Government Assisted Housing

As residents in Section 202 units aged, becoming more frail and in greater need of supportive services, few of those services were developed. Although HUD has been required since 1974 to seek assurance that Section 202 projects provide a range of services which, in combination, will prevent premature institutionalization, researchers found that there had been a clear shift away from supportive design features over the history of the 202 program. These features, known as Congregate Housing Service Programs (CHSPs), include the following:

• • Provision for nutritional needs by serving two meals a day, seven days a week
• • Provision of housekeeping assistance in areas where needed
• • Provision of personal assistance to those demonstrating difficulty with ADLs
• • Provision of expanded personal counseling services to those experiencing emotional problems due to losses
• • Provision for the limited extension of existing transportation services to enable those with physical and mental impairments to meet medical appointments
• • Facilitation of optimal utilization of CHSP services through professional case management.

In view of the requirements and the findings, Congress passed the National Affordable Housing Act of 1990 (NAHA), recognizing a need to (1) expand the supply of supportive housing for the elderly and (2) enhance the supportive environment of existing Section 202 projects. One section of the act requires HUD to ensure that projects approved after 30 September 1991 comply with the law. The act also authorizes up to 15 percent of the 202 funds to be spent on supportive services and retrofitting units (e.g., installing ramps or railings) for the frail and disabled. However, these mandates did not carry the needed appropriations. HUD also neglected to comply with the terms of the NAHA. Instead, HUD used random selection to determine in which projects supportive services were placed; selection was not based on need. The decision to initiate and plan supportive services or to convert the Section 202 units to assisted living facilities was left up to the project managers.

Throughout the history of federal housing, project managers were given far greater authority than they were qualified to assume. In the case of service needs for frail older persons, managers lacking necessary training were asked to make needs assessments. Researchers found that the health conditions of the frail elderly were far worse than self-reported to project managers and far worse than residency policy permitted. Fearing nursing home placement, older residents refused to reveal functional problems. Mandated or not, services became very low priority during the Reagan and Bush administrations, when HUD suffered severe budget cuts—from $80 billion in 1980 to $24 billion in 1992. During the same period staff was cut from seventeen thousand to thirteen thousand.

Perhaps the greatest obstacle to linking housing and services lies in the separate jurisdictions of the policy-making arena: building of housing is under the House and Senate Banking Committees, while providing services is under Health and Human Services. The Subcommittee on Housing and Consumer Interests of the House Select Committee on Aging and the House and Senate Appropriations Committees also affect policy decisions. The history of the public housing program showed that the "bricks and mortar" principle prevailed, and high-rise buildings were far more visible to the constituencies of these committee members than the people who resided in them.