Older Adults: Evolving Outcomes And Supports
Our priorities change as we age. When we become older, we also face new life experiences, opportunities, and challenges that we have to confront. This all contributes to how our outcomes shift throughout the years. Personal Outcome Measures® data tells us that there are significant disparities in outcomes between those who are 65 and older, compared to their younger counterparts. These disparities include quality of life issues involving residential settings, integrated environments, employment and health.
Unsurprisingly, as we navigate through these unfamiliar situations and outcomes, the guidance and support we need from others along the way, also evolves. While that's an obvious observation, what's not so clear is as human service providers, how do we adjust our approaches to better support older adults?
In this article, we use CQL's new data system PORTAL, to dig deeper into disparities in outcomes involving those 65 and older, compared with people who are younger than 65. We then gain practical insight by profiling Mountain Lake Services, the Essex County Chapter, NYSARC, Inc, and find out how services can be tailored to better support people as they age.
Outcomes Data For Older Adults
By Carli Friedman | CQL Director of Technical Assistance and Data Analysis
In our Personal Outcome Measures® data from 2015 to 2016, 166 people (12.5%) are older adults, 65 years old and older. According to our analysis, compared to other people who receive services, older adults were less likely to live in integrated environments (-14.7%), choose personal goals (-9.2%), and choose where and with whom to live (-6.5%). Meanwhile, older adults were more likely to have outcomes present for choose where to work (9.4%) and best possible health (8.5%)
Older adults were also less likely to have organizational supports in place for integrated environments (-10.1%), and choose personal goals (-7.4%) compared to all other people who receive services in our sample.
Choosing Where and With Whom to Live
Only 20.7% of older adults had the outcome present for choose where and with whom to live.
- 29.1% of older adults had options about where and with whom to live.
- 33.6% of older adults decided where to live.
- 24.8% of older adults selected with whom they live.
- 70.1% of older adults determined how to furnish and decorate their homes.
Given the choice, older adults were more likely to choose to live in their own homes, family homes, or other settings rather than private or state ICFs, provider owned or operated group homes, or host homes or family foster care.
Older Adults: Choosing Where To Live By Setting
Living in Integrated Environments
Older adults were also less likely to live in integrated environments than all others who receive services. Only about a third (28.9%) of older adults had the outcome present for live in integrated environments.
- 32.5% of older adults used the same environments at home as people without disabilities
- 15.0% of older adults used the same environments at work as people without disabilities
- 89.5% of older adults used the same environments in the community as people without disabilities
Approximately half of organizations (52.0%) serving older adults knew what integration meant to the person or put in place efforts to learn about the person’s preferences.
Choosing Personal Goals
Older adults were also less likely to choose their personal goals; only 37.6% of older adults had the outcome present for choose personal goals.
- 46.7% of older adults’ priorities regarding goals were solicited
- 53.3% of older adults chose personal goals
- 58.1% of older adults are working towards goals they chose
About half of organizations (48.3%) know the goals the older adult has identified for themselves or have made efforts to learn about the person’s goals. Similarly, approximately half of organizations (48.7%) provide supports and services to assist the older adult in pursing personal goals.
Choosing Where to Work
One of the areas that older adults were more likely to have the outcome present than all others who receive services was choose where to work. Despite being more likely to choose where to work than all others receiving services, the majority of older adults (58.5%) still do not have the outcome present for choose where to work.
When given the choice, older adults most frequently chose competitive employment, supported community employment, retirement, or no work. Older adults were less likely to choose to work in a day program, sheltered workshop, or community based day program.
Older Adults: Choosing Where To Work By Setting
Adjusting Your Approach To Supports
By Sherry L. Taylor | CQL Quality Enhancement Specialist
The population of people supported by agencies accredited by CQL mirrors the population of the world. The World Bank estimates that 8.267% of the world population is aged 65 or older. In the United States the percentage of older Americans has increased from 9% in 1960 to 15% in 2015.
Many organizations have changed the way they provide services to respond to the changing support needs of people who are older. Organizations have found the Personal Outcome Measures® are very helpful in exploring what is important to the person.
Lessons From Mountain Lake Services, the Essex County Chapter, NYSARC, Inc.
Mountain Lake Services, a NYSARC, Inc. chapter accredited by CQL | The Council on Quality and Leadership, in Port Henry, New York noticed that as people aged, their support needs changed. For many, their health deteriorated and they were facing decisions about end of life issues. Many people were experiencing health problems that required specialized medical care. That medical care was not easily available in their current service system. Most of the people had lived in their homes and had been supported by Mountain Lake Services for decades. Some of the people were less active than they used to be.
After several people were forced to move into other facilities of specialized care, the agency learned from people that they wanted to remain in their homes as long as they could. The agency wanted to honor people’s personal goals to remain in their homes. In order to do this, the agency made some changes in how they supported people.
Mountain Lake Services completed an environmental scan of all residences to ascertain what, if any, environmental modifications needed to be made to enable people to live in their own home. Mary lived in a home with three other older women. That home had a ramp on one door to go in and out but if Mary wanted to use the front door, Mary had to use the stairs. Mary also had difficulty evacuating as quickly as she needed to meet the safety requirements. Mountain Lake Services received an e-modification grant from the New York State Department of Health. With the money from this grant, a ramp was built on the front of Mary’s house. She was able to go in and out of the front door and had two accessible egress points for emergencies. Her home was modified so that it had a sprinkler system and fire doors. This increased Mary’s safety and she was able to live in that home until she passed away a few weeks ago.
There are many tools available to help organizations complete an environmental scan and identify small but significant changes that can be made so people can continue to live in their home.
Safety assessments are available at the following websites:
- This checklist can assist you and the person you support in exploring home safety, and determining whether the person is safe in their home:
- This is an additional assessment that can help you evaluate home safety and identify potential concerns:
As people’s life circumstances changed, Mountain Lake Services used the Personal Outcome Measures®, to discover what was really important to people. Mountain Lake Services staff supported people to explore different options for what they do during the day. For most of the older adults the opportunities were primarily focused on leisure and social activities. Mountain Lake Services had to work with the Office for People with Developmental Disabilities (OPWDD) to support people to participate in services on a part-time basis because many people were experiencing a loss in endurance. And sometimes their health supports made it difficult to participate full time in work, day programs or other community supports. Many chose part-time schedules that allowed them to plan their day around their health care supports.
During Donna’s Personal Outcome Measures® conversation, the agency learned that Donna enjoyed quilting and people. Donna had gotten frail and had to take her oxygen with her when she went out so going to a traditional day program didn’t work for her. The staff helped Donna find a quilting club. Each week, Donna and one of her staff go to the quilting club where Donna quilts and laughs with her new friends. June, during her Personal Outcome Measures® conversation, said she really likes being on the go and loves to play Bingo. At least one time a week, June and her staff go play bingo at the local senior center. Robin Hoffman of Mountain Lake Services, said the Personal Outcome Measures® were very helpful in designing supports “one person at a time.”
The Importance of 'End of Life' Planning
'End of Life' decisions are challenging for everyone but particularly for people who need support to understand their health care and their options. Mountain Lake Services works hard to put 'End of Life' Measures in place for people based on their personal preferences after helping them understand this process. In the past, these decisions were made on an emergency basis and people were not always aware/knowledgeable of alternatives. For Mark, as his health condition changed and he was unable to go on those regular visits with his family, Mark invited his family to his home and they came to visit. When Mark’s daughter went to her prom, Mark went to the prom activities to see his beautiful daughter and spend time with her. The family was grateful for the time they shared with Mark at his home.
According to Robin Hoffman of Mountain Lake Services, the agency supports people to live with dignity and provide comfort care if the person is nearing their end of life, many within their own homes. In addition, Robin states “This continues to be a challenge for us as we navigate the process with people, their families, and Mental Hygiene Legal Services. Most important is to prepare, prepare, prepare, while talking about these issues with people and within the agency. It is crucial to finding solutions which will help people choose what best fits their needs/wants.”
Additional information about 'End of Life' Planning:
- This presentation provides information about the need for service coordination for people with intellectual disabilities around end of life planning:
- The 'Advance Care Planning: Workbook and Video' is a guide that can be used in supporting people with developmental disabilities to advocate for themselves and control what happens to them through the end of life:
- As an extension of person-centered thinking, there is an ever-increasing need for advance care planning. This article is about supporting people to clearly communicate their wishes: