Aging Service Providers Research Articles

Network Management--New Strategies in Elderly Services for Thai Government

This study mirrors the increasing importance of network management and also looks at about the devolution of elderly services or social services in general. This survey research was to develop a structural equation model of network management in elderly services. The sample consisted of 556 elderly service providers in Southern part of Thailand. Data were collected using a questionnaire. Findings show the structural equation model had a good fit with the empirical data (χ2 = 767.53, df = 279, RMSEA=0.064, CFI=0.98, SRMR=0.058). The model confirms that 6 factors: trust, mutuality, governance, administration, autonomy and, antecedents possessed effects on network performance. Trust had the highest positive direct effects on network performance, followed by mutuality, governance, and administration respectively, autonomy had negative direct effects and, antecedents only had indirect effect. Therefore, when governments have to work together with partners in elderly services, the problems become more complex so administrators should be concern about these constructs to provide service provisions so that a functional capacity can be maintained for elderly well-being. Int. J. Soc. Sc. Manage. Vol. 4, Issue-4: 232-239

MAINTAINING SERVICE PROVISION IN AN AGE OF AUSTERITY

Many aging services providers in the United States today provide an array of services to the community beyond nutrition, including housing, oral health, physical and mental healthcare, legal aid, and education. However, providing this universe of services in an age of lowered federal funding and competition from for-profit healthcare and other services providers can mean that these not-for-profit aging services providers find it difficult to maintain full funding for even their core missions of nutrition and other basic services provision. This presentation will focus on this challenge and will discuss solutions from the field and from local, state and federal policy.

A hands-on hands-off approach: governance of managed long-term care services in a context of rapid policy change

ABSTRACTAmidst state-level budgetary pressures and growing elderly populations, many US states have adopted managed care for home-based services funded through the Medicaid program. New York State’s managed care mandate is part of a Medicaid ‘Redesign’ targeting health outcomes, cost control, and administrative efficiency, reflecting features emphasized by both governance and New Public Management frameworks, but neither adequately captures this case. Incorporating a Polanyian perspective can elucidate this market expansion and related reactions and re-regulation. Drawing from interviews with staff of service-providing agencies, this case study reveals outcomes contrary to goals: administrative complexity, containment of care, and unexpected costs.

Predicting Perceived Isolation Among Midlife and Older LGBT Adults: The Role of Welcoming Aging Service Providers.

Older lesbian, gay, bisexual, and transgender (LGBT) adults are more likely to live alone and less likely to have children compared with their heterosexual counterparts. The lack of immediate family system can render older LGBT adults particularly vulnerable to social isolation and its consequences. The current study utilizes social exclusion theory, which asserts that not only material resources but also engagement with and inclusion into the society are necessary for marginalized people to be integrated into the mainstream. The study examines whether aging service providers (e.g., senior centers, adult day care, transportation, employment services) who are perceived by older LGBT adults as welcoming to LGBT people may reduce this population's perceived isolation. Data were collected through a needs assessment survey designed for the aging LGBT community in North Carolina. Adults aged 45 and over who self-identified as LGBT were recruited at several formal and informal groups. The survey yielded 222 valid responses. The outcome variable was perceived isolation. Key independent variables included having experienced welcoming aging service providers and living alone. After controlling for potential confounders and demographics, logistic regression results showed that having experienced welcoming aging service providers was a protective factor against perceived isolation and it also buffered the negative impact of living alone. The findings provided preliminary evidence for a new direction of intervention research-targeting LGBT cultural competence training for medical and social service providers.

Advancing LGBT Elder Policy and Support Services: The Massachusetts Model.

The Massachusetts-based LGBT Aging Project has trained elder service providers in affirming and culturally competent care for LGBT older adults, supported development of LGBT-friendly meal programs, and advanced LGBT equality under aging policy. Working across sectors, this innovative model launched the country's first statewide Legislative Commission on Lesbian, Gay, Bisexual, and Transgender Aging. Advocates are working with policymakers to implement key recommendations, including cultural competency training and data collection in statewide networks of elder services. The LGBT Aging Project's success provides a template for improving services and policy for LGBT older adults throughout the country.

Police officer competence in handling Alzheimer’s cases: The roles of AD knowledge, beliefs, and exposure

This study seeks to understand the level of police officer competence for providing assistance during interactions with patients of Alzheimer's disease (AD), and to reveal the roles their knowledge of AD, beliefs of AD, and previous exposure to patients with AD play in influencing these competence levels. Data were collected from police officers in two Phoenix metropolitan-area police departments through focus group discussions and survey. Four focus groups comprised of 27 police officers discussed their perceptions of AD and challenges of dealing with individuals with AD. Building on the findings from the focus groups, an online survey ( n = 228) examined police officer AD knowledge, as well as their experience and competence in the handling of AD cases. Police participants had fair knowledge of AD with an average 71.8% accuracy rate. More AD knowledge ( B = 0.29) and higher levels of education ( B = 0.85) were associated with higher levels of competence of recognizing AD-related behaviors. Low levels of discomfort interacting with AD patients ( B = -0.75) and having a family member of dementia ( B = 1.32) were related to higher levels of competence of reacting appropriately to an AD patient. The findings suggest that information about the best practices for dealing with community residents with AD needs to be made available to police officers. To ensure a dementia-friendly environment, aging service providers need to reach out to local law enforcement departments and provide training that promotes AD knowledge, decreases AD-related stigma, and increases competence of handing dementia cases in a way that fits the policing culture.

Closing the Research to Practice Gap in Therapeutic Residential Care

Residential care has been criticized for its high cost and limited research evidence. While recent studies and reviews of the literature suggest that a number of evidence-based practices are being implemented in residential care settings, more research is needed to develop and test empirically based practices that can be successfully implemented in residential care. In this article, we offer a promising strategy to address this issue: a long-term research partnership between a large service provider agency and a university-based research center to conduct a program of research which has resulted in translation of evidence-supported practices into service provider programs, contributions to the science of residential care, and training opportunities for young applied scientists to specialize in this important work. This evolving program of research includes four core applied research topic areas in which this collaboration has had some ongoing success: program and practice implementation fidelity, therapeutic process factors, aftercare, and psychotropic medication use. We suggest that this type of long-term collaborative research partnership is an approach for others to consider for conducting research that informs effective residential care practices.

Empowering the dementia care workforce to manage behavioral symptoms of dementia: Development and training outcomes from the VOICE Dementia Care Program

ABSTRACTNonpharmacological approaches for managing behavioral symptoms of dementia remain widely underutilized, due in part to near-universal training needs reported by dementia caregivers in recent research. This article examines the development, core components, and initial outcomes of an evidence-informed, competency-based training program in the prevention and management of behavioral symptoms of dementia among care managers and nurses within an aging services system. The Vital Outcomes Inspired by Caregiver Engagement (VOICE) Dementia Care Training Program was developed based on identification of state-of-the-art approaches to managing behaviors through expert review of the literature and structured needs assessment. Results reveal robust improvements in knowledge, attitudes, and self-efficacy among training participants, with largest effect sizes (d = 1.8) on domains of knowledge and self-efficacy to manage behaviors. Findings support the feasibility and effectiveness of training in improving the abilities and confidence of aging services providers in dementia care and, specifically, in the nonpharmacological management of dementia-related behaviors.

Design and Recruitment for a Randomized Controlled Trial of Problem-Solving Therapy to Prevent Depression among Older Adults with Need for Supportive Services.

Addressing subthreshold depression (indicated prevention) and vulnerabilities that increase the risk of major depression or anxiety disorders (selective prevention) is important for protecting mental health in old age. The Depression-Agency Based Collaborative (Dep-ABC) is a prevention trial involving older adults recruited from aging services sites (home care agencies, senior housing, senior centers) who meet criteria for subthreshold depression and disability. Therefore, the authors examine the effectiveness of partnerships with aging services sites for recruiting at-risk older adults, the quality of recruitment and acceptability of the Dep-ABC assessment and intervention, and the baseline status of participants. Dep-ABC is a single-blind randomized controlled prevention trial set in aging services settings but with centralized screening, randomization, in-home assessments, and follow-up. Its intervention arm involves six to eight sessions of problem-solving therapy, in which older adults aged 60+ learn to break down problems that affect well-being and develop strategies to address them. We examined participation rates to assess quality of recruitment across sites and level of disability according to service use. Dep-ABC randomized 104 participants, 68.4% of eligible older adults. Screening using self-reported disability successfully netted a sample in which 74% received home care agency services, with remaining participants similarly impaired in structured self-reports of impairment and on observed performance tests. Direct outreach to aging services providers is an effective way to identify older adults with service needs at high risk of major depression. Problem-solving therapy is acceptable to this population and can be added to current services.

Bisexual Aging and Cultural Competency Training: Responses to Five Common Misconceptions

ABSTRACTBisexual cultural competency training is one important method of improving the services received by bisexual older adults. These trainings aim to give providers the knowledge and sensitivities they require to treat bisexual older adults with respect and to create environments where bisexual people feel comfortable being open about their identities, relationships, and life histories. This article is a primer intended for anyone who formally or informally educates aging and LGBT service providers on the unique cultures, needs, and resiliencies of bisexual older adults.

Managing Responsive Behaviours: A Wicked Problem Addressed through a Grassroots Approach.

Challenging responsive behaviours, such as aggression, wandering and social inappropriateness, exhibited by persons with neurological, mental health or developmental disorders are of increasing concern across Canada. These behaviours can cause distress or catastrophic outcomes for the person, others in care, caregivers and healthcare providers, and result in extensive resource utilization. The objective of this paper is to discuss the role and impact of a unique, grassroots provincial initiative aimed at networking among healthcare providers, decision-makers and caregivers across government ministries and service-provider agencies. This collaboration provides a model for informing service provision and policy development across multiple stakeholders.

Research, practice, and policy perspectives on evidence-based programing for older adults.

Demographers warn us of the “gray tsunami” approaching our global doorstep (1). Researchers are called upon to document the extent to which the growing burden of chronic conditions impacts America’s aging population and examine the uptake and effectiveness of different intervention approaches for improving the health and well-being of older adults across settings and populations (2). Working in conjunction with researchers, practitioners are asked to develop, adopt, and adapt innovative evidence-based health promotion and disease management programing that can be broadly implemented, disseminated, and sustained as appropriate in community and clinical settings (3, 4). Building on a growing research base and inventory of treatment options, policy makers are charged with identifying and supporting needed care and services that can meet the Triple Aims of health reform (i.e., better health, better health care, and better value) (5, 6). This Research Topic on evidence-based programing for older adults reflects decades of progress by researchers, practitioners, aging service providers, and policy makers working together to understand how to help older adults achieve optimal health and well-being. Such efforts have transformed successful aging from a theoretical concept into an achievable goal (7, 8). The scientific roots of this Research Topic are many, but our (Ory and Smith) personal interest began with the evaluation of the Administration on Aging (AoA)’s national disease prevention initiatives introduced in the 2000s, which will be described in length later in this volume (9–11). With our colleagues in the Centers for Disease Control and Prevention (CDC)-funded Healthy Aging Research Network (12, 13), we began documenting the national roll-out of evidence-based programs for older adults.Wewere concernedwithmany issues: (1)whowere themajor stakeholders in this national effort?; (2) what programs were being offered and who they were reaching?; (3) what could we say about the fidelity, dissemination, and sustainability of different programs?; (4) what was known about the impact of different programs in different populations and settings?; and (5) what were the best strategies for advancing the evidence-based movement? As we explored these questions, we realized the need to look beyond single silos or perspectives to understand how researchers, program developers, and policy makers could work together more closely. Such collaborations are essential to develop, promote, and support evidence-based programing that reflects stakeholders’ perspectives and increases the likelihood of being embedded into existing structures. Ideally, evidence-based programs reflect a translation of testable research theories into key intervention elements that resonate with program adopters and intended participants.

A matter of balance: older adults taking control of falls by building confidence.

A matter of balance: older adults taking control of falls by building confidence.

Translating PEARLS: Lessons Learned from Providers and Participants

The Program to Encourage Active, Rewarding Lives (PEARLS) began 15 years ago when the director of our local area agency on aging (AAA) approached the University of Washington Health Promotion Research Center (HPRC). She was looking for a way to serve older adults with depression, including those served by the agency’s home and community-based services (HCBS) program. Depression in this population is high, when we analyzed data from 16,032 elders receiving HCBS in Washington State in 2005, two-thirds met criteria for clinical depression (1). This partnership between the university and local aging service providers created PEARLS, a brief, home-based program to teach people tools to effectively tackle the things in their lives that overwhelm them, and to in turn, improve their depressive symptoms. These tools include a seven-step approach to problem-solving and action planning to increase physical, social, and pleasant activities. PEARLS is a structured intervention delivered in 6 to 8 one-hour visits over the course of a 4- to 5-month period. Sessions are tapered from weekly to monthly to give participants an opportunity to practice and learn the skills. More information about the program can be found at www.pearlsprogram.org. The Program to Encourage Active, Rewarding Lives (PEARLS) reduced depression and improved quality of life in two randomized controlled trials (2, 3). Since then, UW HPRC continues to work with the local AAA and other sites to help translate the evidence-based program into everyday practice. The implementation challenges are striking given that PEARLS includes several ingredients for program success: it was designed with an adopting organization as a key partner, the model trains existing staff to deliver PEARLS so new staff do not need to be hired, and the program is successfully funded in some locations through several diverse funding streams. We have learned a lot from organizations and staff that deliver PEARLS through our monthly technical assistance calls and other dissemination research and activities. We have also learned a lot from program participants through PEARLS sessions, focus groups and interviews. A selection of key learnings is provided below, organized by Glasgow’s RE-AIM framework to help improve the success of evidence-based program delivery in “real-world” settings (4–6). This framework consists of five elements – reach, effectiveness, adoption, implementation, and maintenance – that present the overall public health impact of a program or policy. It is important for programs to perform well across each of these five elements in order to maximize overall impact (7).

Perceived Utility of the RE-AIM Framework for Health Promotion/Disease Prevention Initiatives for Older Adults: A Case Study from the U.S. Evidence-Based Disease Prevention Initiative.

Dissemination and implementation (D&I) frameworks are increasingly being promoted in public health research. However, less is known about their uptake in the field, especially for diverse sets of programs. Limited questionnaires exist to assess the ways that frameworks can be utilized in program planning and evaluation. We present a case study from the United States that describes the implementation of the RE-AIM framework by state aging services providers and public health partners and a questionnaire that can be used to assess the utility of such frameworks in practice. An online questionnaire was developed to capture community perspectives about the utility of the RE-AIM framework. Distributed to project leads in 27 funded states in an evidence-based disease prevention initiative for older adults, 40 key stakeholders responded representing a 100% state-participation rate among the 27 funded states. Findings suggest that there is perceived utility in using the RE-AIM framework when evaluating grand-scale initiatives for older adults. The RE-AIM framework was seen as useful for planning, implementation, and evaluation with relevance for evaluators, providers, community leaders, and policy makers. Yet, the uptake was not universal, and some respondents reported difficulties in use, especially adopting the framework as a whole. This questionnaire can serve as the basis to assess ways the RE-AIM framework can be utilized by practitioners in state-wide D&I efforts. Maximal benefit can be derived from examining the assessment of RE-AIM-related knowledge and confidence as part of a continual quality assurance process. We recommend such an assessment be performed before the implementation of new funding initiatives and throughout their course to assess RE-AIM uptake and to identify areas for technical assistance.

Supporting choice: Support planning, older people and managed personal budgets

Summary English policy emphasises personalised and flexible social care support using ‘Personal Budgets’ (PB) – preferably as cash direct payments. However, most older people opt for their council to manage personal budgets on their behalf. It is not clear what benefits of personalisation are available to this group of older people. This article reports research into the choices available to older people using managed personal budgets to fund home care services in three councils. It focuses on the roles of support planners, in councils and service provider agencies, who are central to supporting choice on the part of service users. Data were collected from three focus groups with 19 council support planning practitioners and interviews with 15 managers of home care agencies. Findings The study suggests that new commissioning and brokerage arrangements have the potential to give older people using managed personal budgets greater choice and control over their support. However, new communication barriers have also been introduced and some staff report receiving inadequate training for their new roles. Above all, resource constraints were reported to impede council support planners in encouraging users to plan creatively how to use personal budgets. Resource constraints also meant councils placed constraints on how flexibly home care agencies could respond to changing needs and preferences of older users. Applications The paper concludes by highlighting the implications of new arrangements for social work practice and some of the barriers that need to be addressed if the potential benefits of personalisation for older people holding managed personal budgets are to be achieved.

Challenges facing the elderly care industry in Hong Kong: the shortage of frontline workers

Background Ageing is a major population problem worldwide, including Hong Kong. With better medical technology, people typically live longer. In 2012, the life expectancy for men and women in Hong Kong was 81 and 86 years, respectively, an increase of 8 years compared with 30 years ago [1]. However, despite a longer lifespan, many elderly people are living with chronic illnesses, creating a huge demand for elderly services. The Hong Kong Government introduced the concept of ‘Ageing in Place’ in 2007. This latest policy paper on ageing explicitly encourages the elderly to stay at home and in the community [2,3]. Although such a policy seems reasonable on paper, its implementation hinges on many associated supportive policies and services. Even though the number of elderly service providers has increased over the past few years, the demand still far exceeds the supply. In fact, elderly service providers are facing increasing difficulty to keep pace with the mass demand for their services. With such high demand and limited funding being allocated, elderly service workers are often forced to overwork but are underpaid and experience high work stress [4]. Elders, in turn, are being put at risk for substandard services caused by insufficient funding, mismatch of benefits allocation, the lack of manpower, highly stressed staff and much more. The present study was conducted to examine the recruitment challenges Hong Kong’s elderly care service providers are facing and their perceptions of the HKSAR government’s latest elderly policy, ‘Ageing in Place’, and the role of vocational education in training manpower for the industry. Methods A survey entitled ‘Challenges of Elderly Service Industry in Hong Kong’ was developed according to the results of a previously conducted qualitative study[5]. The questionnaire consisted of 26 questions aiming to gather demographic characteristics of participants, their routine operational procedures, their opinions on the government’s policy of ‘Ageing in Place’ and their perception of vocational education and training. All registered elderly service providers listed with the Social Welfare Department of Hong Kong were invited to participate in this survey. Of all 551 elderly organizations and service units consulted, 197 (35.8%) completed the survey for analysis.

Examining strategies to build and sustain healthy aging programming collaboratives.

Community collaboratives provide a means to build local capacity, reduce service fragmentation and duplication, maximize efficiency, and create synergies for systems change. But what are the collaborative practices that aging services providers and other stakeholders employ for system change and impact in evidence-based programming for older adults? The aim of this study was to learn how aging and health collaborations created strategic partnerships to foster multisector systems change and pursue long-term goals and near-term activities to sustain and expand evidence-based health programming. Via a multiphase process, we identified eight geographically diverse, exemplar agencies that serve as the coordinators for various community collaborations. Using an interview protocol culled from the literature, we conducted on-site, in-depth interviews with leadership and partners. Four creative strategies emerged across sites as contributing to the growth and sustainability of evidence-based health programming including engagement of nontraditional partners, development of new relationships with health care, building of innovative systems of structures and tools, and systematically working with vulnerable populations. Opportunities for future initiatives include enhancing linkages with health care, advocating for the value of evidence-based programming, supporting local program development and adaptation, and developing marketing strategies and business models. These eight organizations are leveraging their historic strengths and newly acquired expertise to extend health programming beyond established partners and funding silos. The four strategies and specific activities reflected in their work have laid a solid foundation for expanding and embedding future initiatives and positively impacting the health of older adults.

Perceptions about community applications of RE-AIM in the promotion of evidence-based programs for older adults.

Despite the growing literature about the RE-AIM framework as a planning, implementation, and evaluation tool, little is known about practitioners' adoption of the framework, confidence to utilize framework elements, or perceptions of its usefulness. To assess how RE-AIM was implemented by state aging service providers and public health partners, data were collected using an Internet-delivered, cross-sectional survey from 40 stakeholders in 27 funded states in an evidence-based disease prevention initiative for older adults. Most participants agreed the framework was useful for planning, implementation, and evaluation and relevant for evaluators, providers, community leaders, and policy makers. Yet nearly half felt monitoring RE-AIM requirements requires special expertise, and one third felt the different RE-AIM elements were difficult to measure. Findings indicate the RE-AIM's appropriateness and utility for planning and evaluating the dissemination of evidence-based programs to older adults; however, additional trainings, resources, and technical assistance are warranted to enhance uptake in community-wide intervention efforts.

The National Resource Center on LGBT Aging Provides Critical Training to Aging Service Providers

The National Resource Center on LGBT Aging was created in 2010 by Services & Advocacy for Gay, Lesbian, Bisexual and Transgender Elders (SAGE) with seed funding from the US Department of Health and Human Services. Three years into the project, thousands of aging and LGBT service providers have been reached with training and technical assistance; however, a great need, especially for cultural competency training, remains.