Habitat for Humanity Literature Review

Habitat for Humanity

Problem Statement

As the Baby Boomers continue to increase in age, there is a growing need for formalized aging in place systems for changes in housing, health care, and human services. However, 87% of Baby Boomers over 65 years old choose to stay in their own homes and communities and age in place and remain independent (AARP, 2014). Most homes require a significant number of routine repairs or maintenance activities that can be challenging for older adults. When older adults are no longer physically able to complete these repairs or maintenance activities their ability to age in place can be jeopardized (Fausset et al., 2011). Unfortunately, repairing or maintaining homes can be costly and stressful for older adults and their families. Houses in disrepair could harm or injure older adults, which would compromise their resiliency and increase the need for health care and human service resources (James & Saville-Smith, 2010). Though home repairs can be quite expensive, they are generally cheaper than nursing homes and assisted living facilities which can average $3,000 – $7,000 a month (LongTermCare.gov, 2017).  The home repairs that could prevent older adults from aging in place constitute an essential problem for social workers and researchers to understand and address. To this end, we will conduct an outcome evaluation of Habitat for Humanity International Affiliates’ Aging in Place program, which provides home repairs and/or modifications to improve the condition of the home. As social workers, we will effectively evaluate appropriate services and resources to strengthen aging in place. 

Literature Review

Research contributing to older adults aging in place indicate the need for continue discussion of strategies and practices to establish interventions conducive to meeting specific social and economic needs of older adults. Current research evidence concur the physical environment of an age friendly neighborhood as having an impact on mobility, independence and quality of life of older people living in the community. Ageing in place communities thrive when planning is comprehensive, support services are diversified and barriers that segregate and limit the activities of older adults in the community are removing (Lui, et al., 2009).

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When older adults, ages 65 and up, preference remaining in their homes as they age their decision has a direct impact on their continue autonomy and ability to carry out their activities of daily living (ADLs). Getting affiliated care that contributes with ageing in place provides continuity of familiar living environment, independence in the maintenance of ADLs. According to Barrett., et al (2012), framework of rites of passage exploring the changes that occur as a result of having a care recipient within the home provides an opportunity for older adults to receive services and care to enhance their quality of life. Having care services in their home eliminates the isolation and fear associated with no longer having a social connection to society. The goal for home care is to address social inclusion which would impact the outcomes for quality of life for those who choose to age in place.

The Habitat for Humanity International presently uses the intervention in person environmental model Advancing Better Living for Elders (CAPABLE). The CAPABLE model addresses the issues relating to quality of life-housing, health care and human services of aging adults. The intervention team goals are aimed to decrease hospitalization and nursing home usage of community-dwelling aging adults with functional limitations who are eligible for Medicare and Medicaid (Szanton & et.al, 2015). The CAPABLE model integrates referrals from primary care, health departments, or home health providers for concerns with activities of daily living (ADLs). The research method used by John Hoskin University entailed surveying, interviewing and intervention for 100 CAPABLE participants aged 65 and older. These participants were eligible for Medicaid or at risk for Medicaid because their income was low enough to qualify the specified home modifications. The participants enrolled for a 5-month study to evaluate and improve their quality of life in three focal spheres – housing, health care and human services (Szanton & et.al, 2015). After completing the 5month study and intervention, 89% of participants showed vast improvement in daily life activities. The other 11% of participants died, withdrew from the program or was hospitalized during enrollment (Szanton & et.al, 2015). Before the intervention, the participants had an average 3.5 home hazards at baselines such as slippery rugs, deep bathtubs, low toilet seats, high cabinets, narrow entrance way, and missing handrails (Szanton & et.al, 2015).  The outcome for conjoining environmental and human service supports for CAPABLE aging adults-home hazards were decreased by half from 3.5 ± 2.0 to 1.5 ± 1.3 (Szanton & et.al, 2015). Disability cut in half and mental conditions were reduced from an average severity score of 10.1 to 6.3 (Szanton & et.al, 2015)Similar research/interventions used to assist older adults ageing in place is the Village model, the Naturally Occurring Retirement Community-Social Services Programs (NORC-SSP), and the promising home intervention tested in the USA is Advancing Better Living for Elders (ABLE).

 According to McDonough, K. E., & Davitt, J. K. (2011), the Village movement is relatively a new initiative developed in the U.S. approximately in 2001. The Village model is driven by a volunteer-first model initiated by community residents. The Village is informal and relies on common community residents as volunteers. The residents desire to age in place, have live and experienced challenges related to ageing. The residents desire self government and design the programs of assistance in accordance with the community’s expressed needs (McWhinney-Morse, 2009).  Usually Villages require an annual membership fee to join and has a non-profit status.  Volunteer-first Villages provide their own services to the community such as case management, training, managing volunteers, home health care, professional home repairs, transportation, shopping, household chores etc. Some professional services are accessed through vetted vendor lists. This volunteer-first model is totally reliant upon the collective abilities of the community as a whole to deal with communal challenges in the aging process. The Village model has an empowerment community focused philosophy which is compatible with the social work’s practice philosophy. The Village model plays a supporting role in expanding access to critical resources in aging in place communities. Lack of research indicates there is no concrete way of knowing how the practices of the Village model can improve or affect long term care outcomes. Invalid or inaccurate outcomes in the areas of premature institutionalization, quality of life, and overall health or cost effectiveness would create an impossible task to build cases for policy changes. Social workers working within the movement will be challenged as to how they could expand the Village model into low and moderate income communities.

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    Greenfield, E. A., Scharlach, A., Lehning, A. J., & Davitt, J. K. (2012) describes the Naturally Occurring Retirement Community Supportive Service Programs (NORC) as community level initiatives to expand or extend traditional aging services. NORCs are locations not set up or planned as senior housing. The older adults within the particular location or community have grown sizeable as residents over a period of time. The programs have expanded to neighborhoods of single family homes where numerous numbers of older adults reside. NORC programs are administered by a lead agency as opposed to being a free-standing entity. The agency usually is a community base non-profit social provider that provides services as healthcare, educational and recreation opportunities, transportation, home repairs, and a host of common services the elderly need to achieve their desire to age in place (Bronstein, Gellis, & Kenaley, 2011).

Jutkowitz, E., Gitlin, L. N., Pizzi, L. T., Lee, E., & Dennis, M. P. (2012) conducted research on the cost effectiveness of a home base intervention that helps functionally vulnerable older adults age in place. The home intervention tested is Advancing Better living for Elders (ABLE). ABLE I provide occupational and physical therapy sessions. Home modifications are also provided to address client-identified functional difficulties, performance goals, and home safety.  Incremental cost effectiveness ratio (ICER), expressed as additional cost to bring about one additional year of life, was calculated. Two models were then developed to account for potential cost differences in implementing ABLE. Probabilistic sensitivity analyses were conducted to account for variations in model parameters. By two years, there were 30 deaths (9: ABLE; 21: control). Additional costs for 1 additional year of life were $13, 179 for Model 1 and $ 14,800 for Model 2. Investment in ABLE may be worthwhile depending on society’s willingness to pay.

The key findings from the prior evaluations addressed the primary elements that have a direct impact on an older individuals’ ability to successfully age in place; housing, healthcare, and human services. The client-focused model CAPABLE is administered by an intervention team of occupational therapists, registered nurses, and builders who work collectively to significantly reduce the need for hospitalization and nursing home placements. This intervention model can be used to inform the evaluation because it has been used by many organizations and is proven to be most effective in meeting challenges that older individuals face such as, home health risks, social isolation, and need for home repairs and modifications. The Village movement one of the newer intervention models, has been growing exponentially due to the volunteer-based provision of community empowerment services.  This model informs the evaluation because it addresses the issue of social exclusion and isolation that seniors frequently encounter. Finally, the Naturally Occurring retirement Community Supportive Service Program (NORC) is a macro-level initiative that targets senior neighborhoods and communities to provide services that support people in their environment. The NORC model informs the evaluation by taking a holistic approach to aging services and programs that older adults face when attempting to age in a community that is not conducive to their growth. All of these models provide unique strategies and techniques to assist individuals and organizations with combating the challenges that prevent successful aging in place.

References:

• AARP. (2014). Baby boomer facts on 50 livable communities and aging in place. Retrieved from https://www.aarp.org/livable-communities/info-2014/livable-communities-facts-and-figures.html
• Barrett, P., Hale, B., & Gauld, R. (2012). Social Inclusion through Ageing-in-Place with Care. Ageing & Society, 32.
• Costs of care. (2017). Retrieved from https://longtermcare.acl.gov/costs-how-to-pay/costs-of-care.html
• Fausset, C. B., Kelly, A. J., Rogers, W. A. & Fisk, A. D. (2011) Challenges to ageing in place: Understanding home maintenance difficulties, Journal of Housing for the Elderly, 25(2), pp. 125– 141.
• James, B. & Saville-Smith, K. (2010) Older  people’s home repairs and maintenance: Ageing well in place in New Zealand. Paper presented at the meeting of the 22nd International Housing Research Conference, Istanbul, July.
• Greenfield, E. A., Scharlach, A., Lehning, A. J., & Davitt, J. K. (2012). A conceptual framework for examining the promise of the NORC program and Village models to promote aging in place. Journal of Aging Studies, 26(3), 273-284.
• Jutkowitz, E., Gitlin, L. N., Pizzi, L. T., Lee, E., & Dennis, M. P. (2012). Cost effectiveness of a home-based intervention that helps functionally vulnerable older adults age in place at home. Journal of aging research, 2012.
• Lui, C. W., Everingham, J. A., Warburton, J., Cuthill, M., & Bartlett, H. (2009). What makes a community age‐friendly: A review of international literature. Australasian journal on ageing, 28(3), 116-121.
• McDonough, K. E., & Davitt, J. K. (2011). It takes a village: Community practice, social work, and aging-in-place. Journal of Gerontological Social Work, 54(5), 528-541
• Szanton, S. L., Wolff, J. L., Leff, B., Roberts, L., Thorpe, R. J., Tanner, E. K., … & Gitlin, L. N. (2015). Preliminary Data from Community Aging in Place, Advancing Better Living for Elders, a Patient‐Directed, Team‐Based Intervention to Improve Physical Function and Decrease Nursing Home Utilization: The First 100 Individuals to Complete a Centers for Medicare and Medicaid Services Innovation Project. Journal of the American Geriatrics Society, 63(2), 371-374.