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Paper presented at Symposium on Aging in Place in South Carolina: Challenges and Solutions May 10, 2

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Aging in Place in South Carolina: Challenges and Solutions. May 10, 2005. Stephen M. Golant, Ph.D. ... for Clemson Symposium, South Carolina, 5-10-2005 Page ... – PowerPoint PPT presentation

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Title: Paper presented at Symposium on Aging in Place in South Carolina: Challenges and Solutions May 10, 2


1
Paper presented atSymposium on Aging in Place
in South Carolina Challenges and SolutionsMay
10, 2005
Aging in Place or Moving Golants Four
Commandments
  • Stephen M. Golant, Ph.D.
  • University of Florida

2
Higher-income older adults have more choices than
ever to age in place outside of nursing homes
  • Conventional dwellings
  • Senior Apartments and Coops
  • Congregate/Independent Living Communities
  • Assisted Living Residences
  • Continuing Care Retirement Communities

3
Lower-income older adults have fewer affordable
options, especially in some states
  • Board and care facilities/adult foster care
  • Affordable rent-assisted buildings integrated
    with supportive services
  • In some states, affordable assisted living
    residences made possible by
  • State SSI supplement
  • Medicaid state plan
  • Medicaid waivers
  • Section 8 Vouchers

4
Assessing the limitations of aging in place
especially important with fewer noninstitutional
housing options
  • Increased likelihood that lower-income older
    adults will occupy inappropriate residential
    settings
  • Inconsistent with their preferred life-styles
  • Inconsistent with their chronic health problems
    and functional and cognitive limitations
  • At greater risk of being over-served or
    under-served
  • Greater undesired burden on family members and
    thus a greater risk of incompetent care

5
Assessing Aging in PlaceFour Commandments
  • Compare and contrast alternative residential
    contexts
  • Establish the unequal salience of residential
    features
  • Consider the past, current, and future
    residential settings of older individuals
  • Assess how individual differences matter and
    examine their trajectory of change

6
Four commandments are relevant to multiple
stakeholders
  • Older consumers
  • Family members
  • Housing providers
  • Service providers
  • State policymakers
  • Researchers

7
So what is a residential setting?
  • Social, built, and organizational environments of
    the
  • Dwelling
  • Neighborhood
  • Community

8
The dwelling environment
  • More than a dwellings physical condition,
    comfort, safety, and user-friendliness
  • Includes affordability in short- and long-run
  • Includes its equity (if owned)
  • Includes the instrumental and expressive supports
    of its occupants/visitors
  • Include personal belongings having emotional and
    symbolic meanings

9
Neighborhood and community
  • Physical and social conditions (safety,
    assistance from neighbors, accessibility)
  • Sustenance grocery stores, restaurants, churches
  • Feasibility of delivering or accessing long-term
    care
  • Transportation availability
  • Community resources
  • Access to family members
  • Public programs that can be packaged

10
Commandment 1 Compare and contrast alternative
residential settings
  • Assessing place tradeoffs is crucial whether
    expressed in dollars or psychological well-being
    timeline may be crucial
  • Aging in place may not be appropriate for
    everyone Dont over-romanticize
  • Service delivery may be more cost-effective and
    timely if delivered to a congregate housing
    setting than to a private single-family dwelling

11
Breaking Commandment 1 The marketing of
reverse mortgages
  • Reverse mortgages encourage the aging in place of
    low-income older homeowners
  • Occupants receive cash advances by borrowing on
    the equity in their owned dwellingspostpone
    repayment until move, sell, or die

12
Why typical reverse mortgage evaluations violate
commandment 1
  • Infrequent comparisons with other ways of
    releasing dwelling equity e.g.,
    selling/re-invest
  • Absent assessments of whether expected dwelling
    appreciation will offset loan costs and the
    maintaining or upgrading of an older dwelling
  • A reverse mortgage is not just a loan transaction
  • It can result in older homeowners living alone in
    cost-inflated and physically inappropriate
    dwellings
  • Residential life-style and long-term care
    delivery strategy must be compared with
    alternatives

13
Commandment 2 Establish the unequal salience of
residential features
  • Avoiding the elderly where to live community
    guidebook fallacy
  • Community may rank first for active retirees, but
    last for vulnerable old seeking affordable
    assisted living
  • Only a handful of issues may be the most salient
    in residential decision-making
  • Inaccessible family member may undermine aging in
    place, despite a dwellings great design features

14
Commandment 3 Consider the past, current, and
future residential settings
  • Older peoples lives dont begin when they meet a
    case manager or complete an interview or
    application
  • Older people evaluate their current and future
    residential settings from a life-time perspective
  • Some people have always lived in less than
    perfect places and will always be difficult to
    satisfy

15
Commandment 4 Assess how individual differences
matter and examine their trajectory of change
  • Demographics, economic well-being
  • Current and past lifestyles
  • Personal resources (e.g., behavioral competence,
    coping styles)
  • Likely trajectory of change of personal resources
  • Personality styles
  • THUS, ONE SIZE DOES NOT FIT ALL

16
Assessing desirability of aging in place Four
commandments
  • Compare and contrast alternative residential
    settings
  • Establish the unequal salience of residential
    features
  • Consider the past, current, and future
    residential settings of older individuals
  • Assess how individual differences matter and
    examine their trajectory of change
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