Resource allocations to the aged according to greatest social need

The purposes of the study reported on in this article were: (a) to explore the measurement of social need among the elderly, and (b) to develop an appropriate method for including social need in funding allocation procedures. Interview responses from over 4,000 randomly selected elderly persons were used to identify the demographic correlates of those having the most restrictions in their every-day lives. Procedures for intrastate allocations were developed using variables suggested by the Older Americans Act and by research to explain variance in activities of daily living. Variables tested for the model were: age, income, living arrangement, gender, ethnicity, area of residence, occupation, hospitalization, years in the neighborhood, language at home, and utilization of senior services. Prediction formula weights were adjusted (magnitude of beta i/sigma magnitude of beta i) to allocate resources to the proportions of 10 "high-need" groups residing in each planning area: the population aged 75 and older, the proportion of hospital discharges of elderly patients, elderly females, elderly non-Caucasians, the elderly not completing high school, elderly farm workers, elderly urban residents, a proportion for participation in senior services, for low-income elderly persons, and for the elderly not living with their spouses. Compared to current systems, the proposed procedure provides a closer fit to the actual needs of the elderly.     

Equity and efficiency in the allocation of the personal social services

This paper investigates two issues of equity in the receipt of the home help service, one about territorial justice, the other about sex discrimination. It uses GHS data for 1980. An argument is developed about the efficiency with which services are targeted on persons who by normative criteria would appear to have most need of them. Efficiency is of two types: horizontal efficiency, the proportion of persons judged in need who receive services; and vertical efficiency, the proportion of services allocated to persons judged in need. The findings are that there is evidence of inequity both between different areas and between the sexes. Metropolitan areas are advantaged compared with rural areas, and this cannot be explained by differences in social support nor by the availability of other domiciliary services. Among the elderly living alone, neither sex is advantaged, but in elderly married couple households the home help service is more frequently provided in the case of a husband caring for a disabled wife than in the case of a wife caring for a disabled husband.     

Chapter 5 Impacts of Profit Status of Assisted Living Facilities

Abstract

Florida is a bellwether state in terms of the need for assisted living among elderly persons and has more than 2,000 of the nation's estimated 11,459 assisted living facilities (ALFs). The authors of this article surveyed 140 ALFs in Florida in order to examine the relationship of profit status to ownership of other facilities, willingness to serve low income groups, formal policies, and persons involved in decisions about resident retention. Significant differences were found between for-profit and non-profit facilities in terms of ownership of nursing homes and resident involvement in retention decisions. A discussion of how the profit motive and formal policies can impact residents concludes the article.     

Geographic Migration Among Residents in Seniors Housing and Care Communities: Evidence From the Residents Financial Survey

ABSTRACT

Although the elderly as a while show relatively little geographic migration in the U.S., we were interested in the geographic migration patterns among a specific subset of elderly that we know have moved out of the traditional family home—those living in assisted living and independent living communities. We analyze data from the Residents Financial Survey, a survey of 2,617 residents in assisted living and independent living communities that asked about their previous living arrangement, where they lived before moving to their current community, and how their care needs were previously met. We find there is substantial migration among respondents. Using self-reported and community-reported location and zip code information, we calculated whether people moved across state lines and we computed the distance people moved between their previous location and their current community. While the median distance moved is less than 10 miles, 20% moved across state lines and 21% of the sample moved more than 100 miles, with the average distance moved among the sample being 165 to 190 miles. The evolution of living arrangements shows that there are strong correlations among respondents' current living arrangements, previous living arrangements, and their plan to move in the future.     

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.     

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.     

Interviewing Elderly Residents in Assisted Living

The interpretation of interview data requires an understanding of its context. In this study, the context was Assisted Living (AL). Twenty-one interviews were conducted with elderly residents of 4 Midwestern Assisted Living Facilities (ALFs). Institutional fear and loneliness associated with ALF living framed residents’ interpretation of and responses to the interview questions. Residents feared transfer to a nursing home, and they experienced the loneliness of being cut off from their homes and put into the care of busy staff members. Their framing of and responses to questions (both qualitative and quantitative) reflected this context, and included the invocation of impairments, the reluctance to criticize staff, and the refusal to complain about the ALF or their present situation.

Setting priorities in aging populations: formal service use among Mexican American female elders

This study establishes empirical patterns of formal service use by a sample of 483 elderly Mexican American women, and identifies the predictors of formal service utilization. Results indicated two patterns of service use-in the home and at senior centers. Regression analysis demonstrated that the best predictors of who used formal in-home services were those with functional impairment in Instrumental Activities of Daily Living (IADLs) and those with the least amount of assistance with IADLs provided by family members. Living alone and attending group social events were the best predictors of the use of senior center services. Anticipated changes in the Mexican American population portend a growing need for both in-home and senior center services. These findings can be used to establish policy and programming priorities for this neglected population. If resources are to be effectively targeted to frail elders, in-home services should receive priority, and the provision of in-home services should be modified to include additional programs that facilitate care of the elderly by the family.     

Living Arrangements and Informal Social Support Among the Elderly

One of the most pervasive patterns in living arrangements observed among today's elderly has been the increasing propensity to live alone. This paper assesses the extent to which living along, living with a spouse, or living with others (no spouse present) affects several dimensions of informal social support. The data for this study are from a 1983 survey focusing on living arrangement choices among elderly persons living in London, Ontario, Canada. Overall, living arrangement is considerably more important as a determinant of instrumental support than social contact. Elders choosing to live alone appear to sacrifice some degree of mutual exchange for privacy and independence. They also tend to rely on friendship to a greater extent than marred elderly or those who co-reside with others. Implications for support services and changes in the family are discussed in the context of living arrangement selection in later life.     

Utility of the Maryland Assisted Living Functional Assessment Tool

Abstract

The purpose of this study was to consider the utility of the Maryland Assisted Living Functional Assessment (MALFA) in terms of predicting successful living in an assisted living facility. Consideration of utility of this tool was based on the predictive ability of the measure at baseline to explain length of stay and level of care needed for residents (nursing home versus assisted living) over a five year period. A total of 76 residents from a single ALF in the Baltimore area were tested annually over five years. Those who transitioned to a nursing home at some point during the 5-year period (47%) had higher mean scores on admission with regard to need for nursing interventions because of cognitive and psychiatric problems or to perform medical treatments. Medical illness influenced number of years in assisted living and accounted for 7% of the variance (F = 7.2, p < .05). The assessment tool provides a wealth of information about the resident and can be used to alert providers to consider individuals with high scores in subscales such as need for monitoring of cognitive and psychiatric problems or need for medical treatments in terms of being at risk for nursing home placement. Future work should consider how to optimally use the MALFA to implement interventions in assistive living that will prevent decline in areas that seem likely to result in a need for a higher level of care.     

Predictors of Use of Senior Centers by Elderly Chinese Immigrants in Canada

Abstract

This study examined the prevalence and predictors of use of senior centers by a random sample of 1,537 elderly Chinese immigrants in Canada. A service utilization model of Andersen and Newman (1973) was adopted as the theoretical framework to examine the predicting effects of predisposing, enabling, and need factors. The findings showed that 28.8% of the elderly Chinese immigrants reported using a senior center within the past year. Having a religion, living alone, having stronger Chinese ethnic identity and stronger social support were the significant predictors identified, as shown in the hierarchical logistic regression findings.     

Distribution and Utilization of Home- and Community-Based Long-Term Care Services for the Elderly in North Carolina

ABSTRACT

Provision of home- and community-based long-term care is a growing concern at the national, state, and local levels. As more persons grow old, the need for these services is expected to rise. This analysis examines the distribution and utilization of three home- and community-based long-term care programs in North Carolina for each of the state's 100 counties. Maps were generated to examine how counties differed in respect to service utilization among the elderly. Great variability was found in number of elderly utilizing the services across the state as well as the percent of Medicaid- and/or age-eligible persons who utilized the programs. Multivariate modeling for associations to service utilization was only possible for one of the long-term care programs. Results indicated that living alone, being non-white, and having a mobility and self-care limitation were all positively related to utilization. Percent of persons 85 years or older and the ratio of institutionalized long-term care beds were negatively associated with utilization. It was concluded that states must engage in concerted efforts to ensure equity in access to home- and community-based long-term care.     

Naturally Occurring Retirement Community-Supportive Service Program

Summary

Devolution is defined as the transfer of power or authority from a central government to a local government. This article addresses federal policies on housing for the elderly and the devolution of funding for federal senior housing and describes two aspects of devolution of federal housing policy for the elderly. One, it points out the decreasing interest in senior housing by federal authorities as indicated by the decreased amount of funds allocated for this purpose. Two, it emphasizes the need for supportive, assistive services for residents of senior housing and how federal funds have not addressed this need adequately or sufficiently. As a consequence, there have emerged Naturally Occurring Retirement Communities (NORCs) in New York State, a housing arrangement that provides supportive and health services to all eligible residents. The article concludes with a discussion of policy implications and the need for additional research before replicating this model.     

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.     

The Mediating Effect of Resilience Between Social Support for Exercise and Resident Satisfaction in Assisted Living

This study examined whether residents' level of resilience mediated the relationship between social support for exercise from staff and resident satisfaction in assisted living. This was a secondary data analysis using baseline data from a function-focused care intervention study including 171 residents from four assisted living facilities. Using structural equation modeling, we found that mood and social support for exercise from staff were the only variables associated with resilience. Mood, gender, cognition, and social support for exercise from staff directly influenced resident satisfaction and explained 31% of the variance in the model. Implications for future research and practice are discussed.     

The effect of age desegregation on environmental quality for elderly living in public/publicly subsidized housing

A random sample of elderly living in age-desegregated public housing for the elderly is compared with a random sample of elderly living in age-homogeneous Section 202 housing in the same urban area. Findings suggest that the current trend of mixing young handicapped persons with elderly tenants is associated with a decline in environmental quality on three dimensions--social networks, territoriality, and global measures of satisfaction. The differences are not explained away by pre-existing factors, such as social and economic resources and service provision.     

Eldercare policy between the state and family: Austria

Certain aspects of the Austrian system of social security and public welfare for the elderly, on the one hand, and family caregiving, on the other hand, are reviewed. In 1993, a new attendance allowance act for needy persons is being introduced in Austria. This reform includes cash payments on seven different levels according to the degree of need and is supposed to increase the opportunity of choice for the elderly. This assumption remains dubious; it should not be expected that a significant number of new informal caregivers can be recruited. Furthermore, empirical evidence shows that the elderly themselves clearly prefer the expansion of social services over paid family caregiving. There is a need for more research regarding the effects of interaction among the elderly, the family, and professional caregivers and for the promotion of an empowerment approach.     

Family and Household Formations and Suicide in the United States

Family support systems have been theoretically linked to suicide risk. But no research to date has investigated the effects of detailed living arrangements on individual risk of suicide. Using data on 825,462 adults from the National Health Interview Survey Linked Mortality File reveals that living in families with stronger sources of social support and integration decreases risk of suicide. These effects persist despite controls for important individual level characteristics. Risk of suicide decreases for persons in married as well as unmarried families when children are present and risk increases for persons living with unrelated adults. These results reveal the structural importance of family formation on the social integrative forces that contribute to an individual's risk of suicide.     

Relationships Among Active Engagement in Life Activities and Quality of Life for Assisted-Living Residents

This cross-sectional research explored the relationships between active engagement in life activities (leisure, social, and instrumental activities of daily living) and quality of life for seniors aged 65 and older residing in assisted living facilities. It is increasingly recognized that active participation in diverse physical, cognitive, and social activities can promote older adults’ quality of life, including physical and mental health, but there is limited information about this in the population of residents in assisted living facilities. It is estimated that there are one million older adults residing in assisted living facilities, making assisted living facilities a rapidly growing segment of senior housing. Older adults who relocate to assisted living facilities commonly experience lifestyle changes, often related to their altered physical and social environment, reduced demands regarding household chores and meal preparation, and new opportunities for recreation and socialization. In this study, interviews were conducted with 131 ambulatory residents from assisted living facilities in the New York City metropolitan area using the 55-Item Activity Checklist, SF-36v2, Life Satisfaction Index-Z, and demographic questions. Results found significant low to moderate correlations between retained engagement in life activities (leisure, social, and instrumental activities of daily living) and life satisfaction, and several quality of life domains, including physical functioning, mental health, general health, and vitality. Older adults continued to engage in a greater percentage of everyday life activities they identified as important. This data supports exploration of client-centered activity programs to promote participation of residents in assisted living facilities in diverse activities to both maintain resident functional abilities and manage functional decline.     

Naturally Occurring Retirement Community-Supportive Service Program: an example of devolution

Devolution is defined as the transfer of power or authority from a central government to a local government. This article addresses federal policies on housing for the elderly and the devolution of funding for federal senior housing and describes two aspects of devolution of federal housing policy for the elderly. One, it points out the decreasing interest in senior housing by federal authorities as indicated by the decreased amount of funds allocated for this purpose. Two, it emphasizes the need for supportive, assistive services for residents of senior housing and how federal funds have not addressed this need adequately or sufficiently. As a consequence, there have emerged Naturally Occurring Retirement Communities (NORCs) in New York State, a housing arrangement that provides supportive and health services to all eligible residents. The article concludes with a discussion of policy implications and the need for additional research before replicating this model.