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OCR for page 26
Proposals for Policy and
Further Research
When the housing problems of older people first arose as a
matter of public concern during the late 1950s, the direction of
policy and the programs to implement it were relatively clear:
to build good-quaTity shelter for the large number of older people
who were relatively self-supporting but who were limited by
income in their ability to find decent housing on the open mar-
ket. New housing production was one way to provide economic
relief for the poorer elderly. At about the same time, methods
were also under consideration for providing economic relief in
Tong-term health care for the elderly. Two strategies that were
implemented were the redefinition of the home for the aged and
federal facilitation of nursing home development.
Simply stated, then, the federal government wanted to elevate
the quality of life for the Tow-income independent older person
through improved housing; it wanted to do the same for the Tow-
income disabled older person through nursing home care. Yet
these intended policies did not readily accommodate subsequent
changes in American society in general and in the elderly pop-
ulation in particular.
First, the income of older people improved measurably, shrink-
ing the size of the financially indigent population. Second, the
distinction between independent and dependent elderly persons
became blurred: an elderly person's health status could vary,
and there were often unequal rates of change among older resi
26
OCR for page 27
PROPOSALS FOR POLICY AND FURTHER RESEARCH
27
dents clustered in the new housing of the 1960s. Third, the
OlderAmericans Act, the Social Security Act, and Medicare es-
tablished the concept of chronological age as a basis for entitle-
ment to national programs.
In housing and health programs, it became recognized that
prospective clients were not dichotomously healthy or unhealthy
but could exhibit health conditions of any stage in between.
Thus, the nation saw the development of intermediate residen-
tial models-housing for the elderly that fell somewhere be-
tween their own residences and the total care provided by nurs-
ing homes as well as the emergence of local, home-delivered
services that came to be known as community-based long-term
care. All of these developments seemed to be going in the "right"
direction that is, working toward a greater ability to match the
characteristics of environments and services to the varied needs
of elderly people. But expectations about the country's ability to
produce enough housing units, enough varieties of residences,
and the right mix of services were diminished by the economic
downturn of the late 1970s.
At this writing (1987), all federally assisted new housing con-
struction programs have been terminated except for the Section
202 program, which survives on a year-by-year basis over the
recurring objections of the national administration. Nursing
home construction with the aid of public funds has been greatly
reduced. Experimentation with locally provided community-
based Tong-term care continues in spite of reduced public fund-
ing fueled by private sector innovations and a demand by elderly
clients.
Although the present may be a time for the consolidation of
these efforts, it may also be an appropriate time to identify
objectives in environmental policy for the future. This chapter
discusses four policy areas: age and disability, environmental
services and the well-being of older people, person and environ-
ment in life-span perspective, and self-determination in environ-
mental decision making.
AGE AND DISABILITY
Neugarten (1982) and Binstock (1983) have suggested that
there should be no ambiguity in an elderly person's eligibility
for services and programs. One form of eligibility may be chron-
ological age; another is need as defined by levels of disability or
OCR for page 28
28
COMMITTEE ON AN AGING SOCIETY
poverty. As some gerontologists have warned might happen, the
United States is currently in the midst of a disruptive quarrel
over "age equity" (Kingston et al., 1986; Preston, 1984), a quar-
rel fed by the resentments of people who believe that benefits
are going disproportionately to older people who are not neces-
sarily in economic need. Thus, a first question is whether na-
tional housing policies have emphasized chronological age in
their definition of entitlement in a way that undermines the
credibility of the policies. In general, they have not. There was
a time when substantial federal support went into mortgage
insurance and low-interest loans to housing or nursing homes
that served older people who had incomes well above the poverty
level, but those subsidies have for the most part ended. The
attention of national housing policy is now focused on Tow-in
come persons.
Another complaint that is sometimes made is that the new
construction of public programs became concentrated on older
income-eligible clients, some believe to the neglect of younger
families. This trend can be seen in the high proportion of public
housing and Section ~ units that were provided for elderly per-
sons in the 1970s. Thus, age can be said to have been an advan-
tage in the distribution of scarce national housing resources.
Currently, there is concern that almost no new housing for
low-income people is being built to replace units being lost
through the normal processes of housing turnover. However one
may applaud programs to conserve and rehabilitate older hous-
ing, it ought not to occur at the expense of the program that has
produced 800,000 or so new units over the years. Moreover, in
the process of modifying the original objectives of federal hous-
ing policy and defining its target group more carefully, in addi-
tion to income the age criterion must be redefined to recognize
the housing needs of people of all ages.
It is possible that limiting high-expense programs to the most
financially needy may require the introduction of an added cri-
terion in addition to age and income. Some discussion is needed
to develop a consensus about whether less expensive forms of
assistance should be substituted for new dwelling units for poor
older people, reserving the more expensive programs for poor
older Americans who are also disabled. A question that is often
raised is the issue of what minimal level of quality is everyone's
right. Having been guided so strongly and for so long by the
OCR for page 29
PROPOSALS FOR POLICY AND FURTHER RESEARCH
29
simple view that our national programs could provide quality
housing for all, insufficient attention has been paid to specifying
the minimum right versus the purchasable options. Whether
health should be an additional eligibility criterion introduces a
second major policy issue: that of the relationship between the
environment of the elderly and their health and social services.
ENVIRONMENTAL SERVICES AND THE
WELL-BEING OF OLDER PEOPLE
The demographic and health data presented in this volume
(see the eight commissioned papers) quite effectively portray the
size of the "vulnerable" population as a minority of all aged
persons. Yet what must also be considered is that elderly persons
who are vulnerable by reason of health deficits are likely to be
vulnerable in other ways.
Historically, federal housing programs housed older tenants
who grew less independent with the years, creating a growing
group of disabled people who required something more than
mere shelter. The congregate housing model that is, a facility
with supportive services that is clearly a housing unit and not
an institution became firmly established during the one phase
of housing development for the elderly (although never as ubiq-
uitously as is sometimes presumed). For a time, it seemed as if
three models of residence would serve most elderly people's
housing needs: independent housing, congregate housing, and
nursing homes.
The reluctance of society to support these three housing mod-
els financially forced us to search for alternatives to these rela-
tively expensive physical facilities. Social gerontologists were
probably late in recognizing the strength of older people's wishes
to remain in their own homes in the community. Indeed, there
may be a ceiling in terms of the proportion of older people who
may be candidates for planned housing, given improvements in
the access of older people to good supportive services that would
enable them to remain in their own homes.
An apparent failure to pool housing-related resources at the
federal level may be traced to an attempt to maintain separate
programs by the U.S. Department of Housing and Urban Devel-
opment (HUD) and the U.S. Department of Health and Human
Services (HHS). This lack of integration of related services was
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30
COMMITTEE ON AN AGING SOCIETY
extended to the local level, and as a result, opportunities to
develop integrated services were missed. Such opportunities in-
cluded planned small-scale equivalents of congregate housing,
(Lawson et al., 1985), supportive small-scale housing alterna-
tives for the marginally independent, and the incorporation of a
strong housing-quality component in local community-based
long-term care programs.
The papers by Soldo and Longino and by Struyk in this volume
discuss the importance of a health component in housing pro-
grams and the connections between housing, health, and social
service programs. As these authors point out, major policy issues
remain. For instance, where does the responsibility lie for facil-
itating, by a policy of housing maintenance, the continued resi-
dence of older people in homes of their own choice? On balance,
it is clearly more cost effective to subsidize the maintenance of
the usual older existing home rather than pay the costs of re-
placing it with a new home. Yet the problem confronting policy-
makers is the large backlog of potential clients and the high
administrative costs of a centralized small-repair and mainte-
nance program for older homes (Struyk, 19851.
In attempting to delimit the scope of public responsibility and
establish priorities for housing assistance, it may be necessary
to exclude health and disability criteria to qualify for federal
assistance in home adaptation. Soldo and Longino (in this vol-
ume), Newman (1985), and others have demonstrated that mul-
tiple deprivations tend to occur in the same people, who then
exhibit a combination of unmet needs: insufficient income, poor
housing, ill health, and apparent social needs. More specifically,
the impaired elderly who are now being served by subsidized in-
home service programs may well constitute a pool of possible
candidates for home repair and home adaptation services. Such
services might make the critical difference that would enable
these people to remain at home instead of moving to a more
.
expensive rest .ence.
One value issue, then, is whether the nation (like some other
countries that assist the elderly in maintaining their independ-
ent living) is prepared to pay for additional services that may
reduce the necessity for the institutionalization of older persons.
A policy dilemma that must also be faced is the failure to ad-
dress quality-of-life issues for healthy but low-income elderly
OCR for page 31
PROPOSALS FOR POLICY AND FURTHER RESEARCH
31
who live in deficient housing. Does one approach take prece-
dence over the other?
The first two policy areas reviewed in this section have in-
volved vulnerable older people who constitute a high-priority
group even though they may be a minority of older people. Needy
as this group may be in terms of policy attention, the field of
person-environment relationships has much to offer in improv-
ing the quality of life for all older people. Two further policy-
relevant areas suggested by the papers presented in this volume
are the life-span view of person-environment transactions and
the issue of self-determination in environmental decision
making.
PERSON AND ENVIRONMENT IN
LIFE-SPAN PERSPECTIVE
Although the authors of papers in this report were not asked
specifically to address life-span issues, any broad approach to
housing policy must place some of the major policy issues within
the context of the life-span perspective. One proposal made ear-
lier suggests that the needs of the [Larger society require that
some measure of equity be established regarding the housing
needs of people of different ages. An important moderator of
concern about age equity, however, is the realization that the
beneficiaries are seldom restricted to one specific age group:
benefits for one generation often produce benefits for other gen-
erations. For example, housing subsidies for older people in the
form of planned housing developments are likely to remove fi-
nancial burdens from younger wage earners, allow more dwell-
ing-unit space for growing children, and diminish the intrafam-
ily conflict that is often associated with involuntary home
sharing by adult children and their elders.
Yet what is equally important is to conceptualize a person's
life as an "environmental career," a notion that introduces basic
theories of persons in environments with each person shoulder-
ing the task of maximizing the gains and minimizing the
stresses of the various environments inhabited over the course
of one's lifetime. If we agree with Campbell et al. (1976) that
people make a continuing series of choices and engage in active
behaviors that lead to their successful approximation of an ideal
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32
COMMITTEE ON AN AGING SOCIETY
environment, it is not surprising to find that older people are
more satisfied with their ultimate housing, their neighborhoods,
and other facets of their environments than are people of younger
ages.
One line of reasoning suggests that planning for one's housing
environment in old age should be a lifelong process. This ap-
proach may be intuitive for many older people for despite the
problems of nonliquidity, some 75 percent of all elderly in the
United States own their own homes. Buying a home is only one
of a variety of "housing adjustments" (in Struyk's terms) that a
person is required to make. If we enlarge the foregoing concept
to "environmental adjustments," it is possible to identify a large
category of tasks and decisions that extend across the life span
and for which there is need for intervention. The promotion of
national policy to direct such interventions is urgently needed.
The concept of environmental adjustments clearly includes the
transportation concerns expressed in this volume by Wachs, the
specific housing interventions discussed by Regnier, and the rad-
ical readjustment proposed by Morgan, together with the out-
come of "quality-years" cited by Kane.
Perhaps the most useful general policy directive emerging
from a proposed life-span view is that priority should be given
to interventions whose benefits are germane to multiple age
groups. Indeed, any proposed program should be analyzed for its
contemporary effects on multiple generations in addition to its
probable effects on recipients at later stages of their lives.
To reiterate, one principle that ought to guide policy develop-
ment in the environmental area is that what is found to be
useful for older people is likely to be useful for people of any age
as well as for disabled persons. Contributions to the improve-
ment of housing, neighborhoods, and consumer products for most
people may begin in a search for user-friendly designs specific
to the elderly; yet many of the design adaptations discussed by
Regnier have the capacity to enhance the quality of residential
life for people at any stage of life.
There are many implied policy proposals contained in the pa-
pers included in this volume. For example, Struyk's plea for
enlarging the opportunities for timely modification of older per-
sons' housing might well influence the building of age-irreve-
lant housing with features that increase the adaptiveness of the
residence to the changing needs of its occupants over time. Wachs
OCR for page 33
PROPOSALS FOR POLICY AND FURTHER RESEARCH
33
has noted that security is a major need for older people as they
traverse their neighborhoods or use local transportation. Im-
proving security for them will improve the quality of life for all
transit users. And as Kane suggests, the processes of teaching
and establishing an older person's familiarity with new housing-
relevant technologies will reveal useful methods that may apply
to younger users as well. (This principle applies despite a mis-
taken assumption that user-friendly technology is not relevant
to the young.)
In summary, the life-span conception of an environmental ca-
reer leads the process of policy formulation toward a broader
conception of the common good in the realization that there are
few environmental benefits for one group that cannot be made
to work to the advantage of people of any age. This broad con-
ception argues against the idea of age-targeted environmental
designs. In contrast to this point of view, however, is the notion
of disability-oriented or deprivation-targeted housing design.
SELF-DETERMINATION IN ENVIRONMENTAL
DECISION MAKING
There are a number of particular ways in which the varying
needs, preferences, personalities, competencies, and disabilities
of a person influence his or her use of the environment. The
personal factor in environmental interactions should be ad-
dressed to give adequate recognition to individual needs and the
ability of older people to shape their own living environments,
both as individuals and as a group.
The environmental career of a person is determined in part by
the nature of the environment into which the person is thrust
and partly by the active choices the person makes in the selec-
tion of environments and in the shaping of either the given or
the chosen environment. It may be useful to think of the way
people interact with allotted or chosen environments as a ten-
sion between reactivity and inactivity. In addition to this behav-
ioral dialectic, there is a conflict-laden need between the wish
to be challenged and the wish to be secure. National housing
policies for the elderly tend to assume that old age is only a time
of reactivity and a striving for security.
The wish to remain in one's own home is but one instance of
the preference in the elderly for autonomy within the limits of
OCR for page 34
34
COMMITTEE ON AN AGING SOCIETY
a person's physical, mental, and economic capabilities. Yet how
can housing policies be modified to facilitate such active choices
as proposed by several authors in this volume? Community-
based services for elderly persons in congregate housing and in
other housing alternatives can extend the period of community
residence. Although neighborhood dynamics were not originally
to be part of this volume's scope, Wachs' underlining of how a
lack of physical security may limit personal autonomy com-
mands attention. Other forms of neighborhood-wide interven-
tions that help people form at least preliminary relationships
with one another need to be supported by policies affirming the
worth of neighborhood preservation.
An important feature of Sweden's in-home services for the
elderly, as described by Sven Thiberg (in this volume), is the
assistance given by close neighbors, stimulated by small organ-
izational and financial incentives providLed by the federal gov-
ernment. Such an approach has the advantage of enabling active
roles for neighbors who are prepared to help the less independ
ent in their vicinity.
There are few older people who are so impaired that some
degree of choice or autonomy is not within personal range. Our
policies regarding institutional care, as Regnier noted, however,
have supported many regulations that work against preserving
even limited independence for people who must live in a partic-
ular setting. Institutional regulations that import rules from
acute care hospitals or that place an undue premium on the
maintenance of rigidities and internal order defeat the provision
of a flexible living environment for residents. In practice, in
such a situation, few independent behaviors are rewarded. The
performance of instrumental roles such as the making of one's
bed or the assumption of responsibility for one's small living
area is discouraged in the name of conforming to internal
regulations.
In practice, there are few incentives for designers, sponsors, or
administrators to attempt innovative efforts in providing envi-
ronments that maximize choice. For example, consider the small
manufactured home and its relative, the "granny flat." Current
technology can produce such units at reasonable cost to accom-
modate a person's changing needs, but local zoning, land use
restrictions, and building codes have hindered the implementa-
tion of this approach.
Some of the authors of the papers in this volume emphasize
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PROPOSALS FOR POLICY AND FURTHER RESEARCH
35
the importance of consumer preferences in giving direction to
technological developments in housing. Certainly, demographic
projections support the idea that an unprecedented number of
older individuals will be financially and intellectually capable
of expressing and acting on personal preferences in the open
economic market. At the same time, consideration must also be
given to raising the quality of housing for the segment of the
older population that is not financially solvent or knowledgeable
enough to participate fully in the market economy. One way to
achieve this goal is to target life-enriching programs more to-
ward the poor older person. Such publicly subsidized programs
as senior activity centers, transportation, and educational activ-
ities are likely to elevate the quality of life, but a substantial
proportion of these resources tend to be consumed by people who
may not require subsidizing. On the other hand, targeting such
programs only to the poor may mean they are politically less
viable and poor in quality. In any case, a policy that leads to
creative efforts to design aspects of the physical and social en-
vironment that challenge and engage healthy but economically
deprived older persons should be a priority.
To sum up, the prevalence of a proportion of elderly persons
with poor health and economic deprivation identifies one target
group of older people on whom it is appropriate to focus as
subjects for environmentally significant subsidy programs. Yet
the majority of older people are healthy when they enter old
age, and they may remain in good health for most of their lives;
in such cases, their relationship to the environment is a contin-
uous process of active choices and self-determinative behavior.
Therefore, each proposed housing policy must consider carefully
its effect on the use of the environment in bolstering the quality
of a person's life. From this perspective, policies are not age
specific but contribute to the autonomy and well-being of people
of all ages.
RESEARCH AND POLICY NEEDS
An important function of the papers prepared for this volume
was to point to research needs whose implementation might lead
to better theory, policy, services, and design of the social and
built environment of an aging society. Yet the concept of person-
in-environment is by its nature quite broad because it must
integrate discrete elements that are usually treated separately
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36
COMMITTEE ON AN AGING SOCIETY
for convenience: that is, the person, the small group, larger
aggregates of people, social institutions, culture, values, and the
physical environment. To achieve an integrated policy and re-
search product requires a multidisciplinary array of partici-
pants that includes but is not limited to physicians, psycholo-
gists, sociologists, anthropologists, policymakers, architects, and
planners.
Precisely because the field of person-environment relation-
ships is so wide-ranging, it requires a special category of re-
search to address the knowledge-implementation process. It is
not accidental that specific attention to these special research
needs was cited in the papers in this volume by the two archi-
tects in the group, Regnier and Thiberg. The "doers" those who
actually design our physical and to some extent our social envi-
ronments and the risks of such housing are at the far end of
the chain of knowledge generation that begins with theoretical
biology, psychology, and other academic disciplines. Although
some designers active in the investigation or exploration of per-
son-environment relationships are themselves researchers or
are research oriented, the majority of their peers are not. The
latter group depends on socially determined channels of com-
munication for their knowledge, a process strewn with many
barriers, as documented by Regnier and Thiberg.
Thus, one major research need is for a focused inquiry into the
life course of design-relevant ideas: the multiplicity of sources of
the idea such as the potential user, the scientist, and the profes-
sional; the way the idea is subjected to verification; the multiple
modes of transmission of the information; and the determinants
of the extent and manner of its adoption, both informally in
common practice and formally in regulations, housing codes,
law, and broad special policy.
The knowledge-implementation process is a special research
need and is therefore given special priority in this section. Yet
there are also other research needs that have been suggested in
the papers included in this volume and in discussion on the
topics that follow.
Population Issues
The many compositional changes that have already occurred
within the aging population and future projections of coming
change (see Serow and Sly, in this volume) constitute an essen
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PROPOSALS FOR POLICY AND FUR TRIER RESEARCH
37
tial aspect of the social environment of older Americans. Re-
search is needed to study the effects of such changes on the
aging individual at the micro end of the scale and on the total
society at the macro end. One poorly understood determinant of
the behavior of the elderly is the effect on an older person of
having aggregates of people in close physical proximity or within
the person's subjective awareness what may be called the su-
prapersonal environment. Thus, as older people migrate from
one location to another, differing mixes of individuals in terms
of age, health, condition, ethnicity, and other characteristics-
are available with which the older person may interact.
The effects of comparative changes in the educational and
income levels of aging cohorts on their social attitudes is an-
other phenomenon requiring study. For example, will the greater
numbers of the old old reinforce the social stereotype of age as a
period of disability? How much will the growing affluence of
new young old cohorts counteract any negative social valuation
of the broad category of older persons? In fact, what will the
economic status of future cohorts of older persons be, given the
shifts now occurring in the economy (from industrial to service
jobs, earlier retirement, etc.? How will all of these trends affect
housing policy?
Researchable questions also arise regarding the effects of the
migration of older people into an existing community, including
the net effect on demands for local services and amenities, as
well as their integration with the nonmigrant population.
Housing Programs
Housing adjustments within a life-span perspective are a pri-
mary focus for research because they allow the study of the
process by which changing needs, social conditions, and family
status interact with housing and other environmental attri-
butes. The manner in which residential decisions are made and
the nature of the barriers and facilitators what Struyk calls
timely adjustments are areas about which too little is known.
Research is also needed on the multigenerational effects of hous-
ing services directed toward older people. There is a need to
document more thoroughly the indirect benefits to adult chil-
dren and to grandchildren of the economics of housing assis-
tance and the social consequences of separate living
arrangements.
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38
COMMITTEE ON AN AGING SOCIETY
The conditions under which alternative housing is acceptable
to older individuals is an area that requires further research,
including community-level studies of how such enterprises as
shared housing, match-up services, and other housing forms get
started and under which conditions they succeed or fail. In ad-
dition, the last word on congregate housing for older people has
not been written. One of the messages from HUD is that better
targeting of services for older persons and the adjustment of
services to local needs would work in the interest of improved
efficiency and cost-effectiveness. A series of variations on the
basic model of housing for older persons should be implemented
and evaluated. For example, the service block concept used in
Sweden is one of many forms evolving outside the United States
that could be tested experimentally in this country. Congregate
housing service programs could be effectively concentrated in
housing sites that will give preference to elderly persons.
Finally, research and demonstration efforts could be directed
toward identifying a feasible way to introduce a modest home
repair/maintenance/home adaptation program into local com-
munities. The administrative overhead costs seem to preclude
the establishment of such a program in a centralized form, but
there are excellent models currently working at local levels in
cities such as Everett, Washington. Another promising demon-
stration project idea would be to train social- or health-oriented
in-home workers in basic skills that could then be transmitted
to newly impaired older residents to make their current home
functionally usable.
Technology
The interaction between the elderly and technology is just
beginning to receive research attention. A somewhat abstract
question raised by Kane deserves attention: how to introduce
and measure the benefits or other effects of technology on the
quality of an older person's life. A general recommendation
might be that every attempt to assess the economic effect of a
new technology be expanded to include its psychological and
social impact on the user.
Finally, on the macrosocial level, research is needed on the
way political decisions that control the accessibility of various
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PROPOSALS FOR POLICY AND FURTHER RESEARCH
39
innovations are conditioned by community attitudes and value
judgments regarding the aging.
Productivity and New Environmental Forms
The massive field trial proposed by Morgan on the pooling of
resources is an appropriately researchable idea on the productiv-
ity of older people. What is needed is to determine the limits of
older people's abilities to "bank" the services they give and to
accept an economy based on the exchange of services rather than
on money or the use of volunteers. In addition, another issue is
raised by a proposal of this kind. Morgan, as does Regnier, poses
a clear trade-off between the need for privacy and individuality
on the one hand and for sociability and integration on the other.
Research on this issue, both at the level of the individual home
and at the level of group housing environments, is recommended.
The Vulnerable Aged
In portraying some of the current approaches to the problems
of the vulnerable aged, Soldo and Longino raise many as yet
unanswered questions about the alternative pathways to care
by household members versus nonhousehold members and to
care by family versus formal organizations. For example, would
it be helpful to know what personal characteristics of an im-
paired person generate the desire to continue to live alone and
retain autonomy? What is the best route toward achieving
changes in the physical configuration of the home to support
independence? What kinds of compromises are involved for var-
ious family and household members when an impaired older
person is maintained at home?
Related to the concept of the environmental career that sub-
sumes a [Lifetime of housing adjustments, a more limited "care-
giving/care-receiving career" is also deserving of study. In addi-
tion, the course of beginning impairments and the overlay of
multiple impairments, other issues raised by Soldo and Longino,
require study in relation to residential decision making.
Finally, a careful analysis needs to be made of the environmen-
tal behavior of cohorts of affluent older persons as they move
into old age. Their choices and preferences will provide prelimi-
nary information on the consumer preferences of larger num
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40
COMMITTEE ON AN AGING SOCIETY
hers of older people in the future. It is also possible to use and
adapt such knowledge in planning for the needs of the poor and
the near-poor elderly, the groups identified by Soldo and Lon-
gino as the most likely to be deprived of adequate housing.
Transportation
The specific ideas on research in Wachs' paper in this volume
recognize the importance of differences in types of neighbor-
hoods in planning services for the older person. It seems clear
that the effects of differing physical and social forces at the
neighborhood and community levels are poorly understood in
addressing the environment of aging persons.
Although Wachs points out that transportation is primarily
an instrumental activity rather than a goal in and of itself, this
very observation raises the question of identifying the condi-
tions under which transportation per se may be a primary goal.
Is it possible to walk, drive, or ride public transportation for
sheer enjoyment? Is such transportation behavior likely to be
attractive to older people? Can research on this topic lead us to
a broader repertoire of life-enriching experiences in an aging
society?
Concern about the possible restrictions of experience engen-
dered by the inaccessibility of transportation has engendered
questions about the processes by which a person's "social space"
becomes restricted. Growing disability may lead to a diminish-
ment in the geographic extensiveness of activity patterns; an-
other possibility is that an involuntarily imposed restricted
range of transportation alternatives may blunt the desire for
new experiences. These several aspects of the mobility of older
persons deserve study.
A host of cost and cost-benefit issues are raised by Wachs
including the dichotomy of mainstreaming versus tailored spe-
cialized transportation services. Wachs' identification of such
factors as institutional resistance to resource pooling and the
incentives to potential fraud in the voucher approach illustrate
the multiplicity of unanswered questions still remaining after
years of demonstration transportation projects. There is a clear
need for more disciplined research in evaluating contrasting
approaches to satisfying the mobility needs of an aging
population.
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PROPOSALS FOR POLICY AND FURTHER RESEARCH
CONCLUSION
41
Although the researchable issues articulated in the preceding
pages were implicitly or explicitly suggested by the authors of
the papers in this volume, the issues proposed for study tend to
exhibit a bias toward the individual in relation to the larger
environment. Yet there is also great richness in terms of policy
implications and research needs in the macrosocial and eco-
nomic areas that were not covered in this review. Similarly,
there are many important environmental topics that simply
could not be addressed within the limits of the resources availa-
ble for this project. Some of the missing topics include such areas
as rural aging; neighborhood and community planning; the per-
formance of nursing homes, acute hospitals, mental hospitals,
and nonresidential facilities; the role of the family; the ethical
underpinnings and values to be achieved; and the cultural as-
pects of person-environment interactions. Additionally, re-
sources limited a consideration of how data and policies in other
countries (beyond Sweden) can enrich and inform our policies. A
complete agenda for future policy consideration should include
these areas.
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Kingston, E. R., B. A. Hirshorn, and J. M. Cornman. 1986. Ties That Bind: Interdict
penitence of Generations. Washington, D.C.: Seven Locks Press.
Lawton, M. P., M. Moss, and M. Grimes. 1985. "The Changing Service Needs of
Older Tenants in Planned Housing." The Gerontologist 25:258-264.
Neugarten, B. L., ed. 1982. Age or Need? Beverly Hills, Calif.: Sage.
Newman, S. J. 1985. "Housing and Long-Term Care: The Suitability of the Elderly's
Housing to the Provision of In-Home Services." The Gerontologist 25:35-40.
Preston, S. H. 1984. "Children and the Elderly in the U.S." Scientific American
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Struyk, R. J. 1985. "Future Housing Assistance Policy for the Elderly." The Geron-
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Representative terms from entire chapter:
elderly persons
