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Summit
INTRODUCTION
Among the challenges posed by our aging or "graying" society
is the relationship of the elderly to the social and "built" or
physical environment. The changes that have already affected
the growing elderly population in the United States point to a
number of continuing trends: a majority of the aged increasingly
will be female, older, better educated, and probably better off
financially, although there will continue to be a "hard-core"
group of poor older persons. Demographic projections also esti-
mate that, as longevity continues to increase, there may be more
very disabled people, as a function both of the changed age
distribution in the population and of lifesaving medical technol-
ogy. What changes must be made in our social and physical
methods of organizing the environment to accommodate the
needs of these citizens? What policies should be formulated to
effect these changes, and what more do we need to know to carry
out our plans effectively?
To address these issues, the Committee on an Aging Society
convened a symposium in Washington, D.C., in December 1985.
The Summary and the Proposals for Policy and Further Research are based on
contributions from a number of committee members and symposium participants.
We wish to acknowledge particularly William Bell, M. Powell Lawton, George Myers,
and Michael Rodgers.
1
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2
COMMITTEE ONAN AGING SOCIETY
The symposium focused on selected aspects of the social and
built environment and on new ways in which the environment
might be restructured to achieve two essential goals: (1) enhance
the social productivity of aging persons and (2) prolong the resi-
dence of older persons in the community in a manner that en-
hances the quality of their lives and fosters ties with formal and
informal support systems.
In selecting the symposium topic, the committee recognized
that policies influencing the social and built environment have
been largely value driven, often reflecting goals and standards
of decision makers, in both the public and private sectors, that
have remained undefined.
PREVIOUS STUDIES
Although domiciliary and institutional living for the elderly
have been favorite topics from the beginnings of gerontology as
a field of study, their first consolidation in a more scientific form
came in the chapters of the handbooks of gerontology published
almost 30 years ago (Birren, 1959; Tibbitts, 19601. Vivrett (1960)
provided a chapter summarizing much of the service-, policy-,
and design-relevant information of the day; similarly, Klee-
meier's (1959) chapter was the first attempt to formulate an
environmental psychology of later life. Subsequent writings by
Carp (1966), Rosow (1967), Pastalan and Carson (1970), and Law-
ton and Nahemow (1973) developed the issues further in a period
that saw the emergence of a national housing program, the
redefinition of the home for the aged, and the stimulation and
facilitation of nursing home development by the federal
government.
The first and perhaps most influential project of research,
policy, programming, and education in the aging-related envi-
ronmental area was that of the Gerontological Society (later to
become the Gerontological Society of America or GSA) from
1971 to 197S, which was supported by the U.S. Administration
on Aging and directed by the late Thomas O. Byerts. This mul-
tifaceted project treated many of the topics presented in this
volume and resulted in a series of conferences, books, policy
statements, and teaching materials on aging persons and the
built environment. The project succeeded in engaging the atten-
tion of many scientists and professionals who had not previously
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SUMMARY
3
been involved in the field of aging, and it also contributed to an
enrichment of the general methodology of studying person-en-
vironment relations specifically focused on older people. (For
example, throughout its history, meetings and publications of
the Environment Design Research Association have featured
gerontological material in substantial quantity, much of it at-
tributable to the Gerontological Society's project.J
In 1981, GSA provided the U.S. Department of Housing and
Urban Development with a research agenda and annotated bib-
liography (Taylor, 1981; Taylor et al., 1981, 19821. Other relevant
projects funded by the Administration on Aging dealt with
transportation (Cantilli and SchmeIzer, 1971; Institute of Public
Administration, 1975) and gave financial support to help estab-
lish the National Center on Housing and Living Arrangements
for Older Americans at the University of Michigan, a project
that is now continuing with university support.
Other organizations have also begun to address the issue of
the elderly and their environment. In revising its standards for
facilities for the physically handicapped, the American National
Standards Institute (ANST, 1980) engaged a gerontologist-archi-
tect, Edward Steinfeld, who succeeded in stimulating the think-
ing of design practitioners and administrators. Most recently,
the American Institute of Architects mobilized some of its re-
sources to encourage architects to be increasingly sensitive to
the housing needs of older persons. Unfortunately, the ATA proj-
ect appears to have been terminated after the publication of a
single book (American Institute of Architects, 19851.
THE CURRENT FRAMEWORK
The current framework of research on the social and built
environment of an aging society acknowledges a basic tenet that
has been suggested by Howell (among others): to understand
and address the interaction between the environment and an
aging population, one must take into account concepts from and
the knowledge bases of diverse fields (Howell, 19801. The design
of the symposium reported in this volume reflects that stance
in that the-eight papers commissioned for it were prepared by
authors from such fields as sociology, economics, psychology,
medicine, planning, and architecture.
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COMMITTEE ON AN AGING SOCIETY
The Demography of Current and Future
Aging Cohorts
The demographic changes in the elderly population of the
United States are central to addressing the social and built
environment of an aging society. In a review of current demo-
graphic trends and projections, William d. Serow and David F.
Sly (in this volume) suggest the need for a basic understanding
of the characteristics of the various subpopulations of older per-
sons and how the elderly population as a whole evolves within
the larger aggregate of the general population. The authors
emphasize that neither of the two aggregates can be viewed in
isolation:
.. . the needs of this subpopulation (of the aging) and its resulting
demands are going to be strongly influenced by its size. In this sense,
it is important for us to know much more about patterns of mortality
and longevity and how these are changing. This may sound simple, but
the complexity of such knowledge is evident when we consider that the
size of this population is influenced by historical patterns of fertility
and mortality to the point at which persons enter old age, as well as
by patterns of mortality throughout the older years of life-to say
nothing about the patterns of immigration and emigration over the
whole course of life. Similarly, the structure of the processes that are
responsible for growth in the elderly population (fertility, mortality,
and migration) and the changes that are likely to occur in that struc-
ture will influence the demand for "needs" and even influence what
these needs are and will be. For example, temporal patterns of child-
bearing (when combined with increased longevity) across generations
influence how old children are when their parents reach old age and
may have profound influences on the physical, economic, and social
ability of children to care for their aging parents. Similarly, changing
patterns of mortality may not only influence the number of people who
reach old age but may also affect how many people survive for longer
periods after reaching old age. In addition, changes in mortality may
have an impact on the physical, economic, and social abilities of this
subpopulation's members to care for themselves (in old age).
The period examined by these two researchers comprised 1940-
1980, and it is apparent from their findings that the composition
of the population of those aged 65 years or older has changed
sharply. Two features stand out, both of which are associated
with a distinct increase in the educational level of older persons.
First, in general, the economic status of the elderly has im
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SUMMARY
5
proved, although, according to Serow and Sly (in this volume),
"different cohorts have quite different savings and labor force
opportunity patterns, which can have quite different conse-
quences for the financial abilities of the population during the
early years of old age" (emphasis added). The second feature is
increased longevity: older people are living longer after reaching
age 65. Regarding the interaction of these trends, Serow and Sly
(in this volume) commented: "increased longevity among the
aged will have important consequences for how long savings and
retirement income will have to last, which in turn may have
important consequences for how the elderly dispose of income
and savings through old age." The level of disposable income and
the extent of savings on the part of elderly persons will also
dictate the size of the dependent population to be supported
publicly, the period and scope of support to be provided, and the
nature of the private sector's response to the changed economic
position of the elderly.
Yet none of the recent indications of improved economic posi-
tion of the elderly should obscure the continued presence of a
"hard core" of poor older persons, which was estimated in 1980
to be about 12.5 percent of all those aged 65 and older in the
United States. In general, poor older persons are women drawn
from many different minority groups, but most of them are
black, without spouses, and with limited educational achieve-
ment. Higher Social Security benefit levels have helped to lift a
proportion of the elderly out of poverty but not by much. It is
estimated that approximately 40 percent of older persons on
Social Security must survive financially on their monthly pay-
ment, a function that Social Security was not designed to per-
form when it was begun in 1935.
A substantial group of poor elderly persons, combined with the
increased longevity of the subpopulations of all older people is a
factor that must be reckoned with in planning social services
and housing for the elderly. Other recent demographic trends
that are also likely to affect the social and built environment of
older persons include changes in labor force participation (in
particular, the increased numbers of women working) and deci-
sions about when to retire; divorce among couples with substan-
tial years of marriage, often on the threshold of old age; the
diminishing number of family members available to provide so-
cial support of a family's elders as more married women enter
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6
COMMITTEE ONANAGING SOCIETY
the labor force; and changes in mortality differentials by sex.
Collectively, these changes suggest an expanded role for formal
services to the aging and their families.
One segment of the aging population in particular-those 85
years and older, the oldest of the old, frequently characterized
as the frail or vulnerable elderly has grown at a dramatic rate
over the past four decades and is likely to exercise a strong
influence on the social and built environment of the future.
Between the census periods of 1940 and 1980, the population
aged 85 and older expanded by more than 500 percent from
364,752 to 2,240,067. The growth of 85-and-older persons in this
period was almost two to one in favor of women. There is little
known about this age group, largely because of the paucity of
tabulations from published U.S. census data, and the marked
growth in their numbers appears to have surprised some U.S.
policy analysts, despite signs of this potential growth as early
as 1950. (Serow and Sly point out that in the census periods 1940
through 1970, the population aged 90 and older increased by 6S,
90, and 75 percent, respectively, before tapering off to an in-
crease of 45 percent in the census period 1970-1980.)
The future "old old" may differ in important ways from the
current elderly cohort. For example, Serow and Sly (in this vol-
ume) argue that the 1980 group aged 55-64 represents the cut-
ting edge of critical differences between the elderly of yesterday
and the elderly of tomorrow in the composition of the population
and their life-course experiences. The new old are better edu-
cated and have higher incomes, although such economic better-
ment may be offset by other trends. Men may retire earlier, and
women will probably have considerably more labor force experi-
ence. Smaller families portend fewer familial resources to care
for the future old old. Furthermore, despite a better economic
outlook for many of the future oldest old, a substantial group
will still fall under the poverty line.
To summarize briefly, three new factors of importance in the
design of social and physical environments for community-based
elderly persons have become apparent. First, the survivorship of
elderly persons in the upper ranges of the age scale appears to
be increasing. Second is a major demographic trend that will
greatly influence the social and built environment: the emerg-
ing cohort differences by composition and life-course experiences
that suggest the future old old may differ in important ways
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SUMMARY
7
from the current elderly cohort. Finally, we may note the sub-
stantial growth of an elderly subpopulation whose
members are
potentially susceptible to decrements in health and related con-
ditions that may accompany advanced age, suggesting an in-
creasing vulnerability among elderly persons who choose to
maintain their independent residences.
The Concept of Vulnerability Among
the OIclest 01d
With increased longevity, vulnerability among the elderly has
assumed growing importance. As a result, the changes associ
.
ated with the normal process of aging are being subject to in-
creasing scrutiny. Beth d. Soldo and Charles F. Longino, dr. (in
this volume), for example, have proposed the following:
· Changes among elderly persons are not correlated with
chronological age but exhibit variance.
· Changes among older people are not manifest as a simple
linear decline but show a variety of rates; change may even be
arrested.
· Changes in function may produce different effects in the
same person, and the variance among older persons tends to
increase with age.
· The rate of change can proceed along some dimensions rel-
atively independently of change in others, but the serious loss
or compromise of functional capacity in one area can accelerate
the rate of decline in others.
· A supportive social or physical environment or positive
change can retard the rate of functional loss to some degree.
These findings, which were derived from research by Soldo
and Longino and others, suggest not only that changes associ-
ated with the aging process are multidimensional but that vul-
nerability among aging persons should be conceptualized simi-
larly because it includes physical, environmental, economic,
social, and mental health factors. Indeed, Soldo and Longino
suggest that the assessment of vulnerability among older per-
sons calls for an integration of qualitative information (derived
from biomedical research and service delivery experiences) and
quantitative data gleaned from demographic analyses.
Soldo and Longino (in this volume) measured vulnerability
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8
COMMITTEE ON AN AGING SOCIETY
according to five specific areas: (1) income, (2) the existence of
care services, (3) social contact, (4) an unmet but perceived need
for special housing, and (5) satisfaction with one's neighborhood.
Using such a quality-of-life deficiency index to discover vuIner-
ability in disabled elderly persons living with or without a
spouse and living with or without relatives, the authors found
that "nearly 90 percent of the frail are not simply disabled but
also socially, economically, or environmentally impoverished as
well. Nearly two-thirds are deficient in at least two areas, and
slightly more than one-fifth have problems in three or more
areas." The authors concluded that the gradient of need on the
part of the vulnerable elderly is matched imperfectly with the
gradient of available community-based services offered to them.
Citing the work of Glick (1979), the authors suggest that the
demand for community Tong-term care may far outrace the
growth in members of the disabled portion of the elderly. Bar-
ring changes in service delivery approaches, Glick's projections
also suggest that the proportion of the elderly with an unmet
need for Tong-term care and the proportion with multiple social
and environmental deficiencies may increase over time. To un-
derstand better why this mismatch of need and service exists, it
is necessary to examine recent federal housing policies and what
current policies portend.
Federal Housing Policies
Over the years, federal policy on housing for the elderly has
been directed toward two elderly groups. The first, and by far
the largest in monetary terms, comprises moderate and upper
income groups. Tax expenditures, in the form of mortgage inter-
est and property tax deductions, have been extremely successful
in promoting and subsidizing home ownership for elderly per-
sons. By 1986, over 76 percent of the elderly owned their own
homes, and 80 percent of those owned their homes outright.
The second track of federal policy has been directed toward
providing housing and adequate shelter for low-income indivi-
duals. Initiated during the Great Depression as part of the Roo-
sevelt New Deal, federal involvement in housing for the poor of
all ages has a 50-year history. In 1949, Congress adopted a
national policy aimed at ensuring a decent home and suitable
living environment for every American family. Over the years,
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SUMMARY
9
the federal government has developed a number of mechanisms
to achieve this goal including the direct provision of housing
through new construction, rental assistance, mortgage interest
subsidies, and other financing arrangements with local govern-
ments and housing development agencies. Currently, these pro-
grams account for well over 3.5 million units, some 1.5 million
of which are occupied by older persons.
Although the low-income housing created under the Housing
Act of 1937 was not initially intended to provide special assis-
tance to the elderly, it has evolved into one of the principal forms
of housing assistance for this age group. As a result of legisla-
tive changes enacted in the late l950s, the proportion of housing
units occupied by people over age 65 jumped from 10 percent in
1956 to 46 percent in 1984 (U.S. Senate, Special Committee on
Aging, 19861.
The first program specifically designed for the elderly Sec-
tion 202 of the Federal Housing Act of 1964 was initiated in
1959. It has become the centerpiece of federal housing policy for
the elderly, providing low-interest loans to private, nonprofit
sponsors for the construction of subsidized rental units. As of
1985, it had provided an estimated 18S,000 units of assisted
housing for this age group.
Yet despite this construction, one estimate is that approxi-
mately 2 million of the 3.2 million Tow-income elderly who are
eligible for federal housing assistance currently are not served
by federal programs (U.S. Senate, Special Committee on Aging,
19841. Recent congressional studies show that, today, over a
quarter million older persons are waiting to gain entrance to
Section 202 projects nationwide. With the continued "graying"
of the population, this demand is expected to grow.
Although the federal response to assisted housing has been
the major source of Tow-income housing in this country, critics
maintain that the current approach has been deficient in several
areas. First, unlike health and income security programs, hous-
ing has never been seen as an entitlement. Some housing spe-
ciaTists fee! that this narrow vision has exacerbated the prob-
lems of existing substandard housing and resulted in Tong
waiting lists for housing assistance.
Second, the government's response to assisted housing has
been predominantly production oriented. This "bricks and mor-
tar" approach has failed to address the support service needs of
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COMMITTEE ON AN AGING SOCIETY
those requiring help. As indicated by several of the authors
whose papers are presented later in this volume, programs of
nutrition, health, day care, and other social services have not
been fully integrated into assisted housing, which results in a
fragmented and confusing array of service initiatives and con-
siderable unmet needs.
Third, economic concerns in the l980s, fueled by inflation and
changes in federal spending priorities, forced shifts in public
policy on many domestic programs. Although much of the con-
sequent budget-cutting attention was directed toward health and
income transfer programs, federally assisted housing also came
under scrutiny. Administrative and legislative initiatives in the
early l980s substantially reduced assisted housing programs,
resulting in a 70 percent loss of budget authority since 1981.
In light of these economic and political changes, many observ-
ers believe that federal housing programs are undergoing a
gradual evolution that may alter the future of housing policy for
the aging. Three major trends are likely to have an impact on
these developments.
First, a renewed emphasis on federalism in the early l980s
produced a shift to state and local governments of the responsi-
bility to provide for the shelter needs of Tow-income persons.
State governments have experimented with a variety of creative
financing arrangements. Tax-exempt bonds, the integration of
state funds with existing federal dollars from such sources as
community development block grants or urban development ac-
tion grants, and the allocation of a portion of state revenues for
Tow-income housing have all produced promising results. Seven
states now have substantial congregate housing programs for
the elderly, and at least one local community has promulgated
zoning laws requiring developers to earmark a portion of new
developments to Tow- and moderate-income housing.
Second, the federal government has moved away from its his-
toric role in the direct provision of housing and now promotes
private sector and philanthropic initiatives. Rather than build-
ing new public housing units, the Reagan administration has
emphasized stabilizing existing housing programs for the el-
derly. Additionally, the private sector, which has traditionally
been motivated by economic returns, has been encouraged to
adopt new marketing strategies in conjunction with the human
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SUMMARY
11
service agencies to ensure older citizens continued opportunities
for independent living. In recent years, a number of national
and regional organizations have been formed to foster such new
partnerships.
Finally, the economic pressures of rapidly escalating health
care costs, especially among the elderly, are driving the move
toward the development of a comprehensive approach to com-
munity-based Tong-term care services. (Only recently, however,
have the shelter needs of the elderly been recognized as a vital
component in such a system.) Research on congregate housing
demonstration programs at both the federal and state levels has
shown that a mix of support services tailored to individual needs
in an assisted housing environment can reduce more costly in-
stitutional alternatives (U.S. House of Representatives, Select
Committee on Aging, Subcommittee on Housing and Consumer
Interests, 19871. The hope of the advocates of comprehensive
services is that substantial savings in both Medicare and Medi-
caid may be possible through programs designed to provide in-
home support services; yet even if savings are not realized, the
programs may succeed in enhancing the quality of life and pro-
Tonging community residence for older people.
In short, the federal government's 50-year commitment to
housing for the elderly is likely to continue, although probably
in a changed form to meet new needs. Public sentiment and the
congressional priorities that have been established during the
last several decades will ensure that these needs receive the
attention of policymakers. As our society becomes progressively
older and. changes occur in the social and economic environment,
housing policy must keep pace to address these new and varied
challenges.
Public Intervention in Housing Programs
for the Aging
Raymond J. Strnyk's review (in this volume) affirms the rela-
tionship between housing and long-term care and endorses the
role of community-based housing as a major environmental ele-
ment in a multidimensional response to vulnerability among
the aging. Viewing housing programs provided by the public
sector as a form of public intervention, Struyk asserts:
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SUMMARY
Mobility and Social Integration of the Aging
15
As the number of elderly persons surviving into their eighties
and nineties increases, the issue of mobility takes on an added
priority. Mobility, which can be defined as the capacity to travel
from home to essential destinations at reasonable cost, is inter-
dependent with housing location. The opportunity for older per-
sons to maintain a reasonable level of mobility, regardless of the
choice of residential location, contributes to the continued inde-
pendence of the aging. Yet the role of transportation in connect-
ing people to places seems to have received insufficient attention
by policy planners. Wachs (in this volume) has noted that, for the
elderly, housing choice often involves a trade-off in mobility:
If one chooses a low-density suburban living environment, far from
friends, relatives, and services, it may entail high mobility costs for
the individual and society, especially in old age. High-dersity inner-
city environments may impose high housing costs and less aestheti-
cally pleasing environments on their residents, but it may cost indivi-
duals and society much less to provide access to services at such loca-
tions. Although we recognize these principles, we know less than we
would like to know about the economic, social, and cultural trade-offs
between housing and mobility. Therefore, any investigation of the re-
lationships between housing and mobility in old age must include atti-
tudinal and social dimensions as well as physical and economic ones.
Planning for the mobility of older people should be incorpo-
rated into environmental planning for the intact as well as for
the vulnerable elderly. As Wachs suggests, the absence of trans-
portation may be the means by which our environment con-
spires to isolate the elderly; the presence of transportation may
be one of the keys to an active and healthy old age.
Access to transportation services, whether self-provided or pro-
vided by public resources, is particularly important for vuiner-
able persons, regardless of age. Such persons should be assisted
by all reasonable means to maintain a pattern of living that
approximates the norm in a given society if they are to perform
appropriately and effectively in that society.
The mobility problems of inner-city elderly illustrate the com-
plexity and importance of understanding the transportation
needs of older persons. Many urban elderly have never driven
and, being economically limited to infrequent taxi use, must
rely on public transit or relatives and friends who drive. Depend
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16
COMMITTEE ONAN AGING SOCIETY
ing on friends and relatives fosters a sense of dependency and
obligation in a group already prone to such feelings. And unfor-
tunately, public transit is not always a good alternative because
its use may involve substantial physical barriers such as Tong
walks, high steps, narrow doorways, and exposure to the ele-
ments. Although attention has been directed toward the removal
of such physical barriers, Wachs found a distressing lack of
security for persons using public transit (incidence rates of crime
perpetrated on older people are 30 times the crime victimization
cases reported by local transit police). Greater attention to se-
curity- for example, such inexpensive changes as relocating bus
stops and better street lighting might be one of the most im-
portant initiatives by which public policymakers may better
tailor transportation to the needs of the elderly.
Older Americans in this decade are different in demographic
terms compared with their counterparts in the 1970s. It may be
helpful to review some of these major changes and to extract
their transportation implications:
· Older people are living longer, thereby swelling the ranks of
the elderly in the upper ranges of the age span.
· The women-to-men ratio has become even more pronounced
than in prior decades, with the disparity between the two sexes
widening with increasing age.
· As measured by the proportion of elderly persons with a
high school diploma, educational achievement has risen steadily,
thus improving the income, health status, and well-being of
older people.
· The percentage of older persons voluntarily leaving the la-
bor force has increased for both sexes.
· Although a smaller proportion of older persons are now be-
low the poverty line, at least one older person in eight can still
be classified as poor.
· Minorities have increased as a proportion of the aging pop-
ulation, and all projections indicate they will continue to gain
on the white majority.
According to Bell and Revis (1983), the transportation impli-
cations of these changes appear to be the following:
· Car ownership will be maintained by many older persons,
and the private automobile will continue to be the preferred and
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SUMMARY
17
main source of transportation both for disabled and for intact
older persons.
· Specialized transportation, estimated by one study to be
used by less than 10 percent of all elderly persons, will have to
serve an older group of riders who are mostly female, less phys-
ically able, and drawn heavily from minorities.
· Work-oriented trips will decrease as a trend toward early
retirement continues and as elderly riders seek trips to other
destinations.
In keeping with the phenomenon of a more heterogeneous
older population, Wachs (in this volume) states that the travel
patterns and mobility requirements of the elderly are a function
of life-style. He argues that it is not possible to predict the travel
patterns of older people without a grasp of the variations in
activity that reflect differences in life-style.
The concept of life-style is a useful analytic tool in dealing
with the residential location and mobility patterns among the
elderly living in a diversified urban setting (Wachs, 19791. Life-
style takes into account socioeconomic and demographic varia-
bles that singly or collectively affect the elderly differentially.
For example, in a study carried out in the Los Angeles area,
Wachs identified and subdivided the elderly in the region ac-
cording to six life-styTe groups: the central-city dwellers, the
financially secure, the new suburbanites, the early suburban-
ites, the blacks, and the Spanish-Americans. A different set of
life-style groupings could be devised for geographic regions other
than Los Angeles.
The utility of the life-style concept, in terms of mobility among
elderly persons, is that it raises the possibility of differentiating
among their travel patterns according to variations in housing
location, car ownership, reliance on public transportation, and
degree of vulnerability.
The Swedish Perspective on Housing and
Social Environments for the Elderly
The pattern of growth of the elderly population in industrial
countries tends to be similar, but the cultural interpretation of
independence in old age differs among countries. All industrial-
ized nations have exhibited a change in the age pyramid as a
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18
COMMITTEE ON AN AGING SOCIETY
result of a falling birth rate and the increased longevity of the
population. in the short run, urbanization and industrialization
minimize cultural and social differences and may appear to form
a tendency toward increasingly uniform life patterns for older
people. In the long run, the demands of industrialization are
likely to become dominant in shaping residential arrangements
among older parents and their adult children, even in cases in
which such arrangements conflict with existing cultural pat-
terns. Sven Thiberg, a research architect from Sweden (in this
volume), cites the cases of Japan and Sweden, two countries that
are similar in living standards, education, and methods of pro-
duction but quite dissimilar in their cultural norms regarding
the care of parents in old age:
It is not merely that 7 percent of the elderly in Sweden and 60 percent
in Japan live with relatives. The declared social goals of the two nations
differ just as much. In Sweden, the national policy is that an independ-
ent life is desirable and that it can only be attained if older people live
in their own homes; in Japan, the state advocates that the elderly shall
live with their relatives. Great efforts are made in Sweden to support
old people living on their own; in Japan, no reason is seen to develop
such support because it is considered to conflict with the desirable
social pattern.
Thiberg concludes, however, that "everything indicates that a
growing degree of industrialization leads to increased mobility,
the splitting up of households, and less stable families. In the
Tong run, these trends have the effect of separating the young
and the old even more than they are at present, and in general,
cultural ties do not appear to be strong enough to prevent this
development." Cultural influences may become subordinate to
the forces of industrialization, and older people increasingly may
tend to live near but not with adult children, in most instances
by mutual agreement. Rosenmayr and Kockeis (1962) have
termed this expression of independence in living arrangements
on the part of older people in most modernized countries "inti-
macy at a distance."
To keep older people out of institutions or delay their entry
into that form of living arrangement, Sweden has experimented
with several types of specialized housing for the elderly. These
include pensioners' flats in normal housing, which are usually
one- or two-room apartments dispersed within a residential area;
temporary pensioner flats, which are located mostly in sparsely
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19
populated areas; old-age homes for the elderly who could not
look after themselves because of deficiencies in their prior hous-
ing or who require considerable social assistance from paid staff;
and flats in service blocks. Originating in the early 1970s, serv-
ice blocks are apartment buildings that are designed to comple-
ment housing in the normal market for older people and in old-
age homes. About 40 apartments per service block is common,
but some local councils (which sponsor service blocks) prefer a
smaller number-10 to 15 flats to avoid segregating large num-
bers of the elderly in service-oriented buildings.
The primary purpose of the service block is to provide housing
and support services for its elderly residents. The internal serv-
ices offered in the blocks vary but are likely to include a central
dining room, hobby shops, social services, podiatry services on a
scheduled basis, and limited medical supervision. Some blocks
incorporate a child care center on the premises or build a chil-
dren's playground on open space owned by the service block thus
allowing elderly residents to serve as volunteers in the chil-
dren's programs. Frequently, the physical location of the service
b]Lock advances its integration with other resources and other
generations. For example, a block is often located so as to take
advantage either of adjacent health resources or to encourage
the interaction of the service block with neighborhood social life.
Some local councils have built service blocks that are linked by
covered passageways to a contiguous nursing home or health
clinic. In such instances, the service block is located in close
proximity to a local shopping center. To encourage the use of the
service block by area residents and shoppers, it may include
services for the public such as a cafeteria, a post office, a library,
and a social insurance office. The policy thus encourages elderly
residents to remain in their own dwellings, aided when neces-
sary by publicly provided forms of social support and informal
care by relatives offered voluntarily, in that order of priority.
Thiberg (in this volume) indicates that housing programs for
older people are sustained both by the general aims of housing
policy and housing provision, which are listed below.
The aims of Swedish housing policy are as follows:
· to guarantee an abundant supply of forms of housing for all
ages and types of household;
· to make forms of housing economically and technically
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COMMITTEE ON AN AGING SOCIETY
available through government financing and distribution poli-
cies; and
· to give the elderly their choice of dwelling according to need
and desire and not move them to special forms of residence as
Tong as adequate care can be provided in their own home.
The aims of housing provision are as follows:
· to convert the existing housing stock by such methods and
such financing as to make it easier for the elderly to remain in
their homes, modernization comprising the external environ-
ment, service establishments, and communications;
· to ensure that new housing is directed toward strategic ad-
ditions to the existing housing stock (especially important is the
provision of new forms of living environments that are difficult
to realize in existing housing); and
· to plan reconstruction and new construction so that medical
care for the elderly occurs to an increasing extent in their own
homes, ensuring that administration, maintenance, and care of
the residential environment shall be of good quality and take
place in consultation with the residents in order to increase well-
being and security and reduce the risks of accidents.
What lessons can be learned from Swedish policy on designing
appropriate environments for the aging? First, elders are en-
couraged to "age in place" as long as it is feasible to remain in
one's home. Second, housing is viewed as an integral part of a
holistic approach to publicly provided social services for all of
the elderly, thus reducing the need for recurring problems of
shelter. For aging persons to pursue an independent life in old
age requires economic, social, and cultural measures in support
of the goal of normalization.
New Technology and the Productivity and
Indepenclence of the Elderly
With increased longevity and, in general, a more affluent old
age for the elderly in the United States, the possibilities for
enhancing the productivity and independence of older persons
have attracted considerable interest. A number of authors have
examined new technologies relevant to the social and built en
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SUMMARY
21
vironment that might allow the elderly to lead lives of greater
productivity and independence.
Robert L. Kane (in this volume) has focused on the role of
technology and its effect on individual well-being. He views the
growth of new technology as a given that we must assess mainly
in terms of how to establish priorities and how to finance what
is chosen. He holds that there are collective (societal) benefits as
well as individual benefits from the new technology that must
be evaluated and reminds us that the people who will be affected
by the technology of the future will differ from the aged of today.
Kane offers some insight into the assessment of various types
of technological achievements in medicine, preventive health,
and communications. For example, in communications, he fore-
sees the use of personal computers in ways that will not only
increase the pleasure of learning and entertainment but that
will also reshape traditional patterns of social contact. Kane (in
this volume) notes: "The ability to interact with machines as
well as with other people may provide the elderly with a much
more patient, reinforcing set of social patterns than they have
experienced before."
Victor Regnier's contribution (in this volume) focuses on the
more traditional aspects of how housing for the elderly, particu-
larly for the frail elderly, can emphasize "user-friendly" housing
designs. Regnier maintains that to achieve a complete, behavior-
ally based design, all of the desirable goals must be specified
beforehand (e.g., social mix, identity, unobtrusive care, etc.) and
specifically addressed by certain physical design features. Reg-
nier also emphasizes that housing designs must be evaluated
empirically in a formal postoccupancy study. Thus, the design
model that he proposes for the built physical environment must
be carefully integrated with considerations about the intended
social environment. Moreover, the physiological and sensory as-
pects of design must be evaluated within a behavioral context.
Regnier also discusses a number of other considerations in
designing housing for the elderly including the neighborhood
setting, together with appropriate accessibility to varied serv-
ices, and more knowledgeable management of facilities. In the
case studies of congregate residence that Regnier presents, an
assessment is offered of how these two factors are taken into
account in housing design.
Both the Kane and Regnier papers call attention to the cir
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COMMITTEE ON AN AGING SOCIETY
cumstance that regulatory design requirements often militate
against desirable outcomes. Yet often, these regulations are in-
tended to ensure the implementation of new technologies and
products to replace old materials and practices (e.g., using poly-
plastics instead of wood) and are further examples of innova-
tions in the built and social environment that may produce un-
intended consequences.
Working within a somewhat visionary framework, Tames N.
Morgan's thesis (in this volume) calls for a radical reshaping of
the physical and social environments of elderly persons. His
concern is to seek suitable accommodations for older persons in
their passage from welIness to infirmity. He believes this may
best be achieved by exploring the potential for productivity in
older persons. Already in American society, most elderly persons
live long enough to experience an extended period of postretire-
ment; increasing longevity also carries the increased likelihood
that many older persons will spend a large part of those remain-
ing years with functional disabilities that require assistance
from others. Considering the growing costs of long-term care,
Morgan proposes harnessing the productive capacity of older
persons to handle some of the burdens of such care. To do so,
however, requires the removal of barriers economic, legal, so-
cial-organizational, and environmental. He proposes mega-ex-
periments: large-scale demonstrations or trials that involve cre-
ating new, flexible, self-regulated communities of older persons
operating with a system of nonmonetary currency to facilitate
the exchange of services among people who help one another.
Such communities presumably would be self-supporting (i.e., un-
subsidized), more efficient, and equitable as well as encouraging
an increase in productive activity.
What would be the essential features of such new communi-
ties? Morgan believes they would have to be newly constructed,
with homelike living quarters and shared facilities. The com-
munities would be compact with a maximum of several hundred
units so as to encourage close contact and interaction among the
residents. The age composition would be adjusted to maintain a
spread of persons 55 years of age and older, but the residence
would be viewed as permanent for the remaining years of one's
life.
For Morgan, tile "glue" that could hold such a community
together would be the mode of exchange: a resident would be
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SUMMARY
23
able to help others in the community who are disabled and thus
earn exchange credits that would be claimed when he or she
needed help. Unlike currently planned old-age communities and
most congregate housing arrangements, the case services in such
a community would be provided mainly by neighbors rather
than by professionals.
The design of the symposium and of similar efforts to address
systematically a major social issue relevant to the aging illus-
trate a basic principle that is recognized especially, but not ex-
clusively, by researchers and planners in social gerontology. One
way of conceptualizing this principle is to characterize it as the
vertical-horizontal dilemma in the social problem-solving proc-
ess. That is, given the scope and breadth of knowledge in many
areas of social life, it is deemed more efficient and appropriate
to slice that knowledge into vertical segments, thus creating
areas of specialization or disciplines. Yet the problems of the
elderly, among others, frequently fait to confine themselves to
these arbitrarily created divisions of knowledge but rather tran-
scend and cut across separate disciplines, requiring the coliabo-
ration of specialists from several disciplines for problem-solving
purposes.
To that end, the eight commissioned papers presented in the
volume are largely specialized analyses of aspects of the general
subject of this symposium. The remainder of this first part in-
cludes a brief discussion of previous studies and a summary of
the current framework of thought in a number of areas covered
by the symposium. The next section represents the committee's
views on a feasible policy and research agenda for the future.
ideas in the agenda for the future were drawn from the positions
articulated in the commissioned papers, modified by the discus-
sion held at the symposium as well as the perspective of some
committee members.
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Representative terms from entire chapter:
aging society
