Aging in Place or Moving: Golant’s Four Commandments Paper presented at Symposium on Aging in Place in South Carolina: Challenges and Solutions May 10, 2005 Stephen M. Golant, Ph.D. University of Florida

Prepared by Stephen M Golant, PhD, University of Florida for Clemson Symposium, South Carolina, Page 2 Higher-income older adults have more choices than ever to age in place outside of nursing homes Conventional dwellings Conventional dwellings Senior Apartments and Coops Senior Apartments and Coops Congregate/Independent Living Communities Congregate/Independent Living Communities Assisted Living Residences Assisted Living Residences Continuing Care Retirement Communities Continuing Care Retirement Communities

Prepared by Stephen M Golant, PhD, University of Florida for Clemson Symposium, South Carolina, Page 3 Lower-income older adults have fewer affordable options, especially in some states Board and care facilities/adult foster care Board and care facilities/adult foster care Affordable rent-assisted buildings integrated with supportive services Affordable rent-assisted buildings integrated with supportive services In some states, affordable assisted living residences made possible by: In some states, affordable assisted living residences made possible by:  State SSI supplement  Medicaid state plan  Medicaid waivers  Section 8 Vouchers

Prepared by Stephen M Golant, PhD, University of Florida for Clemson Symposium, South Carolina, Page 4 Assessing the limitations of aging in place especially important with fewer noninstitutional housing options Increased likelihood that lower-income older adults will occupy inappropriate residential settings Increased likelihood that lower-income older adults will occupy inappropriate residential settings  Inconsistent with their preferred life-styles  Inconsistent with their chronic health problems and functional and cognitive limitations  At greater risk of being over-served or under- served  Greater undesired burden on family members and thus a greater risk of incompetent care

Prepared by Stephen M Golant, PhD, University of Florida for Clemson Symposium, South Carolina, Page 5 Assessing Aging in Place: Four Commandments Compare and contrast alternative residential contexts Compare and contrast alternative residential contexts Establish the unequal salience of residential features Establish the unequal salience of residential features Consider the past, current, and future residential settings of older individuals Consider the past, current, and future residential settings of older individuals Assess how individual differences matter and examine their trajectory of change Assess how individual differences matter and examine their trajectory of change

Prepared by Stephen M Golant, PhD, University of Florida for Clemson Symposium, South Carolina, Page 6 Four commandments are relevant to multiple stakeholders Older consumers Older consumers Family members Family members Housing providers Housing providers Service providers Service providers State policymakers State policymakers Researchers Researchers

Prepared by Stephen M Golant, PhD, University of Florida for Clemson Symposium, South Carolina, Page 7 So what is a residential setting? Social, built, and organizational environments of the: Social, built, and organizational environments of the:  Dwelling  Neighborhood  Community

Prepared by Stephen M Golant, PhD, University of Florida for Clemson Symposium, South Carolina, Page 8 The dwelling environment More than a dwelling’s physical condition, comfort, safety, and user-friendliness More than a dwelling’s physical condition, comfort, safety, and user-friendliness Includes affordability in short- and long- run Includes affordability in short- and long- run Includes its equity (if owned) Includes its equity (if owned) Includes the instrumental and expressive supports of its occupants/visitors Includes the instrumental and expressive supports of its occupants/visitors Include personal belongings having emotional and symbolic meanings Include personal belongings having emotional and symbolic meanings

Prepared by Stephen M Golant, PhD, University of Florida for Clemson Symposium, South Carolina, Page 9 Neighborhood and community Physical and social conditions (safety, assistance from neighbors, accessibility) Physical and social conditions (safety, assistance from neighbors, accessibility) Sustenance: grocery stores, restaurants, churches Sustenance: grocery stores, restaurants, churches Feasibility of delivering or accessing long- term care Feasibility of delivering or accessing long- term care  Transportation availability  Community resources  Access to family members  Public programs that can be packaged

Prepared by Stephen M Golant, PhD, University of Florida for Clemson Symposium, South Carolina, Page 10 Commandment #1: Compare and contrast alternative residential settings Assessing place tradeoffs is crucial whether expressed in dollars or psychological well- being: timeline may be crucial Assessing place tradeoffs is crucial whether expressed in dollars or psychological well- being: timeline may be crucial Aging in place may not be appropriate for everyone: Don’t over-romanticize Aging in place may not be appropriate for everyone: Don’t over-romanticize Service delivery may be more cost-effective and timely if delivered to a congregate housing setting than to a private single- family dwelling Service delivery may be more cost-effective and timely if delivered to a congregate housing setting than to a private single- family dwelling

Prepared by Stephen M Golant, PhD, University of Florida for Clemson Symposium, South Carolina, Page 11 Breaking Commandment #1: The marketing of reverse mortgages Reverse mortgages encourage the aging in place of low-income older homeowners Reverse mortgages encourage the aging in place of low-income older homeowners Occupants receive cash advances by borrowing on the equity in their owned dwellings—postpone repayment until move, sell, or die Occupants receive cash advances by borrowing on the equity in their owned dwellings—postpone repayment until move, sell, or die

Prepared by Stephen M Golant, PhD, University of Florida for Clemson Symposium, South Carolina, Page 12 Why typical reverse mortgage evaluations violate commandment #1 Infrequent comparisons with other ways of releasing dwelling equity: e.g., selling/re-invest Infrequent comparisons with other ways of releasing dwelling equity: e.g., selling/re-invest Absent assessments of whether expected dwelling appreciation will offset loan costs and the maintaining or upgrading of an older dwelling Absent assessments of whether expected dwelling appreciation will offset loan costs and the maintaining or upgrading of an older dwelling A reverse mortgage is not just a loan transaction A reverse mortgage is not just a loan transaction It can result in older homeowners living alone in cost- inflated and physically inappropriate dwellings It can result in older homeowners living alone in cost- inflated and physically inappropriate dwellings Residential life-style and long-term care delivery strategy must be compared with alternatives Residential life-style and long-term care delivery strategy must be compared with alternatives

Prepared by Stephen M Golant, PhD, University of Florida for Clemson Symposium, South Carolina, Page 13 Commandment #2: Establish the unequal salience of residential features Avoiding the elderly “where to live” community guidebook fallacy Avoiding the elderly “where to live” community guidebook fallacy Community may rank first for active retirees, but last for vulnerable old seeking affordable assisted living Community may rank first for active retirees, but last for vulnerable old seeking affordable assisted living Only a handful of issues may be the most salient in residential decision-making Only a handful of issues may be the most salient in residential decision-making Inaccessible family member may undermine aging in place, despite a dwelling’s great design features Inaccessible family member may undermine aging in place, despite a dwelling’s great design features

Prepared by Stephen M Golant, PhD, University of Florida for Clemson Symposium, South Carolina, Page 14 Commandment #3: Consider the past, current, and future residential settings Older people’s lives don’t begin when they meet a case manager or complete an interview or application Older people’s lives don’t begin when they meet a case manager or complete an interview or application Older people evaluate their current and future residential settings from a life-time perspective Older people evaluate their current and future residential settings from a life-time perspective Some people have always lived in less than perfect places and will always be difficult to satisfy Some people have always lived in less than perfect places and will always be difficult to satisfy

Prepared by Stephen M Golant, PhD, University of Florida for Clemson Symposium, South Carolina, Page 15 Commandment #4: Assess how individual differences matter and examine their trajectory of change Demographics, economic well-being Demographics, economic well-being Current and past lifestyles Current and past lifestyles Personal resources (e.g., behavioral competence, coping styles) Personal resources (e.g., behavioral competence, coping styles) Likely trajectory of change of personal resources Likely trajectory of change of personal resources Personality styles Personality styles THUS, ONE SIZE DOES NOT FIT ALL THUS, ONE SIZE DOES NOT FIT ALL

Prepared by Stephen M Golant, PhD, University of Florida for Clemson Symposium, South Carolina, Page 16 Assessing desirability of aging in place: Four commandments Compare and contrast alternative residential settings Compare and contrast alternative residential settings Establish the unequal salience of residential features Establish the unequal salience of residential features Consider the past, current, and future residential settings of older individuals Consider the past, current, and future residential settings of older individuals Assess how individual differences matter and examine their trajectory of change Assess how individual differences matter and examine their trajectory of change