Executive Summary of the Report on Needs of Older Kentuckians with Developmental Disabilities

Information gathered the past two years from the regional workshops, open forums, and surveys of providers and agency staff indicate the need for information awareness of available community services for older persons with developmental disabilities and aging family members. They reported needs of learning and being trained in aging processes and the additional and unique needs of people in the later life years. Training on age appropriate services and how do you develop, implement and maintain those support services and programs? Training for additional interagency collaboration and networking at the local level and grant writing skills for new moneys to pay for aging services. Cross training of aging professionals on serving an aging and older population with MR/DD. Training of home health providers and rehabilitation counselors. Staff in three ICF/MR institutions have requested training and technical assistance to assist with the aging in place of some of the residents and how to access the social leisure activities in the local community. In summary of the needs expressed by all the participants, a range of categories may be developed that cover:

The main funding source in the state for MR/DD services (Ky. Division of MR) has funded only two projects to serve the aging and older population with MR/DD in the last fifteen years. The Ky. Developmental Disabilities Planning Council has aging as a priority addressed in their five year plan. The DD Council has funded demonstration projects for 3 years (1988-1990) that were not picked up by state general funds. A Subcommittee on Aging was operational from the spring of 1991 until the fall of 1993. The Subcommittee was composed of both professionals in the field of aging and mental retardation and self-advocates. Three Council members and a one council staff participated in the monthly meetings. The accomplishments of the Subcommittee on Aging included the signing of the Memorandum of Understanding between the Divisions of Aging and Mental Retardation by the Commissioners of Social Services and Mental Health and Mental Retardation in 1992 (four years after the directive from the Administrations on Aging and Developmental Disabilities in Washington, DC to fulfill the federal mandate). All identified aging and older clients in the entire state's service systems total 3603.

Where are the aging and older people with developmental disabilities?

The majority of aging and older people with developmental disabilities are not in the available service systems. In Kentucky as like most states that have explored where their aging and older population was, aging and older people with developmental disabilities are living with aging parents, relatives, or surviving semi-independently in the community. In 1989, the Urban Studies Center, College of Urban and Public Affairs, at the University of Louisville published a survey report for the Kentucky Office of Vocational Rehabilitation citing the incidence and prevalence of people over the age of 64 years with developmental disabilities to be 60,260. These disabilities included:

The number of aging and older people with developmental disabilities reported by all agencies and service providers account for less than 10% of the incidence and prevalence reported by the Urban Studies Center for developmental disabilities over the age of 64. The following totals by agencies are for people with mental retardation and other developmental disabilities 60 years old and above:

Nursing Homes ICF/MR Facilities AIS/MR Title19 Waiver Other Community Vocational Rehabilitation Personal Care / Mini Homes MH/MR Regional Boards Senior Citizen Centers Adult Day Care Centers Total of People 60+ with DD Served
622
114
41
1,756
405
65
433
83
87
3,603

Ongoing research indicates the presence of premature aging in people with Down syndrome and Cerebral Palsy. The number of Kentuckians identified in the service systems who will be entering the aging group within the next five years is:

Down syndrome Ages 35-49 233
Cerebral palsy Ages 35-49 26
Totals 259

What are the needs of the aging and older population, their families, and the service providers that are working with them?

Aging and older persons with developmental disabilities needs included:

    (1) Staying out of nursing homes,
    (2) Doing less "work" in day programs,
    (3) Having more social opportunities in the community,
    (4) Be around friends and aging peers, and
    (5) Getting to retire to senior activities.
Concern was voiced in living where they were:
    (1) At home with parent(s),
    (2) In supervised apartments with friends, and
    (3) Not in larger congregate settings.
Aging parents expressed concern with:
    (1) Who would care and support their adult child after they were unable to do so?
    (2) What residential options would be available on long-term?
    (3) How could they assure the financial and support arrangements planned would be carried out?
    (4) The legal issues of living wills, trusts, and guardianship were confusing.
    (5) Parents were unaware of the premature aging processes specific to people with Down syndrome and the possibility of dementia of the Alzheimer's type for 25-40% of this aging group.
    (6) Parents expressed dissatisfaction with some of the services and programs provided by the Regional MH/MR Boards and the frequency of turnover of staff working with their family members.
    (7) Parents wanted more:
    (a) trained professionals who could provide more living skills training to their children being on their own in the community;
    (b) transportation for people in wheel chairs;
    (c) work for real wages and benefits;
    (d) respite in-home and also over night; and
    (e) parent awareness training to understand what is available
    to assist in the local community.
    (8) Parents expressed concern for:
    (a) their family having nothing to retire to or any income to retire with;
    (b) where to go when you need help;
    (c) family supports;
    (d) flexibility of programs;
    (e) loss of skills and abilities of adults with disabilities;
    (f) parent-care giver burnout;
    (g) loss of benefits and eligibility of programs due to aging and inability to participate;
    (h) attendant care access; and
    (i) access to physicians in rural areas who accept medical cards.

Service agencies' staff indicated needs to be:

    (1) More flexible types of activities offered in the later life years for aging persons with developmental disabilities; inflexible funding source requirements (AIS/MR, Title 19 programs, and age eligibility);
    (2) Transportation
    (3) More respite funding;
    (4) Available meeting place for evening activities in the community;
    (5) Opportunity to have the older person take a yearly vacation;
    (6) Age appropriate choices;
    (7) Collaboration between the aging and developmental disability systems;
    (8) Finding older persons and families outside the client service systems;
    (9) Agencies working together in a cooperative effort;
    (10) Accessing alternative funding;
    (11) Crisis response when the primary care giver is unable to continue;
    (12) Population in their fifties who lived for years in institutions before returning to the community;
    (13) Affects of long-term medications is on the rise;
    (14) The activities required by the AIS/MR (Kentucky's Title XIX Community Based Waiver for Mental Retardation) program are becoming more demanding than the older participants are capable of maintaining the schedule;
    (15) Exploitation by family and friends with funds from SSI and other support programs;
    (16) Staff training on aging and developmental disabilities;
    (17) Training for aging individuals for socialization and leisure;
    (18) Specialized services for aging and older persons for nutritional in-home services, opportunity to attend part-time work programs;
    (19) Personal choices as to options in later life activities;
    [20) Current programs are not set up to serve an aging population;
    (21) Train unemployed people to work with aging and older persons;
    (22) Financial planning for families to deal with the increased life spans;
    (23) Less structured, more fun ways for older clients to spend their days;
    (24) Intensify care options as health begins to deteriorate.

Aging Service Agencies

The Senior Day Care Directors identified the following needs:
    (1) Funding for continued services;
    (2) Transportation; and
    (3) Opportunity to involve the community more in the day to day operations of the day care centers.

The Senior Citizens Center Directors expressed the following needs:

    (1) Long-term care or personal care homes- only limited options available;
    (2) Local support groups for aging persons / DD and their families;
    (3) Better communications with hearing impaired individuals;
    (4) Care giver supports;
    (5) Remain out of institutions and in family home;
    (6) Day care centers to care for them when the parents die;
    (7) 4-5 person homes that provide supervision, exercise, craft lessons;
    (8) Personal care for aging people/ DD living alone;
    (9) Funding for delivery of services; and
    (10) Medical assistance on a local level for special needs.

Personal care, family care and mini-home providers listed the following needs for the aging and older individuals with developmental disabilities:

    (1) Adult Day Care
    (2) Part time work for real wages
    (3) Self worth
    (4) Transportation
    (5) Social outings
    (6) Communications by representatives in medical offices
    (7) Mental health and psychiatric services
    (8) Social activities
    (9) Affordable health care
    (10) More contact with families
    (11) Weekend activities
    (12) More income from SSI and Social Security
    (13) Activities without cost for community involvement
    (14) Not be isolated
    (15) Friends
    (16) Person centered planning
    (17) Empowerment
    (18) Choices for residences, work, and personal preferences
    (19) Not be on the streets
    (20) Workshop opportunities
    (21) Sense of accomplishment
    (22) Access to Senior Centers
    (23) Love and understanding
    (24) Exercise programs and physical therapy
    (25) Community needs to be more involved.

Recommendations for Awareness and Dissemination Efforts Needed

1. Policy makers and program administrators must be made aware of the unique needs of the aging and older population with MR/DD in the state through information sharing and public meetings where advocates and family members could express their needs and concerns.

2. Issues concerning premature aging of person's with Down syndrome and Cerebral Palsy need to be fully explored and explained to all older family members, agency staffs and program planners and administrators.

3. Students leaving professional schools need to have up-to-date information on aging and developmental disabilities to be prepared to work with an aging population that continues to grow and demand new supports that are different and unique to the current programs being provided in community and institutional environments.

4. Improve outreach and supports through awareness efforts to older families, including under-served minority and rural families, who are caring for a relative with developmental disabilities by working with the local aging service systems, mr/dd agencies, social services, and the family resource staff in each county extension office.

Recommendations of Funding and Legislation Efforts Needed

1. Very few families have provided for continued support after the deaths or inability of the parents to continue day to day formal and informal supports. (For example, real estate and family homes are major resources for aging and elderly people; however, less than 12,000 elderly homeowners nationwide have used the reverse mortgage option to convert their homes into income for a fixed time period or life and stay there. Additional information must be disseminated to older home owners who are caring for their aging family members with developmental disabilities.

2. Support interagency service coordination and delivery by establishing mechanisms for funds to flow across service systems.

3. Enhance access to aging network services and programs for older adults with developmental disabilities, including individuals who experience premature aging by amending current legislation to include this population.

4. Bolster the economic security of older people with developmental disabilities by restructuring the earnings levels which reduce SSDI and SSI benefits, provide incentives for extending pension plans to adults with developmental disabilities employed in competitive and sheltered work settings, and amending laws which reduce government entitlements due to inherited assets.

Recommended Training Efforts Needed

1. Develop and implement training programs for MR/DD direct staff to understand the aging processes, needs of aging and older persons with MR/DD, and how to access community programs and resources in a timely way.

2. Aging family members need training in what services are available for both themselves and their family member with developmental disabilities.

3. Elderly and aging care givers need training in many different areas including wills and trusts, networking, understanding their child's aging, and accessing services and programs.

4. Provide community-based supports which enable older adults with developmental disabilities to "age in place " rather than move to a more restrictive setting.

5. Train aging and older individuals with developmental disabilities to participate to their full ability in the later life years activities and supports to access their community's resources and activities. Retirement, volunteer work, participation in age appropriate activities of their choosing are just a few of the needs for awareness and understanding by this population.

6. Improve access to health care and the quality of care for people with developmental disabilities by training health care professionals in the needs of both individuals and families. This includes both home health and skilled care staff.

7. Insure the well-being and rights of nursing home residents with developmental disabilities by providing training to the state nursing home ombudsman program and coordinating their activities with the state protective services agency.

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