Phoebe S. Liebig

Creating Elder-Friendly Communities: Preparations for an Aging Society

Summary Because many communities where older people live were not designed for their needs, older residents may require support to remain in the least restrictive environment. ‘Age-prepared communities’ utilize community planning and advocacy to foster aging in place. ‘Elder-friendly communities’ are places that actively involve, value, and support older adults, both active and frail, with infrastructure and services that effectively accommodate their changing needs. This paper presents an analysis of the literature and results of a Delphi study identifying the most important characteristics of an elder-friendly community: accessible and affordable transportation, housing, health care, safety, and community involvement opportunities. We also highlight innovative programs and identify how social workers can be instrumental in developing elder-friendly communities.

Aging in Place: Evolution of a Research Topic Whose Time Has Come

Over the past 30 years, policy makers and professionals who provide services to older adults with chronic conditions and impairments have placed greater emphasis on conceptualizing aging in place as an attainable and worthwhile goal. Little is known, however, of the changes in how this concept has evolved in aging research. To track trends in aging in place, we examined scholarly articles published from 1980 to 2010 that included the concept in eleven academic gerontology journals. We report an increase in the absolute number and proportion of aging-in-place manuscripts published during this period, with marked growth in the 2000s. Topics related to the environment and services were the most commonly examined during 2000–2010 (35% and 31%, resp.), with a substantial increase in manuscripts pertaining to technology and health/functioning. This underscores the increase in diversity of topics that surround the concept of aging-in-place literature in gerontological research.

An aging India: perspectives, prospects, and policies.

This volume is the result of ideas developed in several communications between the two co-editors, Drs. Liebig and Rajan, after completion of Liebig’s Fulbright to India in 1997. By the late fall of 1998, a proposal to create a special book on aging in India was accepted by the Journal of Aging & Social Policy. Sponsorship of Dr. Liebig’s research by Dr. P. V. Ramamurti and the Center for Research on Ageing, S. V.

Old-Age Homes and Services: Old and New Approaches to Aged Care

Summary Although generational co-residence continues to be the dominant form of housing and care for Indian elders and only 1% live in old-age homes, the numbers and types of these homes are growing. This article describes a recent study of 48 old-age homes in different parts of India, approximately 12%-15% of all homes. They included the more traditional free homes for the aged poor who have no family to care for them and the more recent for-pay homes for the middle-class. A small number of day-care centers, also a new phenomenon, were investigated. Two- to three-hour structured interviews were conducted with managers, supervisors, and trustees, augmented by a checklist of environmental and neighborhood features. Most homes house small numbers of residents, have common spaces for dining, TV and prayer, have access to medical care and transportation, provide meals and some assistance with activities of daily living, and are open to all castes. All are run by non-governmental organizations (NGOs), only one-third with any government assistance. Free homes tend to be bigger and older, serve non-aged clients, have less privacy and emphasize occupational therapy and income-generating activities, and are more like board-and-care homes. For-pay homes have more privacy and western-style amenities, focus on local community outreach and provide fewer meals. The gradual increase of all old-age homes has given rise to debates about their appropriate roles in Indian society and about their quality. Government grants to NGOs for homes and day-care centers (often considered more appropriate support for elders) are limited. With the National Policy on Older Persons looking to NGOs and village councils to be the primary sources of non-familial aged care, several ways to build their capacity are suggested.

Zoning, accessory dwelling units, and family caregiving: issues, trends, and recommendations.

Abstract This article explores the relationship between zoning regulations and co-residential family caregiving in the United States. It first provides an overview of U.S. housing policies, especially zoning. We then describe major changes in family structure and composition in the United States with their implications for caregiving and discuss how multigenerational housing options, particularly accessory dwelling units (ADUs) in single-family homes, can help support family caregiving. After an overview of zoning policies and actions that inhibit ADU production, we document current trends, incorporating information from a small non-random study of ADU activity we conducted in 2004. Finally, we present recommendations for promoting more multigenerational housing as a supplement to other family support programs (e.g., dependent care assistance, family caregiver payments) and as a source of affordable, supportive housing for those families choosing co-residence as their eldercare solution.

Nursing Home Deficiencies: An Exploratory Study of Interstate Variations in Regulatory Activity

ABSTRACT This study examines nursing home regulatory activity by the states, assesses interstate variations in the volume and severity of nursing home deficiencies, and explores state-level factors that may account for these differences. Nursing home deficiency citation data over a 5-year period (2000–2004) were obtained from the Centers for Medicare and Medicaid Services. We examined interstate variations in regulatory activity and identified predictors of deficiency volume and severity at the state level (demographics, elected officials, industry characteristics, etc.) using the linear mixed model. Deficiency volume remained stable across the 50 states from 2000 to 2004, while deficiency severity decreased significantly. California had the highest volume of deficiencies per nursing home; Wisconsin had the lowest. New Hampshire had the highest percentage of severe deficiencies; California had the lowest. Higher deficiency volume was found in states with lower median household income, a lower proportion of residents aged 85 and older, and a Democratic legislature. Higher deficiency severity was associated with higher median household income and a higher proportion of Medicaid nursing home residents in a state. In contrast, greater state agency funding, higher state standards for nursing home administrators, and a Democratic and more professional legislature predicted lower deficiency severity. Nursing home residents in the United States receive unequal protection from abuse and neglect, and this is partly due to their state of residence. Interstate variations in deficiency volume and severity are due to a complex set of factors beyond nursing home quality.

Dementia Policy Revisited: An Analysis of the State Laws Targeted Towards Individuals with Alzheimer's Disease and Other Forms of Dementia

Abstract Even though state governments assume public responsibility for persons with dementia, formal analysis of state laws concerning individuals with Alzheimers disease and other forms of dementia has been rare. We responded to this by collecting and evaluating state legislation targeted towards individuals with dementia. These laws were collected by searching online statutory archives and were defined by the type of action, year of passage, and legislative purpose. Our research revealed that the legislatures have targeted an average of slightly more than five actions towards persons with dementia. We also discovered that the earliest legislative act targeting individuals with dementia was passed by South Dakota in 1939, and by the end of the 1997 sessions, 49 state legislatures had enacted at least one targeted law. We sorted the variety of legislative actions into eight categories and illuminated how the purposes of these laws differed from one state legislature to the next. This research expands knowledge concerning state policies targeting people with dementia, introduces a reliable method of collecting state laws, and contributes to the advocacy effort made on behalf of persons with dementia.

Gerontology in India

India, with a population of 1.22 billion, has a predominantly agriculture-based economy. Its 90 million elderly population heavily depend on their children for financial support and caregiving. Research on aging in India today is focused on the medical, biological, behavioral, and social sciences. Aging as an independent subject is only taught at a few institutions. Several national and state agencies and many nongovernmental organizations offer housing, day care, and health care services. The 1999 National Policy on Older Persons is being revised, 2 National Institutes on Aging have been designated, and a pilot health program targeting seniors has been implemented. Indias greatest concern is how to provide adequate health care and income security for its huge elderly population, especially the uneducated rural poor.

Using Home Modifications to Promote Self-Maintenance and Mutual Care

Old-age homes, while not a recent phenomenon in India, are growing in number, especially in the southern part of the country. A study of nearly 50 such homes had, as one focus, the extent to which these facilities have modified the physical environment to enable residents to age in place. Not all desirable home modifications (HMs) are widely available; for example, only 25% had special seating in bathing areas, 48% used ramps and 21% employed handrails in hallways and bathing areas. In addition, many HMs are inelegant or primitive by U.S. and European standards, but still provide needed environmental support for residents. These HMs are important to enhance self-maintenance and also to enable residents to help each other. Mutual care helps build and maintain a sense of community, in keeping with Indian traditions of village-level concern for common well-being, and substitutes for small numbers of staff. With huge numbers of Indian elders (c. 170 million) in the next century, greater use of HMs in group homes will be vital to ensure a high quality of life.

Federalism and suitable housing for the frail elderly: A comparison of policies in Canada and the United States

Abstract The frail elderly have special multidimensional housing needs beyond affordability, including shelter that is more adaptive to reduced function and offers supportive services. Suitable housing for this population comprises three policy areas—housing, health care, and social services. In a federal system, development and implementation of policies in these areas involves participation of several levels of government and the nongovernmental sector. This paper uses federalism as a conceptual framework to examine and compare these policy areas in Canada and the United States. In both countries, general national housing policies—relying heavily on the nongovernmental sector and characterized by joint federal‐provincial programs in Canada and by important local government roles and age‐specific programs in the United States‐have benefited the elderly. The effects of such policies on the frail elderly, however, have been less positive because of the general lack of essential human services and, to a les...