Naturally Occurring Retirement Community-Supportive Service Program

Summary

Devolution is defined as the transfer of power or authority from a central government to a local government. This article addresses federal policies on housing for the elderly and the devolution of funding for federal senior housing and describes two aspects of devolution of federal housing policy for the elderly. One, it points out the decreasing interest in senior housing by federal authorities as indicated by the decreased amount of funds allocated for this purpose. Two, it emphasizes the need for supportive, assistive services for residents of senior housing and how federal funds have not addressed this need adequately or sufficiently. As a consequence, there have emerged Naturally Occurring Retirement Communities (NORCs) in New York State, a housing arrangement that provides supportive and health services to all eligible residents. The article concludes with a discussion of policy implications and the need for additional research before replicating this model.     

Senior Housing in Sweden—A Question of Class Differences and Collective Aging

Abstract

Private senior housing in Sweden has become an alternative to accommodation for elderly in the public welfare system. In the study presented here, the aim was to elucidate this senior housing from the perspective of the residents. The questions that were asked were: (1) Why have the residents chosen senior housing? (2) What are the differences between residents in rental apartments and tenant-owned housing cooperatives? (3) What advantages and disadvantages do the residents think that senior housing has? The interviews showed that: (1) The seniors have chosen the housing for reasons other than its being senior housing; (2) the residents in rental apartments come from the working class and socialize in collective forms, while the residents in cooperatives come from the middle class and socialize through individual initiatives; and (3) the advantages they experience in senior housing are that it involves activities and community. The disadvantages derive from the architectural planning. When the building has a communal yard or entrance, integrity can be threatened and the sense of collective aging can be a Strain.     

State discretion and medicaid program variation in long-term care: when is enough, enough?

Although federal statutes and regulations establish the broad parameters within which state Medicaid programs operate, the federal government grants states substantial discretion over Medicaid and Medicaid-funded long-term care. An appreciation of resulting cross-state variation in Medicaid program characteristics, however, has been lacking in the ongoing debate over whether the federal government should further devolve responsibility for caring for the poor and disabled elderly to the states. To better inform this discussion, therefore, this article documents considerable variation, not only in terms of Medicaid program spending and recipients, but also in terms of strategies chosen to reform long-term care services and financing. Since there is little doubt that states take full advantage of current levels of discretion, advocates of devolution may want to reassess their views to consider whether existing variation has resulted in inequities addressable only through more, not less, federal involvement.     

Housing Concepts For and By the Elderly: From Subjects of Design to a Design Resource

ABSTRACT

The perception of elderly residents as a homogeneous group is challenged by the diversification of lifestyles and emphasis on individuality in housing. Recently, there has been a rise in Finland in housing projects initiated by groups of elderly people, where the seniors themselves are seeking to fill in qualitative gaps in the offering of housing. This article presents a comparative analysis of four senior housing concepts that represent both a producer-driven (“for the elderly”) and a resident-driven (“by the elderly”) approach. The study shows that elderly people can be a resource for residential development and that this necessitates a different “design logic” than in conventional senior housing.     

Who Has the Power? The Role of NPOs in Local Authorities

Recent years have seen accelerated processes of decentralization and devolution of social services from central government toward local authorities and from them to non-profit organizations (NPOs). This article describes a case study of the process of transition of power from a local authority to a NPO and the outcomes of this transition on public policy making. The findings presented in the article are based on a qualitative analysis of documents over a period of 7 years (1999–2006) in a large local authority in Israel and its relations with a NPO which provide services for the elderly.     

State Discretion and Medicaid Program Variation in Long-Term Care

Summary

Although federal statutes and regulations establish the broad parameters within which state Medicaid programs operate, the federal government grants states substantial discretion over Medicaid and Medicaid-funded long-term care. An appreciation of resulting cross-state variation in Medicaid program characteristics, however, has been lacking in the ongoing debate over whether the federal government should further devolve responsibility for caring for the poor and disabled elderly to the states. To better inform this discussion, therefore, this article documents considerable variation, not only in terms of Medicaid program spending and recipients, but also in terms of strategies chosen to reform long-term care services and financing. Since there is little doubt that states take full advantage of current levels of discretion, advocates of devolution may want to reassess their views to consider whether existing variation has resulted in inequities addressable only through more, not less, federal involvement.     

Empowering Domestic Discretionary Spending in Federal Budget Deliberations

Abstract

Federal domestic discretionary spending (DDS) funds a large portion of human services in the American welfare state including mental health, child welfare, childcare, public health, job training, and education programs. Yet relatively little research has been conducted on this small but important part of the federal budget. This article examines a number of factors that have limited the size of DDS and that may imperil its existence in coming decades. The article suggests that policy theorists and researchers need to devote more attention to DDS and that policy advocates need to develop effective strategies for protecting DDS from unwarranted assaults in the budget-making process.     

Live-in Care Workers in Sheltered Housing for Older Adults in Israel: The New Sheltered Housing Law

Supportive housing schemes were historically aimed to provide group accommodation for older adults. With the aging of residents, facilities were required to enable them to receive care services in order to allow them to age in place. Thus, different countries and different facilities developed different models of housing with care, reflecting cultural and policy diversities. Despite all of the different models, there are many commonalities among the supportive housing schemes across countries. These include provision of dwelling units and care services provided by either the facility or by external agencies. The aims of this article are threefold: to describe the historical development of the ever-evolving supportive care housing phenomena; to point at variations in models of housing and care within the international context; and to present a new Israeli model that enables residents to privately hire live-in care workers to meet their care needs. This is a unique model in the international context that has not been reported before. The article describes the main ideas of the new model and discusses the challenges that it raises and pinpoints the unresolved issues associated with the presence of live-in care workers employed by residents of sheltered housing that should be addressed.     

The Poverty Deconcentration Imperative and Public Housing Transformation

Public housing has been on the chopping block for almost two decades now in an effort to deconcentrate poverty. In 1992 the federal government created the Housing Opportunities for People Everywhere (HOPE) VI program. HOPE VI is driven by the assumption that deconcentrating neighborhood‐level poverty will yield better access to upward mobility opportunities for former public housing residents. To accomplish this, existing public housing is demolished and replaced with mixed‐income developments. Public housing residents are relocated, many with Housing Choice Voucher subsidies to private‐market rental housing. However, by its very definition mixed income means that only a small percentage of former residents get the opportunity to return. Do voucher relocated residents end up in lower poverty neighborhoods with greater upward mobility opportunities? We examine the spatial organization of relocation within the critical discourse on the deconcentration imperative. We highlight Atlanta because it recently became the first city in the nation to eliminate all of its public housing. Findings reveal that voucher relocatees end up in neighborhoods with modestly less poverty than the public housing neighborhoods they left. Questions remain about what poverty deconcentration means vis‐à‐vis policy goals. We provide recommendations for future research.     

Municipal Law Enforcement Policy on Illegal Immigration Stops: Do Social Factors Determine How Aggressively Local Police Respond to Unauthorized Immigrants?

The devolution of immigration law has increased local police involvement in the enforcement of federal immigration law. But only some departments have responded by implementing policies that restrict their officers' involvement in order to protect residents from overzealous policing. We test theories of economic and ethnic threat to explore the structural characteristics of cities that explain this variation. Multiple regression results show that the most unequal cities that have large Hispanic populations are less likely to have a policy. Hispanic white segregation and high unemployment also reduce the likelihood of policy implementation. We discuss theoretical and policy implications.     

Resource allocations to the aged according to greatest social need

The purposes of the study reported on in this article were: (a) to explore the measurement of social need among the elderly, and (b) to develop an appropriate method for including social need in funding allocation procedures. Interview responses from over 4,000 randomly selected elderly persons were used to identify the demographic correlates of those having the most restrictions in their every-day lives. Procedures for intrastate allocations were developed using variables suggested by the Older Americans Act and by research to explain variance in activities of daily living. Variables tested for the model were: age, income, living arrangement, gender, ethnicity, area of residence, occupation, hospitalization, years in the neighborhood, language at home, and utilization of senior services. Prediction formula weights were adjusted (magnitude of beta i/sigma magnitude of beta i) to allocate resources to the proportions of 10 "high-need" groups residing in each planning area: the population aged 75 and older, the proportion of hospital discharges of elderly patients, elderly females, elderly non-Caucasians, the elderly not completing high school, elderly farm workers, elderly urban residents, a proportion for participation in senior services, for low-income elderly persons, and for the elderly not living with their spouses. Compared to current systems, the proposed procedure provides a closer fit to the actual needs of the elderly.     

Meeting the Needs of Visually Impaired People Living in Lifetime Homes

ABSTRACT

This article explores perceptions on the suitability and effectiveness of Lifetime Homes standards (LTHS) for those with visual impairment in Northern Ireland. LTHS are a series of mandatory United Kingdom public-sector housing design interventions, providing a model for ensuring accessible and adaptable homes throughout an occupant's life span. An aging demographic with increasing incidence of diabetes has led to rising numbers of elderly, visually impaired people wanting to remain in their homes for longer. Qualitative semi-structured interviews were conducted with 13 key stakeholders and thematically analyzed. Although findings show that employing LTHS offers benefits to visually impaired residents, shortcomings were also identified. Evidence indicates a need for policy makers, health-care professionals, and housing associations to modify practices to better meet the housing needs of visually impaired people. Findings may also be applicable to those with other impairments and disabilities in relation to housing for elderly residents.     

Resource Allocations to the Aged According to Greatest Social Need

The purposes of the study reported on in this article were: (a) to explore the measurement of social need among the elderly, and (b) to develop an appropriate method for including social need in funding allocation procedures. Interview responses from over 4,000 randomly selected elderly persons were used to identify the demographic correlates of those having the most restrictions in their everyday lives. Procedures for intrastate allocations were developed using variables suggested by the Older Americans Act and by research to explain variance in activities of daily living. Variables tested for the model were: age, income, living arrangement, gender, ethnicity, area of residence, occupation, hospitalization, years in the neighborhood, language at home, and utilization of senior services. Prediction formula weights were adjusted (|ß_i|/Σ|ß_i|) to allocate resources to the proportions of 10 "high-need" groups residing in each planning area: the population aged 75 and older, the proportion of hospital discharges of elderly patients, elderly females, elderly non-Caucasians, the elderly not completing high school, elderly farm workers, elderly urban residents, a proportion for participation in senior services, for low-income elderly persons, and for the elderly not living with their spouses. Compared to current systems, the proposed procedure provides a closer fit to the actual needs of the elderly.     

The association between aging inmate housing management models and non-geriatric health services in state correctional institutions

One of the current debates in the literature on aging inmates asks, what is the most efficient housing/health care model for this "special needs" population? State and federal correctional systems place elderly inmates either in specialized segregated housing units away from the general inmate population, consolidate elderly inmates in housing units within the prison, or provide a combination of both models. In general, proponents of the segregated housing model argue that aging inmates will receive specialized medical services in geriatric units. However, proponents of consolidated housing model argue that aging inmates will have the benefit of both geriatric and non-geriatric health services. This paper examines the association between the type of housing management model for aging inmates and the availability of non-geriatric physical and mental health services. Data for the analysis come from the 2000 Bureau of Justice Statistics Census of State and Federal Adult Correctional Facilities. The results suggest that institutions offering consolidated geriatric care provide more mental health services and that these effects are independent of the characteristics of prison facility.     

Housing for Families but Not for People: Federal Policy and Normative Family Ideals in Midcentury California

Abstract

Scholars have documented the harmful effects of urban redevelopment in the middle of the twentieth century with a particular focus on “redlining” to achieve racial segregation. This article considers another way that the state influenced social geography. In the middle of the twentieth century, some city planners argued for housing for single people and childless couples, but federal guidelines and funding specified that new housing be for nuclear, heterosexual families with children. Two historical cases demonstrate how planners attempted to create housing for alternative households but were unsuccessful. These two cases show that in addition to the documented effects of shaping the economic and racial landscapes of cities, federal housing policy sent strong signals to people about acceptable family formations by limiting the type and quantity of housing stock available. By examining how planners attempted to move forward with housing for all types of households, this article shows that federal family-oriented policies were not uncontested even if they were usually implemented. These cases highlight the complicated relationship among federal policies, normative culture, and the built environment. This article proposes that we should further investigate the ways in which the built environment has served as a mediator between the state, as exemplified by housing policies, and culture—normative ideals about the family—in a recursive sense; while federal policies both reflected and projected dominant cultural ideology concerning the primacy and importance of nuclear families, urban redevelopment projects presented this relationship in built form when redevelopment took the form of housing for families but not for single people or childless couples.     

SAMHSA guidelines for recovery housing emphasize MAT

If there's any question about the appropriateness of medication‐assisted treatment (MAT) using methadone and buprenorphine for recovery housing residents, it has been settled by the most recent report from the federal government: Don't ban it, and, furthermore, do it.     

Setting priorities in aging populations: formal service use among Mexican American female elders

This study establishes empirical patterns of formal service use by a sample of 483 elderly Mexican American women, and identifies the predictors of formal service utilization. Results indicated two patterns of service use-in the home and at senior centers. Regression analysis demonstrated that the best predictors of who used formal in-home services were those with functional impairment in Instrumental Activities of Daily Living (IADLs) and those with the least amount of assistance with IADLs provided by family members. Living alone and attending group social events were the best predictors of the use of senior center services. Anticipated changes in the Mexican American population portend a growing need for both in-home and senior center services. These findings can be used to establish policy and programming priorities for this neglected population. If resources are to be effectively targeted to frail elders, in-home services should receive priority, and the provision of in-home services should be modified to include additional programs that facilitate care of the elderly by the family.     

Age Segregation and the Quality of Life of the Elderly People in Studio Apartments

ABSTRACT

The paper attempts to ascertain the impact of age-segregation on the quality of life of elderly people who are living in studio apartments in Singapore. After a review of the relevant literature and statistical analysis of a survey data for 390 elderly respondents in studio apartments, it was found that age-segregation have a deleterious impact on the quality of life of the elderly people. Furthermore, it was found that the perception of the elderly in relation to factors that are most significant to their quality of life is at variance with that of the policy makers. This implies that there is a need for policy makers and service providers to review their existing policies, products and services so as to be more effective in providing housing options for the rapidly aging population of Singapore.