2001 Aging Services Environmental Scan

 

HOW CAN THE COMMUNITY BEST SUPPORT AND CARE FOR OLDER ADULTS?

No matter where an individual is on the aging continuum today, eventually the majority will be faced with decisions about how to maintain quality of life and how to get the care they need as they age. The community as a whole plays a role in these decisions. By understanding the issues and needs facing older adults and by planning to address those needs, the community can impact the decisions older adults and families have to make. The choices the community makes today will impact every citizen.

The purpose of this chapter is to suggest steps the community can take to plan for the changes in the older adult population. Possibly the most important step the community can take now is to establish a community planning body charged with developing and implementing a comprehensive community wide plan to meet the needs of the older adult population. In order for this to be successful, it will require a serious commitment from all community stakeholders - government, service providers, advocates, caregivers and older adults. Ideally, the information in this report will serve as the starting point for the comprehensive plan.

This plan should address the two key points of this report. First, older adults want to live as independently as possible in their own homes. Second, the older adult population is increasing and the composition is changing. The expected shift in composition will produce three changes There will be more individuals over age 75, more individuals needing assistance with ADLs, and more individuals from subsets of the population that traditionally have fewer economic resources and poorer health outcomes. Combined, these three factors mean that over time, the level and complexity of care needed could increase for a significant portion of the population.

To address the key points, a comprehensive plan should focus on:

  • Identifying and implementing strategies that prevent and delay disability.
  • Ensuring the availability and accessibility of community based care and in home supports.
  • Advocating for shifting resources to support community based services.
  • Expanding and leveraging resources to meet the increasing need.

In an ideal world, older adults and caregivers would be able to access a seamless array of community based services that meet their needs. A comprehensive community plan could focus on how to strengthen what is in place today and how to build upon it to create a more seamless system. Table 17 shows an ideal continuum of care and recommendations for improving the current system.

Table 17.
Older Adult Service Continuum

SERVICE
RECOMMENDATIONS
  • Information and Referral (I&R) - Both older adults and their caregivers could benefit from a centralized I & R system as indicated by responses to both local surveys.
  • A centralized I & R system is important for older adults who do not have the capacity to navigate the complex service system. It is equally important for caregivers who do not have the time or knowledge to search for services. Although First Call for Help is an important step towards meeting this need, I & R that is specific to the needs of older adults may be necessary. Caregivers need a clearinghouse of qualified and reputable service providers - public and private.
  • See Red Tape Cutter program under Best Practices in this section. This program offers one stop easy eligibility determination for older adults living in Chicago.
  • Case management to help identify the needs of older adults and help them connect to the services they need. When used appropriately, this service can support the efficient use of resources and prevent the need for more expensive services.
  • There is a need to expand the supply of affordable case management services. As the population size increases the need for this service is likely to increase.
  • Community Connections
  • Senior Activity Centers
  • Opportunities for learning
  • Volunteer opportunities
  • Opportunities for employment
  • Currently, an array of services exists to maintain and strengthen community connections for older adults. However, lack of dependable transportation makes it difficult for individuals to access what is available. More can be done to support employment for older adults and to educate the public and employers about the skills of older adults. The recent change in rules regarding Social Security benefits and earned income may make employment more appealing for many older adults.
  • Food and Nutrition Support
  • Only a small percentage of individuals that qualify for food stamps are currently accessing this service. Increasing connections to this benefit may be a good first step.
  • Please see section of report on Food/Nutrition for specific findings and recommendations.
  • Housing and Home repair/modification
  • Improving the delivery of and increasing the availability of home modification services could be a critical first step. Consider centralized services as identified in best practices under Housing and Home Modification.
  • Please see the section of report on Housing and Home Modification for specific findings and recommendations.
  • In home supports
  • Housekeeping/chores
  • Meal delivery and preparation
  • Personal care assistance: bathing, dressing, etc.
  • Home health - managing medications and chronic illnesses
  • Grocery shopping
  • Two issues seem to be paramount for accessing in home support: cost of services and reliability of service providers. Cost is an important issue for those who do not qualify for public aid but do not have the personal financial resources to pay out of pocket. Changes in federal policy are negatively impacting the ability of individuals to receive home care services. Anecdotal evidence indicates a problem with reliability/dependability among some home care workers.
  • First step is to lobby the state legislature to increase spending for community based services provided through HCBC waivers. This will decrease the strain on local resources and/or allow local resources to be concentrated in areas not covered by state or federal programs.
  • Medical Care
  • Short term supports for recuperating and regaining independence
  • Affordable/accessible medical care
  • Help with prescription drugs
  • The greatest concern in this area is the decline in the number of physicians who are willing to accept Medicare/Medicaid assignment as well as the decline in the availability of managed care services. This is threatening access to primary care the resource that is most critical for preventing more costly care.
  • Align with and provide support to groups that are lobbying the federal government for adjustments to the Medicare benefit.
  • Identify ways to connect older adults with public programs such as the prescription drug assistance available through City/County.
  • Transportation
  • Wheelchair accessible
  • Trip escorts
  • Capacity to meet the need
  • Work with existing planning group (through Capital Metro) to address the needs in this area.
  • Please see section of report on Transportation for specific findings and recommendations
  • Protections from Abuse, Neglect & Victimization
  • Legal information - low cost legal assistance
  • Money management
  • Guardianship
  • Protective services
  • Strengthen recruiting efforts to attract additional volunteers to serve as money managers and guardians to help meet the current need.
  • Please see the section of report on Victimization for specific findings and recommendations
  • Respite care for caregivers
  • Work with local employers to expand employer provided benefits to include eldercare.
  • Please see section of report on Caregivers for specific findings and recommendations
  • Day care including care for individuals with dementia
  • A particular need exists for day care for individuals with dementia. As with other services, individuals without public aid or extensive personal resources are hardest hit by out-of-pocket costs for services.
  • These resources need to be expanded. Could be addressed through increased resources at the State level.
  • See Stride Rite Corporation under best practices in this section.

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Other communities have developed planning processes to address the needs of older adults. These plans may be useful in guiding the development of a local plan. A good example of a strategic plan is the one developed by the United Way of Allegheny County, Pennsylvania. Additional resources include those that currently exist in the community. Consideration should be given to tapping the resources that can be found through the following groups.

  • The Interagency Council on Aging organizes monthly information sessions for service providers and the general public.
  • Several local non-profit service providers meet monthly and are working to improve service coordination among participating agencies. This group has developed a common intake form used by all the agencies and has developed policies for referring clients to one another.
  • A local Community Resource Coordinating Group for older adults is spearheaded by Austin/Travis County Mental Health and Mental Retardation. This group meets monthly to address the needs of specific clients needing services.

As indicated throughout this report, communities all over the country have developed successful programs to serve older adults. These programs could be replicated in Austin and Travis County. For community planners, reconsidering the ways services are delivered can improve the conditions for older adults. The ideas outlined below are ways the community could improve the support for independent living.

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Best Practices

Chicago Department on Aging - Red Tape Cutters Program

This program improves access to services for individuals age 60 and older. Individuals complete one application to determine eligibility for more than 40 city, state and federal benefits such as energy assistance, Food Stamps, Medicare and home weatherization. The Chicago Department of Aging reviews the application and mails the applicant a computer printout of all the programs for which he/she is eligible. Information on programs and how and where to apply for benefits is included. Application is available on line or may be mailed to the applicant.

Assisted Living

Assisted living can be defined and implemented in a number of ways. It is an increasingly popular alternative to nursing home placement for older adults. Assisted living can be a place where an individual lives, or it can be a program to help someone stay in his/her own home. Assisted living facilities are places where older adults can live independently while receiving support such as meals, health care services, and help with ADLs as necessary. Alternatively the same supports can be provided to an individual in his/her home removing the need for placement in a facility. In recent years, Texas has seen a rapid rise in the number of privately funded assisted living facilities. While these provide an important alternative to individuals who are financially comfortable, they are not an option for low income older adults (Latimer). Nationally, the median cost to live in an assisted living facility is more than $2,500 a month (Providing an Affordable Continuum, 2000).

Coming Home Program

A national collaboration between the Robert Wood Johnson Foundation and NCB Development Corporation, this program offers grant support, technical assistance and loans to states to develop affordable assisted living programs linking with health care systems. Specific focus is on developing models for small and rural communities with limited resources. For more information visit www.rwif.org.

Naturally Occurring Retirement Communities (NORCs)

NORCs are another way to address the needs of seniors. These are places, buildings or neighborhoods, where at least 50% of the residents are over age 60 (AAAs 1995). While not formally a housing option, NORCs can be a way to improve the likelihood an individual can stay in his/her own home. Identifying and using NORCs offer many advantages:

  • Service providers can efficiently access and serve a larger group of people
  • Agencies can collaborate to improve efficiency and effectiveness of service delivery
  • Possible areas for locating on site or neighborhood based services
  • Improve service planning
  • Opportunities to build upon the strengths of a community such as neighbor to neighbor support (AAAs 1995).

Project Care - San Diego, CA

Supports frail older adults in living independently and feeling secure. This program has several components:

  • Postal Alert: Postal carriers are trained to keep a watchful eye on older residents. If mail is not collected from mailboxes, carriers will check on residents and report problems.
  • Daily Calls: Computer generated phone calls at a time selected by the client. If call is not answered, volunteers make follow up calls.
  • Gatekeeper: Utility workers and sanitation engineers keep an eye on older adults by recognizing signs of trouble such as uncollected newspapers or garbage not set out on collection day. Concerns are forwarded to proper agency.
  • Health Care Info: Older adults receive a medical information box that affixes to refrigerator. Box contains medical history info, medication records and other health related data. The information is used by paramedics responding to emergencies in a client's home.
  • Home Repairs: Volunteers and local businesses help make minor home repairs that support health and safety.
  • Safe Return: A national program of the Alzheimer's Association, Safe Returns helps local authorities locate, identify and return home individuals with dementia.

For more information contact 800-510-2020.

Spokane County Elderly Services

Helps isolated older adults maintain their independence. Program offers individually tailored services to address the specific needs of persons at risk of institutionalization. The agency coordinates with the local AAA and the local mental health agent to provide the appropriate array of services. Referrals are made through the local gatekeeper program, families, physicians and other medical personnel. Ninety-five percent of all services are provided in the home. On average, Elderly Services enables clients to stay independent for an additional 22 months.

For more information call 509-458-2509 or visit www.ksg.harvard.edu/innovations/winners/eswa92.htm.

Day Care for Children and Older Adults

Stride Rite Corporation of Cambridge, MA is a privately developed joint facility for child care and adult day care that provides opportunities for young and old to participate in shared activities. It also fosters sense of community rather than separating segments of the population.

The decisions this community makes today with regard to services for older adults will have an impact for decades. The local community can identify and implement strategies for improving the ability of older adults to maintain well-being and independence. Doing this can save public dollars by decreasing the number of poor outcomes for individuals who do not receive the support and resources they need. Honoring the wishes of older adults to live independently respects the right to self-determination, improves cost efficiency and supports community connections.

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