The Effect of Housing on Perceptions of Quality of Life of Older Adults Participating in a Medicaid Long-Term Care Demonstration Project

Summary

As the nation struggles with the great increase in the numbers of older adults, many questions arise about how to provide housing and long-term care options that will ensure the quality of life of older adults. This study demonstrates that older adults and their families perceive quality of life more positively once moved from a nursing home to an assisted living facility using Medicaid funds. Results of this exploratory study are promising and suggest that having housing options available across the continuum of care with individualized case management offers older     

Intergroup Contact: Using Storytelling to Increase Awareness of Lesbian and Gay Older Adults in Long-Term Care Settings

ABSTRACT

Due to societally imposed stigmatization, lesbian and gay (LG) older adults fear and prolong accessing long-term care (LTC) even though they need LTC at higher rates. Interventions that decrease negative attitudes toward LG older adults among LTC staff are a first step in addressing this problem. In this study, the influence of intergroup contact (IGC) on LTC staff members’ attitudes toward LG was explored through the use of storytelling as a training mechanism. An embedded mixed-method approach was employed to collect and analyze responses of 60 LTC staff who participated in a storytelling event. Participants completed pretests, posttests, and participated in audio-recorded group discussions. The findings showed that storytelling had a significant (p =0.001) and positive effect (d =0.57) on participants attitudes toward LG. Qualitative analysis revealed 90 codes, 13 process codes, and 4 themes: making meaning of stories, seeking understanding, application to LTC setting, and debating. When guided by IGC theory, storytelling has potential for positively influencing attitudes of LTC staff members toward LG older adults. There is a need for longitudinal work to further test this model.     

Advance Elder Care Decision Making

Abstract

Advances in modern technology have resulted in increasing health care options. Unfortunately, many adults do not think about health and end-of-life decisions until they are faced with a health crisis or long-term care issues. The lack of planning has left many families devastated and overwhelmed by the decisions they face on behalf of their loved ones. Social workers and other professionals are observing family members who are ill-prepared for the decisions they have to make and the roles that they undertake as a result of the failing health of an older relative. The Advance Elder Care Family Planning model (AECFP) is designed to empower families before they face these problems.     

Advance Care Planning in the Delivery of Adult Protective Services

ABSTRACT

In ensuring the safety and protection of older adults from abuse and exploitation, adult protective services (APS) workers face a variety of situations involving serious illness and end-of-life conditions. Many older adults encountered in APS will present with one or more chronic conditions that may warrant discussion of advance care planning with clients and their families. This study surveyed APS workers (n = 508) in 21 states regarding encounters with end-of-life situations and the practice of future care planning. Results revealed that three-fourths of APS workers encounter clients with serious illnesses and about two-thirds do discuss planning in advance for care. More than one-half of the respondents indicated client incapacity and refusal to address future care needs as barriers to discussing planning in advance for care. Recommendations to enhance advance care planning among APS workers are discussed.     

Home modification among families with older adults with disability in Korea

Abstract

This study explores psychosocial factors related to the use of home modification among older adults with disabilities and their caregivers in Korea. Using in-depth interviews, this study elaborates specific socio-cognitive factors leading to home modification from the multiple perspectives of care recipients, family caregivers and home care helpers. The study findings are theoretically organised into four domains: structural factors, care recipients’ service needs, socio-cognitive factors, and enabling resources. Practice and policy implications are discussed in the context of underdeveloped housing policies for ageing-in-place in Korea.     

Current Developments in Social Care Services for Older Adults in the Czech Republic: Trends Towards Deinstitutionalization and Marketization

ABSTRACT

Deinstitutionalization and marketization of eldercare has been delayed by 20 years in the Czech Republic compared to Western Europe, and it takes place in a completely different context, characterized by the legacy of communism, a growing older population, and less generous public subsidies. This study is the first in the Czech Republic to examine how deinstitutionalization and marketization effect implementation of these principles on the availability and quality of eldercare services at regional and municipal levels. A mixed-method approach was used, combining several data sources (policy documents, administrative data, statistics, expert panel, and secondary use of qualitative data). The findings suggest that the support for and availability of home-based care has declined, despite the ever-increasing number of older adults and policy preference for deinstitutionalization. Furthermore, home-based services have failed to adjust to growing care needs of older adults (e.g., inflexible schedules, limited provision of time-demanding care, inadequate staff composition). This situation occasioned an unintended outcome: the emergence of nonregistered, semilegal, for-profit nursing homes offering low-quality care and poor working conditions, and subject to no quality control. The health and even lives of older adults are at risk if they choose such services. Research is needed to study older adult decision making and offer them tools to identify and avoid questionable services.     

“Just Like I'm Saving Money in the Bank”: Client Perspectives on Care Coordination Services

Older adults face many challenges to community living. The literature has not sufficiently explored the roles of care coordination in the maintenance of housing and access to health care among older adults, particularly from their own perspectives. This qualitative study analyzes the findings from 25 interviews and 6 focus group discussions (48 participants) with a multiethnic sample of older adults in the New York City area. Care coordination services appear to assist older adults access health care, and to a lesser extent, maintain affordable housing. Disparities in access to care coordination appear to remain for immigrant, minority and suburban populations.     

Care of Older Adults in Iceland: Policy Objectives and Reality

ABSTRACT

We examine the implementation of the Icelandic government's policy on formal care of older adults in Iceland. The policy as expressed in legislation and other policy documents is to ensure access of older adults to the appropriate level of health and social care services. How does the actual level of formal care compare with the policy objectives? Does there exist an implementation deficit, and if so, why? We address the question by analyzing Icelandic and international statistical databases. The findings reveal a gap between the aims of the current policy and its delivery. As elsewhere in the Nordic region, the policy allows for the emphasis to be on home-care services in which the individual's needs are assessed comprehensively. Administrative problems and insufficient resources to better understand and explain the problem are identified. Current steps to address the problem include the necessity of a comprehensive evaluation of the level and quality of elder-care services in Iceland, which would help compensate for the shortcomings of the existing public statistical databases. In future research, it is necessary to analyze how services can be coordinated while increasing responsiveness to the voices of older adults and their relatives on the care of older people.     

Religion and Spirituality as Defined by Older Adults

ABSTRACT

This exploratory qualitative study examined the intrinsic definitions of spirituality and religion across three different religious or ethnic groups of older adults – Jewish, African American Protestants and Caucasian Protestants. The study explores how older adults from these various backgrounds self-identify with the terms religion and spirituality. Because both African-Americans and Jewish older adults are underrepresented in the research on spirituality and religion, their inclusion lends insights to this topic and helps to anchor the findings in a cross-cultural context. Focus groups were employed to understand how these groups characterize their relationship to spirituality and religion. Social work professionals can utilize these findings to work more effectively with the diverse and complex issues of older adults.     

Advance Care Planning Throughout the End-of-Life

Abstract

Advance care planning throughout the end-of-life is an increasingly important aspect of professional practice with older adults and their families. As the nation's population continues to live longer, more and more people will experience years of functional and cognitive decline prior to death. This article discusses the growing importance of advance care planning using a long-range, holistic perspective of examining care needs throughout the end of life. End-of-life care is conceptualized by three trajectories of decline leading to death, with about two-thirds of all older adults succumbing to four key conditions: congestive heart failure, emphysema, frailty, and dementia. Research regarding the advance care planning needs of older adults with the key conditions is presented. Further research is needed to enhance social work practice in this area.     

Learning Experiences of Older Volunteers in a Community-based Social Program for People with Dementia

Abstract

This qualitative study aimed to explore older adults’ perspectives on volunteering in an activity-based social program for community-dwelling people with dementia called Stepping Stones. Semi-structured interviews were individually conducted with eight older adults who had volunteered in Stepping Stones. Interpretative phenomenological analysis was used to analyze interview data. Four themes related to learning experiences of older volunteers in Stepping Stones emerged. These themes include (a) self-growth and confidence in working with people with dementia; (b) understanding dementia, people with dementia, and needed support for people with dementia and their families; (c) desire not to develop dementia, while recognizing that anything can happen in old age; and (d) exercising person-centered approaches and taking on advocacy roles. Findings suggest that older volunteers gain feelings of personal growth and confidence in working with people with dementia, better understanding, and enhanced attitudes toward people with dementia through volunteering in an activity-based social program for people with dementia. Older adults will be able to fill the needs of community programs for people with dementia, while experiencing benefits from volunteering and learning in later life. Further research is needed to examine to what extent having previous dementia experiences make their experiences and learning different.     

Preparing Social Work Students to Work with Grandparents in Kinship Care

Summary

Grandparents in kinship care represent an expanding population of older adults assuming primary parenting responsibilities for their grandchildren at a time when many grandparents may also be experiencing developmental changes accompanying their own aging process. Research documents a lack of social workers prepared to respond to the needs of an aging population in general, and grandparents in kinship care in particular, as curricular content on this population has been limited in undergraduate and graduate social work programs. This article describes an infusion model proposed for an undergraduate social work program's GeroRich Project designed to introduce content on an aging population in four foundation courses to expand students' knowledge of older adults and grandparents as kinship care providers.     

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.     

Chapter 18. The Aging Network and the Future of Long-Term Care

SUMMARY

Federal and state governments face a significant challenge in meeting the long-term care needs of an older population that will double in size between 2000 and 2020 and continue to increase through 2050. States have made significant improvements in their long-term care systems for the elderly. However, they are still spending a significant proportion of their long-term care funds on nursing homes. Any effort to improve long-term care for the elderly qualitatively, and not just on the margins, must be focused on developing a more flexible and balanced long-term care system that is responsive to consumer choice.

The Aging Services Network is poised to play a significant role in this transformation process. The strengths of the Network include the ability to develop and manage consumer-driven community-based programs; to assess the needs and resources of individual older persons and provide cost-effective community supports; to operate within fixed, capped budgets; and to identify and maintain roles for informal caregivers. Now is the time for national aging organizations, state units on aging, and area agencies on aging to use existing opportunities to move towards the establishment of a balanced system of long-term care.     

Implementing reverse mentoring to address social isolation among older adults

ABSTRACT

Reverse mentoring is a means to address the social work Grand Challenge of social isolation. Among older adults, reverse mentoring can improve social connection by increasing the digital competence of older adults so they can use technology for social benefit, and by facilitating intergenerational connections with young adult mentors. In this paper, reverse mentoring is examined within an intergenerational program that serves older adults and utilizes the native technological knowledge and skills of young adults who mentor older adult participants. Qualitative data were collected through young adult mentor logs of each session, and through open-ended questions on the post-surveys collected from older adults and young adult mentors. Qualitative analysis revealed three themes related to social connection: (1) an increased sense of self-efficacy for older adults as they build confidence in technological use, and for young adults as they develop leadership skills through mentoring, (2) the breaking down of age-related stereotypes, and (3) intergenerational engagement and connection. The findings demonstrate that reverse mentoring can be used in various settings to decrease the social isolation of older adults by developing intergenerational connections and increasing older adult usage of technology.     

Assessment of multiple constructs of social integration for older adults living in nursing homes

ABSTRACT

A variety of terms and measures have been used in the literature to denote being socially integrated, and many studies of older adults focus on only social networks or social support and often only include those living in the community. The purpose of this study was to assess multiple constructs of social integration (i.e., social networks, social capital, social support, and social engagement) for older adults in nursing homes. Data were collected from 140 older adults at 30 nursing homes in Kansas. We interviewed older adults’ in-person using a survey questionnaire, and used multilevel confirmatory factor analysis to analyze the data. The final model that included the four constructs had acceptable fit (χ² = 174.71; df = 112; p < .01; CFI = .93; RMSEA = .06; SRMR-W = .06; SRMR-B = .12). The results showed that the proposed model was supported at the individual level. At the between-level, social networks and social support were supported. Study results have methodological and practice/policy implications for the study of older adults in long term care settings. In particular, this study contributes to understanding how to operationally define and differentiate social integration variables in studies of older adults, particularly when study data are hierarchical.     

Perceived Usefulness and Easiness of Information and Communication Technologies and Volunteering among Older Adults

ABSTRACT

This study investigates the association between older adults’ perception of usefulness and easiness (PUE) of Information Communication and Technologies (ICTs) and volunteering, and if this association differs across their income status. Data were obtained from the 2012 wave of the Health and Retirement Study (HRS), and the sample was restricted to respondents aged between 60 and 84 (N = 901) and who completed the 2012 HRS technology module. Multinomial logistic regression was employed to examine the independent and joint influence of PUE of ICTs and of low-income status on volunteering. The results show that only people with high PUE engaged in more than 100 hours of volunteering among older adults after controlling for covariates. The positive effect of high PUE was found to be more significant in the low-income group. This is the first known research to investigate the PUE of ICTs and volunteering among older adults. This study expands the knowledge of volunteering among older adults by exploring ICTs which can be considered as one of the most influential macrosocial changes in the current society. Moreover, our findings provide some insights and an empirical foundation in volunteering programs for older adults of different PUE levels.     

Research with Older Adult Methadone Clients: The Importance of Monitoring Suicide Ideation

ABSTRACT

This study reports on the importance of monitoring suicide ideation among older adult research participants. A recently completed randomized controlled trial of older adults who are current clients in methadone maintenance treatment (MMT) served as a case study to elucidate a suicide protocol that was designed to account for the potential instances of suicide ideation within the research project structure. As the numbers of older adult heroin users increases, this study’s findings seek to influence research protocols that involve older adults with addictions who may be particularly vulnerable to suicide risk due to comorbid psychiatric conditions and psychosocial adversities.