Assessing the Quality of Care Found in Affordable Clustered Housing-Care Arrangements: Key to Informing Public Policy

Purposively planned or adapted affordable community-based housing arrangements are now available to accommodate lowand modest-income older people who have functional limitations and chronic health illnesses. These housing arrangements introduce various physical infrastructure and dwelling design changes and make available supportive and health-related services that enable their vulnerable older occupants to live independently and manage their health problems. They are known by various names, but are referred to in this article as “affordable clustered housingcare” or “housing-care.” Many of these housing arrangements are federally subsidized, rent-assisted, multiunit apartment projects with low-income older occupants who have aged in place or who have recently entered these properties. Despite support for these options from many advocacy groups, research findings that demonstrate the benefits of offering assistance and services in these housing arrangements are far from conclusive. Such evaluations are essential to justify organizational and funding support from the public and nonprofit sectors and to encourage the participation of housing and service providers. Drawing on the work of Donabedian (1992, 1966), this article constructs a theory-driven conceptual framework by which to organize and assess our current knowledge regarding the quality of the assistance and care found in these housingcare settings. To illustrate the practical applications of the framework, the article then describes an ongoing research investigation that is assessing whether supportive services offered in several federally assisted housing projects in Richmond, Virginia, have reduced emergency room use of their elderly occupants.