Examining the Agency-Foundation Relationship in Local Park and Recreation Services

Local park and recreation agencies supply a variety of community-based services, often at little or no direct cost to users. To supplement tax-based allocations, many agencies rely on partnerships with park foundations, nonprofit organizations that directly support park and recreation service delivery. Despite their prevalence and importance, there is a lack of empirical evidence about the agency-foundation (AF) relationship; this project begins to address this need, and seeks to inform the efforts of professionals navigating these partnerships. Results from a survey of National Recreation and Park Association (NRPA) member agencies (n = 235) illustrated that these partnerships are generally viewed as close, effective, and strong, and of particular value relevant to “big picture” agency activities such as fundraising and community engagement. A comparison of communities indicates that the AF relationship is more common in larger communities, and among larger and more complex agencies. Practical implications for practitioners and potential directions for future research are discussed.

COVID-19 Lockdown Measures: Impact On Older Adults With Dementia And Their Caregivers In Singapore

Family caregivers typically rely on community-based services and social support networks to supplement their caregiving of older adults with dementia (OAwD). In April 2020, the Singapore government implemented a partial lockdown to contain the spread of COVID-19. We assessed the policy's impact on the physical and mental health of caregivers and their OAwD. As part of a larger study, 30 caregivers were interviewed and rated the stress they experienced when caring for an OAwD during the partial lockdown. Qualitative analyses found significant behavioral changes in OAwD such as irritability, aggression and hallucinations, which led some caregivers to believe their dependents’ condition had deteriorated, as well as heightened levels of caregiving stress. Overall, our preliminary results suggested that although social distancing measures may be effective in containing the spread of COVID-19, these measures could lead to negative outcomes on vulnerable populations such as OAwD and their caregivers.

Delivery of Home and Community Based Services During a Pandemic: Unexpected Consequences

The COVID-19 pandemic required AAAs to pause essential services, serving as a catalyst for innovation. We examined such innovations as part of an explanatory mixed-methods, positive deviance study of AAA partnerships with health and social service organizations. We identified 8 AAAs with many partners serving areas with lower levels of health care use, and 3 AAAs with few partners serving areas with higher levels of health care use. We interviewed AAA and partners, (total = 123). Using the constant comparative method, we identified recurrent themes: 1) AAAs adapted to increased demand for services by developing new ways to deliver services, 2) the pandemic raised awareness of unmet needs such as social connection, 3) changes in delivery of services included embracing technology, and 4) AAAs and their partners identified resources to rapidly pivot services. AAAs and partners demonstrated resiliency to not only to sustain programs, but to innovate throughout the pandemic.

Residence in HUD Housing Associated With Greater Benefit From HCBS Services for Medicaid Enrollees in Pennsylvania

State Medicaid programs seek to shift the delivery of long-term care services away from institutional settings and toward community-based settings by expanding access to home-and-community-based services (HCBS). HCBS are hypothesized to prevent or delay the need for protracted nursing home stays. This study explores the question of which types of community residence maximize this protective effect of HCBS. We used a probabilistic matching technique to identify whether waiver-eligible Medicaid enrollees were likely to reside in project-based HUD housing in 2013. We applied multinomial logistic regression to observe the risk of long-stay nursing home admission (>100 days) relative to persistent community residence in the subsequent four years. Our model controlled for age, race, gender, urban status, and receipt of home-and-community based services. Our predictor of interest was the interaction between receipt of home and community based services (HCBS) and residence in HUD housing. The eligible baseline population included 152,632 community-residing Pennsylvania Medicaid enrollees in 2013. The analytic sample excluded individuals who died during 2013 or who were no longer waiver-eligible after 2013. Residence in HUD project-based housing while receiving HCBS is independently associated with a 27% percent reduction in risk of long-stay nursing home admission (p = .01) when controlling for individual-level demographics. No significant association was observed between the predictor of interest and risk of death during the follow-up period, suggesting that this finding is not likely confounded by individual health status. Further research should test whether this association is causal and specify possible mechanisms.

Perceptions of Social Support Sufficiency Among Older Adults With HIV in Sub-Saharan Africa

Globally, the greatest number of older people with HIV (OPWH) are in sub-Saharan Africa (3.7 million). This population will continue to expand with greater access to anti-retroviral therapy. Compared to OPWH in high income counties, these OPWH have constrained access to government and community-based services and largely rely on assistance from family, friends, and neighbors for their social support needs. We examined factors related to perceptions of instrumental and emotional support sufficiency (availability and adequacy) among OPWH age 50 and older in Uganda (n = 101) and South Africa (n = 108). Significant covariates of instrumental support sufficiency included not having an AIDS diagnosis, greater support from family, and less support from friends. Significant covariates of emotional support sufficiency were fewer depressive symptoms, greater support from family, and geographic location (Uganda). Explanation of these findings based on social network characteristics and implications for policy and program development will be discussed.

Environmental Gerontology During COVID-19: Aging in Place Since the Pandemic Onset

The COVID-19 pandemic is fundamentally changing neighborhood landscapes as we shelter in place and adjust our lifestyles. To age-in-place is to live in one’s home and/or community “safely, independently, and comfortably.” The ability to age-in-place is a public health priority for all, regardless of income or health status, and requires a variety of community resources to be sustainable. Since the pandemic onset, access to neighborhood resources was limited to reduce transmission risks. Changes to economic arrangements and socio-spatial norms have profoundly impacted daily life, though how these influence health and well-being is largely unknown. It is likely that these effects may vary in different communities and contexts; for example, neighborhoods that are able to self-organize to safely provide social support and resources may fare better. This symposium brings together cutting-edge studies in urban and rural U.S. places to explicate how the pandemic is transforming aging-in-place experiences and perspectives. The first presentation shows how rapidly community-based services have adjusted operations to meet the needs of their communities. The second presentation explores strategies to provide social support in rural communities. The third presentation highlights the social health needs of a subset of older adults who had not formed friendships with their neighbors. Together, these studies suggest that close examinations of aging-in-place conditions and mechanisms from organizational, socio-spatial, and social network perspectives are evermore important amid a pandemic. We discuss the implications of these empirical findings in relation to emerging theories within environmental gerontology.

Home and Community-Based Services Between the USA and Taiwan

Home and community-based services (HCBS) are critical to support our rapidly growing and aging population around the world. This paper takes initial steps to compare HCBS between the USA and Taiwan from four perspectives: funding sources, service types, challenges, and recommendations. Peer-reviewed articles and governmental reports (both English and Chinese) in the U.S.A. and Taiwan were reviewed. Analyses showed both countries mainly use tax dollars to fund HCBS. Although both countries have similar service categories, USA lack a clear organization scheme whereas Taiwan has detailed and clear services provisions. Workforce quality and shortage were common challenges for both countries, especially from culture perceptive. Recommendations for USA include expanded funding pool, better coordination between agencies, and rebalancing HCBS and institutional care with limited budget. Recommendations for Taiwan include expanded service coverage and quality to reduce disparity in rural areas, and providing more support for informal caregivers.

Home- and Community-Based Services Use Patterns and Functional Improvement among Older Care Recipients in Taiwan

The new version of Taiwan’s 10-Year Long-Term Care Plan launched in 2016 aims to reinforce the integration of home- and community-based services (HCBS). The underlying HCBS use patterns and effectiveness of functional improvement among care recipients merit investigation. The purpose of the study was to examine the association of HCBS and changes in ADLs among care recipients with different levels of disabilities in Taiwan. We accessed the sub data of Taiwan’s Long-Term Care Services Management Online System. Samples were aged 65 and over and had completed records of baseline and reassessment information during 2018 (N = 4787). Latent class analysis and multivariate linear regression were applied to examine the relationship of HCBS and functional changes. Four HCBS subpatterns were found: home-based personal care services (home-based PS) (59.16%), home-based reablement services (home-based RS) (23.90%), home-based multiple services (home-based MS) (11.93 %), and community-based services (5.01%). In the cases with mild disabilities at baseline, recipients receiving home-based RS had higher probabilities of improving in ADLs among four HCBS subgroups (for example: β = 2.65, SE = 1.19 in comparison to home-based PS). Care recipients with moderate-to-severe disability at baseline, ADLs improvement was only found in home-based PS (β = 1.63, SE = 0.82 in comparison of home-based MS). In the cases with profound disabilities, home-based PS showed positive effects on ADLs improvement (β = 2.45, SE = 0.80 in ADLs, compared to home-based RS). The study suggested that HCBS subpatterns had different impacts on older adults with different disability levels.