Public Housing: Distressed Conditions in Developments for the Elderly and Persons with Disabilities and Strategies Used for Improvement
Published: 2005-12-09T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: 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.
section_title: What GAO Found
paragraphs: 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: (1) eleven developments had signs of severe physical distress, such as deterioration of aging buildings and a lack of accessible features for persons with disabilities; (2) 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 (3) 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.

section_title: Letter
paragraphs: 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  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. 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. 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.  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  persons with disabilities and make recommendations for improving this  housing, considering the special needs of the elderly and non-elderly  persons with disabilities. 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.”
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.
subsections: section_title: Background
paragraphs: 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 with disabilities. 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. 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  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. 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.
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. 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  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.
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. 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  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).
section_title: While Comprehensive Data Are Lacking to Determine Extent of Severe Distress, Public Housing Directors Reported Adverse Social and Physical Conditions
paragraphs: 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.
subsections: section_title: HUD Maintains Limited Data about the Condition of Public Housing for the Elderly and Persons with Disabilities
paragraphs: 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.
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.  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.  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.
section_title: Relatively Few Developments Primarily Occupied by the Elderly and Non-Elderly Persons with Disabilities Appeared Potentially Severely Distressed
paragraphs: 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. As noted previously, we then  developed an “index of distress” to score conditions at public housing  developments. 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. 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   72 had a building that was more than 30 years old;  64 had few units (less than 5 percent) that met accessibility standards; 24 had a physical inspection score under 60 percent; 41 were in a census tract with a poverty rate greater than 35 percent;   26 had households with a total median income under $7,000.
section_title: Even If Not Severely Distressed, Public Housing Developments May Pose Problematic Living Conditions for the Elderly and Non-Elderly Persons with Disabilities
paragraphs: 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.
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).
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  spoke with said that high-rise buildings limit social interactions among  elderly residents.
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.)
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  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.
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.
subsections: section_title: Resident Mix
paragraphs: 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  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.”
section_title: Extent of Supportive Services
paragraphs: 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). 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. 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  director, of 21 residents who relocated from one of the public housing  developments during the 2004 calendar year, 6 moved into a nursing home.
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  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. 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. 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.
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). 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.
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).
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.
section_title: Various Strategies Could Improve Physical and Social Conditions at Public Housing for the Elderly and Non-Elderly Persons with Disabilities
paragraphs: 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.
subsections: section_title: Strategies to Improve Physical Conditions
paragraphs: 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  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.  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.
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.  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  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.
section_title: Strategies to Improve Social Conditions
paragraphs: 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. 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  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. 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. 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  used federal grants. 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. 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.
section_title: Observations
paragraphs: 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  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.
section_title: Agency Comments
paragraphs: 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.
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.
section_title: Objectives, Scope, and Methodology
paragraphs: 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. 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  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  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  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  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/cgi- bin/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 non- elderly 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  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  Francisco, California, between November 2004 and October 2005 in  accordance with generally accepted government auditing standards.
section_title: Technical Methodology
paragraphs: 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.
section_title: Description of Site Visits to Two of HUD’s Innovative Models in Public Housing for the Elderly
paragraphs: 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.
subsections: section_title: Homestead Apartments
subsections: section_title: Housing Agency Actions
paragraphs: 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 two- bedroom 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.
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). 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.
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  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.
section_title: Funding
paragraphs: 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.
section_title: Helen Sawyer Plaza
subsections: section_title: Housing Agency Actions
paragraphs: 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,  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.
section_title: Funding
paragraphs: 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. The waiver  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.
section_title: GAO Contact and Staff Acknowledgments
subsections: section_title: GAO Contact
section_title: Staff Acknowledgments
paragraphs: 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.