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     

How do low-income older women experience living in congregate housing? A qualitative study of housing welfare intervention for older adults living alone in South Korea

The purpose of this study was to refine the understanding of the experiences of low-income older women living in congregate housing. Congregate housing refers to small-scale communal living arrangements for low-income older adults intended to reduce their social isolation and financial burden. Interviews with 12 older women and field notes were analysed using thematic analysis. Four themes were identified: (1) these older women chose congregate housing because they had no better option; (2) they gradually grew accustomed to communal living by being alert, mindful, and considerate; (3) their range of activities and interactions with the outside decreased as they aged; and (4) they came to require further care as senility progressed. Based on these findings, the meaning of housing welfare for older adults and the importance of providing additional supportive services are discussed. It is also asserted that housing welfare intervention should include protection of older adults’ housing rights.     

"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.     

“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.     

Sheltered Housing and Community

This paper considers the role of sheltered housing following the introduction of new community care arrangements in 1993 and examines the continuing uncertainty about its exact role as community care continues to develop. It reports on a study conducted in Shropshire, using a postal survey and interviews with older people and service professionals. The study highlights the importance of sheltered housing for older people, particularly in relieving them of concerns about maintenance and repairs, social isolation and security. These factors were crucial for their overall peace of mind and quality of life. While only a small proportion of tenants received help under social services' community care arrangements, the additional support, monitoring and service coordination provided by wardens helped some of them to remain in sheltered housing when residential or nursing home care might otherwise have been necessary. Sheltered housing was overwhelmingly popular with older people — but their satisfaction was closely associated with the availability and quality of the warden service. Although sheltered housing is not currently in vogue in housing policy, the paper argues that it plays a vital role in local provision for older people and needs to be more closely integrated into community care policy, while at the same time preserving the characteristics that make it popular with its residents.     

Adverse Childhood Experiences and Substance Use History among Vulnerable Older Adults Living in Public Housing

ABSTRACT

Previous research shows strong correlations between adverse childhood experiences (ACE) and later life health. The current study examines the relationship between ACEs and substance use among older adults living in public housing. Results show that about one-third of participants had four or more ACEs, and ACE score predicted likelihood of substance use history. Over half of older adults with four or more ACEs experienced substance abuse in their lifetime compared to one out of ten older adults with less than four ACEs. Findings shed light on a vulnerable group and point to next steps in research and practice.     

How Effective are Helpers to Older Adults’ Life Satisfaction?

The effectiveness of help received from home care workers and volunteers to the life satisfaction of community-dwelling older adults is vital but uncharted. To address the effectiveness, this study aims to optimize the use of social resources for the older adults’ life quality. The study thus surveyed 398 community-dwelling older adults in a city of China about the help and life satisfaction. Results showed a significant positive effect of help from home care workers, but not that from volunteers, on the older adult’s life satisfaction. Moreover, the effect of help from volunteers was significantly greater when the older adult had higher education or lower family income. These effects are explicable with resource theory and need fulfillment theory. They imply the worth of promoting help from home care workers generally and volunteers conditionally to champion older adults’ life satisfaction.     

Adults with a Learning Disability Living with Elderly Carers Talk about Planning for the Future: Aspirations and Concerns

The majority of adults with a learning disability live withfamily carers, many of whom are ageing and have support needsof their own. Planning for the future thus becomes the key topreventing a crisis situation when family care is no longerviable because of death or ill health. Existing knowledge andpractice are largely based upon the perspective of professionalsand carers. This study explores the views, aspirations and concernsof adults with a learning disability, about living at home andplanning for the future. Findings show that participants werevery aware of the need for alternative housing or support inthe future and had clear preferences about their future options.However, they also showed extensive concern for their familycarers and this often impacted on their willingness to planfor the future or to move to alternative housing. Their demonstrableawareness of the inevitable death or ill health of family carers,and willingness to engage with the implications, emphasize theimportance of involving adults with a learning disability inplanning for their future, as well as providing them with bereavementsupport.     

Alcohol Misuse Among Older Adult Public Housing Residents

Low-income older adults living in public housing are at heightened risk for substance misuse. This study identified the prevalence of alcohol misuse among older public housing residents (n?=?187) and explored predictors of problem drinking. Including weekly drinking levels and binge drinking, 23% of the sample engaged in problem drinking behaviors. Logistic regression analysis revealed that race, gender, employment status, years smoking, and illegal drug use were significant predictors of problem drinking. No residents were receiving substance abuse treatment. As the number of older adults increase, training social workers to assess and treat alcohol misuse in older adults is critical.     

Housing disparities, caregiving, and their impact for older Puerto Ricans

The needs of older persons in historically oppressed racial and ethnic populations remain "invisible" in the public arena (Wallace & Villa, 1999). Understanding the ethnocultural factors that shape their housing needs is essential to effective, equitable policy formation and program planning. This article examines the impact of housing disparities, health status, and cultural patterns of caregiving in relation to older Puerto Ricans on the U.S. mainland. Following a literature review of the socio-economic, living arrangement, and cultural profiles of older Puerto Ricans, policy recommendations to advance adequate housing options for this population are provided. The article concludes with a discussion of Section 202 housing policies and how they can be adapted to the current and emerging population of older Puerto Ricans.     

Exploring “Home” Through Residents’ Lenses: Assisted Living Facility Residents Identify Homelike Characteristics Using Photovoice

An increasing number of older adults are moving into assisted living facilities when living independently becomes difficult. These facilities afford older adults a home-like environment with opportunities for social activity and a minimal level of professional care, although relocation can negatively impact well-being. Because it is important to study home environments of aging adults, 10 residents of an assisted living facility were engaged in Photovoice to explore perceptions of the facility as home. Through photographic expression, residents identified environment enhancements for home at an assisted living facility. Findings of this study have implications for program planning at long-term care facilities.     

Transitions in Caregiving: Evaluating a Person-Centered Approach to Supporting Family Caregivers in the Community

Caregivers of older adults provide a wide range of informal supports and services that enable older adults to continue living in the community. This study describes the use of a multicomponent intervention combined with a person-centered approach to assist caregivers of older adults in the community. Four hundred and eighteen caregiver and care recipient dyads participated in this study and their outcomes related to burden, depression, well-being, and care recipient functional status were evaluated. The findings suggest that adult child and spousal caregivers experience burden differently. Programs designed to support caregivers must tailor services to the unique needs of adult child and spousal caregivers.     

Religious congregations as social services providers for older adults

A large proportion of older adults are affiliated with congregations. The literature suggests that, in general, religious participation among the older adults enhances their quality of life and provides a network of social care. In this article, we explored the relevant literature on organized religion and social support for older adults. Based on a census study of congregations in Philadelphia (N = 1,393), we documented the following: (1) the number of congregations serving older adults, (2) the types of services provided, and (3) the number of beneficiaries. The study also identified the organizational factors that predict the provision of congregation-based services for older adults. The findings suggest that serving older adults is not a top priority for most congregations. Most senior programs are small and often informal. Approximately half (48%) of the congregations do not provide a formal social service. However, those congregations that are more likely to serve older adults have larger budgets, more members over 65-years-old, and a moderate political orientation. We recommend that congregations, social service providers, and older adults explore ways to maximize this underutilized resource of congregational services to meet the needs of the increasing number of older adults.     

Subjective experiences of older adults in poverty in urban China and the role of social policy

This study establishes an evidence base regarding the experiences of older adults living in poverty in Beijing. Given the factors that shape the lives of low-income older adults, the findings are relevant for many middle- and low-income countries. Based on a series of in-depth interviews conducted with government officials and low-income older adults in Beijing, the study finds that poverty manifests as cumulative stress arising from four sources: financial strain, poor health, care burden and poverty-related shame. This stress is attributable to the co-existence of individual and structural factors that reflect the framing of anti-poverty policies in China.     

农村老年人生活状况的调查与思考——以胶南市Z村为个案

随着我国人口老龄化的加速,数量庞大的农村老年人的生活状况日益引起世人关注。通过对胶南市Z村老年人的经济收支、健康及医疗、住房及养老、精神文化生活等基本状况的调查,发现他们基本实现“老有所养”,但“老有所乐”的目标尚未达到。适度转变农村养老模式、建立健全农村养老保障制度、加强精神文明建设等,成为当前提高农村老年人生活质量的较为可行的对策。     

Ageing Populations and Housing Needs: Comparing Strategic Policy Discourses in France and England

Set against a broad European policy agenda which promotes ‘ageing in place’ and representations of older people as active, independent citizens, this article compares recent English and French policy discourses on population ageing and its implications for the housing needs of increasingly large numbers of older citizens. Through analysis of six recent strategic policy statements representing each government's official responses to population ageing and its social policy implications for the 21st century, we demonstrate how differences in the social representation of the ageing process and of older peoples themselves permeate policy discourse, influencing the perceptions of the housing needs of older citizens and the role that housing itself may play in promoting independent living. In England, demographic ageing, housing and its role in facilitating independent living and active ageing are explicitly articulated, whilst in France, the housing environment has until recently, been portrayed as one which must accommodate the illness, incapacity and dependency of later life. Our article offers explanations for these differences in terms of cultural variations in the social representations or ‘constructions’ of later life, divergences in political philosophies and welfare principles.     

Enabling Adults with Learning Disabilities to Articulate their Housing Needs

Correspondence to Dr Alex McGlaughlin, Department of Social Sciences, The Nottingham Trent University, Burton Street, Nottingham NG1 4BU, UK. E-mail: alex.mcglaughlin{at} ntu.ac.uk Summary This study is about involving adults with learning disabilitiesin service planning by asking them to articulate their own needsin relation to housing. It also identifies some of the barriersto meeting the housing needs of this group. The views expressedindicate that ordinary housing with small numbers is the preference,and that appropriate support is highly valued. This suggestsa need for housing of a supported living model or similar. Theservice users in this study were clearly able to verbalize theirpreferences as well as to think through potential options. However,there is also clear evidence that they feel powerless in makingchoices, with decisions being taken on their behalf by professionalsand carers. This demonstrates the need for a cultural shiftwhereby the voices of adults with learning disabilities areheard and acted upon.     

Preparation of youth in congregate care for independent living

This paper reports on findings from a qualitative study that focused on the quality and adequacy of preparation of youth in congregate care for independent living. This study, conducted in New York, NY, USA, explored the extent to which youth feel prepared to leave care and the opportunities they are given to participate in planning and decision‐making regarding issues that personally affect their future. Interviews were conducted with professionals and young adults who had exited foster care after placements in congregate care settings. Both professionals and young adults stated concerns about the quality of independent living preparation. Many young adults stated that they were not ready to live independently and expressed concerns about failure of staff to begin preparing youth sufficiently in advance of their discharge dates. Young adults also reported limited opportunities to participate in the planning and decision‐making processes affecting them. Recommendations for improvement of independent living preparation are proposed.     

Older Carers of Adults with a Learning Disability Confront the Future: Issues and Preferences in Planning

The Valuing People White Paper (Department of Health, 2001)requires services to secure a plan for all service-users withlearning disabilities living with older carers and promisesthem and their families more choice and control over how andwhere they live. This paper examines the views of the oldercarers (aged over seventy) of sixty-two adults with a learningdisability about planning for the future. Fifty-six took partin interviews in their own homes and six completed a questionnaire.All carers were white and recruited from one local authorityin response to the requirements of the White Paper. Findingsindicate that a significant proportion (thirty-four—55per cent) is either not ready or is unwilling to make futureplans. Barriers to planning include a perceived lack of needdue to the existence of two carers, a lack of awareness of timescalesinvolved in securing housing, difficulties in letting go, alack of confidence in available housing options, and the existenceof mutually supportive relationships. The findings show a needfor a proactive approach to information and support provisionto enable these families to work through a process of makingplans for the future. This is essential to prevent the needfor emergency placements in response to crisis and in turn toensure that adults with learning disabilities have genuine choiceand involvement in how and where they live.