UCSF School of Nursing - UCSF - University of California, San ...

Even today, there are
few public programs
available to subsidize
the construction of
supportive housing facilities,
or to subsidize
the market rents of
these settings.
til his death this year) have continued
to be advisors, friends, and sources of
support throughout my career.
While in graduate school I worked
on a number of planning and architectural
projects with Lou. These afforded
the opportunity to meet the real world –
composed of state and local officials,
boards of directors, consumer groups,
and financial institutions. Through this
work I was introduced to what it took to
get projects built and to be viable as
on-going operations. Even though we
worked almost exclusively with notfor-profit
groups, I also learned about
the sub-populations that were not financially
eligible for these developments.
Even today, there are few public
programs available to subsidize the
construction of supportive housing facilities,
or to subsidize the market
rents of these settings.
After three years in the consulting
sector, I moved to a position with the
San Diego County government as Area
Agencies on Aging and Health Systems
Agencies were beginning to develop.
Thus began my education into
local politics, and the partitioning of
acute and long-term care funding. A
three-year sojourn there solidified my
desire to return to a research career
and the study of community long-term
care programs. This led to a grant writing
collaboration with Carroll Estes –
then an upstart Associate Professor at
UCSF. Many good things have happened
to me since accepting her offer
to work here. Among these has been
the opportunity to pursue my evolving
interest in supportive housing, some of
which involved collaboration with
Philip Lee and his son Paul, and Gay
Becker. Notably among my student collaborators
have been Victor Regnier,
Robyn Stone, Steven Preston, and
Robert Maynard. It has also included a
number of studies of state and local
government interrelationships (with
Estes), studies of managed care and
state long-term care systems (with
Charlene Harrington), and dementia
care coordination (with Patrick Fox).
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So much for the evolution of my research
interests. My plan today is to,
first, provide background on the subject
area of residential care. This will
help place my work in context and
hopefully be informative as well. Second,
I review several of my studies in
this area. These provide some insight
into the effectiveness and concerns
about this industry. Finally, I briefly
review my vision of how (and why) supportive
housing can best serve various
populations. Much of the information
derived from my research may be
viewed as an argument against the hype
and as tests of the potential for supportive
housing. I am still very much an advocate
for this form of care, but merely
combining housing and services does
not assure quality nor appropriateness
of care. There is much to be learned.
Defining Residential Care
Residential care is known by a variety of
terms in federal legislation and state
regulations. Common are board and care,
residential care facilities (RCFs), assisted
living, adult congregate care, and
adult foster care. Of these, the most
widely used are residential care and assisted
living. Not all supportive housing
is licensed. Among the more common
types of unlicensed facilities are rooming
homes, single room occupancy hotels or
SROs (i.e., non-transient hotel rooms),
and even low-income housing projects.
The services typically available in licensed
housing facilities include shelter,
meals, laundering linens, supervising
medications, assisting with activities of
daily living, and help with transportation
and shopping. Beyond these basic services,
licenses and regulatory waivers
are available within California and elsewhere
that permit facilities to provide
additional assistance for residents with
special needs, such as receiving hospice
care, being non-ambulatory, or those using
oxygen or with cognitive impairments
(Mollica, 2000). In many cases, these
services will be provided by an outside
home health agency rather than the
housing provider itself.