The Olmstead decision and the journey toward integration:the evolution of social work responses

The Olmstead decision declared unnecessary institutionalization as discrimination and triggered an expansion of community-based care for all people with disabilities including the elderly, thus accelerating integration. Setting a context for Olmstead and related social work interventions, this paper describes the evolution of definitions of disability and examines how social work has responded to the development of critical social policies aimed at increasing community integration.     

Work Behavior of Older People with Disabilities in the Era of the Americans with Disabilities Act

Abstract

This paper explores the correlation between the implementation of the Americans with Disabilities Act (ADA) and the employment participation of people with disabilities. First, it discusses the methodological difficulties in measuring the ADA's impacts. Second, it describes a longitudinal study using Health and Retirement Survey data exploring changes in employment rates and odds of employment during the 1990s for older working-age people with disabilities. The findings show that while older people with disabilities had slightly lower employment rates than older people without disabilities during the 1990s, the odds that older people with disabilities would be employed has increased since the passage of the ADA.     

Absent Role of the State: Analysis of Social Support to Older People with Disabilities in Rural China

China is experiencing rapid population ageing and already has 44 million older people with disabilities aged over 59 years. Yet social support of these older people with disabilities is undeveloped and not well researched. This article contributes by using a disability rights framework (right to life and protection, economic security and social support) to analyze local cases in rural China. It finds that, although the family is still the main provider of economic and care support to rural older people with disabilities, the absence of a state role in welfare provision has negative impacts on the well‐being of older and younger generations in rural families.     

Housing disparities, caregiving, and their impact for older Puerto Ricans

The needs of older persons in historically oppressed racial and ethnic populations remain "invisible" in the public arena (Wallace & Villa, 1999). Understanding the ethnocultural factors that shape their housing needs is essential to effective, equitable policy formation and program planning. This article examines the impact of housing disparities, health status, and cultural patterns of caregiving in relation to older Puerto Ricans on the U.S. mainland. Following a literature review of the socio-economic, living arrangement, and cultural profiles of older Puerto Ricans, policy recommendations to advance adequate housing options for this population are provided. The article concludes with a discussion of Section 202 housing policies and how they can be adapted to the current and emerging population of older Puerto Ricans.     

Creating elder-friendly communities: preparations for an aging society

Because many communities where older people live were not designed for their needs, older residents may require support to remain in the least restrictive environment. "Age-prepared communities" utilize community planning and advocacy to foster aging in place. "Elder-friendly communities" are places that actively involve, value, and support older adults, both active and frail, with infrastructure and services that effectively accommodate their changing needs. This paper presents an analysis of the literature and results of a Delphi study identifying the most important characteristics of an elder-friendly community: accessible and affordable transportation, housing, health care, safety, and community involvement opportunities. We also highlight innovative programs and identify how social workers can be instrumental in developing elder-friendly communities.     

Sheltered Housing and Community

This paper considers the role of sheltered housing following the introduction of new community care arrangements in 1993 and examines the continuing uncertainty about its exact role as community care continues to develop. It reports on a study conducted in Shropshire, using a postal survey and interviews with older people and service professionals. The study highlights the importance of sheltered housing for older people, particularly in relieving them of concerns about maintenance and repairs, social isolation and security. These factors were crucial for their overall peace of mind and quality of life. While only a small proportion of tenants received help under social services' community care arrangements, the additional support, monitoring and service coordination provided by wardens helped some of them to remain in sheltered housing when residential or nursing home care might otherwise have been necessary. Sheltered housing was overwhelmingly popular with older people — but their satisfaction was closely associated with the availability and quality of the warden service. Although sheltered housing is not currently in vogue in housing policy, the paper argues that it plays a vital role in local provision for older people and needs to be more closely integrated into community care policy, while at the same time preserving the characteristics that make it popular with its residents.     

Safe as Houses? Ageing in Place and Vulnerable Older People in the UK

The UK is very similar to many other European, North American and Australasian countries in its emphasis on ‘ageing in place’. This article does not seek to challenge the importance of this for most older people but rather draws out the challenges and issues raised by older people who are vulnerable or in vulnerable housing situations. This is illustrated through drawing upon three separate studies which are on older homelessness, older people in the private rented sector and owner‐occupiers with dementia.     

Harriet Tubman's last work: the Harriet Tubman Home for Aged and Indigent Negroes

This article focuses on the important contributions the venerable Harriet Tubman made to the field of housing for older persons and other populations at risk. It uses an historical approach to document the importance of early housing and self-help initiatives in the African American community. It embraces Harriet Tubman and other early housers for their good works and acknowledges them as contributors to the rich legacy of community social work practice and its sage principles of empowerment and self-help. The article presents a nexus between the current housing status of older Blacks and the double jeopardy status imposed by historical discrimination.     

Effective personalised housing support for people with disabilities – case study analysis

International policy trends favour personalised approaches to housing support for people with disabilities. Previous research is inconclusive about whether these approaches are effective compared to group home support in the way they use government resources and benefit clients, partly because it does not usually consider the experiences of people who use the support. In this research we compared six new, innovative case studies of personalised housing support to previous research about group home support. We included qualitative data about client experiences, in particular regarding social networks, decision making, community service use and participation in domestic tasks. We found that client outcomes were positive in all four categories, while the financial costs to clients and government were similar to group home support. The results offer evidence that current, personalised approaches to housing support can be an effective policy option that allows people with disabilities to make choices about how to live and participate in their communities, without increasing the cost to government.     

Replacing the Elderly With Older Adults in JGSW Publications

Summary

This article focuses on the important contributions the venerable Harriet Tubman made to the field of housing for older persons and other populations at risk. It uses an historical approach to document the importance of early housing and self-help initiatives in the African American community. It embraces Harriet Tubman and other early housers for their good works and acknowledges them as contributors to the rich legacy of community social work practice and its sage principles of empowerment and self-help. The article presents a nexus between the current housing status of older Blacks and the double jeopardy status imposed by historical discrimination.     

Tenure Differences in Income and Housing Benefit in Later Life

The first half of this article examines the distribution of income among older people in different housing tenures using secondary analysis of the 1988 Family Expenditure Survey (FES). The use of the term “older household” refers to those where the head of household is aged 55 and over. Income has been adjusted in order to take account of the size and composition of elderly households. The second half of the article examines the effects on the distribution of income when the definition of income is widened to include housing benefit. In 1988 the average weekly income of older households who were owner occupiers was twice that of older households who were renters. While the addition of housing benefit to the definition of income has only a marginal effect in reducing income inequality among all older households it had a more significant impact in reducing income inequalities among older renters more of whom, in comparison to older owner occupiers, were located in the lower income groups.     

Contentment and Suffering: the Impact of Australia's Housing Policy and Tenure on Older Australians

Housing policy in Australia historically has focused on facilitating homeownership and creating some buffer for those households that are not homeowners. This paper explores the implications of this policy for older Australians. What is argued is that housing tenure has become a crucial divide and that older Australians who have not had the good fortune to access homeownership or public / community housing and who are dependent on the private rental sector as a result, often find themselves in desperate circumstances. The argument is developed that the failure to put in place a housing policy which would give all citizens the ability to access adequate and affordable housing, has led to a situation where a substantial and increasing number of older Australians have untenable housing costs and minimal disposal income. The article concludes that the present policy initiatives aimed at addressing the housing affordability crisis will have little impact on the situation of older people who are currently in housing stress.     

Western Christianity's two historical treatments of people with disabilities or mental illness

Christianity had two traditions of interpreting people with disabilities. The older tradition viewed disability as the result of sin. This tradition punished, separated, and restricted people with disabilities. It barred them from full participation in the Church and its rituals. However, as Christianity developed, a second tradition emerged that saw people with disabilities as needing compassion and that God accepted everyone. The second tradition saw people with disabilities as representing opportunities for the faithful to do charitable works. Christianity led the movement to provide assistance to people with disabilities until government later began to supplant its efforts.     

Contested Housing Landscapes? Social Inclusion,Deinstitutionalisation and Housing Policy in Australia

Deinstitutionalisation is represented as a major step toward social inclusion through the resettlement of disabled people residing in segregated large‐scale institutions into community‐based homes. By promoting the right to live in ordinary community residential settings, deinstitutionalisation fundamentally changes both the support services and housing arrangements of former institutional residents. In Australia, as in many western countries, debates on community care have tended to focus on the location and nature of non‐housing supports for people leaving dependent care. This focus, however, overlooks the fact that deinstitutionalisation involves a radical rehousing of people in care. This paper explores the character and implications of deinstitutionalisation in Australia as a rehousing process. It is based on a recent national research project that has examined the housing futures of people with intellectual disabilities who have been, or will be, deinstitutionalised. The paper considers the increasingly divergent socio‐political perspectives that have emerged in recent discussions about social inclusion, institutional reform and independent living and their implications for housing and community care policies.     

A Comparative Case Study of Care Systems for Frail Elderly People: Germany, Spain, France, Italy, United Kingdom and Sweden

Comparative studies of European social policies towards frail elderly people typically focus on the systems and their implementation. The study presented in this article, conducted in 2001 in six European countries (Germany, Spain, Italy, France, the United Kingdom and Sweden) aims at comparing the rights of the individuals within the different care systems. The methodology used is a case study approach, which draws on a series of situations of dependent elderly people. Therefore, the analysis focuses on the public authorities’ responses – the care packages, which determine the type of care required and the financial contribution of the user – in each of the six countries, in relation to the concrete situations of frail elderly people. As local variations are important, in all the countries studied, local authorities have been chosen in each of the countries. This approach gives us interesting concrete elements on the services and financial help which can be given to frail elderly people, but it also enables us to understand precisely the national care systems organized in the different countries and the main difficulties encountered by public authorities in facing this problem of frail elderly people.     

Long-Term Care Policy for Functionally Dependent Older People in the Republic of Korea

In the Republic of Korea, the construction of a long-term care system for frail older persons has become an issue of great concern in the twenty-first century, as the population is ageing rapidly. Functionally dependent older people aged 65 and over (excluding those who have difficulty performing so-called instrumental activities of daily living) are estimated to make up 15 per cent of the total population, but only about 1 per cent of older people can afford to use formal services. In response to the increasing burden of supporting frail older persons, a long-term care model is being prepared with the establishment in March 2003 of the Planning Committee for Developing a Public Long-Term Care Security System for the Elderly. This paper analyses the sociodemographic background to the introduction of a long-term care system, as well as the content and problems of the current system, and suggests the fundamental policy areas to be improved on the basis of these results. Policy issues are as follows: expansion of infrastructures for providing long-term care services, transforming small and medium-sized acute hospitals into long-term care hospitals, continuum of health and long-term care services, construction of a system to support informal caregivers, and development of a funding system for long-term care service costs.     

Ageing Populations and Housing Needs: Comparing Strategic Policy Discourses in France and England

Set against a broad European policy agenda which promotes ‘ageing in place’ and representations of older people as active, independent citizens, this article compares recent English and French policy discourses on population ageing and its implications for the housing needs of increasingly large numbers of older citizens. Through analysis of six recent strategic policy statements representing each government's official responses to population ageing and its social policy implications for the 21st century, we demonstrate how differences in the social representation of the ageing process and of older peoples themselves permeate policy discourse, influencing the perceptions of the housing needs of older citizens and the role that housing itself may play in promoting independent living. In England, demographic ageing, housing and its role in facilitating independent living and active ageing are explicitly articulated, whilst in France, the housing environment has until recently, been portrayed as one which must accommodate the illness, incapacity and dependency of later life. Our article offers explanations for these differences in terms of cultural variations in the social representations or ‘constructions’ of later life, divergences in political philosophies and welfare principles.     

"Just like I'm saving money in the bank": client perspectives on care coordination services

Older adults face many challenges to community living. The literature has not sufficiently explored the roles of care coordination in the maintenance of housing and access to health care among older adults, particularly from their own perspectives. This qualitative study analyzes the findings from 25 interviews and 6 focus group discussions (48 participants) with a multiethnic sample of older adults in the New York City area. Care coordination services appear to assist older adults access health care, and to a lesser extent, maintain affordable housing. Disparities in access to care coordination appear to remain for immigrant, minority and suburban populations.     

“Just Like I'm Saving Money in the Bank”: Client Perspectives on Care Coordination Services

Older adults face many challenges to community living. The literature has not sufficiently explored the roles of care coordination in the maintenance of housing and access to health care among older adults, particularly from their own perspectives. This qualitative study analyzes the findings from 25 interviews and 6 focus group discussions (48 participants) with a multiethnic sample of older adults in the New York City area. Care coordination services appear to assist older adults access health care, and to a lesser extent, maintain affordable housing. Disparities in access to care coordination appear to remain for immigrant, minority and suburban populations.     

Allocating Homes for People with Intellectual Disability: Needs,Mix and Choice

Allocation of housing and support services for people with intellectual disability is based on three major sets of criteria: an assessment of the applicants' needs; considerations of social mix; and the applicants' own choices. This article examines the philosophical and institutional rationales underlying each of these notions and the tensions arising when seeking to achieve a balance between them. The first section of the article is based on a review of related studies in the UK, the USA and Australia, mainly on allocation policies in mainstream social housing. The second section presents original empirical work carried out in the state of Victoria, Australia, in 2007–08, illustrating some of the implications of a new balance that was created between needs, mix and choice in allocation of housing and support for people with intellectual disability. The article argues that the concepts of needs, mix and choice should be redefined in a way which reflects the interdependencies between them. Further, the article calls for more extensive mutual learning between studies of mainstream social housing and housing for people with intellectual disability.