Publications on Disabilities

This review of existing estimates confirms an upward trend in the number of facilities, beds, and residents in residential care alternatives to nursing homes, often collectively referred to as "assisted living." Estimates vary substantially, however, depending on the methodology and the type of data used. Key sources of differences are population included (i.e. aged, all ages); definition used to identify assisted living, and for population-based surveys that include both community and facility settings, survey-specific definitions of "facilities" and whether settings identified as assisted living are limited to those meeting the survey-specific facility definition. Greater disagreement exists with respect to trends in the number of nursing homes and users, even between estimates from the same data source.

Older adults with disabilities increasingly are entering residential care alternatives to nursing homes. This study used Medicare Current Beneficiary Survey data for 1992-1998 to compare the characteristics of nursing home and alternative facilities and residents. The proportion of elders in alternative residential care settings increased from 0.8% in 1992 to 1.3% in 1998, and characteristics of facilities and their residents suggest that alternative settings are caring for a more disabled clientele over time. Blacks, long under-represented in nursing homes, increased as a proportion of nursing home residents, but growth in alternative settings was disproportionately among whites and others. Further research is needed to understand the implications of these trends.

Considerable evidence suggests that disability prevalence among older Americans has fallen, but less is known about how to promote further declines. This report develops and begins to demonstrate a framework for comparing population-level effects of interventions. We reviewed the literature for seven interventions and conducted simple modeling exercises. Evidence is strongest for exercise programs that increase strength, balance, and physical activity; depression screening with referral and feedback and therapy with pharmacologic treatment; and multi-factor fall prevention programs. Little evidence exists about the long-term effects of such interventions. Both short and long-term effects are critical when evaluating the population-level impact of such interventions.

In 2005, the Hilton Foundation gave CSH a five-year grant to launch an initiative in Los Angeles County to reduce the number of long-term homeless people, with a special focus on people with serious mental illness. The Urban Institute, which is evaluating the grant's impact, did a baseline assessment of homelessness and permanent supportive housing in 2005. A 2007 report assessed the policy and system changes that, working with others, CSH efforts had stimulated by that time. This report documents two-year changes in the level of homelessness in Los Angeles and the availability and characteristics of PSH availability. A second policy report will be available in fall 2008.

LA's HOPE is one of five HUD/DOL-funded projects awarded in late 2003 to demonstrate the feasibility of moving chronically homeless adults into permanent housing and helping them return to work. Its structure involved three public and nine nonprofit agencies. LA's HOPE was successful in its primary goals, housing 69 percent of ever-enrolled clients and engaging 84 percent in employment-related activities—54 percent in competitive employment. The project also sought to change the ways that the involved agencies worked together, but was less successful with these system change goals. The report discusses lessons learned, which closely resemble lessons from numerous other evaluations.