Part 1: Unmet Needs among Community-Living Elderly
A combination of personal determination and informal care arrangements, provided by friends and family, often enable frail, older adults to remain living in their homes. These arrangements have become the norm given the multi-year’s long wait to access community-based care services provided by the state of Georgia. These are the findings of a small, statewide study conducted by researchers at the Georgia Health Policy Center (GHPC) and the Georgia Department of Human Services’ Division of Aging Services.
Community-based, older adult services, established by the 50-year old Older Americans Act (OAA), are not funded at levels sufficient to meet the needs of the burgeoning senior population. Georgia is one of 42 states that has a waiting list to access state OAA services such as meal delivery, personal care assistance, and homemaker services.
“With 10,000 Baby Boomers turning 65 each day, time is of the essence to address the shortage of community-based older adult services,” says Kristi Fuller, a GHPC senior research associate and lead author of the study. “As a client that was on the waiting list told our researchers, ‘How long can 83 year‐old go without assistance? I don’t have too many more years.’”
In the summer of 2013 researchers conducted semi-structured telephone interviews of 36 clients who were on waiting lists for community-based older adult services. Participants all had high assessment scores—meaning they had needs significant enough to qualify to live in a nursing home. Each of the state’s 12 planning and service areas were represented.
The average age of those interviewed was 78 years (range of 66 to 93 years). Nearly two-thirds were widowed and lived alone. On average, those interviewed had been on a waiting list for services for 2,197 days, or approximately six years, primarily for homemaker services.
Some of themes emerging from the “Frail and Waiting: A Qualitative Study to Understand How Some Older Adults in Georgia Maintain Community Living” study include:
- Client Mindset – Clients describe themselves using adjectives such as tenacious, stubborn, determined, independent, and having willpower. This theme of perseverance likely propels the clients to continue doing as many daily living tasks as possible on their own, enabling them to remain in their homes and persist on the waiting list as long as they have.
- Informal Help – The majority of clients (69 percent) report benefitting from informal help such as personal care and transportation provided by family, neighbors, and church members. Clients report receiving, on average, 6.2 hours of informal help per week.
“Providing supportive services in a way that meets the unique needs of the client can complement what the client is able to manage independently or with existing supports,” Fuller says. “Considering the growing population of older adults, the size of the existing waiting list, and frailty of those waiting, there is a need for states to think seriously about different ways to serve more individuals. One client that we spoke with proposed that the program offer a co-pay option for those who can contribute to the cost of their services.”
This work was co-authored by Kristi Fuller, Mike Henderson, Eric Napierala, and Candace Hicks, all at GHPC at the time of completion. Findings from this study were previously presented at the AcademyHealth Annual Research Meeting (June 14–16, 2015; Minneapolis, Minn.).
Part 2: Setting an Ideal Caseload