7.
THE EXTRAORDINARY RISE of living alone is not in itself a social problem. But it is a dramatic social change that’s already exacerbating serious problems for which there are no easy solutions: Social isolation for the elderly and frail. Reclusiveness for the poor and vulnerable. Self-doubt for those who worry that going solo will leave them childless, or unhappy, or alone.
Today our species has about 200,000 years of experience with collective living, and only about fifty or sixty years with our experiment in going solo on a massive scale. In this brief time, we’ve yet to develop any serious public responses to the challenges related to living alone. Occasionally, a political official, religious group, or cultural critic tries to reverse the tide of history by persuading us that we are, in fact, better off together: The marriage promotion campaigns sponsored by President George W. Bush’s administration. The divorce prevention programs run by churches. The popular books like Marry Him, The Case for Marriage, and The Lonely American. Or the calls for adult children to take in their elderly parents, lest they be left to spend their golden years alone. But these attempts at moral suasion are destined for failure—and not only because their strongest proponents tend not to practice what they preach when their own happiness is on the line. The case against living alone simply runs counter to our modern sensibilities. And when millions of people from all parts of the globe believe they’re better off solo, it’s hard to convince them they’re wrong.
What would happen if we spent less energy on these futile campaigns to promote domestic unity and focused instead on helping people live better—healthier, happier, and more socially connected—if they wind up in places of their own?
We could, for instance, begin thinking about how to redesign our metropolitan areas so they better meet the needs of the people who live and work in them. As the Yale historian Dolores Hayden has shown, most modern cities and, especially, suburbs were designed for nuclear families in which the mother stayed at home to do domestic work while the father labored elsewhere; so, too, were most residential units, both apartments and stand-alone houses.1 These old forms don’t suit today’s world, where women work outside the home and millions of people live alone. And from an environmental perspective, they may even be dangerous, because sprawling, sparsely populated, car-dependent metropolitan areas dominated by large private houses require greater energy consumption than densely populated urban centers. How might the physical places that we call home be redesigned to suit the new metropolitan population, in which most adults are workers and singletons are ubiquitous?
Answering this question is especially urgent for the most vulnerable of those who live alone, the frail elderly and the poor. Today the two most common forms of specialized housing for these groups are the nursing home and the single-room occupancy dwelling, or SRO. But both of these housing options scare off more prospective residents than they attract—and for good reasons.
Nursing homes, the places of last resort for old people who require assistance with basic activities (such as bathing and getting out of bed) and can no longer live by themselves, need not relegate their residents to a sentence of living death. Although most of the 3 million or so Americans who move into one each year are likely to get good care, far too many of them will not.
Most old people who live alone have a catalog of nursing home horror stories at their disposal, which they’ll share in interviews after just the smallest provocation. “One woman I know very well had to go to a nursing home,” says Edna, who’s in her eighties and clings to her independence as if her life depends on it. “She wanted to see me, so I went up there. Ugh! It was horrible! She sat there in this room. And there was one woman screaming her head off. Right over here—” She points to a spot nearby. “I don’t know what was with her. Somebody else was howling over here—” She points to a spot in the other direction. “There were noises all around us. Oh God! So she said to me, ‘I know it may not be easy, but will you please see if you can get me out of here?’” Edna promised to do her best, but she lacked the clout or the resources to do much about the situation. Before long, she got news that her friend had died. “All I could say was ‘Thank God!’” Edna remembers. “Oh, it was terrible!”
A neighbor of Edna’s had a similar experience. She lived alone, had retired early, and then got sick before she had a chance to enjoy it. “They sent her to that terrible place, and she was there a long time. Anyone who went up there came back and said, ‘My God, how does she stand it?!’ Finally she died. Finally. I don’t know how she stood it there. So you live alone. And like it. Get along as best you can.” Do anything, Edna says, to avoid a nursing home, because in her view it’s tantamount to being buried alive.
I’ve seen nursing homes of all kinds and levels, from well-maintained (though still quite lifeless) places where residents get private rooms and attentive care to those that I’d turn down if my only other option was a grave. The Amsterdam Nursing Home, a handsome brick high-rise that abuts the Columbia University campus on Manhattan’s Upper West Side, could easily be mistaken for an expensive co-op apartment building. Not only does it have good doctors, nurses, and social workers, it also offers the kinds of programs and facilities found in a high-end assisted living facility: wireless Internet access, live concerts twice a week, a library cart, an arts and crafts group, day trips of all kinds. This is unusual. Harlem is just a few blocks away from the Amsterdam; the South Bronx is just a few miles farther. Although there are some well-managed nursing homes in these neighborhoods, there are more that get disturbingly low ratings for nurse staffing, health inspections, and overall quality.2 This may not be surprising, but it certainly isn’t acceptable—particularly not for the people who live in them.
Unfortunately, most older people who need a nursing home have trouble avoiding low-quality facilities. According to a 2006 Consumer Reports analysis of 16,000 nursing homes across the United States, some two decades after the federal government passed historic legislation to improve conditions for nursing home residents—the 1987 Nursing Home Reform Act—“bad care persists and good homes are still hard to find.” The study’s key findings confirm the horrific stereotypes that strike fear in everyone searching for a facility where they, or their parents or grandparents, can get good care and assistance. On their site visits investigators found scores of abuses: Unattended residents getting bedsores, even when they have no risk factors. Workers ignoring doctors’ orders. Medication errors. Unsanitized dishes and utensils. Widespread failure to comply with laws that require homes to make inspection records available to anyone who requests them, including prospective residents and their families. The problems are worse in certain states, including Illinois, where the government allows nursing home operators to admit young people with severe mental illnesses, including those with criminal records. The result, as the Chicago Tribune reported, is not just “compromised care,” but a spike in crimes against elderly residents, from robbery to rape and homicide.3
Bad social policies and weak regulatory oversight aren’t the only sources of trouble for nursing homes—so too are some of the companies that have acquired them. The Consumer Reports study is but one of many to report that the lowest-quality facilities tend to be managed by for-profit corporations, and that independently run, nonprofit nursing homes are more likely to provide good care. A New York Times investigation of private equity firms that recently acquired nursing homes reports that “at 60 percent of homes bought by large private equity groups from 2000 to 2006, managers have cut the number of clinical registered nurses, sometimes far below levels required by law.” And that “during that period, staffing at many of the nation’s other homes has fallen much less or grown.”4 Is it a coincidence that, compared with the national average, the investor-owned homes also have more serious health deficiencies cited by regulators, a higher percentage of long-term residents whose need for help with daily activities has increased, and a higher proportion of long-term residents suffering from depression or anxiety? These outcomes have been facilitated, if not promoted, by federal officials whose weak penalties for offending companies send a laissez-faire message to everyone in the industry. And although meaningful reforms are clearly in the public interest, they are difficult to enact now that the nursing home industry has established an influential lobbying presence in the key sites of government power, from state capitals to Washington, D.C.
But reforms are necessary. After all, if nothing changes, what will happen when you, your partner, or your parents find yourselves searching for a nursing home, with no place else to go?
Recent changes in the nation’s stock of single-room occupancy buildings have made many of them similarly inhospitable, to the extent that they are even available. The supply of SROs has been dwindling for decades, largely because they’ve tended to be located near downtown areas that have been revitalized and owners across the country have sold their buildings to developers or converted them into luxury properties on their own. The remaining buildings have transformed from their historic role of sheltering mainly migrant workingmen. The massive deinstitutionalization of the mentally ill, along with the growing number of people who cycle in and out of the criminal justice system, has produced a new population of marginal men in need of SRO-style accommodations. Today, most SROs contain an unstable mix of the poor, the old, the mentally ill, substance abusers, and ex-convicts. SROs may work for some, but for others they are impossible communities, and in all but the best-managed facilities both residents and staff struggle to maintain decent conditions. Like nursing homes, SROs are in desperate need of redesign.
Redesigning the places where people live alone is only one way to address the challenges of a singleton society. Another is to improve the material objects we keep around us, and to design new ones to help those most at risk of isolation become better connected to networks of social support. This, of course, is something we are already doing quite effectively. Massive investments in communications technologies have helped usher in what we alternately call the Network Society and the Digital Age. These technological innovations haven’t merely benefited people who live alone; they’ve also produced the conditions that make solo living attractive, because cheap, accessible communications systems, from the telephone to the Internet, allow us to remain connected while living alone. The next frontier of this ongoing technological transformation is home-based robotics, from “smart home” devices that assist with everyday tasks such as cleaning and getting entertainment to even smarter machine companions that could be particularly helpful for the homebound. These technologies aren’t cure-alls. They’ll be expensive, and the prospect that they could be used to substitute for human contact raises serious ethical questions. But this hasn’t kept engineers and computer scientists from developing new machines that might someday help compensate for our social failures. We need to understand what they are making, and to get people with different backgrounds and experiences to help them, since we all may be touched by the outcome of their work.
PEARL IS JUST A FEW INCHES over four feet, and her hearing, speech, vision, and memory are far from perfect. She moves slowly and has trouble with stairs. She loses energy quickly, and occasionally she crashes from overexertion. Still, Pearl can be tremendously helpful to people who want to live on their own but need special assistance. She is steady, so they can use her to stay balanced when walking. She knows when they should take medications, and provides reliable reminders if they forget. She can help them get connected to the Internet, or to contact family, friends, and health care providers. She monitors their activities and recognizes unusual behavior, such as failing to get out of a chair or neglecting to go to the bathroom. If they don’t respond to her prodding, she’ll ask for an explanation. If she doesn’t get one, she’ll call for help.
Pearl is still developing. She may get taller, but even if she doesn’t, her arms will soon grow long enough to reach items stored on top shelves or pick up things from the ground. She’ll be able to do a few onerous household chores by herself, and to help with others. Her speech will improve, as will her ability to understand language. She’ll play interactive games, and music and TV programs. She’ll be able to warn about threatening weather, answer the phone, program the DVR, and control the lights. When she has access to high-speed wireless service, she’ll transmit remote video and audio signals, mediating virtual meetings in real time. She’ll become a better companion and caretaker—still a robot, but one with a more human touch than her peers today.
Pearl is a prototype for a robotic personal assistant, with origins in a collaborative research and design experiment conducted by computer scientists, nurses, gerontologists, and psychologists at Carnegie Mellon and Stanford universities. Sebastian Thrun, who organized the project in Pittsburgh and now directs the artificial intelligence laboratory at Stanford, says that building machines that can live with and adapt to human beings is now “the cutting edge in robotics.” In a research paper, he and his colleagues, who have also engineered a robotic nurse prototype called Flo (in honor of Florence Nightingale), offer a simple explanation for why they focus on developing machines for the elderly and the isolated: The population of old and very old people (age eighty-five and above) is soaring, the costs of home care and health care are skyrocketing, and there is little political will to provide more help. “Thus,” they explain, “we need to find alternative ways of providing care . . . The vast majority of independently living elderly people is forced to live alone, and is deprived of social interaction. Social engagement can significantly delay the deterioration and health-related problems. While robots cannot replace humans, we seek to understand the degree at which robots can augment humans, either by directly interacting with the person, or by providing a communication interface between different people that is more usable than current alternatives.”5
According to new research led by the gerontologist William Banks and his wife, Marian, a nurse at the Veterans Affairs Medical Center in St. Louis, robotic pets can be just as effective as living ones—at least when it comes to reducing loneliness and establishing feelings of attachment. The Bankses arranged for one group of residents in a long-term nursing home facility to have weekly thirty-minute one-on-one visits with a floppy-eared, trained therapy dog named Sparky, while another had the same number of visits with AIBO, a robotic dog (made by Sony) that wags its tail, vocalizes, and blinks lights when spoken to or touched. A control group had no exposure to either Sparky or AIBO. Marian, who delivered the dogs to the nursing home, did not make personal contact with the residents, but she observed that those who visited with Sparky were quick to build rapport with the canine, whereas those who were placed with AIBO took a week to pet him and talk with him as they would a living dog. Surprisingly, at the end of the eight-week study, the groups who visited with Sparky and AIBO reported similar levels of relief from loneliness and attachment to the dogs, while those who didn’t visit with a dog reported that they were just as lonely as they had been when the experiment began.
When I visit the Stanford University artificial intelligence laboratory, a team of young researchers led by Thrun and Andrew Ng convey great interest in the Sparky experiment. They’re even more excited about their own machines, whose components are scattered around the lab like auto parts in a repair shop, with a few more polished projects on display in a large central room. “We’ve lived with robots for a long time,” Ng tells me. “We call them things like dishwasher, dryer, and microwave. Now we have machines that are mechanically capable of doing household chores and even providing some interaction. But they can’t be all that helpful until we develop software that makes them smarter. We need them to hear and understand, to find the bathroom or know what to pick up. When they can do that, it’s going to be a very exciting change.”
Not everyone shares this enthusiasm for robotic companionship. “The prospects for the ethical use of robots in the aged-care sector are far fewer than first appears,” write the ethicists Robert and Linda Sparrow. They perceive “a profound disrespect for older persons” in even the most well-meaning artificial intelligence research, because it ignores old people’s strong preference for human caretakers and advances projects that will substitute machine companions for human ones. The Sparrows acknowledge that social robotics is a flourishing field, and they recognize that machines could be helpful for certain routine tasks, such as using appliances, opening doors, and fetching food. But they warn that robot designers have a long history of setting unrealistic expectations, and they doubt that there is a technological solution to the problem of caring for the isolated.6
The questions raised by critics like the Sparrows should be directed at all of us, not merely at artificial intelligence researchers: Is there really a shortage of living pets to accompany people? Will robots ever be able to meet the complex needs of people, particularly those who suffer from a lack of social interaction and long for emotional connection? Will machines be able to navigate through the often cluttered rooms of homebound people, let alone clean the floors? Will robotic pets provide enough stimulation and affection to sustain their owners’ interest when the novelty wears off? (The nursing home residents in the robotic dog study had access to AIBO for only eight thirty-minute sessions.) If the robots can be turned on and off, won’t that make it impossible for them to establish what the Sparrows call “the independent presence that is a necessary condition of meaningful relationships”? If the robots can’t be turned on and off, will that make them threateningly invasive, and unappealing?
Skeptics of robot care for the elderly and frail also argue that machines capable of interacting with singletons will be prohibitively expensive—unless, as they predict, the robots ultimately displace human caretakers, deepening the isolation of those they serve. After all, many of the most vulnerable older people we interviewed report that paid caretakers, from cleaners to meal delivery workers and home health attendants, are their most regular sources of social contact. They value the presence of another human being just as much as the labor that the person provides, and they long for more company, not less. Substituting a machine for these already rare visitors would be devastating. Hence the Sparrows’ emphatic conclusion: “We believe that it is not only misguided, but actually unethical, to attempt to substitute robot simulacra for genuine social interaction.”7
But machines need not substitute for social interaction, and with the right design they can even promote it. Consider Kompaï, a robotic companion being developed by the French company Robosoft. Although the machine is still a work in progress, its 2010 incarnation featured a short, sleek human form with a head, a cartoon face, and a video camera on top; a box with two large wheels at its base; and a large touch-screen monitor at its midsection, which its human companions could use for a wide range of Internet-mediated communications. The designers of Kompaï envision the family, friends, and health providers of the machine’s user contacting them through an Internet-based program such as Skype or Facebook or an instant messaging service. When completed, Kompaï will be able to locate and move to its owner, and its speech recognition software will allow physically impaired people to communicate by voice.8
Machines like Kompaï may appeal to homebound and elderly singletons because they provide greater access to a kind of communication that people who live alone are already enjoying. (And by the time the current generation of young adults reaches old age, their comfort with machines will make robotic companions even more attractive.) Senior citizens are not only the fastest-growing segment of Internet users, they are also heavy users of its interactive features, from e-mail to dating and social networking sites to video calling programs, which they now use to enrich their communications with family and friends. There’s not much good research on the effects of this activity. But one report, by economists at the Phoenix Center for Advanced Legal and Economic Public Policy Studies, finds that older people who used the Internet experienced a 20 percent reduction in depression and that the change was actually caused by their online activity.9 Not all old people have good access to the Internet, and many who do lack the training they need to master its most important social features. But there are clear payoffs to helping them get online, and projects designed to do this—from the British old-age advocate Valerie Singleton’s six-button touch-screen desktop computer, the SimplicITy, to state-subsidized programs that bring Internet access to public housing for seniors—will deliver immediate rewards.
There’s also no questioning the value of using machines to link isolated or homebound seniors with health care providers and social workers. Videoconferencing with doctors and nurses is never as good as a face-to-face consultation, but it can be helpful, if only as a way to maintain better contact between visits or to evaluate whether patients are following medical advice at home. New technologies are already enhancing these interactions. Increasingly, health care providers are giving their more frail and isolated patients wireless monitors that convey vital physiological information—pulse, temperature, and breathing levels—to a remote office, where medical technicians can detect potentially serious conditions before they become emergencies. Elderly singletons who are in good health but still worry about a sudden fall (approximately 13 million older Americans fall each year) or some other crisis can benefit from more mundane technologies, like the medical alert systems activated by the touch of an alarm that fits into a pocket or around the neck. And since devices like these bring some peace of mind to those who love or care for seniors who live alone, the rest of us benefit from them, too.
NO MACHINE, be it a compact alert bracelet or a human-size robot, can provide what so many old people and their families need most these days: a home that allows them to maintain the feeling of autonomy while also offering genuine sources of social connection and access to services and amenities. Places like these do exist, and they’re not nursing homes. They’re called assisted living facilities—or, alternatively, independent living facilities, a telling conceptual distinction for a place without a difference—and roughly one million elderly Americans live in them today.
Typically, assisted living facilities are located in large apartment buildings that carve out spaces for communal activities: a dining room for shared meals, a gymnasium, classrooms, or a garden. They also tend to have large support staffs, from cooks to cleaners, security guards to home care assistants. About one-third of assisted living residents occupy smaller places, including houses, that have fewer than sixteen tenants. They may not offer all the amenities of larger facilities, but these homes can offer more personal services, and they lack the institutional feel that can be off-putting to people who are fighting to retain their dignity as they age.
Whether large or small, high-quality assisted living facilities share at least one characteristic: They are prohibitively expensive for all but the most affluent individuals and families. A report published by the trade publication Assisted Living Executive estimates the monthly rent for a typical room at about $3,500, or $42,600 per year. In one recent post on the New York Times blog The New Old Age, Paula Span explains that, at $4,000 a month, a small residential home in New Jersey is a bargain compared to a neighboring facility with ninety-eight beds and fees starting at about $65,000 per year. (Residents pay more for services like home care or medication reminders.)10 In another post, the reporter Jane Gross recounts her own family’s expenses for the nine years that her mother (who, it should be noted, held an expensive long-term insurance policy) spent in two assisted living facilities and one nursing home: “All in all, I figure the years from 1994 to 2003, when my mother died, cost our family $500,000, easy, even without accounting for her lesser expenses or, more important, the emotional and physical wear and tear of so many moves on an old lady.”11
The wear and tear related to moving could be avoided, Gross writes, if families encouraged their elderly relatives to move into a special kind of assisted living facility: a continuing care retirement community, which can accommodate residents no matter how much special care they need when they lose the capacity for domestic independence or approach the end of life. The catch, however, is that these facilities demand a large up-front payment; the one Gross visited, in Tarrytown, New York, asked for about a $200,000 payment against which future costs would be deducted, just to get in the door. Those rich enough to afford this may well benefit in the long run. Then again, they may not, since there’s no refund if the resident dies soon after moving in, as many inevitably do. It’s “a dilemma many can only wish for,” Gross acknowledges. But that doesn’t make it any less difficult for the families that are affluent enough to consider a continuing care facility.12
For the past dozen years my own family has experienced the stress of this fortune. Until her death in 2011, my grandmother Esther had always been humorous, mischievous, and full of life. As a child during prohibition, she learned to make bathtub gin; as a young mother, she was the president of the local school parents’ association and the synagogue women’s auxiliary, and she also threw enormous, occasionally raucous parties where she taught her friends to dance; as a grandmother, she taught me how to hit a baseball and drive with my left hand so I could put my right arm around a date. But for the last twenty-five years of her life, she spent much of her energy in a daily battle with Parkinson’s disease, and the fight became more difficult after her second husband, Irv, died in 1997.
For most of their marriage, Esther and Irv lived in small rental apartments in Los Angeles; among the countless ways that Irv helped her, driving her around town was particularly important, because their city, like so many others, demands mobility, and she could no longer drive. When he died, quite unexpectedly, the quality of Esther’s life in Southern California diminished immediately. She had a few friends in the area, but they too were beginning to suffer from various illnesses and the deaths of their husbands, and it was hard for them to visit. Her three children lived elsewhere: my mother in Chicago, my aunt in Milwaukee, and my uncle in Silicon Valley. After a few scary mishaps, including one where she tried driving a golf cart and accidentally crashed it into the local senior center, we decided she would be better off coming back to Chicago, where she had been born nearly eighty years before.
My grandmother didn’t own a home and had little savings, but her children had been successful and they agreed to share the costs of a luxury assisted living facility on the lakefront. It’s a gorgeous high-rise building, with a sweeping, glass-enclosed atrium on the ground floor; an open, sun-drenched dining room; generously sized apartments, many with water views; and a kind, attentive staff. It’s expensive: about $50,000 per year for a one-bedroom apartment with two meals a day and access to the building’s services and amenities, and more for those, like my grandmother, who need additional care. But when it’s your own parent, who has given so much of her life to you and the family, it’s hard, if not inconceivable, to give back anything but the best.
Esther’s first years in the Breakers went smoothly. Of course, she missed her deceased husband and her life in California. But as a spritely newcomer, she had little trouble making friends and joining in various activities at the complex. She was witty and engaging, and within days she was getting invitations to dine with her new neighbors. She had always been a good bridge player, and once she made that known a small group of women let her into their game. The facility, which is located on the far north side of Chicago, offered shuttle service to the downtown shopping district, and although she didn’t have much to spend, she’d often go just to be social. Moreover, she was close to family—daughters, grandchildren, cousins—as well as old friends, and visits with them made her feel like she was back home.
Things got complicated as her disease progressed, however. Although Esther retained her mental acuity, her Parkinson’s made it difficult for her to walk, speak clearly, and control her hands. Most of her neighbors were sympathetic, and helpful. But as her body failed, she was forced to acknowledge a brutality in the culture of assisted living complexes that she hadn’t previously registered: They are organized around a social hierarchy, with the healthiest and most independent at the top and the sick and frail at the bottom, stigmatized and marginalized, lest their company remind others how vulnerable they really are.13
In her telling, my grandmother’s stories sounded like dispatches from the front lines of junior high school, not a retirement community. Women who had always included her in their social outings began planning them without her. When she confronted them, they’d usually be evasive, but sometimes they could be nasty, too. Friends who once held a place for her at the dining table allowed others to fill her seat. The greatest insult came from her bridge group, whose members decided that her problems communicating made her an impossible partner and barred her from their game. Suddenly she was an outcast, forced to find a new set of friends.
There was no shortage of possibilities, since assisted living facilities are full of people who, like Esther, are physically compromised but intent on preserving their dignity and maintaining their social lives. Remarkably, she quickly found her way into another small community, and repaired a few of her older friendships, too. Yet her enthusiasm for the assisted living facility diminished. She complained more: about the food, the staff, and other residents. She began reporting the times when paramedics would arrive to assist a neighbor, and told us about all the friends who would fail to show up for breakfast one day and turn out to be dead.
By the time she reached her late eighties, my grandmother’s disease had rendered her incapable of living independently, even with the extraordinary support that her building offered, so her children hired someone to move into her apartment. Five years later, Esther was turning ninety-two, and on her birthday, July 4, my mother hired a small bus to bring about fifteen of her neighboring friends to her home for a party. Nothing was easy for my grandmother in those days. She was weak, occasionally depressed, and sometimes disoriented. She was spending ever more time in her apartment, and she said that on some days the effort to go downstairs for dinner demanded more than she could give. Her children faced a different kind of struggle. Her care costs reached more than $80,000 per year by the end of her life, and they’d spent a fortune to help her get through the last decade—a fact that made her feel embarrassed, and perhaps a little proud as well. But that day there was still a lot to celebrate. After all, there she was, still spirited in her nineties, surrounded by family and embraced by friends who lived only steps away. Sitting beside her at our Independence Day ritual, I found myself asking how more of us could wind up this way.
In recent years a number of groups have tried answering this question with projects designed to democratize the experience of “independent living” beyond the most affluent communities. No one believes that affordable independent living is going to come from the private sector. But in 1992, two nonprofit organizations, NCB Capital Impact and the Robert Wood Johnson Foundation (which funded the research for this book), launched Coming Home, a $13 million initiative to develop new models for assisted living that middle-class and even low-income seniors could afford.
The challenges were formidable, because developing, let alone managing, these facilities requires different kinds of economic and political expertise. In most cases, dealing with complicated bureaucratic matters—securing subsidies and low-cost credit from government agencies, or integrating services with Medicaid—proves difficult enough to discourage all but the most motivated parties. And in their final report, the program reviewers noted that the local groups who remained committed to the project were rewarded with an endless series of punishments from the very public agencies that were supposed to help: “slow Medicaid eligibility determinations, slow payments, insufficient payments, delayed licensing processes, adversarial survey agencies and disinterested or unapproachable finance agencies.”14
Ultimately the Coming Home project resulted in fifty completed assisted living complexes in thirteen states. Although most are in rural and suburban areas where development costs are low, a few are in cities—including San Francisco, Milwaukee, Tampa, and Burlington—where local agencies offered land or special loans and showed a genuine interest in solving the housing problems of their solo-dwelling senior citizens. The facilities are typically mixed-income communities, with some residents paying market rate and others no more than their social security insurance affords. And although some of the projects struggled in the late 2000s when the Great Recession arrived and states slashed funding for the elderly, while other projects that had been planned were deemed “infeasible” and never broke ground, the Coming Home staff says they found eager local partners in all parts of the country, and the number of residences they built actually exceeded their expectations.
THERE ARE FEW GOOD MODELS of affordable housing for younger and middle-age singletons, and as a consequence the most marginal of them often live on the edge of homelessness, where a single misstep can result in disaster. Rosanne Haggerty first noticed this problem in 1982, when she graduated from Amherst College, moved to New York City, and began working with Covenant House, a Catholic charity that served the poor. The job came naturally to her. Haggerty had grown up outside of Hartford, Connecticut, in a large religious family that attended church in a congregation made up largely of poor old-timers, many of whom lived in cheap apartments and SROs. “I spent a lot of time in their apartments helping out or just visiting,” she tells me. “They weren’t especially nice places. But they were modest and dignified. Respectable. I came to appreciate that places like that could be decent homes.”
In New York City, Haggerty encountered a very different kind of housing stock. Homeless shelters were makeshift places where nonprofits had squeezed in as many beds as they could fit. The SROs were dilapidated and dangerous. Though she was only in her early twenties and a relative newcomer to the city, Haggerty sensed that the housing problems in New York had become urgent. “It was the moment when our understanding of homelessness was starting to change,” she tells me. “It had always been a Bowery bum issue, confined to a small group of men and just a few places. We treated it like we treat hurricanes: Get them through the crisis and they’ll be fine. But it was getting bigger, and that didn’t work anymore. There were homeless people all over the city, and we’d see young adults come back to our clinic again and again because they didn’t have a place to go. That’s when I realized that no one had an exit strategy. Neither the city nor the charities knew what to do.”
Haggerty left Covenant House for a full-time job at Catholic Charities in Brooklyn, and her first major task was helping to convert three church buildings into housing for the homeless and poor. During the planning process, she visited various shelters and SROs around the city, and she always came away disturbed by how they looked and felt inside. The SROs were particularly upsetting, because many were in beautiful old buildings with terrific bones. They had been neglected, even abused. Public areas had been divided and darkened so that no one would feel comfortable in them. The original molding and fixtures had been replaced with the cheapest materials available. “The problem wasn’t the buildings,” Haggerty explains. “It was the management and the design. I knew we could do it better. We could restore and maintain these places so that they’d look as good as everything else in the neighborhood, maybe better. We could renovate the public spaces inside so that the residents would want to use them. We could create housing that didn’t feel stigmatizing, places that people wouldn’t be ashamed to call home.”
In the late 1980s, Haggerty got her first opportunity to try this experiment on a large scale. A few years earlier, Covenant House had purchased the neighboring Times Square Hotel as a real estate investment, but the project collapsed because the organization, beset by internal conflicts and a pedophilia scandal involving Father Bruce Ritter, failed to maintain the property and its 652 units. “It had once been a gorgeous residential hotel,” she recalls. “But it was in shambles, on the cusp of bankruptcy. I’d spent some time there when I volunteered next door, and I knew it had possibilities. I started a campaign to save it and convert it into low-income housing for people who lived alone, and a lot of people signed on. The problem was I couldn’t find an organization that would do it. That’s when I decided to start my own.”
Haggerty launched Common Ground in 1990, with help from a board made up of other homeless advocates and an attorney whose firm did pro bono work to establish its charter. Although she was not yet thirty, Haggerty had seven years of experience renovating buildings for the homeless, and she knew exactly how to get city funding for the Times Square project. After three years of renovations, Common Ground reopened the hotel in 1994 as an entirely new kind of SRO. About half the residents are formerly homeless, and they struggle with everything from substance abuse to mental illness and HIV. But the other half is made up of the working poor, including aspiring actors and artists and a variety of blue-collar laborers who have a hard time finding a place for themselves in the local rental market. Haggerty hoped that those who were used to working every day would mix with those who weren’t. The groups can help each other, whether it’s dog walking or helping find a job. “The hotel is designed to be a vertical village,” she explains. “The rooms are small, but everything else is as grand as we could make it. There’s a garden roof deck and a large community room on the top floor with amazing views of the city. We built a library, a computer room, an art studio, a medical clinic, and a gym. We restored the lobby so that residents would feel proud when they came home or met visitors.”
In addition to these architectural renovations, Common Ground remade the SRO’s service delivery system, offering everything from health care to counseling to job placement, so that residents wouldn’t have to rebuild their lives on their own. Haggerty says that most low-cost housing for poor singles may rescue people from homelessness, but they also remove tenants from their network of family, friends, and neighbors. “In those places residents often wind up feeling even more alone than they did on the streets,” she explains. “So we needed to strengthen their support systems—to create a substitute for the aggressive daughters—to help them navigate the system and get back on their feet.”
The redesigned SRO proved to be more effective than anyone at Common Ground had imagined. As word of its success spread through news stories and glowing policy reports, foundation officers and local officials throughout the United States came to visit The Times Square, and the organization won funding to expand its model on a larger scale. By 2011, Common Ground had renovated twelve SROs and nearly three thousand individual units in the New York metropolitan area, and six other buildings were under construction. It had established partnerships with organizations in Los Angeles, New Orleans, and Washington, D.C., and branched out into larger projects, including a neighborhood-level initiative to prevent homelessness in Bedford-Stuyvesant. “It’s been totally consuming,” says Haggerty, who’s now working on a doctorate in sociology at NYU (where I teach) in whatever spare time she can find. “But obviously we haven’t even scratched the surface of this problem, because there are just so many people on their own who can’t afford to live in our cities. The housing option we’re trying to create is going to become more and more necessary. Our biggest challenge isn’t keeping up with the demand, it’s catching up. And right now we’re not even close.”
THE MAIN REASON that there’s not enough affordable housing for people who live alone is that our metropolitan areas weren’t built for them, and we’ve failed to redesign cities and suburbs to meet the needs of a singleton society. Compact residential units in apartment buildings, not single-family homes. Walkable and densely populated neighborhoods. Proximity to a range of commercial goods and services, attractive public spaces, and restaurants, bars, and cafés where residents can meet. Good public transit. These are important for people who live in all kinds of domestic arrangements, but they are especially important for those who live alone, because they are such heavy users of the places that support local social life.
As it happens, these metropolitan amenities are also the key elements of more environmentally sustainable cities. For although, as one British study recently reported, singletons tend to consume more land, energy, and household goods than those who live with others, these statistics are misleading.15 After all, a family of four with two cars, long commutes, and a 2,500-square-foot house in the suburbs will leave a greater carbon footprint than four individual city dwellers who live in compact apartments and use public transportation (or, better, walk) to reach work. That’s why Manhattan, the capital of America’s singleton society, is also the nation’s greenest city.16
Manhattan is not the only urban center that’s begun adapting to the new social environment. Planners and developers in cities across the United States are starting to build better accommodations and amenities for the unprecedented number of singletons who live in them. Some urban officials have made special efforts to attract the coveted demographic of professional singles that Richard Florida calls “the creative class,” in hope that they will stimulate the local culture and economy. Cities in Europe, Japan, and Australia have made even more progress. In Stockholm, where 60 percent of all households have just one occupant, a generous supply of publicly subsidized housing in urban centers and a rich, locally based neighborhood life make living alone an affordable and often quite social experience. Tokyo, Paris, Sydney, and London offer not only robust public transit systems, but also an increasing number of small residential apartments, many of them rental units and condominiums designed for young professionals, the fastest-growing segment of the singleton society.
Unfortunately, the fastest-growing part of the American metropolis is the suburb, and that’s also the place that’s proved most inhospitable to people who live alone. While many singletons prefer cities, others share the cultural preference for suburbia that’s so common in the United States and are frustrated by the paltry housing options now available. Rollin Stanley is the director of planning for Montgomery County, Maryland, an affluent area just north of Washington, D.C., and southwest of Baltimore and home to popular commuter havens such as Silver Spring, Germantown, and Rockville. Stanley, who’s in his early fifties and lets the bangs of his wavy brown hair fall across his brow, spent his early career in Toronto, where he got support for promoting more walkable, ecologically sound neighborhoods, places where residents could live, shop, and socialize without traveling far to work. “Coming to an American suburban area has been an entirely different experience,” he tells me. “And this is the fundamental problem: People here are scared to death of traffic. They don’t want to build apartment buildings or expand the commercial districts because they think it will bring congestion. They honestly believe it’s a threat to their way of life.”
But the current arrangement, a sprawling landscape of large single-family homes accessible only by automobile, is unsustainable—and not just for environmental reasons. “Washington, D.C., has more people living alone than almost any other city,” Stanley explains. “And the parts of Montgomery County that have refused to make a place for them are already suffering. Housing prices are down. Tax revenues are way down. The municipalities here need revenue and it’s not clear how they’ll get it.” The places that have best weathered the downturn are what he calls “urban lite” communities, such as Silver Spring and Bethesda. In Montgomery County, the average home is a single-family house that sells for around $500,000. But these places have a range of housing options, at different sizes and prices, and their mix of amenities entice the people who are still hunting for housing: young singles, senior citizens trying to downsize their domestic arrangements, and immigrant workers.
“This isn’t a fleeting issue, and it’s not just about the recession,” Stanley adds. “We’re dealing with a major demographic change. Montgomery County has enough single-family housing to last forever. Today only about a quarter of our households have married couples with children. And almost two-thirds of our seniors live in private houses. When they die, or decide to move into something smaller, we’ll have more single-family houses than we know what to do with.”
As he sees it, what Montgomery County and others like it clearly do need is more diverse and affordable housing choices, as well as more small-scale commercial development—not big-box stores or strip malls, which require automobiles and do clog up local roadways, but stores and restaurants that residents near modest downtown suburban areas could reach on foot. “We’re starting to see some development for the DINKS—dual income, no kids—families. Now I want to get some projects for SINKS [single income, no kids] to break ground, and I’ve told everyone that Generation Y wants to move here. They grew up in suburbs, and they’ll stay here for a long time if we can give them the taste of the city that they need.”
This vision for the future of the suburbs outside the nation’s capital is not widely shared by the people who’ve lived there longest, however, and they tend to be the ones who are most invested in civic affairs. When Stanley rolled out his master plans for Montgomery County, he got fierce resistance from home owners, particularly those near the areas where he wants to promote urban lite developments. Each project generates a mini controversy, he says, so the pace of change is painfully slow. Now, after a few years in the region, Stanley says he’s developed a new strategy for debating the issue. He’s started warning those who refuse to make room for singletons that their resistance is bad for everyone, including, perhaps especially, themselves. “There’s a real risk that we’ll miss the chance to adapt suburbia for the way we’re currently living,” Stanley insists. “And we’re all going to suffer, because as we get older we’ll find that it doesn’t work for us anymore. We’ll want less space and better proximity to amenities when we can no longer drive. And you know what will happen? We’ll wind up having to move to Florida or California. We literally will no longer fit in our hometowns.”