Linkage House: a case study highlighting the challenges and opportunities in linking housing and programs for older adults.

While it is a widely accepted goal that integration of housing and services optimizes successful aging in place, this has generally been difficult to achieve (American Association of Retired Persons, 1997). It is a complex endeavor due to a variety of factors, most notably separate housing and health and social service funding streams and administrative agencies. In this article Linkage House is used to illustrate the opportunities and challenges in developing enriched housing which promotes independence and successful "aging in place." The rationale, need, model, goals, and guiding principles are described. The partnership approach used to develop Linkage House is also highlighted. Challenges in implementing our model, comprised of housing and services, are outlined. Many of the programmatic initiatives have been undertaken by the sponsors for the first time in a housing setting, requiring constant reevaluation and refinement. Further, our partnership approach, while enriching the programs, has made implementation more complicated and time consuming. Since one aim of Linkage House is replication of the model, information about program development and "lessons learned" is being shared in forums such as meetings, presentations and publications. Linkage House Linkage House is a 70-unit building for lower-income older persons funded by a capital grant under the federal Department of Housing and Urban Development section 202 program and HUD operating subsidies and rental assistance. The sponsors of Linkage House are The Mount Sinai Medical Center, New York City and three community-based organizations-The Union Settlement Association, Greater Emmanuel Baptist Church, and the Community Association of the East Harlem Triangle. The name Linkage House reflects the shared vision of the sponsors: to link the residents with safe and affordable housing, to link residents to the community through a variety of programs, and to link the generations through intergenerational educational and recreational activities. The concept of Linkage House was driven by the philosophy that older people deserve to live in settings that promote a quality of life involving mutual exchange and support, opportunities for productive roles, and involvement in the life of the community and with people of all ages. Linkage House is designed to facilitate communal living and the formation of friendships and support networks, while maintaining residents' privacy. Based on a shared-housing model, it has been physically designed to promote helping networks by creating distinct clustered household living arrangements on each floor. Five one-bedroom apartments are grouped around each common area, intended to eliminate isolation and promote interaction and socialization among neighbors. Residents of Linkage House, through a series of meetings, have designated many of these rooms as theme rooms for functions such as games, sewing, and exercise. The two ground floor community rooms and library are for social, recreational, health education, intergenerational, and after-school programs. There are also two examination and consultation rooms on the ground floor for onsite medical programs. All of these common and program rooms are intended to promote group activities, social and health interventions, and programs that reach beyond the residence walls and link tenants with the larger community. There is also a garden in the back of the residence as well as a community garden across the street. Our model for Linkage House was designed to be flexible enough to meet the changing needs of residents as they grow older. Care coordination by a licensed onsite social worker provides residents with communitybased and in-home services as needed. Through this care coordination, on-site programs, and linkages with community health and social services, opportunities for aging in place are maximized. As described below, the initial cohort of residents who moved into Linkage House when it opened during the summer of 1997 had a higher level of social and medical needs than originally anticipated, so care coordination and program implementation were important from the outset. …