HOUSING: ALTERNATIVE OPTIONS

A long time ago a wise woman said, "Everybody needs a place to stay." That includes the elderly members of society. Housing for older people is often ill defined and poorly understood; most people think of high-rise buildings or subsidized projects that older people move into when their neighborhoods are lost to urban development. In reality, there exists great diversity among senior housing arrangements, extending from privately owned dwellings and age-segregated housing to mobile home parks, retirement villages, congregate housing retirement hotels, granny flats, single room occupancies (SROs) and homelessness by choice or necessity. These alternatives are grouped into three main categories: (1) nonplanned or ordinary housing owned or rented by older people, accommodating 90 percent of the elder population; (2) specialized housing, accommodating 4 percent; and (3) nursing homes, accommodating 5 percent of the frail elderly.

Aging in one's own home

In 1994 there were 20.8 million U.S. households headed by older persons; 78 percent were homeowners and 22 percent were renters. Older males and married couples were more likely to be owners (86 percent) than were older females (67 percent). Home owners without mortgage payments spent 16 percent of their monthly incomes on housing in 1993, compared with 29 percent for those with mortgage payments. Owning a home provides by far the least expensive housing for most elderly, particularly for those whose homes are mortgage-free or close to being paid for. Staying in one's own home is the preferred alternative for the majority of older adults, provided that the neighborhood remains free of social and environmental deterioration.

Most of the recent literature referring to older community residents aging in place concentrates on the poor elderly who are low-income home owners, or renters, or who live in publicly subsidized housing. The greater number of older people who are aging in place do not fall into these categories, but live in diverse types of structures in varied physical settings. An emerging social policy aimed at helping older persons remain in their current housing as long as possible is a further component of the choice to age in place.

In order to meet the ever increasing needs of older persons who are aging in place, an array of community services developed during the 1980s and 1990s. The public sector invested huge amounts of funds to deliver health and social services to eligible community residents, and private, fee-for-service enterprises cater to those who can afford to pay.

Renting

In 1995 the Public Policy Institute reported that only 1.9 million vacant rental units had rent low enough to be affordable for the 5.1 million poor renters. The federal government defines expenditures for housing that exceed 30 percent of income as excessive; 71 percent of poor households experience excessive housing cost burdens. (Poor households includes owners and renters.) About 40 percent of the older poor households spend half or more of their income on housing. The incidence of excessive housing cost is particularly high among those age seventy-five and above and among older women living alone. Renters are particularly affected by excessive housing costs: 77 percent of older renters spend more than 30 percent of their income on housing.

Because older renters have few opportunities to raise their incomes through employment and because poverty in old age is more likely to be permanent, it appears that there will be a continued need for housing assistance. In 1999 almost one million older renters with worst-case needs did not receive any housing assistance. Worst-case households are those whose incomes are below 50 percent of the area median and who pay more than 50 percent of their income for rent, or who occupy substandard housing, or are displaced involuntarily. The incidence of worst case housing is highest among the oldest and youngest renter households, and they must wait for several years for housing assistance.

Shared housing

Shared housing can be best defined as facilities accommodating at least two unrelated individuals, at least one of whom is over sixty years of age, and in which common living spaces are shared. It is a program that targets single- and multifamily homes and adapts them for elderly residents. The typical number of elderly is three or four. The most easily recognized benefit of shared housing is that of companionship. It is also a means of keeping the elderly in their own homes while helping to provide them with the economic means to maintain there.

Shared housing may be forbidden by zoning laws in some suburban communities, especially wealthy ones. Often, however, local housing authorities promote shared housing by matching applicants.

Benefits include decreasing loneliness, maintaining the helping role, saving money through shared costs, having a greater sense of security, avoiding institutionalization, providing an alternative to living with children, and maintaining normal neighborhood living and freedom of activities.

Mobile homes

According to the U.S. Census, over two million persons age sixty-five and older lived in manufactured housing. This housing alternative is an important source of affordable housing for older Americans. On the average, mobile homes cost less than $35,000; more than half of them are bought by middle-aged and younger persons who grow older in these homes.

According to the 1999 AARP survey of mobile homes, there are critical deficiencies in the construction of manufactured housing. Strict housing and safety standards have existed since 1974 but have not been enforced by HUD. The AARP survey found that 77 percent of homeowners reported problems with the construction or installation of their homes, and 57 percent reported more than one problem. Even though 95 percent of the homes were covered under warranty, only 35 percent of the deficiencies were repaired.

In spite of the ongoing problems mobile home owners encounter with maintaining their homes, 80 percent expressed high levels of satisfaction with their living arrangements, and they planned to age in place.

Elder cottage housing opportunities

Elder cottage housing opportunities, or ECHO (also called granny flats and modular housing) are movable trailer houses that can be attached to existing homes and removed when no longer needed. The Administration on Aging renamed these accessory units in 1998. The concept originated in the state of Victoria, Australia, in 1972, traveled to the Scandinavian countries, and then to Canada (in the 1980s) and the United States (by the 1990s).

These units are designed to meet the physical needs of the elderly and provide the opportunity for them to live independently or semi-independently, but still be near family or friends. Although usually installed on the property of adult children, ECHO units can also be used to form housing clusters for the elderly on small tracts of land that are leased by nonprofit corporations or local housing authorities.

The major barriers to the development of this form of housing are rigid zoning laws, lack of public information, and concern about decreases in neighborhood property values.

Despite attention from the media and from housing professionals, granny flats have been successful only in part. Use and acceptance have been greater in other countries than in the United States. It is possible that the concept will become more agreeable to Americans as the proportion of elderly persons increases to an expected 20 percent of the population by 2030.

Single-room occupancies

A type of housing that has long been an important source of affordable housing is the single-room occupancy (SRO). The term single room occupancy describes not only the structure but also the common lifestyle characteristics of the residents. SRO units differ depending on the structures where the rooms are located: they may be rented in a rooming house or an old hotel, with or without shared kitchen and bath facilities, or they may be rented in a single-family structure.

By a 1987 estimate, four hundred thousand elderly individuals lived in SROs nationwide. Single elderly often face housing problems more difficult than those faced by the elderly in families; they are likely to live in rental housing, and a disproportionate number are poor. They face a risk of social isolation after the roles and responsibilities of the workplace are no longer part of their lives. Their lower incomes are more often compounded by lack of an assets cushion in the form of home equity, and they have no spouse helper available if they become impaired.

The SRO is an acceptable part of the housing stock. Generally inexpensive, it is one option for the community's very poor, unattached citizens, who include a disproportionate number of the elderly. SRO does not constitute planned housing for the elderly in the same sense that continuing care retirement centers serving the more affluent do.

A related option for those with more income is the retirement hotel, which can be inexpensive, expensive, or in between. Some older hotels in central cities specialize as senior citizens' hotels in order to maintain reasonable occupancy. In some cases, meals and a few organized activities (e.g., bingo and cards) are provided. The hotels are particularly appropriate for self-reliant elderly who wish to continue an independent lifestyle with the amenities of a city—including public transportation—but without the responsibilities of housekeeping.

Continuing care retirement communities

Continuing care retirement communities (CCRC), also referred to as life-care communities, are planned communities that combine housing and a range of services (including independent living, assisted living, and nursing home care), and serve primarily the middle- and upper-middle-class elderly. There were close to 2,000 CCRCs, housing some four hundred thousand to five hundred thousand residents, operating in the United States at the end of the 1990s.

Nearly all CCRCs charge an entry fee plus a monthly fee, a structure which appeals to facility operators because it links revenue to the resident's longevity as well as to the rate of inflation. There are two basic types of contracts. An all-inclusive plan provides an independent living unit, residential services, amenities, health-related services, and long-term nursing care in return for a specific price (paid as entry fee plus monthly payments). A fee-for-service plan provides an independent living unit, residential services, and amenities. It guarantees access to nursing care—for which residents pay a per diem rate, except for minimal services such as twenty-four-hour emergency care. Between these two plans are various other arrangements known as modified plans.

Besides possessing educational and economic advantages, CCRC residents represent a relatively healthy segment of the older age group. This is not surprising, because CCRCs have health status entrance requirements for persons applying for independent living units.

Homelessness

The homeless are defined as persons lacking a permanent residence. Their accommodations at night may be a public or private shelter or a place not intended to be a shelter, such as a train station. Nationwide, 6 percent of homeless people are between fifty-five and sixty-four years of age, and 2 percent are sixty-five or older.

Most homeless elderly have an unstable residential history over a period of years. The majority of homeless elderly are males who have experienced lifetime alcohol abuse, lived alone, had cognitive problems, moved from shelter to shelter, and refused to seek institutionalization. Even if placement in a nursing home would improve their lives, they are unwilling to seek help from traditional health and social service agencies. Homeless older people are likely to remain on the streets and continue their lifestyle. Whether by choice or by necessity, homelessness for these elderly persons is a fact of life, and so far society has not found another housing alternative for them.

Although the housing alternatives described above are available to older people and persons with disabilities, the choice of any one of them depends largely on affordability, willingness to relocate, physical and mental functioning, socio-economic status, race, and gender. If the present trend continues, even more diverse alternatives will have to be developed to accommodate individual income levels and lifestyle choices of the future aging population. The new demographics will likely force the public and private sectors to cooperate and develop housing alternatives until the ultimate goal of community living is achieved and institutions become the last alternative living arrangement for older Americans.

BÉla John BognÁr

See also Continuing Care Retirement Communities; Homelessness; Housing; Long-Term Care.

BIBLIOGRAPHY

American Association of Retired Persons (AARP). National Survey of Mobile Home Owners— Executive Summary. Washington, D.C.: AARP, 1999.

Golant, S. Housing America's Elderly. Newbury Park, Calif.: Sage, 1992.

Hare, P. "The Echo Housing/Granny Flat Experience in the U.S." In. Granny Flats as Housing for the Elderly: International Perspectives. Edited by N. Lazarowich. New York: Haworth Press, 1991. Pages 57–70.

Pynoos, J., and Redfoot, D. "Housing Frail Elders in the United States." In Housing Frail Elders: International Policies, Perspectives, and Prospects. Edited by J. Pynoos and P. Liebig. Baltimore: Johns Hopkins University Press, 1995. Pages 187–210.

Sherwood, S.; Ruchlin, H.; and Sherwood, C. "CCRCs: An Option for Aging in Place." In Aging in Place: Supporting the Frail Elderly in Residential Environments. Edited by D. Tilson. Glenview, Ill.: Scott, Foresman and Company, 1990. Pages 125–164.