Wednesday, October 16, 2013

New AARP report addresses residential decision-making by guardians

Guardians find their choice of residence for an incapacitated individual is “frequently not really a choice, but simply the best of the limited options,” according to a new report from the AARP Public Policy Institute. 
One of the most important decisions a guardian must make is where the person lives: in a personal or family residence, the community or a nursing facility. In making this decision, a guardian may consider a person’s expressed prefereBldgnces, availability of settings, financial resources, perceived risk, care and supervision needed, applicable law, court orders and other factors. The report finds, however, that state budget cutbacks and a short supply of affordable housing have greatly curtailed guardians’ options, especially for low- and moderate-income individuals.
The professional guardians surveyed for Choosing Home for Someone Else: Guardian Decisions on Long-Term Services and Supports say they generally prefer to place incapacitated individuals in community settings—which are less restrictive, less isolating and less costly than institutions. But, guardians are challenged in find state funded long-term services and supports if the individual has few resources and maintaining individuals in the community can require considerably more time, effort and risk than in an institutional setting. The report concludes that helping someone stay in the community is difficult, despite the almost universal desire among older Americans to age in place and the potential for home- and community-based services to cut Medicaid costs.
Highlighting the challenges fac ed by professional guardians, the findings in the report also apply to family caregivers who must navigate today’s fragmented long-term care system when deciding where their loved ones should live. “Family members as well as professional guardians must navigate today’s fragmented long-term care system when deciding where their loved ones will live,” said Erica Wood, the repor t’s co-author. “That is often a very frustrating process.”
Among other things, the report recommends, “States should seek to expand home- and 
community-based services, better balance services from institutional to non-institutional settings, and promote affordable, accessible housing.”
Choosing Home for Someone Else: Guardian Decisions on Long-Term Services and Supports is based on a web-based survey of 531professional guardians conducted in August 2010, a series of ten in-depth telephone interviews with guardians who had responded to the survey and were selected for a diversity of professional roles and geographic locations and the results of a structured invitational roundtable of experts including public, private, and lay guardians; elder law attorneys; a judge; federal agency officials; aging advocates; researchers; and aging and disability organization representatives conducted in May 2011.
 

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