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Wylie MJ, Boerner K, Miller EA, Kim K, Burr JA. Type of Home Care-Informal Versus At Least Some Formal-Matters for Recipients' Perceived Control. Gerontologist 2024; 64:gnad127. [PMID: 37772745 DOI: 10.1093/geront/gnad127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Perceived control is an important psychological resource for middle-aged and older adults. Aging in place may help foster feelings of control, yet many community-dwelling older adults must rely on others-whether family, friends, or professionals-for physical assistance. This study investigated how receiving home care from different sources was associated with two facets of perceived control (mastery and perceived constraints) among adults with varying levels of physical disability. RESEARCH DESIGN AND METHODS Data were drawn from the 2012 and 2014 waves of the Health and Retirement Study. Community-dwelling adults aged 50 years and older receiving help for at least one activity of daily living (ADL) impairment (N = 884) reported their relationship to each respective caregiver (formal professional and/or informal family or friend), level of ADL impairment, and ratings of perceived control. Ordinary least squares regression was used to examine the association between type of support and perceived control, as well as the moderating effect of physical disability on that relationship. RESULTS Compared to receipt of informal support alone, receiving a combination of formal and informal support was related to perceptions of greater control over one's life, but only in terms of mastery. The level of one's ADL impairment did not have a moderating effect on the relationship between support type and perceived control. DISCUSSION AND IMPLICATIONS Findings suggested that the type of instrumental support adults receive in their home has implications for specific facets of perceived control. These findings can help inform home care program development.
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Affiliation(s)
- Molly J Wylie
- Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Kathrin Boerner
- Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Edward Alan Miller
- Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Kyungmin Kim
- Department of Child Development and Family Studies, College of Human Ecology, Seoul National University, Seoul, Republic of Korea
| | - Jeffrey A Burr
- Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts, USA
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Miller EA, Beauregard LK. Medicaid Home and Community-Based Services in the Wake of the COVID-19 Pandemic. J Health Polit Policy Law 2024; 49:289-313. [PMID: 37801016 DOI: 10.1215/03616878-10989703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
The need to bolster Medicaid home and community-based services (HCBS) became more evident during the COVID-19 pandemic. This recognition stemmed from the challenges of keeping people safe in nursing homes and the acute workforce shortages in the HCBS sector. This article examines two major federal developments and state responses in HCBS options as a result of the pandemic. The first initiative entails a one-year increase of the federal Medicaid matching rate for HCBS included in the American Rescue Plan Act championed by the Biden administration. The second initiative encompasses administrative flexibilities that permitted states to temporarily expand and modify their existing Medicaid HCBS programs. The article concludes that the effects of the pandemic flexibilities and enhanced federal funding on most state HCBS programs will be limited without continued investment and leadership on the part of the federal government, which is a Biden administration priority. States that make the American Rescue Act and COVID-19 flexibilities initiatives permanent are states that have the fiscal resources and political commitment to expanding HCBS benefits that other states lack. States' different approaches to bolstering Medicaid HCBS during the pandemic may contribute to widening disparities in access and quality of HCBS across states and populations who depend on Medicaid HCBS.
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Hawes FM, Tavares JL, Ronneberg CR, Miller EA. The Effects of Religiosity on Depression Trajectories After Widowhood. Omega (Westport) 2024; 88:1240-1257. [PMID: 35139669 DOI: 10.1177/00302228211051509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This longitudinal study analyzed data from the 2006-2016 waves of the nationally representative Health and Retirement Study (HRS). Trajectories of depression among older adults ≥ 50 years (N = 1254) were examined over time to explore patterns of depression among those entering widowhood and the potential impact of religiosity on depressive symptoms during various stages of widowhood. Ordinary least squares (OLS) regression analysis was used to examine the association between widowhood and depression and the role of religiosity as a moderator of this association. Older adults experienced a statistically significant increase in depressive symptomology after the onset of widowhood, and depressive symptomology decreased post widowhood, but did not return to pre-widowhood levels. Additionally, high religious service attendance and higher intrinsic religiosity were both associated with lower depressive symptomology. High religious service attendance moderated the relationship between widowhood and depression among widowed older adults living alone.
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Affiliation(s)
- Frances M Hawes
- Health Care Administration Department, University of Wisconsin Eau Claire, Eau Claire, WI, USA
| | - Jane L Tavares
- LeadingAge LTSS Center, University of Massachusetts Boston, Boston, MA, USA
| | - Corina R Ronneberg
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Edward Alan Miller
- Department of Gerontology and Gerontology Institute. University of Massachusetts Boston, Boston, MA, USA
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Nadash P, Miller EA, Simpson E, Wylie M, Shellito N, Lin Y, Jansen T, Cohen MA. Promoting Sustainability in Housing with Services: Insights From the Right Care, Right Place, Right Time Program. Res Aging 2024; 46:113-126. [PMID: 37596771 DOI: 10.1177/01640275231196904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
Despite the widely-acknowledged potential of housing with services for improving the lives of low-income older adults, ensuring their financial sustainability has been challenging. This study aimed to address this issue, drawing on 31 key informant interviews and three focus groups with payers, housing providers, and community partners involved in the Boston-area Right Care, Right Place, Right Time Program, which enrolled about 400 older adults. Transcripts were qualitatively analyzed using thematic coding. Participants agreed on the program's value, but there was little consensus on mechanisms for securing ongoing funding. The broadly distributed responsibility for individuals in housing sites, which involves health insurers, hospitals, and community service providers, provides little incentive for investment by these entities. Findings suggest that governmental mechanisms, probably at the federal level, are needed to channel funding toward these supportive services. Without such reliable funding sources, replication of supportive housing models for low-income older people will prove difficult.
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Affiliation(s)
- Pamela Nadash
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
| | - Edward Alan Miller
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
- Department of Health Services Policy and Practice, School of Public Health, Brown University, Providence Rhode Island
| | - Elizabeth Simpson
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
| | - Molly Wylie
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
| | - Natalie Shellito
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
| | - Yan Lin
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
| | - Taylor Jansen
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
| | - Marc A Cohen
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
- Center for Consumer Engagement and Health System Transformation, Community Catalyst, Boston, MA, USA
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Alberth AG, Miller EA, Silverstein NM, Stokes J, Su YJ. The Mediating Role of Proxy Respondents on the Relationship between Cognitive Function and Self-Rated Health. Gerontologist 2023:gnad163. [PMID: 38102748 DOI: 10.1093/geront/gnad163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Proxy respondents are an important tool in survey research, especially among people with cognitive impairment. However, proxy respondents may be unable to accurately answer subjective survey instruments for cognitively impaired persons. This study investigates the mediating effect of proxy status on the relationship between cognitive impairment and subjectively-rated health. RESEARCH DESIGN AND METHODS Respondents from the 2018 wave of the Health and Retirement Study (N=17,146) were included, and the Baron and Kenny method assessed potential mediating role of having a proxy on subjectively-rated health. Subjectively-rated health and proxy status were dichotomously coded, and relationships between cognitive impairment, proxy status, and subjectively-rated health were assessed using logistic regression. RESULTS Findings indicate that cognitive impairment is inversely associated with subjectively-rated health, and it is directly associated with having a proxy. They also indicate that having a proxy is inversely related with subjectively-rated health. When including proxy status and cognitive impairment in the same model, cognitive impairment no longer predicted subjectively-rated health. This indicates that proxy status perfectly mediated the relationship between cognitive impairment and subjectively-rated health. DISCUSSION AND IMPLICATIONS Measuring the experiences of people with cognitive impairment is challenging in survey research due to the limiting features of cognitive impairment. While having a proxy respondent helps address attrition-related measurement challenges in survey research, findings indicate that proxies report worse subjectively-rated health for people with cognitive impairment compared to individuals with comparable levels of cognitive impairment without a proxy. Future research may benefit from exploring optimal proxy-respondent characteristics.
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Affiliation(s)
- Andrew G Alberth
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
| | - Edward Alan Miller
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
- Department of Health Services, Policy, and Practice, Brown University, Providence, RI, USA
| | - Nina M Silverstein
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
- Gerontology Institute, University of Massachusetts Boston, Boston, MA, USA
| | - Jeffrey Stokes
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
| | - Yan-Jhu Su
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
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6
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Gleason HP, Miller EA, Boerner K. Focusing on the Positive: Home Health Aides' Desire for Autonomy and Control. J Appl Gerontol 2023; 42:728-736. [PMID: 36523133 DOI: 10.1177/07334648221145177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Home Health Aides (HHAs) are one of the fastest growing workforces in the country, yet the industry struggles to recruit and retain workers. This study explored HHAs' experiences with the level of control, autonomy, and decision-making authority in their work. Six focus groups with 37 HHAs were conducted in Massachusetts. Findings showed that HHAs viewed control as a positive job characteristic, which attracted them to and led them to remain in the position. Positive benefits included having control over client selection, location, hours, and the ability to determine their day-to-day tasks and schedules. The study results highlight the value that HHAs place on autonomy and control and the potential benefit that these job qualities have for greater recruitment and retention of these workers. Amplifying control by bolstering training and expanding scope of practice may entice new individuals to pursue a HHA career and help maintain those currently in the position.
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Affiliation(s)
- Hayley P Gleason
- 50252Colorado Department of Health Care Policy & Financing, Denver, CO, USA
| | - Edward Alan Miller
- Department of Gerontology and Gerontology Institute, John W. McCormack Graduate School of Policy & Global Studies, 14708University of Massachusetts Boston, Boston, MA, USA.,Department of Health Services, Policy and Practice, and Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI, USA
| | - Kathrin Boerner
- Department of Gerontology and Gerontology Institute, John W. McCormack Graduate School of Policy & Global Studies, 14708University of Massachusetts Boston, Boston, MA, USA
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7
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Tavares J, Simpson L, Miller EA, Nadash P, Cohen M. The effect of the right care, right place, right time (R3) initiative on Medicare health service use among older affordable housing residents. Health Serv Res 2023; 58 Suppl 1:111-122. [PMID: 36270972 PMCID: PMC9843081 DOI: 10.1111/1475-6773.14086] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To determine the effect of an affordable housing-based supportive services intervention, which partnered with health and community service providers, on Medicare health service use among residents. DATA SOURCES Analyses used aggregated fee-for-service Medicare claims data from 2017 to 2020 for beneficiaries living in 34 buildings in eastern Massachusetts. STUDY DESIGN Using a quasi-experimental design, a "difference-in-differences" framework was employed to isolate changes in outcomes, focusing on changes in pre- and post-intervention health service use across two stages of the intervention. Phase 1 encompassed the initial implementation period, and Phase 2 introduced a strategy to target residents at high risk of poor health outcomes. Key health service outcomes included hospitalizations, 30-day hospital readmission, and emergency department use. DATA COLLECTION Medicare claims data for 10,412 individuals were obtained from a Quality Improvement Organization and aggregated at the building level. PRINCIPAL FINDINGS Analyses for Phase 1 found that hospital admission rates, emergency department admissions and payments, and hospital readmission rates grew more slowly for intervention sites than comparison sites. These findings were strengthened after the introduction of risk-targeting in Phase 2. Compared to selected control buildings, residents in intervention buildings experienced significantly lower rates of increases in inpatient hospitalization rates (-16% vs. +6%), hospital admission days (-25% vs. +29%), average hospital days (-12% vs. +14%), hospital admission payments (-22% vs. +33%), and 30-day hospital readmission rates (-22% vs. +54%). When accounting for the older age of the intervention residents, the size of the decline recorded in emergency department admissions was 6.7% greater for the intervention sites than the decline in comparison sites. CONCLUSIONS A wellness-focused supportive services intervention was effective in reducing select health service use. The introduction of risk-targeting further strengthened this effect. Age-friendly health systems would benefit from enhanced partnerships with affordable housing sites to improve care and reduce service use for older residents.
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Affiliation(s)
- Jane Tavares
- LeadingAge Center for Long‐Term Services & Supports at UMass BostonBostonMassachusettsUSA
| | - Liz Simpson
- Department of GerontologyUniversity of Massachusetts Boston, John W. McCormack Graduate School of Policy and Global StudiesBostonMassachusettsUSA
| | - Edward Alan Miller
- Department of GerontologyUniversity of Massachusetts Boston, John W. McCormack Graduate School of Policy and Global StudiesBostonMassachusettsUSA
| | - Pamela Nadash
- Department of GerontologyUniversity of Massachusetts Boston, John W. McCormack Graduate School of Policy and Global StudiesBostonMassachusettsUSA
| | - Marc Cohen
- LeadingAge Center for Long‐Term Services & Supports at UMass BostonBostonMassachusettsUSA
- Department of GerontologyUniversity of Massachusetts Boston, John W. McCormack Graduate School of Policy and Global StudiesBostonMassachusettsUSA
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8
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Prasad A, Shellito N, Alan Miller E, Burr JA. Association of Chronic Diseases and Functional Limitations with Subjective Age: The Mediating Role of Sense of Control. J Gerontol B Psychol Sci Soc Sci 2023; 78:10-19. [PMID: 35995574 DOI: 10.1093/geronb/gbac121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES This study examined the relationships between chronic diseases, functional limitations, sense of control, and subjective age. Older adults may evaluate their subjective age by reference to their younger healthier selves and thus health and functional status are likely to be determinants of subjective age. Although sense of control is also a potential predictor of subjective age, stress-inducing factors associated with disease and functional limitations may reduce older adults' sense of control, making them feel older. METHODS Using the 2010 and 2014 waves of the Health and Retirement Study, structural equation modeling was performed on a sample of 6,329 respondents older than 50 years to determine whether sense of control mediated the relationship between chronic diseases, limitations in instrumental/basic activities of daily living (ADLs, IADLs), and subjective age. RESULTS Chronic diseases and limitations in ADLs had a positive, direct association with subjective age (β = 0.037, p = .005; β = 0.068, p = .001, respectively). In addition, chronic diseases and limitations in ADLs and IADLs were positively, indirectly associated with subjective age via a diminished sense of control (β = 0.006, p = .000; β = 0.007, p = .003; β = 0.019, p = .000, respectively). DISCUSSION As predicted by the Deterioration model, the findings showed that chronic diseases and functional impairment are associated with older adults feeling older by challenging the psychological resource of sense of control. Appropriate interventions for dealing with health challenges and preserving sense of control may help prevent the adverse downstream effects of older subjective age.
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Affiliation(s)
- Anyah Prasad
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Natalie Shellito
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Edward Alan Miller
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA.,Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Jeffrey A Burr
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA
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Beauregard LK, Miller EA. A Comparative Analysis of State Implementation of the Community First Choice Program. J Appl Gerontol 2022; 41:2140-2147. [PMID: 35658730 DOI: 10.1177/07334648221107073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The Patient Protection and Affordable Care Act included Community First Choice (CFC), a new optional Medicaid home and community-based services (HCBS) state plan benefit which states could adopt. Through the CFC program, states can provide expanded home and community-based attendant services and supports to older adults and persons with disabilities. A benefit of CFC is that states receive a higher federal match rate than other HCBS programs. Thus far, eights states have adopted CFC. This comparative case study analysis examines state-level implementation of CFC to identify what facilitated implementation and what created challenges. The results suggest that consulting with the Centers for Medicare and Medicaid Services facilitated implementation while existing programs, insufficient engagement with stakeholders, aggressive timelines, and limited staff resources presented challenges. Based on these findings, states may want to consider how they approach implementing expansions or enhancements to HCBS benefits under the American Rescue Plan Act.
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Affiliation(s)
| | - Edward Alan Miller
- Department of Gerontology and Gerontology Institute, John W. McCormack Graduate School of Policy & Global Studies, 14708University of Massachusetts Boston, Boston, MA, USA
- Department of Health Services Policy & Practice and Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI, USA
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10
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Li Y, Mutchler JE, Miller EA, Xiao JJ, Tucker-Seeley R. Space, Context, and Human Capital: A Micro–Macro Perspective on the Social Environment and Financial Literacy in Later Life. Popul Res Policy Rev 2022. [DOI: 10.1007/s11113-021-09695-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Miller EA, Beauregard LK. Enhancing Federal Revenue under the American Rescue Plan Act: An Opportunity to Bolster State Medicaid Home and Community-Based Services Programs. J Aging Soc Policy 2022; 35:287-301. [PMID: 34983329 DOI: 10.1080/08959420.2021.2022952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The American Rescue Plan Act (ARPA) includes a one-year 10 percentage point increase in the Federal Medical Assistance Percentage for Medicaid-funded home and community-based services (HCBS). The goal is to strengthen state efforts to help older adults and people with disabilities live safely in their homes and communities rather than in institutional settings during the COVID-19 pandemic. This essay provides a detailed description and analysis of this provision, including issues state governments need to consider when expending the additional federal revenue provided. It also draws lessons from the Affordable Care Act's Balancing Incentive Program to suggest insights for the potential of ARPA to promote further growth in Medicaid HCBS programs. It argues that key to success will be consultation with community stakeholders under the auspices of clear and frequent federal guidance and the development of concrete plans with which to expend the additional revenues in the most effective way possible in the limited time frame provided. The essay concludes by highlighting the importance of instituting strategies and processes for maximizing enhanced federal matching funds under ARPA in preparation for subsequent availability of substantial additional federal resources targeting Medicaid HCBS under other proposed initiatives.
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Affiliation(s)
- Edward Alan Miller
- Professor, Department of Gerontology, and Fellow, Gerontology Institute, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA.,Adjunct Professor, Department of Health Services Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Lisa Kalimon Beauregard
- Director, Home and Community- Massachusetts Executive Office of Elder Affairs, Boston, Massachusetts, USA
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12
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Abstract
The COVID-19 pandemic has disrupted life globally through virus-related mortality and morbidity and the social and economic impacts of actions taken to stop the virus' spread. It became evident early in the pandemic that COVID-19 and the strategies adopted to mitigate its effects would have a disproportionate impact on older adults. This special issue of the Journal of Aging & Social Policy reports original empirical research and perspectives on the ramifications of the COVID-19 pandemic for this population. This introductory essay highlights key issues pertaining to the impact of COVID-19 on older adults and their families, caregivers, and communities. The prevalence and susceptibility of COVID-19 infection in the older adult population is discussed, including the devastating consequences of the pandemic for residents and staff of long-term care facilities. This is followed by a brief examination of ageism and social isolation brought to the fore during the pandemic, as well as the adverse effects of the pandemic for the economy and racial and ethnic minority populations. It concludes with an overview of issue content.
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Affiliation(s)
- Edward Alan Miller
- Professor and Chair, Department of Gerontology, and Fellow, Gerontology Institute, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts, Boston, Massachusetts, USA.,Adjunct Professor of Health Services, Policy and Practice, Brown University, Providence, Rhode Island, USA
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13
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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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14
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Beauregard LK, Miller EA. A Comparative Case Study Analysis of Barriers and Facilitators to Implementing the Affordable Care Act's Balancing Incentive Program. Res Aging 2021; 44:276-285. [PMID: 34134564 DOI: 10.1177/01640275211020795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Affordable Care Act included the opportunity for states to increase spending on Medicaid home and community-based services (HCBS) for older adults and persons with disabilities through the Balancing Incentive Program (BIP). This study utilized comparative case studies to identify the factors that facilitated or impeded states' implementation of BIP. Findings indicate factors that facilitated the implementation of BIP were communication with the federal government and its contractor, merging BIP with existing HCBS programs, and enhanced federal revenue. On the other hand, the short duration of BIP, state procurement and contracting processes, and the need to incorporate feedback from non-governmental stakeholders and determining how to spend the enhanced revenue proved challenging for some states. This research suggests ways federal and state officials can implement new initiatives to achieve greater rebalancing of Medicaid long-term services and supports for older adults.
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Affiliation(s)
- Lisa Kalimon Beauregard
- Home and Community-Based Services Policy Lab, Massachusetts Executive Office of Elder Affairs, Boston, MA, USA
| | - Edward Alan Miller
- Department of Gerontology and Gerontology Institute, John W. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston, MA, USA.,Department of Health Services Policy & Practice and Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI, USA
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15
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Abstract
BACKGROUND AND OBJECTIVES This study examined relationships between the level of control and support and home health aides (HHAs) job satisfaction and intent to leave the job. RESEARCH DESIGN AND METHODS Data derive from a survey of 512 HHAs in Massachusetts. Logistic regression using generalized estimating equations was employed for the analysis. Dependent variables included satisfaction and intent to leave the job as a home care aide generally and satisfaction and intent to leave the job at the aide's current agency. RESULTS The findings showed that greater control and support on the job were important predictors of positive work outcomes, controlling for job demands and other covariates. The odds of HHAs being satisfied with their job as a home care aide increased with the degree of control, whereas the odds of HHAs being satisfied with their job at their current agency increased with the extent of support. Control was negatively associated with HHAs' intent to leave the job as an aide; no relationship was found between control or support and HHAs' intent to leave their current agency. DISCUSSION AND IMPLICATIONS The results from this study illustrate the importance for HHAs of having control and autonomy in their work, as well as the benefit of support from supervisors and the home care agency, on satisfaction and intent to leave. Expanding HHA's ability to maintain control over their day-to-day work, as well as enhancing the supports available to them, is likely to benefit home care workers, clients, and agencies through increased retention.
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Affiliation(s)
- Hayley P Gleason
- Colorado Department of Health Care Policy & Financing, Denver, USA
| | - Edward Alan Miller
- Department of Gerontology and Gerontology Institute, John W. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston, USA.,Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
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16
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Prasad A, Miller EA, Burr JA, Boerner K. Diagnoses of Chronic Health Conditions and Change in Subjective Age: The Moderating Role of Chronological Age. Gerontologist 2021; 62:276-285. [PMID: 33942066 DOI: 10.1093/geront/gnab057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Health is a predictor of subjective age, and although inconclusive, the strength of this association is not uniform across different age groups. This study investigates if new diagnoses of chronic health conditions are associated with a change in subjective age and if chronological age moderates this relationship. RESEARCH DESIGN AND METHODS Using data from the Health and Retirement Study, residualized change regression analysis was performed for a sample of 5,158 respondents older than 50 years to examine their subjective age in 2014 relative to that reported in 2010. The main predictor was the number of chronic health conditions newly diagnosed between 2010 and 2014. Chronological age in 2010 was the moderator. RESULTS Results showed that each new diagnosis of a chronic health condition was significantly associated with a 0.68-year increase in subjective age reported in 2014, compared to subjective age reported in 2010. However, this increase in subjective age was attenuated by 0.05 years for each additional year in 2010 chronological age. DISCUSSION AND IMPLICATIONS According to Social and Temporal Comparison theories, people compare themselves to their age peers and earlier selves. Given expectations for better health at younger chronological ages, being diagnosed with chronic health conditions may have a stronger association with subjective age among middle-aged persons as compared to older persons. The findings suggest that subjective age may be used as a screening tool to predict how chronic disease diagnosis may influence peoples' sense of self, which in turn shapes future health.
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Affiliation(s)
- Anyah Prasad
- Department of Gerontology, John W. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Edward Alan Miller
- Department of Gerontology, John W. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA.,Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Jeffrey A Burr
- Department of Gerontology, John W. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Kathrin Boerner
- Department of Gerontology, John W. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA
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Miller EA, Huberfeld N, Jones DK. Pursuing Medicaid Block Grants with the Healthy Adult Opportunity Initiative: Dressing Up Old Ideas in New Clothes. J Health Polit Policy Law 2021; 46:357-374. [PMID: 32955558 DOI: 10.1215/03616878-8802211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The Trump administration's Healthy Adult Opportunity waiver follows a long history of Republican attempts to retrench the Medicaid program through block grants and to markedly reduce federal spending while providing states with substantially greater flexibility over program structure. Previous block grant proposals were promulgated during the presidential administrations of Ronald Reagan and George W. Bush and majorities in Congress led by House Speaker Newt Gingrich and House Budget Committee Chair and then Speaker Paul Ryan. Most recently, Medicaid block grants featured prominently in Republican efforts to repeal and replace the Affordable Care Act. This essay traces the history of Republican Medicaid block grant proposals, culminating in the Trump administration's Healthy Adult Opportunity initiative. It concludes that the Trump administration's attempt to convert Medicaid into a block grant program through the waiver process is illegal and, if implemented, would leave thousands of people without necessary medical care. This fact, combined with failed legislative efforts to block grant Medicaid during the last forty years, highlights the substantial roadblocks to radically restructuring a popular program that helps millions of Americans.
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Nadash P, Cohen MA, Tavares J, Miller EA. The impact of health-related supports in senior housing on ambulance transfers and visits to emergency departments: The Right Care, Right Place, Right Time Project. Health Serv Res 2021; 56:731-739. [PMID: 33768544 DOI: 10.1111/1475-6773.13640] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To test the impact of placing a wellness team (nurse and social worker) in senior housing on ambulance transfers and visits to emergency departments over 18 months. DATA SOURCES/STUDY SETTING Intervention sites included seven Boston-area buildings, with five buildings at comparable settings acting as controls. Data derive from building-level ambulance data from emergency responders; building-level Medicare claims data on emergency department utilization; and individual-level baseline assessment data from participants in the intervention (n = 353) and control (n = 208) sites. STUDY DESIGN We used a pre/postdifference in difference quasi-experimental design applying several analytic methods. The preintervention period was January 2016-March 2017, while the intervention period was July 2017-December 2018. DATA COLLECTION/EXTRACTION METHODS Emergency responders provided aggregate transfer data on a daily basis for intervention and control buildings; the Quality Improvement Organization provided quarterly aggregate data on emergency department visit rates; and assessment data came from a modified Vitalize 360 assessment and coaching tool. PRINCIPAL FINDINGS The study found an 18.2% statistically significant decline in ambulance transfers in intervention buildings, with greater declines in buildings that had fewer services available at baseline, compared to other intervention sites. Analysis of Medicare claims data, adjusted for the proportion of residents over 75 per building, found fewer visits to emergency departments in intervention buildings. CONCLUSIONS Health-related supports in senior housing sites can be effective in reducing emergency transfers and visits to emergency departments.
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Affiliation(s)
- Pamela Nadash
- Department of Gerontology and Gerontology Institute, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA.,Leading Age Center for Long-Term Services & Supports @UMass Boston, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Marc A Cohen
- Department of Gerontology and Gerontology Institute, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA.,Leading Age Center for Long-Term Services & Supports @UMass Boston, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA.,Center for Consumer Engagement and Health System Transformation, Community Catalyst, Boston, Massachusetts, USA
| | - Jane Tavares
- Department of Gerontology and Gerontology Institute, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA.,Leading Age Center for Long-Term Services & Supports @UMass Boston, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Edward Alan Miller
- Department of Gerontology and Gerontology Institute, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA.,Leading Age Center for Long-Term Services & Supports @UMass Boston, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA.,Department of Health Services, Policy and Practice and Center for Gerontology and Health Care Research, School of Public Health, Brown University, Providence, Rhode Island, USA
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Miller EA, Simpson E, Nadash P, Gusmano M. Thrust Into the Spotlight: COVID-19 Focuses Media Attention on Nursing Homes. J Gerontol B Psychol Sci Soc Sci 2021; 76:e213-e218. [PMID: 32696957 PMCID: PMC7454904 DOI: 10.1093/geronb/gbaa103] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study sheds light on the agenda-setting role of the media during the COVID-19 crisis by examining trends in nursing home (NH) coverage in 4 leading national newspapers-The New York Times, Washington Post, USA Today, and Los Angeles Times. METHOD Keyword searches of the Nexis Uni database identified 2,039 NH-related articles published from September 2018 to June 2020. Trends in the frequency of NH coverage and its tone (negative) and prominence (average words, daily article count, opinion piece) were examined. RESULTS Findings indicate a dramatic rise in the number of NH articles published in the months following the first COVID-19 case, far exceeding previous levels. NH coverage became considerably more prominent, as the average number of words and daily articles on NHs increased. The proportion of negative articles largely remained consistent, though volume rose dramatically. Weekly analysis revealed acceleration in observed trends within the post-COVID-19 period itself. These trends, visible in all papers, were especially dramatic in The New York Times. DISCUSSION Overall, findings reveal marked growth in the frequency and number of prominent and negative NH articles during the COVID-19 crisis. The increased volume of coverage has implications for the relative saliency of NHs to other issues during the pandemic. The increased prominence of coverage has implications for the perceived importance of addressing pre-existing deficits and the devastating consequences of the pandemic for NHs.
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Affiliation(s)
- Edward Alan Miller
- Department of Gerontology, Gerontology Institute, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston
- Department of Health Services Policy and Practice, Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island
| | - Elizabeth Simpson
- Department of Gerontology, Gerontology Institute, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston
| | - Pamela Nadash
- Department of Gerontology, Gerontology Institute, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston
| | - Michael Gusmano
- Health Systems & Policy Concentration, and Department of Health Behavior, Society and Policy, Rutgers University School of Public Health, New Brunswick, New Jersey
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Beauregard LK, Miller EA. Federal Incentives to Reform Long-Term Care under the Affordable Care Act: State Adoption of the Balancing Incentive Program, 2011-2014. J Gerontol B Psychol Sci Soc Sci 2021; 77:191-200. [PMID: 33631012 DOI: 10.1093/geronb/gbab031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The Balancing Incentive Program (BIP) was an optional program for states within the Patient Protection and Affordable Care Act to promote Medicaid-funded home and community-based services (HCBS) for older adults and persons with disabilities. Twenty-one states opted to participate in BIP, including several states steadfastly opposed to the health insurance provisions of the Affordable Care Act. This study focused on identifying what factors were associated with states' participation in this program. METHODS Event history analysis was used to model state adoption of BIP from 2011 to 2014. A range of potential factors were considered representing states' economic, political, and programmatic conditions. RESULTS The results indicate that states with a higher percentage of Democrats in the state legislature, fewer state employees per capita, and more nursing facility beds were more likely to adopt BIP. In addition, states with fewer home health agencies per capita, that devoted smaller proportions of Medicaid long-term care spending to HCBS, and that had more Money Follows the Person transitions were also more likely to pursue BIP. DISCUSSION Findings highlight the role of partisanship, administrative capacity, and program history in state BIP adoption decisions. The inclusion of BIP in the Affordable Care Act may have deterred some states from participating in the program due to partisan opposition to the legislation. To encourage the adoption of optional HCBS programs, federal policymakers should consider the role of financial incentives, especially for states with limited bureaucratic capacity and that have made less progress rebalancing Medicaid long-term services and supports.
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Affiliation(s)
- Lisa Kalimon Beauregard
- Home and Community-Based Services Policy Lab Massachusetts Executive Office of Elder Affairs
| | - Edward Alan Miller
- Department of Gerontology, and Fellow, Gerontology Institute, John W. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston.,Department of Health Services Policy & Practice, and Faculty, Center for Gerontology and Healthcare Research, School of Public Health, Brown University
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Gusmano MK, Miller EA, Nadash P, Simpson EJ. Partisanship in Initial State Responses to the COVID‐19 Pandemic. World Medical & Health Policy 2020. [DOI: 10.1002/wmh3.372] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Intrator O, Miller EA, Cornell PY, Levy C, Halladay CW, Barber M, Corneau E, Mor V, Rudolph JL. Purchasing Quality Nursing Home Care in the Veterans Health Administration. Innov Aging 2020. [DOI: 10.1093/geroni/igaa055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Objectives
U.S. Department of Veterans Affairs Medical Centers (VAMCs) contract with nursing homes (NHs) in their community to serve Veterans. This study compares the characteristics and performance of Veterans Affairs (VA)-paid and non-VA-paid NHs both nationally and within local VAMC markets.
Research Design and Methods
VA-paid NHs were identified, characterized, and linked to VAMC markets using data drawn from VA administrative files. NHs in the United States in December 2015 were eligible for the analysis, including. 1,307 VA-paid NHs and 14,253 non-VA-paid NHs with NH Compare measures in 128 VAMC markets with any VA-paid NHs. Measurements were derived from the Centers for Medicare and Medicaid Services (CMS) five-star rating system, NH Compare.
Results
VA-paid NHs had more beds, residents per day, and were more likely to be for-profit relative to non-VA-paid NHs. Nationally, the average CMS NH Compare star rating was slightly lower among VA-paid NHs than non-VA-paid NHs (3.05 vs. 3.21, p = .04). This difference was seen in all 3 domains: inspection (3.11 vs. 3.23, p < .001), quality (2.68 vs. 2.83, p < .001), and total nurse staffing (3.36 vs. 3.42, p < .10). There was wide variability across VAMC markets in the ratio of average star rating of VA-paid and non-VA-paid NHs (mean ratio = 0.93, interquartile range = 0.78–1.08).
Discussion and Implications
With increased community NH use expected following the implementation of the MISSION Act, comparison of the quality of purchased services to other available services becomes critical for ensuring quality, including for NH care. Methods presented in this article can be used to examine the quality of purchased care following the MISSION Act implementation. In particular, dashboards such as that for VA-paid NHs that compare to similar non-VA-paid NHs can provide useful information to quality improvement efforts.
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Affiliation(s)
- Orna Intrator
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, New York
- Canandaigua VA Medical Center, New York
| | - Edward Alan Miller
- Department of Gerontology and Gerontology Institute, John W. McCormack Graduate School of Policy Studies, University of Massachusetts Boston
- Department of Health Services, Policy & Practice, and Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island
| | - Portia Y Cornell
- Department of Health Services, Policy & Practice, and Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island
- Providence VA Medical Center, Rhode Island
| | - Cari Levy
- Division of Health Care Policy & Research, School of Medicine, University of Colorado, Aurora
| | | | | | - Emily Corneau
- Providence VA Medical Center, Rhode Island
- Rocky Mountain Regional VA Healthcare System, Aurora, Colorado
| | - Vincent Mor
- Department of Health Services, Policy & Practice, and Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island
- Providence VA Medical Center, Rhode Island
| | - James L Rudolph
- Providence VA Medical Center, Rhode Island
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Miller EA, Nadash P, Cohen MA. Stepping into the Breach of Federal Inaction: Reforming the Financing of Long-Term Services and Supports in the Post-CLASS Era. J Health Polit Policy Law 2020; 45:847-861. [PMID: 32597971 DOI: 10.1215/03616878-8543310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The growing need for long-term services and supports (LTSS) poses significant challenges to both individuals and government. This article documents the continuing failure to tackle this problem at the national level-a failure that was most recently seen in the fallout from the Affordable Care Act (ACA), which included the single piece of national legislation ever enacted to comprehensively address LTSS costs: the Community Living Assistance Services and Supports (CLASS) Act. The CLASS Act was passed as part of the ACA (Title 8) but was repealed in 2013. Following its demise, policy experts and some Democrats have made additional proposals for addressing the LTSS financing crisis. Moreover, significant government action is taking place at the state level, both to relieve financial and emotional burdens on LTSS recipients and their families and to ease pressure on state Medicaid budgets. Lessons from these initiatives could serve as opportunities for learning how to overcome roadblocks to successful policy development, adoption, and implementation across states and for traversing the policy and political tradeoffs should a policy window once again open for addressing the problem of LTSS financing nationally.
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Abstract
The COVID-19 pandemic has impacted the lives of people throughout the world, either directly, due to exposure to the virus, or indirectly, due to measures taken to mitigate the virus' effects. Older adults have been particularly hard hit, dying in disproportionately higher numbers, especially in long-term care facilities. Local, regional, and national government actions taken to mitigate the spread of COVID-19 have thus served, in part, to shield older adults from the virus, though not without adverse side effects, including increased social isolation, enhanced economic risk, revealed ageism, delayed medical treatment, and challenges getting basic needs met. This special issue of the Journal of Aging & Social Policy explores the myriad ways in which the COVID-19 pandemic has affected older adults and their families, caregivers, and communities. It proposes policies and strategies for protecting and improving the lives of older people during the pandemic. It draws lessons for aging policy and practice more generally, given underlying challenges brought to the fore by government, provider, community, and individual responses to the pandemic.
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Affiliation(s)
- Edward Alan Miller
- Professor, Department of Gerontology, and Fellow, Gerontology Institute, John W. McCormack Graduate School of Policy Studies, University of Massachusetts Boston , Boston, Massachusetts, USA.,Adjunct Professor, Department of Health Services, Policy and Practice, School of Public Health, Brown University , Providence, Rhode Island, USA
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Bass SA, Caro FG, Miller EA. The Origins and Evolution of the Journal of Aging and Social Policy. J Aging Soc Policy 2019; 32:1-14. [PMID: 31177969 DOI: 10.1080/08959420.2019.1626206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In this essay the current and previous editors discuss the history of the Journal of Aging & Social Policy. In reviewing the past thirty years of publishing the Journal, one can see three phases: Phase 1 took pace during the first decade (1989-1997), Phase 2 covered the next decade and a half or so (1998-2015), and Phase 3 reflects the past five years, a period of continuing growth and success (2016-Present). Despite its inevitable challenges, the Journal of Aging & Social Policy overcame each and has arrived. Today, it is a well-respected Journal that attracts excellent scholarship from around the world, that is well-cited, and that has earned the Journal a commendable impact factor. The editors are proud of that evolution. However, success is never final. The Journal will require continued effective stewardship as it looks to the next thirty years and beyond.
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Affiliation(s)
- Scott A Bass
- Provost Emeritus and Professor, Department of Public Administration and Policy, School of Public Affairs, American University, Washington, DC, USA
| | - Francis G Caro
- Professor Emeritus and Fellow, Department of Gerontology and Gerontology Institute, John W.McCormack Graduate School of Policy Studies, University of Massachusetts Boston, Boston Massachusetts, USA
| | - Edward Alan Miller
- Department of Gerontology and Gerontology Institute, John W. McCormack Graduate School of Policy Studies, University of Massachusetts Boston, USA.,Adjunct Professor, Department of Health Services, Policy & Practice and Center for Gerontology and Healthcare Research, Brown University, Boston, Massachusetts, USA
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Abstract
BACKGROUND AND OBJECTIVES The ongoing shift from defined benefit (DB) to defined contribution (DC) pension plans means that middle-aged and older adults are increasingly being called upon to manage their own fiscal security in retirement. Yet, half of older Americans are financially illiterate, lacking the knowledge and skills to manage financial resources. This study investigates whether pension plan types are associated with varying levels of financial literacy among older Americans. RESEARCH DESIGN AND METHODS Cross-sectional analyses of the 2010 Health and Retirement Study (HRS) (n = 1,281) using logistic and linear regression models were employed to investigate the association between different pension plans and multiple indicators of financial literacy. The potential moderating effect of gender was also examined. RESULTS Respondents with DC plans, with or without additional DB plans, were more likely to correctly answer various financial literacy questions, in comparison with respondents with DB plans only. Men with both DC and DB plans scored significantly higher on the financial literacy index than women with both types of plans, relative to respondents with DB plans only. DISCUSSION AND IMPLICATIONS Middle-aged and older adults, who are incentivized by participation in DC plans to manage financial resources and decide where to invest pension funds, tend to self-educate to improve financial knowledge and skills, thereby resulting in greater financial literacy. This finding suggests that traditional financial education programs may not be the only means of achieving financial literacy. Further consideration should be given to providing older adults with continued, long-term exposure to financial decision-making opportunities.
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Affiliation(s)
- Yang Li
- Department of Gerontology, John E. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston
| | - Jeffrey A Burr
- Department of Gerontology, John E. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston
| | - Edward Alan Miller
- Department of Gerontology, John E. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston
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Miller EA, Gidmark S, Gadbois E, Rudolph JL, Intrator O. Staff Perceptions of Key Factors Guiding Nursing Home Search and Selection Within the Veterans Health Administration. Gerontologist 2018. [PMID: 28641378 DOI: 10.1093/geront/gnx096] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background and Objectives Veterans enter nursing homes (NHs) for short-term postacute, rehabilitation, respite, or end-of-life care. They also enter NHs on a long-term basis due to frailty, disability, functional deficits, and cognitive impairment. Little is known about how a particular NH is chosen once the decision to enter a NH has been made. This study identified VA staff perceptions of the key factors influencing the search and selection of NHs within the Veterans Health Administration (VHA). Research Design and Methods Data derived from 35 semistructured interviews with discharge planning and contracting staff from 12 Veterans Affairs Medical Centers (VAMCs). Results VA staff placed a premium on Veteran and family preferences in the NH selection process, though VA staff knowledge and familiarity with placement options established the general parameters within which NH placement decisions were made. Geographic proximity to Veterans' homes and families was a major factor in NH choice. Other key considerations included Veterans' specialty care needs (psychiatric, postacute, ventilator) and Veteran/facility demographics (age, race/ethnicity, Veteran status). VA staff tried to remain neutral in NH selection, thus instructing families to visit facilities and review publicly available quality data. VA staff report that amenities (private rooms, activities, smoking) and aesthetics (cleanliness, smell, layout, décor) often outweighed objective quality indicators in Veteran and family decision making. Discussion and Implications Findings suggest that VAMCs facilitate Veteran and family decision making around NH selection. They also suggest that VAMCs endeavor to identify and recruit a broader array of higher quality NHs to better match the specific needs of Veterans and families to the choice set available.
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Affiliation(s)
- Edward Alan Miller
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island
| | | | - Emily Gadbois
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island
| | - James L Rudolph
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island
- Providence VA Medical Center, Rhode Island
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Orna Intrator
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island
- Canandaigua VA Medical Center, New York
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, New York
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Abstract
The surprise election of President Donald J. Trump to the presidency of the United States marks a singular turning point in the American republic-not only because of his idiosyncratic approach to the office, but also because the Republican Party now holds the presidency and both houses of Congress, presenting a historic opportunity for change. The role of older Americans has been critical in both shaping and reacting to this political moment. Their political orientations and behaviors have shaped it through their electoral support for Republican candidates, but they also stand as highly invested stakeholders in the policy decisions made by the very officials they elected and as beneficiaries of the programs that Republicans have targeted. This article draws on the content of this issue to explore the ways in which Trump administration policies are likely to significantly undermine the social safety net for near-elderly and older Americans with respect to long-term care, housing, health care, and retirement. It also draws on issue content to speculate on the ways that these policy changes might shape politics and political behavior. We conclude that the response of older voters in the 2018 midterm elections to efforts by the Trump administration and its Republican allies in Congress to draw back on the federal government's commitment to programs and policies affecting them will shape the direction of aging policy and politics in the years to come.
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Affiliation(s)
- Edward Alan Miller
- a Department of Gerontology and Gerontology Institute , John W. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston , Boston , Massachusetts , USA.,b Department of Health Services , Policy & Practice and Center for Gerontology and Healthcare Research, School of Public Health, Brown University , Providence , Rhode Island , USA
| | - Pamela Nadash
- a Department of Gerontology and Gerontology Institute , John W. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston , Boston , Massachusetts , USA
| | - Michael K Gusmano
- c Department of Health Systems & Policy, School of Public Health, Rutgers , The State University of New Jersey , New Brunswick , New Jersey , USA.,d The Hastings Center , Garrison , New York , USA
| | - Elizabeth Simpson
- a Department of Gerontology and Gerontology Institute , John W. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston , Boston , Massachusetts , USA
| | - Corina R Ronneberg
- a Department of Gerontology and Gerontology Institute , John W. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston , Boston , Massachusetts , USA.,e Center for Health Behavior Research , Institute for Health Research & Policy, University of Illinois at Chicago , Chicago , Illinois , USA
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Miller EA, Nadash P, Gusmano MK. AGING POLITICS IN THE TRUMP ERA. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E A Miller
- University of Massachusetts Boston, Boston, Massachusetts
| | - P Nadash
- University of Massachusetts Boston, Boston, Massachusetts
| | - M K Gusmano
- Rutgers University School of Public Health, New Brunswick, New Jersey
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Miller EA, Gusmano M, Nadash P, Ronneberg C. THE ROLE OF GLOBAL SCHOLARSHIP IN THE JOURNAL OF AGING & SOCIAL POLICY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- E A Miller
- University of Massachusetts Boston, Boston, Massachusetts, United States
| | - M Gusmano
- International Editor, Journal of Aging & Social Policy, Rutgers University, New Brunswick, NJ, USA
| | - P Nadash
- Book Review Editor, Journal of Aging & Social Policy
| | - C Ronneberg
- Managing Editor, Journal of Aging & Social Policy, Senior Research Specialist, University of Illinois Chicago, Chicago, IL, USA
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Miller EA, Gaudet Hefele J, Nadash P. THE ROLE OF USER-GENERATED AND SYSTEMATICALLY COLLECTED CONSUMER EXPERIENCE INFORMATION IN THE NURSING HOME SECTOR. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E A Miller
- University of Massachusetts Boston, Boston, Massachusetts, United States
| | - J Gaudet Hefele
- Assistant Professor, Department of Gerontology and Gerontology Institute, McCormack Graduate of Policy & Global Studies University of Massachusetts Boston
| | - P Nadash
- Associate Professor, Department of Gerontology and Gerontology Institute, McCormack Graduate of Policy & Global Studies University of Massachusetts Boston
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32
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Miller EA, Ronneberg C, Gusmano MK. THE INTERNATIONAL DIFFUSION OF KNOWLEDGE: PUBLISHING OPPORTUNITIES IN GLOBAL GERONTOLOGY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- E A Miller
- University of Massachusetts Boston, Boston, Massachusetts
| | - C Ronneberg
- University of Illinois at Chicago, Chicago, Illinois
| | - M K Gusmano
- Rutgers University School of Public Health, New Brunswick, New Jersey
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33
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Miller EA, Gusmano MK, Jones DK. AGING POLICY IN THE TRUMP ERA. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- E A Miller
- University of Massachusetts Boston, Boston, Massachusetts
| | - M K Gusmano
- Rutgers University School of Public Health, New Brunswick, New Jersey
| | - D K Jones
- Boston University, Boston, Massachusetts
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Nadash P, Hefele JG, Miller EA, Barooah A, Wang X(J. A National-Level Analysis of the Relationship Between Nursing Home Satisfaction and Quality. Res Aging 2018; 41:215-240. [DOI: 10.1177/0164027518805001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little research has explored the relationship between consumer satisfaction and quality in nursing homes (NHs) beyond the few states mandating satisfaction surveys. We examine this relationship through data from 1,765 NHs in the 50 states and District of Columbia using My InnerView resident or family satisfaction instruments in 2013 and 2014, merged with Certification and Survey Provider Enhanced Reporting, LTCfocus, and NH Compare (NHC) data. Family and resident satisfaction correlated modestly; both correlated weakly and negatively with any quality-of-care (QoC) and any quality-of-life deficiencies and positively with NHC five-star ratings; this latter positive association persisted after covariate adjustment; the negative relationship between QoC deficiencies and family satisfaction also remained. Overall, models explained relatively small proportions of satisfaction variance; correlates of satisfaction varied between residents and families. Findings suggest that satisfaction is a unique dimension of quality and that resident and family satisfaction represent different constructs.
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Affiliation(s)
- Pamela Nadash
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA
| | - Jennifer Gaudet Hefele
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA
| | - Edward Alan Miller
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA
| | - Adrita Barooah
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA
| | - Xiao (Joyce) Wang
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA
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Nadash P, Miller EA, Jones DK, Gusmano MK, Rosenbaum S. A series of unfortunate events: implications of Republican efforts to repeal and replace the Affordable Care Act For older adults. J Aging Soc Policy 2018; 30:259-281. [DOI: 10.1080/08959420.2018.1462683] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Pamela Nadash
- Department of Gerontology, John W. McCormack Graduate School of Policy Studies, University of Massachusetts Boston, Boston, Massachusetts, USA
- Gerontology Institute, John W. McCormack Graduate School of Policy Studies, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Edward Alan Miller
- Department of Gerontology, John W. McCormack Graduate School of Policy Studies, University of Massachusetts Boston, Boston, Massachusetts, USA
- Gerontology Institute, John W. McCormack Graduate School of Policy Studies, University of Massachusetts Boston, Boston, Massachusetts, USA
- Department of Health Services, Policy & Practice, Brown University, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University, Providence Rhode Island, USA
| | - David K. Jones
- Department of Health Law, Policy & Management, Boston University, Boston, Massachusetts, USA
| | - Michael K. Gusmano
- School of Public Health, Rutgers, State University of New Jersey, New Brunswick, New Jersey, USA
- The Hastings Center, Garrison, New York, USA
| | - Sara Rosenbaum
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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Miller EA, Ronneberg CR, Livingstone I. The Tone of Nursing Home Portrayal in 51 Newspapers in the United States. World Medical & Health Policy 2018. [DOI: 10.1002/wmh3.268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Jones DK, Gusmano MK, Nadash P, Miller EA. Undermining the ACA through the executive branch and federalism: what the Trump administration's approach to health reform means for older Americans. J Aging Soc Policy 2018; 30:282-299. [PMID: 29649407 DOI: 10.1080/08959420.2018.1462684] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The ACA has survived multiple existential threats in the legislative and judicial branches, including dozens of congressional attempts at repeal and two major Supreme Court cases. Even as it seems that the ACA is here to stay, what the law accomplishes is far from settled. The Trump administration is using executive powers to weaken the law, in many cases using the same powers that President Obama used to strengthen the effects of the reform. States have responded by seeking flexibility to pursue reforms, such as work requirements, that could not pass Congress and that were not allowed by the Obama administration. There is no indication that the ACA is imploding as President Trump has predicted and seems to desire, although these changes have a real and substantial impact on the lives of many Americans, including the near-elderly in unique ways.
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Affiliation(s)
- David K Jones
- a Department of Health Law , Policy & Management, Boston University
| | - Michael K Gusmano
- b Department of Health Systems and Policy , School of Public Health, Rutgers, the State University of New Jersey.,c The Hastings Center
| | - Pamela Nadash
- d Department of Gerontology , John W. McCormack Graduate School of Policy Studies, University of Massachusetts Boston
| | - Edward Alan Miller
- e Department of Gerontology and Gerontology Institute , John W. McCormack Graduate School of Policy Studies, University of Massachusetts Boston.,f Department of Health Services , Policy & Practice and Center for Gerontology and Healthcare Research, Brown University
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Miller EA, Intrator O, Gadbois E, Gidmark S, Rudolph JL. VA Staff Perceptions of Barriers and Facilitators to Home-and Community-Based Placement Post-Hospital Discharge. J Aging Soc Policy 2018; 31:1-29. [PMID: 29469672 DOI: 10.1080/08959420.2018.1444889] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study identifies factors U.S. Department of Veterans Affairs (VA) staff perceived to promote or impede home- and community-based services (HCBS) placement post-hospital discharge among Veterans cared for within the VA. Data derive from 35 semi-structured interviews with staff from 12 VA medical centers from around the country. VA staff reported that Veteran's care needs and social and financial resources influence HCBS placement. They also reported prerequisites for successful placement, including housing, unpaid informal care, and non-VA services funded privately and by public programs such as Medicaid and the Older Americans Act. Lack of staffing and failure to offer the specific types of services needed limit referral to and use of HCBS. Budgetary imperatives influence the relative availability of HCBS across VA medical centers. Findings highlight patient-, provider-, and system-level constraints that impede successful placement at home and in the community of Veterans in need of long-term services and supports after hospitalization.
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Affiliation(s)
- Edward Alan Miller
- Department of Gerontology and Gerontology Institute, John W. McCormack Graduate School of Policy Studies, University of Massachusetts Boston, Boston, Massachusetts, USA.,Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Orna Intrator
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island, USA.,Canandaigua VA Medical Center, Canandaigua, New York, USA.,Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Emily Gadbois
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island, USA
| | | | - James L Rudolph
- Providence VA Medical Center, Providence, Rhode Island, USA.,The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
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Miller EA, Livingstone I, Ronneberg CR. Media Portrayal of the Nursing Homes Sector: A Longitudinal Analysis of 51 U.S. Newspapers. Gerontologist 2018; 57:487-500. [PMID: 26884064 DOI: 10.1093/geront/gnv684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 10/08/2015] [Indexed: 11/13/2022] Open
Abstract
Purpose Most Americans' low opinion of the nursing home (NH) sector could derive, in part, from the way in which it is portrayed in the media. This study furthers understanding of media portrayal of the NH sector by identifying how NHs were depicted in 51U.S. newspapers from 1999 to 2008. Design and methods Keyword searches of the LexisNexis database were performed to identify 16,280 NH-related articles. Article content was analyzed, and tone, themes, prominence, and central actor were assessed. Basic frequencies and descriptive statistics were used to examine article content across regions, market type, and over time. Results Findings reveal considerably less NH coverage in the Western United States and a steady decline in NH coverage nationally over time. Most articles were news stories; more than one third were located on the front page of the newspaper or section. Most articles focused on NH industry and government interests, very few on residents/family and community concerns. Most articles were neutral or negative in tone; very few were positive or mixed. Common themes included quality, financing, and legal concerns. Tone, themes, and other article attributes varied across region, market type, and over time. Implications Overall, findings reveal changes in how newspapers framed NH coverage, not only with respect to tone but also with respect to what dimensions of this complex issue have been emphasized during the time period analyzed. Variation in media coverage may contribute to differences in government and public views toward the NH sector across regions and over time.
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Affiliation(s)
- Edward Alan Miller
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston.,Gerontology Institute, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston.,Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island.,Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island
| | - Ian Livingstone
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston
| | - Corina R Ronneberg
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston
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Miller EA, Gidmark S, Gadbois E, Rudolph JL, Intrator O. Nursing Home Referral Within the Veterans Health Administration: Practice Variation by Payment Source and Facility Type. Res Aging 2017; 40:687-711. [PMID: 28899261 DOI: 10.1177/0164027517730383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Veterans enrolled within the Veterans Health Administration (VHA) of the U.S. Department of Veterans Affairs (VA) may receive nursing home (NH) care in VHA-operated Community Living Centers (CLCs), State Veterans Homes (SVHs), or community NHs, which may or may not be under contract with the VHA. This study examined VHA staff perceptions of how Veterans' eligibility for VA and other payment impacts NH referrals within VA Medical Centers (VAMCs). Thirty-five semistructured interviews were performed with discharge planning and contracting staff from 12 VAMCs from around the country. VA staff highlights the preeminent role that VA priority status played in determining placement in VA-paid NH care. VHA staff reported that Veterans' placement in a CLC, community NH, or SVH was contingent, in part, on potential payment source (VA, Medicare, Medicaid, and other) and anticipated length of stay. They also reported that variation in Veteran referral to VA-paid NH care across VAMCs derived, in part, from differences in local and regional policies and markets. Implications for NH referral within the VHA are drawn.
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Affiliation(s)
- Edward Alan Miller
- 1 Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA.,3 Providence VA Medical Center, Providence, RI, USA
| | | | | | - James L Rudolph
- 2 Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI, USA.,3 Providence VA Medical Center, Providence, RI, USA.,4 The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Orna Intrator
- 2 Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI, USA.,5 Canandaigua VA Medical Center, Canandaigua, NY, USA.,6 Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
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Miller EA, Intrator O, Gadbois E, Gidmark S, Rudolph JL. VA staff perceptions of the role of the extended care referral process in home and community-based services versus nursing home use posthospital discharge. Home Health Care Serv Q 2017; 36:63-80. [PMID: 28605268 DOI: 10.1080/01621424.2017.1336960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Little is known about how the extended care referral process-its structure and participants-influences Veterans' use of home and community-based services (HCBS) over nursing home care within the Veterans Health Administration (VHA). This study thus characterizes the extended care referral process within the VHA and its impact on HCBS versus nursing home use at hospital discharge. Data derive from 35 semistructured interviews at 12 Veterans Affairs Medical Centers (VAMCs). Findings indicate that the referral process is characterized by a commitment by care teams to consider HCBS if possible, varied practice depending on the clinician that most heavily influences care team recommendations, and care team emphasis on respecting Veteran/family preferences even when they are contrary to care team recommendations. Potential modifications include adopting systematic assessment practices; improving Veteran, family, and provider education; and promoting informed selection through shared decision making.
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Affiliation(s)
- Edward Alan Miller
- a Department of Gerontology and Gerontology Institute, John W. McCormack Graduate School of Policy and Global Studies , University of Massachusetts Boston , Boston , Massachusetts , USA.,b Center for Gerontology and Healthcare Research, School of Public Health , Brown University , Rhode Island , USA
| | - Orna Intrator
- b Center for Gerontology and Healthcare Research, School of Public Health , Brown University , Rhode Island , USA.,c Geriatrics & Extended Care Data & Analysis Center, Canandaigua VA Medical Center , New York , USA.,d Department of Public Health Sciences, School of Medicine and Dentistry , University of Rochester , New York , USA
| | - Emily Gadbois
- b Center for Gerontology and Healthcare Research, School of Public Health , Brown University , Rhode Island , USA
| | - Stefanie Gidmark
- e Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center , Rhode Island , USA
| | - James L Rudolph
- b Center for Gerontology and Healthcare Research, School of Public Health , Brown University , Rhode Island , USA.,e Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center , Rhode Island , USA.,f The Warren Alpert Medical School , Brown University, Providence , Rhode Island , USA
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Horton WJ, Azar ST, McGuier DJ, Cooley DT, Miller EA, Bartell PA. 0163 AMPLITUDE OF LIGHT EXPOSURE IS ASSOCIATED WITH MATERNAL HOSTILE ATTRIBUTIONS AND CHILD BEHAVIORAL PROBLEMS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Azar ST, McGuier DJ, Horton WJ, Cooley DT, Miller EA, Bartell PA. 0714 DELAYED-PHASE, SLEEP INSTABILITY, SLEEP CONCORDANCE AND AWAKENINGS: PRELIMINARY ASSOCIATIONS WITH SOCIAL AND NEUROCOGNITIVE DIFFICULTIES AND PARENTING RISK. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Miller EA, Traxlmayr MW, Shen J, Sikes HD. Activity-based assessment of an engineered hyperthermophilic protein as a capture agent in paper-based diagnostic tests. Mol Syst Des Eng 2016; 1:377-381. [PMID: 28451464 PMCID: PMC5403157 DOI: 10.1039/c6me00032k] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Antibodies have traditionally served as the affinity reagents of choice in point-of-care diagnostic biosensors. However, this class of proteins is not ideally suited for this use, being poorly characterized and prone to thermal denaturation. Here, we present an activity-based assessment of an alternative engineered binding protein in a cellulose-based assay.
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Affiliation(s)
- E A Miller
- Department of Chemical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02139, USA
| | - M W Traxlmayr
- Department of Chemical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02139, USA
| | - J Shen
- Department of Chemical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02139, USA
| | - H D Sikes
- Department of Chemical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02139, USA
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Affiliation(s)
- Francis G Caro
- a Editor Emeritus, Journal of Aging & Social Policy, Emeritus Professor of Gerontology , University of Massachusetts Boston , Boston , Massachusetts , USA
| | - Edward Alan Miller
- b Editor-in-Chief, Journal of Aging & Social Policy, Professor of Gerontology & Public Policy , University of Massachusetts Boston , Boston , Masschusetts , USA
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Abstract
Few systematically assess the determinants of Medicaid nursing facility reimbursement. Consequently, this article examines what factors influenceprogram administrators’decisions regarding nursing facility cost report data—the basic information states use to establish payment. Whereas elected officials focus primarily on how much is spent on nursing homes, state Medicaid officials assume primary responsibility for the esoteric and highly technical dimensions that help make spending goals a reality. Findings indicate that the federal government influenced state policy by enabling provider litigation under the Boren Amendment. They also indicate that program administrators responded rationally to fiscal and economic concerns, and that states with stronger administrative capacity were better able to overcome obstacles to sustaining desired policies. Although results reveal that states with more powerful nursing home lobbies tended to implement more generous systems, they fail to reveal significant associations between cost report year and lobbying activity on behalf of the elderly.
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Affiliation(s)
- Edward Alan Miller
- Edward Alan Milleris a postdoctoral fellow in the Department of Epidemiology and Public Health at Yale University. His research interests include health politics and policy, long-term care, Medicaid, intergovernmental relations, telemedicine, managed care, organization theory, and federalism. His work has been published in Home Health Care Services Quarterly, Journal of Aging and Social Policy, Journal of Telemedicine and Telecare, and Medical Research and Review
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Abstract
The bifurcation of responsibility for caring for dual eligibles has helped create a fragmented service delivery system, fraught with administrative inefficiencies, barriers to more effective care, and incentives to shift costs. To better serve this population, the federal government and several states have developed a number of pilot initiatives that promote integration by relying on capitated managed care. However, evidence suggests that this approach may be plagued by certain problems, including lack of experience with persons who are chronically ill, incentives to under provide care, favorable selection, limited plan availability, and mixed outcome and satisfaction performance. Although case-managed approaches pursue integration without capitation, they must typically rely on voluntary provider cooperation to be successful, something that is difficult to achieve. Given the recent nature of most integration initiatives, it is recommended that policy makers continue to promote innovation in each of the following areas: care coordination, administration, provider payment, plan participation, and evaluation.
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Chen EE, Miller EA. A Longitudinal Analysis of Site of Death: The Effects of Continuous Enrollment in Medicare Advantage Versus Conventional Medicare. Res Aging 2016; 39:960-986. [DOI: 10.1177/0164027516645843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study assessed the odds of dying in hospital associated with enrollment in Medicare Advantage (M-A) versus conventional Medicare Fee-for-Service (M-FFS). Data were derived from the 2008 and 2010 waves of the Health and Retirement Study ( n = 1,030). The sample consisted of elderly Medicare beneficiaries who died in 2008–2010 (34% died in hospital, and 66% died at home, in long-term senior care, a hospice facility, or other setting). Logistic regression estimated the odds of dying in hospital for those continuously enrolled in M-A from 2008 until death compared to those continuously enrolled in M-FFS and those switching between the two plans. Results indicate that decedents continuously enrolled in M-A had 43% lower odds of dying in hospital compared to those continuously enrolled in M-FFS. Financial incentives in M-A contracts may reduce the odds of dying in hospital.
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Affiliation(s)
- Elizabeth Edmiston Chen
- Department of Gerontology, John W. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston, Boston, MA, USA
| | - Edward Alan Miller
- Department of Gerontology, John W. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston, Boston, MA, USA
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Miller EA. The Continuing Evolution of Old Age Policy in 21st-Century America. J Appl Gerontol 2016. [DOI: 10.1177/0733464815625836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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