Promoting Sustainability in Housing with Services: Insights From the Right Care, Right Place, Right Time Program.

Despite the widely-acknowledged potential of housing with services for improving the lives of low-income older adults, ensuring their financial sustainability has been challenging. This study aimed to address this issue, drawing on 31 key informant interviews and three focus groups with payers, housing providers, and community partners involved in the Boston-area Right Care, Right Place, Right Time Program, which enrolled about 400 older adults. Transcripts were qualitatively analyzed using thematic coding. Participants agreed on the program's value, but there was little consensus on mechanisms for securing ongoing funding. The broadly distributed responsibility for individuals in housing sites, which involves health insurers, hospitals, and community service providers, provides little incentive for investment by these entities. Findings suggest that governmental mechanisms, probably at the federal level, are needed to channel funding toward these supportive services. Without such reliable funding sources, replication of supportive housing models for low-income older people will prove difficult.

Association of Chronic Diseases and Functional Limitations with Subjective Age: The Mediating Role of Sense of Control.

OBJECTIVES: This study examined the relationships between chronic diseases, functional limitations, sense of control, and subjective age. Older adults may evaluate their subjective age by reference to their younger healthier selves and thus health and functional status are likely to be determinants of subjective age. Although sense of control is also a potential predictor of subjective age, stress-inducing factors associated with disease and functional limitations may reduce older adults' sense of control, making them feel older. METHODS: Using the 2010 and 2014 waves of the Health and Retirement Study, structural equation modeling was performed on a sample of 6,329 respondents older than 50 years to determine whether sense of control mediated the relationship between chronic diseases, limitations in instrumental/basic activities of daily living (ADLs, IADLs), and subjective age. RESULTS: Chronic diseases and limitations in ADLs had a positive, direct association with subjective age (ß = 0.037, p = .005; ß = 0.068, p = .001, respectively). In addition, chronic diseases and limitations in ADLs and IADLs were positively, indirectly associated with subjective age via a diminished sense of control (ß = 0.006, p = .000; ß = 0.007, p = .003; ß = 0.019, p = .000, respectively). DISCUSSION: As predicted by the Deterioration model, the findings showed that chronic diseases and functional impairment are associated with older adults feeling older by challenging the psychological resource of sense of control. Appropriate interventions for dealing with health challenges and preserving sense of control may help prevent the adverse downstream effects of older subjective age.