Housing needs of individuals with severe mobility impairments: a case study.

A handicap, if it exists, is not caused so much by the disability as it is by the environment that fails to provide for it. (Morgan, 1976, p.10).

Commensurate with Morgan's (1976) poignant observation, professional rehabilitation literature indicates that "housing" is viewed as being of great importance for persons with physical disabilities (e.g., Battelle's Columbus Laboratories, 1977; Davies & Beasley, 1989; Dean, 1987; Fishman, 1971; Roessler, 1981). Both state and federal governments have attempted to meet the housing needs of individuals with disabilities by enacting legislation addressing such needs. Four pieces of legislation passed by the federal government directly affect housing for people with disabilities: (a) Section 202 of the Housing Act of 1959; (b) the Fair Housing Amendments Act of 1968; (c) Section 504 of the Rehabilitation Act of 1973; and (d) the Fair Housing Amendments Act of 1988.

Section 202 of the Housing Act of 1959 provided for government loans to finance housing projects designed for individuals with disabilities. This resulted in a significant increase in independent living arrangements for individuals with disabilities (U.S. Department of Housing and Urban Development, 1979a), and also facilitated the availability of accommodating living arrangements for those incomes fall between the ability to afford private homes and qualification for public housing (Department of Housing and Urban Development, 1979b).

The Fair Housing Act Amendments of 1968 were passed "in order to ban discriminatory practices in the sale and rental of housing in America" (Smurr, 1988, p. 10). However, people with disabilities were not included in this legislation (Morris, 1988). The coverage to individuals with disabilities, and "also set, for the first time, standards of accessibility for the new construction of multi-family housing" (Morris, 1988, p. 5).

Section 504 of the Rehabilitation Act of 1973 banned discrimination toward individuals with disabilities "in programs or activities receiving federal financial assistance or conducted by the Federal Government" (U.S. Department of Housing & Urban Development, 1985, p. 1). Moreover, it identified three principles which protect the housing rights of individualsk with disabilities: (a) accessibility; (b) integrated housing; and (c) reasonable accommodation.

The Florida Statutes (Charter 187), which include a State Comprehensive Plan and specific long-range policy guidance, "eliminate public policies which result in housing discrimination... diminish the use of institutions to house persons by promoting deinstitutionalization... increase the supply of safe, affordable, and sanitary housing for low-income and moderate-income persons and elderly persons ... [and] reduce the cost of housing construction by eliminating unnecessary regulatory practices" (State Comprehensive Plan, 1987, p. 1047-1048). According to Roessler 1981), having a barrier-free home is critical to an individual's sense of well-being. Without an accessible home, an individual's self-image can suffer and existing limitations are exacerbated (Roessler, 1981). "Without accessible housing...many of the capabilities gained through new medical procedures, prosthetic devicesk and adaptive equipment can be offset by elements of the built environment" (Davies & Beasley, 1989, p. 17). The impact of accessible housing on individuals with severe disabilities was further illustrated by Reizenstein and Ostrander (1981) who stated:

For most quadriplegics, extreme physical limitations lead to almost total dependence on others to accomplish activities of daily living. This physical dependence is extremely debilitating. When sensitively designed, the physical environments can enable the handicapped individual to do various tasks without assistance, thus strengthening feelings of independence and self-worth. Conversely, inappropriately designed environments necessitate outside assistance and constantly remind the quadriplegic of his or her limitations (p. 638).

Rehabilitation literature indicates that the majority of persons with physical disabilities prefer independent living to institutional living (Bjerkesett, undated; Department of Health, Education & Welfare Office for Handicapped Individuals, 1977; Fishman, 1971). Also, individuals with disabilities prefer housing integrated with the general population (Architectural Transportation Barriers Compliance Board, 1975; Battelle's Columbus Laboratories, 1977; Department of Health, Education, & Welfare Office for Handicapped Individuals, 1977; State Planning Services Agency, 1980). Reasons for preference of integrated living include increased public awareness, better housing selection, and feeling of normalcy (Battelle's Columbus Laboratories, 1977; Dean, 1987).

Battelle's Columbus Laboratories (1977) suggested that individuals with disabilities should be given every opportunity to live independently in an integrated community. However, housing discrimination against this minority group has been documented in the literature. According to some housing managers, individuals with disabilities present too visible and depressing an image for other tenants, rentals, and sales (U.S. Department of Housing & Urban Development, 1979b, p. 36). Some individuals with disabilities have been evicted solely because of their appearances (Housing and Community Based Services, 1986). For example, The Mental & Physical Disability Law Reporter (Housing and Community Based Services, 1986) cited a court case in which housing management proposed that disabled occupants (some in wheelchairs) move from the sixth to the first floor because of their visibility as they used the elevators, hallways, and lobbies.

Discrimination is found even within programs designed to assist individuals with disabilities. While Section 202 of the 1957 Housing Act was implemented to benefit individuals with disabilities, very few live in special housing. According to one Housing and Urban Development sponsored field study, 1% of the total tenants of one housing development were individuals with disabilities, while elderly people comprised the majority of tenants (U.S. Department of Housing & Urban Development, 1979b), It has been found that "few Section 202 projects are equipped to accommodate many of the special needs of handicapped individuals" (U.S. Department of Housing & Urban Development, 1979b, p. 36), and many managers surveyed stated that their elderly residents would prefer not to have individuals with disabilities living in their communities (U.S. Department of Housing & Urban Development, 1979b).

In addition to discrimination, the literature suggests that financial resources can also be an inhibiting factor to people with mobility impairments in acquiring suitable housing.

The lack of less restrictive, affordable alternatives for people to move out of institutions and nursing homes into the community are the major barriers that mobility-impaired and other physically handicapped persons face in finding housing (Nelson-Walker, 1981, p. 15).

Nelson-Walker (1981) also stated that a person with a disability, who has no financial burden, can hire help, have a special house built, and meet his or her needs more easily; however, individuals with severe disabilities usually do not have sufficient money for these needs due to their excessive medical bills and other impairment-related expenses. Overall, the literature demonstrates a general need for affordable and accessible housing for people with disabilities and points out the value of independent living in enhancing the sense of worth and esteem of persons with disabilities. The Tempa/Hillsborough County area contains a substantial homeless population of which a significant portion are physically handicapped (Hillsborough County Coalition for the Homeless, 1987). However, the Hillsborough County Coalition for the Homeless (1987) indicated that the existing supply of housing units for persons with disabilities in Hillsborough County is not adequate to meet their housing needs. The primary purpose of this study was to assess the housing needs of individuals with mobility impairments in Hillsborough County, Florida [1].

Method

The original impetus for this study was born out of an initiative on behalf of Self Reliance, Inc., Center for Independent Living in Tampa, Florida, which acted on perceived real housing needs in the community. Self Reliance, Inc. provided the energy and resources for the study which eventually emerged as a collaborative effort with the Department of Rehabilitation Counseling at the University of South Florida.

Subjects

The sample consisted of 250 individuals with disabilities and 47 service providers. For simplicity, residents with mobility impairments are denoted with the term "clients" and rehabilitation service providers with the term "providers" throughout the following description of the study's methodology, results, and conclusions. For the purpose of this study, a mobility impairment was defined as a disability requiring the permanent use of a wheelchair or scooter.

Individuals with Mobility Impairments. Two hundred and fifty individuals meeting the criteria of having a "mobility impairment" were included in the client sample. The clients surveyed consisted of clients known: (a) to have physical disabilities; and (b) to reside in Hillsborough County. Clients were selected from agency client lists; participating service providers were asked to provide client names and phone numbers for survey contact. Fifty clients were contacted by phone. Due to confidentially constraints, many of the surveyed providers were not willing to release client lists. In such instances, providers were asked to assist by mailing out client surveys provided by researchers. One provider participated by mailing surveys to a sample of 200 clients. The total usable sample consisted of 49 (20%) respondents (27 phone contacts and 22 mail surveys). Fifty-two percent of the client sample had multiple sclerosis, 22% indicated a spinal cord injury, 9% indicated orthopedic impairments, 7% indicated cerebral palsy, 7% reported their primary disability as a psychiatric disorder, and 3% indicated stroke. The client sample's mean age was 45 years. Sixty-seven percent of the sample population were female; 33% were male. Fifty-three percent of the clients surveyed were married, 26% were separated, widowed, or divorced, and 21% reported being single. In regard to race or ethnic background, 81% of the sample were Caucasian, 11% were Black, 6% were Hispanic, and 2% were American Indian.

Service Providers. Twelve provider agencies were identified by examining the Hillsborough Community Resource Guide and selecting those providers listed as serving individuals with physical disabilities. The researchers contacted the targeted agencies to identify social workers and counselors who provided direct services to individuals with physical disabilities. The research sample included 10 agencies with 47 providers agreeing to participate. Thirty-two provider responses were usable, yielding an 83% agency response rate and a 68% individual provider response rate. The typical provider was employed by a state or federal agency (50%) as a social worker (44%), had a master's degree (57%), and had been employed by his/her employing agency for less than one year (41%).

Instrumentation 

Individuals with Mobility Impairments. A 46-item Client Survey instrument was designed to assess clients' perceptions of housing needs in relation to other needs including transportation, health services, and attendant care. It was compiled by modifying questions from five previously implemented surveys of housing needs (viz., the U.S. Department of Housing and Urban Development, undated). The survey consisted of multiple-choice, likert-scales, closed, open-ended, and rank-ordered items.

Service Providers. A 25-item Provider Survey, adapted from the Client Survey, was designed to assess providers' perceptions of their clients' needs in relation to housing, transportation, health services, and attendant care. The survey consisted of closed, open-ended, and combined questions.

Consistent with the primary purpose of the study, the items on both survey questionnaires were heavily weighted to assess housing needs as compared to other needs. Instruments were reviewed and refined by two research consultants.

Data Collection

Individuals with Mobility Impairments. Six graduate students, trained to identify clients with severe mobility impairments, contacted 50 clients via telephone to conduct the surveys. A prepared statement was read explaining the purpose of the survey and requesting the respondents' time and cooperation. If a client agreed to participate, they then were read the survey questions and their responses were recorded on a separate survey questionnaire. Data collection was terminated if it was found that a contacted client did not meet the mobility impairment criteria. Twenty-seven (54%) usable responses were obtained (21 surveys were completed on first contact; six were contacted one or more times to obtain a usable response). Thirteen clients were never reached. Ten client surveys were terminated when the clients did not meet the mobility impairment criteria.

Two hundred surveys were mailed with a cover letter and a stamped, self-addressed envelope to a random sample of clients from an agency serving individuals with multiple sclerosis. The surveys were addressed and mailed to the client sample by the agency serving individuals with multiple sclerosis. Due to confidentiality, identities of the respondents and non-respondents could not be determined; thus, it was not possible to conduct a second mailing to non-respondents. Respondents who completed surveys but did not meet mobility impairment criteria were not included in the analyses. Overall, 22 usable survey responses (11%) were obtained via the mail-out.

Service Providers. The researchers contacted the 12 identified agencies and requested contact with rehabilitation professionals involved in direct service delivery to clients with mobility impairments. The purpose of the study was explained and the provider's time and cooperation in completing the survey was requested. After obtaining each provider's cooperation the survey was administered.

Results

Descriptive statistics (frequencies, means, ranges, percentages, and standard deviations) were calculated on all relevant variables. Comparisons of data among respondents were conducted utilizing Chi-Square tests for categorical (nominal) variables; t-tests were utilized for the continuous variables. Comparisons between selected client and provider responses showed no significant differences. Within the Client Survey, selected comparisons were made between responses to questions utilizing Chi-Square tests or analysis of variance.

Comparisons between client mail and phone surveys revealed no significant differences on the survey items; therefore, these samples were considered equivalent for the study. Statistical comparisons between disability groups yielded no significant differences in demographic characteristics of survey responses other than age. The clients diagnosed with multiple sclerosis tended to be older than the remainder of the population; however, no other differences attributable to age or disability were found. The male/female distribution in the sample population did not appear representative of the general population of individuals with mobility impairments. However, racial and ethnic characteristics appeared to be representative.

Accessibility

Eighty-five percent of the provider sample stated that architectural barriers present a problem in locating available housing placements for their clients. Identified barriers included: (a) 39%--"stairways inside or outside"; (b) 31%--"architecturally accessible housing is not available"; (c) 22%--"bathroom/kitchens not accessible"; and (d) 8%--"exterior of house not accessible due to poor location". In the client sample, 74% reported that the location of affordable barrier-free housing in Hillsborough County was undesirable to them. Twenty-seven percent reported location as a moderate problem with 30% reporting it to be a severe problem.

Of the 15 (31%) clients noting dissatisfaction with their current living situations, 44% noted residences were "inaccessible". Thirty-eight percent noted other reasons for their dissatisfaction such as lack of adequate room, loneliness, and poor maintenance of the residence. In regard to accessibility problems, respondents did not indicate any particular problem occurring significantly more often than others.

Availability

Sixty-seven percent of the clients reported that they have difficulty acquiring information about the availability of affordable, barrier-free housing with 36% reporting this as a severe problem for them. Among the service provider sampel, 68% noted that they have difficulty making housing placements or referrals; 35% noted housing being architecturally unsuitable as the major barrier. Other reported barriers included available housing being considered too expensive (30%), housing not available (15%), and support services enabling clients to live independently being inadequate or unavailable (15%).

Availability of affordable, barrier-free housing for persons with disabilities in Hillsborough County was reported as a problem by 80% of the client sampe with 65% of the sample reporting it as a moderate to severe problem. Ninety percent of the provider respondents indicated that there is not adequate housing for clients with severe mobility impairments. Reasons for this problem are listed in Table 1.

Ancillary Services

Providers identified numerous support service needs necessary for individuals to live independently (see Table 2).

                        Table 1
    Providers' Reported Reasons for Inadequate Housing
Reason                                                Percent
Insufficient supply of barrier-free housing              27%
Available housing not being accessible                   20%
Waiting lists for subsidized housing are too long        20%
Available barrier-free housing is not affordable         13%
Housing is poorly located                                 7%
Other reasons                                            13%
                        Table 2
Providers' Perceptions of Clients' Ancillary Service Needs and
                Supportive Service Needs
                                                 Percent *
Transportation                                   96%
Attendant Care                                     88%
Financial Aid                                      88%
Homemaking Services                                76%
Home Health Care                                   64%
Counseling                                         56%
Support Groups                                     52%
Other                                              14%
Financial Assistance Needs                       Percent (*1)
Transportation                                     21%
Rental Subsidy                                     21%
Companion/Homemaking                               11%
Attendance Care                                     6%
Support Groups                                      5%
Medical Equipment                                   5%
ADL Training Needs                               Percent (*1)
Financial Management                               88%
Dressing and Grooming                              80%
Transferring                                       76%
Bowl and Bladder                                   76%
Bathing                                            72%
Cleaning/Home Management                           72%
Eating                                             72%
Cooking                                            72%
Driver's Training                                  68%
Other                                              19%
  * Note: The majority of the respondents provided multiple
answers
to these questions.

Ninety-six percent of the providers indicated that transportation is needed for independent living to even be possible. Providers stated that the lack of available and affordable transportation impacts a client's ability to live independently in the following ways: (a) 29% stated that it limits socialization and enjoyment of life; (b) 21% stated that it hinders their ability to work; (c) 21% stated that it reinforces dependence on family and friends rather than independence; (d) 13% stated that it creates a financial strain; and (e) 16% stated "other" reasons.

Attendant care was identified as a client need by 88% of the providers. Seventy-one percent kof the clients stated that they would have "no problem" living independently with a personal care attendant. However, 92% of the clients reported that the availability of attendant care is a problem for them, and 91% stated that the cost of attendant care is a problem. Individuals with mobility impairments identified several types of services that they would need from a personal care attendant in order to live independently. Specifically, the clients noted a need for assistance with meal preparation (56%), transfers (50%), dressing and grooming (42%), and eating (16%).

Eighty-eight percent of the service providers stated that there are inadequate financial assistance programs available to enable clients, at or below the poverty level, to live independently. Table 2 outlines areas of financial assistance needed to enable individuals with mobility impairments, at or below the poverty level, to live independently.

However, one respondent noted that "those at or below the poverty level have more resources than those exceeding the poverty level guidelines".

Also contained in Table 2 are providers' perceptions of their clients' activities of daily living (ADL) skills training needs to increase their self reliance. However, 51% of the client sample reported difficulty in locating training in ADL skills.

One provider pointed out, however, that the main need was for more accessible housing. Moreover, it was stated that this need must be met before other needs can even be considered

Housing Preferences of Individuals with Disabilities

Table 3 contains the clients' preferences regarding their housing needs. Of the respondents indicating an accessibility problem, 38% noted that if they received funds they would repair and fix up their current residences. When questioned as to what the most importawnt factors in selecting a new residence were, 20% indicated "accessibility to public transportation", 18% indicated "affordable cost", 16% indicated "interior design being barrier free", and 16% indicated "close to family."

Eighty percent of the clients reported to believe that individuals with disabilities should live in integrated housing (i.e., with individuals who are not disabled). The respondents indicated a preference for smaller housing projects (66% noted that they

                        Table 3
           Clients' Reported Housing Preferences
Category                                         Percent
Solving Accessibility Problems
  Fix up current residence                          38%
  Move to new residence                             24%
  No accessibility problems                         38%
Most Important Factors in Selecting Residence
  Accessibility to public transportation            20%
  Affordable cost                                   18%
  Interior design barrier free                      16%
  Close to family                                   16%
  Low crime area                                     9%
  Close to medical facilities                        7%
  Close to shopping facilities                       7%
  Close to employment                                2%
  Parking close/accessible to exits                  2%
  Close to schools                                   2%
  Close to recreation                                2%
Integration of Housing
  Integrated into existing neighborhoods            80%
  Specialized housing projects                      20%
Size of Housing Project Preferred
  5-10 Units                                        19%
  10-20 Units                                       28%
  20-30 Units                                       19%
  30-40 Units                                        7%
  40+ Units                                         28%

preferred complexes with five to 30 units; 28% noted a preference for 10-20 units in the complex).

Discussion

Limitations and Generalizability

This was a case study and interpretations should be made with caution: (a) due to the unrefined nature of the instruments; (b) no measures were taken to randomize clients surveyed according to disability or gender; and (c) because of th constraints imposed by the required confidentially on the method of survey administration, it is difficult to specifically determine the representativeness of the client sample. Another factor relative to the Client Survey was the low return rate of the client mail-out survey. Because of confidentiality issues, it was not possible to follow-up with a second mailing. It also should be noted that the client sample was drawn from clients already receiving some type of service, and due to the nature of the study's methodology, only those clients living in a residence were surveyed (therefore limiting the generalizability of these results to the homeless population). Limitations regarding the provider sample were: (a) the small sample size; (b) a lack of group equivalency; and (c) minimal control available to accommodate differences in the survey administrations.

Although the surveyed client sample differed from the client population described by the Provider Survey (in terms of mean income), it is noteworthy that these two separate client populations appeared to have very similar opinions regarding housing needs. Therefore, it appears that even income may not change the relative needs of these populations. In fact, the similarity between these two groups strengthens the generalizability of the results of this survey. Thus, it would appear that the results could be generalized to other residents with mobility impairments within Hillsborough County, Florida (where the study was conducted). Due to possible differences in demographic and geographic characteristics and the limited size of both samples, however, care should be exercised in generalizing these findings to the general population of individuals with mobility impairments.

Implications

This study examined the housing needs of individuals with mobility impairments as perceived by service providers and the individuals themselves. As noted in previous research, housing needs are viewed as critical to individuals with mobility impairments (Battelle's Columbus Laboratories, 1977; Davies & Beasley, 1989; Fishman, 1971; Roessler, 1981) and are viewed similarly by surveyed providers. A high percentage of clients and providers indicated difficulty acquiring information about available housing, reported a severe lack of barrier free housing, and complained that housing is available in undesirable locations or has architectural barriers such as inaccessible bathrooms and kitchens. As previously reported by Davies and Beasley (1989) and Reizenstein and Ostrander (1981), the lack of properly designed and accessible housing creates dependency and negates capabilities that may have been gained through use of prosthetics and new medical techniques. Also noted as a problem was the expense of available barrier-free housing and long waiting lists for subsidized barrier-free housing. Dean (1987) grippingly captured the criticalness of attending to these phenomena:

Everyone is aware of the many difficulties and frustrations involved in the search for a home. Finding housing that meets an individual's needs, budget and taste requirements and is situated in an area offering ready access to schools, jobs, shopping and transportation is almost becoming the "impossible" American dream. (p. 17)

Eighty-six percent of the providers indicated that there were not sufficient financial assistance programs available to enable clients to live independently. This finding supports earlier findings by Nelson-Walker (1981) who concluded that the lack of financial resources inhibits independent living. The providers reported that assistance is needed to provide attendant care, transportation, rental subsidies, companion and homemaker services, support groups, and medical equipment in order for a client at or below the poverty line to maintain independent living. In fact, both samples indicated that there was a significant number of individuals who could be presently living independently if attendant care and accessible transportation were more available and affordable, and financial assistance were made available for medical equipment and rental subsidization. When questioned as to what factors were most relevant in selecting a new residence, clients indicated that "accessibility to transportation", "affordable cost", "interior barrier-free design", and "proximity to family" were most important to them. Lack of adequate transportation was noted to impact clients' potentials for independent living. In othr words, without available, accessible and affordable transportation, clients tend to be isolated socially, have difficulty obtaining and maintaining employment, and have difficulty keeping medical and other appointments.

These findings coincide with previous recommendations by the Department of Health, Education, and Welfare (1977) (H.E.W.) office that "state and local; agencies should develop a continuum of flexible and alternative living arrangements for the handicapped including attendant care... and accessibidlity to appropriate services" (p. 31). Furthermore, H.E.W. recommended that "all government housing regulations should require that public services such as transportation, shopping, and recreation be accessible to housing the handicapped" (p. 82).

As was the case in previously cited literature, the majority of the clients indicated a preference for housing to be "integrated" as opposed to "the building of a specialized project" (Architectural Transportation Barriers Compliance Board, 1975; Battelle's Columbus Laboratories, 1977; Department of Health, Education and Welfare Office for Handicapped Individuals, 1977; State Planning Services Agency, 1980). Those individuals who preferred specialized housing projects also preferred smaller projects with 5-30 units. This finding corresponds to the Department of Health, Education, and Welfare's (1977) recommendation that housing projects be "small enough to be absorbed into the community" (p. 81).

Conclusions

It appears from this case study that there is a clear need for accessible and affordable housing for persons with mobility impairments. The findings clearly appear to indicate that these needs cannot be considered without also looking at those ancillary services needed to make independent housing a viable option that can be considered by individuals with mobility impairments. For example, more private and affordable transportation sources are needed. The current public transportation system is not meeting the reported independent living needs of many individuals with mobility impairments. Attendant care is not as available or affordable as needed to allow mobility impaired individuals to live independently. The overall agreement between the clients and providers regarding perceived housing needs, suggests that service providers possess a good awareness of client needs. However, the high percentages of needs across the board reported by subjects in both sample groups seem to indicate that this awareness is not being implemented to meet the reported needs of this population, perhaps due to the lack of financial resources pointed out by both groups.

Recommendations

Future specialized housing projects, or programs to modify existing housing, must attend not only to the need for accessible and affordable housing but also to the provision of ancillary services necessary to assure the ability of individuals to truly live independently in the manner which they choose. New projects need to be architecturally accessible, affordable, and have adequate units to serve the need that exists while taking into account clients' preferences for smaller projects. Projects will need to attend to, and make provisions for, clients' needs for attendant care. Transportation should be readily available, not just for an occasional medical appointment but to the extent that individuals can live a "normal" life which includes socialization, work, and the ability to attend to routine appointments.

In additional to the one fourth of the client sample who indicated a preference for specialized housing to be made available to meet their housing needs, 38% indicated a preference for remaining in their current home and "fixing" their existing accessibility problems. To meet this segment's needs, consideration should be given to developing additional programming: (1) to build ramps, widen doorways and remodel kitchens and bathrooms in existing dwellings; (2) to provide adequate transportation systems that will meet their needs; and (3) to provide viable access to affordable and quality attendant care. As Ted Kennedy, Jr. (1986) fittingly stated when he echoed the thoughts of many individuals with disabilities, "Ours is not the disability of accident or birth, but one created by a society insensitive to the needs of millions" (p. 5).

Eighty percent of the client population preferred integration into existing neighborhoods. Thus, program planners may want to focus on targeting a few existing apartment or condominium projects and consider modifying several units within each complex. By doing so, it would be possible to develop sharing programs for transportation and attendant care within each complex while allowing clients to live among the general population (as opposed to living in a segregated community developed strictly for individuals with mobility impairments).

Future research should focus on surveying a broad and more representative sample of the population and should study ways of implementing all of the needs of individuals with mobility impairments into living situations which would truly assist them in their attempts to live independently. Another area for future research would be to compare living satisfaction among all individuals living in integrated housing with those living in segregated projects designed specifically to meet the needs of individuals with mobility impairments.

Winston Churchill suggested that "The best indication of the civilness of a society is the way in which it responds to its disabled citizens." Assuring accessible housing, adequate transportation and quality attendant care for its citizens with disabilities, indeed, would be a meaningful way for the United States to successfully realize Churchill's poignant challenge.

WILLIAM G. EMENER, Department of Rehabilitation Counseling, College of Social & Behavioral Sciences, University of South Florida, Tampa, Florida 33620.

Footnotes

(1) Complete information on this project is contained in the study's 71 page final report, "Assessment of Housing Needs of Individuals with Severe Mobility Impairments in Hillsborough County, Florida" (which contains four Appendices and 18 Tables). To obtain a copy of this document, requests should include the above title of the report and be sent to: National Rehabilitation Information Center, 8455 Colesville Road, Suite 935, Silver Spring, Maryland 20910-3319, (800-346-2742).

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