ferent in different communities. The greatest need now is for openmindedness, flexibility in policies, and a cooperative attitude.

Recommendation

The Commission recommends a closer association of homes for the aged with each other and with other social agencies for the purpose of studying and developing policies and practices in sheltered care of the aged.

COORDINATED STATE PLAN

The Commission believes that progress in improving the housing conditions of the aged population in Rhode Island demands statewide planning and an organized leadership. Housing is so closely identified with economic, health, and recreational needs that a coordinated attack on problems in these fields is imperative. Recommendation that a State commission on aging be created is presented in section III. The State housing unit referred to in the discussion of housing would function under such a commission.

8. CHANGING NEEDS OF OLDER PEOPLE: IMPROVED HOMES FOR THE AGED 1

By Ollie A. Randall, consultant, services for the aged, Community Service Society of New York

What are some of the factors making for a change in the attitudes, practices, and programs in which older people are involved? First, there are too many older people for them to be cavalierly consigned to thoughtless and antiquated situations. Then, too, older people are no longer paupers in yesterday's meaning of that word. In spite of the low level of income among older people, it is increasingly true that practically no one need be without some cash income from some source or other. With social-security payments reaching a new high in numbers and amounts, with pensions and annuities more common, older people are in a far greater number of instances in a position to finance more adequately at least a portion of the cost of their care in homes for the aged. This ability to pay, in whole or in part, makes for an entirely new relationship between the individual and those providing accommodations and services or care. The major difference is that the old person is, or should be, an active participant in the arrangement which is made. He is no longer "placed" by someone, against his will or without his knowledge, unless he is mentally incapable.

Not only does this change in the manner of payment make a difference in the feeling of dignity and independence for the individual resident, but it makes a great difference in the manner of financing the work of the home. It makes possible a change in rates as those changes are warranted. It also means there is a reduction in the philanthropic element. But mainly it places the management of homes somewhat more on their toes to see to it that their programs and services meet what residents want, need, and should have and what the community is newly aroused to want for them.

It is here that the major differences in our concepts of living through the later years have occurred. It goes without saying that older people are among the beneficiaries of many good things which accrue to all of us through the advances of medicine and related sciences—as well as of the years themselves. They are not only longer lived than their forebears; they are, in spite of common opinion to the contrary, as a rule much healthier. They remain vigorous and relatively ablebodied into their seventies and eighties. They continue active, taking part in the life of their communities when they are permitted to do so; they go on working; they carry responsibilities for themselves and often for others; they play; they follow their hobbies and vocations; they travel. They tend more and more to live by themselves in their own homes, maintaining themselves on their limited incomes (the majority of them), until some disaster such as the loss of family or

1 Source: Architectural Record, vol. 119 (May 1956), pp. 208-212. This edition of the magazine is entitled "Building for the Aging."

social contacts or a catastrophic illness drives them to seek the security of what is nowadays known as "sheltered care."

What then is the function of a home for the aged today-and what is it likely to be tomorrow? Today institutions house from 4 to 6 percent of the older people of the country, using 65 as the beginning age, which is a great many people. At 5 percent, this kind of living would account for some 700,000 persons and most of us close to the situation are convinced that this is by no means the number of persons who could or should profit by living in such homes, provided there were enough of them and they were properly designed, built, and managed. As the number of older persons continues to grow, so will the need for sheltered care. But the demand will be for persons of a somewhat different group with different needs from those which prompted people to ask for such a plan in the years gone by.

A home for the aged is over and above all else a place to live. It means a place in which every resident has the opportunity to live to the fullest of his own capacity. With this as a goal-general as it sounds-we have all the opportunity we could want to use modern materials, modern design, and to give scope for those flights of imagination which in our modern world seem to need to know few if any bounds. The day has long since gone when we must confine ourselves to the accepted patterns of living or of places in which to live. If the newer ones of which architects, builders, and engineers are justly proud, offer greater comfort and ease of living, are not older people the very ones who should have the advantages of space, controlled climatic conditions, light and air and a wide view of the world and the people in it? The outworn argument that older people cannot adapt to the new-that they are only content with the old-holds true no more than does any generalization for any group of human beings. As a matter of fact, older people willy-nilly have had to acquire a habit of adaptation to many changes-and rapid ones at that. This is a fact that most of us are quite apt to forget or overlook.

The home for the aged of the future must be a home, with all that connotes. It must be a place where "the heart is." No matter how fine, it is at best a substitute for the resident's own home, however humble and plain that may have been, but it can be so built, so designed, and so managed that the substitute may ultimately prove to be as satisfying as the home that has been left, if not more so, because of what it can offer in meeting a person's need to belong, to be useful, and at the same time to be somewhat sheltered from the stresses of community living with which he is no longer able to cope by himself.

The home must be so situated that it is accessible for the entire family, residents and staff, to those "goods and services" which the community provides for its citizens the church, the school (adult education), the doctor, the clinic and the hospital, shopping, work, entertainment. It is not easy to give all this and still give space for some outdoor living and gardening for those whose circle of activity must be geographically circumscribed because of failing strength or crippling infirmities. But the sense of space, with the green of trees and shrubs and the colors of gardens, large or small, to give it depth and a feeling of freedom from confining walls, can be achieved even in city or suburban areas.

The home will need to provide not only the opportunity for living without a feeling of isolation in the city or town, but it must be so con

structed as to provide a full life for those who will not be able to venture forth. The doors must open both in and out-to let the community come in to be a part of the life in the home as well as to permit residents to go forth. The home must invite friends and relatives to visit as they do to any family home. The living rooms, the recreation rooms for activity and entertainment and the auditorium for passive entertainment and for worship, the hobby rooms and workshops, the dining rooms, the library, must be pleasant but functional, so planned that they help rather than hinder the residents in the things they wish to do together or alone. The rooms of those residents who are well and able to get about should be single rooms, and double rooms only for couples who wish to be together. Perhaps rooms can be so planned that there will be a more flexible use of walls, which in our old buildings are such deterrents to good use of space because they are so difficult and expensive to remove or to change. Single rooms might become double and double rooms ought to be capable of conversion into single rooms, as the constant shifts in the composition of the household dictate.

The home will house people older in years on the average or at least more of them in the upper age brackets than used to be the case. And the meaning of this for living and building is clear. There will be more and more of them who will need the protection of general supervision and watchfulness, and active nursing care in those illnesses more characteristic of old age than of the earlier stages of life. This, too, leads to the thought that the possibility of a flexible use of the building is of vital importance, for as more persons require nursing there will need to be space that can be used as an infirmary with an efficient use of space and of scarce nursing staff, without loss of the quality of hominess.

Admittedly this is a most difficult thing to do, but the emphasis here is on the "home," and no hospital can ever become a truly acceptable "home." With our new knowledge of older people-their wish to live and to serve and to have other daily occupation than breathing, eating, and sleeping, we realize that even the infirmary must be so designed as to provide for diversion, for entertainment, and even work for others, for patients singly or in groups. Patients are not bedbound so long as they were once, and their interests, even those who have withdrawn from reality around them, can be directed to the world around them, to people other than themselves, and to a relatively high degree of creativity.

The whole setting must be one which stimulates those interests, which encourage optimism, and which makes it possible for staff to accomplish the daily routines of living with a maximum of efficiency and a minimum of unnecessary physical effort. There must be provision for rehabilitative therapy, but the whole atmosphere, derived from the effectiveness of design, must be conducive to a rehabilitative state of mind on the part of the patient, staff, and visitors alike.

It might be possible to sum up the home for the aged of the future as a place in which any one of us will be glad and proud to live so long as that answers our personal needs (and we cannot judge too accurately in advance what those physical and psychological needs will be); a place in which we can remain if that suits us, or a place from which we may return to the community refreshed in body, mind, and

spirit, if that, too, is what seems wisest and best; a place which supports us in our desire both to serve and to be served; a place in which as persons we have meaning to ourselves and to others; a place in which there is assurance of concern for our well-being and care in the event of illness; a place in which each new day is to be anticipated for the "something" of interest it will bring; a place which is so much a part of the community in which it is located that we, too, are a part of it; a place in which older people may truly be said to find themselves and to have the opportunity of demonstrating positively how fully life can flower in the later years under favorable conditions.