Living Arrangements

Various housing options exist for semi-independent older adults who require some assistance with daily tasks. These options, which provide a supportive setting linked with services, can take place either in the home or in housing built for the expressed purpose of providing services.

Aging in place. Since most older adults prefer to remain in their own homes despite increasing frailty, bringing services into the home is an option for semi-independent older adults. Home care describes a situation in which an older person receives help in his or her home from an organization or another individual who is not a family member. As of March 2000, there were about 20,000 home care providers serving approximately 8 million individuals of all ages nationwide.

Persons preferring home care tend to have difficulties with ADLs or IADLs. This arrangement tends to be favored by persons who are divorced, separated, or widowed. The presence of children nearby decreases the likelihood of choosing home care.

A second option for receiving assistance within the home is shared housing, an arrangement in which two or more unrelated people share a house or apartment. Each person usually has his or her own sleeping quarters, with the rest of the house being shared. Members of the household can benefit from the potential for mutual assistance with chores and tasks. Surveys suggest that 2.5 percent of older adult households have at least one nonrelative living in their home, and almost 20 percent of older adults would consider living with someone they did not know. This living situation may occur naturally when individuals decide to form a household, through matches facilitated by an agency, or in small group-type homes operated by nonprofit or private organizations.

Older adults who have difficulties with activities of daily living, instrumental activities of daily living, and those without children living nearby tend to favor a shared arrangement. Divorced, separated, widowed, and persons who have never married are more likely to live in shared housing than married persons. Minorities, especially blacks and Asians, are also more likely to choose this arrangement.

Supportive housing. Frail older persons are likely to need a more physically supportive dwelling unit, greater supervision (e.g., with medications), more services, or more companionship than can be efficiently provided in conventional homes or apartments. While these options require older adults to relocate, they can offer the benefits of a built environment that is physically supportive and linked with services. These housing types tend to attract older adults and those who do not have children living nearby. Persons with difficulties climbing stairs are also more likely to select supportive housing. Supportive housing options include congregate housing, board and care homes, assisted living, and continuing care retirement communities.

Congregate housing refers to a wide range of multi-unit living arrangements for older persons in both the private and public sector. Older persons who live in this type of housing generally have their own apartments that include kitchens or kitchenettes and private bathrooms. Most of this housing has dining rooms and provides residents with at least one meal a day, which is frequently included in the rent. The housing also has common spaces for social and educational activities and, in some cases, provides transportation.

Congregate housing generally does not offer personal-care services or health services, and therefore attracts older persons who can live independently. It especially appeals to older persons who no longer want the responsibility of home maintenance and meal preparation, and who positively anticipate making new friends and engaging in activities.

Board and care homes are residential facilities that generally offer on-site management, supervision, a physically accessible environment, meals, and a range of services for physically or mentally vulnerable older people, as well as younger disabled people who experienced difficulties living independently in their previous residences. In facilities that primarily serve seniors, the average age of older persons in these settings is approximately eighty-three, about eight years older than residents of government-assisted housing.

Studies suggest that over 30,000 board and care homes exist in the United States, more than double the number of nursing homes. However, owing to their smaller size (usually between 5 and 20 dwelling units), board and care facilities house only about 400,000 residents (one-fourth the number of residents in nursing homes) and include about 200,000 persons under age sixty-two.

Assisted living is a housing option prevalent in the U.S. and northern Europe (Regner and Scott) that involves the delivery of professionally managed supportive services and, depending on state regulations, nursing services in a group setting that is residential in character and appearance. During the 1990s, assisted living was the fastest growing segment of the senior housing market. It has the capacity to meet unscheduled needs for assistance and is managed in ways that aim to maximize the physical and psychological independence of residents.

In 1999, there were approximately 30,000 to 40,000 assisted-living facilities in the United States, housing approximately one million individuals. A variety of services can be provided, including meals, housekeeping, transportation, medication management, laundry services, and recreation activities. Assisted living is intended to accommodate physically and mentally frail elderly people without imposing on them a heavily regulated, institutional environment. For many residents, assisted living has served as an alternative to nursing homes.

Also referred to as life care communities, continuing care retirement communities (CCRCs) are unique in that they offer various levels of care within one community to accommodate residents who have changing needs. Most CCRCs offer independent living areas, assisted living, and skilled nursing care. A variety of services are offered, including transportation, meals, housekeeping, and physician services. While some communities provide most of their own services, others obtain many of them through contracts with outside organizations.

By 1992, there were approximately 1,000 CCRCs in the United States, housing approximately 350,000 to 450,000 older persons. Each community houses between 400 and 600 older persons, often in campus-type settings. CCRCs generally require, as a condition for entry, that new residents be in reasonably good health.

The growth of housing types for semi-independent older adults provides increasing options for older adults who face increasing frailty in later life. In addition, home-care agencies, which provide needed assistance with household tasks and personal-care needs coupled with environmental modifications, can enable older adults to remain in their own homes.