cross sectional look at relationships among housing type, input (tenant) char- acteristics, process variables (judged hous- ing quality and observed behaviors), and outcome criteria (tenant well-being factor scores) showed a gross difference between the 202 and the public housing programs in e The kinds of tenants served (higher socio- economic status in 202 programs) e The judged physical, programmatic, and administrative quality of the housing (202 housing was judged of higher quality) In addition, there were gross differences in some kinds of behaviors that may have been determined by tenant characteristics related to housing program. On the other hand, with so many other differences, it is of interest to note that there was a difference in favor of 202 housing in only one of the four ulti- mate criteria: Housing Satisfaction. These differences attributable to type of housing program overshadowed other rela- tionships, although there is a succession of suggestive findings that may form hypothe- ses for future research: eo Jewish tenants show a greater readiness to voice a negative outlook on life. e Poor health leads to greater use of within- building common spaces rather than the environment outside of the housing. eo Less healthy tenants have less favorable neighborhood locations and management. e [Functional spaces have higher occupancy in architecturally superior and relatively life-sustaining environments. e The likelihood of social interaction oc- curring is greater where there are fewer common spaces over which tenants may spread themselves. eo Lower socioeconomic status is conducive to more social interaction among those in common spaces, Chapter 8 Physical and Social Aspects of the Living Environment Descriptive information was obtained on a variety of aspects of the environments in which both rehoused and control subjects lived. In contrast to material presented in earlier chapters, these data did not lend themselves well to multivariate analysis. However, much of the information may be of interest to planners and designers and is presented in some detail. LOCATIONAL PREFERENCES Choice of a dwelling unit is a most com- plex decision, based on a poorly understood set of factors, including familiarity with a neighborhood, financial cost, proximity to work and schools, neighborhood resources, personal security, and so on. Detailed analy- sis of such preferences was made in a study by Peterson et al. (1973) which included tenants in a variety of both scattered and planned residential environments. The research reported here examined such preferences on a relatively small scale, the items being introduced after much of the data had been gathered. The results are of interest partly from a methodological point of view: The varying success of the three methods of inquiry should be helpful to those planning future research in this area. The first method was used with the Jersey City community-comparison group (N = 200). Subjects were asked to indicate whether each of the 11 items on a checklist would be “important” or ‘not important” in choosing a place to live (table 17). There was a strong tendency for all aspects to be viewed as important. Still, some clearly were more important overall than others. A nice neighborhood, proximity to someone who could help in time of need, privacy, a nice- looking structure, and proximity to trans- portation and shopping were the most im- portant bases for choice, while onsite meal service was clearly the least important. While a fairly wide distribution of re- sponses was obtained by this method, the subjects were not asked to rank the criteria in order of importance. Therefore, when these subjects were seen a year later a rank- ing procedure was used. Pilot work had indi- cated that ranking a set that included all 11 items was a laborious process. Therefore, the list was reduced to five items by combin- ing some items that were related to one another and eliminating others. Those five were then ranked by 99 Jersey City com- munity residents interviewed one year after the first interview. The right-most column of table 18 shows the summed ranks, with high scores indicating higher overall pref- erence. Because number and wording of items were changed, these results cannot really be compared with those obtained from the earlier rating. However, it is of interest that when the privacy item competed with the remaining four, it assumed far less importance. Because subjects had difficulty with the ranking procedure, a third approach was taken with 260 community residents and applicants for planned housing (the last groups of subjects interviewed for this study). The same five criteria were pre- sented as paired comparisons, so that each criterion appeared 4 times in a total of 10 pairs. While this procedure took as much time as ranking, each judgment was quite simple and we felt it was the most satisfac- tory procedure. Table 19 shows the number of times each was chosen; if the items had been chosen with equal frequency, each would have been chosen 520 times. By this 55 56 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED Table 17. Importance to community residents of criteria for choosing a place to live (N=200) Not Criterion Important important A nice neighborhood 196 1 Near someone who could help if needed 190 6 A place where you could have privacy, or be by yourself when you want to be 189 9 A home or building that looks nice 184 8 Near a bus or streetcar 183 14 Near shopping 182 16 Near a hospital or doctor 167 29 A place with no steps to climb 152 40 Near old friends 146 44 Near relatives 132 55 A place where meals are served 70 123 method, being in a nice neighborhood was clearly the most important criterion and a place to be by oneself the least important. As the data show, the three methods yielded substantially different estimates of the locational preferences of older people. While the paired-comparison method seemed superior from a methodological point of view, further work is needed to determine whether the relative preferences shown in table 19 are reliable and stable when other subject groups are studied. It is possible that random variation produced the observed differences and that few stable differences would appear in a larger, more representa- tive sample. Above all, it must be emphasized that housing and locational preferences are highly individual and that searching for an “ideal” location pleasing to all tenants is fruitless. For whatever the results are worth, over- all, “a nice neighborhood” seemed to be of greatest importance. We can speculate that this very general concept includes physically attractive structures, neighbors like one- self, and freedom from crime. Privacy was least valued, though this finding remains ambiguous until it can be considered in rela- tion to each subject’s actual living situa- tion. This goal might be most important to those who live in another person’s household, of moderate importance to those who live with a spouse, and of even negative value to lonely people in single-person households. It is of some interest that proximity to friends and relatives was relatively low in two of the three preference hierarchies. It may be relevant that all subjects were urban residents; it may be that transportation (in- cluding automobile rides from families) was good enough that physical distance was not seen as a barrier of major proportions. COMMUNITY RESIDENTS’ ATTITUDES TOWARD MOVING Lawton et al. (1973) reviewed the results of several studies that have provided esti- mates of the prevalence of a wish to change residence. The several community-compari- son groups interviewed for the present re- search afforded further information on this issue. Groups in this study lived in lower middle and low-income areas of Philadelphia and Jersey City and were approximately equally divided among black and white Table 18. Frequency of ranking by community residents of five criteria for choosing a place to live (N=99) Rank Second Second Most most Medium least Least Summed Criterion important important importance important important rank Near shopping, buses, church, etc. 33 20 28 12 1 261 Near friends and relatives 29 21 18 12 15 227 In nice neighborhood 18 23 23 25 6 212 Near hospital, doctor, or people to help 20 20 17 27 11 201 Place to be by yourself if you want to be 8 8 10 12 58 88 PHYSICAL AND SOCIAL ASPECTS OF THE ENVIRONMENT 57 elderly. The figures shown in table 20 indi- cate a greater wish to move than was found in large-scale surveys reported by Langford (1962) and Goldscheider (1966) but consid- erably smaller than that of residents of a high-crime neighborhood in Philadelphia (Lawton et al. 1971). Most of the subjects in the present study lived in older neighbor- hoods that were experiencing moderate prob- lems with recent or impending population changes. It seems reasonable to suggest that the moderate wish to move expressed by these groups is representative of urban dwellers in average to somewhat substand- ard neighborhoods. HOUSING APPLICANTS: RESIDENTIAL HISTORY AND THE DECISION TO MOVE The tenants at the five longitudinal sites (Golden Years, President House, Blueberry Acres, Ebenezer Towers, and Sholom Alei- chem House) had resided an average of about 19 years in the same city and 11 years in the dwelling unit from which they would shortly move. The community-comparison groups, in contrast, had lived about 17 years in their current residences. This finding con- firms those of other studies that residential change is more likely among relatively short- term residents. In addition, homeownership was far greater among community residents than among housing applicants. Table 21 shows the frequencies of coded open-end responses to the question, “Why did you decide to move?” There was a mix- ture of “push” (negative features of current environment, urban renewal) and “pull” factors (low rent, social needs, needs for both dependence and independence) involved in the decision to move. It is of greatest interest to note the diversity of needs for which people anticipated satisfaction in mak- ing the move, including the opposites noted above. Again, there is clearly no dominating single motivation for moving. Tenants were asked about who in addition to the tenant or the spouse was involved in making the decision to move. Seventy-one percent of all tenants said that no one else was involved. The decisions made jointly with others primarily involved children and siblings. Very few spoke of anything that could be considered strong pressure from another person to move. Thus, one can con- clude that the majority of moves were self- initiated and that an even greater number Table 19. Number of times community resi- dents and applicants chose five criteria for choosing a place to live in paired comparisons (N= 260) Number of times Criterion preferred * In nice neighborhood 686 Near hospital, doctor, or people to help 558 Near shopping, buses, church, etc. 527 Near friends and relatives 485 Place to be by yourself if you want to be 303 “If criteria had been chosen with equal frequency, each would have been chosen 520 times. Table 20. Attitudes and behavior toward moving of aged urban community residents Per- Attitude /Behavior centage N Subject would like to move to another place 36 321 Subject thinks he/she will move sometime 27 298 Subject has sought a new residence in past year 15 299 Table 21. Applicants’ reasons for deciding to move (N=491) Percentage giving Reason * reason Low rent in new housing (mostly public housing applicants) 19 Social needs 14 Negative physical features of current residence 14 Urban renewal /forced relocation 12 Negative features of current neighborhood 7 Decline in health of self or spouse 6 Gain satisfaction of dependency needs 5 Gain independence 5 Negative feature of current neighbors 2 Other 15 * Open-ended responses of subjects were categorized by in- vestigators. 58 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED were voluntary. The combination of forced urban renewal and strong family pressure accounted for only 13 percent of the moves. HOUSING PREFERENCES AND EVALUATIONS Subjects were asked about a variety of aspects of their physical and social environ- ments. A number of questions were intro- duced after earlier groups had been studied, and some were specific to particular loca- tions, so the number of cases on which the data are based varied widely. Age Segregation and Age Integration Rosow’s (1967) study of apartment dwell- ers in Cleveland gave unusually definitive results supporting the conclusion that there are many social gains for older people who live in high density housing among age peers. Since all the housing sites in the present study were age-segregated, our primary in- terest was the attitudes expressed by older individuals toward different types of age mixing. Contrasts were afforded by compar- ing the responses of people before and after they had lived in age-segregated housing and comparing the responses of community resi- dents who had not applied for such housing with those of rehoused subjects. Table 22 shows the results from this set of questions asked of different subject groups at different times. It should be noted that when all of the questions in table 22 were asked of nonapplicant community residents, they were preceded by the phrase, “If you were going to move, would you like . . .”). Responses to the first two questions showed that different ways of asking the questions resulted in quite different re- sponses. Unfortunately we did not fully ap- preciate this difference at the time and do not have followup data on the clearest pref- erence item, “Would you prefer to live in a place with only people over 62 years old or in a place with people of all ages?” Table 22 shows that community residents and appli- cants did not differ appreciably on sheer preference for living with age peers. How- ever, community residents were twice as likely as applicants to age-segregated hous- ing to prefer total age mixing. This great difference was balanced by a greater (and similarly lopsided) tendency for applicants to indicate doubt or lack of preference one way or the other. Applicants already had made a choice to move into such housing, but they clearly were very uncertain as to how they would respond to this feature. They had been accepted into the new housing anywhere from two months to only a few days before being interviewed; one might suggest that cognitive balance between personal prefer- ence and the fact of their new social environ- ment had not been achieved. The second question shown in table 22, “Would it bother you to have only people 62 and over living in the new building?’ ap- parently allowed much clearer expressions of opinion than the one asking about pure preference. Although community residents were more likely than housing applicants and tenants to think they would be both- ered by age-segregated living, the great ma- jority in all groups said they would not be or were not bothered. The other three questions asked about suc- cessively older fellow tenants: children, teen- agers, and younger adults without children. The results show a pattern similar to that for the first question: There were relatively small differences between community resi- dents and housing applicants or tenants in clear willingness to accept younger tenants, but a far greater number of applicants and tenants were clearly opposed to having such fellow tenants. It also should be noted that significantly fewer applicants and tenants were willing to accept children than were community residents. A number of significant conclusions are possible from the results shown in table 22: e The best estimate of preference for age- segregated living among older people living in scattered community residences is 37 per- cent. While this represents a minority, if we extrapolate this estimate to the entire elderly population of the country, this would rep- resent the wishes of 7 million people. The best estimate of the total number of pres- PHYSICAL AND SOCIAL ASPECTS OF THE ENVIRONMENT Table 22. Attitudes toward age mixing Percentage giving response Community Question /Response residents Applicants Tenants Would you prefer to live in a place with only people over 62 years old or a place with people of all ages? Only those over 62 37 39 Can’t say /Doesn’t matter 21 40 All ages 42 21 Number interviewed (264) (446) Would (will) (does) it bother you to have only people 62 and over living in the new building? Yes 18 3 8 No 75 94 91 Can't say 8 3 1 Number interviewed (222) (534) (1,108) Would you like to have young children living in the building? Yes 28 8 11 Can't say /Doesn’t matter 28 27 12 No 44 64 77 Number interviewed (322) (368) (1,112) Would you like to have teenagers living in the building? Yes 20 15 Can't say /Doesn’t matter 51 20 No 29 65 Number interviewed (331) (1,124) Would you like to have younger adults without children living in the building? Yes 24 31 Can't say /Doesn’t matter 62 27 No 14 43 Number interviewed (218) (1,013) ently available federally assisted and private units designed for the elderly as of 1977 is only about 600,000. Thus, it appears that it will be many years before need for this type of housing is met. e On the other hand, community resi- dents overwhelmingly would prefer age- integrated to age-segregated communities. Furthermore, one out of five applicants awaiting occupancy of age-segregated units would prefer living with those of all ages. Depite the fact that most of this latter group said that they would not object to living in age-segregated housing, it is clear that some proportion of tenants who move into this type of housing do so because of a lack of suitable age-integrated housing, rather than because they actively prefer age segregation. Thus, we can conclude that the number of residences in normally age-mixed communi- ties suitable for older occupants is totally inadequate at present. In light of these data it seems unfortunate that Federal incentives for good housing have been limited almost exclusively to the age-segregated model. Good as this latter type is for many people, it limits the options for the large number of older people whose style of life would be more consistent with normal community living. The age-inte- grated living provided within the public housing program has constituted a singu- larly unsuccessful test of the viability of age mixing, for reasons that have more to do with crime and the social disorganization of many people living in family units than with intergenerational relationships per se. We need much more research to determine the conditions under which age-integrated housing is likely to succeed. 60 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED Other Social Aspects of the Environment Rehoused subjects were asked if they thought they had changed in a number of ways during the past year and whether they had changed for the better or the worse (table 23). This question was not asked of community-comparison subjects, nor was it asked prior to occupancy, so responses should be viewed primarily as indicating the relative extent to which tenants saw their behavior in their social environment as hav- ing changed over the first year of occupancy. For most items, the most frequent response was ‘no change,” so the figures in table 23 represent the percentage indicating positive change minus the percentage indicating neg- ative change. A number of items show some negative net change, including all of those in some way related to physical vitality: activity, energy, health, and frequency of going out. This is not an unexpected find- ing, considering the net downhill trend of the biological aging process. Also noteworthy is the perceived net decline in frequency of seeing friends and family. Some of this de- cline may be accounted for by the tendency of people to interpret “friends” as meaning preoccupancy friends and the obvious decline in frequency of family contact among those who formerly had lived with a family mem- ber. Contrasted with these two items, the sharp rise in number of friends is clearly a function of new friends made in the housing environment. It is of interest to note that despite these declines in very significant areas, perceived happiness increased mark- edly, along with feeling safer and the greater engagement with the outside world implied by following the news more closely. Appar- ently a generalized feeling of security was strong enough to override some specific, im- portant negative perceived changes. There seems to be a slight tendency for positive changes to have been perceived less often by 202 tenants. It may have been that the con- trast between their earlier poor quality of living environment and the new planned housing environment was greater among tenants of public housing. The greater finan- cial security of public housing tenants is probably a realistic appraisal since rents not only were lower in public housing than in 202’s, but for many tenants represented an absolute reduction from what they had been paying before occupancy. Community residents and some rehoused groups also were asked, “Do you feel safe here?” Of the 523 rehoused longitudinal sub- jects, 94 percent answered ‘‘yes,” compared with 84 percent of the 223 community resi- dents. Physical Environmental Evaluations and Preferences In general, in this subject population as in others studied by different investigators, it was difficult to elicit satisfyingly informa- tive responses about specific features of the physical environment. A major barrier to collecting these kinds of data is the older tenant’s anxiety about saying anything that might be considered critical of the housing, thereby jeopardizing continued residence there. Over and above this age- and situa- tion-specific response style is the general difficulty people have in introspecting about the environment. We do learn to tune out Table 23. Tenants’ self-perceived changes in self and quality of life during past year Percent net change * Tenants Tenants of of public 202 Change housing housing Is better off financially 16 —10 Worries less about money 8 — 1 Feels safer 57 66 Is more active — 8 — 4 Has more energy —13 —34 Has better health 5 —15 Has more friends 21 16 Sees friends more often —17 — 9 Sees family more often — 6 —14 Eats better 15 1 Sleeps better 18 — 2 Gets out more often — 1 — 7 Dresses up more often — 1 17 Follows the news more 39 17 Is happier 46 29 Number interviewed (592) (290) u Percent net change —percent indicating change for the better minus percent indicating change for the worse. PHYSICAL AND SOCIAL ASPECTS OF THE ENVIRONMENT 61 our awareness of the environment, in the interest of paying attention to the more important tasks of the moment, and the for- mal interview is not well suited to cutting through this unconscious lack of awareness. The most informative responses came from the most highly structured questions. However, such questions succeeded primarily in identifying the relative importance of rather gross environmental features. Much more could have been learned had there been time for unstructured inquiry following each closed-end response. The open-end for- mat was less successful because the subjects were reluctant to voice critical opinions, the open-ended questions were too vague, and the time limits precluded extended in- formal discussion of the first spontaneous response. One of the most persistent questions in planning housing for the elderly is whether high rise or low rise buildings are “better.” As with many other environmental features, it is safe to say that this question cannot be answered categorically. The present re- search illuminated the issue somewhat by asking simple preference questions of com- munity residents, people awaiting occupancy of high rise buildings, and tenants after they had lived in such buildings for at least one year. Several different questions were used to explore this issue. Table 24 shows responses to two separate questions asked of four groups of community-comparison subjects. More information on the same sub- ject is given in table 25 for community resi- Table 25. Attitudes toward building type Table 24. Community residents’ preferences for building type Percentage Question /Response responding If you were going to move, how much would you like to live in a tall building with elevator? Very much 26 Somewhat 19 Not much 50 Can't say 5 Number interviewed (223) If you were going to move, how much would you like to live in a 2-story garden apartment? Very much 55 Somewhat 24 Not much 17 Can't say 5 Number interviewed (224) dents, housing applicants, and tenants. These data show rather conclusively that the el- derly urban community residents in our sample much preferred low rise structures. (Of course, the distribution would have changed had one-story structures and other building types been included among the al- ternatives.) Applicants who had been ac- cepted but had not yet moved into high rise housing indicated less preference for low rise buildings than did community resi- dents. It is most interesting that 32 percent of applicants—people who were about to move into a high rise building—preferred low rise housing. Additionally, once tenants had lived a year or more in high rise hous- ing, a substantial portion of those who ear- Percentage responding Community Question /Response residents Applicants Tenants (If you were going to move) Would you prefer to live in a 2-story garden apartment or in a tall building with elevator? Garden apartment 70 32 20 Tall building 12 38 68 Either/Can’t say 18 30 12 Number interviewed (221) (218) (918) (Would) (Will) (Does) living in a tall building bother you? Yes 42 4 6 No 51 92 93 Can't say 7 4 1 Number interviewed (224) (186) (945) 62 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED lier either had preferred low rise or were unable to choose had come to the point where they preferred the high rise. Finally, while 42 percent of community residents felt they would be actively bothered by high rise liv- ing, few applicants or tenants felt that way. These results may be viewed in two ways. One might say that while people prefer what is familiar to them, once they have chosen or experienced something new, they are more likely than not to adapt well to the new way. Therefore, we could reason that one need not be concerned about their ini- tial lack of enthusiasm for the high rise. On the other hand, one could point to the fact that the percentage of rehoused tenants who even after occupancy would prefer something else is large enough to be of con- cern. This suggestion is strengthened by recognition that this occurred in spite of the very strong pull exerted by the reality of their residence in a high rise; the establish- ment of cognitive balance was not suffi- ciently effective for at least 32 percent of applicants or 20 percent of tenants. One may wonder further about the difference between “not being bothered” by high rise living and actively enjoying it. The latter percent- age, if capable of being measured, surely would be substantially less than the 93 per- cent who were not bothered. It would seem that older people ought to have a right to have their simple preferences satisfied, even if they are perfectly capable of adapting to their second choice. Later, more carefully controlled research (Lawton 1975) showed a small but signifi- cant tendency for tenants in high rise build- ings to be less generally satisfied with their housing and less likely to go out into the local neighborhood. It seems reasonable to conclude again, asin the case of other environmental options, that diversity of available choice is highly desirable, not simply because of the relatively few whose lifestyle is constricted by, or who actively despise, high rise living, but also because some substantial group of potential tenants simply prefers living in low rises. One may recommend that within the limits imposed by land costs in urban areas a stronger attempt be made to offer more low rise alternatives, either as completely low rise projects or in a mixture of high and low rise units. Information on specific physical features of the environment was sought through both closed-end and open-end questions. Table 26 shows the percentages of rehoused tenants who indicated that a particular feature was a problem to them. This array serves pri- marily as an indicator of which systems or features are likely to be trouble points, since no further inquiry was made about what particular aspect of a feature constituted a problem. In general, most features appar- ently caused relatively few problems. Win- dows stand out as the major source of problems. There were enough spontancous comments to enable us to say that difficulty in opening and closing windows was para- mount; tenants also frequently mentioned that windows were not airtight and were too high for viewing and cleaning and that the unit had too few windows. The rela- tively high proportion mentioning difficulty with television reception highlights the great importance of this activity to older people. A well-functioning central antenna system should be an absolute requirement for senior housing projects. The ventilation problems were almost exclusively the result of the Table 26. Tenants’ problems with physical features of planned housing Percentage indicating Number Feature problem questioned Windows 519, 875 Television reception 32 857 Ventilation /temperature in hot weather 27 873 Laundry room & equipment 19 743 Floors in apartment 18 872 Closets & cabinets 15 871 Elevators 14 731 Bathrooms 13 850 Balcony 13 340 Heat 11 873 Kitchen 11 858 Halls 11 788 Plumbing 10 854 Apartment size 9 1054 Apartment lighting 4 871 Community room 4 819 Electrical outlets 2 866 PHYSICAL AND SOCIAL ASPECTS OF THE ENVIRONMENT 63 prohibition of central air conditioning in public housing at the time the study was done. This policy has been relaxed since that time. Those mentioning problems with eleva- tors spoke of having to wait too long, of having too few elevators to handle high- traffic times, and of their mechanical un- reliability; a few mentioned the security risk of riding in elevators. Very few people (9 percent) mentioned dissatisfaction with the size of their apartments, but virtually all who did felt that they were too small rather than too large. For the other features, little further elaboration on the source of problems is possible. A small group of community residents (N = 148) was given the same checklist. They reported too few problems to allow meaningful feature-by-feature comparisons. However, 21 percent of tenants, compared with 39 percent of community residents, re- ported having no problems. On the average, planned housing tenants mentioned 2.3 prob- lems, and community residents, 1.2 prob- lems, a highly significant difference. Thus, by this index, it seems that tenants had a a lower level of satisfaction. This difference is no doubt at least partly a function of com- munity residents’ being predominantly home- owners who presumably had had some hand in creating a congruent environment for themselves. Also, they obviously had had a much longer time in which to become famil- iar with their own physical environment than had rehoused tenants. Another view of problems is seen in the responses of 99 community residents and 223 tenants (all from Philadelphia) to the question, “What is the thing you like the least about this (house) (building) ?’ (Table 27.) A somewhat similar inquiry was made in the next question, “What improvements could you suggest to make this building a better place to live?’ Table 28 shows the coded first response of the same group of tenants to this open-ended question. The re- sults shown in these two tables illustrate the infrequency and the scattered nature of spontaneously given dissatisfactions. They do indicate the relatively high salience of the social environment as represented by comments concerning other tenants. Ten- ants were not asked specifically about kitchen appliances in the closed-end ques- tions (table 26). The relative frequency of mention of such dissatisfaction in the open- end questions (tables 27 and 28) suggests Table 27. Responses to question: What is the thing you like least about this (house) (building)? Number mentioning feature Community Feature residents Tenants None mentioned 43 102 Neighborhood 18 5 Specific physical features 12 13 Neighbors 5 22 Appliances 0 15 Maintenance 5 8 Windows 1 8 Elevators 0 7 Apartment size 3 3 Ventilation /Heating 2 3 Expense 2 3 Staff N/A 3 Lack of privacy 2 1 Other 6 30 Number interviewed (99) (223) Table 28. Tenants’ responses to question: What improvements could you suggest to make this building a better place to live? (N =223) Number suggesting Improvement suggested improvement None 95 Improvements in kitchen 36 Increased apartment space 11 Improved windows More closet space Added medical services Better class of tenants Improved food (Sholom Aleichem only) Improved elevator service Different rules, administrative procedures Improved maintenance Added recreation, activities Lower rent Better intercom system Improved balconies (Ebenezer Towers only) Improved staff attitudes Improved heat Improved floors Improved community room Better location Other OMNMMNPNMNNON WWWWE POON ©O —_ Total suggestions 223 64 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED that a more intensive study of the functional characteristics of kitchens might produce better design specifications. Metropole Center Metropole Center is a cylindrical build- ing with truncated wedge-shaped apart- ments opening into a hall that is wrapped around the central elevator-stairwell-service system core. Its contemporary design stands out in a sea of other institutional-looking public housing projects. Since at the time designers and planners were interested in older tenants’ responses to such an uncon- ventional structure, we attempted to study tenant evaluations. Table 29 shows the re- sponses of the 137 tenants interviewed at Metropole Center. A constant 7 percent gave negative responses (‘not much” or “not as well as others”) to all three questions. To make judgments more concrete, tenants then were shown schematic drawings of four buildings—a cylindrical building, a long, low building, an L-shaped high rise, and a tall high rise—and schematic drawings of four apartment shapes—wedge, square, rectangu- lar, and L-shaped. Each tenant ranked the four pictures in each set in order of prefer- ence. Table 30 shows the distribution of preference scores; the lowest score repre- sents the most preferred shape. The cylin- drical building shape very clearly was pre- ferred, while the square apartment was somewhat preferred over the wedge-shaped one. An interesting design problem is thus suggested: to provide square apartments in a cylindrical building! Some indication of the salience of the building’s design is given in the responses of the subjects who were positive toward Metropole to the open-end question, “Why do you like this building better than others you have seen?’ Twenty percent commented favorably on the design, a substantial pro- portion considering the very scattered, non- physical-environmental nature of all other responses. An even more explicit open-end question was asked: “Why do you like the shape of the building?” The responses are shown in table 31. It is clear that the novelty was the primary basis for liking. Many peo- ple spontaneously mentioned its similarity Table 29. Metropole Center tenants expressing positive feelings about residence (N=137) Evaluation Percentage Likes shape of building very much 71 Likes shape of apartments very much : 71 Likes building as a whole better than or as well as others for elderly 67 Table 30. Summed preference scores for schematic drawings Summed Configuration rank Building Cylindrical 198 Low 272 High rise 275 L-shape 299 Apartment Square 216 Wedge 230 L-shape 260 Rectangular 306 Note: The lowe. the score, the greater the preference for the style. Table 31. Responses of Metropole Center tenants to question: Why do you like the shape of this building? (N=107) Percentage giving Response * response Different/New/Conversation piece 59 Aesthetic attraction 13 Room shape 6 Other 22 « Free respon:zes were grouped by experimenter. to Marina Tower, a high-rent building in the central city that had received much publicity. When asked explicitly “What is bad about a round building ?”’ only 23 could name any disadvantage; 5 mentioned diffi- culty in arranging furniture in the apart- ment and none mentioned psychological dis- comfort with the “radical” design, the two reservations most frequently expressed by professional critics of the building. Table 32 shows the responses to the question, “Why (do) (don’t) you like the shape of the apart- ment?” The response “too small” is irrele- vant to the question, and again one sees that PHYSICAL AND SOCIAL ASPECTS OF THE ENVIRONMENT 65 only a few were bothered by furniture place- ment. In sum, overall tenant evaluation of Met- ropole Center appears to have been relatively positive. SPACE UTILIZATION Chapter 6 considered space utilization as measured by direct observation of behav- ior. Some additional information on this subject was obtained from interviews. A group of applicants and another group of rehoused tenants were asked where their contacts with friends most frequently took place. As table 33 shows, for applicants one another’s dwelling units were the common loci of interaction, followed by church or synagogue. For tenants housing-related spaces were more common than non-dwell- ing-unit locations, as shown in table 34. Table 34 also reflects the great change in proximity of friends, that is, in one’s old dwelling, this number of friends would not have been available to visit in the dwelling unit. Most locations for social contacts of tenants were in the housing environment, while only 24 percent were before occupancy. It seems clear that a lesser geographic range for social interaction is one common effect of moving into new housing. The mobility of tenants within their neigh- borhoods did not differ markedly from that Table 32. Responses of Metropole Center tenants to question: Why (do) (don’t) you like the shape of the apartment? (N=138) of community residents, but community resi- dents were slightly more likely to have taken at least one trip out of the city dur- ing the past month (table 35). A little less than one-third of both public housing and 202 tenants had left the building after dark within the month preceding the interview. Table 36 shows where tenants reported they had spent the preceding Sunday. Finally, two questions were asked about within-building social behavior. Table 37 presents responses of public housing and 202 tenants separately. The community room Table 33. Location where applicants usually see friends (N = 249) Location Percentage At church or synagogue 19 In applicant’s own dwelling 13 In friend’s dwelling 11 “We visit each other” (location varies or was not specified) 10 On the street 4 At clubs, meetings 3 Other places 7 No friends/Can’t say 32 Table 34. Location where tenants usually see friends (N =283) Location Percentage In tenant's own apartment 31 In common spaces of housing 31 In friend’s dwelling 16 Anywhere off the housing site 9 Outdoor spaces of housing 4 Halls of housing 2 Senior center associated with housing 2 Other 4 Percentage giving Opinion/Reason response Like New/Different/Conversation piece 249, Easy to clean 9 Good light 1 Good ventilation 1 Other positive 24 Dislike Apartment too small 12 Hard to fit furniture 7 Other negative 4 Can't say 18 Table 35. Furthest distance gone during the past month Percentage giving response Community Distance residents Tenants Never out of the neighborhood 29 23 Never out of the city 30 44 Out of the city 42 33 Number questioned (284) (1,088) 66 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED clearly is only one of many locations for social behavior. There was a tendency for public housing tenants to use the community room less often, the difference from 202 ten- ants being much more marked in regard to the general ‘passing time” question than to the community room question. There seems to be a minority who completely avoid public spaces for interaction; this group is slightly larger in public housing. The information on space utilization is most useful as a baseline against which tenant use of space in other housing envi- ronments may be compared. These purely descriptive data do highlight the strong tendency for social contact with friends to occur within the housing environment rather than outside it and the great importance of the public spaces for this contact. It is of interest that on a random Sunday, the traditional day for family contact, less than half the tenants left the premises. It does seem that further exploration of the reasons tenants stay close to the housing site, as well as examination of the determinants of who does and who does not use the building com- mon spaces, would be worthwhile. Table 36. Location where tenants had spent the preceding Sunday (N=890) Location Percentage Away from the housing site 43 In own apartment 40 On housing premises but not in own apartment 5 Can't say 12 Table 37. Frequency of tenant within- building social behavior Percentage Public 202 housing housing Question /Response tenants tenants How often do you join others to pass time downstairs or outside? Almost every day 36 64 Once to several times per week 26 16 Less than once a week 9 5 Never 28 15 How often do you go to the community room? Almost every day 12 22 Once to several times per week 40 39 Less than once a week 21 17 Never 27 22 Chapter 9 The Manager Much has been written about the financing, the designing, the programs, and occupants of housing for the elderly. Much less has been reported about the person who man- ages such housing. The administrator is the key person who sees to the day-to-day opera- tions of the housing, influences the way or- ganizational goals are pursued, and sets the tone for the relationship between staff and tenants. PURPOSE On the assumption that the housing ad- ministrator’s attitudes and ideologies affect in an important way the entire housing en- vironment, this research examined the per- sonal background characteristics, profes- sional characteristics, role conceptions, task performance, job satisfactions, and styles of housing management of administrators. Since we were interested in making some generalizations about administrators and their projects, we turned from the intensive study of 12 sites to a national sample of housing sites. In this chapter we enumerate and then explore the linkages between administrator characteristics. However, it is difficult to draw conclusions relating tenant well-being to administrator characteristics. For exam- ple, while we can assert that it is desirable for an administrator to enjoy his/her job, it is difficult to define what is desirable in terms of specific attitudes about the elderly or managerial practices. One can assume that an administrator should follow a basic administrative policy that preserves the in- dividuality of each tenant and recognizes the elderly as a special group with special day-to-day needs; beyond that a wide range of attitudes can have a favorable effect on the tenant. The most appropriate approach will depend on both the particular housing situation and the elderly being served in terms of their background and general competence. SAMPLE In 1970 we selected a sample of low-rent projects for senior citizens from a Depart- ment of Housing and Urban Development (HUD) directory of public housing projects occupied as of 12/31/67. This ensured that when the survey was activated, all projects had been in operation at least three years and enjoyed relative stability of operation. The sample of 792 low-income public hous- ing projects with units for the elderly that was chosen constituted 62 percent of all such projects (57 percent of all units) in the country at that time. The sample was drawn so as to be representative in both geographic location and in size of project: large, moderate, and small housing sites in 15 States and the District of Columbia, rep- resenting each of the (then) six HUD re- gional offices with at least two States, were studied. In order to have a sizable representation of moderate-income 202 sites, all 196 proj- ects in the country active as of 1/1/67 were included in the study. A questionnaire was mailed to the admin- istrators of the total 988 projects selected. It contained questions about administrative practices and policies, the administrator’s conception of the role, and a set of 49 atti- tude statements written to reflect attitudes toward older people, judgments of the ad- ministrator’s housing environment and of the ideal housing environment for the el- derly, and stereotypic attitudes toward 67 68 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED aging, illness, and dependence of the aged. The questionnaire also included a number of questions about the administrator’s own background, professional qualifications, and activities. Returns were received from 346 public housing administrators; because some managed more than one project, this repre- sented 489, or 62 percent, of the 792 public housing projects in the survey (table 38). Of the administrators of 202 housing, 135 responded, representing 68 percent of the 196 projects in the universe. Responding and nonresponding sites were compared in terms of HUD region location, years the site had been under management, number of units on the site, and, for 202 housing, the type of sponsor. These two groups were comparable in years under management and sponsorship, but they differed in number of units: nonresponding public housing sites were considerably smaller than responding sites (mean size, 38 and 131 units, respec- tively). There also was a differential re- sponse rate by geographic location among public housing sites: Sites in the most in- dustrialized areas of the country (the east and west coasts) had a notably higher re- Table 38. Characteristics of sites of responding administrators Public housing 202 Characteristic sites sites Percentage of sites responding, by HUD region * New York (New York & New England States) 71% 63% Philadelphia (Middle Atlantic States) 73 79 Atlanta (Southern States) 52 70 Chicago (Midwest States) 59 68 Fort Worth (South Central States) 60 82 San Francisco (Pacific Coast & Mountain States) 72 73 Median years under management 5 4 Sponsor Nonprofit club, organization (not church related) N/A 52 Nonprofit club, organization (church related) N/A 47 City, county, or municipal housing authority 1009, N/A Mean number of units per site 131 155 © HUD regions existing in 1969, sponse rate than did those in the areas in between. Thus, in interpreting the results it should be kept in mind that the sample is biased toward larger urban sites and that gener- alizations from the study will need to com- pensate for the notable relative absence of small sites located outside urban areas. RESULTS The data were first examined descrip- tively; the range of responses, frequencies, percentages, measures of central tendency, and tests of significance were used to de- scribe the administrators and their back- ground characteristics, their administrative practices, and their job satisfaction. When several measures of action, satisfaction, or opinion were obtained, summative indices were calculated to indicate the overall trend. Personal Background Characteristics Table 39 shows information on character- istics of the administrator and the job. The administrator of housing for the elderly was somewhat more likely to be a man than a woman. A typical administrator was more than 50 years old, had some college educa- tion, was more often Protestant and mar- ried, and worked solely in housing adminis- tration. Almost all administrators were born in the United States. Comparing pub- lic housing and 202 administrators: e Public housing administrators were somewhat younger (median age = 52) than 202 managers (median age = 57). e The 202 administrators were better educated. Only half as many public housing administrators had attended graduate school. Female public housing administra- tors were less educated than both their male counterparts and 202 administrators, male or female. Male 202 administrators were not significantly better educated than their female counterparts. e The 202 administrators’ religious pref- erences were representative of the church sponsorship of the 202’s in the sample, sug- gesting that a religiously sponsored 202 THE MANAGER 69 Table 39. Background characteristics of administrators (percentages unless otherwise indicated) Characteristic Public housing 202 Sex: Male 56 65 Age: Approximate median 52 years 57 years Religious preference: Protestant 71 81 Catholic 22 8 Jewish 3 9 Other or not known 4 2 Marital status: Married 81 89 Employment: Management of project housing only 87 83 Place of birth: USA 98 95 Mean salary in 1970: Male $7,325 $8,300 Female 5,600 5,870 Education: Total Male Female Total Male Female High school only 33 25 44 22 21 26 Some college 38 37 39 32 29 36 College graduate 15 21 7 11 8 17 Graduate school 14 17 10 35 42 21 100 100 100 100 100 100 Number of respondents (330) (190) (148) (133) (86) (47) employs members of its own group as man- agers. Professiona! Characteristics Professional characteristics of adminis- trators are shown in table 40. Most admin- istrators were experienced in work related to management of housing for the elderly, having worked in family or elderly housing, with older people, or in other types of admin- istration. Evidence of professionalization of their management roles was scant, however: eo Fewer than half were members of any professional organization. e Only about half had attended any con- ference or training course for management of housing for the elderly. e Given four possible sources of informa- tion on management of housing for the el- derly (discussion with fellow employees, management conferences held explicitly for local housing authority or nonprofit spon- sor, professional meetings, and journals and magazines), the mean number of sources named was fewer than two. Nevertheless, more than 80 percent of the administrators said they felt well informed on elderly hous- ing management, perhaps reflecting the value of experience or, possibly, expressing their degree of ego involvement in their jobs. Compared with public housing administra- tors, 202 administrators had greater experi- ence in the human aspects of service to the elderly and showed a higher degree of pro- fessionalization. Their experience was more in the areas of work with the elderly and social welfare. They belonged to more pro- fessional organizations and had more sources of information on housing for the elderly, especially outside sources of information (professional meetings, journals, and maga- zines). Public housing administrators’ ex- periences were more in family housing and administration. They named inservice types of information sources (discussions with fellow employees and their own manage- ment conferences) more often than outside sources, though the extent of their inservice exposure was about equal to that of 202 administrators. About 70 percent of the administrators received salaries of $10,000 or less in 1970, hardly professional salaries commensurate 70 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED with their years of experience. The median salary of 202 administrators ($8,500) was significantly higher than that of public housing administrators ($7,100). Female administrators were paid notably less than were male administrators ($5,600 and $7,325, respectively). Role Conception The administrators were provided a list of administrative activities and asked to indicate how much time—a great deal, a moderate amount, little, or none—they de- voted to each. Activities dealing with the Table 40. Professional characteristics of administrators Public housing 202 adminis- adminis- Characteristic trators trators Mean number of years worked In family housing projects 8.5 years 2.0 years In housing for older people only 2.5 4.6 With older people, but not in housing 2.2 5.5 For present employer 8.9 5.3 In present position 6.6 3.8 Previous employment related to (percentages) * Housing 17% 28% Elderly 1 24 Social welfare (aside from housing for elderly) 7 30 Administration 78 60 None of the above 21 19 Membership in related professional organizations Percentage belonging to one or more 33% 47% National Association of Housing & Redevelopment Officials (NAHRO) 17 2 National Association of Nonprofit Retirement Housing (NANRH) 0 17 American Association of Homes for the Aged (AAHA) 0 10 Gerontological Society 0 4 Other national organizations 6 8 State organizations 9 20 Local organizations 6 11 Training (percentages) Had attended some course or conference about managing housing for the elderly 529, 52% Best sources of information on management of housing for the elderly Mean number of sources named (range 0-4) 1.5 1.7 Type of sources named (percentages) Internal sources 79% 73% Discussions with fellow employees 42 33 Management conferences 37 40 External sources 57 85 Professional meetings 33 48 Journals, magazines 24 37 Feeling of being quite well or very well informed about management of housing for the elderly (percentages) 82% 87% Salary in 1970 (percentages) Less than $5,000 319% 20% $ 5,001-% 6,500 13 12 $ 6,501-% 8,000 17 13 $ 8,001-$10,000 13 22 $10,001-$12,000 16 14 $12,001-$15,000 8 15 More than $15,000 2 4 Median salary $7,100 $8,500 « Totals add to more than 100% because some administrators gave more than one answer. THE MANAGER 71 mechanics of managing the housing opera- tion were termed “managerial” tasks and those referring to contact with tenants were termed ‘“‘social-personal” (table 41). Since these were subjective estimates given by managers, it seems more appropriate to re- fer to them as ‘role conceptions” rather than the more objective term “job perform- ance.” All the activities required some time on the part of almost every administrator. Table 41 lists the percentage of adminis- trators who reported spending much or a moderate amount of time on each. Most time consuming were contacts with the hous- ing authority or sponsor, talking with ten- ants in their apartments, talking with ten- ants in the office, and recordkeeping. Recordkeeping was somewhat less time consuming for 202 administrators, probably because the 202 program has fewer levels of bureaucracy. On the other hand, the amount of time public housing administra- tors spent in contact with the housing au- thority was less than the time 202 managers spent with sponsors, again probably a func- tion of the greater number of hierarchical bureaucratic levels in the public housing structure. Relatively few administrators spent much time talking to relatives of ten- ants, although 202 administrators were more likely to do so. In addition, 202 administra- tors were more apt to talk informally with tenants in the halls or in other common Table 41. Role conception: Percentage of administrators who reported spending much or a moderate amount of time at various tasks Public housing 202 adminis- adminis- Task trators trators Managerial tasks Supervising other employees 61 63 Recordkeeping, report writing 85 73 Contact with housing authority or sponsor 85 92 Social-personal tasks: Talking with Tenants in the office 81 82 Tenants in the halls or common spaces 46 63 Tenants in their apartments 88 88 Relatives of tenants 22 33 spaces than were public housing adminis- trators. The higher level of contact with rela- tives and informal contact with tenants at 202 sites may be due to 202 administrators being able to “specialize” in dealing with the elderly, by their having a smaller num- ber of tenants under their care, by the pre- dominance of one-building sites where the administrator’s office is likely to be readily visible to all visitors, and the greater amount of common space at 202 sites. Task Performance More specific details of how the manager performs the job are referred to as “task performance,” some aspects of which are shown in tables 42 and 43. They often in- cluded conducting a personal interview with each tenant, making a periodic check on tenants’ apartments, and dealing with ten- ant problems. Fewer 202 than public hous- ing administrators conducted yearly per- sonal interviews and apartment checks. Variation in frequency of checks and inter- views was less in public housing, probably Table 42. Percentage of administrators performing various tasks Public housing 202 adminis- adminis- Task trators trators Handles tenant problems 97 97 Conducts a personal interview with tenants at least once a year 84 64 Once a year 62 25 2-3 times a year 13 21 4 or more times a year 9 18 Conducts an apartment check at least once a year 93 79 Once a year 47 15 2-3 times a year 30 42 4 or more times a year 16 22 Table 43. Percentage of administrators’ offices handling various tasks Public housing 202 Task offices offices Building maintenance 91 96 Rent collection 91 95 Tenant selection 71 93 Building security 66 93 72 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED reflecting administrative regulations. Clearly there were differences in the way adminis- trators achieved the same end: Some had contact with tenants through formal inter- views with varying frequency, while others talked to them in the office, the halls, or their apartments. Table 43 lists other tasks that may or may not be handled by the administrator’s office and may involve the administrator to varying degrees. Over 9 out of 10 adminis- trative offices handled building maintenance and rent collection. The greater involvement of the 202 administrator’s office in tenant selection may charge the manager with a feeling of involvement with and responsi- bility for each tenant at an earlier date, that is, from the moment of application, rather than from the day the tenant moves in. Security is more often the responsibility of the administrator at 202 sites than it is in public housing. The public housing au- thority, being a quasi-municipal agency, may either depend on local police for secu- rity or have an authority-wide force that is independent of any one project; 202 hous- ing is located in poor neighborhoods less often than is public housing and is more likely to consist of a single high-rise build- ing, simplifying security problems to the point where they are more feasible for the administrator to handle. Attitudes Toward Roles and Job Tasks Administrators were asked which of a variety of tasks they enjoyed doing, which they did not like doing, and which, if any, they or their staffs should spend more time doing, if resources were available. The norm was not to express dislike for any task. Over half of the administrators enjoyed doing two or three managerial tasks, and only about 5 percent disliked that many. Only 19 percent felt that there were any mana- gerial tasks that required more time. Atti- tudes toward social-personal tasks were clearly more positive than attitudes toward managerial tasks, and over half the admin- istrators felt more time should be spent in social-personal tasks. Administrators of 202 housing enjoyed more social-personal tasks than did public housing administrators. Talking with tenants in the office was the task most often enjoyed, while recordkeeping was the one most often not liked ; administra- tors would most like to spend more time talk- ing with tenants in their apartments. In ac- cord with their reports of amount of time invested, 202 administrators enjoyed the more informal contact with tenants and dealing with relatives. Job Satisfaction Administrators found the human aspects of their jobs both gratifying and frustrating (table 44). From the list of possibilities presented to them, almost all administrators indicated they derived satisfaction from helping older people and the appreciation they received for it. Their greatest dissatis- factions were with impolite tenants and demanding relatives of tenants. Salary was an area of relatively great dissatisfaction among public housing administrators, who were also more dissatisfied than 202 admin- istrators with management policies, the amount of recognition they receive, and the amount of work they have to do. While administrators of the two housing types did not differ in source of greatest satisfaction (helping older people), 202 ad- ministrators seemed slightly more likely to Table 44. Percentage of administrators expressing much satisfaction or dissatisfaction with various aspects of the job Public housing 202 adminis- adminis- Aspect of job trators trators Satisfaction Helping older people 96% 929%, Gratitude expressed by tenants 75 82 Being in on policy formation 55 62 Trying out new programs 51 72 Dissatisfaction } Not enough pay 56 34 Demanding, uncooperative relatives 50 52 Tenants who are impolite 48 42 Too much work 35 25 Management policies 31 19 Not enough recognition 21 10 Too much pressure 44 38 THE MANAGER 73 have the chance to enjoy “creative” tasks such as policy determination and planning new programs. Overall summary scores were calculated by assigning a score to the degree of satis- faction or dissatisfaction an administrator indicated he/she derived from various areas of the job and totaling the individual scores. Public housing and 202 administrators did not differ on these scores. Asked directly about the adequacy of their salaries, roughly half were dissatisfied; pub- lic housing administrators were less satis- fied (40 percent) than were 202 managers (53 percent). To a question of how generally satisfying they found managing housing for the elderly, 86 percent of all administrators said it was “very satisfying,” and there was no differ- ence between 202 and public housing man- agers in this respect. Administrative Attitudes and Managerial Style To explore the ideological and attitudinal aspects of management, a set of 49 items was constructed from the literature and from ideas gained by direct observation of housing environments. These statements ex- pressed attitudes about such things as issues in planning, management, service provision, approaches to older people, and generalized views of tenants and of older people gener- ally—areas in which there might be room for varying opinions. To reduce the data to meaningful and more manageable pro- portions, the 49 attitude statements were subjected to a principal components analy- sis. The resulting five usable factors, the items that contribute to each factor, and the “loadings” of each item on the factor are shown in table 45. (The loading figure represents the relative strength of the item’s contribution to the factor.) Scores were created for each administra- tor on each attitudinal factor. In two cases there was a significant difference between the mean scores of the public housing and 202 administrators (appendix table 14): Public housing administrators were more flexible in administration and more business- oriented in their contacts with elderly ten- ants than were 202 administrators. It is possible that public housing, requiring the administrator to assume responsibility for tenants of all ages, by its very nature de- mands greater flexibility. The possibility should be considered that the relative rigid- ity of the 202 administrators may also be in accord with the needs of the less competent tenants, though the greater age of 202 ad- ministrators may also be involved in their tendency to be less flexible. Two other managerial style indices were constructed on a purely rational basis: Im- personal vs. social-personal and localism vs. cosmopolitanism. A “plus” score was as- signed to each item answered in the direction indicated by the name of the index (table 46). Public housing administrators tended to be relatively impersonal in dealing with tenants and local in their professional orien- tations; 202 administrators were more social-personal and cosmopolitan in manage- rial style (appendix table 15). Suggestions for Changes on the Site Administrators were asked what changes they might like to make (a) in the policies, regulations, or manner of administration of their site; (b) in their buildings—redesign- ing them, adding anything, or removing any- thing; (c) on the grounds or the outdoor spaces around their buildings; and (d) in the location of their building (appendix table 16). Almost 80 percent of the public hous- ing administrators and 90 percent of the 202 administrators made at least one sug- gestion for some change. Suggestions for changes in the buildings were far more fre- quent than suggestions for other types of changes. Despite the strong impression that public housing sites were frequently located disadvantageously, only about one in five suggested relocation; the same proportion of 202 managers made similar suggestions. Overall, 202 administrators suggested more changes than did public housing administra- tors, and most particularly, more building changes. Table 47 suggests that the central theme of administrators’ reasons for wanting to 74 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED relocate the project was in order to be closer e Attitudes toward roles and job tasks to facilities of all kinds. e Job satisfaction Thus far, nine types of information re- eo Administrative attitudes garding administrators have been described: eo Managerial style e Personal background characteristics * Suggestions for changes e Professional characteristics Clearly, if we go beyond mere description, e Role conceptions there are an immense number of interrela- e Task performance tionships among these areas that may be Table 45. Related administrative attitude factor loadings Factor/Item Loading Factor 1. Administrative Rigidity vs. Administrative Flexibility in Policy (high score means ‘“flexibility’’) People who look sick, or who have a disability visible such as shaking, should live in another type of place. 57 People who need help in shopping or housekeeping should not be here. 52 Housing like ours is best for completely independent older people. 47 When a person comes here, he is better off concentrating all his activity here, rather than trying to keep up his contacts in his old neighborhood. 47 If their apartments are not inspected pretty often, a lot of tenants would let their place get too dirty. 42 It confuses the tenants to have people from other agencies coming in to help with activities. .40 The majority of older people are happier when you “mother” or “father” them. 39 It is better for housing for the elderly to be located out in the country away from cities, traffic, shopping centers, etc. .38 It is best to have very definite rules for older people in this type of housing. .36 Factor 2. Paternalism vs. Nonpaternalism (high score means ‘‘paternalism”) A lot of our tenants should have more help with personal problems than they now get. .64 A lot of our tenants should have more help with medical problems than they now get. .64 It would be ideal if every housing site for older people had a medical clinic or nurse on duty. .64 It is good for senior housing to have homemakers come in to help tenants cook, do laundry, clean, etc. .51 Most older people in housing like this would do better if their meals, medical service, and recreation were provided on the housing site. .48 If there were time, it would be good for someone on the staff to check every tenant every day to see that he is all right. 44 Most of our older tenants are neglected by their families. .38 The manager should play an active role in organizing activities. .36 The manager should encourage community groups to help conduct programs in his building. 34 Having a lot of services in the housing site (meals, doctors, social workers, etc.) does not make tenants lose their wish to be independent. .48 Factor 3. Business vs. Social Orientation to Elderly Tenants (high score means ‘‘social orientation”) The manager of a building like this should be concerned primarily about the business end of the housing; the social work with tenants should be handled by someone else. .53 Most old people are set in their ways and hate to change. 49 Retirement is, on the whole, bad for most healthy old. 47 It is better that a manager should not get personal with tenants, such as accepting small favors from them or visiting them in their apartments. .46 Tenants should not sit around the lobby or in front of the building. 42 People become somewhat harder to get along with when they get older. 31 Factor 4. Social Age Integration vs. Age Segregation in Living Arrangements (high score means ‘age segregation”) It is probably better for most older people to live in buildings with people their own age. .65 Tenants should not be encouraged to form committees to make regulations, bring up problems to man- agement, etc. —.49 Tenants should have a substantial role in policy setting. —.51 Old people would not prefer living in the same building with young people. —.54 Factor 5. Old Age as Dependence vs. Self-Reliance (high score means “‘self-reliance”) For the most part, older people in housing like this need to have most decisions made for them. 45 People seem to become less independent after they move into housing like this. .40 When left to themselves, older tenants don’t take much initiative in planning programs for themselves. .35 Older people seem to be no more thoughtful than younger people. —.47 Most of our tenants would not rather go without something than depend on others. —.49 Older people here are less independent than the average older person. —.55 THE MANAGER 75 Table 46. Rational indices of managerial style Social-personal Managerial Style (vs. Impersonal Style) Time spent talking with tenants in his office Time spent talking with tenants in halls or other common spaces Time spent talking with tenants in their apartments Time spent talking with relatives of tenants Likes talking with tenants in his office Likes talking with tenants in halls or other common spaces Likes talking with tenants in their apartments Likes talking with relatives of tenants Should spend more time talking with tenants in his office Should spend more time talking with tenants in halls or other common spaces Should spend more time talking with tenants in their apartments Should spend more time talking with relatives of tenants Frequency of periodic check on tenants’ apartments Frequency of personal interviews with tenants Satisfaction gained from helping other people Satisfaction gained from gratitude of tenants Cosmopolitanism (vs. Localism) Attendance at any conference or training courses Number of memberships in professional organizations Member of National Association of Housing and Redevelopment Officials Member of National Association of Nonprofit Retirement Housing Member of American Association of Homes for the Aged Member of Gerontological Society Professional meetings as best sources of information Journals, magazines as best sources of information examined. Since this study represents a first look at housing management for the elderly, it seemed desirable to be relatively exhaus- tive in looking at these interrelationships. Relationships Between Managerial Style and Other Characteristics An administrator who scored high on social-personal managerial style was likely to be more concerned with all aspects of the job than one who scored low. That adminis- trator performed more managerial and social-personal tasks, enjoying even the man- agerial tasks more than the administrator whose managerial style was impersonal, and was concerned with the site’s physical plant, making more suggestions for changes on the site, particularly for reasons related to ten- ant well-being rather than for administra- tive or maintenance reasons. The socially oriented manager was also more likely to have a high cosmopolitanism score. A social-personal managerial style was also related to certain attitudes about the elderly that have bearing on administrative practices. As might be expected, an admin- istrator whose style was social-personal be- lieved in relating to the elderly in a social, rather than a businesslike manner, was flexible in administrative policy, and viewed old age as a state of self-reliance. Finally, the social-personal administrator was likely to be more experienced in work- ing in housing for the elderly, to find the job satisfying, and to be better paid. The cosmopolitan administrator per- formed more tasks and enjoyed both the social-personal tasks and the managerial Table 47. Percentage of administrators who would and would not relocate their building Public housing 202 adminis- admini- Response /Reason trators strators Would not relocate 78 79 Would relocate 22 21 For physical convenience, comfort, ease 8 4 Nearer shopping 9 13 Nearer city, downtown area 5 4 Nearer other resources (movies, church, etc.) 4 5 Nearer public transportation 2 4 Nearer medical facilities 2 2 Away from city 2 1 Out of bad neighborhood (security) 2 1 76 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED tasks more than did the “local” and, as might be expected, was likely to practice the social-personal style. Such an adminis- trator believed that contacts with the elderly should be socially oriented, was flexible in administrative attitudes, and believed that older people are independent. Finally, the cosmopolitan administrator was likely to be better paid, to feel better informed about management of housing for the elderly, and to have more education and more years of experience in housing for the elderly. Relationships Between Administrators’ Attitude Factors and Other Characteristics Business vs. Social Orientation to the Elderly Administrators whose attitudes to the elderly were more business-oriented tended to be more rigid, saw old age as implying a state of dependence, were less cosmopoli- tan, liked fewer tasks, whether managerial or social, found more dissatisfactions in the job, and were less likely to offer suggestions regarding changes in policy. Administrative Rigidity vs. Administrative Flexibility Flexible administrators believed that the elderly are not dependent, but self-reliant persons. Flexibility was more likely to be the outlook of younger administrators and those having a high cosmopolitan score. Social Integration vs. Segregation Support for social segregation for the elderly (i.e., belief that they should live and associate mainly with persons their own age and should not participate in the deci- sionmaking) was most closely associated with a nonpaternalistic attitude and with a belief that older persons are self-reliant rather than dependent. Paternalism vs. Nonpaternalism Paternalistic administrators also viewed the elderly as dependent and felt that there were many social-personal tasks requiring more time. They expressed more dissatisfac- tion with the frustrating aspects of the job, such as pressure, too much work, low salary, or lack of appreciation by tenants and their families. Old Age as Dependence vs. Old Age as Self-Reliance Administrators who saw old age as char- acterized by self-reliance had more sources of information on housing management for the elderly and were more likely to have attended a training course on related sub- jects. Overall, they found managing housing for the elderly to be more personally satis- fying than did those who felt that old age was characterized by dependence. While ideologies relevant to managing housing for the elderly are multidimensional, if one key attitude is known, the other ide- ologies the administrator espouses may be predicted better from this attitude than from most other characteristics. Flexibility, social orientation, and a view of old age as characterized by self-reliance seem to be an attitude package held by administrators who are professional in their backgrounds and satisfied in their work. Attitudes advocating paternalism and social integration seem related to one another, but in a less defined way. Relative independence of the five admin- istrators’ attitudes and measures of role conception was indicated by the relatively low levels of association between these two variable sets. This suggests the lack of de- velopment of a coherent ideology for man- aging socially oriented housing. The some- what higher relationships between one attitude—a social orientation to the elderly —and the administrators’ educational and professional backgrounds does offer hope that exposure to experiences and education stressing the human elements in administra- tion of housing for the elderly can help de- velop both a socially oriented ideology and a technology for putting these principles into practice. Background and Professional Characteristics of the Administrator Younger administrators were more flexi- ble in their attitudes toward the elderly THE MANAGER 7 and were more likely to make suggestions for changes on the site but felt less informed and reported more dissatisfactions from such job conditions as amount of work, pres- sure, recognition, salary, or rudeness of tenants or their relatives. Women administrators tended to be younger than male administrators; they felt less informed about managing housing for the elderly, made more suggestions for site changes, and liked the social-personal tasks of the job more than did men. As mentioned previously, women earned lower salaries than did men. The relationships of sex to salary and to not feeling well informed may be a function of the women administrators being less educated than their male counter- parts; these factors also may have contrib- uted to the women’s lesser satisfaction in managing housing for the elderly. The size of an administrator’s income was not related to administrative attitudes, other than minimally to flexibility. However, in- come was higher for administrators who belonged to many professional organiza- tions, were better educated and more experi- enced in elderly housing, and had attended a training course. Income was also positively related to the number of managerial and social-personal tasks performed and to the administrator’s belief that more time should be spent on social-personal tasks. It also was linked to many indicators of job satis- faction: number of managerial tasks en- joyed, number of social-personal tasks en- joyed, and the index of task satisfaction. Better educated administrators received higher salaries, were members of more pro- fessional organizations, were more likely to have attended a training course, and were more experienced in managing housing for the elderly. The better educated were also more likely to have a social orientation to the elderly but would give more time to social-personal tasks if they were able, and made more suggestions for building changes but found management-oriented tasks more distasteful than those with less education. Administrators who had worked longer in elderly housing were more likely to believe that relating to the tenants in a social way is part of the job and to make suggestions for changes in housing policy or administra- tive practices. Task Satisfactions and Their Correlates When administrators say they like either a number of managerial tasks or a number of social-personal tasks they are expressing overall enthusiasm for their work. Liking many managerial tasks was very strongly related to liking many social-personal tasks. Administrators who felt that more time should be spent on the managerial aspects of the work also were likely to feel that more time should be spent on the social- personal aspects. Expressing the desire to spend more time on either type of task marks an administrator who is involved in more than the minimally specified everyday tasks; that administrator was also likely to make suggestions for change about the site. Those who preferred managerial over social-personal tasks in general seemed to be less committed and involved in their jobs than those whose preferences were in the opposite direction. This difference suggests that there may be different types of admin- istrators with different approaches to their work—both perform, both do well and enjoy the purely managerial aspects of directing housing, but one enjoys and values especially the relationship with tenants. Job Satisfactions Because of the centrality of job satisfac- tion as a management concept, some findings regarding the relationship of job satisfac- tion to other variables that have been pre- sented are recapitulated here. Reported over- all satisfaction in managing housing for the elderly, in response to a direct question, was frequently related to what the administrator does on the job. Administrators who found the job satisfying tended to do fewer day- to-day managerial and social-personal ad- ministrative tasks, but the time they did spend was devoted disproportionately to the social-personal ones. Such administrators did not enjoy doing managerial tasks and did not think managerial tasks should be allotted more time. Satisfied managers par- 78 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED ticipated in policy formation by making sug- gestions for changes in regulations and the manner of administration. Satisfaction in managing elderly housing thus appeared to be intimately associated with both the social- personal and the more policy-related aspects of the job. The direct expression of satis- faction with managing housing for the el- derly was not related either to the adminis- trator’s salary or to most indicators of professionalism, except for the feeling of being well informed about management of housing for the elderly. Satisfaction was related to only two of the attitudes toward the elderly—that the elderly are independ- ent and that they live best with peers rather than in a socially integrated environment. Satisfaction and dissatisfaction with the more specific aspects of the job behaved quite differently in their relationships to other administrator characteristics. The amount of expressed satisfaction from the gratifying aspects of administration—help- ing older people, gratitude of tenants, being in on policy formation, and trying out new programs—was not related to any other characteristic. In contrast, frustration in the job—too much work and pressure, not enough recognition or pay, management policies, impolite tenants, and demanding relatives— was related both to the administrator’s prac- tices and to attitudes toward the elderly and the job. The greater the number of areas of dissatisfaction, the more time the admin- istrator devoted to managerial tasks, the more managerial tasks he/she felt required more time, and, to add to the frustration, the more managerial tasks he/she did not enjoy. The dissatisfied administrator also believed in maintaining a businesslike rela- tionship with tenants and tended to be pa- ternalistic. Since the human aspects of the job were more gratifying to most adminis- trators, it may be that those whose jobs force them toward the less social and per- sonal kinds of activity develop more imper- sonal ways of relating to tenants. Dissatisfaction was not linked to low sal- ary but to the feeling of being inadequately paid. However, the feeling of being ade- quately paid increased as income became larger. The greater the dissatisfaction with specific job conditions (too much work and pressure, unappreciative tenants and rela- tives, management policies, and too little pay), the less the feeling of being adequately paid. Feeling adequately paid was not re- lated to any specific aspects of the work itself, although those who made suggestions for changes were less likely to feel they were adequately compensated. CONCLUSION This exploratory examination of man- agers’ background characteristics, profes- sional behavior, administrative practices, job satisfaction, and attitudes is primarily descriptive in nature. Since all the informa- tion was self-reported, no external criterion was available regarding the effectiveness of the administrator’s performance on the job. Thus we really cannot conclude that any of these measured characteristics are associ- ated with better or poorer performance. Many of the measured variables do have some apparent or presumed association with quality. There seems to be a broad tendency for the following characteristics to be inter- related: e High salary Better education Longer experience Cosmopolitanism Social-personal role conception and role performance Job satisfaction eo Willingness to make suggestions for change, especially policy changes It is a task for the future to determine whether such characteristics do, in fact, lead a manager to do a better job in relation to his/her overall tasks. The “business,” “man- agerial,” and “impersonal” style of manag- ing seems to be a contrasting cluster of approaches to administration. Future re- search ought to determine not only whether such a cluster is associated with inferior overall management but also whether the business and human, tenant-oriented sides of management are complementary, unitary, or mutually interfering. The first question that needs answering is whether manage- THE MANAGER 79 ment does, in fact, make an appreciable dif- ference in how satisfying life is for the tenant. Information from other studies (e.g., Francescato et al. 1975) clearly indi- cates that tenants’ satisfaction with man- agement is a highly important aspect of their total evaluation of their housing situ- ation. But this is not the same question as that of manager impact on housing quality. Do other tenant social indicators such as life satisfaction, feeling of security, social behavior, or independent behavior vary as a function of the kinds of policies, behav- iors, and attitudes exhibited by the admin- istrator? One answer might be that manag- ers may be perceived by tenants as good or bad, popular or unpopular but that such personal qualities or styles of relating to tenants have relatively little effect on how satisfying a life the tenant is able to live. These are most difficult questions to answer, but the answers will be required before we know how to construct an ideal housing environment. Chapter 10 Research Conclusions The foregoing chapters have reported on some of the more important aspects of the research. This chapter summarizes the ma- jor findings, notes some areas of interest for which data exist but analysis is yet to be done, and concludes with a recapitulation of researchable questions raised by this study. THE IMPACT OF REHOUSING The study of tenants of five housing sites before and one year following occupancy allowed the conclusion that planned housing has an overall positive effect on the lives of the older people. Specifically, when com- pared with community residents who had not applied to planned housing, the re- housed were better off in Housing Satisfac- tion, perceived Change for the Better, Ex- ternal Involvement, and Satisfaction with the Status Quo. No difference was found in the factors of Loner Status, Orientation to Children, Continued Breadth of Activity, or Morale. Finally, a negative change in Functional Health was found for the re- housed, as compared to those who stayed in the community; the possible reasons for this bear further investigation. Thus, Carp’s (1966) positive evaluation was confirmed over more kinds of tenant populations. SERVICES IN HOUSING FOR THE ELDERLY A relatively high need for medical serv- ices was expressed both before and after occupancy, and a high degree of approval of such services was expressed by tenants whose housing provided them. A much smaller proportion wished meal services, 80 and this proportion decreased after people had lived in their new housing for a year. Medical services were used more by those of lower competence. Optional meal services were used selectively both by independent tenants who had high social needs and by those who were least independent. Tenants applying to service-rich housing were less competent by many measures than were those applying to housing without services. Study of the differential impact of hous- ing providing many services and that pro- viding few services revealed a mixed effect of services. On one hand, service richness was associated with declines in two meas- ures of well-being: Middle-Class Leisure Pattern and External Involvement. On the other hand, those moving to a service-rich environment were relatively better off a year later in Morale, Loner Status, and Housing Satisfaction. While many ambigui- ties about the desirability of high levels of service in housing remain, one suggestion is that service does, in fact, tend to lower activity levels in offsite behavior, but at the same time to increase the feeling of security and of being a part of the onsite social group. Another possibility is that selective recruitment may result in attracting peo- ple who already are experiencing a decline in competence, so that the decrease in ex- ternal activity is not attributable to service- rich housing. In any case, it is clear that there is a segment of the older population that can and does find a congruent environ- ment in housing that offers a high level of medical, food, social, and activity services. SELECTIVE RECRUITMENT Comparison of those who chose to move into one housing environment with a sam- RESEARCH CONCLUSIONS 81 ple of the universe from that city who were eligible but did not apply revealed that ap- plicants were more likely to be female, not presently married, of lower income, and Jewish (rather than Italian), to have fewer children, to still hold paying jobs, and to have more memberships in organized groups. Three other tests of selective recruitment compared applicants to community resi- dents, controlling basic background varia- bles statistically. In contrast to the findings reported above, these comparisons suggested that housing applicants were somewhat less active socially than nonapplicants. Appli- cants also tended to be less satisfied with their previous housing, to perceive less re- cent favorable change in their lives, to have a smaller preoccupancy social network, and to express less need for services than com- munity residents. Thus, overall, senior- citizen housing seems to appeal somewhat more to those of deprived social status whose social needs are not being met. Little or no evidence was found to suggest that housing applicants were of lower personal competence than nonapplicants. PREDICTION OF FAVORABLE RESPONSE TO REHOUSING The relationship of background variables and preoccupancy factor scores on the in- dices of well-being to well-being a year fol- lowing occupancy was tested. Followup well- being was measured with data from two independent sources: tenant interviews and ratings by the housing administrator. A moderate level of predictability and of agreement between the two types of followup criteria was noted. The results may be sum- marized by the general statement that those who were better off originally did better a year later, even when control was exercised over the particular preoccupancy index of well-being that was used as the dependent variable. While the sponsor could, by screen- ing applicants carefully in terms of such indicators of well-being, maximize the proba- bility of selecting an original tenant group that likely would do exceptionally well dur- ing the first year, it is suggested that such selectivity is counter to the goal of serving all older people or those with some level of social deprivation or mild impairment. USE OF SPACE IN HOUSING SITES The behavior of tenants in public spaces was studied by using behavior mapping techniques. Sites differed widely in the pro- portions of their populations observed in pub- lic spaces. Highest occupancy rates occurred at sites with the least healthy populations, which underlines the importance of these spaces for the social lives of those with re- stricted motility. High occupancy also was facilitated by low-security neighborhood con- ditions, but was diminished by competition with offsite attractions such as a boardwalk or a center-city area. Centrality of location and availability of seating space was asso- ciated with high use. The presence of peo- ple in common spaces was highly likely to lead to social interaction, though this was more true in public housing than in 202’s. Finally, both individual tenants and entire sites varied widely in tendency to leave apartment doors open. On both the individual and the site level, the open door was asso- ciated with a high level of other measures of social interaction. In sum, the data give considerable support to the idea that the use of space in housing for the elderly is not random and that further study of the spatial- behavioral environment can lead to better design. SITE DIFFERENCES IN IMPACT There was a significant degree of varia- tion among the five longitudinal sites in the extent to which favorable or unfavorable impact was observed. These site- and index- specific differences allowed for interesting speculations regarding possible reasons for the variation. However, since these reasons could be discussed primarily on a post hoc basis, the interpretations must be seen as a source of hypotheses for future direct testing rather than as firm conclusions. A cross sectional analysis of all sites studied 82 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED was also done, using followup status and overall quality ratings made by the investiga- tors as the dependent variables. In this case, simple correlations, without controls for im- portant mediating variables (because of the small number of sites), were done between these site-quality measures and aggregate site measures such as tenant background characteristics, space use, and size and type of housing (public housing vs. 202 housing). While a large number of very significant relationships were observed, many of them appeared to have been mediated by the socio- economic difference between public housing and 202 residents and by the richer pro- grams at 202 sites. Other findings appeared less related to these built-in contrasts and offer suggestions for future research. PHYSICAL AND SOCIAL ENVIRONMENT Descriptive data were obtained on pref- erences, evaluations, and reported use of social space. Locational criteria for residen- tial choice by older people seemed to place living “in a nice neighborhood” as most important overall, and privacy as least im- portant, although differences were rather small. Individual needs were seen as the only basis on which the ideal location, as well as a number of other aspects of the social and physical environment, might be discussed. Age-segregated living was highly prefer- able to people already living in planned hous- ing, but less so to community residents, about 37 percent of whom might choose to live this way were they to seek a new resi- dence. Acceptability of younger fellow-ten- ants decreased among tenants, applicants, and community residents as the reference age decreased. The results suggested that a very large number of older people prefer a more integrated style of living, despite the high acceptability of age-segregated envi- ronments to those who freely choose them. While few people who lived in high rise buildings were actively bothered by the building height, a substantial number ap- plying to high rises or living in them would prefer low rises. The norm for community residents, most of whom lived in low rise buildings or detached houses, was clearly to prefer the low rise. Again, greater diversity of choice is needed to be able to atch indi- vidual preference with the right environment. Tenants were both reluctant to criticize and inarticulate in their criticisms of physi- cal features of their housing. Windows, tele- vision reception, ventilation, and several aspects of the kitchen were frequent prob- lem areas where better design solutions should be sought. Tenants in one innovatively designed building gained a sense of pride from their building and apparently had little difficulty adapting to some unfamiliar features of the building, such as its odd-shaped apartments. THE MANAGER A large-scale mail survey was conducted, vielding responses from 346 managers of public housing and 135 managers of 202 housing sites to a large number of questions regarding personal characteristics of the manager, administrative practices, sources of satisfaction and dissatisfaction, role con- ceptions, attitudes, and some characteristics of the housing site. The typical manager was a person of moderate educational attainment who had had few opportunities for profes- sionalization but who nonetheless had a high level of interest in tenants and generally was satisfied with most aspects of the job except the salary, and possibly the intrusion of paperwork into opportunities for direct con- tact with tenants. Purely descriptive analy- ses of the intercorrelations among items re- vealed that administrators apparently do differ widely in style of management. A clus- ter of characteristics appeared that included high salary, high educational level, cosmopol- itanism, social-personal role conception, and willingness to make suggestions for change. Since no external criterion of job perform- ance or management quality was available, it could not be determined whether this cluster or its opposite was associated with RESEARCH CONCLUSIONS 83 effectiveness or related to tenant well-being in any way. However, since the manager has been widely neglected as a subject for either research or training, the descriptive information derived from the research ought to be useful for future exploration of the question as to what constitutes effective management. Chapter 11 A Current Look at Housing Policy Issues: 1979 Since the research reported here was be- gun and completed there have been many changes on the national housing scene. While most of the issues addressed in this research are still relevant, the form in which feder- ally assisted housing is being produced has changed greatly. In this chapter past and present Federal programs are reviewed and the current status of some of the major issues in housing for the elderly is discussed. PAST FEDERALLY ASSISTED HOUSING PROGRAMS FOR THE ELDERLY Public Housing While what we know as public housing began with the Housing Act of 1937, the first such units designated explicitly for the elderly were mandated in the 1956 Housing Act. In public housing, HUD finances hous- ing initiated and operated by a local housing authority, whose members are appointed by municipal or county political leaders. Ten- ancy is limited to those who fulfill local mcome eligibility standards. In the case of housing for the elderly, a tenant or spouse must be 62 years or older, or, if younger, have a handicap. Victoria Plaza in San Antonio, Texas, was one of the first projects designated for the elderly. Developed under the leadership of Marie McGuire (Thompson), who later became national Commissioner of Public Housing and then Special Assistant on Prob- lems of the Elderly within HUD, the project was designed by Thomas Thompson and still stands as a model of a fine living environ- ment for the elderly. Research dealing with the first year of Victoria Plaza’s operation was reported by Carp (1966) and in many other later reports. 84 As of 1976, elderly and handicapped per- sons occupied 456,000 public housing units, of which 293,000 were designated for the elderly and 200,000 were located in projects housing only the elderly. The 202 Program The 202 program, the next most impor- tant Federal program, was authorized in the 1959 Housing Act. It provided 50-year direct loans at 3 percent interest to nonprofit spon- sors that could establish evidence of both their ability to plan and administer such housing and their financial viability. This program has been extremely successful, both in providing a wide range of enriching en- vironments for lower middle income older people and in its extremely low rate of financial failures. A total of 45,000 housing units were produced under the 202 program before Congress replaced it with section 236 housing (1968 Housing Act). The research reported in this volume ex- amined only sites supported by these two programs. There have been changes in both public housing and 202 housing programs since the study was made; these changes are discussed later. Other Federal housing programs are described briefly in the fol- lowing paragraphs. The 231 Program The 1959 Housing Act also authorized Federal mortgage insurance on market-rate loans to profit and nonprofit organizations for housing and retirement communities. The housing produced under the 231 pro- gram served people whose income was higher than that of people served by the public housing and 202 programs. Although more than 54,000 units were produced up until A CURRENT LOOK AT HOUSING POLICY ISSUES 85 the time of the housing construction mora- torium of 1973, the high rate of failures led to this program’s becoming inactive until recently. Section 236 Housing The 1968 Housing Act created the 236 housing program, which was not limited to elderly or low-income tenants. Sponsors took mortgages at market rates but were reim- bursed for interest on a sliding scale pro- portional to the number of low-income ten- ants, down to a rate as low as 1 percent. A number of such projects that were limited to lower and lower middle income elderly were produced. Almost 200,000 section 236 units are occupied by the elderly and handi- capped. Because of the excessive long range cost of this program to the Government and other difficulties, the 236 program was su- perseded by the section 8 program of the 1974 Housing Act, which is described later. Rent Supplementation The 1965 Housing Act established the rent supplement, a Federal cash subsidy that allowed a landlord who leased a unit to a tenant whose income met the local pub- lic housing maximum requirement to receive a market-rate rental fee while the tenant paid only at the public housing rate. This program has enabled about 27,000 low- income elderly to reside in 202 housing, as well as in scattered units throughout the community. The Brooke Amendment The Brooke amendment to the 1969 Hous- ing Act provided that no low-income person in federally subsidized housing would be required to pay more than 25 percent of his/her income for rent. The difference be- tween the 25 percent figure and the estab- lished public housing rental fee is paid from Federal funds to the housing authority. Other HUD rental programs and several in the Farmers Home Administration of the U.S. Department of Agriculture have served many older people. These programs and sev- eral that aid homeowners are reviewed in Lawton (19750). CURRENT FEDERAL PROGRAMS As of 1979, there have been many changes in Federal programing, and undoubtedly there will be many more. Because implemen- tation of new programs proceeds slowly, it is by no means clear at the time of writing how those now in operation will actually perform. A brief description of those cre- ated since our research was completed is presented below. Congregate Housing The 1970 Housing Act explicitly author- ized for the first time the use of Federal funds for constructing and equipping spaces designed to provide supportive services be- yond the shelter itself in public housing and 236 housing (and now in the new 202 pro- grams described later). Chapter 3 discusses in detail some of the issues involved in pro- viding such services. Some of these issues have been resolved by the legitimation of building space for common dining rooms, kitchens, and supportive-service personnel. “Congregate” housing is housing that in- cludes a common dining room serving at least one meal a day and that provides other services such as housekeeping, home health aides, and meals on wheels. Such housing is not required to have kitchen facilities with every unit. Implementation of the con- gregate housing provision has been very slow and no figures on production are avail- able at this time. The 1978 Housing Act authorized funds for the provision of the services themselves, together with the precedent-shattering man- date for HUD-HEW collaboration regarding how the services are delivered. It remains to be seen whether the coordination will be successful and the funding level high enough to make a significant impact. Section 8 Housing A late interpretation of section 23 of the 1937 Housing Act allowed public housing 86 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED authorities to lease units from private own- ers (including 202 sponsors) and fill them with eligible occupants from their waiting lists, in a manner similar to the rent sup- plement program. Section 8 of the 1974 Housing Act superseded this program and is now the major form of housing subsidy. The mechanism is similar to the rent sup- plement program. Section 8 may be used for new construction, existing housing, or rehabilitated housing. It also may be used in conjunction with the 202 program, so that up to 100 percent of 202 units may be rented with section 8 subsidies. Section 8 thus has the great advantage of being adapt- able to either clustered or scattered housing, to older as well as new construction, and at least theoretically to income- and age-mixed housing. Development and management may also be either by a nonprofit or a limited- dividend corporation. As of 1977, half of all section 8 units (180,000) were occupied by the elderly; an astounding 88 percent of sec- tion 8 newly constructed units were desig- nated for the elderly. Public Housing In the past few years there has been little new activity in traditional cluster-type pub- lic housing, except in housing for the elderly, which is still being produced. Most notable on this scene is the growth of community- based services in conjunction with public housing, Title VII nutrition programs in particular. The 1978 Housing Act provided funds for congregate services in public housing. The New 202 Program Despite strong administration opposition, Congress revived the 202 program in 1974 with a number of differences from the origi- nal program. While interest rates now aver- age only slightly less than market rates, the coupling of the 202 program and section 8 subsidy succeeds in keeping rentals within limits payable by low-income and middle- income elderly. In the first two years of the revived program, only a small proportion of 202 project applications have been funded, and actual production has been very slow. Complaints have been made about slow proc- essing by HUD, difficulty in obtaining seed money loans, and a requirement that control of an acceptable site be in hand prior to application processing. It seems likely that, given the success of the earlier 202 program, the enthusiasm with which the new program was greeted, and the effective pressure of the 202 constituencies, the program will begin to operate more smoothly. State Programs Since this research was begun, a number of State programs have been established to finance the building of new housing. They are too varied to describe here, but in gen- eral they have benefited middle-income more than low-income people. Many are in finan- cial difficulty and their future seems uncer- tain. RETIREMENT COMMUNITIES One may note, finally, that construction of housing and retirement communities under private nonprofit and commercial sponsorship, without Federal assistance, continues. Regrettably, no information is available on the number of such environ- ments or of people living in them. A num- ber of nonprofit communities that operate on a life-care basis (i.e., a large, nonre- turnable initial payment together with a monthly charge that does not change as higher levels of health care are required) have had financial difficulties for several reasons: Actuarial estimates did not foresee the increased lifespan, expansion went be- yond market capability, and local property tax exemptions changed. The current ver- sion of life care allows monthly charges to be adjusted to changing costs of mainte- nance. Many such communities have pro- vided high-quality environments for rela- tively affluent older people. It is plausible that the kinds of environments provided for these upper middle-class elderly of today will be sought increasingly by later genera- tions of older people whose earlier lives A CURRENT LOOK AT HOUSING POLICY ISSUES 87 have given them a taste of the recreational and other opportunities provided in the retirement community. OTHER ISSUES IN PERSPECTIVE Crime in Housing for the Elderly Since the research reported here was be- gun, the nation as a whole and the elderly in particular increasingly have become pre- occupied with the issue of crime and public safety. While victimization rates for the elderly are notably lower than for younger age groups for most crimes other than lar- ceny with contact, the fear of crime is exceedingly high. Unquestionably, many indi- vidual older people are sought out as vie- tims because of their vulnerability. Those who are victimized may be more traumatized than people of younger age, because of both their poorer physical condition, and greater psychological vulnerability and the higher relative loss occasioned by larceny and bur- glary. To an unknown extent, the lowered risk to some types of crime may be at the expense of decreased freedom to leave the dwelling unit. The appearance of Oscar Newman’s book Defensible Space (1972) has sensitized peo- ple to the possibilities inherent in the use of physical design in the interest of security. Both HUD and the Law Enforcement As- sistance Administration have sponsored re- search and design development projects aimed at increasing the security of the el- derly. At present it is inconceivable that site selection, building design, and manage- ment planning could take place without careful consideration of how both objective and perceived security might affect decision- making. Age Integration/Age Segregation Few age-integrated projects have been built in recent years, particularly because of the assumed greater crime risk where problem children and teenagers live in physi- cal proximity to elderly tenants. In addition, the apparent favorable consequences of age segregation in other areas have led to in- creased reliance on the age-segregated pat- tern. Thus, there is little that is new in this area. However it seems important to reiterate the caution that all age-integrated models not be rejected. We must continually remind ourselves that an unknown number of elderly live in age-segregated housing because this was the only option that would allow the satisfaction of other needs, whether for a physically modern dwelling unit, greater security in the face of neighborhood crime, or a loca- tion more proximate to resources; although this may not have been their first prefer- ence, they have adapted to the tradeoff and found the age homogeneity to their liking once having had the experience. Others are in a situation that remains contrary to their preference, but they evaluate it positively in order to maintain cognitive consonance with reality—the phenomenon Carp has called the “sweet lemon.” While we do not know the size of the groups whose first preference would not have been age-segregated housing, it is cer- tain that the lopsided Federal programs are not providing the type of housing many people would choose. The research findings on age segregation are not to the liking of many because most people wish for older people to be integrated into the younger society. They point out that ageism is reinforced when clusters of older people are made highly visible, as in housing environments, that older people’s social skills atrophy in the absence of diver- sity, and that the young themselves are de- prived not only by decreased access to the wisdom and reminiscences of the elderly, but even more deeply by the lack of oppor- tunity to rehearse in advance their own aging. However, there has been no attempt to verify these assertions empirically. It seems that until that is done the best we can do is accept the evidence that for the majority of older people in age-segregated environments there are many gains, recog- nize that there are many more people who wish to live this way than there are units, and continue to plan more age-segregated housing. Concurrently, some righting of the balance seems required to satisfy the ma- 88 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED jority who would like better housing but in a more age-diverse setting. If the following conditions are met, the mixing of genera- tions within housing might have some chance for success: 1. Careful control over the characteristics of the individuals in the housing. Regret- tably, this may mean limiting occupancy to intact families or to families that have been screened for indicators of disorganization of the kind likely to produce delinquency among children and teenagers. 2. Physical design that can control the extent of age mixing. Zones and social spaces designed especially to meet the needs of children, teenagers, or adults can be created so that one age group can have access when desired, but that access is controlled and age groups are not forced to be together. 3. Sponsorship or management by a group that is equipped to encourage positive inter- change among the generations. Planning must recognize the risks of age mixing in the earliest stages of site selection and phys- ical design. In addition, management must be ideologically committed to multigenera- tional living and must be willing to do the extra work required to control behavior and program activities so as to make possible the mutual enrichment that can come from active contact between people of different ages. As long as Federal programs offer no in- centive for establishing such programs, we shall see further segmentation of our society and identification of the elderly as a deviant group. Site Selection and the Location of Housing The security issue has resulted in greater awareness of the desirability of locating planned housing so as to minimize the crime risk. However, the need for new housing is frequently greatest in poor central-city areas. Thus, some balancing can be done by physical design and administration prac- tices that reduce the impact of an other- wise undesirable neighborhood. We do not yet know how far federally assisted (especially low-rent) housing can penetrate typical middle-class neighbor- hoods. Even where tenancy is limited to older people, such housing is not always welcome, and a number of zoning battles have been lost through a neighborhood’s suspicion of older people, Federal assistance, or the usually unspoken concern over such a project’s bringing minorities into the neighborhood. We also do not know what proportion of older people would prefer good housing in a familiar but rundown neighborhood over a change to a better neighborhood. Therefore, the way will need to be left open for new projects in old neighborhoods. Minority groups in particu- lar have been very concerned about the HUD practice of disapproving projects located in racially impacted areas. They have a very legitimate concern that older minorities should have the option, if they wish, to live in better housing located in an impacted neighborhood, even if the tenant population should turn out to be racially homogeneous. While some States have well-developed public housing programs in small towns and rural areas, as a whole the nation’s rural population is poorly served by federally as- sisted housing. Since 1976 more funds have been appropriated and more use made of the Farmers Home Administration section 502 rental assistance loans and the section 504 grants, and priority has been given to rural areas in processing 202 loan applica- tions. Continuing problems to less densely populated areas are the scarcity of local ini- tiative and the related difficulty of Federal agencies in providing assertive encourage- ment, as well as the difficulties inherent in the smaller (and sometimes less cost-effi- cient) scale often required in nonmetropoli- tan areas. It seems likely that the greater cost of providing housing in rural and smalltown areas must be accepted as a reality and that this segment of the elderly population must be served despite the addi- tional cost. In 1979 a joint agreement was signed be- tween FmHA and the Administration on Aging (DHEW) to develop a demonstration program for congregate housing in ten rural areas of the country. Another area of increasing concern to A CURRENT LOOK AT HOUSING POLICY ISSUES 89 planners with an eye to the future is the needs of older people living in the suburbs of metropolitan areas. At present, the elderly are underrepresented in suburbs, by com- parison with younger families. However, suburban residents also will age, and it is highly probable that twenty years from now many suburbs will contain high proportions of people who have grown old in their sub- urban residences. The dependence of sub- urban residents on automobile transporta- tion is well known. The physical layout of most such neighborhoods is poor in terms of access to goods and services, and public transportation facilities are typically defi- cient. Therefore, these people, as they age and health and economic factors limit their driving, may find their neighborhoods funec- tionally resource-poor. Some planned hous- ing (202 and higher income housing particu- larly) has been built in suburban areas, and it is likely that a great deal more will be needed in the years to come. It has been much more difficult to locate public housing in such areas because of local resistance to low-income housing generally. Clearly it will be needed, and it is not too early to begin planning methods of mobilizing the positive interest of community residents and deci- sionmakers. Services in Housing Environments Some of the questions raised in chapter 3 regarding impact of congregate housing on the motivation to exercise one’s independ- ence remain unanswered. Furthermore, many housing environments, both congre- gate and independent, have ‘aged’ over their lifespans. A project ten or fifteen years old may show little similarity to the way it was at the time of occupancy. This section addresses the questions of how tenants change, how housing environments change, and how the prospects for a good match be- tween the individual and the environment change over time. There are two contrasting developmental models of the traditional independent (i.e., noncongregate) housing environment: the constant model and the accommodating model. The constant model attempts to pre- serve the original character of the total en- vironment, while the accommodating model assumes that all aspects of the system will change over time. Some characteristics of the constant model are: e Admission criteria for replacement ten- ants are the same as those for original ten- ants. Most frequently the primary criterion is the physical and mental capability for fully independent living, including ambula- tion, performance of household tasks, and financial judgment. e (Criteria for continued residence are established so as to lead to administrator- initiated termination of residence when a tenant’s physical or mental condition de- clines below a specified level. e Termination of residence due to de- creased independence leads to transfer to either (a) the home of a family member, (b) congregate housing, or (¢) an institu- tion. e Since congregate housing is in very short supply and is also relatively expensive, a disproportionate number of such increas- ingly dependent persons transfer to institu- tions; for some, institutionalization will be premature. eo The likelihood is relatively high that those who transfer to the home of a family member or to congregate housing will have to transfer again—to an institution—during their lives. In light of the research data demonstrating the stress associated with re- location, multiple late-life changes in resi- dence seem undesirable. e The community continues to regard the housing environment as a place for inde- pendent living, resulting in the housing’s continued ability to recruit replacement tenants who are fully independent. In contrast, the prototypic accommodating environment is characterized as follows: e Criteria for continued residence are considerably less stringent than those ap- plied to the environment’s original appli- cants. e Changes in tenants’ physical and men- tal health require the addition of services: congregate meals, meals-on-wheels, errand service, homemaker, home health service, 90 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED and various forms of onsite health services ranging from medical/nursing clinic to infirmary. e Provision of additional services re- quires corresponding space-use and physical changes for delivery of services. If such structural changes are not anticipated in a future-oriented master plan for a physical plant originally designed as fully independ- ent housing, it is likely the changes will be makeshift and dysfunctional. e Since the needs of tenants do not change at an equal rate, services at first are not cost- effective, being applied to a relatively small proportion of tenants. The mix of independ- ent and less independent tenants also will cause anxiety in the former, who do not like to be reminded every day of their own vul- nerability to decline. e¢ Admission criteria for replacement ten- ants are relaxed as the capability for addi- tional support of marginally independent tenants increases. e The community image of the housing as a supportive environment stimulates mar- ginally independent people to apply in greater numbers, while the more independ- ent are less likely to apply. Nonetheless, some fully independent people who have major housing problems continue to apply and be accepted, for lack of other options. Incongruence of the desires and needs of such persons with the dominant supportive quality of the environment will be a source of continued tension. e If such a possibility were incorporated into the original design, the completely ac- commodating environment could, during its 40- or 50-year physical life, evolve into a long-term care institution. Admittedly, most housing environments are not as extreme as the two types that have been sketched. But the fact remains that many older projects that have attempted to become accommodating are having increas- ing difficulty recruiting, remaining financially viable, and providing services in settings not originally planned to function this way. Similarly, housing projects where accom- modation is more difficult to achieve, espe- cially public housing, face the unpleasant necessity of terminating tenancy because of lack of services or of maintaining marginal tenants without being able to provide them with the requisite services. Can congregate housing on a large, na- tional scale alleviate these problems by pro- viding a level of support intermediate be- tween independent housing and institutions and by being physically planned so as to deliver the services ideally? My feeling is that we must be cautious about placing all our hopes in this option. For one thing, there is evidence that some fully independent people choose congregate housing for posi- tive reasons such as the enjoyment of relief from humdrum tasks, rather than because they cannot perform them; thus the tension consequent to a mix of independent and marginal tenants will not be resolved. In addition, the prospect of introducing a third stage of residential movement (i.e. inde- pendent housing to congregate housing to institution) into the lives of older people is not appealing. Possible solutions, suggested in total ab- sence of relevant knowledge, might include the following: 1. A sponsor could plan in the beginning for either a constant or an accommodating environment and steadfastly resist the temp- tation to hybridize. 2. Two kinds of congregate environments could be planned: One for independent peo- ple seeking leisure, for whom criteria for admission would remain constant but crite- ria for continued residence would be flexible, and the other for marginally competent per- sons. Concurrently, two kinds of independ- ent housing could be planned, one that will remain constant and one that is planned to become accommodating. With these four al- ternatives, the prospect of three residential moves could be minimized by the following pathways: eo People who were independent when they entered congregate housing could, as they decline, remain longer than they could in independent housing—until the time when institutionalization is appropriate. e People moving directly into the congre- gate-dependent housing could be those whose A CURRENT LOOK AT HOUSING POLICY ISSUES 91 community residence was extended by com- munity-based services and whose only other move would be to an institution. e Those moving into independent but ac- commodating housing could continue to face only a transfer to an institution. e Only for those moving into independent, constant housing might intermediate resi- dence in congregate housing be required. 3. A change of residence may be less stressful when the possibility is anticipated, when the mechanisms for doing so are de- fined and known, when the move is to another unit under the same administration, and when the move is carefully planned. The fur- ther development of the campus concept, where independent housing, congregate hous- ing, and institution are appropriately placed at least in psychological proximity to one an- other, may reduce the negative character of moving three times. Resolutions of these dilemmas are not readily available. Again, one of the prob- lems is that we know too little about the lifespans of residential environments: To what extent have constant and accommodat- ing environments and all the hybrids in between actually evolved? What are the processes by which accommodation has taken place? What are the consequences to tenants and to sponsors of constancy or accommoda- tion? What are the characteristics of suc- cessful and unsuccessful constancy or accom- modation? Clearly, a major research effort will be required, using retrospective, cross sectional, and longitudinal strategies, fol- fowed by evaluation of contrasting models established on the basis of this research. Professionalization of Housing Management This research indicated that at the time of study housing management for older ten- ants had not been professionalized (see chapter 9). Some moves toward this clearly desirable goal have been made since the re- search was completed. HUD has stepped up its efforts to train its own administrators through inservice training seminars and the production of management manuals, The National Center for Housing Management (NCHM) was founded as a private non- profit training institution for administra- tors. Under an Administration on Aging grant, the NCHM began a major specialty in training managers of housing for older peo- ple. Extremely useful management manuals and training materials have been produced by the NCHM, and large numbers of people have gone through regional training semi- nars using these materials. The American Association of Homes for the Aged similarly has expanded its concern for the manage- ment of private nonprofit housing and offers many resources to assist people involved in this effort. Participation in such training is volun- tary, of course, and one is tempted to sug- gest that an undue proportion of adminis- trators who have participated in such train- ing have been those who require it least. The major goal of the NCHM—to become a self-sustaining organization supported at least as much through training fees paid by the private for-profit sector as through public and nonprofit funds—has not been realized. Thus one is inclined to predict that full professionalization can take place only under the compulsion of licensure require- ments. Model regulations for eligibility and licensure have been circulating for several years, but no movement to establish legal requirements for housing management seems near actualization at this time. It seems imprudent not to protect the large Federal investment in housing for the elderly, by making continuing education, at the very least, mandatory through a legal licensure status for all administrators of federally assisted housing. Nonprogrammatic Housing The general success of the housing pro- grams with which this research was con- cerned has obscured the fact that the great majority of older people do not live in planned, clustered housing. Well over 90 percent of all older Americans live in owned or rented units scattered throughout the “normal” communities where people of all ages live. Some Federal programs have been 92 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED addressed to this majority. The HUD sec- tion 115 rehabilitation grant program (now inactive) and the section 312 rehabilitation loan program offers assistance to older homeowners, as does the Farmers Home Ad- ministration section 504 home repair loan program. The old HUD section 23 leased housing program, the rent supplement pro- gram, and section 8 all encourage the use of existing or rehabilitated scattered housing for elderly tenants. The experimental hous- ‘ing allowance program now being studied by HUD similarly concentrates on renters in ordinary communities. Many communities have established home-repair, home-mainte- nance, and handyman programs for their older residents, though there is no Federal mandate for such programs as yet. Despite this multitude of programs, their actual magnitude has been very small. Total expenditure for such programs is far less than that devoted to the 4 percent or so who live in planned housing environments. It is time to rethink housing priorities for the elderly population as a whole. First, it is unlikely that enough new project-type hous- ing could ever be built to accommodate the needs of those who might like to live in planned, clustered housing. The public tax burden to build such housing simply could never be borne. Second, there has been in- creased recognition of the profligate manner in which older housing has been allowed to deteriorate, leading to the deterioration of entire neighborhoods. Attention to maintain- ing or rehabilitating older structures not only can provide thousands of livable units for older people, but also can assist mate- rially in the physical and social preservation of neighborhoods. Finally, the fact is that the majority of older people clearly do not wish to move into new project-type housing, especially when it involves relocating in an unfamiliar neighborhood. Many have affec- tive attachments to the homes in which their families have grown up and which often were purchased through a lifetime of work. They also have attachments to their neigh- borhoods, even when the neighborhoods leave much to be desired in physical and social quality. On the negative side, many more simply either cannot afford a move or feel psychologically and physically incapable of dealing with the stresses of relocation. Therefore, it seems clear that some right- ing of the balance of expenditures on planned versus unplanned housing is in order. Elderly homeowners and renters in normal communities have many housing and housing-related problems for which assist- ance is very hard to obtain through the scat- tered programs now available. Recently HUD and HEW have acknowledged this sparsity of resources for the majority, and it is likely that considerably greater effort will be expended for this purpose in the years to come. More extensive considera- tion of these issues, together with sugges- tions for future solutions, may be found elsewhere (Center for Urban Policy Studies 1978; Lawton et al. 1978). This call for a redirection of priorities is not in any way meant to suggest that the successful planned housing programs should be downgraded. Every good planned hous- ing environment has a discouragingly long waiting list. Clearly, continued production of these units is necessary. However, a far greater number of people will be served better if local, State, and Federal bodies, as well as the private sector, take a longer look at possible modes of assistance to the 20 million elderly not in planned environments. CONCLUSION There is much more that could be dis- cussed in terms of changes over the past ten years and prospects for the future. In particular, a tremendous mobilization of in- terest in the physical design of environ- ments for the aging has occurred. This important topic and many others must be left to other endeavors for the extended treatments they deserve. REFERENCES 93 REFERENCES Barker, R.G., Explorations in ecological psychology. American Psychologist, 20:1-14, 1965. Blenkner, M. Environmental change and the aging individual. Gerontologist, 7:101-105, 1967. Carp, F.M. A Future for the Aged. Austin: Univer- sity of Texas Press, 1966. Center for Urban Policy Studies. Occasional Papers. I. Housing for the Elderly. Washington, D.C.: American University, 1978. Cohen, J., and Cohen, P. Multiple Regression in the Behavioral Sciences. Hillside, N.J.: Erlebaum, 1975. Cumming, E., and Henry, W.E. Growing Old. New York: Basic Books, 1961. Francescato, G.; Weidemann, S.; Anderson, J.; and Chenoweth, R. User needs: Evaluating housing for low and moderate income families. In: Con- way, D., and Beedle, L.S., eds. Human Response to Tall Buildings. Washington, D.C.: American Institute of Architects, 1975. Goldscheider, C. Differential residential mobility of the older population. Journal of Gerontology, 21:103-108, 1966. Greenbaum, M.; Lawton, M.P.; and Singer, M. Ten- ant perceptions of health, health services, and status in two apartment buildings for the elderly. Aging and Human Development, 1:333-334, 1970. Hall, E.T. The Hidden Dimension, New York: Doubleday, 1966. Hamovitch, M.B.; Peterson, J.A.; and Larson, A.E. “Perceptions and Fulfillment of Housing Needs of an Aging Population.” Paper presented at the 8th International Congress of Gerontology, Wash- ington, D.C., August 26, 1969. Harris, C.W., ed. Problems in Measuring Change. Madison: University of Wisconsin Press, 1963. Ittelson, W.H.; Rivlin, L.G.; and Proshansky, H.M. The use of behavioral maps in environmental psy- chology. In: Ittelson, W.H.; Proshansky, H.M.; and Rivlin, L.G., eds. Environmental Psychology. New York: Holt, Rinehart and Winston, 1970. Jackson, J.J. Social impacts of housing relocation on urban, low-income black aged. 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In: Archea, J., and Eastman, C., eds. Environmental Design Research Asso- tion II. Pittsburgh: Carnegie-Mellon University, 19705. Lawton, M.P. The dimensions of morale. In: Kent, D.P.; Kastenbaum, R.; and Sherwood, S., eds. Research Planning and Action for the Elderly. New York: Behavioral Publications, 1972. Lawton, M.P. The Philadelphia Geriatric Center morale scale: A revision. Journal of Gerontology, 30:85-89, 1975a. Lawton, M.P. Planning and Managing Housing for the Elderly. New York: Wiley-Interscience, 1975b. Lawton, M.P. The relative impact of congregate and traditional housing on elderly tenants. Ger- ontologist, 16:237-242, 1976. Lawton, M.P., and Cohen, J. The generality of hous- ing impact on the well-being of older people. Journal of Gerontology, 29:194-204, 1974. Lawton, M.P.; Hoover, S.; and Kostele, J. Com- munity Housing Choices for Older Americans: An Early Summary of Programs and Policy Sug- gestions. Philadelphia: Philadelphia Geriatric Center, 1978. Lawton, M.P.; Kleban, M.; and Carlson, D. The inner-city resident: To move or not to move. Gerontologist, 13:443-448, 1973. Lawton, M.P.; Kleban, M.H.; and Singer, M. The aged Jewish person and the slum environment. Journal of Gerontology, 26:231-239, 1971. Lawton, M.P., and Krassen, E. Federally subsidized housing not for the elderly black. Journal of Social and Behavioral Sciences, 19:65-78, 1973. Lawton, M.P., and Nahemow, L. Ecology and the aging process. In: Eisdorfer, C., and Lawton, M.P., eds. The Psychology of Adult Development and Aging. Washington, D.C.: American Psy- chological Association, 1973. . Lawton, M.P., and Nahemow, L. Cost, Structure and Social Aspects of Housing for the Aged. Final report to the Administration on Aging. Philadel- phia Geriatric Center, 1975. Mimeographed. Lawton, M.P.; Nahemow, L.; and Teaff, J. Housing characteristics and the well-being of elderly ten- ants in federally assisted housing. Journal of Gerontology, 30:601-607, 1975. Lawton, M.P., and Simon, B. The ecology of social relationships in housing for the elderly. Geron- tologist, 8:108-115, 1968. Lipman, A. Public housing and attitudinal adjust- ment in old age. Journal of Geriatric Psychiatry, 2:88-101, 1968, 94 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED Mangum, W. “Adjustment in Special Residential Settings for the Aged: An Inquiry Based on the Kleemeier Conceptualization.” Unpublished doc- toral dissertation, University of Southern Cali- fornia, 1971. Nahemow, L., and Lawton, M.P. Toward an eco- logical theory of adaptation and aging. In: Preiser, W., ed. Environmental Design Research. Vol. 1. Stroudsburg, Pa.: Dowden, Hutchinson & Ross, 1973. Newman, O. Defensible Space. New York: Mac- millan, 1972. Osmond, H.A. Function as the basis of ward design. Mental Hospitals. 8:23-30, 1957. Peterson, J.A.; Hamovitch, M.; and Larson, A.E. Housing Needs and Satisfaction for the Elderly. Los Angeles: University of Southern California, Ethel Percy Andrus Gerontology Center, 1973. Reiss, A.J.; Duncan, O0.D.; Hatt, P.K.; and North, C.C. Occupations and Social Status. New York: Free Press, 1961. Rosow, I. Social Integration of the Aged. New York: Free Press, 1967. Rosow, I., and Breslau, N. A Guttman health scale for the aged. Journal of Gerontology, 21:556-559, 1966. Sherman, S.R. “Housing Environment for the Well- Elderly: Scope and Impact.” Paper presented at the annual meeting of the American Psychological Association, Montreal, 1973. Sherman, S.R.; Mangum, W.P.; Dodds, S.; Walkley, R.; and Wilner, M. Psychological effects of retire- ment housing. Gerontologist, 8:170-175, 1968. Sommer, R. Small group ecology in institutions for the elderly. In: Pastalan, L.A., and Carson, D.H., eds. Spatial Behavior of Older People. Ann Arbor: University of Michigan Institute of Ger- ontology, 1970. Sommer, R., and Ross, H. Social interaction in a geriatrics ward. International Journal of Social Psychiatry, 4:128-133, 1958. Waldman, A., and Fryman, E. Classification of resi- dents. In: Leeds, M., and Shore, H., eds. Geriatric Institutional Management. New York: Putnam, 1964. ‘Appendix Table 1. Factors contributing to the well-being of old people and the items making up those factors Factor 1 Functional Health Factor 2 Social Stimulus Value Factor 3 Middle-Class Leisure Pattern Loading Item Loading Item Loading Item —.620 +4 * Can go to movie —.741 4+ * Receptive/closed —.623 + Number of organizations —.618 +4 * Can walk half mile —.721 4+ * Eager/reluctant particip. —.596 * Number activities bldg. —.617 +4 * Can walk stairs —.720 + * Fluent/minimal speech —.575 Number organizations —.604 Difficult to use transportation —.716 +4 * Eager to see interviewer —.520 Number organized meetings —.602 Difficult to shop —.713 + * Engrossed in relationship 474 * Rent is high —.600 +4 * How often leaves grounds —.655 + * Keen/poor attention .469 Number open doors —.535 + Is your health good —.650 + * Comfortable/distressed 437 Relationships with other —.509 Cleans —.634 + * High/low energy —.429 How often an officer —.504 + * More active than most —.611 4+ * Trustful/suspicious .408 * Where relatives live —.493 + * How often leaves area —.557 + * Keen/no self-perspective —.373 Had help moving in —.484 Difficult to climb stair —.547 4+ * Vigorous/feeble .367 Maintenance is good —.464 + * Rosow limit in work —.522 + * Alert —.351 + Knew anyone moving —.458 Climbs stairs —.521 4 * Pleasant with interviewer 342 + Prefer age segregation —.453 + * Can do heavy work —.520 + * Good memory .338 * Most people different —.446 How often transportation —.478 + * Non-self-engrossment —.310 + Voted last election —.445 + * Any illness bother you —.455 + * Controlled-tang thought alpha= .77 —.441 + * How often shops —.407 Independence —.436 Shops .401 General happiness —.436 How often climbs stairs —.339 * Individuality of room —.384 Health better than most —.334 + How often reads —.331 Difficult to use shower alpha= .90 —.321 Worry about health much —.320 Out after dark with whom —.308 + * Spare time do most alpha= .83 # Item appears on Established-site score representing this factor. + Item appears on Preoccupancy score representing this factor. (Continued next page) XIANHTddV G6 Appendix Table 1. Factors contributing to the well-being of old people and the items making up those factors (continued) ~~ Factor 4 Factor 5 Factor 6 Morale Change for the Better Female Role Loading Item , Loading Item Loading Item —.857 + “Gets mad ‘more often —.547 * Is more active .763 * Cooks hot meal —.761 + Afraid of lot of things —.533 * Health is better .759 Difficult to cook —.745 + Little things bother you —.522 * Is happier .734 * How often cooks _.740 + Life is hard —.481 * Has more energy .691 * Can use transportation —.7338 + Lot to be sad about —.477 * Dresses up more .610 Difficult to clean —.691 + Worries so can’t sleep —.473 + * How happy are you .485 * How does laundry —.678 + Things getting worse —.460 * Gets out more often .484 Who lives with you —.669 + Life not worth living —.453 + Now unhappiest time .480 * Difficult to do laundry —.652 + Feels less useful —.408 + How much feels lonely —.413 Has car —.604 + Do you take things hard —.400 * Eats more alpha= .85 —.601 Do as you please more —.394 + Now happiest time —.596 Enjoy doing nothing —.369 * Sleeps better —.585 + Gets upset easily —.367 * Has more friends —.499 Care less about others —.361 +4 * Likes new bldg. —.382 Friends not as important —.361 Satisfied with life —.380 + Better in old days —.348 + Has as much pep —.338 + Happy as when younger —.336 + Sees enough friends, etc. —.316 * Sees friends more often —.303 * Worries about money less —.300 Rather live in old place alpha= .79 alpha= .83 * [tem appears on Established-site score representing this factor. + Item appears on Preoccupancy score representing this factor. (Continued next page) 2] o 2 > = > Z o = = S a > = wn = = os a 5 wn Z jos o a za Z a = o = - en = > 2 = oO Appendix Table 1. Factors contributing to the well-being of old people and the items making up those factors (continued) Factor 7 Loner Status Factor 8 Orientation to Children Factor 9 Housing Satisfaction Loading Item Loading Item Loading Item —.636 + How many kids living .562 + * Most frequent relative .443 Where like to live —.533 + * Number children named .455 * How often cooked a meal 438 + Has a stove —.474 Who helped in moving —.425 + * Mean contact children 406 + Has a refrigerator A472 Kids not living .380 * Did last Sunday —.397 * Number of problems .384 * Where friends live 357 + Children ask for advice .391 * Worry much about money 378 + Kind of residence mostly .352 +4 * How often church 389 + Likes city lives in —.356 Rent old building .344 + * Contact with children .388 + Likes present apt. —.342 + Finance compared friend .337 * Furthest trip last year .385 + * Likes new neighborhood —.330 + Finance compared relative .335 * Furthest trip last month .385 + Dissatisfaction rating 328 + How often married .334 * Did last Sunday where .349 Stay in present apartment —.318 * More time outside friend alpha= .68 .335 * Has TV —.301 + * Mean freq. all friends —.332 * Would like to work now .282 Female education 325 + People will be different —.280 + Sisters live nearby .315 * Has phone —.270 How many sisters living —.293 + Urban renewal —.262 + Brothers live nearby —.218 + Whose decision to move .230 Number good friends (FU) alpha= .71 alpha= .67 * Item appears on Established-site score representing this factor. + Item appears on Preoccupancy score representing this. factor. (Continued next page) XIANAddV L6 Appendix Table 1. Factors contributing to the well-being of old people and the items making up those factors (continued) Factor 10 Factor 11 Factor 12 Sociability Need for Services External Involvement Loading Item Loading Item Loading Item .660 * Building friends named .557 How often would eat lunch .495 * Follows the news more .650 Number mutual choices .533 Add staff-pers. probs. 439 +4 * How much time outside 537 * Number friends named 528 + Would like meal service 403 + Know many in neighborhood .506 Total choices rec'd. .526 Yes activities worker .398 Now an officer .504 * Number you visited .458 Would use social worker .339 Expects to join activity .501 * Number visited you .394 Would prefer which medic 311 * Feels safer .499 Own floor received .368 Too many activities .293 + * How often watches TV 429 Friends sex 361 + Would like maid service 391 4+ * Many activities 410 Has best friend 301 + Will like new building alpha=.39 .378 Own floor choices made —.290 Near enough to shopping .376 * How often community room .258 + Will be social life .369 * Left neighborhood with alpha= .61 .343 Names leaders .333 Number people talked to .326 * How often joins others .316 Knew tenants before .315 How often see neighbors .244 Social activity alpha= .82 Factor 13 Factor 14 Factor 15 Continued Breadth of Activity Satisfaction with the Status Quo Deprivation Loading Item Loading Item Loading Item .602 4+ * Works now —.462 Better off financially .539 How many days sick bed 425 4 * Furthest trip with whom —.457 + Mind old people in bldg. —.484 Near enough to church 394 + Has record player —.431 How much money left —.416 Near enough to recreation .373 * How often saw doctor —.355 + Has to live for today .331 Children helped finances 291 + Has radio —.293 Gets enough medical care .318 Why not like old apt. .285 How people different —.276 + Things better than thought .302 When retired .282 * Grooming alpha= .31 .289 Like see more of people .280 Know people neighborhood —.277 Apt. compared to relatives’ apt. alpha—= .47 —.275 Children visit you more alpha= .44 “ Item appears on Established-site score representing this factor. -+ Item appears on Preoccupancy score representing this factor. AdDV IHL 40d DNISNOH NI SHDIAYIES TVOIAUN ANV TVIDOS APPENDIX 99 Appendix Table 2. Mean factor scores and characteristics of tenants before and approximately one year after occupancy Factor/Characteristic Mean S.D. N Functional Health Before 3.77 1.68 473 After —.71 5.72 591 Morale Before .01 4.13 591 After —.61 4.09 591 Change for the Better Before .05 1.55 591 After —.43 3.74 591 Loner Status Before 73 1.06 591 After 97 .78 591 Orientation to Children Before .03 1.08 591 After —.54 1.50 591 Housing Satisfaction Before .08 1.30 591 After .23 1.19 591 External Involvement Before —.70 .70 591 After —.58 .89 591 Continued Breadth of Activity Before .07 .97 591 After —.25 1.00 591 Satisfaction with the Status Quo Before .01 .61 591 After .01 .89 591 Age 72.8 6.32 568 Sex (1 = male, 2 = female) 1.75 .43 584 Marital Status (1 = unmarried, 2 = married) 1.29 .45 588 Race (1 = black, 2 = white) 1.70 .46 585 Income $180.10 $130.36 471 Income II (0 = not reported, 1 = reported) 77 42 591 Religion Jewish 184 Catholic 139 Protestant 235 Longstat (1 = rehoused, 2 = community) 1.25 .43 591 Appendix Table 3. Significant effects of rehousing Percent of Effect: Compared with community Criterion variance F residents . . . Functional Health 1.86 10.08** Rehoused were less healthy. Morale .79 4.25% Rehoused had higher morale. Change for the Better 6.88 37.92** Rehoused perceived more change for better. Housing Satisfaction .86 4.33" Rehoused were more satisfied. External Involvement 1.41 7.09" Rehoused were more involved. Satisfaction with the Status Quo 5.34 26.43** Rehoused were more satisfied. *p <.05. **p <.01, 100 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED Appendix Table 4. Percentages of tenants exhibiting well-being as measured by certain indices: comparison of congregate housing with and without special- care area Index of well-being Congre- Congre- gate gate housing housing with without special- special- care area care area (New (Old Gotham) Gotham) Participation in three or more activities during past year * High social activity " Good relationships with tenants ® “I have a lot to be sad about” * © “Things keep getting worse as | get older” “© One or more good friends * Unhappy ® Relatively independent” No general deterioration during past year" Good or excellent behavioral adjustment ® 34 31 17 16 54 48 42 50 67 65 58 60 41 47 57 70 46 51 71 79 u Self-reported by tenant. b Administrator rating. ¢ Tenant agreement with statement. 4 Physician rating; Gotham not included. tenants of special-care floor of New Appendix Table 5. Indices of competence of applicants to sites with and without services Chi Index square df Difference Age 16.4 3" Applicants to sites with services were older. Functional health rating 45.1 3** Applicants to sites with services were less healthy. Number of organizational memberships 37.8 2** Applicants to sites with services belonged to fewer. Organizational meetings attended 27.0 1** Applicants to sites with services attended fewer. Self-rated happiness 16.3 2** Applicants to sites with services were less happy. Frequency of leaving building 10.4 1 Applicants to sites with services left less frequently. Voted in 1964 2.9 1* Frequency of leaving neighborhood 2.7 2* Complexity of most frequent leisure activity 4.7 2" Number of friends 1.8 2* * p>.05. ** p <.001. APPENDIX 101 Appendix Table 6. Significant effects of housing with services Percent of Criterion variance F Effect Middle-Class Leisure Pattern 4.80 10.72** Increase in activity at nonservice site Morale 1.63 3.97* Increase at service site Loner Status 2.08 4.22% Decrease at service site Housing Satisfaction 2.10 4.52* Increase at service site External Involvement 5.47 11.09** Increase at activity in nonservice site *p <.05. “* p <.01. Appendix Table 7. Distribution of tenants among building common spaces Percentage of tenants observed in * Percentage of common space occupants in" No. of % of com- Func- Out- Social Social Func- Out- room mon All Activity tional door inter- inter- Activity tional door doors Site spaces spaces Halls Lobby spaces spaces spaces action action Halls Lobby spaces spaces spaces open Blueberry Acres 2 9.6 1.9 0.5 0.6 1.3 5.2 6.0 64 20 6 6 13 55 7.9 Ebenezer Towers 3 6.7 1.8 2.9 0.4 1.6 0.0 3.3 48 27 43 6 24 0 1.4 Flower Tower 4 71 1.1 0.5 1.6 0.5 3.4 4.9 69 15 7 22 7 48 0.1 Golden Years 4 5.1 2.2 0.5 0.1 0.7 1.7 2.9 57 41 10 2 14 34 1.1 Luther Lodge 8 10.9 4.2 2.6 0.8 1.8 1.5 5.7 52 38 24 8 17 14 7.1 New Gotham House 8 15.2 3.9 3.8 2.1 1.6 3.8 8.2 54 25 25 14 11 25 5.8 Old Gotham House 8 14.4 2.5 3.1 0.9 1.7 6.3 7.2 52 17 21 6 12 43 2.6 President House 2 13.2 3.6 0.3 7.3 1.3 0.8 8.9 66 27 2 55 10 6 21.0 Riverlake 7 15.1 5.7 1.1 4.1 1.1 3.1 9.1 60 38 7 27 7 21 17.5 Samuel Gompers Gardens 6 6.9 2.3 1.4 0.8 1.6 0.4 3.7 55 34 22 12 25 8 1.3 Sholom Aleichem House 10 10.5 2.3 3.0 1.4 2.2 1.6 5.6 54 22 28 13 21 16 2.5 Van Winkle Houses 4 17.7 1.5 0.4 6.5 1.1 8.2 12.9 71 8 3 37 6 46 0.9 + Occupancy percentages obtained by dividing mean number of people observed in each location or in social interaction by the total number of tenants of tae building. ! D’stribution percentages obtained by dividing the mean number of people observed in each location or in cocial interaction by the mean number observed in all common spaces. 01 dHEDV HHL 40d DNISNOH NI SHDIAYIES TVOIAHAW ANV TVIODOS Appendix Table 8. Housing impact at five different sites Site Golden President Blueberry Ebenezer Sholom Years House Acres Towers Aleichem Factor r F* r, F r, F In F I F Functional Health ® rs —— — _— —.11 — — en .16 10.7** Social Stimulus Value" 19 15.7** —.28 37.2** .30 41.3" ns ns —.11 5.3% Middle-Class Leisure Pattern" —.35 57.1** .27 31.3" .24 25.6" —.12 6.2% —— ——— Morale ® 13 71%" RA Nl nn en —.13 71 ns —— Change for the Better —_— en mn mn re en sen mn a — Loner Status ® — — —— — — — 15 9.0** —.19 15.4** Orientation to Children © —.11 5.0% re , 13 7.4%" ns is en Housing Satisfaction ee eee ee —— ee ee en Need for Services me en en ee —.15 9.3" ——— ee — — External Involvement © 11 5.4% — ns —.1 4.8" —.12 6.8%" Continued Breadth of Activity © —.19 15.0** 11 5.5" sm —_ 14 8.0"* ee en Satisfaction with the Status a Quo" a7 11.8** —.17 12.2** — rn re en — ee | J « For all factors, df =1,410, except for Functional Health, where df =1,312. = Y A positive r, means site membership is associated with unfavorable change in this factor. oS © A positive ry, means site membership is associated with favorable change in this factor. — “p <.05. > #¢p <.01. Appendix Table 9. Significant correlations between suprapersonal site characteristics and four ultimate criteria Sex Race % % % Mean 1=M 1=black Marital Educa- In- Occ. Ultimate criterion Jewish Cath. Prot. age 2=F 2=white status tion come level Health (low=good) Happy (low=happy) —57 80 60 Housing satisfaction 72 —70 83 50 (high=satisfied) Morale (low=high 49 morale) p <.05. Appendix Table 10. Correlations between behavior process variables and four ultimate criteria % of those in common spaces engaged Percentage of population in in % of Total Number of Func- social room popu- common Common Activity tional Outdoor Social inter- doors Ultimate criterion lation spaces spaces Halls Lobby spaces spaces spaces spaces action open Health (low=good) 60 58 58 Happy (low=happy) 75 53 Housing satisfaction (high=satisfied) 49 Morale (low=high morale) Appendix Table 11. Correlations between site quality process variables* and four ultimate criteria Safety Overall Amount of Archi- Life-sus- Neigh- of Amount Quality quality common tectural Activity taining borhood neighbor- of manag- of manag- of man- Ultimate criterion space quality program quality resources hood ing ing agement Health (low=good) 64 66 Happy (low=happy) —69 —54 —66 —66 —54 Housing satisfaction —61 —71 —83 —51 (high=satisfied) Morale (low=high morale) * A low process score indicates good quality. 01 ADV HHL 404 DNISNOH NI SHEDIAYUS TVDIAANW ANV TVIDOS Appendix Table 12. Correlations between suprapersonal site (input) characteristics and behavior process variables % of those in common spaces Number . ) engaged % of Suprapersonal Total of Percentage of population observed in in social room site popula- common All common Activity Functional Outdoor Social inter- doors characteristic tion spaces spaces Halls Lobby areas spaces spaces spaces action open % Jewish 65 66 9% Catholic —61 % Protestant —62 Age 53 57 Sex —52 —60 Race 53 Marital status 50 Education —67 —60 Income 62 59 —60 Occ. level 53 Appendix Table 13. Correlations between behavior process variables and site quality process variables Amount of Archi- Extent of Life-sus- Neigh- Safety Overall Site quality process common tectural activity taining borhood of neigh- Amount quality of Total variable space quality program quality resources borhood of managing management quality Tenant population —85 —55 —69 —65 —57 —77 Number of common —94 —70 —92 —91 —84 spaces % of population in all common spaces % in halls % in lobby _54 % in activity areas % in functional spaces —53 % in outdoor spaces % in social spaces % of those in common 49 64 spaces engaged in social interaction % of room doors open XIANIddV 106 SOCIAL AND MEDICAL SERVICES IN HOUSING FOR THE AGED Appendix Table 14. Mean scores of administrators on administrative attitude factors Paternalism/ Dependence/ Location of Rigidity / Non- Business / Integration/ Self- administrators Flexibility * paternalism Social* Segregation reliance Public housing 5.5 3.0 2.6 2.4 3.3 202 housing 4.7 3.5 3.0 2.5 3.1 Range 0-9 0-9 0-7 0-5 0-7 * Difference between mean scores of public Appendix Table 15. Mean scores of administrators on managerial style indices housing and 202 administrators significant at the .01 level. Social-personal style Administrator (vs. impersonal Cosmopolitanism group style) (vs. localism) Public housing 0.442 0.200 202 0.485 0.264 Note: Differences between mean scores of public housing administrators on both indices were significant at the .01 level. The higher the score, the more the group reported and 202 attitudes consistent with the stated style. Appendix Table 16. Percentages of administrators suggesting various changes at their sites, by number of changes suggested Area of change Number of Policy Building Grounds Relocation Any change suggestions PH 202 PH 202 PH 202 PH 202 PH 202 0 66 73 31 15 59 50 78 79 19 9 1-2 : 30 22 51 45 37 45 19 19 35 27 3 or more 4 5 18 40 4 5 3 2 46 64 1.4 2.2 .6 7 3 3 3.4 3.9 Mean 5 4 Index Activity programs, 19 desire for, 22 Golden Age Clubs, 19, 50 proximity to outside resources and, 46 rooms for, 42 Activity room use, 42, 66 Administrators, 82-83. See also Public housing administrators; Section 202 housing administrators attitudes of, 67, 73, 74 backgrounds of, 68-69, 76-77 income, 69-70, 77 job satisfaction, 72-73, 77-78 managerial styles, 73, 75-76, 78 professional characteristics, 69-70, 76-77, 78 ratings of tenants, 8, 36-37 role conceptions, 70-71, 72 task performance, 71-72, 77 training of, 91 women, 70, 77 Age, prediction of tenants’ well-being from, 36, 38 Age integration, 58. See also Age segregation community residents’ preference for, 59 environmental facilitation for, 88 Age-segregated living preferences, 58-59, 82 Age segregation, 87-88 Applicants’ characteristics, 30-34, 80-81. See also Tenants’ characteristics activity participation, 34 compared to nonapplicants, 31-32, 33-34 decision to change residence, 57-58 homeownership, 32, 57 religion, 32 residential history, 57 services offered and, 28 Architecture, 46. See also Environment, physical; Housing environment; Space utilization activity rooms, 42 apartment shape, 64, 65 building type preferences, 61-62, 64, 82 common spaces, defined, 39-40 common spaces and social interaction, 44, 46 community residents’ satisfaction with, 63 functional space, 42, 54 halls, 40-41, 45, 46 high-rise vs. low-rise buildings, 61-62, 82 kitchens, 82 outdoor space, 42-43, 46 space variety in section 202 housing, 52 television reception, 62, 82 tenants’ problems with, 62-64, 82 ventilation, 62-63, 82 windows, 62, 82 Behavior microsocial behavior, 45 physical environment and, 2, 39 sitting-and-watching syndrome, 45, 53 Black aged, 5 in public housing, 52 in section 202 housing, 52 Blueberry Acres, 48, 57, 103 applicants’ characteristics, 5, 33 changes in tenants’ well-being, 50 described, 3, 6 impact study sample size, 11 outdoor space, 43 religion, 36 services offered, 17 Brooke amendment, 85 Carp, F.M,, 1, 11, 31, 35, 36. See also Victoria Plaza Catholic tenants characteristics, 36, 105 Happiness, 53, 105 Change for the Better, 13, 15 applicants and nonapplicants, 33 of Catholic tenants, 36 defined, 9 of Jewish tenants, 36 Orientation to Children and, 36 Common space defined, 39-40 functional space and, 42 in public housing, 44 safety from outside intruders, 41, 46 social interaction and, 43-44, 46, 54 usage increase with poor health, 46 Community residents. See also Comparison groups age-integrated housing preference, 59 attitudes toward changing residence, 56-57 building type preferences, 61 characteristics compared to applicants, 32-34, 80-81 characteristics compared to tenants, 80 demographic characteristics, 5 homeownership, 57 locational criteria for housing environment, 55-56 mobility, 65 perceived need for services, 34 satifaction with architectural features, 63 Community rooms. See Activity room use Comparison groups, 4. See also Community residents Jersey City residents, 5, 12 Philadelphia residents A, 5, 12 Philadelphia residents B, 4, 5, 32 Philadelphia residents C, 4, 5 Congregate housing, 17, 18, 85, 90 107 108 INDEX Continued Breadth of Activity, 14, 15 applicants compared to nonapplicants, 33 before and after rehousing, 36 defined, 10 External Involvement and, 36 income and, 36 independence and, 36 Loner Status and, 36 tenants compared to community residents, 12 Control group subjects. See Comparison groups; Community residents Crime, 25, 87 safety from outside intruders, 41, 46 Data analysis cross-sectional analysis of tenants’ well-being, 51 data reduction, 9 factor analysis, 9-10 prediction of favorable housing impacts, 80 variables studied, 8 Data gathering, 4-5. See also Psychometric scales administrators’ ratings of tenants, 8, 36-37 behavior mapping, 7, 39, 46 interviewing, 5, 7 managerial style indices, 73, 75 medical examinations, 7-8 physical environment evaluations, 60-61 qualitative observations, 8 questionnaires for administrators, 67-68 ranking of housing sites, criteria for, 8 sample selection of administrators, 67 sociometric surveys, 7 stream of behavior, 46 subject selection procedures, 5-7, 11 Demographic data as controlled variables, 13 Deprivation, 10 Deterioration, 8, 36, 37 Dimensions of tenants’ well-being, 9-10. See also Well-being of tenants; and entries for specific factors compared to community residents, 12 impact of rehousing on, 12-15, 80 Ebenezer Towers, 32, 36, 48, 57, 103 applicants’ characteristics, 5, 33-34 changes in tenants’ well-being, 50 comparison group subjects, 12 described, 4, 6 impact study sample size, 11 medical examination of applicants, 7-8 medical services, 18 religion of tenants, 36 services offered, 17 social interaction of tenants, 44 Environment, physical. See also Architecture; Housing environment as behavior determinant, 2, 39, 45, 46 microsocial behavior and, 45 Environmental influences, vulnerability to, 13 Ethnic groups, 32 External Involvement, 13-14, 15 continued breadth of activity and, 36 defined, 10 impact of services on, 27, 80 passive behaviors in, 36 Female Role, 9-10 Flower Tower, 103 applicants characteristics, 5 described, 3-4, 6 medical services, 17, 23 open doors at, 44 services offered, 17 Food services. See Meal services Functional Health, 14 age and, 36 applicants compared to community residents, 34 as basis for selecting tenants, 38 b:fore and after rehousing, 36, 38 decline in, 14, 15 defined, 9 impact of services on, 27 of Jewish tenants, 36 tenants compared to community residents, 12 Functional space, 42, 54 preservation of competence and, 46 General Deterioration, 8, 36, 37 General Happiness, 8, 36, 37 Golden Age Clubs, 19, 50 Golden Years, 8, 48, 57, 103 activity programs, 19 applicants’ characteristics, 5, 26, 33-34 common space occupancy, 40 described, 3, 6 effects on tenants’ well-being, 49-50 medical examination of applicants, 7-8 open doors at, 44 outdoor space, 43 services’ impact on tenants, 27-28 subject group size, 11 tenants’ background characteristics, 27 Gompers Gardens. See Samuel Gompers Gardens Gotham Houses. See also New Gotham House; Old Gotham House activity room use, 42 common space occupancy, 40 health differences in tenants, 21 housekeeping services, 19 outdoor space, 43 Halls, 45, 46 safety from outside intruders, 41, 46 as social centers, 41, 42 tenants’ occupancy of, 41, 42, 44, 46 Hamovitch, M.B., 48 Hapniness, 53. See also General Happiness Health. See also Functional Health; Medical services managerial practices and, 53, 54 neighborhood security and, 53, 54 preoccupancy, 13 Homemaker service, 19 Homeownership of applicants, 32 INDEX 109 Housekeeping services, 19, 22 Housing, nonprogrammatic, 91-92 Housing Act of 1937, 84, 85 Housing Act of 1956, 84 Housing Act of 1959, 84 Housing Act of 1968, 84, 85 Housing Act of 1969, 85 Housing Act of 1970, 18, 85 Housing Act of 1974, 84, 85 Housing Act of 1978, 85, 86 Housing administrators. See Administrators Housing and Community Development Act of 1970, 2 Housing environment. See also Architecture; Space utilization appeals to different social groups, 45-46 as behavior determinant, 2 changes in tenants’ well-being and, 49 defined, 2 locational criteria for applicants’ choosing, 55-56, 82 site selection, 88-89 Housing Satisfaction, 13, 15 age and, 36 before and after rehousing, 36 defined, 10 happiness and, 53 impact of services on, 27, 28, 80 of Jews, 53 Orientation to Children and, 36 of Protestants, 53 public housing tenants and section 202 housing tenants, 52 religious background and, 53 section 202 housing and, 53 Housing site selection, 88-89 Housing sites studied, 2-4. See also names of particular sites; Public housing; Section 202 housing; Section 231 housing characteristics, 6 differences in impact on tenants, 81-82 Impact of planned housing on lifestyle, 1 Income, as predictor of tenants’ well-being, 36, 38 Independence, 8, 36 Continued Breadth of Activity and, 36 functional space and, 46 managers’ rating scale for, 37 Institution, defined, 2 Interviews procedures, 5, 6 subject areas covered, 7 subject groups for followup interviews, 11-12 training for, 5 Italians in public housing, 32. See also Catholic tenants Jackson, J.J., 31 Jersey City residents comparison group, 4, 5, 12, 55 Jewish aged, characteristics, 32 Jewish tenants characteristics, 36, 54, 104 Housing Satisfaction, 53, 104 in public housing, 52 in section 202 housing, 32 Morale, 53, 104 Lifestyle, impact of planned housing on, 1 Lobbies, 46 activity room use and, 42 seating in, 40-41 Loner Status, 14, 15 applicants compared to nonapplicants, 12 Continued Breadth of Activity and, 36 defined, 10 impact of services on, 27, 80 Orientation to Children and, 36 tenants compared to community residents, 12 Luther Lodge, 103 activity programs, 19 applicants’ characteristics, 5 behavior mapping at, 40 described, 4, 6 hallway occupancy, 41 outdoor space, 43 services offered, 17 Man-environment psychological relationships, 2 Managers. See Administrators Managers’ rating scales of tenants, 37 Marina Tower, 64 Meal services, 18-19 dependency and, 22, 28-29 frequency of use, 23-24 perceived need for, 21-22, 80 Title VII nutrition programs, 18, 24, 86 Medical services, 78. See also Functional Health actual use of, 23, 80 perceived need for, 20, 34, 80 presence of the disabled, 21 Metropole Center, 8, 40. See also Public housing activity programs, 19 apartment shape preferences of tenants, 64 applicants’ characteristics, 5 architectural features, 64-65 building type preferences of tenants, 64 described, 3, 6 homemaker service, 19 meal services, 18, 24 services offered, 17, 19 transportation service, 19 Microsocial behavior, environment and, 45 Middle-Class Leisure Pattern applicants compared to nonapplicants, 33 of Catholic tenants, 36 defined, 9 housing site differences on changes in, 49 impact of services on, 27, 80 income and, 36 110 INDEX Morale, 13, 15 applicants compared to nonapplicants, 34 before and after rehousing, 36 Catholic tenants’ decline in, 36 defined, 9 impact of services on, 27, 80 tenants compared to community residents, 12 National Center for Housing Management (NCHM), 91 Need for Services, 25 applicants compared to nonapplicants, 33 of Catholic tenants, 36 defined, 10 Neighborhood security, 41, 46, 53. See also Crime desire for a nice neighborhood, 56 New Gotham House, 8, 103. See also Gotham Houses; Old Gotham House applicants’ characteristics, 26 attitudes toward disabled tenants, 21 behavior mapping at, 40 described, 4, 6 housekeeping services, 19 independence of tenants, 22 meal services, 18 medical services, 17, 20 monthly cost, 17 as pilot study site, 4 services offered, 16, 17 Newman, Oscar, 87 Normandie Hotel, 5 Northbridge described, 4 services offered, 17 Nutrition programs, Title VII, 18, 24, 86. See also Meal services Old Gotham House, 103. See also Gotham Houses; New Gotham House activity programs, 19 applicants’ characteristics, 5 described, 4, 6 meal services, 18, 22, 24 medical services, 17, 23 services offered, 17 Older Americans Act, 18 Orientation to children, 14, 15 applicants compared to nonapplicants, 34 change for the better and, 36 defined, 10 Housing Satisfaction and, 36 impact of services and, 27 income and, 36 loner status and, 36 tenants compared to community residents, 12 Outdoor space, 42-43, 46 use by tenants, 43 Passive activities Catholic tenants’ increase in, 36 external involvement and, 36 visual scanning, 45 President House, 48, 57, 103 activity room occupancy, 42 applicants’ characteristics, 5, 33 changes in tenants’ well-being, 50 described, 3, 6 impact study sample size, 11 open doors at, 44 religion, 36 services offered, 17 social interaction of tenants, 45 Protestants housing satisfaction, 53, 104 in public housing, 52 Psychometric scales Cumming and Henry Morale Scale, 10 managers’ rating scales of tenants, 37 Philadelphia Geriatric Center Physical Classification Scale, 8 Philadelphia Geriatic Center Morale Scale, 7, 9 Pre-Long Functional Health Index, 13, 14 Rosow Health Scale, 7, 9 VIRO Scale, 7, 9 Public housing, 86. See also Metropole Center; Riverlake; Van Winkle Houses activity rooms’ use, 42, 52, 66 common space in, 44 hallways as social centers, 41 independence of tenants, 22 lobbies, 42, 52 meal services, 18, 22 section 202 housing compared, 52 Public housing administrators, 67, 68, 73 professional backgrounds, 69 section 202 housing administrators compared, €8-72, 73 use of time, 71 Recruitment of tenants, 25-27, 80-81 Rehousing, impact of, 12-15, 60 Relationships with Other Tenants, 8, 36 managers’ rating scale for, 37 Religion. See also Catholic tenants; Jewish aged; Jewish tenants; Protestants at housing sites studied, 36 Housing Satisfaction and, 53 as predictor of tenants’ well-being, 36, 38 tenants compared to community residents, 32 Research methodology. See also Psychometric scales comparison groups, 4 data analysis, 8-10 data gathering, 4-5 site selection, 2-3, 5 Retirement communities, 86-87 Riverlake, 103. See also Public housing activity programs, 19 activity room use, 42 applicants’ characteristics, 5 common space occupancy, 40, 41 described, 4, 6 meal services, 18, 24, 25 medical services, 17, 23 open doors at, 44 INDEX ) 111 outdoor space, 43 services offered, 17, 19 social interaction of tenants, 44-45 transportation service, 19 Samuel Gompers Gardens, 32, 103 activity programs, 19 applicants’ characteristics, 5 common space occupancy, 40 described, 3, 6 medical services, 18, 23 open doors at, 44 services offered, 17 tenants’ backgrounds, 32, 33 tenants’ characteristics compared to community residents, 32 Satisfaction with Status Quo, 13, 15 Change for the Better and, 36 defined, 10 of Jewish tenants, 36 Section 8 housing, 85-86 Section 202 housing, 3, 52, 86 activity room use, 66 architecture, 52 behavioral changes of tenants, 60 common space in, 44 ethnicity, 32 meal services, 18 public housing compared, 52 social interaction in, 44, 52 Section 202 housing administrators, 67, 68 professional backgrounds, 69 public housing administrators compared, 68-72, 73 security responsibilities, 72 suggestions for changes, 73 use of time, 71 Section 231 housing, 3 meal services, 18 services offered, 16 Section 236 housing, 85 Services offered by housing sites, 16-17, 19, 89-90 applicants’ characteristics and, 28 activity level and, 28 contentment and, 28 impact on tenants, 27-28, 80 perceived need for, 20-22 use of, 23-25 Sex, as predictor of tenants’ well-being, 38 Sherman, S. R., 48 Sholom Aleichem House, 32, 48, 57, 103 activity programs, 19 activity room use, 42 applicants’ characteristics, 5, 26, 33-34 changes in tenants’ well-being, 50 described, 3, 6 independence of tenants, 22 meal services, 18, 22, 24 medical services, 18, 23 religion, 36 services’ impact on tenants, 27-28, 50 services offered, 16, 17 subject group size, 11 tenants’ background characteristics, 27 Sitting-and-watching syndrome, 45, 53 Sociability defined, 10 impact of services on, 27 of Jewish tenants, 36 Social Activity Participation onsite, 8, 36 managers’ rating scale for, 37 Social interaction of tenants common space and, 43-44, 46-47, 54 open doors and, 44-45, 47 socioeconomic level and, 44, 47 Social networks, 36 Social services, 19 perceived need for, 22 Social stimulus value, 9 housing site differences on changes in, 49 Space utilization, 65-66, 81. See also Architecture activity rooms, 42 ’ common spaces, 40, 43-44 functional space, 42 halls, 40-41, 42 health and, 53 lobbies, 41-42 outdoor space, 42-43 social interaction and, 65-66 ’ " State housing programs, 86 Television reception, 62, 82 Tenant selection administrative selectivity in, 31 applicants’ characteristics and, 38 self-selectivity in, 31 Tenants. See also Well-being of tenants community residents compared, 12-15 ethnic population, 32 impact of services on, 27-28 social interaction, 43-44 visibility in common spaces, 40-43 Tenants’ characteristics, 2, 5, 25-27, 53, 104. See also Applicants’ characteristics activity level decrease, 28 attitudes toward presence of disabled tenants, 20-21 compared to community residents, 1, 80 independence, 22 mobility, 65 passive contentment, 28 preoccupancy characteristics, 1 religion, 32, 36 services’ impacts on, 27-28, 80 services offered and, 25-27 social and ethnic backgrounds, 27 social network, age and, 36 space utilization and, 53, 54 use of services and, 1 Title VII nutrition programs, 18, 24, 86 112 INDEX Van Winkle Houses, 8, 103. See also Public housing activity room use, 42 applicants’ characteristics, 5 common space occupancy, 40, 44 described, 4, 6 ’ meal services, 18, 24 open doors at, 44 outdoor space, 43 social interaction of tenants, 44 Victoria Plaza, 11, 84 applicants, 31 tenants’ adjustment, 35 Well-being of tenants. See also Dimension of tenants’ well-being changes after one year in planned housing, 49-50, 80 cross-sectional analysis, 51 } prediction from demographic characteristics, 35, 49 prediction from well-being at time of application, 35, 37-38 tenants’ self-perceived changes in, 60 Yishay Apartments, 40 activity programs, 19 applicants’ characteristics, 5 described, 3, 6 independence of tenants, 22 meal services, 18, 22, 24 services offered, 17 vr U.S. Government Printing Office; 1980—322-821 DEPARTMENT OF HEALTH AND HUMAN SERVICES i POSTAGE AND FEES PAID IRSA ER el EE 0 ALCOHOL, DRUG ABUSE, AND THIRD CLASS MENTAL HEALTH ADMINISTRATION EELS 5600 FISHERS LANE ROCKVILLE, MARYLAND 20857 OFFICIAL BUSINESS Penalty for private use, $300 NOTICE OF MAILING CHANGE [] Check here if you wish to discontinue receiving this type of publication. [J] Check here if your address has changed and you wish to continue receiving this type of publication. (Be sure to furnish your complete address including zip code.) Tear off cover with address label still affixed and send to: Alcohol, Drug Abuse, and Mental Health Administration Printing and Publications Managements Branch 5600 Fishers Lane Rm. (6C02) Rockville, Maryland 20857 DHHS Putlication No. (ADM) 80-861 Printed 1980 EL SR i ming iii a ——