Assessment of multiple constructs of social integration for older adults living in nursing homes.

A variety of terms and measures have been used in the literature to denote being socially integrated, and many studies of older adults focus on only social networks or social support and often only include those living in the community. The purpose of this study was to assess multiple constructs of social integration (i.e., social networks, social capital, social support, and social engagement) for older adults in nursing homes. Data were collected from 140 older adults at 30 nursing homes in Kansas. We interviewed older adults' in-person using a survey questionnaire, and used multilevel confirmatory factor analysis to analyze the data. The final model that included the four constructs had acceptable fit (χ2 = 174.71; df = 112; p < .01; CFI = .93; RMSEA = .06; SRMR-W = .06; SRMR-B = .12). The results showed that the proposed model was supported at the individual level. At the between-level, social networks and social support were supported. Study results have methodological and practice/policy implications for the study of older adults in long term care settings. In particular, this study contributes to understanding how to operationally define and differentiate social integration variables in studies of older adults, particularly when study data are hierarchical.

Integrating education, research, and practice in gerontological social work: lessons learned from the reclaiming joy peer support program.

The practice-to-research gap has been attributed to many factors, including differing goals and priorities, differing knowledge bases and skill sets, and lack of recognition of limits of agency and community resources. Although many scholars have called for more collaboration between educators, researchers, and practitioners, these challenges can make collaboration difficult. The authors illustrate how the application of the strengths perspective, by acknowledging and building on the strengths and goals of researchers, practitioners, and educators, can help to mitigate some of the barriers that contribute to the research--practice gap and to create more relevant research. The Reclaiming Joy Peer Support Program is offered as a case study in gerontological social work to demonstrate how the strengths perspective can be applied in a real-life research setting.

Multilevel examination of facility characteristics, social integration, and health for older adults living in nursing homes.

OBJECTIVES: Testing a model based on past research and theory, this study assessed relationships between facility characteristics (i.e., culture change efforts, social workers) and residents' social networks and social support across nursing homes; and examined relationships between multiple aspects of social integration (i.e., social networks, social capital, social engagement, social support) and mental and functional health for older adults in nursing homes. METHODS: Data were collected at nursing homes using a planned missing data design with random sampling techniques. Data collection occurred at the individual-level through in-person structured interviews with older adult nursing home residents (N = 140) and at the facility-level (N = 30) with nursing home staff. RESULTS: The best fitting multilevel structural equation model indicated that the culture change subscale for relationships significantly predicted differences in residents' social networks. Additionally, social networks had a positive indirect relationship with mental and functional health among residents primarily via social engagement. Social capital had a positive direct relationship with both health outcomes. DISCUSSION: To predict better social integration and mental and functional health outcomes for nursing homes residents, study findings support prioritizing that close relationships exist among staff, residents, and the community as well as increased resident social engagement and social trust.

Hospital to community transitions for adults: discharge planners and community service providers' perspectives.

Discharges from the hospital to community-based settings are more difficult for older adults when there is lack of communication, resource sharing, and viable partnerships among service providers in these settings. The researchers captured the perspectives of three different groups of participants from hospitals, independent living centers, and Area Agencies on Aging, which has rarely been done in studies on discharge planning. Findings include identification of barriers in the assessment and referral process (e.g., timing of discharge, inattention to client goals, lack of communication and partnerships between hospital discharge planners and community providers), and strategies for overcoming these barriers. Implications are discussed including potential for Medicaid and Medicare cost reductions due to fewer re-hospitalizations.

Multidisciplinary team perspectives on older adult hoarding and mental illness.

This qualitative study examined multidisciplinary team members' perspectives of their involvement in older adult hoarding cases. Fifteen informants, as representatives of four hoarding teams, described cases in which teams did or did not work well together. Specifically, informants described their (a) team characteristics, (b) awareness of hoarding as a mental health illness, (c) barriers to providing mental health services for older adults who hoard, and (d) components of successful teamwork within the team and with the older adult as hoarder. Implications include research to better guide interventions, team training to develop common perspectives, and policy development that supports mental health representation on teams and in-home mental health treatment.

Reclaiming joy: pilot evaluation of a mental health peer support program for older adults who receive Medicaid.

PURPOSE: Stigma and lack of access to providers create barriers to mental health treatment for older adults living in the community. In order to address these barriers, we developed and evaluated a peer support intervention for older adults receiving Medicaid services. DESIGN AND METHODS: Reclaiming Joy is a mental health intervention that pairs an older adult volunteer with a participant (older adult who receives peer support). Volunteers receive training on the strengths-based approach, mental health and aging, goal setting and attainment, community resources, and safety. Participant-volunteer pairs meet once a week for 10 weeks. Participants establish and work toward goals (e.g., better self-care, social engagement) that they feel would improve their mental health and well-being. Aging services agencies provide a part time person to manage the program, match volunteers and participants, and provide ongoing support. Outcomes evaluation for this pilot study included pre/postintervention assessments of participants. RESULTS: Thirty-two participants completed the intervention. Pre/postassessment group means showed statistically significant improvement for depression but not for symptoms of anxiety. Quality-of-life indicators for health and functioning also improved for participants with symptoms of both depression and anxiety. IMPLICATIONS: The Reclaiming Joy peer support intervention has potential for reducing depression and increasing quality of life in low-income older adults who have physical health conditions. It is feasible to administer and sustain the intervention through collaborative efforts with minimal program resources and a small amount of technical assistance.

Hoarding cases involving older adults: the transition from a private matter to the public sector.

Hoarding interventions with older adults require significant resources from multiple public agencies, yet recidivism occurs frequently. To improve services through better coordination, some communities have formed multiagency hoarding teams (MAHT), which include aging services. MAHTs requested this mixed methods study to understand the progression of cases through the public sector. Quantitative data collected on 52 cases involving adults ages 60+ identified steps in this process. Qualitative data collected from MAHT members were the basis for case studies illustrating the progression of cases through the public sector. Findings have implications for social workers involved in local service coordination, training, and policy.

Older adults' expectations to move: do they predict actual community-based or nursing facility moves within 2 years?

OBJECTIVE: This study examined the relationship between older adults' expectations to move and actual residential relocation in the community or to a nursing facility within 2 years. METHOD: Two waves of data (2000, 2002) from the Health and Retirement Study were used to compare expectations with subsequent moves. Logistic regression techniques were used to analyze the association between decision outcomes and expectations to move, health and functioning, physical environment, informal supports, and formal services. RESULTS: Findings indicated that expectations to move did predict community-based moves but did not predict moves to nursing facilities. Additional factors had significant effects but did not diminish relationships between expectations and actual moves. DISCUSSION: Results support the residential decision process as a dynamic one based on the cumulative effect of factors from an ecological model. Findings will inform policy makers and practitioners as they work to support older adults' preferences to remain living in their homes.

Using multidisciplinary teams to address ethical dilemmas with older adults who hoard.

Multidisciplinary teams, representing professionals from diverse disciplines, are often involved in addressing difficult ethical dilemmas as they work with older adults who hoard (e.g., resolving conflicts between the older adult's freedom to engage in hoarding behaviors versus individual or public safety). The purpose of this article is threefold: (a) to explore the current use of hoarding task force or team interventions to address ethical dilemmas that occur within hoarding cases; (b) to propose an ethical decision making framework for use by teams and others; and (c) to discuss practice implications for hoarding teams in implementing this ethical decision making framework.

Residential outcomes for nursing facility applicants who have been diverted: where are they 5 years later?

PURPOSE: The purpose of this longitudinal study was to determine the length of community tenure for adults aged 60 and older after application for nursing facility (NF) admission and to examine the proportion of older adults who lost community tenure due to either (a) death while a community resident or (b) permanent NF admission. DESIGN AND METHODS: In this 5-year prospective study, we tracked older adults who had applied for NF admission and were diverted (residing in the community 30 days later). Four waves of NF applicants (N = 2,882) were identified, and those diverted (n = 599) were tracked for 60 months at 3-month intervals. RESULTS: Sixty months after diversion, 18.0% of older adults (n = 108) were residing in the community, 39.2% died as community residents (n = 235), and 42.7% (n = 256) became permanent NF residents. In all, 414 diverted older adults (69.1%) died during the 5 years following NF application, with the majority of deaths occurring while older adults were community residents. IMPLICATIONS: This longitudinal study documents the capacity of NF applicants aged 60 and older to remain in the community long term, which was previously unknown. Policymakers now have data indicating that for many NF applicants, diversion does not simply delay NF admission; rather, diversion helps older adults avoid permanent NF placement until death.

Measurement of late-life residential relocation: why are rates for such a manifest event so varied?

OBJECTIVES: This methods article examines how characteristics of residential relocation (e.g., housing type) and research design decisions (e.g., level of analysis, geographic scale) influence reported rates for residential relocation among older adults. METHODS: Examination of key studies on late-life residential relocation (1992-2005) revealed a wide range of residential mobility rates and factors that contributed to this variation. These rates were rescaled to a common 5-year time period to allow for a degree of comparison across methodological approaches. RESULTS: We identified a wide range of rates for residential relocation in the literature (from 5% to more than 30% for a 5-year time period). Research design decisions accounted for much of the variation in these rates across studies; geographic scale was associated with the greatest amount of variation. DISCUSSION: We translate the findings into concrete suggestions for investigators. The article provides the background needed to identify the research design best suited to the end purpose of studies on residential relocation (e.g., inform economic policy, understand the individual's aging experience, plan for long-term-care systems). These methodological issues are also relevant to other areas of investigation in which relocation influences the variables being studied (e.g., caregiving, urban planning, neighborhood development).

Hospice use by older adults knocking on the door of the nursing facility: implications for social work practice.

Since 1983, federal funding has been available for hospice services. However, research studies have found that hospice is underutilized by people with terminal illnesses and their families. Low-income older adults are particularly at risk for underutilization. This study examined utilization of hospice services by nursing home applicants in one Midwestern state. Characteristics of users and non-users, and potential barriers to hospice use were examined. Findings further document that hospice is underutilized, especially by the Medicaid population, and point to barriers to hospice utilization. Specific recommendations are made to help practitioners increase hospice access.

Responding to the Hartford Geriatric Social Work Initiative: a multilevel community approach to building aging competency.

Infusing age-specific, multigenerational content into social work curricula at both the MSW and BSW levels are key goals in preparing age-competent social workers to meet the needs of our current and future aging populations. The social work profession has a holistic approach and crucial skills that can promote aging well. This article will discuss an innovative, multilevel intervention strategy supported by the Hartford Geriatric Social Work Initiative that formulates, implements, and sustains age-infused curricula and assures the education of age-competent social workers by capitalizing on a "community-focus" strategy.

The relationship between psychiatric disorders and the ability to age in place in assisted living.

OBJECTIVE: Residential care/assisted living (RC/AL) has become a popular long-term care option in the past decade, in part because these settings offer residents a more home-like environment than nursing homes (NHs) while still offering supervision and assistance to meet individuals' personal and healthcare needs. One of the goals of RC/AL is to facilitate residents' ability to age in place by providing access to needed services and thereby delaying NH admission. This article explores individual and facility-level characteristics associated with discharge from RC/AL to NH with particular attention to persons with a psychiatric disorder. METHODS: A Cox proportional hazards model was used to examine the risk factors associated with discharge from RC/AL to NH for a nonrandom sample of 366 residents in 37 RC/AL facilities in one state. RESULTS: Thirty-two percent of residents sampled had a psychiatric disorder. Residents with a psychiatric disorder were 1.78 times more likely to discharge to a NH. Other factors significantly associated with discharge from a RC/AL to NH included age (older), being married, more hospitalizations, for-profit ownership status, and part of a NH or continuing care retirement community. CONCLUSION: This article identifies both facility and individual characteristics that increase the likelihood of RC/AL residents discharging to NHs. Given that one of the main findings is that persons with a psychiatric disorder are at increased risk of discharge to NH, there is a need for improved provision of services for this population in RC/ALs to reduce premature discharge to NHs and to support aging in place in RC/ALs.