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Kahuku ADRC Project Caroline St. Laurent, Bree Shimizu, Doris Matayoshi Beverly Diaz, Romney Skeem, Kahuku ADRC Project Caroline St. Laurent, Bree Shimizu, Doris Matayoshi Beverly Diaz, Romney Skeem, Susan Miyamoto

Elder Population Growth 1980 U. S. Age 60 & older (in 1000 s) State Elder Population Growth 1980 U. S. Age 60 & older (in 1000 s) State of Hawaii U. S. Age 85 & older (in 1000 s) State of Hawaii 2000 41, 858 45, 797 113, 944 207, 001 3. 080 4, 240 10, 397 17, 564

Problems Elders Face in General Chronic heath conditions increase as age increases Acute physical/mental Problems Elders Face in General Chronic heath conditions increase as age increases Acute physical/mental illnesses also increase Therefore, as the elder population ages, ◦ the numbers will grow ◦ and the severity of their illnesses will also increase

Needs for elder Eldercare services in the community Access to network sources and referral Needs for elder Eldercare services in the community Access to network sources and referral agencies Access to special needs in transportation Person-to-person interaction and communication

Older Americans Act—Title III (1965) Established framework • Guaranteed Access Network 1. Comprehensive planning Older Americans Act—Title III (1965) Established framework • Guaranteed Access Network 1. Comprehensive planning 2. Coordinating 3. Delivery of services for elders in need • Mandated age criteria of 60 years old – regardless of income and need

Title III -continued Opportunity to receive services such as access to senior centers, congregate Title III -continued Opportunity to receive services such as access to senior centers, congregate dining –home delivered meals Information and referral lines Respite care for family caregivers

Title III -continued Opportunity to receive services such as access to senior centers, congregate Title III -continued Opportunity to receive services such as access to senior centers, congregate dining –home delivered meals Information and referral lines Respite care for family caregivers

Problems Rural Areas-Overview Rural Areas Lack Services Poverty-Lack of Education Minority Population Little opportunities Problems Rural Areas-Overview Rural Areas Lack Services Poverty-Lack of Education Minority Population Little opportunities education & employment = “OUT –MIGRATION” TANF Food Stamps Little Assistance Physical Ailments Environmental Barriers Limitation for independence & activity level

Kahuku Areas Consists of 11 sub-districts: Hauula, Kaawa, Kahana Valley, Kahuku, Kawela, Laie, Punaluu, Kahuku Areas Consists of 11 sub-districts: Hauula, Kaawa, Kahana Valley, Kahuku, Kawela, Laie, Punaluu, Pupukea, Sunset Beach and Waimea

Rural Sample: Kahuku Higher percentage unemployment Per capita income: $16, 620 Food stamps: 20. Rural Sample: Kahuku Higher percentage unemployment Per capita income: $16, 620 Food stamps: 20. 3%; TANF : 9. 3% Large minority population living below poverty level English second language

Comparison: Kahuku State of Hawaii Elder 65+ living alone --- With disabilities 15% 43. Comparison: Kahuku State of Hawaii Elder 65+ living alone --- With disabilities 15% 43. 4% 17. 7% 40. 4% Elders in Poverty ( 150%) 10. 5% 7. 4% 21 -64 ages w/disabilities 16. 0% 3. 2% Adults-high school degree 84. 1% 84. 8% Residents-English second language 25. 2% 26. 6% Pop. over 16 in labor force 8, 462 612, 773 4. 0 ( rounded)* 3. 3% 2. 0% Average household size Household lacking telephone service

Question “ Will a one stop service such as the Aging and Disability Resource Question “ Will a one stop service such as the Aging and Disability Resource Center Program ( ADRC) improve the availability of services and consequently the well-being of the elderly population at risk? ”

Why is there a need? Kahuku Medical Center Referred Agencies Only facility on the Why is there a need? Kahuku Medical Center Referred Agencies Only facility on the North Shore Provides Referral Service ◦ ◦ Honolulu Gerontology Program Bathing Services Elderly Affairs Division Castle Home Care ◦ ◦ Nursing Home without Walls Foster Care Program DOH Medicaid Division Volunteer Legal Services

Inconveniences Rural Agencies are located in the Honolulu District Long waitlist No follow up Inconveniences Rural Agencies are located in the Honolulu District Long waitlist No follow up assistance Length of time Currently no organized programs

Distance Kahuku Wa h Ho iawa spi tal Pali Momi Castle Medical Distance Kahuku Wa h Ho iawa spi tal Pali Momi Castle Medical

Complexities of searching Programs have different eligibility requirements Unnecessary selections made Complexities of searching Programs have different eligibility requirements Unnecessary selections made

What does an ADRC have to offer? Synchronization of services Intake Coordinator Screening tool What does an ADRC have to offer? Synchronization of services Intake Coordinator Screening tool to assess Financial capacity Functional capacity Direction of appropriate services

Knowledge is key Why have an ADRC? Benefits caregiver and the care recipient Prompt Knowledge is key Why have an ADRC? Benefits caregiver and the care recipient Prompt response to services Opportunity to make choices Well organized More self directive Promotes their dignity

Theory Keyes and Shapiro (2005) Social Well-Being Theory Keyes and Shapiro (2005) Social Well-Being

Social Integration • The relationship with one’s community Social Integration • The relationship with one’s community

Social Contribution • The evaluation of one’s value Social Contribution • The evaluation of one’s value

Social Coherence • Make sense of life’s events Social Coherence • Make sense of life’s events

Social Actualization • Seeing the growth & positive outcomes Social Actualization • Seeing the growth & positive outcomes

Social Acceptance • Learning to trust and accept others Social Acceptance • Learning to trust and accept others

Well-being There are three aspects to well-being: Physical Psychological Social Well-being There are three aspects to well-being: Physical Psychological Social

Physical Well-being “Physical functioning, role limitation due to physical health problems, bodily pain, general Physical Well-being “Physical functioning, role limitation due to physical health problems, bodily pain, general health, and vitality” (Oswald, Salemi, Michel, & Sprott, 2008, p. 919). Low blood pressure Chronic and acute illness Weakness Pain and fatigue

Psychological Well-being “Indicators of positive mental health such as morale, happiness, and life satisfaction” Psychological Well-being “Indicators of positive mental health such as morale, happiness, and life satisfaction” (Ellison & Fan 2007, p. 248). Spiritual fulfillment Depression Life accomplishments Anxiety Good coping skills Dementia

Social Well-being “An individuals’ perception of his or her integration into society, of his/her Social Well-being “An individuals’ perception of his or her integration into society, of his/her acceptance of other people, of the coherence of society and social events, of a sense of contribution to society and the belief in the growth potential of the society in which one resides” (Keyes & Shapiro, 2004; Keyes & Shapiro, 2005; Brim, Ryff, Kessler, 2004; Keyes, Shomotkin and Ryhff, 2002; Keyes, 1998; Keyes, 1996). Community Events Political Involvement Neighborhood Boards

Method Wellbeing Index Pre-test Post-test Survey elderly 60+ years in Kahuku area (Hau`ula to Method Wellbeing Index Pre-test Post-test Survey elderly 60+ years in Kahuku area (Hau`ula to Kahuku and Lāi`ei to Wai`mea)

Statistics Quasi experimental Design ◦ Pretest ◦ Post test ◦ No comparison group Measures Statistics Quasi experimental Design ◦ Pretest ◦ Post test ◦ No comparison group Measures used ◦ Demographic information ◦ Social well being measure, before and after program Hypothesis ◦ Significant changes in Social Well being after the program

Statistics continued Analyis Data collection Entering data Data transferred into an SPSS file The Statistics continued Analyis Data collection Entering data Data transferred into an SPSS file The dominant statistics involve chi-square analyses Before and after exposure Mean scores ◦ Analysis of covariance controlling for: Pretest scores Demographic information

ADRC’s History National Initiative launched in 2003 Administration on Aging (Ao. A) and the ADRC’s History National Initiative launched in 2003 Administration on Aging (Ao. A) and the Centers for Medicare and Medicaid Services Forty-three states and territories have received three-year grants

Concept Commonly referred to as a “one stop shop”, Restructure services and supports for Concept Commonly referred to as a “one stop shop”, Restructure services and supports for older adults and younger persons with disabilities Enhance their access to community resources and the long term care system Integrated points of entry into the longterm care system Address many of the frustrations consumers and their families experience when trying to Access needed information, services, and supports

Core values Respect Care Warmth Comfort Trustworthiness Courtesy Customer orientation Responsiveness Accessibility Core values Respect Care Warmth Comfort Trustworthiness Courtesy Customer orientation Responsiveness Accessibility

Requirement for grantees 3 main ADRC functions: 1. Information and awareness 2. Assistance 1. Requirement for grantees 3 main ADRC functions: 1. Information and awareness 2. Assistance 1. Access

And. . . Create visible and trusted places in the community Provide access to And. . . Create visible and trusted places in the community Provide access to long term supports Establish information technology systems to support ADRC’s functions Sustain the program beyond the life of the grant Serve adults 60 years of age and older and at least one other target population of younger individuals with disabilities in at least one community of all income levels Encourage strongly grantees to design ADRCs that uses community strengths to address their unique needs

ADRC models Management (State vs. Local) Structure (Centralized vs. Decentralized) Mode of consumer access ADRC models Management (State vs. Local) Structure (Centralized vs. Decentralized) Mode of consumer access (Physical setting vs. Virtual)

Management State One or more state agencies have primary responsibility for planning and oversight, Management State One or more state agencies have primary responsibility for planning and oversight, with limited input from pilot sites/local level organizations. Local level organizations have primary responsibility for pilot site planning and implementation, with limited state involvement.

Structure Centralized One primary organization offers all ADRC functions; partners play a limited role, Structure Centralized One primary organization offers all ADRC functions; partners play a limited role, referring clients to the ADRC and receiving referrals back for direct services. Decentralized Two or more primary organizations partner to offer ADRC functions; many organizations play significant roles; client information is shared among primary partners and peripheral partners

Mode of consumer access Physical Virtual Consumers access the ADRC mainly by calling or Mode of consumer access Physical Virtual Consumers access the ADRC mainly by calling or ADRC mainly by a using Web-based walking in or by calling. searchable resource database; they can electronically submit personal information and/or application forms to begin eligibility process for Medicaid and/or other public programs.

Targeted groups 1. Primary Markets ◦ Seniors 60 years and older ◦ Individuals 18 Targeted groups 1. Primary Markets ◦ Seniors 60 years and older ◦ Individuals 18 years and older, with physical disabilities 2. Secondary Markets ◦ ◦ ◦ Service Providers Caregivers Government Officials Business Community General Public

Hawaii’s ADRC Hawaii received $800, 000 in 2005 1. 2. Was divided into two Hawaii’s ADRC Hawaii received $800, 000 in 2005 1. 2. Was divided into two pilot sites: Hawaii county, coordinated by Hawaii County Office of Aging Honolulu, coordinated by Elderly Affairs Division

Hilo’s ADRC Hawaii county ADRC located in Hilo Mostly physical with virtual components Consumers Hilo’s ADRC Hawaii county ADRC located in Hilo Mostly physical with virtual components Consumers access the ADRC mainly by walking in or by calling; they may find basic information about ADRC and services on a website

Honolulu’s ADRC Virtual Website in construction Backed up by the Elderly Affairs Division system Honolulu’s ADRC Virtual Website in construction Backed up by the Elderly Affairs Division system and services already in place Telephone line Community outreach workers Community partners

Honolulu’s virtual ADRC Website: local service provider directory, educational information, decision support tools Mgmt Honolulu’s virtual ADRC Website: local service provider directory, educational information, decision support tools Mgmt Info System: data collection, client intake, tracking, reporting and follow-up Telephone Help Line Information, referral, personalized assistance, community outreach and education Partnerships: CMS, Ao. A, State, City/County, ADRC Advisory Board members, local aging and disability providers

Kahuku Identified as one of the areas with pockets of population hard to reach Kahuku Identified as one of the areas with pockets of population hard to reach Smaller physical ADRC satellite was proposed Collaboration with the Kahuku Medical Center Provided a small office space and one of the workers is present at the site 4 days a week at this time

Kahuku Part of the virtual ADRC Have a physical site where people will come, Kahuku Part of the virtual ADRC Have a physical site where people will come, feel safe and comfortable, and be able to find help Face-to-face service Same services: intake, assessment, eligibility screening and determination, information and options counseling, short term case management and follow-up, help people plan ahead for their long term services and support needs, etc.

Why the need for a Hilo ADRC? To provide information. To provide available options Why the need for a Hilo ADRC? To provide information. To provide available options rather than nursing facility placement. To prolong community placement or living with family. So, to answer the question, “why was Mayor Kim invested in this program? ”

What is the target population? Targeted to serve the entire countypopulation of 173, 000. What is the target population? Targeted to serve the entire countypopulation of 173, 000. Serves: Elders 60+ y/o, 55+ y/o for employment training, 18+ y/o for individuals with disabilities

Funding National initiative ADRC grant awarded $800, 000 to the City and County of Funding National initiative ADRC grant awarded $800, 000 to the City and County of Honolulu and Hawaii. Subsidies awarded by the state legislature Concern that the governor may not release other funds due to budget cuts. $100, 000 awarded by the state grant. Total budget to fund program estimates $650, 000

Reason for ADRC site in Hilo Using a renovated building structure as a resource Reason for ADRC site in Hilo Using a renovated building structure as a resource and county paying for the lease. Other sites office of aging are considering: Kona and Honokaa pending on funds. Core services for LTC or home options. One of the small networks in the county to have a co infusion model if model is a success.

Challenges Concern on continuing funding. County of Hawaii needs to pick up the fallen Challenges Concern on continuing funding. County of Hawaii needs to pick up the fallen cost. Renovation problems related to existing building.

Grand opening November 15, 2008 Hilo ADRC 101 Aupuni St. Suite Hilo, HI 96720 Grand opening November 15, 2008 Hilo ADRC 101 Aupuni St. Suite Hilo, HI 96720 Website: www. hcoahawaii. org 808 -961 -8600 Hours: 7: 45 am to 4: 30 pm

Conclusion A physical one stop shop (ADRC) in Kahuku will… eliminate fragmentation enhance the Conclusion A physical one stop shop (ADRC) in Kahuku will… eliminate fragmentation enhance the wellbeing of the elderly empower the community

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References continued Aging And Disability Resource Center, & The Lewin Group. (2006, November). The References continued Aging And Disability Resource Center, & The Lewin Group. (2006, November). The Aging and Disability Resource Center (ADRC) Demonstration Grant Initiative. Retrieved October 6, 2008, from U. S. Department of Health and Human Services Web Site: http: //www. adrc-tae. org Average household size: U. S. Census Bureau. (2000). Census 2000. [Online: ] http: //www. census. gov/ census 2000/ states/ hi. html (September 30, 2002). Brim, O. , Ryff, C. , & Kessler, R. (2005). How healthy are we: A national study of well-being at midlife. Chicago: University of Chicago Press. descriptive Epidemiology. ” Pp. 350 -372 in How healthy are we: A national study of well-being at midlife, ed. Orville Brim, Carol Ryff, and Ronald Kessler. Chicago: University of Chicago Press. Ellison, C. , & Fan, D. (2008). Daily spiritual experiences and psychological well-being among US aults. Social Indicators Research, 88(2), 247 -271. Retrieved November 15, 2008, from Academic Search Premeire database. Families receiving food stamps: State of Hawai‘i, Department of Human Services. (1999). TANF and food stamps data. Unpublished raw data, And U. S. Census Bureau. (2000). Census 2000. [Online: ] http: //www. census. gov/ census 2000/ states/ hi. html (September 30, 2002). Hawaii ADRC. (2008). Documents Provided by Hawaii ADRC Orientation Training word document. Retrieved November 16, 2008 from http: //www. adrc-tae. org/tikiindex. php? page=Hawaii. Page. Public Hawaii ADRC. (2008). Documents Provided by Hawaii Marketing Plan for ADRC. Retrieved November 16, 2008 from http: //www. adrc-tae. org/tiki-index. php? page=Hawaii. Page. Public Hooyman, N. and Asuman Kiyak, H. (2008). Social gerontology: A multidisciplinary perspective (8 th ed. ). Boston, MA: Pearson Education, Inc.

References continued Households lacking telephone service: U. S. Census Bureau. (2000). Census 2000. [Online: References continued Households lacking telephone service: U. S. Census Bureau. (2000). Census 2000. [Online: ] http: //www. census. gov/ census 2000/ states/ hi. html (September 30, 2002). Individuals age 65 & older living alone: U. S. Census Bureau. (2000). Census 2000. [Online: ] http: //www. census. gov/ census 2000/ states/ hi. html (September 30, 2002). Individuals age 65 & older living in poverty: U. S. Census Bureau. (2000). Census 2000. [Online: ] http: //www. census. gov/ census 2000/ states/ hi. html (September 30, 2002). Individuals age 65 & older with a disability: U. S. Census Bureau. (2000). Census 2000. [Online: ] http: //www. census. gov/ census 2000/ states/ hi. html (September 30, 2002). Jürg Oswald & Souzan Salemi & Beat A. Michel & Haiko Sprott (2008). Use of the short-form-36 health survey to detect a subgroup of fibromyalgia patients with psychological dysfunction. Clinical Rheumatology 27(7), 919– 921. Retrieved November 15, 2008, from Academic Search Premeire database. Keyes, C. & Shapiro, A. (2004). Social well-being in the United States: a descriptive epidemiology. In Orville Brim, Carol Ryff, and Ronald Kessler (Eds. ), How healthy are we: A national study of well-being at midlife (Pp. 350 -372). Chicago: University of Chicago Press. Keyes, C. & Shapiro, A. (2005). Social well-being in the United States: a descriptive Epidemiology. In Orville Brim, Carol Ryff, and Ronald Kessler (Eds. ), How healthy are we: A national study of well-being at midlife (Pp. 350 -372). Chicago: University of Chicago Press.

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References continued Persons receiving Temporary Assistance to Needy Families (TANF): State of Hawai‘i, Department References continued Persons receiving Temporary Assistance to Needy Families (TANF): State of Hawai‘i, Department of Human Services. (1999). TANF and food stamps data. Unpublished raw data, And U. S. Census Bureau. (2000). Census 2000. [Online: ] http: //www. census. gov/ census 2000/ states/ hi. html (September 30, 2002). Population ages 21 -64 with disabilities: U. S. Census Bureau. (2000). Census 2000. [Online: ] http: //www. census. gov/ census 2000/ states/ hi. html (September 30, 2002). Population over age 16 in the labor force: U. S. Census Bureau. (2000). Census 2000. [Online: ] http: //www. census. gov/ census 2000/ states/ hi. html (September 30, 2002). Residents over age 5 with language other than English at home: U. S. Census Bureau. (2000). Census 2000. [Online: ] http: //www. census. gov/ census 2000/ states/ hi. html (September 30, 2002). Steenhuysen, J. (2008, March 27) “Older Americans Wealthier, Living longer” Reuters. , Retrieved November 7, 2008 from http: //www. reuters. com/article/top. News/id. USN 2740398720080327? feed. Type=RSS&feed. Name=top. Ne ws&rpc=22&sp=true U. S. Census (2000), Census, retrieved November 7, 2008 from http: www// factfinder. census. gov/home/saff/main. html.