Live-in Care Workers in Sheltered Housing for Older Adults in Israel: The New Sheltered Housing Law.

Supportive housing schemes were historically aimed to provide group accommodation for older adults. With the aging of residents, facilities were required to enable them to receive care services in order to allow them to age in place. Thus, different countries and different facilities developed different models of housing with care, reflecting cultural and policy diversities. Despite all of the different models, there are many commonalities among the supportive housing schemes across countries. These include provision of dwelling units and care services provided by either the facility or by external agencies. The aims of this article are threefold: to describe the historical development of the ever-evolving supportive care housing phenomena; to point at variations in models of housing and care within the international context; and to present a new Israeli model that enables residents to privately hire live-in care workers to meet their care needs. This is a unique model in the international context that has not been reported before. The article describes the main ideas of the new model and discusses the challenges that it raises and pinpoints the unresolved issues associated with the presence of live-in care workers employed by residents of sheltered housing that should be addressed.

Predictors of smoke-free policies in affordable multiunit housing, North Carolina, 2013.

INTRODUCTION: Smoke-free policies can effectively protect nonsmokers from secondhand smoke (SHS) exposure in multiunit housing. We surveyed all affordable multiunit housing properties in North Carolina to determine the statewide prevalence of smoke-free policies and to identify predictors of smoke-free policies. METHODS: Representatives of affordable housing properties in North Carolina completed a mailed or online survey during June through October 2013. The primary outcome measure was presence of a smoke-free policy, defined as prohibiting smoking in all residential units. We used χ(2) analysis and multivariate logistic regression to identify correlates of smoke-free policies. RESULTS: Of 1,865 eligible properties, responses were received for 1,063 (57%). A total of 16.5% of properties had policies that prohibited smoking in all residential units, while 69.6% prohibited smoking in indoor common areas. In multivariate analysis, an increase in the number of children per unit was associated with a decrease in the odds of having a smoke-free policy at most properties. Newer properties across all company sizes were more likely to have smoke-free policies. Accessing units from interior hallways predicted smoke-free policies among medium-sized companies. CONCLUSION: More smoke-free policies in affordable multiunit housing are needed to protect vulnerable populations, particularly children, from SHS exposure. Public health professionals should continue to educate housing operators about SHS and the benefits of smoke-free policies at all properties, including older ones and ones where units are accessed from outside rather than from an interior hallway.

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.

LGBQ-Specific Elderly Housing as a "Sparkling Sanctuary": Boundary Work on LGBQ Identity and Community in Relationship to Potential LGBQ-Specific Elderly Housing in Sweden.

This study explored how boundaries in relationship to community and identity were created and negotiated among lesbian, gay, bisexual, and queer (LGBQ) people within the framework of picturing LGBQ-specific elderly housing as a housing alternative in older age, by applying focus group methodology. "An island as a sparkling sanctuary" was identified as a metaphor for how symbolic resources defining the LGBQ community can be manifested in LGBQ-specific qualities of elderly housing. The boundary work underlying this manifestation included elaborations on the dilemma between exclusiveness and normality. The findings illustrate further how symbolic resources and collective identities were developed through dialectic interplay between internal and external definitions. Further, the findings show how boundary work generated shared feelings of similarity and group membership. The associated symbolic and social resources not only served to deal with difficult situations but also to manifest LGBQ identity and sense of community as a "gold medal."

'An ant against an elephant': Retirement village residents' experiences of disputes and dispute resolution.

OBJECTIVE: To record Victorian retirement village residents' experiences of dispute management and satisfaction levels related to dispute resolution processes. METHODS: Survey distributed to 6500 retirement village residents. RESULTS: Surveys returned from 1876 residents (29% return rate). Most residents rated life in retirement villages as positive (mean 7.9/10), with an association between life satisfaction and management's ability to resolve disputes (rs = 0.44, P < 0.01). Almost 70% of respondents reported issues of concern to management were resolved satisfactorily; 38% were not resolved to residents' satisfaction. One-fifth reported contacting regional managers or higher personnel regarding issues affecting them, with two-thirds of these respondents reporting a negative outcome. Over 30% did not know if their village had dispute resolution processes in place. CONCLUSION: Despite finding retirement village life positive, residents of retirement villages found disputes and dispute resolution processes unsatisfactory and desired change to address these concerns.

Bankruptcy risk and state regulation of continuing care retirement communities.

Continuing care retirement communities (CCRCs) often require substantial financial investment from residents, prompting concern about potential losses to residents in the event of a CCRC's bankruptcy. State governments have responded to this concern with varying levels of regulation. Overall, CCRC bankruptcy rates are very low (.3% per year). We found that measures of varying regulation stringency had no effect on indicators of CCRCs' financial performance relating to bankruptcy risk. CCRCs that offer extensive contracts, including unlimited long-term care in addition to housing, have less positive indicators of financial strength than other types of CCRCs. When measured by traditional health care industry standards of financial strength, CCRCs appear less profitable than other types of health care facilities. This raises the question of whether CCRCs can continue to attract the needed capital from private markets and because of that, suggests that their future growth may be limited.

State unit on aging involvement with continuing care retirement community (CCRC) legislation.

State units on aging (SUAs) from 29 states with continuing care retirement community (CCRC) legislation were surveyed to (a) assess staff familiarity with CCRC legislation, (b) examine interdepartmental working relationships surrounding such legislation and ask what role(s) ombudspersons are playing in CCRC oversight, (c) determine what role(s) aging units have had in developing legislation, and (d) gain insights regarding legislative impact. Results indicate that SUAs have been active in legislative development but vary greatly in the intensity of their involvement with the implementation and enforcement of CCRC regulation and in their perception of legislative impact.

Use of multidimensional assessment to provide testimony on behalf of residents in a life-care home.

City administrators challenged a life-care home's tax-exempt status. A successful, empirically-based case was made based on data collected by gerontological nurses using the Iowa Self-Assessment Inventory (ISAI) and related instruments (Mini-Mental State Examination [MMSE], Instrumental Activities of Daily Living Scale [IADLS], and Physical Self-Maintenance Scale [PSMS]) to describe the life-care population. Testimony by gerontological nurses included comparisons between these life-care residents and statewide data on elderly individuals currently residing in nursing homes and in the community. The data they presented showed not only that this life-care home provided a high quality of life, but also saved society substantial amounts of money in government-funded services that would otherwise be provided to residents of this home. The judge ruled in favor of continuing tax-exempt status for this life-care home because credible evidence clearly demonstrated that taxpayer savings from the services provided to life-care home residents and the life-care commitment dramatically outweighed the taxpayer costs associated with lost tax revenues.

Financing of independent and assisted-living retirement communities by nonprofits.

The article provides reasons for decreased activity in the development of market rate senior housing and briefly describes the criteria lenders use to assess risk. It summarizes the various financing options available for nonprofits to finance senior housing projects. Options discussed include tax-exempt bond financing: different supportive senior housing options administered by the Department of Housing and Urban Development, such as Sections 202, 232, and 221 (d)(3) and (4); the HOME Investment Partnership Program (HOME Program); and low-income housing tax credits.

The delegate's dilemma: ACAT re-assessment in hostels.

The provision for 'ageing in place' in the Aged Care Act of 1997 has provided an opportunity for hostel facilities to broaden their scope of care for older people. Aged Care Assessment Teams (ACATs) are required to provide assessments to give approval for high or low level entry to these facilities, and to provide approval for reclassification from low to high care. However, guidelines for ACAT assessments are contradictory with respect to the Resident Classification Scale (RCS) which provides the facility funding formula, thus creating gatekeeping compared with advocacy difficulties for the ACAT. If the facility can support a claim of high care need for a resident via the RCS but the ACAT (using different and less in-depth criteria) does not agree with that claim, then the care of that resident might be compromised due to inadequate funding. Recommendations made to solve this dilemma include conferring the right of the hostel staff to reclassify residents when necessary, with the responsibility for confirmation of that classification to remain with the trained validation officers from the Commonwealth Department of Health and Family Services, not the ACAT.

The evolution of assisted living. A view from the states.

Use of nursing homes has declined significantly with the expansion of home care services and the explosion of assisted living facilities. To give consumers more choices, many states allow assisted living facilities to provide higher levels of service that enable residents to continue to live as independently as possible as their needs change.

Senior housing comes of age. Cautious but steady growth characterizes the industry.

This is the fourth year that Contemporary Long Term Care, in conjunction with Senior Housing Investment Advisors, Inc., has prepared a report on the state of the senior housing industry. This year's report is based on the comments of 22 industry experts. Vast changes in our nation's political landscape, in conjunction with an improved awareness of the senior housing market, are shaping the growth of this business into the 21st century. The answers to the following questions offer perspective on some of the factors impeding and enabling that growth.

Supporting aging in place & assisted living through home care.

This article defines assisted living, discusses the pros and cons of limited regulation, scope of service, Aging-in-Place partnerships, and how home care agencies can work with assisted-living facilities to provide care. It also examines a study on assisted living in six states that is funded by the Robert Wood Johnson Foundation.

Assisted living: opportunities for partnerships in caring.

Throughout the United States, a variety of state government bodies license or certify assisted-living facilities. States have taken a variety of approaches in setting standards and protecting consumers. Consumers will respond to innovative solutions that enable elders to remain independent while assuring peace of mind of their adult children.