Impact of age and transitions out of nursing homes for adults with developmental disabilities

Preferences for a Cash Option Versus Traditional Services for Florida Children and Adolescents with Developmental Disabilities

Traditional personal assistance programs often lack a significant consumer-direction focus that allows or encourages consumers to be in charge of their services. Independent evaluations of the Cash and Counseling Demonstration and Evaluation (CCDE) project are comparing costs of, quality of, and satisfaction with traditional personal care services versus consumer-directed cash benefit and information services. Because the disability community is composed of diverse subgroups, each group having with its own needs and concerns, the interests of each of these various populations should be assessed. This article presents the results of a telephone survey conducted in Florida as background research for the CCDE project to assess the interest in a cash option among families of children and adolescents with developmental disabilities. The findings indicate overall high levels of interest in the cash option, especially among individuals who were willing to pay a worker directly, persons who desired more involvement with services, and consumers dissatisfied with the current services. The authors of this article also include suggestions regarding how to communicate with families when informing them of such an option.

A Cross-Disability Analysis of Person-Directed, Long-Term Services

Person-directed service models have emerged as important initiatives in improving long-term care. Person-directed services typically have been targeted to particular groups, such as persons with mobility or developmental disabilities or elders with disability. Few attempts have been made to analyze the commonalties, differences, and relative efficacy of the various models. This article presents a cross-disability review of the common elements of person-directed services, describes three primary types of models (personal assistance services, brokered support, and cash and counseling), and summarizes the research evidence related to their efficacy. The major barriers that impede the expansion of person-directed services are discussed. Emerging research findings across disability groups suggest that person-directed services have a positive impact on factors such as quality of life, control, productivity, unmet need, use of preventative health care, and cost. The need to build the evidence base for person-directed services, to address barriers to the expansion of these service models, to support advocacy efforts, and to bolster the political will required for directing substantial resources to person-directed long-term services is emphasized.

Residential characteristics, social factors, and mortality among adults with intellectual disabilities: transitions out of nursing homes

The present study examined the degree to which residential characteristics and social factors are associated with mortality, after controlling for personal characteristics, among adults with intellectual disabilities who have resided in nursing homes (facilities providing skilled care and related services) at baseline in the Chicago area. Initial assessments were conducted on 330 residents, and 2 follow ups were performed over 10 years. Seventy-one residents had died by the end of the study. The variables examined included personal characteristics of age, gender, intellectual level, health, and adaptive behavior; residential characteristics of type of residence, size of facility, attractiveness of physical environment (cleanliness, conditions, and aesthetic appeal), and diversity of physical environment (personalization of residents' rooms and distinctiveness of all living spaces); and social factors of family involvement and community integration. The results indicated, beyond age, adaptive behavior, and health, that size of residences, residential characteristics, and social factors are related to mortality.

Outcomes in different residential settings for people with intellectual disability: a systematic review

Large-scale reviews of research in deinstitutionalization and community living were last conducted about 10 years ago. Here we surveyed research from 1997 to 2007. Articles were included if the researchers based the study on original research, provided information on the participants and methodology, compared residential arrangements for adults with intellectual disability, and were published in English-language peer-reviewed journals. Sixty-eight articles were found. In 7 of 10 domains, the majority of studies show that community-based services are superior to congregate arrangements. These studies provide more evidence of the benefits of deinstitutionalization and community living and continue to indicate variability in results, suggesting that factors other than the basic model of care are important in determining outcomes.

Determinants of remaining in the community after discharge: results from New Jersey's Nursing Home Transition Program

PURPOSE

To inform states with nursing home transition programs, we determine what risk factors are associated with participants' long-term readmission to nursing homes within 1 year after discharge.

DESIGN AND METHODS

We obtained administrative data for all 1,354 nursing home residents who were discharged, and we interviewed 628 transitioning through New Jersey's nursing home transition program in 2000. We used the Andersen behavioral model to select predictors of long-term nursing home readmission, and we used Cox proportional hazards regressions to examine the relative risk of experiencing such readmissions.

RESULTS

Overall, 72.6% of the 1,354 individuals remained in the community, with 8.6% readmitted to a nursing home for long stays (>90 days) and 18.8% dying during the study year. Cox proportional hazards regression analysis showed that being male, single, and dissatisfied with one's living situation; living with others; and falling within 8 to 10 weeks after discharge were significant predictors of long-term nursing home readmission during the first year after discharge.

IMPLICATIONS

Most of the factors predicting long-term readmission were predisposing, not need, factors. This fact points to the limits of formulaic approaches to assessing candidates for discharge and the importance of working with clients to understand and address their particular vulnerabilities. Consumers, state policy makers, nursing home transition staff, discharge planners, and caregivers can use these findings to understand and help clients understand their particular risks and options, and to identify those individuals needing the greatest attention during the transition period as well as risk-specific services such as fall-prevention programs that should be made available to them.

Effects of intelligence level and place of residence on the ability of individuals with mental retardation to identify facial expressions

This study was designed to investigate the abilities of individuals with mental retardation to recognize and match emotional facial expressions from a series of photographs depicting various facial expressions. There were four groups of participants according to their place of residence (community or institution) and their intelligence level (mild or moderate). Each individual participated in two tasks: (1) recognizing a facial expression from an array of three pictures presented, and (2) matching a facial expression from one picture with a picture depicting a similar emotion from an array of three pictures. All information was presented to the participants in the native language, Hebrew. The six facial expressions used for the study included happiness, sadness, fear, anger, surprise, and disgust. The ability to recognize and match facial expressions was significantly higher for individuals with mild than moderate mental retardation. There was no significant difference for place of residence. Happiness was the easiest feeling to recognize and match for all groups. Fear and anger were the most difficult to recognize, while sadness and anger were most difficult to match.

Eight-year follow-up of the impact of environmental characteristics on well-being of adults with developmental disabilities

The impact of environmental features of residences on adaptive behavior, community integration, and health of adults with mental retardation over an 8-year period was examined. Environmental features included residence type, size, choice-making opportunities, physical attractiveness, and family involvement. We assessed 186 residents who initially lived in nursing homes. At the 8-year follow-up, 133 had moved to community-based residential settings. Findings indicated that residents who moved to community settings had higher levels of adaptive behavior and community integration than residents who remained in nursing homes. A more attractive physical environment and greater opportunity for choice-making were associated with higher levels of adaptive behavior at follow-up. Greater opportunity to make choices and family involvement were associated with higher levels of community integration.

Living with support in the community: predictors of choice and self-determination

Ensuring that people with intellectual disability experience typical levels of choice and self-determination has become an essential objective for quality disability services. Three perspectives on self-determination were identified in the literature: psycho-educational, ecological, and socio-political. Personal characteristics, specific self-determination competencies, and environmental variables all were found to be associated with choice and self-determination. Living environments that were smaller and more individualized were linked to greater choice and self-determination. The theoretical perspective investigators applied to the issues influenced approaches to research and intervention, and differences in emphasis were evident regarding the relative importance of self-determination competencies and environmental factors. MRDD Research Reviews 7:91-98, 2001.

Living with support in the community: predictors of satisfaction with life

Ensuring that people with an intellectual disability have normative levels of life satisfaction is increasingly considered a worthy goal for service providers. This review concerns the determinants of such satisfaction and embeds this literature within the Homeostatic Theory of Subjective Well-Being. This posits that life satisfaction is under considerable endogenous control and, as a consequence, does not normally vary in sympathy with changes in the external environment. This situation changes, however, if the environment is sufficiently aversive to defeat such homeostatic control. Under these conditions the circumstances of living correlate with life satisfaction as they wrest control away from the homeostatic system. One important implication is that the measure of life satisfaction may or may not be a sensitive indicator for changes in service provision, depending on the functional status of the homeostatic system. MRDD Research Reviews 7:99-104, 2001. (c) 2001 Wiley-Liss, Inc.