HB II Poverty and Aging DB & Responses. Week 11

Journal of Aging Studies 30 (2014) 47–55

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Journal of Aging Studies

journal homepage: www.elsevier.com/locate/jaging

Exploring identity and aging: Auto-photography and narratives of low income older adults

Jacklyn Kohon a,⁎, Paula Carder b

a Urban Studies and Planning, Portland State University, P.O. Box 751, Portland, OR 97207, United States b Institute on Aging, Portland State University, P.O. Box 751, Portland, OR 97207, United States

a r t i c l e i n f o

⁎ Corresponding author. Tel.: +1 503 725 3952. E-mail addresses: [email protected] (J. Kohon), ca

(P. Carder).

http://dx.doi.org/10.1016/j.jaging.2014.02.006 0890-4065/© 2014 Elsevier Inc. All rights reserved.

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a b s t r a c t

Article history: Received 9 October 2013 Received in revised form 27 February 2014 Accepted 28 February 2014 Available online 17 April 2014

This study focused on meanings of health, housing, independence and aging among low-income adults age 55 and older who live in, or are on a waiting list for, publicly subsidized rental housing. The purpose was to learn how low-income older adults perceive their independence and health, and how their place of residence contributes to these perceptions, as well as related perceptions of self. Qualitative data were collected using in-person narrative interviews with 45 individuals and a second photo elicitation interview with 31 of these persons. Themes describe how disrupted identities influence subjective thoughts about the aging process, housing, health, and finances, the process of clinicalization, and place identities. These findings highlight the relationship between housing status, dignity, and shifting identities as older adults experience the aging process in a low-income context. This study expands the current scholarship on the relationship between environment and aging as well as our understanding of poverty among older persons. These topics are relevant for new policies and programs to support the aging in place of older persons in subsidized housing. Understanding the life worlds of those who live in or have applied to this form of housing will be instrumental in developing such strategies.

© 2014 Elsevier Inc. All rights reserved.

Keywords: Qualitative Photo elicitation Photovoice Subsidized housing Poverty Identity

Introduction

The purpose of this study was to learn how low-income older adults perceive their independence, health, and identity in relation to their place of residence. Participants included both current residents of publicly subsidized housing and individuals who had applied for and were on a waiting list for rental assistance. By exploring the relationship between independence, health, personal identity, and place identity in the context of low-income older adults, this study expands the current scholarship on the relationship between environment and identity and aging in place, especially as these concepts relate to older persons living in poverty. Traditional represen- tations of aging in place are challenged when considering

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persons who are very low income and/or live in distressed urban neighborhoods (Byrnes, 2011). These topics have policy rele- vance, as housing providers, advocates, and policymakers seek strategies to support the aging in place of elderly subsidized housing residents (Golant, 2003; Harahan, Sanders, & Stone, 2006; Milbank Memorial Fund, 2006; Redfoot & Kochera, 2004; Spillman, Biess, & MacDonald, 2012).

Poverty, housing, and health of low-income older persons

Nearly 3.5 million persons age 65 or older were below the poverty level, with annual incomes no more than $10,830 in 2010; another 2.3 million were classified as “near-poor” with incomes between poverty and 125% of that level (Administration on Aging, 2011). These numbers represent about 15% of older persons. Older women had higher poverty rates than men (10.7 versus 6.7%), with those living alone three times as likely to be poor than those living with

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48 J. Kohon, P. Carder / Journal of Aging Studies 30 (2014) 47–55

others (Administration on Aging, 2011). The median income of older persons was $25,704 for males and $15,072 for females (Administration on Aging, 2011). These statistics, however, offer only a partial profile of poverty among older persons.

Publicly-subsidized housing provides an important source of income stability for low-income seniors. In the United States, more than one-third of the approximately 5 million house- holds receiving housing assistance from the Department of Housing and Urban Development (HUD) are headed by a person age 62 or older (Locke, Lam, Henry, & Brown, 2011). The majority of older, subsidized housing residents are women living alone with annual incomes between $5000 and $15,000 (Haley & Gray, 2008) and a median net worth of $500 (Parsons, Mezuk, Ratliff, & Lapane, 2011). The racial and ethnic makeup of this group of older women is primarily White (61%), but also includes Black (19%), Hispanic (13%), and other non-Hispanic racial groups (7%) (Haley & Gray, 2008).

Subsidized rental housing is intended for persons who can live independently. However, some older adult residents of subsidized housing have significant health and social needs. Most residents age 62 and older have at least one chronic health condition (Parton et al., 2011; Vladeck, Segel, Oberlink, & Gurson, 2010) and one-fourth have difficulty with instru- mental activities of daily living (IADL) (Cotrell & Carder, 2010; Haley & Gray, 2008; Parton et al., 2011). These individuals have a hospital admission rate 2.3 times the rate among age peers, and 3.4 times the rate of all low-income persons (Gibler, 2003).

Nearly one-third of residents in HUD properties for seniors are age 80 or older and nearly 20% of new residents are age 80 or older (Haley & Gray, 2008). Over one-fourth of elderly persons who moved out between 2000 and 2008 were at least 85 years old (Locke et al., 2011). Thus, subsidized housing is important to persons who have very low incomes and are among the oldest old.

Most applicants for rental assistance face long waiting lists, despite meeting income eligibility requirements. A study of HUD properties designated for people age 62 and over found that properties in metropolitan areas had about 11 applicants per available unit; applicants typically wait over two years for an available unit (Haley & Gray, 2008). In reality, many U.S. cities have closed their public housing waiting lists, or open them only infrequently (Quigley, 2010). Information about older persons waitlisted for housing assistance is nearly absent from academic literature. Thus, this paper reveals the lived experiences of both current residents and those who have been waitlisted for subsidized housing.

Independence and place

Independence in the context of living environments is an enduring theme in gerontology. Research has been conducted on the socio-cultural meanings of independence for older persons in nursing facilities (Gubruim, 1993; Kapp, 2005; Smithers, 1990), assisted living residences (Ball et al., 2004; Carder, 2002; Morgan, Eckert, Piggee, & Frankowski, 2006), and the home environment (Cristoforetti, Gennai, & Rodeschini, 2011; Kahana, Lovegreen, Kahana, & Kahana, 2003; Kaufman, 1994; Rubinstein, 1989, 1990; Smith, Braunack-Mayer, Wittert, & Warin, 2007). In these and other studies, independence has been conceived as a basis for quality of life, autonomy, personal identity, and aging in place (Wiles, Leibing, Guberman, Reeve, & Allen, 2012).

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Prior research, however, has not illuminated the meaning and experience of independence among low-income older persons.

Identity and place

Broadly speaking, identity refers to the individual's defini- tion of who one is. The meanings and sources of personal identity have been explored in relation to aging (de Medeiros, 2005, 2009; Moss & Moss, 2007; Twigg, 2010), psychiatric illness (Estroff, 1989; Karp, 1997), and chronic disease (Carder, Vuckovic, & Green, 2003; Charmaz, 1995; Hayes-Bautista, 1976). The relational identity between individuals and their living environment, an important concept for gerontologists (Rowles, 1978; e.g., special issue of the Journal of Aging Studies edited by Moore & Ekerdt, 2011), is the focus here. Rubinstein (1990) introduced the concept of “environmental expression” to describe how key aspects of personal identity were ex- pressed in environmental terms—essentially, the process by which the individual is both made by and makes their local environment, and how this is expressed in narrative form. This concept is important because it expanded on Lawton's (1986) notion of person–environment fit by considering the socio- cultural dimensions of person and place. More recently, Byrnes (2011) critiqued “aging in place” by showing how residents of a subsidized apartment building cultivated spaces within the building that substituted for those in their Detroit neighborhood that were either lacking or unsafe. She argues that gerontologists must recognize that some environments are not suitable for aging in place and that our normative notions of place attachment are based on middle class ideals. Similarly, Golant (2008) has cautioned against over-emphasizing the impor- tance of aging in place.

Methods

Research design

This project integrated auto-photography with narra- tive interviews and photo elicitation with photographs taken by research participants. The study aimed to address two research questions: 1) How do low-income older adults living in, or on a waiting list for, subsidized housing perceive their health and independence? 2) How do low-income older adults describe the benefits and challenges associated with their current housing or surrounding neighborhood? A third research question emerged during analysis: How does living in or apply- ing for subsidized housing affect older adults' identity and sense of self?

Many studies using visual research methods have highlight- ed the themes of self, identity, and place. Visual methods paired with individual narratives including auto-photography, photo- voice, and digital storytelling have provided a unique platform for understanding the identification of self and the exploration of changing identities. The use of auto-photography with in- dividual narratives has been instrumental in research related to identity among aging bodybuilders (Phoenix, 2010), hairdressers in their workplace (Shortt & Warren, 2012), adolescent Latina girls (Noland, 2006), and Indian women (Noland, 2006), among others. Pairing auto-photography and narratives has been used to understand experiences of homeless spaces (Johnsen, May, & Cloke, 2008) and the

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49J. Kohon, P. Carder / Journal of Aging Studies 30 (2014) 47–55

meanings of risk to older persons (Rush, Murphy, & Kozak, 2012). Auto-photographic methods have been successfully used in identity studies to elicit how research participants see themselves in relation to others and the world around them. Using auto-photography, participants create visual representations of their identity that add additional layers of meaning to qualitative data and allow the researcher to see the participants' world through their unique lens. Qualitative researchers have employed the similar photovoice method developed by Wang and Burris (1997) to inspire policy action to address social injustice. Photovoice has been used to highlight health disparities among marginalized populations (Hergenrather, Rhodes, & Clark, 2006; Morrell, 2007), promote health (Jurkowski & Paul-Ward, 2007; Wang, Yi, Tao, & Carovano, 1998), advocate for community needs (Newman et al., 2008), and develop programs (Jurkowski, 2008). Though the terms auto-photography and photovoice are often used interchangeably, we use the term auto-photography to describe individual interviews with participants who take their own photographs to represent their reactions to the research question.

Sites and sample

This qualitative study took place in Portland, Oregon during the summer of 2010. The sampling goal was to seek variation among low-income older persons. A public housing agency and a for-profit owner of affordable housing provided us access to five buildings restricted to persons age 62 and older or adults with disabilities. The buildings were located in geographically distinct areas of the city, ranged in size from 58 to 115 apartments, and included low- and mid-rise buildings. Three properties employed a part-time on-site service coordinator to help residents access local services. To recruit current residents, we attended resident council meetings and distributed fliers. To recruit waitlisted appli- cants, the management of the two housing agencies mailed a recruitment letter to about 200 individuals. A total of 47 individuals participated in the study; of these, 29 lived in a publicly subsidized housing unit and 18 were on a waiting list. All participants were invited to take part in a second interview to discuss photographs that they were asked to take (described below); a total of 31 people (25 subsidized housing residents, six waitlisted persons) completed two interviews. The research protocol was reviewed and approved by the Portland State University Human Subjects Research and Review Committee, and all participants received a $5 gift card.

Data collection

Data sources for this study include interviews, photo- graphs, and interviewer field notes. The initial interview in- cluded both open-ended and forced-choice questions about participants' self-rated health, perceptions of independence, use of or need for social and medical services, demographics, housing history and future housing needs and wants (e.g., Do you want to continue living in your current home? Do you expect to do so?). All interviews were audio-recorded and transcribed, and took place in the participant's apartment or in a location of the participant's choosing.

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Thirty-one participants who agreed to complete the auto- photography component of the study received a disposable camera with up to 27 exposures. Participants were asked to take pictures relating to the best and most challenging aspects of living in their apartment and neighborhood, as well as their perceptions of independence. The interviewer gave detailed instruction on camera use, and asked each person to demonstrate their understanding by taking one photograph. Each participant received written instructions and a numbered list to track when and where photographs were taken, the photo subject, and their reasons for selecting each photo subject. We collected cameras and processed film, and within three weeks conducted a photo elicitation inter- view. The interviewer then asked the participant to talk about photographs representing what made it either easier or more difficult to live in their current home or neighborhood and to provide a caption, or brief title, for each photograph.

Data analysis

Transcribed interview data were inductively coded by the authors, beginning with descriptive codes on topics such as money, family, health, and housing preferences; later analysis was more interpretive, with the goal of identifying salient themes by reading, coding, and rereading the text. For example, codes such as “money talk,” “independence,” and “why move” were compared and used to develop an understanding of shifting identities and environmental expres- sion. Data management and textual analysis were facilitated with Atlas.ti software (Muhr, 2008). Photographs were hand- sorted and organized into categories that both reflected and expanded the analysis of interview-based data. As final codes and categories were developed, we identified three themes that tied them together (Luborsky, 1994; Morse, 2008). Interpreta- tion of photographic data relied on the context of the narrative from interviews, specifically the reasons participants gave for taking each photo and the main points they emphasized during interviews. All participants were assigned a pseudonym to protect their confidentiality.

To understand these participants' identity and environ- ment, we followed the advice of de Medeiros (2005) to con- sider the interplay between “the expected and the actual” when interpreting the meaning of personal narratives and identity. This meant working iteratively between the differ- ent sources of data and questioning whether responses might reflect “habitual categorizations” that individuals make about themselves (Rubinstein, 1990). In particular, Rubinstein (1990) suggests that summary statements that individuals make reflect a crystallization of the individual's self-consciousness. Some participants' photographic captions offered such crystallization, especially when substantiated by the interview narratives. For example, one resident provided the photo caption, “What would I do without the library? I'm a reader.”

Also important for our work is de Medeiros' (2005) des- cription of the “complementary self,” her phrase for capturing the dynamic interplay between master, cultural narratives and personal narratives that mediate individual notions of identity and of the self. We used the combination of narrative alone and photo-based narrative to provide both the participants and us, as interviewers and listeners, an opportunity to delve into themes

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50 J. Kohon, P. Carder / Journal of Aging Studies 30 (2014) 47–55

that bridge culturally expected and external presentations of self with the complementary and internal awareness of self.

Results

All 47 participants had low incomes (an eligibility require- ment for subsidized housing) and most (66%) reported that they received food stamps; nearly one-quarter received home delivered meals (see Table 1). One-quarter rated their health as fair or poor; 36% receive assistance with housekeeping or laundry, and 23% receive assistance with grocery shopping. Both current residents and those who were waitlisted reported that they had lived in their current residence for about five years on average.

Differences were observed by respondent type to ques- tions about future housing wants and expectations. Perhaps not surprisingly, most (19) of the current residents preferred to remain in their current home, while only four waitlisted applicants wanted to do so, and a few participants expressed mixed feelings. A similar pattern occurred in response to a question about whether they expected to remain in their current home for the next few years, with several waitlisted applicants explaining that they could not afford to remain in their current home. Most participants of both types (85%) agreed that their current residence allowed them to feel independent, with many of them offering supporting state- ments such as “I can come and go at will” or “I can be my own person.”

The participants shared their experiences of living in their current homes and neighborhoods, and of moving or hoping to move into rent-subsidized apartment buildings. Three themes related to identity emerged in the analysis phase of this study: disrupted and uncertain identities, building identities, and clinicalization of the subsidized housing environment. Examples of these narratives are discussed in the following.

Disrupted and uncertain identities

Similar to Becker's (1997) discussion of the “disrupted lives” experienced by persons who had suffered a stroke, some participants described changes in their health or financial circumstances that affected their self-identity. Several felt that they did not belong in age-segregated or publicly-subsidized housing. For example, a 70 year old man referred to here as Larry, on a waiting list for subsidized housing, said he isn't “that old yet” and does not identify with the group of people he associates with certain types of public housing.

But I mean those are really old folks' homes. And I don't feel like I'm that old yet. You know, I really don't. I've been to those places, jeez, I mean it's so depressing. There's hardly anybody under eighty and most of them are disabled. And I'm not and I'm active and I really don't feel seventy. I really don't, you know.

Larry applied for housing because his $675 monthly rent left little of his $1030 monthly income to afford anything other than utility bills and cable TV. When asked whether in the prior year the food he bought didn't last and he lacked money to purchase more, he stated that this occurred often. Although he liked his apartment and neighborhood, the financial burden

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was a “challenge” every month, and although his medical diagnoses include high blood pressure and Parkinson's disease, he stated, “the only problem I have is my income.” Moving into subsidized housing would reduce his rent by nearly half, yet he looked toward this change with trepidation because he did not identify as “old.”

Some participants struggled to find ways to cope with their aging bodies and their increasingly limited mobility. These changes are often compounded by their financial and housing status, resulting in expressions of isolation, physical limitations within the living environment, and a perceived lack of meaningful activities. Michael, a 57 year old man who drove trucks and worked in warehouses before retiring, explained that his wife died soon after they moved into their apartment; they had been waitlisted for over four years. Now, he said,

I feel like a useless slug. Sit upstairs, sit on my ass, watch TV…bitch about my aches and pains, and…the doctor has me taking so many pills, I'm surprised I don't light up at night. And the inactivity, I feel, is what is really killing me… I've got a name for my TV, too, you know? We're on a first-name basis. Get so tired of it, really, and then I see all the other people in here struggling, and I think, jeez.

Michael described himself as a “Pez dispenser” because of the many medications he takes for several physical and emotional health conditions. Although he takes issue with living in an apartment building, and with some residents he avoids “like the black plague,” his monthly income of less than $700 per month results in a rental payment of $192, an amount that he recognizes “couldn't let me buy a tent or even camp out.” Similarly, Deborah, a resident of an apartment building designated for people age 62 or older, described how her aging body and low income collided to limit her choices:

I want to get out of here as soon as I can, but I can't find a place… I found another place and I liked it, and then I went back to see it again. I realized it was foolish of me to do that because my legs were starting to go. And I found it difficult walking the distance from the elevator to the front door. So, I cancelled it and I'd already given my notice in here. Then she [Property Manager] said “you can't take it back.” I can't find another place that's affordable, so I'm like a captive. I really feel trapped.

Similarly, Michael said,

Everybody wants to move out of here, nobody does. When they leave it's usually in an ambulance. I mean, God that sounds terrible, don't it? But it's true. I mean… Christ, I hate to say it, but it's like you come here to die.

Despite their middle-class work histories, some older persons now found themselves either living in or applying for subsidized housing. After unexpected medical, family or financial struggles, they had no choice but to move into subsidized housing, leaving behind the lifestyle and homes to which they had become accustomed. Rosanne, a 62-year old said,

It's just how you look at it, and I guess because really I came basically from a middle class family, now I'm not. Maybe it's more devastating to me than it would be to somebody else.

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Table 1 Demographic profile of study participants (n = 47).

N (%)

Gender Women 33 (70%) Men 14 (30%)

Housing status Subsidized housing 29 (62%) Waiting list 18 (38%)

Marital status Single or never married 5 (11%) Married/partnered 11 (23%) Separated/divorced 22 (47%) Widowed 9 (19%)

Race White/Caucasian 35 (74%) Black/African American 5 (11%) American Indian/Alaska Native 1 (2%) Asian 1 (2%) Multiracial 3 (6%) No response 2 (4%)

Mean age 69 years Average monthly income $938

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In addition to disappointment over their financial cir- cumstances, several residents expressed feelings of extreme dissatisfaction or even devastation over where they have “ended up.” The residents' own words demonstrate the potential impacts on mental health that these feelings can have, particularly as their former self-identity collides with their current status. Deborah said, “If I thought I had to live here for the rest of my life I'd probably shoot myself right now.”

The photo in Image 1 was taken by a 74-year old woman, referred to here as Denise, who was on a waiting list for a publicly subsidized apartment. Despite the significant finan- cial success she experienced throughout her life, Denise now describes herself as a victim of the recent economic collapse. Her financial resources had been mostly drained, as a result.

Denise lives in a manufactured home and works as a caregiver, a recent career change for her. She knows that there will be a time soon when she will no longer be able to

Image 1. “So the reason I can't stay in this place is money. Life can't continue without enough money as it is.”

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work and therefore will be unable to pay her mortgage. She applied for subsidized housing even though she doesn't know when she'll need to make the transition. Pointing to Image 1 during the interview, she said that money represented “my biggest concern” and “I cannot continue to live here.” Denise fears not having enough financial resources to remain indepen- dent in her current home, which she would much prefer to subsidized housing. In this image, the money appears to be somewhat far away from the camera, which may suggest that she feels that money is increasingly not within her reach, since she does not anticipate any gain in financial resources. Denise shared her intent in taking this photo, making sure that it was a small amount of money appearing far away from the camera view. “It was my daughter's idea but I did it and I love it, yeah. I was going to…I had a wad of $20s and lots more money, and I went, now, it needs to be significantly little.”

In addition to the disrupted financial identity that Denise felt when her economic stability was lost, she distanced herself from the “type of people” who live in subsidized housing when she said, “I'm sure that my situation is very different from the other people you're interviewing,” and “I don't think my situation applies to what you want to know.” She explained that she never thought she would “end up there [in subsidized housing]” because of her financial success and her perceived social status. She did not want her identity associated with the stigma of public housing (Tester, Ruel, Anderson, Reitzes, & Oakley, 2011).

To provide a contrast to her feelings represented by the photo of money (Image 2), Denise photographed her current living room, depicting framed photos of family and friends and a living environment that is comfortable to her.

Denise's comments about this photo, contrasting with her intentions behind the previous photo illustrated her feelings about how her sense of security and her identity are threatened by her financial instability and impending move to a subsidized apartment building. She said,

Yeah, plus [it reflects] how much that is me and what I would like the rest of my life to be, so one and [the money photo] are the two polar opposites. One is the joy and comfort, and the other is not being able to continue because of…[limited resources]

Image 2. “Surrounded by my things, and family photos. A number of these paintings were done by my relatives, so that is also very important, not many people have that in their lives.”

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52 J. Kohon, P. Carder / Journal of Aging Studies 30 (2014) 47–55

Building identities

This theme of building identities primarily describes the experiences of current residents who described their apartment buildings in various ways. From very positive descriptions to quite negative descriptions, these illustrative metaphors dem- onstrated the complex ways in which residents view the identities of their housing community and their relationships with the building management, other residents, and the outside community. Specific examples include the building as dormitory, building as prison, building as library of life, and building as a town within a city. Charles, an 85-year old widower with a doctorate degree, described his building as being run similarly to a college dormitory.

I wish it were different sometimes…plenty of people here who gripe, and who can tell you a list that long, but I'm not one of them. I like it. So I would say that, what can you say when you like a place? If you're living on [a college] campus, then you gotta… like the dorms enough to stay there. Like here. There are some things you don't like about the college, some of the restrictions or things like that. Or you get tired of hearing lectures all the time. For instance, we got a lecture on bedbugs. But…it's hard, because organizations like these housing projects are for all sorts and conditions of people. Mostly if you're used to the collegiate style of living, this is a pretty nice dorm.

Charles' description is further illustrated by his photo of his apartment building's exterior (Image 3), a building that might otherwise be situated on a college campus. To provide a caption of the photo, Charles remarked on “the beauty of the neighborhood.”

Rosanne lives in an apartment building designated for persons who are disabled and/or age 62 and older. Several participants from the building reported regular conflicts between residents of different ages, problems with certain residents “mooching” off of others, residents who sell drugs in their apartments or let trouble-makers into the building. Rosanne, whose narrative also supports the theme of disruption,

Image 3. “Beauty of the neighborhood.”

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compared her experiences of living in her building to being in prison:

It's interesting, a lady and I were talking earlier that this is like, and excuse me when I say this, but this is like a prison here. Sure we have day passes and stuff, but we're limited where we can go by transportation, because of lack of transportation, although we have a bus system. It imprisons you into your lifestyle. I know I sound terribly negative, but you see the people out there, and I know there are a lot of people who have their own homes that ride the bus. It's not the fact you have to ride the bus, it's the fact that your life is so different now. It's inconvenient to have to buzz in, have people sitting out front, a group of people sitting out there smoking.

One of Rosanne's photos (Image 4), depicting an old pick-up truck parked along the street, reflected this sense of what she described as the "passing of time" and the difficult changes in identity construction (as reflected in her quote above) that result from "where we've been and where we're at now.”

Louise, a 55-year old who lives in another building, shared a similar sentiment when she described the identity of her building as “a library of life,” reflecting the different personalities and life experiences represented in affordable housing.

The challenges of the building, when I first came here I looked at the building and it looked like a bookshelf. The way the bricks are lined up, the masonry outside, and the windows, it kind of reminded me of a library or a commercial building or something. On the outside, and cause you know, there's no swing set, no playground or anything, and I wasn't sure, and in the parking lot I was talking to somebody, I said this building isn't just a building of people and complex and housing, this is a library of life. Every room in here, there's almost 80 rooms here, each of us have our own story. Some are first-rate novels and some you may never shake the dust off and ever try to read, but this place is a book of life and no two people are the same here. A lot of personalities.

Image 4. “It kind of shows passing of time. It's an old pickup, it reminds me of how much time has passed, and that it reminds us of where we've been and where we're at right now.”

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53J. Kohon, P. Carder / Journal of Aging Studies 30 (2014) 47–55

Judy, a 67-year old, described her building, restricted to low-income seniors, as a “hippie commune” because of “our social groups” that help each other by sharing food, driving those who cannot get to the grocery store, and checking on each other. This “sense of community” said Judy, “keeps us all independent.” Delia, a 54 year old woman who lives in a building with resident services staff who organize social activities for residents describes her building as a “little town within a city.”

All of the things that we have on the monthly community chart, as far as the monthly-daily activities chart, it gives me an opportunity to, if I chose, this could be like my little town within a city because it's so many people and it's close to everything. And the help that we get from the community partners to help us and to get around and to do things, activities and so forth, it makes it really great. So having that it makes a wonderful opportunity for me to be able to participate in a lot of different things.

Delia's representation is similar to the effort that residents of a subsidized property in Detroit made to compensate for their distressed neighborhood (Byrnes, 2011), though Delia's apartment building provided just one of several choices of local places to socialize and access services. The neighbor- hood context of subsidized housing is clearly central to any larger understanding of place, identity, and health.

Clinicalization of social control

The final theme reflects narratives from participants who experience a sense of clinicalization because of their ascribed social status from other residents, staff, and outside service providers. This term refers to the tendency to define, manage or control residents' social and health concerns as clinical concerns because of their perceived low status in the social– political order as both old and poor (O'Neill, 1995, p. 31). For example, Rosanne explained an event that occurred as she was taking photographs for this study:

I had two women come, and it was around the time I was taking the picture. The three of us were coming in the building, we were laughing, and after they left and I was downstairs somebody said, “Who were those women?” I said they were women from my church. They said they thought they were caseworkers or something. Do I always have to have caseworkers?

Rosanne's comments and the assumptions of her neighbors indicate how an interaction with non-residents was assumed to be a clinical matter. Many of the residents have health concerns or disabilities for which they receive treatment or social services. Most residents rely on public assistance for food, in addition to the support they receive for housing. Some residents described case managers who help them access services and stay “on track.” However, as reflected in Rosanne's comment, the housing environment is not intended to be a clinical setting and many residents expressed that their perceived identities are too intertwined with these health and social service needs. Her words also expressed a lack of privacy in her housing environment; a feeling echoed not only by current residents, but also by Dwight, a 62-year old who was

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waitlisted for an apartment. As illustrated in Dwight's words, the lack of privacy associated with the application process impinged on his sense of dignity and sense of self:

You know bureaucracy; if you're poor they require your life story plus your finances and your friends and all like that. Why is it so necessary to know all that to keep track of, have we gotten to the point in America we're keeping track of personalities and our citizenship?

Several residents described problems associated with their building being designated as “disabled.” Rachel, a resident of a mid-rise building designated for both older persons and persons with disabilities explained, “it's low income housing, yes, but it also has people with disability in there, we have needs people [who are] disabled. There's a real stigma with living here.” Rachel's comment reflects the layers of marginalization that many residents shared, as a result of the dual experiences poverty and the tendency in our society to conflate old age and disability.

Discussion

This qualitative study combined in-depth interviews and an auto-photography technique to ask low-income older adults to photograph images that represented aspects of their home and neighborhood that either supported or restricted their ability to remain independent. Participants provided vivid descriptions and shared rich stories about their lives, and the challenges to their long-held concepts of individual identity that shaped their current perceptions of self and place. As demonstrated through the words of these 47 individuals, being poor and either living in or applying for subsidized rental assistance act as crucibles for identity formation and transition. Some individuals experienced cognitive dissonance as they realized the limitations of their aging bodies coupled with another layer of conflict between a perceived class identity and the experience of downward class mobility.

The interview and photographic data indicate that these low-income older persons have rich and varied lives. While we focus here on their identities as residents and prospective residents of subsidized housing, and how this informs their current conception of self, we recognize too that these individuals both ascribe to and are assigned other identities based on their work history, family status, country of origin, and many other aspects of their lives (de Medeiros, 2005). For example, when Mary described how others assumed that her visitors must be case workers, she simultaneously recognized and rejected the wider cultural definition of public welfare recipients as ‘cases’ to be managed by a worker. This identity did not square with Mary's notion of self, and she took the opportunity to relate this story in order to defend against the perceived accusation that her identity is attached to this stigma.

Similarly, residents' attempts to illustrate the identity of their building as a whole demonstrate a desire to develop meaning from their lived experience that confronts norma- tive assumptions and cultural definitions of what public housing is like. The identity they define within their building or immediate community provides another layer to their sense of self situated in a collective “other” in society. These layers of identity, as well as the shifts in identity they

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54 J. Kohon, P. Carder / Journal of Aging Studies 30 (2014) 47–55

experience as part of the aging process and changes in social class status, are compounded to create an overall identity structure through which they experience everyday life.

For those who are living in or transitioning to subsidized housing after being financially self-sufficient, this experience disrupts and requires renegotiation of their identity. The meaning of independence to these participants was similarly complex, with independence defined in terms of choice, physical ability, living alone, finances, and taking care of one's daily needs. A few participants referred to the classification of “independent housing,” with one person explaining that “subsidized is housing. It isn't a nursing home.” That is, to live in subsidized housing, occupants must be independent. Yet residents recognize the dissonance between this classifica- tion and the designation of housing for the “disabled” which creates a sense of stigma for some.

Implications

In light of dwindling public resources, the desire for older residents to remain independent and in their home for as long as possible not only remains a challenge but also is considerably less expensive to individuals and public funding sources, such as Medicaid. For many low-income older persons, moving is not a choice, but rather a financial necessity that may or may not result in “residential normalcy” (Golant, 2011). As new policies and programs are developed to integrate long-term services into subsidized housing (Harahan et al., 2006; Redfoot & Kochera, 2004), it will be important for planners to understand that subsidized housing residents represent a range of identities that both reflect and contradict standard images of public housing occupants as entirely needy, sick, or disabled. This research highlights the importance of providing supportive housing communities for older adults where they can maintain a sense of dignity and pride in their self-identity.

Limitations

Because we used a convenience sample, we lack informa- tion about individuals who did not participate. Further, the sample was made up of primarily Caucasian older adults and greater representation of various racial or ethnic groups could provide for a more in-depth understanding of the effects of aging, poverty, and the socio-emotional effects of one's housing environment on identity. While the auto-photography component added depth to the research, some residents either refused to take photos or had mobility or vision impairments that presented challenges when they attempted to photograph certain aspects of their living environment. We asked partic- ipants if there were any photos that they would have liked to take but were unable and some shared ideas about photos they would have taken if possible.

Many participants took photos of friends, family, and other residents in their buildings. Without informing and receiving consent from those who were photographed, we faced an ethical dilemma in presenting these photos as part of the study findings. Therefore, we chose to omit all photographs in which faces were visible and recognizable. Future research might benefit from asking participants to obtain written consent from those who they choose to photograph.

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Directions for future research

More information is needed about the life-worlds of current residents of and waitlisted applicants for subsidized housing. We need to understand the relationship between identity, place and independence among persons from various ethnic and racial groups. The situation of waitlisted applicants, persons who currently reside in a liminal status, has been largely ignored by researchers. Research is needed to explain how and why they apply for housing assistance and the status of their health and living environment. Such information can guide how housing agencies develop waitlist policies and develop new housing.

Acknowledgments

We would like to thank all of our participants for inviting us into their homes and sharing their stories and photos with us. Many thanks to the Aging Matters, Locally and Globally Initiative at Portland State University for providing funding support for this project. Finally, we would like to extend a very special thanks to Jenny Weinstein, project coordinator extraordinaire.

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