Housing Plus Services, IADL Impairment, and Healthcare Expenditures: Evidence From the Medicare Current Beneficiaries Survey.

BACKGROUND AND OBJECTIVES: Despite enthusiasm for the potential cost savings of embedding supportive services in senior housing, few population health studies have empirically examined such associations. We investigated the extent to which associations between housing plus services in senior housing and healthcare expenditures depend upon residents' instrumental activities of daily living (IADL) impairment and the level of services available. RESEARCH DESIGN AND METHODS: We used data from 2,601 participants aged 65 or older in the 2001-2013 Medicare Current Beneficiary Survey, who reported living in senior or retirement housing. Based on survey self-reports, we created a measure of housing with different levels of services, including the categories of housing without services, housing plus services (i.e., assistance with IADLs, but not with medications), and housing plus enhanced services (i.e., assistance with IADLs including medications). Administrative and survey data were used to create measures of healthcare expenditures paid by all sources. We estimated generalized linear models based on pooled data from participants across the 13 years of data collection. RESULTS: Residents with IADL impairment-who lived in housing plus enhanced services-had lower total healthcare expenditures than their counterparts in housing without services and housing plus services. Upon examining component healthcare costs, this pattern of results was similar for inpatient/subacute care, as well as ambulatory care, but not for home health care. DISCUSSION AND IMPLICATIONS: Findings indicate the importance of studies on the cost savings of housing-based service programs to consider resident IADL status and the types of services available.

A Cluster Randomized Trial of Tai Chi vs Health Education in Subsidized Housing: The MI-WiSH Study.

OBJECTIVES: Tai Chi (TC) may benefit older adults with a variety of diseases and disabilities. We tested the hypothesis that TC improves physical function in older adults living in low-income housing facilities. DESIGN: Cluster randomized controlled trial. SETTING: Subsidized housing facilities in Boston, Massachusetts, and neighboring communities. PARTICIPANTS: Volunteers were recruited from 15 facilities. The 180 randomized participants were 60 years of age or older, able to understand English and participate in TC, expected to remain in the facility for 1 year, and able to walk independently. INTERVENTION: TC classes were conducted in the housing facilities twice/week for 1 year and compared with monthly health promotion educational classes and social calls. MEASUREMENTS: The primary outcome was physical function measured by the Short Physical Performance Battery (SPPB). Secondary outcomes included other aspects of physical and cognitive function, and falls. RESULTS: An interim analysis revealed less improvement over 12 months in SPPB scores among TC participants (+.20 units; 95% confidence interval [CI] = -.20 to +.60; P = .69) vs control participants (+.51 units; 95% CI = +.15 to +.87; P = .007), a difference of -.31 units (95% CI = -.66 to .04; P = .082). This met the criterion for futility, and the Data Safety Monitoring Board recommended trial termination. No differences were found in 6- or 12-month changes favoring TC in any secondary outcomes or adverse events. CONCLUSION: In older adults with multiple chronic conditions living in subsidized housing facilities, 6 and 12 months of twice/week TC classes were not associated with improvements in functional health. J Am Geriatr Soc 67:1812-1819, 2019.

Differential Aging in Place and Depressive Symptoms: Interplay Among Time, Income, and Senior Housing.

OBJECTIVE: We examined cumulative and differential experiences of aging in place. METHOD: Data came from the 2002 and 2010 wave of the Health Retirement Study. We modeled the trajectory of later-life depressive symptoms, and how senior-housing environments moderate the negative association between economic disadvantages and depressive symptoms. RESULTS: At baseline, economically disadvantaged older adults were more likely to exhibit depressive symptoms. However, detrimental effects of income group (non-low income vs. moderate income; non-low income vs. low income) on depressive symptoms did not significantly change over time. The age-leveler hypothesis may account for nonsignificant effects of disadvantaged income groups over time. DISCUSSION: Findings suggest that moderate-income seniors may experience positive differentials if they age in place in a supportive senior-housing environment. Moderate-income seniors may have broader opportunities in senior housing compared to private-home peers. Senior housing might partially counter risks such as low mental health, emerging from life-course disadvantage.

Availability of services in registered retirement villages in Queensland, Australia: A content analysis.

OBJECTIVE: The study investigates and compares the services available in different types of registered retirement villages in Queensland (QLD). METHODS: A content analysis based on official websites of 175 registered villages in QLD, Australia, is presented. RESULTS: This study identifies 82 services, with activity organisation, emergency response, hairdressing and transportation being most frequently available to residents. The number of services available is associated with the village size and financial type, with residents living in large private villages having access to significantly more services. CONCLUSION: The research findings reveal the state of the art of current industry practice. They provide useful implications for stakeholders. For instance, residents who prefer to get access to various services should focus more on large private villages. Developers can check their service delivery environment to confirm its balance with residents' competencies. The government can propose innovative initiatives to promote the delivery of appropriate services in villages.

Is it time for a change? A cost-effectiveness analysis comparing a multidisciplinary integrated care model for residential homes to usual care.

OBJECTIVE: The objective of this study was to evaluate the cost-effectiveness of a Multidisciplinary Integrated Care (MIC) model compared to Usual Care (UC) in Dutch residential homes. METHODS: The economic evaluation was conducted from a societal perspective alongside a 6 month, clustered, randomized controlled trial involving 10 Dutch residential homes. Outcome measures included a quality of care weighted sum score, functional health (COOP WONCA) and Quality Adjusted Life-Years (QALY). Missing cost and effect data were imputed using multiple imputation. Bootstrapping was used to analyze differences in costs and cost-effectiveness. RESULTS: The quality of care sum score in MIC was significantly higher than in UC. The other primary outcomes showed no significant differences between the MIC and UC. The costs of providing MIC were approximately €225 per patient. Total costs were €2,061 in the MIC group and €1,656 for the UC group (mean difference €405, 95% -13; 826). The probability that the MIC was cost-effective in comparison with UC was 0.95 or more for ceiling ratios larger than €129 regarding patient related quality of care. Cost-effectiveness planes showed that the MIC model was not cost-effective compared to UC for the other outcomes. INTERPRETATION: Clinical effect differences between the groups were small but quality of care was significantly improved in the MIC group. Short term costs for MIC were higher. Future studies should focus on longer term economic and clinical effects. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN11076857.

The effect of ethnicity and economy upon intergenerational coresidence: northern Norway during the last part of the nineteenth century.

During the last part of the nineteenth century, Finnmark province and the northern part of Troms experienced a decline in intergenerational coresidence. This article discusses what impact ethnic affiliation and economic activity had on the living arrangements of the elderly, and what contributed to the change. Logistic regression shows that ethnicity played a role but its effect disappears after controlling for economic activity. Intergenerational coresidence was positively associated with being a married Sámi male with an occupation in farming or combined fishing and farming. As such a person grew older, he was increasingly likely to live separately from an own adult child. This pattern changed toward the end of nineteenth century. By the close of the century, ethnic differences had disappeared, and headship position, irrespective of marital status, was strongly related to coresidence.

Housing and location choices of retiring households: evidence from France.

In this paper, a study is made of the mobility and housing choices of the elderly when retiring, using household data collected in France. From a theoretical viewpoint, individuals are likely to decrease their housing quantity because of an income loss when retiring, but they may also increase it to benefit from more housing comfort for leisure. Using the 1992 Trois Générations survey, it is first shown that housing mobility at retirement is substantial in France, with a variety of self-reported motives. Then, using the 1994­2001 French Europanel survey, evidence is found of both upsizing and downsizing for mobile recent retirees. In many cases, housing adjustments lead to a correction of the initial disequilibrium between the number of rooms and the number of occupants. However, a significant proportion of mobile recent retirees improve the quality of their dwelling.

Future housing plans and funding for the care of older people.

The Government recently launched a housing strategy for older people, which promises more inclusive housing and community design. Yet more needs to be done to ensure the strategy makes a real difference to older people's lives. Joe Oldman explains the situation for The British Journal of Community Nursing.