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.     

TigerPlace,A State-Academic-Private Project to Revolutionize Traditional Long-Term Care

ABSTRACT

The Aging in Place Project at the University of Missouri (MU) required legislation in 1999 and 2001 to be fully realized. An innovative home health agency was initiated by the Sinclair School of Nursing specifically to help older adults age in place in the environment of their choice. In 2004, an innovative independent living environment was built and is operated by a private long term care company, as a special facility where residents can truly age in place and never fear being moved to a traditional nursing home unless they choose to do so. With care provided by the home care agency with registered nurse care coordination services, residents receive preventative and early illness recognition assistance that have markedly improved their lives. Evaluation of aging in place reveal registered nurse care coordination improves outcomes of cognition, depression, activities of daily living, incontinence, pain, and shortness of breath as well as delaying or preventing nursing home placement. Links with MU students, faculty, and nearly every school or college on campus enrich the lives of the students and residents of the housing environment. Research projects are encouraged and residents who choose to participate are enjoying helping with developing cutting technology to help other seniors age in place.     

Environmental Evaluations and Modifications to Support Aging at Home With a Developmental Disability

ABSTRACT

Increasing numbers of people with developmental disabilities are living into old age and are now residing in community-based housing, largely due to the deinstitutionalization movement. The overlay of age-related impairments onto pre-existing, lifelong disabilities puts this population at a magnified risk for premature behavioral limitations and loss of independence. This article describes a demonstration project designed to enable people with developmental disabilities to age in place. Interviews and observational assessments with 45 older adults with developmental disabilities were conducted in their community-based homes to identify potential barriers to aging in place. An Individualized Environmental Intervention Plan was developed for each study participant, recommending ways to solve problems and eliminate potential barriers. Individualized Environmental Intervention Plans were implemented to the extent possible through home modifications and assistive technology. Pre- and post-modification task performance and self-report revealed the positive impact that home modifications and assistive technology can have. The study demonstrates the need for ongoing evaluation and assessment sensitive to the needs of people with developmental disabilities and the unique characteristics of supported living settings.     

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.     

Residential Relocation in Later Life: A Comparison of Proactive and Reactive Moves

Proactive coping involves anticipating future events or stressors and preparing for them in advance. Housing is an important consideration in preparing for later life. This study examines residential relocation among older adults, comparing those who moved proactively with those who moved reactively. Data from the Longitudinal Study of Aging included a final sample of individuals who had relocated at Wave 2 (n = 736) and Wave 3 (n = 713). The proactive group of movers was younger, more educated, and had higher incomes. Results provide support for proactive coping theory and its application to residential relocation in later life.     

Planning for Aging in Place: Incorporating the Voice of Elders to Promote Quality of Life

Abstract

Aging in place offers emotional and physical benefits; however, challenges associated with advanced age may make aging in place difficult. As communities across the country prepare for forecasted increases in the proportion of older residents, it is important to understand barriers that may prevent aging in place. Perceived barriers voiced by residents of a suburban county who completed an Aging in Place Needs Assessment Survey were categorized into four themes: need to downsize/home modification; need for assistance; family desire to reciprocate care; and isolation. A fifth group with no intent to relocate, but with concerns about having to, was also identified. Included among this group were persons with mental health or developmental disorders, such as anxiety and autism spectrum disorder. Results were examined through a person-centered lens to illustrate that aging in place may be the desired option even among residents who indicate that it is not. It is important that aging-in-place initiatives preserve identity by fostering a sense of autonomy, control, and well-being in older residents.     

Affordable Clustered Housing-Care: A Category of Long-Term Care Options for the Elderly Poor

ABSTRACT

What we label as affordable clustered housing-care options are making it increasingly possible for poor and frail older Americans to age in place comfortably and securely in residential-like settings combining both affordable shelter and long-term care. The hallmark of these housing arrangements is their sizable population clusters of low-income frail persons in need of supportive services. Despite their greater availability and the compelling factors underlying their growth, the diversity of their supportive services and operations cloud their identity resulting in uncertainty as to whether they have a common mission. In response to the need for a more careful delineation of this aging in place option, this paper describes the distinguishing features of these hybrid settings and constructs a typology of their representative exemplars or prototypes.     

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.     

Tracing Stigma in Long-Term Care Insurance in Israel: Stakeholders’ Views of Policy Implementation

A rapidly expanding number of baby boomers provide care to aging parents. This study examines associations between caregiver status and outcomes related to awareness and anticipation of future long-term care (LTC) needs using 2007 Connecticut Long-Term Care Needs Assessment survey data. Baby boomers who were adult child caregivers (n = 353) versus baby boomers who were not (n = 1242) were more likely to anticipate some future LTC needs and to have considered certain financing strategies. Although baby boomer adult child caregivers more readily anticipate some future LTC needs, they are not taking specific actions. It is important to address the need for public education directed toward those who are currently (or have recently completed) caring for aging parents.     

Older Adults' Perceptions of Well-Being after Intergenerational Experiences with Youth

Abstract

Drawing upon Ryff's (1995) positive dimensions of well-being in older adulthood, thisstudy investigated older adults' perceptions of well-being following participation in anintergenerational program. Specifically, we examined the relationship between age, years of volunteer service, and sense of well-being among older adults (n= 46; 55 to 100 years of age) participating in intergenerational programs at 10 sites in Midwestern, agriculturally based communities. Using a mixedmethods design, results revealed that olderadults perceive a heightened sense of well-being from intergenerational interactions wit youth. Older adults reported successful aging included staying active, not worrying aboutone's problems, feeling young, and keeping up with the children and community. Adults aged 74-85 experienced significantly greater satisfaction and enjoyment than their older counterparts, particularly in anticipating working with youth and positive self-perception. No relationship emerged between years of involvement in the program and well-being. Implications for research and program development are discussed.     

The Long-Term Care Insurance Law in Israel: Present and Future

Aging in place is a core component of the policy on aging in Israel. This was well expressed in the Long-Term Care Insurance law enacted in 1986 and implemented in 1988. Under the law, disabled persons can receive in-kind home- and community-based services to enable frail older adults to age in place and to complement or supplement the care provided primarily by family caregivers who are legally responsible for caregiving of their elderly family members. This article presents the main principles of the law and reviews the amendments that this law has undergone during the past 22 years. Finally, some core issues and dilemmas are discussed.     

The long-term care insurance law in Israel: present and future

Aging in place is a core component of the policy on aging in Israel. This was well expressed in the Long-Term Care Insurance law enacted in 1986 and implemented in 1988. Under the law, disabled persons can receive in-kind home- and community-based services to enable frail older adults to age in place and to complement or supplement the care provided primarily by family caregivers who are legally responsible for caregiving of their elderly family members. This article presents the main principles of the law and reviews the amendments that this law has undergone during the past 22 years. Finally, some core issues and dilemmas are discussed.     

Designing an Ageless Social Community: Adapting a New Urbanist Social Core to Suit Baby Boomers in Later Life

ABSTRACT

Since 90% of older adults prefer aging in place (Wang, Shepley, & Rodiek, 2012), it is important that neighborhood design supports successful aging. Beyond basic needs, research indicates quality interaction is associated with positive health and well-being benefits, particularly for older adults. In this, design supporting social relationships plays an essential role. This study's purpose was to identify New Urbanist neighborhood and social space design attributes supporting older residents' physiological and social needs. This case study used keyword-in-context analysis with focus group interview data to identify domains supporting social interaction for residents aging in place including: location factors, social factors, design factors, and programmatic factors.     

Families' Values and Attitudes Regarding Responsibility for the Frail Elderly

Abstract

This study examines the norms and values associated with care to disabled and frail aging parents, in particular those with regard to the sharing of responsibilities for care between families and formal services, and this within three age cohorts in Quebec, Canada. It is based on a telephone interview of 1,315 people. Factor analysis yielded four factors: (1) family responsibility; (2) uncompromising family obligations; (3) acceptance of services; (4) distrust of services. Analyses of the data indicate that all three age cohorts consider that families have responsibilities for their aging family members, at the same time that they score very high on the acceptance of service scale. This article discusses these seemingly paradoxical results and their implications for aging policy.     

Kaiser Permanente's Manifesto 2005 Demonstration

Summary

In 1996, the eight-million member Kaiser Permanente HMO adopted a vision statement that said by 2005 it would expand its services to include home- and community-based services for its members with disabilities. It funded a 3-year, 32-site demonstration that showed that it was feasible to link HMO services with existing home-and community-based (HCB) services and that members appreciated the improved coordination and access. This private-sector project showed that devolution can produce innovative and feasible models of care, but it also showed that without federal financial and regulatory support, such models are unlikely to take hold if they are focused on “unprofitable” populations, for example, those who are chronically ill, poor, and/or disabled.     

Surabaya green and clean: Protecting urban environment through civic engagement community

ABSTRACT

This study explores the involvement of townspeople in efforts to protect their environment through environmental awareness program. The environmental program implemented is Surabaya Green and Clean (SGC) which was initiated by Surabaya City government since 2005 in kampung (community-based housing) in Surabaya (Indonesia). This study employed a qualitative approach with semi-structured interviews, observations, and literature studies as data collection technique. The data were taken in Kampung Margorukun with a total of 14 informants involving the head of kampung, environmental cadres, and residents who are engaged in developing Kampung Margorukun to be one of the ecotourism models. The research results indicate that the resident involvement in SGC includes environmental cadres formation, environmental awareness education, waste recycling, waste bank management, and ecotourism development. The implementation of SGC in Kampung Margorukun is a form of operationalization of residents’ concern for environmental protection and sustainable development from ecological citizenship perspective.     

Infants' lexical comprehension and lexical anticipation abilities are closely linked in early language development

Theories across cognitive domains propose that anticipating upcoming sensory input supports information processing. In line with this view, prior findings indicate that adults and children anticipate upcoming words during real-time language processing, via such processes as prediction and priming. However, it is unclear if anticipatory processes are strictly an outcome of prior language development or are more entwined with language learning and development. We operationalized this theoretical question as whether developmental emergence of comprehension of lexical items occurs before or concurrently with the anticipation of these lexical items. To this end, we tested infants of ages 12, 15, 18, and 24 months (N = 67) on their abilities to comprehend and anticipate familiar nouns. In an eye-tracking task, infants viewed pairs of images and heard sentences with either informative words (e.g., eat) that allowed them to anticipate an upcoming noun (e.g., cookie), or uninformative words (e.g., see). Findings indicated that infants' comprehension and anticipation abilities are closely linked over developmental time and within individuals. Importantly, we do not find evidence for lexical comprehension in the absence of lexical anticipation. Thus, anticipatory processes are present early in infants' second year, suggesting they are a part of language development rather than solely an outcome of it.     

Elderly-Friendly Neighborhoods: Case Lauttasaari

The way in which the qualities of neighborhoods are perceived is an important environmental factor that affects independent living and life satisfaction during old age. The aim of this study was to include the elderly as active participants in society. How environments are planned and built has an impact on independent coping and inclusion. Involving elderly in the planning and assessment process of developing local neighborhoods is important. Accessible housing and local service networks—private, public, and third sector—promote aging in place. Cross-sector collaboration within city services is important for planning user-friendly living environments in an integrated way.     

Estimating the Expense of a Mandatory Home- and Community-Based Personal Assistance Services Benefit Under Medicaid

Abstract

Personal assistance services (PAS) are essential for many people of all ages with significant disabilities, but these services are not always available to individuals at home or in the community, in large part due to a significant bias toward institutions in the Medicaid program. This study aims to provide an estimate of the expense of a mandatory personal assistance services (PAS) benefit under Medicaid for persons with low incomes, low assets, and significant disability.

Design and methods: We use year 2003 data from the Survey of Income and Program Participation to estimate the number of people living in households who would be eligible, based on having an institutional level of need and meeting financial criteria for low income and low assets, combined with additional survey data on annual expenditures under Medicaid programs providing PAS.

Results: New expenditures for PAS are estimated to be $1.4–$3.7 billion per year (in 2006 dollars), depending on the rate of participation, for up to half a million new recipients, more than a third of whom would be ages 65 and older. These estimated expenditures are a tenth of those estimated by the Congressional Budget Office for implementing the Medicaid Community-Based Attendant Services and Supports Act (MiCASSA).

Implications: Creating a mandatory PAS benefit for those with an institutional level of need is a fiscally achievable policy strategy to redress the imbalance between institutional and community-based services under Medicaid.