Independent living services,adjudication status,and the social exclusion of foster youth aging out of care in the United States

Recent policy changes have increased the availability of independent living services (ILS) to foster youth aging out of care in the United States. Yet, it is possible that youth who are also involved in the juvenile justice system may have trouble accessing these services. This study uses a social exclusion framework to examine associations between independent living service receipt, adjudication status, and early adult outcomes for youth aging out of the U.S. foster care system. Outcomes and ILS receipt data for 7412 older youth from the National Youth in Transition Database (NYTD) were used for this study. Chi-square tests and logistic regression models were used to explore the relationships among adjudication status, ILS, social exclusion, and social connectedness at age 19. Findings indicated that postsecondary education support and education financial services at baseline were related to a higher likelihood of being socially connected and lower likelihood of being socially excluded at age 19. Being an adjudicated delinquent and receiving special education and career services were related to a lower likelihood of being socially connected. This suggests that ILS are well-suited for youth already doing well, but may not do enough for those who struggle the most during this period.     

Independent Living: gender, violence and the threat of violence

In what ways is independent living for young adults with disabilities compromised by violence and its threat? A qualitative study of 42 young adults with severe physical disabilities explored their perceptions and concerns about independent living, access to services and the meeting of needs. Young women especially experienced difficulties about leaving home, because of their own and their parents' fears about vulnerability; some who did leave home experienced highly restricted social lives because of anxiety about neighbourhood violence. Few had established partnerships, but violence and sexual abuse from partners emerged as an issue for which there is little policy. Control and abuse within caring relationships are serious issues for those who need personal care. Violence and lack of protection may undermine independent living, especially for women.     

Life-Stage and Mobility: An Exploratory GPS Study of Mobility in Multigenerational Families,Ahmedabad, India

As the population of older adults in India grows, research is needed to plan a sustainable future for India’s older adults. This article reports results from a Global Positioning System (GPS)–based pilot study that examined the mobility of middle-class, older adults living in Ahmedabad, Gujarat, India. Using mobility as a lens through which to examine the lives of older adults, we map potential research and identify policy areas of interest considering older adults in urban India. The study explores the role of life stage in mobility as well as the effects of gender and urban environment on mobility. Using this distinctive perspective on day-to-day life, we propose themes through which, using policy and planning tools, the living environments of older adults in Indian cities can be improved. These policy measures include focusing on walkability and pedestrian safety in residential areas and building on existing mixed land use to create high accessibility to goods and services in urban environments.     

Commentary: the forgotten older adult with serious mental illness: the final challenge in achieving the promise of Olmstead?

Older adults with serious mental illness disproportionately reside in nursing homes despite the U.S. Supreme Court Olmstead decision supporting the rights of persons with disabilities to benefit from integrated services in the community. This commentary addresses the neglected policy debate on implementing Olmstead for this rapidly growing, older population with special needs. First, the author describes research findings on older adults with serious mental illness living in nursing homes who might more appropriately reside and receive services in the community. Second, the author summarizes the evidence base for effective psychosocial rehabilitation interventions and services facilitating independent living in community settings for this subgroup. Finally, he concludes with seven policy recommendations aimed at advancing the promise of the Olmstead decision with respect to older adults with serious mental illness.     

Social Innovation in Rural Regions: Older Adults and Creative Community Development*

Many so-called structurally disadvantaged rural regions are characterized by an ongoing demographic change, low economic productivity, and an insufficient infrastructure. Paradoxically, citizens of such regions are often urged to address local challenges by developing innovative ideas, products, or services. Innovation is becoming a “message of salvation” and imperative to local action due to a rise of an innovation regime that conceptualizes innovation as reflexive and ubiquitous. Unlike cities, however, disadvantaged rural regions are often seen as not conducive to innovation. And older adults are rarely ever regarded as potential innovators. This article will examine how innovations emerge in disadvantaged rural regions and what role older adults play in this context. It focuses on social innovation which is important for processes of rural renewal. Drawing on insights gained through the “Innovation in Rural Municipalities” research project, the paper illustrates the resourcefulness of older adults in the context of socially innovative community development. Older adults can in fact act as drivers of innovative projects, actively participate in and make use of social innovations. Their specific role, however, depends on their personal motives, community-related interests, and available resources.     

Housing for Older People in Iceland: Apartments and Nursing Homes

The first residential and nursing homes in Iceland were built in the early 1920s, and the first apartments for older people in the early 1970s. Most of the existing housing for older persons was built in the last 30 years. Legislative provisions on housing and particularly on assisted living have not changed significantly since laws relating to the affairs of the elderly were first passed in 1983. While approximately 90% of older people in Iceland own their own home and the primary stated goal of the government is to support independent living, official policy relies on placement in nursing homes. Services and care at home, provided by social and home healthcare services, has not been developed to the same extent as in the other Nordic countries. Clearer guidelines on integrated service housing are needed to reach the government's primary stated goal. Placing more emphasis on delivering services, care, and rehabilitation to people living in the community could shorten individuals’ length of stay in hospitals, delay admission to nursing homes, and better meet the expectations of older people for independent living.     

Coping strategies used by LGB older adults in facing and anticipating health challenges: A narrative analysis

ABSTRACT

Given that lesbian, gay, and bisexual (LGB) older adults face notable health disparities compared to their heterosexual counterparts, there is a need for understanding how LGB adults cope with health challenges in late life. The current study analyzes narratives from nine LGB adults age 65 and older living in an urban area in the Southeast United States. Participants spoke of coping strategies related to health promotion behaviors, shifting perspectives of health and body, trusting in spirituality for comfort, and accepting the end of life. We discuss implications for social services professionals who work with older LGB adults and for future research.     

Under new management: the changing role of the state in the care of older people in the United Kingdom

This article examines recent changes and those currently being introduced in the formal care of older people in the United Kingdom. These are part of a general trend in all welfare states towards welfare pluralism but, in addition, the United Kingdom represents something of a special case because of the radical ideological engine that has driven the restructuring of the role of the state. The first part of the article outlines the main changes--the promotion of the private sector, the residualization of the public social services, and the new managerial role of the state in the care of older people. The second part considers the implications of these changes for older people and their informal helpers (or caregivers). The conclusion refers to both the particular changes taking place in the United Kingdom and, in general terms, to welfare pluralism as a policy goal.     

A Conspectus of Types,Options and Conditions of Elder-accommodation in the European Continent

A European housing typology for older people does not exist. There is a need to formulate a workable typology of elder-housing to enable planners and providers to make use of a meaningful categorization of accommodation within public, voluntary, private and mixed housing in a highly diversified Europe. This paper proposes an overarching typology, incorporating the notion of independent living accommodation and of assisted living accommodation as major categories, embracing 21 housing options. The usual use of the category of social housing is excluded because in Europe it has conflicting and overlapping meanings. Using the suggested typology, the provisions of independent living and of assisted living are commented upon in centre-periphery terms. Finally, the paper indicates that although the EU is the main European provider of welfare, it has virtually no housing policy, and its planning and provision are hindered by long-term constraints.     

An Examination of the Adult Day Services Industry Using the Resource Dependence Model within a Values Context

The adult day services (ADS) industry continues to grow and develop in providing care to larger numbers of older adults and their caregivers. Despite the growth in the number of programs and the changes in the way services are delivered, a systematic examination of the development of the ADS industry from a policy perspective has not been published since the mid-1990s. This article provides an analysis of the development of the ADS industry using the resource dependence model within a values-based context to determine whether public reimbursement opportunities are congruent with the needs of older adults and caregivers. Potential directions for the future development of the industry are presented through analysis of the collaborations of adult day providers with the providers of other services for older adults and the effort by public and private funders to connect quality outcomes and resources.     

Social Relationships of African American and Hispanic Older Assisted Living Residents: Exploring the Role of Race and Ethnicity

African American and Hispanic older adults are underrepresented in assisted living communities, so little is known about how they experience social relationships in these settings. The purpose of the study was to explore resident-to-resident and resident-to-staff relationships experienced and perceived by African American and Hispanic older residents in assisted living settings. In-depth interviews with 15 African American and 15 Hispanic older adults were conducted in seven assisted living communities in Central Florida. Three salient themes emerged using a grounded theory approach: formation of relationships: emotional vs. instrumental support; language as a facilitator or barrier; and avoidance of inter-racial relationships. Implications for providing culturally competent services in assisted living communities with diverse populations are discussed.     

An examination of the adult day services industry using the resource dependence model within a values context

The adult day services (ADS) industry continues to grow and develop in providing care to larger numbers of older adults and their caregivers. Despite the growth in the number of programs and the changes in the way services are delivered, a systematic examination of the development of the ADS industry from a policy perspective has not been published since the mid-1990s. This article provides an analysis of the development of the ADS industry using the resource dependence model within a values-based context to determine whether public reimbursement opportunities are congruent with the needs of older adults and caregivers. Potential directions for the future development of the industry are presented through analysis of the collaborations of adult day providers with the providers of other services for older adults and the effort by public and private funders to connect quality outcomes and resources.     

The crisis of local authority funding and its implications for independent living for disabled people in the United Kingdom

The recent financial collapse of Northamptonshire County Council sets a worrying precedent for local authorities in the United Kingdom, and in particular for disabled people who depend on services provided by local authorities, such as Direct Payments for personal assistance, for their daily living needs. While the Northamptonshire situation has been blamed on financial incompetence, we argue that it has deeper roots in austerity policies implemented by Conservative-led governments since 2010 on a national level. We also argue that the placement of responsibility for funding personal assistance services in the hands of local authorities creates a deeply unjust ‘postcode lottery’ for disabled people, and we call for a national right to all services necessary for independent living, regardless of cost.     

Perceived Need for Home- and Community-Based Services: Experiences of Urban Chinese Older Adults With Functional Impairments

Guided by Cantor’s social care model, this study identified individual, family, and social support factors that influence urban older adults’ need for home- and community-based services, including medical and rehabilitation, instrumental care and support, and psychosocial services. The data were extracted from the Sample Survey on Aged Population in Urban/Rural China conducted by the China Research Center on Aging in 2006. Results from multiple logistic regression show that older adults’ need for medical and rehabilitation services is significantly related to instrumental activities of daily living, depression, not having filial children, friend support networks, and having a confidant. Older adults’ need for instrumental care and support is related to their educational attainment, financial strain, instrumental activities of daily living, not living with children, and friend support networks. Finally, older adults’ need for psychosocial services is significantly related to educational attainment, depression, not being married, friend support networks, and having a confidant. Implications for social service development are discussed.     

The notion of precariousness among older adults living alone in the U.S.

This paper argues that older adults living alone in the U.S. face a set of unique challenges, as they are likely to experience a sense of precariousness. The term precariousness points to an intrinsic sense of instability and insecurity stemming from a lack of, or difficulty to, access essential resources. During a two-year ethnography of 47 older solo dwellers, this term captured one of the distinctive traits of the experience of living alone in older age in the U.S. The findings from semi-structured interviews and participant observation highlight the emergence of the notion of precariousness along three levels of analysis. First, on the micro and subjective level of analysis, older solo dwellers may struggle to perform the chores related to their household as they may deal with a failing body, faltering memory, and fixed if not shrinking income. Second, on the meso and institutional level of analysis, older adults living alone need to navigate the complex, scattered, and ever-changing landscape of services and understand their eligibility criteria, accessibility, fees, and conditions. At the same time they may have to deal with family issues. Finally, the macro level examines the pressure on older solo dwellers of a prevalent ideology that prizes independent behaviors and personal responsibility. In conclusion, the notion of precariousness illustrates the unique position of older adults living alone as they face different type of challenges on a micro, meso, and macro dimension. The paper ends with an invitation to create social policies that accommodate the needs of a growing number of older adults living alone.     

Mental health disparities in the older Afro-Caribbean population living in the United States: cultural and practice perspectives for mental health professionals

Cultural characteristics play an important role in the lives of many older Afro-Caribbean as they continue to migrate, acculturate, and assimilate in the United States. Many among this unique cultural subgroup will develop mental illness; however, despite the availability of effective treatment, seeking appropriate care within the formal mental health system continues to be a challenge for this group as a consequence of their cultural heritage. This review describes how these cultural determinants often lead to mental health disparities among older Afro-Caribbean living in the United States. Suggestions are also included for how mental health nurses and other professionals can incorporate research and practice into the caring model of cultural humility as they continue to come in contact with this population in various clinical settings.     

An Examination of Older Immigrants' Use of Dental Services in the United States

The recent influx of immigrants aged 65 and older in the United States triggers an increasing need to understand older immigrants' dental services use. This paper uses data (n = 9,617) from the 2004 and 2006 waves of the Health and Retirement Study to examine the dental services use of older Americans. In particular, this study focuses on differences in dental services use between immigrants and natives and potential contributing factors. Multivariate logistic regression analyses showed, contrary to expectation, that older immigrants were more likely to use dental services than older natives despite numerous barriers (odds ratio = 1.30 in 2004). The results in 2006 confirmed these findings. The results from 2004 and 2006 analyses showed dental insurance coverage, sex, and marital status were associated differently with dental services use for immigrants and natives. Implications for current oral health policies and future research of older Americans are discussed, as well as methods for meeting older immigrants' growing dental services needs.     

The Evolution of Housing Typologies for Older Adults in The Netherlands From 1945 to 2016: An Analysis in the Context of Policy,Societal, and Technological Developments

This study aims to examine housing typologies for older adults in the light of three qualitatively examined exogenous factors: policy, societal developments, and technology. The developments in inpatient and assisted ambulatory housing facilities for older adults have been mapped from 1945 to 2016 using quantitative data. Using these data, five transition periods can be distinguished. Within the first transition periods, policy factors were tremendously important, while within the later ones, societal influence empowered by technological change became the primarily driving factor. This research shows that the classification of inpatient, assisted ambulatory housing, and outpatient housing may no longer be applicable in its current form.