Community-Based Elder Care: A Model for Working with the Marginally Housed Elderly
Mai, Loan, Eng, Judy, Care Management Journals
The community-based elder care (C-BEC) model is a critical treatment leverage that can be used to serve the older geriatric population who live in marginal housing tenements and who have little to nonexistent formal or informal support systems. Service engagement includes a model of care encompassing health maintenance with ongoing assessment of several specific dimensions. These dimensions include motor functioning, environmental barriers, emotional health, supportive services, and adherence motivation. All of these effect outcome and treatment course, despite a variety of medical diagnosis, level of functioning, and supportive needs. From evaluation of the individuals described in this article, considerations for collaborative treatment relationships, interdisciplinary teams, and service assessments are recognized as focal points of change that can be facilitated with C-BEC. The model is replicable and recommended for service providers working with an ambulatory, homebound, frail, and older aged population.
Keywords: community-based elder care; congregate services; marginal housing; in-home health care; nutrition services
Aging is a complex process involving a combination of health, functional, emotional, and social factors affecting the over all quality of life of older persons. Elderly clients desiring to age in place and who live in substandard housing considered as marginal are further at risk for homelessness due to extreme levels of poverty, lack of access to support services, increasing urban gentrification, and the rising cost of living. Additionally, as the average life span increases, service models must address the need of this growing complex cohort of older persons. As part of service engagement, the setting of first contact can guide and leverage the treatment relationship.
CHARACTERISTICS OF STUDY SIZE AND POPULATION
New York City's lower east side, known to the Bureau of Primary Health as a health disparity zone, is home to a unique subset of elderly men living in "flophouses" on the Bowery. Notable research has documented a history from the 1950s of transient men who may rent a 4-by-6-foot wooden cubicle nightly or weekly for $7 per night. Residents are merely asked their name and to agree to the house rules. The tenants receive a level of guaranteed anonymity with a freedom of movement to fit personal and day labor needs. While these flexible housing accommodations once served the needs of men who were in their 30s and 40s, these same flophouses now present multiple risks to the health of the men now 60 years and older who may have lived in these same 4-by-6-foot wooden cubicles for several decades.
The New York City Department of Homeless Services recognizes flophouse men as homeless because their living quarters are so markedly substandard. The wooden cubicles, usually 40 such to each floor, have chicken wire fencing on the upper half of the walls to improve ventilation in these windowless units. There are three bathroom stalls with two showers to be shared among 20 men. All flophouses are walk-ups, with stories topping at the 6th floor. Hallways are 3 feet across, dimly lit, with fire exits in the front and back of the building. No kitchen or cooking facilities are provided. However, some tenants warm food on unapproved hotplates or lobby radiators. Tenants have found that once residency begins, death is usually the only way out.
In our study, the site of first contact was a local senior center that provides nutritional lunch services, in addition to limited case assistance and on-site primary medical care to impoverished older persons. The senior center is funded by the New York City Department for the Aging, City-Meals-On-Wheels, United Way, Bureau of Primary Health Care, and private philanthropic organizations, and for at least 30 years has been well known among the so-called skid row Bowery men. The center is housed in a building located on Delancey Street and is structurally managed by the Department of Parks Building. …