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Aging in seniors' multiple housing in the Vancouver area : a comparative study of three organizations Cairns, Joseph 1993

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AGING IN SENIORS' MULTIPLE HOUSINGIN THE VANCOUVER AREAA Comparative Study of Three OrganizationsbyJOSEPH CAIRNSB.G.S., Simon Fraser University, 1977M.E.Des.(Arch.), University of Calgary, 1981THESIS SUBMITTED IN PARTIAL FULFILLMENT OFTHE REQUIREMENTS FOR THE DEGREE OFMASTER OF ADVANCED STUDIES IN ARCHITECTUREinTHE FACULTY OF GRADUATE STUDIES(School of Architecture)We accept this thesis as conformingto the required standardTHE UNIVERSITY OF BRITISH COLUMBIAApril, 1993© Joseph Cairns, 1993In presenting this thesis in partial fulfilment of the requirements for an advanceddegree at the University of British Columbia, I agree that the Library shall make itfreely available for reference and study. I further agree that permission for extensivecopying of this thesis for scholarly purposes may be granted by the head of mydepartment or by his or her representatives. It is understood that copying orpublication of this thesis for financial gain shall not be allowed without my writtenpermission.(Signature)Department of ^5 01A4r11 (^C4A-1171-V2.5--The University of British ColumbiaVancouver, CanadaDate  A-17(2-11L 2-I " (113 DE-6 (2/88)ABSTRACTThe intention of this thesis is to provide observations and concepts for those personsconcerned with the delivery of seniors' living arrangements, which may contribute in theplanning and operation of these facilities.The thesis first looks at the topic of aging-in-place from a broad context using Lawton'secological housing model as a framework. It consists of four separate interrelated categories: themacrosystem, the exosystem, the microsystem and the individual.At the macro level, demographic trends suggest that future needs for supportiveenvironments will be high among the older seniors group. Assisting aging-in-place will offsetincreasing health care costs. At the exosystem level, remaining in one's neighbourhood is bothdesired by and supportive of seniors aging-in-place. Avoiding the negative effects ofinstitutionalization further supports the argument for aging-in-place.The competence/press model is a useful means of conceptualizing changing needs of seniorsas they age-in-place at the micro level. At the individual level, a typology of competencies isintroduced along with a discussion on control theory. The need to provide environments whichmaintain and enhance all the competencies is suggested.Next, the case studies investigate whether aging-in-place in seniors' multiple housingprojects is occurring and whether there are differences by building type (high/low rise) or byorganization. Case studies of three seniors housing organizations are presented; New VistaSociety (NVS), British Columbia Housing Foundation (BCHF), and British Columbia HousingManagement Corporation (BCHMC). Data on median age of tenants, duration of stay, original tototal tenants, sex distribution, age subgroups, tenant replacement rate and proportion of couplesto all tenants are analysed.Case study findings indicate that the median age of tenants remained almost constant overthe study period. Distinct differences in median age are evident by organization. Therelationship of aging-in-place to building type is not significant, although in low rise buildingsthe median age was lower.IIIOf the four key variables analysed, differences in median age of tenants by organisation arebest explained by differences in median age of replacement tenants. The proportion of tenants inthe older seniors age subgroup increased substantially with only small increases in median ageacross the six buildings studied. BCHMC had a substantially lower median age of tenants and also amuch lower proportion of older seniors than the other two organizations.The evidence suggests that the differences are likely due to policies being more formallyapplied by BCHMC than by NVS or BCHF. The fact that there are higher median ages at NVS andBCH F, suggests that tenants could be kept longer by BCHMC.Recommendations include the utilization of an accommodating model in programmingseniors housing; relaxation of BCHMC housing policy in relationship to tenant admissions andseparations; standardization of record keeping by agencies responsible for the delivery ofseniors living environments, and an interdisciplinary approach in the delivery of seniors livingenvironments. The need to study where tenants move to after leaving seniors' multiple housingwas identified.In closing, the merits of the Abbeyfield housing model are discussed in relation to thethesis findings. It is suggested that this model will gain in popularity in meeting the challenge ofproviding appropriate living environments for aging-in-place.TABLE OF CONTENTSABSTRACT^ iiTABLE OF CONTENTS^ ivLIST OF TABLES viLIST OF FIGURES viiiACKNOWLEDGEMENTS^ xCHAPTER ONE: INTRODUCTION1.1^Problem Statement^ 11.2^Significance^ 41.3^Purpose 51.4^Definition of Key Terms^ 61.5^Research Study^ 7CHAPTER TWO: THEORETICAL FRAMEWORK2.1^Frame of Reference^ 112.2^Macro System Considerations^ 132.3^Exosystem Considerations: Importance of Neighbourhood^ 332.4^Microsystem: Competence/Press: Institutionalization: Housing Options^372.5^The Individual: Competence and Control^ 46CHAPTER THREE: CASE STUDIES: METHODOLOGY3.1^Selection Process^ 553.2^Study Boundaries 553.3^The Cases^ 553.4^Unit of Analysis 563.5^Pretests 573.6^Data Collection^ 573.7^Reconstruction of Records^ 593.8^Comparability of Data 613.9^Missing Data^ 623.10 Small Numbers 633.11^Sampling 64ivVCHAPTER FOUR: RESULTS4.1^Median Age of Tenants^ 664.2^Median Age of Replacement Tenants^ 694.3^Tenant Replacement Rate 734.4^Duration of Stay^ 754.5^Surviving Original Tenants to Total Tenants^ 764.6^Sex Distribution 784.7^Comparison by Age Group^ 824.8^Couples to All Tenants 874.9^Summary^ 89CHAPTER FIVE: ANALYSIS5.1^Differences by Building^ 915.2^Summary of Differences by Building^ 965.3^Differences by Organizations 99CHAPTER SIX: SUMMARY. EVALUATION & CONCLUSIONS6.1^Background Studies^ 1096.2^Case Studies 1136.3^Limited Study Period 1146.4^Incomplete Data^ 1146.5^Organization Comparisons^ 1156.6^Generalizability 1156.7^Conclusions^ 116APPENDIXA^Reference List^ 121B^Organizations: NVS; BCHF; BCHMC^ 133C^Pretests 139D^Annotated Bibliography^ 143viLIST OF TABLESTABLE 2.01^Population in Canada 1986 ^19TABLE 2.02^Population in B.C. 1986 ^19TABLE 2.03^Population in CMA Vancouver 1986 ^19TABLE 2.04^Marital Status 1986 in Canada ^20TABLE 2.05^Marital Status 1986 in B.C. ^ 21TABLE 2.06^Mobility Status 1981-1986 Canada 65+  ^21TABLE 2.07^Mobility Status 1981-1986 B.C. 65+  ^22TABLE 2.08^Disabled Population 1986 Canada  ^22TABLE 2.09^Disabled Population 1986 B.C.  ^23TABLE 2.10^Prevalence of Selected Health Problems B.C.  ^23TABLE 2.11^B.C. Leading Causes of Death All Ages ^  24TABLE 2.12^Canada 1985 Percentage of Population Having 10or More Consultations with Doctor in Last 12 Months  ^24TABLE 2.13^Medical Services Utilization in B.C. by Age of Patient,by Sex of Patient - 1986/1987  ^25TABLE 2.14^Occupied Private Dwellings Canada 1986 Seniors 65+ ^26TABLE 2.15^Occupied Private Dwellings B.C. 1986 Seniors 65+ ^26TABLE 2.16^Cohort of men and Women Aged 75-79 in 1971, Canada,1971 to 1986  ^27TABLE 2.17^Living Arrangements of Older Elderly Population, by Sex,Canada, 1971 and 1986, and Projections for 2001  ^28TABLE 2.18^B.C. Population by Five-year Age Groups and Sex, 1986  ^29TABLE 2.19^Distribution of Income Sources of Men and Women Aged 65and Over, 1971 and 1986  ^30TABLE 2.20^Shelter Costs as a Percentage of Household Income of OlderElderly Renters and Homeowners (1986 Spending on1985 Income)  ^31VIITABLE 2.21^Percentage of Population 55 Years of Age and Over RequiringSome Help or Unable to Carry Out Selected Activities by Sex,then Age Group, Canada, 1985  ^32TABLE 3.01^BCHMC Data  ^58TABLE 3.02^NVS Data  ^59TABLE 3.03^Missing Occupancy Data  ^62TABLE 4.01^Median Age of Tenants  ^66TABLE 4.02^Median Age of Replacement Tenants  ^69TABLE 4.03^Yearly Tenant Replacement Rate (%)  ^73TABLE 4.04^Duration of Stay (Months)  ^75TABLE 4.05^Surviving Original Tenants (%)  ^76TABLE 4.06^Sex Distribution (Males per 100 Females)  ^78TABLE 4.07^Age Sub-groups Under 65 and 75 and Over (%)  ^82TABLE 4.08^Couples to All Tenants (%)  ^87TABLE 5.01^Cross Building Comparison  ^96LIST OF FIGURESVIIIFIGURE 2.01 Ecological Housing Model^ 12FIGURE 2.02 Seniors Age Groups B.C. 1986 18FIGURE 2.03 Ratio of Females to Males in Selected Age Groups, ^Canada, 1931-203129FIGURE 2.04 Canadian Seniors 65 and over Sources of Income 1986^ 30FIGURE 2.05 Competence/Press Model^ 39FIGURE 3.01 Median Age of Replacement Tenants: Low Rise^ 64FIGURE 4.01 Median Age by Building Type^ 67FIGURE 4.02 Median Age: Low Rise 67FIGURE 4.03 Median Age: High Rise^ 68FIGURE 4.04 Median Age by Organization 68FIGURE 4.05 Median Age: Total and Replacement Tenants^ 70FIGURE 4.06 Median Age: Replacement by Organization 70FIGURE 4.07 Median Age: Replacements by Building Type, Trends^ 71FIGURE 4.08 Median Age Replacements by Building Type^ 72FIGURE 4.09 Tenant Replacement Rate: Low Rise/High Rise 74FIGURE 4.10 Replacement Rate by Organization^ 74FIGURE 4.11 Duration of Stay by Organization 75FIGURE 4.12 Surviving Original Tenants by Building Type^ 76FIGURE 4.13 Surviving Original Tenants by Organization 77FIGURE 4.14 Sex Distribution by Building Type^ 79FIGURE 4.15 Sex Distribution by Building Type, Trends^ 79FIGURE 4.16 Sex Distribution: High Rise^ 80FIGURE 4.17 Sex Distribution: Low Rise 80FIGURE 4.18 Sex Distribution by Organization^ 81ixFIGURE 4.19 Sex Distribution by Organization, Trends^ 81FIGURE 4.20 Age Sub-group by Building^ 83FIGURE 4.21 Under 65 Age Sub-group: High/Low Rise^ 83FIGURE 4.22 75 and Over Age Sub-group by Building Type^ 84FIGURE 4.23 Under 65 Age Sub-group: High Rise^ 84FIGURE 4.24 75 and Over Age Sub-group: High Rise 85FIGURE 4.25 Under 65 Age Sub-group: Low Rise^ 85FIGURE 4.26 75 and Over Age Sub-group: Low Rise 86FIGURE 4.27 Age Sub-groups by Organization^ 86FIGURE 4.28 Couples by Building Type^ 88FIGURE 4.29 Couples by Organization 88FIGURE 5.01 Cross Building Comparison^ 97FIGURE 5.02 Median Age vs 75 Years and Over by Building^ 98xACKNOWLEDGEMENTSI would first like to express my appreciation for the direction, support and encouragementprovided by my advisors at the University of British Columbia, to wit: Dr. Richard Seaton(School of Architecture) and Dr. Dorcas Susan Butt (Department of Psychology). Also, mythanks go to Dr. Gloria Gutman and Professor Jim Wilson ( Gerontology Research Centre, SimonFraser University ) for their research guidance.For providing access to tenant files, I thank B.C. Housing Foundation, New Vista Societyand B.C. Housing Management Corporation. Also, I extend special thanks to their staff andresidents for their assistance and comments.Finally, I would like to acknowledge the financial support provided through the C.M.H.C.Graduate Scholarship Program.CHAPTER 1: INTRODUCTION^ 11.1 PROBLEM STATEMENTI was first exposed to the issue of aging-in-place, ie., remaining in one's own homethroughout the process of aging in one's later years, at the end of the 1960's. At that time,Actionline Housing Society, a non-profit private housing society, sponsored the design andconstruction of a seniors' housing project in Burnaby. The Society, under the leadership ofEmmet Cafferky, researched the issue of aging-in-place, including field trips in Canada and theUSA to state-of-the-art facilities. The continuum-of-care concept was seen as the appropriatesolution, and the project, known as Seton Villa, provided self-contained apartment units, roomand board, personal care, intermediate care, all the way to extended care. Numerous amenitieswere also included such as indoor swimming pool, hydrotherm pool, penthouse recreation andbanquet room facilities, dining room and commercial kitchen, community hall and anon-denominational church. Many small laundry/kitchen rooms are scattered throughout themain building to provide opportunities for socializing in small groups.The idea of being able to remain in place in the local neighbourhood was key. Due todifficulties of implementation (political jurisdictions and funding problems), the project neverbecame a full continuum-of-care, and presently it provides up to personal care only. However,the project, when conceived, was a harbinger of emerging thoughts on housing older persons, atleast in British Columbia, and it continues to be popular, with a three year waiting period to getin (Cunningham 1989).In recent years, numerous options for seniors' living arrangements have emerged designedto accommodate aging-in-place. These options range from congregate care living tocontinuum-of-care retirement communities; all aim at one not having to move to an institution2when personal competence diminishes ( Newcomer et al. 1986; Gutman & Blackie 1984,1986,1988). For those who can afford it, these options, which are mainly available in the privatesector administration, have proved marketable and appear reasonably successful, at least in theshort term.At the other end of the spectrum, options are limited for those elderly persons who havelimited assets and incomes. Particularly, this applies to elderly persons, who may enjoy onlythe option of multiple seniors' social housing. For many older persons, the move to seniors'multiple housing is made due to the problems of upkeep and maintenance of the single familyhome, or sometimes due to the death of a spouse, or "lack of funds" to keep paying the housetaxes, etc. One may assume that usually the older person may prefer to stay put, if at allfeasible, whether in private dwelling or low-income collective housing.The Provincial Government, through the Ministry of Health, has expressed a policy ofaging-in-place for seniors in B.C. (Hoppenrath 1981). However, this policy has created adilemma since social housing policy for the elderly in B.C. is still based on an independent livingmodel. These seniors' facilities, typically composed of many small units which are designed forindependent living, have neither the physical nor administrative capabilities to accommodateaging-in-place. The implications of an aging-in-place policy remain to date to be considered inthe light of social housing programs and the present inventory of social housing units forindependent living.In the Vancouver area, there are a number of non-profit seniors' multiple housing projectsbuilt in the 1960's and 1970's in which some members of the resident populations have aged inplace. This problem was brought to my attention when I was approached by Professor JohnGaitinakis (UBC School of Architecture) to assemble a graduate student team to study the3problem for the British Columbia Housing Foundation. In discussing the topic of aging-in-placewith British Columbia Housing Management Commission, I was informed that this problem, ie.,residents aging in multiple seniors' social housing, is not being evidenced in its public-runfacilities (McCririck 1988) Notwithstanding this BCHMC statement, it is likely that theseenvironments, which were designed for retirement age seniors, do not meet current needs of theolder senior members of the resident senior populations (Lawton, Greenbaum & Liebowitz1980). There are persons who moved into these facilities at retirement age (about 65) who arenow over 80 years old. As tenants age in place, the ages of occupants range upward to include the8th and 9th decades. This likely causes upward movement of the median age of occupants in anygiven project, unless it is regularly expanded in its capacity to accommodate new admissions of(younger) seniors.Non-profit seniors' multiple housing projects are operated under a presumption thattenants are "independent" insofar as they require no external support service for daily living.However, the older the tenants become, the more tenuous is this presumption. For example,couples in tenancy tend to become widowed, with survivors suffering loss of spousal support.Also partial infirmities and impairments will develop and become more disabling over time,thereby reducing an individual's self-dependence. Indeed, there is evidence that currentresidents of some private non-profit seniors' multiple housing do use off-site and in-homesupport on a regular basis while continuing to age in place in their self-contained bachelor andone bedroom units (Cove 1989). With passage of time, residents in independent multiplehousing projects must vacate their units either because they become too disturbed, ill ordisabled to continue residence in their self-contained units. The period of residence precedingvacating of units through illness or infirmity may impose a severe overload on non-profitseniors' housing managements and a high health and safety risk to the tenant. Alternatively, to4avoid overloading, forced moves may occur resulting in these residents being prematurely placedin care institutions.Recently a number of alternatives to moves to institutions for the elderly with changingneeds have been developed. The Abbeyfield model of small family-style congregate living hasbeen studied in relation to its marketability and affordability in the Vancouver context (Murrayet al. 1988). In Housing Choices for Elderly Canadians (CMHC 1985), many alternatives toinstitutionalization are presented.Problems related to environment and changing residents' needs due to aging-in-place inpersonal care facilities have been addressed and guidelines formulated (Champagne and Brink1985; CMHC Design Guidelines, 2nd ed. 1987). However, there appears to be a gap in theresearch concerning older seniors living in public multiple housing for seniors built throughgovernment-sponsored programs in the Sixties and Seventies. Referring to a similar situationin the United States, Lawton stresses the need to research the changes in the thousands of housingenvironments built as housing for independent seniors (Lawton, Greenbaum & Liebowitz 1980,62 ) .The effects of aging-in-place were studied by Lawton et al. in two congregate housingprojects in Philadelphia. Tenant population changes suggested that "a process of stabilization at arelatively low level of independence may be occurring" (1980, 63). The researchers ask thequestion "Will such a state be reached by every housing environment if extraordinary measuresare not taken?" ( ibid., 63). As they suggest, housing sponsors "need to know how tenantpopulations change over time and what factors influence this change, in order to be able to planfor future services to the tenants" ( ibid., 57).51.2 SIGNIFICANCE We are experiencing a "seniors boom" in Canada. In the next 45 years, the seniorpopulation (65 years of age or more) is expected to almost triple in size. Today among the oldold (over 80), a sharp increase in growth rate (77%) is expected over the period 1986 to2001 (Stone and Fletcher 1986, 1). In British Columbia, an increase of 128% in populationaged 80+ is projected from 1981-2001.Presently, it can be expected that the survivors of that cohort of seniors 65+ admitted tomultiple housing projects for seniors built in the Sixties and Seventies have experiencedconsiderable debility. Particular problems associated with the changing needs of these old oldcitizens are only recently being explored.Government-sponsored multiple seniors' housing projects have been built throughoutCanada. Putting aside regional program differences, we are likely to see that the problems beingexperienced in these facilities by cohorts of older seniors aging-in-place are similar,irrespective of locations, given that the program criteria are national in substance In B.C.seniors' public multiple housing projects are being implemented through the BCHMC program.It could be, therefore, expected that findings from this study will have wider applicability thanjust the local study focus.Given the increasing numbers of elderly in Canada and their increasing longevity, this groupcannot be ignored. Members of this age group are becoming more vocal in terms of their humanrights; also they represent a most valuable community resource whose potential is presentlybeing overlooked. At the same time, re-housing them in intermediate or extended care hospitalsis both unappealing and costly. For this reason it is is important that we better understand thecircumstances which defer or avoid transferance to various levels of care.61.3 PURPOSE The thesis explores the issue of aging-in-place as it relates to seniors' multiple housingprojects. The thesis first explores aging-in-place from a broad perspective, looking forrelevant factors to consider in planning seniors' housing facilities. At a more detailed level, thequestion of whether aging-in-place is occurring in seniors' multiple housing projects isinvestigated. Also explored is the question of whether aging-in-place varies by organization orby building type (high/low rise).1.4 DEFINITION OF KEY TERMS:The following key terms are defined by the writer for the purposes of this thesis.Aging-in-Place^ Remaining in one's own dwelling throughout theprocess of aging in one's later years."Staying put" is another term synonymouswith aging-in-place.Seniors^ Those persons of 65 years of age or overOlder Seniors Those persons of 75 years of age or overOld old^ Those persons 80 years or olderSeniors' Multiple Housing^Housing designed specifically for seniorsfor independent living. Usually in theform of row houses or apartmentbuildingsPersonal Care^ Minimal non-professional care andsupervisionIntermediate Care^ Three categories at varying levels ofprofessional care and supervision.Extended Care^ Full-time professional nursing careCongregate Housing Supportive living environment with somemeals and services to assist aging inplace.Continuum CareCompetenceInterdisciplinaryAll needs are met from independentliving through to extended care withinthe one facility.Represents the givens within theindividual such as physical, mentalhealth. It covers a range from low to high.Consisting of the collaboration andco-ordination of more than one discipline.7ACRONYMSA.I.L.^ Assisted Independent LivingR.R.A.P. Residential Rehabilitation AssistanceProgramSAFER^ Shelter Aid for Elderly Renters (B.C.)GAIN Guaranteed Annual Income for NeedG.I.S.^ Guaranteed Income SupplementOAS. Old Age SecurityC/QPP^ Canadian/Quebec Pension Plan1.5 RESEARCH STUDYAging-in-place reduces the incidence of institutionalization of the elderly. However, changesthat take place to individuals and environments have to be considered at inception of seniors'housing programs designed to accommodate aging-in-place, if these programs are to be successfulon a continuous basis.The main thesis question is concerned with the implications of aging-in-place for present andfuture seniors' housing policies and programs, particularly given the present B.C. Provincialaging-in-place policy as stated through the Ministry of Health long-term care program.8In Chapter 2, aging-in-place issues from macro level to individual level are reviewed.Demographic statistics and projections respecting the elderly population are first discussed to raiseour level of understanding of the needs of the population to be served. The desire of seniors toremain in their neighbourhoods and the advantages of doing so are discussed.The competence/press model is introduced as a useful conceptual means of understanding thetheoretical implications of aging-in-place at the micro level. At the individual level, a typology ofcompetences is introduced along with the argument that there is a need to maintain and enhance allthe competencies to support aging-in-place.Chapter 2 provides a broad perspective on the implications of aging-in-place. The macrosystem discussion suggests the general magnitude of need for supportive environments; theexosystem discussion suggests locational implications, the micro system discussion emphasizessupportive environments over institutionalization, and a broad definition of individual need issuggested at the individual level.Chapters 3, 4 and 5 present the case studies. These case studies focus on the segment of theelderly population who are housed to a large extent in "social housing", provided through some formof government-sponsored program. The general question explored is whether aging-in-place isoccurring in these facilities and whether there are differences by organization or building type.Chapter 3 introduces the model for the case studies and outlines the methodology used. Case dataused in this study are drawn from seniors' public and non-profit multiple housing projects inVancouver, built before 1978, two of which are operated by each of three independent9organizations. These organizations are New Vista Society (NVS), British Columbia HousingFoundation (BCHF) and the British Columbia Housing Management Commission (BCHMC).An analysis of tenant populations for each of the organizations and buildings is provided inChapter 4. These measures include median age of tenants and replacement tenants, duration of stay,original tenants to total tenants, sex distribution; age sub groups, tenant annual replacement rate,and proportion of couples to all tenants.Findings indicate that the median age (the primary indicator for aging-in-place) has remainedalmost constant for the seven-year study period irrespective of organization. There are differencesby building with examples of increases as well as decreases in median age. Surprising is thefinding that there are distinct differences in median age of tenants by organization with a spread offour years between BCHMC (70) and BCHF (74). Another important finding is that there aredistinct differences in age subgroup distribution by organization.Chapter 5 attempts to explain why the median age is remaining almost constant for allorganizations, why there are differences in median age by organization and differences by building.The median age of replacement tenants is the critical variable in explaining differences in medianage of residents within a particular organization. There are indications which suggest that olderseniors do tend to age-in-place if left to do so.Chapter 6 summarizes the thesis and evaluates its effectiveness in meeting stated objectives.Limitations of the findings are discussed. Notwithstanding limitations, it is concluded that BCHMC isless accommodating to aging-in-place than the other two organizations. This is likely due to thepolicy of BCHMC being more formally applied than in the other two organizations, given theinherent inflexibility of a large bureacracy. Possibly "forced" moves of older seniors are1 0occurring, along with premature institutionalization. Such occurances may be more likely whenmedian age is higher, so that there is an increased need for caregivers along with a higher risk tothe health and safety of the tenants if they remain in "independent" living environments.There is a need for further study to ascertain where tenants move to after they leave thesemultiple housing projects. Standard forms of record keeping requirements would assist agencies inpredicting present and future requirements for tenants. Keeping a record of where tenants moveafter leaving would facilitate analysis of the proportion being institutionalized.The present model for the delivery of seniors' multiple housing results in the production ofcontrolled environments. This independent living model is not very effective in supportingaging-in-place. The provision of supportive living environments will require an interdisciplinaryapproach both in facilities programming and management.The provision of small housing facilities along the lines of the Abbeyfield model may, in the longrun, prove practical to implement in predominately single family neighbourhoods and help meet thechallenge of providing appropriate living environments for aging-in-place, in other wordscompetent environments.11CHAPTER 2: THEORETICAL FRAMEWORK2.1 FRAME OF REFERENCEThe intention of this thesis is to provide observations and concepts for those persons andagencies concerned with the delivery of seniors living arrangements, which may contribute inthe planning and operation of these facilities. In Chapter 2, the background research looks ataging-in-place from a broad perspective. The questions asked are typical of those a housingagency might ask in the process of facilities planning. The first question concerns the magnitudeof the demand and the characteristics of the population to be served; the second concerns theappropriate location to fulfill the need; the third concerns the functional and spatial needs ofparticular facilities; and the fourth concerns the individual needs at the detail level. Thefollowing discussion attempts to provide answers to the preceding questions and in doing so raiseour understanding of aging-in-place issues in relation to seniors' multiple housing.It is no easy task for those individuals and agencies involved with the delivery of seniors'housing to select programme requirements from the plethora of research which covers a vastrange of disciplines and topics. In addition to the problem of complexity, there is littletheoretical research which is generalizable for application to programming of seniors' multiplehousing. One explanation for this problem lies in the specificity of the research. "From thevantage points of its own advocates, each conceptual framework appears to be a complete,consistent, and correct prescriptive model of reality. Each enables researchers to convenientlystructure their own work. Each also provides them with the only available frame of referencefor interpreting the research of others working in the same context area. Unfortunately,however, a conceptual commitment provides no basis for the translation or accumulation ofresearch findings across frameworks. Herein lies the dilemma - all research is frameworkspecific" (Lawton, Windley et al. 1982, 157).1 2The Ecological Housing Model (Lawton 1980) is a helpful tool for categorizing theresearch within the overall environmental context. It consists of four separate interrelatedcategories, the macrosystem; exosystem; microsystem and the individual.The macrosystem includes dominant societal values, social forces, economic and policialdecisions and policies. The exosystem includes community characteristics and structure,neighbourhood characteristics and structure. The microsystem includes personal environment,group enviromental, the physical environment and suprapersonal environment.The last category is the individual including personal characteristics, competences, needsand wants, beliefs and values.(dominant societal values,MACROSYSTEM/^4^societal forces,economic/ENVIRONMENT  political decisions and policies)EXOSYSTEW ^/^Z 3^(community characteristics/structure,neighborhoodENVIRONMENT characteristics/structure)\^\MICROSYSTEM/^ (personal environment, groupENVIRONMENT environment, physical environment(^(suprapersonal environment)\^\^\(PERSONAL: characteristics,INDIVIDUAL competences, needs and wants,beliefs/ values)Figure 2.01 Ecological housing model13In this study, the Ecological Housing Model is used as a frame of reference within which,both the background research and the case studies are placed. Final conclusions are considered inthe light of this broader context while limitations are also recognized. It should be noted thatwhile these categories provide a general framework for discussion purposes, there are bound tobe overlaps among the categories.2.2 MACRO SYSTEM CONSIDERATIONS: ORGANIZATIONS/SENIORS DEMOGRAPHICS The macro system includes dominant societal values, social forces, economic and politicaldecisions and policies. The rationale for understanding issues at the macrosystem level isprovided by Irwin Altman. "However, the larger social, polical and economic forces andprocesses within a particular changing society are the primary determinants in explaining andaccounting for the existence and range of housing alternatives and in the variation in choicebetween groups of elderly, as well as the changes in these housing options over time." (1984,123) It is not the intention of this document to address all of these areas of the macro systemgiven the time constraints. Rather, two areas will be covered, the first concerning economic andpolical decisions and policies, is organizations, and the second concerning social forces, isseniors demographics.2.2.1 ORGANIZATIONS In the introduction, we discussed the fact that BCHF reported aging-in-place was occurringin their facilities, while BCHMC reported that aging-in-place was not occuring in theirs. Thefirst question for the case studies presented in Chapters 3 through 5, is concerned withconfirming or refuting these reported occurences. Assuming that actual differences might beconfirmed by organization, the question that remains is why are these differences occuring?1 4For the purpose of this thesis the measure of effectiveness (i.e. success) of an organizationis longevity of tenancy. This implies that, in successful organizations, median age of tenantswould be high, the proportion of original tenants would be high, the proportion of older seniorswould be high and tenant turnover would be low. The following discussion provides a definition oforganization, and presents some theoretical ideas on why differences in outcome by organizationmight occur.Leon Ullmann provides a "concept of organization as a group of people with a commonpurpose" ( 1967, 164). The common purpose is what justifies the existence of an organization.In order to evaluate the effectiveness of an organization, the attainment of purpose has to bemeasured.The relationship of size to groups and organizations has been the focus of a number ofstudies concerned with effectiveness. The benefits of small size in industrial settings (Worth1950) were higher employee morale, supervisors and higher administrative officers wereknown personally, there are fewer levels of supervision, less minute divisions of labour, and theorganization operates on a face-to-face rather than on an impersonal, institutional basis. In astudy by Barker et al. (1964), the benefits of small size in education settings were, increasedstudent participation, enthusiasm and responsibility. In his discussion on the advantages ofsmall care facilities, John Phillips argues that there is an "ability for all staff to know thepatients personally" (Phillips 1977, 126).Small group research shows a similar relationship between size and participation. As sizeincreases, participation decreases (Kelly and Thibart 1954; LeCompte and Balar 1960; Dawe1934). In discussing small group housing it is suggested that these settings "because of theirsmall size, also offer the potential for small group interaction and integration into the nearby1 5community (Peace 1981, 16). On the other hand, it was found that _Ironically, England's ownDepartment of Environment has published a survey of grouped schemes in which it was foundthat, of a sampling of flats, project size was not important to the elderly tenants" (Goldenberg1981, 174).A major justification for large size organization is economies of scale. A centralizedadministration can expedite tasks of many units. The benefits of increased size are efficiency inproduction or reduction in cost per unit, mainly due to centralization of maintenance andadministration functions. Arguments have been presented both supporting and rejecting thisreasoning. Ullmann cites Blau & Scott (1962) and Bendix (1956) as sources supporting theargument that the percentage of administration salaried workers decreases with increasing thesize of the establishment; and cites Terlin & Mills (1958) as a source opposing the argument(Ullmann 1967, 16). This study of three school districts in California indicated that as sizeof organization increased, the percentage of employees in the administrative componentincreased. In other words, there is an increased need for coordination, which leads to the counterargument that small size reduces the need for task coordination and therefore reduces overhead.There is also a direct relationship between the size of an organization and bureaucratictendencies. Bureaucracy is defined as a technique for organizing the efforts of many peopletowards a common goal, having the four basic characteristics of specialization, hierarchy, rulesand impersonality (ibid., 127).The general purpose or goal of an organization may be displaced due to the effects of thebureaucratic characteristics discussed. The following is a review of some of the featuresassociated with these characteristics and some of their effects.1 6First, there is a continuous organization of official functions bound by rules. The effect isthat there is not a need to raise new solutions to problems, but rather all cases are givenstandardized and equal treatment. When situations change, it is easier to categorize them asappropriate to old rules than to devise new rules. (Merton, 1940). Second is the systematicdivision of labour, rights and power. The job is defined, always with its limits. The problem isthat in practice there may be overlap is a person's area of specialization, especially in thetreatment of humans. The system does not accommodate overlaps in jurisdiction. Third, with anorganizational hierarchy, there is no position left uncontrolled. At the same time, a seniorperson might end up in control or having no control over a particular department or area outsidehis/her particular expertise. Fourth, the rules of conduct are technical, applied rationally;therefore persons tend to "play it safe", not take risks. In the end the policy may become theprimary criterion for decisions. "Adherence to the organization's policy has become theorganizational goal of the bureaucrat" (Etzioni 1964, 12). Fifth, administration acts, decisionsand rules are formulated and recorded in writing. The result is that a paper trail is the visiblerecord of work accomplished. Effectiveness is measured in terms of performance records (Blau& Scott 1962, 179).Large organizations or bureaucratic organizations are not inherently bad but might be lesseffective in particular situations than small organizations, especially in situations concerninghuman needs. Thus, differences in outcome might be explained by differences in size oforganization.In a comparative study of government prisons (DiLulio, Jr. 1987) several possibilitieswere suggested in accounting for differences in outcome by organization. Some of the suggestedfactors of relevance to the present study are: i) inaccurate or biased data (e.g.: flawed, bogus orincomplete), ii) characteristics of the population, iii) architecture and iv) management style.17In DiLulio's study there was a correlation between age of inmates and level of violence.Some correlation between level of order and architecture was evident but inconclusive. Of all ofthe factors considered in explaining the difference, management style was central. It wasconcluded that "prison management is the strategic variable, one that may be subject to changewith predictable and desired consequences" ( ibid., 95).We will return to the consideration of this discussion on organizations and size in theclosing chapters which cover case studies analysis and evaluation.2.22 SENIORS DEMOGRAPHICS The changing characteristics of the seniors population both nationally and locally is one ofthe major social forces with implications for aging-in-place; it concerns the question of thenature and magnitude of the demand. In presenting statistical data there has been a tendency toignore older seniors as an age sub group of the seniors population. Most demographic studiestend to talk of the seniors population as a whole (65 and over). This oversight focuses theattention away from the groups who are most in need of support, particularly those who, for thepurposes of this study, are defined as older seniors (75 years and over). To rectify thisimbalance statistical data are therefore analysed and presented in the forthcoming discussionwith an emphasis on older seniors.182.2.3 POPULATION The older seniors population in Canada in 1986 totalled 1,047,490 (4.1% of thepopulation) while the seniors population under 75 totalled 1,650,085 (6.5% of thepopulation). In British Columbia, the older seniors population totalled 134,025 (4.6% of thepopulation) and the under 75 seniors population totalled 215,480 (7.5% of the population).The largest proportion of seniors in British Columbia was in the Vancouver Central MetropolitanArea, which accounted for almost half (48%) of the Provincial seniors population. In BritishColumbia, the older seniors group is 39% which is the largest seniors age sub group (Seetables 2.01-2.03 and Figure 2.02).Figure 2.02 Seniors age groups B.C. 198619Table 2.01 Population Canada 1986Both Male FemaleTotal 100.0 25,309,330 12,485,650 12,823,68065-69 3.6 911,765 414,545 497,22070-74 2.9 738,320 324,330 413,99075+ 4.1 1,047,490 394,460 653,02565+ total 10.6%(Source: Statistics Canada, Census of Canada 1986)Table 2.02^Population in B.C. 1986Male FemaleBothTotal^100.0^2,883,365 1,428,115 1,455,2556 5 - 6 9^4.1 117,485 53,405 64,0807 0 - 7 4^3.4^97,975 44,202 53,9607 5 +^4.6 134,025 53,560 80,46565+ Total^12.1(Source: Statistics Canada, Census of Canada 1986)Table 2.03^Population in CMA Vancouver 1986Total 1,380,7256 5 - 6 9 54,2257 0- 7 4 46,1707 5 + 66,560(Source: Statistics Canada, Census of Canada 1986)2.2.3 GROWTHFrom 1971 to 1986 the older seniors population in Canada increased 56%, compared to anincrease of 16% for the under 75 population. Nationally, it is forecast that the older seniors2 0population will reach 1.7 million by the year 2001 (6% of the total population). This isapproximately an increase of 70% from 1986 (Priest, 1988, 27). The forecast for B.C. is anincrease of older seniors to 6.6% of the total population by 2011; that is an increase of130,975 older seniors (Statistics Canada 1986). In British Columbia by year 2011, theseniors population may total 588,500 representing 14.6% of the population. Projections forthe 65-74 seniors age group indicate a short-term easing in growth rate for the period 1995 to2005. However, this easing will only be temporary until the early Baby-boomers reach seniorsage (Government of B.C. Central Statistics Bureau October 1988).2.2.4 MARITAL STATUSFifty-four percent of the total seniors population in Canada in 1986 were married.^Thisaccounted for 74% of the male seniors population and 40% of the female seniors population. InB.C. 58% of the total seniors population were married, constituting 76% of male seniors and44% of female seniors respectively. Of the seniors age 75+ in Canada, the proportion droppedto only 2/3 of the male population and less than 1/4 of the female population ( Priest 1988,27). In B.C. in 1981, 58% of the older seniors male population were married and only 18% ofthe female population (Gutman et al. 1986 18). These lower figures are attributable to theincreasing longevity of older seniors in B.C. (see Tables 2.04 and 2.05).Table 2.04 Marital Status 1986 in CanadaTotal^Married^0/0^Single^Widowed^Divorce^Separ.65+ T 2,697,580 1,462,185 54% 220,265 907,240 58,920 48,820M 1,133,340 843,945 74% 85,560 153,365 25.665 24,800F 1,564,240 618,235 40% 134,805 753,920 33,255 24,020(Source: Statistics Canada Census 1986)21Table 2.05 Marital Status 1986 in British ColumbiaTotal Single Married 0/0 Widowed Divorced Separ.65+ T 349,485 19,925 201,760 58 108,955 12,535^7,210M 150,990 8,740 114,995 76 18,465 5,105^3,690F 198,495 10,290 86,765 44 90,495 7,435^3,520(Source: Statistics Canada Census 1986)2.2.5 MOBILITYNorthcott (1988) has questioned the myth that there is little mobility among the elderlypopulation. From his analysis he shows that there was still substantial mobility among the 65and over age group in Canada. In Canada, 22% of the population 65 and over changed residence forthe period 1981-86. The figure for B.C. was 26% (see Tables 2.06 & 2.07).Moves among the older seniors (over 75) population are less well documented. For the period1976-81, 36% of the male senior population under 75 and 32% of the female seniors populationmoved residence in B.C. compared to 28% for both groups in the older seniors (75+) category.Moves among the older seniors population are more local in nature, varying both within theprovince of B.C. and among local neighbourhoods in the urban environments.Table 2.06 Mobility Status^1981-1986 Canada 65+Non^Same^Diff.^OutsidePop.^Non-movers^Movers^Migrant^Prov. Prov.^Can.T 2,495,105 1,953,685 541,421 316,375 161,775 34,906 28,370M 1,072,050 851,325 220,730 123,410 70,430 14,975 11,915F^1,423,055 1,102,360 320,700 192,965 91,350 19,930 16,450(Source: Northcutt 1988, 33-65)22Table 2.07 Mobility Status 1981-1986 B.C. 65+Non^Same^Diff.^OutsidePop.^Non-movers^Movers^Migrant^Prov. Prov.^Can. T 325,000 129,380 85,620 43,335 27,370 9,215 5,700M 143,445 105,915 37,525 18,110 12,595 4,365 2,500F^181,510 133,465 48,045 25,220 14,770 4,850 3,200(Source: Northcott 1988 33-65)2.2.6 HEALTH STATUS Canada's elderly population are a comparatively healthy group. However, there is generallyan increase in reported health problems among the elderly with increasing age (See Tables 2.08and 2.09). In 1985, persons over 65 reporting functional disabilities numbered 1,221,995(37%) of the disabled population in Canada; correspondingly, seniors in B.C. constituted151,540 (38%) of the disabled population in B.C. Of the total seniors disabled in Canada and B.C.in 1986 over 51% are older seniors. Among the reported health problems of seniors, arthritis isthe most prevalent (48%) followed by hypertension (40%) cardiovascular troubles (21%),respiratory problems (19%) and diabetes (8%).Table 2.08 Disabled Population 1986 CanadaIn InstitutionsTotals^ In Households65+ Tot 1,221,995 1,026,915 195,080F 727,655 589,295 138,360M 494,340 437,615 56,72065-69 Tot 305,310 291,705 13,605F 151,375 144,650 6,725M 153,940 147,055 6,88070-74 Tot 298,78575-79 Tot 250,380 214,33580-84 Tot 190,445 142,54085+ 177,075 101,455(Source: Statistics Canada, Health Activity Limitation Survey 1988, 45-46)Table 2.09 Disabled Population 1986 B.C.Total In Households % In Institutions 0/065+^T 151,535 128,050 85 23,485 15F 87,600 70,865 47 16,735 11M 63,940 57,185 37 6,755 465-69^T 36,780 35,805 24 975 0.6F 19,390 18,915 13 470 0.3M 17,395 16,890 11 505 0.370-74^T 36,915 34,970 23 1,940 1.3F 17,725 16,520 11 1,210 0.8M 19,185 18,455 12 735 0.575-79^T 31,800 27,995 18 3,800 2.5F 17,805 15,160 10 2,645 1.7M 13,995 12,840 1,15580-84^T 23,735 17,655 12 6,085 4F 15,800 11,620 8 4,180 2.8M 7,935 6,035 4 1,905 1.285+^T 22,310 11,625 8 10,685 7F 16,880 8,655 6 8,230 5.5M 5,425 2,970 2 2,455 1.515-64^T 216,770Total Dis. Pop. 395,120(Source: Statistics Canada, Health Activity Limitation Survey 1988, 39)Table 2.10 Prevalence of Selected Health Problems B.C. 65+^Hypertension^ 40%Cardiovascular diseases^21Diabletes 8Respiratory Problems 19Arthritis^ 48(Source: Health and Social Support 1985 154)2324Table 2.11 B.C. Leading Causes of Death All AgesRate per 100,000Diseases of Heart^ 217.9Malignant Neoplasms 191.7Cerebrovascular Diseases^58.4Accidents^ 42.8Pneumonia 27.8Diseases of arteries^ 20.0(Source: Health and Social Support 1985 154)2.2.7 HEALTH CARE UTILIZATION Utilization of the health care system also increases with age (See Table 2.12). Of Canada'stotal population, 20% of the under 75 seniors age group had ten or more consultations with theirphysician in the past 12 months in 1989. This figure increased to 29% for the older seniorspopulation in Canada.Table 2.12^Canada 1985 Percentage of population having 10 or more consultations with doctorin last 12 months. All ages^5 5 - 6 4^6 5 - 7 4^7 5 + Both^11%^15^20^2 9M 8 15 17 25F 13^15^22^3 1(Source: Statistics Canada Health and Social Support 1985)22.8 COST OF CAREGiven the increasing utilization of the health care system, this obviously reflects in anincrease in cost of care delivery for older persons (See Table 2.13). In B.C. the cost per capita ofcare 1986/87 for persons under 60 ranged from a low of 155.08 (10-19 age group) to a high of318.66 (50-59 age group). For the ages 60-69 the figure was 428.23 , for the 70+ agegroup the per capita cost of care was 623.09 i.e., roughly two to three times the cost of deliveryin the other age groups. Although a further breakdown of the older seniors category is not2 5available one might predict that the per capital cost for the 75+ group would be even higherthan the preceding costs.Table 2.13^Medical services utilization in B.C. by age of patient. by sex of patient - 1986/87Age Group MalesCost per CapitaTotalFemales0-9 190.92 184.10 187.6110-19 136.83 174.22 155.0820-29 137.42 350.04 244.3730-39 169.62 348.96 259.4940-49 213.56 328.64 270.1150-59 291.87 346.46 318.6660-69 445.31 413.42 428.2370+ 684.97 578.10 623.05All Ages 238.04 328.32 283.61Dental surgery in hospital and payments for out-of-province services not included.(Source: B.C. Ministry of Health Annual Report 1986-1987)2.2.9 LIVING ARRANGEMENTS Of the total seniors under 75 in Canada, 63% of them were living with their spouse in 1985compared to 43% for the older (75+) seniors group. Of the under 75 senior males this figurewas 79% versus only 50% for the under 75 senior females. Of the older senior males thepercentage was 65% vs. 29%. A total of 1,620,690 private dwellings were occupied by Canadianseniors in 1986. Sixty-five percent were owned dwellings and 35% were rented. Of the rentaldwellings 37% were in apartment buildings with five or more storeys. (Statistics Canada, Censusof Canada 1986)Seniors 65 and older occupied 213,970 private dwellings in B.C. in 1986. Of these, 68%were owned dwellings and 32% were rented (See Table 2.14 and 2.15). Eighty-one percent of2 6owned dwellings were single detached homes, 25% of rented dwellings were apartments inbuildings five storeys or more, 65% were others ( Statistics Canada, Census of Canada, B.C.1 9 8 6).Table 2.14 Occupied Private Dwellings Canada 1986 Seniors 65+Total^1,620,690 Owned 1,037,325 65.0%Rented 576,720 35.0%Single^922,880 Owned 867,275 83.6%Detached Rented 49,990Apartment^238,360 Owned 27,185 2.6%5 storeys + Rented 210,810 36.5%Movable^14,905 Owned 13,375 1.3%Dwelling Rented 1,060 0.2%Other^444,540 Owned 129,490 12.5%Rented 314,850 54.0%Table 2.15 Occupied Private Dwellings. B.C. 1986 Seniors 65+Total^213,970^Owned 145,358 63.0%Rented 65,875 32.0%Single^126,095 Owned 118,170 81.3%Detached Rented 6,055 9.2%Apartment^21,065 Owned 4,100 2.8%5 storeys + Rented 16,585 25.2%Movable^5,520 Owned 4,785 3.3%Rented 310 .5%Other^61,290 Owned 18,295 12.6%Rented 42,925 65.2%272.2.10 LIFE EXPECTANCYThe average life expectancy in 1986 for a male is 72 years and a female 79 years in Canada.Among older seniors a woman of 75 (1986) can expect to live another 12 years and a mananother nine years on average. The attrition rate is higher among Canadian males than amongfemales. Of male cohorts 75-79 in year 1971, 60% survived five years; 31% survived 10years and only 15% survived 15 years. Comparing figures for the female cohorts 75-79; 73%survived five years; 47% survived 10 years and 30% survived 15 years (See Table 2.16).Table 2.16COHORT OF MEN AND WOMEN AGED 75-79 IN 1971, CANADA, 1971 TO 198675-79^80-84^85-89^90+In 1971 In 1976 In 1981 In 1986COUNT^%^COUNT^`)/0^COUNT^%^COUNT %Survivors Survivors^SurvivorsMEN 139,360^100^84,355 60 43,585 31 20,345 15WOMEN 184,730^100^134,575 73 86,105 47 54,790 30(Source: Gutman & Blackie 1988, 8-18)2.2.11 LIVING IN INSTITUTIONS The institutionalization of older seniors increased between the period 1971 and 1986. Of themale population 75 and over, 9% were living in institutions in 1971 compared to 12% in 1986.Institutionalization was higher among females (75+) with 14% living in institutions in 1971compared to 19% in 1986. The projections to 2001 forecast that the proportion ofinstitutionalized males is expected to remain stable, while institutionalization of females is28expected to continue to increase to 23%. However the actual number of institutionalized males isforecast to increase by 30,200 persons (from 45,300 1986 to 75,500), while the actualnumber of females to increase by 121,600, from 120,900 1986 to 242,500 in 2001.(Priest 1988,^26-30)Table 2.17: Living arrangements of older elderly population. by sex. Canada 1971 and 1986. andprojections for 2001 19710/01986%2001^(Projected)Number Number Number^%MENInstitution 25,700 9 45,300 12 75,500 12Other 255,400 91 346,000 88 581,000 88Total 281,100 100 391,300 100 656,500 100WOMENInstitution 53,200 14 120,900 19 242,500 23Other 333,500 86 527,300 81 811,000 77Total 286,700 100 648,200 100 1,053,500 100(Reconstructed from data in Priest 1988, 30)2.2.12 SEX DISTRIBUTION The proportion of males to females in the Canadian seniors population has becomeincreasingly imbalanced. In 1956 in the 75+ age group men were slightly outnumbered byfemales 100 to 125. By 1981 there were 195 females per 100 males 75 and over. This trendseems to have stabilized and it is expected that the sex ratio will remain stable at 2:1 into the 21stCentury.29Figure 2.03Ratio of Females to Males In Selected Age Groups, Canada, 1931-2031( 1 )Females per 100 males260 —Females per 100 males— 260ft". •ii. ^240 —^— 65 and over r. n,/ft.., Q.",...... ...... — 240....220 —^75 and over/— 220200 —^'• 85 and over — 200- 180Total population—180160 — 160—140 — ... .... — 140120iro—.— 120100..............100 —.....00,0914.1,„;y80 I^i^I^I^I^I^I 1 I 1 I^I I I I 1 I I I 1 I^801931^'36^'41^'46^'51^'56^'61 '66 '71 '76 '81^'86 '91 '96 '01 '06 '11 '16 '21 '26 '31Year(2)21st century(1) Data for 1986 and beyond are averages of the latest Statistics Canadahighest and lowest projections.(Source: Stone & Fletcher 1986, 16)In B.C. the number of females per 100 males 75 and over was 150 in 1986.Table 2.18 B.C. Population by Five-year Age Groups and Sex. 1986 Total^ Men^Women65-69 years^117,485 53,405 64,08070-74 97,975 44,020^53,96075 +^134,025^ 53,560 80,4652.2.13 INCOMEPeople 65 and over for the most part constitute the majority of the poor in Canadian society.In 1986, average annual income for population 65 and over was $13,212.00. There is asignificant disparity between elderly male and female incomes: this relation diminishes if oneincludes hidden rents. In 1986, the average income of Canadian male seniors was $16,760compared to $10,527 for females, for a 1.7 to 1 ratio. However, the proportional discrepancybetween men and women was greater in 1971, at 2:1.EMPLOYMENT9.8%PRIVATE PENSIONS15.7%Table 2.19 Distribution of income sources of men and women aged 65 and over, 1971 and 1986.1971Men Women1971Total1986 1971 1986 1986OAS/GIS 28.1 25.2 59.5 45.33 9.6 34.4C/QPP 2.1 16.3 1.1 11.0 1.7 13.9Other gov't transfers 2.1 3.5 2.4 3.6 2.2 3.6Investment income 20.2 18.9 19.6 24.1 20.0 21.2Private pensions 15.8 20.1 8.5 10.5 13.2 15.7Employment earnings 30.2 14.6 7.2 3.9 21.8 9.8Other 0.9 1.3 1.3 1.5 1.0 1.4Total 100.0 100.0 100.0 100.0 100.0 100.0Total income(constant 1986 $)12,554.0 16,760.0 6,183.0 10,527.0 9,122.0 13,212.0(Source: Statistics Canada, Household Surveys Division 1986)The main sources of income for Canadian seniors are investment income, G.I.S. and O.A.S.Additional sources of income are private pensions, employment earnings and other governmenttransfers (Statistics Canada, Canadian Social Trends 1988).FIGURE 2.04 CANADA: SOURCES OF INCOME 1986 65+30In the older seniors group there is a high percentage of persons who pay 30% or more of theirincome on shelter. This percentage is highest among women living alone who rent. For all olderseniors renters are more likely to spend a high proportion of their income on shelter costs.Table 2.20 Shelter costs as a percentage of household income of older elderly renters and homeowners (1986 spending on 1985 income) 31No. of persons per 100population paying atleast 30% of income on shelterNo. of persons per 100population paying atleast 50% of income on shelterRenters Owners Renters OwnersWomen living alone 52 21 20 5Men living alone 46 15 15 4Couples (no otherhousehold members) 33 4 6 1(Constructed from data in Priest 1988, 26-30)2.2.14 SOCIAL SUPPORTThe need for help with selected activities increased dramatically for the older seniors group.Reported need in 1985 more than doubles in most categories of activity from the under 75seniors to the older seniors group, especially among widowed householders. In order ofdiminishing^rated need these activities are as follows:Help with yardwork 64%,Heavy housework 4 6%,Grocery shopping 33%,Meal preparation 1 7% ,Managing money 1 7%,Light housework 9%and Personal care 7%.32Table 2.21 Percent of Population 55 Years of Age and Over Requiring Some Help or Unable to Carry out Selected Activities by Sex then Age Group, Canada, 1985Activity^Total^Males^Females^5 5 - 6 4^6 5 - 7 4^7 5 +Yardwork^33%^1 8 %^46%^20%^37%^6 4 %Heavy Housework^21 %^2 0%^2 2%^!0%^2 2%^4 6%Grocery Shopping^1 2%^8%^1 6%^5%^1 2%^3 3%Meal Preparation^7%^10%^5%^3%^8%^1 7 %Managing Money^4%^3%^6%^1%^4%^12 %Light Housework^3%^3%^3%^2%^3%^9%Personal Care^2%^2%^3% 2%^7%(Source: Statistics Canada, Health and Social Support 1985,177)2.2.15 SUMMARYA number of factors have been identified from the seniors population which haveimplications respecting the provision of seniors' multiple housing for aging-in-place. The olderseniors are increasing in both absolute and relative terms and B.C.'s forecast exceeds the nationalaverage. Assuming the same percentage of seniors living in rental units (32% in 1986), thenthere may be a demand for approximately 45,000 more rental units by the year 2011.Of the older seniors age sub group, demand for supportive living will be higher among womensince they live longer, have a lower income, mostly live alone, pay a higher ratio of accommodationto income, and are institutionalized at a higher rate than their male counter parts.Mobility of seniors is lower among the older seniors age sub group. This group tends to stayput. There is a high need of social support for activities of daily living within this group. The3 3number of older seniors with high cost of accommodation to income are renters. Health careutilization by older seniors is high and the cost of care more than doubles in this age group. In B.C.we can expect by the year 2011 that approximately 18,000 more seniors will be institutionalizedunless other options to institutionalization are available.From the preceding discussion, it appears that the demand for supportive living environmentsfor seniors will continue to increase; housing programs that accommodate aging-in-place will notonly reduce institutionalization but also will serve to alleviate spiralling health care costs.342.3 EXOSYSTEM CONSIDERATIONS: IMPORTANCE OF NEIGHBOURHOOD The exosystem includes community and neighbourhood characteristics and structure. Thefollowing discussion suggests that supportive housing options should be available in one's ownneighbourhood or community.The desire of seniors to remain in one's community or neighbourhood is strongly expressedin the findings of the National Seniors Housing Consultation: "the housing and senior optionsavailable should enable us to take responsibility for ourselves in our homes and communities aslong as possible. Our ability to be actively involved in our own familiar context is important toour sense of well-being and is consistent with the way we have conducted ourselves" (Corbett1990, 15). This preference of seniors to remain in one's neighbourhood is also expressed inGutman1988), and a more recent user survey for CMHC found that "the overwhelming majority ofresidents preferred their existing location and wanted to remain in their existing community"(Baldwin 1990, 6).There are definite advantages to aging-in-place in one's own community or neighbourhood.The neighbourhood is a source of informal support from both family and friends ( Golant, 1986).Also, there are elements of association within the neighbourhood (Regnier and Gonda, 1981).Older persons also have a sense of attachment to place (Rowles 1978). Familiarity with theneighbourhood ("one's cognitive map") assists orientation as one's mobility and memory declines."It likewise is of considerable importance to learn more about maximising the ability of olderpeople to make ongoing use of already developed cognitive maps. This might mean increasing effortsto maintain independent living in familiar settings" (Lawton, Windley and Byerts 1982,76).(Before my father was institutionalized, he was constantly picked up by the local police at avacant site which once was the location of his parents' house in which he grew up. He was finally3 5institutionalized after being repeatedly removed from the arterial highway which once was the"main street" of the older neighbourhood. The old neighbourhood was a victim of urban renewal inthe late 1960's. The point being made is that large scale renewal in existing neighbourhoods maydestroy the cognitive maps of the older residents.)The neighbourhood may even provide a strong support respecting one's sense of self; "thesubjective sense of self is defined and expressed not simply by one's relationship to other peoplebut also by one's relationships to the various physical settings that define and structureday-to-day life" (Proshansky et al. 1983, 58) when the onset of memory loss occurs.Although there are benefits to remaining in one's neighbourhood, it is not always possible todo so as one's competence declines. There is a lack of housing options in local communities forthose persons who presently are "overhoused" in single detached family homes(Mendritzki1983; Whiting and Woodward 1985). In looking at small towns in Canada, GeraldHodge identified a similar problem and concluded that these small towns will require innovativesolutions to meet the needs of small town aging seniors for more services and housing options(1987). Given the high proportion of seniors in these populations, which in towns of 500 andless was 20% in 1981, the need to provide sufficient options and services is critical to avoidinstitutionalization.The lack of housing options in the local neighbourhood may also be a function of the "NimbySyndrome" i.e., Not In My Back Yard. Attempts to provide multiple seniors housing facilities andeven congregate housing facilities are often met with opposition from local neighbours, especiallywhen three-storey seniors' apartment buildings or greater are proposed in single familyneighbourhoods. The objections usually concern the scale and density of development proposed.3 6However, small scale and low density presumably entail higher unit costs. It is thereforeboth prudent and considerate to address concerns of the neighbours and also to raise the level ofunderstanding of future needs for neighbourhood based supportive housing. Recent inclusion oflocal community participation programs in seniors public housing is a move in the right direction(Baldwin 1990).Another reason why supportive housing may not be available in the local neighbourhood aresite selection criteria in which cost of land is given primacy. "Many times what happens is that asite is chosen on economic grounds with the sponsoring group not thinking seriously enough as towhat location is going to mean for the residents" (Gutman 1979, 2).Social isolation of the elderly in the neighbourhood or community is another potentialproblem of aging-in-place; the negative effects of social isolation may result in poor socialadjustment and cognitive functioning. Resocialization programs are a means of reversing thesenegative effects. Ruth Bennett emphasizes the need for social policies, practises and programs tocombat involuntary isolation (Bennett 1973).Diversity (1), options (2), mobility (3) and security (4) have been identified as the fourmajor dimensions to be addressed in planning for successful aging-in-place in the community orlocal neighbourhood (Hodge 1990, 23).The first dimension refers to the diverse nature of the senior population as a special needsgroup. (This fact has been discussed in Macrosystem Section and is subject to further discussionin the section below on individual level.) This main concern is that irrespective of one's specificcircumstance, changes will occur due to aging; thus it is important that diverse housing options,diverse public transit and diverse support services are available.3 7Availability of options is the second dimension, options for housing, goods and services withinthe community. The third dimension, mobility, the ability to get around the neighbourhood, isarguably the most important of all. A lack of mobility can result in individual isolation andloneliness. The availability of local transportation and an accessible neighbourhood environmentare critical in assisting seniors getting around.Fourthly, security is broadly defined to include financial security, security of tenure inhousing, security of movement as well as personal safety. Security of tenure in housing is acritical concern for those seniors in the community who have already made the move to multiplerental housing from owner-occupied dwelling.SummaryRemaining in one's community or neighbourhood is both desirable and advantageous for mostseniors. The neighbourhood provides proximity to family and friends for emotional and physicalsupport. Familiarity with local surroundings assists orientation and sense of place and self.Problems of aging-in-place in one's neighbourhood include social isolation, lack of housingoptions and services, and land costs. The four dimensions of diversity, options, mobility andsecurity are suggested to assist in planning for aging-in-place in the local community.3 82.4 MICROSYSTEM CONSIDERATIONS: COMPETENCE/PRESS: INSTITUTIONALIZATION: HOUSING OPTIONSThe interaction of older persons with their more immediate living environment is dealt within the microsystem section which follows. The microsystem is concerned withperson-environment relationships and relates to what are the functional and space requirementsto assist aging-in-place at the building level?By far the majority of study in gerontology and housing has taken place at this level. Thefollowing works have been included as they most closely relate to the context of aging-in-place inseniors social housing.2.4.1 COMPETENCE/PRESS MODEL. An important general theoretical work concerning the relationship between aging and theenvironment is the Competence Press Model. (Lawton & Nahemow, 1973) M. Powell Lawton hasdeveloped an ecological model of aging which "suggests that behaviour is a function of thecompetence of the individual and the environmental press of the situation" (1977, 8).The concept of competence was introduced by Robert W. White "to describe a person'sexisting capacity to interact effectively with his environment". (White 1963, 39) Building onthis concept a number of related theories linking the effect of the environment on behaviour ofolder persons have been developed. The Press-Competence model developed by Lawton andNahemow combined the concept of competence with Murray's definition of environmental "press"(1938, 37).Both competence and environmental press have a range of dimensions from low to high.Competence represents all of the attributes of the individual physical and mental framework andNegative^/affectMaladaptivbehaviourNegative affectMaladaptive behaviour3 9includes ego strength. Many older seniors may display a low level of competence due to changes inphysical, sensory or mental condition.The aspect of the environment which has a potential demand character is "press", whichrefers to attributes which are known to be behaviour activating. The range of dimensions ofenvironmental press is classified by strength. It may be negative, positive or neutral in effect.Fig. 2.05 graphically illustrates the competence/press model. At a given level of competence aperson's reaction to environmental press has various possible behaviour overtones. Theadaptation level represents the normal balance one would attain in engaging in activities of dailyliving. Marked changes in press may result in maladaptive behaviour by the person at the samelevel of competence, and may ultimately reduce competence. These demands may be of stronger orweaker environmental press either of which may have negative affect when occurring to extremes(outside the shaded area in the diagram).Figure 2.05 Competence/press modelHIGHLOWWEAK^STRONGENVIRONMENTAL PRESSSource: Lawton, 1977, 94 0The "zone of maximum performance potential" is where the level of environmental press iskept slightly above the individual's adaptation level, resulting in growth behaviour. That is, bylightly increasing the demands, competence may be enhanced. The marginal area of behaviour oraffect is where the normal level of environmental press is uncomfortable for the individual. Therange of environmental press has to be reduced to achieve the individual's comfort zone.The model also suggests that at a high level of competence an individual's adaptation levelspans a much wider range of environmental press than at a low level of competence. Therefore,much more care is required in considering the environmental setting within which the older, lesscompetent, senior is placed.As environmental designers our task "is to create situations that are modestly demanding onan individual without being excessively demanding. We can than elevate the behavioural outcome,and hopefully the level of competence, an increment above whatever level the individual startedwith no matter what level of individual competence we have chosen to deal with" (Lawton1977,9).The competent/press model has been criticized for its generality and its inapplicability toscientific testing. Some researchers have responded by developing sophisticated typologies ofcompetence and press which may result in the development of usable specific design criteria forplanning and facilities programming for older seniors (eg., Kahana, 1982).Notwithstanding the theoretical problems, the environmental press model serves as animportant conceptual model because it acknowledges the individual differences among seniors whenconsidering implications of aging-in-place and the environment and because it introduces thebasic idea that a certain amount of press is desirable.4 12.4.2 INSTITUTIONALIZATION "Canada has one of the highest rates of institutionalization in Western Society: 8.4% of thepopulation 65 and older are in some form of institutional care, as compared with 5.1% in GreatBritain and 6.3% in the United States." (Cohen1984,194) Environments in which the pressdelimits the individual's competence level are excessively monotonous. Institutionalenvironments may often generate too little press for some older seniors.Goffman wrote the classic sociological study on institutions from the view of the "inmate". Heintroduced the concept of the total institution which he defined as "a place of residence and workwhere a large number of like-situated individuals cut off from the wider society for anappreciable period of time, together lead an enclosed, formally administered round of life"(Goffman 1961, xiii). Hospitals and homes for the aged are among the facilities defined asinstitutions by Goffman. The bureaucratic organization and its formal regulations are a keyfeature of total institutions. Exclusion from decision making for the resident is also a keycharacteristic and one that often prevails in institutions for the elderly.Forced moves to institutions occur when the environment or home/community supportsystems fail to meet all the needs of persons of reduced competence. The resulting rigid routines ofinstitutions can have negative effects (Tobin and Lieberman 1976). Moves into care facilities canbe a traumatic experience for the elderly and may even be linked to mortality rates (Gutman1 982) .Admission of older seniors to institutions has been linked with early death. The high rate ofdeaths in the first year of admission to long-term care was investigated and recommendations forsupports to mitigate these conditions (Gutman et al. 1982). Further study in this area pointed to4 2the large proportion of deaths which occurred in the first six months of admission to an institutionand posited the possibility of admission stress effect ,i.e. too little press (Gutman et al. 1986),leading to increased mortality rates (Gutman et al 1986; Wershow 1976).Studies on the effects of institutionalization of the older seniors on psychological wellbeingand physical integration have been reviewed (Lieberman 1969). Leiberman acknowledged thenegative effects of institutionalization, but concluded that it may be that distinctive effects aremore associated with radical environmental change (from dwelling to institution) than withinstitutionalization per se. However he qualified his conclusions as highly tentative due tomethodological biases.The institutionalization of older persons is likely made palatable to society given theargument of the low percentage (-5%) of institutionalization of this group at any one time.However, the error of these statistics has been called the 4% (or 5%) fallacy (Kastenbaum &Cardy 1973; Wershow 1976; Lesnoff-Caravaglia 1978). All of these research studiesdemonstrated that the actual percentage of persons annually dying in these institutions far exceededthe reported figures for institutionalization of 4% to 5%. The main reason given for thediscrepancy is the fact that the statistics are based on a cross-sectional sample at any one time andtherefore annual turnovers (i.e. short-term admissions and separations) are overlooked.Given the preceding discussion, there is sufficient evidence to err on the side of cautionrespecting premature institutionalization of older persons. Overseas, the whole concept ofinstitutionalization of the elderly has been questioned. In Denmark present nursing homes will bephased out by the end of the century, and in Sweden present care institutions are being completelyremodelled. Control over the environment and security of tenure is being provided to the residentsthrough government leases ( Gutman 1988). In British Columbia, the provision of small care4 3facilities (e.g. Abbeyfield house) has been recommended as one means of humanizing institutions(Philips 1977; Murray et al. 1988).2.4..3 HOUSING OPTIONS The preceding discussion emphasizes the desirability of keeping older seniors out ofinstitutions. Although keeping them in their own homes serves to provide some of the benefits ofaging-in-place, there are numerous problems. In single family dwellings, whether owned orrented, many older seniors are overhoused and land-poor i.e., living in accommodation too largefor their needs. In this form of housing there is usually a high maintenance required for outsideyards. In multiple housing accommodation the yard and maintenance problems are usuallyeliminated as this function is usually performed by the management group.However, all of these forms of housing are usually designed for "independent living" which,simply translated, means that there is no accommodation in the physical environment for changesin competence of the occupant. This problems has been addressed to some extent through a numberof programs at the national and provincial level, for example, RRAP program. For those personswho rent, the rental RRAP programme is limited, since the funds go to the landlord. This meansthat the control of what is done or when, is not in the hands of the occupant (Cosh et al. 1986).There are planning guidelines with special design features to accommodate aging-in-placepublished by CMHC and others which are periodically updated. However, as Gloria Gutmanreported in her study of 10 seniors housing projects, the level of implementation of theseguidelines in the Vancouver area was minimal. "In the majority of suites there was little in theway of special design features that might protect or enhance the functioning capacity of theelderly..." (Gutman 1975, 18).4 4Housing options and adaptations to accommodate aging-in-place are discussed in Gutman &Blackie 1986. Also, programming for detailed adaptations to assist physically impaired elderly tostay put are covered in Maltais 1989. CMHC has published a document listing the many availablehousing options and programs for seniors (CMHC1988; CMHC 1985; Brink 1984). However,for those seniors in independent living environments who rent, a number of the preceding optionsare unavailable.Also, for elderly renters there is a paucity of housing options for A.I.L. (assisted independentliving). Since the B.C. Government stopped providing for the delivery of personal care homes in1979, the need for supportive housing, especially for those older seniors at the lower income end,is more critical. Congregate housing and multi-level continuum care accommodation is providedmainly by the private sector at quite expensive rates. For example, Parkview Manor inCoquitlam, B.C. presently charges $1,900 per month for providing congregate support includingmeals and some housekeeping.The physical environment is only one part of the equation in looking at options for olderseniors. Support systems are also in place which provide assistance with daily living and healthcare to those in need. For example, the B.C. long-term care program provides for professionalcare services in the home. The local health unit operates the home care nursing program.However, provisions of service is subject to Physician's Referral; in-home services might beterminated for a person assessed by the health unit for institutionalization who refuses to go. Also,a financial assessment determines how much a person will pay. A variety of community supportservices are available through volunteer agencies and organizations, including Meals on Wheels,telephone contact services, and Red Cross loan service for sickroom equipment. Special treatmentcentres, adult day care centres and information centres also provide out-of-home services.4 5Homemaker services are also available but free service is subject to income limitations.Also, the number of homemaker hours are limited. Additional hours may be purchased atcompetitive market rates (Hoppenrath 1981, 1982). Private home support help is alsoavailable for those who can afford it. The problem at the lower income level again is theavailability of sufficient support.Emerging OptionsThe Abbeyfield model, a room-and-board variant of congregate housing, provides "smallgroup living" (6-9 persons) in a home-like environment for older single seniors who are lonely.The key ingredient is the provision of a "housekeeper" who runs the household, prepares meals,provides some assistance and serves as a friend. This is a British concept which is over 30 yearsold, and which has made its way into Canada in recent years. Presently there are nine facilitiesacross Canada, six of them in British Columbia. A conversion/ renovation Abbeyfield project isunderway in the Marpole area of Vancouver, to be completed in the Spring of 1993 (Abbeyfield1993). The present Abbeyfield projects in Canada are not targeted to low income persons only; thefocus is on mitigating loneliness.Group living is not for everyone. A survey by the American Association of Retired Personsconcluded that the "majority of older people who are living alone prefer it that way" (1986, 28).However the analysis was not broken into age sub groups. The survey had only one age category of65 and over, so this conclusion could be misleading regarding older seniors who need support.2.5 INDIVIDUAL: COMPETENCE AND CONTROLThe last level in Lawton's ecological model is the individual. Housing design guidelines at thislevel have been developed to accommodate changing needs (Pastalan1977; Goldsmith1967;Maltais1988). For the most part the emphasis has been on special design details to compensatefor diminishing physical competence among the elderly. This emphasis is underscored by theemergence of the term "prosthetic environment" in designing for the elderly (Hiatt 1985).Less attention has been given to the changing needs related to changes in other competencies ofthe elderly. Pastalan's emphathetic model goes a long way in giving the programmer or design ahands-on sense of the diminishing physical competence that older seniors experience, and some ofthe feelings generated by coping with these losses (Pastalan 1977,77-84). Susan Howell goes astep further by providing the first study linking theories of environment and behaviour todesigning for older persons (1980).The preference for independence mentioned earlier, reflects a desire of older persons to be incontrol of their life events. The need for control over one's environment has been considered to be"an intrinsic necessity of life itself" ( Adler 1930, 398). At a more subtle level, it might be thatthe feeling of being in control enhances competence of older seniors. The following discussionfocuses on changes in competence the individual might experience in later years and theimplications of these topics of control and competence for programming seniors' housingprojects for aging-in-place.2.5.1 AGE & AGING Most of us think of age and aging in chronological terms. That is, a senior is a person of 65years of age or older. But age can be defined in a number of other ways, such as biological age,46psychological age and sociological age. This broader view of aging is very helpful in appreciatingthe heterogenieity of older seniors. An older individual of say, 80 years of age may have a physicalimpairment yet have a high self-esteem. This individual would likely socially interact with otherseniors and appear much younger than another individual who is in better physical condition butlacking in psychological or social competence. Although an older senior's physical competencemay be impaired, his or her ability to successfully age-in-place may also be a function of othercompetencies.2.5.2 TYPOLOGY OF COMPETENCIES A typology of competencies which are important to the well-being of the individual is givenby Butt (1989). This includes physical competence, intellectual competence, emotional, socialcompetence, and spiritual/existential competence. Although declines occur in these competenciesin one's later years there are individual differences in the severity and timing of decline. Alsothere are individual differences in one's abilities to adapt and cope.Physical Competence Although chronological aging does not affect each individual in quite the same way in terms ofbiological aging, there are certain changes that generally take place as we age which affectphysical competence. Deterioration in hearing, vision, sense of taste and smell, sense of balance,and onset of arthritis occur.Presbycusis, (hearing loss), affects one third of the population over 65, while presbyopia(loss of ability to see close), affects one fifth of the population over 65. Loss of hearing isgenerally in the high frequency range. Arcus senilis is the deterioration of peripheral vision dueto the development of an opaque band around the cornea. The major complaint of the elderly is with47arthritis. Contrary to what one might expect, presbycusis, not presbyopia, is the most sociallydebilitating sense loss for the elderly (Belsky 1984).Intellectual Competence Getting older does not necessarily result in loss of intellectual competence.^A theoreticalreview is given in changes in intellectual functioning in The Journey of Adulthood (Bee 1987).Bee gives the optimistic general suggestion that... "There is little significant loss in intellectualpower or reasoning, or problem solving ability until quite late in old age, perhaps as late as 70 or80 on the average, and perhaps not until a few years before death" (1987, 136). Bee qualifiesthis statement by saying that well-practiced, familiar skills are likely to be retained into old agewhile less-practiced skills and skills which demand speed decline earlier. Even more important isthe observation that there are striking individual differences in changes in intellectual functioningin adulthood. The theory of terminal drop suggests that there is very little decline in theintellectual capabilities of older persons until a few years before death, when a sudden rapiddecline occurs (Bee 1987, 135-6). However, findings are indeterminate. Likely the mostreliable conclusion is that cases vary among individuals with some persons experiencing little orno decline, while others might experience dramatic decline. However, memory loss, due toillnesses such as Alzheimers disease and Korsakoffs Syndrome, affects intellectual performance. Itis estimated that Alzheimers disease affects 5-10% of seniors 65 years and over (Sarason &Sarason 1987).Emotional Competence The ability to cope in later life may be influenced by biologically inherited personalitytraits, differences in coping strategies, personality type, personal development and even one'sself-esteem.48The personality trait of "hardiness" has been identified as important in one's ability to copewith stressful events. The merits of this trait is discussed by Brown in his article on health andbehaviour. "There is a personality resource called hardiness, which includes control as one of itscomponents, that seems to be especially important in distinguishing, among individuals subjectedto the same high stress, those who will fall ill from those who will not. It is clear that hardiness isthought of as a highly desirable thing" ( Brown 1987, 638).In the study of age differences in coping with stress, the researches found that there wereclear age differences in both types of stress and coping. The findings suggested the developmentalinterpretation "that there are inherent changes in the way people copy as they age" (Folkman et al.1987, 171), although the contextual interpretation, that age difference in coping are the result ofchanges in what people must cope with as they age, also applied. Older persons used more passive,intra-personal emotion-focused forms of coping (distancing, acceptance of responsibility andpositive reappraisal) than did the younger people" (ibid., 182). Two gender differences were thatmen used more self-control than women, women used more positive reappraisal than men.A landmark field study in a Connecticut nursing home by Langer and Rodin suggested that"some of the negative consequences of aging may be retarded, reversed, or possibly prevented byreturning to the aged the right to make decisions and a feeling of competence" (1979, 198).Perceived personal control over one's environment was seen as a critical factor in well-being. Onencouraging the residents to take responsibility of caring for themselves, improvement wasmeasured in active participation in events, alertness and a general sense of well-being. Althoughthe results of the study are not generalizable due to the small sample size population (47 personsin the responsibility-induced group), the findings suggest that enhancement of perceived controlmay improve well-being of older persons.49Social Competence During the lifespan, especially in older years, one experiences a number of losses: loss ofsocial role, loss of friends, family and possibly the loss of one's spouse. As a result, an individualmay end up living alone and in some cases experiencing extreme loneliness. Loneliness is definedas "the unpleasant experience that occurs when a person's network of social relationships isdeficient in some important way, either qualitatively or quantitatively." (Perlman 1988, 191).One lifespan study of loneliness suggests that predictable loneliness in old age may be a myth,and that a large proportion of old people are not lonely. "To present only portraits of old peoplewho are isolated and severely lonely is to paint a false picture of aging" (Revenson and Johnson1984, 84). However, an analysis of the scores on the loneliness scale in this study shows thatonly 13 persons comprised the age subgroup 75+ and over, indicating that findings are verytentative.In the Canadian national survey, although the stereotype of old age as a time of loneliness isrejected, the exception is pointed to the group defined as the old old (over 80). Among this group,loneliness is common (Government of Canada 1982).In discussing why loneliness occurs, Perlman makes a distinction between precipitatingevents and predisposing factors contributing to loneliness, the former relating to an event such asa loss of a loved one, or loss of friends due to moving residence, and the latter relating to thepersonality characteristics of the individual, early parent-child relations, or the situation orcultural values (Perlman 1988). One may suddenly be left with no emotional support or have nocompanionship.50An experimental program aimed at helping individuals in coping with loneliness wasdeveloped in Sweden (Andersson 1985). The researchers reported that "ancillary data showed thatthe program changed the participants' sense of perceived control, and that perceived controlcorrelated with post treatment loneliness scores. Presumably these changes in perceived controlwere a key ingredient in the intervention's success in alleviating loneliness" (Brown 1988, 214).For those single persons who have no relatives or friends, home visitation programs providethe opportunity to socialize and access emotional support. Companionship may also be provided bypets. The therapeutic value of pets to older persons was investigated by Cusack & Smith 1984,who concluded that pets provide important emotional support for those elderly seniors who arelonely or alone. In our study of BCHF Lion's View facility, where the median age was 81, most ofthe tenants had pets. Cats and dogs are easily accommodated at this facility because units havedirect access to outside at ground level ( Assoon et al. 1989).2.5.9 SUPPORTS AT THE INDIVIDUAL LEVEL FOR AGING-IN-PLACE As discussed earlier, a number of guidelines and standards are available which deal withrequirements for losses in physical competence. These "accessible environment" publications areof a hardware nature, i.e., the focus is on physical elements such as slopes of ramps, heights ofhandrails, dimensions between fixtures for wheelchair circulation etc. Although these items areimportant to consider in supporting aging-in-place, supports relating to the other competenciesare at least as important, if not more so. Also these competencies are interrelated and interactiveso enhancing one of the competencies enhances others.The discussion on control suggests that supports to enhance all of the competencies foraging-in-place should focus on the issue of individual control. By this, I mean removing obstacles51that would limit the individual's opportunity of choice. At the exosystem level this means theprovision of sufficient alternative living arrangements in one's neighbourhood. At themicrosystem level this means not only having supportive housing which accommodates all thecompetencies, but also supportive management which allows individuals to stay put whencompetence declines. This aspect of control is already being recognized in Sweden and Denmarkthrough the provision of security of tenure for tenants (discussed earlier in the microsystemsection).Provision for accommodation of pets; a guest suite for visitors from out of town, family orfriends, and communal space for opportunities to interact with others could help alleviateloneliness among older seniors.The motorized "wheelchair" is a technical innovation which is becoming very popular amongseniors. Although aimed at the enhancement of physical competence, this innovation provides theopportunity for seniors who might otherwise be homebound to get out into the neighbourhood to seethe world around them, go shopping and visit friends. Thus, it provides a means of controllingone's personal environment and enhancing all the competencies.2.6 SUMMARYIn attempting to answer the questions relevant to facilities planning for aging-in-place,Chapter 2 has taken a broad view of these issues using the ecological housing model as aframework. At the macrosystem level, we saw that the seniors population is growing bothrelatively and absolutely, especially in older seniors category. Growth in British Columbiacontinues to exceed the national average and the need for supportive living environments is higheramong the female population. The discussion on organizations argued that organizational52characteristics vary by size. At the micro system level, we discussed the importance of locatingsupportive living options for seniors in the local neighbourhood: at the microsystem level,keeping older persons out of institutions by assisting aging-in-place was emphasized, and thecompetence/press model discussed as a means of conceptualizing changing person/environmentneeds.At the level of individuals, the discussion on individual competencies and control underscoredthe diversity among individuals of the older population, and suggested directing attention to theprovision of options in the living environment that enhance individual control.Two critical themes emerge from the background research: one the theme of change, theother the theme of diversity. In consideration of the supportive living environments foraging-in-place, one implication is for environments that can accommodate changes in thecharacteristics of the population as they age-in-place, the other is for environments that providefor "both/and" rather than "either/or" solutions ( Venturi 1966), to recognize the individualdifferences of older persons and their need for control over their environment.Chapters 3, 4, 5 discuss case studies which investigate the changes occurring in the seniors'multiple housing facilities of three organizations in the Vancouver area. The background study andcase study findings are integrated in Chapter 6.5354CHAPTER 3: CASE STUDIES: METHODOLOGYThe opening two chapters provided a general overview of the implications of aging-in-placein seniors' multiple housing facilities. The following chapters 3, 4 and 5, investigate in detailwhat is happening in present seniors' multiple housing facilities in the Vancouver area. Theapproach used is modelled in part after a study of two congregate housing buildings in Philadelphia(Lawton, Greenbaum and Lieowitz 1980), which measured how the relative independence of thetenants changed over time. Chronological age and physical health were the two indicators of tenantindependence used.The approach for the case studies in this thesis differed from the other study in threeprincipal ways. First, physical health data of tenants were not readily available so thisindependence measure could not be included. Second, this study included a comparison of threeindependent housing organizations. Third, comparisons by building type were included, bothlarger high-rise and smaller low-rise. Specifically, three questions were asked. " Is the medianage of the tenants increasing over time?", "Are there differences in median age of tenants byorganization?", or "Are there differences by building type, larger high-rise or smaller low-rise?". Inherent in the first question is the assumption that the higher the median age the betterthe success. The second question implies that different types of organization may have differentoutcomes due to the nature of these organizations. The third question relates to size of facilitysince for the most part low-rise buildings mean small populations and high-rise buildings meanlarge populations. At the same time, the question as to whether there is an association of successto building form is being asked.5 53.1 SELECTION PROCESS A multi-stage purposive selection process was used to establish the six buildings examined.The three organizations chosen are the principal providers of housing for seniors in Vancouverand vicinity. Selection of high- and low-rise buildings was done by matching acrossorganizations; where identical building options were present random choice applied. Both 100%sampling and 50% systematic sampling were used to obtain tenant characteristics withinbuildings.3.2 STUDY BOUNDARIES The City of Vancouver and the Corporation of the District of Burnaby were chosen as theboundaries of the study. This choice was made due to ease of access .3.3 THE CASES Three organizations were selected: British Columbia Housing Management Commission(BCHMC), British Columbia Housing Foundation (BCHF), and New Vista Society (NVS). BCHMC isthe public housing agency responsible for the delivery of all social housing programs in theprovince. Although BCHMC no longer directly builds and operates new projects, it owns andoperates many projects throughout the province built prior to 1978.BCHF is a private non-profit society.^It is the largest owner/operator of seniors' privatenon-profit housing for independent living housing in the City of Vancouver. I had established aprior contact with BCHF when we conducted a study for the Lions View Project (Assoon, Cairns &Marek 1988).5 6NVS is also a private non-profit society, and is the largest owner/operator of seniors'private non-profit housing for independent living in Burnaby. Also, NVS owns and operates apersonal care home adjacent to some of the independent living units. I had prior contact with NVSwhen programming requirements for Seton Villa. NVS was very accommodating at that time inproviding assistance with this programming task. Access to tenant data was likely made easierbecause of the prior dealings with the two seniors' private non-profit organizations (SeeAppendix B for more background on the history and philosophy of the three organizations).3.4 UNIT OF ANALYSIS The building is the unit of analysis. The operational definition of building is a freestanding,independent structure for seniors' housing for independent living.Selected buildings are as follows:WS^Building 1, Apartments at 8246 - 11th Avenue, BurnabyA 20 unit low-rise building.Building 2, Ernest Winch Tower, 7216 Mary Road,Burnaby. A 200 unit high-rise buildingBCHFBCHMCBuilding 1, Soroptimist Manor, 1444 E. 13th Ave.Vancouver. A 25 unit low-rise building.Building 2, Gordon Fahrni House, 1630 Barclay Street,Vancouver. A 44 unit high-rise building.Culloden Court, 6265 Knight Street, VancouverA 42 unit low-rise buildingHall Tower #2, 7264 Kingsway, Burnaby.A 113 unit high-rise buildingSelection of the buildings was purposive. Two buildings were selected from each organizationin order to compare low-rise and high-rise buildings. Buildings were selected to achieve a matchwith respect to size among the three organizations.573.5 PRETESTS The question as to what type of data would be available was addressed through initialdiscussions with the three organizations. Over a period of time and after some lengthydiscussions, access to primary archival data was made possible. Preliminary investigations weremade to assess the availability and compatibility of the data bases among the three organizations.The original intention was to analyze data over a ten-year timespan. However, neither BCHMCnor BCHF retain data on their previous tenants other than minimal financial records for a seven-year period, as required by Provincial Statute. New Vista Society had data going back further butfiles were incomplete. The data were therefore limited to the past seven years commencing onJuly 1,1982.Test runs of archives were conducted first for a small BCHF building and then for a small NVSbuilding. A one hundred percent sample of tenant data was made. This procedure took much timeto conduct the field work, particularly with respect to identified cases with differing filingsystems of organizations, and locating indicated data gaps.Informal interviews were conducted with management staff of each housing organization.Archives, policies and access procedures were discussed as well as staff perceptions of problemsin sample buildings.3.6 DATA COLLECTION Collection of primary data on individual tenants was first obtained for the BCHMC buildings.The following extract from the computer printout indicates the form of the data provided (seeTable 3.01). Reading from left to right in the first column, the type of individual dwelling unitis identified as M for a modified (handicapped) unit and S for senior's unit. The next column5 8indicates whether the unit is a bachelor or one-bedroom unit (0 = bachelor; 1 = one-bedroom).Tenant status in the next column is represented by F = former and A = current. In the next twocolumns the admission and separation dates are indicated by year, month and day. The next threecolumns indicate the birthdate and sex of each tenant in the unit. In this extract data for the lasttwo columns were omitted.TABLE 3.01 BCHMC DATASTART VACATE B/DATE B/DATE B/DATEHOUSE NUMBER TENANT DATE DATE TEN #1 TEN #2 TEN #3TYPE BEDRMS STATUS Y/M/D Y/M/D Y/M/D SEX Y/M/D SEX SEXUNIT 00558M^0 F 790101 860731 510613 M^000000 000000M^0 F 860901 870930 221216 M^000000 000000M^0 F 871101 871231 330711 M^000000 000000M^0 F 880301 881231 361209 F^000000 000000M^0 A 890301 000000 150221 M^000000 000000UNIT 00559M^0 F 850201 860228 000512 F^000000 000000M^0 F 860501 880531 550713 M^000000 000000M^0 A 880801 000000 181224 F^000000 000000UNIT 00560S^0 F 780415 860831 030305 F^000000 000000S^9 A 861001 000000 260125 M^000000 000000UNIT 00561M^0 A 770501 000000 330612 M^000000 000000593.7 RECONSTRUCTION OF RECORDSNext, data were collected for the New Vista Society buildings. Data on current tenants wereavailable on computer printout. The form of this data is indicated in the following extract (seeTable 3.02).TABLE 3.02 NVS DATA7216 ERNEST E. WINCH TOWERSUITE NAME ADM. DATE BIRTHDATE BACH/COUP.M/ D/ YR0101 03/01/88 1941/1945 COUPLE0103 06/01/86 1918 BACHELOR0105 01/77/88 1898 BACHELOR0107 03/01/88 1899 BACHELOR0109 04/01/89 1920 BACHELOR0111 02/08/82 1910/1918 COUPLE0112 02/15/89 1906 BACHELOR0114 10/10/79 1909 BACHELOR0201 02/01/88 1930/1922 COUPLE0202 12/01/87 1915 BACHELOR0203 08/10/88 1910 BACHELOR0204 11/01/77 1900 BACHELORReading from left to right, column one indicates the suite number. The next column indicatesthe name of the tenant (deleted). Column three indicates the admission date by month, day andyear, followed in the next column by the tenant's birthdate by year only. The last columnindicates the suite type, bachelor or one-bedroom. One bedroom units are identified as "couples",whether or not they are so occupied.6 0Since only data on current tenants were provided on this computer printout, data on formertenants had to be collected from NVS files. The NVS files on former tenants are stored in twofacilities. NVS 1986 to 1989 files are kept in the Housing Department office of NVS ,and 1975 to1985 are kept in the NVS Care Home offices. Tenant files are filed alphabetically by tenant nameand are not ordered by building. There are 18 files boxes in all.In order to extract the pertinent information for the study buildings the tenant files in eachfile box first were colour coded to identify former tenants by building. Next, the former tenantsof sample buildings were listed alphabetically by building for the 1986-89 period and then forthe 1975-85 period. From the computer printout on current data, "original" tenants were firstidentified by highlighting. Next, the data on former tenants were identified by tracing buildingand unit numbers. The data on former tenants no longer current were next listed by each unitnumber. A final summary of buildings and units was made identifying whether missing data onformer tenants were completely reconstituted by unit number, coded C - complete, and I -incomplete, respectively.Data were next collected for the BCHF buildings. BCHF does not have a computer data base sodata were first constructed by hand in tabular form from files on current tenants stored at theBCHF downtown office. Following this, data on former tenants were reconstructed similar to theapproach used for NVS. BCHF maintains no particular order for storing data on former tenantsother than a "loose" order by chronology. Tenant files were first ordered by building. Next, dataon former tenants were listed by each unit number and summarized Complete or Incomplete byunit number, as with NVS data.6 1Access to BCHF financial records was granted which facilitated tracing of occupancies of unitsby building back to January 1982 (to fill data gaps). Access for BCHMC and NVS financialrecords was not necessary for this reconstruction.3.8 COMPARABILITY OF DATAData for all three organizations are current to June 20, 1989, although the computerprintout for BCHMC current tenant data is actually dated June 26, 1989. Unlike the other twoorganizations, NVS records gave current tenant dates of birth only by year. For ease ofcalculation, all NVS tenants' dates of birth were assumed to be on or before June 30th of the yearof their birth. This means that analysis of age data for current NVS tenants will tend to bias theresults slightly upward since the age of such tenants born after June 30th would be one year lessthan the assumed age. This problem however, does not arise with respect to NVS former tenantdata or data from the other two organizations.Access to financial records of BCHF allowed an exact account of the number of tenancies in thebuildings back to January 1982. However, since similar data were not available for BCHMC andNVS, the earliest tenancy of a unit during the study period 1982-1989 was assumed to havecommenced on July 1982.A similar assumption about dates was made for computing duration of occupancy of a givenresident. An error of underestimate might occur under such an assumption, since more than oneoccupancy could have occurred in a unit within the period from last-known occupancy back toJanuary 1982. Furthermore, some occupancies likely extended further back than January1982. 6 2When sets of unmarried people (2-3) lived together in a given dwelling unit, theirindividual attributes (sex, age, etc.) may tend to "cluster" and thus not be as fully independent ofeach other as those of persons living in separate units.3.9 MISSING DATAIn general, the data cover or exceed the seven-year period. However, there are somemissing occupancy data about some units , and these increase progressively the further back intime we go. The extent of these missing data for all buildings is summarized in Table 3.03.TABLE 3.03 MISSING OCCUPANCY DATA (Individual Occupants) Size^Building^1982-3 83-4^84-5^85-6^86-7^87-8^88-926^11th Ave^4^3^4^4^4^3101^Winch Tower^14^13^14^7^6^2Soroptimist27^Manor^5^-*Fah rn i44^House^14^11^6^4^355^Culloden Court^10^5^2^2^2^2^171^Hall Tower II^12^8^2^2^2*- : indicates no missing dataUnfortunately, BCHF disposed of a number of boxes with tenant files when the Foundationchanged its office location in 1988. Available former tenant files therefore only go back to 1984and are not all complete. Gaps were filled using financial records to some extent. Also, some6 3omissions are evident in BCHMC computer data respecting earlier tenancies. These now areuntraceable, with the absence incalculable.The median ages of tenants over time were calculated for the data available for each year andbuilding. From the summary table on missing data, it is apparent that the most seriousdeficiencies in data are for the first three years of the study period. In terms relative to the totalpopulation per building, the most serious case of missing data is for Fahrni House, 1982-83. Inthis example, 32% of the tenant data is missing.3.10 SMALL NUMBERS In some instances it is difficult to identify trends from an analysis of the data due to smallnumbers. This is especially a problem in the data from the small buildings. For example, lookingat the median age of the replacement tenants in NVS 11th Avenue Apartment Building, the graphbased on annual change fails to communicate any trend due to the extreme differences generated bysmall numbers (see figure 3.01). To reduce the instability of small numbers as it is compoundedby the problem of missing data, running averages in three-year "moving" intervals are used forthe purpose of analysis.Figure 3.1 Median Age of Replacement Tenants - Low Rise64wco243- 11th AveSoroptomist411- CullodenYear •3.11 SAMPLING For four of the six buildings, the dwelling unit sample size is 100%, ie. there is nosampling error. For two of the large high rises, I chose to sample 50% of the total list ofoccupants. These 50% samples produced a standard deviation of approximately 2% indicating apossible error of approximately 4-5% at a 95% level of confidence. In conclusion, I have notelsewhere in the text mentioned sampling probability as the error is too small to quantitativelyaffect my results.The preceding discussion defined the case study objectives, described the cases and units ofanalysis, the method of data collection used and some of the limitation respecting the data. InChapter 4, the findings for each of specific variables measured are presented for all of the sixbuildings investigated.65CHAPTER 4 : RESULTSThe ostensive reason for construction of social housing for the elderly can be assumed to beeconomics "to provide inexpensive housing for the aged". However, an assumption of this essay isthat purposive housing for the aged can be appraised in terms of the longevity of occupancy: thebetter the housing the longer residents will be able to remain in their abodes. By implicationhousing for the very old will be less effective if it neglects residents' satisfaction in terms ofoccupants' tenure of residence.In this model, therefore, the longer that one can "age in place", the better the place.Presumably, housing should be targeted to this end. If so, it should be designed to this end, toreduce the misfortune of the very old. If so designed, and with less cost of accommodation, thevery old should reside longer, growing older and older.Comparisons of the three organizations, discussed in Chapter 3, are made to assess whetheraging-in-place is occuring and if so, whether there are variations by organization or buildingtype [high-rise (large) or low-rise (small)].To measure patterns of aging-in-place, the following indicators were used for individualbuildings: median age of tenants, median age of replacement tenants, duration of stay, proportionof original tenants to total tenants, tenant age sub-groups, annual replacement rates, sexdistribution and the proportion of couples to all tenants. Data spanning a seven-year period wereanalyzed.Medians rather than means are used to analyze the data to compensate for missing data andextremes in age (for example, in British Columbia any person 19 or over on a disability6 6pension is eligible for residency in seniors' social housing. Also, some of these persons may havechildren living with them). In addition, three-year running averages for values are used togenerate a number of the line graphs where the data are not complete (as indicated on theindividual figures).4.1 MEDIAN AGE OF TENANTSTable 4.01 indicates that among the six buildings studied, the median age of their seniortenants remained roughly constant at about 73 years over the seven-year period of study time.TABLE 4.01 MEDIAN AGE OF TENANTSOrganisation &BuildingNVSSize(n) 82-5 83-6 84-7 85-8 86-9 7 yr mean11th Avenue 26 70 71 71 72 72 71Winch Tower 101 76 76 75 74 75 75Both Buildings 73 74 73 73 74 73BCHFSoroptimist Manor 27 73 74 75 75 74 74Fahrni House 44 75 75 74 74 73 74Both buildings 74 75 75 75 74 74BCHMCCulloden Court 55 69 69 69 69 69 69Hall Tower 71 70 70 71 72 72 71Both^buildings 70 70 70 71 71 70Mean for high rise 74 74 73 73 73 73Mean for low rise 71 71 72 72 72 72Mean for 6 buildings 72 73 73 73 73 73* year end is taken as June 30** numbers might not total due to roundingThere were, however, distinct differences between buildings in terms of median age oftenants. Winch Tower averaged a median tenant age of 75 years while the median age of CullodenCourt averaged six years younger (See Figure 4.01).Figure 4.01 Median age by building type67 767574737271706968676665cs)caco:5E▪ High Rise^ Low RiseNVS^BCHF^BCHMCyearAs shown in Figures 4.02 and 4.03, the 11th Avenue apartment building and Hall Towershowed a distinct trend of increasing age over time, while median age in Fahrni House droppedsomewhat over the study period.Figure 4.02 Median age low risea) 7 ^^765 ^^^74 ^77 73 L ^coc 72 ^:6 71 ^E 7,, E69•^ • ^68 ^67 ^66 82-5^83-6^84-711th AvenueSoroptimistCulloden85-8^86-9yeara)asa)E767574737271706968676665median ageFigure 4.03 Median age high rise68 7776 ^75 ^74 ^73 ^72 ^71 ^7069 ^68 ^67 ^66 ^82-5a)a)asa)EWinchFahrniHall83-6^84-7 85-8^86-9yearOf the three organizations, there were distinct differences in median age of tenants.Generally, the BCHMC buildings had the youngest tenants (-70 years) while BCHF had the oldest(-74 years) averaged over the seven-year study period (See Figure 4.04).Figure 4.04 Median age by organizationNVS^BCHF^BCHMCorganization4.2 MEDIAN AGE OF REPLACEMENT TENANTSThe number and age of replacement tenants affects the median age of tenants in a building.Therefore, an analysis was next made comparing the median age of replacement tenants to medianage of total tenants and the ratio of replacement tenants to total tenants for each building. Theseven-year median age of replacement tenants (-67) is distinctly lower than the seven-yeararithmetic mean of the annual median age of total tenants for all buildings (-73).TABLE 4.02 MEDIAN AGE OF REPLACEMENT TENANTSOrganisation &BuildingNVSSize(n) 82-5 83-6 84-7 85-8 86-9 7 yr mean11th Avenue 26 68 67 66 64 66 66Winch Tower 101 77 75 71 69 69 72Both Buildings 72 71 69 67 68 68BCHFSoroptimist Manor 27 64 67 75 69 69 72Fahrni House 44 70 67 66 63 61 65Both^buildings 67 67 68 69 65 67BCHMCCulloden Court 55 63 64 67 64 61 64Hall Tower 71 66 66 68 67 63 66Both buildings 65 65 68 66 62 65Mean for high rise 71 69 68 66 64 68Mean for low rise 66 66 67 68 65 66Mean for 6 buildings 68 68 68 67 65 67* year end is taken as June 30** numbers might not total due to rounding69—II— Total tenantsReplacements7 0Also, a clear trend of decreasing median age of replacement tenants is evident while median ageof total tenants has remained constant (See Figure 4.05).Figure 4.05 Total & replacement tenants^77 ^^76 ^75 74 ^w 73 ^• 72 ^c 71 ^70 ^,w• 69 ^c 68 r^67 ^66 ^65 ^64 ^82-5 83-6 84-7year85-8^86-9Distinct differences were apparent among the three organizations. BCHMC had the youngestaverage median age of replacement tenants for the seven-year study period (-65) while NVS hadthe oldest (-68).Figure 4.06 Median age replacements by organization median ageNVS^BCHF^BCHMCorganization727170w 69c• 68co 67^11) 66 ^E 656463 ^62 ^82-5 83-6 84-7year85-8 86-97 1Moderate differences emerged between the median age of those replacement tenants inlow-rise compared with high-rise buildings(-2 years higher in high-rise buildings). While thehigh-rise buildings replacement tenants averaged 2 years older, they also showed a marked declinein age of replacements down to below the average of the low-rise builidngs (see Figure 4.07). Incontrast, the low-rise building median age of replacements remained constant at about 66.Figure 4.07 Median age replacements by building typehighI ow7 2Also, there were other minor differences between buildings. For example, the 7-yeararithmetic mean of the annual median age of replacement tenants (see Figure 4.08) was 70 yearsfor Winch Tower, compared to a difference of 64 years for the corresponding Culloden Courtmedian age of replacement tenants (6 years younger). 737271706968676665646362Figure 4.08 Median age replacements by building typea)rnarco:13a)ELow rise^ High riseNVS^BCHF^BCHMCyear734.3 TENANT REPLACEMENT RATE The seven-year mean of the annual tenant replacement rate for the six buildings was 11%. Adistinct trend of increasing replacement rate is evident with an increase from 8% to 12%.However, since the majority of incomplete data occurred in the first two to three years of the studyperiod, the replacement rate may have been higher.TABLE 4.03 YEARLY TENANT REPLACEMENT RATE (%)Organisation &Building Size(n) 82-5 83-6 84-7 85-8 86-9 7 yr meanNVS11th Avenue 26 4 0 4 8 12 5Winch Tower 101 6 10 10 14 12 10Both Buildings 5 5 7 11 12 7.5BCHFSoroptimist Manor 27 7 7 7 11 11 9Fahrni House 44 11 9 14 11 14 12Both buildings 9 8 11 11 13 10.5BCHMCCulloden Court 55 11 16 15 11 11 13Hall Tower 71 11 14 16 18 14 15Both buildings 11 15 16 15 13 14Mean for high rise 9 11 13 14 13 12Mean for low rise 7 8 9 10 11 9Mean for 6 buildings 8 9 11 12 12 11* year end is taken as June 30** numbers might not total due to roundingThere were moderate differences between low-rise and high-rise buildings with replacementrates of 9% and 12% respectively. Both low-rise buildings and high-rise buildings showed adistinct trend of increasing replacement rates over the seven-year period. The 11th AvenueApartments had the lowest turnover rate at 6% and Hall Tower II had the highest at 15% ; inabsolute values, the number of tenants displaced (for whatever reason) must be much greater (seeFigure 4.09).high riselow rise83-6 84-7year17^16 ^15 ^14 ^^61) 13 ^4s 12 ^c 11 ^ad 109a. 8 ^765 ^4 ^82-5 85-8^86-983-6 85-884-7year86-917161514w 1340°' 12c 11041) 10ai; 9Q. 8765482-5NVSBCHFBCHMCFigure 4.09: Tenant replacement rate high rise/low^74riseSignificant differences were evident by organization. The highest tenant replacement rate wasBCHMC at 14% and the lowest NVS at 7.5% over the seven-year period (see Table 4.03 & figure4.10). Some significant trends were apparent. Both NVS and BCHF experienced a distinct increasein tenant replacement rate, from 5% to 12% and 9% to 13% respectively, while BCHMCexperienced a modest increase from 11% to 13%.Figure 4.10 Replacement rate by organization754.4 DURATION OF STAY The average duration of stay is the product of the number of occupied units times 84 monthsdivided by the number of unit occupancies for the same period.TABLE 4.04 DURATION OF STAY (months)NVS BCHF BCHMC MEANHigh rise 39 37 41 39Low rise 45 50 42 46Both^buildings 42 43.5 41.5 42.5Overall, the mean duration of stay was substantially longer among low-rise buildings (46months) than among the high-rise buildings (39 months). Among the high-rise buildings, modestdifferences in the mean duration of stay were evident with a low of 37 months for Fahrni House toa high of 41 months for Hall Tower. Differences among the low-rise buildings were more distinct,with a low of 42 months for Culloden to a high of 50 months for Soroptomist Manor. Generally,differences in duration of stay by organization were slight with only two months difference betweenthe highest BCHF (43.5) and the lowest BCHMC (41.5) ( see Figure 4.11).605550454035ZI 302520151050Figure 4.11 Duration of stay by organization DI high rise^ low riseNVS^BCHF^BCHMCOrganization764.5 SURVIVING ORIGINAL TENANTS TO TOTAL TENANTS As expected, given the observed differences between the high-rise versus low-rise in termsof duration of tenure of residence, it follows that the proportion of surviving original tenants tototal tenants among the low-rise buildings, 40%, is generally higher than in the high-risebuildings, 37%. Also, distinct differences by building are apparent with a low of 32% forCulloden Court to a high of 54% for the 11th Avenue Apartments.TABLE 4.05 SURVIVING ORIGINAL TENANTS ( % )NVS BCHF BCHMC MEANHigh rise 37 33 40 37Low rise 54 33 32 40Both buildings 46 33 36 38Figure 4.12 Surviving original tenants by building type605550• 4540c 35o 30a 2520151050 ^ Low rise▪ High riseNVS^BCHF^BCHMCyear77Distinct differences in the proportion of original to total tenants were evident by organization,with NVS highest at 46% and BCHF lowest at 33%.Figure . 4.13 Surviving original tenants by organization60555045• 40tn35to• 30e. 25a. 20151050 11 PercentageNVS^BCHF^BCHMCOrganization784.6 SEX DISTRIBUTION Among the six buildings, the seven-year arithmetic mean of the annual proportion of males tofemales is 63/100 (see Table 4.06 and Figure 4.14).TABLE 4.06 SEX DISTRIBUTION ( Males per 100 females)Organisation &BuildingNVSSize(n) 82-5 83-6 84-7 85-8 86-9 7 yr mean11th Avenue 26 58 57 51 47 43 50Winch Tower 101 34 34 38 45 48 40Both Buildings 46 46 44 46 46 45BCHFSoroptimist Manor 27 55 62 66 67 78 67Fahrni House 44 86 85 81 79 77 81Both buildings 71 74 74 73 78 74BCHMCCulloden Court 55 73 81 90 102 113 93Hall Tower 71 45 46 48 . 47 44 45Both buildings 59 64 69 74 79 69Mean for high rise 55 55 56 57 57 56Mean for low rise 62 67 69 72 78 70Mean for 6 buildings 59 61 63 65 67 63* year end is taken as June 30** numbers might not total due to roundingThe proportion of males to females varies considerably over the buildings. The proportion of7 9males to females is higher in low-rise (70) compared to high-rise buildings (56), except forBCHF.1009590(a 85• 80P. 70F^0• 6560o 5550L 454035O 3025▪ 202 151050Figure 4.14 sex distribution by building type ▪ Low rise^ High riseNVS^BCHF^BCHMCA steady increase in the proportion of males to females is evident in low-rise buildings whilethe proportion has remained constant in the high-rise buildings (See Figure 4.15).Figure 4.15 Sex distribution by building type1151100 1051009585o 807570t 650. 60 [1coa)5550Ta 452 40353082-5^83-6 84-7year85-8 86-9No marked trends in sex ratio values are apparent over the seven-year period for the high-8 0rise buildings with Hall Tower remaining stable and Winch Tower and Fahrni House registeringa slight increase and decrease in sex distribution respectively.Figure 4.16 Sex distribution high riseWinchFahrniHall115110mu) 105▪ 10095• 9085o 807570I 650- 60co 55  • 50To 45^2 40 ^^35 30 82-5 83-6^84-7 85-8^86-9OrganizationHowever, in the low-rise buildings, distinct increases are evident for both Soroptomist Manorand Culloden Court. The former building's sex ratio increased from 55 males per 100 females to78 per 100 females over the seven-year study period and the latter building's sex ratio increasedfrom 73 males per 100 females to 113 males per 100 females (See Figure 4.17).Figure 4.17 Sex distribution low rise11th AvenueSoroptimistCulloden82 - 5^83-6^84-7^85 - 8^86 - 9year115110^alcn 105 ^-tra 10095of 9085^o 80 ^7570t 650- 60• 55co 50is 452 403530 ^81Also, there are distinct differences by individual building, with Culloden Court having aseven-year arithmetic mean of 93 males per hundred females to a low of 40 males per hundredfemales for Winch Tower.Among the three organizations, BCHF had the highest ratio of males tofemales over the seven year study period of 74 males per 100 females, while NVS had the lowest at46 males per 100 females.Figure 4.18 sex distribution by organization OrganizationNVS^BCHF^BCHMCOrganizationA clear trend of increasing proportion of males to females is evident for BCHMC, and BCHF isshowing a modest increase. The proportion of males to females has remained constant for NVS (SeeFigure 4.19).Figure 4.19 Sex distribution by organization^115 ^110owl 105To 1009 5^a) 90 ^8 58 00° 7 57 0 rL.▪ 65NVSBCHFBCHMCex. 6 0• 5 5e 50To 4 52 40353082-5^83-6^84-7^85-8^86-9year1982-5^1983-6^1984-7^1985-8^1986-9^7 r mean>75 <65 >75 <65 >75 <65 :>75 <65 :>75 <65 :>7522^14^24^11^29^9 30^11 31^13 2757^8^56^9^54^9 51^10 52^8 5440^11^40^10^42^9^40^11^42^11^4142^18^45^17^50^22 50^28 48^21 4652^10^51^13^48^17 47^23 42^15 4847^14^48^15^49^20 49^25 45^18 4731^27^31^27^31^29 31^34 30^30 3123^24^26^27 28^29 32^31 34^27 2827^26^29^27 30^29 32^33 32^29 30•44^14^44^16^43^19 43^21 43^17 4332^20^30^19^33^20 34^24 36^22 3538^17^39^17^40^19^40^23^40^19^39SizeOrganisation &Buildin<65NVS11th Avenue 26 16Winch Tower 1 01 7Both Buildings 12BCHFSoroptimist^Manor 27 17Fahrni House 44 11Both^buildings 14BCHMCCulloden Court 55 28Hall Tower 71 22Both^buildings 25Mean for high rise 13Mean for low rise 21Mean for 6 buildings 17824.7 COMPARISON BY AGE GROUPIn order to gain a better understanding of change in population subgroup over time, thepopulation age data were analyzed in three categories as follows: under 65 years, 65 to 74 yearsof age, and 75 years and over. Only two of these categories, under 65, and 75 & over, arepresented in the results, since these data are the most germane to my study focus.TABLE 4.07 AGE SUB-GROUPS UNDER 65 &75 & OVER °/0* year end is taken as June 30** numbers might not total due to roundingAmong the six buildings, 19% were under 65, and 39% were 75 and over and this proportionhas remained pretty constant over the seven-year period. Significant differences were apparentby individual building with Winch Tower recording the highest percentage of old seniors8 3(54%) compared to Hall Tower II (28%). Similarly, differences were apparent comparingproportion of young senior tenants by individual building. Of the under 65 age group, WinchTower had a low of 8%, while Culloden Court had a high of 30%.Figure 4.20 Age sub-group by building65605550an 4540t 35ow30r, 25et. 20151050 III under 65^ 65-74▪ 75 and overCE ca)0buildingGenerally, there was a slightly higher percentage of younger senior tenants (<65) in thelow-rise buildings (22%) compared to the high-rise buildings (17%). The percentage ofyounger tenants in both high- and low-rise buildings increased over the seven-year period withthe larger increase occurring in the high-rise buildings (see Figure 4.21).Figure 4.21: Under 65 age sub-group high/low rise^60 ^^55 ^50 ^45 ^40 ^2, 35 ^a)• 30^2 25 ^^ci. 2 0 -^1 5^•^10 ^50 ^82-5High riseLow rise83-6^84-7 85-8^86-9Year85-8 86-983-6 84-760555045g 40Lti• 35w3025a 2015105082-5Low riseHigh rise83 - 6^84 - 7 85-8^86-9--III— WinchFahrni• Hall8 4Also, there was generally a higher percentage of older senior tenants (>75) in the high-risebuildings (43%) compared to the low-rise buildings (35%) for the seven-year period. Thispercentage remained fairly constant for the high-rise buildings while a small increase is evidentin the low-rise buildings (see Figure 4.22).Figure 4.22 75 and over age sub-group by building typeyearOf the three high-rise buildings, Hall Tower and Fahrni House showed a trend of an increasingpercentage of < 65 age group over the seven-year period, while Winch Tower increased onlyslightly (see Figure 4.23).Figure 4.23: Under 65 age sub-group high rise^60 ^^55 ^50 ^45 ^^041 40 ^2 35 ^co• 30^P. 25 ^a_ 20 ^15 ^10^II^50 ^82-5Year85-8^86-9WinchFahrniHsll8 5In the >75 age group, Hall Tower was the only high-rise to record an increasing percentage.The other two high-rises showed a slight decreasing trend for the same age subgroup.Figure 4.24^75 and over age sub-group high rise60^5 5 ^ --^50 ^45 ^g40 ^„..9 35^0) 30 2 5^a. 2 0 ^15 ^10 5 ^^0 82-5^83-6^84-7yearAmong the low-rise buildings both Soroptimist and Culloden showed a trend of increasingpercentage of younger seniors (<65 age group) over the seven-year period while 11th AvenueApartments showed a slight decline (see Figure 4.25).60555045cD 40coFigure 4.25: Under 65 age sub-group^low rise11th Ave35a)^30 Soropt25.7.1■•■■•■•11•1•1111a. 20 r_ Culloden1510 ^ ib5082-5^83-6^84-7^85-8^86-9Year8 6Both 11th Avenue and Sorroptomist showed a trend of increasing percentage of older seniors(>75) while Culloden remained constant.Figure 4.26 75 and over age sub-group low rise60 ^555045a)^Ia) 40rat 35g 30ct 252015105082-5 83-6 84-7 85-8 86-9yearThere were also significant differences by organization. The highest proportion in the <65 agegroup are housed by BCHMC (-29%) while the lowest proportion are housed by NVS (-11%). Thehighest proportion in the >75 age group are housed by BCHF (-47%) while the lowest proportionare housed by BCHMC (-30%) (see Figure 4.27).Figure 4.27 Age sub-group by organization 50454035302520151050a)rnasa-▪ under 65^ 65-74▪ 75 and overNVS^BCHF^BC M3OrganizationAll the organizations have shown a remarkable stability of age structures over time. Much thesame also applies to the proportion of coupled pairs of occupants of units.11th AvenueSoroptimist—S ^Culloden4.8 PROPORTION OF COUPLES TO ALL TENANTAmong the six buildings, the proportion of tenant couples to all tenants has remained verystable over the seven-year study period other than for BCHMC, which has experienced an increase.Organisation &BuildingNVSSize(n)TABLE 4.08 COUPLES TO ALL TENANTS (%)82-5^83-6^84-7^85-8 86-9 7 yr mean11th Avenue 26 24 25 22 26 22 22Winch Tower 101 10 10 11 13 14 12Both Buildings 17 16 17 17 18 17BCHFSoroptimist Manor 27 13 14 14 12 9 12Fahrni House 44 8 8 8 8 8 8Both buildings 11 11 11 10 9 10BCHMCCulloden Court 55 11 15 18 19 19 15Hall Tower 71 13 15 16 16 16 15Both buildings 12 15 17 18 18 16Mean for high rise 10 11 12 13 13 12Mean for low rise 16 17 18 17 17 17Mean for 6 buildings 13 14 15 15 15 14* year end is taken as June 30** numbers might not total due to rounding878 8There are distinct differences by individual building, with a low percentage of tenant couplesto all tenants at Fahrni House (-8%) to a higher percentage at 11th Avenue Apartments (-22%).2520a)c• 15a)▪ 10a.50Figure 4.28 Couples by building type Low rise^ High riseNVS^BCHF^BCHMCBuilding typeThere are also significant differences by organization, BCHF has the lowest percentage oftenant couples to all couples (-10%) while NVS has the highest at 17% (See Figure 4.29).Figure 4.29 Couples by organization252015a)10cf.50CouplesNVS^BCHF^BCHMCOrganization8 94.9 SUMMARY The preceding discussion presented the findings for the eight variables investigated for thesix buildings, which are median age of tenants, median age of replacement tenants, tenantturnover, duration of stay, original to total tenants, sex distribution, comparison by age subgroup,and couples to all tenants. Critical findings are that the median age is not increasing, but there aredistinct differences in median age by organization and by individual building. It appears that fourof the variables are useful in explaining why these differences exist. These four variables areanalyzed in more detail in Chapter 5, which attempts to explain why the differences.CHAPTER 5: ANALYSISThe preceding chapter presented findings of the case studies data. The central questionsaddressed were, whether the median age of senior residents is increasing, and whether there aredifferences in the median age by organization and/or differences by building type (high-rise/low-rise). Thegeneral result for all six buildings examined indicated that the median age of occupants has remainedalmost constant. In other words, it would appear that no aging-in-place is occurring, i.e., that the numbersof older seniors moving out are replaced by younger replacements. Slight differences in median age areevident by organization and building type; both BCHMC and NVS have experienced slight increases inmedian age while BCHF has remained constant. In terms of building type, the low-rises experienced aslight increase in median age over time while the high-rises experienced a slight decrease.These results do not seem surprising since it was expected that over time the median age wouldreach an upper limit at which point it would stabilize. Since all of the six buildings studied have been inoperation for approximately 20 years, it is likely that this stabilization occurred prior to the commencementof the study.However, the most striking finding is that this constant median age varies by organization. Theconstant median age for BCHMC is much lower than the constant median age for the other twoorganizations. Also, there are distinct differences in median age by individual buildings.In this chapter, an attempt is made to explain why these differences in median age exist. The followingdiscussion first takes a critical look at the results by individual building, and compares them to the resultsfor all buildings. Secondly, questions are posed of four key variables to explain the differences in median90age. Can the median age differences be explained by organizational policies in the median age ofreplacement tenants or by the volume of replacement tenants? How is the median age affected by thevolume of surviving original tenants, and how does the proportion of older seniors present explaindifferences in the median age? In addressing the preceding questions, results for only two of the sixbuildings, Winch Tower and Hall Tower, are discussed in order to avoid excessive repetition. A summarytable and graph are included for all six buildings, while detailed discussion for the other four buildings isavailable from the author upon request.Thirdly, Lawton's three factors which influence median age: suprapersonal environment;applicant screenings; and tenant notification to vacate, are considered in relationship to eachorganization.5.1 DIFFERENCES BY BUILDING WINCH TOWER (NVS)Median age of tenants (u=202; n=101)In Winch Tower, the seven-year arithmetic mean of the annual median age of tenants was 75compared to 73 years for all six buildings. The median age of tenants in Winch Tower slightly decreasedfrom 76 to 75 over the seven-year period while it slightly increased from 72 to 73 across all six buildings.In fact, the median age for Winch was higher than any of the other buildings. To explain this difference,the first question to address is, how can this higher median age be explained by the median age ofreplacement tenants?91Replacement TenantsThe seven-year arithmetic mean of the annual median age of the Winch Tower replacementtenants was 72, substantially higher than the median age of 67 for replacement tenants across all sixbuildings. Winch showed a distinct trend of decreasing median age of replacement tenants from 77 to 69over the seven-year period compared to only a slight decrease from 68 to 65 for all buildings. The highermedian age in Winch can be explained in part by the higher median age of replacement tenants. Also,the slight decrease in median age is consistent with the decrease in median age of replacement tenantswhich occurred.Replacement RateWinch Tower seven-year arithmetic mean of the annual tenant replacement rate was 10%, whichis about the same as the rate of 11% for all buildings. There was a trend of increasing replacement rateat Winch Tower, from 6% to 12% over the seven-year period, which compares to a similar increasingtrend for all buildings from 8 to 12%. This would suggest that the replacement rate is not an importantvariable in explaining differences in median age between Winch Tower and all buildings. The proportionof surviving tenants to a degree is related to the replacement rate. We need to next look at how themedian age is affected by the proportion of surviving tenants.Surviving Original Tenants The proportion of surviving original tenants to total tenants for Winch Tower was 37%, which isalmost the same as the arithmetic mean of 38% for all buildings. A means of testing the expectedproportion of surviving original tenants is by use of the simple equation SP = 1-KR, where Sp equal theproportion of survivors from start to end of an interval; R is the annual replacement rate in the population92and K is the number of years in the interval. In this construct, it is assumed that incoming tenants replace"original tenants" and that the annual replacement rate is generally constant "Original tenants" aredefined as those tenants who were tenants at study commencement date. "Surviving original tenants" aredefined as those tenants who were tenants throughout the whole study period. "Non-original tenants" aredefined as those persons who became tenants after study commencement.Using our theoretical equation the expected proportion of survivors over the seven years 1982-1989, based on a 10% annual turnover rate would be as follows:SP = 1-KR = 1-0.7 = 0.3 or 30%Since the actual result for Winch Tower is 7% higher than the theoretical one, this would indicatethat some of the incoming tenants replaced non-original tenants. This conclusion has to be qualified bythe fact that the equation is based on a constant replacement rate which, of course, was not the actualcase. We saw that there was a increase from 6% to !2% over the seven years. Nevertheless, it isreasonable to conclude that most of the incoming tenants replaced original tenants, which is to beexpected given the high median age of the tenants in the building.Age SubgroupsIn the 75 years and over age group, Winch Tower at 54% had a higher proportion (based upon aseven-year arithmetic mean) than the corresponding proportion in this age group of 39% for all buildings.Also, the proportion in Winch was higher than the proportion in any of the other buildings. There was atthe same time a slight trend of decreasing proportion of the older seniors age subgroup in Winch over theseven-year period from 57% to 52%, while the proportion for all buildings remained stable at 39%.93This slight decreasing trend of the older seniors age subgroup in Winch is consistent with the observeddecrease in median age of Winch replacement tenants over the seven years. The same trend is alsolikely due in part to the fact that a personal care facility was built in the late 1970's near to Winch Tower(next block), and older seniors are moving in to the facility as they get more frail.HALL TOWER (BCHMC)Median Age of Tenants (u=142; n=71)At Hall Tower, the seven-year arithmetic mean of annual median age was 71 years; ie, two yearslower than the median age of 73 for all buildings. There was a small trend of increasing tenant medianage from 70 to 72 over the seven-year period compared to a similar small trend from 72 to 73 for allbuildings.Replacement TenantsThe seven-year arithmetic mean of annual median age of replacement tenants was 66, being fiveyears younger than the median age of all Hall Tower tenants. This median age of replacement tenants isabout the same as the median age of replacement tenants (67) for all buildings. There was a nonlineartrend over time of decreasing median age of replacement tenants from 66 to 68 and then down to 63years which is similar to a trend from 68 to 65 years for all buildings.The pattern of relationship between average age of all tenants by year versus corresponding ageof replacements resembles that of another building, namely 11th Avenue (see Tables 4.01 and 4.02).The difference between the median age of replacement tenants and median age of al tenants is similar tothe difference in 11th Avenue, and the median ages are the same for both buildings. The small decrease94in median age of replacement tenants for both these buildings parallels a small increase in tenant medianage of two years for both buildings. However, the median age of replacement tenants decreased from 66to 63 years for Hall Tower, compared to a decrease from 68 to 66 years for 11th Avenue. All other thingsbeing equal, a lower median age for Hall Tower would be expected.Replacement RateIn Hall Tower, the annual replacement rate of 15% (based upon a seven-year arithmetic mean)was higher than the rate for all buildings of 11%. A trend of increasing replacement rate was evident,from 11% to 14% for Hall Tower over the seven-year study period; and a similar trend from 8% to 12%was evident for all buildings. Comparing this result to 11th Avenue's turnover rate of 6%, a lower medianage than that for 11th Avenue would be expected.Original TenantsIn Hall Tower, there were 40% original to total tenants which is above the arithmetic mean of 37%for all buildings. The expected percentage of original tenants is zero based on the annual turnover rate of15% for this buildingSP-KR = 1-1.05 = -0.5 or -5%This implies a bipolar distribution of two tenant populations. The presence of 40% survivingoriginal tenants would indicate that there was been a high turnover among the population of non-originaltenants. This result may help to explain the inconsistencies discussed earlier related to the differences inmedian age of replacement tenants and the replacement rate.95Age SubgroupWithin the age subgroups for Hall Tower, the seven-year arithmetic mean percentage of olderseniors was low at 28%, compared to 39% for all buildings. This is to be expected, given the low medianage of 71 in this building There was a trend of increasing percentage of older seniors from 27% to 34%over the seven-year period compared to a very slight increase from 38% to 40% for all buildings.5.2 SUMMARY OF DIFFERENCES BY BUILDING Table 5.01 and Figure 5.01 give a summary of differences among the key variables for all sixbuildings.TABLE 5.01 CROSS BUILDING COMPARISONOrganisation &^Median age^Replacem'tBuilding^ Rate %Surviv'g.tenants %75 & over^Median ageage grp. %^replacem'tsNVS11th Avenue 7 year mean 71 6% 54% 27% 66(u=26) 1-7yr span (70-72) (4-12%) 22-31) 68-66)Winch Tower 7 year mean 75 10% 37% 54% 72(n=101) 1-7yr span (76-75) (6-12%) (57-52%) (77-69)BCHF 7 year meanSoroptimist 1-7yr span 74 9% 33% 46% 69(u=27) 7 year mean (73-74 ( 7-11%) (42-48%) (64-69)Fahrni House 1-7yr span 74 12% 33% 48% 64(u=44) (75-73) (11-14%) (52-42%) (70-61)BCHMCCulloden Court 7 year mean 69 13% 33% 31% 64(u=55) 1-7yr span 69 13% (31-30%) (63-61)Hall Tower 7 year mean 71 15o/0 40% 28% 66(n=71) 1-7yr span (70-72) (11-14%) (23-34%) (66-63)Mean all 6 blgs. 7 year mean 73 11% 37% 39% 671-7yr span (72-73) (8-12%) (38-40%) (68-65)965040 w3020 0-1008 07 06 0a)c 500coco• 402(1)• 302010060Median ageReplacementsAge group 75Replace rateSurvivorsFigure 5.01: cross building comparison97c^c.) w^c^a)• 1-^'00^a^CO 0> I-- 0 LL^-5016 0(f)BuildingThe median age of replacement tenants was consistently lower than the median age of tenantsfor all buildings. At the same time, there was a spread of eight years between the median age ofreplacements for Winch Tower (72 years) and Culloden Court (64 years). This logically followed from thefact of a six-year gap between the median age of tenants for these two buildings, ie, the median age ofreplacement tenants affects differences in median age by building.It was expected that variations in the annual replacement rate would affect the median age oftenants since the number of replacement tenants as well as their median age has to be considered. Forexample, the replacement rate for Winch Tower was 10% versus 13% for Culloden Court. This 3%difference represents only two tenants in Culloden.The proportion of surviving original tenants in a building was expected to have a directrelationship to the median age. This was not the case. Both 11th Avenue and Hall Tower had highpercentages of surviving original tenants of 54% and 40% respectively, yet the median age of tenants inboth these buildings was only 71 years.Finally, it was expected that differences in median age would be evident in relation to theproportion of older seniors in a building. This, indeed, was true in all cases, with buildings of low medianage tenants having low proportions of older seniors and buildings of high median age having highproportions of older seniors. In fact, it is evident that, with a difference of only a few years in median age,there is a substantial change in the proportion of older seniors in a building. For example, a 5% differencein median age parallels a 26% difference in the percentage of older seniors present; ie, a 5% differencebetween Winch Tower (75) and Hall Tower (71) in median age, results in a 26% difference betweenWinch 54% and Hall 38% (Figure 5.02). The implications of this discovery will be discussed shortly.Figure 5.02 Median age vs 75 years & over by building9880706013,2 5 0R 40. 3 013w22010080706050403020100 Median agepercentage^a)^_c L.-^_c = 0 w4- c^c,- a),- >^§ 152E0.00Buildinga)0roIn the preceding discussion, the median age of replacement tenants was the most importantvariable in explaining differences in median age among the buildings. The next question is why are theredifferences in the median age of replacement tenants? This question will be addressed in the followingdiscussion of the three organizations. Obviously, differences by individual building would tend to biasresults when averaged by organization since only two buildings of each organization are studied. Whereapplicable, this point will be addressed.5.3 COMPARISON OF DIFFERENCES BY ORGANIZATION Three factors have been suggested which affect the median age of tenants in a building. Two of thesefactors are directly controlled by the administrations operating the facilities while the third is indirectlyinfluenced by the administrations. The first factor concerns the control over how long a tenant can stay,the second concerns control of who is allowed in, and the third factor is the suprapersonal environmentwhich is defined as the aggregate characteristics of all individuals populating a defined area, in this case,the housing environment. The salient characteristic is the level of independence of the tenant. Thus, thesuprapersonal environment will tend to attract or repel applicants depending on the level of independenceof its tenants (Lawton, Greenbaum and Liebowitz 1980). The reason for the difference in median age ofthe replacement tenants by organization might be due to one or more of the preceding three factors.Suprapersonal EnvironmentIf we try to explain the difference in terms of the suprapersonal environment we would expect thatin buildings of high median age the median age of replacement tenants would tend also to be high andalso tend to increase over time similar to the results in the Philadelphia study (Lawton et al. 1980).Looking at the results by organization, a partial correlation is evident. The median ages of 74, 72, and 7099for BCHF, NVS and BCHMC respectively, correspond to median ages of replacement tenants of 67, 69and 65. Although NVS's Winch Tower had the highest median age of 75, the median age of the otherNVS building (11th Avenue) was only 71. If we consider the suprapersonal environment by individualbuilding,we see a clearer relationship between the median age of tenants and the median age of replacementtenants. Thus, Winch Tower and Soroptimist Manor have high median age of 75 and 74 whichcorrespond to high median ages of replacement tenants of 72 and 69 respectively. However, onlySoroptimist Manor has shown an increase in median age of replacement tenants over the seven years.The idea that an individual applicant will screen the suprapersonal environment in seniors' housingassumes that housing options are abundant. However, in seniors' multiple housing the options arelimited, at least in the Vancouver area. In addition, the tenant option to choose is limited by thecontrolling rules of the organizations. In the case of BCHMC for example, if an applicant for tenancy isoffered a dwelling unit in a building and turns it down, the applicant loses priority position on the waitinglist (earlier it was mentioned that the waiting list at BCHMC was over 1700). This does not totally negatethe likelihood that some prospective tenants might wait until the desired unit is available. For most,however, the prospect of waiting for years for the ideal unit would likely by unpalatable.This reduces the likelihood that the suprapersonal environment is a major contributing factor inexplaining the differences in median age by organization. On the other hand, for both NVS and BCHF,replacement tenants are older the BCHMC replacement tenants. So some selection seems to beoccurring consciously or otherwise. In particular reference to NVS Winch Tower, it would appear that thesuprapersonal environment may be a factor due to the size of the facility and its proximity to the personalcare facility. In comparing the NVS experience to Seton Villa, Gloria Gutman suggests that "it may wellbe100that proximity to up to 25% of persons requiring personal care, as at Seton Villa, is tolerable to the well-elderly, but that larger proportions, especially if they require more than personal care, are not" (1988,154).Screening of ApplicantsThe other two factors, screening of applicants and notifying tenants to leave are in the directadministrative control of the organizations. Given that the BCHMC median age of replacement tenants islower than the other two organizations, it is possible that BCHMC is screening for younger applicants. Onother hand, screening might be happening in an unplanned fashion. Since BCHMC is a governmentagency and also the largest single deliverer of seniors' housing in the province, it is likely that mostapplicants for seniors' housing go to BCHMC first. It may be that those tenants who are less willing towait go elsewhere or are referred elsewhere. Older applicants are likely in more immediate need forseniors' housing. Thus older applicants by circumstance may be directed to the other two organizations.In discussions with both NVS and BCHF staff, they pointed out that some prospective tenants are referredto them by BCHMC. In the case of BCHF, it was perceived by staff that older seniors were being sent tothem. It could be that given the high demand for seniors ' social housing registered at BCHMC, (over1700 on the waiting list) the BCHMC staff provides the names of the other two organizations asalternative housing sources to prospective tenants.A third type of screening might be occurring; screening on a specific building basis. This is, thetenants are being selectively distributed throughout the buildings that each organization operates. On-siteand adjacent factors might influence why a particular building would be selected by staff for an applicant.This would help to explain why there are distinct differences by building.101Exploring this possibility, the fact that the youngest median age was in BCHMC's Culloden Courtmight be explained by the unsuitability of its site and surroundings for older seniors. It fronts on a roadclassified as a major arterial (Knight Street), which has high traffic volumes and is noisy. The site is notclose to shopping or other amenities. It is not an accessible environment due to the slope of the adjacentsidewalk.This argument gains credence when we consider than in Hall Tower, BCHMC's other building, themedian age is two years higher than Culloden Court and the site and surroundings are more suitable forolder seniors. The building is located in proximity to shopping and a library. On-site amenities includegarden plots for residents; a community building is directly adjacent to the site; and it is an accessibleenvironment.Similarly, site and surroundings seem to play a role in the case of NVS. The median age in the11th Avenue apartments is lower than that for Winch Tower. This building is located on a residentialstreet. Access to shopping is constrained by the presence of steep slopes of adjacent roads. The site isaccessible to handicapped, but the building has no elevator.In contrast, Winch Tower, which has a median age of 75, is located in proximity to shopping andother amenities. The site is accessible to handicapped, and the building has communal recreation andentertainment facilities. In addition, NVS operates a personal care facility on an adjacent site. It is alsopossible that NVS management is moving older tenants from other facilities into the Towers to be close tothe care facility as they become more frail.102Both BCHF buildings have a high median age. The sites and surroundings of both arecontextually suitable for older seniors being located in proximity to shopping and other amenities, havingelevators and having accessible sites.The preceding argument that on-site and adjacent factors might influence why a particular building mightbe selected by staff for an applicant seems quite plausible and consistent except it still does notsatisfactorily explain the distinct difference in median age by organization. For instance, Hall Tower isonly a few blocks away from Winch Tower. Both buildings are contextually similar, yet BCHMC's HallTower has a median age four years less than NVS's Winch Tower. There is almost double the amount ofolder seniors (>75) in Winch Tower than in Hall Tower (54% versus 28%). It could be argued that theproximity to its personal care facility makes Winch Tower more attractive to older tenants, but this facilityis still close at hand to Hall Tower.The same inconsistency is apparent when we look at Culloden Court and 11th AvenueApartments. Again, both buildings are contextually similar, yet BCHMC's Culloden Court has a medianage two years younger than NVS's 11th Avenue Apartments.Notification to VacateThe third factor which Lawton attributes to the median age in a building is the control over how long atenant can stay. Given the lower median age and low proportion of older seniors in the BCHMC facilitiesversus the other two organizations, there is little doubt that BCHMC exercises more control respectingnotification to vacate than do the other two organizations. However, none of the organizations is keepingtenants as long as they might. Life expectancy (at birth) for males is 72 and 79 for females in Canada(1986). Based on the sex distribution in Winch Tower and life expectancy it might be expected that the103natural levelling of mean age would be approximately 76 years. However, life expectancy is much higherfor these seniors since they already represent a select group. In 1981, a 75 year old male could expect tolive another nine years and a 75 year old female another 12 years on average (Schwenger 1986, 51). Inthe two congregate buildings studied in Philadelphia, the mean ages were 83.4 and 83.6. Of course,these were congregate housing facilities which provide extra services.Organizational DifferencesThe macrosystem section in Chapter 2 gave a definition of organization and presented sometheoretical ideas on why differences in outcome by organization might occur. The following discussionexamines the three organizations studied in relation to the theoretical characteristics discussed in Chapter2 and see if there are parallels between the differences in outcome and the differences in organizations(the background of each organization is in Appendix B).BCHF is the smallest of the three organizations consisting of a nine-member board of directors anda management staff of five (one manager, three assistants and one "field" tenant coordinator). Inaddition, there is one caretaker at each building owned and operated by BCHF and two caretakers at theLionsview Project, their oldest facility. The management office is located in downtown Vancouver at thecorner of Hastings Street and Cambie Street, where all of the management staff are located. Thepremises are small and modest; there is no computer system, all records are filed by hand. One wouldcategorize the organization as informal, personal, non-hierarchical, and friendly. The staff seem quitefamiliar with tenants in their facilities and the tenant coordinator was aware of details of people andproblems at all of their buildings.104New Vista Society is similar to BCHF in terms of organization size, consisting of a board ofdirectors of 12 persons and a management staff of five full-time and two to three part-time employees.However, there is a separate larger management unit which operates the personal care facility adjacent toWinch Tower. Not all of the NVS buildings have individual caretakers and there is no separate fieldtenant coordinator. The management offices is located at the ground floor of Winch Tower, so it is readilyaccessible to tenants in the building and adjacent buildings (the other tower and some small cottages). Atthe time of field work only the newest facility, Douglas Manor, was on computer (annual records) butcurrent records for al facilities are entered on the computer. Offices are small, one for the manager andan adjacent general office space. Although NVS is a larger organization than BCHF, the housingmanagement is informal, personal, friendly, accessible and non-hierarchical. However, from myexperience collecting data stored in the NVS care facility, the personal care facility exhibits a more formalstyle of management.BCHMC in contrast to the other two organizations is a large bureaucratic organization headed bysix commissioners, and a six member management committee (five directors and a general manager).There are five separate branches within the commission. It displays all of the characteristics of abureaucracy listed in Chapter 2, ie, it is hierarchical, specialized, it has a formal rule structure and it isimpersonal.It was mentioned earlier that the effectiveness of an organization has to be measured in terms of itsattainment of stated purpose. Both NVS and BCHF have a stated purpose of providing housing for theelderly. BCHMC has five stated purposes, the primary one being "to execute provincial housing policiesas directed by the Ministry charged with the administration of the Housing Act" (BCHMC 1987, 4). Thesepurposes are carried out within a 12-point general policy framework. One of these policies is "to allocatehousing to modest income senior citizens and disabled persons on the basis of need" (ibid., 1987, 4).105In contrast to NVS and BCHF, the primary purpose of BCHMC is the execution of a policy outside of itsdirect control. Additionally, within its general policy framework, the provision of seniors' housing is not itsprimary function. Furthermore, housing for the disabled is accommodated within seniors' housing.Although the general purpose of all three organizations is the same, i.e. the provision of seniors' housingfor independent living, the emphasis is different. It is the primary goal of NVS and BCHF, while it is onlyone of many for BCHMC.The differences in outcome appear to be associated with differences in organization characteristics andpurposes. Differences in median age seem to be more of a function of the control of the organization thana natural occurrence through aging, although the screening of the suprapersonal environment byapplicants may still play a role, as seems the case in Winch Tower. The difference in median age seemsto have an inverse relationship to the level of bureaucratization of the organization. Thus, the lowestmedian age is present in BCHMC, the biggest organization and the highest median age is present in thesmallest organization, BCHF. This is consistent with DeLulio's findings that differences in managementstyle was the critical variable in explaining differences in outcome (1987, 95). Of course, we mustconsider that only two buildings of each organization have been studied, which is not necessarilyrepresentative of what is occurring in all the buildings of these organizations.It is difficult to define the degree of screening occurring respecting applicants and notices tovacate exercised by each organization. What we can say is that since replacement tenants are youngerand median age is lower for BCHMC, this organization exercises more selective control over who entersand remains in their buildings than do the other two organizations, perhaps because policies andguidelines are more formally followed than in the other two organizations.106The fact that the median age of tenants is lower in BCHMC buildings has another implication.The majority of tenants in the BCHMC buildings studied are not in the older seniors category, unlike thecase for the other two organizations. As was mentioned earlier, relatively small differences in median agebetween buildings can result in dramatic differences in the proportion of older seniors being housing in thebuildings. The characteristics and needs of this older seniors age group are quite different from those ofyounger seniors age groups.When seniors demographics were discussed in Chapter 2, a problem identified was that there is atendency for facts on seniors to be presented in one general category, i.e. for those persons of 65 yearsof age and over. There is a related problem in the development of facilities programming criteria forseniors' housing. For example, in a study for BCHMC the conclusion was that the majority of the tenantswere satisfied with their accommodation and were not in need of additional services. However, if theolder seniors age group is considered independently, it is evident that most of this group expressed aneed for extra services (Gaudin-Reis 1987).Similarly, a recent CMHC study concluded that most seniors will trade off extra services and communalspaces for larger housing units (Baldwin 1990). The conclusion fails to address the future needs oftenants aging-in-place and also overlooks the fact that younger seniors do not anticipate their futureneeds for aging-in-place (Kalymun 1985, 8; Rosow 1974, 126). Also in a survey of health status ofseniors in public housing it was suggested that there is a "tendency on the part of elderly seniors in publichousing to under-report health problems" (Denton and Davis 1986, 149).107It is important to develop criteria that recognizes the changing needs of the tenant population inseniors' housing in the planning of these facilities. Educating the seniors population to anticipate and panfor these changing needs is a part of this program. More immediate is the need to provide extra servicesfor those older seniors presently housed in seniors' multiple housing for independent living if the provincialaging-in-place policy is to be successful in keeping older persons out of institutions.In Chapter 6 both the background studies and the case studies are reviewed and evaluated interms of the stated thesis objectives. Limitations are identified and suggestions to assist aging-in-place inthe light of the study findings are discussed in the conclusions.108109CHAPTER 6 : SUMMARY. EVALUATION & CONCLUSIONSThis thesis has two distinct parts, one being the broad question concerning theimplications of aging-in-place, the other addressing questions specific to the case studies. Thefirst part asked "which factors are important to consider in programming foraging-in-place." The second part asked three questions. " Is the median age increasing overtime ?"; "Are there differences by organization?"; and "Are there differences by buildingtype?".Lawton's ecological housing model provided the framework for the broad question as to theimplications of aging-in-place in part one. Factors important to consider (for aging-in-place)were presented from a) the macrosystem, b) the exosystem, and c) the microsystem , and theindividual level.Part two presented findings from the case studies and attempted to relate these findings tothe broader context of part one. The following discussion considers how successful the thesis is,in meeting defined objectives and the validity of the findings.6.1 BACKGROUND STUDIES In part one, the material presented is both qualitative and quantitative . The quantitativematerial presented is mainly analyses constructed from statistical data both historical andpredictive.The qualitative material covers an array of studies from many disciplines with varyingmethodologies. No attempt at detailed criticism of these studies is made in terms of theirscientific validity. Rather the emphasis was upon integrating a number of those concepts andfindings germane to the issue of aging-in-place in order to raise the awareness of both the1 1 0reader and the writer on the subject. This overview therefor by no means represents asystematic survey of the literature.In presenting the factors to consider at the macro level, the analyses tried to emphasizeolder seniors, however certain statistical data were not always available for this group. Forexample, data on marital status, mobility, cost of care, living arrangements, income andinstitutionalization are all either incomplete or not available for the 75 years and over group.The problem is underscored by Herbert Northcott... "rather substantial percentages of the oldestelderly (80 years of age and more) are lost to the analyses. This means that the Censusmobility data underrepresent the geographic mobility of the older elderly and, in particular,underestimate moves into institutional settings - moves which are often forced bycircumstances of declining health" (1988, 28).At the macro system there were a number of relevant findings concerning aging-in-place.The number of older seniors is increasing and at a higher rate than other seniors sub-groups.The majority of older seniors are women. Income is lowest among older seniors. The need forassistance with daily living more than doubles in most categories of activity from those under75 to those 75 and over. Of older seniors, annual cost of medical care is approximately 3 timeshigher than that in the general population. At the same time, the rate of institutionalization isincreasing.Macrosystem factors excluded other societal forces, and values such as changes in socialstructure eg. single parents, gay couples, or ethnic subgroups, which all have implications forspecial housing needs.1 1 1Similarly, economic and political decisions were not discussed other than theaging-in-place policy at the Provincial level, and the general observation that organizationalsize may influence outcome. Other issues, such as seniors involvement in the decision-makingprocess will ultimately have implications for aging-in-place in terms of the needs and wants ofolder seniors. To some extent awareness of this need for seniors involvement has beenaddressed (as discussed in Kathler 1987), and is being acknowledged in current planning(Baldwin 1990); but there is need to have user input from the older seniors group.At the exosystem scale, the importance of remaining in one's neighbourhood to assistaging-in-place was emphasised. Yet there is a lack of options to allow older seniors toage-in-place in their neighbourhood. "Policy makers and program personnel should give higherpriority to appropriate siting of purpose-built housing for the very old" (Havens 1988, 40).The "nimby" ( not in my backyard) syndrome is one barrier to the provision of appropriateoptions such as granny suites and congregate housing. The problem of physical obstacles in theneighbourhood weren't addressed in this thesis; these issues are already discussed inpublications on site planning ( CMHC vol.2 1982, CMHC 1987).The microsystem investigation first acknowledged the plethora of studies in Gerontology atthis level. I discussed the problem that in the area of aging/environment studies "researchfindings are often contradictory" ( Datan & Lohmann 1980, 38), and also lack generalizability(Lawton et al. 1982,157). Thus a comprehensive set of theories isn't available to thoseindividuals directly responsible for the delivery of seniors facilities to assist them informulating guidelines and design criteria.A definition of institutions was presented which included hospitals and old age homes(Goffman 1961). The negative Impact of institutionalization was emphasized. Keeping people112out of institutions is one strong reason for supporting an aging-in-place policy. Lawton'scompetence/press model was introduced showing the dynamics of person/environmentrelationships. In the absence of a comprehensive set of theories, this model serves as a usefultool for both programming and designing seniors facilities for aging-in-place. The generalimplication is that a range of opportunities should be available in the environment in order thatenvironmental press does not exceed resident diminishing competence levels. At the same timeopportunities should be provided that demand some press.From the viewpoint of the programmer/designer, the section on microsystem doesn't dealwith space planning issues, or provide information respecting design details within the dwellingunit. These issues have already been dealt with in a number of other studies (Goldsmith 1967;Howell 1978,1980; Lawton 1975; Maltais 1988). Rather, this section focuses on the need toprovide supportive environments for aging-in-place to avoid institutionalization and introducesa conceptual model for doing so.In a list of factors at the individual level to consider for aging-in-place a typology ofcompetences was introduced, and the notion of maintaining all of the competences for successfulaging-in-place was discussed. Enhancement of psychological, social and emotional competenceare some of the factors to consider for aging-in-place which are not emphasized in presentseniors' multiple housing. In particular personal control of one's environment, andopportunities for social interaction to mitigate loneliness, are factors requiring attention at theindividual level. All of the competences may be considered when using the competence/pressmodel. Thus opportunities to socialize may be conceived at various levels. An example of this isin the Captain Clarence Eldridge House, Massachusetts ( Belsky 1984, 140). In this building113the main social gathering space is linked to the circulation spaces which access all residentialunits. The resident may sit near her/his unit and watch social activities or enter the centralspace and join in. A similar arrangement is provided at the Weiss Institute of the PhiladelphiaGeriatric Centre where the resident and staff circulation borders the central social space(Lawton 1980, 128-131).The thesis did not deal with details for individual need from a designer's viewpoint Thissection of the thesis really addresses factors to consider to avoid institutionalization and enhancethe quality of life of older persons.6.2 CASE STUDIESThe second part of the thesis asked questions: "Is the median age increasing in seniors'multiple housing projects? Are there differences by organization, or by building type?" Theassumption was that if the median age is increasing then older seniors are being kept out ofinstitutions. At the outset, the expectation was that a clear indication of aging-in-place wouldbe evident through increasing median age. It was also expected that low-rise buildings wouldhave a higher median age than high-rise buildings, and that there would be distinct differencesby organization.The findings that the median age did not increase, and that there is little difference interms of low-rise vs high-rise buildings, therefor came as a surprise. However, a distinctdifference by organization in the median age of tenants was revealed. Given this finding, itsvalidity has to be considered in terms of statistical probabilities.1146.3 LIMITED STUDY PERIOD One possible reason why an increase in median age was not apparent was the limitation ofthe study time of seven years. All of the buildings have been in operation for at least 20 yearsand the median age had reached a constant level prior to the commencement of this study, 1982.Therefore, Lawton's hypothesis is likely correct - that a process of stabilization has occurred ata lower level of tenant competence.With the passage of time and aging, it can be assumed that a lower level of competence hasbeen reached by many tenants in all of the facilities . Unlike in Mr. Lawton's study, I was unableto assess changes in health status over the study period. Data respecting health status of thetenants in the six buildings studied were not readily available. Both the Burnaby and Vancouverhealth units have data on persons receiving home care from the Provincial Long Term CareProgram. The data are only filed by person not building and are not yet computerized (McGowan1989; Leutkehoter 1989). Assembling these data was therefor beyond the scope of this study.However, the assumption of reduced level of competence is reasonable considering the facts onhealth care utilization provided in Chapter 2 (pages 25-28). Also, the actual number ofseniors who have moved from the buildings studied into institutions are not presented in thisstudy since these data were unavailable. One can only refer in relation to available data forCanada as a whole, or British Columbia.6.4 INCOMPLETE DATAOne reason for differences in outcome by organization discussed in Chapter Two wasinnacurate or biased data (Di Lulio 1987). The fact of incomplete data was discussed in Chapter3. The most critical paucity of data was for Fahrni House - 30% of the data is missing for thefirst two years.115Secondly, we had a problem dealing with small numbers in two of the low-rise buildings,in analysizing trends in certain variables such as replacement tenants; couples and original tototal tenants. Erratic changes in trends from year to year were thus experienced. Theincomplete data were mainly for the early years 1982-4. To compensate, some data wereanalyzed in terms of three-year running averages. As discussed in Chapter 5, the median agevariable had likely stabilized prior to the study period.6.5 ORGANIZATION COMPARISONS Only three high-rise buildings and three low-rise buildings were analyzed in total. Thequestion is can the results of this handful of buildings reliably be generalised to differentperformances among the three organisations studied. Since only two buildings from eachorganization were analysed, it might be argued that the findings are not representative of thewhole (organization). NVS has a total of 517 housing units and BCHF a total of 387. For bothNVS and BCHF the findings are quite representative since the samples taken represent 25% and20% of the whole seniors populations of the respective organizations. BCHMC has a total of3496 seniors' housing units in the GVRD. In the case of BCHMC therefore, the findings are lessrepresentative since the study sample of about 100 units from BCHMC buildings represent onlyapproximately 3.5% of the total seniors population (GVRD) administered by BCHMC.6.6 GENERALIZABILITYThe selections were purposive, so findings are not generalizable outside the individualorganizations studied. Specific findings by individual buildings are valid since data was 100%for all buildings with populations of 55 or less, and sampling was 50% for those populationsgreater than 55.116Irrespective of how representative the findings are by organization, the fact remains thatthe median age is substantially lower for both BCHMC buildings . All of the buildings studiedwere built within a period of three years of each other (1969-72). There is no reason tobelieve that the two BCHMC buildings investigated are so atypical of BCHMC standards as toproduce such a low median age after 20 years.6.6 CONCLUSIONS The background exploration revealed a need for neighbourhood based supportive livingenvironments for seniors. From the six cases studied, the median age in the BCHMC facilitieswas four years less than the other two organizations, and the proportion of older seniors housedby BCHMC was about half of that of the other organizations. Variation in these two key variablesand by organization was explained by differences in organization size, suggests that BCHMC isless effective in providing supportive environments contributive to aging-in-place.On the other hand, none of the organizations kept older seniors as long as they could toavoid forced institutionalization. This is, of course, due to the policy of all three organizations toprovide seniors' multiple housing for independent living. So persons have to leave when theyare not independent any more, ie. when supportive environments become necessary tooccupants. In other words, the organizations control aging-in-place rather than other factors.Thus the programming, design, and operation of these facilities reflect this policy.Constant/Accommodating EnvironmentsTwo models are suggested in the planning and administration of seniors' housing. The aimof the constant model is to preserve the original character of tenants and the general housingenvironment. The aim of the accommodating model is to allow tenants to maintain residence117despite declining competence. Admission requirements may be relaxed in this model (Lawton etal.^1980, 62-3).The constant model forces residents to leave when they exhibit declining competence. Thustenants' lives may be disrupted by early enforced transfer, and in some cases prematureinstitutionalization may occur. This model benefits the administration to the extent that there isno need for additional services over time.The accommodating environment may occur at three levels. First, facilities and servicesmay be included at building inception as at Seton Villa multi-level facility in Burnaby. Second,spaces and services may be added over time as declining competence occurs. New Vista Societyadded unit alarms in Winch Tower and added a personal care facility adjacent to the two Towers.Third, there may be accommodation due to lax administration policy on admissions andseparations without the addition of spaces and services. This is the case with BCHF. However,the commissioning of the study for their Lions View project resulted from the need to addressthe growing problem of aging-in-place in their seniors' multiple housing facilities.Existing Housing Considerations To support the Provincial aging-in-place policy, the accommodating model is the moreappropriate one to adopt in the future planning and administration of seniors livingenvironments in order to keep seniors out of institutions. More immediate is the need foraccommodation in the existing inventory of seniors' multiple housing built for independentliving. To meet this need there could be a relaxation on evictions when tenant become frail.This would, in turn, necessitate evaluation of the potential impact on existing facilities on anindividual building basis.118Given the difference in median age of tenants in BCHMC facilities, a large number ofseniors tenants presently housed could extend their stay by at least four years withoutsignificant changes to the facilities. Of course there would be increased demand on caretakers forsupport which if not available would put tenants at risk. At BCHF's Soroptimist Manor,caretakers changed almost every year, due to repeated demand for help from tenants, and LionsView has two full-time caretakers for 63 tenants. There is also additional help available for allof the BCHF facilities from Helen Cove, the itinerant tenant coordinator. NVS has installedemergency alarms in all of the units in their two towers and tenants take turns serving asmonitors on each floor to check that tenants continue in good shape.Future Housing Considerations Next, the policy of housing for independent living requires reassessment. It is notreasonable to imagine that an aging-in-place policy and a policy of independent living cancoexist when dealing with seniors accommodation. The fact is that many of the seniors whomove to seniors' multiple housing expect to live there for the rest of their lives (Leung, nodate). Either housing has to be sited and designed for aging-in-place at the outset toaccommodate future needs, or policies have to be developed which will provide the means tomodify these environments as the tenants age-in-place.The British experience has shown that the provision of sheltered housing (assistedindependent living) has resulted in keeping approximately 80% of older seniors out ofinstitutions. These persons instead have been able to remain at home for the rest of their lives(Goldenberg 1981, 74; Townsend 1964). This is consistent with the experience of theAbbeyfield Society which estimates that "about one in five residents in the ordinary supportivecare houses eventually require extra care" (Wright, no date, 13). For the remaining 20% ofolder seniors, Abbeyfield Extra Care facilities provide a non-institutional alternative.119Providing adequate housing economically for the poverty level occupants is one of theprimary missions of BCHMC. This objective creates the argument for economies of scale whichinfluences site selection and housing programs. By only looking at the need to provide sheltereconomically, limitations are being built into this housing in terms of the ability toaccommodate changing needs as the tenants age-in-place. These built-in (program) limitationsare ultimately responsible for tenant premature moves to institutions. Investigating prematureinstitutionalization in the United States, the researchers found that "of the ten cases, for onlytwo did one-half or more of the Judges recommend that the resident-to-be actually be admittedat this time" (Tobin & Lieberman 1976, 223).A similar problem with seniors' public multiple housing is being experienced in Manitobaby the Winnipeg Regional Housing Authority. "The changing circumstances of EPH (ElderlyPersons Housing) has caused problems for the Winnipeg Regional Housing Authority.Established primarily as a manager of public housing, the mandate of the WRHA is linked tomatters directly related to landlord and tenant affairs. The WRHA is not responsible foraddressing the care-related needs of its elderly tenants. Without a mandate to deal with suchissues, the WRHA can do little to assist those seniors who have aged-in-place and now findthemselves in a housing situation that no longer meets their needs" (Badiuk 1990, 30).If the provision of seniors' housing is conceived holistically, then even if only the cost ofcare is brought into the housing equation, (aside from consideration of other social values)there is a fair budget available to spend on the provision of supportive living environments pertenant who might otherwise be institutionalized. While recognizing the need to control economiccosts, this criterion is not only one to consider in the provision of seniors' housing "Obviously,economic costs can only be one consideration in planning for people. Human costs are certainlyof more importance" (BCRC 1981, 224).120Earlier it was discussed that the actual number of institutionalized older persons farexceed the reported number. One can only presently speculate as to the extent of human costsassociated with forced moves to institutions due to society's inability to provide supportivehousing options. Future study of where tenants move to after leaving seniors' multiple housingfacilities would establish the actual dimension of these forced moves. Standardization of recordsby housing organizations would help to facilitate this investigation.The Abbeyfield model provides supportive housing for frail elderly who might otherwisebe institutionalized. This model, which is easy to integrate into residential neighbourhoods, alsoprovides opportunities for enhancing all the competences, and personal control over one'senvironment. Given the increasing demand for supportive housing and changing expectations ofyounger senior cohorts, it is likely that the Abbeyfield model will gain in popularity as a viableneighbourhood-based supportive housing option in the future.BCHMC is only a sub-unit of the larger bureaucratic organization the ProvincialGovernment. We have to look further up the hierarchy for a solution to improving publichousing agency performance in supporting aging-in-place. The policy of aging-in-place is amission of the Ministry of Health. The dilemma of competing and contrasting missions ofseniors public housing and seniors public health will only be resolved by the embodiment of anaging-in-place policy throughout the agencies responsible for seniors' living arrangements."Housing the very old is truly a multi-disciplinary, multi-dimensional and multi-facetedarea of concern within gerontology, within society and within the older population"(Havens1988, 42). The implication is for an interdisciplinary approach to the delivery of appropriateliving environments for seniors, in other words, competent environments.121APPENDIXA: REFERENCE LISTAbbeyfield Houses of Vancouver. 1992. News, 43, (August).Adler, A. 1930. "Individual Psychology". In C. Murchinson Ed. Psychology of 1930.Worcester,Mass.: Clark University Press.Altman, Irwin, M.P. Lawton, and J.R. Wohlwill,eds. 1984. Growing older in America: elderlypeople and the environment. (vol 7), Plenum Press, New York.American Association of Retired Persons. 1986. 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Beverly Hills, CA: Sage, 190-217.Phillips, J.M. 1977.^Examination of optimal sizing of geriatric facilities, with a view ofconsideration of building smaller units and decentralizing to neighbourhoods in urban and suburban area.  M.A._Thesis, Public Administration, University of Victoria,B.C.Priest, G.E. 1988. Living Arrangements of Canada's "Older Elderly" Population: Canadian SocialTrends, 10. Autumn.Proshansky, Harold M., Abbe K. Fabian and Robert Kamionoff. 1983.^Place identity: physicalworld socialization of the self. Journal of Environmental Psychology 3:57-83.1 30Raschko, Bettyann. 1988. "Aspects of Housing and Services in Sweden and Denmark to Assist theVery Elderly to Live in Their Own Home". in Gutman,G.M. and N.K. Blackie eds.Housing the very old, Gerontology Research Centre, Simon Fraser University, B.C.Regnier, V., and J.M. Gonda. 1981. "Aging houses: Environmental and psychological factorsassociated with choosing a residential location." In Human Settlement Issues: Aginghouseholds, long term care and environments for the elderly.  Vancouver, B.C.:University of British Columbia Centre for Human Settlements, Occasional paper 20.Revenson, T., and J. Johnson. 1984. Social and demographic correlates of loneliness in late life.American Journal of Community Psychology 12: 71-85.Rosow, Irving. 1974. Institutional position of the aged. ^University of California Press,1 2 4 -1 2 7.Rowles, G.D.,1978. Prisoners of space? Exploring the geographical experience of older people.Boulder, Colorado: Westview Press.Sarason, I.G. and B.R. Sarason, 1987. Brain Disorders and Changes Related to Aging. Chapter 13in Abnormal Psychology Englewood Cliffs, N.J.: Prentice-Hall. 345-373.Schwenger, Cope. 1986. The Demographics of Aging in Voices for Choices, AccessingIndependence: Procedings of the Second Ontario Conference on Home Support Servicesfor Elderly and Disabled People, May 21-23. 1986, Ryerson Polytechnical Institute,Toronto, Ontario, 55-60.Shulz, R. 1976. The Effects of Control and Predictability on the Psychical and PsychologicalWell-being of the Institutionalized Aged. Journal of Personality and Social Psychology. 33: 563-573.Slater, Al, 1988. Interview by author, January 20, B.C.H.F., Vancouver, B.C.Statistics Canada. 1985.  Health and Social Support,  General Social Survey Analysis Series.Ministry of Supply and Services Canada.131Statistics Canada 1986 Census - Selected Characteristics: Greater Vancouver.Statistics Canada 1986 Census - Data Collected from All Households, British Columbia.Statistics Canada. 1988. Canadian Social Trends. Ottawa. No. 10 - Autumn.Statistics Canada. 1988. The Health and Activity Limitation Survey.  Ottawa.Stone, Leroy, 0. and S. Fletcher. 1986. The Seniors Boom: Dramatic increases in longevity andprospects for better health. Ottawa:  Minister of Supply ans Services Canada.Tobin, S.S. and M.A. Lieberman.1976. Last home for the aged: critical implications ofinstitutionalisation.  San Francisco, CA.: Jossey-Bass.Ullman, Leonard P. 1967. Institution & Outcome: A Comparative Study of Psychiatric Hospitals.London: Pergamon Press.Valins, Martin. 1988. Housing for Elderly People.  London: The Architectural Press.Vancouver Province, 1974, 20 June.Vancouver Sun, 1968. 15 March.Vancouver Sun, 1969. 22 October.Vancouver Sun, 1978. 24 June.Vancouver Sun, 1979. 19 April.Venturi, Robert. 1966. Complexity and Contradiction in Architecture. New York: Museum ofModern Art.Wershow, Harold J. 1976. The Four Percent Fallacy. Some Further Evidence and PolicyImplications.  The Gerontologist 16, 1, Pt.1, 52-55.1 32White, Robert W. 1963. Ego and Reality in Psychoanalytic Theory: A Proposal RegardingIndependent Ego Energies. Psychological Issues. Vol. III No. 3 Monograph II.International Universities Press, Inc. New York, N.Y.Whiting, D. and B. Woodward. 1985. A Seniors' Home. Design for Independent Living..  Calgary,Alberta: Alberta Department of Housing.Worthy, J.C. 1950. Organizational structure and employee morale. American Social Review15, 169-79.Wright, Dr. H.B. (No date). Understanding Extra Care, The Abbeyfield Society, Burts ofBedford, England, 1-19.133B: ORGANIZATIONS: NVS; BCHF; BCHMCORGANIZATION: NVSThe New Vista Society is a non-profit organization founded in 1943 with the objective ofproviding housing to low income individuals in Burnaby. It is registered under the Societies Actin the Province of British Columbia. The earliest housing projects were built to houseconvalescing single women with psychiatric problems. Later, the focus shifted to low-incomeseniors housing. In 1975, the Society built a care home and became a Service Provider in 1978under the Provincial Long Term Care program. This facility provides health care to residentsrequiring Personal and Intermediate Care.In its mission statement the NVS lists the following philosophical beliefs:A^That every resident is entitled to receive optimum care in an environment of dignity,respect, understanding, and concern, with regard to their individual social, mental, spiritual,and physical needs.B That the family and support groups are an integral part of the resident's life and thereforewill receive every encouragement and opportunity to share in the decision making of theresident's care.C That recognizing every resident is a physical, emotional, intellectual, social, and spiritualperson, the care process will address the total needs of the resident.D. That the personnel, recognizing the unique aspects of gerontology, will base their care oncurrent accepted principles of gerontological care.E. That the ongoing provision of an adequate and competent staff is essential in maintainingoptimum care. The Society should encourage the promotion of appropriate continuance ofeducation and upgrading of staff.F. That sound management is essential to support the determined standards of health care.Effective utilization of human, material, and financial resources^is dependent on theparticipation by the Board, Administration, and all employees in meeting the changing needs ofresident care.G That regular monitoring of the quality and quantity of services provided in each individualdepartment/clinical area will effectively promote the maintenance of recommended standardsand continual improvement of established and new services.H. That individual resident independence, through good health habits, physical, mental, andsocial stimulation, must be encouraged for the well being of the residents.I. That the availability of residential accommodation at reasonable rates to the low income,senior population is essential.134J. That the New Vista Society as a non-profit community organization should work withgovernment and other community organizations towards improved quality of life for all seniors,particularly the^economically under-privileged.K. That progressive labour relation practices are an integral part of any successful operation(NVS 1987, 2,3).The Society is located in Burnaby and has a board of directors consisting of 12 members. Thereare two major departments, Care Home Services and Finance & Housing. The former is the largedepartment with the most staff. The residential department has five fulltime and 2-3 part timestaff. The Society might be categorized as mid-size between the BCHF and the BCHMC. However,in terms of operations of the residential independent living component, staff size is similar toBCHF. There are six seniors projects for independent living owned and operated by NVS providinga total of 517 units. All projects are located in Burnaby. There is one live-in caretaker perproject, except for the Cottages and Douglas Manor which share caretakers from the 11th AvenueApartments and Towers respectively.ORGANIZATION: BCHFBritish Columbia Housing Foundation was established in 1952 under the Societies Act of B.C.The stated objectives of the BCHF are as follows:A. To provide housing for elderly and handicapped persons of low income and for that purpose toacquire land by purchase, lease or gift.B. To buy and sell land and other property and to construct, manage and operate low rentalhousing projects and to rent or lease the same or any units thereof to such person or persons andon such terms as the Directors may deem advisable.C. To repair, alter, demolish and reconstruct any buildings owned or operated by the Society.D. To enter in arrangements contracts or undertakings with any Government, Federal,Provincial, Municipal, Local or otherwise, and any person or persons or any corporation,whether incorporated or not, that may seem conducive to the Society's objects or any of them,and to obtain from such Government, person or corporation, grants, rights, privileges andconcessions which may further the objects of the Society.E. To carry out, exercise and comply with such arrangements, contracts or undertakings, andany rights, privileges, concessions or obligations arising or resulting therefrom.F. To dispose of any surplus assets upon winding up the affairs of the Foundation to a recognizedCanadian charitable organization or organizations, this provision of the Constitution to beunalterable (BCHF Constitution 1953 1984, 4).Compared to the BCHMC, BCHF is a small organization. The board of directors consists ofnine members and there is a management staff of five persons. The various members of the board135serve on five working committees along with the management staff. These committees are finance;building, social services, admissions and new projects.Although the BCHF has the mandate to operate throughout British Columbia, to date the area ofoperation has been limited to the City of Vancouver. Since inception, BCHF has constructed a totalof 387 seniors housing units in Vancouver. There are ten projects owned and operated by theFoundation and two projects operated only. All projects are located in the City of Vancouver.There is one live-in caretaker at each project except for Lions' View which has two. Managementand maintenance of these projects is administered by the management staff which includes a fieldsupervisor.Similar to BCHMC, the Foundation's policy is the delivery of independent living units forseniors and the handicapped.ORGANIZATION: BCHMC HISTORY OF BCHMCPresently, BCHMC is the primary deliverer of social housing in the Province of BritishColumbia. Programs for the delivery of social housing in B.C. are complex. It is necessary tobriefly review the evolution of social housing at the national level to better understand thepresent system in B.C.In 1949, Section 40 of the N.H.A. provided for the delivery of social housing throughFederal/Provincial agreement whereby 75% of the project capital and 75% of operating losseswere funded by the Federal Government and the remaining 25% capital costs and operatingdeficiencies were funded by the Province. The Province had the option to pass on a share of itscost to the municipalities if it so chose. Sections 43 and 44 of the N.H.A. introduced in 1964provided for Federal loans up to 90% of capital funds and a 50% Federal contribution to offsetoperating losses. The assets were put in the hands of the Province.Further amendment to the N.H.A. were introduced in 1973, aimed at encouraging provisionof social housing through non-profit societies and co-ops. Rent supplements were also introducedat this time (Sections 34.18 and 15.1).In the late 1970's a simplified program for social housing was introduced. Section 56.1 ofthe N.H.A. provided for interest reduction grants which effectively reduced interest on projectcapitol costs to 2%. These 100% loans were now provided through private lending institutions.Major modifications to social housing programs were again introduced in 1986. A newnon-profit social housing program was targeted to 100% of units for core-need tenants.Operating subsidies are provided to the societies for the difference between operating costsand rent revenues. Also rental RRAP was introduced in addition to the existing RRAP program.The May 1986 "global agreement on social housing" is a joint FederaVProvincial planningand funding program to cover a three year period.136Additional social housing programs include Province-only programs and municipalprograms. These programs have been broadly categorized as supply side and demand sideprograms.BCHMC was set up as an agency of the British Columbia Provincial Government in December8, 1967 under the terms of the Provincial Housing Act to coordinate and manage all low costhousing projects in the Province (Vancouver Sun October 22, 1969). On March 25, 1968, theProvincial Government authorized the dissolution of the Vancouver Housing Authority (set up inAugust, 1953), and its absorption by the BCHMC. The public-funded projects expedited throughSection 40 of the National Housing Act in the Lower Mainland and formerly operated by theVancouver Housing Authority were taken over by the BCHMC (Vancouver Sun, March 15, 1968).The first Board of Commissioners consisted of two appointed by the Province, two appointed fromCMHC and City of Vancouver Commissioner Gerald Sutton Brown.In 1974, following a period of critical review at the municipal level, the ProvincialGovernment replaced civil servants with appointed citizens as BCHMC commissioners. The firstappointees were Paul Grieve, President of Askethorne Construction Ltd. and Mayor of NorthSaanich; Rosemary Harveton, Assistant Director of Research and Social Policy for UnitedCommunity Services in Vancouver; Frances Huot, resident of BCHMC Rupert Lane project,Vancouver; and Peter Stratton, honorary treasurer of British Columbia Housing Foundation(Vancouver Province June 20, 1974). David Davies, former Director of Ontario HousingCommission was appointed as chairman of the Board of Commissioners.Around the same period of 1974, the Provincial Government purchased the DunhillDevelopment Corporation. This Corporation was renamed the Housing Corporation of BritishColumbia and incorporated as a Crown Corporation. The new role of BCHMC was the provision ofrental accommodation in cooperation with the Crown-owned Dunhill Development Corporation aswell as through the private building industry (Vancouver Province June 20, 1974). This wasinitiated through the new Proposal Call Programs.Following an intensive development program for the next few years the ProvincialGovernment put up the Housing Corporation of British Columbia for sale in 1978 to privateinvestors. The Minister of Housing, Hugh Curtis, explained that the sale was due to the lull inhousing demand (Vancouver Sun 1978).In 1979, with a resurgence of demand, the delivery of social housing was put in the hands ofthe Ministry of Lands Parks and Housing. At the same time, the age limitation on qualification assenior for entry to seniors housing projects built under the program was reduced from 65 to 55( Vancouver Sun 1979).In August 1985, the Ministry of Lands, Parks and Housing asked the Provincial Governmentto resume responsibility for the operation and delivery of social housing in the Province(M.L.P.H. 1985). During this period the Federal government had underway a review of socialhousing policy and programs with all the Provinces with especial reference to CMHC (CMHC1985).BCHMC completed a report as of January 1986 to the Ministry of Land, Parks and Housingwith recommendations respecting social housing policy and programs (BCHMC 1986).The role of BCHMC at this time was to provide advice and direction as to screening ofapplicants for the accommodation, operating management and accounting and other necessary137requirements (Annual Report, BCHMC 1986). From the 1986 changeover BCHMC took on theresponsibility from the Ministry of Lands, Parks and Housing for handling both the operations anddelivery of social housing in British Columbia.The Commission has five branches within its organization which carry out day-to-dayoperations. These branches are Financial and Administrative Services, Field Operations, SocialHousing, Development and Technical Services, Personnel and Labour Relations Services. Thepresent Board of Commissioners are Mary H. Kerr Chairman; Duncan McDougall, Noramata; BettyShandro, Richmond; Audrey Laboucane, Fort St. John; Douglas Mowat MLA, Vancouver and SamuelTravers, Ministry of Social Services and Housing. Senior management are J.C. (Ian) Leman,General Manager; Peter Robinson, Director, Field Operations; Richard Staehli, Director,Development and Technical Services; Enid J. Buchanan, Director, Social Housing; R.L. (Lin)Matthews, Director, Financial and Administrative Services; Sylvia Porter, Manager, Personneland Labour Relations (BCHMC Annual Report 1987). The Directors of each branch, along withthe General Manager, make up the Management Committee "which establishes operating policiesand provides leadership and direction to the organization" (BCHMC 1987, 5).In 1986, following the Provincially initiated Commission of Inquiry into social housing inBritish Columbia, new Federal-Provincial "Global and Operational Agreements for SocialHousing" were established in B.C. (Cosh et al. 1986 57-58). A key finding of the Inquiry wasthat "there is no Provincial agency responsible for overall planning and initiative on behalf ofthose most in need of social housing. Rather, what we found was a series of separate programs,each with its own rules, interests, perspectives and clients" (ibid., 1986, 137). The Inquiryrecommended the "establishment of a Social Housing Committee responsible to a committee ofCabinet Ministers and chaired by a senior administrator with deputy minister status" ( ibid.,1986, 21).This review serves to explain in part the complexity of social housing programs in B.C. andthe role of BCHMC within the system. However, as of 1986 seven Provincial agencies had a rolein social housing delivery in the Province of B.C. These were BCHMC; Ministry of Lands, Parksand Housing; Human Resources; Health, Municipal Affairs; Consumar and Corporate Affairs; andFinance (ibid, 25). Some consolidation of responsibilities has recently taken place, such asBCHMC taking primary responsibility for social housing over from Lands, Parks and Housing andalso the administration of the SAFER program. The social housing system still can be described as"a patchwork of Federal, Provincial and FederaVProvincial programs and services" (ibid.,1986, 13).British Columbia Housing Management Commission was established as an agency of theProvince of British Columbia in 1967 to manage provincial and federal-provincial housing andproperty. The mandate of BCHMC was expanded in 1985 "to incorporate the development,delivery and administration of all provincially led subsidized social housing and the developmentof social housing policy." (BCHMC 1987, 4) The Commission's home office is in Vancouver, inaddition to which there are five regional offices and two area offices in British Columbia. TheProperty Management Portfolio (1987) consists of 8,157 units throughout the Province. Ofthese, 398 units are managed by the City of Vancouver and 126 units are managed by thePenticton and District Retirement Centre. The balance is managed by the Commission. In theGreater Vancouver Region there are 3,496 units for senior citizens managed by the Commission( 1 9 8 7).Unlike the other two organizations BCHMC provides both family and seniors housing and itsarea of operation is the whole province of British Columbia. The delivery of seniors housing islimited to units for independent living under present policy.138The stated purposes of the Commission are as follows:A. To execute provincial housing policies are directed by the Ministry charged with theadministration of the Housing Act (Social Services and Housing).B. To manage provincial and federal-provincial housing and property on behalf of the Ministry.C. To administer rent supplement programs of the Ministry in:- housing managed by the Commission;- housing operated by non-profit societies and;- housing owned and operated in the private sector.D. To monitor the performance and value of programs under its jurisdiction.E. To develop social housing policy and also to recommend to the Ministry policy or programchanges related to matters under the Commission's jurisdiction.F. To provide the Ministry with housing program services as required (BCHMC 1987, 4).These purposes are carried out within the following general policy framework:- To determine housing needs in the Province.- To ensure that the funds available for social housing are targeted to those most in need andmanaged conscientiously and economically.- To allocate housing to modest income senior citizens and disabled persons on the basis of need.To provide a living environment for tenants that is safe, secure, and provides quiet enjoyment.To pursue maintenance standards that produce modern, safe, sound, and aesthetic properties.To ensure that new social housing developments are consitent with neighbourhood design, meetquality standards, and are built to minimize long term operating costs.- To ensure accountability by staff and tenants to the terms of the Tenancy Agreement and theResidential Tenancy Act.- To asset positive, fair, and consistent relations with tenants and the larger community.- To foster the idea and practice of local tenant associations and resident groups.- To inspire professionalism, innovation, and accountability in staff performance.- To encourage skilled management in the non-profit housing sector.- To be a cooperative resource in relations with the Ministry of Social Services and Housing andother agencies with which the Commission is associated (BCHMC 1987, 6).C: PRETESTSBCHF PROJECT:^Soroptimist Lions Manor, VancouverThis project was selected to provide a model for research design. It is located at 1444 East13th Avenue, Vancouver. The project is a two-storey building with 25 units, 20 bachelor andfive one-bedroom. It has a small lounge on the ground floor. There is no elevator. There is alive-in caretaker. Available records consist of financial records going back seven years to1982, current project files, and miscellaneous records on all projects going back to 1986. (Thisinfo might be available for 1984, but Lynn Brewer who looks after this material is in hospitaland won't be back at work for about two weeks.)Pertinent information from the financial records include names of tenants, units they occupyon a per-project basis, and rents paid per unit. Also, vacancy periods show up in these files.Current project files include data on current tenants. These data are documented on tenancyagreements, tenants personal records and tenant application forms (as per data base: BCHF - seeApril 10 submission). Correspondence to and from tenants is also included in these files (eg.complaints from tenants, notices to vacate etc.). The miscellaneous records are loosely kept inboxes and contain the same information as the project files. However, these records areincomplete.Review of the currrent project file for Soroptomist Manor revealed that the occupants of 10of the 25 units had been in the project since 1982 or before. From the financial records it waspossible to trace the changes in the other units by name of tenant, but not the tenant's age. Thismiscellaneous file filled the gap for some of the tenant ages (eight in total).139140Discussions with BCHF staff raised the possibility of tracing (ages) of the remaining tenantsthrough the caretaker or previous caretaker who is now a tenant at the facility. Some of thecaretakers of the projects maintain their own tenant records which might extend back fartherthan the BCHF miscellaneous files.Another source might be discussions with present long-time tenants. The local health unitmight be another means of tracing some of the former tenants particularly since the names of theindividuals are on record. Contracts with the Vancouver City Health Unit so far have beenunsuccessful. The Health Planner who is the recommended source for assistance is out of theoffice til Tuesday, May 2, 1989 (Information respecting sex of previous tenant is available fromthe financial records). Following up with these sources will be the next step of this investigation.Prior to final commitment on the scope of field investigation a similar dry run will be done for asmall New Vista project and a small BCHMC project (if at all possible). This work is targeted forcompletion on May 5, 1989.NVS PROJECT:^Apartment Building, 7581 - 4th Avenue,^Burnaby.This project was selected as a model for investigation of NVS projects similar to theinvestigation of Soroptimist Manor (BCHF). The project is a two-storey building with 12 units,four one-bedroom and eight bachelor. There is no elevator.New Vista Society records go back to 1975, for all projects. Current records and file boxrecords back to 1986 are kept in the housing management office. Pre-1986 records are kept in astoreroom in the New Vista Care Home. Current records are filed by project. Recently, data for141current residents in all of the projects have been recorded on the NVS computer system. Onlyproject, unit, admission date, birthdate and unit type are included on computer.Data in box files are filed alphabetically by tenant name. There are a total of 18 file boxes.In order to facilitate sampling, the files were colour-coded by the researcher by project for eachtenant. The project categories used are as follows:i) Cottages - whiteii) Apartment complex - yellowiii) 4th Avenue Apartment - greeniv) Winch Tower - bluev) New Vista Tower - redThis initial categorization allows data collection for the selected apartment building back to1975. Further refinement may be necessary for the cottages and/or apartment complex. Data inthe files includes tenancy agreements, tenant personal record files, application forms andcorrespondence, and notices to vacate.First, box files were reviewed at the New Vista Society housing management office. Next, boxfiles back to 1975 were reviewed at the New Vista Care Home. Following this, the box files at theNVS housing management office were colour coded (back to 1986). Next, current files werereviewed. During this time NVS entered data for current projects on computer. Printouts wereobtained by the researcher for all projects. Access to files in the NVS Care Home was cut off forthe week ending May 27. Colour coding will be completed by June 3.142Only one occupant of the 12 units has been in the 4th Avenue Apartment project since 1981or before. The current median age of the tenants is 74.Analysis of current data for change in median age is tabulated for the 4th Avenue project.NVS: 4th Avenue Apartment, BurnabyUnit Number^ Median AgeYearF irst^1989File^1988Set^19871986Second 1985File^1984Set^198319821981171:7570 :7469 :7368 :7267:7166:7065:6964:682838237776484838281564:6963:6862:6761:6660:6568180797877767575958575655873729767 57 47372717010575655116312787 77 67 57 47 37 271Age74This analysis indicates the extent of data collection required to complete age data for theproject.D: ANNOTATED BIBLIOGRAPHY1 Allen, N.R. The transition to institutional living: the experience of elderly people. 1985.Examines experience of institution amongst elderly subjects.Convenience sample of five subjects admitted to ECU withinprevious year. Up to four interview occasions. Analysis ... using"grounded theory" Glaser & Strauss (1967). Discusses fivephases of transition - 1. anticipation; 2. reaction;3. interpretation; 4. negotiation; 5. integration.Good intentions - findings not reliable: Can't makerecommendations based on them.Discusses Life Stage Theory - (Ericksen) - Accepts concept ofinstitutionalization - has some useful literature reviewmaterial on institutionalization.2 British Columbia Housing Management Commission. A Social Housing Report for B.C.Burnaby, B.C.: The Commission, 1986, Jan. Kerr, Mary H. Chairman.Discusses the Federal Provincial partnership concept forfuture social housing.Exposes the disparity between the number of those in needwho are recipients of social housing and the number ofnon-needy currently being housing by the programme. Theconcept of income mixing and social integration is supported.Max. 40 unit family developments are reccommented.Co-operation with M.O.H. and H.R. is established for projectscatering to physically and mentally disabled. Includes tableshowing percentage of households paying more than 30% of incomefor rent by region. (use this p14). Also includes distributionof total units allocated for province by group (p16 copy).3^British Columbia Housing Management Commission. An Inquiry into Social Housing forBritish Columbia: Common Ground in Meeting Core Need. James C. Cosh. Chairman.Victoria, B.C.: Ministry of Lands, Parks and Housing, 1986, August.A Commission of Inquiry into the effectiveness of the deliveryof social housing in B.C. in serving those most in need ofassistance in obtaining affordable housing. Includes 10 majorrecommendations. Primary recommendation is for the creationof a system for the management of the provincial social housingsector (see p 191) Calls for establishment of a social housingcommittee and Social As. Advis. Committee. Defines need in termsof level of income. Has useful analysis of adequacy of "Safer" benefits. (use thisp100) Also has useful summary tables of Fed/Prov. Social Housingprogrammes.1431444^British Columbia Research Council, Community based planning for seniors B.C. HospitalEmployees Union. Long term care in British Columbia: the union members' perspective.Vancouver, B.C.: Hospital Employees Union, Local No. 180, May, 1981Provides a view from a staff perspective rather than organizationalperspective. Exposes a number of problems related to delivery ofcare to the elderly. Discusses drug abuse still a problem ...indicates the monitoring of care that can effectively take placeby staff ... reporting through union protection .. (a voice)- checks and balances.... Point out that no uniform standards exist;guidelines not regulatory.5^City of Vancouver. Who Lives in Non-Market Housing? An Evaluation of the City ofVancouver Housing Program. Planning Department of Vancouver: 1983. pp. 11-21. 22.McAfee, Ann.Study precipitated by 1981 newspaper article showing highincome households living in City assisted (through the landprogramme) co-op housing. Findings showed that mostnon-market units are occupied by modest income households.Some imaginative analysis tables included. eg . rent to incomeratios.6^Cusack, 0., and Smith, E. Pets and the Elderly: The Therapeutic Bond. 1984Key research studies concerning therapeutic benefits ofpets to the elderly are discussed. Issues concerningin-house pets well addressed. Optional programmes andrange of pets are included and recent housing institutionpolicy changes provides list of organizations involved in pettherapy in USA and Canada.Good indication of the emotionalsupport potential of pets.7^Heumann, L. Identifying the Housing and support service needs of the semi-independentelderly, 1977.Comprehensive study on housing support services needsfor Dept. on Aging, State of Illinois. Purpose was to defineelderly with functional and social problems not requiringinstitutionalization; to define their needs respectinghousing, environmental and supportive services,and attempt to enumerate this population at the local levelfor planning of the necessary housing and support servicesprogrammes.Functional disability level is the measure of "semi-independent"needs. Info at local level not available, presently crude estimatesare held. Problems of lack of coordination identified. Makesimportant distinction between market demand and social need.Provides a needs analysis model; a subarea quality analysismodel (4 factors), try to identify priority areas for programmeimplementation. Includes support service model (hrs/monthavaiVneeded). Basic unit is elderly household. Uses area agencies in aging, (AAA) to measure market areas.Problem... doesn't deal too much with psycho social. oremotional concerns. Presents 5 measures of functional disability(including social) - p54. (need to check if info is available atlocal level.) Also provides subscales for each measure by degreeof problem. - Gives good list of support services (p99).- Includes in Characteristics^....% of older seniors withfunctional disability.8^Heumann, Leonard F. Principal Investigator. A Cost Comparison of Congregate Housing andLong-Term Care Facilities in the Midwest. Housing Research and Development Program,University of Illinois, Urbana, Illinois. September, 1985.Study for Illinois Housing Development AuthorityLook at whether significant cost savings in providing congregatehousing vs. long term care facilities for elderly capableof assisted independent living.Study shows that savings are possible both in terms of human costand economic cost. In terms of quality of life ... also vast improvement.Good detailed analysis. Provides useful definitions of terms.Framework for facility analysis by size, year built, etc^Good tables for comparing care and attentive costs.Discusses quality of life/congregate vs. long term care briefly.Also includes conversion of seniors apartments to congregatefacilities .... & CHSP program Also has an inventory of congregate facilities9^Lawton, M.P. Windley & Byers. Aging and the Environment. 1982A review of some prominent theories in man-environmentrelations. Identifies early source of essays (Preiser 1973).Discusses the problems of non-universality of theories,of particular interest is the Competence, Press discussionby Lawton and Congruence Model of P.E. interaction by Kahana.Good summaries and critiques of models presented are includedby Pastalan and Archea.10^Newcomer, R.J., Lawton, M.P., and Byerts, T.O., eds. Housing an aging society: issues,alternatives and policy. New York: Van Nostrand Reinhold, 19861 45A broad look at housing the elderly. Discusses housing needsand influences including policy, demography, commoncharacteristics, location. Also covers alternatives andopportunities, references and choices; retirement communities(including continuing care); supportive living and neighbourhoods.Of particular importance are chapters on housing for frailand marginal elderly. Also discusses the housing continuum- good table on chronic illness- good chart on growth of the older elderly- includes cohort-based housing consumption - projections- good chart on housing programs and who delivers- good chart on owners-renters receiving assistanceResidential supportive aspect of attaining personal-environ. congruenceImportant discussion on moves and model- definitions of board and careDoesn't address age difference among elderly as problemof data analysis and findings11^Newton, E. This Bed my Centre. Virago, 1979A diary account of one well-educated elderly woman's experiencesin institutions. Gives poignant sense of the psychological effects ofinstitutionalization and the despair, loss of independence, control,disruption, drug abuse, etc. Also points out that being physicallyimpaired doesn't mean mental impairment and documents how shefinally managed to get back into the community on her own.12^Phillips, J.M. Examination of optimal sizing of geriatric facilities, with a view ofconsideration of building smaller units and decentralizing to neighbourhoods in urban andsuburban area. M.A. Thesis, Public Administration, University of Victoria, 1977Thesis ... argues for small decentralized care facilities asviable options to large facilties converted to hospitals.Lists rationale for small facilities including less costsand social consequences. Considers that administrationcan oversee a number of small facilities to realizeoperational "economies of scale". Gives three scenariosusing James Bay as a test cast. Useful model for neigh-bourhood planning. (Considers 75 bed max. as small facility -little justification for this number.)14614713^Prior, J. Mapping census tract data: the case of the aged population in the Vancouver,British Columbia census metropolitan area. In: N.M. Waters(Ed), Current Issues inCanadian Human Geography - The Lethbridge Papers, 1982. Vancouver, B.C.: TantalusResearch Ltd., 1983Provides four distinct measures of mapping censustract data. Data emphasizes the aged population. Uses75 percentile age as the single measure to represent the oldersegment of the population by census tract for mapping purposes.This is an imp. measure if a more refined measureof the aged population is needed. The three census tracts with75th percentile eg... 70+ are in Arbutus, Strathcona andEssondale areas of the Vancouver CMA. Could use this tool forNeighbourhood Planning for Seniors.14^Tobin, S.S. and Lieberman, M.A. Last home for the aged: critical implications ofinstitutionalisation, San Francisco, CA.: Jossey-Bass, 1976.Discusses the effects of institutions on the old, (includingpreconceptions) adjustments to institutionalization.Studies good quality institutions, care homes.Also considers good innovative institutions(Attacks institutional model for long term care - calls forcomprehensive community care..) Has press/competencemodel and ecological change model (Lawton) in it.Has useful tables in income/income sources. Also interestingarticle on "competent older woman" indictment of "doublestandard of aging". Argues for advantaged women in coping"successful aging".Article on life satisfaction research in Aging .. good references.(Age segregating-integrating argument non-conclusive) constraining vs.non-constraining environment^ higher level of satisfaction."Transitions of Aging"15^Watt, J. & Calder. Taking Care: A Self-help Guide for Coping with an Elderly, ChronicallyIII or Disabled Relative.Practical guide to day-to-day caregiving for (informal support)Useful discussion on attitudes and feelings and practicalways of responding.Has useful hist. of Canadian and USA societies, organizations andassociations.


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