Federalism and Suitable Housing for the Frail Elderly: A Comparison of Policies in Canada and the United States

The frail elderly have special multidimensional housing needs beyond affordability, including shelter that is more adaptive to reduced function and offers supportive services. Suitable housing for this population comprises three policy areas—housing, health care, and social services. In a federal system, development and implementation of policies in these areas involves participation of several levels of government and the nongovernmental sector. This paper uses federalism as a conceptual framework to examine and compare these policy areas in Canada and the United States. In both countries, general national housing policies—relying heavily on the nongovernmental sector and characterized by joint federal-provincial programs in Canada and by important local government roles and age-specific programs in the United States-have benefited the elderly. The effects of such policies on the frail elderly, however, have been less positive because of the general lack of essential human services and, to a lesser degree, health care that enables them to live outside institutions. This is especially true in the United States, where health care policy is fragmented and is dominated by a private insurance system, partial federal financing of health insurance for the elderly, and tense federal-state relations in financing health care for the poor. Although Canadian policies and programs operate autonomously and more uniformly within a national health plan, neither country has a universal, comprehensive long-term care system. Geographically diverse patterns of social services, funded by grants to states and provinces and the nonprofit sector, are common to both countries. However, the United States has inadequately funded age-specific programs and has relied on a growing commercial service provision. Housing outcomes for frail elders are moving in the right direction in both countries; however, Canada seems to be better positioned, largely because of its health care system. As increased decentralization continues to characterize the three policy areas that affect suitable housing for frail elders, the United States can learn from Canada’s negotiated federalism approach to more uniform solutions to merging housing and long-term care. Introduction Cross-national policy comparisons are often dominated by the view that policy development is particularistic and evolves from a unique sociocultural, political, and historical context, rendering 200 Phoebe S. Liebig valid comparisons difficult, if not impossible. Fruitful international comparisons can be made, however, if a conceptual framework, such as federalism, is introduced. This article addresses the issue of suitable housing for the frail elderly in two federal societies, Canada and the United States. These North American neighbors are linked by history, geography, and heritage, as well as by comparably diverse populations with similar living standards. They also share accelerated population aging, requiring the development of housing to meet the multidimensional needs of frail elders. Discussions about appropriate housing for the elderly invariably focus on issues of horizontal coordination across programs and services (see, for example, Pynoos 1990). Nevertheless, too little attention has been paid to the vertical integration of policy domains affecting frail elders, often because a myopic focus on “national policy” has needlessly obscured the vital roles and actions of other levels of government. Closer scrutiny of federal systems, which involve several levels of government and the for-profit and nonprofit or voluntary sectors, can provide more complete explanations for the patterns in housing policies for the elderly. This article first describes the federal structures of Canada and the United States and their effects on the policy environment for the aged. Attention is then focused on three policy areas—housing, health, and social services—that comprise suitable housing for frail elders, and how each is apportioned among the three levels of government and nongovernmental institutions in the two countries. The trends in federalism and their implications for suitable housing policy outcomes for frail elders in Canada and the United States are discussed in the final section. Framework of federalism Under federalism, a national government and one or more subnational levels of government each have substantial policy-making powers and can make arrangements for working out solutions, making joint decisions, and adopting joint policies (Friedrich as per Nathan 1990, 249–50). The resultant sharing of authority between the national and subnational governments is neither simple nor static. A complex set of relationships emerges that can be categorized as independent/competitive (autonomous), interdependent/cooperative Federalism and Suitable Housing for the Frail Elderly 201 (negotiated), or dependent/coercive (hierarchical), accompanied by high levels of discretion, incentives, or mandates.1 Autonomous relations are characterized by clear boundaries between federal and subnational authority. Discrete, appropriate authority is defined for specific levels of government, such as property taxes and land use at the local level, sales taxes and professional licensure at the state level, and defense and interstate commerce at the national level. Hierarchical relations are exemplified by mandates from a higher level of government to a lower one, such as requiring uniform standards or new programs, often without financial or technical assistance. This results in less flexibility for the lower level of government. Negotiated relations are characterized by give-and-take, developed through formal intergovernmental councils or lobbying efforts, leading to articulated, often shared responsibilities. This can include agreements about the national government’s preemption of several areas of taxation, with a fixed proportion of the resulting revenues allocated to subnational governments, or about shared regulation of health and safety in the workplace. Relations within federal systems are dynamic. Constant shifts blur the boundaries of effective jurisdiction among the several levels of government (Bloksberg 1989; Landes 1983; Stevenson 1985). Both Canada and the United States have recently moved away from an earlier period of effective expansion of national jurisdiction. This decentralization has been accompanied by reduced central government funding, often with fewer strings attached; by greater regional government involvement in domestic affairs; and by heavier reliance on market strategies and the voluntary sector.2 The resulting devolution, accompanied by increased variation in policy approaches and solutions, has been hailed as a way to adapt to new social, technological, and economic needs and conditions (e.g., population aging); to afford more points of access for voicing citizen preferences; and to reconcile competing and conflicting diversities, such as the accommodation 1 Wherever possible, both Canadian and American writers are cited to demonstrate the basic agreement on concepts presented. In this instance, see Burgess (1990), Dye (1990), Hanson (1990), and Leach (1981). 2 This theme of involving the nongovernmental sector in addition to subnational governments has been sounded more frequently in recent writings on federalism. See, for example, Brown-John (1990), Chandler and Bakvis (1989), and Pagano and Bowman (1989). 202 Phoebe S. Liebig of ethnic, linguistic, and institutional roots.3 However, because of shifts in effective jurisdiction and geographically disparate and poorly integrated policies, it is also seen as expensive, inefficient, and conducive to diffused responsibility.4 Federalism in Canada and the United States—An overview Canada and the United States exemplify the major characteristics of federal systems of government. See table 1 for a summary of their national-regional relationships relative to six consequential powers.5 Regional governments in both countries have legal powers to establish and revise their own political structures and processes. The U.S. Constitution lists the powers of the national government and their limits; powers not granted to the national level are reserved to the states or the people. By comparison, Canada’s constitution is far more explicit about the powers of the provincial governments. Subnational governments in both nations have distinct functional-area authority and responsibilities. Canadian provinces, however, have specific constitutional authority for education, law enforcement, and local government affairs, enabling them to bargain more effectively in their dealings with the national government. Regional governments in both nations, concurrent with their respective national governments, are responsible for health and social services, which can lead to either cooperative or competitive interactions. They also exercise power over local governmental units, which are seen as their creations and often as their administrative arms. The U.S. doctrine of home rule gives some cities greater local autonomy, and local governments actively lobby at both the national and state levels. Larger cities in Canada 3 This pattern (discussed in Bowman and Pagan