Research That Matters (January 17 - 20, 2008)

Purpose. Although community-based long-term care services have been shown to assist older adults in maintaining community tenure, certain subpopulations have unique barriers to receiving these services. In particular, older adults who are members of racial/ethnic minority groups, those with limited English proficiency, and those with low levels of literacy are some of the most vulnerable to barriers. The aims of this study are to identify difficulties that vulnerable older adults encounter when accessing community-based services and to explore case managers' successful strategies in serving these populations.

Methods. Questionnaires were distributed to all 137 Area Agency on Aging case managers in Kansas. We had a response rate of 70.8% (n = 97). The questionnaire contained both close- and open-ended questions measuring perceived barriers, specific types of barriers, and successful strategies. Perceived barriers measured how often case managers think vulnerable older adults encounter barriers in receiving services using 5-point Likert response categories (1 = never to 5 = very frequently). The specific barriers encountered and the strategies utilized by case managers to meet older adults' needs were collected through open-ended questions. Descriptive statistics were used to report the case managers' demographic information and perceived barriers. Open-ended questions were coded and analyzed by themes.

Results. The majority of case managers were female (85.6%) and Caucasian (94.7%). They had an average caseload of 74.7 (SD = 33.9) and 5.5 (SD = 3.2) average years of work. Seventy percent of case managers (n = 66) perceived that members of racial or ethnic minority groups never or rarely encountered barriers whereas 71.6% (n = 60) reported that older adults with limited English proficiency encountered barriers either sometimes (34.1%) or often/very frequently (36.5%). Thirty-two percent (n = 29) perceived older adults with low levels of literacy as sometimes encountering barriers and 25.6% (n = 23) perceived these older adults as often encountering barriers.

Commonly mentioned barriers to receiving services were: 1) different cultural perceptions and issues of trust, 2) ethnic tradition that rely more on informal services, 3) structural issues including lack of minority or bilingual staff, 4) lack of knowledge about existing services, and 5) feeling ashamed. Successful strategies that case managers used include: 1) involving ethnic leaders, 2) networking with other support systems such as family, cultural, and community organizations, and 3) case managers' initiatives to ensure that materials are understood.

Conclusion and Implication. Case managers identified barriers encountered on multiple levels: cultural, structural, and personal, for each of the subpopulations. The examination of barriers for these populations, as perceived by service providers, can raise agency awareness of structural and personal barriers for older adults. In addition, identifying particular successful strategies for serving vulnerable older adults is important as it guides further development of interventions and community resources to meet the needs of older adults. Case managers identified various successful strategies focused on maximizing available resources. Incorporating these strategies into the development of resources to strengthen the community service system and expand community networks will help increase access to services for these vulnerable older adults.