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McGarry BE, Grabowski DC. Medicaid home and community-based services spending for older adults: Is there a "woodwork" effect? J Am Geriatr Soc 2023; 71:3143-3151. [PMID: 37326313 DOI: 10.1111/jgs.18478] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/09/2023] [Accepted: 05/19/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Although older adults prefer to age at home, Medicaid has a longstanding institutional bias in funding long-term services and supports (LTSS). Some states have resisted expanding Medicaid funding for home- and community-based services (HCBS) due to budgetary concerns related to the so-called "woodwork" effect whereby individuals enroll on Medicaid to access HCBS. METHODS To examine the implications associated with state Medicaid HCBS expansion, we obtained state-year data for 1999-2017 from various sources. We estimated difference-in-differences regressions comparing outcomes in states that expanded Medicaid HCBS aggressively versus those that expanded less aggressively, controlling for several covariates. We examined a range of outcomes including Medicaid enrollment, nursing home census, Medicaid institutional LTSS spending, total Medicaid LTSS spending, and Medicaid HCBS waiver enrollment. We measured HCBS expansion by the total share of state Medicaid LTSS spending for aged and disabled persons devoted to HCBS. RESULTS HCBS expansion was not associated with increased Medicaid enrollment among individuals ages 65 and older. A 1% increase in HCBS spending was associated with reductions in the state nursing home population of 47.1 residents (95% confidence interval [CI]: -80.5, -13.8) and institutional Medicaid LTSS spending of $7.3 million (95% CI: -$12.1M, -$2.4M). A $1 increase in HCBS spending was associated with $0.74 increase (95% CI: $0.57, $0.91) in total LTSS spending, suggesting each dollar directed to HCBS was offset by $0.26 savings from decreased nursing home use. Increased HCBS waiver spending was associated with more older adults receiving LTSS at a lower cost per beneficiary served relative to the nursing home setting. CONCLUSIONS We did not find evidence of a woodwork effect in those states that expanded Medicaid HCBS more aggressively, as measured by age 65 and older Medicaid enrollment. However, they did experience Medicaid savings from reduced nursing home use, suggesting states that expand Medicaid HCBS are able to use these additional dollars to serve more LTSS recipients.
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Affiliation(s)
- Brian E McGarry
- Division of Geriatrics and Aging, Department of Medicine, University of Rochester, Rochester, NY, USA
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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2
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Scheckler S. Household Composition Under Strain: Regional Unemployment Rates and the Older American Housing Decision. J Aging Soc Policy 2023; 35:125-153. [PMID: 34420481 DOI: 10.1080/08959420.2021.1941703] [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: 10/20/2022]
Abstract
This research explored the relationship between regional unemployment rates and the community-based housing configuration of older Americans. The analysis used the American Community Survey from 2006 to 2016 to examine regions experiencing high unemployment for differences in the likelihood of older adults to live alone, with a spouse or partner, or in a multigenerational household. Findings demonstrated that under the strain of higher regional unemployment, older adults were less likely to live alone and more likely to live in a multigenerational household. Additionally, older adults with a difficulty that could signify a need for support were less likely to live with a spouse or partner, while those without a difficulty were more likely to live with a spouse or partner. Recession-related safety-net policy should target supports to community-dwelling older adults, particularly those living alone, those with more support needs, with lower income, and older renters, because their housing arrangements may become vulnerable during regional economic contraction. Implications during COVID-19 are discussed.
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Affiliation(s)
- Samara Scheckler
- Joint Center for Housing Studies, Harvard University, Cambridge, Massachusetts, United States of America Postdoctoral Fellow
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3
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Beauregard LK, Miller EA. A comparative analysis of state adoption of the Community First Choice program. Home Health Care Serv Q 2021; 40:177-191. [PMID: 34311673 DOI: 10.1080/01621424.2021.1947926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Over the last several decades, policymakers have focused on rebalancing Medicaid-funded long-term services and supports toward home and community-based services (HCBS). The Patient Protection and Affordable Care Act (ACA) included several opportunities for states to further promote HCBS options. One optional opportunity for states to expand Medicaid HCBS was the 1915(k) Community First Choice (CFC) program. To date, eight states have elected to add CFC as a Medicaid benefit. This study utilized comparative case studies to identify the factors that influenced states' adoption of CFC. Results highlight the important role that state bureaucrats, economic concerns, and existing HCBS programs had on states' decisions to adopt CFC.
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Affiliation(s)
- Lisa Kalimon Beauregard
- Massachusetts Executive Office of Elder Affairs Massachusetts Executive Office of Elder Affairs, Boston, Massachusetts, USA
| | - Edward Alan Miller
- Department of Gerontology, and Gerontology Institute, John W. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA.,Department of Health Services Policy & Practice, and Faculty, School of Public Health, Brown University Providence, Rhode Island, USA
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4
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Gaugler JE, Marx K, Dabelko-Schoeny H, Parker L, Anderson KA, Albers E, Gitlin LN. COVID-19 and the Need for Adult Day Services. J Am Med Dir Assoc 2021; 22:1333-1337. [PMID: 34044009 PMCID: PMC8103140 DOI: 10.1016/j.jamda.2021.04.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 12/31/2022]
Abstract
COVID-19 has shone a harsh light on the inequities of health care in the United States, particularly in how we care for older people. We summarize some of the effects of lockdown orders on clients, family caregivers, and staff of adult day service programs throughout the United States, which may serve as a counterpoint to scientific evidence suggesting a lack of efficacy of these programs. Given the ramifications of state lockdown orders for users and staff of the long-term services and support system, we provide recommendations to better support community-based programs and those they serve. Specifically, (1) adult day programs should be classified as essential, (2) a focus on the value of adult day and similar programs is needed, and (3) an exploration of new ways to finance home and community-based services is warranted. Such advances in policy and science would help to integrate adult day services more effectively into the broader health care landscape.
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Affiliation(s)
- Joseph E Gaugler
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
| | - Katherine Marx
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | | | - Lauren Parker
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Keith A Anderson
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
| | - Elizabeth Albers
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
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5
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Fashaw SA, Thomas KS, McCreedy E, Mor V. Thirty-Year Trends in Nursing Home Composition and Quality Since the Passage of the Omnibus Reconciliation Act. J Am Med Dir Assoc 2019; 21:233-239. [PMID: 31451383 DOI: 10.1016/j.jamda.2019.07.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/28/2019] [Accepted: 07/04/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE In 1987, the Omnibus Reconciliation Act (OBRA) called for a dramatic overhaul of the nursing home (NH) quality assurance system. This study examines trends in facility, resident, and quality characteristics since passage of that legislation. METHODS We conducted univariate analyses of national data on US NHs from 3 sources: (1) the 1985 National Nursing Home Survey (NNHS), (2) the 1992-2015 Online Survey Certification and Reporting (OSCAR) Data, and (3) LTCfocUS data for 2000-2015. We examined changes in NH characteristics, resident composition, and quality. SETTING AND PARTICIPANTS US NH facilities and residents between 1985 and 2015. RESULTS The proportion of NHs that are Medicare and Medicaid certified, members of chains, and operating not-for-profit has increased over the past 30 years. There have also been reductions in occupancy and increases in the share of residents who are racial or ethnic minorities, admitted for post-acute care, in need of physical assistance with daily activities, primarily supported by Medicare, and diagnosed with a psychiatric condition such as schizophrenia. With regard to NH quality, direct care staffing levels have increased. The proportion of residents physically restrained has decreased dramatically, coupled with changes in inappropriate antipsychotic (chemical restraint) use. CONCLUSIONS AND IMPLICATIONS Together with changes in the long-term care market, the NHs of today look very different from NHs 30 years ago. The 30th anniversary of OBRA provides a unique opportunity to reflect, consider what we have learned, and think about the future of this and other sectors of long-term care.
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Affiliation(s)
- Shekinah A Fashaw
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI; Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI.
| | - Kali S Thomas
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI; Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI; Center of Innovation in Long-Term Services and Supports, US Department of Veterans Affairs Medical Center, Providence, RI
| | - Ellen McCreedy
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI; Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI
| | - Vincent Mor
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI; Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI; Center of Innovation in Long-Term Services and Supports, US Department of Veterans Affairs Medical Center, Providence, RI
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6
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Abrahamson K, Hass Z, Arling G. Shall I Stay or Shall I Go? The Choice to Remain in the Nursing Home Among Residents With High Potential for Discharge. J Appl Gerontol 2018; 39:863-870. [PMID: 30366510 DOI: 10.1177/0733464818807818] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Minnesota’s Return to Community Initiative (RTCI) assists private-pay nursing home (NH) residents to return to the community. Using data from a 1-year admission cohort of RTCI-targeted NH residents, we examined why residents who at admission expressed a desire for discharge, were paying privately, and had relatively low-care needs chose to remain in the NH. Characteristics of those who remained were compared with those who discharged using logistic regression, and barriers to discharge were summarized. Residents who were older, more cognitively impaired (OR = 1.8), unmarried (OR = 1.4), had behavior problems (OR = 1.6), or diagnosed with dementia (OR = 2.0) were more likely to remain than discharge to the community. Between admission and their 90-day assessment, residents remaining in the facility had a small decline in cognitive status, yet their continence improved and they became more independent in activities of daily living (ADLs). Seventy-four percent reported a perception of health-related barriers to discharge.
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7
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Lau JYC, Wong ELY, Chung RY, Law SCK, Threapleton D, Kiang N, Chau P, Wong SYS, Woo J, Yeoh EK. Collaborate across silos: Perceived barriers to integration of care for the elderly from the perspectives of service providers. Int J Health Plann Manage 2018; 33. [PMID: 29701255 DOI: 10.1002/hpm.2534] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/19/2018] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To examine the barriers that hinder collaboration between health care and social care services and to report recommendations for effective collaboration to meet the growing support and care needs of our ageing population. METHODS Data for this qualitative study were obtained from interviews with 7 key informants (n = 42) and 22 focus groups (n = 117) consisting of service providers who were from the health care or social care sectors and supporting elderly patients with multiple chronic diseases or long-term care needs. Data collection was conducted from 2015 to 2016. The data were analysed using an inductive approach on the basis of thematic analysis. FINDINGS Qualitative analysis reviewed a number of factors that play a significant role in setting up barriers at the operational level, including fragmentation and lack of sustainability of discharge programmes provided by non-governmental organisations, lack of capacity of homes for the elderly, limitation of time and resources, and variation of roles in supporting end-of-life care decisions between the medical and social sectors. Other barriers are those of communication to be found at the structural level and perceptual ones that exist between professionals. Of these, perceptual barriers affect attitudes and create mistrust and interprofessional stereotypes and a hierarchy between the health care and social care sectors. CONCLUSION Health care and social care service providers recognise the need for collaborative work to enhance continuity of care and ageing in place; however, their efforts are hindered by the identified barriers that need to be dealt with in practical terms and by a change of policy.
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Affiliation(s)
- Janice Ying-Chui Lau
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
- Centre of Urban History, Culture and Media, Institute of Future Cities, The Chinese University of Hong Kong, Shatin, Hong Kong
- Department of Anthropology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Eliza Lai-Yi Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Roger Y Chung
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
- JC Institute of Ageing, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Stephen C K Law
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
- Centre for Applied Health Economics, School of Medicine, Menzies Health Institute Queensland, Griffith University, Nathan, Australia
| | - Diane Threapleton
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
- Nutritional Epidemiology Group, University of Leeds, UK
| | - Nicole Kiang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Patsy Chau
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Samuel Y S Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jean Woo
- JC Institute of Ageing, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Eng-Kiong Yeoh
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
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Lepore M, Knowles M, Porter KA, O'Keeffe J, Wiener J. Medicaid Beneficiaries' Access to Residential Care Settings. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/02763893.2017.1335669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Molly Knowles
- RTI International, Research Triangle Park, North Carolina, USA
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9
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Rocco P. Informal Caregiving and the Politics of Policy Drift in the United States. J Aging Soc Policy 2017; 29:413-432. [DOI: 10.1080/08959420.2017.1280748] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Philip Rocco
- Assistant Professor, Department of Political Science, Marquette University, Milwaukee, Wisconsin, USA
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10
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Dean KM, Hatfield LA, Jena AB, Cristman D, Flair M, Kator K, Nudd G, Grabowski DC. Preliminary Data on a Care Coordination Program for Home Care Recipients. J Am Geriatr Soc 2016; 64:1900-3. [DOI: 10.1111/jgs.14351] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Haverhals LM, Manheim CE, Gilman CV, Jones J, Levy C. Caregivers Create a Veteran-Centric Community in VHA Medical Foster Homes. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2016; 59:441-457. [PMID: 27598768 DOI: 10.1080/01634372.2016.1231730] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The Veteran's Health Administration's Medical Foster Home program offers a unique long-term care option for veterans who require nursing-home- or assisted-living-level care. Veterans in a medical foster home reside with community-based caregivers who provide 24-hr-a-day care and monitoring. The veterans often remain in the medical foster home until end of life. Support and oversight is provided to the caregiver from the Veteran's Health Administration's community-based medical team. This qualitative descriptive study is based on secondary analysis of interviews with 20 medical foster home caregivers from 7 programs across the United States. The study's research aims are to describe and explain (a) the type of care backgrounds and skills these caregivers possess, (b) caregivers' primary motivations to open their homes to veterans who often have complex medical and social needs, and (c) how caregivers function in their role as primary caregiver for veterans. Findings indicated that caregivers interviewed had worked in long-term care settings and/or cared for family members. A strong desire to serve veterans was a primary motivation for caregivers, rather than financial gain. The caregivers' long-term care skills aided them in building and sustaining the unique medical foster home family-like community.
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Affiliation(s)
- Leah M Haverhals
- a Denver Veterans Affairs Medical Center , Denver-Seattle Center of Innovation , Denver , Colorado , USA
| | - Chelsea E Manheim
- a Denver Veterans Affairs Medical Center , Denver-Seattle Center of Innovation , Denver , Colorado , USA
| | - Carrie V Gilman
- a Denver Veterans Affairs Medical Center , Denver-Seattle Center of Innovation , Denver , Colorado , USA
| | - Jacqueline Jones
- a Denver Veterans Affairs Medical Center , Denver-Seattle Center of Innovation , Denver , Colorado , USA
- b University of Colorado , Anschutz Medical Campus, School of Nursing , Aurora , Colorado , USA
| | - Cari Levy
- c Denver Veterans Affairs Medical Center, Denver-Seattle Center of Innovation , Denver , Colorado , USA
- d University of Colorado , Anschutz Medical Campus, School of Medicine, Department of Medicine, Division of Health Care Policy and Research , Aurora , Colorado , USA
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12
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Provision of Health Services: Long-Term Care. Health Serv Res 2016. [DOI: 10.1007/978-1-4614-6419-8_24-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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13
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Tyler DA, Fennell ML. Rebalance Without the Balance: A Research Note on the Availability of Community-Based Services in Areas Where Nursing Homes Have Closed. Res Aging 2015; 39:597-611. [PMID: 26685182 DOI: 10.1177/0164027515622244] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Policies to "rebalance" funding away from nursing homes and toward home and community-based services (HCBS) have encouraged national trends of nursing home closure and an expansion of the HCBS industry. These changes are unfolding without a clear understanding of what services are available at the local level. The purpose of this study was: (1) to describe the current distribution of community-based services (CBS) in areas where nursing homes have closed and (2) to examine differences in availability of CBS using local market and population characteristics as regressors in a multinomial logistic model. We collected data on and geocoded CBS facilities and then used ArcGIS to define a 5-mile radius around all nursing homes that closed between 2006 and 2010 and compared these local market areas. In rural areas, availability of CBS does not appear to compensate for nursing home closures. Policies encouraging HCBS may be outpacing availability of CBS, especially in rural areas.
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Affiliation(s)
- Denise A Tyler
- 1 Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, USA.,2 Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Mary L Fennell
- 1 Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, USA.,3 Department of Sociology, Brown University, Providence, RI, USA
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15
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Liu C, Eom K, Matchar DB, Chong WF, Chan AWM. Community-Based Long-Term Care Services. J Aging Health 2015; 28:307-23. [DOI: 10.1177/0898264315590229] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This study examines the relationship between caregivers’ perception of community-based long-term care (CBLTC) services and the service use. Method: We used first two waves of the longitudinal data set of 1,416 dyads of care recipients and their caregivers in Singapore. Four perceived attributes of LTC services—service quality, convenience, social connectedness, and affordability—were measured on a 5-point scale. Results: Among the four perceived attributes, perceived affordability was significantly associated with future utilization for all types of CBLTC services. Perceived service quality and convenience was significantly associated with center-based LTC services use. Discussion: Caregivers are critically involved in the decision of using CBLTC services, and their perception of service characteristics is significantly associated with the uptake of CBLTC services. It is important to incorporate both care recipients’ and caregivers’ needs and preferences when designing and promoting integrated health care delivery models.
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Affiliation(s)
- Chang Liu
- Duke-NUS Graduate Medical School Singapore, Singapore
| | - Kirsten Eom
- Duke-NUS Graduate Medical School Singapore, Singapore
| | - David B. Matchar
- Duke-NUS Graduate Medical School Singapore, Singapore
- Duke University Medical Center, Durham, NC, USA
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16
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Abstract
Background. Current policies redirecting long-term care (LTC) delivery away from institutional care to home- and community-based services are being made in the absence of crucial evidence on preferences. Studies indicate that the shift to home care is generally not cost-saving; thus, an empirical assessment of effectiveness is needed to evaluate policies incenting home care investment. This study quantifies LTC preferences between different delivery modes. Design. This study extended the time tradeoff method to elicit utilities and LTC preferences associated with the receipt of different modes of LTC services, conditional on health states defined by varying levels of functional and cognitive impairment. Users’ LTC preferences are measured as differential utilities between alternative LTC options for each health state. Results. For the same health state, respondents ( n = 81) significantly preferred home care over institutional care, except for the most impaired health state. The preference for home care over institutional care is quantified as 0.30 quality-of-life (QOL) weight when people need help with only 1 activity of daily living (ADL). The preference for home care depends significantly on levels of disability and was weaker once the need for help became greater. Under the most severe health state of having moderate to severe dementia and needing help with 6 ADLs, the quantified home care preference was only 0.03 QOL weight and was not statistically significant. Limitations. Because the sample is mostly composed of African Americans, the results may not be generalizable to other racial and ethnic groups. Conclusions. People do not always strongly prefer home care over institutional care, as is often assumed. The costs of expanding home- and community-based care should be weighed against these preferences.
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Affiliation(s)
- Jing Guo
- American Institutes for Research, Washington, DC, USA (JG)
- University of Chicago, Chicago, IL, USA (RTK)
- Department of Medicine, University of Chicago, Chicago, IL, USA (WD, EM)
| | - R. Tamara Konetzka
- American Institutes for Research, Washington, DC, USA (JG)
- University of Chicago, Chicago, IL, USA (RTK)
- Department of Medicine, University of Chicago, Chicago, IL, USA (WD, EM)
| | - Elizabeth Magett
- American Institutes for Research, Washington, DC, USA (JG)
- University of Chicago, Chicago, IL, USA (RTK)
- Department of Medicine, University of Chicago, Chicago, IL, USA (WD, EM)
| | - William Dale
- American Institutes for Research, Washington, DC, USA (JG)
- University of Chicago, Chicago, IL, USA (RTK)
- Department of Medicine, University of Chicago, Chicago, IL, USA (WD, EM)
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18
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Guo J, Konetzka RT, Dale W. Using time trade-off methods to assess preferences over health care delivery options: a feasibility study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:302-305. [PMID: 24636391 DOI: 10.1016/j.jval.2013.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 11/26/2013] [Accepted: 11/27/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Time trade-off (TTO) methods are often used for utility assessments of different health states to measure quality of life (QOL). They have not generally been used to assess social preferences with respect to options for health care delivery, although the need for quantifying these preferences is arguably just as important. Policymakers are increasingly faced with decisions about how much to invest in, and how much to incentivize, particular modes of health care delivery, generally with little evidence about user preferences. METHODS This study draws on long-term care (LTC) delivery modes as an example. Focus groups were conducted to approach this issue both qualitatively and quantitatively. In a qualitative pilot study, two focus groups discussed issues of the LTC decision-making process and preferences among different LTC options. The TTO was then used to assess QOL for each LTC option, conditional on a specific health state, and then quantified user's LTC preferences by differential QOL between the two options. RESULTS This study found that the TTO-elicited utilities and their differences are consistent with the LTC preferences revealed from focus group discussions. These preferences depend on levels of disability and education. CONCLUSIONS The modified TTO technique seems a feasible method to quantify preferences over LTC delivery options. These methods may be applicable to various health care alternatives in which better evidence is needed to guide funding policy.
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Affiliation(s)
- Jing Guo
- American Institutes for Research, Washington, DC, USA.
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19
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Abstract
There continue to be serious deficiencies in the quality of life available to many nursing home residents in the United States. One significant response to this undesirable situation is the nursing home "Culture Change" movement, which attempts to improve the nursing home environment-and consequently residents' quality of life-by making facilities less institutional and more homelike. One of the impediments often interfering with the adoption and implementation of culture change in specific facilities is apprehension by staff, administrators, and governing boards about potential legal liability and regulatory exposure if residents suffer injuries that might arguably be attributed to facility conditions or policies that were inspired and encouraged by the culture change movement. This article addresses and responds to the provider liability and regulatory apprehensions that impede the progress of culture change in nursing homes, using proposed new dietary services standards as an example.
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Affiliation(s)
- Marshall B Kapp
- *Address correspondence to Marshall B. Kapp, JD, Center for Innovative Collaboration in Medicine and Law, Florida State University, 1115W. Call Street, Tallahassee, FL 32306-4300. E-mail:
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Konetzka RT, Karon SL, Potter D. Users Of Medicaid Home And Community-Based Services Are Especially Vulnerable To Costly Avoidable Hospital Admissions. Health Aff (Millwood) 2012; 31:1167-75. [DOI: 10.1377/hlthaff.2011.0902] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- R. Tamara Konetzka
- R. Tamara Konetzka ( ) is an associate professor in the Department of Health Studies at the University of Chicago, in Illinois
| | - Sarita L. Karon
- Sarita L. Karon is a senior scientist at the Center for Health Systems Research and Analysis at the University of Wisconsin–Madison
| | - D.E.B. Potter
- D.E.B. Potter is a senior survey statistician in the Center for Financing, Access, and Cost Trends at the Agency for Healthcare Research and Quality, in Rockville, Maryland
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Wiener JM. Long-Term Care: Getting on the Agenda and Knowing What to Propose. Med Care Res Rev 2010; 67:126S-40S. [DOI: 10.1177/1077558710365718] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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