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Introduction

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"I find that the 'winding down' process of life isn't much different than the 'growing up' process: New experiences everyday and problems to be solved. We had lots of help in growing up and we have lots of help in winding down."

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—Richard Kauffman, retired musician and settlement house worker, at age 88

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LEARNING OUTCOMES

By the end of this chapter, readers will be able to:

  1. Discuss factors that influence the use of services.

  2. Identify levels of service barriers.

  3. Describe resources that link individuals with available community services.

  4. List the various resources available for older adults to remain active through work, learning, volunteerism, or social and recreational experiences.

  5. Explain the nature of adult protective services.

  6. Identify housing options that exist for older adults.

  7. Describe the roles of physical and occupational therapy in supporting older adults in the community.

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Clinical Vignette

Jean Clark is 70 years old and reasonably healthy, except for hypertension and some arthritis. Divorced with two adult children living in other parts of the country, she just retired after decades in the labor force, first as secretary and more recently as office manager of a small insurance firm. Jean did not make specific plans for her retirement and is now concerned about what she will do. Although her health is good at present, she worries about what would happen if she became ill or disabled.

  1. How might Ms. Clark explore what she might do with her time?

  2. What help is available, if she needs it?

  3. What factors might she need to consider with regard to whether to remain in her present home or move elsewhere?

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Nearly all older adults want to remain in the community and out of institutions (Keenan, 2010). Most believe that they will be able to live in their current homes until they die (Robison, Shugrue, Fortinsky, & Gruman, 2014). It is not so much that medical and nursing facilities are seen as uncaring or unsafe. Rather, community-dwelling carries with it a sense of familiarity, individual identity, personal control, and freedom. As adults age, remaining in the community becomes more challenging. Impairments and social losses can serve to compromise well-being and independence. Facing these challenges usually means confronting the need for services. Much help comes from family and friends (Feinberg, Reinhard, Houser, & Choula, 2011; National Alliance for Caregiving & American Association of Retired People [AARP], 2009; O'Shaughnessy, 2013a; Reinhard, Levin, & Samis, 2012). The rest is available from organizations or housing options in the community. Many of these community-based services are described here; others are considered in the remaining chapters.

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Discussion in this chapter focuses on the importance placed on community-based services. The chapter then identifies various ways to classify them and select a functional approach to care. Service utilization and barriers to service use are explored. Identifying community-based services can be difficult without the help of linkage ...

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