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
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SERVICE
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RECOMMENDATIONS
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- 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.
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- 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
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- 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
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- 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
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- Day care including care for individuals with dementia
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- 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.
RETURN TO TOP
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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