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.     

Medicaid Managed Care Programs for High-Risk Older People in Massachusetts

The Commonwealth of Massachusetts has undertaken a major initiative in the development of comprehensive managed health care programs for two sets of high-risk older people: those who are frail and homebound and those who reside in nursing homes. This effort has been coordinated by the state's Department of Public Welfare (DPW; Medical Assistance [Medicaid] Program) and Executive Office of Elder Affairs, and expedited ba a set of Health Care Financy Administration (HCFA) waivers and by the state's revised Nurse Practice Act (MGS Chapter 56). Than act allows nurse-practioners and physician assistants expanded roles as primary providers in home care and nursing home settings. The managed care initiatives have supplemented other efforts (1) to coordinate health and social services for older people, (2) to provide as broad a range as possible of community-based services for older people, and (3) to enroll as many older adults as possible in Health Maintenance Organization (HMO) "Senior Plans" and other similar "Competive Medical Plans."

Though there is still no evidence of the managed care programs' effects, this article summarizes some of the possible risks and benefits of managed care programs for those kinds of populations and presents an agenda of questions that evaluations of managed care programs must address.     

The Effectiveness of Adult Day Services for Disabled Older People

Abstract

Adult day care has attracted a considerable amount of attention among researchers, practitioners, and policymakers. However, there have been few efforts to synthesize empirical results. This paper reviews research that determines the effectiveness of adult day services in improving client functioning, alleviating caregiver stress, and delaying nursing home placement. In addition, the strengths and limitations of the research are considered. This paper concludes with a discussion of policy-relevant issues that must be addressed when determining the effectiveness of adult day services.     

Housing Conditions and Risk: Reporting on a European Study of Housing Quality and Risk of Accidents for Older People

The declining capacities in older people often lead to limitations in activities of daily living and a simultaneous rising demand for care services. Many of these limitations in daily activities are to a varying degree caused, enhanced or facilitated by disadvantageous housing and environmental conditions. Home modifications have been credited as an important part of the solution, allowing for an extended and safer use of the home. In order to examine this issue in more detail, this paper provides empirical evidence on the type and extent of risks associated with accidents around the home. It reports on findings from a European case study on the difficulties using the home and risks of accidents which may lead to injury. It is argued that healthy housing conditions for older persons are important to maximize the supportive capacity of one's home, to stimulate an active and healthy lifestyle, and to avoid unnecessary institutionalization.     

Social Origins and Transformations: The Changing Role of English Housing Associations

Following the suggestion of Ragin (1998, Voluntas, 9(3), 261–270), this article uses social origins theory (Salamon and Anheier, 1998, Voluntas, 9(3), 213–248) as an heuristic device to explore change in a specific field of nonprofit activity; the English housing association sector. Conventional histories of the sector in the twentieth century suggest a succession of eras with different policy drivers. These eras can be seen as consistent with shifts in welfare regime from liberal to social democratic (after 1919) and to neo-liberal/neo-corporatist (after 1980). Examples drawn from a panel study support the analysis of Esping-Anderson (1990, The Three Worlds of Welfare Capitalism, Princeton University Press, Princeton) that underlying the apparent stability of welfare regimes there are constant processes of negotiation and conflict which may lead to transformations at organization, sector, or regime level. Rather than simply responding to policy drivers, some housing associations have been able to influence the environment in which policy is made and thereby to shape their own and the sector's transformations.     

A Comparison of Spanish and American Housing Policy Frameworks Addressing Housing for the Elderly

Abstract

Housing policies in Spain and die United States have important similarities and dissimilarities mat affect housing for the elderly. Spain, even more so than me United States, promotes homeownership. Bom countries face significant challenges in addressing the housing needs of the elderly, particularly those challenges associated wim aging in place. The paper reviews me broader housing policy frameworks in bom countries in order to understand me context for elderly housing policy. The paper identifies lessons from the American experience mat can expand housing policies in Spain.     

Valuing and Integrating Informal Care as a Core Component of Long-Term Care for Older People: A Comparison of Recent Developments in Italy and Spain

The international long-term care (LTC) debate has recently been focusing on how to strengthen home care provision. In this regard, a major role has been played by informal care and how to best integrate it in a holistic care approach. Italy and Spain, usually labeled as “familialist” or “family-based” care models, have been promoting national reforms or actions to support the integration of “informal” actors into the overall LTC system. Through a comparative review of recent trends observed in the two care regimes, this article aims at contributing to improve our cross-national understanding of how LTC is changing across Europe, identifying the basic approaches adopted in Italy and Spain and highlighting both their strengths and drawbacks.     

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.     

Risk and the welfare state

The British welfare state developed as a state-centred response to the problem of handling the risks encountered in a typical life-course. The influential work of Giddens and others implies that the traditional welfare state is under attack from two directions: a changing international politico-economic environment limits the freedom of national governments to pursue independent policies involving relatively high taxation to finance social spending. At the same time, changes in the experience of risk and declining confidence in the expertise of welfare state planners and professionals undermine support for state-centred solutions. This approach fails to acknowledge that available non-state services are often inadequate to meet many everyday life risks and that the authority of private sector advisers, insurers and professionals is also increasingly open to question. This article discusses whether people reject welfare state solutions to problems of risk in the context of research on the perceptions and behaviour of people buying or selling their homes, considering provision for long-term care needs and defrauding social security carried out by the ESRC's Economic Beliefs and Behaviour programme. Individual responses endorse the continued provision of state welfare in order to meet unprovided risks alongside disenchantment with the record of both state and private professionals and planners and awareness that state retrenchment requires greater individual responsibility for meeting one's own needs. The theory of risk society requires development to recognize that citizens are not necessarily alienated from state welfare.     

Housing Dissatisfaction and Cognitive Decline in Older Adults

Analysis of a nationally representative, longitudinal survey of community-dwelling Americans older than 50 years of age indicated that rating the physical condition of one's dwelling unit as “poor” predicted significantly more rapid cognitive decline in subsequent years. This relationship persisted after controlling for a variety of factors such as wealth, income, education, health, family status, neighborhood safety, depression, and initial cognitive ability. Dissatisfaction with the physical conditions of one's housing may have a direct effect on the rate of cognitive decline in older adults. Addressing housing inadequacy for older adults may thus produce a wider range of societal benefits than previously realized.     

Housing Implications of Individual Budget Home Care Models for Older Renters: An Australian Case Study

Policies and programs relating to successful aging in place are premised on the fact that older people's housing is stable and suitable. Home-based aged care delivery models such as individual budgets aim to deliver increased service flexibility, choice, and control for consumers. Little attention has been paid to the consequences of such models for older renters, who often have less stable housing and restricted rights to modify their accommodation. This article reports on a project in Australia that explored the delivery and receipt of individual budget style models of home-based aged care services to older renters.     

The Physical Housing Environment and Subjective Well-Being Among Older People Using Long-Term Care Services in Japan

Abstract

For older people using long-term care services, the conditions of their life-space may be critical. The relationships between the physical housing environment and aspects of health were examined among older people in Japan (aged 65+ years, N?=?1,928) by multivariable logistic regression analysis, adjusting for sociodemographic characteristics. Lack of safety, low access to emergency assistance, low or high indoor temperature, poor sanitary conditions, and state of home disrepair were significantly associated with negative aspects of health among people with low activities of daily living (ADL) independence. Home care service providers and policymakers need to consider the importance of appropriate environmental conditions for the most vulnerable groups.     

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.     

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.     

The Impact of In-Home Services Utilization on the Institutionalization of Older People in Korea

As a result of aging populations, institutionalization of older people is creating an increasing financial burden in many countries. The purpose of the present study was to explore the impact of in-home service utilization on institutionalization. The subjects were newly certified as eligible for long-term care insurance between January and February 2009 in Korea. The follow-up period was 40 months, to April 2012. We used logistic regression models to identify factors influencing the transition to institutional service, adjusting for gender, age, living status, income level, activities of daily living, and chronic disease. The institutionalization rate was estimated to be 17.3% over 40 months. The interval from transitional living to institutionalization was 36 ± 8 months. Risk factors of transition to institutional services are being female, having advanced age, living with friends or cousins, getting dementia, and not using in-home services. We determined that institutionalization is mitigated by use of in-home services. Therefore, supplying appropriate in-home services to current nonusers would help to greatly reduce the rate of institutionalization of older people.     

In Search of a Future for Large-Scale Care Homes in Flanders

Housing for older people in Flanders evolves toward small-scale facilities and better quality of life. Ageing population strains the means to achieve this to the limit. The authors investigate whether and how Flemish large-scale facilities can adapt to meet contemporary and future requirements of housing for older people. By analyzing current tendencies, they depict what this housing should look like, both now and in the future. They then investigate how an existing large-scale care home could fit this picture by using design as a mode of knowledge production. They propose to redesign the site such that its actual evolution would be thoroughly redirected. Beyond the facility at issue, the study shows how Flemish large-scale facilities could develop to keep playing a role in the future. They should timely adapt their size with qualities of small-scale housing schemes, and integrate in the neighborhood.     

Costs and Outcomes of an Extra Care Housing Scheme in England

Extra care housing, which provides support and care for people in specially designed accommodations, has now been part of the range of housing and care services available to older people in England for several years. Currently, the United Kingdom evidence base tells us little about the financing, estimation of the costs, or burden to the public purse of housing with care. The United Kingdom has significant state welfare provision in the areas of health and social care. The objective of this in-depth case study was to investigate the cost and outcome consequences for a sample of people who moved into an extra care housing scheme in Bradford, England, and to reflect on the methodological implications for future research in this developing area. The main finding of the study was that the overall cost per person increased after a move to extra care housing, but that this increase was associated with improved social care outcomes and improvements in quality of life.     

Resident Service Coordinators: Roles and Challenges in Senior Housing

ABSTRACT

This study aims to explore the challenges that Resident Service Coordinators (RSCs) encounter in senior housing and the meanings they attach to their role. Using a mixed methods approach, surveys and interviews were conducted with RSCs working in age-segregated housing in Connecticut. Survey responses indicate that, despite certain similarities, no single profile characterizes the scope of the role. Analysis of the interview data reveals 5 themes: interpersonal conflicts, mental health problems, inadequate resources, unclear policies regarding residents' rights, and inconsistencies in role definition. These results underscore the need for increased training for RSCs, and additional research is needed to understand the role and identify best practice models.     

Monitoring Quality of Care in Residential Care for the Elderly: The Information Challenge

This study assesses the administrative data compiled on residential care facilities for the elderly (RCFEs) by the state of California and considers the feasibility of their adaptation into a comprehensive information system. Required state RCFE reporting forms were reviewed for potential data elements. Recording and reporting variation was evaluated using a stratified probability sample of 340 facilities licensed in Northern and Central California. Stratification was by facility size and state district office. Data collection included a 5-year retrospective review of forms and documents in each facility's public file. Little of the information required from RCFEs is computerized. Most of it is maintained at the individual facility and not included in public files. Basic information, while included in the public file, is commonly either not available or not current. Resident characteristics and outcomes are not compiled, except indirectly in citations. The information required from RCFEs, if appropriately compiled and maintained, would produce a comprehensive quality assurance system and more effectively support consumer information and policy needs.     

A GIS Analysis of East Asian Care Gaps in Residential and Assisted Living Facilities in Vancouver,Canada

Residential care and assisted living services provide support to seniors who may not have the ability to live independently. However, East Asian residents often do not have sufficient access to culturally specific activities, which may result in psychosocial stress and isolation. This study presents a geographic analysis method to evaluate spatial distribution of culturally tailored senior care facilities in Metro Vancouver. We identify geographical disparities, indicating that many East Asian seniors have poor local access to a culturally tailored facility. We recommend the use of geographical analysis techniques to improve the analysis and planning for senior care in an increasingly diverse population.