a

GAO

United States Government Accountability Office

Report to Congressional Committees

December 2005 PUBLIC HOUSING

Distressed Conditions 

in Developments for 

the Elderly and 

Persons with 

Disabilities and 

Strategies Used for 

Improvement

GAO-06-163
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

December 2005

PUBLIC HOUSING

Distressed Conditions in Developments 

for the Elderly and Persons with 

Disabilities and Strategies Used for 

Improvement 

Highlights of GAO-06-163, a report to 

congressional committees 

In 2003, Congress reauthorized 

HOPE VI, a program administered 

by the Department of Housing and 

Urban Development (HUD) and

designed to improve the nation’s 

worst public housing. In doing so, 

Congress required GAO to report

on the extent of severely distressed

public housing for the elderly and 

non-elderly persons with 

disabilities. “Severely distressed” is 

described in the statute as 

developments that, among other 

things, are a significant 

contributing factor to the physical

decline of, and disinvestment in, 

the surrounding neighborhood;

occupied predominantly by very 

low-income families, the

unemployed, and those dependent 

on public assistance; have high

rates of vandalism and criminal

activity; and/or lack critical

services, resulting in severe social 

distress. 

In response to this mandate, GAO 

examined (1) the extent to which

public housing developments 

occupied primarily by elderly 

persons and non-elderly persons 

with disabilities are severely

distressed and (2) the ways in 

which such housing can be

improved. 

HUD officials provided oral

comments indicating general

agreement with the report.

Available data on the physical and social conditions of public housing are 

insufficient to determine the extent to which developments occupied 

primarily by elderly persons and non-elderly persons with disabilities are 

severely distressed. Using HUD’s data on public housing developments—

buildings or groups of buildings—and their tenants, GAO identified 3,537 

developments primarily occupied by elderly residents and persons with 

disabilities. Data from HUD and other sources indicated that 76 (2 percent) 

of these 3,537 developments were potentially severely distressed. To gather 

more information on the 76 developments that were potentially distressed, 

GAO surveyed public housing agency directors responsible for these 

developments. GAO received responses covering 66 of the 76 developments 

(the survey and aggregated results are available in GAO-06-205SP). These 

responses indicated the following: 

• Eleven developments had signs of severe physical distress, such as 

deterioration of aging buildings and a lack of accessible features for 

persons with disabilities; 

• Another twelve developments had signs of severe social distress, which 

included a lack of appropriate supportive services such as transportation 

or assistance with meals; and 

• An additional five developments had characteristics of both severe 

physical and social distress. 

Nevertheless, many of the directors GAO surveyed reported that numerous 

factors adversely affected the quality of life of elderly persons and non-elderly

persons with disabilities residing in their developments. The factors cited most 

frequently were (1) aging buildings and systems, including inadequate air 

conditioning; (2) lack of accessibility for persons with disabilities; (3) small size 

of apartments; (4) the mixing of elderly and non-elderly residents; (5) inadequate 

supportive services; and (6) crime. 

To better address the special needs of the elderly and non-elderly persons with 

disabilities, public housing agency officials GAO surveyed or contacted have

used various strategies to improve both physical and social conditions at their 

developments. Strategies to reduce physical distress include capital

improvements such as renovating buildings, systems, and units or, in extreme 

cases, relocating residents and demolishing or selling a development. Methods to 

reduce the level of social distress include a range of actions, such as designating 

developments as “elderly only,” converting developments into assisted living

facilities, and working with other governmental agencies and nonprofit 

organizations to provide supportive services to residents. 

www.gao.gov/cgi-bin/getrpt?GAO-06-163.

www.gao.gov/cgi-bin/getrpt?GAO-06-205SP. 

To view the full product, including the scope, 

methodology, and related survey, click on the 

links above. For more information, contact 

David G. Wood at (202) 512-8678 or 

woodd@gao.gov. 
Page i GAO-06-163 Housing for the Elderly and Persons with Disabilities

Contents

Letter 1

Results in Brief 4

Background 5

While Comprehensive Data Are Lacking to Determine Extent of 

Severe Distress, Public Housing Directors Reported Adverse 

Social and Physical Conditions 9

Various Strategies Could Improve Physical and Social Conditions at 

Public Housing for the Elderly and Non-Elderly Persons with 

Disabilities 23

Observations 28

Agency Comments 29

Appendixes

Appendix I: Objectives, Scope, and Methodology 31

Appendix II: Technical Methodology 38

Appendix III: Description of Site Visits to Two of HUD’s Innovative Models 

in Public Housing for the Elderly 40

Homestead Apartments 40

Helen Sawyer Plaza 43

Appendix IV: GAO Contact and Staff Acknowledgments 47

Table Table 1: Point System and Indicators Used in Our Distress 

Index 39

Figures Figure 1: Percent of Public Housing Units Occupied by the Elderly 

and Non-Elderly Persons with Disabilities 8

Figure 2: Level of Deterioration of Physical Structures, According 

to Public Housing Directors 12

Figure 3: Conditions Most Frequently Cited as Adversely Affecting 

the Elderly and Persons with Disabilities and Challenges 

Most Frequently Cited in Providing Public Housing 13

Figure 4: Signs of Severe Physical Distress Include Deteriorating 

Infrastructure Such as Concrete Surfaces 14

Figure 5: Inadequate Shelter, Such as Exterior Walkways at a 

High-Rise Development, Exposes Residents to the 

Elements 15

Figure 6: Most Developments Are Undergoing or Will Need 

Demolition, Replacement, or Rehabilitation 16
Contents

Page ii GAO-06-163 Housing for the Elderly and Persons with Disabilities

Figure 7: Examples of Lack of Access for the Elderly and Persons 

with Disabilities Include Narrow Hallways and Elevators 

That Cannot Easily Accommodate Wheelchairs or 

Scooters 17

Figure 8: Number of Developments with Supportive Services 

Available On-Site for Elderly Residents 19

Figure 9: Access to a Service Coordinator 21

Figure 10: Extent of Crime Problem in and near Developments 22

Figure 11: The Local Housing Agency Completely Rebuilt Historic 

Village to Improve Conditions 25

Figure 12: Physical Therapy Area at the Community LIFE Center 42

Figure 13: Commercial Kitchen Space at Helen Sawyer Plaza 45

Abbreviations

HUD Department of Housing and Urban Development

LIFE Living Independently for Elders

MTW Moving to Work

PACE Program of All-Inclusive Care for the Elderly

PIC Public and Indian Housing Information Center

REAC Real Estate Assessment Center

ROSS Resident Opportunities and Self Sufficiency

UPMC University of Pittsburgh Medical Center

This is a work of the U.S. government and is not subject to copyright protection in the 

United States. It may be reproduced and distributed in its entirety without further 

permission from GAO. However, because this work may contain copyrighted images or 

other material, permission from the copyright holder may be necessary if you wish to 

reproduce this material separately.
Page 1 GAO-06-163 Housing for the Elderly and Persons with Disabilities

United States Government Accountability Office

Washington, D.C. 20548

A

December 9, 2005 Letr

The Honorable Richard C. Shelby

Chairman

The Honorable Paul S. Sarbanes

Ranking Minority Member

Committee on Banking, Housing, and Urban Affairs

United States Senate

The Honorable Wayne Allard

Chairman

The Honorable Jack Reed

Ranking Minority Member

Subcommittee on Housing and Transportation

Committee on Banking, Housing, and Urban Affairs

United States Senate

The Honorable Michael G. Oxley

Chairman

The Honorable Barney Frank

Ranking Minority Member

Committee on Financial Services 

House of Representatives

The Honorable Robert W. Ney

Chairman

The Honorable Maxine Waters

Ranking Minority Member

Subcommittee on Housing and Community Opportunity

Committee on Financial Services

House of Representatives

By the year 2020, one in six Americans will be 65 years or older. Just as our 

citizens are aging, so is the nation’s stock of public housing for the elderly 

and non-elderly persons with disabilities. Most public housing was 

constructed in the 1960s and 1970s and has not been adapted to meet the 

needs of a growing number of residents who are frail or have disabilities. 

The needs of these residents present public housing agencies with unique 

challenges in providing safe and decent housing, compared with the needs 

of residents of family housing. For example, the elderly and persons with 

disabilities need features such as wider hallways and doorways, wheelchair 

ramps, or lowered countertops; aging buildings that are physically and 
Page 2 GAO-06-163 Housing for the Elderly and Persons with Disabilities

functionally obsolete are unable to meet these needs. However, public 

housing developments are still an affordable housing resource for 

low-income elderly persons and persons with disabilities who otherwise 

have few housing options due to their limited resources and incomes.

In 1992, the National Commission on Severely Distressed Public Housing 

reported that 6 percent of existing public housing units, about 86,000 units, 

were in “severely distressed” condition.1

 The commission described 

“severely distressed” as public housing that had one or more of the 

following conditions: physical deterioration of buildings, serious crime in 

the development or surrounding neighborhood, inadequate management, 

or a high concentration of very low-income residents living on a small site. 

To improve severely distressed public housing, the commission 

recommended physical and management improvements, in addition to 

social and community services to address resident needs. As a result of the 

commission’s recommendations, in fiscal year 1993, Congress enacted the 

HOPE VI program, which defined severe distress and was intended to 

revitalize the nation’s severely distressed public housing.2

 In 2003, 

Congress expanded the statutory definition of “severely distressed public 

housing” for the purpose of HOPE VI to include indicators of social 

distress, such as a lack of supportive services and economic opportunities.3

According to professionals knowledgeable about the housing needs of the 

elderly and non-elderly persons with disabilities, public housing 

developments that lack accessibility features, social and recreational 

activities, or isolate residents in their apartments can produce severely 

distressed living conditions.

In the HOPE VI Program Reauthorization and Small Community Mainstreet 

Rejuvenation and Housing Act of 2003, Congress reauthorized the HOPE VI 

program through 2006. The act also mandated that we report on the extent 

of severely distressed public housing for the elderly and non-elderly 

1

The Development Reform Act of 1989, Pub. L. No. 101-235, title V, 103 Stat. 1987, 2048 (Dec. 

15, 1989), established the National Commission on Severely Distressed Public Housing, 

which was charged with (1) identifying severely distressed public housing projects, (2) 

assessing strategies used to improve the condition of severely distressed public housing 

projects, and (3) developing a national action plan for eradicating severely distressed public 

housing by the year 2000.

2

Departments of Veterans Affairs and Housing and Urban Development and Independent 

Agencies Appropriations Act, 1993, Pub. L. No. 102-389, title II, 106 Stat. 1571 (Oct. 6, 1992).

3

See 42 U.S.C. § 1437v(j)(2)(A)(iii)(III).
Page 3 GAO-06-163 Housing for the Elderly and Persons with Disabilities

persons with disabilities and make recommendations for improving this 

housing, considering the special needs of the elderly and non-elderly 

persons with disabilities.4

 After consultations with your offices, we 

addressed the mandate by examining (1) the extent to which public 

housing developments occupied primarily by elderly persons and 

non-elderly persons with disabilities were severely distressed and (2) the 

ways in which the stock of severely distressed public housing for the 

elderly and non-elderly persons with disabilities can be improved.

To address these objectives, we interviewed officials from the U.S. 

Department of Housing and Urban Development (HUD) and reviewed 

relevant laws and regulations to determine the criteria for severely 

distressed public housing. We analyzed data (obtained in January 2005) 

from HUD’s Public and Indian Housing Information Center (PIC) database 

to determine how many public housing developments were occupied 

primarily by elderly persons or non-elderly persons with disabilities. We 

met with HUD officials to establish the reliability of the PIC data, 

conducted our own data reliability testing, and concluded that the data 

were sufficiently reliable for purposes of this report. We focused our 

analysis on housing “developments” because much of the available data 

were at the development level rather than the individual building or unit 

level. (A development can be a collection of buildings, located near each 

other or scattered geographically, or an individual building.) As a result, 

our analysis does not necessarily include all public housing units that are 

occupied by elderly persons or non-elderly persons with disabilities, 

because such units may be located in developments that are occupied 

primarily by residents other than the elderly or persons with disabilities. 

The developments occupied primarily by elderly persons or non-elderly 

persons with disabilities, according to HUD’s data, represent 27 percent of 

all public housing developments in the nation. To determine the extent to 

which these developments were “severely distressed,” we first created an 

index of distress using eight indicators, including physical characteristics 

(such as building age) as well as social characteristics (such as the poverty 

level in the surrounding area). Using data from HUD’s PIC system, we 

computed a distress score for each development and considered those that 

scored high on our distress index to be potentially “severely distressed.”5

4

Pub. L. No. 108-186, title IV, 117 Stat. 2693 (Dec. 16, 2003).

5

We do not have current information on the potential impacts of Hurricane Katrina on public 

housing developments that were within the scope of our review, including developments 

located in New Orleans, Louisiana and Mobile, Alabama. 
Page 4 GAO-06-163 Housing for the Elderly and Persons with Disabilities

To obtain detailed information about the condition of these potentially 

distressed developments and information on strategies for improving 

distressed conditions, we sent surveys to the directors of the 46 public 

housing agencies that operate the developments. We received responses 

from 43 directors. In addition, we visited 25 developments. To determine 

the special housing needs of elderly persons and non-elderly persons with 

disabilities, as well as strategies to improve severely distressed public 

housing for these residents, we interviewed individuals knowledgeable 

about these issues. We also reviewed applicable reports by federal agencies 

and interest groups. We interviewed public housing agency officials, and 

included questions in the survey about the strategies that have been used to 

improve severely distressed public housing. We did not evaluate the 

effectiveness of one improvement strategy over another; therefore, in this 

report, we only describe the approaches housing agency officials used to 

improve distressed conditions. For a more detailed explanation of our 

scope and methodology, see appendixes I and II. The survey and the 

aggregated results can be viewed at

www.gao.gov/cgi-bin/getrpt?GAO-06-205SP.

We conducted our work in Washington, D.C.; Miami and St. Petersburg, 

Florida; Homestead, New Castle, and Pittsburgh, Pennsylvania; Evansville, 

Indiana; St. Louis, Missouri; Seattle, Washington; and Oakland and San 

Francisco, California, between November 2004 and October 2005 in 

accordance with generally accepted government auditing standards.

Results in Brief Available data on the physical and social conditions of public housing 

developments are insufficient to determine the extent of severe distress 

among units occupied by elderly persons and non-elderly persons with 

disabilities. According to our analysis of HUD’s limited data, 3,537 public 

housing developments were occupied primarily by such residents, and 76 

of these had characteristics indicating potential severe distress. Based on 

the survey responses we received from public housing directors, covering 

66 developments with indications of potential distress, we found that

• Eleven developments had characteristics that indicated severe physical 

distress, such as deteriorated building systems and a lack of 

accessibility features for persons with disabilities;

• Another twelve developments had signs of severe social distress, 

including a lack of appropriate supportive services such as access to 

transportation and assistance with meals; and
Page 5 GAO-06-163 Housing for the Elderly and Persons with Disabilities

• An additional five developments had characteristics that indicated both 

severe physical and social distress.

Even if not considered severely distressed, developments may have 

conditions that adversely affect the quality of life of the elderly and 

non-elderly persons with disabilities. Many of the public housing directors 

we surveyed reported a number of such conditions, citing most frequently 

(1) aging buildings and systems, including inadequate air-conditioning; (2) 

lack of accessibility for persons with disabilities; (3) small size of 

apartments; (4) the mixing of elderly and non-elderly residents; (5) 

inadequate supportive services; and (6) crime.

To better address the special needs of the elderly and non-elderly persons 

with disabilities, public housing agency officials we contacted have used 

various strategies to improve both physical and social conditions at their 

developments. Strategies to reduce physical distress include capital 

improvements such as renovating buildings, systems, and units or, in 

extreme cases, relocating residents and demolishing or selling a 

development. Methods to reduce the level of social distress include 

designating developments as “elderly only,” converting developments into 

assisted living facilities, and working with other governmental agencies 

and nonprofit organizations to provide supportive services to residents.

We provided a draft of this report for HUD’s review. HUD provided oral 

comments, generally agreeing with our report, and technical comments, 

which we incorporated as appropriate.

Background Under the United States Housing Act of 1937, as amended, Congress 

created the federal public housing program to provide decent and safe 

rental housing for eligible low-income families, the elderly, and persons
Page 6 GAO-06-163 Housing for the Elderly and Persons with Disabilities

with disabilities.6 HUD administers federal aid to local public housing 

agencies that manage housing for low-income residents at rents they can 

afford. More specifically, 3,150 public housing agencies manage 

approximately 1.2 million public housing units throughout the nation, of 

which approximately 1 million are occupied. Public housing comes in all 

sizes and types, from scattered single-family houses to high-rise 

apartments.

Funding for public housing construction, renovation, or operation can 

come from a number of HUD programs, as well as other government and 

private sources. HUD’s Public Housing Capital Fund (Capital Fund) 

provides funds (distributed by formula) for activities such as redesign, 

reconstruction, improvement of accessibility, and replacement of obsolete 

utility systems.7

 The fiscal year 2005 appropriation for the Capital Fund was 

about $2.4 billion. HUD’s Public Housing Operating Fund (Operating Fund) 

provides operating subsidies to housing agencies to help them meet 

operating and management expenses. The fiscal year 2005 appropriation 

for the Operating Fund was about $2.4 billion. In addition, between fiscal 

years 1993 and 2005, Congress appropriated $6.8 billion for the HOPE VI 

program, which HUD awarded to public housing agencies for planning, 

technical assistance, construction, rehabilitation, demolition, and housing 

6

United States Housing Act of 1937 (Low-Rent Housing Act) (Wagner-Steagall Housing Act), 

ch. 896, 50 Stat. 888 (Sept. 1, 1937). For purposes of low-income housing, HUD defines 

“elderly” as a person aged 62 or older, and a “person with disabilities” as a person who (1) 

has a disability as defined in 42 U.S.C. § 423; (2) has a physical, mental, or emotional 

impairment expected to be of long, continued, and indefinite duration that impedes the 

individual’s ability to live independently, which is of the nature that independence could be 

improved by more suitable housing conditions; or (3) has a developmental disability as 

defined in 42 U.S.C. § 15002(8)(A). 42 U.S.C. § 1437a(b)(3)(D) and (E); and 24 C.F.R. §§ 

5.100, 5.403, and 5.603. The term “disability” is further defined as the inability to do any 

substantial gainful activity because of a physical or mental impairment that will result in 

death or has lasted or will last for a continuous period of 12 months or more. 42 U.S.C. § 

423(d)(1). The term “developmental disability” is further defined to mean a severe, chronic 

disability that is attributable to a mental or physical impairment or combination thereof; is 

manifested before 22 years of age; likely will continue indefinitely; results in substantial 

functional limitations in three or more major life activities; and reflects the person's need 

for individualized special services, supports, or other forms of lifelong assistance. 42 U.S.C. 

§ 15002(8)(A). See appendix I for the criteria we used for categorizing developments as 

occupied by “primarily elderly and non-elderly persons with disabilities.”

7

The Public Housing Capital Fund provides funds, annually, to public housing agencies for 

the development, financing, and modernization of public housing developments and for 

management improvements. 42 U.S.C. § 1437g(d). The funds may not be used for luxury 

improvements, direct social services, costs funded by other HUD programs, and ineligible 

activities as determined by HUD on a case-by-case basis.
Page 7 GAO-06-163 Housing for the Elderly and Persons with Disabilities

choice voucher assistance. While most of the funds are intended for capital 

costs, a portion of the revitalization grants may be used for community and 

supportive services. In addition, public housing agencies use the HOPE VI 

revitalization grant to leverage additional funds from sources such as other 

HUD funds, state or local contributions, or public and private loans. In 

2002, we reported that housing agencies expected to leverage—for every 

dollar received in HOPE VI revitalization grants awarded through fiscal 

year 2001—an additional $1.85 in funds from other sources.8

 We also found 

that housing agencies that had received revitalization grants expected to 

leverage $295 million in additional funds for community and supportive 

services. In addition to leveraging funds from a variety of sources, housing 

agencies may use Low-Income Housing Tax Credits—which are federal tax 

credits for the acquisition, rehabilitation, or new construction of affordable 

rental housing—as well as Medicaid Home and Community-Based Services 

waivers, which allow flexibility in providing healthcare or long-term care 

services to Medicaid-eligible individuals outside of an institutional setting.9

Residents of public housing who are elderly or have disabilities may have 

more special needs, compared with other residents, due to their age and 

type of disability. According to a 2002 study by the Housing Research 

Foundation, elderly public housing residents are more likely to be “frail” or 

have disabilities, compared with other elderly persons not living in public 

housing.10 The researchers reported that more than one in five elderly 

public housing residents were classified as persons with disabilities, 

compared with only 13 percent of U.S. elderly persons. In addition, the 

report found that over 30 percent of elderly public housing residents have 

at least one functional problem, such as difficulty with cooking, seeing, and 

hearing, compared with just over 20 percent of all elderly persons. Some 

elderly persons or persons with disabilities may require assistance with the 

basic tasks of everyday life, such as eating, bathing, and dressing. In 

addition, the needs of the elderly or persons with disabilities result in a 

8

GAO, Public Housing: HOPE VI Leveraging Has Increased, but HUD Has Not Met Annual 

Reporting Requirement, GAO-03-91 (Washington, D.C.: Nov. 15, 2002).

9

Section 1915(c) of the Social Security Act, codified at 42 U.S.C. § 1396n(c), authorizes the 

Secretary of Health and Human Services to, by waiver, provide Medicaid reimbursement for 

home or community-based services (other than room and board) where, but for the 

provision of such services, the individuals would require treatment in a nursing facility or an 

intermediate care facility for the mentally retarded, the cost of which could be reimbursed 

under the state Medicaid plan.

10Housing Research Foundation, Public Housing for Seniors (Washington, D.C.: 2002).
Page 8 GAO-06-163 Housing for the Elderly and Persons with Disabilities

need for physical features in residences that adequately accommodate 

physical limitations.

According to 2005 HUD data, 64 percent of the approximately 1 million 

occupied public housing units are occupied by at least one elderly person 

or a person with a disability, and 50 percent of all heads of public housing 

households are either elderly (31 percent) or non-elderly persons with 

disabilities (19 percent), as shown in figure 1.

Figure 1: Percent of Public Housing Units Occupied by the Elderly and Non-Elderly 

Persons with Disabilities

Note: See appendix I for a discussion of the limitations of the data.

Residents who are elderly or have disabilities live in a variety of public 

housing settings, including developments that are occupied primarily by 

elderly residents or residents with disabilities as well as developments that 

are occupied primarily by families.11 According to 2005 HUD data, of 

approximately 500,000 public housing units that are occupied by a head of 

household who is elderly or has a disability, 47 percent are in developments 

11In this context “families” refers to households consisting of residents other than the elderly 

or persons with disabilities.

19%

14%

36%

31%

Elderly or person with disability

in household (not head of household)

Non-elderly head of 

household with disability

Elderly head of household

No elderly or person 

with disability in household

Source: GAO analysis of 2005 HUD data.

(n=1,024,274 occupied units)
Page 9 GAO-06-163 Housing for the Elderly and Persons with Disabilities

that are occupied primarily by elderly persons or persons with disabilities, 

40 percent are in developments that are occupied primarily by families 

(family housing developments), and 13 percent are in developments that 

include buildings that are occupied by families and buildings that are 

occupied by elderly persons and persons with disabilities (mixed 

developments).

While Comprehensive 

Data Are Lacking to 

Determine Extent of 

Severe Distress, Public 

Housing Directors 

Reported Adverse 

Social and Physical 

Conditions

While HUD collects data for several elements describing the physical and 

social conditions that exist at its public housing developments, the data do 

not sufficiently establish whether a housing development is severely 

distressed. Based on survey responses from public housing directors— 

covering 66 housing developments with indications of potential distress 

and occupied primarily by the elderly or persons with disabilities—we 

found that 11 developments exhibited signs of severe physical distress; 12 

had signs of severe social distress; and an additional 5 developments had 

signs of both severe physical and social distress. Although the remainder of 

the 66 developments had fewer signs of severe distress, the public housing 

directors we surveyed pointed out several conditions that adversely 

affected the quality of life for their tenants who are elderly or have 

disabilities. The factors they most frequently cited were (1) aging buildings 

and systems, including inadequate air-conditioning; (2) lack of accessibility 

for residents with disabilities; (3) small studio apartments; (4) tension 

between elderly residents and non-elderly residents with disabilities; (5) 

lack of supportive services; and (6) security and crime issues.

HUD Maintains Limited 

Data about the Condition of 

Public Housing for the 

Elderly and Persons with 

Disabilities

As previously discussed, Congress expanded the statutory definition of 

“severely distressed public housing” in 2003 to include, among other 

factors, housing developments in severe distress because of a lack of 

sufficient appropriate transportation, supportive services, economic 

opportunity, schools, civic and religious institutions, and public services. 

However, HUD data do not indicate whether a development has these kinds 

of public and other supportive services.

HUD collects, maintains, and analyzes data on public housing primarily 

through a database system and a management center. HUD uses the Public 

and Indian Housing Information Center (PIC) system—which was designed 

to facilitate Web-based exchange of data between public housing agencies 

and local HUD offices—to monitor the housing agencies, detect fraud, and 

analyze and provide information to Congress and other interested parties. 
Page 10 GAO-06-163 Housing for the Elderly and Persons with Disabilities

PIC contains a detailed inventory of public housing units and tenant 

(household) information about occupants. For example, the PIC database 

maintains information on the number of developments and units, age of the 

development, extent to which apartment units are accessible for persons 

with disabilities, and tenant information such as the age, disability status, 

and income of families who participate in public housing programs.12

HUD’s Real Estate Assessment Center (REAC) monitors and evaluates the 

physical condition of public housing and other properties that receive 

financial assistance from HUD and also assesses their financial condition.13

For example, the Physical Assessment Subsystem within REAC maintains 

information about the physical condition of HUD properties, based on 

on-site physical inspections, which identifies housing developments that 

are physically deteriorated, have health and safety hazards, or deficiencies 

such as tripping hazards on sidewalks or parking lots, damaged fences or 

gates, blocked emergency exits, or inoperable smoke detectors inside 

apartments.14

Relatively Few 

Developments Primarily 

Occupied by the Elderly and 

Non-Elderly Persons with 

Disabilities Appeared 

Potentially Severely 

Distressed

Using the limited data that were available from HUD and other sources, we 

defined eight measures to indicate potential severe distress for 

developments: (1) REAC physical inspection results; (2) adjusted physical 

inspection results provided by the Urban Institute; (3) building age; (4) 

vacancy rate; (5) total household income by unit; (6) poverty rate for the 

census tract; (7) accessibility of units to persons with disabilities; and (8) 

whether developments applied for HOPE VI or were approved for 

demolition, disposition, or HOPE VI funding.15 As noted previously, we then 

developed an “index of distress” to score conditions at public housing 

12The PIC “Housing Authority” sub-module maintains descriptive information about the 

developments and units under management of public housing agencies, while the “Form 

HUD-50058” sub-module collects, stores, and generates reports on families who participate 

in Public Housing, Indian Housing, or Section 8 rental subsidy program.

13We have reported on HUD’s systems for overseeing properties in the public housing 

program. See GAO, Public Housing: New Assessment System Holds Potential for 

Evaluating Performance, GAO-02-282 (Washington, D.C.: Mar. 15, 2002).

14HUD-certified REAC inspectors annually inspect a random sample of the units to assess 

the housing agencies’ performance in maintaining their properties, and assign a score.

15The Urban Institute is a nonpartisan economic and social policy research organization. In 

addition to HUD physical inspection results, we used the Urban Institute’s adjusted data 

because the methodology the researchers employed put more weight on the soundness of 

the physical structures. See also appendix 1.
Page 11 GAO-06-163 Housing for the Elderly and Persons with Disabilities

developments.16 We found that 76 (2 percent) of the 3,537 housing 

developments mainly occupied by the elderly and non-elderly persons with 

disabilities showed indications of severe distress.17 In contrast, other 

developments were more likely to show indications of severe distress. We 

found that 958 (12 percent) of 7,932 family housing developments and 69 

(15 percent) of 466 mixed housing developments showed indications of 

severe distress. In addition, some public housing directors we interviewed 

reported that family housing developments, near or adjacent to their 

developments occupied primarily by elderly residents and residents with 

disabilities, were more likely to be in worse condition or afflicted by 

neighborhood crime or illicit activities.

According to HUD’s data, the following characteristics describe the 76 

housing developments that were occupied by mostly elderly persons and 

non-elderly persons with disabilities:

• 21 had been approved for demolition, disposition, or HOPE VI 

revitalization;

• 72 had a building that was more than 30 years old;

• 64 had few units (less than 5 percent) that met accessibility standards;18

• 24 had a physical inspection score under 60 percent;19

• 41 were in a census tract with a poverty rate greater than 35 percent; 

and

• 26 had households with a total median income under $7,000.

16See appendix I for additional information on the methods we used to develop the index of 

distress and on limitations of the data.

17Our results are based on a total of 11,935 public housing developments in the 50 states plus 

the District of Columbia with at least 10 occupied units and with data available on at least 

five indicators of distress. See appendix I for the criteria we used for categorizing 

developments as “mainly occupied by the elderly or non-elderly persons with disabilities,” 

“mainly occupied by families,” or “family housing developments with concentrations of 

elderly persons or persons with disabilities.”

18According to the definition of “accessible units” in 24 C.F.R. § 945.105.

19HUD designates a public housing agency with a physical inspection score less than 60 

percent as “troubled performer.”
Page 12 GAO-06-163 Housing for the Elderly and Persons with Disabilities

Even If Not Severely 

Distressed, Public Housing 

Developments May Pose 

Problematic Living 

Conditions for the Elderly 

and Non-Elderly Persons 

with Disabilities

Responses to our survey of public housing directors indicated that some of 

the 76 public housing developments occupied primarily by elderly persons 

and non-elderly persons with disabilities were severely distressed and that, 

among those that were not, certain characteristics nevertheless adversely 

affected the quality of life for their residents. We received responses 

covering 66 of these 76 developments and found that 11 showed signs of 

severe physical distress, 12 had signs of severe social distress, and five 

others had signs of both physical and social distress. In developments 

where survey data indicated signs of severe distress, housing directors 

reported deterioration and obsolescence in key systems. However, housing 

directors described the condition of the physical structures at 34 

developments as either, “not at all deteriorated” or “a little deteriorated” 

(see fig. 2). Indicators of severe social distress that the directors reported 

include inadequate supportive services, such as transportation, assistance 

with meals, and problems with crime.

Figure 2: Level of Deterioration of Physical Structures, According to Public Housing 

Directors

Note: For this survey item, we received responses for 62 developments.

Even though not necessarily indicative of severe distress, a number of 

factors were reported by many public housing agency directors as 

adversely affecting living conditions for the elderly and persons with 

disabilities. Among the most frequently cited characteristics or conditions 

were aging buildings, lack of accessibility for residents with disabilities, 

small size of apartments, mixing elderly and non-elderly residents with 

disabilities, the lack of supportive services, and crime. To varying extents, 

the survey respondents also cited these factors as challenges in providing 

public housing (see fig. 3).

Deterioration status Number of developments

Extremely deteriorated

Very deteriorated

Somewhat deteriorated

A little deteriorated

Not at all deteriorated

3

6

19

20

14

Source: GAO.
Page 13 GAO-06-163 Housing for the Elderly and Persons with Disabilities

Figure 3: Conditions Most Frequently Cited as Adversely Affecting the Elderly and 

Persons with Disabilities and Challenges Most Frequently Cited in Providing Public 

Housing

Note: Based on survey responses from 41 public housing agency directors covering 64 developments. 

Responses are from open-ended survey items; therefore, in some cases, directors reported multiple 

challenges—including those that directors encountered over the past 15 years.

Aging Buildings Eleven surveyed housing agency directors mentioned that aging buildings 

posed maintenance and other challenges for their housing 

agencies—nearly all (96 percent) of the developments that we surveyed 

were more than 30 years old. Some buildings had deteriorating structures, 

as shown in figure 4. In addition, several public housing agency officials 

further noted during our site visits and in our survey that because of their 

age, the developments were “functionally obsolete.” That is, many of the 

design features were outdated and did not meet the needs of residents. For 

example, 11 of the survey responses cited lack of adequate air-conditioning 

as a condition that most adversely affected the elderly and persons with 

disabilities. The building manager at one development said that during the 

summer months some elderly tenants who have heart conditions face 

increased health risks because their apartments do not have 

air-conditioning. At another development, an antiquated steam system 

provided heating. The public housing agency official whom we spoke with 

said this contributed to exorbitant utility bills. In addition to outdated 

systems, housing agency officials also cited outdated building designs as 

affecting the quality of life. For example, we visited two high-rise buildings 

that were more than 30 years old and constructed with exterior walkways, 

which residents had to use to access their apartments. During the winter 

months residents were routinely exposed to extremely cold weather and 

snow (see fig. 5). In addition, one public housing agency official whom we 

Most adversely affect life

(Number of developments)

Challenges (Number of 

housing agency directors)

Aging buildings (or systems)

Lack of accessibility

Small studio apartments

Mixing of elderly and non-elderly

persons with disabilities

Lack of supportive services

Problems with security or crime

17

8

6

9

9

8

11

6

5

17

13

2

Source: GAO.
Page 14 GAO-06-163 Housing for the Elderly and Persons with Disabilities

spoke with said that high-rise buildings limit social interactions among 

elderly residents.

Figure 4: Signs of Severe Physical Distress Include Deteriorating Infrastructure 

Such as Concrete Surfaces

Source: GAO.
Page 15 GAO-06-163 Housing for the Elderly and Persons with Disabilities

Figure 5: Inadequate Shelter, Such as Exterior Walkways at a High-Rise 

Development, Exposes Residents to the Elements

Due to the age of the buildings, public housing agency directors who 

responded to our survey reported that most of the 66 developments were 

undergoing, or will need, demolition, replacement, renovation, or 

rehabilitation (see fig. 6). Of the 66 developments for which we received 

responses, 11 were or are going to be demolished or replaced; and 21 had 

building systems (such as air-conditioning and elevator systems) that were 

recently or currently are being renovated; while 28 developments will 

require renovation to building systems within 3 years, according to housing 

agency directors. Respondents most frequently indicated that plumbing 

and sewer systems, elevators, and exterior building doors required 

near-term replacement or renovation. Other systems or features that were 

cited nearly as frequently were site lighting, parking lots, and heating and 

hot water systems. (Because our survey targeted developments that were 

most likely to be distressed, these conditions may not be representative of 

public housing for the elderly and persons with disabilities in general.)

Source: GAO.
Page 16 GAO-06-163 Housing for the Elderly and Persons with Disabilities

Figure 6: Most Developments Are Undergoing or Will Need Demolition, 

Replacement, or Rehabilitation 

Note: GAO analysis based on responses to multiple survey questions, including whether development 

has been demolished or disposed of, extent of and reasons for physical deterioration, status of 

renovation to various building systems, and actions taken or planned to address current conditions. For 

these survey items, we received responses for 66 developments.

Lack of Accessibility Public housing agency directors reported that a lack of accessibility 

throughout their developments was one condition that most adversely 

affected the quality of life for the elderly and persons with disabilities. For 

example, directors reported that 13 developments had elevators that were 

not large enough to allow a person in a wheelchair to easily turn around 

(see fig. 7). Our survey results also found that some developments did not 

have entrance and lobby doorways wide enough to allow passage for a 

person in a wheelchair or power scooter. We visited one housing 

development that had hallways on the main floor that were too narrow for 

modern power scooters to pass one another. According to a public housing 

agency official from this development, narrow halls are a problem because 

about one-third of the residents at the housing development use power 

scooters. This development also had a wheelchair ramp at the building’s 

entrance that was too narrow for power scooter users to easily navigate, 

and we observed power scooter users making difficult three-point turns on 

the narrow ramp. Additionally, six developments we surveyed did not have 

ramps of any kind for persons using wheelchairs or power scooters. 

Moreover, according to our survey, 23 developments had entrance and 

lobby hallways without grab bars. According to professionals 

knowledgeable about the housing needs of the elderly and persons with 

disabilities, grab bars or hand-rails in hallways are important because they 

help prevent falls, which are potentially disabling or fatal events. Based on 

our survey responses, housing agency directors for 32 developments 

indicated less than 5 percent of their units were accessible. During our visit 

Development status Number of developments

Demolished or no longer used for elderly or persons with disability

Demolition or replacement in progress or planned

Renovation or rehabilitation recently completed or in progress

Others needing renovation of building systems within 3 years

Little deterioration/no remedial actions indicated

2

11

21

28

4

Source: GAO.
Page 17 GAO-06-163 Housing for the Elderly and Persons with Disabilities

to one housing development, the building manager told us that none of the 

apartment units were accessible to persons with disabilities; therefore, 

prospective residents with special needs were referred to another building 

within the housing agency’s portfolio.

Figure 7: Examples of Lack of Access for the Elderly and Persons with Disabilities Include Narrow Hallways and Elevators That 

Cannot Easily Accommodate Wheelchairs or Scooters

Size of Apartments, Particularly 

Studio Apartments

Housing directors reported that small studio apartments adversely affected 

the quality of life at six developments for the elderly and persons with 

disabilities and represented a major challenge for five housing agencies. 

One of the building managers that we interviewed noted that elderly 

residents who live in studio apartments sometimes do not have enough 

room for a lifetime’s worth of possessions and often have difficulty finding 

space for other family members, such as grandchildren, for whom the 

residents may serve as primary caregivers. 

Resident Mix In response to our survey, 17 public housing agency directors reported that 

a mixed population of elderly residents and younger residents with 

disabilities represented a challenge at their developments. During our visits 

to housing developments, housing agency officials and building managers 

told us that the mixed resident population sometimes led to tension 

because residents from each group often lead different lifestyles. In 

Source: GAO.
Page 18 GAO-06-163 Housing for the Elderly and Persons with Disabilities

addition, many of the elderly residents that we interviewed told us that 

younger residents were more likely to have late-night visitors, play loud 

music, and lead active lifestyles, while they preferred quieter activities. 

Resident leaders at one development we visited told us that some elderly 

residents did not spend time in the common areas because they feared 

younger residents. Another elderly resident told us that some younger 

residents in his development robbed and terrorized the older residents. 

Further, officials that we interviewed also said that younger residents with 

disabilities sometimes have mental health conditions the housing agencies 

were not equipped to address. More specifically, building managers and 

residents told us that residents with mental health disabilities often 

disturbed other residents if they did not take proper medication.

We found that at 29 of the developments for which we received survey 

responses, elderly residents made “very frequent” or “somewhat frequent” 

complaints about younger residents with disabilities. Conversely, at 59 of 

the developments, younger residents with disabilities made complaints 

about elderly residents “a little” or “not at all.”

Extent of Supportive Services Thirteen surveyed public housing agency directors mentioned that 

providing adequate supportive services was a challenge. Most of the 

developments we visited and surveyed had some on-site supportive 

services, which assist with activities of daily living and are intended to help 

the elderly and persons with disabilities remain independent and in their 

communities (see fig. 8).20 However the array of supportive services varied 

and often could not be characterized as meeting the needs of residents. 

According to a HUD report on housing needs for the elderly, residents’ 

needs for greater assistance, such as that offered by a nursing home, may 

increase as a result of inadequate supportive services.21 Many of the 

building managers and residents that we interviewed told us that residents 

who moved out of the public housing development often moved in with 

family or to a nursing home because the development lacked sufficient 

supportive services. According to data from one public housing agency 

20We recently reported and testified on the availability of supportive services at 

HUD-assisted properties housing the elderly, including public housing. See GAO, Elderly 

Housing: Federal Housing Programs That Offer Assistance for the Elderly, GAO-05-174

(Washington, D.C.: Feb. 14, 2005); and Elderly Housing: Federal Housing Programs and 

Supportive Services, GAO-05-795T (Washington, D.C.: June 16, 2005).

21HUD, Housing our Elders (Washington, D.C.: 1999).
Page 19 GAO-06-163 Housing for the Elderly and Persons with Disabilities

director, of 21 residents who relocated from one of the public housing 

developments during the 2004 calendar year, 6 moved into a nursing home.

Figure 8: Number of Developments with Supportive Services Available On-Site for 

Elderly Residents

Note: The data in this table are for services available to elderly residents. In most cases, the same 

services were available for non-elderly persons with disabilities—although for some, such as 

housekeeping assistance and medical or health services, the overall percent of developments with 

services available to non-elderly persons with disabilities was several points lower. For these survey 

items, we received responses for 64 developments.

Although 28 of the developments from which we received survey responses 

had some type of on-site medical or health services, these varied from 

development to development because not all of the developments with 

health services offered assistance with medication. According to 

professionals knowledgeable about the housing needs of the elderly and 

non-elderly persons with disabilities, having a nurse or healthcare 

professional at the development to help residents manage their 

medications is beneficial.

The elderly and non-elderly persons with disabilities also often need 

assistance with housekeeping, personal care, and meals. One building 

manager at a development we visited told us that the residents without 

nearby family often needed assistance with housekeeping. During one of 

our visits, we observed a resident receiving assistance with housekeeping. 

At another development, the housing agency officials told us that residents 

appreciated the services from an on-site hair salon. According to our 

analysis of our survey data, 34 developments offered on-site meal 

Medical or health services 28

Housekeeping assistance 42

Meal preparation assistance 34

Personal grooming assistance 18

Recreational activities 42

Door-to-door transportation 55

Counseling services 30

Source: GAO.

Number of developments
Page 20 GAO-06-163 Housing for the Elderly and Persons with Disabilities

preparation services. One building manager at a development we visited 

told us that on-site lunch programs were often the only hot meal of the day 

for some residents. Building managers at other developments indicated 

that many of their residents can no longer safely cook. 

According to our analysis of survey responses, most of the developments 

offered recreational activities for the elderly or non-elderly persons with 

disabilities. Furthermore, residents we interviewed reported that 

recreational activities, such as outings, or organized potluck dinners, were 

important to their quality of life. One public housing agency official with 

whom we spoke said that many elderly residents do not have family nearby 

and without planned activities at the housing development many would 

never leave their apartments. According to one study on public housing for 

the elderly, up to a third of elderly residents living in public housing in New 

York almost never left their apartments.22 During our visits to 25 housing 

developments, we observed on-site activities such as arts and crafts 

workshops and sewing and computer classes. Many of the buildings also 

had libraries, television rooms, and exercise rooms. According to 

knowledgeable professionals, elderly residents need physical activities 

incorporated into their daily lives to maintain their health.23 At some 

developments we visited, residents said they had events such as bingo or 

pancake breakfasts, but lacked activities involving physical exercise. 

According to our survey responses, we also found that 25 housing 

developments offered job training or placement services for their residents.

Public housing agency directors reported that in 55 of the developments 

some kind of scheduled or on-demand door-to-door transportation service 

was available. Door-to-door transportation includes vans or buses that pick 

up residents at the housing development and take them to destinations 

such as grocery stores, banks, or to medical appointments. However, 

survey responses from eight developments indicated that accessing any 

form of transportation was “not very easy,” nor were grocery stores or 

other services located near these developments, which increased the 

isolation of residents. Several of the residents at the housing developments 

that we visited said a lack of accessible transportation affected their quality 

of life because they could not easily get to a grocery store or doctors’ 

appointments.

22Housing Research Foundation, Public Housing for Seniors (Washington, D.C.: 2002).

23American Family Physician, Promoting and Prescribing Exercise for the Elderly (2002).
Page 21 GAO-06-163 Housing for the Elderly and Persons with Disabilities

According to our survey results, 26 housing developments provided access 

to a service coordinator at least 20 days per month, while 19 had no service 

coordinator, and 11 had one available less than 5 days per month (see fig. 

9).24 According to HUD, a service coordinator assists elderly residents and 

non-elderly residents with disabilities of federally assisted housing to 

obtain needed supportive services from community agencies, thereby 

preventing premature and inappropriate institutionalization. For example, 

a service coordinator might find a public housing resident with a disability 

someone to help with housekeeping, enabling the resident to remain 

independent. Service coordinators also help elderly residents and 

non-elderly residents with disabilities determine if they qualify for 

government services. According to the 2002 Housing Research Foundation 

Report cited above, 83 percent of elderly residents in public housing live 

alone, and therefore may not have a support network to help them access 

services or fill out paperwork. While service coordinators are an important 

aspect to improving the quality of life for the elderly and non-elderly 

persons with disabilities who reside in public housing, some developments 

provided access to service coordinators on a less frequent basis. For 

example, one housing agency we visited had one service coordinator for 

2,500 units occupied by elderly persons and non-elderly persons with 

disabilities. According to the housing director, this staffing level was not 

sufficient to meet resident needs. In another case, two service coordinators 

were responsible for all of the housing agency’s 20,000 residents.

Figure 9: Access to a Service Coordinator

Note: For this survey item, we received responses for 64 developments.

24According to our survey responses, of the 45 developments with at least a part-time service 

coordinator, 29 were HUD-funded, 12 were not HUD-funded, and 4 did not specify.

Availability Number of developments

Available 20+ days per month

Available 5-15 days per month

Available less than 5 days per month

Available, but number of days not specified

No service coordinator

26

6

11

2

19

Source: GAO.
Page 22 GAO-06-163 Housing for the Elderly and Persons with Disabilities

Crime Near Developments Survey data indicated that 38 developments had at least some problems 

with crime in surrounding neighborhoods, while 24 developments had at 

least some problems with crime inside the development (see fig. 10).

Figure 10: Extent of Crime Problem in and near Developments

Note: For these survey items, we received responses for 63 developments.

A few developments that we visited were adjacent to family public housing 

developments, which in general—according to our analysis of HUD data 

and interviews with housing agency directors—tend to be in worse 

condition than public housing occupied by the elderly and non-elderly 

persons with disabilities. Housing directors stated that, as a result, crime 

was more of a problem at those family-adjacent developments. Some 

elderly residents and non-elderly residents with disabilities told us that 

they did not feel safe in their neighborhoods or, sometimes, in their 

developments. At one housing development, one resident told us that 

young people from the neighborhood loitered in and around their 

development, which made the elderly residents feel uncomfortable. At two 

other housing developments we visited, public housing agency officials and 

residents identified tenants who sold drugs from their apartments, which 

attracted unwanted outsiders into the development. Residents at one 

development said they stopped participating in recreational activities 

because they feared someone would break into their apartments if they 

left. When problems with crime and vandalism peaked at another housing 

development, residents told us that they formed their own security group 

to monitor the activity at the building.

Extent of problem In nei In development ghborhood

Very much

Fairly much

Some

A little

None or almost none

1

3

20

23

16

5

12

21

19

6

Source: GAO.
Page 23 GAO-06-163 Housing for the Elderly and Persons with Disabilities

Various Strategies 

Could Improve 

Physical and Social 

Conditions at Public 

Housing for the Elderly 

and Non-Elderly 

Persons with 

Disabilities 

According to officials whom we surveyed and interviewed, various 

strategies have been used to improve both physical and social conditions to 

better address the special needs of the elderly and non-elderly persons with 

disabilities. Methods to deal with physical distress included capital 

improvements such as renovating or modernizing buildings, systems, and 

units or, in extreme cases, demolishing or selling a development. Methods 

to reduce the level of social distress include a range of actions to address 

the needs of the elderly and non-elderly persons with disabilities, such as 

designating developments as “elderly only” for reasons of safety, converting 

developments into assisted living facilities, and working with other 

agencies, such as nonprofit and religious organizations, to provide in-home 

supportive services to residents.

Strategies to Improve 

Physical Conditions

To improve physical conditions at public housing developments, 18 of the 

43 responding public housing agency directors said they had ongoing or 

planned actions, such as modernizing building structures, upgrading 

accessibility features, and installing new building systems such as air 

conditioning and electrical systems. During our site visits, public housing 

agency officials whom we interviewed also described current or planned 

renovations to improve the physical conditions of their developments. For 

example, at one development the housing agency had recently improved its 

lobby and exterior with new paint, tiles, and landscaping. Building 

managers at this location told us that these renovations improved living 

conditions for residents and made the development more marketable. The 

housing agency also converted some of the first-floor units to be accessible 

to persons with disabilities and installed new appliances in the units. Other 

actions taken by housing agencies to improve physical conditions include 

planned or implemented elevator upgrades, which in some cases have 

made elevators more accessible to elderly residents or residents with 

disabilities. In addition, at one development we visited that had exterior 

walkways, the housing agency was undertaking large-scale renovations, 

which included enclosing the exposed areas to protect residents from 

inclement weather. At five developments we visited, public housing 

agencies had recently added central air-conditioning. Lastly, at three 

locations we visited, public housing agencies had previously converted, or 

planned to convert, studio apartments into one-bedroom units to better 

meet the needs of residents.

Housing agency directors we interviewed during our site visits said that 

their housing agencies use public funding from federal, state, and local 
Page 24 GAO-06-163 Housing for the Elderly and Persons with Disabilities

sources, and funding from private sources to address physical conditions. 

Public housing agency directors whom we surveyed made similar 

comments, with 17 citing HUD’s Capital Fund as a funding source to 

implement building modernizations or to renovate building components, 

including actions to accommodate the needs of persons with disabilities. 

The Capital Fund provides housing agencies with funds based on a formula 

that takes into account the size, location, and age of developments, along 

with the need for modernization, among several other characteristics. 

Public housing agency directors also reported using Low-Income Housing 

Tax Credits to make large-scale improvements or for new construction.25

Public housing agencies have also entered into partnerships with 

private-sector firms to implement a variety of improvements, such as 

building upgrades and comprehensive renovations. According to a housing 

agency official responsible for three large housing developments we 

visited, public housing agencies often lack development experience; thus, a 

partnership with private developers can bring valuable resources to 

improve public housing developments.

Public housing agencies also undertook more comprehensive improvement 

programs to address difficulties at developments that are associated not 

only with physical deterioration, but also with the overall deterioration of 

the surrounding neighborhood. For example, in St. Petersburg, Florida, the 

housing agency received a $27 million HOPE VI grant in 1998, which it used 

to tear down and rebuild all housing at the Historic Village development 

and the accompanying family housing development, Jordan Park. The 

housing agency made physical improvements to the development and 

individual apartments, such as improving accessibility for persons with 

disabilities and adding air-conditioning. Before the redevelopment, Jordan 

Park had a high concentration of poverty and a reputation as being a haven 

for criminal activity. Building managers told us that the incidence of crime 

in the area has since gone down. The HOPE VI grant made up about 40 

percent of the funding necessary for the $70 million improvements at 

Historic Village and Jordan Park. Low-Income Housing Tax Credits and a 

combination of state and local sources made up the rest of the funding. 

According to St. Petersburg housing agency officials, the large-scale 

improvements at Historic Village reduced vacancy rates and lowered the 

crime rate in the surrounding area, which is one of the goals of the HOPE 

VI program.

25Under the Low-Income Housing Tax Credit program, federal tax credits are used as an 

incentive to the private sector to develop rental housing for low-income households.
Page 25 GAO-06-163 Housing for the Elderly and Persons with Disabilities

Figure 11: The Local Housing Agency Completely Rebuilt Historic Village to Improve Conditions

However, at the Graham Park development, the housing agency in St. 

Petersburg determined that modifications necessary to improve 

accessibility were not feasible or cost effective because widening the 

narrow hallways would affect the structural integrity of the building. As a 

result, the housing agency submitted an application to sell Graham Park 

and use the proceeds to acquire or develop alternative affordable housing.26

Furthermore, the housing agency will offer current residents Section 8 

housing vouchers so they can rent housing elsewhere.

Some survey respondents also reported that they were planning to or were 

in the process of replacing some of their developments. For example, eight 

Sources: St. Petersburg Housing Authority (left); GAO (right).

Before revitalization. After revitalization.

26Section 18 of the Housing Act of 1937 (the Act), as amended, authorizes the demolition and 

disposition of public housing. 42 U.S.C. § 1437p. HUD promulgated its regulations in 24 

C.F.R. Part 970, which details the administrative steps required to perform 

demolition/disposition activity in accordance with the Act. Valid reasons for disposition or 

demolition include (1) prohibitive costs to bring existing developments into compliance 

with current standards; (2) locations no longer conducive to residential use; (3) high land 

values that would allow public housing agencies to replace existing developments with 

improved developments at no cost to HUD; (4) demolition or disposition of a portion of the 

development will allow the remaining portions of the development to be renovated, or (5) 

that leasing of the development to another party would be more cost-effective or efficient.
Page 26 GAO-06-163 Housing for the Elderly and Persons with Disabilities

housing agency directors reported that they were considering or were 

implementing actions to demolish or dispose of existing developments in 

order to acquire or build new housing for the elderly and non-elderly 

persons with disabilities.

Strategies to Improve Social 

Conditions

Public housing agency officials we contacted mentioned a variety of 

strategies to improve social conditions at housing developments for the 

elderly and non-elderly persons with disabilities. For example, 28 housing 

agency directors who responded to our survey mentioned actions they 

have taken or plan to take to address social conditions for elderly persons 

and persons with disabilities who reside in public housing. For instance, 12 

housing directors reported that they have taken actions to resolve 

problems associated with having elderly and non-elderly residents in the 

same development, such as designating their developments as “elderly 

only.” In particular, a number of housing directors cited safety concerns 

caused by young persons with mental health disabilities. Housing agency 

directors also reported that they have added security features and 

established programs to reduce crime and increase security. At one 

development for example, the housing agency partnered with the local 

police department to establish a community watch program. Thirteen 

survey respondents also reported taking other actions to address the needs 

of the elderly and persons with disabilities, including in-home health and 

nutrition assistance and other supportive services. In particular, one public 

housing director reported that the housing agency created its own senior 

resident advisor, who provides an array of supportive services to address 

the needs of its elderly residents.

To improve social conditions on a larger scale, the housing agency in 

Allegheny County completely revitalized the Homestead Apartments 

outside of Pittsburgh, Pennsylvania.27 The housing agency built space 

on-site for two nonprofit elder care service providers in addition to 

remodeling the buildings. One provider met the needs of the frailest 

residents with complete nursing services, meals, and adult day care. The 

other provider operates a walk-in wellness center that provides 

27The Homestead Apartments, one of HUD’s eleven “Innovative Models in Elderly Public 

Housing,” were developed for the frail elderly. One of the goals of HUD’s innovative models 

initiative is to determine the special needs of elderly public housing residents and how to 

maximize service dollars from non-HUD entities using HUD housing resources. See 

appendix III for more information on the innovative Homestead Apartments.
Page 27 GAO-06-163 Housing for the Elderly and Persons with Disabilities

Homestead’s more independent residents with blood pressure checks, 

assistance with medication, and service coordination and referrals. 

Housing officials whom we interviewed at Homestead estimated that the 

services provided at the adult day care center prevented nursing 

home-eligible residents from prematurely entering nursing homes. This 

resulted in a monetary savings for the state because, according to a 

Pennsylvania Department of Public Welfare director, the cost of care for 

those enrolled in the adult day center was only 85 percent of the cost of 

caring for them at a nursing home. Much of the new development at 

Homestead was financed with Low-Income Housing Tax Credits.

In another large-scale effort, the Miami-Dade Housing Agency converted 

Helen Sawyer Plaza into an assisted living facility.28 Twenty-four hour 

nursing care, meals, and recreational activities are now provided on-site. 

According to the building manager, the conversion eliminated high vacancy 

rates at the development, created a sense of community among the 

residents, and prevented residents from prematurely entering nursing 

homes. The housing agency uses Medicaid Home and Community-Based 

Services waivers to obtain federal funding for the assisted-living care of 

residents at Helen Sawyer. Such Medicaid waivers offer states the 

flexibility to pay for nursing services delivered outside of institutional 

settings.29 In addition, officials we interviewed at Helen Sawyer asserted 

that conversions to assisted living facilities are cost-effective options, in 

part, because public housing agencies own the property on which the 

public housing is built. As a result, housing agencies do not have to assume 

the mortgage or lease payments that comparable private assisted living 

facilities often have.

Based on our survey results and information from housing officials whom 

we interviewed, housing agencies partnered with outside agencies, such as 

community-based nonprofits or churches, to provide supportive services 

for the elderly and non-elderly persons with disabilities. In some cases, the 

agencies paid for the services; but in some cases, housing agencies also 

28Similar to the Homestead Apartments, Helen Sawyer Plaza is one of HUD’s eleven 

“Innovative Models in Elderly Public Housing,” where comprehensive improvements were 

made to better address the needs of frail elderly residents. See appendix III for more 

information on the innovative Helen Sawyer Plaza.

29The conversion of public housing into assisted living facilities is not feasible in states that 

do not obtain Medicaid Home and Community-Based Services waivers unless other sources 

of funding are identified.
Page 28 GAO-06-163 Housing for the Elderly and Persons with Disabilities

used federal grants.30 A building manager for one development that we 

visited said they partnered with a nearby church to provide a van to take 

residents shopping once a week. Local churches also provided food 

assistance to elderly residents and residents with disabilities who were not 

able to leave their apartments at this development. At another housing 

development we visited in Miami, Florida, Catholic Charities, a 

community-based organization, provided lunches on a daily basis to 

residents and assorted grocery items such as bread, fruit, and cereal on a 

weekly basis. We also observed a partnership in Seattle, Washington, where 

the housing agency partnered with a community-based organization to 

provide an on-site elderly community center where residents had access to 

meals, social activities, and assistance with filling prescriptions. Residents 

at this development also had access to an on-site health clinic. In addition, 

based on responses to our survey, five housing agency directors cited 

HUD’s Resident Opportunities and Self Sufficiency (ROSS) grant program 

as a means to provide supportive services such as assistance with health, 

activities of daily living, and transportation.31 Finally, public housing 

officials at two locations we visited also reported that ROSS grants funded 

door-to-door transportation for residents, assistance with housekeeping, 

and service coordinators, among other services.

Observations The extent to which public housing developments for the elderly and 

non-elderly persons with disabilities is severely distressed cannot be 

determined definitively with existing data, which are insufficient regarding 

factors that contribute to distress. Moreover, much of the data that are 

available are at the development level, rather than the individual building 

or unit level. These limited data, along with information from housing 

agency directors, suggest that severe distress in public housing 

developments primarily occupied by elderly residents and residents with 

disabilities was less prevalent than in developments occupied primarily by 

other types of residents. However, our work indicates that a number of 

developments primarily occupied by the elderly and non-elderly persons 

with disabilities are physically and/or socially distressed. Further, our site 

30For more information on federal housing programs that assist the elderly and persons with 

disabilities, including those that provide supportive services, see GAO, Elderly Housing: 

Federal Housing Programs That Offer Assistance for the Elderly, GAO-05-174 (Washington, 

D.C.: Feb. 14, 2005).

31The ROSS grant program helps fund service coordinators and helps link residents with 

appropriate services.
Page 29 GAO-06-163 Housing for the Elderly and Persons with Disabilities

visits and survey of selected public housing directors indicate that, even in 

developments that may not be considered distressed, a number of physical 

and social factors can negatively affect the quality of life for public housing 

residents who are elderly or have disabilities.

The directors’ agencies have implemented several strategies to address a 

variety of factors that contribute to problematic conditions for both elderly 

and non-elderly residents with disabilities, such as improving accessibility 

to persons with disabilities, addressing problems associated with mixing 

elderly and non-elderly disabled persons, and undertaking larger scale 

efforts to provide supportive services. Nevertheless, our work indicated 

that a significant number of the 66 developments covered by our survey 

will need replacement, renovation, or rehabilitation in the future and that 

the array of supportive services has often not met the needs of residents. 

These findings suggest that continued efforts will be needed to improve the 

quality of life for residents who are elderly, increasingly frail, or have 

disabilities.

Agency Comments We provided a draft of this report to HUD for its review and comment. We 

received oral comments from officials in HUD’s Office of Public and Indian 

Housing indicating general agreement with the report. As a general 

comment, one official stated that the draft report underrates the adverse 

impact of the lack of accessibility of units for persons with disabilities. The 

official also noted that as elderly residents continue to age in place, their 

accessibility needs will increase. We did not attempt to determine a 

correlation between the extent of accessibility in public housing units and 

the percent of residents with disabilities. However, our report notes that 

public housing residents who are elderly or have disabilities may have 

more special needs, compared with other residents, due to their age and 

type of disability and that elderly public housing residents are more likely 

to be “frail” or to have disabilities, compared with other elderly persons. 

HUD also suggested that the report should contain additional discussion on 

how public housing agencies use HOPE VI funds to provide supportive 

services to the elderly. We did not insert additional information because in 

this report, as well as previous reports cited herein, we have provided 

information on the use of HOPE VI as a funding source for community and 

supportive services. Finally, one official expressed agreement with the 

public housing directors who, in responding to our survey, indicated that 

one method of reducing social distress is working with governmental and 

nonprofit organizations to provide supportive services. HUD also provided 

technical clarifications, which we incorporated as appropriate.
Page 30 GAO-06-163 Housing for the Elderly and Persons with Disabilities

We are sending copies of this report to the HUD Secretary and other 

interested congressional members and committees. We will make copies 

available to others upon request. In addition, this report will also be 

available at no charge on our Web site at http://www.gao.gov. 

If you or your staff have questions about this report, please contact me at 

(202) 512-8678 or Woodd@gao.gov. Contact points for our Offices of 

Congressional Relations and Public Affairs may be found on the last page 

of this report. Key contributors to this report are listed in appendix IV.

David G. Wood

Director, Financial Markets and

 Community Investment
Page 31 GAO-06-163 Housing for the Elderly and Persons with Disabilities

Appendix I

Objectives, Scope, and Methodology AAppenednxidexiIs

The objectives of this report were to examine (1) the extent to which public 

housing developments occupied primarily by the elderly and non-elderly 

persons with disabilities were severely distressed and (2) the ways in 

which the stock of severely distressed public housing for the elderly and 

non-elderly persons with disabilities could be improved.

We analyzed tenant and development characteristic data from the 

Department of Housing and Urban Development’s (HUD) Public and Indian 

Housing Information Center (PIC) database and physical inspection data 

from the Real Estate Assessment Center (REAC) database. We obtained 

data from HUD in January 2005 for both databases. For purposes of this 

report, we sought to use PIC data to describe the number of households 

headed by elderly persons or persons with disabilities and to identify 

developments occupied primarily by elderly persons or persons with 

disabilities that were potentially severely distressed. To assess the 

reliability of data from the PIC database, we reviewed relevant 

documentation, interviewed agency officials, including contractors who 

worked with these databases, and conducted electronic testing of the data, 

including frequency and distribution analyses. Our assessment showed that 

some tenant and development characteristic data for the 28 housing 

agencies that are Moving to Work (MTW) sites were outdated by as many as 

6 years because, at the time of our data collection, HUD had not yet 

implemented a system that allowed PIC to accept MTW data.1

 For the 

purposes of this report, we sought to identify developments that were 

potentially distressed; therefore, we determined these data to be 

sufficiently reliable for use in our first index. However, for the 

developments that we surveyed, we asked housing agencies to verify data 

for the six fields we used from PIC to identify developments that were 

potentially distressed. When we compared the updated data that were 

received through our survey to the data contained in PIC, we found that 39 

of 62 developments had decreased vacancy rates, compared with the PIC 

data, while 8 had increased vacancy rates. In a few cases, we found that 

developments that had been demolished were reported in the PIC system 

as existing developments. Similarly, we found a few instances where 

1

MTW is a HUD demonstration program that was authorized under the Omnibus 

Consolidated Rescissions and Appropriations Act of 1996 (Pub. L. No. 104-134, 110 Stat. 

1321 (Apr. 26, 1996)). The program offers public housing agencies the opportunity to design 

and test self-sufficiency strategies for low-income families by allowing exemptions from 

existing public housing and tenant-based Housing Choice Voucher rules and permitting 

housing agencies to combine operating, capital, and tenant-based assistance funds into a 

single agencywide funding source, as approved by HUD.
Appendix I

Objectives, Scope, and Methodology

Page 32 GAO-06-163 Housing for the Elderly and Persons with Disabilities

developments had been approved for sale but remained in the PIC system 

as part of a public housing agency’s current housing portfolio.

To assess the reliability of the data from the REAC database and the 

adjusted REAC data from the Urban Institute, we reviewed relevant 

documentation, interviewed knowledgeable officials, including contractors 

who worked with the database, and conducted electronic testing of the 

data, including frequency and distribution analyses. We determined the 

data to be sufficiently reliable to identify developments that were 

potentially distressed. However, we also asked housing agency directors to 

verify their physical inspection score that we obtained from REAC. We 

compared the updated data received through our survey with the data 

contained in REAC and found that in 6 of 62 cases, the two data points 

differed by more than 15 percent. A possible reason for these discrepancies 

is that REAC scores can be volatile based on the nature of the problems 

identified in the rating. For example, an updated REAC score that was 

markedly better than the previous one could have resulted from the 

remedying of easily fixable items. Had HUD possessed current PIC and 

REAC data on all developments, our first index may have identified some 

developments that were different from those identified in this report; this 

was the reason that we sought corroboration on these data through survey 

questions. We have noted these limitations in our report when appropriate.

We focused our analysis on housing “developments” because much of the 

available data were at the development rather than the individual building 

or unit level. (A development can be a collection of buildings, located near 

each other or scattered geographically, or an individual building.) As a 

result, our analysis does not necessarily include all public housing units 

that are occupied by elderly persons or non-elderly persons with 

disabilities, because such units may be located in developments that are 

occupied primarily by other types of residents.

To determine criteria for defining public housing as primarily occupied by 

elderly persons and non-elderly persons with disabilities, we consulted 

with officials from HUD and reviewed relevant studies. We decided to 

identify public housing developments as primarily those occupied by 

elderly persons or non-elderly persons with disabilities if they met the 

following criteria:

• There were at least 10 occupied units in the development; and
Appendix I

Objectives, Scope, and Methodology

Page 33 GAO-06-163 Housing for the Elderly and Persons with Disabilities

• 50 percent of head of households were elderly persons (aged 62 or 

older); or 50 percent of head of households were non-elderly persons 

with disabilities; or 80 percent of head of households were either elderly 

persons or non-elderly persons with disabilities.

Based on our analysis of PIC data, we categorized public housing 

developments as either (1) developments occupied primarily by elderly 

persons or non-elderly persons with disabilities if they met the above 

criteria, (2) family developments if they did not meet the above conditions, 

and (3) developments that were mostly family housing but contained 

buildings with a concentration of elderly persons or persons with 

disabilities.

To determine the criteria for a severely distressed development occupied 

primarily by elderly persons and non-elderly persons with disabilities, we 

interviewed HUD officials, knowledgeable individuals from social research 

organizations, and reviewed relevant laws and literature. To determine if 

HUD’s developments occupied by elderly persons or non-elderly persons 

with disabilities were severely distressed, we identified eight indicators of 

severe distress from the PIC and REAC systems and data from other 

sources. For each development we used (1) physical inspection score; (2) 

adjusted physical inspection score provided by the Urban Institute; (3) 

building age; (4) percent of units deemed accessible to persons with 

disabilities; (5) vacancy rate; (6) household income; (7) percent of 

population in census tract below poverty line; and (8) status of the 

development regarding application for HOPE VI funding or approval for 

demolition, disposition, or revitalization. For the “adjusted physical 

inspection score,” the Urban Institute edited HUD’s REAC physical 

inspection scores to avoid heavily penalizing developments for deficiencies 

that were easily correctable. For example, HUD deducts many points for 

inoperable smoke detectors, a serious but easily fixable problem. The 

Urban Institute deducted fewer points for these defects, so the “adjusted 

score” puts more weight on the soundness of the physical structures.

Although we used the eight indicators to identify potentially severely 

distressed developments, these indicators had some limitations. For 

example, we used a high vacancy rate as one indicator of severe distress. 

However, in some instances, a development had a high vacancy rate 

because some of the units were being taken out of the available housing 

stock for purposes such as redesign, but still were categorized in HUD’s 

database as available. Moreover, we used the age of the building as an 

indicator of physical distress. However, in some cases, we found that 
Appendix I

Objectives, Scope, and Methodology

Page 34 GAO-06-163 Housing for the Elderly and Persons with Disabilities

housing developments recently had undergone renovation. In these cases, 

building age was not a good indicator of physical distress.

For each development, we obtained data for each of the eight indicators of 

severe distress. We then examined the distributions of the data for each of 

the eight indicators, and scaled each indicator from 0 to 10. We then 

calculated a composite score for each development by computing an 

average for each development from their scores on the eight indicators. 

Based on the distribution of the composite scores, and judgment as to what 

constituted distress, we established a threshold score to indicate potential 

severe distress and potential moderate distress. We eliminated from the 

scoring developments that were missing data from three or more of the 

indicators.

From our analysis, we found a total of 11,935 developments in the 50 states 

and the District of Columbia that had at least 10 occupied units and data 

available on at least six of the eight indicators of distress. We determined 

that 3,537 of these developments met our criteria as “primarily occupied by 

elderly persons or non-elderly persons with disabilities.” Of these 3,537 

developments, we identified 76 developments (administered by 46 public 

housing agencies) that were potentially severely distressed. We conducted 

site visits to 25 of these developments, interviewed building managers, 

resident leaders, and local public housing agency officials, and observed 

the physical and social conditions at the sites. We selected housing 

agencies to visit based on factors such as diversity of size, geographic 

location, and number of potentially distressed developments.

We then surveyed the 46 public housing agencies that manage the 76 

potentially severely distressed developments to collect data describing 

their physical and social conditions. In developing the survey questions, we 

utilized our literature review on distressed public housing and the special 

needs of the elderly and non-elderly persons with disabilities, conducted 

interviews with representatives of advocacy organizations and professional 

associations interested in issues affecting the elderly and non-elderly 

persons with disabilities, and reviewed our field work conducted at several 

public housing developments. Through this research, we identified 

supportive services and housing features that are needs of the elderly and 

non-elderly persons with disabilities that reside in public housing and 

structured survey questions, accordingly. HUD staff located in the Office of 

Public and Indian Housing and the Office of Policy Programs and 

Legislative Initiatives reviewed the survey questionnaire and provided 

comments. Knowledgeable individuals from the National Association of 
Appendix I

Objectives, Scope, and Methodology

Page 35 GAO-06-163 Housing for the Elderly and Persons with Disabilities

Housing and Redevelopment Officials and the American Association of 

Service Coordinators also provided feedback on the survey. We pretested 

the survey with the directors of six housing agencies located in California, 

Connecticut, Hawaii, New Jersey, and Indiana. Lastly, four independent 

social scientists reviewed the survey for soundness.

We mailed the survey (questionnaire) to each public housing agency on 

June 10, 2005. In the survey, we asked the local housing agency to verify, 

update, or correct the data we obtained from HUD on percent of units that 

were occupied by elderly persons or non-elderly persons with disabilities 

and data on five of our eight indicators of distress. Questions covered the 

following topics: physical deterioration, systems requiring renovation or 

modernization, the neighborhood environment in which the development 

was located, accessibility features, access to social and public services, and 

actions to remedy housing challenges (see www.gao.gov/cgibin/getrpt?GAO-06-205SP for a copy of the survey). Each questionnaire 

contained a set of specific questions about the identified development and 

a set of general questions about public housing for the elderly and nonelderly persons with disabilities. In the 11 cases where the housing agency 

managed more than one of the identified 76 developments, respondents 

were asked to provide separate answers—in response to the specific 

questions—for each of the identified developments. For the 35 public 

housing agencies with one development, we also asked the local housing 

agencies whether they had other developments or buildings occupied 

primarily by elderly persons or non-elderly persons with disabilities that 

did not score above our distress threshold, but had conditions comparable 

to or worse than the developments we identified. In a few cases, public 

housing agencies indicated that they did have other developments 

comparable or worse than the ones we identified. This indicates that the 

eight indicators we used to identify potentially distressed developments did 

not always capture cases of potential distress in developments occupied 

primarily by elderly persons or non-elderly persons with disabilities.

Participants could return the questionnaire by mail or fax. To increase the 

response rate, we conducted three sets of follow-up telephone calls to 

offices that had not responded to our survey by the initial deadline. 

Collection of survey data ended on August 30, 2005. We had 43 housing 

agencies return the survey, providing a response rate of 93 percent, and 

representing 66 of the 76 developments. We did not attempt to verify the 

respondents’ answers against an independent source of information; 

however, we used two techniques to verify the reliability of questionnaire 

items. First, we used in-depth cognitive interviewing techniques to evaluate 
Appendix I

Objectives, Scope, and Methodology

Page 36 GAO-06-163 Housing for the Elderly and Persons with Disabilities

the answers of pretest participants. Interviewers judged that all the 

respondents’ answers to the questions were correct. Second, we compared 

some responses with observations made during site visits; again, observers 

concluded that responses to these items were correct.

The practical difficulties of conducting any survey may introduce certain 

types of errors, commonly referred to as nonsampling errors. For example, 

differences in how a particular question is interpreted, the sources of 

information available to respondents, or the types of people who do not 

respond can introduce unwanted variability into the survey results. Steps 

such as pretesting and follow-up contacts to increase response rates serve 

to minimize nonsampling errors. In addition, to further reduce errors, we 

performed statistical analyses to identify inconsistencies and used a 

second independent reviewer for the data analysis. We edited for 

consistency before the data were entered into an electronic database. All 

survey data were 100-percent verified, and a random sample of the surveys 

was further verified for completeness and accuracy. We analyzed responses 

to close-ended questions using statistical software. One analyst reviewed 

and categorized responses to open-ended questions, which was then 

independently verified by a second trained analyst. Because the 

developments selected for our survey were not based on a random sample, 

the results are not generalizable to all public housing for the elderly and 

non-elderly persons with disabilities. To identify the developments with the 

greatest indications of severe social or physical distress based on survey 

responses we developed “distress indexes.” See appendix II for more detail.

To examine the ways in which the stock of severely distressed public 

housing for the elderly and non-elderly persons with disabilities could be 

improved, we reviewed relevant laws and regulations, and reports by 

federal agencies and research organizations. We also interviewed residents 

of public housing and public housing agency directors. We analyzed the 

interview responses and developed a summary of the most frequently 

reported strategies. Finally, we included questions in our survey to the 

public housing agency directors that operate the 76 developments that we 

identified as potentially severely distressed. We analyzed the responses 

from the survey and developed a summary of the most frequently reported 

strategies (see www.gao.gov/cgi-bin/getrpt?GAO-06-205SP for a copy of the 

survey and aggregated results).

We conducted our work in Washington, D.C.; Miami and St. Petersburg, 

Florida; Homestead, New Castle, and Pittsburgh, Pennsylvania; Evansville, 

Indiana; St. Louis, Missouri; Seattle, Washington; and Oakland and San 
Appendix I

Objectives, Scope, and Methodology

Page 37 GAO-06-163 Housing for the Elderly and Persons with Disabilities

Francisco, California, between November 2004 and October 2005 in 

accordance with generally accepted government auditing standards.
Page 38 GAO-06-163 Housing for the Elderly and Persons with Disabilities

Appendix II

Technical Methodology ApendxiI

To identify the developments with the greatest indications of severe social 

or physical distress based on survey responses, we developed “distress 

indexes.” To create the indexes, we assigned points to individual survey 

questions based on their level of importance and impact on the quality of 

life for the elderly and non-elderly persons with disabilities. We used 

evidence from interviews with individuals knowledgeable of the housing 

needs of the elderly and non-elderly persons with disabilities to determine 

how to weight the questions. The nature of some topics, and thus the 

number of items about that topic, reflect the relative importance of that 

topic in determining distress. For example, we asked nine questions about 

which supportive services are available to residents, reflecting how 

significantly supportive services can affect conditions for residents of 

public housing.

We assigned points to survey response items that indicated conditions of 

physical or social distress, giving higher points to responses that indicated 

more distress and no points to responses that indicated little distress. For 

example, one of the survey questions asked about the extent to which the 

physical structures at the development were deteriorated. We assigned 20 

points to the physical distress index score if the respondent answered, 

“extremely deteriorated,” 15 points if the answer was “very deteriorated,” 

10 points if “somewhat deteriorated,” 5 points if “a little deteriorated,” and 

no points if the answer was “not at all deteriorated.”

We then summed the points for all questions for each development, which 

resulted in overall physical and social distress index scores. Each 

development could score up to 139 points on the physical distress index 

and up to 205 points on the social distress index. We analyzed the results 

for each of the 66 developments for which we had survey responses to 

determine the total scores for both physical and social distress. We 

determined that developments that had a score of 50 percent or more of the 

total points for either index had signs of severe physical or severe social 

distress. We were able to verify that a score of 50 percent or more indicated 

severe distress because we visited some of these developments and made 

detailed observations on their condition. See table 1 for the specific points 

assigned to each indicator of physical and social distress.
Appendix II

Technical Methodology

Page 39 GAO-06-163 Housing for the Elderly and Persons with Disabilities

Table 1: Point System and Indicators Used in Our Distress Index

Source: GAO.

Physical distress score Points Social distress score Points

How deteriorated is the building 20 Various services provided on-site 60

Various systems in need of renovation 42 Services available nearby 35

Accessibility issues for persons with disabilities 32 Availability of a service coordinator 20

Physical reasons for vacancies 20 Access to transportation 20

Estimated repair cost per unit 10 Crime indicators 30

Secure entrance 5 Graffiti 10

How well lit 5 Vacant homes/businesses nearby 10

Mold 5 Complaints about other residents 20

Total points 139 205
Page 40 GAO-06-163 Housing for the Elderly and Persons with Disabilities

Appendix III

Description of Site Visits to Two of HUD’s 

Innovative Models in Public Housing for the 

Elderly ApendxiI

We visited both the Homestead Apartments and Helen Sawyer Plaza 

developments and interviewed public housing agency officials and building 

managers. We also interviewed residents at the Homestead Apartments. 

The following describes in more detail the approaches used by the housing 

agencies to provide housing and services to its elderly residents at these 

developments.

Homestead 

Apartments

Housing Agency Actions Allegheny County housing agency officials successfully renovated the 

Homestead Apartments near Pittsburgh, Pennsylvania, and made 

improvements to provide supportive services. The housing agency chose to 

renovate the Homestead Apartments because of the high concentration of 

elderly residents and because two of Homestead’s high-rise buildings were 

the oldest buildings in the housing agency’s portfolio. To renovate the 

apartments at Homestead, the housing agency partnered with a private real 

estate development firm that specialized in residential housing and 

community development. The interior portions of each of the 

development’s four high-rise buildings were replaced, and the housing 

agency added or built updated features. As part of the renovation, the 

housing agency converted 350 units into 240 apartments, with twobedroom apartments and lounges added to every floor. Previously, the 

apartments were exceptionally small and had kitchen and bath 

configurations that would not accommodate persons with disabilities. 

Further, the housing agency reconfigured 5 percent of the units, and all of 

the laundry areas and lounges, to be accessible to persons with disabilities. 

To improve common areas of the development, the housing agency also 

installed large windows in the hallways to increase levels of natural light.

A primary goal of the Homestead revitalization was to provide enhanced 

supportive services to elderly residents, in particular frail elderly residents. 

The housing agency in Allegheny County surveyed Homestead residents to 

determine how best to provide services and based on their responses, 

developed three categories according to the level of care they needed. The 

first group included the “most frail” residents, who had medical or 

functional frailties. The second group consisted of “at-risk” residents, who 

may have needed occasional services. The third group was made up of 

residents who were healthy and rarely used any of the available services. 
Appendix III

Description of Site Visits to Two of HUD’s 

Innovative Models in Public Housing for the 

Elderly

Page 41 GAO-06-163 Housing for the Elderly and Persons with Disabilities

According to the health care staff at these facilities, residents typically 

progress through these three stages as they age.

The housing agency then partnered with several non-HUD entities to 

improve services for the elderly and colocate an assisted living type of 

facility at the development. To help the most frail elderly residents, the 

housing agency partnered with a nonprofit organization—Community LIFE 

(Living Independently for Elders)—which offers complete nursing 

services, meals, and physical therapy (see fig. 13) to Homestead residents 

who are enrolled in the program. The LIFE Center also has a beauty salon 

that enrollees can use once a month for free. These services are modeled 

after the Program of All-Inclusive Care for the Elderly (PACE).1

 For most 

participants, these comprehensive services permit them to continue living 

at home. Homestead residents represent about 40 percent of the LIFE 

Center’s enrollees. 

1

PACE is a program through the Center for Medicaid and Medicare Services. PACE is a 

managed care benefit for the frail elderly provided by a not-for-profit or public entity that 

features a comprehensive medical and social service delivery system. It uses a 

multidisciplinary team approach in an adult day health center supplemented by in-home and 

referral service in accordance with participants' needs.
Appendix III

Description of Site Visits to Two of HUD’s 

Innovative Models in Public Housing for the 

Elderly

Page 42 GAO-06-163 Housing for the Elderly and Persons with Disabilities

Figure 12: Physical Therapy Area at the Community LIFE Center

For at-risk residents, who do not require the level of care provided at the 

LIFE Center, the housing agency partnered with the University of 

Pittsburgh Medical Center (UPMC) to provide on-site services in the form 

of a walk-in wellness center. The services include blood pressure checks, 

glucose tests, assistance with medication, social service coordination, and 

space for visiting physicians. The UPMC facility also had two registered 

Source: GAO.
Appendix III

Description of Site Visits to Two of HUD’s 

Innovative Models in Public Housing for the 

Elderly

Page 43 GAO-06-163 Housing for the Elderly and Persons with Disabilities

nurses on staff. All Homestead residents are free to take advantage of the 

services offered at the UPMC facility, which is colocated at the 

development and easily accessible to residents. UPMC also operates an 

exercise room in the Homestead Apartments, which has become popular 

among residents.

Funding According to the housing agency officials at Allegheny County, the 

renovation and colocation of supportive services were made possible by an 

innovative coordination of efforts and use of mixed financing. 

Approximately 67 percent of the funding for the Homestead renovation was 

based on Low-Income Housing Tax Credits. Under this program, states are 

authorized to allocate federal tax credits as an incentive to the private 

sector to develop rental housing for low-income households. After the state 

allocates tax credits to developers, the developers typically offer the 

credits to private investors, who use the tax credits to offset taxes 

otherwise owed on their tax returns. Other funding sources included state 

and local grants, a federal loan, and a $2.5 million dollar HOPE VI grant. 

According to the Allegheny County officials, the award of the HOPE VI 

grant helped to ensure potential investors that the project was viable. In 

addition, the LIFE Center was developed during renovation, thereby 

facilitating the colocation of this supportive service. To maintain the LIFE 

Center over the long-term, the housing agency was able to offer an 

attractive low-cost lease to Community LIFE because the agency already 

owned the land on which the facility was built. In addition, residents who 

are enrolled in the LIFE Center are eligible for Medicare or Medicaid, so 

Community LIFE receives payment through those programs. Proceeds 

from the LIFE Center’s lease with the housing agency are used to fund 

UPMC services.

Helen Sawyer Plaza

Housing Agency Actions The Miami-Dade Housing Agency converted Helen Sawyer Plaza into an 

assisted living facility to enable elderly residents to “age in place” and avoid 

often costly institutional alternatives such as nursing homes. According to 

officials at Helen Sawyer, prior to conversion, the facility suffered from a 

high vacancy rate, and some of the building systems were outdated. Helen 

Sawyer residents now receive a variety of supportive services, which were 

made available as part of the assisted living conversion. For example, 
Appendix III

Description of Site Visits to Two of HUD’s 

Innovative Models in Public Housing for the 

Elderly

Page 44 GAO-06-163 Housing for the Elderly and Persons with Disabilities

residents receive 24-hour nursing care and three hot meals per day in the 

dining room. A hairdresser and manicurist visit the development twice 

weekly. The development offers 30 hours of activities weekly, including 

aerobics, dancing, cultural events, and arts and crafts. Residents also have 

access to door-to-door transportation and a weekly shuttle for grocery 

shopping. Staff on-site offer or coordinate other supportive services such 

as podiatry, assistance with taking prescribed medications, and adult day 

care. An additional benefit of the conversion is that married residents can 

continue to live together in their apartments, even when one spouse 

requires assisted living care.

To improve physical conditions at the eight-story Helen Sawyer Plaza, the 

building was modernized and apartments were made more spacious, which 

made the development more attractive to elderly residents. The 

development now has 104 apartments, including 83 studio apartments and 

21 one-bedroom apartments. The studio units are 450 square feet while the 

one-bedroom units are 600 square feet. Security features at the 

development include perimeter iron fencing with card-access entry and 

individual emergency alarm systems for each apartment. Amenities now 

include a lobby, public restrooms, commercial kitchen, resident dining 

room, and community room. The housing agency also added grab bars 

throughout common areas and made improvements to more easily 

accommodate wheelchairs or motorized scooters.
Appendix III

Description of Site Visits to Two of HUD’s 

Innovative Models in Public Housing for the 

Elderly

Page 45 GAO-06-163 Housing for the Elderly and Persons with Disabilities

Figure 13: Commercial Kitchen Space at Helen Sawyer Plaza

Funding Helen Sawyer Plaza’s conversion into an assisted living facility was a 

multiphase process that required coordination among several 

organizations. For example, the housing agency contracted with a 

consultant who had expertise on assisted living facilities, obtained HUD 

modernization funding, and borrowed money to rehabilitate the building, 

obtained a license from the State of Florida to operate as an assisted living 

facility, and petitioned the Florida Department of Elderly Affairs for a 

Medicaid Home and Community-Based Services waiver.2

 The waiver 

Source: GAO.

2

Section 1915(c) of the Social Security Act, codified at 42 U.S.C. § 1396n(c), authorizes the 

Secretary of Health and Human Services to, by waiver, provide Medicaid reimbursement for 

home or community-based services (other than room and board) where, but for the 

provision of such services, the individuals would require treatment in a nursing facility or an 

intermediate care facility for the mentally retarded, the cost of which could be reimbursed 

under the state Medicaid plan.
Appendix III

Description of Site Visits to Two of HUD’s 

Innovative Models in Public Housing for the 

Elderly

Page 46 GAO-06-163 Housing for the Elderly and Persons with Disabilities

essentially allows the housing agency to receive money from the state to 

cover the cost of caring for residents at Helen Sawyer. The Miami-Dade 

officials also pointed out that funding from Medicaid waivers can be an 

incentive to convert a public housing development to an assisted living 

facility. For example, 65 Helen Sawyer Plaza residents receive Medicaid 

waivers that reimburse up to $28 per day for services. The Miami-Dade 

Housing Agency also coordinated with the city of Miami and Dade County 

to revitalize abandoned buildings in the neighborhood and offer 

transportation service at Helen Sawyer Plaza.
Page 47 GAO-06-163 Housing for the Elderly and Persons with Disabilities

Appendix IV

GAO Contact and Staff Acknowledgments ApendxiIV

GAO Contact David G. Wood, (202) 512-8678 or woodd@gao.gov

Staff 

Acknowledgments

In addition to the contact named above, Paul Schmidt, Assistant Director; 

Isidro Gomez; Robert Marek; Alison Martin; Marc Molino; Don Porteous; 

Linda Rego; Barbara Roesmann; and Michelle Zapata made key 

contributions to this report.

(250206)
GAO’s Mission The Government Accountability Office, the audit, evaluation and 

investigative arm of Congress, exists to support Congress in meeting its 

constitutional responsibilities and to help improve the performance and 

accountability of the federal government for the American people. GAO 

examines the use of public funds; evaluates federal programs and policies; 

and provides analyses, recommendations, and other assistance to help 

Congress make informed oversight, policy, and funding decisions. GAO’s 

commitment to good government is reflected in its core values of 

accountability, integrity, and reliability.

Obtaining Copies of 

GAO Reports and 

Testimony

The fastest and easiest way to obtain copies of GAO documents at no cost 

is through GAO’s Web site (www.gao.gov). Each weekday, GAO posts 

newly released reports, testimony, and correspondence on its Web site. To 

have GAO e-mail you a list of newly posted products every afternoon, go to 

www.gao.gov and select “Subscribe to Updates.”

Order by Mail or Phone The first copy of each printed report is free. Additional copies are $2 each. 

A check or money order should be made out to the Superintendent of 

Documents. GAO also accepts VISA and Mastercard. Orders for 100 or 

more copies mailed to a single address are discounted 25 percent. Orders 

should be sent to:

U.S. Government Accountability Office

441 G Street NW, Room LM

Washington, D.C. 20548

To order by Phone: Voice: (202) 512-6000 

TDD: (202) 512-2537 

Fax: (202) 512-6061

To Report Fraud, 

Waste, and Abuse in 

Federal Programs

Contact:

Web site: www.gao.gov/fraudnet/fraudnet.htm

E-mail: fraudnet@gao.gov

Automated answering system: (800) 424-5454 or (202) 512-7470

Congressional 

Relations

Gloria Jarmon, Managing Director, JarmonG@gao.gov (202) 512-4400

U.S. Government Accountability Office, 441 G Street NW, Room 7125 

Washington, D.C. 20548

Public Affairs Paul Anderson, Managing Director, AndersonP1@gao.gov (202) 512-4800

U.S. Government Accountability Office, 441 G Street NW, Room 7149 

Washington, D.C. 20548