Differential Health and Social Needs of Older Adults Waitlisted for Public Housing or Housing Choice Vouchers

Affordable housing is an important form of income security for low-income older persons. This article describes characteristics of older persons waitlisted for either public housing or a housing choice voucher (HCV) (previously Section 8) in Portland, Oregon. 358 persons (32% response rate) completed a mailed survey with questions about demographics, health and housing status, food insecurity, and preference for housing with services. Findings indicate that many waitlisted older persons experienced homelessness or housing instability, poor health, high hospital use, and food insecurity. Public housing applicants were significantly more likely to report lower incomes, homelessness, and food insecurity than HCV applicants. We conclude with policy implications for housing and health agencies that serve low-income older persons

Oregon Community-Based Care Survey: Assisted Living, Residential Care, and Memory Care

In Oregon, community-based care (CBC) communities include assisted living (AL), residential care (RC), and memory care (MC) communities. These settings provide residential, personal care, and health-related services, primarily to older adults. As the population of Oregonians aged 65 and older is estimated to increase from 16 percent in 2015 to nearly 23 percent in 20501, the availability of CBC settings will continue to be an important source of long-term services and supports. This report provides an in-depth look at Oregon’s CBC settings. Because no central dataset of CBC services, staff, and residents is available, as opposed to nursing facilities, information for this report was collected using a questionnaire that CBC providers (e.g., administrators, directors) were asked to complete. CBC settings provide long-term services and supports to many older Oregonians and their families. These services include daily meals, housekeeping and laundry, assistance with personal care needs, medication administration, monitoring of health conditions, communication with residents’ health care providers, and social and recreational activities. Of the 517 AL, RC, and MC communities licensed as of fall 2016, 60 percent (308) returned a questionnaire. The data described in this report are based upon these 308 communities unless noted otherwise. The goals of the project described in this report included: Describe assisted living, residential care, and memory care community characteristics, including staffing types and levels, policies, and monthly charges and fees Describe current residents’ health and social characteristics Compare current results with prior Oregon surveys and national studies of similar setting types to identify changes and possible trends Compare setting types for differences that might affect access, quality, or cost

2022 Adult Foster Home Resident and Community Characteristics Report on Adult Foster Homes

This report describes results from a study of Oregon adult foster homes (AFH), including home and owner characteristics; monthly charges and payment sources; resident characteristics, personal and health-related needs; and owners’ experiences with supports and challenges due to the COVID-19 pandemic. The study’s purpose was to collect and report data that can inform and advise policymakers, state and county agency staff, aging advocates and AFH owners about the status of AFHs in Oregon. The report includes information collected between December 2021 and March 2022 and, where possible, compares it to findings from prior years of this study and to other reports and articles about AFHs and other types of community-based care

Accessing Opportunities for Household Provisioning Post-COVID-19

In this project, we used a mixed-methods study to collect critical information to evaluate the extent to which people modified their shopping behavior, either by choice or necessity, to meet their provisioning needs during the COVID-19 crisis and the following recovery. First, four waves of a cross-sectional survey were administered online to a representative sample of households in Arizona, Florida, Michigan, Oregon, and Washington. This longitudinal, comparative study responded directly to a critical research gap and advanced behavioral science by providing a rich survey dataset to support and test theories of behavioral change and technology adoption. Second, focus groups were conducted with older adults in Oregon to discuss their arc of technology adoption for grocery shopping. Focus groups were also conducted with two sets of mentors who provide assistance to family members and friends with online food purchases to understand what kinds of interventions might be necessary to broaden access to e-commerce and delivery platforms for vulnerable populations. This report presents high-level descriptive statistics from these surveys comparing results by wave and/or by state. The findings from the focus groups with older adults and mentors are also described. The findings of this research are critical for emergency planning but also for understanding the ever-changing mechanism used to access retail and service opportunities (whether in-person vs. online), and the opportunities for future interventions to remedy barriers to accessing food that are relevant after the pandemic recovery

State Variability in the Prevalence and Healthcare Utilization of Assisted Living Residents with Dementia

Objectives: Almost 1 million older and disabled adults who require long‐term care reside in assisted living (AL), approximately 40% of whom have a diagnosis of Alzheimer\u27s disease and related dementias (ADRD). States vary in their regulations specific to dementia care that may influence the presence of residents with ADRD in AL and their outcomes. The objectives of this study were to describe the state variability in the prevalence of ADRD among Medicare beneficiaries residing in larger (25+ bed) ALs and their healthcare utilization. Design: Retrospective observational national study. Participants: National cohort of 293,336 Medicare fee‐for‐service enrollees residing in larger (25+ bed) ALs in 2016 and 2017 including 88,867 (30.3%) residents with ADRD. We compared this cohort\u27s characteristics and healthcare utilization with that of individuals with ADRD who resided in nursing homes (NHs; n = 602,521) and the community (n = 2,074,420). Methods: Medicare enrollment data, claims, and the NH Minimum Data Set were used to describe differences among ADRD patients in AL, NHs, and the community. We present rates of NH admission and hospitalization, by state, adjusting for age, sex, race, dual eligibility, and chronic conditions. Results: The prevalence of ADRD among AL residents varied by state, ranging from 24% to 47%. In 2017, AL residents with ADRD had higher rates of NH admission than their community‐dwelling counterparts (adjusted national average = 24%, ranging from 14% to 35% among states). AL residents with ADRD had higher rates of hospitalization (38%) than populations in either NHs (29%) or the community (34%), and ranged from 29% to 45% of residents among states. Conclusion: These findings have implications for states as they regulate AL and for healthcare professionals whose patients reside in AL. Future work is needed to understand specific elements of states’ regulatory environments and local markets that may impact access and outcomes for this vulnerable population of residents with ADRD. J Am Geriatr Soc 68:1504‐1511, 2020

Oregon Community-Based Care Survey 2016: Adult Foster Homes

This report describes adult foster homes in Oregon. An adult foster home (AFH) is a type of licensed community-based care (CBC) setting that provides residential, personal care, and health-related services, primarily to older adults. The study collected information from adult foster homes to achieve the following four main goals. Describe adult foster home characteristics, including staffing types and levels, policies, and monthly charges and fees Describe current residents’ health and social characteristics Compare current results to prior Oregon surveys and to national studies of similar setting types to identify changes and possible trends Compare setting types for differences that might affect access, quality, or costs The study findings are intended to provide information that state agency staff, legislators, community-based care providers, and consumers may use to guide their decisions. Providing state-level information was one of the goals of Oregon’s LTC 3.0 planning process

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Housing with Services

This report describes findings of an evaluation of the Housing with Services project in Portland, OR. This evaluation was designed to assess the implementation process and impacts of a novel program of coordinated health and social services on behalf of over 1,400 residents of 11 affordable housing properties in Portland, Oregon. Affordable housing for older adults and persons with disabilities provides an important financial subsidy for persons with low incomes. To qualify for the affordable housing described in this report, individuals must have incomes of no more than $15,450 for a single person. In the U.S., over one million older adults receive housing assistance or live in a publicly-subsidized housing unit, such as an apartment funded by the Department of Health and Human Services (HUD) (Harvard Joint Center for Housing Studies, 2015). Among all HUD-assisted housing programs in the U.S., 60% of household heads are either elderly or adults with a disability (34% are elderly) (US Center of Budget & Policy Priorities, 2015). Despite the importance of rental assistance to low-income adults, housing alone is not enough for some residents who lack access to health and social resources, including a primary care provider, preventative health services, mental health services, and food

Housing With Services: Year 1 Evaluation, October 2014

This report describes the initial findings of an on-going evaluation of the Housing with Services project based in Portland, OR. Housing with Services was supported, in part, with funding from Oregon’s State Innovation Model (SIM) project grant from the Center for Medicare and Medicaid Innovations to Cedar Sinai Park. Housing with Services, LLC is a collaborative model of supportive services delivered or made available to low-income residents of affordable housing. The SIM grant helped to establish the project and funded the evaluation of the program implementation and resident- and system-level outcomes. The collaborative model includes partnerships between health plans, coordinated care organizations (CCOs), housing providers, health and social service agencies, and long-term supports and services providers. The mission is to improve the health outcomes, reduce health care costs, and to promote community inclusion and self-determination for seniors and people with disabilities living in subsidized housing. The broad program goals include reducing hospital and long-term care service use, improving health outcomes among building residents, addressing social determinants of health, increasing member engagement in preventive health care, and saving health-related costs by coordinating services to low-income residents of affordable housing. Affordable housing is an important resource for low-income older adults and persons with disabilities. Over half of all recipients of Housing and Urban Development (HUD) assisted housing are elderly or disabled (Sard, 2013). In order to identify policy and program solutions that support residents aging in place, LeadingAge, a national non-profit organization with support from Enterprise Foundation, organized a Learning Collaborative that includes 12 non-profit housing providers in 11 states (Leading Age, 2014). Cedar Sinai Park has been part of this collaborative since 2012

Health-Related Needs Assessment of Older Residents in Subsidized Housing

When a nonprofit organization with nursing-home and assisted-living experience purchased a 30-year-old highrise apartment building in downtown Portland, Oregon, the new owners were faced with how to manage a building that provided housing to more than 200 older residents whom they knew very little about. As long-term care providers, they knew that older people were at risk for developing chronic illnesses, disabilities, and other factors that could result in moves to nursing homes, hospitalizations, and early death. They also knew that older adults in subsidized housing, such as this Section 8 building, have higher levels of disability than their age cohorts in unsubsidized housing and apartment rentals (Redfoot and Kochera, 2004). What they did not know was whether and in what ways these residents\u27 independence and quality of life might be jeopardized by unmet health and social service needs. In collaboration with the Portland State University School of Social Work, a multidimensional needs assessment was developed and conducted to identify the most important unmet needs of the residents as a group so that targeted services could be planned. Findings based on interviews with 130 residents revealed a heterogeneous population of older adults whose health status varied considerably, especially among the four different ethnic and language groups living in the building. This article describes how the results of such an assessment can be used to plan for enriching services to those most in need