The Citizenship Approach to Community Living

The Citizenship Approach to Community Living

Health, community and housing are three vital and intertwined components associated with healthy longevity. For community to be achieved, Nexus Insights believes we need to shift from the current primary focus on what is done ‘for’ and ‘to’ older adults, to a focus on what is done ‘by’ and ‘with’ older adults.

Nexus Fellow and President & CEO of Christian Living Communities, Jill Vitale-Aussem, recently led a discussion on the importance of community. CLC’s citizenship model is rooted in the belief that each individual, at every age and level of abilities, has gifts, passions, talents and experience that make the community stronger and better.

She was joined by Maddy Chapman, the Associate Executive Director at Holly Creek, and Andrew Sharp, the Community Life Director at Clermont Park, to discuss how citizenship helps to revolutionize aging services.

“Citizenship is the ultimate goal of a person-directed culture.” Jill Vitale-Aussem.

Continuum of Person-Directedness

Previously, the traditional framework was provider-driven, where management made decisions for elders and staff, but organizations like Christian Living Communities have moved a new model – one that CLC calls the citizenship model – where elders contribute to their community and play important roles.

Provider Directed – Management makes most of the decisions with little conscious consideration of the impact on elders or staff. Elders are expected to follow existing routines.

Staff Centered – Staff consults elders or put themselves in elders’ place while making the decisions. Elders have some choices within existing routines and options.

Person Centered – Elder preferences or past patterns form the basis of decision-making about some routines. Staff begin to organize routines in order to accommodate elder preferences, either articulated or observed.

Person Directed – Elders make decisions every day about their individual routines. When not capable of articulating needs, staff honor observed preferences and habits. Staff organize their hours, patterns and assignments to meet elder preferences.

Citizenship – Elders influence their community, they are problem solvers, share responsibility for each other and are expected to contribute. The organization, leadership, management and staff support others to exercise autonomy, connection and well-being, and work to remove systemic barriers.

(Source: Pioneer Network, Continuum of Person Directed Culture, modified by Christian Living Communities to include the Citizenship model.)

During the presentation, Sharp shared a video, “I am”, from Clermont Park where residents explain their roles. “It’s ‘I am’ because it’s right now. Not I was or back in the day I did. It’s ‘I am’,” said Sharp. Examples of residents’ roles included Gallery Committee Chair, Conversation Connections, Campus Gardner, Chronicle Editor, Ambassador, and Researcher.

The Five Rs of Citizenship

The Five Rs of Citizenship published by the Journal of Community Psychology are Rights, Responsibilities, Roles, Resources and Relationships. In reference to community living, rights refer to the Rights of the residents that need to be upheld. Responsibilities are the duties residents are responsible for. Roles are the titles the residents hold. Resources are time, money and training that need to be given to residents. Relationships are people getting to know one another.

“We need a life with purpose. We need true belonging. We need roles to play. There’s not been one study that says to live a long and healthy life you should live a life of leisure and have everything done for you.” Jill Vitale-Aussem

Disrupting Aging Services Through Citizenship

Watch the full discussion:

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ATI Analysis of Medicare Population Needs and the Critical Role of LTC Pharmacy

As many as 70 percent of individuals who reach age 65 will experience severe long-term-care (LTC) needs before they die. Those needs might range from help with managing their finances or medications, to help bathing and getting dressed. Having LTC needs does not necessarily correspond to living in a long-term care facility, however. Instead, people with LTC needs may live and receive services at home or in other community-based settings.

Unfortunately for those living outside of LTC facilities, they face barriers to getting the assistance they need. A study conducted by ATI Advisory, in partnership with the Senior Care Pharmacy Coalition (SCPC), found that “state and federal policy and health plan requirements can create barriers that restrict people aging outside facility settings from accessing long-term services and supports, including LTC pharmacy.”

As a population with high prescription drug utilization, access to LTC pharmacy is especially important to Medicare beneficiaries with LTC needs. The study found, however, that despite the pivotal role that LTC pharmacies play in the care of those with LTC needs, this role is not widely understood or acknowledged by individuals, caregivers, policymakers, and payers.

Moreover, the study found that Medicare beneficiaries with LTC needs are demographically different from those without LTC needs in several important ways. The population studied was statistically “more likely to be Black or Latinx, female, dually eligible for Medicaid, clinically complex, and have higher healthcare and prescription drug utilization than beneficiaries without LTC needs.” Addressing the barriers to access to LTC services is necessary to work toward parity in access to services, coverage for services, support for caregivers, and equity in outcomes.

Read the study outcomes.

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