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Congregate housing

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Title:
Congregate housing
Creator:
O'Brien, Paul
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Language:
English
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vi, 104 leaves : ; 29 cm

Thesis/Dissertation Information

Degree:
Master's ( Master of arts)
Degree Grantor:
University of Colorado Denver
Degree Divisions:
Department of Sociology, CU Denver
Degree Disciplines:
Sociology

Subjects

Subjects / Keywords:
Congregate housing -- Colorado -- Denver ( lcsh )
Congregate housing ( fast )
Colorado -- Denver ( fast )
Genre:
bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

Notes

Bibliography:
Includes bibliographical references (leaves 84-88).
General Note:
Submitted in partial fulfullment of the requirements for the degree of Master of Arts, Department of Sociology.
Statement of Responsibility:
by Paul O'Brien.

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|University of Colorado Denver
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Auraria Library
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All applicable rights reserved by the source institution and holding location.
Resource Identifier:
18008616 ( OCLC )
ocm18008616
Classification:
LD1190.L66 1987m .O25 ( lcc )

Full Text
CONGREGATE HOUSING
by
Paul 0'Brien
B.A., Metropolitan State College, 1985
A thesis submitted to the
Faculty of the Graduate School of the
University of Colorado in partial fulfillment
of the requirements for the degree of
Master of Arts
Department of Sociology
1987


This thesis for the Master of Arts degree by
Paul William O'Brien
has been approved for the
Department of
Sociology
by
Date
Nov. 18, 1987


iii
O'Brien, Paul William (M.A., Sociology)
Congregate Housing in the Denver Metropolitan Area
Thesis directed by Professor Karl H. Flaming
This thesis examines an alternative type of housing for the
elderly, termed "congregate", located in the Northeast quadrant of
Denver, Colorado. A study of these facilities has included on-site
visits of a cross section of available complexes and interviews with
directors of 47 facilities.
The study compares data from the aforementioned survey with
a nation-wide study done on congregate housing in 1976, and
additionally examines variations between congregate housing in
Denver and other sections of the country. Finally this paper
addresses data analysis, with theoretical construct for congregate
housing, and matters of implementation and policy.


CONTENTS
CHAPTER
I. CONGREGATE HOUSING ......................................... 1
An Emerging Alternative for the Elderly ................. 1
Statement of the Problem ............................. 3
Significance of the Research ............................ 3
II. EMERGING HOUSING ........................................... 4
Needs for the Elderly ................................... 4
Population Issues ...................................... 4
Economic Issues ......................................... 6
Health Issues ........................................... 7
Elderly Housing Issues .................................. 8
Housing Options ........................................ 10
Congregate Housing ..................................... 14
Theoretical Issues ..................................... 17
Summary ................................................ 20
III. METHODOLOGY ............................................... 21
Inception of Project ................................... 21
The Sample ............................................. 22
On-Site Inspections .................................... 24
Instrumentation ........................................ 26
Data Analysis Procedures ............................... 36
IV. TWO CASE STUDIES .......................................... 37
Introduction
37


V
V. RESULTS ......................................... 51
Structural and Economic Characteristics ................ 51
Vacancy Rates and Waiting Lists ........................ 54
Age Characteristics of Residents ....................... 57
Medical Facilities Available ........................... 57
Denver/National Data ................................... 58
Security Systems ....................................... 59
Transportation ....................................... 60
Amenities Offered ..................................... 6l
VI. DISCUSSION ....................................... 63
Theoretical Issues ..................................... 66
Summary ................................................ 71
VII. SUMMARY ......................................... 74
Conclusions ............................................ 77
Implications/Theoretical ........................... 78
Implications/Policy .................................... 79
Implications/Research .................................. 82
BIBLIOGRAPHY ................................................... 84
APPENDIX
A. The Pre-Test Questionnaire ............................. 89
B. The Research Questionnaire ............................ 97


TABLES
Table
1. Financing Options .......................................... 13
2. The Living Continuum ....................................... 16
3- Elderly Transitions ....................................... 28
4. Square Footage of Available Units .......................... 52
5. Handicapped Accessibility ............................. 53
6. Move In Related Charges .................................... 54
7- Waiting Lists ............................................. 55
8. Vacancy Rates .............................................. 56
9. Subsidies, and Religious Affiliation ....................... 57
10. Medical Services Offered .................................. 58
11. Security Systems .......................................... 59
12. Transportation ............................................ 60
13- Ranking of Service Availability of Sample Sites ........... 6l
14. Amenities Offered ......................................... 62


CHAPTER I
CONGREGATE HOUSING
An Emerging Alternative For The Elderly
Congregate housing has been called the missing link in the
elderly housing market today (Chellis, 1982:27). Such statements
have been made because congregate housing appears to provide a
bridge between independent living arrangements and full-care nursing
homes. Congregate housing offers an array of amenities, security
devices and some health related components which, combined, might
enhance the lives of many men and women.
With new. developments in the area of housing for the
elderly, better theory and research are needed. Little research
exists exploring answers to the many elderly housing questions. It
is thought that the congregate concept will have a prominent place
in the emergence of new housing alternatives for the elderly.
Today's housing market for those citizens sixty-five and
older is in a state of flux, and includes increasing
institutionalization of the feeble elderly in nursing homes. The
costs involved with such care are accelerating, and who will
ultimately bear its costs has been called into question. Research
shows that many residents in skilled nursing homes have been
placed there inappropriately (Chellis, 1982:1).


2
Congregate housing has been promoted as one viable
alternative to the full-care facility, and this thesis examines the
extent to which this concept offers a solution to the need for
intermediate care. Housing specialists, gerontologists and builders
in the private sector collectively believe that such a concept might
indeed provide a plausible and effective link between the full care
nursing home and independent living (Huttman, 1977; Malozemoff,
1982; Chellis, 1982).
In order to address this issue a study was conducted of
congregate residences available in metropolitan Denver. The study
includes other categories of elderly housing under Sections 8 and
202 of the Housing and Urban Development (HUD) program in addition
to those units financed by the private sector. It also lists the
locations of current stock, rental ranges of the units, square
footage, and available amenities.
This thesis also examines the theoretical and policy
implications of congregate housing. This includes a history of
elderly housing in general, and a discussion of the current
congregate concept. This study also explores financing options
available to builders of these and other elderly housing units.


3
Statement of the Problem
Why the study? The problem is that we do not know very much
about congregate housing for the elderly, either in Denver or
elsewhere. We know very little about the physical lay-out of such
housing, where it is located, how it is staffed, and what kinds of
services and opportunities it provides. More importantly, there has
been virtually no attempt to look at congregate housing as a
sociological phenomenon.
Significance of the Research
This study is a timely one, as there are currently many
different congregate facilities being built nation-wide. It is
estimated that in 1978 approximately 400 congregate residences were
in operation in the U.S. (Malozemoff 1978:12). Only a few studies
have looked at the benefits and disadvantages of these projects.
At the present time only Malozemoff's study has been published. This
research was done on a nationwide scale with an N of 27, drawing a
sample from the four-hundred known units.


CHAPTER II
EMERGING HOUSING
NEEDS FOR THE ELDERLY
The elderly are a population, currently in a state of flux,
with many unique housing problems. These range across socio-economic
and health issues. In response to the increasing need the federal
government has instituted senior housing programs for this
population. Of these, congregate housing appears to be one plausible
and viable response.
Population Issues
"Crisis" is the word often used today when looking at the
elderly population of the United States. Such dramatic language is
generated by the demographics; with declining birth rates and
increased longevity, our society faces crises in housing and health
care. The sixty-five and over population has grown dramatically not
only in absolute numbers but also as a percentage of the total
population (Golant, 1979:21). The problem is not that there is not
enough subsidized housing, as much as it is that there is not enough
senior housing available for elderly whose housing needs fall
between conventional housing and full care nursing homes.


5
In 1900, older Americans totaled 3*1 million people,
representing only 4 percent of the total population. By 1950, the
percentage of elderly had doubled, growing steadily to 9 percent of
the total population in i960. This number has continued to grow,
reaching 11.3 percent by 1981 (Katz, 1982:3).
There are currently over twenty-five million Americans
sixty-five years of age or older. Projections indicate that the
percentage of older people will increase anywhere from 14 to 22
percent of the population by the year 2030 (Katz 1982:4).
Additional national patterns of migration and locational
choice have changed markedly since the 1960s. Migration flows can
generate an aging population in three ways (McCarthy, 1983:Vii). In
many local areas, the growth of elderly is increased through
migration. Migration flows can generate an aging elderly, as seen in
many industrial cities of the midwest, a process called
"accumulation. Alternatively, the elderly may be drawn to areas
where other residents are leaving, making the elderly concentrations
highera process called "recomposition". If migrants of all ages
are drawn to an area, older people may be drawn in larger numbers
than younger ones; and as a result, there could be a concentration
through a process called "congregation", as seen in states such as
Arizona and Florida.
Each of these different processes produces high
concentrations of elderly in selected areas throughout the United
States. Two extremes can be identified with respect to density and
demand for services. In the first case, accumulation, where the


6
elderly are left behind and are very often at a disadvantage, the
abandoned region is often economically distressed. In stark
contrast are the areas of rapid influx of migrants of all ages. Such
areas may not be able to satisfy the needs of affluent elderly
newcomers, but may indeed prosper from the influx of residents, with
the increased aggregate demand, without taxing the local labor
market (McCarthy 1983:vi). As a result of these demographic forces,
the fraction of the nation's elderly living in concentrated
counties increased from twenty-seven to fifty percent (McCarthy
1983:vii). In addition, the elderly are becoming increasingly a
metropolitan population. These shifts reflect new patterns of
locational choice since 1970.
Economic Issues
The economic issues relevant to the elderly are directly
linked to the demographic make-up of the elderly population. Many
researchers and gerontologists have claimed that one of the
fundamental problems faced by the elderly population is simply the
lack of resources to acquire housing that best suits their needs
(Katz, 1982:2). One related factor of concern is labor force
participation. 1950 saw 46 percent of those over sixty-five and
over still in the labor force. The rate has decreased continuously
to 33 percent in i960, 27 percent in 1970 and finally to an all time
low of 19 percent by 1981 (Current Population Reports, 1976:51)
Not only are fewer people working past the age of sixty-five, but an
ever-increasing number are taking retirement at an earlier age.


7
The growth of the elderly male population parallels
declining economic independence. In the early 1900s, nearly two-
thirds of the men aged sixty-five and over were active in the labor
force, with the majority of these men living only a few years after
they became unable to continue working (Katz, 1982:4). The
j
statistics are slightly different for women. The percentage of
elderly women in the labor force has been relatively constant since
1950, with a 10 percent participation ratio (Katz, 1982:5).
Health Issues
Health concerns are paramount in the lives of the elderly.
As the number of ill, elderly and handicapped adults in the nation
increases, there is also an increasing urgency to develop long-term
care services that do not require institutionalization (Brody, 1969;
Wenkert, Hill and.Berg 1969; Caro and Morris 1971; Morris and Harris
1971; Pfeiffer 1973; Kahara and Coe 1975; Sherwood 1975).
Increase in Medicaid costs of the past decade, from $1.8
billion to $11 billion (with 40 percent for nursing home care),
contributes to a grim economic picture (Thompson, 1983:1). When
one notes that 40 percent of these payments are for nursing home
care, and then considers that twenty-five to fifty percent of older
persons in nursing homes do not need that level of care, the need
for housing alternatives within communities, new sources of interest
and financial support, and improvement of the product becomes
dramatically clear (Huttman, 1977:35).
Congregate housing is seen as a bridge to gap what is
presently being offered to the elderly. When looking at raw health


8
cost projection statistics, it is understandable why such concepts
are currently being funded by HUD. In a 1980 press conference,
Secretary Patricia Harris of the Department of Health, Education and
Welfare (HEW), responded as follows in to a question on the costs of
the "greying of America":
The aging phenomenon will have a significant impact on HEW's
activities. By 2030, 18 percent of the population55 million,
will be 65 or older. Today, only one man in five and one woman
in twelve are in the workforce at age 64 or older. Thirty years
ago half of all men 65 or older remained in the workforce. One
of the most obvious results of these demographic changes will be
an increased cost for programs serving older people. By 2010,
the cost of Social Security, SSI, Medicare and Medicaid,
Disability Insurance, and Black Lung programs is expected to
triple to $350 billion. It will jump to $635 billion by
2025...the vast majority of these payments will go to older
people. (HEW, 1980:1).
Elderly Housing Issues
Today, as never before housing deprivation is prevalent
among a substantial number of older Americans (Katz, 1982:163). For
those elderly who have no financial constraints, housing in a more
expensive price range is rather easy to locate. For those elderly,
however, who live on fixed incomes, the problem is great and is
expected to increase due to federal cutbacks in the HUD section 202
subsidies.
The 1976 Annual Housing Survey by HUD estimates that at
least 10 percent of the elderly population's residences are
physically inadequate. In addition, homes are very often located in
run-down urban centers. These homes were purchased during high
earning years before the rapid decay began, and thus are much older
than are those of the general population. Katz states that:


9
Older households, however, are more likely to live in older
structures (60 percent reside in housing built before 1950 and
47 percent in units constructed prior to World War II),
requiring costly maintenance and heating, to own their homes,
and to live in central cities or isolated rural areas (Katz,
1982:164).
The problem of the older unit is compounded by the fact
that many of these homes are located in less desirable
neighborhoods. In many American cities these neighborhoods are in
areas of decay and present physical dangers because of high
unemployment and racial tension. Many of these areas lack real
support services for the elderly.
Approximately 30 percent of all older households occupy
housing in central cities and are concentrated within the
slums or slowly deteriorating communities, one-third live on the
fringes of the central cities-often in older working-class
neighborhoods; and 40 percent reside in non-metropolitan areas,
mostly in small rural towns or on farms. (Katz, 1982:164).
The statistics given above are for homeowners. Another' 28
percent of the older population live in apartments, boarding homes
or hotels, and 61 percent of these renters are single people with
extremely low incomes. These rental units are often more deficient
than owner-occupied homes. In 1976, 17 percent of all rental units
and 16 percent of those occupied by the elderly had one or more
major flaws compared to 4 percent of all owner-occupied homes and 6
percent of those owned by older people (HUD, 1979:11)*
In summary, a growing proportion of the U.S. population is
older and is concentrated in relatively fewer counties, often in
declining neighborhoods. In addition, this population is less
affluent and is in need of housing which falls somewhere between the


10
traditional single family housing unit and full care nursing
facilities.
Housing Options
In order to combat many of the elderly housing deficiencies
the federal government has implemented a variety of housing
programs. Of the more than four million elderly rental households,
over 700,000 are now or shortly will be financed or insured by the
federal government (Villareal, 1977511) The major programs relating
to the elderly are included under Section 202 and Section 8
housing. Other programs, which greatly help the elderly, but are
not limited to them, are included under Sections 236, 231 and 232.
Section 202 housing was established in 1959 and was the
first direct loan program sponsored by the federal government. This
program provided construction financing and 50-year permanent
financing at 3% interest to non-profit and limited dividend sponsors
of housing for low and moderate income elderly and handicapped
persons. Before this program was discontinued in 1969, over 45,000
units in approximately 330 developments were built. Of the total 330
project loans, only one was foreclosed (Villareal, 1977:13)-
The 202 program was revised in 1974. This new plan provides
direct 40-year permanent financing to non-profit sponsors for con-
struction or substantial rehabilitation of housing for the elderly,
handicapped or disabled. Each project must be eligible for Section
8 rental assistance, from a special 202 set-aside fund. Each 202
housing development must be designed specifically for elderly and
handicapped residents; it can provide congregate dining facilities


11
and an array of support services. These may include health,
education, transportation, housekeeping, counseling, and referral
services et cetera. However, the established rent level is to cover
shelter costs only and not additional services such as those
provided by congregate facilities (Villareal, 1977:13)
In addition to Section 202, Section 8 is a major program
that provides rental assistance to low income elderly in both
metropolitan and non-metropolitan areas. This program is a rental
subsidy paid to the housing owner on behalf of an eligible resident.
The housing assistance payment makes up the difference up to 30.
percent of a person's monthly income and a rent established for the
unit. With a percentage of 25# set at the beginning of the program,
this amount was cbnsidered low by the Reagan administration, and in
1980 new guidelines were established at the higher 30 percent level.
This was slowly implemented at a one percent increase yearly to the
present 30 percent (New HUD Guidelines, 1987). The exact income
limits are defined by geographical area (Villareal, 1977:13)*
Whereas Sections 202 and 8 housing are primarily for elderly
populations within the exceptions stated above, older Americans may
also benefit from public housing. This option provides the elderly
with the greatest number of dwellings. In low rent public housing,
43 percent of all apartments are rented to the elderly (Villareal,
i
1977:14). Although this is a federal program, individual states do
participate through local taxes; instead of paying full property
taxes, these units make a payment in lieu of taxes (PILOT) which


12
equals 10 percent of shelter rents, and is the matching subsidy of
the local government (Villareal, 1977-15)
Table 1 has been compiled to show how some of these
financing packages conform to various kinds of subsidized housing
types. In addition, the table lists the advantages and disadvantages
of each option.


Table 1. Financing Options for Housing
Homeownership
Advantages Disadvantages Financing Opt Ions Place of Con 11nuum
Pride of Maintenance FHA Indepen-
owner sh1p Work/cos ts 203(b) dent
Fami1i ar i ty Real estate 220(d)
Rental Units taxes Too much apace Too much land to care for 221(d)(2) 223(e) 235 ( j ) 237 FmHa 502 Private Mortgage- c ompan ie s Financing Place of
Advantages Disadvantages Options Con t inuum
Independence Age-segregated 202 Indepen-
Social Inter- cannot live Public- dent
action with younger Houslng
Keasonable members of 231
rent (vhen family 236
subsidized) Not Buited FmHa 515
De & 1gned for for those BM1R
elderly who need assistance Rent Supple- ment Section 8
Congregate Housing
Financing Place of
Advantages Disadvantages OptlonB Con tInuum
Lira!ted- Costs may be 207 S em 1 -
maintenance high 231 indepen-
202 dent
Social- Age-segregated Pub 11c-
lnteractlon Semi- houslng
Central- Institutional Section 8
dining setting Conventlonal
Support- FmHa 515
services
Facilities
designed for
elderly
Nursing Hose
Financing Place of
Advantages D1ssdvan t age s Options Con tInuum
No maintenance Costs may be HEW Dependent
responsibilities proh1b11 ive Private
Social Inter- Age segregated
action Institutional-
Specially designed setting
facilities


14
Congregate Housing
Congregate housing is a relatively new concept given
official support under Title IV of the Older Americans Act of 1970
(Sherwood, 1981:284). Its basic purpose is to enable the elderly to
live independently, or at least semi-independently for as long as
possible, keeping those who are able out of the "skilled" nursing
home setting (Huttman, 1982:99)* Although congregate housing was
officially sanctioned in 1970, the fifty-year Section 202 funding
did not cover any service costs. Congregate housing was finally
accorded legislative support by Section 7 of the Housing and
Community Development Act of 1974:
The secretary shall encourage public housing agencies to
design, develop or otherwise acquire . housing to meet the
special needs of the occupants. .for use in whole or in part
as congregate housing (Malozemoff, 1982:1).
And although Congress approved this amendment it did not
appropriate federal funds to help defray the costs of the services
that congregate housing was to provide. It was not until 1978, under
Title IV of the Housing and Community Development Amendments Act 92
Stat 2080, 42 USC 5301, that limited funding was authorized
(Sherwood, 1981:285). It was then that apartments were planned and
built using federal subsidy to help defray the costs of services to
residents.
The congregate housing concept has been under consideration
for the past 17 years; however, little research has been reported
concerning its feasibility or viability. In order to fully
understand congregate housing, one must first define its intent.
Congregate housing was first conceived to be a semi-independent


15
facility for handicapped persons of all ages, for citizens with
mental disabilities and for the elderly population. The Director of
the Newark Housing Authority states:
Congregate housing is primarily designed to prevent un-
necessary institutionalization,to alleviate social isolation, to
provide health, education, screening, diagnostic counseling, as
well as to provide a program of balanced nutrition, and
nutrition counseling, designed to meet the needs of older
people; to provide program participants with the knowledge and
ability to run their households efficiently and with a minimum
of exertion; and to provide group interaction, and a sense
of community in a variety of recreational and social activities
(Notte, 1975:911).
In the early 1970's the federal government recognized a need
for a new type of housing for the elderly. Previously, older
Americans had lived either independently or perhaps with family or
friends. When the aging began to have emotional, physical or
economic difficulities, they would be transferred to a skilled
nursing home where they would receive 24-hour care.
There were, however, some major flaws within the skilled
nursing home alternative as the only option. The skilled nursing
home has been designed to help those no longer able to care for
themselves under Medicaid. In the 1960's the cost of Medicaid was
about $1.8 billion annually; this figure increased in one decade to
$11 billion, with over 40 percent going to nursing home care
(Thompson, 1982:1), and these costs are projected to skyrocket as
the actual number of the elderly increase. Planners have turned to
congregate housing in reaction to numerous studies that show 25 to
50 percent of those elderly now being taken care of in nursing homes
do not require that level of care (Chellis, 1982:1).


16
The federal government is currently dispersing substantial
monies to pay for a level of service that seems to be required only
in a small number of cases:
Clinical assessments of elderly persons seeking institu-
tionalization indicate that many. require only some of the
services that are offered with the institution and would
probably be maintained successfully in more independent settings
where such services are available (Sherwood, 1971)
In looking at congregate housing in relationship to other
types of housing, the following matrix shows that congregate housing
is the middle tier of the total housing concept that bridges many
gaps between independent and dependent living:
TABLE 2. THE LIVING CONTINUUM
INDEPENDENT CONGREGATE DEPENDENT
* Shelter X X X
^Management & X X X
Operations Essential
* Housekeeping X X
* Transportation X X
* Nutrition/Meals X X
* Health & Medical X X
* Protective & X
Security
* Social/ X
Educational/
Recreational
As people grow older, what begins as a convenience or
amenity which allows more leisure, gradually becomes more and more a


17
necessity. The differences between independent, congregate and
dependent facilities are primarily of degree rather than kind
(Villareal, 1977:38). The same basic categories of services may be
offered in all three, but a different level of services is typical
to each. The tendency in dependent living facilities, such as
nursing homes, is to provide care rather than services,and this
distinction between care and services implies a different attitude
focus on the part of the management. While service is provided to
the consumer on demand, provision of care involves the actual
survival needs of the residents.
Thus congregate housing falls in the large middle ground
between the two extremes of independent and dependent living. Its
focus is the provision of services to residents who want and desire
the security of knowing help is available if needed, but for whom
such help is neither a permanent requirement nor usually necessary
for survival (Villareal, 1977:38).
Theoretical Issues
As discussed in the introduction, this research project is
exploratory, theoretical as well as empirical; Its theoretical basis
is Goffman's concept of the total institution.
Congregate housing offers an alternative to the typical full
care residential settings, i.e., nursing homes which might be
described as "total institutions". According to Goffman a total
institution is a place where "people can be handled in batches
because they are pressed into a uniformity that makes any deviation
stand out (Schmidt, 1981-82:157)- Particularly in the case of full-


18
care facilities for the feeble aged, such features as "the assault
on privacy, lack of individualization, loss of autonomy and caste-
like separation of patients from personnel (Schmidt, 1981-82:157)
have raised concern. Schmidt offers one promising approach to
further analysis of congregate housing settings:
If institutionalization totality describes the structure,
the social exchange perspective explains such behavior as the
paucity of friendships between patients; the hierarchy of
patients, boarders and staff; and some of the deadening control
(Schmidt, 1981-82).
Although this theory has been applied to nursing homes it
can also be applied to the congregate concept. Congregate housing is
set up in such a way to give more autonomy to the individual than in
the nursing home setting by simply having an apartment available to
each resident. Some congregate housing is moving toward a semi-
nursing home environment as its resident population ages, through
the addition of nursing home "wings".
This new development is due in part to the fact that
congregate housing is becoming increasingly more popular and that
with this increased popularity, residential needs are changing. The
phenomenon of "aging in place" is starting to become more common
than one would have thought at the inception of the congregate
concept.
The aging-in-place phenomenon can be described as involving
those elderly who settle within a facility that meets their needs.
Once this has been accomplished, they naturally remain out of
contentment as studies have shown. A Cornell study relates that 70
to 80 percent of, the surveyed members of elderly households were


19
unwilling to leave their neighborhoods (Chellis, 1982:53)
Additionally relocation studies have found a forced move so
stressful that it may have caused an increased death rate (Huttman,
1977sl5) Thus the elderly commonly age in that setting where they
are first located, resisting a move due to expense, physical
incapacity and the trauma of uprooting even if the current residence
is substandard.
As the elderly grow older, they are in need of increasingly
specialized services. There are two main alternatives currently
undertaken by the study sample: those facilities which are
completely independent of any hospital affiliation are opting to
have these older residents make the transition into nursing homes.
The other alternative, exercised mainly by those affiliated with
hospitals, is to either build or set aside room for more intensive
care for residents, thus incorporting a nursing home environment
into the congregate setting.
The concept of "life-course" developed by Matilda White
Riley, offers another view of congregate housing. Although it is not
a theoretical concept, it is useful as a descriptive tool. Life-
course is a multi-disciplinary, multi-dimensional idea of how people
age. Its basic premise is that a community or group of "cohorts" of
people begin to age at birth, and that the life span of the
individual is a steady development of common experiences built upon
each other.
This concept of aging is not new to the field of sociology.
Matilda White Riley and Glenn Elder have used the construct to


20
examine many past assumptions about aging. The concept cohort is
critical to the meaning of "life course", especially when one speaks
of a generation of cohorts going through similar experiences and
thus holding similar values. But the time frame for one generation
is too long, as a cohort group can consist of one to many years.
One example often cited is that of the Vietnam War era. That group
of cohorts who were in the last year; of draftees today differ
greatly from those that came only one year later; although both
groups belong to the same generation their values, lifestyles, and
political outlook diverge.
Summary
A review of the literature reveals a growing need for more
diversity in housing stock for aging Americans. Congregate housing
has evolved as an vital response to the gap that existed between
independent living and full care.
Additionally, research on this new phenomenon is all but
missing, with the exception of one national study. Thus a need is
present for both descriptive research and an elaboration of theory.
Of particular note is the aging in place phenomenon, which increases
the risk of unnecessary institutionalization within congregate
housing facilities. This study, essentially exploratory and
descriptive in nature, attempts to respond to this recently
emerging phenomenon in elderly housing.


CHAPTER III
METHODOLOGY
Inception of Project
A request for assistance with a market analysis from a
private developer in the Denver metropolitan area initiated this
study. The developer had a plot of land, located just to the east of
Downtown Denver, in an area with a heavy concentration of senior
citizens. The developer was interested in acquiring data on the
feasibility of a high income elderly high rise congregate facility,
and on other congregate residences in a three mile radius of his
planned development.
The developer turned to the Applied Sociological Research
Team (ASRT) at the University of Colorado at Denver. The ASRT
considered and accepted this request for an in-depth look at
congregate housing, since it has focused on similar gerontological
issues in the past.
The ASRT took on the job of conducting the research for the
developer, but at the same time enlarged the project so that it
could serve a wider group in the community than the original
sponsor. Once the project was underway, and the literature review
began, a national survey of congregate housing was found to have


22
been done in 1976- by The Urban Systems Research Group of Cambridge,
Massachusetts, chaired by Irene Malozemoff.
This researcher decided to replicate parts of this national
research, comparing one section of the Denver Metropolitan Area with
the national study. The research proceeded with two goals in mind:
to help the developer, and to broaden the data base that could be
used by local community organizations upon completion.
The Director of the Colorado Gerontological Society helped
the project by an informal conference which was held to lay out the
research instrument for her inspection.; It was our hope to tap her
many years of experience in the elderly housing field, avoiding as
many pitfalls as possible in the actual design of the research
instrument.
The Sample
A base list compiled by Choice, a local social service
agency, possible units. Of the 'JO available units, 48 were picked
within a three-mile radius from Cheeseman Park. This sample, within
the Denver elderly housing market, represents an adequate cross
section of care levels.
Lists detailing the number of units and locations of elderly
housing were acquired through Choice, a local non-profit
organization, which receives federal grants to research available
housing for the elderly and to act as a housing referral for this
population. This list was used to identify the population, and it
gave a total of over seventy units as potential residences. Those
facilities located within a three mile radius of the Cheeseman Park


23
Area were deemed; to fit the criteria jof this project and were
included in the survey.
Forty-seven units, randomly chosen from a total of eighty-
seven and taken from lists provided by Choice were included in this
research. They vary widely with respect to classification, rental
ranges and amenities offered. Among the units contacted, three main
sub-categories can be described.
The first category, in which the majority of the research
units can be grouped, is in the subsidized apartment sub-class.
From the total sample, thirty units fall in this category. These
apartment buildings are similar to, if not exactly the same as other
.non-subsidized non-elderly complexes. Very often these units have
been converted from regular residences to elderly use with wider
doors, ramps, and emergency pull cords with upgraded smoke and fire
detectors in the apartments, in corridors and open meeting areas.
These apartments are solely for those residents who are able to
maintain an independent life style, with few if any amenities
available.
The second category is the low-income, subsidized congregate
facility. From the total sample, twelve fit this definition.
Services in this grouping include prepared meals, some type of
emergency pull cord system, a buddy system in which residents check
on each other daily, and an Activity Director. When they were
interviewed many managers stated that the residents appear to have
a greater sense of community than in non-congregate residences due
to shared activities. The average cost of these units varies. The


24
HUD guidelines state that the monthly cost of each unit may not
exceed one-third of the resident's income; this means that the cost
varies per person, depending on the total gross income. Most of the
managers interviewed said that the typical cost ranges from $85 to a
maximum of $250 monthly.
The third: category encompassing five units is the private,
for-profit, congregate residence. The costs of these units with the
exception of the Downtowner, which was one of the major units
visited and explained in the Two Case Studies chapter, were
considerably higher than the subsidized units,ranging from $800 to
$1700. All of these dwellings have amenities similar to those
offered by the subsidized units, and other conveniences as well.
On-Site Inspections
Once the research team had begun phone interviews it also
began to conduct on-site inspections. The interview's intent was to
get a feeling for the actual "look" of the varying housing options.
The questionnaire was designed to acquire data in regard to the
amenities offered at each residence, but, it did not give an idea
of the condition of individual units, or neighborhood and other
factors.
Ten different units were picked from the sample to be
visited during on-site inspection. Four of these were subsidized
congregate residences, and four others from the private congregate
market. The remaining two were of the first category, in that they
were independent living arrangements. This skewed distribution,
looking at few of the independent residences, was intentional:


25
congregate residences have been the actual focus of the study within
which independent residences were a control group. The process of
the on-site inspection incorporated appointments at each of the
different residences, and management or other representatives gave
tours of each complex. In non-subsidized housing, this function was
usually carried out by the Activities Director or other office
personnel as part of their regular duties. All four tour guides in
the private sector were extremely well-informed about not only the
units themselves, but the amenities and services offered. After our
tours, it became clear that these were seasoned professionals, who
treated us as if we were going to move into the units ourselves, and
who attempted to relate to us as professionally as possible.
The person giving the tours at the subsidized units was
always the manager of the complex. The tours were very informative
about both building and amenities. However, the presentation was not
as heavily influenced by a clear marketing objective as in the
private sector. The notion of subsidy conjures up many pictures for
different people; In it some feel the subsidized units are drab,
dreary and unlivable. Gauging from the on-site inspections one feels
that this conclusion is unwarranted. Many of the subsidized units
are older and therefore lack some of the newer amenities offered in
the private sector; however, they are not strictly speaking inferior
Perhaps the outer appearance of the older dwellings contributes to
their negative image. Or private sector marketing programs may work
harder at packaging their product.


26
Instrumentation
The survey had 199 variables upon completion. The average
time spent on each interview was between 10 and 15 minutes; this
varied with the number of comments given by the interviewee. All of
the questions posed to the managers were closed-ended, with the
exception of the last two. Many of the managers wanted to elaborate
on the particular benefits of their building, and this brought the
total time for many interviews up to 30 minutes or more. A pre-
test, included in the Appendix was administered to five randomly
selected complex managers. Minor changes in the final instrument
were made on the basis of five initial questionnaire. The wording of
the questionnaire was revised for clarity, and a few new items were
added in direct response to questions posed by managers, to ensure
thoroughness. All of their concerns were addressed in the final
instrument.
The first part of the interview asked for information on
the building, such its name, address and idenification of its owner.
This information was used later as an identifier. Researchers also
asked at this point for the name of county in which the facility
was located. The name of the contact person and the phone number.
The contact person and phone varied with the size of the unit; very
often this name was the same as the manager being interviewed.
However, in larger complexes, a management firm had control of all
j '
operations, including answering any and all questions. Some large
organizations had an information officer, who handled all questions.


27
A typical example is the Catholic Archdiocese of Denver, which owns
and operates several of the complexes included in the survey.
Some of the age qestions attempt to determine the range in
age of residents of each unit. The subsidized complexes were
expected to have a higher average age than private complexes, since
it was thought that many people moving to expensive complexes
retreat from the responsibilities of home ownership, whereas those
in the subsidized units come to a facility as a last resort: short
of a nursing home; because this postpones the decision to move as
late as possible, they appear to older.
In addition, the study addtesses a question posed in the
Gerontology literature referring to the elderly in terms of "young-
old", "middle-old" or "old-old" (Housing Management 1977:6). These
distinctions (See Table 3) have evolved out of the longevity
phenomenom of the elderly population. As this population increases
in size and variety, the difficulty in finding common terms
increases. The matrix below a breakdown of age distinctions:


28
Table 3 Elderly Transitions
AGE
62 75 85
Young-Old Middle-Old Old-Old
Capable of living Probably face Increasing
independently, disruption in isolation as
in comparison lifestyle due peers die and
to two older to death of health
subgroups spouse, decreasing financial resources and increased health problems. deteriorates
Adapted from The National Center for Housing Management 1977
It was important to classify each facility included in the
interviewing into either "congregate" or "non-congregate". Most of
the managers needed brief explanations of the categories, as they
were not always aware of them. Then they decided which category best
described their buildings. The last question in the section of the
questionnaire (number 6) was whether the residents owned or rented
%
their apartments. If the units were owned, the interview was to be
terminated, since this survey focused exclusively on rentals. None
of the residences listed by Choice, were owned, and therefore no
interview was concluded at this point.
The questions of greatest difficulty for the managers
concerned square footage, number of vacancies, rental ranges and
total number of units in the efficiency, one- and two-bedroom cate-
gories. This question required a deep familiarity with the complex,
that many of the managers simply did not have. The square footage
question was of extreme importance. It was the major unit of measure


29
used to make comparisons among the range of complexes. For example
the category with one bedroom ranged from under 100 square feet up
to 660 square feet. This places a quantitative difference at the
basis of a comparison.
Of the forty-seven cases in this survey, forty-one required
a damage deposit. This variable seemed to be standard among all
residences questioned. Other fees for entry, handling and processing
etc., are more often associated with privately owned units than with
rentals and are not allowed by HUD. Only the damage fee and, if
applicable, a pet damage fee can be charged. The minimum damage fee
chargeable is $50, with the maximum being 30 percent of gross
monthly income that a resident pays (New HUD Guidelines, 1987).
The question regarding a waiting list is in direct
relationship to vacancies; this was broken down into either the
total number on a waiting list, the more commonly used measurement,
or into number of months, which was given by a number of
managers/owners. The private high-rises, the high end of the market
had, without exception, no waiting lists (See Table 7)- Each of
these four residences had immediate move in possibilities. The
subsidized buildings, on the other hand, all had waiting lists
without exception. The total on the waiting list varied from unit to
unit, but the range was spread evenly from one month up to three
years.
Question 16, asking whether the complex provided personal
property insurance, should have been omitted after the pretest.
Every complex answered this question in the negative. It was


30
originally thought that the complex might at least offer additional
protection of the contents of one's residence, using the complexes
blanket policy.
Additionally an important question asks who pays utilities.
Who pays utilities is an important question. Whereas the federal
government has invoked the one-third amount with regard to income
and total rental payment, this includes major expenses such as heat
and electricity for facilities in the private sector. HUD looks at
heating and electric costs in its 30 percent subsidy figure, and
this 30 percent rate assumes that all; utilities are paid by the
l .
owner. If this is not the case in subsidized housing, the 30 percent
paid to the owner can drop proportionately to 25 percent.
Therefore, most owners opt to pay all utilities which entitles them
to the full 30 percent subsidy limit (New HUD
Guidelines, 1987).
The entire concept of congregate housing has been discussed
in previous chapters. In looking for that one common denominator,
service and costs involved had to be covered at length. These
questions, numbers 18 through 20, are the main variables used to
classify a residence as congregate or non-congregate. In question
18, there were some minor problems with the meal concept; many of
the residences had a traditional in-house kitchen. Other complexes,
only within the subsidized sector, had contracted with firms to have
prepared meals brought into the complex. This difference was quickly
noted during the interview process; however, it was decided not to
make a distinction between the two for the purpose of classification


31
into congregate or non-congregate. The fact that meals were served
to the residents was considered to be in compliance with the
congregate concept. The most common outside firm used in the Denver
Area, is the Title X meal program, run by the Volunteers of America.
The first group of questions included in this survey can be
grouped into the categories of security, services offered and
amenities. These .specific items are used to separate a congregate
residence from the non-congregate, in addition to the meal service
provided. The issues of safety and fear recurs throughout the
literature on the elderly (Huttman, 19775186). Very often these are
paramount concerns due to the location of the older citizens in
centralized urban areas with high crime rates. Not being able to
fend off an attacker, because of frailty, combines to make the
elderly vulnerable to urban crime.
To get a feeling for what steps are being taken to
ameliorate this distress, questions regarding the security of the
building were asked. Guards, staff, electronic devices and emergency
pull cords seemed to be common to many buildings, and the managers
of all complexes were questioned as to the extent of these
services. If any or all of these were installed and in operation,
the hours provided were also ascertained. To have guards or staff
on duty is reassuring but if they all leave at five in the
afternoon, the building is defenseless at night. On the
questionnaire, "electronic" was operationalized as a door buzzer
system. This seemed to be the most common security device, used
even in the older units.


32
Other items such as oxygen in rooms, intercom in room, hall
cameras, and a daily check system were also included in this first
section. Although these might not be technically considered security
devices, they were put in this section because they relate to an
additional fear that many elderly have, of falling down and not
being able to summon help. The Emergency pull cords help solve this
hazard as does oxygen in the rooms. The fear of falling and being
incapacitated alone for long time periods is a profound fear of
residents and the daily check system does offer one solution to this
problem.
The daily check system is in place in the majority of units,
often as a buddy system. The complex is usually split up into groups
such as floors, wings or perhaps a certain number of units. In most
cases the residents volunteer to participate; assigned residents
take the responsibility of checking on other units in their own
sector. There are a number of ways of accomplishing this including
going door to door and knocking. This method has been criticized by
many as an invasion of privacy and subsequently due to this the
"ring" system has been instituted in many buildings. The ring
system involves putting a ring around the outside door knob at bed-
time. The ring itself can be made from different materials; very
often they are knitted by the residents for this sole purpose. At a
specified time the next morning, any rings that have not been
removed will serve as a warning to that person responsible for the
floor or sector. This person will first knock and speak with the
occupant, to see if the ring was not left accidentially. If no one


33
answers the manager is summoned immediately to investigate whether
or not there is a real problem.
This procedure can vary according to kinds of control
mechanisms available within the variations in congregate residences.
Very often if a resident does not come to the dining area for
breakfast, a staff person is then responsible for calling his or her
apartment. In speaking to a number of residents, researchers found
that some resented this keeping track of their personal lives,
although the majority supported behind the policy, realizing that it
could someday save their lives.
Health is the elderly's paramount concern. For this reason,
a number of questions regarding professional care providers were
incorporated into the survey. This is one major area where
congregate housing is trying to offer many shared services to the
residents for convenience and also to reduce individual costs. In
this category, the study tried to evaluate to what extent residents
needs were being met.
The availability and prevalence of counseling was also
included in this section. Questions about general legal and other
counseling were asked to get a feeling for whether financial and
legal problems that many elderly face are being addressed. Mental
stress that many residents experience through the trauma of loss
constitutes an instance in which professional counseling might be
used. Finally, the adjustment that many must make to living in a
group living arrangement after lifelong independence was thought to
be an additional source of stress that requires counseling.


34
Transportation was an important question in terms of how
readily residents might leave their complexes. Whereas the City and
County of Denver does operate a bus system with an additional
handicap vehicle, if one is not going to an area of major
concentration it is time consuming and difficult. Thus whether or
not the management perceived a need to make transportation available
to their residents was questioned in addition to whether there was
a charge for such'a service.
The amenities section of the questionnaire is complex and
lengthy. It was hoped to cover any and every possibility for what a
complex could offer to its residents. As the questionnaire in the
appendix illustrates, the list runs through arts and crafts, a
library, guest parking and common television area to a beauty shop
and a swimming pool. These categories are further subdivided
according to whether the particular amenity is within the walls of
the complex or in the neighborhood. Neighborhood is operationalized
as being within walking distance.
The full list of amenities ranging from a common television
area to sauna and whirlpool were adequate for all the residences
interviewed. These categories cannot be directly related to the
national study by Malozemoff, as in her study they are collapsed
into a more limited range, including: meal service, transportation,
commercial, medical, housekeeping, linen, and protection. These
different groups are compared in the Summary section of this study.
Parking is a critical issue for any complex- located within
the urban setting. This study attempted to ascertain how many


35
spaces, if any, were provided to the residents, and if no spaces
were provided whether rental space was made available.
Although ^ the congregate concept does provide for meal
service, the study asked if individuals had kitchens or kitchen
privileges. The reason for this was two-fold: first, to find out if
the congregate units would provide any type of cooking, thereby
providing each resident with opportunities to cook for him or
herself. The fact that residents naturally might want to cook their
favorite recipes were all seen as additional reasons to ask this
question.
Secondly, although congregate housing is undeniably the
focus of this research, other non-congregate units have been
included for the purpose of comparisons. It has been imperative to
have a comparison in the independent living sector to use as a base
measurement tool. Therefore question 27 was designed to determine
whether the kitchen was fully or partially equipped. To better
define this point, five sub-questions were added asking about major
appliances to see if the kitchen was full by our definition and not
by one the manager could have thought correct. Some, but not all
managers, might consider a hot-plate to be a kitchen.
In 1985, the Department of Housing and Urban Development
(HUD) made a new ruling. That allows residents to have pets.
Previously, complex managers made this decision. Research has shown
that pets can have a quieting effect on certain people and can help
meet the elderly's need for companionship (Chellis, 1982:155)*


36
Also of interest was whether any additional damage deposit was
required; for pets (the maximum of $300 allowed by HUD).
One of the few open-ended questions in the survey concerns
the policy of a complex when a resident becomes incapacitated. This
was left in the open-ended form to prevent a facile response, and
then coded upon completion, and a variety of answers were given. The
last question of the survey is also open-ended, asking for any
additional information from the manager or owner which might have
been over looked by this research instrument.
The above described variables and/or questions are perceived
to deal with the major aspects of congregate housing for this
study. In order tp get a complete picture of the congregate housing
concept, two additional aspects, researched in the national survey
would have to be incorporated including interviews concerning the
entire financial make-up of the organization as well as a survey of
the residents themselves. These aspects were a concerned of this
project; however, it was felt to be too large a project to
undertake, and that the data gathered in this survey might enable
others to go one or two steps further.
Data Analysis Procedures
Upon completion of telephone! surveys and the on-site
inspections, the data were computed with all cases entered into the
system. Statistical manipulations were kept to a minimum. Since this
project is considered exploratory, and therefore almost entirely
descriptive, Cross-tabulations and frequencies were run on the data,
and this was the extent of statistical manipulations.


CHAPTER IV
TWO CASE STUDIES
Introduction
An important part of the research for the developer was to
personally visit a cross-section of congregate housing facilities in
the catchment area, an area which extended approximately three miles
out from the site of the proposed new- development. These on-site
visits were designed to elicit information about the following
general topics.
a) Physical lay-out of different facilities
b) Resident's patterns of activity, especially in the public
areas of the facilities
c) Staff presentation of information as the tour was
conducted
d) Neighborhood settings of the facilities
A total of ten facilities were visited. Of the ten completed
in this survey, two facilities were picked to represent two extremes
with respect to location, resident; population and problems
encountered at eabh site.
The Denver Arms, located in suburban Denver, and the
Downtowner, located in the downtown urban core function as the
poles of the study. (Both names have been changed to protect
residents and management). The Denver Arms was selected to represent


38
the high end of the market; its average rent of $1500 monthly can
. only be paid by a small number of retired professionals. The
Downtowner, on the other hand, is composed of low-income residents,
who are used to living in the downtown area. Many of these residents
are Chronically Mentally 111 (CMI) and/or alcoholics.
The Denver Arms is located at the edge of the study area
included in the survey. It is in an older, established residential
neighborhood; it has non-profit status through its affiliation with
a major acute-care hospital, and occupies the same grounds
approximately 500 yards to the south of the hospital. This
residence is one of the most expensive complexes in the Denver
Metropolitan Area. Monthly rents range from $1200 for a studio
apartment to approximately $1700 monthly for the large two-bedroom
unit on the top floor.
Ample parking is located in a semi-circle around the front
entrance. A wide driveway also has an awning to the entrance,
making the delivery of residents into the complex extremely easy,
and something that can be accomplished in bad weather. The grounds
are nicely kept with abundant landscaping.
One enters the complex through automatic electric doors and
is confronted with an impressive lobby. The ceiling is two stories
high, giving the feeling of openness and airiness. There are ample
plants and other foliage suggestive of a personal touch. The thick,
rich carpet imparts an immediate sense of quality, along with the
black Steinway grand piano, located in a strategic area, in full
view from almost any angle in the lobby. Chairs, couches and all


39
other furnishings are done either in quality fabrics or leather,
giving an overall picture of quality, elegance, good taste.
An information center faces the electric doors where one
picks up mail and buys postage stamps. Staff and management are also
located behind this area, ready to answer questions about the day's
menu and other things of interest to residents. There are large
electronic boards mounted on the walls to keep track of all burglar
and fire alarms within the building. Television monitors are also
on to see who is coming and leaving the building at any given time.
This area also serves as the monitoring area for the emergency pull
cord system, installed in each and every unit. Should any resident
use his or her emergency system, a light goes on in the main foyer
showing exactly where the cord has been pulled, and staff can be
dispatched immediately.
After we had waited in the lobby for several minutes, the
male director of the complex approached us, and the two elderly
women seated next to us. These women were prospective residents,
there for the first time. There was! little movement of other
residents through the lobby and no visable planned activity.
The manager first provided us with an array of literature
about the concept of congregate housing, the history behind the
construction of the building, complete descriptions of building
security, and a list with full descriptions of all amenities
offered. We then went to the first wing of the building to begin
our tour.


At this point, we were unable to actually see a unit; it was
explained to us that this corridor has a dual purpose. Family and
friends visiting regular residents can rent these extremely small
apartments on a day-to-day basis, protecting the privacy of all
concerned, and making it easier for visiting relatives or friends to
remain in the same building. It also gives the visitors the
opportunity to eat with the resident in the dining room.
The second function of these units is to allow family or
friends from out of town who have someone in the adjacent hospital
to rent a unit. This is one of the benefits of having both
congregate residence and hospital next door to each other with
official affiliation. Shared services can benefit both complexes. At
the time of our tour this wing was filled to capacity, and therefore
the individual rooms could not be inspected.
We proceeded to take the elevator to the second floor; there
are two sets of double elevators in the center of the building. All
elevators are extremely wide, allowing wheel chairs and mobile beds
to be rolled in and out. Each floor's elevator door is a different
color, to allow for easy identification. At this juncture the
director gave us more information on the complex; there is a weekly
linen service which changes all linens and throughly cleans each
apartment. In addition, there are washing machines located at each
end of the hallways. All of these services are included in the
monthly rent.
As we steped off the elevator, the director constantly
greeted residents, appearing to know each of them by first name


kl
basis. There appears to be a conscious effort to give all
residents a feeling of belonging and identity within this complex.
During our examination of a one-bedroom unit, the director explained
the emergency cord system, showing us where they are located
throughout the apartment. The apartment is of average size at 600
square feet, in which the use of space is maximized The director
spent considerable time explaining the bathroom layout, stating that
it is regrettable that there is no bathtub, and that this seems to
be a common complaint. Instead there is a large shower, with a seat
if one needs or wants it. He further explained that there is less
risk of falling with this construction. The kitchen is fully
functional, though extremely small; refrigerator, stove and single
sink are standard in each unit. The director said that many
kitchens are indeed used to prepare meals, although it is mainly
used for snacks. Research had shown that people were not interested
in a unit without a kitchen whether it is used or not; possibility
of living without a kitchen after a lifetime of living with one is
unthinkable to most prospective residents.
From the apartment we proceeded to the library on the top
floor. The room is spacious with very comfortable chairs to sit and
read in. All books have been donated by residents and not purchased
by the complex. There are current magazines spread around the room,
which have been subscribed to by the Denver Arms organization. There
were no residents in the library at the time of our visit; the
Director reports that it is seldom used by the residents.


42
The building director left us to resume his normal
activities; with.the activity director, we went to the bingo room,
where a game was in progress. The activity director told us that
bingo is the most popular pastime activity among the residents; the
entire question of gambling had been brought up by several
residents, but when management attempted to ban the money part of
the game, the residents joined forces to resist the new rule and
management quickly backed down.
The Resident Committee is a duly elected body from the
residents at large, who decide some policy. The bingo controversy
was one such matter. The activity director also related an incident
concerning movie rental. Originally, it was the activity director's
job to choose and procure the movie for the nightly entertainment.
Many residents were displeased by her selection, so she relinquished
this function to the Resident Committee, who took over the role and
now chooses all movies for the complex.
Clearly, the Resident Committee has many functions.
Foremost among these is to keep residents active and in contact with
their immediate community. Secondly, via the Committee, residents
can make decisions affecting their own lives. The elderly are
affected positively by being able to have control over some of their
actions (Huttman, 1977117)
Tables were being set for dinner as we observed the dining
area from the second-floor. The dining room is on the other side of
the walkway from the spacious lobby. The dining room is large, with
each table set for four persons, and there is a cafeteria-type of


43
service with trays that are for breakfast only. Lunch and dinner
are ordered from a waiter or waitress and are then brought to the
individual tables.
Back in the lobby, the activity director asked us if we had
further questions; we asked what the official relationship is
between the hospital next door and this residence. She explained
that there is an official connection, and that anyone requiring
medical attention can get it immediately from the hospital either
when paramedics are dispatched, or by being transferred next door.
Each situation isguaged according to its seriousness.
The main drawback to the Denver Arms is its high rent. The
amenities and services offered are excellent; all of the services
such as laundry, linen, maid service and others are included in the
monthly rent. Most of the other residences in this survey also
offer many of these same services; however, many are not free of
charge. There is an additional charge for each service used. In
other residences, for example, the washing machines are coin-
operated. When one is paying $1700 per month for an apartment, one
would expect to get above-average treatment and this is definitely
the case at Denver Arms.
The Downtowner, located in the downtown inner-core, six
blocks from the main train station and five blocks from the downtown
bus depot, is in stark contrast to the Denver Arms. The main
entrance faces a heavily used one-way street; the other three sides
of the building are surrounded by parking lots which are full during
the day and empty at night.
)


44
We began our tour of the Downtowner in the main lobby.
There were a number of residents sitting on the outside porch of the
building six feet from the busy one-way street. We were greeted by
the representative of the building management firm which manages
not only this building, but a number of others included in this
survey. We were immediately told that this complex is not
subsidized as we had assumed. The management company does indeed
l
have the 501 (C) 3 non-profit status, however, it is simply managing
the building for a private group of investors. The residence
currently does not generate enough funds to show any profit, so the
non-profit management company is waiving its fees until a profit
margin is achieved. It will then receive its professional fees for
the past number of years.
As the Downtowner is over 100 years old, it has the turn-of-
the-century architectural style, however, it has been modernized
with an elevator, smoke detectors, emergency power system for power
outages, and a fully-functional fire emergency sprinkler system in
all rooms, hallways and bathrooms.
We rode up to the mezzanine to tour the kitchen located on
this level. Tables and chairs, which can accommodate up to thirty
people at a time are located in this area. The tables are placed
next to the railing, so that one can see over the railing and down
one floor into the lobby. This gives one a feeling of openness,and
the opportunity to see all the "goings on" below.
The kitchen itself is compact, but with enough room to work
without bumping into other objects. No open cookingflames or


45
grills are allowed in this kitchen. This stipulation was ordered by
the fire department, since the owners were unable to obtain an
easement to use the air space above the parking lot in the rear of
the building, for required ventilation. .
In spite of these technical problems, the kitchen looks and,
we were told, functions very well. There are microwave cooking
machines and ovens which can be used. The director showed us the
entire kitchen in detail, giving us a weekly menu. The range of
offerings made us wonder how the staff is able to prepare such a
rich variety of meals with their cooking handicap. We were told
that the food is excellent and that most residents rarely miss a
meal.
The Downtowner has a warm feeling. The floors, doors and
trim have all been done in dark wood stain. The ceilings are high
(12 feet where current code sets 8 as the standard) with the old
turn-of-the-century ceiling style which has a rich three-dimensional
pattern. All door knobs, floor level indicators and door numbers
have brass fixtures.
When we asked about renovation, we learned that the building
has been placed under the National Historic Preservation system.
One of the originators of the renovation program was an architect
who believed that the original integrity of the building should be
preserved. It was through her efforts and that of others that the
building was brought up to current code without the sacrifice of its
character. When we inspected a one-bedroom apartment, we were
impressed with how well the renovation has been done; all lamp


46
fixtures are new, but reflect the time period of the building. All
woodwork is in excellent condition, and adds an elegance that is
lacking in many of today's buildings, where cheaper materials such
as plastic are used extensively.
One-bedroom apartments in the Downtowner are extremely
small. There is one small closet and a sink for fresh water; none
of the units in the building have any cooking facilities. Most
bathrooms are shared by up to, but not more than, four residents.
There is a single bed in the room next to the window, with little
room for anything else. The unit encompasses approximately 120
square feet.
On the top floor, we viewed a unit with a half-bath; one may
choose half-full-f or no bath, and this is the distinction in the
t
various rental ranges. Height is not a factor in price as is common
in many high rises, with rents going up from floor to floor. This
top floor, as all others mentioned, is extremely well rennovated.
All hallways and bathrooms are spotless; each room is cleaned once a
week, and all common areas daily. There is no emergency pull cord
system in the building, but we were told that the maid keeps track
of residents, and alerts management when a resident is not seen for
a day.
While we looked at this unit, we discussed the resident
population. We were told that the population varies greatly, and
that all residents are required to sign a one-year lease. However,
if a medical emergency should arise and the resident should have to
leave, there is no penalty for breaking the lease.


47
The Downtowner's population is older than in many of the
other residences in this survey; many of the people who currently
reside here are residents from other Single Resident Hotels (SRO)
which used to be located in the downtown area. The boom-town
mentality which, Denver experienced during the oil era of the 1970's
and early 1980's, displaced many residents with the rapid
construction of new office space at the expense of the older hotels.
These residents have made a slow exodus to the Downtowner. We were
told that many of these residents are chronically mentally ill (CMI)
or alcoholics; this is a disappointment to the staff at the
Downtowner, as they view their structure as unique and take pride in
its history.
The Downtowner management feels at times forced to take
these residents into their facility. Many of the CMI clients, as
well as the others, do not exhibit strange behavior until the lease
has been signed. The director feels that these residents overall do
not negatively affect the building. There are strict guidelines in
place on drinking, drugs and noise at the complex and they are
enforced by the resident manager.
The financial side of the Downtowner also plays a role in
the types of clients served. There are financial pressures on the
hotel to take in any resident who can live independently and afford
the rent, since the hotel is not yet up to capacity. No waiting
list exists at the Downtowner, and when the conversation of a
waiting list came'up, it was spoken about almost in terms of awe.


48
There is more floor space, with a antique bureau and
spotless bathroom, in the one-bedroom, half-bath unit. There are
large windows, which allow sunshine to flood into the room. The
multi-colored walls have a Southwestern Indian-type mosaic pattern
about eight feet-; above the floor, giving the room a larger-than-
reality feeling.
As we left the room, our discussion continued to focus on
the make-up of the resident population. We were told that the
majority of the population living in the building is extremely
independent. There is an informal network of residents who watch
over each other, which can be described as a "Buddy System", seen in
many of the other residences in this survey. However, privacy is a
highly desired commodity in the building, and is respected by all.
The residents were portrayed as not being "joiners" in
different organizations or in activities of the building. We were
told that the hotel is constantly attempting to sponsor and promote
different activities, but that these activities are poorly attended.
The director stated that, in her constant contact with the
residents, she has come to the conclusion that many if not most of
the residents view activities as a form of institutionalization.
The planned activities which do bring residents together are things
such as billiards, bingo and poker. These activities are informal,
allowing the residents to join at any .stage of the game and also
leave at any time.
With this1thought of independence among the residents, there
has been an effort to form a resident council. Although there were


k9
difficulties at the beginning, a formal resident council is now in
place. It is this group's function to act as a liaison between
residents and the management company. The director stated that she
is extremely pleased with the council, as it helps with many facets
of hotel life.
The director shared a story with us about the resident
council. The resident council on its own initiative, contacted the
Retired Senior Volunteer Program (RSVP) in Adams County. (RSVP is a
federally funded Title X program, getting seniors involved in local
projects). The Adams County RSVP decided to hand-make quilts for
all the residents. Each quilt is left on the bed, which brings a
warmth to each room.
When management noticed that temporary residents were
taking the quilts with them when they left, it made a rule that all
quilts would be sent out to be cleaned and given out only in the
winter months. Two days after the posting of the new rules, the
resident council submitted a petition to the management to void the
new guidelines. The management agreed immediately, and the quilts
remain today on the beds.
Back in -the mezzanine, we sat with the director and
discussed the residents, watching them interact in the lobby
below. The problem of resident drinking and mental illness once
again became the focus of discussion.
Many of these people have been "dumped" at the Downtowner by
other social agencies. High medical costs have a major role in the
equation, in that the treatment of these different populations is


50
expensive. Many agencies simply cannot afford to give the level of
care that many of the residents require for any sign of improvement;
thus, the Downtowner is seen as a cheap alternative though the hotel
runs the risk of becoming a "holding" institution for many until
more funds are available.
At three o'clock in the afternoon the hotel slowly came to
life. The residents either came down from their rooms or returned
from trips outside of the hotel; the lobby was the center of
activity, with residents meeting each other on an informal basis.
The director said, in closing that there are a host of problems
related to the Downtowner and its resident population. The
counterbalance is the personal involvement of staff, management and
the private investors, who have had a vision of what should be. That
vision is the thread that keeps the hotel running on a steady
course.


CHAPTER V
RESULTS
The data supplied by kj resident managers of congregate
facilities is reported in this chapter. These data, where
appropriate, will be compared with a study completed by Irene
Malozemoff. In addition, the data are compared to information from
resident managers of non-congregate facilities in Denver.
Structural and Economic Characteristics -
Of the total of kj facilities isurveyed, 17 were subsidized
congregate, with an additional six being private. All of the private
facilities are for profit, and do not participate in any rent
subsidy program. Most of the subsidized units are under the
Department of Housing and Urban Development (HUD), Section 8.
One facility, written up in the Two Case Studies Section,
is a private-for-profit institution operated by a non-profit
organization. This was the only complex in the study that had a
dual relationship to both sectors.
Apartments, rather than townhouses, were found in all
surveyed housing facilities. The range of square footage found in
studio, one- and two-bedroom units varies greatly.


52
Unit size can vary from 130 to 913 square feet (See Table 4),
regardless of whether the facility is congregate or not.
TABLE 4. AVERAGE SQUARE FOOTAGE OF AVAILABLE UNITS
Low Income High Income
Type of Unit Non-congregate Congregate Congregate
N=47
Studio 430 305 305
One-Bedroom 551 445 549
Two-Bedroom 671 544 781
Congregate and non-congregate housing varied in handicapped
accessibility (See Table5) Handicapped was operationalized by
having an elevator in the building if more than one floor was
present. In the apartment itself, the requirements were that
theremust be wider doors to enter the unit with hand railings for
the toilet, and a grab bar in the bathtub.
Table 5 shows fourteen percent of non-congregate studios
were accessible, with twenty five percent in the congregate
category. Thirty-four percent of one-bedroom non-congregate and
twenty-nine percent of the congregate have the special features.
The two-bedroom apartments had the fewest number of handicapped
units, with the non-congregate having 3 percent and the congregate
thirteen percent.


53
TABLE 5. HANDICAP ACCESSIBILITY
Type of Unit N=47 Non-Congregate Congregate
Studio lk% 25%
One-Bedroom 34# 29%
Two-Bedroom 3% 13%
There are a number of charges related to moving into a unit,
regardless of its status whether it is congregate or non-congregate:
reservation, damage, handling, processing and entry fee (See Table
6). Current HUD guidelines prescribe what the requirements are for
these fees, and which ones can be changed.
A reservation fee is charged at some facilities to insure
that a person seriously intends to live there. With such long
waiting lists, it is not uncommon for a future resident to visit
many different facilities, putting his or her name on each and every
list, waiting for the first available complex to call. This
reservation fee parallels buying a house, where one must make a
deposit of intent, often called "earnest money" to insure that one
is sincere about being interested.
Some organizations use a handling fee as a deposit. This
category was added with the processing fee, even though it was not
expected that many congregate complexes required it. In our meeting
with the Colorado Gerontological Society, the society maintained
that the categories do indeed occur, and this was the case as the
data were processed.


54
The entry fee is similar to what one pays to gain admission
to a country club' or health spa. It is like a reservation fee, in
that it is not refunded upon leaving the building as would be
i
expected with a damage deposit. The usage of this fee was extremely
small as shown in Table 6.
TABLE 6. MOVE IN RELATED CHARGES
Type of Charge N=47 Non-Congregate Congregate
Reservation 3% n%
Damage Deposit 86% 88%
Handling Fee 0% 5%
Processing Fee 0% 5%
Entry Fee 6% 0%
Vacancy Rates and Waiting Lists
The vacancy rate of each unit varied. Most subsidized units
in this study did have a waiting list; the total can be viewed in
Table 7* These lists varied greatly involving waits from one month
up to three years.
As Table 7 shows, an extremely high level of units currently
have a waiting list. This is due to the fact that eligibility for
subsidized units depend on ones income, and are often substantially
cheaper than rentals in the open market place. Added to these
factors are increased services, including meals offered at
congregate facilities; it is clear that both congregate and even the
non-congregate residences are very competitive in the open market


55
place. The combination of these factors makes the HUD subsidized
elderly housing units very attractive.
TABLE 7. WAITING LIST
Type of Facility ; Waiting List
N=47
Non-Congregate 80%
Congregate 76%
The results portrayed in Table 7 are skewed in favor of the
non-congregate units. As discussed earlier, the non-congregate
category is composed primarily of the independent living apartments.
That the congregate category, appears to have a lower overall
waiting list is deceiving. Included as congregate are the four
private units are extremely expensive, with rents starting at
around $800 and going up to $1700. None of these four private high
rises have waiting lists. Therefore, these four units skewed the
total congregate rate, with an N of 17, to a below non-congregate
rate, which is not the case in looking at only subsidized
congregate facilities.
In order to represent this difference, Table 8 shows the
differences in vacancy rates. The high end of the congregate
category has been marked with HI to H4. One sees that vacancy
rates differ according to size of the unit. Apartment managers
stated repeatedly that the one-bedroom apartment is by far the most


56
apartment is ranked number two with the explanation that it is
simply too small for many people. The direct opposite is true in the
two-bedroom category, which has the highest vacancy rate. There
were two reasons given for this: because its the largest, it cost
more.
TABLE 8. VACANCY RATES
Facility n=47 Vacancy Rate Waiting List
Subsidized Units
Studio 0 3 months-2 years
One-Bedroom 0 6 months-3 years
Two-Bedroom 1-2% 0- 6 months
High Income
HI 0 No
H2 10% No
H3 6% No
h4 0% 2 months
As Table 9 shows, a majority of congregate and non-
congregate units are subsidized. Federal Section 8 and state aid is
identified, and ;the table includes a third variable: religion
L
affiliation. This variable was included to help explain the
subsidy rates. As discussed in previous chapters, many of the
complexes in this survey had not formally applied for any type of
subsidy; certain units rely on the support of a religious sponsor.
There is a link between a religious affiliation and non-subsidy.


57
TABLE 9. SUBSIDIES, AND RELIGIOUS AFFILIATION
Type of Subsidized Religious
Facility Yes No Affiliation
N=47
Congregate 11 6 8
Non-Congregate 23 6 10
Age Characteristics of Residents
The age ranges given the apartment managers varied greatly.
It cannot be forgotten that all questions related to age were the
opinions of the managers. It was beyond the scope of this project
to go in and question each resident as to age and other demographic
variables. The only statement that can be made with certainty
regarding the residents is that the average age is around 75 years.
v
Medical Facilities Available
Medical facilities are paramount in the lives of many
elderly. The entire concept of shared services in the congregate
complex comes into play here. Table 10 breaks down and compares the
various medical services.


58
TABLE 10. MEDICAL SERVICES OFFERED
Type of Service N=47 Congregate Non-Congregate
Nurse 76% 36%
Dentist m 3%
Physician n% 0%
Podiatrist 23% 0%
These rates are for facilities that offer medical
professionals generally through visitation and are not to be
interpreted as full-time staff. The conclusion to be drawn is that
the medical component is important enough to be addressed in some
form by most of the complexes in the study.
Denver/National Data
Tables 11 through 14 incorporate both data sets from this
thesis and from Irene Malozemoff's national study. The national
study has been marked accordingly, showing the national N of 27 in
the final column in all tables.
Whereas the national data can be used in comparisons with
the Denver Data, the data collected in Denver is in much greater
detail. Each table which has the national data has been expressed as
one number. The Denver data breaks each category into sub-sections.
Each table shows the degree of participation in a particular item or
amenity, and hence does not total one-hundred percent due to missing
cases and/or the fact that not all units reported.


59
Security Systems
As pointed out in the literature review, security is an
important factor in the lives of many elderly. A variety of
different questions were asked to see what the overall rate of
security was in the buildings. Table 11 outlines many of the
various services offered while also placing the response rate in the
last column of how the national study data compared, which had been
presented simply as whether security was present or not.
TABLE 11. SECURITY SYSTEMS
Type of System Congregate Non-Congregate National Study
N=47 N=27
Guard on Duty 33% 16%
Staff on Duty m 66%
Electronic Buzzer 9W 86%
Emergency Pull Cord 10% 43%
Intercom in Room 47% 50%
Monitor in Room 11% 6%
Daily Check 100% 10%
National Study Collapsed 89%
It is clear from the breakdown of units into two categories
of congregate and non-congregate that there are a number of glaring
differences in security offered. The variables of electronic buzzer
and intercom in room are very similar. This researcher feels that
this can be explained by the fact that many of the independent
apartment buildings, which now serve only the elderly, were in many
cases built originally for non-elderly persons. When these
buildings were converted to serve the elderly, the buzzer and
intercom systems were security systems that had already been present


60
in the building and simply retained. In terms of more specialized
systems such as the emergency pull cord, congregate facilities stand
out.
Transportation
Transportation is a category often overlooked by planners.
Whereas many seniors can drive their own vehicles after retirement
this becomes increasingly difficult as the resident ages. Table 12
shows how the transportation compares in reference to both types of
facilities. The national data is portrayed on the left side of the
table.
TABLE 12. TRANSPORTATION
Type of Facility Transportation Offered N=47
Congregate j 52#
Non-Congregate 1 26#
National Study 85#
N=27
The national data dominates showing that over three-fourths
of all congregate residences offer transportation. Transportation
was operationalized as a service provided by management and/or a
volunteer. Payment of any transportation related fees is included
in the basic monthly charge for in-house service or at no charge if
volunteer-sponsored. The Denver data does not meet the national


61
average with 52 percent; however, this is double the rate found in
the non-congregate category.
Table 13 shows national data ranking services available
from the sample of 27 sites. These findings have been given in
their entirety.
TABLE 13. RANKING OF SERVICE AVAILABILITY OF SAMPLE SITES
NATIONAL SURVEY DATA
Type of Service N=27 # with Service % with Service
Meal Service 27 100
Recreational 27 100
Social 24 89
Security 24 89
Transportation 23 85
Medical ( 21 78
Linen 16 59
These data presented here an idea of how the national
survey. Although the data does not compare completely to the Denver
data, they give a visual impression of what the congregate housing
concept is about in reality. High percentages in all categories,
with a low of 59 percent in the linen area, clearly shows the high
percentage of services offered on a nation-wide basis.
)
Amenities Offered
Amenities are the last important component in the congregate
housing package. Table 14 breaks down all the amenities into
congregate and non-congregate categories. The Denver and national
study survey data are side by side. As with other national data,


62
these figures do not parallel exactly with the Denver data, but give
an idea of how the two data sets compare.
TABLE l4. AMENITIES OFFERED
Type of Amenity N=47 Congregate Non-Congregate National N=27
Arts and Crafts 16% 33% 81%
Library 88% 13% 69%
General Rec. Area 88% 93%
Garden Plots kl% 33% 31%
Provision for Guest W 3%
Guest Parking 10% 56%
Resident Storage 90% 10%
TV Area 6k% 66%
Exercise Area 10% 3% 81%
Beauty Shop 5%% 23%
Barber Shop 35% 20%
Laundry Area 88% 93%
Swimming Pool 11% 0%
Sauna/Whirlpool 11% 0%
Linen Service 11% 13%
Religious Services 10% 60%
Social Events ! 93%
Volunteer Work 30%
Active Recreation 26%
It is clear that congregate facilities offer many more
amenities on a percentage basis than one finds in the non-congregate
complexes. But the differences between the two are not always so
great;the Denver data presented in Table 14 shows a lower-than-
average rate when compared to the national data. This difference is
only a matter of a few percentage points in most cases and is not
seen as significant when viewing the data in its entirety.


CHAPTER VI
Discussion
This thesis began as a request for information from the
Applied Sociological Research Team (ASRT) at the University of
Colorado at Denver over two years ago. As often happens, the project
expanded in size and scope. At the beginning of this project there
was no theoretical basis for this study. The research has pointed to
the close relationships between aging, increasing health needs, and
the associated changes in housing which must accompany the aging
process.
As we have discussed health plays a major role in the lives
of the elderly. As one ages one becomes more dependent the on
\
health care delivery system. This of course, has important
implications for housing. As one grows older, the housing bundle
must gradually incorporate more features having to do with
increasing health related needs. The emerging congregate model
could have medical care directly on the premises; dentists,
physicians, podiatrists and other health care professionals could be
on the premises on a regular part-time basis or involved a
visitation program such as Visiting Nurses.
The visitation model provides residents access to health
care, but at a level reduced from what one would find in a


traditional nursing home. The Visiting Nurse Program is the most
popular, widely used by the various residences. A nurse is able to
keep patient histories and meet the day to day needs of the
population without the intervention of a physician. Some apartment
managers related stories of older residents being skeptical of a
female nurse attending to them, instead of the traditional male
physician. However, with time, and as a relationship of trust
developed, the residents grew accustomed to "their" nurse,
realizing that she was a professional and capable of handling almost
all of their needs.
A second model one can find in congregate residences is to
have a medical center located closeby. There are two distinct
variations in this arrangement. In the first instance, usually
associated with larger hospitals, the congregate residence is built
next door to the hospital, as is the case with the Denver Arms. At
times, the congregate residence is built on the same property,
often financed by the hospital. This can be viewed as
diversification within the health care field. Although each
organization is a separate entity, the two organizations do have
official affiliation with each other.
The second option, is a clinic, offering an array of
medical services, located near the medical center. In many cases,
these are completely autonomous, and separate businesses. In such
cases, residents have the freedom to choose to use a clinic if
needed, but are not automatically charged for its use. This is one
of the main justifications of federal government limited funding


65
for congregate housing. It can be seen overall as a health care cost
reduction program. These varying methods of health care delivery
for congregate residences are both found in the Denver Metropolitan
Area.
Provision of health care for the elderly has been primarily
concerned with the issue of cost effectiveness. Research has been
quoted in this thesis that shows that many nursing home placements
are not done properly, i.e.; many clients are there unnecessarily.
The high level of care offered in the nursing home environment
should not be wasted, as it is so expensive.
The notion of shared services in the medical area is also
relevant to the food service and other amenities offered by a
particular unit. On the average, as shown in Table 14 there are
twelve to fourteen amenities offered by each congregate complex.
With a large resident population, these costs can be held down using
the shared services concept, spreading the burden of costs
equallyover the entire resident population. This allows the
complexes to offer a wide variety of amenities and still remain
financially sound.
This single factor of cost containment will be, in this
researcher's opinion, the driving force behind the federal
government's decision to build more units. The aspects of social
interaction, security, balanced dietary plan, easy access to medical
facilities and a more humanitarian environment, are not reasons for
the federal government to support such services. But the financial


66
incentive will promote a concept that, with its multi-faceted
nature, might ultimately benefit its residents.
Amenities have been discussed in many previous chapters.
This is of lesser importance than the health issue or though they
are an important aspect of the congregate package. As Table 13 in
Chapter 5 shows, there were sixteen separate amenity items offered
in the Denver area survey, with an additional three from the
national data.
Amenities are an important part of the congregate concept.
Many meet a basic needs, such as a linen, service, beauty shop and
guest parking. But there is another more important function to the
amenities: social interaction possibilities that reduce isolation.
Theoretical Issues
As discussed throughout this thesis, there are a number of
problems now being faced by the elderly. Some of these include
ongoing population growth rates among the elderly, bringing
financial burden into public debate, especially in the old-old age
category of over seventy-five. With this increasingly aged
population, there are individual pressures as life savings are
slowly exhausted. Finally, the health care needs of this population
are constantly increasing.
This phenomenon will have many effects on current and future
residents of congregate facilities. With the move into the special
sector or wing of} a facility, deemed ans increase of dependence, the
social rules which were in place in the "traditional" congregate
setting will no longer necessarily be valid, according to Goffman.


67
For a person who has cared for him or herself, having had power over
his or herr own life, the balance of power will slowly tip in the
favor of the institution. As the individual becomes more dependent,
there will be an increasing possibility, as described by Goffman,
that the individuality of that person will be harder to maintain.
This is a real threat in the development of these new special wings
in the congregate facilities. A clear distinction must be made at
this point in stating that it is not congregate housing that has the
possibility of becoming a warehouse, rather the development of
putting elderly in nursing home wings within the congregate setting.
During one on-site inspection, the manager of ones unit told this
researcher that all new capital construction is going solely to
build new wings in the complex to house the population who have aged
at the facility and are in increasing need of higher levels of
l; 1
service. !
The private sector benefits in the development of these new
facilities in a number of ways. With the higher level of dependent
care offered in these new satellites, the cost to the consumer
increases in proportion to the level of care. This translates into a
larger profit for the private sector with more revenues earned. In
addition, once a person's resources are depleted, the federal
government assumes the role of financing through Medicare, so the
risk to the private business is greatly diminished. Finally, as in
all private sector activities, competition comes into force. As
mentioned earlier, none of these newer private residences are filled
to capacity and therefore have no waiting lists. This means that the


68
more expensive private residences must aggressively compete for
those more affluent elderly willing and able to pay the higher costs
associated with the non-subsidized sector. It is therefore a benefit
to the private providers to retain their customer base as they move
through the aging;continuum.
As outlined in Table 2, there are services common to all
facilities located in the life-continuum. Some of these include
shelter, housekeeping, transportation and security. All complexes
offer these items; however, as one moves from the independent status
through congregate, ending finally at the dependent stage, the level
of service has changed dramatically. The tendency in the dependent
living facilities, such as in the new congregate wings, is to
provide care rather than services. This distinction between care and
services is very important as it implies a different attitude on the
part of management. While services are provided at the discretion
and used by the free choice of those served, provision of care
involves more control of the resident's lifestyle by management.
In viewing Table 3. the life continuum, one sees that as a
person grows older, he or she becomes increasingly isolated and
dependent. This begins during the "middle-old" period, where the
death of a spouse, decreasing financial resources, and increased
health problems affect the individual. This is logically increased
as one continues ..to age and ones peers; begin to die. All of these
factors translate into how the individual, becomes increasingly
isolated from his or her surroundings and from companionship.


69
As we have seen congregate housing addresses this problem by
offering many shared activities. Logically, this is a matter of
choice for the individual; however, with such activities as a common
TV room, a library, arts and crafts, an exercise area, volunteer
work and other social activities the average resident does not have
to feel isolated. There are an important component of sustained
social contact, and over-all individual well-being.
Goffman's concept of the total institution provides a useful
perspective. Schmidt states: "Unlike prisons and mental hospitals,
special settings for the aged do not change people deliberately
except to facilitate care" (Schmidt, 1982:157)- This idea of
facilitating care is of major importance and concern. A private
housing provider might choose to add a dependent wing to a current
congregate complex; is he motivated by the best interests of the
client population? The possibilities of abuse i.e., for a total
institution to develop which, as Goffman states "handle batches that
are pressed into uniformity", raqises a legitimate concern.
When looking at this possibility one can turn to the
current situation in many nursing homes. Research estimates that
from twenty-five to fifty percent of all persons in nursing homes
currently do not require that level of care (Huttman,1977:35) This
is a shocking statistic, showing that many people have been
relocated to institutions with no system in place that determines if
that person really needs a high level of care. There also seems to
be no mechanism to follow up on individual placements.


70
The life-course material is an; exploratory tool which can
help in viewing a particular population which does not have to be
the elderly. The basic assumption of the model i.e., that each
cohort group ogether in its own unique way, can be utilized in many
facets of research. In terms of its application to congregate
housing, there are ways to exploit underlying assumptions in
bringing this research further. One can, for example, visit a number
of congregate facilities which are all designated for the elderly.
An excellent example of this is well documented in the book "I Hope
to Live Forever, in a Congregate Residence" by Pat McCarthy. Many
residents state how much they enjoyed the first ten years of a "new"
i
life in a particular complex. After that time, they began to voice
an increasing number of complaints. Upon closer examination of the
residents concerns, a plausible and logical explanation was found.
When the residence first opened, all those residents sixty-five and
over qualified to be admitted. Without forethought on management's
part, the complex filled quickly with seniors in the same age group,
i.e., all at or within a few years of sixty-five. There were few
problems with a group of people who, as the life-course concept
states, have a common shared experience.! It was not until a full ten
years later that problems began to arise.
At the beginning of this higher-than-average complaint
period, there had been a number of deaths. This had required the
facility to admit for the first time in years, a number of new
residents. Thus the "mix" of residents was slowly changing. The
population was no longer as homogeneous as it had been at the


71
beginning of the project. It was hypothesized that this new age re-
mix was the cause of the new problems. Things such as television
programs to watch at night, recreational activities, destination of
outings and other areas of common interests to the residents were
slowly changing. The "old" guard was no longer able to mandate
every activity. This in turn brought changes to the complex.
Summary
In summary, it is found that the aging-in-place phenomenon
becomes somewhat better understood when examined within the
perspective of total institutionalization. It seems plausible to ask
if each aging cohort group may share common experiences thus being
viewed as having common needs and desires. However, one must view
this as only suggestive, with further study recommended.
Subsequently, ideas of the total institution, taken from
Erving Goffman, exchange theory, as conceptualized by Schmidt, and
the life-course concept, informed our study of congregate care
facilities. In this chapter, congregate housing as an alternative to
full care nursing home facilities will be discussed, applying these
various theoretical concepts.
Both the concept of life-course and of the total institution
discussed in this section may prove useful in further research on
congregate housing. The idea of Goffman's total institution is a
negative one. It is not a logical conclusion to assume that simply
because the area of congregate housing is increasing, and that these
new nursing home wings are being added to present congregate


72
facilities, creating an institution within another institution,
i
that a total institutional must or will evolve. Rather, this thesis
points to the fact that such a danger does exist. If one is not
aware of the potential for abuse there is a greater chance that it
could occur. This is an area that will require more research in the
future. The hope of our outlining of potential abuse is that
professionals working in this area will at least consider such
events.
The thesis or theoretical concept by Schmidt is only good to
the extent that one knows how a certain group will react to it. The
entire notion of if power relationships, and how people deal with
them, comes back to the life-course concept of how a particular
group will react. This, of course, means that each and every
congregate residence will have to be "fine-tuned", since geographic
area and age ranges of the resident population differ. Also, the
problem of "aging in place" comes into play when a younger and older
residents begin to interact in a dynamic.
How does life-course relate to congregate housing? There
seems to be a link when viewing the age of residents at a facility.
Each different cohort group brings with it a different set of
experiences. This cannot be forgotten in congregate housing, which
entails putting a large group of people together in communal
setting.
When making decisions regarding services, facilities, meals
and even movies to be shown, the concept of cohortism comes into


73
play, since one cannot forget this dynamic and possible consequences
it may have for the facility.
The incorporation of the life-course concept into the
congregate housing question is relevant. It is not merely that one
may use it being able to use it as a grand theo- retical construct,
but rather, it is a tool with which to look at the dynamic process
of different human beings, how they interact and their reaction,
based on that interaction.


CHAPTER VII
SUMMARY
This research began with an informational request by a local
land developer in the Denver area, who was planning to build a
private congregate housing facility for technical assistance with a
marketing analysis. Through the examination of research completed to
date on this subject, and of congregate housing in Denver
metropolitan area, this study confirms that congregate housing is
bridging the gap between full care and independent living. Further,
the study emphasizes that congregate housing must be kept affordable
if it is to fulfill its purpose.
The physical structure of congregate housing has been
researched in this thesis. The locations, sizes of complexes, square
footage of individual apartments and amenities offered were all
examined to provide a sense of what is currently being offered in
the market place under the definitions of elderly and congregate
housing. Available amenities, medical care and social activities are
also included here.
A number of concepts or ideas have been elucidated in this
discussion. Housing for the elderly is sorely needed today; nearly
all subsidized housing units in this survey have waiting lists.
Current unmet demand raises many questions for the elderly, since


75
it is clear that this population is indeed increasing while the
federal government is cutting back on subsidies that have been in
effect, since the late 1950's.
Congregate housing attempts to address a multi-service
concept by offering a wide variety of services and amenities to a
population at a total cost, far less than for an individual to seek
out each service. A vital component of the congregate concept is
the idea of shared activity, which enables residents a "window" of
opportunity to have contact with others.
The data in this study shows what is currently being
offered in both the congregate and non-congregate residences today.
The items looked at here included square footage, handicapped
i
accessibility, move-in related charges, waiting lists, vacancy
rates, security, medical services offered and amenities.
Square footage, as shown in Table k, can be characterized as
relatively consistent in all residences included in the study. There
are no rules by HUD, which force a builder to allow for so many
square feet per resident per apartment. There are residences in
operation that have been converted from regular non-elderly
buildings, although none are in the congregate area. These buildings
were built to specifications in force at the time; HUD standards
must be adhered to in any building constructed after June 15, 1976
(Programs of HUD, 1986:61).
Handicap accessibility is available in less than one-third
of the facilities included in this survey, although many units have
provided larger doors, hand railings around the toilet and grab bars


I
76
!
in the bathtub. The percentage of accessibility in Denver was lower
than expected; one manager provided a plausible explaination. He
stated that the majority of residents do not like to see handicapped
residents, or even residents who are restricted by wheelchairs,
walkers or canes, that the residents do not want to be constantly
reminded and/or confronted with what could possibly be in their own
future.
Move-in related charges are prescribed by HUD, and thus
are consistent in government subsidized congregate and non-
congregate units. In the private sector, forces and in-house policy
dictate which fees will be charged. From the data in Table 6, it is
clear that these charges are not used widely. Many of these fees are
more appropriate in the areas of life-care and nursing homes.
The prevalence of waiting lists, and high vacancy rates can
be viewed in various ways. It is clear that all subsidized units do
have a list, and that this is not the case in the private complexes.
One can conclude that the private sector has priced itself out of
the market for the majority of the elderly. Secondly, all residences
do vary, not only in amenities offered, but also in the actual
'l
structure of the building, management style, whether or not there
is an activities director and cohesiveness among residents. These
factors probably play a role in how popular a building is and how
long the waiting list is. One finds units with a three-month wait,
and others with a three-year list. Since they are subsidized, rental
costs are not the issue. Security, is of great concern to many
elderly, and as Table 10 shows, both congregate and non-congregate


77
residences offer an array of protective devices and staff. As a
general rule, newer buildings have newer devices, such as
emergency pull cords, for their residents.
Medical services are vital to the congregate concept, and
are addressed in all residences. Table 11 shows the actual breakdown
of available services. Most congregate facilities that do not have
medical staff on duty or the Visiting Nurse Program do have some
type of medical facility located close to their complex.
The final section of this thesis discusses the within Denver
Metro congregate housing amenities offered. The data shows that
Denver facilities are comparable with facilities included in a
national survey. This high amenity rate guarantees that social
interaction among elderly is available if desired. This is an
important finding.; it suggests that congregate facilities provide a
bundle of services beyond meeting the physical needs of residents.
Conclusions
Congregate housing is an alternative which is located
between independent housing and the full care nursing home. Non-
congregate complexes on the continum of elderly housing alternatives
are also included in this study. In many cases, independent living
arrangements are similar to congregate facilities. The major
difference is that these independent complexes do not offer a meal
service, the cornerstone in the congregate package. The major
"missing link" in those independent complexes is the dietary plan
and additionally medical care. Both are critical in the lives of the
elderly.


78
Congregate housing is coming of age. It gives the elderly-
many benefits to enhance their lives, and is cost-effective.
National demographics clearly show that the elderly population will
continue to grow, exploding when "baby-boomers" reach retirement.
The housing options needed in the future are being tested today.
Implications/Theoretical
Although this project began without a concrete theoretical
construct to guide it, a subsequent review of sources on elderly
housing yielded three general concepts which guided the proposition
of writing a thesis. Erving Goffman's concept of the total
institution, the concept of exchange as used by Schmidt and the
concept Life Course as described by Milta White Riley and Glenn
Elder, have all been utilized.
It is apparent that gerontologists in research and applied
settings have been more concerned with the qualitative aspects of
the elderly and aging than with the theoretical. Much research on
elderly is available but when one pursues a topic of interest, one
seems to almost always come to a theoretical "dead-end". The
emphasis has not been on developing a theoretical construct to
further advance the knowledge in the area of gerontology.
Perhaps this is due, in part, to the fact that only recently
have sociologists begun to investigate the aged and housing. Since
many define these issues as social problems, and because the
elderly, struggling with income maintenance, are the largest growing
segment of the current population, a new focus is emerging.


79
This area needs to be given close scrutiny. Public opinion
is informed and policy decisions are made by the general public's
perception of an issue. The field of sociology needs to either have,
or feel it has, a mandate to give conceptual and theoretical
structure to the; public arena. As mentioned, public debate will
intensify as the elderly population continues to grow.
Implication/Policy
Congregate housing received official support under Title IV
of the Older American's act of 1970. At that time, numerous studies
had been completed, showing premature nursing home placements. This
premature placement was extremely costly. In addition, human lives
were wasting in institutions, not designed to improve the quality of
life, but simply to maintain it.
Since Congress had not appropriated any funds to support the
service element of congregate housing, little action was taken on
this issue in 1970 and subsequent years. Without funding, these
programs could only proceed if outside funding was acquired, since
the rental fees paid by the residents were collected for HUD and
could not be used for services.
In 197*1, congregate housing was again debated in Congress,
in the Committee for Aging, with complete support for the concept of
congregate housing, though no funds were appropriated. Under Title
IV of the Housing and Community Development Act of 1978, Congress
sanctioned congregate housing with limited funding.
Since these are strong points in favor of strong public
policy to further development of congregate housing, why has this


80
such development been so slow? Congregate housing was unfortunate or
unlucky enough to have come into existence at the end of the 1970's.
With the election of Ronald Reagan in 1980, two separate but
parallel policy directions were initiated. First, federal subsidies
of elderly housing was slowly eliminated from the various housing
programs. The only program left largely untouched was the FHA
program, which is used mainly to benefit builders of single family
dwellings. Those programs assigned to the elderly find affordable,
adequate housing were slowly being left to find their own financing.
The concept that government was an inappropriate
organization to administer programs was the second policy action
(Conboy, 1984:3) The Reagan administrations rationalized that
governmental organizations lack profit-making incentive, and that
bureaucratic management, lessens the quality of services. Business,
on the other hand had the ability to better respond to the needs of
individuals, since it could be held accountable for the quality of
the services provided (Conboy, 1984:3)-
This research shows some of the effects of policy decisions
made a little over seven years ago. In interviewing many of the
residences and inspecting some of them personally, it is obvious to
this researcher that these buildings were primarily built before or
<
at least started before the Reagan ideology of budget cut-backs.
New housing for the elderly is coming almost exclusively
from the private sector. This fact is in and of itself is not
negative until one looks closely at what private developers are
building. New units cater almost exclusively to those elderly who


81
can afford a base rental payment of $800. This profit-making
incentive, praised by the Reagan administration, effectively forces
the elderly to remain in less suitable housing, and will do so on an
ever-increasing basis.
One sees how this new housing course is already having an
effect on the Denver elderly housing market. First, in the
subsidized sector; there is not one unit which does not have a
waiting list. A wait of one or more years is not at all uncommon.
This can be a discouraging factor for many elderly, and is an
unthinkable situation to an elderly person who has perhaps recently
suffered a stroke, heart attack or other illness necessitating an
immediate move into a facility, from totally independent living.
In the area of low income housing, once the elderly have
waited to acquire a new residence, there is a new threat to their
medical welfare. It is strictly forbidden for residents who are
sick or unable to care for themselves to remain in semi-independent
settings, even with medical supervision. Although the congregate
dwellings can offer more support, they, too, are not for dependent
care. Therefore, when an elderly person becomes sick, he or she may
be less likely to report such an illness.
; !
Conversely, the private residences have immediate move-in
possibilities. Those able to pay the high rental price can move in
on a day's notice. None of the units in this survey from the private
sector had a waiting list, which is consistent with the general
lack of financial resources available to many elderly. Current and
future housing policies must begin to address these problems. A more


82
humane housing policy for the elderly is sorely needed, and this can
take many forms. Social Security can be increased to a level where
each and every senior citizen can afford the private housing, if
needed; regulating rents in the private .sector so that at a low rate
f
it is affordable to those on the current low-benefit scale of Social
Security is also an option.
Housing and medical care for the elderly are social problems
which will not go away in the near future. Current policy is not
addressing these concerns, and the outlook is progressively bleaker.
As opposed to finding solution to these issues, the current
administration continues to cut programs in the name of budget
austerity.
Implications/Research
r,
This research has concentrated on defining exactly what
congregate housing is and making comparisons with data at the
national level. There are many areas which need further research and
areas that until now have remained untouched. This section will
address some of these in order bring a full picture of both
congregate and non-congregate housing to a level where it can be
fully evaluated.
Studies of resident demographics, would allow policy
evaluations more data in gauging kinds of available elderly housing,
and how residents relate to it. Such studies would also enable a
policy maker to
evaluate the medical and amenity aspects of
congregate housing to see which aspects are most often used and thus
receiving the most funds.


83
Secondly,' a housing satisfaction survey of congregate
!
housing residents; is needed. This could be done in conjunction with
the three phases in the life Course, i.e., the young-old, middle-old
and old-old continuum. A researcher would thus gain the ability to
compare independent, congregate and dependent care and, most
importantly, learn how residents relate to the variety of services
at different levels.
Participant observation research would provide a deeper
view of the inner workings of the congregate setting possible.
Questions looking at exchange theory and the transitions of the
v
life course could all be analyzed through a researcher's eyes, on
location, rather than one having to rely solely on the memories,
feelings and reactions of the resident population taken from
interviews.
These various research areas can be developed and then
pulled together to give one a better understanding of congregate
housing. Housing is and will remain an important sub-area of
research in the sociology of aging. It affects the quality of daily
life for all elderly. This research has attempted to gain more
insight into the area of congregate housing, in hope of its
i
promotion. If this goal is even only partially realized, resulting
in greater awareness of the topic, and, ultimately, a more
humanitarian, less institutional setting for the elderly, then the
project succeeded.


84
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Carrol, K.
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Elder G. H.
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1983b The Aging Enterprise. San Francisco, CA.: Jossey-Bass
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1984 "Elderly housing offers support to healthy aged."
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Gerontologists 24


APPENDIX
CONGREGATE HOUSING THESIS PROJECT
Pre-test of Questionnaire
1. Facility Name:_________________________________
Address:______________________________
Owner:________________________________
Owner's Phone:________________________
Owner's Address:______________________
2. County where facility is located:________________-
3. Contact Person:______________________________________
4. Phone:_______________________________________________
5. Is this building: Public (non-profit)_______ Private
6. Type of Housing Apartment:________
Townhouse:________
Life Care:________
Nursing Care:_____
Congregate:________
Other (specify)_____


7- Do residents own or rent their units? Own______
Rent/Lease_____
First some questions about the units in your facility.
8. Type of Unit/ Number Vacancies Sq.Footage Rental Range H
Efficiency ____ _______________________________________
One-Bedroom ____ _______________________________________
Two-Bedroom ____ _______________________________________
9* Do you require any of the following initial charges/ fees,
or deposits for:
Reservation? NO YES (specify) $
Damage/Security NO YES (specify) $
Handling Fee NO YES (specify) $
Processing Fee NO YES (specify) $
Entry Fee NO YES (specify) $
10. Does this complex have any religious affiliation?
NO_______ YES_________________________
Religion_____
Other non-profit___________
11. Does your complex provide personal property insurance for
the residents?
NO_________
YES_________
Specify_____________________


91
t
12. Do residents pay any of the following?
Gas__________________
Electric___________
Water______________
Sewer______________
Garbage____________
Phone____________
l
Other____________
12. Are meals provided in the building?
NO_______________
YES______________
Check all that apply
Breakf ast____________
Lunch_____________
Dinner_________1
Special_____________
Specify_____________
Other_____________
Specify_____________
13. Are meals included in the monthly rent?
NO__________
YES__________
14. What is the cost for any additional meals not covered as
part of the monthly rent?
$


92
15. Which, if any, of the following special security services or
features are provided in your complex on either a 24-hour
basis or less. (Check all appropriate and note number of hours)
Feature Hours Provided
Guards ________________
Staff ________________
Electronic: ________________
Emergency cords in rooms _________________
Oxygen in rooms ________________
Intercom in rooms ________________
Hall monitoring devises __________________
Daily Check system ________________
Other:
16. Which, if any, of the following types of Professional care
Providers are available and where appropriate, indicate when
they are available. First, is there an activities director and
if so, when is this person available? (THEN ASK, and what
about_____________)
Professional Not Time when Comments
Personnel available Available
A. Activities
Director
B. Nurse
C. Dentist
D. Physician
E. Podiatrist
F. Legal Counseling


93
G. Other Counseling
H. Other
17. Does your facility provide transportation for residents?
NO YES
(specify:
Type
)
(specify:
Frequency
)
Charge? NO__________ YES___________$
18. Which, if any, of the following amenities are available to
your residents in the complex itself, in the immediately
surrounding neighborhood or both?
Amenity Available NO YES: COMPLEX NEIGHBORHOOD BOTH
A. Arts and crafts________________________________________
B. Library________________________________________________
C. General Recreational
area with games________________________________________
D. Garden Plots___________________________________________
E. Provisions for
short term guests______________________________________
F. Guest Parking__________________________________________
G. Resident storage
area ______________________________________
H. Common TV area_________________________________________
I. Common Exercise
area ____________
J. Beauty Shop


K. Barber
L. Laundry Facilities____________________________________
M. Swim Pool_____________________________________________
N. Sauna/Whirlpool_______________________________________
O. Linen Service_________________________________________
P. Religious Services____________________________________
19. What type of parking is available to your residents?
(Check all that apply) YES COST Comments, if any
A. On street $
B. Off street $
C. Underground in Complex ________ $
D. Above ground Garages __________ $
E. Other (specify:__________________
20. Do your units have private Kitchens? NO______ YES:
Full
Partial
If kitchens are available, do they have :
Stove
Oven
Microwave
Sink
Ref rigerator