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.     

Bringing Assisted Living Services into Congregate Housing

Beginning in April 2000 and continuing for 21 months, Florida's legislature allocated $31.6 million (annualized) to nursing homes through a Medicaid direct care staffing adjustment. Florida's legislature paid the highest incentives to nursing homes with the lowest staffing levels and the greatest percentage of Medicaid residents—the bottom tier of quality. Using Donabedian's structure-process-outcomes framework, this study tracks changes in staffing, wages, process of care, and outcomes. The incentive payments increased staffing and wages in nursing home processes (decreased restraint use and feeding tubes) for the facilities receiving the largest amount of money but had no change on pressure sores or decline in activities of daily living. The group receiving the lowest incentives payment (those highest staffed at baseline) saw significant improvement in two quality measures: pressure sores and decline in activities of daily living. All providers receiving more resources improved on deficiency scores, suggesting more Medicaid spending improves quality of care regardless of total incentive payments.     

Linking Housing,Social Services and Family Well-Being

Abstract

Securing adequate housing is a key component in achieving family well-being and a decent quality of life. It is expected that as many as twenty percent of the families currently on welfare, many of whom are disproportionately female and African American, may not be employable by the end of their lifetime benefit. These families, classified as “hard-to-serve” or “hard-to-employ,” are headed by an adult who may be struggling with substance abuse, physical or mental health problems, as well as low literacy and social competency issues that inhibit achieving self-sufficiency. This author will examine existing literature on welfare-dependent households coping with substance abuse and mental health problems, and how the lack of affordable housing impacts their ability to achieve self-sufficiency. This article presents a case study     

The Needs of Older Persons at Risk of Housing Loss

This chapter explores the implications of some of the earlier findings about elders at risk, especially the significance of social support, mental competence, and income. There is need for research exploring consumer perspectives and preferences, as well as agency constraints and flexibility. Services needed include health and mental health outreach, home maintenance and creative matching of natural helpers and formal care. Fundamentally, a national commitment is needed to "housing for all."     

Advancing Program Theory for Licensed Assisted Living Services in Independent Housing

Assisted living programs (ALPs) embed licensed assisted living services within independent housing. To advance nascent research on this type of housing plus services, this study aimed to develop empirically grounded program theory on the processes through which ALPs benefit residents within independent housing. Eighteen in-depth interviews were conducted with current and prospective consumers of an ALP in northern New Jersey, including residents and family caregivers. The setting for the ALP was a federally subsidized independent housing building, which had introduced the ALP approximately 1 year prior to the study. Themes emerging from an iterative coding process indicated the most valued aspects of the ALP’s service delivery, including the comprehensiveness of the service options, the flexible timing for their delivery, and the relational aspects of care. Participants further described the ways in which the structure of the ALP facilitated prevention, such as preventing the occurrence and escalation of adverse health events. The study concludes by presenting a program model that integrates these findings, which suggests that ALPs deliver care in ways that make long-term services and supports more accommodating and acceptable to consumers. This, in turn, can enhance their preventive value to facilitate aging in place among independent housing residents in clinical need of such supports.     

Health Status and Health Care Services Among Older Persons in India

Summary

India is characterized by significant rural-based living, population heterogeneity, financial constraints, and reverse sex ratio. Traditions of joint families, life-long physical activity, vegetarianism, and social and spiritual enrichment, all known to promote healthy aging, are widely prevalent. With the increasing pace of population aging, the health of older persons in India has been the focus of recent attention. Existing data indicate a significant morbidity among the aged, much of which may remain subclinical. Considerable variations in morbidity exist with respect to gender, place of residence (rural vs. urban), and socioeconomic status. Rapid demographic transition without a concomitant epidemiological transition is responsible for the dual load of infections and degenerative diseases in older persons, these being common causes of death. Most age-related morbidity is preventable. Health promotion and cost-effective interventions based on the primary health care approach over a lifelong course, especially at the village level, will greatly help towards achieving the goal of healthy aging. The rapidly changing socioeconomic scenario in India also calls for appropriate policy actions to achieve this goal.     

Senior Centers and Services for the Frail Elderly

This article reviews and synthesizes the research on senior center programming and utilization relating to one important group of elders-the physically and mentally frail. It examines the thesis that senior centers do play an important role in providing programs for this population, especially given the resources available to them, and can be considered as part of the long-term care continuum. The article also identifies a number of barriers that limit how much most centers do in serving significant numbers of frail older persons.     

Health Care for Older Persons in Singapore

Abstract

Health care policy in Singapore is similar to that in the United States and the United Kingdom, where a residualist strategy is used to pass health care costs to individuals and their families, the rationale being that this enables the state to concentrate on devolution of care to the community and ensure efficient and affordable service to all Singaporeans. The services include public restructured hospitals and outpatient poly-clinics as well as community services such as community hospitals and hospitals for the chronically ill, nursing homes, day care centers, and home help services. Availability does not translate into optimum usage because current and potential users and their families are not able to match their financial and social resources with the services. Instead, the state acts as the case manager and places parameters on what individuals can access.     

Resource Effects on Access to Long-Term Care for Frail Older People

Abstract

Access to long-term care depends primarily on personal resources, including family members and income, and on external resources, including Medicaid and Medicare. This study investigates how resources affect frail older individuals' access to long-term care, with a focus on Black and White widows. Data from the 1989 National Long-Term Care Survey is used, in conjunction with state-level Medicaid and Medicare reimbursement rates for nursing home and home health care, to estimate the likelihood of five types of care arrangements. Results show that children are a primary resource for unmarried individuals in maintaining access to informal care. Income effects are nonlinear in relation to nursing home care: increasing incomes below the mean income are associated with decreasing probabilities of nursing home care, while increasing incomes above the mean are associated with increasing probabilities of nursing home care. Income and Medicaid effects are interrelated, with nonlinearities associated with income having the potential to adversely affect some older persons' ability to access nursing home care.     

Uses of Guardianship as a Protective Intervention for Frail,Older Adults

The uses of guardianship as a protective intervention for frail, older adults, especially those at risk for abuse and exploitation, are examined. Findings are based on results from four projects: a model project providing guardianship services to low-income older adults; an elder abuse demonstration project; a study of judicial decisionmaking on gaurdianship and the elderly; and a survey of guardianship petitions and adjudications. The findings suggest that guardianship is not always the most effective means for meeting the needs of at-risk older adults, and guardianships do sometimes fail to protect wards from abuse and neglect. Eight recommendations for developing guardianship alternative programs are offered.     

Non-Abstinence-Based Supportive Housing for Persons with Co-Occurring Disorders: A Human Rights Perspective

Surveys of providers of social services in Portland, Oregon, in 2003 and 2007 revealed a significant policy shift in meeting the housing needs of chronically mentally ill, homeless persons with ongoing substance-abuse problems. The shift in policy, taking place in Portland, Seattle, Washington, Minneapolis, and other U.S. cities, from a sobriety-first requirement to a housing-first philosophy has occurred largely because of cost-effectiveness. Only when such housing is provided as a human right can we say that a true paradigm shift has occurred.     

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.     

The Availability of Adequate Housing for Older People:

Part of the strength of the arguments posed by housing advocates for the elderly rests on why the elderly merit special attention. Using two indicators of housing need, physical adequacy and affordability, the elderly are shown to be relatively less well-off than the nonelderly both at a point in time and persistently over time. A review of the federal government's response to the elderly's housing needs suggests that the number of households in need will continue to outdistance the number of households who actually receive assistance.     

澳门特区残疾人就业支持和社会服务考察报告

为了落实党的十九届四中全会关于“健全残疾人帮扶制度”“完善重点群体就业支持体系”等要求,在澳门特区回归20周年之际,2019年11月20日至23日,中国残联研究室、维权部、教就部、港澳台办和信息中心、残疾人事业发展研究中心共同组团赴澳门特区就残疾人就业支持和社会福利服务进行考察和交流,先后拜访了中央人民政府驻澳门特别行政区办公室、澳门特别行政区政府社会工作局,与澳门街坊总会、澳门扶康会、澳门弱智人士服务协会及所属服务机构进行了交流。代表团分外感受到澳门地区各界爱国爱澳的浓厚氛围和社会服务的显著成效。现将有关情况报告如下。     

A Global View of Changing State and Family Support for Older Persons

No abstract available for this article.     

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.     

Influence of Satisfaction with Services on Assisted Living Resident Satisfaction

The purpose of our investigation was to provide insight into the service domains that most heavily influenced self-reported resident satisfaction among residents in assisted living facilities. Data was gathered from the 2008 Press Ganey Assisted Living Survey. Satisfaction with service domains was measured using 7 subscales addressing the areas of activities, staff attentiveness, meals, apartment space, facility attractiveness, personal issues, and management. Generalized linear mixed models were specified to assess the influence of demographics, functional status, self-rated health, and satisfaction with service domains on resident satisfaction. In the final multivariate model self-rated health, independence with laundry and finances, and satisfaction with aides, meals and management demonstrated a significant positive effect on resident satisfaction. As the number of assisted living facilities continues to increase, senior management would be wise to consider which domains of service are particularly salient in assisted living environments.     

Scandinavian Contrasts and Norwegian Variations in Special Housing for Older People

De-institutionalization is a general trend for Scandinavian long-term care over the last decades. Denmark and Sweden have taken this trend a step further than Norway has, as Denmark suspended institutional care altogether in 1987 and Sweden in 1992. Since then, residential care has been provided to individuals in special housing in various forms. This housing is in principle “independent housing,” where residents are tenants and are provided services according to needs and not sites. This article concentrates on the Norwegian variations to this system, as this is the only country of the 3 that still provides residential care under 2 “regimes,” an institutional care regime and an assisted housing regime. Is assisted housing essentially different from institutional care, or is it better described as old wine in new bottles? The latter may be the case for Sweden, whereas Denmark stands out as having the most housing-oriented care model. Institutional care (i.e., nursing homes) still dominates in Norway, where assisted housing is merely a minor supplement to institutional care in most municipalities. The article explores the reasons for these trends and, in particular, the reasons for the Norwegian resistance to assisted housing as an alternative form of residential care.     

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.