The Supportive Community

Abstract

This study examines supportive community programs in Israel, which aim to improve the quality of life of the elderly. These innovative programs pool existing resources to provide a benefits package that includes medical services, an emergency call switchboard, a “neighborhood facilitator,” and social activities. Data were collected in 2000-2001 using qualitative and quantitative methods. The program provides specific services to meet needs that otherwise are not adequately addressed. The major contributions of the program reported by the members was increasing their personal security (two-thirds), easing the burden on their children (one-third), and enabling them to remain at home (one-quarter). The supportive community program enriches the variety of services available, thus providing the elderly with the choice of staying within their familiar surroundings of their homes and neighborhoods. This model appears to be both a cost-effective way to facilitate aging in place and a way to meet many of the elderly's essential needs, thereby maintaining their quality of life.     

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.     

Community responsibility for the self-neglectful client

Self-neglectful clients, including the elderly, are in jeopardy, partly through their refusal to accept community services that could help them; they require protection from the community. These people are alienated and isolated, and need to be integrated into the community. Their individual rights to control their own lives, however, must be protected. It is the responsibility of the community to structure services in a way that will engage these people. A comprehensive community service program appropriate to their needs would integrate formal and informal care systems by interweaving professional services, informal assistance, and mutual aid within structures that facilitate coordination of formal care programs.     

Community Responsibility for the Self-Neglectful Client

Self-neglectful clients, including the elderly, are in jeopardy, partly through their refusal to accept community services that could help them; they require protection from the community. These people are alienated and isolated, and need to be integrated into the community. Their individual rights to control their own lives, however, must be protected. It is the responsibility of the community to structure services in a way that will engage these people. A comprehensive community service program appropriate to their needs would integrate formal and in normal care systems by interweaving professional services, informal assistance, and mutual aid within structures that facilitate coordination of formal care programs.     

Keyworkers for elderly people in the community: case managers and care co-ordinators

In the United Kingdom a range of services for elderly people in the community has developed that is delivered by a variety of professionals and administered within different organisations. This has resulted in a problem of co-ordinating services to meet the individual needs of the most frail elderly people. In the United States 'case management' has been introduced as a way of improving the co-ordination of care. Despite structural differences in the provision of health and social services between the United States and the United Kingdom, the concept of case management has influenced the design of a number of innovatory schemes in the United Kingdom, including the Gloucester Care for Elderly People at Home project (CEPH). These innovatory schemes have demonstrated the need for a 'keyworker' and clarified the tasks that are involved in taking responsibility for co-ordinating services to meet the needs of elderly people at risk of failing to cope at home. There is, however, a danger of proliferating the complexity of service provision by creating a new breed of professional; an alternative might be to alter the responsibilities, attitudes and team orientation of existing professional workers so as to include taking on the keyworker role for some of their clients.     

“They give you back that dignity”: understanding the intangible resources that make a transitional house a home for homeless families

Approximately 33% of the homeless population in 2017 were families with children. Researchers have argued for interventions and services to employ an ecological perspective to mitigate some of the unintentional harm inherent in existing programs designed to serve homeless families. This paper utilized a case study of a transitional housing program to (1) determine how well the program met recommendations informed by the ecological perspective and (2) explore underlying themes across recommendations. Past and current residents of a transitional housing program participated in semi-structured interviews as part of a program evaluation. Interviews were deductively and inductively coded to meet aims 1 and 2, respectively. Residents identified several aspects of the program that met the ecological perspective recommendations including culturally-responsive services, trauma-based services, and social and community connections. Major underlying themes spanning across recommendations included interpersonal resources (caring, sense of belonging), empowerment resources (advocacy, family preservation), impact on family (family life, positive youth development), and communication. This case study, through the analysis of residents’ perspectives, highlights the important role of transitional housing programs in providing a supportive, empathetic, empowering, and home-like environment that gives residents “back that dignity” so they are emotionally and physically prepared to successfully transition to permanent housing.     

Utilizing findings from a gender-based analysis to address chronic disease prevention and management among African-American women in a Michigan community

This research note underscores the importance of including strategies to address gender-based disparities when planning and implementing community health improvement programs. Working in collaboration with the Inkster Partnership for a Healthier Community (IPHC), the National Kidney Foundation of Michigan conducted a gender-based analysis as part of its broader community health needs assessment efforts in Inkster, MI. The findings from these studies revealed significant challenges impacting women that were not being adequately addressed within the community. In response to these findings, the IPHC created a strategic action plan to respond to the highest priority needs by increasing community awareness of and linkages to resources that provide supportive services for low-income African-American women.     

Built community: architecture,community, and participation in a permanent supportive housing project

Housing and the social processes that create it are an important part of a better world. The permanent supportive housing movement holds that housing, in addition to a variety of human services, is the most dignified and effective way to help people without homes. But the design of such initiatives matters. This community-based, qualitative research project investigates the connection between space, participation, and community. It draws on the experiences of residents of an innovative housing organization on Skid Row in Los Angeles, California. Residents of the program find community space to be both promising and contested. Their experiences also reveal the way that institutional space can be trauma-informed and impact their overall wellbeing and opportunities for interacting with others. However, their feelings of being a part of the community and their involvement in activities are not always connected, as identity and social context can cause residents to identify or dis-identify with their community despite how involved or uninvolved they are. Intentionally designed community spaces in permanent supportive housing units can respond to trauma and set the stage for interaction, but they cannot solve all problems.     

Consumer evaluation of community treatment

Development of community programs for offenders requires innovation in program design and evaluation. The Complex Offender Project (COP) provided intensive community treatment, and its clients' opinions were used as a component of its evaluation. Treated clients perceived the same needs for services as did other offenders, but more of them reported receiving the services. Compared to probation, COP was perceived to be more helpful in resolving problems, more continuously helpful, and of helping more to learn useful skills and achieve meaningful goals. The Complex Offender Project provides a model for program development, and the techniques of consumer evaluation are recommended as a means of evaluating such programs.     

For those left behind. An educational inpatient rehabilitation program

1. An interdisciplinary program model was developed for the treatment of mentally ill individuals remaining in long-term state mental institutions that focused on self-maintenance, social functioning, and community living skills. 2. Patients were categorized according to their levels of functioning and diagnoses, and were assigned to programs that were developed to meet the needs of a specific group of patients. 3. The goals of the program were to enhance the quality of life for the patients; promote self-direction and capacity for self-care by increasing the patient's opportunities to make life decisions; and prepare the patients to live in a less restrictive environment.     

Factors contributing to the subjective quality of life of the chronic mentally ill.

Although the deinstitutionalization of the seriously mentally ill has been severely criticized, the success of some model community programs shows that community care can enhance patients' quality of life. We lack specific knowledge, however, about the components that make these programs effective, and why. A theoretical framework for identifying these critical components is proposed. Services can enhance life satisfaction by increasing individuals' actual power through economic resources or status, thus enhancing their perceptions of mastery. An internal evaluation of a model program provides support for this hypothesis. One hundred and fifty-seven patients were interviewed about services, quality of life, and perceptions of mastery. Results show that services providing economic resources and an empowerment approach to service delivery are significantly related to overall quality of life. Furthermore, perceptions of mastery account for the impact of these components on life satisfaction. These findings suggest interventions that can be adopted by a wide range of mental health programs for the improvement of the quality of life of the chronic mentally ill.     

Organizational structure,leadership and readiness for change and the implementation of organizational cultural competence in addiction health services

Increasing representation of racial and ethnic minorities in the health care system and on-going concerns about existing health disparities have pressured addiction health services programs to enhance their cultural competence. This study examines the extent to which organizational factors, such as structure, leadership and readiness for change contribute to the implementation of community, policy and staffing domains representing organizational cultural competence. Analysis of a randomly selected sample of 122 organizations located in primarily Latino and African American communities showed that programs with public funding and Medicaid reimbursement were positively associated with implementing policies and procedures, while leadership was associated with staff having greater knowledge of minority communities and developing a diverse workforce. Moreover, program climate was positively associated with staff knowledge of communities and having supportive policies and procedures, while programs with graduate staff and parent organizations were negatively associated with knowledge of and involvement in these communities. By investing in funding, leadership skills and a strategic climate, addiction health services programs may develop greater understanding and responsiveness of the service needs of minority communities. Implications for future research and program planning in an era of health care reform in the United States are discussed.     

Long-term care: a comparison of policies and services in Israel and the United Kingdom and implications for the United States

The issue of long-term care continues to be a main concern in the United States. As the country wrestles with the development of policies and services, the experiences of Israel, whose system rests upon national insurance, and that of the United Kingdom, which is based on grants to local authorities, can act as valuable teaching aids in the development of programs in the United States. Although both countries focus on community care with virtually universal access, concern over resources is forcing each to target their services increasingly to the most frail. The findings underscore the necessity for accurate planning and adequate resources if services are to meet the needs of the frail elderly population.     

Quality of life in the evaluation of community support systems

As a result of the authors' experience in conducting an evaluation of the community support system (CSS) program in New York State, they have identified five reasons for focusing on quality of life (QOL) as a desired outcome for programs for the chronically ill. These reasons are presented and problems in QOL evaluative research are discussed. Psychological indicators are distinguished from social indicators of QOL, and two methods of operationalizing perceived QOL, the psychological well-being and life domains methods, are examined. A conceptual model is presented and the results of an exploratory study of the QOL of 118 chronic psychiatric patients receiving CSS services are presented.     

'The more things change…': Barriers to community services utilisation in Queensland

Community services are central to the lives of many elderly Australians or Australians with disabilities if they are to remain in the community. Over the past two decades, significant advances have been made in policy and associated programs, significantly improving the standards of service delivery. This research reports on the perceptions of service providers in community services for people with disabilities in six communities in Queensland. It illustrates that significant barriers to service utilisation remain, despite reform. It suggests that continuous efforts to promote service access need to be built in at the program level.     

The public library system. Social services resource for the geriatric population

The public library system is targeting the geriatric population and instituting programs to meet informational and recreational needs. From retirement planning, visual aids, and screening, to accessing library material to the elderly, the public library system attempts to meet the challenge of providing service to this special population. Although not a formal group, the library has inherent therapeutic effects that benefit the elderly who participate in their programs. The clinician would be advised to take advantage of these various programs. Because each local and regional center will offer different programs, calling a local library is the most effective way to find out what a specific public library system has to offer. Nurses may also consider joint efforts to initiate programs in their library systems to better meet the population's needs.     

Consumer-directed home and community services programs in eight states: policy issues for older people and government.

This study assesses consumer-directed home and community services for older persons by examining public programs that serve this population in eight states. These programs give beneficiaries, rather than agencies, the power to hire, train, supervise, and fire workers. Most stakeholders interviewed, in addition to the quantitative research, indicate that many older beneficiaries want to and can manage their services, although significant issues arise for persons with cognitive impairments. Research results suggest better, or, at least, no worse, quality of life for beneficiaries when they direct their services, although quality of services remains a contentious issue. For workers, consumer-directed care has some disadvantages, including fewer fringe benefits. With exceptions, state agencies have not provided extensive consumer or worker support or aggressively regulated quality of care.     

Getting by in the community: lessons from frail elders

This study explores how functionally impaired, elderly persons are able to remain in the community without home- and community- based care (HCBC) under the Medicaid program. Using HCBC administrative data, Medicare data, and survey data, we find the nonparticipants in the community appear to get by through a combination of reliance on informal care, use of Medicare home care, and going without needed services. Despite their efforts to manage their care in the community, non-participants were significantly more likely than the participants to enter a nursing home during the six months following assessment. While our analysis does not allow us to attribute the higher nursing home entry to the absence of HCBC services with certainty, the finding does raise questions about whether the elements of the HCBC program that discourage participation may save Medicaid dollars in the short-run at the expense of future Medicaid costs from more rapid nursing home entry.     

Assuring the quality of long-term care insurance benefits through care management: the California partnership for long-term care

Despite recent improvements in long-term care insurance (LTCI) policies, concerns have been raised regarding just how well LTCI benefits actually meet elderly consumers' health and financial needs. In this case study, we examined the quality assurance (QA) provisions in a state-sponsored LTCI program, the California Partnership for Long-Term Care (CPLTC). CPLTC invests the primary responsibility for QA with care management networks, which assure quality services through care monitoring, quarterly service record reviews, and annual documentation of care manager clinical competence. Study findings suggest a number of limitations in existing QA policies and procedures, which can undermine the ability of care managers and other third parties to identify and rectify potential unmet needs among LTCI policyholders. These findings, while based on an intensive analysis of QA provisions in a particular, state-sponsored LTCI program, are likely to have implications for other LTCI programs and policies, most of which have less well-developed QA provisions.     

Recreation as a component of the community youth development system

In an era of fragmented school systems and budget cuts, many educators and youth leaders seeking to solve the problems that youth face are turning to out-of-school-time programs. In many communities, these programs are seen as essential in the development of youth into fully functioning adults. One such area of the out-of-school-time sector is the provision of recreation services. Recreational services have a vital role in connecting youth to their communities, as well as enabling youth and adult allies to improve challenging conditions. This chapter outlines the historical role that recreation has played in community youth development programs and shows how community youth development has evolved. It then looks at how organizations in three communities--the Youthline Outreach Mentorship program in Minneapolis, a 4-H initiative in Parker City, Texas, and the Hockey Is for Everyone program--have successfully applied the theoretical knowledge. Best practices from these programs illustrate that the role of recreation in community youth development is changing. No longer are recreation programs about providing just "fun and games." Recreation organizations are now placing more value on the development of the community as a whole, in addition to the individual well-being of young people.