"Move or Suffer": Is Age-Segregation the New Norm for Older Americans Living Alone?

538118 research-article2014

JAGXXX10.1177/0733464814538118Journal of Applied GerontologyPortacolone and Halpern

Article

“Move or Suffer”: Is Age-Segregation the New Norm for Older Americans Living Alone?

Journal of Applied Gerontology 1–21 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0733464814538118 jag.sagepub.com

Elena Portacolone1 and Jodi Halpern2

Abstract Despite ethical claims that civic societies should foster intergenerational integration, age-segregation is a widespread yet understudied phenomenon. The purpose of this study was to understand the reasons that led communitydwelling older Americans to relocate into senior housing. Qualitative data were collected through participant observation and ethnographic interviews with 47 older adults living alone in San Francisco, California. Half of study participants lived in housing for seniors, the other half in conventional housing. Data were analyzed with standard qualitative methods. Findings illuminate the dynamics that favor age-segregation. Senior housing might be cheaper, safer, and offer more socializing opportunities than conventional housing. Yet, tenants of senior housing may also experience isolation, crime, and distress. Findings suggest that rather than individual preference, cultural, political, and economic factors inform the individual decision to relocate into age-segregated settings. Findings also call for an increased awareness on the ethical implications of societies increasingly segregated by age.

Manuscript received: September 20, 2013; final revision received: April 3, 2014; accepted: May 3, 2014. 1University 2University

of California, San Francisco, USA of California, Berkeley, USA

Corresponding Author: Elena Portacolone, Institute for Health and Aging, University of California, San Francisco, 3333 California Street, Suite 340, San Francisco, CA 94118, USA. Email: [email protected]

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Journal of Applied Gerontology

Keywords ageism, ethics, housing, independence, intergenerational relationships, relocation and transition, sociology of aging, urban sociology

The increasing spatial separation of community-dwelling older adults living alone from younger generations is an increasing yet understudied phenomenon. Perpetuated in institutions such as schools and often portrayed as a “natural” consequence of growing old, age-segregation—the separation of individuals according to their age—has received limited attention in aging studies (G. O. Hagestad & Uhlenberg, 2005; Vanderbeck, 2007). Numerous services for older adults reinforce the separation between old and young generations. Age-segregated programs for the elderly have often been exalted as opportunities to share the challenges of aging (Croucher, 2006; Hochschild, 1973; Lawrence & Schigelone, 2002). These celebrations run counter to claims that intergenerational integration is a defining trait of civic societies (Riley & Riley, 2000; Uhlenberg & Gierveld, 2004; Vanderbeck, 2007). Within this perspective, relationships between different age cohorts foster a sense of belonging to our community, as well as understanding and mutual respect of people of different age cohorts. Further studies suggest that generations benefit from mutual contact. For instance, the vigilance of communitydwelling older adults allows younger generations to play safely outdoors (Engwicht, 2005) and contact with younger generation improves elders’ health (Thang, 2001). Whereas the majority of community-dwelling older Americans occupy conventional households, 10% of them reside in age-restricted settings such as senior housing (Shafer, 2000). Financed by public and private funds, these buildings offer accommodation, in addition to a few limited services such as a community room and a supervised entrance. Residents of senior housing do not receive the supportive services that are available to residents of institutions such as nursing homes or assisted living facilities. Only individuals over a certain age—often 55 or 62 years—can relocate to senior housing. Older Americans living alone make up the majority of residents in senior housing for two reasons. First, living alone in older age is becoming increasingly popular (Jamieson & Simpson, 2013). Second, senior housing residents who live alone comprise those who moved alone as well as those that came with a partner and remained solo often following their partner’s death, institutionalization, or separation. As the number of solo dwellers in age-segregated settings increases, it is important to better understand this phenomenon. This is the first in-depth analysis of the composite dynamics behind the increasing segregation of older Americans living alone. This article reflects


Portacolone and Halpern

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on the reasons for moving (or resisting the move) to senior housing of 47 older adults aged 75 or above living alone in San Francisco. Its findings add depth to previous analyses of living alone in the United States (Klinenberg, 2012; Portacolone 2011, 2013, 2014; Rubinstein, 1986; Rubinstein, Kilbride, & Nagy, 1992) as it focuses on the processes supporting age-segregation among community-dwelling older Americans. Although the small sample does not allow sweeping generalizations, this ethnographic study reflects on the reasons behind the choice of living in age-segregated settings such as senior housing in urban America. Qualitative research (QR) methods are particularly critical to fill the existing gap in knowledge, given their ability to elicit personal perspectives, as well as their capacity to study the influence of social policies in the lived experience of the subject studied. For these reasons, this study relies on the micro/subjective, meso/institutional, and macro/ideological lens of analysis (G. Hagestad & Dannefer, 2001; Lennox Kail, Quadagno, & Reid Keene, 2008; Silverstein & Giarrusso, 2011). This conceptual framework adds depth to the study, thanks to the examination of the influence of social policies and prevailing ideologies—circumstances that participants often take for granted or consider unalterable.

Method Study Design The study used a qualitative design to collect and analyze information. Its original aim was to describe the condition of living alone for a diverse sample of adults over age 75 living alone. Living alone was defined as living without a cohabitant in a non-institutional setting. Whereas the topic of age-segregation was not included in the original aim, study participants often discussed at length the reasons behind moving in senior housing or remaining in conventional housing, as well as the advantages and disadvantages of these settings. Data were collected through ethnographic interviews and participant observation. Ethnographic interviews are a well-documented (Briggs, 1986; Skinner, 2012; Spradley, 1979) interview style recommended for projects that explore new areas of inquiry and focus on subjective experiences. In these projects, interviewers must be able to develop rapport, a sense of trust with interviewees. To develop trust, the first author carefully used as much as possible the same words used by participants, and she reinstated what she heard to show her interest in learning from them. To ease the expression of


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thoughts that are usually kept unsaid, she skillfully used silences at the end of participants’ sentences. Participant observation, the second method of data collection, is a foundational mode of inquiry in QR (Creswell, 1998; Fetterman, 1989). During observation, researchers become increasingly attuned to the lived experience of their subjects through questions, observations, as well as potential participation in activities performed by them. In this mode, researchers use their experience in relation to the studied population as part of the data (Rubinstein, 1992). As researchers participate in the observations, they also take careful note of subjects’ appearance and behavior as well as their environment.

Procedures and Participants The study was conducted in two phases. To become acquainted with different settings, the first author conducted participant observation as a volunteer for Meals-on-Wheels, a program that delivers meals to older adults. In 2009, she helped deliver meals to 89 older adults, mostly living alone. To protect the privacy of its clients, the management of Meals-on-Wheels asked the first author not to recruit any study participants when delivering meals. She also interviewed 16 officials of local agencies serving older adults. Afterward, multiple recruitment techniques facilitated the recruitment of a culturally diverse sample. First, flyers written in English, Spanish, Japanese, Cantonese, and Russian were hung by the first author in public spaces, shops, senior centers, and meal sites. Second, advertisements were posted in classified advertisements websites and local papers. Third, presentations were given to seniors’ meal sites. Fourth, social workers, officers of in-home care agencies, and city planners assisted with recruitment by spreading advertisements of the study to potential participants. Finally, the first author asked participants to connect her with other subjects, a technique called snow-ball sampling. In general, participants were not promised any compensation. Table 1 below provides more information on the study participants. Table 1. Gender, Ethno-Racial Background, and Type of Residence of Participants.

Conventional housing Building for seniors Total %

Total

Male

Female

White

Asian

Black

Latino

24 23 47 100

7 9 16 34

17 14 31 66

15 11 26 55

2 9 11 23

5 2 7 15

2 1 3 6



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Most interviews occurred in participants’ homes. Interviews were audiorecorded. During the encounter, the investigator engaged in activities spontaneously suggested by participants such as drinking, watching TV, or looking at pictures. To capture her fresh observations, the first author typed her field notes soon after leaving the premises. Thirty participants were interviewed once, whereas 17 participants were interviewed several times to gain new insights or when the information gathered the first time around was considered partial.

Data Analyses The first author started the process of data analysis as soon as the transcripts and fieldnotes were created. Data were uploaded into the Atlas-Ti software. In QR, data collection and analysis usually inform one another (Corbin & Strauss, 2008). At first, the researcher became familiar with the data. From the beginning, the first author organized data assigning codes to portion of texts with the intention of understanding the factors that facilitated or hampered relocation to an age-segregated setting and the advantages and disadvantages of these settings. In this standard process of QR (Strauss, 1987), the text of transcripts and fieldnotes is analyzed line by line. A code was created every time a particular item needed to be identified. In the first phase, coding was basic. Then, at the end of data collection, once the first author analyzed and reflected on all the data, more sophisticated codes were created (Luborsky, 1994). In this phase, the primary author associated codes to the micro, or meso, or macro levels of analysis for instance. Also, in this phase, she refined themes emerging from the data, themes defined as “general propositions that emerge from diverse and detail-rich experiences of participants and provide recurrent and unifying ideas regarding the subject of inquiry” (Bradley, Curry, & Devers, 2007, p.1776). The affordability of senior housing is an example of a theme. The process was iterative and ended once new themes and codes stopped emerging. With regard to rigor (Kirk & Miller, 1986; Sandelowski, 1986), three means validated data. First of all, the sample of the proposed study was large enough to allow data saturation (Corbin & Strauss, 2008)—a point where researchers start noticing similar patterns in data collection and analysis. In QR, this phenomenon points to the validity of the data. Rather than the quantity of participants, theoretical samples are based on the expected heterogeneity within the sample and the number of interviews needed to reach data saturation. Second, the first author made note of cases of participants that were particularly articulate, and therefore capable to bias the findings because of their oral sophistication (Miles & Huberman, 1984). Finally, during data collection, the first author sought evidence disconfirming her findings (Kuzel


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& Like, 1992). For example, she asked when exceptions to a given pattern occurred and why. This standard technique in QR allows researchers to test the strength of observed patterns.

Findings Findings revealed the multiplicity of factors that influenced the relocation, or the resistance to the relocation, to senior housing. At a micro/subjective level of analysis, the affordability of these settings, as well as their conviviality and amenities often magnetized potential tenants. The relative advantages of these settings at the micro level are emphasized by the case study of a woman who resisted age-segregation. Her trajectory suggests that living in older age in conventional housing can aggravate isolation. Once we shift the lens of analysis beyond the micro level, yet more dynamics appear to influence the relocation. At the meso-institutional level of analysis, the prohibitive costs of real estate and the limited services available for older residents of conventional housing facilitated the move. At a macro-ideological level, ageism and the emphasis on individual responsibility further contributed to the appeal of segregation.

Resistance to Age-Segregation: A Case Study To better understand the reasons behind the relocation to senior housing or other age-segregated settings, it matters to consider that living alone in older age in urban America is often a difficult enterprise, as older solo dwellers manage their household at a time in their life when most resources may be limited or declining (Portacolone, 2013, 2014). Whereas a comprehensive analysis of living alone in conventional housing is outside the scope of this article, the case study of 81-year-old Michelle sheds some insight on the experience of older adults resisting the move toward agesegregation. Her case clearly illustrates the interplay of dynamics at the subjective/micro level, the institutional/meso level, as well as at the macro/ ideological level. In the last two decades, Michelle has occupied a tiny apartment perched on the top of a two-story house. A former secretary, Michelle qualifies for public benefits, given that her income is very low. Following her social worker’s invitation to move into senior housing, Michelle visited a senior housing residence. The social worker’s initiative to find a unit for Michelle is an example of institutional forces at meso level encouraging segregation by age. Michelle’s visit of her unit made her appreciate her home even more. In her words,



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I have more sun than most people, I have noticed, and more view. I like that. I would miss that if I moved. These places I looked at, they were apartment buildings. You go down a long corridor with all these doors [laughter] and then you get into a dark place. [ . . . ] It’s a little depressing, it seems to me. And usually in those [buildings] they are either disabled or elderly people I think, and that’s also a little depressing. [ . . . ] This may sound a little selfish, but I prefer to be with younger people, younger and healthy people, you know. That sort of gives me a little lift. I have a tendency to get depressed when I’m with older people or people who are sick.

As a result, Michelle decided to remain in her apartment. Her resistance to move into an age-segregated setting stems from her preference to enjoy the company of younger people, as well as her location. At a micro level, for Michelle, the opportunity to interact with different generations and the familiarity and light of her apartment are very important. Interestingly, Michelle interprets her desire to interact with younger generations as “selfish.” At the macro level of analysis, her interpretation suggests that moving into agesegregated settings can be interpreted as “good” or “proper” behavior. In the last three years of observation, Michelle did enjoy the sunlight in her one-bedroom apartment. However, her idea of spending time with younger generations seldom materialized. Often she asked the first author what strategies she should use to make new friends as the few old ones either died or relocated. With the passing of the years, her wish to be connected with the community around her becomes less feasible, as her memory falters, and her energy to negotiate two flights of narrow stairs wanes. Conversations with her are also getting more difficult as her hearing worsens. While her old hearing aids are too uncomfortable to wear, new and better ones are too expensive to consider. Her only constant companion is her public home care aide with whom she entertains a conflictual relationship. Sometimes she receives visits from a volunteer from a local non-profit, visits supplemented by the occasional stopovers of the first author. Michelle spends most of her time alone, sleeping in the afternoon or watching TV in her bedroom, an assemblage of secondhand furniture surrounding a single mattress lying on the bare floor. The rest of the time she sits around a cluttered table next to the window—a rusty fridge humming nearby, open shelves with brown-paper boxes against the wall, and the window with the sunny view of the hills warming her back. Once she joked, “I don’t know if I am bored because I am boring or boring because I am bored.” Michelle exemplifies some of the consequences of resisting the move toward age-segregation when one lives alone in older age in urban America. Aging alone can become so alienating as to make age-segregation an attractive alternative. As the next section will discuss, living in senior housing can be less isolating and distressful than aging alone in the community.


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Advantages of Age-Segregation at a Subjective/Micro Level of Analysis From a personal perspective, living alone in senior housing is often appealing. As this section illustrates, one can find company and services, feel safe, and even save money by residing in these buildings. Company. Living in a building for seniors may spark camaraderie. A sense of community may develop from meaningful interactions. This contact may even question the idea of living alone, as a resident of a building for seniors, 78-year-old Sylvia observes as follows: You’re not actually living alone because it’s a building—I think there are 120, 121 people or so—so there’s always something going on and somebody’s around, so if you feel like talking there’s always somebody that you can talk to. So it’s not actually like you’re alone. Because I don’t really feel that way.

In her building, tenants often gather in the community room for dinners. Sometimes a retired chef who moved there even throws dinners in her apartment. Tenants also organized a library and often watch movies together. Other participants share similar experiences. “We’re really trying to get along,” says Carmen. She moved from a conventional unit to a building for seniors under invitation of her partner who already moved there. Living in conventional housing for Carmen meant to live nearby people just “waiting to get a better place.” She adds, “I never hardly knew my neighbors. There wasn’t the community room. There wasn’t an area where we could meet. There wasn’t anything to bring us together. [ . . . ] There wasn’t any feeling of commitment, or continuity.” Even though it is “very hard” not to have children around, a sense of continuity derives from her awareness that tenants are “committed” to remain in the building: “It is more important for me to have this kind of place where I am with people who are dealing with the same thing in their lives.” Similarly, in another senior building, Rebekah, an 88-year old immigrant from Belarus, tells that she enjoys having a place of her own in a building kept very clean. She then proudly shows a picture of her dressed up for a dinner in the community room. These accounts resonate with literature (Dupuis-Blanchard, Neufeld, & Strang, 2009; Lawrence & Schigelone, 2002) exalting the togetherness from “being in the same boat” with persons of the same age cohort. Yet this conviviality does not apply to everyone. For one, isolation endures in age-segregated settings as well. Older adults living alone in senior housing sometimes shun contact with other tenants because of different languages, suspicion of



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others, mental disorders, or unwillingness to display vulnerabilities. For example, a constant fear that people are after his money isolated 89-year-old Leo from other tenants. Troy, a 77-year old divorcee, stopped visiting the community room after a stroke. A fine dancer, he feels too uncomfortable nearby the dance floor. He explains, It is not only about being out there. It is about being out there and really do your craft. I can’t do that anymore. [ . . . ] All the ladies want to dance with me [giggles] when I go down there. So you know, it’s just the way it is. So I don’t. I don’t really get bothered by it.

Relief. Living in an apartment for seniors can relieve some of the pressure of aging alone in the community. For one, the closed gates of these buildings shield older adults from crime. This is more visible in poor neighborhoods. Marco, an 83-year-old Filipino resident of a building for seniors, explains how important it is to have an iron fence around his building and a reserved parking area for drop-offs in front of the gate. Inside the buildings, long corridors often allow residents to get some exercise. Some buildings even offer stationary bicycles in their lobbies. Walking inside can be easier than negotiating steep pavements regularly battered by wind. In some buildings, activity managers organize gatherings; social workers can point to resources available. Also, logistically, because it is easier to provide services to older adults concentrated in one location, residents of senior buildings are likely to receive more services than those living in conventional housing. For instance, the food bank can serve several seniors in a single stop. On a subtler level, senior buildings often shield older adults from the eyes of younger generations. This particularly matters to older adults living alone in conventional housing as they often think that they have to prove to landlords, neighbors, and family members that they can still “make it” on their own (Portacolone, 2011; Smith, Braunack-Mayer, Wittert, & Warin, 2007). As a consequence, living in agesegregated settings relieves part of this pressure. On the other hand, residents of senior housing often come under the gaze of administrators. Troy joked that once the building manager threatened to check under his bed to verify that he did not hide another tenant. Some administrators of senior buildings may be reluctant to have tenants that may be dangerous to themselves or others. For example, Mark, the son of 80-year-old Anne, explained that his mother prefers staying put in her cluttered studio in a senior building as she did not want to show that she tends to get lost more easily than in the past. Other accounts question the idea that living in age-segregated settings shields solo dwellers from crime. For instance, during a sudden hospitalization, Troy left his home care aide alone in his studio. As a result, she gained


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access to his banking documents. He says, “I get this statement from the bank, and I see all this money that had been charged to my account—six, seven hundred dollars, or more.” These accounts suggest that the advantages of living in age-segregated settings are partial and very much dependent on the character of administrators and home care aides. Affordability. An important reason that led to relocations to age-segregated settings is that apartments in buildings for seniors are usually more affordable than conventional units. In addition, apartments eligible for subsidized rent under Section 8 are usually easier to find in buildings for seniors. Subsidized rent is one of the most important benefits to very low-income older Americans living alone. In San Francisco, to have a better chance to qualify for Section 8, a one-person household annual income should be less than $23,750 per year.. Cynthia’s subsidized rent allows her to say: “I don’t have to worry about anything, you know. My rent is reasonable here; I pay about 200 a month.” For some older solo dwellers like Troy, subsidized rent is the only way to live in an apartment. As other older adults living alone, Troy lived in a hotel room until he managed to find an apartment with subsidized rent in a building for seniors. Subsidized rent is easier to find in senior buildings for three reasons. First, conventional units often do not qualify for Section 8 because their rent exceeds the ceiling placed on the rent for Section 8 units. Second, administrators of senior developments are more familiar with the administrative part of Section 8, whereas private landlords may rather avoid the bureaucratic procedures associated with the benefit. Finally, some developments for seniors may have apartments eligible for subsidized rent under Section 8 even if one does not have the voucher that is usually necessary to access this benefit.

Dynamics Behind Individual Choices As the previous section illustrated, moving into age-segregated settings can relieve some of the pressure of living in the community. On the surface, older solo dwellers have the choice to either stay in the community or move into age-segregated settings. However, at a closer look, political, economic, and cultural dynamics further influence the transition. Real estate. A first dynamic often beyond older solo dwellers’ control derives from the often-astronomic prices of living in conventional housing, especially in cities such as San Francisco or New York. In the last six years, San Francisco surpassed New York as the American city with the highest income gap between rich and poor residents. The average income of richest households



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reached $291,000, whereas $11,000 was the average income of poorest households (Steinmetz, 2014). The presence of affluent residents, primarily employees from high-tech companies based in Silicon Valley, has boosted the local economy. This dynamic also led to the gentrification of low-income neighborhoods and the steep increase in housing prices. No wonder that in 2014, San Francisco reported an increase in rent prices three times higher than then national average with one bedrooms in upscale neighborhoods renting at almost $3,000 a month (Erwert, 2014). In this context, San Franciscan renters are more vulnerable than homeowners (Wallace & Smith, 2009). Even though homeowners may have to face expensive maintenance work, they can capitalize on the increased value of their property and are protected by significant rent increases. Also, the state of California protects longtime owners through a local policy (Proposition 13) that limits property taxes. Renters, on the other hand, are directly affected by the fluctuations in rent prices. This dynamic is concerning as older renters who live alone are indicated as a population extremely likely to struggle to make ends meet (Wallace & Smith, 2009). The policy of rent control only partially protects older renters living alone from the increases. Through this local policy, landlords can rise the rent by a fixed percentage (usually 2%) every year. The policy of rent control, combined with strict rules on eviction, is in place to protect tenants. As 75-year-old Pierre, a former accountant, explains, “I’m very lucky that I have rent control, even though the owner of the building hates me, and would love to get rid of me, I’m not going anywhere.” San Franciscan landlords are often ready to replace older tenants who have occupied the same apartment for decades with executives working in the remunerative high-tech sector burgeoning in the Bay Area of San Francisco. As a result, landlords may try to evict older tenants, as in the case of James, a lanky 78-year-old veteran who successfully fought a notice of eviction. Aware that the relatives of his 90-year-old landlady may become more combative after his landlady dies, he banters, “If I live that long, I might not even have a house.” The pressure to avoid eviction is evident in the curriculum of the “Senior Survival School,” a series of five sessions organized by a local non-profit to teach older San Franciscans about their rights. The morning the first author attends a session, to make sure that all attendees digest the lesson, we receive an assignment to be performed with the student next to us: “I have problems with my landlord; he is getting old and wants me out.” Everyone has ten minutes to formulate strategies to fight an impending eviction. The student sitting next to the first author, an Indonesian man, tells her that the main tactic is to “go to the Rent Board, file a petition against the landlord, and ask for a hearing.” As we strategize, the speaker galvanizes us with the mantra: “You have rights: you have muscles. You need to exercise muscles: you have to exercise your rights!”


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However, for older adults living alone, being combative about their right to age in place is not easy. The case of 89-year old Cheryl illustrates the subtle dynamics that led to her relocation to senior housing. Cheryl has lived alone in the same building for more than 40 years. When she meets the first author, she complains that the maintenance of her apartment and common areas has worsened. Lately, her landlady neglected Cheryl’s requests for a new carpet, a toilet seat that does not wiggle, and the installation of banisters along the walls. Cheryl observes: She [the landlady] don’t [sic] want to do anything for me, because she thinks I’m not paying as much as the rest of them [other tenants] are paying. [ . . . ] Because the other people come here, they pay more than I do, because when they come in, they come in at a different rate from what I did. And then the raises . . .

Cheryl’s neighborhood is gradually catering to a wealthier population. As neighborhoods become more upscale, landlords are free to ask higher rents from wealthier and transient tenants. With reluctance, Cheryl gradually set her mind to move into a senior development under invitation of her social worker. Like Michelle, earlier on she refused the chance of relocating in an age-segregated building. She recalls, They called it a studio. But it’s just like this. You got the kitchen and then you got your bed and everything. Everybody walk in [sic], they’re looking right at the whole place, you know. And I didn’t want that.

However, over the years, Cheryl finds it harder to negotiate four flights of stairs. At night, she worries about the chores she cannot do any longer. Repainting the walls is impossible because of her arthritis; her last boyfriend who did most of the maintenance died not long ago. The turning point is her landlady’s behavior: “It is so dirty!” Cheryl repeats of the carpet in the stairway. The landlady also does not comply with regulations, such as providing banisters on each side of the stairway: “she’s supposed to have two, but she doesn’t have but one. I can’t get too much out of her.” As a result, an unstable toilet seat and a decade-old carpet are not replaced; the walls get dirtier from the kitchen fan. Cheryl cannot pay someone to upkeep her place: “It takes too much money.” As a result, “Either I move or stay here. And suffer [chuckle]. I can take my choice. Yeah, move or suffer.” Eventually, Cheryl left the building and moved in a senior development. Cheryl’s account shows that the move into age-segregated buildings can be influenced by the “competition among groups for scarce and valuable locations”—the foundation of the ecological model of spatial segregation



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(Lagory, Ward, & Juravich, 1980, p. 60). According to this model, the ability to pay often determines one’s location especially in areas where real-estate prices have dramatically increased. The process is amplified in areas with a majority of renters, which makes the process more fluid. This dynamic is evident in San Francisco, where more than 60% of residents rent in a very limited and attractive geographical area and where 40% of households are occupied by solo dwellers of any age. As a result, older adults living alone may be forced to relocate into senior developments for their inability to financially compete for the limited spatial resources available. Limited financial resources constrain the choices available to this population (Lehning, Smith, & Dunkle, 2013). Limited services. Limited services are available to allow older adults living alone to remain in their homes as they age. As Medicare, the public health insurance for Americans over 65, does not cover long-term care services, the majority of older adults living alone are not eligible for public home care aides. In the United States, these services are available for free to individuals with scarce resources (less than $2,000 in their bank account for single householders) through Medicaid, the health insurance program for very indigent Americans. As a result, most older solo dwellers with more than $2,000 cannot afford the high prices of private home care aides, which often leaves them in a precarious situation (Portacolone, 2013, 2014). In addition to limited access to public home care aides, as already mentioned earlier, subsidized rent under Section 8 is hard to obtain—especially for older adults living alone in conventional housing. Because of all these factors, social workers often recommend and assist older adults living alone to transition to age-segregated settings. Ageism. Yet another force at play is ageism (G. O. Hagestad & Uhlenberg, 2005; McHugh, 2003; Vanderbeck, 2007). On one side, age-segregation contributes to ageism as older adults become less visible and younger generations lose sense of the challenges faced by their elders (Uhlenberg & Gierveld, 2004). Besides, by moving into separated buildings, older adults may internalize and comply with the idea of being not strong enough or even unworthy to reside in the community. On the other side, ageism contributes to age-segregation as ageist attitudes and policies tend to separate older generations from younger ones (Estes, 1979). We are segregated when we are set apart from something else. Ageism disregards the role of older generations in the development of their younger counterparts, as well as contributions of older adults to their community. Under this framework, the increasing number of older adults becomes a


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burden to society in terms of public benefits, health care services, and space (Walker, 2000). As space becomes more limited, age-segregation becomes a means to contain and manage a growing mass of older adults aging alone. Almost half a century ago, Clark (1971) coined the term “geriatric ghettos” to denounce the practice of isolating elders in specific spaces. Individualization. Finally, the advantages of age-segregated settings are intensified by the prevailing emphasis on one’s responsibility to take care of oneself, what Beck calls “individualization” (Beck & Beck-Gernsheim, 2002). Within this frame, individuals feel compelled to “make themselves the center of their own planning and conduct of life” (Beck, 1992, p. 88). As a result, individuals expect less from public institutions and feel in charge of controlling and shaping their own destiny through their own choices (Beck & BeckGernsheim, 1995, 2002; Dannefer, 2000; Laliberte Rudman, 2006). Within this frame, moving into an age-segregated setting can be interpreted as a moral undertaking. As Michelle notes, her desire to interact with younger generations and enjoy the sun from her windows becomes an act of selfishness as she resists the pull of age-segregation. To conclude, the analysis of the interplay of forces promoting the move toward age-segregated settings suggests that the apparent attractiveness of senior housing mostly derives from dynamics that are beyond the control of older Americans living alone. As the findings illustrate, the relocation into senior housing may foster new relationships and a sense of security. Living in senior housing is often more affordable than renting an apartment in conventional housing. Also, one may receive more services by living in a building with other older adults. Yet, findings on the dynamics behind individual choices hint that these advantages mostly derive from meso and macro processes. These processes make living in conventional housing an arduous enterprise for many older Americans living alone, especially those with limited resources. At a meso level, the increasing competition for housing contributes to community-dwelling older adults moving into senior developments. The presence of limited and scattered services available to residents of conventional housing induces social workers to invite older solo dwellers like Michelle to relocate into senior buildings. On a macro level, the combination of prevailing ageism and emphasis on individual responsibility transforms the relocation into senior housing as a moral and responsible undertaking.

Discussion This study questions age-segregation as a natural process. This study argues that the seeming advantages of this process mostly derive from the fact that Downloaded from jag.sagepub.com at UNIVERSITE LAVAL on November 14, 2015


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living alone in conventional housing in urban America is a difficult enterprise for many older adults. As urban space becomes more compressed and expensive, we need to be wary of urban dynamics that exacerbate inequalities (Blocklan & Savage, 2008; Soja, 2010). The fiercer the competition for space, the higher the occurrence of age-segregation (Lagory et al., 1980): “The tension here is between the social needs of older people, as an increasing important constituent of urban population, and the pressure on public space arising from private ownership” (Phillipson, 2011, p. 288). Although many individuals might live well in segregated housing, the meso and macro processes forcing this to be the only livable choice raise ethical concerns, especially regarding justice. The most fundamental aim of justice is treating people with equal regard. There are competing views of why we need to treat each other with equal regard. One view is that of self-interested reciprocity. This is the view that we take care of others because they will reciprocate to meet our needs. A competing view is that of subject-centered justice. This is the view that we owe people equal regard simply because they are human beings, like ourselves, regardless of their capacity to reciprocate (A. Buchanan, 1990). The ethics of segregated housing looks different depending on which of the views our society truly holds. First, regarding resources, both real-estate dominance by the well-off and a paucity of available services for elders living alone raise questions of fairness or distributive justice. It seems unfair to ask older adults to choose between security/affordability and full inclusion in society including living near younger generations. However, given that we live in a society where economic stratification dictates so much inequality already, and given that many older adults are comfortable with segregated housing, how much priority should society put on investing in affordable intergenerational housing? If the basis of treating people with equal regard is self-interested reciprocity, then the answer to this question will depend on how integrated housing might help elders reciprocate. If elders can do childcare or other needed tasks, then they would have a claim on such housing. Those who can do little would have a lesser claim. On the other hand, if the basis of treating people with equal regard is subject-centered justice, then the answer to this question will depend on how much intergenerational housing improves the quality of life of older adults, independently from their contribution. Second, regarding ageism, before we even consider distributing resources, we make assumptions about who we include or exclude in the first place. Ageism, like racism and sexism, regards the target population (elders) as less than full persons, and thus as not really meriting inclusion. Again, it is not the presence of optional segregated housing, but the forced choice out of quality intergenerational housing, that indicates less-than-equal regard. Society’s


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tolerance of the ghettoization of the elderly implies wanting them out of sight or at least not seeing their presence as essential for the rest of us. How one counters ageism will differ depending on which conception of regard for persons one holds. If self-interested reciprocity is the basis of regard, then evidence of elders’ ongoing contributions will engender more respect. This seems to be the prevalent argument for the value of the elderly in American popular culture (Martison and Halpern, 2011). The problem with this view is that elders of lesser social status, those who have done less visible work (mothers and housewives), or who have labored so much that they prefer to spend their senior years being rather than doing (blue-collar workers), lose their social value. They can be excluded. In contrast, if the basis of inclusion is subject-centered justice, then all elders are included in the social “we.” Their worth to the rest of us is not just an abstract fact, but quite concrete— we would view elders as having accrued life experiences and often wisdom. Perhaps even more importantly, we would experience the emotional value of intergenerational living as constitutive of fully human lives. Note that this same shift in perspective also counters the trend toward radical individualism that makes older adults feel that they only present burdens to their younger counterparts. It is probably clear by now that for vulnerable populations like the elderly, the subject-centered view is preferable; however, this view is not the solution to all ethical dilemmas surrounding segregated housing. Seeking inclusion still does not solve issues regarding whose needs are prioritized. Buchanan, Brocks, Daniels, and Wikler (2000) give this example: If there are only enough resources for one card game, is it fair for adults to play bridge and exclude children or must they play simpler games? Of course, this example immediately makes one want to challenge the premise, why should there be only one card game? Which returns us to where we started. We need innovative social policies that can expand the pie so that elders are not pitted against younger generations. In future research, the critical analysis of the numerous repercussions of age-segregation should be at the forefront of life-course studies. Rather than treating senior housing as a given or as a living arrangement to be “encouraged” (Huang, 2012), scholars should evaluate the reasons behind its acceptance, if not celebration. More research is also needed on factors that led to relocation. Whereas poor health conditions may facilitate relocation (Stoeckel & Porell, 2010), the role of financial resources and access to services in the community, as well as ethnic/racial background deserves more attention. As the first senior housing facilities for lesbian, gay, bisexual and transgender (LGBT) older adults are built (Adelman, 2014; Wildermuth, 2013), research is needed on the lived experience of its residents that relocate in age- and sexualorientation- segregated settings. In regard to senior housing, researchers



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should accurately track the demographics of adults who reside in these developments — even though these data are often difficult to access given that residents of senior housing are hard to distinguish from residents of conventional housing in databases such as the American Census. However difficult it may be, this research is critical because the knowledge on the magnitude of this increasing form of age-segregation is limited. Studies have highlighted the increase of age-segregation at neighborhood level (Cowgill, 1978; Winkler, 2013). However, their design did not allow the assessment of the numbers of individuals residing and relocating in senior housing. Tracking this number over a period of time is important as it can inform us to the many obstacles faced by community-dwelling older adults to age in place. Research is also needed to evaluate the political and economic mechanisms that channel financial resources to age-segregated buildings versus benefits that allow individuals to remain in conventional housing. We also need to further understand and compare the lived experience of residents of public and private senior housing. In the United States, more research is needed on the consequences of having low-income people with disabilities and persons with substance abuse relocating into senior housing, especially in neighborhoods with high crime. In addition, programs to adapt the environment around the needs of the elderly need to be conscious of the dynamics behind age-segregated settings. This especially applies to the “Age-friendly Cities and Communities” initiative of the World Health Organization (2007). Finally, on a broader level, research is needed to consider the overall implications of a society increasingly segregated by age. Studies on the esprit de corps of segregated older adults should also question and examine the external conditions that created the emergence of this camaraderie. Furthermore, interdisciplinary research questions include the following: Would age-segregation still exist if aging in conventional housing were overall easier? Looking at the future, what kind of values can be transmitted in a society increasingly segregated by age? What kind of relations younger generations can create with older adults spatially separated from them? Finally, is it ethical to sustain, promote, and celebrate the spatial segregation of older adults? More research is urgently needed on these topics. Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Sigma Xi, the White Fellowship of the


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University of California Humanities Institute, the Virginia Olesen Fellowship, the Andrew Scholarship Funds, the Carroll Estes Fellowship, the Lesbian Health Fund, and the Graduate Dean’s Health Science Award of the University of California in San Francisco.

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Author Biographies Elena Portacolone, MBA MPH PhD, is Assistant Professor at the Institute for Health and Aging at the University of California in San Francisco. She is also affiliated with the Mack Center on Mental Health and Social Conflict and the Institute for the Study of Societal Issues, both at the University of California, Berkeley. Her research interests include the influence of social policies and the market economy in the wellbeing of community-dwelling older adults, living alone in old age with cognitive impairment, and aging in place in high-crime neighborhoods. Jodi Halpern, MD PhD, is Associate Professor of Bioethics and Medical Humanities at the University of California, Berkeley, in the Joint Medical Program and the School of Public Health. As a psychiatrist with a background in philosophy, her research interests include public health ethics, empathy, and distributive justice.


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