Going Home: Low-Income Elders Can Live Full Lives

The first of two parts

Among humans, it's a matter of common knowledge - better yet, common sense - that increased age eventually results in a decreased level of body performance. The older we get, the less agility we have, the more brittle our bones get and the weaker our immune system becomes. As a result, hospital stays due to sickness, injuries and disease are commonplace among the elder population in American society.

What's more, such life course disruptions require a certain amount of rehabilitation in preparing elders for their return to the community. And, with trends in health care moving toward shorter hospital stays, these individuals are often discharged to skilled nursing units which provide transitional care services to prepare them for that return.

But what happens when it's time to go home?

More specifically, how well do elders adapt to either new or familiar environments after hospital stays brought on by the onset of illness or disability? And what happens when those elders are part of a low-income bracket?

For the past two years, Drs. Gayle Hersch and Jean Spencer of the Texas Woman's University School of Occupational Therapy have been asking these very questions. With the help of some private funding, a handful of dedicated graduate students and a cadre of supportive peers, the pair has completed two studies on the subject. In the fall of 1998, they began two additional studies - further investigations in a line of research that focuses on a population with a limited set of choices: low-income elders.

"Some people have little problem getting a wheelchair to get around in once they get back home or back into the community," Dr. Spencer says. "However, for others, it can be a big hassle to even get something as simple as a tub bench because their HMO won't pay for it. If you have a lot of money you can just go out and buy the wheelchair or the tub bench. Well, these people can't do that."

Off and Running

Four years ago, colleagues Hersch and Spencer began discussing their shared interest in community support arrangements for elders and how those individuals manage to deal with health crises and return to their life in the community. That interest spurred them to write grant proposals for two different studies - one to compare protocol-based and adaptation-based treatments for elders following their release from the hospital, and another to look at whether minority elders who made functional improvements in a transitional unit sustained or lost those improvements after they returned to the community.

The two TWU researchers set to work in late 1996 on both studies. A $30,000 grant from the American Occupational Therapy Foundation made it possible to pursue the first study, while another $30,000 grant - this one an extra-mural research associate award (EARDA) available through TWU from the National Institutes of Health (NIH) - allowed Drs. Hersch and Spencer to start in on the second.

The first study, which will be published in March 1999 in the American Journal of Occupational Therapy under the title "Outcomes of Protocol-Based and Adaptation-Based Occupational Therapy Interventions for Low-Income Elders on a Transitional Unit," involved eight participants, all with multiple chronic physical conditions ranging from pneumonia to hip fractures to gangrene.

During their stay in the transitional unit, the eight elders were provided with both an O.T. protocol-based intervention and an adaptation-based intervention. The first was administered by geriatric program staff occupational therapists or certified occupational therapy assistants and emphasized exercise to improve strength, endurance and performance of basic activities of daily living. The second was provided to the participants by an occupational therapy doctoral student with clinical experience in mental health and long-term care practice, as well as in a geriatric psychiatry day program.

This approach used both a Client Centered Evaluation (CCE), which addressed the elders' perceptions of their hospitalization, their expectations about what life changes it might bring about, and what they wanted to do once they returned home; and a Commnity Adaptive Planning Assessment (CAPA), which was essentially a process of joint problem-solving by the therapist and the client to identify alternative solutions to adaptive problems and implementing goals.

Dr. Spencer says the adaptation-based intervention was part of her and Dr. Hersch's desire to compile more qualitative, individual-oriented results. They took it one step further by developing the "Outcome Tracking System," a computerized means of analyzing this data.

"With the quantitative tradition, researchers have already decided what's important," Dr. Spencer says. "The qualitative tradition, on the other hand, really is intended to capture an insider's perspective. Since what is important to the subject may be quite different than what might occur to you to ask, the researcher tries to provide as little structure as possible. By keeping it open-ended, you tend to see things more from their point of view."

To be continued in the July 15 issue

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©2006 Texas Medical Center

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