The supportive community: a new concept for enhancing the quality of life of elderly living in the community

This study examines supportive community programs in Israel, which aim to improve the quality of life of the elderly. These innovative programs pool existing resources to provide a benefits package that includes medical services, an emergency call switchboard, a "neighborhood facilitator," and social activities. Data were collected in 2000-2001 using qualitative and quantitative methods. The program provides specific services to meet needs that otherwise are not adequately addressed. The major contributions of the program reported by the members was increasing their personal security (two-thirds), easing the burden on their children (one-third), and enabling them to remain at home (one-quarter). The supportive community program enriches the variety of services available, thus providing the elderly with the choice of staying within their familiar surroundings of their homes and neighborhoods. This model appears to be both a cost-effective way to facilitate aging in place and a way to meet many of the elderly's essential needs, thereby maintaining their quality of life.     

Quality of life of older people in Israel: a comparison between older people living at home who are members of a ‘supportive community’ and nursing home residents

The supportive community is a program that was developed in Israel for older people who live at home. The program provides its members with a service package that includes medical and social services, emergency call-button, cultural activities, and a ‘community parent’ who is responsible for the members. Using quantitative method, this study compared the level of quality of life between 55 older people living in their homes who are members of a supportive community (average age = 74.7) and 60 elderly people living in nursing homes (average age = 75.8). As expected, results indicate that quality of life among the older people living at their homes who are members of a supportive community was higher than among the older people living in a nursing home. In addition, the quality of life of married, educated, functionally independent older people in good health and with a good economic situation was higher. Predictor variables of quality of life were: the place of residence, health status, and age. In light of increased life expectancy and the growing need to care for the older population, the practical application of the study focused on a recommendation for the social services to continue the support community development program.     

Aging in Place or Relocation: Perceived Awareness of Community-Based Long-Term Care and Services

ABSTRACT

This study used data from the Community Partnership for Older Adults Program Survey (N = 4,611) to examine associations between the perceived awareness of community-based long-term care and supportive services and the anticipation for aging in place and relocation. Respondents varied substantially in their knowledge about services and anticipation for aging in place and relocation. Perceived availability and unavailability of a series of community services was associated with the likelihood of anticipating aging in place and relocation, and awareness of the lack of visiting nurses, personal assistance, or transportation was related to respondents reporting a younger age at which they anticipated needing help to age in place or anticipating a need to relocate. Findings have implications for raising the public awareness of community-based services in addressing the needs of community-dwelling elders for aging in place and relocation.     

Community responsibility for the self-neglectful client

Self-neglectful clients, including the elderly, are in jeopardy, partly through their refusal to accept community services that could help them; they require protection from the community. These people are alienated and isolated, and need to be integrated into the community. Their individual rights to control their own lives, however, must be protected. It is the responsibility of the community to structure services in a way that will engage these people. A comprehensive community service program appropriate to their needs would integrate formal and informal care systems by interweaving professional services, informal assistance, and mutual aid within structures that facilitate coordination of formal care programs.     

Community Responsibility for the Self-Neglectful Client

Self-neglectful clients, including the elderly, are in jeopardy, partly through their refusal to accept community services that could help them; they require protection from the community. These people are alienated and isolated, and need to be integrated into the community. Their individual rights to control their own lives, however, must be protected. It is the responsibility of the community to structure services in a way that will engage these people. A comprehensive community service program appropriate to their needs would integrate formal and in normal care systems by interweaving professional services, informal assistance, and mutual aid within structures that facilitate coordination of formal care programs.     

An interprofessional internship model for training master’s level social work and counseling students in higher education settings

ABSTRACT

The mental health needs of college students are steadily on the rise, which compels mental health service providers and educators to explore innovative ways to provide more collaborative, supportive, and interdisciplinary service models of practice and professional training. Graduate programs in social work and counseling are at the crux of producing internship training programs to help accommodate the influx of students with persistent mental health concerns across a variety of needs and cultures. This article describes an interprofessional internship program structured and designed to meet the clinical training needs of master’s level students matriculating in social work and counseling who aspire to provide mental health services in higher education settings. The interprofessional internship training model proposes an innovative interdisciplinary approach to field education which may result in positive training outcomes and learning experiences for social work and counseling students. This paper discusses the model’s emphasis on individual and interdisciplinary group supervision, objectives of the internship experience, internship site criteria, and professional and personal benefits to pre-service social workers and counselors. Recommendations for training and limitations of the model are provided.     

Local Housing and Service Decisions

Abstract

The purpose of this research was to identify factors associated with local housing and service decisions that support aging adults in rural communities. These decisions represent de factostrategies that affect the quality of life of older residents and their ability to age in place. Data were collected from 951 informants in 134 Midwest rural communities. Analyses were undertaken to identify the role of community characteristics in predicting the availability of a group of housing options and support services. Findings support the notion that the community context is important to the delivery of key housing and service needs. Population size, proportion of community residents 65 years and older, and housing planning processes promoted gains in housing and services.     

Medicaid State Plan Personal Care Services

Abstract

Policymakers face mounting pressures from consumer demand and the 1999 Olmstead Supreme Court decision to extend formal (paid) programs that deliver personal care to the elderly, chronically ill, and disabled. Despite this, very little is known about the largest program that delivers personal care: the Medicaid State Plan personal care services (PCS) optional benefit. This paper presents the latest available national program (participant and expenditure) trend data (1999–2002) on the Medicaid PCS benefit and findings from a national survey of eligibility and cost control policies in use on the program. The program trends show that, over the study period, the number of states providing the Medicaid PCS benefit grew by four (from 26 to 30), and national program participation, adjusted for population growth, increased by 27%. However, inflation-adjusted program expenditures per participant declined by 3% between 1999 and 2002. Findings from the policy survey reveal that between 1999 and 2002 there was a marked decline in the range of services provided, and by 2004, almost half the programs operated a cap on the hours of services provided.     

Diversity Within Diversity

Summary

Asian American elderly form a heterogeneous group with respect to immigration history, ethnic/cultural background, socioeconomic position, and health and mental health status. This paper provides an overview of the internal heterogeneity within the Asian American elderly population and identifies those who experience multiple stressors affecting their quality of life. Then it discusses barriers to formal service utilization as well as strengths and deficits of informal support systems. To better serve Asian American elders with their multiple needs for health, mental health, and social services, increased funding is recommended for research on this group, diversification of social service programs in coethnic communities, and increased cultural competence in non-Asian social service agencies.     

Targeting Services to Those Most at Risk

Abstract

The budget crises facing many state Medicaid programs have increased interest in the goal of linking services and housing as a way to provide more options to people with disabilities at less cost than institutional care. This article examines some of the premises underlying this interest, especially with respect to linking supportive services and federally subsidized housing for older persons. The first section provides a brief history of the activity in this area. The second section examines the risk factors associated with nursing home admission and how those factors match the characteristics of renters receiving subsidies. The third section focuses specifically on the likelihood that subsidized renters will also become eligible for Medicaid. The fourth section explores the capacity of housing programs to meet the challenges associated with service delivery. Finally, the conclusion examines the implications for public policy decision-makers interested in linking services and housing in order to address the long-term care (LTC) needs of older persons with modest incomes.     

Where Do We Stand? Testing the Foundation of a Shared Site Intergenerational Program

Abstract

Shared site intergenerational care programs provide ongoing services simultaneously to old and young community members at a single facility, thereby, meeting the care needs of multiple generations. However, they face the challenge of sustainability common to all community-based programs. We employed the results management model to identify program elements that may enhance or inhibit sustainability of intergenerational programming at a shared site facility involving a child development lab school and adult day services program. The 4-step results management approach is a strengths-based model that supports community capacity and achievement of community and program goals. The current paper describes the first step in the results management approach, mapping the terrain, which involves gathering evidence of community needs and strengths. Focus groups were conducted with eleven staff members from both programs after a 4-month intergenerational program. The focus groups targeted the needs and strengths related to intergenerational programming. Respondents identified strengths that enhanced staff members' and clients' capacity for collaboration. These included affective and developmental benefits for both generations and strong partnerships between staff members. Respondents also identified factors that limited collaboration, such as the need for greater authority support and cross-training opportunities. Findings from our study have been used by program administrators to continue using the results management approach to further build intergenerational community and expand the scope of evaluating intergenerational shared site programs. Other intergenerational programs may utilize the results management model to enhance intergenerational programming and increase program sustainability.     

Financial Exploitation of Elders: Analysis of Risk Factors Based on County Adult Protective Services Data

ABSTRACT

While all types of elder abuse and neglect are serious problems affecting thousands of vulnerable elders, financial exploitation has especially serious implications for the victims’ economic well-being and quality of life, because it may deprive the victims of their life savings and assets and thus their economic foundation for independence. In this study, data from the case files of a county adult protective services program were analyzed to identify risk factors associated with financial exploitation of and mismanagement by elders. The elders who were financially exploited were, on average, in their late seventies and tended to be cognitively impaired. We also found that owner-occupant elders were especially vulnerable to exploitation and that financial mismanagement and exploitation often occurred together. Approximately 60% of the perpetrators were relatives of the elderly victims, mostly their adult children, and the rest of the perpetrators were not related to the victims. Implications for interventions include case management for frail, cognitively impaired elders; preventive educational programs; and ongoing collaboration among adult protective services, financial institutions, and law enforcement agencies.     

EDITORIAL

Abstract

Hope is a key construct for successful community adjustment among those with severe mental illnesses, particularly given the strengths-based recovery model increasingly prevalent in mental health services and in social work. Consumer-run mental health self-help agencies (SHAs) are well suited to fostering hope via their supportive program environments. This study examines factors associated with hope among members of four self-help agencies via a two-stage least squares regression model (N =310). Findings provide evidence of both individual and program-level associations with hope. These findings mirror social work ethical values of focusing on consumer strengths and self-determination, which are primary goals of SHAs.     

“They give you back that dignity”: understanding the intangible resources that make a transitional house a home for homeless families

Approximately 33% of the homeless population in 2017 were families with children. Researchers have argued for interventions and services to employ an ecological perspective to mitigate some of the unintentional harm inherent in existing programs designed to serve homeless families. This paper utilized a case study of a transitional housing program to (1) determine how well the program met recommendations informed by the ecological perspective and (2) explore underlying themes across recommendations. Past and current residents of a transitional housing program participated in semi-structured interviews as part of a program evaluation. Interviews were deductively and inductively coded to meet aims 1 and 2, respectively. Residents identified several aspects of the program that met the ecological perspective recommendations including culturally-responsive services, trauma-based services, and social and community connections. Major underlying themes spanning across recommendations included interpersonal resources (caring, sense of belonging), empowerment resources (advocacy, family preservation), impact on family (family life, positive youth development), and communication. This case study, through the analysis of residents’ perspectives, highlights the important role of transitional housing programs in providing a supportive, empathetic, empowering, and home-like environment that gives residents “back that dignity” so they are emotionally and physically prepared to successfully transition to permanent housing.     

“At times I kinda felt I was in an institution”: Supportive housing for transition age youth and young adults

Housing stability is essential for young adult development. Older youth and young adults transitioning from public systems of care, such as foster care, the public mental health system and residential settings, commonly experience high levels of transience and housing instability. In recent years, supportive housing policies and programs have emerged to address this situation, yet we know little about whether (or not) new programs are meeting the needs of youth in transition, and, if so, how they are addressing the unique developmental, social, and emotional needs of this population. This study is one of the first to speak directly with young adults living in a supportive housing program designed specifically for youth transitioning out of children's systems of care. Study participants spoke about both their overall transition experience and their views on the housing program where they reside. The study conducted four focus groups (N = 26) with transitioning youth and young adults, ages 18 to 25 (Mean age = 22), in order to explore the following three broad research questions: 1) what is it like to make the transition to adulthood from public children's systems of care?; 2) how does the supportive housing model they reside in shape their transition experiences?; and, 3) how do they experience the services and staff who are part of the program? Data analysis included grounded theory coding techniques and constant comparison with four coders. Results suggest that participants feel like they continue to be treated as children, and they receive mixed messages regarding their need to be increasingly autonomous, yet follow the rules. Finally, they reported specific aspects of what they found to be helpful in both staff relationships and overall program components. These themes constitute the results of the study. Findings underscore the importance of both listening directly to service users, and developing young adult supportive housing programming expressly designed to meet the unique needs of marginalized young adults transitioning to increased independence and self-sufficiency.     

Mental Health Needs and Supportive Services for Elderly and Disabled Residents

Abstract

This study longitudinally assesses the impact that the provision of supportive services has on the mental well-being of the elderly and disabled population living in independent housing developments. The results indicate that the use of supportive services by the mentally ill allowed them to overcome initial lower functional status and achieve a level of mental functioning virtually similar to that of the total resident population. Thus, it is argued that independent living facilities with supportive services can certainly be a successful and cost effective model for a number of frail elderly and mentally ill residents.