Where the Heart Is

By Gia Scafidi

Helping elders remain safely and healthfully at home is the goal of a newly launched two-year project at USC's Andrus Gerontology Center. The project seeks to lessen the stress and boost the skills of seniors and their caregivers alike. With the growing preference of seniors to live at home, the role of the caregiver has become increasingly important. With that in mind, USC's Andrus Gerontology Center has embarked on a two-year project to increase the skills and awareness necessary to reduce the mental and physical strain that often comes with caregiving.

The CARES (Caregiver Adaptations to Reduce Environmental Stress) project, funded by the Administration on Aging, aims to arm service providers and caregivers with information and coping strategies that will enable older persons to remain in their homes more safely and effectively. "The physical and mental burden on caregivers comes from various aspects of their work," said USC's Jon Pynoos, a professor of gerontology and the project's principal investigator. "The stress can range from the emotional strain of constant vigilance to physical strain of having to routinely lift an older person out of a bed, chair or bathtub. If we can help to reduce that strain, then both the caregivers and those they care for will benefit. Often overlooked in current caregiving strategies, the home environment plays a critical role in the mental and physical health of both caregivers and care recipients. And most of today's housing is not properly equipped for the special needs of elderly people, I often call it Peter Pan housing--designed for people who never age." he said. "By enhancing safety and comfort levels, home modifications can be a key factor in increasing the likelihood of older persons remaining independent, injury-free and active," said Pynoos.

According to Julie Overton, a member of the National Resource Center on Supportive Housing and Home Modification and the CARES program manager, helpful home modifications may include:

• Removal of hazardous clutter and electrical cords throughout the house
• Installation of grab-bars in the shower, near the toilet and by the tub
• Walk-in showers
• Flexible showerheads
• Proper lighting
• Easy-to-grab ring handles on cabinets
• Sliding shelves
• Wider hallways
• Ramp installations for accessible entry and exit.

The National Center for Disease Control suggests that one-third of home accidents can be prevented with repairs and modifications. The CARES project centers on increasing knowledge about the benefits of such home modifications. "The impact of home modifications and other home-based technologies on family caregivers has largely been overlooked," said Phoebe Liebig, an associate professor of gerontology at USC and a CARES associate. Consisting of four stages, the project will target Area Agencies on Aging, state-funded service-providing organizations that coordinate with caregivers and assess problems of older persons. Within the country, there are 660 AAAs. California Alone has 33.

The project's first stage will involve surveying these local agencies to determine the extent to which environmental coping strategies are incorporated in their Family Caregiver Support Program. Additionally, four focus groups will be held to ascertain caretakers' daily experiences in the home environment and how come home modifications might ease physical and mental stresses. Next, 60 agency employees will take part in an eight-week CARES online training and technical assistance course. Gerontology experts and mentors will participate as lecturers in cyber classrooms, and each trainee will submit a plan of action to increase the use of environmental coping strategies within their AAA or community. Stage three, conducted over six months, will allow for the implementation of these plans of action. Finally, CARES staff will survey the AAAs to assess the success and impact of their efforts following implementation. "Besides changing a home, using your environment effectively sometimes also means changing your behavior," said Pynoos. "It's important for frail, older people to actually learn how to get into the bathtub and learn how to avoid possible falls," he said. "If we can effectively teach service providers and caregivers these skills, they can pass them on to seniors."

In 2000, the older population--persons 65 or older--numbered 35 million, the majority of whom lived either with family members or alone. By 2030, the Administration on Aging predicts that the population of seniors will more than double. "Our ultimate goal is to help people age in place," said Pynoos. "Most seniors prefer to stay at home rather than live in a nursing home. "Increased awareness and skills will allow them to use their environment more effectively and remain independent for as long as possible," he added. "On top of that, this could also make caregivers' responsibilities a little easier."

For more information, call (213) 740-1364 or email homemods@usc.edu

The NRCSHHM to Offer Internet Courses for Care Managers

The National Resource Center on Supportive Housing and Home Modification is offering an internet-based course for care managers in the County of Los Angeles, California. "Six Steps to Integrating Home Modification into Your Care Plan" begins Tuesday, January 28, 2003 to educate busy care professionals about the significant role of home modifications in alleviating the stress associated with caregiving. The course is offered in an asynchronous format via the internet to that participants can access course work any time at their convenience.

Home modifications (HMs) are adaptations to the physical environment to increase ease of use, safety, comfort, security and independence. HMs include structural changes (e.g., widening doorways, remodeling bathrooms), use of special equipment and assistive devices (e.g., grab bars, handheld showers, transfer benches), and behavioral changes (e.g., moving furniture). HMs provide family caregivers with adequate space and supportive features so that care can be provided safely and easily. HMs also increase the care receivers' independence, comfort, safety, and help everyone to save money by reducing the need for paid caregiving and delaying institutionalization.

During the course, care managers will participate in interactive exercises to test and enhance their knowledge of the various issues surrounding home modifications. By the end of the course, care managers will be able to assist their clients with incorporating home modifications into their daily routines, and have networked with their counterparts in the rest of the Los Angeles County.

For more information, contact Maria Henke at (213)740-1364 or email mhenke@usc.edu.

"Six Steps to Integrating Home Modification into Your Care Plan: A Special Course for Los Angeles County Care Managers" is made possible through support of the Los Angeles County Area Agency on Aging under Title III-E, the National Family Caregiver Support Program.

Older Southern Californians Get Free Home Modifications

Older Californians in the Santa Clarita Valley may be able to have free home modifications and repair done to their homes. In addition to funding assistance, the Handyworker Program of the Santa Clarita Senior Center provides eligible applicants with a free home assessment, the installation of home modification items such as grab bars, handrails, lever door handles, and ramps as well as screen and smoke detector installation. The Santa Clarita Valley, one of the fastest growing communities in Southern California, is located 35 miles north of Los Angeles and has over 33,000 senior citizens.

The Handyworker Program provides free home modifications and home repair to eligible owner and renter occupied single-family homes, condominiums, and mobile homes. Low and moderate income elderly, single parent households, and persons with disabilities in need of emergency repairs are accorded priority.

For more information, contact the Santa Clarita Senior Center at (661) 259-9444 or (800) 822-9444.

On January 10, 2003, Governor Davis revealed the California 2003-2004 Budget, which proposed the reduction of funds for the Senior Housing Information and Support Center (SHISC) Program. The Governor's Mid-Year Spending Reduction Proposal, released in December 2002, had mentioned budget cuts for various community-based service programs like SHISC. The SHISC is a program under the Department of Aging. Citing poor economic growth and a sluggish California economy, Governor Davis had proposed elimination of other Department of Aging programs like the Respite Registry, Foster Grandparent, Senior Companion, and Brown Bag Programs. As these programs face elimination, the existence of SHISC also becomes tenuous. Proactive measures are necessary to ensure the continued existence of SHISC.

The SHISC Program acts as an information and referral center that addresses senior housing issues and home modifications. The SHISC motto of "Better Living at Home" propels the various services that include a housing resource library, home modifications information service, and home mods training program for seniors and professionals. Home safety, assistive equipment, and funding resources are other issues that are addressed by SHISC. In addition, the center also acts as a liaison between seniors and the general public in promoting the mission of supportive and lifelong independence for seniors through educational seminars.

Voices that support the SHISC and discourage possible elimination should be directed to relevant budget subcommittees within the Department of Aging. In the Assembly, correspondence can be directed to staff members, Christian Griffith (e-mail: christian.griffith@asm.gov) and Ana Matosantos (e-mail: ana.matosantos@sen.ca.gov) in the Senate. Letters to the Assembly should be sent to Budget Sub Committee No. 1 and directed to Assemblypersons Judy Chu, Mervyn Dymally, Dario Frommer, Ray Haynes, or Robert Pacheco. Letters to the Senate should be sent to Sub Committee No. 3 and directed to Senator Wesley Chesbro or Senator Deborah Ortiz. All contact information can be found at www.assembly.ca.gov or www.senate.ca.gov.

As other programs in the Department of Aging are in danger of elimination, efforts to preserve the SHISC become urgent. As the SHISC acts as a unifying agency in the fragmented world of senior housing, the state cannot afford to lose such a valuable service. Home modifications can positively impact state spending by allowing individuals to age in place and prevent premature institutionalization and the rapid impoverishment that necessitates Medi-Cal assistance.

New Developments: Washington University in St. Louis Introduces Occupational Therapy Doctoral Program

Washington University in St. Louis, Missouri has recently added an OTD or Doctor of Occupational Therapy degree to their existing occupational therapy program. The addition of this program allows students to pursue either a Masters of Science in Occupational Therapy or the clinical doctorate. OTD students are offered four areas of specialization: aging, pediatrics, social participation and environment, or work and industry.

The National Resource for Supportive Housing and Home Modifications is proud to welcome Dorothy Sabata, OTD as a project specialist. Dr. Sabata recently graduated from Washington University's new doctoral program in occupational therapy. One of only five graduates from the program's first cohort of students, Dr. Sabata specializes in aging.

For further information about the OTD program, contact the Washington University in St. Louis School of Medicine at 4444 Forest Park Ave., St. Louis, MO 63108-2292, phone 314-286-1600, or email WUOTinfo@msnotes.wustl.edu. The web page for the program is located at http://www.ot.wustl.edu/.

National Center for Seniors' Housing Research Announces Winners Of "Aging in Place" Student Design Competition

The National Center for Seniors' Housing Research recently announced the winners of its third annual national student design competition, Aging in Place: An Open Design Competition for Students. Students were challenged to develop a community on a 10-acre-urban site, remembering that a majority of the community's residents would be over 55. A total of 115 students submitted 68 entries. A panel of experts from the fields of architecture, gerontology, housing and community development, urban planning, universal design, and environmental psychology scrutinized each and every design and were very impressed by the high quality and level of detail shown. The competition jury met on January 9-10, 2003 and selected first place, runner up, and honorable mention designs. Winners were announced at an open house held at the NAHB Research Center on January 10, 2003.

For further details and pictures of the winners, visit http://www.nahbrc.org/.