Expansion of long-term care in the prison system: an aging inmate population poses policy and programmatic questions

Throughout the United States, departments of corrections are experiencing increases in their inmate populations. More specifically, the number of aging inmates is increasing and will continue to grow as younger prisoners who have long sentences with no possibility of parole age in prison. In addition, the number of younger inmates with illnesses such as AIDS has increased. Although long-term care can be required by individuals of any age, the need for such assistance tends to increase with age. Long-term care, therefore, can be seen as an issue confronting prisons with aging inmate populations. Yet, little is known about the nature or extent of the need. This paper focuses on older inmates and includes reasons for the increased need for long-term care in the prison setting. The standard for prison health care, the long-term-care status of older inmates, and examples of long-term-care services and facilities are described. Key questions related to furnishing long-term care to an older incarcerated population are identified. Recommendations are presented for both corrections and long-term-care providers and policymakers as they develop strategies to address this challenge.     

Treatment of late-life mental disorders in primary care: we can do a better job

Health care services provided to older adults today are not as effective as they should be. The quality of care for late-life mental disorders often falls short of desired standards. The growth of the elderly population makes it imperative for the health care system to address late-life mental disorders more effectively. Intervention strategies based in primary care settings show the most promise, but effectiveness will depend on solving the geriatric psychiatry workforce crisis. Collaborative care is one promising model for improving geriatric mental health care delivery in primary care. Diffusion of collaborative care into the health care system and integrating geriatric psychiatry into other models such as geriatric medical homes will require redesign of the organization and financing of primary care and psychiatry to overcome current barriers. Public policy should reflect the essential role of psychiatry in geriatrics and promote the integration of geriatric psychiatry with primary care.     

Mental Health Care for American Indians in Prison

Abstract

Based on an earlier finding that as many Native Americans in upstate New York received mental health care in prison as outside of prison during a 10-month period, this study was designed to investigate if prisons had become an alternative treatment option for Native Americans with a mental illness in New York State. The study was not able to answer this question due to the limited number of cases and to outside constraints. However, it is possible from the results to provide a picture of mental health needs and attitudes among Native American inmates which is surprising and instructive for those who provide psychiatric care to American Indians, either within or outside of prison walls. A noteworthy finding was the importance placed by these inmates on the use of culturally appropriate ceremonies to assist in their rehabilitation. Low rates of serious mental illness among the American Indian sample highlight the need for further study in this area.     

Geropsychiatric education programs. Providing skills and understanding

1. The treatment of mental health problems is a growing concern in long-term care facilities; up to 80% of nursing home residents suffer from some type of mental illness, but most receive no active treatment. 2. Nursing home staff do not receive sufficient training on mental health issues, the aging process, and assessment and management of psychiatric symptoms in the elderly. 3. Psychiatric nurses can provide a number of quality geriatric mental health programs to increase staff knowledge and promote quality of care.     

Role incongruence and gender variation in the provision of prison mental health services

Correctional administrators are equipped with a variety of responses to manage problematic inmate behavior. The forms of these responses range from subtle coercion in the context of everyday prison life to segregative placements that include protective custody, disciplinary confinement, and mental health residential services. Using logistic regression, the present study examines the disproportionate placement of female inmates in mental health facilities. The results suggest that placement differences for male and for female inmates reflect both psychiatric need and differential responses to role-incongruent behavior.     

State Units on Aging and Housing for the Elderly:

One major goal of the Older Americans Act (OAA) is to promote suitable housing for the elderly through the aging network that includes the State Units on Aging (SUAs). Little is known, however, about SUA activity in this area. This article reports on the results of a recent survey of SUA housing efforts and roles played, collaborations and networks, resources, and priorities, accomplishments and future initiatives. To better link housing and services and expand housing options as some SUAs are already doing-especially in services coordination in existing housing, board and care, home equity conversion mortgages and assisted living-they must redefine housing as part of community-based care, vigorously focus political and advocacy skills on housing issues, and expand their capacity building and expertise in housing by resetting priorities and reallocating budgets.     

Supportive Housing Initiatives in Arkansas

Abstract

Arkansas has a significant need for improving the availability of affordable housing with access to supportive services for its large population of elderly and persons with disabilities. Factors that contribute to this need are the high level of poverty, general poor health, low employment rate for persons with disabilities, and the geographic and social isolation problems typical of a rural State.     

Oral diagnostics: an integral component to geriatric health care

Abstract

Aging is inevitable, every day we live we age. The mouth is referred to as a mirror of overall health, reinforcing that oral health is an integral part of general health. Oral health reflects overall well being for the elderly population. Compromised oral health may be a risk factor for systemic diseases commonly occurring in age. Diagnosis and proper treatment is essential for healthy aging. Timely diagnosis, appropriate treatment and regular follow-up of both oral and systemic diseases are a prerequisite for active aging. Oral diagnostics is a revolutionary development with high potential to replace other investigative modalities. Changing demographics, including the increase in life expectancy and the growing numbers of elderly, has focused attention on the need for dental research activities to be expanded for geriatric dentistry. This paper is aimed to shed light on the growing elderly population and their ailments. It also aims to create awareness among health care providers about oral diagnostics and their application in geriatrics.     

The mental health of young people aging out of care and entering adulthood: Exploring the evidence from England and France

This paper explores the research evidence from England and France on the mental health of young people aging out of care and into adulthood. It represents the first comparative review based on the evidence from these two countries. Set in the legal, policy and service framework for both countries, it reviews evidence on the mental health of young people in the general population, young people living in care, young people aging out of care, and young adults. It shows: the high levels of psychological adversity of young people entering care; the high rates of mental health problems of young people in care compared with the general population of young people; the increased risk of mental and physical problems at the time of aging out of care, and the general improvement in longer-term outcomes for young adults, although some continue to have serious mental health problems. In conclusion, it suggests that interventions across the life course of young people are needed.     

Deaf or hard of hearing inmates in prison

Despite laws in the United States enacted to protect individuals with disabilities in prison, there is ample case law to demonstrate that the intent of these laws has not been achieved. Using the existing US legal and social science literatures and experiences, this article considers: the problems hearing-impaired offenders face in prison that are not encountered by non-deaf or hard of hearing inmates; the services and accommodations prisons provide for deaf or hard of hearing inmates so that they can function at least as well as non-deaf or hard of hearing inmates; and the types of scientific research that should be conducted to understand the possible types of deaf or hard of hearing experiences in prisons, the consequences of these experiences, and the best way to address pathological sequela of being deaf or hard of hearing in prison. We argue that the creation of rules to protect this population is of no value unless these laws are implemented as intended. Without monitoring the law in action and studying why the intent of the law may be thwarted, an atmosphere in which deaf or hard of hearing offenders are neglected and even abused will likely occur.     

Naturally Occurring Retirement Community-Supportive Service Program: an example of devolution

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.     

Homes of Choice

Abstract

State policymakers increasingly recognize that housing is not only an important shelter resource for older persons, but also a key element of community-based care. Over the last two decades, significant state and local activity has led to an increase in service-enriched housing for older persons. Service-enriched housing refers to living arrangements that include health and/or social services in an accessible, supportive environment. Emerging forces are leading to increased pressure for the expansion of service-enriched housing. These forces include: a growing and diverse population of older renters; older adults' preferences to age in place; the increasing frailty of subsidized housing residents; the development of assisted living (AL); the enactment of Medicaid waivers; and implementation of the Olmstead decision. Although studies have not included cost-analysis, available research demonstrates that service-enriched housing promotes resident satisfaction, successfully provides services to frail populations, and supports aging in place.

Given both limited resources and research, this article addresses how states can adequately respond to and capitalize on these forces in order to best meet the long-term needs of older adults.     

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.     

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.     

Health care paraprofessionals' awareness of the symptoms of geriatric depression.

1. Depression is not part of the normal aging process. 2. It is important to increase awareness of the symptoms of geriatric depression among health care paraprofessionals. 3. If depressed elderly people are identified and appropriate referrals are made, treatment for depression is available and effective. 4. Health care paraprofessionals can be taught to recognize geriatric depression.     

Long-Term Care Alternatives:

Definition of Life Care Community. A continuing care requirement community (CCRC), or life care community, is a long-term care alternative providing a package of services, including housing, health care and social services, to the elderly. More specifically, a CCRCL (1) provides independent living units, either apartments, rooms or cottages; (2) guarantees a range of health care and social services, which may include intermediate or skilled nursing care, usually available on the premises; (3) requires some type of prepayment, generally an entrance fee and/or monthly fees; and (4) offers a contract that lasts for more than one year or for life and that describes the service obligations of the community and the financial obligations of the resident.     

Changes in health, mortality, and disability and their impact on long-term care needs

The need for long-term care is driven both by the growth of the elderly population and changes in the age relations of morbidity, disability, and mortality. Data show these relations changed in the U.S. elderly population from 1982 to 1989. Chronic disability prevalence declined between the 1982 and 1989 U.S. National Long Term Care Surveys. Among those impaired, many persons using personal assistance to meet their needs shifted to the use of assisted housing and special equipment. The relation of these trends to other changes--such as the increasing educational level of the elderly population--is examined to estimate how future changes in disability and morbidity may affect the demand for long-term care. Disabilities at specific times as well as their transition rates were examined to determine how long individuals need long-term care. The analyses suggest that, while the amount of long-term care services needed will increase rapidly, the types and amounts of services used by the U.S. elderly population will undergo significant change.     

Changes in Health,Mortality, and Disability and Their Impact on Long-Term Care Needs

The need for long-term care is driven both by the growth of the elderly population and changes in the age relations of morbidity, disability, and mortality. Data show these relations changed in the U.S. elderly population from 1982 to 1989. Chronic disability prevalence declined between the 1982 and 1989 U.S. National Long Term Care Surveys. knong those impaired, many persons using personal assistance to meet their needs shifted to the use of assisted housing and special equipment. The relation of these trends to other changes-such as the increasing educational level of thc elderly population-is examined to estimate how future changes in disability and morbidity may affect the demand for long-term care. Disabilities at specific times as well as their transition rates were examined to determine how long individuals need long-term care. The analyses suggest that, while the amount of long-term care services needed will increase rapidly, the types and amounts of services used by the U.S. elderly population will undergo significant change.     

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.     

浅析廊坊市社区居家养老服务体系的构建

廊坊市老龄人口总数和年增长率均高于全国平均水平,已提前进入老龄化社会,养老服务问题愈加凸显,加快养老服务体系建设至关重要。社区居家养老服务模式集合了家庭养老和机构养老的优点,以其人性化、便捷性、操作性强等独特优势,已成为全世界非常推崇的养老服务模式。通过纵向数据分析和横向比较分析,描述廊坊市人口老龄化的基本态势,深入剖析居家养老服务模式的内涵,并在探讨廊坊市居家养老服务的实践与存在的不足的基础上,提出构建社区居家养老服务体系的对策。