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Nah S, Savla J, Roberto KA. Dementia Care in Rural Appalachia: Multilevel Analysis of Individual- and County-Level Factors. THE GERONTOLOGIST 2024; 64:gnae037. [PMID: 38661552 PMCID: PMC11192855 DOI: 10.1093/geront/gnae037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Home- and community-based services (HCBS) are underutilized, despite offering significant health benefits to both care recipients and caregivers. Drawing upon Andersen's extended behavioral model of health services use, we examined individual- and county-level factors influencing HCBS utilization for dementia care in rural Appalachia. RESEARCH DESIGN AND METHODS We analyzed data from telephone interviews with 123 dementia family caregivers in rural Appalachian counties (Mage = 64.7, SDage = 12.2). Multilevel analyses were conducted to examine the effects of individual-level and county-level factors on the use of home-based services (home healthcare and personal care services) as well as community-based services (adult day care and transportation services). RESULTS Results indicated that caregivers' receipt of informal support from family or friends was associated with more use of home-based services (B = 0.42, p = .003). Conversely, longer travel times to service providers were linked to use of fewer community-based services (B = -0.21, p < .001). Residing in counties with more home health agencies was associated with higher utilization of home-based services (B = 0.41, p = .046). However, higher county tax expenditures for HCBS were not linked to home-based or community-based service use. DISCUSSION AND IMPLICATIONS Findings suggest that informal support in caring for the person living with dementia enables HCBS use in rural Appalachia. In contrast, limited geographic accessibility and service availability can impede HCBS use in rural regions. Policymakers are urged to allocate direct public funding to service providers to expand service availability in underresourced rural regions.
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Affiliation(s)
- Suyoung Nah
- Center for Gerontology, Virginia Tech, Blacksburg, Virginia, USA
| | - Jyoti Savla
- Center for Gerontology, Virginia Tech, Blacksburg, Virginia, USA
- Human Development and Family Science, Virginia Tech, Blacksburg, Virginia, USA
| | - Karen A Roberto
- Center for Gerontology, Virginia Tech, Blacksburg, Virginia, USA
- Institute for Society, Culture, and Environment, Virginia Tech, Blacksburg, Virginia, USA
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Tyagi P, Bouldin ED, Hathaway WA, D'Arcy D, Nasr SZ, Intrator O, Dang S. Preimplementation Evaluation of a Self-Directed Care Program in a Veterans Health Administration Regional Network: Protocol for a Mixed Methods Study. JMIR Res Protoc 2024; 13:e57341. [PMID: 38875003 PMCID: PMC11214023 DOI: 10.2196/57341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/18/2024] [Accepted: 05/08/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND The Veteran-Directed Care (VDC) program serves to assist veterans at risk of long-term institutional care to remain at home by providing funding to hire veteran-selected caregivers. VDC is operated through partnerships between Department of Veterans Affairs (VA) Medical Centers (VAMCs) and third-party Aging and Disability Network Agency providers. OBJECTIVE We aim to identify facilitators, barriers, and adaptations in VDC implementation across 7 VAMCs in 1 region: Veterans Integrated Service Network (VISN) 8, which covers Florida, South Georgia, Puerto Rico, and the US Virgin Islands. We also attempted to understand leadership and stakeholder perspectives on VDC programs' reach and implementation and identify veterans served by VISN 8's VDC programs and describe their home- and community-based service use. Finally, we want to compare veterans served by VDC programs in VISN 8 to the veterans served in VDC programs across the VA. This information is intended to be used to identify strategies and propose recommendations to guide VDC program expansion in VISN 8. METHODS The mixed methods study design encompasses electronically delivered surveys, semistructured interviews, and administrative data. It is guided by the Consolidated Framework for Implementation Research (CFIR version 2.0). Participants included the staff of VAMCs and partnering aging and disability network agencies across VISN 8, leadership at these VAMCs and VISN 8, veterans enrolled in VDC, and veterans who declined VDC enrollment and their caregivers. We interviewed selected VAMC site leaders in social work, Geriatrics and Extended Care, and the Caregiver Support Program. Each interviewee will be asked to complete a preinterview survey that includes information about their personal characteristics, experiences with the VDC program, and perceptions of program aspects according to the CFIR (version 2.0) framework. Participants will complete a semistructured interview that covers constructs relevant to the respondent and facilitators, barriers, and adaptations in VDC implementation at their site. RESULTS We will calculate descriptive statistics including means, SDs, and percentages for survey responses. Facilitators, barriers, number of patients enrolled, and staffing will also be presented. Interviews will be analyzed using rapid qualitative techniques guided by CFIR domains and constructs. Findings from VISN 8 will be collated to identify strategies for VDC expansion. We will use administrative data to describe veterans served by the programs in VISN 8. CONCLUSIONS The VA has prioritized VDC rollout nationwide and this study will inform these expansion efforts. The findings from this study will provide information about the experiences of the staff, leadership, veterans, and caregivers in the VDC program and identify program facilitators and barriers. These results may be used to improve program delivery, facilitate growth within VISN 8, and inform new program establishment at other sites nationwide as the VDC program expands. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/57341.
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Affiliation(s)
- Pranjal Tyagi
- South Florida Veteran Affairs Foundation for Research & Education, Miami, FL, United States
| | - Erin D Bouldin
- Division of Epidemiology, Department of Internal Medicine, University of Utah Eccles School of Medicine, Salt Lake City, UT, United States
| | - Wendy A Hathaway
- Providence Veterans Affairs Medical Center, Providence, RI, United States
| | - Derek D'Arcy
- Canandaigua VA Medical Center, Department of Veterans Affairs, Canandaigua, NY, United States
| | - Samer Zacharia Nasr
- VISN 8 Network Office, Department of Veterans Affairs, St. Petersburg, FL, United States
| | - Orna Intrator
- Department of Public Health Sciences, University of Rochester, Rochester, NY, United States
- Geriatrics and Extended Care Data Analysis Center, Canandaigua VA Medical Center, Canandaigua, NY, United States
| | - Stuti Dang
- Miami VA GRECC, Miami VA Healthcare System, Miami, FL, United States
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Choi H, Reblin M, Litzelman K. Conceptualizing Family Caregivers' Use of Community Support Services: A Scoping Review. THE GERONTOLOGIST 2024; 64:gnad039. [PMID: 37022354 DOI: 10.1093/geront/gnad039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Only a fraction of the 53 million caregivers in the United States use available formal community services. This scoping review synthesized the literature on the barriers and facilitators of community support service utilization by adult caregivers of a family member or friend with an illness, disability, or other limitation. RESEARCH DESIGN AND METHODS We searched PubMed, CINAHL, PsycInfo, and Web of Science for quantitative and qualitative articles assessing barriers and facilitators of caregivers' access to and utilization of resources, following Preferred Reporting Items for Systematic Review and Meta-Analysis scoping review guidelines. Thematic analysis, drawing on an initial conceptualization, informed key insights around caregivers' resource navigation process. RESULTS The review provides support for individual factors affecting service use. Notably, some factors-such as time restrictions and increased caregiving demands-appear to function as barriers to accessing services even as they increase caregivers' need for support. Additionally, contextual barriers including cultural factors and support of friends/family can affect caregivers' access to resources. Finally, experience with health systems and structures and the intersection with other factors can affect service utilization. DISCUSSION AND IMPLICATIONS Suboptimal access to and utilization of community support services can be addressed at both the person and system level to mitigate potential inequities. Ensuring that caregivers are aware of, eligible for, and have the capacity and support to access the appropriate resources at the right time is essential for improving caregiver outcomes, reducing burnout, and supporting continued care.
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Affiliation(s)
- Hyojin Choi
- Department of Human Development and Family Studies, School of Human Ecology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Maija Reblin
- Department of Family Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Kristin Litzelman
- Department of Human Development and Family Studies, School of Human Ecology, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Vipperman A, Savla J, Roberto KA, Burns D. Barriers to Service Use Among Dementia Family Caregivers in Rural Appalachia: Implications for Reducing Caregiver Overload. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:950-960. [PMID: 36543967 PMCID: PMC9771774 DOI: 10.1007/s11121-022-01479-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
Although the benefits of home- and community-based services (HCBS) to support the needs of older adults are well-established, researchers have persistently reported service underutilization by dementia caregivers to assist them with their caregiving responsibilities. Using the Health Behavior Model and Conservation of Resources Theory, the aim of the current study was to understand what barriers prevent caregivers from using HCBS and the toll it takes on them. Utilizing a sample of 122 rural family caregivers (74% female, 87% white, Mage = 64.86 years) of persons living with dementia (PLwD), simultaneous ordinary least square regressions were employed to understand the association between barriers to service use and the current use of support services and personal services, and concurrently on caregiver role overload. Financial barriers, caregiver's reluctance to use services, and their capability of seeking services were associated with lower use of support services. After controlling for need and enabling factors, caregivers who used more support services, and those who reported system complexities to using support services experienced higher role overload. Financial barriers, system complexities, and caregivers' reluctance also affected the use of personal care services. Despite the use of personal services, caregivers of PLwD with greater needs and fewer enabling factors experienced higher role overload. Study findings suggest that reducing system complexities of HCBS and improving prevention and intervention efforts to facilitate caregivers' awareness of HCBS are needed to address lack of service use and reduce caregiver overload.
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Affiliation(s)
- Andrew Vipperman
- School of Medicine, University of Virginia, Charlottesville, 22908, VA, USA
| | - Jyoti Savla
- Center for Gerontology, Virginia Tech, 230 Grove Lane, Virginia Tech, Blacksburg, 24061, VA, USA
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, 24016, VA, USA
| | - Karen A Roberto
- Center for Gerontology, Virginia Tech, 230 Grove Lane, Virginia Tech, Blacksburg, 24061, VA, USA.
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, 24016, VA, USA.
- Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, 24016, VA, USA.
| | - Derek Burns
- Department of Psychology, Virginia Tech, Blacksburg, VA, USA
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Kallas J, Sterling MR, Ajayi O, Mulroy E, Kuo E, Ming J, Dell N, Avgar AC. Making a Bad Situation Worse: Examining the Challenges Facing Rural Home Care Workers. J Appl Gerontol 2023; 42:768-775. [PMID: 36510645 DOI: 10.1177/07334648221134793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This study examines the unique challenges facing rural home care workers. Semi-structured interviews were undertaken between July 2021 and February 2022 with 23 participants that have experience in rural home care delivery. The major challenge confronting rural home care workers involved distance and transportation. This challenge emerged due to long distance between clients, unreliable vehicles, inadequate reimbursement, and inclement weather. In turn, this challenge exacerbated three other types of challenges facing rural home care workers: workforce challenges that consisted of a persistent labor shortage and shorter visits that forced workers to rush through tasks, client isolation due to the social and physical seclusion of households, and the poor working conditions of home care work more broadly. Without policy interventions that respond to these particular challenges, the care gap in rural areas can be expected to grow.
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Affiliation(s)
- John Kallas
- 47792Cornell University ILR School, Ithaca, NY, USA
| | | | - Olay Ajayi
- 47792Cornell University ILR School, Ithaca, NY, USA
| | - Ethan Mulroy
- 47792Cornell University ILR School, Ithaca, NY, USA
| | - Elizabeth Kuo
- Department of Information Science, The Jacobs Institute, Cornell Tech, New York, NY, USA
| | - Joy Ming
- Department of Information Science, 5922Cornell University, New York, NY, USA
| | - Nicola Dell
- Department of Information Science, The Jacobs Institute, Cornell Tech, New York, NY, USA
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McCann BR, Roberto KA, Blieszner R, Savla J, Atkinson E. Vigilance, risk, and service use among caregivers of people living with dementia. DEMENTIA 2023; 22:727-742. [PMID: 36790090 DOI: 10.1177/14713012231156856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE The purpose of this investigation was to understand the dynamics among dementia caregiving, vigilance, and home and community-based service use. METHODS This paper is derived from a larger, mixed-methods study on caregiving. We used a descriptive qualitative approach to analyze interview data of 30 family caregivers of relatives with dementia. RESULTS We found five domains of vigilance in which caregivers felt "on duty": ensuring attentiveness, ensuring safety, ensuring resources, ensuring healthcare, and ensuring closeness. Formal service use did not necessarily give caregivers relief from vigilance, with the language of risk often employed by caregivers. CONCLUSION Because service use could contribute to feelings of vigilance, rather than give caregivers a break from a sense of watchfulness, these findings support calls for dementia-specific training for service providers. In future caregiving research, the relationship between vigilance, caregiver distress, and role captivity should be explored.
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Affiliation(s)
| | - Karen A Roberto
- Institute for Society, Culture and Environment and Center for Gerontology, 1757Virginia Tech, Blacksburg, VA, USA
| | - Rosemary Blieszner
- College of Architecture, Arts, and Design and Center for Gerontology, 1757Virginia Tech, Blacksburg, VA, USA
| | - Jyoti Savla
- Center for Gerontology and Department of Human Development and Family Science, 1757Virginia Tech, Blacksburg, VA, USA
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