Rural small towns: an environmental context for aging

Following a brief review of sociological and psychological definitions of rurality, this paper illustrates the uses of an empirically-derived taxonomy of environmental perceptions for understanding the rural experiences of older residents of small towns in the midwestern United States. Specifically, variations in perceptions of twelve dimensions of rural environments were examined (1) among older residents of small towns of different sizes (populations 100–500, 501–1500 or 1501–2500), and (2) among four groups of older residents (n = 898) displaying differing profiles of subjective social and psychological well-being. Reliable town- size differences in environmental perceptions were found for eight of the 12 environmental attributes. Illustratively, residents of smaller towns reported lower levels of community satisfaction and community involvement, higher levels of intimacy and consensus on town issues, and fewer barriers to services and activities than residents of larger towns. Reliable differences in environmental perceptions were found for ten of the attributes for older residents differing in well-being. For example, more frail residents were less satisfied with their communities, and felt more constricted and isolated by physical barriers and social norms; they were less involved in their communities and less aware of available community services. The advantages of the application of person-environment taxonomies to research and intervention in rural environments are discussed. Chief among these is the refinement gained in the understanding of individual differences in ecological adaptation.     

Social Capital and Participation in Community Improvement Activities by Elderly Residents in Small Towns and Rural Communities*

Abstract This study critically reviews theoretical concepts and measurements of social capital and tests hypotheses that elaborate how four dimensions of social capital (informal social ties, formal social ties, trust, and norms of collective action) and sense of community are related to participation in community improvement activities for elderly residents in small towns and rural communities. Mail surveys of 2,802 elders in 99 small towns and rural communities in Iowa reveal that many elders are actively involved in their community. Social capital and sense of community are very important in predicting elderly participation in community improvement activities, but they relate differently to elderly community involvement. Formal ties and sense of community have much stronger relationships with community involvement than informal ties and norms of collective action. Generalized trust is not significantly related to elderly community involvement.     

Community Connections: Social Capital and Community Success1

This article examines the impact of two types of community social capital—ties between civic organizations formed through shared members and ties between residents formed through socializing in local gathering places—on residents’ subjective appraisals of community success. Community social capital studies tend to focus on the first of these types of ties, networks of civic engagement, while the second, gathering place networks, has received relatively little scholarly attention. Studying both allows me to assess the formal and informal arenas of community sociability, providing a more thorough understanding of social capital and community life. I assess the effects of community‐level social capital networks on the individual‐level experience of residing in the community using survey data on 9,962 residents from 99 small towns in Iowa. This rich data set allows me to avoid two shortcomings common in social capital research: I construct genuine network measures of social capital (rather than infer network structure from community attributes) and conduct multi‐level analyses (rather than rely on disaggregation). My findings indicate both types of social capital are positively and significantly associated with resident ratings of community success, suggesting community networks—in both the formal and informal sectors—have important consequences for small towns and their residents.     

On the edge: Balancing health, participation, and autonomy to maintain active independent living in two retirement facilities

This study examines how independent living residents in Continuing Care Retirement Communities (CCRCs) work to maintain a healthy, active community. Specifically, this paper elucidates how independent living residents, who have high status in CCRCs but also face transitions to more advanced care, manage their daily lives to build a positive sense of community against the backdrop of potential health and social declines. The researcher supplemented four years of observation in one CCRC and two years of observation in another with qualitative interviews with thirty residents from both facilities. Results indicated that shared sentiments contrasting the active social world in independent living with other living units, norms of mutual support balanced with autonomy, social participation as a source of belonging (or isolation), and definitions of deviance surrounding functional health and manners framed residents' understandings of daily life by reaffirming independent living residents' privileged status in each facility.     

Chapter 3 Residential Care Facilities for the Elderly

Abstract

Residential Care Facilities for the Elderly (RCFEs), known as board and care homes, are licensed in California and many other states for non-medical care in the community. RCFEs are examined here to provide illustrative issues in the definition of types of long-term residential care. The research examines physical functioning, social supports, and course of residential placement for 109 RCFE residents (mean age 84 years). A significant portion of the residents had personal assistance needs not usually provided at the RCFE level (75% assistance with medication, 52% used walking aids, 29% assistance in bathing). Additionally, a third of the residents had restricted social supports and social activity. Residents report declines in functioning and support as reasons for moving to residential care. Length of residence in the facility (range less than a year to 15 years) was not related to physical functioning or social activity. These findings do not support “aging in place,” within the facility, as the rationale for increased need for assistance in residential care. Implications include the need to maintain the social model of residential care ample for the majority of residents while assuring the availability of a higher need for assistance of a significant portion of the residential care population.     

Extra Care Housing in the UK: Can it be a Home for Life?

Extra care housing is believed to constitute a home for life, precluding the need for institutional accommodations, but currently there is little substantiating evidence. Longitudinal data show that 8.2% of extra care housing residents will move to institutional accommodations after 5 years. Matching analyses suggest that extra care housing residents aged 80 years and older are approximately half as likely to enter institutional care compared with older people in the community in receipt of domiciliary care, albeit with some caveats. Extra care housing may embody a home for life for the majority of residents, although a substantial minority is likely to require institutional care.     

Creating SPOTs for Successful Aging: Strengthening the Case for Developing University-Based Retirement Communities Using Social-Physical Place Over Time Theory

Five elements are cited as being critical for a university-based retirement communities’ (UBRCs’) success: proximity to the university, two-directional programming, continuing care, a financial link to the university, and a minimum 10% resident connection to the university. We illustrate these criteria using examples from existing UBRCs. The comparisons are then contextualized in the broader framework of Social-Physical Place Over Time (SPOT) theory. SPOT theory focuses on the interactions between social and physical places among older adults. By analyzing the intersections between SPOT theory and UBRC criteria, we identify additional criteria to improve the definition of a UBRC: transportation support and facilitating activity. UBRCs offer value because they provide the social and physical place where older adults can live when they retire, thereby improving changes in individual agency and belongingness needs, which are key tenets of SPOT theory. The integration of the UBRC criteria and the SPOT theory framework builds on this relatively new meta-theory in environmental gerontology. SPOT theory effectively highlights how UBRCs benefit older adults and the community; UBRCs provide significant benefits not only to older adult residents, but also to the university communities that house them.     

The Meaning of a “Sense of Community” in a Finnish Senior Co-Housing Community

In the foreseeable future, alternative housing options will be needed to meet the needs of and answer to the wishes of older people. Co-housing schemes are developed to fulfill the need for a housing type that provides mutual support and social contacts while alleviating the isolation and loneliness often experienced in ordinary neighborhoods. This study on a senior co-housing community in Finland asked what a “sense of community” meant to the residents and how a sense of community becomes visible in daily life. For these residents, a sense of community meant not only living with like-minded people but also communal activities, doing things together, learning from each other, and having reciprocal support, all of which created a sense of togetherness, belonging, and trust. The findings of this study showed that moving in later life can offer a viable option of having a living environment that one likes, which calls for a broader interpretation of housing policy guided by “aging in place” thinking.     

Users' involvement in their care. A follow-up study

1. User involvement in both care planning and staff development helped staff and residents at a community rehabilitation unit in terms of attitudes and care delivery. 2. Undertaking follow-up work shows progress in care management for staff and in social skills development for residents. 3. The results of this study provide clear indications of positive progress and identify a few areas where work still need to be done to improve care.     

Gender Competition and the Preservation of Community in the Allocation of Administrative Positions in Small Rural Towns in Montana: A Research Note1

Abstract Assignment of administrative positions in a sample of rural towns is demonstrated to be significantly associated with gender. Most civil administrators are women, while most legal and educational administrators are men. The difference indicates structural assignment of positions by gender. Gender and administrative position are demonstrated to have zero-order correlations with perceptions of two important behaviors for community: migration and social problems. The characteristics of the occupation and of the administrators are qualitatively different. The data are compiled from interviews with seventy administrators in five pairs of small towns in Montana, ranging in size from about 200 to approximately 7,000 residents. Each pair contains one agricultural and one scenic recreational town. Comparatively, more women were employed in agricultural towns. Many rural women who become administrators, particularly long-term administrators, may be selected for reasons that help preserve the community by providing opportunities for themselves and their families.     

“It Depends on How You Define Integrated”: Neighborhood Boundaries and Racial Integration in a Baltimore Neighborhood1

There are a significant number of racially integrated neighborhoods in the United States, many of which have been stable over time. However, very little is known about the characteristics of these neighborhoods and of the residents who live in them. With data taken from a larger study of an integrated neighborhood in Baltimore, Maryland, this article discusses homeowners’ perceptions of their community and racial integration. Fifty semi‐structured interviews were completed with 67 homeowners to investigate their perceptions and experiences of race, class, and change in their community. This study shows that statistical racial integration and perceptions of racial integration are two different factors. Residents define true racial integration as both residential and social. As a result, homeowners reported that their neighborhood is both segregated and integrated—a type of “qualified” integration. Perceptions of racial integration are also affected by inconsistently defined neighborhood boundaries and racial clustering, block by block.     

Theory-Based Community Practice for HIV Prevention in Midlife and Older Women

ABSTRACT

In the last decade there has been a significant increase in HIV transmission among midlife and older women, particularly those from racial/ethnic minority communities. Although the number of women aged 50 and older diagnosed with HIV infection in the United States is increasing, they are rarely included in community HIV prevention strategies. This article presents integrating social capital with social justice themes into a socioecological framework for community practice that can significantly impact the efficacy of HIV prevention programs for midlife and older women. It also reviews the research and program implications for including midlife and older women in community interventions to halt the spread of HIV infection in this at-risk group. Suggestions for HIV prevention community practice with this underserved population are presented.     

The Association Between the New Rural Cooperative Medical System and Health Care Seeking Behavior Among Middle-Aged and Older Chinese

The new rural cooperative medical system (NCMS) is the primary form of social insurance in rural China. This study aims to explore how the NCMS influences the health care seeking behaviors of middle-aged and older Chinese, considering the family and community contexts. A series of multi-level (three-level) models using data from the first wave of the China Health and Retirement Longitudinal Study (CHARLS) are used. We find that the presence of NCMS coverage has a statistically significant association with seeking inpatient and outpatient care but not physical checkups among middle-aged and older rural Chinese: Rural residents insured by NCMS were more likely to seek inpatient and outpatient care than people who were not insured. Other factors at the individual level (such as self-perceived health and number of doctor-diagnosed chronic diseases), the family level (such as living arrangements and household expenditures), and the community level (such as the presence of township hospitals within the community) are also significant predictors of health care seeking behaviors.     

Racial differences in urban neighboring

Despite mixed expectations generated by existing theories and evidence, this analysis documents clear racial differences in urban neighboring behavior. Using data from a survey of Nashville, Tennessee, residents, we show that blacks interact with their neighbors more often than whites do, and in a greater variety of ways. The only noteworthy similarity between the two groups is the positive impact of neighboring on feelings of community affect. Overall, our results support the view that neighbor relations — like other kinds of informal participation — have helped blacks cope with constrained social opportunities and provided them with access to resources unavailable through formal institutional channels.Revised version of a paper presented at the annual meeting of the American Sociological Association, San Francisco, August 1989.     

Experiences of Informal Caregivers of Older Adults Transitioned From Nursing Homes to the Community Through the Money Follows the Person Demonstration

This study examined experiences of 156 informal caregivers of older adults who transitioned to the community through the Connecticut Money Follows the Person (MFP) Rebalancing Demonstration after prolonged nursing home stays. Caregiver burden, positive aspects of caregiving, depressive symptoms, anxiety, and comparative subjective stress were examined in relation to caregiver demographics and care receiver characteristics with a cross-sectional survey. Caregivers reported low burden, depressive symptoms, and anxiety, and fairly high levels of positive aspects of caregiving and satisfaction with community services. Most caregivers were less stressed compared to the time the care recipient was in, or before they entered, a nursing home. Live-in caregivers experienced more positive aspects of caregiving, but adult children reported higher burden than other caregivers. Unmet service needs also increased caregiver burden. Programs like MFP are a viable option with broadly positive outcomes from a caregiver’s perspective. Enthusiasm for increasing access to community care is growing for older adults who otherwise would reside in nursing homes for extended periods. Identifying unmet service needs and needs for targeted functional support could further enhance caregiver experiences and contribute to the successful transition of older adults to the community.     

The racial geography of child welfare: toward a new research paradigm

This article examines the community-level impact of concentrated child welfare agency involvement in African American neighborhoods. Based on interviews of 25 African American women in a Chicago neighborhood, the study found that residents were aware of intense agency involvement in their neighborhood and identified profound effects on social relationships including interference with parental authority, damage to children's ability to form social relationships, and distrust among neighbors. The study also discovered a tension between respondents' identification of adverse consequences of concentrated state supervision for family and community relationships and neighborhood reliance on agency involvement for needed financial support. The author discusses the implications of these findings for a new research paradigm aimed at understanding the community-level effects of racial disproportionality.     

It Takes a Community: Older Lesbians Meeting Social and Care Needs

Although specialized formal services are becoming more prevalent in addressing the needs of the older LGBT community, little is known about informal groups that have organized to meet the needs of this population. This article presents two case examples that depict the efforts of older lesbians to meet the social and care needs of members of their communities. The concept of psychological contracting is used to analyze these experiences, and combined with a review of the literature, practice implications for care and support for this special population are discussed.     

Predictors of Nursing Home Admission: A Social Work Perspective

Abstract

Institutionalisation of geriatric patients is a growing trend in ageing societies, such as Singapore. Earlier studies focused on the sociodemographic profile and attributes of nursing home residents and applications, but neglected to address the predictors of nursing home admission from a social work perspective. The present retrospective study identifies independent risk factors that predispose a patient to a nursing home discharge from a general rehabilitation ward in a community hospital in Singapore, with a multidisciplinary emphasis on clinical intervention. Factor analysis results reinforced findings that functional impairment and dementia are consistent predictors of nursing home admission. Multivariate logistic regression analysis showed that positive predictors of nursing home admission include older age, length of hospital stay, low socioeconomic status, dementia, and functional disability. Social work interventions include early referrals to the medical social worker, so that options for social and family support can be explored prior to deciding to place patients in a nursing home. Other interventions include suitable family therapy and counselling for patients and their families.     

Unfair treatment, neighborhood effects, and mental health in the Detroit metropolitan area

Why do racial differences in many indicators of mental and emotional well-being show inconsistent patterns? We propose that mental and emotional well-being are influenced by aspects of the social context, including experiences of unfair treatment and the concentration of households with incomes below the poverty level, and that differential exposure to these factors influences racial differences in mental well-being. We analyze the reporting of psychological distress and life satisfaction in a multistage area probability sample of 1,139 African American and white residents of the Detroit metropolitan area aged 18 and older. Both psychological distress and life satisfaction are significantly associated with exposure to unfair treatment and with the proportion of households in the census block group that were below the poverty level. Racial differences in psychological distress and life satisfaction were eliminated or reversed once differentials in the percent of households living below the poverty line and exposure to unfair treatment were accounted for. These findings contribute to a growing body of evidence that "race" effects operate through multiple pathways that include race-based residential segregation and its attendant economic disinvestment at the community level, and interpersonal experiences of unfair treatment.     

Quality of life of older people in Israel: a comparison between older people living at home who are members of a ‘supportive community’ and nursing home residents

The supportive community is a program that was developed in Israel for older people who live at home. The program provides its members with a service package that includes medical and social services, emergency call-button, cultural activities, and a ‘community parent’ who is responsible for the members. Using quantitative method, this study compared the level of quality of life between 55 older people living in their homes who are members of a supportive community (average age = 74.7) and 60 elderly people living in nursing homes (average age = 75.8). As expected, results indicate that quality of life among the older people living at their homes who are members of a supportive community was higher than among the older people living in a nursing home. In addition, the quality of life of married, educated, functionally independent older people in good health and with a good economic situation was higher. Predictor variables of quality of life were: the place of residence, health status, and age. In light of increased life expectancy and the growing need to care for the older population, the practical application of the study focused on a recommendation for the social services to continue the support community development program.