This research portrays a paradigm for the assessment of aging services to support populations aging in place. The dissertation was designed to establish a model to identify and evaluate senior ready communities. Area specific social programs and services are identified. In order to meet the growing needs of aging populations, the dynamic representation of existing services and the need for services that could be developed in certain communities require reevaluation in current planning, restructuring, and/or community development.

The aging experience of men and women in rural America is different than that of their urban counterparts. In this study, I identified key disparities in access to health care, mortality, and utilization of health care that result from geographic location. Foundational theories are discussed to illustrate that disparities can originate from historical societal behaviors. Secondary data and literary reviews create a combined qualitative and quantitative approach to explore the rural/urban divide, concluding that the potential for increased disparities as the aging population grows is very real and rural residents remain vulnerable to a poor(er) aging experience. Recommendations for policy and practice, as well as additional research, are made to address the conclusion.

I examined the factors that led to the rise and fall of psychiatric hospitals and its impact on two select groups of individuals: adults and older adults with severe mental illness. To explore the reasons behind these fluctuations, the State of Texas was used as a case study. Additionally, the fluctuations occurred for different reasons in public vs. for-profit investor-owned psychiatric hospitals. Using an investor-owned psychiatric hospital organization as a case study, I investigated the differences in factors that influenced the growth and/or demise in public vs. investor-owned psychiatric hospitals. Evolution and devolution of psychiatric hospitals was assessed during select time periods: 1700 to1930, 1940 to1970, 1980 to 2000, and 2000 to present. Time period selections were relevant to the important drivers of the span of time that influenced the psychiatric hospitals. Historical review and trend analysis was used to identify the total number of psychiatric hospitals and/or total number of psychiatric hospital beds and psychiatric hospitals by type. Analysis showed there was a cyclical pattern of evolution and devolution of psychiatric hospitals and each cycle altered the form, function, and role of the psychiatric hospital along with altering the location of care for adults and older adults with severe …

To meet the growing demand for community-based adult services (CBAS) adult day health care (ADHC) programs, it is important these programs make the necessary modifications in their systems of care to embrace a person-centered care (PCC) model. This study was designed to create an assessment to determine a community-based CBAS/ADHC program's readiness to meet the new federal standards as determined by the program's current operational evidence and by center participants', their families' as well as staff's perspectives. This was measured by self-report of access to the community, choice of setting, individual rights, autonomy and independence, choice of services and supports, center accessibility as well as their needs and preferences in the practice. Results will assist similar CBAS/ADHCs in identifying the necessary modifications within their own program to continue as a certified licensed entity and remain a viable agency.

The long-term care administrator profession is one that is both new and evolving. The unique historical perspective of this health profession is brief in the number of years it encompasses and crucial in understanding the current issues facing the profession. Administrator experiences provide a point of reference regarding the profession's structural problems. Ethical considerations play a dynamic role in administrators' daily jobs as well as their continued licensure. The significance of the profession's ongoing problems at the state and national level causes the need for alternatives to the current system. A combination of these alternatives must be embraced to assist in the recruitment and retention of long-term care administrators.

This secondary research study uses data from two convenience samples of homeless persons in Central Arkansas collected during 2004 and 2011 Point in Time Counts. The prevalence of predictors of homelessness are compared across years, and also compared by age (<50 and > 50) controlling for year of survey. The number of older adults increased significantly between 2004 and 2011 surveys, and reporting serious mental illness and veteran status significantly decreased from 2004 to 2011. Age differences were noted in 2004 with older adults more likely to report serious mental illness in comparison to younger adults. Older adults were also more likely to report veteran status in comparison to younger adults during both the 2004 and 2011 surveys. The predictors of homelessness -- including serious health problems, substance abuse, race, age, and developmental disabilities-- remained fairly consistent from 2004 to 2011 and across "age groups". In addition to Point in Time data, qualitative surveys and interviews of providers were performed for their observations of the older homeless population. Providers indicated their belief that the older homeless population is increasing. Providers suggested possible challenges and reasons for the increase among older adults who are homeless. In central Arkansas, service providers feel …

The purpose of this study was to examine perceptions of Texas Adult Protective Services (APS) case managers (CM) in regard to their relationships with the law enforcement community and area courts. The sample consisted of 138 Texas APS CMs. The survey measured respondents' perceived strengths and weaknesses of their relationships with both the law enforcement community and with area courts. Items also included respondents' interest in receiving additional training and their perceptions of level of job-readiness of newly hired APS CMs. Data were analyzed quantitatively using SAS. Findings of the survey revealed high ratings of perceived teamwork on the part of the CM are associated with high relationship ratings with both area courts and law enforcement. Findings also revealed that high ratings of perceived autonomy on the part of the CM are associated with lower relationship ratings with law enforcement personnel but not with area courts.

Access to healthcare is needed and wanted by people of all ages and especially by those of the older population. The number of people in the 65 years of age and older population is rapidly growing with their needs expected to have a significant impact on the existing healthcare system and healthcare providers. The impact will be critical given the severe shortage of healthcare providers, especially of nurses and the rate of services being more often provided in non-hospital settings. The objectives of the study were to discover the plans of graduating nursing students as they choose their first place of employment, if they have future plans to pursue a nursing advance practice degree, and if they are very happy with their decision to become a nurse. Data for the study were obtained from a questionnaire presented to senior graduating nursing students. The findings were: (a) Most students prefer a hospital setting. (b) Younger students are three times as likely to seek out the hospital, and 1/3 of the students seek out the hospital setting because they were encouraged to become a nurse. (c) About 70% of the students want to work with their friends while 1/3 will seek the …

Assisted living, the fastest growing segment of the senior housing industry, allows individuals to remain as independent as they prefer and still receive necessary services. However, assisted living residences exist primarily to serve those seniors who can pay for the services from their own savings/income. We are facing a critical need for housing options for both the current senior generation and the soon-to-be-retired baby boomers. How will access to assisted living be opened to all types of payors? How will states fund the growth of assisted living? The purpose of this paper is to discuss opportunities for expansion that will make assisted living an affordable option for the low- and moderate-income elderly.

Although humor is a generally accepted part of everyday life for humans, its existence, importance, and positive influence on older persons are often underestimated. The purposes of this study are to determine whether humor is a normal experience for nursing home residents, enhancing their activities of daily living, and whether it plays a role in contributing to their psychological well-being. The study includes a discussion of research on humor, particularly as it relates to the elderly and the aging process; analysis and comparisons based on interviews with residents on the subject of humor and review of their psychological state as evaluated by the MDS 2.0 nursing facility assessment; individual case studies, and anecdotes illustrating the beneficial contributions humor brings to the lives of nursing home residents.

The intent of this qualitative, grounded theory study was to understand why the Nigerian (Igbo) adult immigrants in the United States provide long distance international caregiving to their elderly parents left behind in Nigeria, the challenges they encounter, and their views on long-term service care. This study was grounded in semi-structured interviews of 20 Igbo adult immigrants residing in the Dallas/Fort Worth Metropolis. Analysis of the literature demonstrates a lack of existent topic on long distance international caregiving to elderly parents left behind in Nigeria. Findings show that reasons for Igbo adult children immigrants providing care to their elderly parents left behind stem from filial obligation, immigrant’s position in the family, perceived vulnerability of parents, and lack of government support. Also because of cultural expectations, the participants felt obligated to reciprocate to the care their elderly parents gave to them when they were growing up. While providing long distance international care, the participants encountered some challenges like adjusting to their new country, distance, financial constraints, being available for family procreation, issues with means of communication, and legal papers and parental adjustment to life in the U.S. This study also revealed that the participants would support the Nigerian government and private …