Improving Aging in Place in Subsidized Housing

This pilot study will evaluate the feasibility and preliminary effectiveness of an adapted version of the Function Focused Care intervention, delivered by telephone, for improving aging in place for older adults living in subsidized housing. The study will include participants with and without mild cognitive impairment or mild dementia and will examine whether the study outcomes differ by cognitive status. Findings from this study will provide new information about how to optimize function and physical activity among older adults with and without cognitive impairment living in subsidized housing.

Millions of older adults with low incomes live in federally-subsidized housing and are at disproportionate risk for nursing home admission. Effective approaches are needed to improve aging in place for this vulnerable population. The objective of this study is to pilot test the feasibility and preliminary effectiveness of a telephone-based intervention to improve aging in place for older adults living in subsidized housing. In the first phase of this study, the investigators used methods of implementation science to adapt an existing intervention, Function Focused Care for Assisted Living, to the unique setting of affordable housing. Function Focused Care is a philosophy of care in which assisted living staff members engage residents in functional and physical activity during all care interactions. Prior research supports the effectiveness of Function Focused Care for maintaining function and increasing physical activity among older adults in assisted living settings.

In the first phase of this study, the investigators interviewed subsidized housing stakeholders - including residents, staff members, and caregivers - to identify barriers, facilitators, and needed adaptations to Function Focused Care for Assisted Living. The investigators used the findings from these interviews to adapt the intervention. In this 2-month pilot study, the investigators will use a wait-list control design with site randomization to assess the feasibility and preliminary effectiveness of the adapted intervention. The investigators will recruit individuals with and without mild cognitive impairment or mild dementia and will examine whether the study outcomes differ by cognitive status. The findings from this study will provide new information about how to optimize function and physical activity among older adults with and without cognitive impairment living in subsidized housing.

Eligibility Criteria:
Inclusion Criteria, Residents:

* Lives in an included subsidized housing setting
* 62 years of age or older
* Speaks English or Spanish well or very well
* Able to provide informed consent OR able to provide assent and has a proxy who provides informed consent on his/her behalf
* Has difficulty or needs help in at least 1 ADL and/or IADL OR has mild cognitive impairment or mild dementia based on their Montreal Cognitive Assessment (MoCA) score
* Not enrolled in hospice

Inclusion Criteria, Study Partners:

* Speaks English or Spanish well or very well
* Able to provide informed consent
* Spends at least an hour per week with the resident

Inclusion Criteria, Staff Members:

* Speaks English or Spanish well or very well
* Able to provide informed consent

Exclusion Criteria, Residents:

* Younger than 62 years of age
* Does not speak English or Spanish
* Lacks decision making capacity and lacks a proxy to consent on his/her behalf
* Does not have functional impairment or cognitive impairment
* Has moderate to severe dementia based on his/her MoCA score
* Is enrolled in hospice

Exclusion Criteria, Study Partners:

* Does not speak English or Spanish
* Unable to provide informed consent
* Does not spend at least an hour per week with the resident

Exclusion Criteria, Staff Members:

* Does not speak English or Spanish
* Unable to provide informed consent