Congregate Housing

Supportive housing for people with low incomes is one reasonable response to the following intertwined factors (among others):

• • The number of people who need assistance with daily activities is increasing. The population is aging and younger people with disabilities are living to older ages. In addition, long hospital stays are increasingly discouraged.
• • People strongly prefer to live in community rather than institutional settings.
• • Policymakers and individuals are interested in cost-effectiveness and flexibility. Settings with large numbers of older residents, such as senior housing, offer unique service delivery opportunities through service "clustering." Clustering can reduce service costs, improve efficiency, and increase flexibility by reducing the number of workers on-site and the minimum hours workers must spend with one person.

Stephen Golant, in his excellent report The Casera Project: Creating Affordable and Supportive Elder Renter Accommodations, put it this way: "Not considering the elder-occupied rent-subsidized facility as a major service delivery target is a badly missed opportunity" (p. 37).

At its best, supportive housing offers accessible environments, well-functioning communities, social support, choices, control, access to flexible, cost-effective health care and supportive services, and social activities. Many observers believe that the setting, with its flexibility and balance between support and challenge, promotes health and functional independence, prevents or slows the progress of disability, prevents or tempers accidents, helps residents adhere to medical regimens, and responds creatively and effectively to diversity (the older population is, on almost any measure, more diverse than any other age group).

Although most older Americans live in single-family housing, about 12 percent—nearly four million—live in multiple-unit housing developments. About twenty thousand of these developments are federally subsidized and built specifically for older people. Many thousands more have been built with federal and state assistance. As residents age in place, these developments and community-based service providers have increasingly responded to residents' service needs. Often residents, families, professionals, and property managers arrange services as best they can (a "patchwork" approach). A more organized and effective strategy is on-site service coordination (also known as "resident service coordination" or "resource coordination").

The goal of service coordinators is to improve residents' quality of life and delay or avoid institutionalization by helping residents to obtain services they need and want. Coordinators play multiple roles, including service broker, community builder, educator, advocate, quality monitor, mediator, investigator, and counselor. Before 1990 the Department of Housing and Urban Development (HUD) and others in the housing realm prohibited service-related activity. Today, thousands of managers and residents depend on coordinators, who are often considered the key to successful supportive housing. The American Association of Service Coordinators was founded in 1999. Many states have active coordinators' associations.