Senior Transportation Abstracts: A Focus on Options

This collection of abstracts represents a publication of importance for understanding the needs, challenges, solutions, and/or every day issues related to senior transportation services. While several of the abstracts include information about senior driver safety, the collection’s primary purpose is to present a holistic approach to transportation options for older adults. Such a collection is timely because, although the practice of providing transportation to older adults is not new, research and preparation of practical informational and technical materials related to older adult transportation service needs and service delivery are quite recent

Assessing Stakeholder Opinions of Medical Review of Impaired Drivers and Fitness to Drive: Recommendations for Massachusetts

Driving is the main mode of travel for Americans age 65 and older, and although older adults are generally found to be safe drivers, aging often brings about functional limitations and an increase in medications that can impede safe driving and fitness to drive (Rosenbloom, 2003; Kissinger, 2008; Adler & Silverstein, 2008). Effective licensing policies and Medical Advisory Board practices are critical components in identifying medically at-risk drivers and may even have a role in the transition to alternative transportation options; yet, states vary greatly in their approach to licensing and renewal practices and in the utilization, composition, and function of Medical Advisory Boards (MAB). For many of the policies and practices, there is limited or no clear evidence about their effectiveness. Thus, seeking the opinions of the stakeholders most closely involved with these issues through their professional and clinical practice experiences was a starting point for understanding where more evidence-based data are needed or where current practice is supported

Driving in Massachusetts: When to Stop and Who Should Decide?

The purpose of this exploratory research was to assess three stakeholders’ perceptions of the locus of responsibility for driving cessation and identify the criteria that should be included in that decision. The stakeholder groups studied were law enforcement officers, physicians, and the general public age 50 years and older. Defining areas of agreement and disagreement across stakeholders will be valuable for informing policy makers who may be considering statewide or national initiatives. Findings will also be useful for public information and training

Community Mobility and Dementia: A Review of the Literature

By the year 2030, 70 million Americans will be 65 or older. Approximately 80 percent of this population will likely be driving themselves. And without appropriate and timely interventions, many are likely to be driving with Alzheimer’s disease (AD). Current estimates suggest that 2 percent of the population 65 to 74, 19 percent of the population 75 to 84, and 47 percent of the population 85 and older are likely to suffer from Alzheimer’s disease or a related disorder. By the year 2050, the number of Americans with Alzheimer’s disease could range from 11.3 million to 16 million. This significant portion of the aging population will eventually have its community mobility affected by the disease progression. The focus of concern surrounding transportation for those with dementia has until recently been on driving cessation. However, while it is important to be aware of issues related to driver screening and assessment, equal attention should be devoted to cessation counseling and helping the driver move to the passenger seat. Currently, alternative modes of transportation are not very “elder-friendly,” let alone “dementia-friendly.” This paper reviews the available literature on community mobility and dementia, beginning with driving and concluding with community-mobility options. The document provides a starting point for addressing the policy, program, and research issues implicit in finding ways to meet the community mobility needs of a population for whom driving is no longer safe

Massachusetts’ Home Care Programs and Reasons for Discharge into Nursing Homes

Home and community-based services (HCBS) are a range of long-term care services intended to enable older adults and persons with disabilities to “age in place” in their own homes and communities. Previous studies well document that older adults prefer receiving HCBS rather than institutional care at a nursing home. One study concluded that 84 percent of older Americans, aged 50 years and older, want to remain in their homes for as long as possible. Medicaid is a major source of funding for long term care. Currently, a large proportion of Medicaid funds in most states has been spent on institutional, and older adults and their families have relied on nursing homes to be the provider of long-term care. In 2006, the national average of the proportion of Medicaid long-term care spending for disabled older adults and persons with disabilities going to institutional care was 75 percent, while 25 percent was directed towards HCBS. Similar to the national average, the proportion of Medicaid long-term care spending for institutional care in 2006 was greater than the proportion for HCBS in Massachusetts with 78 percent of Medicaid long-term care spending directed towards institutional care, and 22 percent going to HCBS. Moreover, in 2007, Massachusetts had nearly 25 percent greater rate of nursing home utilization than the national average. As of 2008, according to the Massachusetts State Profile Tool, approximately 60 percent of MassHealth (Massachusetts’ state Medicaid program) long-term care spending is spent on nursing facilities

Chronic Disease Self-Management Programs: Relevance for Persons with Dementia

The context for this study is the work of the Healthy Brain Initiative. The CDC has established a cooperative agreement with the Alzheimer’s Association to develop and implement a multifaceted approach to look at cognitive health as a public health issue. Late in 2010, the Association commissioned a review of the major chronic disease prevention programs from a systems approach to begin to understand the source of findings that Medicare beneficiaries with Alzheimer’s and related disorders are much higher cost than those simply with a single chronic disease and no AD. This led to the conclusion that Chronic Disease Self‐Management Program (CDSMP) is the current “gold standard” initiative in this arena. Thus, the Association in cooperation with Dr. Kate Lorig, the researcher who developed CDSMP, began systematic research to explore the extent to which persons with AD are served in CDSMP workshops. Dr. Lorig is the Director of the Stanford Patient Education Research Center and Professor of Medicine in the Stanford School of Medicine

Leaving Home Care: Decision Making, Risk Scenarios & Services Gaps in the Home Care System

Home and community-based services (HCBS) enable older and disabled adults to age-in-place in their homes and communities by helping them function independently for as long as possible (Grabowski et al., 2010; Wong & Silverstein, 2011). Previous studies well document that older adults prefer receiving HCBS rather than institutional care at a nursing home (e.g., Walker, 2010; Fox-Grage, Coleman, & Freiman, 2006). Medicaid is a major source of funding for long-term care. Currently, a large proportion of Medicaid funds in most states has been spent on institutional care (National Conference of State Legislatures & AARP, 2009), and older adults and their families have relied on nursing homes to be the provider of long-term care (Miller, Allen, & Mor, 2009). The purpose of this research is to provide additional insights to policy decision makers on the need to rebalance long-term care spending in Massachusetts by further exploring the reasons elder clients are terminated from home- and community-based care. Care managers are key personnel in providing HCBS to elder clients and have unique insights regarding HCBS. This study builds on qualitative research conducted by Wong and Silverstein (2011) by further exploring the themes that emerged from the previous study related to termination triggers, gaps in HCBS, and the identification and roles of key decision makers in the termination process. In addition, this study examined risk scenarios that may trigger discharge from home- and community-based care programs into institutional settings

“Growing Pains and Challenges”: GrandFamilies House Four-Year Follow-Up Evaluation

During the past decade, there has been increased awareness of issues facing grandparent caregiver families on the part of policymakers and service providers. This awareness has prompted efforts to document the numbers of children being raised by grandparents, to identify challenges faced by grandparents raising grandchildren, and to provide services to meet the needs of these families. National estimates suggest that the numbers of grandparent caregiver families are increasing. Recent estimates suggest that 1.4 million (2%) of all children under 18 live in “skipped generation” families in the United States; similarly, 29,000 (nearly 2%) of all children in Massachusetts live in grandparent care. A large majority of grandparent caregivers are responsible for grandchildren three years or more, suggesting that this is a sustained commitment. Grandparent caregiving is a social phenomenon that cuts across all socioeconomic, racial, and ethnic groups. However, a substantial number of grandparent caregiver families face economic hardship; in Massachusetts, a third of grandparent caregiving families and half the grandchildren in grandparent care families have incomes below 133% the federal poverty index. These nontraditional families face many challenges, including healthcare, income security, education, social support, and housing. Public and private partnerships are beginning to respond to some of these challenges. An initiative to provide affordable, supportive housing for grandparent caregiver families was undertaken in 1998. The current report, based on the first four years of the initiative, builds on an earlier study based on the initial six months. It presents the experiences and views of families and front-line staff, as well as reflections from those responsible for its development. Recommendations are presented for future efforts to address supportive housing for grandparent caregiver families

Evaluation of Lift Up Your Voice! Advocacy Training for Older Adults and Their Caregivers: Executive Summary

The Lift Up Your Voice! (LUYV) training, a component of Community Catalyst’s effort to support the Campaign for Better Care (CBC), is designed to mobilize grassroots advocacy structures of vulnerable older adults by directly engaging and empowering older adults and their caregivers. The goal of the evaluation is to assess the effectiveness LUYV in recruiting potential advocates, educating them about the health care reform, empowering them via advocacy skills training, and engaging them in state-based CBC activities

Seniors Count Follow-Up Study

Seniors Count is an ongoing outreach initiative under the direction of Boston Mayor Thomas M. Menino with the leadership and support of Joyce Williams, Boston\u27s Commissioner on Affairs of the Elderly. The program\u27s purpose is to identify and reach out to those members of the city\u27s elderly population who live in private housing arrangements and help provide them with the information and services they [may] need (Boston Commission on Affairs of the Elderly, 2002). Since the program\u27s inception in 1999, it has reached over 5,500 community-dwelling elders in the City of Boston (Boston Commission on Affairs of the Elderly, 2002). The purpose of this study was to conduct a follow-up assessment of the first phase of Seniors Count. This follow-up study provides insights into Seniors Count participants\u27 satisfaction with the program, how well participants felt their needs had been addressed, and whether new needs had arisen since their 1999 in-person household interviews. In addition, respondents were asked about health status, neighborhoods, safety, voting behavior, and their perception of Boston as an elder-friendly city. The current report provides information and data collected from the Seniors Count Phase I Follow-Up Study and will share information about elders\u27 experiences with Seniors Count, as well as descriptive information about these other areas of interest