Homes of Choice

Abstract

State policymakers increasingly recognize that housing is not only an important shelter resource for older persons, but also a key element of community-based care. Over the last two decades, significant state and local activity has led to an increase in service-enriched housing for older persons. Service-enriched housing refers to living arrangements that include health and/or social services in an accessible, supportive environment. Emerging forces are leading to increased pressure for the expansion of service-enriched housing. These forces include: a growing and diverse population of older renters; older adults' preferences to age in place; the increasing frailty of subsidized housing residents; the development of assisted living (AL); the enactment of Medicaid waivers; and implementation of the Olmstead decision. Although studies have not included cost-analysis, available research demonstrates that service-enriched housing promotes resident satisfaction, successfully provides services to frail populations, and supports aging in place.

Given both limited resources and research, this article addresses how states can adequately respond to and capitalize on these forces in order to best meet the long-term needs of older adults.     

Affordable Clustered Housing-Care: A Category of Long-Term Care Options for the Elderly Poor

ABSTRACT

What we label as affordable clustered housing-care options are making it increasingly possible for poor and frail older Americans to age in place comfortably and securely in residential-like settings combining both affordable shelter and long-term care. The hallmark of these housing arrangements is their sizable population clusters of low-income frail persons in need of supportive services. Despite their greater availability and the compelling factors underlying their growth, the diversity of their supportive services and operations cloud their identity resulting in uncertainty as to whether they have a common mission. In response to the need for a more careful delineation of this aging in place option, this paper describes the distinguishing features of these hybrid settings and constructs a typology of their representative exemplars or prototypes.     

Targeting Services to Those Most at Risk

Abstract

The budget crises facing many state Medicaid programs have increased interest in the goal of linking services and housing as a way to provide more options to people with disabilities at less cost than institutional care. This article examines some of the premises underlying this interest, especially with respect to linking supportive services and federally subsidized housing for older persons. The first section provides a brief history of the activity in this area. The second section examines the risk factors associated with nursing home admission and how those factors match the characteristics of renters receiving subsidies. The third section focuses specifically on the likelihood that subsidized renters will also become eligible for Medicaid. The fourth section explores the capacity of housing programs to meet the challenges associated with service delivery. Finally, the conclusion examines the implications for public policy decision-makers interested in linking services and housing in order to address the long-term care (LTC) needs of older persons with modest incomes.     

Elderly Living in the Community:

Helping an older individual remain in the community requires the creation of living environments that maximize the individual's strengths while providing supportive services in the areas of decreasing competency. Historically, the community care system has not been viewed by reimbursers as terribly important. The aging of the population, plus the high cost of institutional care has resulted in renewed interest in services provided in one's own home. However, there are both challenges and opportunities in providing such service. Adapting supportive housing and neighborhood environments which help unstable persons remain in their homes is crucial to this effort.     

Formal Volunteering among Vulnerable Older Adults from an Environmental Perspective: Does Senior Housing Matter?

Based on the premise that environmental support is an important facilitator for engagement in formal volunteering among vulnerable subgroups of older adults, we focus on older low-income individuals who live alone. Drawing on the environmental docility hypothesis, we examine the role living in senior housing has on the likelihood of volunteering. Data came from the 2012 wave of the Health Retirement Study (N = 1415). Kernel weights derived from propensity scores were used to account for observed sociodemographic and health characteristics associated with both senior housing living and the outcome. Logistic regression models showed that living in senior housing positively affected engagement in formal volunteering after adjusting for personal and environmental factors. As a modifiable target of intervention for successful and healthy aging, our findings provide important background knowledge for the development and implementation of housing-specific volunteer programs for vulnerable elders.     

Political and organizational barriers to satisfying low-income U. S. seniors' need for affordable rental housing with supportive services

A substantial share of the low-income older tenants who occupy U. S. government-subsidized rental housing has physical and cognitive limitations. These older tenants are often women living alone in their 70s and 80s, who need help obtaining community-based services, demand-responsive transportation, help with apartment housekeeping and maintenance, self-care assistance, and design modifications made to their dwellings. Other low-income and frail older persons who have large housing expense burdens or occupy physically deficient dwellings also need affordable rental housing with these supportive services. The unmet supportive service needs of these groups persist even as this country's major political and professional stakeholders are aware of their problems and have solutions. This paper examines five major political and organizational barriers that have restricted the availability of supportive services in affordable rental developments. It offers 12 policy recommendations.     

Most Successful Intervention Strategies for Abused Older Adults

ABSTRACT

In this Project CARE study, intervention plans for 83 cases, with a total of 473 strategies, are analyzed in a qualitative content analysis method. The 473 strategies are designed and implemented by an abuse-trained, multidisciplinary, health and social service agency, home care team. Each strategy is rated by the team for its acceptance/refusal by clients and levels of success. The most accepted and successful strategies for abused older adults are concrete: nursing and other medical care and homemaking assistance, followed by empowerment strategies, such as support groups for abused older adults, information about rights and resources and volunteer buddy/advocates. Less successful strategies for abused persons are referrals to general community activities and programs. For caregiver abusers, the most successful and accepted interventions involve individual supportive counselling to reduce anxiety, stress and depression and education and training. Abuser-oriented strategies are most accepted and successful in the study. Thus, it would seem pertinent for intervenors to focus services and strategies on abusers and not only on abused older adults, in particular offering them supportive individual counselling to reduce anxiety, stress, and depression. For abused care receivers, home-based services can offer the necessary support to move out of their abuse situation with the help of volunteers and support group activities.     

Social Support and Depression Among Low Income Elderly

Abstract

Demographic, functional and social characteristics of residents living in a low-income senior housing complex are explored. These variables and perceptions of social support were analyzed for their effects on depression. The strongest predictor of depression was perceptions of social support. The findings are consistent with the research which shows that support through family and friends is important to consider when older adults experience health problems that lead to functional disability.     

Chapter 3. Housing Older Canadians

ABSTRACT

Reflecting a world-wide trend toward avoidance of institutionahzation and the fostering of aging in place in the community, a range of housing alternatives has been developed for older persons in Canada. This paper examines: (1) current patterns of housing and living arrangements of older Canadians; (2) philosophies that have dominated policy and production of housing for seniors for the last 30 years; and (3) seniors' preferences and utilization rates of various options. Data sources include the 1991 census and two cross-Canada studies, one urban and one rural, in which seniors were asked about their housing and related support service needs, usage patterns and preferences. The paper concludes with a discussion of emerging trends blending shelter and services and of policy gaps that need to be addressed in meeting the future housing needs of older Canadians.     

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.     

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.     

Local Housing and Service Decisions

Abstract

The purpose of this research was to identify factors associated with local housing and service decisions that support aging adults in rural communities. These decisions represent de factostrategies that affect the quality of life of older residents and their ability to age in place. Data were collected from 951 informants in 134 Midwest rural communities. Analyses were undertaken to identify the role of community characteristics in predicting the availability of a group of housing options and support services. Findings support the notion that the community context is important to the delivery of key housing and service needs. Population size, proportion of community residents 65 years and older, and housing planning processes promoted gains in housing and services.     

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.     

Functional Ability,Neighborhood Resources and Housing Satisfaction among Older Adults in the U.S.

The purpose of this study was to explore neighborhood resources that influence the housing satisfaction of older adults. The study included 10,146 participants from the 2009 panel of the American Housing Survey who were 65 years and older. Hierarchical regression modeling was performed to examine older adults’ perceptions of neighborhood resources and consequently the role these resources play in predicting housing satisfaction among community dwelling and residents of assisted living, controlling for age, sex, ethnicity, education, and housing maintenance. In addition, three levels of physical functioning among residents of assisted living were examined. Results showed that there were differences in housing satisfaction by residences and levels of physical functioning. Subjective evaluations of neighborhoods and the near surrounds were significant predictors of housing satisfaction. Results of the study suggest that policy makers and housing professionals need to continue to consider the role of supportive neighborhoods and social environments in promoting successful aging particularly for frail older adults.     

Demographic Comparisons of Aging in Five Selected Countries

The worldwide aging of the population is having a major impact upon society. The United Nations General Assembly has declared 1999 to be the International Year of Older Persons to increase the awareness of aging worldwide. They identified five principles for older persons: independence, participation, care, self-fulfillment, and dignity. The numbers of elderly are growing around the world with many elderly living considerably longer than in past times. Developed countries are struggling with the high cost of maintaining support programs, and developing countries face dissolution of traditional care systems without institutional replacements. Women around the globe typically live longer than men, often without the economic resources to maintain independence. As nations adapt to their aging populations, a partnership among policy makers, family members, and older persons themselves is needed to offer alternatives to meet the needs of elders.     

Elders and the Courts

Abstract

This article examines how trial courts should address complex issues of an aging society. More older people, living longer, will enter courthouses with underlying problems that will impede effective access and court processes and will require judges to enhance linkages with community health, mental health, and social services providers. The article analyzes how court systems perceive these issues and explores how they have begun to address them. It concludes with an argument in support of innovative new approaches to assist courts in responding to emerging issues of older adults.     

Supportive Housing Initiatives in Arkansas

Abstract

Arkansas has a significant need for improving the availability of affordable housing with access to supportive services for its large population of elderly and persons with disabilities. Factors that contribute to this need are the high level of poverty, general poor health, low employment rate for persons with disabilities, and the geographic and social isolation problems typical of a rural State.     

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.     

Private Lives and Public Programs

Abstract

Major late life events, reported in the Dubbo longitudinal study of older Australians, are used to examine the interaction of private lives with public programs. First, the data indicate strong supportive effects of publicly funded income, health, and aged care programs in reducing family burdens from major life changes. In particular, financial crises were rarely mentioned, directly or indirectly, as major threats. Next, the central role of informal social support in these events is demonstrated, first, as in previous studies, family support was responsive to risky events and to aging itself. Also, in new findings, one-third of surviving elderly respondents coped with the burdens of family crises as a substantial proportion of the “major” life changes that occurred over 13 years of the study. Within the security and support provided by the Australian welfare system, and with strong social networks, families with older persons in the Dubbo study manage multiple, major life changes. With rapid population aging, the development of more, and more easily accessible, services for a growing population of older people is a priority. The critical challenge will be to harmoniously grow public financing, private funding, and informal caregiving to deal with the growing burden arising from an aging society.     

Neighborhood Experiences and Community Integration

Abstract

This exploratory study examines the social interactional aspect of community integration among persons with psychiatric disabilities. Six focus groups were conducted with 18 mental health consumers in three publicly sponsored community residential programs and 11 staff members providing services to these consumers. Mental health consumers reported both positive and negative experiences in their interactions with community residents. Despite perceived differences between persons with psychiatric disabilities and their neighbors, consumers considered reciprocity and mutual accommodation to be critical for building social relationships in their communities. Mental health providers suggested that social integration can be facilitated by developing independent living and social skills, by overcoming self-stigma and institutional and homeless mindsets, and by having a supportive community of consumers.