Independence at Risk: Sustaining Fragile Support Networks for Low-Income Older Adults

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Principal Investigator: Steven Wallace

Aging independently at home is a strongly held desire among most Americans, and the U.S. Supreme Court’s Olmstead decision requires public programs to honor these desires when feasible. California offers a rather disconnected set of services and supports for low-income elders and others with disabilities. We conducted qualitative interviews four times over 18 months with 33 elderly recipients of state-funded in-home services to understand how they constructed networks of care, and how state funded programs worked in those networks. We found that levels of need for an individual often varied much more widely than their available support, creating unpredictable periods of “feast and famine.” Key supports that are not integrated into the long term care system include housing and transportation. The most enterprising seniors were able to identify a varied set of family and paid assistance; others relied only on a single in-home worker. Managing the mix of supports was particularly difficult for some due to mental health problems. The uncertainties caused by proposed program cuts and changes further undermine the stability of those arrangements. Creating integrated and stable programs, as well as helping stabilize family support, will help low-income seniors with disabilities maximize their ability to remain at home.