CREATING NEW MODELS FOR AGING IN PLACE: DIVERSE COMMUNITIES AND THE NAVIGATION OF LONG-TERM SERVICES AND SUPPORTS

Abstract There is a growing interest among aging services providers to better understand the pathways through which older adults and their caregivers navigate LTSS. Although there have been attempts at modeling this process they are often dependent on the quality of existing data, which can result in models which are incomplete and study samples that homogenize diverse older adult populations. These models face two challenges – 1) the data may not include information about important elements of the LTSS navigation process, and 2) the actions of ethnic/cultural sub-groups may not be captured. This study uses a conceptual method called Social Interaction Modeling (SIM) to examine how older adults in two limited English-speaking communities (Spanish / Mandarin Chinese) navigate the use of LTSS and to evaluate disparities in service access. The findings will help to build a more comprehensive model which looks at service navigation among all older adults in Philadelphia.


BARRIERS TO VILLAGE MEMBERSHIP AMONG MINORITY SENIORS
Carrie Graham, 1 and Winston Tseng 2 , 1. University of California,Berkeley,California,United States,2. University of California,Berkeley,Berkeley,California,United States Villages are a relatively new consumer-driven model that promotes aging in place for community-dwelling seniors. Villages promote social engagement, civic engagement, member-to-member-support, and collectively bargain for services of their members. Members report improved social support and more confidence aging in their own homes. Currently, there are over 200 operational villages nationwide and the model is proliferating rapidly. Most Villages members are white, well-educated, and well resourced. Researchers at UC Berkeley conducted 6 focus groups with Latino, African American and Asian seniors (N=58) who have not joined Villages in their regions. Focus group findings describe a lack of awareness of the Village model among underrepresented groups; and barriers to membership including the cost of membership, lack of language inclusion, and lack of diversity. The national anti-immigrant discourse emerged as a barrier to membership for non-white seniors. Participants describe how Villages could make programmatic changes to attract a more diverse membership.

EXPLORING HOW CARE PROVIDERS TALK ABOUT COMMUNICATION DIFFICULTIES WITH ETHNIC MINORITY PATIENTS
Pernilla Ågård 1 , 1. Deparment of Sociology, Uppsala University, Uppsala, Sweden Previous research into cross-cultural interactions in health care settings shows that care providers experience communicating with elderly ethnic minority patients as problematic. According to the social constructionist framework upon which this presentation draws, people negotiate the characteristics they ascribe to the world around them through talk. It is against this backdrop that the presentation -which is based on a focus group study with end-of-life care providers (n=60) -sets out to explore how care providers talk about communication difficulties with elderly ethnic minority patients. The presentation demonstrates how the study of communication difficulties can illustrative the challenges of cross-cultural interaction in end-oflife care settings. Through the attention on how communication difficulties are discussed, this presentation shifts the focus from the elderly ethnic minority patients and the reasons for why they are experienced as problematic when it comes to communication, to the actual process where these problems are negotiated.
There is a growing interest among aging services providers to better understand the pathways through which older adults and their caregivers navigate LTSS. Although there have been attempts at modeling this process they are often dependent on the quality of existing data, which can result in models which are incomplete and study samples that homogenize diverse older adult populations. These models face two challenges -1) the data may not include information about important elements of the LTSS navigation process, and 2) the actions of ethnic/cultural sub-groups may not be captured. This study uses a conceptual method called Social Interaction Modeling (SIM) to examine how older adults in two limited English-speaking communities (Spanish / Mandarin Chinese) navigate the use of LTSS and to evaluate disparities in service access. The findings will help to build a more comprehensive model which looks at service navigation among all older adults in Philadelphia.

UTILIZING PRINCIPLES OF LIFESPAN DEVELOPMENTAL PSYCHOLOGY TO EXAMINE RESILIENCE TO ADVERSITY Frank J. Infurna 1 , 1. Arizona State University, Tempe, Arizona, United States
Lifespan developmental psychology has many guiding principles. My past, current, and future research has been influenced by the lifespan developmental principles of multidimensionality and multidirectionality and the premise that development is not entirely bound to chronological age, but to historical-, contextual-, non-normative event-, pathologyand mortality-related processes. The first part of my talk will discuss ways I have utilized these principles in my research examining individual's ability to be resilient to diverse types of adversities (cancer diagnosis, unemployment, and bereavement) and resources they are drawing on to promote more positive outcomes, such as social support. The second part of my talk will focus on future research directions that aim to advance the conceptual and methodological significance of this research. Future directions include explicitly studying individuals in midlife, inclusion of outcomes beyond that of mental health and well-being, such as character strengths, and longitudinal research designs that assess people more frequently.

MEDICAID MANAGED LONG-TERM CARE PROGRAMS VS. THE TRADITIONAL MODEL: COMPARATIVE COSTS AND OUTCOMES Chair: Larry Polivka, Florida State University, Tallahassee, Florida, United States
Several states have adopted Medicaid Managed Long-Term Care (MLTC) programs over the last several years. At this point at least 30 states are either administering such models or have plans to in the near future. We do not, however, know much yet about the relative cost-effectiveness of the MLTC model when compared to the traditional non-profit model of Medicaid LTC. Is the for-profit MLTC model actually generating savings in the Medicaid program while improving the quality of care? This symposia is designed to address the question through three presentations on experiences with MLTC programs in the states of Ohio, Texas and Pennsylvania and a fourth presentation offering a national overview and critique of Medicaid MLTC in comparison to the traditional Medicaid LTC program still administered through non-profit Aging Network organizations. The state focused presentations describe the current status and results of MLTC in three states that vary in their specific features, extent of formal accountability for outcomes and the political contexts in which the programs currently function. The presentations also include discussions of the implications of each states experiences for the future of Medicaid LTC policy at the state and federal levels. The fourth presentation is a critical analysis of the main differences between the traditional non-profit model of Medicaid LTC services and the for-profit MLTC programs in terms of commonly accepted criteria of cost-effective LTC services, such as access, quality of care and per-person costs and differences in the roles of advocacy and accountability. Most of the states now have Medicaid LTC programs administered by corporate HMOs. Several states, however, still have programs administered by non-profit community based organizations, most of which are members of long standing Aging Networks which grew out of the Older Americans Act in the 1970s. This paper will offer a comparative overview of these models of LTC administration including a typology designed to identify major cultural and political differences between the states with and without corporate managed LTC models and an analysis of the available information regarding their comparative costs and outcomes, mainly access to care and quality of care. The paper will conclude with an assessment of the implications of the information presented for the future of Medicaid LTC policy and politics at the state and federal levels and for the future of LTC advocacy and accountability across the states.