The effect of caregiver's burden on change in frail older persons' use of formal helpers

We used a national longitudinal probability sample of frail older persons and their caregivers to examine three questions: 1) What are the probabilities of transition to use of formal helpers over a two-year period? 2) What is the role of predisposing, enabling, older person's need, and caregiver's need variables in changes in the use of formal helpers? 3) Do determinants of change in the use of formal helpers vary by level of caregiver's burden? Results show a slight trend to increased use in formal help over time. Personal burden, but not interpersonal burden, had a lagged effect on increased use of formal services. Use of formal helpers was greater in situations combining high levels of older person's need, high levels of caregiver's personal burden, and insufficient support from the informal network.     

Predisposing,Enabling, and Need Predictors of Community versus Institutional Long-Term Care

Abstract

This research explored characteristics of the elderly that are associated with the use of long-term care services. Using the 1999 National Long Term Care Survey, logistic regression was employed to examine the relationship of race with the use of formal and informal long-term care. This study also examined the relationship of health insurance with the use of formal and informal long-term care. The Andersen Model on health services utilization was used as the theoretical framework. The findings indicated that race was not associated with the use of long-term care but rather with predisposing, enabling, and need variables. Health insurance was found to be associated with the use of long-term care even after controlling for predisposing enabling and need variables.     

The Problems for Academic and Entrepreneurial Research in the Use of Health Services: the Case of Unstable Structural Relationships*

Multiple regression analysis was used to determine the longitudinal stability of the structural relationships between the predisposing, enabling, and illness-morbidity characteristics of the population-at-risk and measures of health services utilization. The structural coefficients estimated from the 1971, 1972, and 1973 Health Interview Surveys were examined using the Relative Instability Ratio (RIR) presented in this paper. The RIR values indicate that—except for age, family size, occupation, and family income—all the predisposing, enabling, and illness-morbidity characteristics produce unstable structural relationships. In addition, a negative monotonic relationship was found between the temporal ordering of the groups of characteristics and their ability to produce stable structural relationships. These results demonstrate the need for entrepreneurial health manpower projection techniques and abstract academic explanatory models of health services utilization to become dynamic, rather than remaining in their present static states.     

SOS—Satisfied or Stuck,Why Older Rural Residents Stay Put: Aging in Place or Stuck in Place in Rural Utah*

As rural communities undergo substantial demographic and economic changes, understanding the migration intentions and their antecedents of rural elderly persons becomes increasingly important. Using data drawn from a survey of adults from 24 rural Utah communities conducted in 2008, we examine whether rural residents 60 years of age or older plan to remain in their present communities (N= 621). We use structural equation models (SEM) to estimate the relationships between a variety of individual and community-level background measures, including perceptions of local service quality, leaving one's community for health care, Internet use, attachment to and satisfaction with community, and plans to age in place. Results suggest that even as the rural context of economic decline, population loss, and distance to medical services may reduce the viability of staying in a community, a desire to remain in the community is primarily a function of perceptions of the quality of local services and community satisfaction. This research highlights the need to better understand the interplay between the availability of medical services and perceptions of distance as well as to understand the complex relationship between individual and community level characteristics for migration intentions.     

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.     

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.     

Sense of Need for Financial Support and Respite Services among Informal Caregivers of Older Americans

ABSTRACT

Financial support and respite services are two of the most frequently reported types of help that caregivers of older adults need. Using an expanded health behavioral model, this study examined the effects of predisposing, enabling, and needs factors on caregivers' sense of need for these two types help. Data were drawn from the 1999 National Long-Term Care Survey and included 1,058 caregiving dyads in the community. The results indicated that caregiver-related factors more than care recipient–related factors affected caregivers' sense of need to seek both types of help. The findings direct to two important implications for long-term care policy for and practice with older adults: improvement of service for caregivers and service delivery systems.     

Factors Predicting Relocation Among Older Adults

Having a greater understanding of what influences the older adults decisions to move and the characteristics of older adults who are more likely to move is valuable to help plan for the housing needs of the expanding older adult population. The authors examined how contextual, push and pull factors influence preferences of older adults to relocate. A total of 1,015 community-dwelling older adults completed a survey. Results of logistic regression analysis indicated the following variables as significantly related to relocation: gender, age, household income, province resided in, driving status, whether the current home met the older adult's needs, and unmet heavy cleaning needs. Policies and services need to focus on identification of those at most risk of relocation and support them either in their preference to age in place or through the relocation process.     

Factors Associated with Drug Treatment Entry Patterns Among Hispanic Women Injection Drug Users Seeking Treatment

SUMMARY

This paper examines patterns of drug treatment entry and factors that are associated with these patterns among 1,849 Hispanic women injection drug users (IDUs). The data analyzed originates from a statewide drug-treatment database covering seven years, 1996–2002. Through the use of logistic regression analyses, the study identified significant differences in predisposing, need and enabling factors in the use of detoxification only, residential treatment, or methadone maintenance. Compared to other Hispanics, Puerto Rican women were 40 percent less likely to use only detoxification services and one and a half times more likely to use methadone maintenance. Having health insurance was an especially important factor associated with methadone treatment utilization. Two of the most important factors associated with residential treatment use were history of mental health services utilization and involvement with the criminal justice system. This article discusses specific social work practice implications including the need for social work practitioners to promote services such as residential treatment, to be trained in treatment of co-occurring mental health disorders, especially among women in residential treatment, and the need to establish close linkages with the mental health and criminal justice systems.     

Differential Health and Social Needs of Older Adults Waitlisted for Public Housing or Housing Choice Vouchers

Affordable housing is an important form of income security for low-income older persons. This article describes characteristics of older persons waitlisted for either public housing or a housing choice voucher (HCV; previously Section 8) in Portland, Oregon. 358 persons (32% response rate) completed a mailed survey with questions about demographics, health and housing status, food insecurity, and preference for housing with services. Findings indicate that many waitlisted older persons experienced homelessness or housing instability, poor health, high hospital use, and food insecurity. Public housing applicants were significantly more likely to report lower incomes, homelessness, and food insecurity than HCV applicants. We conclude with policy implications for housing and health agencies that serve low-income older persons.     

Quality of life of older people in Israel: a comparison between older people living at home who are members of a ‘supportive community’ and nursing home residents

The supportive community is a program that was developed in Israel for older people who live at home. The program provides its members with a service package that includes medical and social services, emergency call-button, cultural activities, and a ‘community parent’ who is responsible for the members. Using quantitative method, this study compared the level of quality of life between 55 older people living in their homes who are members of a supportive community (average age = 74.7) and 60 elderly people living in nursing homes (average age = 75.8). As expected, results indicate that quality of life among the older people living at their homes who are members of a supportive community was higher than among the older people living in a nursing home. In addition, the quality of life of married, educated, functionally independent older people in good health and with a good economic situation was higher. Predictor variables of quality of life were: the place of residence, health status, and age. In light of increased life expectancy and the growing need to care for the older population, the practical application of the study focused on a recommendation for the social services to continue the support community development program.     

Child welfare involvement among children in homeless families

An analysis of 8251 homeless children in New York City found that 18% of them received child welfare services over the five-year period following their first shelter admission, and an additional 6% had a history of having received such services before their first shelter admission. Recurrent use of public shelters, exposure to domestic violence, older age at first episode of homelessness, and larger number of children in a household were associated with an increased risk of child welfare involvement. The high rate of crossover between homelessness and the child welfare system suggests the need for service coordination for children in homeless families.     

Public policy implications of elderly interstate migration to Oregon, 1985-1990

Several Oregon counties received a noticeable influx of elderly migrants from other states during the 1980s. Oregon policy regarding taxes, land use, and long-term care is examined for possible influence on migration. Models of elderly migration are examined for insight into how public policy influences migration, and previous research regarding the effects of elderly migration on public policy is reviewed. Data regarding disability and financial vulnerability among elderly by migration status are analyzed for possible influence upon public policy. Change in the population aged 65 and older mirrored state and national patterns for 1980 to 1990 and 1990 to 1999. Interstate elderly arriving in attractive counties reported a low prevalence of disability and financial vulnerability, indicating a low risk of demanding public assistance. Interstate elderly arriving in population centers reported a relatively high prevalence of disability but a low prevalence of financial vulnerability. This may suggest that Oregon's long-term care policy influenced elderly migration.     

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.     

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.     

Intercounty Variability of Net Migration at Older Ages as a Path‐Dependent Process

This article seeks to identify factors associated with the formation and development of nonmetropolitan destinations for older in‐migration, thereby explaining why some U.S. counties are more likely than others to be nonmetro retirement destinations. We contend that most nonmetro retirement destinations are established and developed over time through a path‐dependent process. When amenities are commodified as recreation and tourism, migration streams tend to be established that ultimately produce sustained in‐migration of older persons to selected destination communities. We use data from a variety of official sources and a spatial statistics methodology to examine intercounty variability in net migration rates at ages 60–74. Our findings are consistent with the aforementioned path‐dependent development framework. Counties with a long history of population growth, previous experience attracting older in‐migrants, attractive natural amenities, and a developed recreation and tourism industry are those most likely to be retirement‐age migration destinations. In contrast, agricultural heartland and relatively large population size are associated with lower rates of older in‐migration. Older in‐migration should be seen as neither a panacea for strapped rural communities nor a “pensions and care issue.” Older migrants can be “gray gold,” but they can also pose challenges, such as possibly increased demand for public services as they age in place.     

Foreign retirement income among new older immigrants in the United States

Older adults make up an increasing share of new legal immigrants to the United States. These immigrants are often financially dependent on family since they are often barred from receiving several US support programmes and are less likely to receive US retirement benefits than natives. However, little information exists as to whether they receive retirement income from abroad. Using the New Immigrant Survey (N=2,150), we find that only 8.1 per cent of older recent immigrants report receiving foreign retirement income. In logistic modelling, older immigrants from Asia and Latin America were less likely to receive retirement income from abroad than those from Europe (Odds ratio = 0.50, p<0.05; Odds ratio = 0.22, p<0.001, respectively). Results suggest that newly admitted older immigrants from Asia and Latin America face an additional economic disadvantage compared with older Europeans that cannot be attributed to their demographic and migration characteristics.     

Crossing Borders,Crossing Seas: The Philippines,Gender and the Bounding of Cumulative Causation

In this study, we assess how the composition of migrant workers varies with migration prevalence within Filipino communities. Specifically, we test the hypothesis of past cumulative causation scholars that increased migration prevalence results in a decline in migrant selectivity. The Philippines has a social, political and geographical context that differs from that of many other countries characterized by high migration. In this study, we consider whether these different contexts and contingencies might alter the process by which the social phenomenon of cumulative causation occurs. Multiple fixed‐effects models were estimated at the municipality level, with the dependent variable in each model being a demographic characteristic related to the propensity to migrate: marital status, age, sex and years of education. We find, consistent with cumulative causation theory as posited by Douglas S. Massey, that increased migration prevalence did yield a decline in selectivity for education and marital status. However, migration prevalence had no effect on the gender composition of migrants, while time did impact the gender composition, suggesting sustained selectivity by gender attributable to global demand for specifically gendered, migrant labour.     

Coming,Going, Remaining in Public Housing:

This study investigated policies of retention and transfer among housing authorities in North Carolina which had projects with 50% or more elderly (N = 40). Results showed approximately 90% of the housing authorities had written eligibility and continued residence policies but few reported having services offered within their projects. Reconsideration of eligibility status was done by a combination of participants, but the ultimate decicision to evict a tenant usually lay with upper level management. Approximately one-half of the authorities reported having no resident staff persons in their projects and fewer than this amount required special training of their managers in the services and needs of their older clients. Recommendations are made to decision makers in public housing.