Opting for Independence Case Study Report: Stair Masters and Stair Lifts Opting for Independence …when your health care needs are changing and you want to stay in the home you love. Stair Masters and Stair Lifts: A Case Study Report on attitudes of older adults toward aging in place. December, 2011 For more information, contact The Coordinating Center at 8258 Veterans Highway, Suite 13 Millersville, MD 21108 410-987-1048 [email protected]. The Coordinating Center Opting for Independence Case Study Report Aging in Place: “Stair Masters and Stair Lifts” Interviews with Older Adults TABLE OF CONTENTS EXECUTIVE SUMMARY .................................................................................................2 INTRODUCTION AND PLANNING ................................................................................5 OPTING FOR INDEPENDENCE GRANT .............................................................................. 5 BUILDING BLOCKS FOR THE CASE STUDY PROJECT .......................................................... 6 CASE STUDY TEAM AND PROJECT PLAN ......................................................................... 8 SCOPE ................................................................................................................................ 8 DEVELOPING THE INTERVIEW GUIDE ................................................................................. 11 IMPLEMENTATION ......................................................................................................12 OUTREACH/RECRUITMENT PROCESS ............................................................................... 12 INTERVIEW PROCESS ........................................................................................................ 13 CODING REPORT ................................................................................................................. 15 FINDINGS .....................................................................................................................16 SUMMARY FINDINGS OF THE INTERVIEWS ......................................................................... 17 IMPLICATIONS AND IDEAS FOR HOWARD COUNTY .......................................................... 26 APPENDICES ................................................................................................................29 A. INTERVIEW GUIDE QUESTIONS WITH SUMMARY REPONSES ...................................... 29 B. PARTNERS AND RESOURCES ........................................................................................ 37 C. DETAILED SUMMARY AND ANALYSIS OF THEMES AND SUBTHEMES ........................... 39 D. FORMS AND DOCUMENTS ............................................................................................ 71 INTERVIEW CONSENT FORM PROJECT BUDGET INTERVIEW GUIDE RECRUITMENT FLIER Executive Summary The Coordinating Center (The Center) is pleased to release the Opting for Independence Case Study Project Report: Aging in Place – Stair Masters and Stair Lifts.” This report is a part of the larger Opting for Independence (OFI) program that is piloted in partnership with the Howard County Office on Aging to provide direct service to adults over age 65 living in selected zip codes. Grant funding for OFI is from the U.S. Department of Health and Human Services, Administration on Aging, and Community Innovations for Aging in Place Program (http://www.ciaip.org/). In Howard County, Maryland, for six weeks in the summer of 2011, The Center and its community partners conducted thirty open ended interviews with older adults in selected Columbia ZIP codes. The goal for this qualitative research was to learn what individuals are thinking about their personal aging in place prospects. The Center also viewed the Case Study Project as a way to engage the community. The Project provided a vehicle for community members to understand how older adults use their strengths to stay at home and the range of supports they anticipate needing in their future. As a result, aging in place can be seen as a community opportunity, not simply the personal choice of an older adult. Howard County has a fast growing aging population with highly educated residents. It often appears on national lists of desired places to live, situated between major metropolitan centers of Baltimore, Maryland and Washington D.C. Over the years, median income has grown, in 2009 the County’s median annual household income was $101, 417, compared with $69,193 for Maryland. While not all older adults reflect these demographics, the Case Study sheds light on how universal the concerns are among older adults wanting to remain in their homes. The Case Study Project was led by The Center, a mission driven nonprofit organization providing statewide care coordination to persons with complex health and social needs. Since 1983, The Center has helped over 10,000 children and adults safely leave hospitals and nursing facilities to live at home, or continue to stay in the community with healthier outcomes. Opting for Independence, with its focus on older adults and their family support networks is its newest service. Partnership and Community Engagement The Case Study Project was designed to inform and engage the Howard County community. It drew the attention of residents, elected officials, and community advocates, all of whom enriched the project and created dynamic community roots for the project. The Center’s premier partner was Leadership Howard County along with six members of the Class of 2011 who chose the effort as their community project. They provided essential leadership and community ownership and remained involved through the report’s release. PATH members (People Acting Together in Howard), an advocacy network in Howard County and an affiliate of the Industrial Areas Foundation (IAF), were effective in identifying interviewees. 2 The local chapter of the National Active and Retired Federal Employees also assisted. Senior centers publicized the Case Study Project to its members. Professional partners included the New York Academy of Medicine’s Center for Evaluation and Applied Research; Howard Community College’s Executive Director of Planning, Research and Organizational Development; Transcripts 4 North America; and a professional coding consultant. Findings “Stair Masters” are a symbol of the many actions that interviewees describe as a positive part of aging in place, representing personal action to stay healthy and active. “Stair Lifts” represent a potential solution when stairs in the current home prove to be an overwhelming barrier. Many interviewees described a number of favorable “aging in place” supports. These can be compared to four pillars holding up a building: health stability, financial stability, strong informal support network, and knowledge/use of a formal service network. Many, although not all, of the Case Study interviewees have three strong pillars: health stability, some degree of financial stability, and social networks they have cultivated over many years. Interviewees described good health coverage and healthy life styles that included regular exercise. Many saved money over time, although the degree of financial confidence has been shaken with the economy’s downturn. With over 6,700 federal retirees living in Howard County, it is no surprise that many interviewees have federal retiree pensions and health care coverage, including long term care insurance. This provides a relatively high level of health and financial confidence that may not be indicative of other Howard County older adults. The third pillar of informal support provided a strong foundation for many of the interviewees to remain in Columbia, even if adult children are not nearby. Descriptions abound of relationships which nurtured over time with friends, neighbors, members of interest groups and former work “family”. Stated differently, long-standing and deep relationships with others have built a favorable “aging in place” environment that continues to root them in Columbia. However, a fourth pillar emerged that reflected missing elements or concerns about their future. Transportation was a common worry. Stairs present current and projected barriers in houses and condominiums, except for those living in senior housing. Some would like options for housing that makes it easier to address issues of declining health. Another described an ideal “assisted living at home” concept that might bring services into the home. Interviewees seemed to want an integrated approach that would reflect their priorities amid a range of health and social needs, some of which will emerge only in the future. Some desired “trusted, vetted, or reliable” consumer home services. Many interviewees had not closely examined the formal support network, but were generally confident that the Office on Aging (part of the Howard County Department of Citizen Services) would be able to provide them with information to assist in further decisions regarding their aging in place options. The more experience that interviewees had with services from the Office, including senior centers, the more 3 strongly they believed they would turn to it in time of need. Others would turn to spouse, friends, and physicians when new issues emerged. Barriers to aging in place were somewhat consistent across interviewees: limited transportation options, the stairs in their homes, and significant changes in their support system. The loss of the ability to drive was seen as significant in a suburban setting.