Aging-in-Place Initiative

Most Americans want to remain in their homes as they get older. Personal comfort and satisfaction with a familiar house or apartment, neighbors and community constitute powerful reasons to search for ways to make this possible.

In an AARP survey, an overwhelming number of older Americans agreed with the statement, "What I'd really like to do is stay in my current residence as long as possible." Among persons age 55 to 64, 83 percent agreed or strongly agreed, compared to 92 percent of persons age 65 to 74 and 95 percent of personage 75 and older.

Beyond 50 | 2003: A report to the Nation on Independent Living and Disability, AARP, 2003

From society's perspective, there is another important reason for increasing options for aging-in-place: The shifting structure of financing services for the elderly and the attendant upward spiraling of health care costs. At the same time our nation faces the challenges of caring for a growing, aging population, publicly-funded reimbursement for nursing home care has focused more narrowly on patients who require the most intensive, expensive medical care. This has increased the importance of developing community-based services for seniors who may be frail or have less acute needs, whether for personal care and treatment of chronic illnesses or for rehabilitation services following an illness or accident.

In Howard County, Maryland, over a period of five years, The Horizon Foundation has teamed with the Office on Aging and other community practitioners and leaders to create a service model designed to start permitting the quality of life and quality of care that older residents both want and deserve - ideally, in their own homes, and at a cost that the community can afford.

Phase 1 Defined

The first step in this process was the multi-faceted Aging-In-Place Initiative from 1999 to 2002. From the beginning, the Foundation's approach was based on these overarching principles:

• Forging a strong partnership between the public and private sectors,
  
• Integrating service components into a seamless service delivery model that is supported by appropriate planning and evaluation, and
  
• Developing benchmark information against which progress toward aging-in-place could be measured, and measuring that progress.

Guided by these principles, the Aging-In-Place pilot program consisted of four service components:

Home Repair, Remodeling and Assessment

Lack of a wheelchair ramp, stair railings or other safety features can make the difference between a safe and happy home and an unsafe residence that virtually imprisons an older person or forces her or him to vacate. The Aging-In-Place pilot initially addressed this problem by creating a unique collaboration between the Office on Aging and Our House youth home, a residential program that trains at-risk males 16 to 21 to work in the construction trades. As a result, 155 homes of county seniors were repaired or modified.

In addition, a new coalition, Howard County Rebuilding Together, was created to provide home modification training for professionals and consumers, enabling seniors to receive an assessment of their home, and, if necessary, repairs and modifications to make the building safer. Funding for this project, from the federal Community Development Block Grant program, the Foundation and the county, reflected the sponsors 'strong commitment to public- private partnerships'. Negotiations between the Foundation and county to seek CDBG funds in this manner represented the first fold-in of federal funds under the initiative.

Fall Prevention

Falls are the leading cause of injury deaths among people age 65 and older, and 60 percent of fatal falls occur in the home. The fall prevention component of the Aging-In-Place Initiative embraces two strategies, community education and training and direct services to clients. The program screened several hundred seniors for fall risk and functional fitness, served 160 clients referred for fall prevention services and collaborated with the American Red Cross on creation of a Senior Safety program.

Mental Health

Aging causes a number of physical changes, often resulting in problems such as reduced mobility, vision or hearing; and disorders such as dementia or mental illness. Coupled with lack of family support, these changes often leave older people isolated and vulnerable in their homes. The Older Adult Consultation Services (OACS), funded by The Horizon Foundation initiative, addressed the mental health of seniors by stimulating awareness of community health services in general and OACS in particular, and by direct client services.

In this program component, community awareness was heightened through 32 training sessions throughout the county on the mental health of the elderly for doctors and other professionals, and numerous staff speaking engagements at senior centers and other community forums.

Through home and close-in community visits, mental health services were provided to nearly 250 clients.

The project seeks innovative models to provide mental health care in the home or close-in community setting. As in other jurisdictions, this is proving extremely difficult in light of tightening funding, a paucity of acceptable models and other stressors in the general provision of mental health care.

Affordable In-Home Care

Routine and necessary tasks such as shopping, housecleaning, meal planning and preparation or bathing can become overwhelming for an older adult who is frail or disabled. Through the Aging-In- Place Initiative, Family and Children's Services of Central Maryland, a non-profit agency, provided these types of services to clients at a time when the county's demographic trends were intensifying pressure on their resources.

OTHER PHASE 1 OUTCOMES

In addition to the service components, the Initiative contributed in other ways to the evolution of Howard County's strategies to prepare for the future aging population.

A steering committee of representatives of all of the components provided ongoing oversight and coordination, joint training for the agencies involved, systems for tracking and monitoring the project, and development of community awareness and outreach. Many older adults have multiple needs, and the steering committee played a key role in facilitating coordination of intake and referrals through the County Office on Aging.

As an outgrowth of the initiative, in July 2001, the Office on Aging, a Community Council organized by The Horizon Foundation and other local partners created the Elkridge Aging Alliance, designed to address the needs of the 2,000 elders in the close-knit community of Elkridge. The Community Council, one of four geographically dispersed advisory units created by the Foundation in 2000, is made up of local residents who advise the Foundation about local needs, assist in outreach to their communities and collaborate to achieve change.

The Alliance provided an outreach coordinator to conduct outreach and improve residents' access to services. As a result, more residents have been able to secure assistance with expenses such as prescriptions, in-home care and emergency dental services, utility bills and food, as well as additional health care services available through Medicaid and programs for low-income Medicare beneficiaries. The program continues to grow and offer more support to the community's seniors through ongoing county funding. The Elkridge Horizon Council is currently working with the Foundation and the Office on Aging on an intergenerational project.

Another outgrowth of the AIP Initiative was the June 2002 conference, "Aging in Place: A Blueprint for Change," sponsored by The Horizon Foundation, the Robert Wood Johnson Foundation and the county in Ellicott City, Maryland. For the first time, this conference brought together a wide range of experts from across the nation to share their experiences and strategies and brainstorm about future directions to support aging-in-place. Among the distinguished speakers were Josefina Carbonell, U.S. Assistant Secretary for Aging, and Mayor Glenda Hood of Orlando, Florida.