"Who believes most in me and in my recovery": the importance of families for persons with serious mental illness living in structured community housing

In this article, the authors report on qualitative findings on the role of family in supporting recovery for mental health consumers living in structured, community housing in a large Canadian city. Despite living separately from families and relying heavily on formal services, residents identified their families more often than mental health professionals, friends, and residential caregivers as those who most believe in them and their recovery. Families supported recovery by providing affection and belonging, offering emotional and instrumental support, and by staying actively involved with residents. Families are a vital, untapped resource for social workers in promoting independent living.     

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.     

On the edge: Balancing health, participation, and autonomy to maintain active independent living in two retirement facilities

This study examines how independent living residents in Continuing Care Retirement Communities (CCRCs) work to maintain a healthy, active community. Specifically, this paper elucidates how independent living residents, who have high status in CCRCs but also face transitions to more advanced care, manage their daily lives to build a positive sense of community against the backdrop of potential health and social declines. The researcher supplemented four years of observation in one CCRC and two years of observation in another with qualitative interviews with thirty residents from both facilities. Results indicated that shared sentiments contrasting the active social world in independent living with other living units, norms of mutual support balanced with autonomy, social participation as a source of belonging (or isolation), and definitions of deviance surrounding functional health and manners framed residents' understandings of daily life by reaffirming independent living residents' privileged status in each facility.     

Relationships Among Active Engagement in Life Activities and Quality of Life for Assisted-Living Residents

This cross-sectional research explored the relationships between active engagement in life activities (leisure, social, and instrumental activities of daily living) and quality of life for seniors aged 65 and older residing in assisted living facilities. It is increasingly recognized that active participation in diverse physical, cognitive, and social activities can promote older adults’ quality of life, including physical and mental health, but there is limited information about this in the population of residents in assisted living facilities. It is estimated that there are one million older adults residing in assisted living facilities, making assisted living facilities a rapidly growing segment of senior housing. Older adults who relocate to assisted living facilities commonly experience lifestyle changes, often related to their altered physical and social environment, reduced demands regarding household chores and meal preparation, and new opportunities for recreation and socialization. In this study, interviews were conducted with 131 ambulatory residents from assisted living facilities in the New York City metropolitan area using the 55-Item Activity Checklist, SF-36v2, Life Satisfaction Index-Z, and demographic questions. Results found significant low to moderate correlations between retained engagement in life activities (leisure, social, and instrumental activities of daily living) and life satisfaction, and several quality of life domains, including physical functioning, mental health, general health, and vitality. Older adults continued to engage in a greater percentage of everyday life activities they identified as important. This data supports exploration of client-centered activity programs to promote participation of residents in assisted living facilities in diverse activities to both maintain resident functional abilities and manage functional decline.     

Training child welfare workers from an intersectional cultural humility perspective: a paradigm shift

The increasing diversity of the populations encountered and served by child welfare workers challenges cultural competence models. Current concerns focus on the unintentional over-emphasis on shared group characteristics, undervaluing unique differences of individuals served, and privileging worker expertise about the client's culture, thereby exacerbating the power imbalance between them. This article promotes cultural humility in child welfare service delivery as a compliment to cultural competence, to liberate workers from expectations of cultural expertise about others, and to actively engage the clients, inclusive of their cultural differences, in the service delivery process. Skills and practice principles are discussed.     

Housing Costs in an Oil and Gas Boom Town: Issues for Low-Income Senior Women Living Alone

In resource-based towns that have historically been dominated by young workers and their families, seniors’ housing issues have received little attention by community leaders and senior policymakers. However, since the 1980s there has been a growing trend of older women living alone in Canadian rural and small town places. Although research on rural poverty focuses on small towns in decline, booming resource economies can also produce challenges for low-income senior women living alone due to higher housing costs and the retrenchment of health care and service supports. Because housing costs can consume a significant proportion of household income, low-income senior women living alone may not have the financial resources to cover expenses in a competitive housing market. Using a household survey, we explored this different dimension of the Canadian rural landscape by looking at housing costs for low-income senior women living alone in the booming oil and gas town of Fort St. John, British Columbia, Canada. The authors findings indicate that low-income senior women living alone are incurring higher housing costs compared with other senior groups.     

Finnish Seniors’ Move to a Senior House: Examining the Push and Pull Factors

The purpose of this article is to explore the factors influencing residential decisions of Finnish seniors. Analysis draws on qualitative data gathered from in-depth interviews and open-ended survey questions completed by 37 seniors living in three independent living facilities in Finland. Content analysis was used to identify key factors pushing residents out of their former living situations and pulling them into their respective independent living facility. Analysis indicates that different senior houses attract different types of residents. Nevertheless, as a group, they reported similar motivational factors relating to community, physical, and social environments and to their personal circumstances.     

Autonomy in Assisted Living: Employees’ Perspectives

This focused ethnography explores how employees in assisted living facilities give meaning to the term autonomy, a core value in the mission of assisted living facilities. In-depth interviews were conducted with managerial and front line staff in two assisted living facilities to understand their interpretation of the concept of autonomy and how they felt they enhance the autonomy of the residents. Four interrelated themes capturing the meaning of autonomy emerged from analysis of the interview data: (1) autonomy is synonymous with functional independence, (2) expectations of residents of assisted living are different from residents of nursing homes, (3) rehabilitation is a goal of assisted living, and (4) a tendency to intervene in the best interests of the residents. The implications of the findings are discussed in terms of their potential effect on residents.     

Live-in Care Workers in Sheltered Housing for Older Adults in Israel: The New Sheltered Housing Law

Supportive housing schemes were historically aimed to provide group accommodation for older adults. With the aging of residents, facilities were required to enable them to receive care services in order to allow them to age in place. Thus, different countries and different facilities developed different models of housing with care, reflecting cultural and policy diversities. Despite all of the different models, there are many commonalities among the supportive housing schemes across countries. These include provision of dwelling units and care services provided by either the facility or by external agencies. The aims of this article are threefold: to describe the historical development of the ever-evolving supportive care housing phenomena; to point at variations in models of housing and care within the international context; and to present a new Israeli model that enables residents to privately hire live-in care workers to meet their care needs. This is a unique model in the international context that has not been reported before. The article describes the main ideas of the new model and discusses the challenges that it raises and pinpoints the unresolved issues associated with the presence of live-in care workers employed by residents of sheltered housing that should be addressed.     

Bringing assisted living services into congregate housing: housing directors' perspectives

The purpose of this research is to explore the impact of an Assisted Living Services (ALS) program on directors of state-funded congregate housing. Using focus groups, we interviewed congregate housing directors about how adding the ALS program to their facilities impacted their management experiences. Four themes emerged from the analysis of the focus group data: (1) importance of assisted living services for promoting aging in place; (2) "costs" of offering ALS; (3) differences in how the ALS program was implemented; and (4) organizational issues emerging from the merger of housing and health-care models. Based on the present findings, we propose a number of policy issues that need to be addressed when services are added to existing housing.     

Influence of Satisfaction with Services on Assisted Living Resident Satisfaction

The purpose of our investigation was to provide insight into the service domains that most heavily influenced self-reported resident satisfaction among residents in assisted living facilities. Data was gathered from the 2008 Press Ganey Assisted Living Survey. Satisfaction with service domains was measured using 7 subscales addressing the areas of activities, staff attentiveness, meals, apartment space, facility attractiveness, personal issues, and management. Generalized linear mixed models were specified to assess the influence of demographics, functional status, self-rated health, and satisfaction with service domains on resident satisfaction. In the final multivariate model self-rated health, independence with laundry and finances, and satisfaction with aides, meals and management demonstrated a significant positive effect on resident satisfaction. As the number of assisted living facilities continues to increase, senior management would be wise to consider which domains of service are particularly salient in assisted living environments.     

You Can't Get There From Here: Reaching the Outdoors in Senior Housing

By providing access to outdoor environments, exterior doors can enhance the sense of freedom in residential environments for aging. However, doorways may also present barriers to outdoor access. Using environmental audits, this study examined doorway problems at 68 assisted living facilities in three geographic regions. Results were compared with resident surveys (n = 1,128), staff surveys (n = 432), and resident focus groups (n = 76). Specific doorway issues were found to be associated with residents’ weekly minutes of walking, outdoor usage, and perceived ease of reaching outdoor areas. The main problems were door opening/closing, thresholds and landings, and self-locking doors. The findings indicate that exterior doorways often present barriers to assisted living residents, resulting in lower levels of walking and outdoor use. By discouraging these health-related behaviors, doorway problems may negatively affect residents’ health and well-being. Practice implications suggest that many existing doorway problems, such as high thresholds or excessive opening force, are easily remedied.     

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.     

From the streets to assisted living: perceptions of a vulnerable population

The rapid growth of assisted-living facilities is paralleled by the necessity to understand the needs of the people living in them. A hallmark challenge for individuals who are poor and disabled, and often marginalized from mainstream society, is maintaining integrity and being a whole person, rather than a sum of broken parts. A key to maintaining this integrity is the ability to find stable housing and support systems. The inner-city assisted-living facility in this study is unique in that all of its residents are funded by Medicaid. The residents have complex needs related to histories of homelessness, mental illness, drug and/or alcohol addiction, and chronic illness. The purpose of this study was to explore the needs of this vulnerable population as they adapt to a new home and a new concept of assisted, yet independent, living. Structured interviews with key informants and oral survey questionnaires with residents provided quantitative and qualitative data about physical and mental health status, social support, perception of control, psychological wellbeing, and life satisfaction. This study provided valuable insights into the challenges inherent in providing a high quality of life in assisted living for a vulnerable population with diverse needs.     

Understanding the complex negotiations in fulfilling the right to independent living for disabled people

The independent living agenda has become dominated by a rights focus that has helped drive national-level shifts in setting norms and changing mind-sets. This paper is concerned with examining how rights are utilised by service providers in the process of facilitating independent living. Drawing on an empirical study of providers in Ireland, the paper identifies the strategies being used to put rights into practice. The findings show that in the process of creating a well-managed support arrangement for each individual, providers often take a delicate approach to using rights, and sometimes dilute their guiding principles when engaging in ongoing complex negotiations between individuals, families, staff and volunteers. The disabled people's movement can contribute to the shared learning required in enabling managers handle this process better, rather than solely rely on an abstract call for rights.     

Stakeholder perspectives on integrated services for people who experience chronic homelessness

This article concerns a SAMHSA-funded service intervention, Pathways to Independence, that combined the use of SAMHSA’s SSI/SSDI Outreach, Access, and Recovery approach to facilitating disability entitlement claims with financial management classes, mental health assessment and referral, and access to employment and housing for people experiencing chronic homelessness. The purpose of this study was to explore perceptions of this form of service delivery and the benefits and challenges of the program model from the perspective of those who experienced it. Focus groups were conducted with a total of 17 program stakeholders, including program participants, program staff, collaborating case management staff of the parent agency, and a landlord and an employer, with questions to each regarding the program and its impact. Focus groups were analyzed through independent coding followed by discussion to reach consensus on key themes. Five themes were identified across the groups: (a) the importance of relationships, (b) staff specialization and provision of individualized services, (c) an orientation to outcomes, (d) comprehensiveness of services and facilitation of connections to community resources, and (e) systems challenges. The Pathways to Independence program provides a working model for integrated employment, entitlement assessment and application, housing, and behavioral health treatment for persons experiencing chronic homelessness.     

Moving On From Supportive Housing (MOSH): Development and evaluation of a transitional skill-building curriculum for providers helping residents exit homeless services

This article describes the development and evaluation of MOSH (Moving On From Supportive Housing), a transitional skill-building curriculum for providers helping residents exit homeless services to mainstream housing without embedded supports. In this evaluation, we assess the feasibility, acceptability, fit, and potential efficacy of the MOSH curriculum to improve proximal provider-level outcomes, including self-efficacy to provide MOSH-related independent living skills and supports. Homeless-services providers (N = 49) from a range of programs and settings participated in the training. Findings from focus groups and pre- and posttest surveys indicate high levels of overall satisfaction with the training. The majority of trainees perceived the training to be useful to their work and potentially useful for service recipients, felt the training would fit well within their existing day-to-day work, and said they were very likely to use MOSH skills in such work. Statistically significant improvements in self-efficacy regarding all skills but one were also found. MOSH holds promise as an intervention that can enhance provider practice and promotion of independent living skills in homeless services. Although these initial findings on MOSH are encouraging, further research will be needed to evaluate provider knowledge gains and effective use of these skills in practice.     

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.     

Balancing Safety and Privacy: The Case of Room Locks in Assisted Living

Assisted living settings are charged with protecting privacy and choice of residents while guaranteeing safety and providing services. This article uses qualitative data from seven distinct assisted living settings to illuminate the challenge of balancing these expectations to maximize quality of life for residents. The simple object of door locks serves as the focal point for narrative from residents, family, staff, and administrators regarding the daily dilemmas of balancing these goals. Results show that there is a lack of consensus on the relative importance of locks and security within and across groups and settings. As residents age in place, sustaining the balance is likely to become even more challenging.