HUMBOLDT COUNTY

IN HOME SUPPORTIVE SERVICES RESOURCE AND REFERRAL GUIDE

By

Joslyn Flint

A Project Presented to

The Faculty of Humboldt State University

In Partial Fulfillment of the Requirements for the Degree

Masters of Social Work

Committee Membership

Yvonne Doble, MSW, Committee Chair

Jamie Jensen, MSW, Committee Member

Martha Rangel, Committee Member

Dr. Marissa O'Neil, Graduate Coordinator

July 2015

ii

Abstract

HUMBOLDT COUNTY IN HOME SUPPORTIVE SERVICES RESOURCE AND

REFERRAL GUIDE

Joslyn Flint

The focus of this project is to create resource and referral guide for current and

future Humboldt County In Home Supportive Services social workers, public health

nurses, and social service aides to use. This electronic guide is organized based on

recommended categories identified by Grantmakers in Aging. This resource and referral

guide is the first step towards a more comprehensive guide that will be made in the future

and that will include In Home Supportive Services mandatory forms, procedures and

relevant regulation citations.

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Acknowledgements

I would like to thank the members of my master's project committee, Yvonne

Doble, MSW, Jamie Jensen, MSW, and Martha Rangel, for their support throughout the

process of attaining my master's degree. I would also like to thank my parents and my

three beautiful daughters, Camille, Allegra, and Kendra.

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Table of Contents

Abstract ............................................................................................................................... ii

Acknowledgements ............................................................................................................ iii

Appendix List.......................................................................................................................v

Introduction ..........................................................................................................................1

Aging in Place in Rural Environments............................................................................3

Ecological Theory on Aging ............................................................................................4

In Home Supportive Services ..........................................................................................6

Social Model versus Medical Model...............................................................................8

Project Vision...................................................................................................................9

Literature Review...............................................................................................................11

Aging in Place................................................................................................................11

What is Needed to Successfully Age in Place................................................................12

Methods..............................................................................................................................17

Results................................................................................................................................19

Discussion..........................................................................................................................23

References..........................................................................................................................27

Appendix............................................................................................................................31

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Appendix List

In Home Supportive Services Resource and Referral Guide Folders………………….31

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Introduction

Most older adults would choose to live in their own homes throughout their lives

regardless of physical, cognitive, or economic abilities (Greenberg & Schwartz, 2010;

Fausett, Kelly, Rogers, & Fisk, 2011). The concept of aging in one’s own home without

having to move is commonly referred to as “aging in place” (Wahl, Iwarsson, & Oswald,

2012). The Centers for Disease Control and Prevention (n.d.) 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”. According to Altman and Low

(1992), the desire to age in place is related to a sense of “place attachment”, which is

one’s emotional connection to a particular location. An additional positive aspect of aging

in place is that it is more cost effective than institutionalized care (“Considering the

state…” 2009).

There are, however, many challenges presented with growing old in one’s own

home. Physical and mental abilities decline with age, and people typically require more

assistance as they grow older (Mynatt, Essa & Rogers, 2000). In order to successfully age

in place, older adults must be able to manage their Activities of Daily Living (ADL’s)

such as eating, toileting, and bathing, as well as their Instrumental Activities of Daily

Living (IADL’s), which are tasks such as cooking, managing medications, managing

finances, and performing housework (Fausset, Kelly, Rogers, & Fisk, 2011). In research

conducted by the National Academy on an Aging Society (2013), one in four U.S. adults

65 and older living outside of institutions reported having difficulty with at least one

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daily activity and receiving no assistance. Twenty percent of the respondents reported

having difficulty with personal care activities, such as bathing, dressing, eating, or getting

out of bed, and sixteen percent reported having difficulty with household tasks, such as

meal preparation, shopping, managing money, and using the telephone (Helping

Americans Age in Place, 2013). Individuals who are considered frail, which is defined by

the Older Americans Act as “being unable to perform at least two Activities of Daily

Living (ADL’s)” have a higher risk for institutionalization, due to their frailty, (as cited in

Berg, 2012).

Another common challenge many face as they grow older is managing the home

that they live in. Most homes are not designed to accommodate people as they age (Neal,

2007). In fact, most falls, which are the leading cause of death by injury among older

people, occur in one’s home (California State Plan on Aging, 2013; Scharlach, 2009).

Home maintenance, which can range from changing light bulbs to mowing the lawn, can

also become difficult for older people as functional limitations increase with age

(Hudson, O’Neill, & McCutcheon, 2013).

Isolation is also a serious risk factor for older adults in general, and even more so

with older adults who live alone, especially if they lose the ability to drive. Public

transportation is not always available or convenient and taking a taxi is often cost

prohibitive. According to The Center or Home Care and Policy Research (2004), 43

percent of people over 65 stated that public transportation was not available in their

community. The lack of consistently reliable transportation is also evidenced by the fact

3

that even care coordinators who are familiar with available community services routinely

have difficulty finding and arranging appropriate and reliable transportation for their

clients (California State Plan on Aging, 2013).

Aging in Place in Rural Environments

In addition to the challenges that older people who live independently can expect

to experience cited above, there are additional challenges faced by elders who live in a

rural environment, such as Humboldt County, who wish to age in place. Rural areas are

more likely to be the homes of financially disadvantaged elders (Golant, 2006; Berg,

2012). Additionally, rural older adults are less educated and have more health problems

than their urban counterparts (Berg, 2012; Li, 2006). Also prevalent among rural resi-

dents is a tradition of self-reliance, a feeling of wanting to protect privacy, and a distrust

of government workers (Li, 2006).

Lack of family support is another challenge faced by elders in rural communi-

ties. Although rural adults tend to rely on family more than on formal supports for care-

giving services in the home, younger generations often move away from home and their

families due to the lack of educational and career opportunities (Berg, 2012). This leaves

elder residents in rural communities without the natural supports of their extended family

to help them as they age. This is exacerbated by the fact that rural older adults are more

likely to live alone than urban older adults (Golant, 2006).

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Living in a rural setting has consistently been associated with a reduced availabil-

ity of and access to formal health services (Goins, Spencer & Byrd, 2000). Rural areas

often have limited health care options, as well as limited availability of social services.

Rural areas, Humboldt County among them, also have difficulty recruiting and retaining

primary care physicians and medical personnel. This has resulted in Humboldt County

being designated by the state as a “medically underserved area” (Berg, 2012). Additional-

ly, because needed services may not be available in local communities, rural older adults

may have to travel greater distances and spend more time to obtain health and social ser-

vices (Li, 2006).

Another consideration is that rural older adults are more likely to live in dwellings

that are older and in poor physical shape, and are often located in declining or unsafe

neighborhoods (Golant, 2006). In addition to this being a quality of life issue for older

rural adults, home health agencies will not assist people in homes that they feel are

unsafe, even when that individual is transitioning from hospital to home and requires

home health services (Berg, 2012).

Ecological Theory of Aging

Gerentological researchers Lawton and Nahemow (1973) developed a framework

called the ecological theory of aging (ETA). According to Lawton (1982) social and

physical environments are tangible and measurable entities. The social environment

includes human relationships, as well as people's interactions with bureaucratic

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organizations, social groups, and the community in which they live. The physical

environment includes physical structures, the natural environment and all that

encompasses, such as weather patterns and natural disasters, and the economic and

political environment. According to the ecological theory of aging, all of these elements

combine to affect the human experience of growing older (Probst, 2012).

Lawton (1982) and colleagues believed that human behavior and function result

from the competencies of the individual and the individual’s ability to successfully

interact with the environment. This model presumes that when a person has the

capabilities to meet the demands of the environment or the demands of the environment

are modified to match the person's capabilities, a successful interaction between the

individual and the environment occur. Conversely, when the demands of the environment

exceed the individual's ability to function within it, a maladjusted interaction occurs

(Fausett et.al. 2009). An example of this is when someone becomes dependent on their

wheelchair for ambulation and they are no longer to reach their counters and sinks or

their wheelchair is not able to fit through the doorway of their bathroom.

The ecological theory of aging views old age as a critical phase in the life

course that is profoundly influenced by the individual’s social and physical environment.

As people age, deepening existing relationships becomes a priority (Scharlach, 2009).

According to the ecological theory of aging, older individuals who have more sources of

social support also have better physical and psychological well-being, and greater

response to illness and other life stressors (Scharlach, 2009). Additionally, research has

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shown that helplessness-inducing environments such as nursing homes can foster poorer

functioning, while independent living and the desire to appear functional and capable in

social context can promote better functioning (Scharlach, 2009).

In Home Supportive Services

A program that bridges the gap of the services that older people need and the

services that older people are receiving in Humboldt County is In Home Supportive

Services (IHSS). IHSS is a program that provides elderly and disabled people assistance

with personal care and domestic services to help them remain safely in their own homes

(Seyden & Robert, nd). IHSS is a benefit of the federal Medicaid program, known as

Medi-Cal in California (Howes, 2010). Under the federal Medicaid statutes, states are

required to provide institutional long term care services to low income individuals who

require an institutional level of care and IHSS is the program which California uses to

meet this mandate (McDonald, 2003). IHSS is administered by each of California’s 58

counties under the direction of the California Department of Social Services (Miles &

Zarraga, 2008). For almost all IHSS recipients, 50 percent of program costs are paid for

by the federal government with the remaining 50 percent paid for with state and county

funds ("2014-2015 budget in-home," 2014). This means that in addition to providing

care to people who wish to age in place, IHSS also stimulates the local economy by

providing salaries that are largely paid for with money that is from out of the area.

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Being at risk for institutionalization is a requirement for IHSS

eligibility. Eligibility can also be justified if there is a chance that, without help in the

home, someone’s functioning will decline to the point where they would require

institutionalization in the future (CWDA, 2003). Since California uses IHSS to fulfill its

mandate on providing an institutional level of care to those residents who need it, there is

no cap on growth to the IHSS program (McDonald, 2003). IHSS is available to all

applicants who meet the eligibility requirements. There are never periods of blocked

enrollment or waiting on a waiting list. This is unlike many other social service programs,

even government funded social service programs. Additionally, IHSS serves all eligible

county residents, regardless of how remote the location of their home is. And IHSS

assessments are completed in the recipient’s home, which means that the recipient does

not need to leave their home to receive services (McDonald, 2003).

Unlike many other public assistance programs, which typically only serve a

subset of the population, IHSS serves a diverse population with varying levels of need for

assistance. The common thread in their lives of IHSS recipients is having a low income, a

demonstrated functional impairment, and desire to remain in their own homes. Once

someone is deemed eligible for IHSS, by meeting the financial requirements and by

demonstrating that they have a need for assistance in the home, they will receive services.

The amount of assistance needed is not a factor in determining eligibility. The average

amount of hours that will be provided to IHSS recipients in the fiscal year 2014-2015 is

projected to be 84 hours per month, although a someone can be eligible for services if

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they only require assistance for as little as an hour a month, if they are able to

demonstrate that the one hour of assistance they receive is what helps them to remain

safely in their own homes. The maximum amount of hours is 283 hours per month (Miles

& Zarraga, 2008).

Also unique to the IHSS program is that IHSS social workers, public health

nurses, an social service aides visit recipients in their own homes. IHSS recipients are

often socially and physically isolated, they frequently are not connected to other services

and resources. Even IHSS recipients who are connected to other programs typically have

to travel to participate in such programs as opposed to having the program staff visit with

them in their own environment.

Social Model versus Medical Model

IHSS provides a social model of service delivery, which is different from a

medical model of service delivery. The medical model views the elderly person or the

person with a disability as someone with a medical deficit who is not able to care for

themselves, someone who needs to be cured. The social model however focuses on the

whole person (Kane, 2014). Using the social model of service delivery, IHSS assesses the

person and their abilities in their own environment. This resonates with the ecological

theory of aging and the importance of the relationship between the individual and their

environment.

9

Consistent with this social model, the IHSS care providers are usually non-

medical personnel. Often they are people in the community who simply want to work

with others, or sometimes members of the recipient's own family. The recipient is

expected to independently manage as many of his or her ADL's as they can safely

manage without assistance (CWDA, 2003).

As IHSS is a socially based program, social workers have historically conducted

all of the assessment and case management services for IHSS recipients. In recent years,

however, many counties, Humboldt County included, have employed an integrated

service model, employing public health nurses along with social workers. Social workers

continue to complete the majority of assessments and the public health nurses have a

smaller, specialized caseload of recipients with high medical needs (CWDA, 2003).

Project Vision

I have been a social worker for IHSS in Humboldt County for ten years. Our

caseloads are divided geographically and I have worked in every location of Humboldt

County. And in part because our caseloads are divided geographically and not by

impairment or need, I have worked with clients with varying levels of physical, cognitive,

and mental impairment. I have observed IHSS being a convenience in one’s life and I

have also observed IHSS being the most significant factor contributing to keeping

individuals out of institutional care. A social worker or a public health nurse will visit the

recipient in the home regardless of where in the county they live, as annual assessments

are required to be completed in the recipient’s home. Due to the remote locations in this

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county Humboldt County IHSS social workers and public health nurses sometimes drive

over two hours one way to visit recipients.

Many of the people who receive IHSS services are quite isolated from other social

service programs such as home delivered meals and day programs. Because IHSS case

managers see people who frequently are unable to receive other formal support, we feel

the ethical obligation to connect our recipients to the additional resources that are

available to them. For this reason, there is a feeling of responsibility for us to have

knowledge of the most relevant and appropriate resources available to the people we see.

It has long been a goal of Humboldt County IHSS to create a resource and

referral guide so that information regarding what resources are available to our clients is

accessible to all case managers. There are limited resources available to the people we

see, and often an individual must meet specific criteria, such as living in a certain

geographical location of the county, to obtain certain services. The information about

available resources has historically been passed down by word of mouth or announced at

a monthly unit meeting. This was not problematic when there were more services and

supports available. However that is sadly no longer the case. IHSS is frequently the only

social service many of our recipients receive. For that reason, we are our recipient’s link

to other available services and programs.

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Literature Review

This section of the paper will provide a review of the literature that I have

researched regarding what elders need to age in place, including the factors that

contribute to successfully being able to age in place. Additionally, I reviewed literature

that describes challenges presented to those who wish to remain in their own homes as

they age, as well as methods of addressing these challenges.

Aging in Place

A goal of many adults is to remain in their own homes as they age (Fausset et. al.

2011). The extent to which individuals are able to manage environmental demands

determines the quality of interaction between the person and the environment. Even

older adults who consider themselves to be in overall good health reportedly experience

some difficulties maintaining their homes (Fausset et. al. 2011). This issue is exacerbated

for rural elders, as research indicates that rural elders more likely to live alone.

Additionally, their dwellings are also likely to be older and in poorer physical condition

(Golant, 2006). Although Fausset et. al. (2011) found that home maintenance is required

to ensure a safe and healthy environment, they also found that a detailed assessment is

lacking of the home maintenance needs of older adults as they age in place.

12

In addition to their actual home, the neighborhood in which the individual’s home

is located can also enhance or impede an elder’s ability to age in place. A qualitative

analysis suggested that older people’s choice of housing was strongly influenced by

whether the physical environment and local amenities supported their mobility and

health, e.g. was their home in close proximity to reliable transportation, shopping, and

medical offices (Scharlach, 2009). In other research, a sample of elderly U.S. citizens

found that objective measures of housing and neighborhood characteristics such as safety,

cleanliness, quiet, privacy, and proximity to services were directly connected to the

feeling of residential satisfaction (Rioux and Warner, 2011). A significant amount of

elders who don’t have family living close to them rely on support from friends and

neighbors (Bascu et.al., 2014).

What is Needed to Successfully Age in Place

In research conducted by the North Coast Long-Term Services and Supports

Coalition (2012), providers of functionally disabled and elder Humboldt County residents

responded to a 2012 survey. Providers identified food and nutrition programs,

transportation, in home care assistance, Adult Day Health Care (ADHC), In Home

Supportive Services (IHSS) as services and supports needed for our county's elders to be

able to successfully age in place (Berg, 2012). Respondents specifically identified food

and nutrition issues as a lack of availability of home delivered meals. Respondents also

identified the lack of reliable and appropriate transportation as an issue that their clients

face on a regular, ongoing basis. In home services such as home maintenance, home

13

delivered meals, and home health were also mentioned. Having sufficient medical

providers was also identified as a challenge (Berg, 2012).

In the same research, when asked to identify services needed to remain

independent, Humboldt County functionally disabled and elder respondents identified

assistance with Activities of Daily Living (ADL’s), e.g. toileting, bathing, dressing and

Instrumental Activities of Daily Living (IADL’s), e.g. meal preparation, shopping,

errands as assistance needed to remain safely in their home. Assistance with

transportation, clean and affordable living situations, streamlined access to IHSS and

other social support services, assistance with medical care, and social connectivity to

alleviate loneliness were also identified as needed supports to ensure successful aging in

place (Berg, 2012). In other research, older adults were asked describe the frustrations

and limitations they experienced in their daily lives. The responses indicated that nearly

40% of the problems encountered by older adults were a result of physical limitations and

30% were attributed to cognitive limitations (Fausset et. al. 2009).

Issues related to consistent and reliable in home caregiving have also been

identified as a significant barrier which impedes people’s ability to age in place. The

specific issues identified that are related to in home care include home care worker

availability, not enough hours for caregivers to do the needed services, and care provider

transportation needs in rural areas (Berg, 2012).

Grantmakers in Aging (2010), an organization that serves as a resource to

philanthropists and is dedicated to improving the experience of aging by tracking

and responding to trends in the field of aging. Grantmakers in Aging examined various

14

aging in place models and found that there are certain factors that contribute to successful

aging in place. These supports include: engagement in life in the community; economic

security; housing; health, wellness, and social services; transportation and mobility;

technology; institutions and public places.

Engagement in life in the community consists of social connections, learning, and

a sense and feeling of purpose. This could include community leadership roles and

participation, such as becoming a member of the IHSS Advisory Board, which consists of

IHSS recipients and as well as community members. It could also include volunteer roles

for seniors, or enrolling in enrichment classes and programs. Attending cultural events is

also a part of engaging in the life in the community (Grantmakers in Aging, 2010).

Grantmakers in Aging (2010) identified economic security includes assisting

older adults with maintaining financial stability. This includes ongoing bill paying and

money management assistance. It also includes annual tax preparation assistance and

seminars on financial planning, budgeting, reverse equity loans, living wills, and long

term health insurance.

Housing assistance consists of home safety assessments, assistance with home

modification and repairs and assistance locating and applying for home energy saving

programs. Other housing assistance include locating, securing, and retaining safe and

affordable housing, including securing housing that is appropriate for aging in place

(Grantmakers in Aging, 2010).

15

Health, wellness, and social services as defined by Grantmakers in Aging (2010),

includes exercise programs and classes, as well as preventive health programs and

support groups. It also includes information health screenings, and programs in which

regular phone calls are made to check on the physical and mental well- being of elders

living alone. Grantmakers in Aging (2010) also identified home delivered groceries and

prepared meals, help with household chores, care managers to assist with coordinating

care and services, companion services, and support and education for family caregivers as

needed health, wellness, and social services.

Transportation assistance includes accessible, affordable public transportation

with routes that transport older people to places that they want to go. Transportation also

includes affordable door to door transportation for the circumstances in which public

transportation is not an appropriate option ((Grantmakers in Aging, 2010).

Technology assistance includes information about medical alert systems, as well

as training regarding assistive devices and programs that provides technology to

moderate and low income people. Technology also includes training for care managers

about assistive devices and tools, and programs that make assistive technology available

to low and moderate income people.

According to Grantmakers in Aging (2010), institutions and public places consists

of efforts to make the natural world, such as parks and town squares, accessible to older

people. Additionally, this category includes educational and recreational programs that

are located in libraries, parks, hospitals, and institutions. This category can also include

16

surveying older adults to learn what services and programs they would find to be useful

and life enhancing and useful. Training staff at public institutions regarding aging adults

and services appropriate for aging adults would also be in this category. Efforts to make

parks and other public places accessible to seniors, educational and recreational programs

for older adults in public libraries, parks, and academic institutions was also identified.

The final category, information and referral, consists of general information for

older citizens. Grantmakers in Aging (2010) suggests one central phone number for older

people to receive the guidance and information to find whatever they need. As a part of

the information and referral category, Grantmakers in Aging also included promotion of

this central phone number so that older adults would be aware of the service as well as

how to access the service (Grantmakers in Aging, 2010).

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Methods

The process of developing this guide began with brainstorming what information

I thought would be relevant and integral to such a guide. I wanted to include resources

that would enhance the lives of elders who wish to grow old in their own environments.

My broad focus was resources and supports that would augment the services that IHSS

provides.

I read existing literature, focusing on the needs and challenges faced by those who

wish to age in place. I reviewed the literature through the lens of the ecological theory of

aging. I chose to focus on the ecological theory of aging because this framework

resonates with the many core philosophies and practices of IHSS. According to the

ecological theory of aging people’s social and physical environments and the way that

individuals are able to interact with their environments is a determining factor in their

overall well-being. If a person’s environment in modified to fit the person’s

competencies, the person will be able to manage successfully within that environment

(Lawton and Nahemow, 1973). This directly connects with the social model that

underlies IHSS services.

After reviewing literature about aging in place and the ecological theory of aging,

I decided to divide the resource and referral guide based on what Grantmakers in Aging

(2010) identified as key factors that promote successful aging in place. Each topic that

Grantmakers in Aging (2010) identified as necessary to promote successful aging in place

18

became a folder for the desk guide. This resulted in the creation of six folders:

Engagement in the life in the community; economic security; housing assistance; health,

wellness, and social services; transportation assistance; and information and referral.

Using the topics that Grantmakers in Aging (2010) identified as necessary components to

successfully aging in place provided a way to organize the folders based on relevant

aging in place issues and also provided a way to categorize and limit the amount of

information that would initially be included in this guide.

Once I had the topics for each folder, I began research on available resources. I

already had some information regarding certain agencies and the services they provide,

however I did not have this information in electronic form. I reviewed agency literature

to verify their current availability, eligibility, as well as the services and support they

provide. I tried to be very specific throughout this step, as I did not want a resource guide

that only contained broad information that would require an information inquiry to the

agency. I wanted to include all relevant information so that when other IHSS case

managers refer to the resource and referral guide, they are able to ascertain if the resource

or program that they are reading about is appropriate for their need just by reading the

information that is contained in the folder. Once I gathered and updated most of the

information I wanted to include, I scanned it into specific folders.

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Results

This project resulted in the creation of a resource and referral guide that has been

organized based on the topics that Grantmakers in Aging (2010) have identified as factors

that promote successful aging in place. The six categories are: Engagement in life in the

community; economic security; housing assistance; health, wellness, and social services;

transportation assistance; and information and referral. Each folder has sub-folders

located within it.

Engagement in life in the community has information about volunteer

opportunities through the Retired Senior Volunteer Program. It also contains information

on two Adult Day Health Care programs, one located in Arcata, and one located in

Eureka. The information regarding the Adult Day Health Care programs includes

eligibility requirements, services provided, and waiting list information.

The Economic Security folder has information about utility company assistance

programs, including eligibility and program requirements. This folder should be

particularly useful because if someone meets the financial eligibility requirements to

receive IHSS, they also qualify for these programs. There is also information about

private payee services, as some IHSS recipients are unable to manage their own finances.

Since private money managers charge a monthly fee for managing one’s money, there is

also information regarding programs that will pay for these services for their clients, such

as MSSP and the Redwood Coast Regional Center. This is because most of the people we

20

see are on limited incomes and are unwilling or unable to pay for someone to manage

their money, so sometimes the most effective way to have a recipient’s money managed

for them is to refer them to a program that they are eligible for that includes money

management as one of the services they provide. The economic security folder also

includes information and applications for Angel Fund, which is a small grant program

that provides assistance to people who require financial assistance with specific items,

such as a specific home repair or a wheelchair battery.

The Housing Assistance folder has information about different low income

housing options. This includes information on the Housing and Urban Development

(HUD) program, commonly referred to as Section 8, as well as information regarding low

income apartment complexes located throughout the county. Recipient’s frequently

inquire about Section 8, and are often not aware of other affordable housing options.

The Health, Wellness, and Social Services folder has information about the Open

Door Community Health System, as Open Door Clinics have offices in different locations

in the county, and they accept Medi-Cal, which is the medical insurance that most of our

recipient’s receive. There is also information about the Scotia Bluffs Medical Center in

Scotia as Scotia Bluffs accepts Medi-Cal and there are no Open Door Clinics located near

where Scotia Bluffs is located. It was important to include medical services located in

different areas in the county. Also in the Health, Wellness, and Social Service folder is

information on the Southern Trinity Health Center because this is a clinic that offers

dental services and accepts Medi-Cal. This folder also contains information about the

21

Friendship Line, which is phone line that elders can call to talk to someone and hopefully

alleviate any feelings of loneliness and isolation they may be experiencing.

The Transportation folder has information about volunteer provided rides for

medical appointments and how to access and schedule appointments for such rides. The

transportation folder also has information on how to obtain Dial A Ride tickets.

Additionally, this folder contains information about case management programs such as

MSSP, as similar to paying for their client’s to have a money manager, MSSP will pay for

Dial A Ride tickets for their clients. Since Dial A Ride tickets are cost prohibitive for

many of our clients, needing these tickets may be incentive for them to enroll in MSSP.

And as a bonus, they may receive additional beneficial case management services.

The Technology folder contains information about medical alert systems and how

to use them. There is also information about the American Cancer Society’s lending

library as our local American Cancer Society loans out wheelchairs, walkers, and other

assistive devices.

The Institutions and Public Places folder has information about public libraries.

This gives people access to the locations of local libraries in the area. It also includes

hours, and why type of amenities each location provides, such as internet access, or

material for people with visual impairments.

The Information and Referral folder has information about Food for People, the

local food bank, including their various drop off sites, which are located throughout the

county. There is also additional information about the Humboldt County Switchboard and

22

the Area One Agency on Aging’s information and referral line, both of which are

available for people to call to receive information about programs and services available

throughout the county.

Now that this resource and referral guide is complete, instead of some staff

members having some information about resources available to our recipients, and other

staff members having other information, there is one central place for all of us to have

access to all of the available resources and programs for the people that we see.

23

Discussion

The reason that a resource and referral guide was wanted in IHSS was so that we

would be able to achieve a much agreed upon goal of providing access to resources to all

of our recipients. It has been apparent in recent years, as other social service programs

have been reduced or eliminated, that although IHSS case managers have a specific role

in the lives of the recipients that see, many recipients view us as their link to other

services, programs, and supports. For this reason, the importance of creating a

comprehensive resource guide became apparent.

I chose to review literature that focused on specific factors that contribute to

people’s ability to remain independent as they age. From there I chose to narrow my

focus on specific factors that augment the services that IHSS provides. In addition to the

assistance with ADL’s and IADL’s that IHSS provides assistance with, older people who

live independently also frequently require assistance with other tasks, such as money

management, medical issues, home maintenance, and making and retaining social

connections. Because the needs identified by Grantmakers in Aging (2010) appeared to

comprehensively address all of the necessary ingredients for aging in place identified by

my literature review and my experience as an IHSS social worker, I chose to organize and

categorize my information based on the six broad topics that Grantmakers in Aging

(2010) identified.

24

When IHSS administration and I initially began discussing such a guide, the

primary focus was on policies and procedures as they related to IHSS. An unanticipated

barrier was the lack of ability to include specific procedures and protocols which required

a high level of input and collaboration from other staff and management, which was

outside of the IRB protocol. This is something that will hopefully be completed in the

future, perhaps as an addition to this current guide. Choosing these six broad topics also

presented me with a way to limit the information I initially included as once I began

researching I discovered that there are a multitude of topics that could be relevant to the

people served by IHSS.

Upon completion of my literature review and the organization of the folders based

on topics relevant to aging in place, I realized that although Grantmakers in Aging (2010)

defined six broad topics which appeared to complement the services that IHSS provides,

the topics may be too broad as the resource and referral guide grows and expands.

Additionally, although the broadness of the Grantmakers in Aging (2010) topics initially

appealed to me, my intention was to create a guide that is easy to use, and I am concerned

that there will need to be too much thought given into what category a certain resource

falls into, i.e. what folder certain resources would be found in. I look forward to receiving

feedback from others which will help me to evaluate if the resources are easily accessible

for others who choose to use this guide.

There are also topics that I would like to add to the guide that the literature I

reviewed did not address. For example, none of the literature I reviewed addressed pets,

25

pet care, and how animals assist (or detract from) one’s ability to age in place. I have

completed research on the importance of pets to elderly people in the past, yet in the

information I recently researched regarding aging in place and one’s ability to age in

place effectively, although social companionship was addressed, interaction and

companionship between aging people and their pets was not addressed. As this desk

guide grows and evolves, I plan on adding information regarding pet care and pet

resources, such as information regarding low cost vaccinations, or even people who are

able and willing to watch pets if their elderly owners are hospitalized for short periods of

time.

Additionally, I was unable to provide much information for the institutions and

public places folder. I was able to provide information about public libraries but did not

have information on other public spaces that seemed particularly relevant to the lives of

local IHSS recipients. I am hoping that with time, I or someone else will be able to

provide additional information and resources for this folder.

I am hopeful that this resource and referral guide will be useful and will enhance

our ability to provide resources and information to the people we see. I am also hopeful

that as new resources and information becomes available that this guide will also

expand. As other programs are losing funding and being reduced or eliminated, I see the

need for IHSS social workers to have knowledge of and access to as many other

resources that are available to IHSS recipients. A future project could be to survey IHSS

case managers regarding the information contained in the resource and referral guide that

26

they find particularly useful as well as additional information they would like to see

included.

An additional need I have identified in creating this resource and referral guide is

a handout to have available for clients. This would be different than a resource directly

for older people that already exists in our community as it would address the specific

needs of those who receive IHSS. A comprehensive resource handout would provide

information to clients about services they are requesting information on as well as

services that they may not even know are available. Schoenberg & Coward (1998) have

shown that close to 70% of rural elderly people reported a lack of awareness of the

availability of services. For those who were aware of the services, many were still

reluctant to use services, often because they lacked understanding about the access

procedures.

This resource and referral guide has been created and is expected to be

implemented shortly. It is my intent to maintain it for the time being. It is also my intent

to survey other IHSS case managers regarding the information contained in the resource

and referral guide that they find particularly useful as well as other information that they

would like to see included. I am hoping that in time this guide will be expanded to

include folders on additional relevant information, including best practices, information

on IHSS policies and procedures, and training material. Including such information

would require increased collaboration from IHSS administration as well as IRB approval

and may be something that a future social work student would choose to work on.

27

References

Altman, I., & Low, S. (Eds.). (1992). Place attachment (Human Behavior and Environment) (pp. 1-12). New York: Plenum Press. Baccu, J., Jeffery, B., Novik, N., Alonyi, S., Oosman, S. Johnson, S., & Martz, D. (2014). Policy, Community and Kin: Interventions That Support Rural Healthy Aging. Activities, Adaptations, & Aging, 38, 138-155.

Carstensen, L. L., Charles, S. T., & Isaacowitz, D. M. (2000). Applying science to human behavior. American Psychologist, 55(3), 343. Chernoff, MD, B. (2014, November 1). White House Conference on Aging. Retrieved May 31, 2015, from http://www.scanfoundation.org Cleary, K., PT, PhD & Howe, D., PhD, OTD, OTR/L (2007). Prescription medication use and health-related quality of life in rural elderly. Physical & Occupational Therapy in Geriatrics, 26 (2). Farber, N. & Shinkle, D. (2011, December). Aging in Place: A State Survey of Livability Policies and Practices. Conference of State Legislatures. Washington, D.C. Fausset, C.,Kelly, A., Rogers, W., Fisk, A. (2011). Challenges to aging in place: Understanding home maintenance difficulties. J Hous Elderly, Spring, 25 (2) 125-141. Fausset, C., Mayer, A., Rogers, W. & Fisk, A. (2009). Understanding Aging in Place for Older Adults:A Needs Analysis. Proceedings of the Human Factors and Ergonomics Society 53rd Annual Meeting. Georgia Institute of Technology. University of Calgary. Goins, R., Spencer, S., & Byrd, J. (2009). Research on rural caregiving. Journal of Applied Gerentology, 28, (2), 139-170. Golant, S. 2006. Supportive housing for frail, low-income older adults: Identifying need and allocating resources. Supportive Housing for an Aging Society, Winter 2005-2006 (4), 37-43. Hayslip, B., Maiden, R., Thomison, N. Temple, J. (2010). Mental health attitudes among rural and urban older adults. Clinical Gerentologist. 33, 316-331.

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Helland, S. & Woolley, A., (2014) The Effect of Physical Environment on Social Participation in Person's with Alzeheimer's Disease and Related Dementia. (published doctoral dissertation). The College of St. Scholastica Duluth, MN. Howes, PhD, C. The Institute for Women's Policy Research, (2010). Costs and benefits of in home supportive services for the elderly and persons with disabilities: A california case study(responding to the california legislative analyst's report of 1/21/10)(IWPR...... Hudson, R., O’Neill, G., & McCutcheon, M. (2013, Fall). Public Policy and Aging Report. National Academy on an Aging Society, 23 (4). Kane, R. (2014). The future of the aging network. Generations-Journal of the American Society on Aging. 38, (2), 80-84. Lawton MP. (1982). Competence, environmental press, and the adaptation of older people. Aging and the environment: Theoretical approaches. New York: Springer; pp. 33–59. Lawton MP & Nahemow L. Ecology and the aging process. In: Eisdorfer C, Lawton MP, editors. The psychology of adult development and aging. Washington, DC: American Psychological Association; 1973. p. 619-674. Lawton, MP & Brody, E. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. The Gerentologist. 9, (3 Part 1), 179-186. Li, H. (2006). Rural older adults' access barriers to in-home and community based services. Social Work Research. 30 (2), 109-118. McDonald, T. The Southern Area Consortium of Human Services, The Academy for Professional Excellence. (2003). Factors contributing to ihss caseload growth:perspectives from sachs counties Miles, M. & Zarraga, M. 2008. Home from the hospital: The In-home Supportive Services discharge liasion unit in San Francisco county. Executive Summary. BASSC Executive Development Training Program. 223-233. Mynatt, E., Essa, I. & Rogers, W. (2000). Increasing the Opportunities for Aging in Place. Conference on Universal Usability. Atlanta, Georgia. Neal, A. (2007, July 1). Elder Care: Aging in Place. The Saturday Evening Post, 56-60. Probst, B. (2012). Living with and living within: Visions of 'environment' in contemporary social work. Qualitative Social Work. 12, (5), 689-704

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Rioux, L., Werner, C. (2011). Residential satisfaction among aging people living in place. Journal of Environmental Psychology, 31, 158-169. www.elsevier.com/locate/jep Seyden, N., & Robert, B. (n.d.). The history of in-home-support services and public authorities in california. Retrieved from website: cicaihss.org/ihss-public-authority-history Scharlach, A. (2009). Creating aging-friendly communities. Generations-Journal of the American Society on Aging. 33, (2), 5-11. Schoenberg, N. & Coward, R. 1998. Residential differences in attitudes about barriers to using community based services among older adults. The Journal of Rural Health. 14, (4). Wahl, H-W, PhD, Iwarsson, S. PhD, Oswald, F. PhD (2012). Aging well and the environment: Toward an integrative model and research agenda for the future. The Gerentologist, 52, (3), 306-316. Area I Agency on Aging. (2012). Restructuring long-term care in Humboldt County. Final Report. Berg, P. Centers for Disease Control and Prevention. (n.d.). Healthy Places Terminology. www.cdc.gov/healthyplaces/terminology.htm. Considering the state costs and benefits: In-Home Supportive Services Program. (2009). Executive Summary. www.lao.ca.gov/reports/2010. Grantmakers in Aging. (2010). Aging in place...with a little help from our friends. Greenburg, B. & Schwartz, J. Helping Americans Age in Place. (2013, May 1). Retrieved June 1, 2015. In-Home Supportive Services: Past, present, and future. (January 2003). County Welfare Directors Association of California. Retrieved June 6, 2015 from www.cwda.org. In-Home Supportive Services. 2014-2015 Budget. Legislative Analyst’s Office. Retrieved June 12, 2015 from www.lao.ca.gov. U.S. Department of Health and Human Services, Office of Disability, Aging and Long-Term Care Policy. (1999). In-home supportive services for the elderly and disabled: A comparison of client-directed care.

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California State Plan on Aging. (2013-2017). Brown, E. Jr., Dooley, D., Connolly, L. (2013). Sacramento, Ca. Center for Homecare Policy & Research. (2004). Retrieved July 6, 2015.

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Appendix

Engagement in Life in the Community

• Adult Day Health Care of Mad River • Eureka Adult Day Health Care • Retired and Senior Volunteer Program (RSVP)

Economic Security

• REACH Energy Assistance for Fortuna, Rio Dell, and Scotia residents • RCAA Energy Assistance • CARE/Assistance with PG&E • Private Money Managers

• Angel Fund

Housing

• Housing Authority of Eureka (Section 8 Housing) • Humboldt Plaza Apartments • River Community Homes

Health, Wellness, and Social Services

• Open Door Community Health Clinics • Scotia Bluffs Community Health Center • Southern Trinity Community Health Services (dental care) • Friendship Line

Transportation and Mobility

• Dial A Ride • Volunteer Driver Program

Technology and Assistive Devices

• Medical Alert Systems

• American Cancer Society Lending Library

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Institutions and Public Spaces

• Humboldt County Public Libraries

Information and Referral

• Humboldt County Community Switchboard • Food for People