At the Edge of the Slope: Views from a Multicultural Geriatric Affordable Housing Facility Brian J. O’Hare Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy under the Executive Committee of the Graduate School of Arts and Sciences COLUMBIA UNIVERSITY 2016 © 2016 Brian J. O’Hare All rights reserved Abstract At the Edge of the Slope: Views from a Multicultural Geriatric Affordable Housing Facility Brian J. O’Hare This study is about the elderly poor living Brooklyn, New York and their caretakers. It is an attempt to gain a local perspective on the direct and indirect social effects of institutional policies towards indigent elder populations receiving funding from federal and state level agencies. Using theoretical models from medical and psychological anthropology on cultural studies of death, grieving, and mourning, the analysis focuses on entitlement/benefit policies and their social impact on the organizational structure at a geriatric residential complex. Especially salient were the notions of self-identity and the coping strategies used to deal with daily challenges that are attached to low social and economic positioning within a social order. In this diverse setting, social work staff engaged in caretaking practices in the hope of addressing inequalities experienced by the tenant population. Subsequently, social workers acted as gatekeepers in maintaining the measurements of equality used to determine eligibility for many resources. Ultimately, the regulations designed to alleviate inequality created boundaries among tenants and were a source of tension embroiled in large issues surrounding ethnic, linguistic, and social difference. By exploring the ways in which professional experts with authoritative-knowledge guided and interacted with the elderly-poor at one independent living facility, the research addresses the growing complexity shadowing affordable housing for older adults in the United States as the populace at large continues to diversify. In addressing how these initiatives were enacted and allocated under these conditions, one of the main aims of this research was to reveal how conflicts and struggles emanating from them were managed Table of Contents Acknowledgments ........................................................................................................................iii Dedication ...................................................................................................................................... v Part One: The Research ............................................................................................................... 1 I. Introduction: Contrasting Definitions of Old Age .............................................................. 1 Issues Affecting Impoverished Elders in the United States ................................................................ 4 Statement of the Problem....................................................................................................................... 7 Theoretical Framework.......................................................................................................................... 8 Psychosocial Theories on Aging: Disengagement, Activity, and Continuity..................................... 9 Ways for Coping with Adversity: The Psychoanalytical Approach ................................................ 10 Self-Identity as Crucial to the Cultural Context of Aging ................................................................ 12 Anthropological Perspectives on Death: Dying, Grieving, and Mourning...................................... 18 II. The Setting: Contextualizing Brooklyn, New York ......................................................... 22 Economic Change and Social Transformation in Park Slope .......................................................... 23 Affordable Housing Options ................................................................................................................ 30 Living Arrangements at a Charity Housing Center for the Elderly and Disabled......................... 32 The Structure ........................................................................................................................................ 34 The Tenants ........................................................................................................................................... 36 The Caretakers...................................................................................................................................... 40 Moving In: The Lottery System........................................................................................................... 42 Chapter Summary ................................................................................................................................ 45 III. Methodology: Structuring Research Objectives............................................................. 47 Being and Knowing the Other: Choosing a Research Design .......................................................... 50 Limitations to Research........................................................................................................................ 63 Reflections on Self-Identity: Discovering Hidden Bias in the Field ................................................. 64 Chapter Summary ................................................................................................................................ 67 IV. A Method of Inquiry: Becoming a Participant Observer .............................................. 70 Various Models: Advocacy and the Preservation of Life.................................................................. 76 Tales from the Field: An Unfortunate Event Brings Us Closer Together....................................... 84 “Much More Than A Form”: The Role of Empathy in Caretaking Practices................................ 88 Chapter Summary ................................................................................................................................ 92 Part Two: The Results................................................................................................................ 93 V. Limitations of Intergenerational Ties within Families .................................................... 93 “Without a Family You’re Lost”....................................................................................................... 104 Far from Kin: Replacement of Caretakers ...................................................................................... 113 The Reality of Benefit and Entitlement Regulations for the Elderly Poor.................................... 119 Overcoming Obstacles: Discovering the Social Impact of Benefits & Entitlements .................... 125 Chapter Summary .............................................................................................................................. 130 VI. Conflict and Opposition in the Communal Practices of an Institution....................... 133 Institutional Control by the Administration .................................................................................... 133 Peers and the Alienation of the Other............................................................................................... 159 Home Attendants as Extensions of the Self ...................................................................................... 179 Limitations of Exchange: Tenants as Recipients ............................................................................. 187 i Chapter Summary .............................................................................................................................. 191 VII. Moving Out: Perceptions about the Health and Well-Being of Tenants................... 192 Quality of Life and Quality of Death: Rehabilitation versus Maintenance................................... 192 The Caretaker’s Dilemma: Resistance to Aid.................................................................................. 199 “How Long Do You Want to Live For?”.......................................................................................... 200 “It Kills Me That I Can’t Do It Myself!”.......................................................................................... 204 “She Came Home to Die”................................................................................................................... 212 Chapter Summary .............................................................................................................................. 220 Part Three: An Impression ...................................................................................................... 222 VIII. Acknowledging Death .................................................................................................. 222 Identities in Transition: Coping Strategies at the End of the Life Course.................................... 228 Final Thoughts and Discussion.......................................................................................................... 233 Areas for Future Research................................................................................................................. 237 Works Cited............................................................................................................................... 240 Appendices................................................................................................................................