Rosemary K. Chapin

Older Adults’ Expectations to Move: Do They Predict Actual Community-Based or Nursing Facility Moves Within 2 Years?

Objectives: This study examined the relationship between older adults’ expectations to move and actual residential relocation in the community or to a nursing facility within 2 years. Method: Two waves of data (2000, 2002) from the Health and Retirement Study were used to compare expectations with subsequent moves. Logistic regression techniques were used to analyze the association between decision outcomes and expectations to move, health and functioning, physical environment, informal supports, and formal services. Results: Findings indicated that expectations to move did predict community-based moves but did not predict moves to nursing facilities. Additional factors had significant effects but did not diminish relationships between expectations and actual moves. Discussion: Results support the residential decision process as a dynamic one based on the cumulative effect of factors from an ecological model. Findings will inform policy makers and practitioners as they work to support older adults’ preferences to remain living in their homes.

Decision Making in Long-Term Care

Abstract This article reports findings from a qualitative study of approaches to long-term care decision making used by older adults (N = 52) who continued to reside long-term in the community following nursing facility pre-admission screening. Older adults used different approaches to decision-making (autonomous, collaborative, and delegated) while seeking the most appropriate care setting. Factors such as mental capacity, the role of family caregivers, and self-advocacy skills influenced the choice of decision-making approach. Findings also illustrate how older adults moved through multiple pathways in order to reach their eventual long-term residence. These findings are discussed in terms of their implications for clinical practice and research.

Reclaiming Joy: Pilot Evaluation of a Mental Health Peer Support Program for Older Adults Who Receive Medicaid

PURPOSE Stigma and lack of access to providers create barriers to mental health treatment for older adults living in the community. In order to address these barriers, we developed and evaluated a peer support intervention for older adults receiving Medicaid services. DESIGN AND METHODS Reclaiming Joy is a mental health intervention that pairs an older adult volunteer with a participant (older adult who receives peer support). Volunteers receive training on the strengths-based approach, mental health and aging, goal setting and attainment, community resources, and safety. Participant-volunteer pairs meet once a week for 10 weeks. Participants establish and work toward goals (e.g., better self-care, social engagement) that they feel would improve their mental health and well-being. Aging services agencies provide a part time person to manage the program, match volunteers and participants, and provide ongoing support. Outcomes evaluation for this pilot study included pre/postintervention assessments of participants. RESULTS Thirty-two participants completed the intervention. Pre/postassessment group means showed statistically significant improvement for depression but not for symptoms of anxiety. Quality-of-life indicators for health and functioning also improved for participants with symptoms of both depression and anxiety. IMPLICATIONS The Reclaiming Joy peer support intervention has potential for reducing depression and increasing quality of life in low-income older adults who have physical health conditions. It is feasible to administer and sustain the intervention through collaborative efforts with minimal program resources and a small amount of technical assistance.

Residential Outcomes for Nursing Facility Applicants Who Have Been Diverted: Where Are They 5 Years Later?

PURPOSE The purpose of this longitudinal study was to determine the length of community tenure for adults aged 60 and older after application for nursing facility (NF) admission and to examine the proportion of older adults who lost community tenure due to either (a) death while a community resident or (b) permanent NF admission. DESIGN AND METHODS In this 5-year prospective study, we tracked older adults who had applied for NF admission and were diverted (residing in the community 30 days later). Four waves of NF applicants (N = 2,882) were identified, and those diverted (n = 599) were tracked for 60 months at 3-month intervals. RESULTS Sixty months after diversion, 18.0% of older adults (n = 108) were residing in the community, 39.2% died as community residents (n = 235), and 42.7% (n = 256) became permanent NF residents. In all, 414 diverted older adults (69.1%) died during the 5 years following NF application, with the majority of deaths occurring while older adults were community residents. IMPLICATIONS This longitudinal study documents the capacity of NF applicants aged 60 and older to remain in the community long term, which was previously unknown. Policymakers now have data indicating that for many NF applicants, diversion does not simply delay NF admission; rather, diversion helps older adults avoid permanent NF placement until death.

Hospital to Community Transitions for Adults: Discharge Planners and Community Service Providers’ Perspectives

Discharges from the hospital to community-based settings are more difficult for older adults when there is lack of communication, resource sharing, and viable partnerships among service providers in these settings. The researchers captured the perspectives of three different groups of participants from hospitals, independent living centers, and Area Agencies on Aging, which has rarely been done in studies on discharge planning. Findings include identification of barriers in the assessment and referral process (e.g., timing of discharge, inattention to client goals, lack of communication and partnerships between hospital discharge planners and community providers), and strategies for overcoming these barriers. Implications are discussed including potential for Medicaid and Medicare cost reductions due to fewer re-hospitalizations.

Hoarding Cases Involving Older Adults: The Transition From a Private Matter to the Public Sector

Hoarding interventions with older adults require significant resources from multiple public agencies, yet recidivism occurs frequently. To improve services through better coordination, some communities have formed multiagency hoarding teams (MAHT), which include aging services. MAHTs requested this mixed methods study to understand the progression of cases through the public sector. Quantitative data collected on 52 cases involving adults ages 60+ identified steps in this process. Qualitative data collected from MAHT members were the basis for case studies illustrating the progression of cases through the public sector. Findings have implications for social workers involved in local service coordination, training, and policy.

The legislative tenets of client's right to treatment in the least restrictive environment and freedom from harm: implications for community providers.

For over four decades, national legislation has supported efforts to move persons with severe and persistent mental illness out of restrictive hospital settings and into community based services. Within institutional walls, numerous duties of state have been established to help ensure humane and effective treatment. However, the legal protections afforded hospitalized residents have not appeared to follow these individuals into the community. This article analyzes relevant case law and attempts to establish similarities between the state hospitals duty to protect its residents and the responsibility of community mental health centers to do the same for the persons they serve. The authors argue that the clients right to freedom-from-harm must receive increased attention and community based service providers will have to enhance their capacity to deliver more effective risk management services if mental health reform is to become a successful social policy.

Using multidisciplinary teams to address ethical dilemmas with older adults who hoard.

Multidisciplinary teams, representing professionals from diverse disciplines, are often involved in addressing difficult ethical dilemmas as they work with older adults who hoard (e.g., resolving conflicts between the older adults freedom to engage in hoarding behaviors versus individual or public safety). The purpose of this article is threefold: (a) to explore the current use of hoarding task force or team interventions to address ethical dilemmas that occur within hoarding cases; (b) to propose an ethical decision making framework for use by teams and others; and (c) to discuss practice implications for hoarding teams in implementing this ethical decision making framework.

Community-Based Volunteer Home-Repair and Home-Maintenance Programs for Elders

Social workers in community agencies are working to develop the array of services necessary for elderly people with disabilities to age in place. Faced with the strong need for community-based home repair and maintenance programs for older people and the limited funds available to support such programs, many community agencies and organizations are attempting to meet this need through volunteer labor. This study is an exploratory examination of the adequacy and effectiveness of volunteer home repair and maintenance programs, using qualitative data from interviews with a national sample of 80 program coordinators. A typology for classifying programs into service models is developed. These includ: ongoing handyman repair services; one-time fixup or seasonal services; and intergenerational programs designed to have specific effects on young volunteers as well as to help older people. Analyses of the interview data suggest: (1) repairs of conditions that threaten the older persons health and safety are the m...

Changing Aging Competency Following a GeroRich Intervention Initiative: Implications for Bachelor's and Master's Social Work Education.

This article reports an evaluation of a GeroRich effort to increase age-specific content throughout bachelor and master-level social work curricula. A total of 426 students (128 BSWs and 298 MSWs) completed pre and posttests in 2004–2005, self-rating their aging competency using the Social Work with Aging Skill Competency Scale II (New York Academy of Medicine, 2005). Additional outcome questions were included to assess elements of the specific strategy. Findings indicate that both groups showed improved aging competency, but policy and human behavior courses were key to competency for BSW students, while practice and field classes predicted competency for MSWs.