Toward Improved Support for Research on Delivery of Home- and Community-Based Long-Term Care

Stronger and more consistent support is needed for research on long-term care. A greater investment in research will strengthen the ability of public and private organizations to provide effective and efficient assistance to people with disabilities and their informal caregivers. This paper provides a rationale for stronger research funding for the field and outlines several options to strengthen research

Long-Term Care: Informed by Research

Health services research has contributed to health policy and service developments that have led to major improvements in the quality of long-term care in the United States. This policy brief highlights a few areas in which publicly and privately funded research has informed the long-term care field

Seniors in Public Housing

In recent years, the Boston Housing Authority (BHA) discovered that nearly 40% of the seniors (residents aged 62 and over) living in their public housing developments were living in family housing developments rather than in senior/disabled housing developments. Administrators at the BHA were aware that some seniors lived in family developments, but they were committed to learning more systematically about this population and their needs. They turned to the Gerontology Institute at the University at Massachusetts Boston as a partner in this effort. With funding from the Boston Foundation, the collaboration resulted in a research and policy development effort on which this document reports. This collaborative activity includes both research and service planning. As part of the research plan, we obtained information on the older population living in family developments through a variety of sources, including site visits, informal discussions with residents and on-site managers, and finally through a survey of older residents. To facilitate service planning, we established an advisory committee including representatives of the BHA, residents, health care and aging services providers, and the UMass Gerontology Institute (see Appendix A for a list of participants). This committee met during the initial phase of the project in order to provide guidance regarding the research effort. The committee met again following the completion of the research in order to discuss the results and contribute to the planning process for addressing the needs of elders living in family public housing. Several goals guided the research. First, we sought to profile the characteristics and special needs of seniors living in family housing, in terms of both their physical and their social needs, and to determine the extent to which family housing is providing an environment conducive to meeting those needs. We sought to examine the ways in which family housing could be made more suitable for successfully aging in place, and to estimate the extent to which elders currently living in family housing are interested in moving to senior housing, where the services are more readily available. Finally, we sought to examine the ways in which existing social networks shape older residents’ needs for services and their interest in moving to alternative sites

Access to Training for Mature Workers Through One-Stop Career Centers in Massachusetts

The major purpose of this research is to determine the extent to which career centers in Massachusetts are providing mature workers with access to federally funded training. The research is based on two large administrative data sources: The MOSES database made available by the Massachusetts Department of Employment and Training (now Division of Career Services and Division of Unemployment) and a customer service database maintained by The Career Place, a career center in Woburn, MA. The MOSES data file provided for this research includes data on user characteristics and service transactions for all career centers in Massachusetts from July 1, 2001 through June 6, 2003 for individuals who were classified as eligible for training. Data from the career center cover all users for a three-year period beginning July 1, 2001

Providing Low-Cost Assistive Equipment Through Home Care Services: The Massachusetts Assistive Equipment Demonstration

This report describes the Massachusetts Assistive Equipment Demonstration, a collaborative project funded by the Robert Wood Johnson’s Home Care Research Initiative and carried out collaboratively by the Gerontology Institute at the University of Massachusetts Boston and the Executive Office of Elder Affairs (EOEA). The purpose of the demonstration was to systematically encourage the use of low-cost assistive equipment among elderly clients through existing case management resources, thereby extending the effectiveness of the Massachusetts home care program by supplementing formal services with expanded use of assistive equipment

Consumer Perspectives on Quality in Adult Day Care

Purpose: The purpose of this project was to gain insight into the quality of care and services provided through adult day care from the user’s perspective. Design and Methods: The project utilized 13 focus groups to explore aspects associated with user needs, preferences, and satisfaction with adult day care centers. Results: Focus group participants described aspects of adult day care that are important in delivering quality care, program features that are effective, and key areas in need of improvement. Ensuring the safety of clients; having caring, friendly, and compassionate staff available to provide one-on-one attention; engaging clients in stimulating activities; and providing the opportunity for clients to socialize with others were the most salient features of care. Potential areas of improvement for specific centers included enhanced communication with caregivers regarding clients’ well being and program events and activities, modifications to the physical environment, improving the quality of food, and ensuring consistent transportation services. In addition, focus group respondents noted that adult day care programs need to be better publicized and made known to the community. Implications: Findings identify dimensions useful for provider organizations and regulatory agencies to use in their quality improvement efforts

Enhancing Employment Opportunities for Mature Workers Through Training: Case Studies of Employment Services in Massachusetts

Extension of working years among those approaching “normal” retirement ages is receiving increased attention. Much of the impetus is financial. The weakening of private pension systems is leaving increasing numbers of those approaching retirement with inadequate savings. Rising health care costs and the erosion of retiree health benefits also encourages older workers to remain in the workforce. The current recession has greatly escalated the financial concerns of those who are late in their working lives. With the deterioration of financial markets, the values of 401K portfolios have declined enormously. Further, the decline in home prices has left many with substantial reductions in home equity. In addition, some mature workers are among those with home mortgages that exceed the market values of their homes

Implications of Changing Social Norms for Social Security Benefits: Results of Pilot Research

Problem. The U.S. Social Security program is designed to protect the American family structure that existed when the program was introduced in the 1930s. Both family structure and social norms regarding family life have changed substantially in the interim. Major changes in family structure invite proposals to modify Social Security benefits to accommodate contemporary conditions. To remain politically viable, the program must make adjustments to reflect contemporary public opinion regarding family life. We asked to what extent contemporary public opinion is supportive of the current benefit structure and the extent to which public opinion points to possible changes in benefits? Methods. We explored the feasibility of using factorial survey designs to determine public opinion about Social Security benefits. In this method, respondents are asked to make judgments about vignettes that describe specific situations. Specific vignettes are generated randomly from a vignette structure that includes both a set of dimensions and specific conditions within each dimension. Each respondent is asked to judge a set of vignettes. Through multivariate statistical analysis, the effects of vignette structure on judgments are determined. The project was concerned with the feasibility of applying this method in studying the normative underpinnings of Social Security benefits. Results of two pilot studies are reported. One study was concerned with survivor benefits; the second was concerned with pensions at normal retirement age. Respondents were undergraduate students. Findings. Overall, the research showed that the factorial survey is a promising method of measuring public opinion regarding Social Security benefits. In the study of survivor benefits, the research found public support, for example, for current policy regarding the presence of 2 minor children in the home for the eligibility of surviving widows or widowers for benefits. However, respondents were less likely to recommend benefits for surviving spouses with undesirable social characteristics. Under current policy, the “worthiness” of survivors is not taken into consideration in determination of benefits. In the study of retirement benefits, the findings show support for the policy of basing pensions heavily on numbers of years of contributions to the system. However, the findings point to possible reform by showing support for providing Social Security credits to full-time unpaid providers of elder care. Further research with more representative samples is needed both to determine whether the current findings can be generalized and to examine other issues concerning Social Security benefits

Transportation: A Crucial Issue for Adult Day Care in Vermont

Transportation arrangements are an integral but fragile element in the effectiveness of adult day care services in Vermont and nationwide. Almost by definition, adult day center participants generally cannot drive due to cognitive and/or physical limitations. Since adult day care services are congregate in nature and serve community-residing elders, this long-term care option is feasible only when there are arrangements to transport elders to and from service centers. Transportation is therefore a major issue for adult day care services. The aim of this report is to call attention to transportation issues in adult day care services in Vermont. The report provides an overview of adult day care transportation arrangements for the state and focuses on the dimensions of transportation arrangements that are critical to the success or failure of adult day care services. The report is based on information from a number of sources. Interviews were conducted during November and December of 2001 with administrators of all of the adult day care service programs in the state. Administrators were asked to report on their involvement with transportation arrangements, their sources of transportation services, transportation financing, and issues in offering transportation services effectively. Additional information for this report was obtained through interviews with directors of several regional public transportation agencies and administrators in the Vermont Department of Aging and Disability. Also reported here is a statistical profile of individual transportation arrangements reported by nine centers for 389 participants. These centers provided information for each of their participants on the mode of transportation used, the distance traveled, the travel time, and the sources of transportation financing