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As the age-friendly movement grows in its second decade, urgent questions of initiative sustainability have taken hold in the academic literature and among advocates implementing age-friendly changes. The creation of authentically age-inclusive environments requires not just the continuation of the initiative, but that its principles become embedded in formal and informal organizational processes, across sectors and beyond familiar networks focused on older populations. This embedding ensures the initiative's values take root permanently in a community's institutional culture. This article argues that the sustainability of age-friendly initiatives is enhanced by "spillover" effects, in which a behavioral or policy change in one environment spurs change in another environment. Evidence for such spillover and an understanding of how and when it occurs is currently limited in the context of age-friendly environments. This article draws on the experiences of Age-Friendly Boston, which has been working toward age-friendly goals for more than 5 years. Based on Boston's experience, we identify, describe, and exemplify 3 pathways to positive spillover across environments: (a) branding positively, (b) publicizing successes, and (c) embarking on new relationships, while strengthening existing ones, in pursuit of shared goals. We also draw conclusions about what positive spillover means for the sustainability of age-friendly environments. [ABSTRACT FROM AUTHOR]

We summarized the recently published, peer-reviewed literature that examined the impact of investments in social services or investments in integrated models of health care and social services on health outcomes and health care spending. Of 39 articles that met criteria for inclusion in the review, 32 (82%) reported some significant positive effects on either health outcomes (N = 20), health care costs (N = 5), or both (N = 7). Of the remaining 7 (18%) studies, 3 had non-significant results, 2 had mixed results, and 2 had negative results in which the interventions were associated with poorer health outcomes. Our analysis of the literature indicates that several interventions in the areas of housing, income support, nutrition support, and care coordination and community outreach have had positive impact in terms of health improvements or health care spending reductions. These interventions may be of interest to health care policymakers and practitioners seeking to leverage social services to improve health or reduce costs. Further testing of models that achieve better outcomes at less cost is needed. [ABSTRACT FROM AUTHOR]

Objectives: The shift towards home and community-based care, coupled with the growing prevalence of mental and behavioral health conditions, increases the demand for skilled home care workers. However, little is known about the experiences of home care aides who provide care to clients with mental and behavioral health diagnoses. The purpose of this study was to identify challenges aides face in providing care to this particular group of clients, as well as the strategies and support they utilize to complete their job responsibilities. Methods: Data from five focus groups with home care workers (N = 49) throughout Massachusetts were used to examine the experiences of home care workers providing services to adults with mental or behavioral health needs. A constant comparative method was used during analysis of the focus group transcripts. Results: Aides described a lack of prior-knowledge of challenging client behaviors, leaving them unprepared to deal with disruptions to care delivery. Aides feel unsafe or unsure providing care to someone with complex needs, made worse by a perceived lack of training and support from the broader care team. Aides develop unique strategies for accomplishing their work. Conclusion: This analysis of the aide's perspective contributes valuable, and often unheard, insight to inform what we know about providing reliable, quality and safe home care to this growing group of vulnerable adults. Implications of this convergence are discussed relative to aides. [ABSTRACT FROM AUTHOR]