Community-based Services
Community-Based Services include everything from home repair and financial literacy programs to in-home meals and assistance with everyday activities. Community-Based Services recommendations focus on ways to enhance the effectiveness and capacity of the system of services by:
- Increasing collaboration among and integration of the health care and social services systems to create user-friendly access to comprehensive services
- Adopting principles and practices that have been scientifically tested, have evidence-based support, and promote customer choice
- Ensuring adequate, sustainable, and diverse funding resources.
Desired Outcome
Older adults have opportunities and necessary supports to make choices and live independently.
Background
Although the overwhelming majority of older Kent County residents want to remain in their homes as long as they can, nearly one in four (more than 14,000 individuals) need assistance from others to carry out everyday activities. A disproportionate number of the most vulnerable groups - low-income elders, minorities, those with a lower education, and those age 85 or more - need assistance to maintain independence in the community.
While thousands of older adults in Kent County are served by community - based programs, two out of three Kent County elders who need assistance with everyday activities are not receiving the help they need. One in four older adults simply does not know whom to call for information about supportive services.
In 2005, Governor Granholm created the Michigan Long-Term Care Supports and Services department and citizens' advisory commission within the Michigan Department of Community Health. The Governor charged these groups with streamlining and simplifying the state's long-term care system, providing a full array of coordinated services, and emphasizing individual choice. She also called for demonstration projects to help develop a single point of entry system.
According to most estimates, Kent County's aging population will double in the next 30 years. Linking older adults with a daily nutritious meal, home repair service or other supportive services as their needs change can mean the difference between their ability to age in place and the costly and often disruptive option of moving to a long-term care facility.
One-Fourth of Kent County Elders Need Assistance
While the vast majority of Kent County elders are able to live independently, nearly one in four - 14,203 people - need assistance with everyday activities. Among those who need such assistance, only one out of three are receiving the assistance they need.
Assistance with Activities of Daily Living (ADLs)
Fourteen percent of Kent County elders - nearly 9,000 people - need assistance with activities of daily living, the most frequently cited being taking a bath or shower (5%), getting in or out of a bed or chair (3%), and just getting around (2%). Among those needing help with ADLs, a full 71% are not getting the help they need.
Assistance with Instrumental Activities of Daily Living (IADLs)
Seventeen percent of Kent County elders - more than 10,500 people - need assistance with instrumental activities of daily living, the most frequently cited being going outside the home (7%), housework (6%), keeping track of money or bills (5%), and transportation (4%). Among those needing help with IADLs, just over half (53%) are not getting the help they need.
Extent of Limitations
The qualification criteria for services varies by program. For many services elders must indicate that they need assistance with 3 or more ADL or IADL limitations. This means that the majority of those in Kent County who need assistance would not meet the qualification criteria for certain services.
Demographics of Elders Needing Assistance (ADLs and IADLs)
In Kent County, low income elders, minorities, those with a lower education, and those age 85 or more are significantly more likely than their counterparts to need assistance to maintain independence in the community. For example:
- 37% of elders age 85 or more need assistance, compared with 22% of those age 75 to 84 and 19% of those age 65 to 74.
- Among Kent County elders who need assistance with everyday activities, 69% are female and about half are low income (52%), have a lower education (51%), and live alone (52%).
- 35% of low income elders need assistance with everyday activities compared to only 11% of mid- and upper-income seniors.
- 40% of elders with less than a high school education need assistance while only 16% of those who completed high school have similar needs.
Recommendations
A User-Friendly Service System
Goal 1
Increase collaboration and integration of health care and social services in order to improve access for customers and formal and informal caregivers.
Objectives
- Implement a single point of entry program that empowers customers and increases choice.
- Increase opportunities for joint planning by creating a county-wide standing committee with representation from appropriate social services and health care providers to address the effective delivery of community-based services (e.g., a subcommittee of the Kent County Emergency Needs Task Force).
- Explore case management options and shared case management across systems.
- Conduct outreach to elders, caregivers, and providers through diverse channels to improve knowledge of the available service and support resources.
Adequate, Sustainable and Diverse Funding
Goal 2
Assure adequate resources directed to maintaining quality of life for long-term living.
Objectives
- Encourage personal financial planning and increase awareness of payment options including reverse mortgage, long-term care insurance, and Medicaid.
- Advocate for Kent County Senior Millage funds that are adequate to meet the identified needs of older adults in Kent County.
- Expand state and federal public revenues that support a community-based service system.
- Develop capacity for non-profit service providers to diversify their funding, including collaborative public campaigns, development of income-generating products, etc.
- Advocate for comprehensive Medicare coverage to preserve personal income for purchase of community-based options not covered by insurance.
- Advocate for local foundations to provide long-term commitment to the work of Creating Community for a Lifetime and to give priority to the needs of older adults.
Customer Choice
Goal 3
Preserve independence through development of a service system that supports self determination and provides customer education, autonomy, and informed choice.
Objectives
- Create a process among service providers to develop a shared vision for a county service system that supports informed consumer choice.
- Create and offer consumer-directed service approaches.
- Increase opportunities for user feedback.
Evidence-Based Practices
Goal 4
Provide effective services, particularly prevention services, through use of scientifically-tested practices that have evidence-based support.
Objectives
- Educate service providers on the principles and use of evidence-based practice.
- Support service provider system capacity to identify, collect, analyze and use client outcome data for quality improvement.
- Maximize physical health through increased support and use of health prevention practices including such things as chronic disease management programs, fall prevention programs, etc.
Work Group
Co-Chairs
- Tom Czerwinski - Area Agency on Aging of Western Michigan
- Andrew Zylstra - Department of Human Services
Members
- Nora Barkey - Area Agency on Aging of Western Michigan
- Bob Barnes - Senior Neighbors
- Scott Blinkhorn - Visiting Nurses Association
- Jan King Duncan - Grand Rapids Public Housing
- Lynette Dykhouse - Hope Care Services Staffing
- Ron Hoort - Elders Helpers
- Ellen Kerson - St. Mary's Home Care
- Kate Luckert - Grand Rapids Community Foundation
- Susan Marks - Gerontology Network
- Harold Mast - Genesis Non-Profit Housing Corporation
- Lesa Neinhuis - Hope Network West Michigan
- Karen Pakkala - Gentiva Health Services
- Dave Paxton - Priority Health
- Bob Perl - Clark Retirement Community
- Vicki Pickel - Kent County Department of Human Services
- Gerri Roobol - Spectrum Health Access Management
- Sharon Symko - Spectrum Health Access Management
- Sharon Uherek - Lutheran Social Services of Michigan
- Beth Zeldes - Senior Advisory Services