Role of Home-Modification Training for Care Managers

With the aging of society, the long-term care insurance system -which includes home modifications to continue living at home- was established in 2000. However, the quality of home modifications has been persistent issue, and effective training is expected to conclusively solve this problem. To this end, the purpose of this study is to clarify the rational for training care managers who plan home modifications. A survey comprising two sets of questionnaires was conducted; one set encompassed is all 62municipalities in Tokyo, whereas the other involved care manager who participated in training program. The results of the first questionnaire showed that, out of 62 municipalities, 9 (14.5%) provided training on home modification, of which 8 (88.9%) provided training on administrative procedures. In one municipality that provided training on practical aspects of home modification, we provide questionnaires to 59 care managers participating in the training. -Lectures on administrative procedures, physical conditions of invalids, and reading drawings were conducted by administrative staff, occupational therapists, and architects, respectively. Afterwards, the participants attended a planning workshop. According to the questionnaire conducted after the workshop, 80.4% of the participants could understand home modifications in the system, 85.5% understood how to modify homes based on the occupants’ symptoms and physical conditions, 81.6% could interpret drawings, 90.2% could plan modifications, and 81.6% found the training useful. These findings indicate that the training of care managers has indeed been effective in actual practice. Improving the quality of home modifications through multidisciplinary cooperation is significant in maintaining home life.

Supportive Homes as Mediator between Rural Status and Disability of Older Adults

By definition, older adults living in rural communities have fewer formal resources available to address aging-related functional needs. Supportive environments are frequently relied on in rural settings to help address this discrepancy. The purpose of this study was to assess the role of supportive housing features and home modifications in mediating the association between rurality and disability. We hypothesized that environmental supports would be more crucial in rural settings than non-rural settings. We analyzed data from the National Health and Aging Trends Study (NHATS). Variable selection was guided by the International Classification of Functioning, Disability and Health (ICF), including covariates for sociodemographics, chronic conditions, mobility functioning, and participation. A series of regression models tested mediation by environmental variables of the association between rurality (as determined by the metro/nonmetro file indicator) and ADL/IADL disability. Supportive home environments were operationalized using indicators of whether participants had access to homes from the outside without having to use stairs; presence of a bedroom, kitchen, and full bathroom with a shower or tub on the same floor; and whether bathroom fixtures had been modified with features such as grab bars. Results suggest a statistical relationship between rurality and disability that is explained in part by the presence or lack of supportive home features, and these effects were greater in rural settings. Implications are that older adults who live in rural settings can benefit greatly by supportive environments and modifications in areas of the home that are known to cause difficulty.

Disparities in Basic Housing Needs as a Predictor of Psychological Well-Being Among Older Adults

Adequate housing and safe environments are among older adults’ foundational needs. Prior research suggests minority older adults face significant barriers to accessing affordable and appropriate housing. However, the effects of this environmental press on their psychological well-being are rarely addressed. This project examined racial disparities between minority and white older adults’ housing and environment conditions and the differential impact on their psychological well-being. Using nationally representative data from the National Health & Aging Trends Study (NHATS), older adults' reported rating of the quality of housing conditions, financial security, neighborhood security, and the interviewer’s rating of the home environment were analyzed. A total of 4,048 community-dwelling older adults aged 65 and over were selected for analysis. The sample demographics are predominantly white (77.5%), female (61.4%), and residing in the community (82%). Results found minority older adults reported poorer housing conditions, fewer home modifications, and lower financial and neighborhood security, compared to white counterparts. The impact of housing quality was more detrimental to minority older adults’ psychological well-being, compared to white counterparts. These findings suggest a significant negative impact of home conditions on the psychological well-being of minority older adults. Home modifications are a viable option to increase or preserve functional status in the home, which could lessen the deleterious effects of environmental press on older adults’ psychological outcomes, especially minorities. This study’s findings provide information that bolsters our knowledge of housing and environment conditions, which are critical in efforts to reduce health disparities in late life.

The Cost Efficiency of Home Modifications to Reduce Health Care Costs

The existing quantity of housing dedicated for older adults is not sufficient to meet the needs of this growing population. And even as the Centers for Medicare and Medicaid Services reimbursement structures are shifting from traditional inpatient and outpatient settings to care in the home, it is a commonplace that most homes were not designed or built to support the needs of aging residents or the provision of healthcare. It is time for America’s 100 million existing houses to be made as safe and accessible as possible for aging in place. Falls cost over $50 billion a year in medical expenses. This paper distills current knowledge regarding healthcare cost reductions from home modifications, and then calculates the cost efficiency to society and to the federal government of providing government subsidies for home modifications for older adults at the ages of 50, 65 and 75. Cost sharing among insurers, government and the beneficiary is one way to achieve the positive social returns.

Can We Do Better for Older Adult Research Participants? Clinical Trial Improvements Prompted by a Global Pandemic

Retaining older adults in clinical trials has often been a challenge for researchers. Clinical trial procedures, aimed at improving fidelity, often offer barriers to frail older adults who have challenges traveling to medical centers and enduring long clinical assessment visits. During the COVID-19 pandemic, we modified the procedures of two randomized controlled trials. COMPASS: A novel transition program to reduce disability after stroke is a clinical trial examining the efficacy of a transition home program that provides home modifications and self-management strategies compared to stroke education. HARP: Removing home hazards for older adults living in affordable housing is a pragmatic trial examining the effectiveness of a home hazard removal program for residents of low-income housing. Modifications to the trials were designed to reduce human contact but in some cases reduced the burden on trial participants. Modified procedures addressed retention, assessment of endpoints and intervention methods.

A Social-Ecological Approach to Identify Facilitators and Barriers of Home Modifications

Aging individuals may face difficulty with independently navigating and interacting with their home environment. Evidence-based interventions promoting home modifications are needed to support aging-in-place across the lifespan. This study identified the facilitators and barriers to implementing home modifications from the perspectives of residents and professionals (N = 16). Guided by a social-ecological model, researchers utilized directed content analysis of focus group interviews. While participants discussed facilitators and barriers mainly on the individual level, factors were presented at the relationship, community, and societal level of the model. Overall, the findings suggest a potential for targeted interventions on all levels of the model to promote adoption of home modifications.