Community Living for Individuals with Disabilities and Seniors

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Benefits of Community Living

In the United States, both people with disabilities and the aging population are increasing in numbers.  The increased costs, and decreased independence, dignity and community participation of institutional housing options have precipitated the growth of community living alternatives.

CDS Life Transitions offers community living for people with disabilities through its CDS Monarch affiliate, taking the form of residences within neighborhoods.  For seniors, veterans and families, CDS Life Transitions offers integrated, affordable community living through its CDS Housing affiliate.

The goal of community living is happier and healthier living through a community format, that encourages different perspectives, social interaction, and community participation.

Community Living for People with Disabilities

Many of the 6.2 million people living in the United States who have intellectual or developmental disabilities live with their families.  The smaller number of people who leave their families, many in early adulthood, have more living options than ever before.  There remains a vast difference in the type of living arrangements available to this population, and more inclusive, community based options are on the rise.

There is mounting evidence that independent living arrangements or small residential community living arrangements are more conducive to overall happiness and well-being, however many people with IDD still live in large, segregated, congregate environments including residential programs located on campuses, state and private institutions, or large group settings.

Over the past decade, there have been numerous studies comparing quality of life outcomes in community (residential) versus institutional (congregate) settings.  A literature review of nearly seventy articles that examined this comparison concluded that residential living arrangements are superior to congregate arrangements[1].

Individuals who live in community based, residential settings have more personal relationships, social networks, and friendships given the more intimate structure of community housing.  These individuals also typically experience greater autonomy, self-determination and choice in a community setting.  A residential setting allows for more integration and participation in their communities, and more opportunities relative to recreation, activities, training and employment.  Overall, quality of life is higher in residential settings, when all of these factors are combined.  Individuals themselves and their family members also substantiated these findings, based on satisfaction levels.

Smaller scale residential communities offer greater continuity of employed caregivers which helps to foster relationships and trust.  This continuity also encourages more specific knowledge of conditions and behaviors, and associated treatments and amelioration techniques.  Smaller settings are better equipped for more person-centered support to meet individual needs, as well as monitoring changing needs for dynamic shifts in care.

It is true, that some health and behavioral conditions necessitate congregate settings with more focused medical attention, however many individuals can be accommodated in smaller, residential living arrangements.  It may also be true that low expectations of individuals with disabilities by professionals, families, and community members can perpetuate assumptions about 24-hour support and a one size fits all approach to care that ultimately results in unnecessarily over-serving this population[2].

Fortunately, public policy has been evolving so that federal funding can be used to better support people with intellectual or developmental disabilities to live, work, and engage more actively in their respective communities[3].  For people who are able, living and participating in community means that they have greater autonomy in deciding where to live and who to live with, they can often earn a living wage, and they can participate in activities that interest them personally.  For those people who, by virtue of their disabilities are more limited, community means that they have relationships with friends, family and support professionals, can be physically and emotionally healthy, and have opportunities to continually learn and grow.

Community Living for Seniors

Similar to the insights cited about community living for people with disabilities, community based living for seniors seems to be advantageous relative to institutional settings.  Although many governments worldwide are actively formulating policies that enable “aging in place” for older people and there are benefits including continuity of self, individuality, and autonomy, these policies may lead to extreme isolation for some subset of the population[4].  Between aging in place and an institutionalized setting, lies a range of living alternatives that take different forms depending on culture and geography.  At the core of this range, however, is the notion of “living together on one’s own”[5], which may amount to the best of all worlds for many people, providing privacy through individual housing units within a larger community that offers common space and common activities at residents’ discretion.  Ideally, individuals who choose to live in a living community will be the decision makers in making that choice.

The benefits of community living that are most often cited relate to social contacts and the ease of finding company, as well as security, by virtue of having a built in safety net[6].  Generally, research across cultures reports positive experiences related to a sense of community and support.  Community members come to rely significantly on their peers, who become more than simply neighbors but rather a key contributors in a social and emotional support system.

One large scale study conducted in the UK compared seniors living in retirement communities versus seniors living alone and concluded that those seniors living in communities remained healthier for longer, were more active, reported less loneliness, experienced a greater sense of security, enjoyed life more and felt more in control of their lives[7].   A vast majority of the study participants maintained that their lives had improved after becoming residents in a living community.

Another study conducted in the United States revealed that living communities designed for seniors are important in promoting healthy lifestyles[8].  This study confirmed cognitive, physical and mental health benefits from a structure that offers stimulation, socialization, empathy, and support. The confluence of cognitive, physical, and mental health well-being is critical in driving overall quality of life and satisfaction, and for many people community living provides this opportunity.  Community living may augment one or more facets of a person’s life that is lacking.  For instance, an individual may live alone and be well physically and cognitively, however due to loneliness, lack of optimism or lack of self compassion, this individual may suffer from compromised mental health.

National statistics related to loneliness in the United States reveal that nearly three quarters of people aged 75+ feel lonely given their lack of social contacts and interaction[9].  Loneliness is widely acknowledged as one of the most significant issues facing aging societies today and living communities for seniors are able to address, in large part, feelings of loneliness through emotional support and social interaction.  Community living has challenges too, as residents may sometimes struggle to find the right balance between private life and public/communal life,  as well as experience emotional loneliness that may linger even as social loneliness subsides.

The benefits of community living for seniors also extends to family members who have a vested interest in the happiness and well-being of their loved ones.  Unlike institutional settings, both community residents and family members have complete freedom related to mobility, travel and visitation.  Community living for seniors unfortunately may not accommodate residents with severe medical needs requiring frequent or continuous oversight by trained professionals.

Conclusion

There are a number of parallels between the benefits of community living for seniors and for individuals with intellectual or developmental disabilities.  Most notable is the importance of encouraging vibrant living that includes social networking, community integration, and self-determination.

[1] American Journal of Intellectual and Developmental Disabilities, 2014 November; 119 (6); 496-515; “Residential Transitions among Adults with Intellectual Disability across 20 Years”; Ashley C. Woodman, Marsha R. Maiilick, Kristy A. Anderson, and Anna J. Esbensen.

[2] Joint Position Statement of American Association on Intellectual and Developmental Disabilities (AAIDD) and Association of University Centers on Disabilities (AUCD), 2016 June; “Community Living and Participation for People with Intellectual and Developmental Disabilities”.

[3] Joint Position Statement of American Association on Intellectual and Developmental Disabilities (AAIDD) and Association of University Centers on Disabilities (AUCD), 2016 June; “Community Living and Participation for People with Intellectual and Developmental Disabilities”.

[4] International Journal of Environmental Research & Public Health, 2019 October; 16 (19): 3776; “Senior Co-Housing in the Netherlands: Benefits and Drawbacks for Its Residents”; Katja Rusinovic, Marianne van Bochove, and Jolien van de Sande.

[5] International Journal of Environmental Research & Public Health, 2019 October; 16 (19): 3776; “Senior Co-Housing in the Netherlands: Benefits and Drawbacks for Its Residents”; Katja Rusinovic, Marianne van Bochove, and Jolien van de Sande.

[6] International Journal of Environmental Research & Public Health, 2019 October; 16 (19): 3776; “Senior Co-Housing in the Netherlands: Benefits and Drawbacks for Its Residents”; Katja Rusinovic, Marianne van Bochove, and Jolien van de Sande.

[7] www.arcouk.org; “Housing, health and care; the health and well-being benefits of retirement communities”; Copyright Ó2019. Associated Retirement Community Operators Ltd.

[8] The American Journal of Geriatric Psychiatry, 2019 September; Volume 27, Issue 9; Pages 895-907; “Study of Independent Living Residents of a Continuing Care Senior Housing Community: Sociodemographic and Clinical Associations of Cognitive, Physical, and Mental Health”; Dilip V. Jeste M.D., Danielle Glorioso M.S.W., Ellen E. Lee M.D., Rebecca Daly B.A., Sarah Graham Ph.D., Jinyuan Liu M.S., Alejandra Morlett Paredes Ph.D., Camille Nebeker M.S., Xin M. Tu Ph.D., Elizabeth W. Twamley Ph.D., Ryan Van Patten Ph.D., Yasunon Yamada Ph.D., Colin Depp Ph.D., and Ho-Cheol Kim Ph.D.

[9] International Journal of Environmental Research & Public Health, 2019 October; 16 (19): 3776; “Senior Co-Housing in the Netherlands: Benefits and Drawbacks for Its Residents”; Katja Rusinovic, Marianne van Bochove, and Jolien van de Sande.

 

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