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As the demand for quality intergenerational care increases, it is imperative that intergenerational care providers exhibit developmentally appropriate practice across the lifespan. This paper defines intergenerational programming and discusses the emergence of intergenerational studies as integrating the fields of early childhood education and gerontology. The paper details the need for cross-training for practitioners involved in existing intergenerational programs and describes the development of guidelines and standards for intergenerational specialist practice. Six standards are detailed along with sample key indicators. The following options for providing cross-training are explained: (1) academic preparation related to curriculum planning and implementation, program evaluation, family systems, theory, cultural differences, and social policy; (2) experiential opportunities such as service-learning and internships; and (3) on-the-job training utilizing the guidelines and standards. The paper concludes by noting that the success of an intergenerational specialist depends on the quality of education and training he or she receives. Education, experience, and training based on the guidelines and standards for intergenerational practice will prepare practitioners to develop a program philosophy, thereby providing a strong foundation upon which an effective, sustainable intergenerational program may be built. (Contains 14 references.) (KB)

There is a potential crisis in caring for the elderly in California as the over-65 population is expected to double by 2020 and several demographic dynamics a lower growth rate in the population segment of women aged 24-54 that traditionally care for seniors; increasing participation of women in the workforce who have traditionally been at-home caregivers for seniors; and a robust economy offering many competing entry-level occupations at comparable or higher wages may contribute to a shortage of caregivers. Legislation passed in July 2000, the Caregivers Training Initiative, directed the Employment Development Department to develop an understanding of the labor supply-demand principles affecting workers in entry-level direct care occupations in relationship to nineteen other comparable occupations competing for the available labor force. Caregiver occupations may be viewed as less desirable compared to competing occupations for the following reasons: (1) wages are often lower; (2) there is less access to affordable benefits such as health insurance; (3) there is a greater chance for occupational injury or illness; (4) there are greater training and certification requirements; and (5) there is less opportunity for advancement. The following suggestions are made to improve caregiver recruitment and retention: conduct exit interviews and identify best practices; develop core competencies and career paths; and give financial incentives. (Contains 6 appendices, 21 exhibits, and 35 references.) (MO)

This report on "Options for Individuals" is part of a series documenting innovative supports for community living for adults with severe disabilities. Options for Individuals, which began in 1984 in Kentucky, uses Medicaid waiver funding to support 29 people with severe and often multiple disabilities during the day. While the program is based at a facility, the agency has a long history of creative community-building efforts that they have used to get people involved in meaningful activities and relationships outside of the facility. In doing so, they have facilitated peoples involvement in paid and volunteer work, varied leisure interests, and social engagements. This report, based on a site visit in June 1997, documents the positive community-building efforts used by Options to create meaningful daytime opportunities and connections for the people they support. It describes key strategies Options uses to promote community participation and relationships, including recognition of the importance of place, active involvement in facilitating the development of relationships, focus on variety of peoples daytimes, use of an in-depth person-centered planning process, and long-term commitment to people. The experiences of three clients are highlighted. The report also discusses some of the challenges faced in relation to these efforts. (CR)

In this proposed training model for caregivers working with the frail elderly, the focus is first on encouraging participants to construct and share fragments of their lived experiences with elderly people and their beliefs about the aging process. Next, participants are asked to bring back written observations of their own work styles and working conditions in skilled nursing facilities. The model is adapted from the life history approach, an important tool for social science research in both sociology and anthropology. This radically abridged version of the approach involves oral sharing, elaboration and recording of life history events in writing, analysis, and group discussion in each session. Much current writing on use of the life history approach in adult education and training is in French by French, Canadian, and Swiss adult educators. Focus of adult educators using this approach seems to be on the education and training of adult educators and trainers. Components of the training program include the following: a program goal, objectives, design, and brief outline for three sessions that cover a life history approach to understanding conceptions of aging, understanding working with the elderly, and developing a work style. (Contains 16 references.) (YLB)

In response to the need for an increase in services directed specifically to the elderly, a training and educational needs assessment of the existing elder service organizations in Lake County (Illinois) was conducted. Thirteen gerontological organizations were chosen for participation; the organizations were categorized into these groups: nursing homes; senior centers; adult day care centers; retirement housing facilities; and hospitals. Interviews were conducted on-site by student interns; interviewees were either the Administrative Director, the Social Services Director, the Director of Nursing, or a staff supervisor. Topics covered included agency characteristics; background on the respondents; extent of employee-sponsored work related training; tasks, challenges and difficulties which service workers face in their work and staff's observations and suggestions about the kind of skills, knowledge, and training needed; ratings of the workshops and themes presented in The Center for Applied Gerontology program; aspects of workshop format and design; comments on the factors influencing the decision whether or not to attend; and open-ended comments. The subject matter declared most salient among the training needs identified pertained to advocacy and interventions for infirm elder clients. Supervisors directly stated they would like training in the ethics of elder care. Another important training need identified was that of interpersonal skills. (ABL)

The tremendous growth in the number of women in the labor force has dramatically changed the world of work. Traditional human resources policies were not designed for this new workforce. Federal regulations prohibit federal workers from using any of their sick leave to care for a child or a parent. To learn about nonfederal work/family efforts, the General Accounting Office interviewed human resources officials in 16 nonfederal organizations with a number of "family-friendly" programs in place. It investigated federal experiences in the work/family area and identified barriers that deter adoption or expansion of federal work/family programs. The leading nonfederal organizations offered their employees a variety of work/family programs: flexible work arrangements, leave policies, child care and elder care programs, and other programs (work/family counseling and financial support for adoptions). Different factors, such as employee input or recruitment and retention goals, led the nonfederal organizations to adopt work/family programs. They strongly recommended assessing employee needs and community resources before adopting these programs and offered advice on doing the assessments. Implementation strategies included effectively communicating the programs within and outside the organization and recognizing concerns about equal treatment of employees. The federal government offered many of the same work/family programs but generally did not use them as extensively as it could have. Statutory and cost barriers were identified. The study recommended that work/family-related programs be approached strategically. (Appendixes include the objectives and methodology, a 71-item bibliography, a list of 16 related products, and an index.) (YLB)

An assortment of 38 case studies illustrates efforts to integrate elderly individuals with developmental disabilities into generic aging services and into community life. The case studies include models and practice experiences that aided seniors to retire, participate in programs and services, and become part of their community's aging network. The first section describes four projects which sought to build bridges between the aging network and the disability system in New York and California. Efforts that began with "top down" or state level planning and development are then described, focusing on examples in Delaware, Kentucky, Utah, New York, and Rhode Island. Retirement assistance ventures, which pair the older person with a developmental disability with a "coach" to facilitate preparation for retirement, are discussed, with examples from England, Missouri, Mississippi, New York, and Oregon. Case studies are then offered of "pull-out" programs in New York, Connecticut, and California. These "pull-out" programs are described as programs in which two or more groups of people are drawn together for a common purpose during a distinct period of time. Senior companion ventures in Washington and New York are then described. Seven case studies describe efforts to train and otherwise aid older persons with developmental disabilities to use the services at their local senior centers, in Minnesota, Ohio, Connecticut, Wisconsin, Connecticut, New York, and Ohio. Supportive services provided in social model site programs are also addressed, with examples from New York, Kansas, and California. The final section describes adult day health model programs in Massachusetts and New York. (JDD)

This report discusses findings from a review of a plan of the South African KwaMashu Christian Care Society (KMCCS) for introducing an educare program in which active older women give in-service training to grandmothers and other childminders who look after preschool children at home. Before launching the proposed program, a KMCCS committee conducted a study in 1987 with the help of the University of Natal to determine community reactions to this educare concept. A total of 302 residents were surveyed, of whom approximately 75 percent were women. Two-thirds had children of their own and one-third were grandmothers. The major finding was that the KMCCS educare program would be wholeheartedly accepted, as would a training program for women of all ages. It was also found that there was general support for the concept of institutional care for the aged and a feeling that traditional respect for the elderly is not necessarily affected by the perceived loss of the elder's role in modern industrial society. The survey resulted in a recommendation that the ZamaZulu Nkosi Centre, an old-age home, should proceed with its proposed educare program. A total of 25 tables are included, and 4 appendices describe characteristics of the sample, a map of the area, a circular sent to survey participants reporting on the results of the survey, and a leaflet advertising the Khulakahle Childminding Association and Training Program. Contains 7 references. (LB)

This fact sheet discusses the outcome of a study designed to understand the needs of American Indians with disabilities who may have problems that limit their ability to carry out daily activities. Thirty-two American Indians with disabilities were interviewed in three counties in northwest New Mexico regarding the things they used or needed because of their disability. Results indicated many of the respondents had more than one disability, with the most common disabilities being blindness, hearing impairments, and hypertension. The three most common activities limited by the respondent's disabilities were working on a job, taking care of things/responsibilities, and driving. The services needed but not received in the past year were help with services, help with food, dental care, help with clothing, and help with housing. The three most common service agencies providing help were Social Security, Indian Health Service, and Medicaid/Medicare. Respondents needing personal assistance services indicated they had a person who helped them with daily living activities. Recommendations are provided, including the need for service providers: to collaborate on providing services, to provide advocacy training, and to be aware of different tribal cultures. (CR)

The effects of adult day care and homemaker services on a Medicare-eligible population were examined, and the impacts of those services on institutionalization and Medicare costs was assessed. Differences between experimental and control groups in health outcomes were also compared, and patients were identified for whom the new services might prove more effective. Day care is defined as a program of services provided under health leadership in an ambulatory care setting for adults who do not require 24-hour institutional care. Homemaker services consist of home management, personal care, supportive activities and health care management services. Subjects initially numbered 1,871 and were divided into three study groups: (1) day care patients and a control group, (2) homemaker patients and a control group, and (3) patients who received both services and a control group. Findings reported that day care patients had fewer days per year (four) in a skilled nursing facility as compared to their control group (nine). Those using homemaker services spent the same amount of time in a skilled nursing facility as did their control group (four each). Also, the proportion of patients in the combined services experimental group who died during the study year was significantly lower than that of the control group. (Author/BMW)

The results of a reivew by the United States General Accounting Office (GAO), this paper examines the Title XX Program of the Social Security Act and makes suggestions for its improvement. The Title XX Program provides funds to states to enable them to tailor social services programs to fit the needs of local communities. Such services are primarily for the elderly, such as home health aides or adult day care programs, but also include other services, such as child day care and delinquency prevention. The services are provided directly by public agencies or purchased from other agencies. Programs reviewed were offered in New York, Maryland, North Carolina, California, and New Mexico. The GAO found that most contracts awarded to purchase services under Title XX in four of the states visited were stated in such general terms that the states did not know what contractors were committed to deliver or whether commitments were met. The GAO recommends that the Secretary of Health and Human Services improve state contracting by encouraging the use of contracts based on unit prices or specific levels of service and prompt states that authorize elderly persons to hire their own homemaker and chore service providers to monitor the quality of services and assure that the required hours are delivered. (Author/JM)

The Adult Day Care Program (ADC) in the Province of Manitoba is a health and social service program providing socialization and recreation in a supportive environment to those who, without this intervention, might deteriorate in physical or mental health function. To examine the impact of adult day care on the utilization of other health care services (including long-term institutionalization, physician visits, and hospital stays) and on quality of life (including survivorship, overall well-being, activity, and social integration), 76 randomly selected Winnipeg, Manitoba older adults were interviewed. Study participants were matched with those using no home care or home care other than ADC. Interviews were conducted in 1980 and again in 1982. Interview data contained standard demographic information, health information, and activity and social interaction information. An analysis of the results showed that the ADC, per se, was not having a unique effect on the utilization of medical claims services or inpatient hospital services. Rather, in both instances, the ADC participants tended to fall "between" the users of other home care services (the heaviest users) and the nonusers of home care services (the lightest users). Participation in the ADC resulted in a greater likelihood that the individual would be assessed for long-term institutional care and would be admitted to a personal care home. No significant differences emerged between the groups in terms of survival. Participation in ADC led to increased life satisfaction and increased participation in specific activities. Participation also led to increased social integration, a change not shared either by users of other home care services or nonusers. These findings suggest that ADC appears to be successful in fulfilling the objective of socialization. (BL)

This Technical Committee Report concerns the adoption of public policy for the development of a comprehensive continuum of services available to all older persons. Basic values, trends, and changing patterns of living are presented along with key issues such as the interrelationships among the family, social services, and other support systems in providing personal care and support services within the home and community. The strengths and weaknesses of the family, social services, and other support systems are also discussed separately. Alternative approaches to social support are considered, e.g., congregate housing, multi-purpose senior centers, day services and respite care, homemaker-home health aide services, and hospice care. Committee recommendations for the formation of public policy are categorized under the headings of: (1) economic security; (2) social services, informal support, and the family; (3) in-home and community-based service; (4) linkages, access and follow-up; (5) diversity and choice; (6) prevention, wellness and independence; and (7) newer service programs. The appendix contains additional documentation in support of the committee recommendations. An executive summary of this report is also included. (NRB)

Day care is a growing service in the field of long-term care, increasing the options available to the impaired elderly. To study the development of adult day care centers in southeastern New England, and to identify the relationship of day care centers to the long term care network of services, the 11 day care centers in the catchment area of the southeastern New England Long Term Care Gerontology Center were studied (6 in Massachusetts and 5 in Rhode Island). Surveys of professional personnel and clients, and site visits were used to compare the centers in terms of physical facilities, admission criteria, participant characteristics, financial resources, staffing services and activities, and relationship with families and community activities. Results showed that all centers admit clients regardless of living conditions, although 41% of those admitted live alone. Day care had no significant effect on nursing home entry or length of stay. The population served was similar to the general elderly population rather than those at special risk. The data indicated a clear identification of day care centers as an integral part of the network of long term care services. The results suggest leadership and advocacy roles for the southeastern New England Long Term Care Gerontology Center. Appendices include letters to centers, interview questionnaires, a list of day care centers in the catchment area, and the Massachusetts Adult Day Health Manual. (JAC)

In the past few decades, senior centers have developed at an exponential rate. To investigate elderly citizens' knowledge of senior center activities and services, 250 white older adults (125 center users and 125 nonusers) from a small urban community were personally interviewed about the services and activities provided by their local senior center. An analysis of the demographic data showed that the subjects were mostly married female homeowners with a median age of 71. Annual income was under $7500, and the majority had lived in the community for 50 years. All subjects were aware of the existence of the community senior center and 99 percent could correctly identify its location. Only a small minority of the sample was aware of any services, other than the 83 percent who were aware of the hot lunch program. The local newspaper, family, and friends were the most cited sources of information by nonusers. As would be expected, center users were more aware of activities than nonusers. Dinner parties, cards, square dances, bingo, trips, and clubs, respectively, were the most recognized activities of the senior center. Center users identified the senior center publication as their major source of information. (BL)

This executive summary reviews results of a survey of 154 publicly-funded programs providing personal assistance services to disabled individuals. Introductory chapters identify the need for a national personal assistance program and policy, the concept of personal assistance and attendant services, the potential user population, and U.S. sources of funding. Key findings are reported in a section on survey results, focusing on the areas of program goals, number of programs per state, program age, administering agencies, funding sources, eligibility, services, hours of service availability, maximum amount of service allowed, types of service providers (individual providers, contract agency providers, and government agency providers), determination of services allowed, medical supervision, degree of program conformity to the Independent Living Model, program utilization and expenditures, availability of services across the United States, and the estimated need versus adequacy of the system to meet that need. Tables include, among others, "Programs with the Highest Independent Living Orientation,""Comparison Across States of Expenditures and Total Clients of Attendant Service Programs," and "Comparison of Home Care Survey Estimates of Need for Assistance with Number Actually Being Served." The report concludes with 17 recommendations to guide the development of national policy on personal assistance services. (JDD)

Data were gathered from 154 U.S. programs providing personal assistance services for the disabled. The survey identified approximately 850,000 people receiving community-based, publicly-funded personal maintenance, hygiene, mobility, or household assistance services, with physically disabled individuals being the most often served. The report explores the growth in the need for personal assistance services, explains the World Institute on Disability's rationale for studying this situation, and identifies the potential user population. Background information describes several federal and state programs providing personal assistance services. Survey data includes such information as number of programs per state, year of implementation, goals, state agencies administering the programs, and their funding sources. Analysis of program structure focuses on eligibility, services, hours of service availability, maximum service amounts allowed, direct service providers, determination of services allowed, and medical supervision. Also examined is program conformity to the Independent Living Model, in which the personal services attendant is managed by the user and no medical supervision is required. The study analyzes service recipients and program expenditures, and compares the availability of attendant services across the United States. The report concludes with an analysis of the need versus adequacy of the system to meet that need and makes several recommendations. (JDD)

This study compared the functional disability levels of participants in adult day centers with patients in intermediate care facilities (ICFs). A three-page questionnaire measuring demographics, social resources, physical health, mental health, and activities of daily living as assessed by the Activities of Daily Living scale and the Instrumental Activities of Daily Living scale was administered by trained staff at all 15 of Hawaii's adult day centers and at 22 of Hawaii's 26 ICFs. The final sample (N=824) consisted of 462 ICF patients, 67 Adult Day Health (ADH) participants, and 295 Adult Day Care (ADC) participants. The results revealed significant differences among the three subgroups in functional status while similarities existed in medical diagnoses and demographic characteristics. The demographic makeup of the ADC and ICF groups was similar for mean age, percent female, and incidence of medical diagnoses. The two groups differed in that the ADC group was healthier, more independent, and more involved in social activities that was the ICF group. The degree of family support of ADC participants was significantly higher than for ICF patients. The ADH participants, compared to ICP and ADC participants, were younger, equally likely to be male or female, and had the shortest length of stay in the program. The findings suggest that the availability of family and informal support is an important factor in the use of adult day centers. Appendixes include the functional disability questionnaire and four data tables. (NB)

This study examined the behaviors of intergenerational group members of an intergenerational program involving seven adult day care clients and seven preschool day care children. Coordinators of the program include a recreational therapist from the adult center and the children's teacher. The 14 "friends" met once a week for an hour. In this study, nine of the group sessions were observed. Findings revealed that the interactions between adults and children were overwhelmingly positive. Interview data supported observations regarding the positive ways in which seven of the group members viewed the group. Printed materials from the organization suggested that "caring" and "life enrichment" were among its priorities. Program coordinators built on the group members' feelings of solidarity by encouraging them, through applause and cheering, and by directing each meeting to minimize conflict and confusion. Two enthusiastic adult group members assisted the coordinators. To the extent that interactions between older adults and young children in society resemble those found in this study, the results may be even more generalizable. (ABL)

Research into the decisionmaking process of families faced with investigating alternatives to institutionalizing frail aged members could yield valuable information for service planners and providers. To analyze the extent to which its original service plan remained responsive to the changing needs of the frail elderly service population, interviews were conduted with 36 family caregivers who contacted the Council for Jewish Elderly (CJE) for planning assistance in selecting alternatives to permanent institutionalization of their frail elderly relatives. Analysis of interview data revealed six alternatives most frequently considered by families: long-term care, companions, supportive congregate housing, counseling, in-home services, and independent housing. Companions and supportive congregate housing services were not provided by CJE. The data on barriers to successful attainment of preferred services indicated that one in four families had sought alternatives which they reported were unavailable, and 35.3 percent reported cost as a barrier to services. Over half of the respondents indicated that some option mentioned by the CJE social worker had been unfamiliar to them. Some respondents reported that their elderly relatives had refused at least one option which the caregiver had considered, and some level of conflict between the caregiver and the elder was present in 61.5 percent of the families. In response to these findings, CJE has begun a planning effort to analyze further how the needs for companion and supportive congregate living characterizing the sample, and the population it represented, could best be addressed. (NRB)

Adult day care, a community-based group program designed to meet the needs of functionally impaired adults through an individual plan of care, is being considered by many communities seeking care options for their most frail and functionally impaired adults. In 1969 there were only a dozen adult day care centers in the United States, today there are over 1,400 centers. In 1979, the National Institute on Adult Daycare (NIAD) was established as a National Council on the Aging (NCOA) professional unit to provide a focal point for adult day care at the national level. NIAD conducted a nationwide survey of adult day care centers (N=847) in 1985. Preliminary results showed that 85% of respondents ranked the provision of an alternative to premature or inappropriate institutionalization as one of the top three objectives of adult day care. Other highly ranked objectives were maximization of functional capacity and provision of respite for caregivers. The majority of centers (74%) reported being private, nonprofit agencies. While many centers reported having at least one license, only 15 states have standards for licensure. Other findings focus on center locations, referral sources, number and characteristics of participants served, exclusions from participation, services provided, costs of adult day care, changes to participants, and level of participant functional impairment. (NB)