Key considerations in lgbt aging in place and care coordination by SAGE

Key Considerations in LGBTAging in Place and Care Coordination PRESENTED BY KELLY W. KENT

Services & Advocacy for GLBT Elders (SAGE) is the country's largest and oldest organization dedicated to improving the lives of lesbian, gay, bisexual and transgender (LGBT) older adults. Our mission is to lead in addressing issues related to lesbian, gay, bisexual and transgender (LGBT) aging.

National LGBT Elder Housing Iniative

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Building Housing Training Providers Changing Policy Educating Consumers Expanding Services

Presentation Objectives

Presentation Objectives • To better understand the demographics facing local communities • To understand the additional implications for LGBT aging older adults • Understanding the basic tenets of aging in place • Key considerations for your organization in partnering to ensure care coordination for clients.

Understanding the Issue

Aging Demographics •

It is estimated that there are currently 3 million LGBT older adults 50+ in the United States.

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That is roughly the size of the City of Chicago

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By the year 2040, this number could reach 7 million LGBT older adults.

Aging Demographics • Today, 1/3 of households 50+ pay more than 1/3 of their monthly income for rent/mortgage. • By 2024, it is projected that an estimated 4.7 million low income households 50+ will have annual incomes less than $29,999.

• Cost burdened households are at risk of not paying for needed medications, transportation and food.

LGBT Specific Implications • 2014 report by the Equal Rights Center found that 48% of older same sex couples applying for senior housing were subjected to discrimination. • Mainstream affordable housing and assisted living/nursing homes have often not received training for staff in cultural competence of the LGBT community.

LGBT Specific Implications • Despite continued advocacy, housing discrimination continues to be an issue for LGBT aging older adults. • The LGBT community often struggles with affordability in older age due to history of discrimination and economic marginalization.

The Solution • LGBT-welcoming multi-family developments. 1. Provides Culturally competent services 2. Welcoming community of peers and allies 3. Affordability is taken into consideration • Aging in place best practices provide alternatives for communities unable to galvanize political will or that do not have economies of scale. • Cultural Competency training for staff of all affordable housing, assisted living/nursing homes serving LGBT aging older adults.

Aging in Place

Aging in Place The Center for Disease Control defines aging in place as "the ability to live in one's own home and community safely, independently, and comfortably, regardless of age, income, or ability level.â&#x20AC;&#x153;

Aging in Place Statistics - 90

percent of adults over the age of 65 report that they would prefer to stay in their current residence as they age. (AARP) - One-third of American households are home to one or more residents 60 years of age or older. (AARP)

- By 2030, it is expected that 10 states with have more Medicare-eligible seniors than school-aged children. (AARP)

Aging in Place - A viable alternative to an independent or assisted living facility. - The average cost of assisted living in our area ranges from $4,500 to $7,000 per month. - Many places have what is referred to as a buy-in that can range from $100K - $350K. In certain communities, this fee is not refundable.

Aging in Place Specialists Certified Aging in Place Specialist (CAPS) designation. Course developed by the AARP and NAHB. Executive Certificate in Home Modifications (ECHM) â&#x20AC;&#x201C; homemods.org (USC) Certified Environmental Access Consultant (CEAC) â&#x20AC;&#x201C; Accessible Home Improvement of America (AHIA)

Key Considerations

Key Considerations • Housing Expense and Appropriateness • Transportation • Long-term care Costs

• Social Isolation • Care Coordination

Housing Expense and Appropriateness - What are current monthly expenses? Does monthly income cover expenses? - How much of the current space is used on a daily basis? - Is living area all on one level? - Are there opportunities to modify the home to make it safer for aging? - Is a reverse mortgage product like the Home Equity - Conversion Mortgage (HECM) through the federal government make sense? https://portal.hud.gov/hudportal/HUD?src=/program_offices/housing/sfh/hecm/hecm home - Is the current home near services and amenities? - Home modifications can cost on average between $4,500-$30,000

Housing Modification Considerations If monies are available for home modification: • • • • • • •

Using low-maintenance materials. Eliminating stairs wherever possible. Expanding doorways. Incorporating a multifunctional first-floor suite, with bedroom and bathroom. Installing levered faucets and easy-to-grab cabinet and drawer hardware. Including wheelchair-accessible sinks, counters and appliances. Installing grab bars in showers and near toilets, bath benches, and elevated toilet seats or safety rails. • Incorporating bright lighting, handrails, and nonslip flooring without fall hazards like cords or rugs. • Installing smoke detectors with strobe lights for the hard-of-hearing.

Key Components to Keep in Mind Around Physical Space

Flexibility in Use

Simple and Intuitive Use

Perceptible Information

Tolerance for Error: The design minimizes hazards and the adverse consequences of accidental or unintended actions. Low Physical Effort: The design can be used efficiently and comfortably and with a minimum of fatigue.

Transportation • As individuals age their ability to drive a vehicle may often diminish • Many communities lack public transportation options except within inner cities. • Uber, Lyft and other types of ride-share programs can provide alternatives to driving in areas with limited public transportation. • Some communities have other transportation programming for older adults for healthcare appointments and related activities.

Long Term Care Costs • As an individual ages, the cost of care can be a primary concern. • While the cost of care varies by area of the country you live, here are estimates based on the national median cost of care: • Private nursing home care - $87,600 per year • Home healthcare aides - $45,188 per year • Assisted Living - $28,800 per year

Social Isolation • Senior Center Programming – In locations with SAGE affiliates (29 programs in more than 21 states) there are active group activities for older adults to participate in daily. • Volunteering – Provides a sense of purpose. To find options available in your area look at Senior Corps or Retired and Senior Volunteer Program (RSVP) at https://www.nationalservice.gov/programs/senior-corps • Senior Visitor Programs – many communities have local versions of these types of services that link homebound seniors to visitors more resources at: http://homevisitor.org/ • Use of Technology (Adaptive technology, smart phones, tablets, programs like Facetime or Skype utilizing internet) to keep in contact with family or friends in other locations. Copyright ©2017, SAGE, All Rights Reserved

Care Coordination

What is Care Coordination?

Care coordination unites a team of providers to meet individual needs, improving health care access and outcomes, and synchronizing the variety of long-term services and supports needed for housing and overall stability.

Components Care Coordination • Comprehensive needs assessment – assessment of how participant functions in daily life, patient’s preferences regarding community participation and goals for care. • Individualized care planning – needs based on assessment is foundation for tailored care plan which should include participant, family members and care team.

Considerations for LGBT individuals who are aging in place? • The Gay & Lesbian Medical Association maintains a searchable online database of LGBT-friendly doctors and care providers, as well as web pages devoted to transgender health resources. Their website can be found at http://www.glma.org • The national Register of Health Service Providers in Psychology maintains a searchable online provider database. under the Qualifications field, you can choose “Gay, Lesbian, Bisexual or Transgender Issues.” Their website can be found at http://www.nationalregister.org

Components Care Coordination â&#x20AC;˘

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Facilitating access to needed services - services include connection to services like transportation, meals on wheels as well as potentially assistive technology and durable medical equipment (if needed) Communication and monitoring a. Between health care professionals and patients and their families b. Within teams of health and social service professionals; c. across the entire care spectrum (hospital, rehabilitation facility, nursing home, or community residence).

Additional Considerations 1. Needed services – ensuring that activities of daily living are assessed can be beneficial in overall care coordination.

2. Transportation needs – Identifying appropriate public transportation or other services like Uber/Lyft as needed. 3. Available activities – What type of services/activities are offered through local Area Agency on Aging (examples: Matter of Balance, Tai Chi, water aerobics, etc.)

Additional Considerations 4. Finances – Identifying programming that may be covered by Medicare/Medicaid. You can compare the health plans available in your area by using the “Medicare Personal Plan Finder” under the “Find Out What Medicare Covers” option at www.medicare.gov, or you can call 1-800-633-4227. You can also contact your state’s State Health Insurance Assistance Program (SHIP)—for help finding the SHIP in your state, you can contact NCLR or SAGE, or your local Area Agency on Aging (AAA). 5. Nearby family/friend support – a support system is important to create community and prevent isolation.

Use of Technology - Technology can be an enabler for aging in place and care coordination - Four categories of technology that act as an enabler ◦ Communication and Engagement/Community (social media) ◦ Health and Wellness/Body (vital sign, sleep, activity monitors) ◦ Learning and Contribution/Caregiving (caregiver, tele-health platforms, assistive robots) ◦ Safety and Security/Home Environment (fall detection, sensors, video monitoring) (Home: Communities for all Ages, Idea Book 2013)

Key Considerations

Key considerations • Regular physical activity contributes greatly to the fitness, health, functioning and quality of life of older adults. • Social interaction is an important factor in sustaining a high quality of life. • The majority of people enjoy good or excellent health, even past age 85. Later life need not be a steady decline in health, but rather a number of healthy years followed by a much shorter period of ill health immediately before death. • Enhanced fitness is an evidence-based exercise program proved to increase strength, boost activity levels and elevate mood.

In Summary

In Summary • There are simple, cost-effective interventions you can make to your home to increase its safety. • Engaging an organization that providers lower cost home safety assessment and home modifications. http://rebuildingtogether.org/our-impact • Engaging senior service providers in your community (identified through the local Area Agency on Aging), on LGBT national list serves (included in this presentation) or your local LGBT center can help you access case management • Case Managers to assist in coordinating care throughout the community to better assist meeting individuals programmatic needs (primary healthcare, day services, mental health, transportation, wellness) Copyright ©2017, SAGE, All Rights Reserved

Questions & Follow Up Kelly Kent Director, National Housing Initiative kkent@sageusa.org 816-832-7526

Much of the best practice interventions highlighted here were drawn from generous work of Rebuilding Together Clay County. To find out more: http://rebuildingtogether.org/our-impact