Social and Behavioral Sciences Commons^™

Extreme Heat Vulnerability Among Older Adults: A Multi-Level Risk Index For Portland, Oregon, Jacklyn N. Kohon, Katsuya Tanaka, Dani Himes, Paula Carder, Eiji Toda, Bryant Carlson

Institute on Aging Publications

Background and Objectives

Extreme heat is an environmental health equity concern disproportionately impacting low-income older adults and people of color. Exposure factors, such as living in rental housing and lack of air conditioning, and sensitivity factors, such as chronic disease and social isolation, increase mortality risk among older adults. Older persons face multiple barriers to adaptive heat mitigation, particularly for those living in historically temperate climates. This study measures two heat vulnerability indices to identify areas and individuals most vulnerable to extreme heat and discusses opportunities to mitigate vulnerability among older adults.

Research Design and Methods

We constructed two heat …

Paperwork, Paradox, And Prn: Psychotropic Medication Deficiencies In Assisted Living, Sarah Dys, Paula Carder

Institute on Aging Publications

Individual state approaches to assisted living/residential care (AL/RC) licensing and oversight in the United States result in different practice standards and requirements, including psychotropic medication use. We examined 170 psychotropic medication deficiency citations issued to 152 Oregon AL/RC settings from 2015 to 2019. Applied thematic analysis resulted in the following themes: (1) documentation issues are primarily responsible for noncompliance, (2) unclear parameters place direct care workers in a role paradox, and (3) there is a persistent disconnect about when to seek qualified expertise before requesting psychotropic medications. AL/RC-specific mechanisms for medication prescription and administration are necessary to improve the structure …

Climate Change Policies And Older Adults: An Analysis Of States’ Climate Adaptation Plans, Bryant Carlson, Jacklyn N. Kohon, Paula Carder, Dani Himes, Eiji Toda, Katsuya Tanaka

Institute on Aging Publications

Background and Objectives

As climate change drives more frequent and intense weather events, older adults face disproportionate impacts, including having the highest mortality rates from storms, wildfires, flooding, and heat waves. State governments are critical in deploying local resources to help address climate change impacts. This policy study analyzes states’ climate adaptation plans to assess the methods through which they address the impact of climate change on older adults.

Research Design and Methods

This study uses content analysis to analyze available climate change adaptation plans for all U.S. states for strategies designed to increase resilience of older adults to impacts …

Wage And Cost Study Of Oregon Assisted Living And Residential Care Providers, 2022, Ozcan Tunalilar, Sarah Dys, Paula Carder, Diana Jacoby

Institute on Aging Publications

Senate Bill 703 directed Oregon Department of Human Services (ODHS) to conduct a study of licensed residential care (RCF) and assisted living (ALF) facilities, including those with a memory care (MC) endorsement, to evaluate: a) Total cost to provide care to residents, b) the sufficiency of the Medicaid reimbursement paid to facilities to meet the total cost of care, and c) the average compensation paid to direct care workers by the facilities by geographic region. ODHS contracted with the Institute on Aging (IOA) at Portland State University (PSU) to conduct a study to achieve these three objectives. In the fall …

Direct Care Staff Experiences In Oregon Assisted Living, Residential Care And Memory Care Communities, 2022, Paula Carder, Sarah Dys, Lindsay Schwartz, Diana Jacoby, Jacklyn N. Kohon, Dani Himes, Madeleine Fox, Sheryl Elliott, Lauren Bouchard, Portland State University Institute On Aging

Institute on Aging Publications

Resident care assistants (e.g., direct care workers, caregivers, personal care aides) provide the majority of services to assisted living, residential care and memory care-endorsed (ALF/RCF) residents. They faced significant burdens during the COVID-19 pandemic, which amplified existing challenges in some ALF/RCF communities, yet little is known about their work experiences. This qualitative study collected data through focus group and individual interviews with 21 resident care assistants and 12 external colleagues who have experience hiring, training or managing resident care assistants and other ALF/RCF staff, including registered nurse consultants, staffing agency operators, state policy staff, ALF/RCF community operations managers, and advocates. …

The Resident View In Community- Based Care Residential Settings, Diana L. White, Ozcan Tunalilar, Serena Hasworth, Jaclyn Winfree

Institute on Aging Publications

The Resident VIEW is a measure of person-centered care (PCC) from residents’ perspectives and was previously studied in nursing homes. The current study presents descriptive data for the Resident VIEW in community-based care settings including assisted living, residential care (AL/RC), and adult foster homes (AFH). Using a two-stage sampling design, we recruited 31 AL/RC and 119 AFH in Oregon and completed face-to-face structured interviews with 227 and 195 residents, respectively. Residents provided ratings for both the importance of and their experience with 66 items that tapped into PCC practices in eight domains. Results are provided for each item, many of …

2022 Community-Based Care: Resident And Community Characteristics Report On Assisted Living, Residential Care, And Memory Care Communities, Ozcan Tunalilar, Paula Carder, Jaclyn Winfree, Sheryl Elliott, Minju Kim, Diana Jacoby, Wafi Albalawi, Portland State University Institute On Aging

Institute on Aging Publications

This report summarizes findings from the 8th annual study of Oregon community-based care settings, including assisted living and residential care facilities, and memory care communities. This study was conducted during fall 2021 and winter 2022.

2022 Adult Foster Home Resident And Community Characteristics Report On Adult Foster Homes, Ozcan Tunalilar, Paula C. Carder, Jaclyn Winfree, Sheryl Elliott, Minju Kim, Diana Jacoby, Wafi Albalawi

Institute on Aging Publications

This report describes results from a study of Oregon adult foster homes (AFH), including home and owner characteristics; monthly charges and payment sources; resident characteristics, personal and health-related needs; and owners’ experiences with supports and challenges due to the COVID-19 pandemic. The study’s purpose was to collect and report data that can inform and advise policymakers, state and county agency staff, aging advocates and AFH owners about the status of AFHs in Oregon. The report includes information collected between December 2021 and March 2022 and, where possible, compares it to findings from prior years of this study and to other …

Lifelong Instability And Perceived Risk Of Future Homelessness In Older Adults, Sarah Dys, Anna Steeves-Reece, Paula Carder

Institute on Aging Publications

Housing has long been considered a social determinant of individual and population health. Older adults with low incomes face several challenges to maintaining stable, affordable housing. Using data from a previous explanatory study of older adults waitlisted for housing assistance (n = 267), we explore individual characteristics and themes associated with older adults’ perceived housing instability and risk of future homelessness. This mixed-methods study identifies salient themes of financial insecurity, age discrimination, employment and health, interpersonal relationships, and trauma. Our analysis and findings highlight experiences of instability over the life course related to older adults’ current housing circumstances.

Validating The Resident View In Long-Term Care Settings: Final Report To Oregon Department Of Human Services, Aging & People With Disabilities Division, Diana L. White, Ozcan Tunalilar, Serena Hasworth, Jaclyn Winfree, Institute On Aging, Portland State University

Institute on Aging Publications

In 2015, Portland State University Institute on Aging (PSU/IOA) received a grant from the Quality Care Fund to develop the Resident VIEW (Voicing Importance, Experience, and Well-being), a measure of person-centered care (PCC) from the perspective of residents. Structured open-ended interviews were conducted with residents living in nursing homes (NH), assisted living (AL/RC), and adult foster homes (AFH) settings to learn more about their everyday concerns, values, and preferences. Each interview focused on one of eight domains of PCC. These domains had been identified from the literature and in prior research. Personhood, or as described by residents as being “treated …

State Of Aging In Portland, Alan Kenneth Delatorre, Richard Lycan, Margaret Neal

Institute on Aging Publications

Introduction

From 2006-2019, the Age-Friendly Portland Initiative operated as a city-university- community partnership that began in 2006, resulting from a global World Health Organization (WHO) research project. In 2010, the City of Portland joined the WHO Global Network of Age-Friendly Cities and Communities and in 2012, it also joined the AARP Network of Age-Friendly States and Communities. The Action Plan for an Age- friendly Portland was passed by Resolution by Portland City Council in 2013 (Resolution No. 37039) and contains 10 domains: (1) housing; (2) transportation; (3) outdoor spaces and buildings; (4) employment and the economy; (5) civic participation and …

Coronavirus Disease 2019 Regulatory Response In United States-Assisted Living Communities: Lessons Learned, Sarah Dys, Jaclyn Winfree, Paula Carder, Sheryl Zimmerman, Kali S. Thomas

Institute on Aging Publications

Coronavirus disease 2019 (COVID-19) has disproportionately affected residents, their families, staff, and operators of congregate care settings. Assisted living (AL) is a type of long-term care setting for older adults who need supportive care but not ongoing nursing care and emphasizes a social model of care provision. Because AL is a type of long-term care, it has at times been referenced along with nursing homes in discussions related to COVID-19 but not recognized for its different care practices that pose unique challenges related to COVID-19; in that manner, it has largely been left out of the COVID-19 discourse, although ~812,000 …

Connecting Policy To Licensed Assisted Living Communities, Introducing Health Services Regulatory Analysis., Lindsey Smith, Paula Carder, Taylor Bucy, Jaclyn Winfree, Joan F. Brazier, Brian Kaskie, Kali S. Thomas

Institute on Aging Publications

To document dementia-relevant state assisted living regulations and their changes over time as they pertain to licensed care settings.

Assisted Living Communities That Accept Medicaid Are Not Subject To Federal Oversight, Lindsey Smith, Sarah Dys, Paula Carder

Institute on Aging Publications

We commend Mauldin et al. (2020) for their recent article titled “Supports and gaps in federal policy for addressing racial and ethnic disparities among long-term care facility residents,” which addresses opportunities to mitigate racial and ethnic disparities in long-term care (LTC) through federal policies. However, we would like to clarify a statement regarding federal oversight of assisted living (AL) communities made by the authors.

Survey Deficiencies As Quality Indicators In Oregon Assisted Living Communities, Ozcan Tunalilar, Sunny C. Lin, Paula C. Carder

Institute on Aging Publications

Background and Objectives License inspection data have commonly been used as a quality measure for nursing homes but has not yet been used to assess the quality of assisted living/residential care (AL/RC) communities. Drawing on resource dependency theory, we test the hypothesis that structural and environmental characteristics influence AL/RC quality as measured by deficiency citations (“deficiencies”) issued during license inspections.

Research Design and Methods Using data from 526 licensed AL/RC communities in Oregon that received a license inspection visit between 2008 and 2016, we examined the prevalence of deficiencies by type and year. We estimated regression models to identify structural …

2021 Adult Foster Home Resident And Community Characteristics Report On Adult Foster Homes, Paula Carder, Jason Z. Kyler-Yano, Ozcan Tunalilar, Sarah Dys, Sheryl Elliott, Ellis Jourdan Hews, Minju Kim

Institute on Aging Publications

This report describes results from an annual study of Oregon adult foster homes (AFH). Data contained in this report include home and owner characteristics; monthly charges and payment sources; and resident characteristics, personal and health-related needs. The study’s purpose was to collect and report data that can inform and advise policymakers, state and county agency staff, aging advocates and AFH owners about the status of AFHs in Oregon. These data were collected between December 2020 and February 2021. This report constitutes the first year during the COVID-19 pandemic that these annual data were collected.

2021 Community-Based Care: Resident And Community Characteristics Report On Assisted Living, Residential Care, And Memory Care Communities, Ozcan Tunalilar, Paula Carder, Sheryl Elliott, Jason Z. Kyler-Yano, Sarah Dys, Minju Kim, Diana Cater, Ellis Jourdan Hews

Institute on Aging Publications

This report summarizes findings from the 7th annual study of Oregon assisted living (AL) and residential care (RC) facilities, including memory care (MC) communities. The purpose of this report is to inform Oregon Department of Human Services (ODHS), providers, consumers, and other interested parties about this sector of long-term services and supports (LTSS) and ensure data-informed policy decisions. The report contains information about various resident and community characteristics, including capacity and supply, resident demographics and health services use, and community services, policies, fees, and staffing. These data were collected between winter 2020 and spring 2021. This report constitutes the first …

Evaluation Of The Livewell Method: Final Report, Paula Carder, Serena Hasworth, Diana Cater

Institute on Aging Publications

The LiveWell Method uses a practice-based framework to improve the quality of life for people living and working in long-term care settings, including assisted living and memory care. It is designed to improve teamwork, communication, and morale by helping staff organize, track, measure, and improve daily operations. This evaluation is informed by the LiveWell Method’s “bottom-up and top enabled” approach, which engages and empowers direct care staff and administrators to create a more democratic and transparent workplace. In addition, the evaluation included questions to assess LiveWell’s core values, such as creating care innovations, nurturing dignity, creating community, and honoring elders, …

Mitigating The Impact Of The Covid-19 Outbreak: A Review Of International Measures To Support Community-Based Care, Walter D. Dawson, Elizabeth C. Ashcroft, Klara Lorenz-Dant, Adelina Comas-Herrera

Institute on Aging Publications

Key findings

• Community-based care faces unique challenges during the COVID-19 pandemic compared to other parts of the long-term care continuum.
• Several countries have taken steps to prevent the spread of COVID-19 infections in community-based care including the closure of adult day centres and other service providers.
• Continuity of care is of upmost importance. A disruption of care and support could have serious negative impacts on individual health and well-being due to increased risk of loneliness and social isolation.
• The dispersed nature of community based care suggests that direct governmental action and oversight may be more difficult to provide than for …

Impact Of The Covid-19 Outbreak On Long-Term Care In The United States, Courtney H. Van Houtven, Nathan A. Boucher, Walter D. Dawson

Institute on Aging Publications

The United States (US) currently has the most confirmed cases of COVID-19 of any country. Yet, adequate testing for the virus remains a major issue. Approximately 51.6 million Americans are over the age of 65 and 56 percent of adults over 65 are living with two or more chronic conditions (23 percent have 3 or more). Given the higher risk of death and complications associated with advanced age and underlying health conditions, COVID-19 has had an immense impact upon LTC in the United States. Yet, the level and intensity of impact has been sporadic in application. This is due in …

Brain Health Innovation Diplomacy: A Model Binding Diverse Disciplines To Manage The Promise And Perils Of Technological Innovation, Kylie Ternes, Vijeth Iyengar, Helen Lavretsky, Walter D. Dawson, Laura Booi, Agustin Ibanez, Ipsit Vahia, Charles Reynolds, Steven Dekosky, Jeffrey Cummings, Bruce Miller, Carla Perissinotto, Jeffrey Kaye, Harris A. Eyre

Institute on Aging Publications

Background: Brain health diplomacy aims to influence the global policy environment for brain health (i.e. dementia, depression, and other mind/brain disorders) and bridges the disciplines of global brain health, international affairs, management, law, and economics. Determinants of brain health include educational attainment, diet, access to health care, physical activity, social support, and environmental exposures, as well as chronic brain disorders and treatment. Global challenges associated with these determinants include large-scale conflicts and consequent mass migration, chemical contaminants, air quality, socioeconomic status, climate change, and global population aging. Given the rapidly advancing technological innovations impacting brain health, it is paramount to …

2020 Community-Based Care Resident And Community Characteristics Report On Assisted Living, Residential Care, And Memory Care Communities, Paula Carder, Ozcan Tunalilar, Sheryl Elliott, Sarah Dys, Portland State University Institute On Aging

Institute on Aging Publications

This report summarizes findings from the 6th annual study of Oregon community-based care settings, including assisted living and residential care facilities, and memory care communities. This study was conducted during fall 2019 and winter 2020.

2020 Adult Foster Home Resident And Community Characteristics Report On Adult Foster Homes, Paula Carder, Sheryl Elliott, Ozcan Tunalilar, Sarah Dys, Portland State University Institute On Aging

Institute on Aging Publications

This report is the sixth in a series prepared by the Institute on Aging at Portland State University for Oregon’s Department of Human Services (ODHS) and examines a sample of Adult Foster Homes (AFHs) throughout the state. This study has four objectives: 1. Describe AFH characteristics, including staffing types, policies and monthly charges and fees. 2. Describe current residents’ health-related needs, service use and demographic characteristics. 3. Compare current results with prior Oregon surveys to identify changes and current trends. 4. Describe characteristics that might affect access, quality, or cost. Oregon has licensed adult foster homes (AFHs) as a type …

The Resident View In Nursing Homes, Diana L. White, Ozcan Tunalilar, Serena Hasworth, Jaclyn Winfree

Institute on Aging Publications

This article presents the Resident VIEW (Voicing Importance, Experience, and Well-Being), a measure designed to learn directly from long-term care residents the extent to which they experience support that matters most to them. The Resident VIEW contains 63 items across eight domains developed through cognitive interviews with residents in different types of residential settings (e.g., nursing homes, assisted living, and adult foster care). Residents rate items on both importance and their experience. In total, 258 nursing home residents living in 32 Oregon nursing homes were selected through a two-stage random sampling design and participated in the study. Results demonstrate that …

Consumer Satisfaction With Aging & Disability Resource Connection Of Oregon: Round 6, Diana L. White, Allyson Stodola

Institute on Aging Publications

This report describes findings from the sixth consumer satisfaction survey conducted with consumers or family members who are served by the Aging and Disability Resource Connection (ADRC) of Oregon, focusing on Call Center staff (or Information, Referral and Assistance; IR&A) and recipients of options counseling services. The Institute on Aging at Portland State University directed the project, partnering with Washington State University Social & Economic Research Center, who conducted the telephone survey between February 27 and April 5, 2019.

2018 Adult Foster Home: Resident And Community Characteristics Report On Adult Foster Homes, Paula C. Carder, Sheryl Dejoy Elliott, Ozcan Tunalilar

Institute on Aging Publications

Adult foster homes (AFH) are small, residential settings that are licensed to provide assistance to older persons or adults with disabilities. These settings may offer a home-like setting in which residents’ independence, personal choice, and decision-making are promoted. Homes may be licensed for one to five residents and must be staffed 24-hours daily to respond to residents’ scheduled and unscheduled needs or requests. Adult foster homes offer a variety of services, including daily meals, housekeeping and laundry, assistance with personal care needs, medication administration, monitoring of health conditions, communication with residents’ health care providers, and social and recreational activities.

This …

2018 Community-Based Care: Resident And Community Characteristics Report On Assisted Living, Residential Care, Memory Care, Paula C. Carder, Ozcan Tunalilar, Sheryl Dejoy Elliott, Sarah Dys

Institute on Aging Publications

This report is the fourth in a series prepared by the Institute on Aging to describe Oregon’s assisted living, residential care and memory care service sectors which are referred to by Oregon Department of Human Services as community-based care (CBC) settings. These settings may also be referred to as Home and Community Based Services (HCBS).

Community-based care settings provide a variety of services, including daily meals, housekeeping and laundry, assistance with personal care needs, medication administration, evaluation, coordination, and monitoring of health conditions, communication with residents’ health care providers, and social and recreational activities. As the population of Oregonians aged …

Oregon Community-Based Care Survey: Adult Foster Homes, Paula C. Carder, Sheryl Dejoy Elliott, Ozcan Tunalilar, Sarah Dys, Margaret B. Neal

Institute on Aging Publications

Adult foster homes (AFH) offer long-term services and supports to older adults and people with disabilities who wish to remain in the community but need assistance with personal care and health-related tasks. This report focuses on Oregon AFHs that are licensed to care for individuals aged 65 and older and younger adults with disabilities. Homes may be licensed for one to five residents and must be staffed 24-hours daily to respond to residents’ scheduled and unscheduled needs or requests.

This report provides an in-depth look at a sample of Oregon AFHs. Since no central dataset of AFH services, staff, and …

Oregon Community-Based Care Survey: Assisted Living, Residential Care, And Memory Care, Paula C. Carder, Ozcan Tunalilar, Sheryl Dejoy Elliott, Sarah Dys, Margaret B. Neal

Institute on Aging Publications

In Oregon, community-based care (CBC) communities include assisted living (AL), residential care (RC), and memory care (MC) communities. These settings provide residential, personal care, and health-related services, primarily to older adults. As the population of Oregonians aged 65 and older is estimated to increase from 16 percent in 2015 to nearly 23 percent in 20501, the availability of CBC settings will continue to be an important source of long-term services and supports.

This report provides an in-depth look at Oregon’s CBC settings. Because no central dataset of CBC services, staff, and residents is available, as opposed to nursing facilities, information …

Two Forecasting Models For Portland, Oregon: Hamilton –Perry Vs Metroscope, Richard Lycan

Institute on Aging Publications

Presentation focuses on population forecasting models and compares the Metroscope Forecasting Model and the Hamilton-Perry Model.