Meeting the Challenges of Aging in Public Housing
Frail seniors need a range of supportive services. The residents themselves are a largely untapped resource.
Public-housing authorities across the country are wrestling with meeting the needs of frail seniors in need of supportive housing, where the services that elderly people need to age in place safely, independently and comfortably are readily available. The bad news is that the numbers in need of these services will only grow in coming years, as will the costs. The good news is that a potent, largely untapped resource is close at hand: the seniors themselves.
The challenge is not a minor one. In 2014, Harvard's Joint Center of Housing Studies released a report chronicling the continued shortage of affordable, accessible and supportive housing confronting the growing number of seniors in need. Adults 65 years and older are projected to represent over 20 percent of the U.S. population by 2040. By that time, long-term-care Medicaid costs for this population are expected to triple from $115 billion in 1997 to $346 billion in inflation-adjusted dollars.
What could avert this daunting arithmetic? One promising possibility is the provision of more community supports for the needs of those who are aging in place, including help with such tasks as housekeeping, transportation, grocery shopping, meals and medication management.
At present, the nation's public-housing managers do not appear prepared for -- and perhaps are not even aware of -- such possibilities. Housing authorities have increasingly shifted construction, management and even ownership responsibilities to the private sector to cut costs. And while public-housing administrators are strongly encouraged to provide supportive housing to meet the demographic trend, it is not typically found in the privately managed subsidized-housing market. In addition, previous research has found that private managers often have limited training or understanding about meeting the needs of residents who wish to age in place, perceiving their responsibilities to be more administrative -- collecting rent and maintaining and leasing the units -- than programmatic.
Where to turn? The results of a study we recently completed indicate that both public and private providers of public housing are consistently overlooking the opportunity to support the untapped resource that is the residents themselves. We examined a publicly managed site, a privately managed site and a privately managed site with public case managers operated under the federal HOPE VI program to determine how residents are supported or inhibited from successfully aging in place in such varying environments.
The most successful of these, the HOPE VI site, exhibited a high degree of "social resilience." Social resilience, which draws heavily upon the residents' own attitudes and actions, is correlated with lower rates of certain diseases, increased longevity and well-being, and other health benefits. The site with the most social resilience had a manager who valued resident participation and hired a resident as the activity director. The organization's procedures, staffing and use of gathering spaces contributed to a community-wide culture that expected residents to be civically and informally engaged, contributing to the community and connected to each other.
At all three sites there were instances in which residents filled service gaps or augmented existing services through informal engagement. Indeed, many searched for ways to meaningfully contribute to their communities and to take care of one another. Some were caring for sick neighbors, running errands and offering each other emotional support. Where management does not support these efforts through funding or the provision of public space, these instances are isolated and not sustained. But where there is financial support for a resident position and space available for resident networking activities, informal engagement is community-wide and sustainable.
In a resilience-nurturing framework, administrators see all residents as having inherent strengths that can be leveraged as resources for the community. Practitioners should seek out, facilitate and grow instances of community-building that are already occurring, as well as create spaces for new connections. By listening to and observing the actors in programs and services, managers can discover what is working, how current spaces are being used, who is helping others, who is trusted and respected, and who is left behind. They should then integrate what they learn in a framework for service delivery.
Social resilience is a key ingredient for building stronger communities and for addressing aging-in-place issues that is not sufficiently prioritized in public-housing administration. As our study found, successful aging-in-place initiatives require a multi-faceted, holistic approach that goes beyond simple service provision and bricks and mortar. It requires the active participation of the true experts on public housing: the people who live there.