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

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

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

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

State Experiences with Affordable Housing Plus Services: Report to Seniors and Persons with Disabilities, On The Move

Housing developers, providers, policy makers, and advocates, increasingly recognize that for some groups of individuals, access to affordable housing alone is not enough. That is, some individuals require more than shelter. Examples include individuals who have chronic health conditions (e.g., HIV/AIDS), those with physical or cognitive limitations (e.g., persons with developmental disabilities, adults with physical disabilities), and those who have a combination of health conditions or who cannot thrive in traditional housing (e.g., persons who have been homeless, individuals with chronic mental illness). Increasingly, housing providers, social service agencies, advocates, states, and federal agencies have recognized the need to combine housing with supportive services designed to address the health and social needs of such groups and individuals. Older adults want to remain in their homes as long as possible (Bayer & Harper, 2000), and providing supportive services to them in their homes is one approach to preventing or delaying unnecessary institutionalization in an acute or long-term care facility (Gibson et. al., 2003). Increasingly, policy makers and advocates recognize that homes includes subsidized rental units occupied by older persons and adults with disabilities. There are a variety of affordable housing and service models across the United States, and they fall under a range of categories and terms (e.g., permanent supportive housing, enriched housing, affordable housing plus services). Whether or not some combination of housing and services can meet the needs of individuals transitioning out of nursing homes remains a question of interest to current nursing home residents, advocates, and policy makers. The purpose of this report is to describe examples of affordable housing plus services (AHPS) that might serve as models for Oregon’s On the Move demonstration project (a Centers for Medicare and Medicaid Services Money Follows the Person project). For this analysis, we reviewed existing reports and articles and collected information about policies and programs in several states in order to learn whether older adults and persons with disabilities, including those discharged from nursing homes, might be served by AHPS programs. Given that Oregon has a long history of providing home and community-based services, we focused primarily on unlicensed housing models rather than licensed residential settings such as assisted living and adult foster care. It is important to note that other states do not have as well-developed a home-and community based care network as does Oregon. Thus, for some states, assisted living is being promoted as a relatively new, and less expensive, alternative to institutionalization. In Oregon, one goal of creating nursing home alternatives is to expand individuals\u27 choices to include affordable housing plus service options

Survey Deficiencies as Quality Indicators in Oregon Assisted Living Communities

Background and Objectives License inspection data have commonly been used as a quality measure for nursing homes but has not yet been used to assess the quality of assisted living/residential care (AL/RC) communities. Drawing on resource dependency theory, we test the hypothesis that structural and environmental characteristics influence AL/RC quality as measured by deficiency citations (“deficiencies”) issued during license inspections. Research Design and Methods Using data from 526 licensed AL/RC communities in Oregon that received a license inspection visit between 2008 and 2016, we examined the prevalence of deficiencies by type and year. We estimated regression models to identify structural and environmental characteristics associated with the number of deficiencies. Results Most (79%) inspections resulted in at least one deficiency. The most common deficiencies concerned medications and treatments (57%), change of condition and monitoring (48%), and resident health services (45%). Structural characteristics associated with higher odds of receiving one or more deficiencies included: larger size, memory care designation, shorter administrative tenure, and for-profit status. Environmental characteristics associated with higher odds of receiving one or more deficiencies included: rural location, lower unemployment, and market concentration. The number and likelihood of a given community receiving a deficiency decreased over time. Discussion and Implications Resource dependency theory constitutes a useful framework to consider the role of structural and environmental factors that affect AL/RC quality, including resident needs, institutional knowledge, resource availability, and market pressure. License inspection data are a viable option for assessing the quality of AL/RC communities