A recent study and policy note from the UCLA Center for Health Policy Research (Kietzman et al 2011) provides some needed context for discussions about social service cuts. California has provided low-income older adults with disabilities with a program called the In-Home Supportive Services Program (IHSS) and a variety of other programs to enable individuals to remain in their homes and communities. In these times of recession, such programs have been a popular target for politicians looking to cut expenses in states, such as California, with budget deficits. In fact, the proposed 2011-12 California budget continues the previous year’s reductions of these services. What will such cuts mean for older adults and their communities, not only in California but in other states where such programs are being targeted?
These initial findings include are based on interviews with older adult program recipients, their caregivers (paid and otherwise) and family members. The purpose of this research was to determine what these older adults need to remain in their communities, and to examine the strategies used to do so. A qualitative and person-based method such as the one used here is an effective means to identify the often-shifting, often informal networks of care that are relied on for daily living. The researchers interviewed a wide range within this population, from individuals utilizing only 10 hours of paid assistance per month, to those near the program-maximum 283 hours. Study participants varied not only in quantity of care used; the services used included assistance with basic household organizing tasks to assistance with activities of daily living such as bathing.
The policy note points to a few key needs and strategies, and addresses how service cuts will affect them. The authors point out that this population is particularly subject to frequent, dramatic changes in level of needs, often has unmet or understated needs, and has few or no other options for assistance. (The not also provocatively points out that “a combination of denial and resilience may help these older adults protect and maintain their independence… [but may] work against their interests by making it more difficult” to seek the assistance they need.)
The interviews show that while individuals vary in how they address these needs, their strategies in addressing them involve fragile, patched-together networks of care that are especially vulnerable in the current political-economic climate. The article show that proposed cuts will have immediate and direct consequences on these older adults—rather than entering institutional settings, they are likely to “eat less often, let their homes becaome less safe, and allow their medical conditions to worsen.” The authors connect this finding with research in other states that has found that budgetary reductions to in-home care like the IHSS program leads to increased use of emergency and other crisis care.
The Center will be publishing further findings based on their “Helping Older Adults Maintain IndependencE” (HOME) study. Interested readers can follow these findings, and multiple other findings and policy notes of relevance, at http://www.healthpolicy.ucla.edu.
Kietzman KG, Wallace SP, Durazo EM, Torres JM, Choi AS. Benjamin AE, Mendez-Luck C, (2011). “Holding On: Older Californians with Disabilities Rely on Public Services to Remain Independent.” Policy Note, UCLA Center for Health Policy Research.
Accessed at: http://www.healthpolicy.ucla.edu/pubs/Publication.aspx?pubID=457