Examining Stakeholder Perspectives: Process, Performance and Progress of the Age-Friendly Taiwan Program.

Since Taiwan's age-friendly city (AFC) program was launched in 2012, the central government has provided various resources to the country's 22 local authorities, including budgetary support, policy advocacy, and consultation from a team of experts. This study examines stakeholder perspectives on the process, performance, and outcome of the AFC program. A 53-item questionnaire was developed based on the World Health Organization (WHO) guideline, including mechanisms and processes (20 items), outcome evaluations (23 items), and resource integration (10 items). There was a "great difference" found among scores between facilitators and experts for "inter-exchange experience with local and international cities" (40%) and "monitor and revise indicators" (37%) in mechanisms and processes, "evaluate performance of indicators and action plans" (37%) in outcome evaluations, and "interaction between government and community" (46%) and "interaction between civil organization and senior society" (39%) in resource integration. Clearly, facilitators showed overly optimistic assessments in AFC mechanisms and processes, outcome evaluation, and resource integration. The results showed disconnect between experts' expectations versus actual practice conducted by facilitators. Implications of these findings are to integrate top down expectations with the realities of bottom up practice to design more realistic evaluations; continue to educate stakeholders about design, implementation and evaluation; and further integrate resources from government, civil organizations, and community.

Organizational Characteristics Associated With the Predicted Sustainability of Villages.

Guided by resource dependence theory, this mixed-methods study examined organizational characteristics contributing to the perceived sustainability of Villages, a rapidly proliferating grassroots approach for promoting social participation and service access for community-dwelling older adults. Surveys conducted with leaders of 86% of Villages in the United States in 2012 found that higher predicted confidence in their Village's 10-year survival was associated with greater financial reserves, human resources, number of Village members, formal policies and procedures, and formal collaboration agreements. Respondents' explanations of their confidence ratings revealed additional themes of organizational leadership and perceived community need. Member resource inputs were not found to be as salient for Village leaders' perceptions of sustainability as was anticipated given the Village model's emphasis on consumer involvement. Despite the lack of longitudinal prospective data, study findings suggest potential limitations of consumer-driven organizational models such as Villages, including the need for a more stable resource base.

Do Villages Promote Aging in Place? Results of a Longitudinal Study.

Villages are a new, grassroots, consumer-directed model that aims to promote aging in place and prevent unwanted relocations for older adults. In exchange for a yearly membership fee, Villages provide seniors with opportunities for social engagement (social events and classes), civic engagement (member-to-member volunteer opportunities), and an array of support services. In total, 222 Village members were surveyed at intake and 12-month follow-up to examine changes in their confidence aging in place, social connectedness, and health. The strongest positive results were in the domain of confidence, including significantly greater confidence aging in place, perceived social support, and less intention to relocate after 1 year in the Village. As most seniors were in good health and well connected at the time they joined the Village, there were not improvements in health or social connectedness. Authors discuss the importance of longer term, longitudinal studies to examine the effectiveness of Villages in preventing institutionalization over time.

Impact of the Village Model: Results of a National Survey.

Villages are a relatively new, consumer-directed model that brings together older adults in a community who have a mutual interest in aging in place. These membership organizations provide social and civic engagement opportunities, volunteer provided support services, and referral to vetted community providers to achieve their primary goals of promoting independence and preventing undesired relocations. This cross sectional survey of 1,753 active Village members from 28 Villages across the US measured members' perceived impacts in the areas of social connection, civic engagement, service access, health and well-being, and ability to age in place. Results showed that involvement in the Village was a key factor associated with greater perceived impacts. Over half of members perceive that the Village has improved their sense of connection to others and their feeling that they have someone to count on. Though younger members in better health were more likely to perceive impacts in social connections, results suggest older women, living alone with some disability may be the most likely to experience improved health, quality of life, and mobility. The implications for social work practice are discussed.

Aging in Context: Individual and Environmental Pathways to Aging-Friendly Communities-The 2015 Matthew A. Pollack Award Lecture.

Reflecting the theme of the 2015 Gerontological Society of America (GSA) Annual Scientific Meeting, "Aging as a Lifelong Process," this paper examines intersections between aging processes and their environmental context, develops theory regarding constructive developmental processes and their environmental context, and considers potential implications for conceptualizing and creating aging-friendly communities. The first section examines the primary goals of aging-friendly communities, that is, promoting elder well-being. The second section explores the role of environmental pathways in fostering well-being throughout the lifecourse. The third section presents a new Process Model of Constructive Aging that identifies key developmental processes at the intersection of individual and environmental pathways. The final section considers potential implications for creating aging-friendly communities, including ways in which cities and towns can promote the ability of community members to live fully throughout their lives, and identifies some key conceptual and empirical challenges affecting the future of the field.

Variations on the Village Model.

Villages, which are community-based initiatives designed to help older adults age in place through a combination of services, participant engagement, and peer support, have expanded rapidly since their initial development in the early 2000s. Using a sample of Villages in the United States, we examined variations from characteristics of the Village model as portrayed by media and organizational leaders. Results indicate there is no uniform Village model that can be implemented and evaluated by policy makers, funders, service providers, and researchers. Based on the extent of member involvement, methods of service provision, and funding sources, we developed a conceptually and empirically informed typology of Villages that reflects the model's focus on consumer involvement. Descriptive analyses indicate potential differences in member, community, and organizational characteristics. This emerging typology has implications for understanding the implementation and sustainability of Villages, including whether specific Village types are best suited to certain community contexts.

Age-friendly community initiatives: conceptual issues and key questions.

Public policy and programs for older adults traditionally have focused on the delivery of benefits to targeted individuals. Over the past decade, age-friendly community initiatives (AFCIs) have developed as a paradigm shift in contrast to this predominant focus. AFCIs engage stakeholders from multiple sectors within a typically local geographic area to make social and/or physical environments more conducive to older adults' health, well-being, and ability to age in place and in the community. We describe three general categories of AFCIs, including community planning approaches, support-focused approaches, and cross-sector partnership approaches. Following from this conceptual overview, we posit four key policy-relevant questions with implications for the expansion of AFCIs, including what public policy supports are necessary for the implementation of AFCIs across diverse communities, how entities outside of aging can be engaged to collaborate, to what extent advocates for various models can work together, and how the outcomes of these initiatives can be rigorously evaluated. We conclude by discussing how AFCIs are germane to the primary issues highlighted by the 2015 White House Conference on Aging.

Estimating the value of volunteer-assisted community-based aging services: a case example.

This study demonstrates the use of a social return on investment (SROI) approach in estimating the financial and social value created by volunteer-assisted community-based aging services. An expanded value added statement (EVAS) analysis found that the total value of outputs produced by the Concierge Club of San Diego substantially exceeded the cost of the program, after considering likely secondary and tertiary benefits for a range of affected stakeholders-including elderly service recipients, family members, volunteers, and societal institutions. Additional research is needed regarding the direct and indirect costs and benefits of volunteer support services for vulnerable older adults and their families.

An Integrated Model of Co-ordinated Community-Based Care.

PURPOSE OF THE STUDY: Co-ordinated approaches to community-based care are a central component of current and proposed efforts to help vulnerable older adults obtain needed services and supports and reduce unnecessary use of health care resources. DESIGN AND METHODS: This study examines ElderHelp Concierge Club, an integrated community-based care model that includes comprehensive personal and environmental assessment, multilevel care co-ordination, a mix of professional and volunteer service providers, and a capitated, income-adjusted fee model. Evaluation includes a retrospective study (n = 96) of service use and perceived program impact, and a prospective study (n = 21) of changes in participant physical and social well-being and health services utilization. RESULTS: Over the period of this study, participants showed greater mobility, greater ability to meet household needs, greater access to health care, reduced social isolation, reduced home hazards, fewer falls, and greater perceived ability to obtain assistance needed to age in place. IMPLICATIONS: This study provides preliminary evidence that an integrated multilevel care co-ordination approach may be an effective and efficient model for serving vulnerable community-based elders, especially low and moderate-income elders who otherwise could not afford the cost of care. The findings suggest the need for multisite controlled studies to more rigorously evaluate program impacts and the optimal mix of various program components.

Aging, place, and technology: toward improving access and wellness in older populations.

OBJECTIVE: To review the range of promising technologies (e.g., smart phones, remote monitoring devices) designed to enhance aging in place; identify challenges for implementation of those technologies; and recommend ways to improve access to technologies in older populations. METHOD: A narrative review of research, practice, and policies from multiple fields, including information science, gerontology, engineering, housing and social services, health care and public health. RESULTS: Despite a wide range of emerging and current technologies, there are significant challenges for implementation, including an uneven evidence base, economic barriers, and educational and ergonomic issues that adversely affect many older adults. DISCUSSION: Recommendations for future development and adoption include improving the evidence base through field-testing of "packages" of devices in diverse populations of older adults; development of innovative funding mechanisms involving multidisciplinary teams, older adults, and caregivers; and promotion of safety and security in the use of these technologies in older populations.

The impact of the "Village" model on health, well-being, service access, and social engagement of older adults.

BACKGROUND: Villages represent an emerging consumer-driven social support model that aims to enhance the social engagement, independence, and well-being of community-dwelling seniors through a combination of social activities, volunteer opportunities, service referral, and direct assistance. This study aimed to assess the perceived impact of Village membership on factors associated with the likelihood of aging in place. Additionally, the research examines the characteristics and service use of members who benefit the most. METHOD: Perceived impacts of Village membership in the areas of social engagement, service access, health and well-being, and self-efficacy for maintaining independence were assessed through a survey of 282 active Village members from five sites in California. Bivariate and multivariate analyses examined associations between member characteristics, volunteerism, service use, and self-reported impacts. RESULTS: Villages have the strongest impact in the area of promoting social engagement and facilitating access to services. Three quarters of the participants report that the Village increases their ability to age in place. Positive impacts were associated with level of Village involvement, but less likely among members who had worse self-reported health. CONCLUSION: Villages represent a promising new model designed to support community-dwelling seniors with a number of positive impacts that may reduce social isolation, improve well-being, and increase confidence aging in place. Villages appear to have the greatest benefit for members who are most involved and fewer positive impacts for members in poor health, prompting questions about the long-term effectiveness of the Village model in helping more frail seniors to age in place.

Does the Village model help to foster age-friendly communities?

This article explores the potential role of the Village model, a social initiative that emphasizes member involvement and service access, in helping communities to become more age-friendly. A survey of 86.3% of operational Villages examined activities designed to help members access a variety of supports and services consistent with the World Health Organization's (WHO) Global Network of Age-Friendly Cities and Communities program model, as well as other potential contributions to community age friendliness. Analysis revealed that 85.5% of Villages provided assistance with at least six of the eight WHO domains, but only 10.1% implemented features of all eight; more than one-third were engaged in direct or indirect efforts to improve community physical or social infrastructures or improve community attitudes toward older persons. These findings suggest that Villages and other social organizations may have untapped potential for enhancing their members' ability to age in place consistent with the goals of age-friendly initiatives while also promoting constructive changes in the overall community.

A tale of two community initiatives for promoting aging in place: similarities and differences in the national implementation of NORC programs and villages.

PURPOSE: Villages and Naturally Occurring Retirement Community (NORC) Supportive Service Programs (NORC programs) are among the most prominent community-based models for promoting aging in place. To advance systematic understanding of their development, this study examined how these models have been implemented nationally and the models' similarities and differences. DESIGN AND METHODS: A survey of program leaders representing 69 Villages and 62 NORC programs was conducted from January to June of 2012. Bivariate analyses compared measures of the initiatives' services/activities, beneficiaries, service delivery processes, and funding sources. RESULTS: Village members were reportedly more likely than NORC program participants to be younger, to be less functionally impaired, to be more economically secure, and to reside in higher socioeconomic communities. Reflecting these differences in populations served, NORC programs reported offering more traditional health and social services, had more paid staff, and relied more on government funding than Villages. IMPLICATIONS: Findings indicate that Villages and NORC programs both aim to promote aging in place by offering a diverse range of supports and services to older adults within a locally defined geographic area. Nevertheless, key differences were found in the means through which they seek to achieve these aims, as well as the populations likely to benefit from their efforts. These differences raise questions regarding the models' inclusivity, sustainability, expansion, and effectiveness and have implications for community aging in place initiatives more broadly.

From interviewers to friendly visitors: bridging research and practice to meet the needs of low-income Latino seniors.

This article describes a community-based participatory research (CBPR) effort conducted in a low-income, predominantly Latino community, which bridged traditionally-separate domains of practice and research by engaging neighborhood residents in a collaborative capacity-enhancement process for meeting the needs of vulnerable elderly residents. What began as a simple needs assessment to facilitate program development became a mechanism for engaging neighborhood residents in a collaborative social capital development process. The article describes the origins of this community-based effort, its consumer-led transformation from traditional needs assessment to service provision, resulting benefits and challenges, and implications for meeting the needs of vulnerable populations.

Racial and ethnic variations in caregiver service use.

OBJECTIVE: This article examines whether race and ethnicity contribute to the differential use of caregiver support services, when controlling for caregiver and care recipient characteristics, as represented by predisposing, enabling, and need factors included in the Behavioral Model of Health Services Use. METHODS: The study includes 1,508 individuals who provide care to an ill or disabled adult aged 50 or older, identified through a random digit dial telephone survey of California households. Logistic regression analysis is utilized to examine factors that predict use of caregiver support services. RESULTS: Race and ethnicity do not contribute significantly to caregiver service utilization, when controlling for relevant covarying factors such as age, education, emotional support, family contribution, care recipient service use, and care recipient impairment. A significant interaction exists between ethnicity and family closeness, with reduced rates of service use among Asian and Pacific Island caregivers whose families are brought closer by the caregiving experience. DISCUSSION: These findings suggest that racial and ethnic disparities in caregiver service use found at the bivariate level are attributable to covarying predisposing, enabling, and need factors. Further research and theoretical development are suggested to clarify the impact of sociocultural factors on caregiver service use.

A stress process model of family caregiver service utilization: factors associated with respite and counseling service use.

This study examines whether caregivers' differential utilization of respite and counseling support services is associated with different situational stress processes. A multinomial regression analysis was conducted to compare respite users, counseling users, and those who used neither service, using data collected on a statewide random sample of 1,643 California caregivers providing assistance to individuals aged 50 or older. Compared with caregivers who used neither service, respite service users were more likely to have demanding care situations giving rise to physical symptoms of stress, and were more likely to use community services for the care recipient to augment their care. In contrast, counseling service users were more likely to be managing the meaning of their care situation by seeking out information about services and talking with a confidant about their situation, while coping with both emotional and physical symptoms of stress. Tailoring caregiver interventions to meet the support needs and coping strategies stemming from diverse caregiving situations and caregiver characteristics may increase the likelihood that those interventions will be effective in alleviating or preventing deleterious secondary stress frequently experienced by family caregivers.

Assistance received by employed caregivers and their care recipients: who helps care recipients when caregivers work full time?

PURPOSE: This study examined the association among caregiver labor force participation, employees' caregiving activities, and the amount and quality of care received by care recipients. DESIGN AND METHODS: Telephone interviews were conducted with 478 adults who were employed full time and 705 nonemployed adults who provided care to a family member or friend aged 50 or older, identified through random sampling of California households. We assessed care recipient impairment and service problems; the amounts and types of assistance received from caregivers, family and friends, and paid providers; and caregiver utilization of support services. RESULTS: Care recipients of caregivers employed full time were less likely to receive large amounts of care from their caregivers, more likely to receive personal care from paid care providers, more likely to use community services, and more likely to experience service problems than were care recipients of nonemployed caregivers. Employed caregivers were more likely to use caregiver support services than were nonemployed caregivers. IMPLICATIONS: Accommodation to caregiver full-time employment involves selective supplementation by caregivers and their care recipients, reflecting increased reliance on formal support services as well as increased vulnerability to service problems and unmet care recipient needs. These findings suggest the need for greater attention to the well-being of disabled elders whose caregivers are employed full time.

Cultural attitudes and caregiver service use: lessons from focus groups with racially and ethnically diverse family caregivers.

Focus groups were conducted with caregivers from eight racial-specific or ethnic-specific populations (African Americans, Chinese, Filipinos, Hispanics, Koreans, Native Americans, Russians, and Vietnamese), to examine cultural variations in caregiving experiences, care-related values and beliefs, care practices, and factors contributing to decisions about the use of caregiver support services. Analysis of focus group transcripts revealed three cross-cutting constructs: familism, group identity, and attitudinal and structural barriers to service use. We discuss these findings in terms of their implications for existing knowledge regarding family responsibility, resource utilization, and program development for racially and ethnically diverse family caregivers.

Availability of caregiver support services: implications for implementation of the National Family Caregiver Support Program.

This study examines the scope and range of existing resources for family caregivers from the perspective of the Area Agencies on Aging (AAAs), which are charged with implementing Title III-E of the reauthorized Older Americans Act. California is used as a case example because of its substantial experience in providing caregiver support services. In particular, we examine the extent and adequacy of resources available in California corresponding to each of the five Title III-E service areas, utilizing data from AAAArea Plans, a follow-up survey of AAAs, and an Internet search. AAAs identified more than 276 providers of caregiver support services, and our Internet search identified another 195. Nearly two-thirds of these programs offer access to respite care, while other support services (e.g., counseling, training, support groups) are less often available. Service gaps most frequently identified included culturally and linguistically appropriate caregiver services, transportation, respite care, financial assistance, and services in rural areas. These findings suggest the need for enhanced efforts to improve the service network for supporting family caregivers, as states implement the National Family Caregiver Support Program.

Care management in long-term care insurance: meeting the needs of policyholders?

Despite the increase in long-term care insurance (LTCI) sales, little attention has been given to the quality of services provided to policyholders receiving benefits. This article describes a qualitative analysis of care management (CM) services within LTCI. Key components of analysis included the assessment and care planning process, service coordination, monitoring of policyholder needs, discharge planning, and consumer knowledge and satisfaction. Extensive case record reviews, including longitudinal in-person and telephone interviews with policyholders, caregivers, and other stakeholders, were performed to gain insight into the CM process as experienced by LTCI policyholders under the California Partnership for Long-Term Care. Results suggest that CM may be somewhat restricted under LTCI. While the basic CM services available to policyholders may be appropriate for addressing the simple needs, individuals with chronic and unstable disabling conditions may require a more comprehensive form of CM.