Community Service Use by Older Adults: The Roles of Sociocultural Factors in Rural–Urban Differences

ABSTRACT

This study examined the influence of sociocultural factors in explaining the rural–urban differences in home and community-based service (HCBS) use among older adults. Survey data of 228 older adults living in Alabama were analyzed. Sociocultural factors included participants’ perceptions of service availability, attitudes toward seeking formal help, informal support, and religious behaviors. Rural older adults were less likely to use HCBS than their urban counterparts (p < .05). An interaction effect between perceived service availability and church attendance was found. These findings suggest a need for collaborations between community aging services with religious organizations to ensure existing programs are accessible to older adults living in rural areas. Future research based upon large probability samples is needed to shed more light on the relation between church attendance and service use.     

Utilization of Community-Based Social and Health Services Among Foreign Born Hispanic American Elderly

ABSTRACT

This study examined factors associated with the utilization of community-based social and health services among foreign born elderly Hispanic Americans. The data came from a nationwide probability sample of Hispanic Americans age 65 and older including 296 Mexico-born Mexican Americans, 571 Cuba-born Cuban Americans, and 247 respondents from other Hispanic countries. Being a Cuba-born Cuban American, living alone, having poorer self-rated health and living below poverty level were positively related with the utilization of community-based social services. Cuban Americans with more limitations in activities of daily living (ADL) used more community-based health services. Among Mexico-born Mexican Americans, those who lived alone used more social as well as health services while those who were married used more social services. Those with greater limitations in ADL used more health services. Among other foreign born Hispanic Americans, going to church, living alone and living below poverty status, were positively correlated with the utilization of social services. Respondents with better English language ability were less likely to use community based health services. Elderly men and people who rated their health as poorer or had more ADL limitations were more likely to use these services. Implications of these findings for health and social services are discussed.     

Community-Based Services and Depression from Person-Environment Fit Perspective: Focusing on Functional Impairments and Living Alone

ABSTRACT

Guided by the Person-Environment Fit perspective, we investigated the extent to which personal and environmental factors influence depression among community-dwelling adults. The data came from the special section about community-based service utilization in the 2012 Health and Retirement Study (N=1,710). Although community-based service was not significantly associated with depression after controlling for covariates, respondents with functional limitations and living alone were less likely to be depressed when using community-based services. This study demonstrates the different associations between community-based services and depression depending on personal needs. It discusses the importance of community-based services for aging-in-place policy, particularly among vulnerable populations.     

The Older Woman:

Interviews were conducted with 302 elderly persons residing in two ethnic urban communities to determine their problems as well as their needs for diverse community services. Sex and living arrangements were found to be critical mediators of the demand for and use of various services. A greater proportion of women than men (particularly women living alone) reported needs for household, self-maintenance, and community services. Older women living alone were also more likely to report that they had experienced neighborhood problems. Implications for designing community-based services to better meet the needs of older persons in diverse living situations are discussed.     

Formal Social Participation and Utilization of Community-based Services among Urban Elderly Chinese Living Alone in Shanghai,China

This research examined formal social participation among elderly Chinese adults living alone and the association between utilization of community-based services and formal social participation, which refers to participation in employment, volunteer jobs, and social groups. Using a secondary analysis on a survey data from a simple random sample of 228 adults aged 60 and older living alone in a Shanghai neighborhood, it was found that only small percentage of older adults living alone were involved in formal social participation. Hierarchical multiple regression analysis showed that use of community-based services is significantly associated with formal social participation among elderly Chinese living alone. Thus, future policies and programs should focus on strengthening community-based services for elderly Chinese, to more effectively promote and facilitate their social participation.     

Individual- and Contextual-Level Factors Affecting the Use of Social Support Services among Older Adults

ABSTRACT

By 2060, the number of Americans aged 65 and older is expected to more than double, while the number of Americans aged 85 and older is expected to nearly triple. As the nation's aging population grows, older adults will need to rely on social support services, such as transportation and housing services, in order to remain active and lead independent lives. In this study we use data collected from the elderly supplement of the Southeastern Pennsylvania Household Health Survey (SPHHS) (n = 3,042) to explore the relationship between the availability of elderly specific social service providers and utilization of social support services among older adults. We find that while the number of elderly specific social service providers can increase use of social support services among older adults, its impact is relatively minimal. We find that individual factors, instead, are stronger predictors of service use. This is a finding that should be particularly encouraging for elder care providers who may not have the resources needed to undertake large structural changes (like building new facilities). Still, future research should explore how the availability of a broader range of elderly specific social services (than explored in this study) impacts use.     

Poverty Among Korean Immigrant Older Adults: Examining the Effects of Social Exclusion

ABSTRACT

Previous studies have shown that elderly Asian immigrants face greater risks for living in poverty compared with their native contemporaries. Particularly, Korean immigrant older adults are reported to be most likely to experience poverty among many Asian immigrant groups. The purpose of this study is to examine the extent to which demographic, human capital, and social exclusion factors contribute to such economic vulnerability among Korean immigrant older adults. Adding to previous research, this study broadly conceptualizes social exclusion and tests for its additive effects on poverty using nationally representative public data of Korean immigrant older adults. From the 2008–2010 Public Use Microdata Sample of the American Community Survey, this study extracts a sample that consists of individuals aged 65 years and older whose national origin is Korean, who were not born in the United States, and thereafter immigrated to the United States (N = 3,820). The findings indicate that 3 dimensions of social exclusion—exclusion from social and civic life, exclusion from asset building, and exclusion from the labor market—contribute significantly to Korean immigrant older adults’ odds of living in poverty. The study concludes with practice implications for socially inclusive workforce development as a way to ameliorate economic afflictions among Korean immigrant older adults.     

Exploring Formal Service Use by Older Chinese: A Case Study on a Naturally Occurring Retirement Community

ABSTRACT

This study examined secondary data from a naturally occurring retirement community in which 296 older Chinese were interviewed to understand and identify the factors related to formal service usage. Regression analysis found that the importance of perception of formal services impacts predicting service use. The results also indicated older female Chinese participants were more likely to use services. Implications for practice and policy to improve access to services by older Chinese were presented and the development of culturally sensitive services for this group is encouraged.     

Beyond Income: A Social Justice Approach to Assessing Poverty among Older Adults with Chronic Kidney Disease

ABSTRACT

How social workers define and assess poverty is a matter of economic and social justice. Recent conceptual and measurement advances point to a multidimensional definition of poverty which captures material, social, and political deprivations. Using data from a survey, this article describes how nephrology social workers assess poverty among older adults living with a chronic kidney disease (N = 52). Results suggest respondents already conceive of poverty as a multidimensional experience, support awareness-raising about poverty, and primarily assess poverty by employment status, income, access to transportation, and education. Opportunities to expand poverty assessment in future work are promising.     

Using Private Social Care Services in Finland: Free or Forced Choices for Older People?

ABSTRACT

Use of private social care services among older people is increasing in Finland. This study aims to understand why older people choose private care in a comprehensive tax-subsidized social care system and examines whether people choose private service as a free choice or a forced choice as well as what factors contribute toward making these choices. Data for this study (N = 1,436) were gathered in 2010 from people aged 75 and above living independently at home in two Finnish cities: Tampere and Jyväskylä. Data were analyzed with several quantitative tests: chi-squared tests, multinomial regression analysis, and qualitative content analysis (for the open-ended responses from the survey questionnaire). Findings reveal that people chose private services mostly because of the effortlessness involved in its use and of the need for additional services that are unavailable through municipality; for example, cleaning. Majority of the respondents performed a free choice to use private services. People who lived in a city center with a higher level of income and who needed more services were more likely to be constrained toward using private support. Major concern, due to diminishing public service provision, is about service accessibility of economically disadvantaged groups; therefore, more research is required to understand the effects of the growing care market in Finland.     

Secure Attachment to Family and Community

ABSTRACT

Disproportionately large numbers of high risk clients from Multiple Problem Families (MPFs) utilize a disproportionately large percentage of Medicaid, Health and Human Services. Clients from these families are involved in domestic violence, addiction, child abuse and neglect. They are over represented on the caseloads of state protective service agencies. The approach outlined in this paper is based on social attachment theory models. It stresses the use of long-term, home-based therapy, and community support agencies to establish and maintain safe secure attachment for these fragile families. The therapeutic goals are to foster attachments that lead to increased mentalisation, and to decrease the crisis-driven behavior that often results in high cost utilization of state services. A placement prevention model, outlined as an alternative “mentalising social system” approach, is proposed for treating disruptive MPF children. Family oriented, in-home, community-based treatment is found to be more cost effective and therapeutically helpful for these children than costly inpatient psychiatric admission followed by residential care.     

Immigration,living arrangement and the poverty risk of older adults in Hong Kong

Using 2011 census data, this study investigated how living arrangement affects disparities in poverty between older adults (aged 65 and older) who migrated to Hong Kong from Mainland China and those who were born in Hong Kong. Our sample consisted of 29,987 immigrants and 9,398 natives, all of whom were ethnic Chinese and living in Hong Kong at the time of the census. We found higher poverty rates among older immigrants than among natives, a disparity that persisted even after adjusting for living arrangement, human capital characteristics, assimilation‐related variables, household composition and demographic characteristics. We also found that living arrangement moderated the impact of immigrant status on the poverty risk among older adults, and that the impact was due mainly to the number of earners in the household. The implications of our results with respect to poverty among older adults and anti‐poverty measures are discussed.     

Ageing-in-place in studio apartments in Singapore: maintaining independence in community living

Abstract

Living alone in later life is increasingly a common style of living in Singapore. We investigated the extent of maintaining independent living in a studio apartment using a survey of older residents (n = 925), focusing on three aspects of coping strategies: self-care management, social support, and use of social services. As compared to older adults who lived with others, those who lived alone had better self-care management, tended to rely more on friends and neighbours, and indicated higher use of social services. Those living alone also showed higher awareness in managing their health. This study provides valuable insights to understand the issues on coping strategies involved with living alone in later life.     

Immigrant households and hardships after welfare reform: a case study of the Miami-Dade Haitian community

Compared with other nations such as Canada and Australia, the US experiment with welfare reform has yielded steeper and more immediate caseload declines. These declines have been especially pronounced for immigrants who have been subject to a new set of service restrictions implemented under the 1996 Welfare Reform Act. This article examines service access for Haitian immigrants in Miami, Florida since the onset of these reforms. The data presented here are derived from a series of qualitative interviews with Haitian service professionals and a quantitative survey of Haitian immigrant households. The survey data indicate that many Haitians who are living in poverty and qualified to access services are not enrolled for government services. Confusion over eligibility guidelines explains some of the variation of these low enrolments for specific services (such as child health insurance and childcare) but not for services most commonly used by immigrant adults such as food stamps and Medicaid. The survey also demonstrates that qualified immigrants living in households with unqualified persons are less likely to access services than are other qualified immigrants and are more likely to experience hardships that impede their ability to find stable employment. The concluding discussion highlights the significance of using a household unit of measure in assessing immigrant enrolments and hardships.     

Contributors to Reunification or Permanent Out-of-Home Care for Physically Abused Children

This paper presents data on the outcomes of reunification or permanent out-of-home plans from physical abuse cases served under permanency planning. Client and service characteristics discriminated between placement outcomes with more severe abuse; the child's older age, poor school behavior, lower SES, and intensive contract services associated with permanent out-of-home placement and intensive direct services associated with reunification. Implications for service delivery are discussed.     

Effects of Placement Changes on Health Insurance Stability Among a National Sample of Children in the Child Welfare System

ABSTRACT

Children in the child welfare system have entitlements to health insurance coverage—critical because of their considerable physical and mental health needs—based largely on their placement status. This study conducted path and transitions analyses on data from the National Survey of Child and Adolescent Well-Being (3,801 children followed-up for 3 years) to examine the interplay between placement changes and insurance stability. Children maintained in-home at Wave 1 had significantly lower odds of being insured (OR = 0.7); children transitioning from out-of-home placement to in-home care had significantly lower odds of maintaining insurance coverage (OR = 0.6). Child welfare workers working with children maintained in-home and those being reunified should safeguard the children's insurance status. Policy makers should consider extension of categorical eligibility to all children presenting to child welfare agencies in order to assure access to needed services for these vulnerable children.     

Impact of the Village Model: Results of a National Survey

ABSTRACT

Villages are a relatively new, consumer-directed model that brings together older adults in a community who have a mutual interest in aging in place. These membership organizations provide social and civic engagement opportunities, volunteer provided support services, and referral to vetted community providers to achieve their primary goals of promoting independence and preventing undesired relocations. This cross sectional survey of 1,753 active Village members from 28 Villages across the US measured members’ perceived impacts in the areas of social connection, civic engagement, service access, health and well-being, and ability to age in place. Results showed that involvement in the Village was a key factor associated with greater perceived impacts. Over half of members perceive that the Village has improved their sense of connection to others and their feeling that they have someone to count on. Though younger members in better health were more likely to perceive impacts in social connections, results suggest older women, living alone with some disability may be the most likely to experience improved health, quality of life, and mobility. The implications for social work practice are discussed.     

Validating a Behavioral Health Instrument for Adults: Exploratory Factor Analysis

ABSTRACT

Increasingly, social workers and behavioral health practitioners use assessment instruments to support service planning and to monitor progress. Following statewide implementation of the Adult Needs and Strengths Assessment (ANSA) to identify behavioral health symptoms, related functional challenges, risks, and strengths, this validation study explored the underlying structure of the instrument. An exploratory factor analysis used routinely collected information for Midwestern adults with diagnosed behavioral health disorders who participated in community-based services (N = 46,013). Five factors with adequate to good internal consistency (α = 0.733?0.880) emerged: personal recovery, trauma and stress related problems, substance use risks, self-sufficiency, and cultural-linguistic considerations. Validation of the ANSA supports use of the instrument to engage individuals and families, to plan services, to monitor progress, and to conduct research. Implications for social work education, supervision, and practice include the importance of understanding culture, holistic assessment, and services supporting personal recovery for individuals living with mental illness or substance use disorders. Confirmation of findings requires additional research.     

Pathways to Service for Older Persons

Abstract

As services for older persons continue to shift from hospital and nursing home care to greater reliance on support for care at home, the need to understand the ways older persons obtain services becomes more important. This study examines the use of home-delivered meals as a case study to gain insight into the process of service use from the recipients' point of view. It explores the research question: What are the pathways by which older persons acquire home delivered meals? Narrative analyses of structured and unstructured questions asked of thirty frail older persons suggested that the process of acquiring home delivered meals was accompanied by patterns of adjustment in shifting between independence and dependence in managing loss of physical function, and themes of isolation, loss, and abandonment. The results provide insights for social workers in providing the support needed for the role transition that service acceptance symbolizes for older adults.     

“As Needed” Case Management Across Aging Services in Response to Depression

A lack of clarity on how and where case management for older adults is delivered persists, even as evidence supports its use to respond to depression. We used in-depth interviews with managers (n = 20) and staff surveys (n = 142) from 17 service agencies to explore the provision of case management services in adult day services, homecare, senior centers, and supportive housing. Limited case management services were found. Barriers included limited time and resources, especially for senior centers and supportive housing. Results revealed a concern about the role, feasibility, and availability of case management for older adults within these settings.