Public Housing: Distressed Conditions in Developments for the	 
Elderly and Persons with Disabilities and Strategies Used for	 
Improvement (09-DEC-05, GAO-06-163).				 
                                                                 
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.		 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-06-163 					        
    ACCNO:   A42937						        
  TITLE:     Public Housing: Distressed Conditions in Developments for
the Elderly and Persons with Disabilities and Strategies Used for
Improvement							 
     DATE:   12/09/2005 
  SUBJECT:   Community development				 
	     Community development programs			 
	     Housing for the disabled				 
	     Housing for the elderly				 
	     Housing programs					 
	     Public housing					 
	     Quality of life					 
	     Strategic planning 				 
	     Urban development programs 			 
	     Weathering of buildings				 
	     HUD Hope VI Program				 
	     HUD Low Income Housing Tax Credit			 
	     Program						 
                                                                 

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GAO-06-163

     

     * Report to Congressional Committees
          * December 2005
     * PUBLIC HOUSING
          * Distressed Conditions in Developments for the Elderly and Persons
            with Disabilities and Strategies Used for Improvement
     * Contents
          * Results in Brief
          * Background
          * While Comprehensive Data Are Lacking to Determine Extent of
            Severe Distress, Public Housing Directors Reported Adverse Social
            and Physical Conditions
               * HUD Maintains Limited Data about the Condition of Public
                 Housing for the Elderly and Persons with Disabilities
               * Relatively Few Developments Primarily Occupied by the
                 Elderly and Non-Elderly Persons with Disabilities Appeared
                 Potentially Severely Distressed
               * Even If Not Severely Distressed, Public Housing Developments
                 May Pose Problematic Living Conditions for the Elderly and
                 Non-Elderly Persons with Disabilities
                    * Aging Buildings
                    * Lack of Accessibility
                    * Size of Apartments, Particularly Studio Apartments
                    * Resident Mix
                    * Extent of Supportive Services
                    * Crime Near Developments
          * Various Strategies Could Improve Physical and Social Conditions
            at Public Housing for the Elderly and Non-Elderly Persons with
            Disabilities
               * Strategies to Improve Physical Conditions
               * Strategies to Improve Social Conditions
          * Observations
          * Agency Comments
     * Objectives, Scope, and Methodology
     * Technical Methodology
     * Description of Site Visits to Two of HUD's Innovative Models in Public
       Housing for the Elderly
          * Homestead Apartments
               * Housing Agency Actions
               * Funding
          * Helen Sawyer Plaza
               * Housing Agency Actions
               * Funding
     * GAO Contact and Staff Acknowledgments
     * let.pdf
          * Results in Brief
          * Background
          * While Comprehensive Data Are Lacking to Determine Extent of
            Severe Distress, Public Housing Directors Reported Adverse Social
            and Physical Conditions
               * HUD Maintains Limited Data about the Condition of Public
                 Housing for the Elderly and Persons with Disabilities
               * Relatively Few Developments Primarily Occupied by the
                 Elderly and Non-Elderly Persons with Disabilities Appeared
                 Potentially Severely Distressed
               * Even If Not Severely Distressed, Public Housing Developments
                 May Pose Problematic Living Conditions for the Elderly and
                 Non-Elderly Persons with Disabilities
                    * Aging Buildings
                    * Lack of Accessibility
                    * Size of Apartments, Particularly Studio Apartments
                    * Resident Mix
                    * Extent of Supportive Services
                    * Crime Near Developments
          * Various Strategies Could Improve Physical and Social Conditions
            at Public Housing for the Elderly and Non-Elderly Persons with
            Disabilities
               * Strategies to Improve Physical Conditions
               * Strategies to Improve Social Conditions
          * Observations
          * Agency Comments
     * let.pdf
          * Results in Brief
          * Background
          * While Comprehensive Data Are Lacking to Determine Extent of
            Severe Distress, Public Housing Directors Reported Adverse Social
            and Physical Conditions
               * HUD Maintains Limited Data about the Condition of Public
                 Housing for the Elderly and Persons with Disabilities
               * Relatively Few Developments Primarily Occupied by the
                 Elderly and Non-Elderly Persons with Disabilities Appeared
                 Potentially Severely Distressed
               * Even If Not Severely Distressed, Public Housing Developments
                 May Pose Problematic Living Conditions for the Elderly and
                 Non-Elderly Persons with Disabilities
                    * Aging Buildings
                    * Lack of Accessibility
                    * Size of Apartments, Particularly Studio Apartments
                    * Resident Mix
                    * Extent of Supportive Services
                    * Crime Near Developments
          * Various Strategies Could Improve Physical and Social Conditions
            at Public Housing for the Elderly and Non-Elderly Persons with
            Disabilities
               * Strategies to Improve Physical Conditions
               * Strategies to Improve Social Conditions
          * Observations
          * Agency Comments
     * let.pdf
          * Results in Brief
          * Background
          * While Comprehensive Data Are Lacking to Determine Extent of
            Severe Distress, Public Housing Directors Reported Adverse Social
            and Physical Conditions
               * HUD Maintains Limited Data about the Condition of Public
                 Housing for the Elderly and Persons with Disabilities
               * Relatively Few Developments Primarily Occupied by the
                 Elderly and Non-Elderly Persons with Disabilities Appeared
                 Potentially Severely Distressed
               * Even If Not Severely Distressed, Public Housing Developments
                 May Pose Problematic Living Conditions for the Elderly and
                 Non-Elderly Persons with Disabilities
                    * Aging Buildings
                    * Lack of Accessibility
                    * Size of Apartments, Particularly Studio Apartments
                    * Resident Mix
                    * Extent of Supportive Services
                    * Crime Near Developments
          * Various Strategies Could Improve Physical and Social Conditions
            at Public Housing for the Elderly and Non-Elderly Persons with
            Disabilities
               * Strategies to Improve Physical Conditions
               * Strategies to Improve Social Conditions
          * Observations
          * Agency Comments

Report to Congressional Committees

December 2005

PUBLIC HOUSING

Distressed Conditions in Developments for the Elderly and Persons with
Disabilities and Strategies Used for Improvement

Contents

Table

Figures

December 9, 2005Letter

The Honorable Richard C. Shelby Chairman The Honorable Paul S. Sarbanes
Ranking Minority Member Committee on Banking, Housing, and Urban Affairs
United States Senate

The Honorable Wayne Allard Chairman The Honorable Jack Reed Ranking
Minority Member Subcommittee on Housing and Transportation Committee on
Banking, Housing, and Urban Affairs United States Senate

The Honorable Michael G. Oxley Chairman The Honorable Barney Frank Ranking
Minority Member Committee on Financial Services House of Representatives

The Honorable Robert W. Ney Chairman The Honorable Maxine Waters Ranking
Minority Member Subcommittee on Housing and Community Opportunity
Committee on Financial Services House of Representatives

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.1 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.2 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.3 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.4 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."5 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 w 
ww.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.

Results in Brief

Available data on the physical and social conditions of public housing
developments are insufficient to determine the extent of severe distress
among units occupied by elderly persons and non-elderly persons with
disabilities. According to our analysis of HUD's limited data, 3,537
public housing developments were occupied primarily by such residents, and
76 of these had characteristics indicating potential severe distress.
Based on the survey responses we received from public housing directors,
covering 66 developments with indications of potential distress, we found
that

o Eleven developments had characteristics that indicated severe physical
distress, such as deteriorated building systems and a lack of
accessibility features for persons with disabilities;

o Another twelve developments had signs of severe social distress,
including a lack of appropriate supportive services such as access to
transportation and assistance with meals; and

o An additional five developments had characteristics that indicated both
severe physical and social distress.

Even if not considered severely distressed, developments may have
conditions that adversely affect the quality of life of the elderly and
non-elderly persons with disabilities. Many of the public housing
directors we surveyed reported a number of such conditions, citing most
frequently (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 we 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
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.

We provided a draft of this report for HUD's review. HUD provided oral
comments, generally agreeing with our report, and technical comments,
which we incorporated as appropriate.

Background

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.6 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.7 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.8 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.9

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.10 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.

Figure 1: Percent of Public Housing Units Occupied by the Elderly and
Non-Elderly Persons with Disabilities

Note: See appendix I for a discussion of the limitations of the data.

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.11 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).

While Comprehensive Data Are Lacking to Determine Extent of Severe
Distress, Public Housing Directors Reported Adverse Social and Physical
Conditions

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.

HUD Maintains Limited Data about the Condition of Public Housing for the
Elderly and Persons with Disabilities

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.12 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.13 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.14

Relatively Few Developments Primarily Occupied by the Elderly and
Non-Elderly Persons with Disabilities Appeared Potentially Severely
Distressed

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.15 As noted previously, we
then developed an "index of distress" to score conditions at public
housing developments.16 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.17 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:

o 21 had been approved for demolition, disposition, or HOPE VI
revitalization;

o 72 had a building that was more than 30 years old;

o 64 had few units (less than 5 percent) that met accessibility
standards;18

o 24 had a physical inspection score under 60 percent;19

o 41 were in a census tract with a poverty rate greater than 35 percent;
and

o 26 had households with a total median income under $7,000.

Even If Not Severely Distressed, Public Housing Developments May Pose
Problematic Living Conditions for the Elderly and Non-Elderly Persons with
Disabilities

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.

Figure 2: Level of Deterioration of Physical Structures, According to
Public Housing Directors

Note: For this survey item, we received responses for 62 developments.

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).

Figure 3: Conditions Most Frequently Cited as Adversely Affecting the
Elderly and Persons with Disabilities and Challenges Most Frequently Cited
in Providing Public Housing

Note: Based on survey responses from 41 public housing agency directors
covering 64 developments. Responses are from open-ended survey items;
therefore, in some cases, directors reported multiple challenges-including
those that directors encountered over the past 15 years.

Aging Buildings

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.

Figure 4: Signs of Severe Physical Distress Include Deteriorating
Infrastructure Such as Concrete Surfaces

Figure 5: Inadequate Shelter, Such as Exterior Walkways at a High-Rise
Development, Exposes Residents to the Elements

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.)

Figure 6: Most Developments Are Undergoing or Will Need Demolition,
Replacement, or Rehabilitation

Note: GAO analysis based on responses to multiple survey questions,
including whether development has been demolished or disposed of, extent
of and reasons for physical deterioration, status of renovation to various
building systems, and actions taken or planned to address current
conditions. For these survey items, we received responses for 66
developments.

Lack of Accessibility

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.

Figure 7: Examples of Lack of Access for the Elderly and Persons with
Disabilities Include Narrow Hallways and Elevators That Cannot Easily
Accommodate Wheelchairs or Scooters

Size of Apartments, Particularly Studio Apartments

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.

Resident Mix

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."

Extent of Supportive Services

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).20 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.21 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.

Figure 8: Number of Developments with Supportive Services Available
On-Site for Elderly Residents

Note: The data in this table are for services available to elderly
residents. In most cases, the same services were available for non-elderly
persons with disabilities-although for some, such as housekeeping
assistance and medical or health services, the overall percent of
developments with services available to non-elderly persons with
disabilities was several points lower. For these survey items, we received
responses for 64 developments.

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.22 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.23
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).24 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.

Figure 9: Access to a Service Coordinator

Note: For this survey item, we received responses for 64 developments.

Crime Near Developments

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).

Figure 10: Extent of Crime Problem in and near Developments

Note: For these survey items, we received responses for 63 developments.

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.

Various Strategies Could Improve Physical and Social Conditions at Public
Housing for the Elderly and Non-Elderly Persons with Disabilities

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.

Strategies to Improve Physical Conditions

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.25 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.

Figure 11: The Local Housing Agency Completely Rebuilt Historic Village to
Improve Conditions

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.26 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.

Strategies to Improve Social Conditions

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.27 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.28 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.29 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.30 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.31 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.

Observations

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.

Agency Comments

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.

Objectives, Scope, and Methodology Appendix I

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.1 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:

o There were at least 10 occupied units in the development; and

o 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 w bin/getrpt?GAO-06-205SP
ww.gao.gov/cgi- 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 w  ww.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.

Technical Methodology Appendix II

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.

Table 1: Point System and Indicators Used in Our Distress Index

                                        

        Physical distress score      Points    Social distress score   Points 
How deteriorated is the building      20  Various services provided     60 
                                             on-site                   
Various systems in need of            42  Services available nearby     35 
renovation                                                          
Accessibility issues for persons      32  Availability of a service     20 
with disabilities                         coordinator               
Physical reasons for vacancies        20  Access to transportation      20 
Estimated repair cost per unit        10  Crime indicators              30 
Secure entrance                        5  Graffiti                      10 
How well lit                           5  Vacant homes/businesses       10 
                                             nearby                    
Mold                                   5  Complaints about other        20 
                                             residents                 
Total points                         139                               205 

Source: GAO.

Description of Site Visits to Two of HUD's Innovative Models in Public
Housing for the Elderly Appendix III

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.

Homestead Apartments

Housing Agency Actions

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).1 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.

Figure 12: Physical Therapy Area at the Community LIFE Center

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.

Funding

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.

Helen Sawyer Plaza

Housing Agency Actions

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.

Figure 13: Commercial Kitchen Space at Helen Sawyer Plaza

Funding

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.2 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.

GAO Contact and Staff Acknowledgments Appendix IV

David G. Wood, (202) 512-8678 or [email protected]

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.

(250206)

www.gao.gov/cgi-bin/getrpt? GAO-06-163 .

www.gao.gov/cgi-bin/getrpt? GAO-06-205SP .

To view the full product, including the scope, methodology, and related
survey, click on the links above. For more information, contact David G.
Wood at (202) 512-8678 or [email protected].

Highlights of GAO-06-163 , a report to congressional committees

December 2005

PUBLIC HOUSING

Distressed Conditions in Developments for the Elderly and Persons with
Disabilities and Strategies Used for Improvement

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.

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:

           o  Eleven developments had signs of severe physical distress, such
           as deterioration of aging buildings and a lack of accessible
           features for persons with disabilities;

           o  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

           o  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.

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 [email protected]. 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.

David G. Wood Director, Financial Markets and Community Investment
*** End of document. ***