A Report on Services for Older Adults in Marin

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A Report on Services for Older Adults in Marin

A ong>Reportong> onServices for OlderAdults in MarinExecutive SummaryPrepared byHarder+CompanyCommunity ResearchSeptember 2008


A call to actionIn late 2007, the Marin Community Foundation (MCF) askedHarder+Company Community Research with the help of Field ResearchCorporation to take a close look at the system of services for older adultsin Marin County. Over 800 older adults, policy leaders, service providers,and other community stakeholders generously provided their input.Our study of Marin’s system of services for older adults went beyondtallying health statistics and counting residential care beds. We askedMarin’s older adults about how they experience services, what they needand expect, their engagement with community life, and the roles of theirfamily and neighbors. We made sure to hear from Spanish-speaking olderadults; rural residents; and lesbian, gay, bisexual, or transgender (LGBT)older adults – members of our community who often are not wellrepresented by broad, generalized studies.This booklet highlights the findings from the community-wide study.Now comes the exciting part! The findings are intended to stimulate abroad community conversation about services for older adults and toserve as a platform for developing a county-wide action plan thataddresses all aspects of healthy aging.The findings are offered as a springboard forinclusive planning and action.The findings presented here address three main areas of need andopportunity: services, access, and social engagement. Also included as astarting point for discussion are ideas offered by the study’s participants.Turn these pages to read the collective voices of hundreds of Marinresidents and be inspired to join in creating a strong and responsivesystem to support our olderadults—and our communityas a whole.Find out moreIf you’re interested in more detailsabout the study, including the methodsused, we invite you to look up the fullreport, A ong>Reportong> on Services for OlderAdults in Marin, available atwww.marincf.org/olderadults.1


costs for medical care. As one Marin leader put it, “Many people fallbetween the income levels at which senior services are covered. Forexample, many earn too much to be eligible for low-income services butare not wealthy enough to afford to pay for services out of pocket.”As Marin plans for its growing and changing older adult population, itdoes so in the company of the rest of the nation. The health care system ishurting everywhere. Changes are occurring simultaneously across thecountry as people develop new concepts of healthy aging, adapt to newcommunication technologies, and recognize challenging economicsituations. Adjustments will need to occur in the policies that determinehow dollars are spent and how programs are administered. The voices ofMarin’s residents can help to shape those policies.A collaborative effortLeaders and service providers in Marin recommend greater collaborationamong county government, the philanthropic community, and nonprofitswith regard to planning and delivery of services for older adults. If serviceproviders were better able, through a strengthened communication andcoordination system, to match older adults who need services withproviders’ capacity to provide them, resources would likely be used moreefficiently while ensuring a better quality of life for older adults. Toachieve this, and to prepare for the rising number of older adults, thesystem of services needs a coordinated overall plan.At the same time, a common theme that surfaced throughout ourinformation gathering was that older adults should play a key role inshaping the service system that affects them. There are many ways forolder adults to participate in this process: serving on the AgingCommission and nonprofit boards, becoming volunteers, and advocatingfor policy changes to expand resources for older adults.The groundswell of interest and participation in this study, along with theefforts already undertaken by many others, creates the opportunity forpositive change.What will your role be?3


ServicesKey Finding #1Marin’s older adults need more affordable home careand support for caregivers.Independent living and aging in place appeal to many older adults, butrising costs and limited supportive services are making this lifestyle choicemore difficult. In order to age in place, older adults need home-basedsupport and assistance managing chronic health issues.Examples of In-HomeCare Services• Housekeeping• Meal preparation• Transportation to medicalappointments• ErrandsWhile unpaid family caregivers bear mostof this workload, they often have littletraining and support themselves. As oneolder adult caregiver shared, “Myhusband goes to adult day care one day aweek, but it is expensive and not coveredby long term care insurance.” She andother informal caregivers need affordablerespite day care, as well as knowledge ofsupport and resources available to them.• Personal carePaid caregivers cannot meet the rising• Medication management demand for in-home support due to thehigh cost and short supply of theirservices. Most older adults in Marin donot meet the income criteria to qualify for government-subsidized, inhomesupport, yet many still cannot afford the services they need.Moreover, much of the workforce needed to provide home-based carecannot afford to live in the county, creating a labor shortage. As Marin’spopulation ages in coming years, demands are likely to grow.Ideas from the communityConduct outreach to informal caregivers to provide information andsupport. Service providers, informal groups, and others have theresources that may be of great help to them.Create opportunities for the public sector, funders, and the businesscommunity to work together to develop incentives to add to the ranksof trained home care staff. Take into consideration both affordabilityof services and the necessity of livable wages.4


ServicesKey Finding #2Affordable residential care is scarce.The high cost of living in Marin, combined with fixed incomes and risingmedical expenses, means some older adults are unable to afford long termresidential care without financial assistance. Unfortunately, affordablehousing options for older adults in Marin are few, and needs are especiallyhigh in West Marin. Across the county, many subsidized residential carefacilities have waits of several years, and some have simply closed theirwaiting lists for the time being.“They don’t even put you on a waiting list anymorebecause there’s no senior housing.”-Central Marin older adultUntil affordable housing options open up, in-home care will be even morecritical. As community leaders pointed out, planning efforts for homecare and residential care should occur in tandem.This issue of affordable residential care involves service providers,policymakers, advocacy groups, funders, and of course, older adultsthemselves.Ideas from the communityCreate stakeholder working groups to consider a wide range ofoptions, including a search for model solutions in other communities.In the meantime, seek alternatives for older adults on waiting lists foraffordable housing, including targeted home care support.5


ServicesKey Finding #3A shortage of health care providers is a commonconcern.As they look ahead to an aging population, Marin’s leaders and residentsare concerned that a shortage of health care providers could become aMedical Facilities Available to OlderAdults in Marin Countyserious problem. A provider shortage islikely to increase as the Baby Boomergeneration (which includes manydoctors) ages and retires.Study respondents noted that attractingand maintaining a sufficient health careworkforce is tied to a large number offactors, among them the cost of living,federal and state reimbursements forcare, hospital presence in the county,and the supply of graduates of nearbymedical and nursing schools.Strategies and incentives to bring inmore providers will need to creativelyaddress many of these issues over thelong term, but proactive monitoringand planning will be necessary to prevent access problems before theyspread. Reducing a shortage of health care providers will requirecollaborative efforts among policy leaders, health care facilities, funders,and medical and nursing programs, among others.Source for hospital information: California Office ofStatewide Health Planning and Development.NOTE: Map locations are approximate.Ideas from the communityCreate a task force to identify incentives for health care providers,especially geriatric specialists, to settle and stay in Marin.In consideration of the growing number of non-English-speakingolder adults, tailor recruitment efforts to attract multi-lingual healthproviders.“There are no new physicians moving in to replacethose retiring due to the high cost of living in thecounty.”- Policymaker6


AccessKey Finding #4Marin needs transportation planning thatincorporates pedestrian-friendly zones.The need for improved and expanded transportation is recognized as amajor issue among all who contributed to this study. As adults age, manystop driving and rely on friends, family members, fixed route publictransportation, or flexible route paratransit to get around. Disabilities orincreasing difficulty walking can pose challenges to using publictransportation, riding in cars, or navigating hilly sidewalks.Lack of transportation hinders older adults’ ability to reach services and beactive members of society. In particular, West Marin residents say it isdifficult to access health care services. Many voice concern about drivinglong distances for routine care, yetthey report having trouble findingconvenient, affordable transportationto take them to their appointments.For those who continue to drive intotheir later years, there are safety issuesto consider with more older driverson our roads.“Transportation isinfrequent, and there arelimited stops for ruralareas. People can take anambulance to the hospital,but not on the way back.”A related concern is walk-ability.Marin’s older adults lead active lives.An important factor influencing their ability to remain active is living inan environment with easily accessible parks, trails, and walk-ableneighborhoods that are located close to stores and restaurants.Pedestrian-friendly neighborhoods are also crucial for older adults whodepend on being able to walk to a bus stop or other transportation pick-upand drop-off points.Ideas from the community-West Marin older adultFind ways for the needs of older adults and those who serve them tobe incorporated into transportation planning, especially for remoteareas.Consider risk reduction strategies for helping older drivers maintainsafety and skills.7


AccessKey Finding #5Older adults seek a one-stop source for reliableinformation.Across the board, Marin residents expressed the need for better access toinformation and referrals relevant to older adults, and providers andleaders agreed. Policymakers and providers noted that communitymembers often do not know whatWhat types of informationare older adults looking for?• Assistance with finances:• daily money management• bill paying• concerns about predatorylending and bankruptcy• Job searches• Opportunities about physicalactivities that accommodateolder adultsThe good news is that theMarin County Division onAging is already hard at workon a centralized informationsource! The Division ofAging launched its MarinNetwork of Care website inservices are available. In the wordsof one, “If a family has aging parentsand they reach some sort of crisis –which is usually how people first findservices – where do they turn?”A centralized source of informationcould connect people to each other,not just to services. Across Marin,people emphasized the importance ofsocial connections and reducingisolation. Informing older adults ofsocial opportunities that fit a widerange of personalities and interestswould be a positive step.70% of Marin’s olderadults use theInternet at home.early 2008 (http://marin.networkofcare.org). It’s still too soon todetermine its success in connecting older adults to information andservices, but due to the growth of Internet use among those over age 65, aweb-based resource is a practical approach.8


AccessKey Finding #6There are broad opportunities to improvecultural competency.It is a special challenge for some populations to find services that areculturally sensitive and in their primary language. To provide a fewexamples:• Marin’s Spanish-speaking older adults have trouble finding healthcare providers who speak their language, sometimes resulting inpatients misunderstanding diagnoses or medication instructions.• Non-English speaking community members note that confusionabout cultural norms pose problems to their ability to accessservices, including health care and housing.• LGBT older adults expressed the importance—and challenge—offinding health care and social service providers that are LGBTfriendly.Service providers agree that improvement is needed: Nearly half of thosewho responded to the study reported that cultural competency of serviceswas inadequate.Because Marin is less ethnicallydiverse than other parts ofCalifornia, some populations areless visible, and their needs lesslikely to be met. At the sametime, the county is becomingmore ethnically and culturallydiverse. Thus, it is an important time for service providers andstakeholders to increase awareness of and ability to serve people who spandifferent languages, cultural backgrounds, and orientations.Ideas from the communityWork with racial/ethnic minorities in Marin to develop tailoredcultural competency guidelines and training materials.Work with LGBT older adults to develop guidelines for providersregarding sensitivity to LGBT people, with particular emphasis on theunique perspectives of older adults.Share materials widely with providers and the public.“Language is very important.If you don’t speak English youmiss the chance to have a goodexperience with the doctors.”-Spanish-speaking older adult9


Social EngagementKey Finding #7Older adults benefit from social engagement.The study found that more than one in three older adults in Marin livesalone. For these people and others, there was wide agreement thatinterpersonal connections withBenefits associated withsocial connections• Life satisfaction• A feeling of aging successfully• High self worth• Healthier behaviorothers through day to day activitiesor involvement in social clubs,religious organizations, or othergroups are important to quality oflife. Many factors, though, posechallenges to older adults’ effortsto maintain social connections,including declining mobility, lossof capacity to drive at night or atall, and living alone.Marin’s older adults, as well as leaders of informal groups point out that:• The social network is important to the safety, health, independence,and dignity of older adults. For instance, as a leader of a culturalgroup remarked, “I know there are people who have trouble driving,and they don’t seem to want to ask for help, but other people try tobe sensitive and try to provide it.”• The increase in Internet use among older adults offers newopportunities to foster social interactions.“Chances for socialization are very important as weget older. It takes our mind off our ailments.”Ideas from the community-South Marin older adultProvide training in outreach and capacity building to informal groups,connecting them to service providers and other resources, so they canact as a bridge between older adults and other services.Create opportunities for older adults to participate inintergenerational activities, as they noted these were in particularlyshort supply.10


Getting StartedThese findings come directly from the community. They are intended tocatalyze and inform a community-wide conversation, sparking a processof engagement aimed at ensuring a strong and responsive system ofservices for our older adults.Thank you to everyone who has participated so far. As the conversationcontinues, it will depend on the active participation of many.What are your ideas?11


Funded by:The Marin Community Foundation is the primary center for philanthropyin Marin County, California. Dedicated to enhancing the community'squality of life, the Foundation provides support in the areas of the arts,community development, education, the environment, community health,and religion. The Foundation administers assets of the Leonard and BerylH. Buck Trust and of funds established by 350 Marin individuals, families,businesses, and community groups.Research conducted by:Harder+Company Community Research is a comprehensive social researchand planning firm with offices in San Francisco, Davis, San Diego, and LosAngeles, California. Our mission is to strengthen social services, improvedecision-making, and spur policy development by providing quality research,technical assistance, and strategic planning services. Since our founding in1986, we have worked with foundations, government and nonprofitsthroughout California and the country. Our success results from deliveringservices that contribute to positive social impact in the lives of vulnerablepeople and communities.

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