The Contribution of Sheltered Accommodation to the Housing of the Elderly in a Rural and an Urban Area of Wales

The primary objective of Government policy for the care of the elderly is to enable old people to live independent lives in the community for as long as possible. To facilitate this, recent policies have switched the emphasis away from long-term institutional care to the provision of care within the community. An integral aspect of this has been the provision of sheltered housing, with or without additional facilities and backed up by domiciliary and community services. This paper examines the contribution made by sheltered dwellings to the accomodation of the elderly in two areas of Wales, by comparing the characteristics of those resident in sheltered schemes with those residing in non-specialist accommodation.     

Scandinavian Contrasts and Norwegian Variations in Special Housing for Older People

De-institutionalization is a general trend for Scandinavian long-term care over the last decades. Denmark and Sweden have taken this trend a step further than Norway has, as Denmark suspended institutional care altogether in 1987 and Sweden in 1992. Since then, residential care has been provided to individuals in special housing in various forms. This housing is in principle “independent housing,” where residents are tenants and are provided services according to needs and not sites. This article concentrates on the Norwegian variations to this system, as this is the only country of the 3 that still provides residential care under 2 “regimes,” an institutional care regime and an assisted housing regime. Is assisted housing essentially different from institutional care, or is it better described as old wine in new bottles? The latter may be the case for Sweden, whereas Denmark stands out as having the most housing-oriented care model. Institutional care (i.e., nursing homes) still dominates in Norway, where assisted housing is merely a minor supplement to institutional care in most municipalities. The article explores the reasons for these trends and, in particular, the reasons for the Norwegian resistance to assisted housing as an alternative form of residential care.     

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.     

Assisted Living for Lower-Income and Frail Older Persons from the Housing and Built Environment Perspective

Abstract

This paper examines the linkages between housing and supportive services from the built environmental perspective. When it comes to linking supportive services, it is usually true that the wealthier an individual is the more private resources he or she has available to define a personal support system at every step in the aging process; the poorer the individual is, the fewer choices she or he has and the successful linkages of government subsidized housing, health and supportive services become more important to successful aging of that person. Low-income and aging individuals are the real testing ground for whether current policy allows holistic support linkages to occur and whether programs are available in both the quantity and quality to empower low-income older persons with options and support choices.

The discussion that follows is limited to supportive services and aging in place in conventional housing and affordable purpose built assisted living programs and facilities; it omits institutional living. For low-income older persons, institutional care provides few if any housing choices or individual power to control support delivery, and thus linkages between cooperating support professionals and programs becomes increasingly moot.     

Moving Beyond Housing: Service Implications for Veterans Entering Permanent Supportive Housing

As a result of efforts to end homelessness among U.S. veterans, more former service members are entering permanent supportive housing (PSH). While PSH has been successfully used to house homeless veterans, more research is needed about services beyond housing placement and retention. This study uses the Gelberg–Andersen behavioral model for vulnerable populations to determine associations between predisposing, enabling, and need characteristics and recent service use (i.e., services to satisfy basic needs, occupational development, financial, healthcare, mental health) among unaccompanied homeless veterans (N?=?126) entering PSH in Los Angeles. Among the significant findings, as indicated using univariable logistic regression models, were veterans who had incarceration histories were more likely to utilize basic needs services, compared to those without incarceration histories. Veterans who received an honorable discharge were more likely to utilize occupational development services, compared to veterans with other discharge statuses. Veterans who had a case manager were more likely to utilize mental health services than those without a case manager, while those who received social security were less likely to utilize mental health services compared to veterans who did not receive social security. Veterans who met criteria for a psychological disability and veterans who met criteria for probable PTSD were more likely to use basic needs services and mental health services than veterans who fell below these thresholds. Clinical implications for social workers including “equal access to services,” “enhancing economic stability,” “providing safe and affordable housing with trauma-informed services,” and “training service social workers to deliver well-informed linkages and services” are discussed.     

Changes in the health status of newly housed chronically homeless: the Alaska Housing First program evaluation

The Housing First (HF) model is an evidence-based supportive housing initiative that provides permanent housing for the homeless without preconditions such as sobriety or treatment compliance. This three-year longitudinal study investigated the effects of Alaska's inaugural Housing First projects in Anchorage and Fairbanks on local service usage, costs and tenant quality of life (QoL). A total of 94 tenants participated at baseline in the QoL study and 68 continued to follow-up. Cost data was collected from local municipalities, Alaska Department of Corrections, and local hospitals, health care clinics, behavioral health providers, and detox facilities. Emergency services use by tenants decreased from the year before moving into Housing First to the year after. Changes in health care costs were more variable depending on site and type of service.     

Advancing Program Theory for Licensed Assisted Living Services in Independent Housing

Assisted living programs (ALPs) embed licensed assisted living services within independent housing. To advance nascent research on this type of housing plus services, this study aimed to develop empirically grounded program theory on the processes through which ALPs benefit residents within independent housing. Eighteen in-depth interviews were conducted with current and prospective consumers of an ALP in northern New Jersey, including residents and family caregivers. The setting for the ALP was a federally subsidized independent housing building, which had introduced the ALP approximately 1 year prior to the study. Themes emerging from an iterative coding process indicated the most valued aspects of the ALP’s service delivery, including the comprehensiveness of the service options, the flexible timing for their delivery, and the relational aspects of care. Participants further described the ways in which the structure of the ALP facilitated prevention, such as preventing the occurrence and escalation of adverse health events. The study concludes by presenting a program model that integrates these findings, which suggests that ALPs deliver care in ways that make long-term services and supports more accommodating and acceptable to consumers. This, in turn, can enhance their preventive value to facilitate aging in place among independent housing residents in clinical need of such supports.     

Linking Federally Assisted Housing with Services for Frail Older Persons

Advocates of policies designed to link federally assisted housing with social services for the frail elderly have encountered barriers such as the historical separation of housing and services, political and bureaucratic fragmentation, and budget constraints. Over a 20-year period, they have attempted to address these issues by identifying the nature and extent of the problem, creating workable models, and developing a political constituency. Major reform, however, occurred only in 1990 when Congress passed the landmark National Affordable Housing Act (NAHA) which provided an "open policy window" for supportive housing legislation. NAHA's passage, however, still left many issues unresolved (e.g., targeting and funding for services). The future challenge is to develop new models of supportive housing and provide a range of residential settings and portable services to increase the choices for frail older persons.     

Client satisfaction with live-in and live-out home care workers in Israel

In an era of globalization where the migration of longterm care workers is common, foreign live-in home care workers can compensate for the unavailability of family members and, perhaps, even substitute for institutional care in the provision of long-term care services to disabled older persons. This study examines differences in home care satisfaction between disabled older persons in Israel with "live-in" home care workers and those with "live-out" workers, and explores some differences in sociodemographic and personal characteristics between these two groups. Face-to-face interviews were held with a random sample of 93 older persons in Beer-Sheva. Older persons with live-in home care workers were more satisfied with their home care service than those with live-out workers. Those with live-in workers were more severely disabled, tended not to have any children living in close proximity, although an adult child was available as an informal caregiver. Communication difficulties between the elderly persons and their home care workers were found not to affect negatively the satisfaction with the service.     

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.     

The Continuation of Dwelling: Safety as a Situated Effect of Multi-Actor Interactions Within Extra-Care Housing in Sweden

This article examines the space–time situatedness of residing within extra-care housing (ECH) in Sweden. EHC constitutes an example of ordinary housing but is often categorized, along with senior housing, as “in-between housing.” What differentiates the extra-care housing from the ordinary is an age limit for moving in, the provision of communal facilities, and the presence of staff at certain times each week. Two housings with different environmental and architectural conditions have been analyzed through spatial analyses, observations, and interviews with residents (n?=?18). The article concludes that the two different assemblings enabled two very different possibilities for accessing “safe aging.” One offered opportunities for the continuation of identities which contributed to feelings of safety, and one demanded the reconstitution of identities for developing meaning in the new housing.     

Sheltered Housing in Britain

Following an analysis of the growing "need" and demand for sheltered housing, the paper considers the function of different sheltered housing types and the role of the warden. Sheltered housing management is also addressed and planning and policy conclusions drawn. The principle sources of data referred to in the paper consist of surveys of 17 housing managers, 156 wardens and some 5,000 or so tenant records, drawn from the urban West Midlands and rural Devon. Management and warden opinions and characteristics are analaysed against site and tenant characteristics (e.g., demographic, health, activity and movement/transition patterns).     

Client Satisfaction with Live-In and Live-Out Home Care Workers in Israel

Abstract

In an era of globalization where the migration of long-term care workers is common, foreign live-in home care workers can compensate for the unavailability of family members and, perhaps, even substitute for institutional care in the provision of long-term care services to disabled older persons.

This study examines differences in home care satisfaction between disabled older persons in Israel with “live-in” home care workers and those with “live-out” workers, and explores some differences in socio-demographic and personal characteristics between these two groups. Face-to-face interviews were held with a random sample of 93 older persons in Beer-Sheva.

Older persons with live-in home care workers were more satisfied with their home care service than those with live-out workers. Those with live-in workers were more severely disabled, tended not to have any children living in close proximity, although an adult child was available as an informal caregiver. Communication difficulties between the elderly persons and their home care workers were found not to affect negatively the satisfaction with the service.     

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.     

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.     

Long-Term Care Crisis in The Netherlands and Migration of Live-in Care Workers: Transnational Trajectories,Coping Strategies and Motivation Mixes

The crisis of the welfare state has generated a powerful pulling effect for contemporary intra-European migration flows. This article focuses on the migration of live-in care workers from Central and East European countries to the Netherlands, following the Dutch care reform. It explores the motivations and strategies of live-in migrant carers (LIMC) engaging in transnational mobility, aiming to understand how their agency is structured in multiple contexts. I am especially interested in transnational coping strategies and in how migrants pursue specific motivation mixes combining need and self-realization. The article draws on in-depth interviews with LIMC workers, triangulated with data from LIMC providers, family carers and other stakeholders. Participants use the LIMC jobs to cope with home and host country constraints, reconcile work and private life, and keep family ties. Continuous mobility is a strategic choice, which makes tough working conditions bearable and enables the achievement of long-term goals.     

Emigration,Housing Conditions,and Social Stratification in China1

Using data from the 1995 China 1% Population Sample Survey, this article examines the impact of international migration on housing conditions in China. We find that international migration affects housing conditions differently in cities, towns, and rural areas. In rural areas, the impact of emigration on housing conditions is seen primarily through the increase of housing space, whereas in cities the impact of emigration on housing conditions is mainly reflected in the improvement of facilities. Although having a cadre in the household continues to be an important factor, international migration has begun to challenge, and even rival, this legacy of social stratification in China.     

Perceived Safety in Extra-Care Housing for Senior Residents

Extra-care housing (ECH) is a new housing model in Sweden, falling in between ordinary homes and sheltered housing. The perception of safety among residents living in ECH was explored with the use of in-depth interviews (n = 28, on average 83 years old). A qualitative thematic analysis resulted in a model of perceived safety in the housing environment consisting of four themes: being able to manage on my own; a safe social context; being able to stay; and protection and safety. The model can be used for information, planning, and development of ECH in general.     

MODERNIZATION,GENDER EQUALITY,AND MORTALITY RATES IN LESS DEVELOPED COUNTRIES

Although greater accessibility to health care and increasing levels of education among residents of less developed countries have clearly contributed to mortality decline, few theoretical models to date have adequately explained the relationship. A comprehensive model of mortality decline should document both the factors that directly drive down mortality rates and the underlying structural dynamics that give rise to such direct effects. The present article draws on fundamental diffusion concepts and a psychosociological model of modernization that attempts to explain how less developed countries increase their availability of health care services and reduce gender inequality. Two diffusion mechanisms are argued to be operating: the transfer of raw material goods and technology through the international capitalist exchange system and the transfer of modern values, ideas, practices, and knowledge through the mass media. The model was tested with data on four measures of mortality for a sample of 43 less developed countries circa 1993. Partial support is found for the model, and suggestions for future research are made.     

The international migration of nurses in long-term care

This article describes five major factors that are affecting patterns of international migration among nurses who work in long-term care settings: DEMOGRAPHIC DRIVERS: The aging of the populations in developed countries and the low to negative growth in the working-age population will increase the demand for international workers to provide long-term care services. GENDER AND RACE: A dual labor market of long-term care workers, increasingly made up of women of color, is becoming internationalized by the employment of migrating nurses from developing countries. CREDENTIALING: The process of credentialing skilled workers creates barriers to entry for migrating nurses and leads to "decredentialing" where registered nurses work as licensed practical nurses or aides. COLONIAL HISTORY AND GEOGRAPHY: The colonial histories of many European countries and the United States have increased migration from former colonies in developing countries to former colonial powers. WORKER RECRUITMENT: Efforts to limit the recruitment of health care workers from some developing countries have had little effect on migration, in part because much of the recruitment comes through informal channels of family and friends.