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Smith L, Carder P, Hua C, Zimmerman S, Sloane PD, Zhang W, Wretman CJ, Cornell P, Thomas KS. A National Typology of Health Service Regulation in Assisted Living. Gerontologist 2024; 64:gnad109. [PMID: 37549891 PMCID: PMC11020221 DOI: 10.1093/geront/gnad109] [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: 03/01/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES State-regulating agencies use 350 different licenses and certifications to govern assisted living (AL), resulting in significant variation in regulations governing health services, the scope of practice, and capacity. This lack of standardization makes it difficult to compare and contrast AL operations and residents' outcomes across similarly regulated communities. RESEARCH DESIGN AND METHODS We used qualitative and quantitative methods to empirically develop and describe a typology of state AL regulations that captures inter- and intrastate variation. Based on the rules governing health services, we created regulatory specificity scores for 5 thematic dimensions: medication administration, third-party care, skilled nursing, medication review, and licensed nurse staffing. With these scores, we conducted a K-means cluster analysis to identify groups of AL license types. To differentiate the regulatory types, we calculated standardized mean differences across structure, process, outcome, and resident characteristics of the AL communities licensed under each type. RESULTS We identified 6 types of AL differentiated by the regulatory provisions governing health services: Housing, Holistic, Hybrid, Hospitality, Healthcare, and Health Support. The types align with previous work and reflect tangible differences in resident characteristics, health service structures, processes, and outcomes. DISCUSSION AND IMPLICATIONS This typology effectively captures differences across regulated dimensions and can inform and support quality of care. Researchers, policy-makers, and consumers may benefit from using this typology and acknowledging these differences in AL licensure when designing research studies, developing policies, and selecting an AL community.
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Affiliation(s)
- Lindsey Smith
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Institute on Aging, Portland State University, Portland, Oregon, USA
| | - Paula Carder
- Institute on Aging, Portland State University, Portland, Oregon, USA
- Oregon Health & Science University, Portland State University School of Public Health, Portland, Oregon, USA
| | - Cassandra Hua
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center of Innovation in Long-Term Services and Supports, US Department of Veterans Affairs Medical Center, Providence, Rhode Island, USA
| | - Sheryl Zimmerman
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- School of Social Work and the Center for Excellence in Assisted Living, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Philip D Sloane
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Wenhan Zhang
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Portia Cornell
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center of Innovation in Long-Term Services and Supports, US Department of Veterans Affairs Medical Center, Providence, Rhode Island, USA
| | - Kali S Thomas
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center of Innovation in Long-Term Services and Supports, US Department of Veterans Affairs Medical Center, Providence, Rhode Island, USA
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Samper-Ternent R, Razjouyan J, Dindo L, Halaszynski J, Silva J, Fried T, Naik AD. Patient Priorities Care Increases Long-Term Service and Support Use: Propensity Match Cohort Study. J Am Med Dir Assoc 2024; 25:751-756. [PMID: 38320742 DOI: 10.1016/j.jamda.2023.12.014] [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] [Received: 07/18/2023] [Revised: 12/11/2023] [Accepted: 12/25/2023] [Indexed: 02/29/2024]
Abstract
OBJECTIVES Patient priorities care (PPC) is an evidence-based approach designed to help patients achieve what matters most to them by identifying their health priorities and working with clinicians to align the care they provide to the patient's priorities. This study examined the impact of the PPC approach on long-term service and support (LTSS) use among veterans. DESIGN Quasi-experimental study examining differences in LTSS use between veterans exposed to PPC and propensity-matched controls not exposed to PPC adjusting for covariates. SETTING AND PARTICIPANTS Fifty-six social workers in 5 Veterans Health Administration (VHA) sites trained in PPC in 2018, 143 veterans who used the PPC approach, and 286 matched veterans who did not use the PPC approach. METHODS Veterans with health priorities identified through the PPC approach were the intervention group (n = 143). The usual care group included propensity-matched veterans evaluated by the same social workers in the same period who did not participate in PPC (n = 286). The visit with the social worker was the index date. We examined LTSS use, emergency department (ED), and urgent care visits, 12 months before and after this date for both groups. Electronic medical record notes were extracted with a validated natural language processing algorithm (84% sensitivity, 95% specificity, and 92% accuracy). RESULTS Most participants were white men, mean age was 76, and 30% were frail. LTSS use was 48% higher in the PPC group compared with the usual care group [odds ratio (OR), 1.48; 95% CI, 1.00-2.18; P = .05]. Among those who lived >2 years after the index date, new LTSS use was higher (OR, 1.69; 95% CI, 1.04-2.76; P = .036). Among nonfrail individuals, LTSS use was also higher in the PPC group (OR, 1.70; 95% CI, 1.06-2.74; P = .028). PPC was not associated with higher ED or urgent care use. CONCLUSIONS AND IMPLICATIONS PPC results in higher LTSS use but not ED or urgent care in these veterans. LTSS use was higher for nonfrail veterans and those living longer. The PPC approach helps identify health priorities, including unmet needs for safe and independent living that LTSS can support.
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Affiliation(s)
- Rafael Samper-Ternent
- Department of Management, Policy, and Community Health, UTHealth Houston, Houston, TX, USA; Institute on Aging, UTHealth Houston, Houston, TX, USA.
| | - Javad Razjouyan
- VA Health Services Research and Development Service, Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey VA Medical Center, Houston, TX, USA; Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Big Data Scientist Training Enhancement Program (BD-STEP), VA Office of Research and Development, Washington, DC, USA
| | - Lilian Dindo
- VA Health Services Research and Development Service, Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey VA Medical Center, Houston, TX, USA; Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jaime Halaszynski
- Social Work Service, Butler VA Health Care System, Butler, PA, USA; VA National Social Work Program, Care Management and Social Work Services, Office of Patient Care Services, Department of Veterans Affairs, Washington, DC, USA
| | - Jennifer Silva
- VA National Social Work Program, Care Management and Social Work Services, Office of Patient Care Services, Department of Veterans Affairs, Washington, DC, USA; Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Terri Fried
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA; Connecticut Veterans Administration Health System, West Haven, CT, USA
| | - Aanand D Naik
- Department of Management, Policy, and Community Health, UTHealth Houston, Houston, TX, USA; Institute on Aging, UTHealth Houston, Houston, TX, USA; VA Health Services Research and Development Service, Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey VA Medical Center, Houston, TX, USA; Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Kwon JH, Qiu X, Abbott KM, Straker JK, Applebaum R. Associations between Complaints and Organizational Characteristics among Ohio Nursing Homes. J Am Med Dir Assoc 2024; 25:585-590. [PMID: 37579926 DOI: 10.1016/j.jamda.2023.07.008] [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] [Received: 04/01/2023] [Revised: 07/05/2023] [Accepted: 07/05/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVES In recent years, Ohio nursing homes (NHs) have received an increasing number of complaints. The current study aims to gain a better understanding of the relationship between NH organizational characteristics and the number of complaints. DESIGN Secondary data analysis was used. SETTING AND PARTICIPANTS Four data sources on Ohio NHs were merged. Ohio NH complaints data reported in 2018 and 2019 was linked with the 2017 Ohio Biennial Survey of Long-Term Care Facilities, 2017 Ohio Nursing Home Resident Satisfaction Survey, and 2018 Ohio Nursing Home Family Satisfaction Survey. METHODS Descriptive analysis, bivariate tests (ie, analysis of variance and χ2 test), and multinomial logistic regression analyses were conducted. RESULTS Findings included that urban location, NH administrator (NHA) and director of nursing (DON) turnover in the previous 3 years, NH size, occupancy rate, certified nursing assistant (CNA) retention, and overall family satisfaction were significantly associated with total complaints. NHA and DON turnover, NH size, CNA retention, and overall family satisfaction were found to be significantly associated with substantiated complaints. CONCLUSIONS AND IMPLICATIONS The importance of leadership (ie, NHA and DON) turnover, CNA retention, and family satisfaction indicates that specifically targeted efforts to improve in these areas can have a positive impact on NH quality.
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Affiliation(s)
- Jenny H Kwon
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA.
| | - Xiao Qiu
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA
| | - Katherine M Abbott
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA; Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Jane K Straker
- Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Robert Applebaum
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA; Scripps Gerontology Center, Miami University, Oxford, OH, USA
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Sperber NR, Miech EJ, Clary AS, Perry K, Edwards-Orr M, Rudolph JL, Van Houtven CH, Thomas KS. Determinants of inter-organizational implementation success: A mixed-methods evaluation of Veteran Directed Care. Healthc (Amst) 2022; 10:100653. [PMID: 36108526 PMCID: PMC10174078 DOI: 10.1016/j.hjdsi.2022.100653] [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] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 06/16/2022] [Accepted: 08/24/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Veteran Directed Care (VDC) aims to keep Veterans at risk for nursing home placement in their communities. VA medical centers (VAMCs) purchase VDC from third-party organizational providers who then partner with them during implementation. Experiences with VDC implementation have varied. OBJECTIVES We sought to identify conditions differentiating partnerships with higher enrollment (implementation success). METHODS We conducted a case-based study with: qualitative data on implementation determinants two and eight months after program start, directed content analysis to assign numerical scores (-2 strong barrier to +2 strong facilitator), and mathematical modeling using Coincidence Analysis (CNA) to identify key determinants of implementation success. Cases consisted of VAMCs and partnering non-VAMC organizations who started VDC during 2017 or 2018. The Consolidated Framework for Implementation Research (CFIR) guided analysis. RESULTS Eleven individual organizations within five partnerships constituted our sample. Two CFIR determinants- Networks & Communication and External Change Agent-uniquely and consistently identified implementation success. At an inter-organizational partnership level, Networks & Communications and External Change Agent +2 (i.e., present as strong facilitators) were both necessary and sufficient. At a within-organization level, Networks & Communication +2 was necessary but not sufficient for the non-VAMC providers, whereas External Change Agent +2 was necessary and sufficient for VAMCs. CONCLUSION Networks & Communication and External Change Agent played difference-making roles in inter-organizational implementation success, which differ by type of organization and level of analysis. IMPLICATIONS This multi-level approach identified crucial difference-making conditions for inter-organizational implementation success when putting a program into practice requires partnerships across multiple organizations.
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Affiliation(s)
- Nina R Sperber
- Center to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, USA; Department of Population Health Sciences, Duke University, USA; Duke-Margolis Center for Health Policy, USA.
| | - Edward J Miech
- VA EXTEND QUERI, VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, USA
| | | | - Kathleen Perry
- Vagelos College of Physicians & Surgeons, Columbia University, USA
| | | | - James L Rudolph
- Brown University School of Public Health, USA; Providence VA Medical Center, USA
| | - Courtney Harold Van Houtven
- Center to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, USA; Department of Population Health Sciences, Duke University, USA; Duke-Margolis Center for Health Policy, USA
| | - Kali S Thomas
- Brown University School of Public Health, USA; Providence VA Medical Center, USA
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Travers JL, D’Arpino S, Bradway C, Kim SJ, Naylor MD. Minority Older Adults' Access to and Use of Programs of All-Inclusive Care for the Elderly. J Aging Soc Policy 2022; 34:976-1002. [PMID: 35125064 PMCID: PMC9357232 DOI: 10.1080/08959420.2021.2024411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/17/2020] [Accepted: 04/26/2021] [Indexed: 10/19/2022]
Abstract
Programs of All-Inclusive Care for the Elderly (PACE) are an effective approach to improve care quality and delay institutional admissions especially for Black and Hispanic older adults who have seen a disproportionate rise in nursing home use. Guided by Andersen's Behavioral Model of Health Services Use and employing focus groups and one-on-one interviews, we qualitatively examined factors influencing access to and use of PACE by Black and Hispanic older adults. The study sample consisted of thirty-two PACE enrollees, six marketing-team members, and four family-caregivers from three PACE sites in a northeast urban city. Informed knowledge, cultural beliefs, and attitudes toward PACE were found to affect access. Community resources, available services, and care quality facilitated enrollment/participation. Barriers identified included poor dissemination of information and inadequate emphasis on staff's sensitivity to enrollees' cultural and disability differences. Findings will help healthcare leaders capitalize on facilitators and address barriers to enhance access and use of PACE by racial and ethnic minority older adults.
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Affiliation(s)
- Jasmine L. Travers
- New York University Rory Meyers College of Nursing, 433 1 Avenue, New York, NY 10010
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Abstract
OBJECTIVES The goal of this study was to investigate diversity in stakeholders' perspectives on how best to maximize older adults' well-being when they use long-term services and supports (LTSS). METHODS We used Q methodology, an exploratory method, to investigate preference patterns among a purposive sample of older adults, family members, and leadership professionals (n = 57). Participants categorized 52 items related to 9 domains of LTSS quality relevant to well-being into categories of importance. We used factors analysis and qualitative methods to identify groups of individuals who identified similar priorities. RESULTS The analysis identified four shared viewpoints, each prioritizing different aspects of well-being: 1) physical health and safety; 2) independence; 3) emotional well-being; and 4) social engagement. Individual and contextual factors, including stakeholder role, care needs, and expectations for LTSS, appeared to influence participants' perspectives. CONCLUSIONS Distinct viewpoints on how to maximize well-being when older adults use LTSS exist. Our results affirm the importance of person-centered care yet demonstrate that shared preference patterns LTSS exist. CLINICAL IMPLICATIONS Engaging with older adults' values and preferences is critical to improving their experiences with LTSS. Better understanding common preference patterns could help providers deliver person-centered care more efficiently and effectively.
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Affiliation(s)
- Heather Davila
- Center for Healthcare Organization and Implementation Research, Boston University School of Medicine, Boston, Massachusetts, USA
| | - David R Johnson
- Department of Organizational Leadership, Policy, and Development, College of Education and Human Development, University of Minnesota, Minneapolis, Minnesota, USA.,Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
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Jenkins Morales M, Robert SA. Examining Consequences Related to Unmet Care Needs Across the Long-Term Care Continuum. J Gerontol B Psychol Sci Soc Sci 2022; 77:S63-S73. [PMID: 35030256 PMCID: PMC9122632 DOI: 10.1093/geronb/gbab210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 07/14/2021] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To examine how different care arrangements across the long-term care continuum are associated with experiencing unmet care need consequences (UCNCs), such as skipping meals, going without clean clothes, or taking the wrong medication. METHODS We include older adults receiving assistance with at least one self-care, mobility, or household activity (for health/functioning reasons) in the 2015 National Health and Aging Trends Study (N = 2,388). We examine the likelihood of experiencing a UCNC across the long-term care continuum: those receiving unpaid community care only, paid community care, and residential care. Cross-sectional logistic and longitudinal multinomial logistic regression models examine if type of care arrangement in 2015 is associated with UCNCs in 2015 and change in UCNCs by 2017. RESULTS In adjusted cross-sectional models, paid community care recipients had roughly 2 times greater odds of experiencing a UCNC in 2015 compared to those living in residential care or receiving only unpaid care. In adjusted longitudinal models, the risk of experiencing persistent UCNCs (compared to having needs met in both years) was 4.81 times higher for those receiving paid community care compared to those in residential care and 2.17 times that of those receiving unpaid care only. DISCUSSION Older adults receiving paid care face significant and consequential gaps in care, particularly in comparison to those in other care arrangements. More attention is needed to determine how paid care arrangements can be improved and/or expanded to meet the needs of the growing number of older adults receiving paid care in the community.
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Affiliation(s)
- Meghan Jenkins Morales
- Sandra Rosenbaum School of Social Work, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Stephanie A Robert
- Sandra Rosenbaum School of Social Work, University of Wisconsin–Madison, Madison, Wisconsin, USA
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Falzarano FB, Cimarolli V, Boerner K, Siedlecki KL, Horowitz A. Use of Home Care Services Reduces Care-Related Strain in Long-Distance Caregivers. Gerontologist 2022; 62:252-261. [PMID: 34166493 PMCID: PMC8827323 DOI: 10.1093/geront/gnab088] [Citation(s) in RCA: 4] [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] [Received: 03/04/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Prior work examining the role of older adult home care service use in alleviating strain in family caregivers has resulted in contradictory findings. However, prior research has been entirely limited to caregivers who live within close geographical proximity to their care recipients. Long-distance caregivers are a unique caregiving subgroup that has remained understudied. Guided by the stress process model, this study examined if the association between primary caregiving stressors (the care recipient's functional and cognitive status) and secondary stressors (perceived role strains related to work and to other family responsibilities) in long-distance caregivers was mediated by the care recipient's utilization of home care services. RESEARCH DESIGN AND METHODS The sample included 166 long-distance caregivers in the United States who provide and manage care to a community-dwelling care recipient living 2 or more hours away. Participants reported on their care recipient's cognitive and functional status, perceived interference of caregiving with work and other family responsibilities, and the care recipient's use of home care services. RESULTS Path analyses show that home care use by the care recipient fully mediated the association between care recipients' functional impairment and caregiver strains (work and family). Furthermore, home care use partially mediated the effects of care recipients' cognitive impairment on caregiver strains. DISCUSSION AND IMPLICATIONS Results indicate that the care recipient's home care service utilization may serve as a protective factor against care-related strain in long-distance caregivers. These findings can be used to inform intervention efforts focused on a family-centered care approach that can be specifically tailored to long-distance caregivers.
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Affiliation(s)
- Francesca B Falzarano
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Verena Cimarolli
- LeadingAge LTSS Center @UMass Boston, Washington, District of Columbia, USA
| | - Kathrin Boerner
- Department of Gerontology, University of Massachusetts Boston, USA
| | | | - Amy Horowitz
- Graduate School of Social Service, Fordham University, New York, New York, USA
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Kim JJ. Personal Care Aides as Household Employees and Independent Contractors: Estimating the Size and Job Characteristics of the Workforce. Innov Aging 2022; 6:igab049. [PMID: 34993354 PMCID: PMC8719739 DOI: 10.1093/geroni/igab049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Objectives Although studies pointed out that the number of personal care aides (PCAs) at risk of being in informal employment arrangements is sizeable, little is known about its size and worker characteristics. This study aimed to estimate the share of PCAs working as household employees or independent contractors. It also aimed to compare their basic job characteristics against the job characteristics of those working as agency and government employees. Research Design and Methods Using data from the 2014–2018 American Community Surveys, a sample of 43,287 PCAs working for pay in the home- and community-based service (HCBS) industry was identified, and their job characteristics—full-time weekly work (i.e., working at least 35 hours per week), year-round work (i.e., working at least 50 weeks a year), and annual gross earning—were analyzed by their employment arrangement. Results Analyses found that (a) close to a quarter of aides in the HCBS industry work as household employees or independent contractors while their share in the workforce varies by state and that (b) the work hours and earnings of full-time year-round working household employees or independent contractors are greater than those of their agency counterparts. The results shed light on why some aides may work as household employees or independent contractors. Discussion and Implications The presence of household employees and independent contractors has important implications for PCAs’ job characteristics and labor shortage in the U.S. home care industry. Considering the potentially negative consequences for both the aides’ economic security and the quality of care that consumers can receive, attention should be paid to ways to bring the aides into a more formal employment arrangement.
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Affiliation(s)
- Joy Jeounghee Kim
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
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Angelelli J, McCartney D, Roehmer C, Swart ECS, Quinby E, Darwin J, Dicianno BE. Effect of Social Determinants of Health Interventions on Adults Living with Disabilities: A Scoping Review. Arch Phys Med Rehabil 2021; 103:1023-1033.e11. [PMID: 34756446 DOI: 10.1016/j.apmr.2021.06.021] [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: 04/16/2021] [Revised: 06/18/2021] [Accepted: 06/25/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To investigate social determinants of health (SDoH) interventions on individual health outcomes, population health, and cost for persons in the United States over age 18 living with disabilities and receiving long-term services and supports (LTSS) in noninstitutional settings. DATA SOURCES A review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted of literature from PubMed, PsycINFO, REHABDATA, and Web of Science Core Collection published between January 1997 and July 2020. STUDY SELECTION Search terms were based on the primary SDoH domains identified by the Centers for Medicare and Medicaid's Accountable Health Communities Model. A total of 5082 abstracts were screened based on identification criteria of persons age 18 and above living in non-institutional, community-based settings receiving LTSS. DATA EXTRACTION During Level 2 review, articles were reviewed based on population focus, type of LTSS (personal assistance services, home care, adult day care, home modification, durable medical equipment, community transition services, caregiver supports and/or prevention services related to home- and community-based care), SDoH intervention and association with health outcomes, population health and/or cost. A total of 1037 abstracts underwent Level 2 review, yielding 131 publications or 1.3% for full review. DATA SYNTHESIS Studies (n=33) designed a priori to test outcomes of interventions were rated according to Grading Recommendations Assessment Development and Evaluation (GRADE) criteria. Qualifying articles that did not include interventions (n=98) were included in our summary of the literature but were not assessed by GRADE. CONCLUSIONS The preponderance of research surrounding SDoH and health outcomes has focused on older adults living with disabilities, and most interventions scored low or very low using GRADE criteria. Evidence is limited to the extent SDoH interventions are measured against outcomes for persons of all ages living with disabilities. Robust evaluation of models that feature SDoH interventions in partnership with community-based organizations is recommended as home and community-based care infrastructure expands in response to the American Rescue Plan Act of 2021.
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Affiliation(s)
- Joe Angelelli
- UPMC Center for High-Value Health Care, UPMC Health Plan, Pittsburgh, PA.
| | - David McCartney
- UPMC Center for High-Value Health Care, UPMC Health Plan, Pittsburgh, PA
| | - Christian Roehmer
- Human Engineering Research Laboratories, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, PA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Eleanor Quinby
- Human Engineering Research Laboratories, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, PA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jessa Darwin
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Brad E Dicianno
- Human Engineering Research Laboratories, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, PA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Corrigan JD, Vuolo M, Bogner J, Botticello AL, Pinto SM, Whiteneck GG. Do state supports for persons with brain injury affect outcomes in the 5 Years following acute rehabilitation? Health Place 2021; 72:102674. [PMID: 34700065 DOI: 10.1016/j.healthplace.2021.102674] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 08/11/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
While a substantial literature has examined the effects of individual and family-level factors on outcomes following traumatic brain injury (TBI), minimal attention has been directed to the potential influence of the larger environmental context on outcomes. The purpose of the current study was to investigate the effects of state-level resources and supports as an environmental factor influencing long-term outcomes from TBI using data from the TBI Model Systems. We examined the effects of U.S. state supports that specifically target people with TBI (federal funding for state brain injury programs, per capita revenue generated by brain injury trust funds, and expenditures for brain injury specific Medicaid waivers) and one measure of the relative quality of a state's Long-Term Services and Supports (LTSS) for all people with disabilities. The primary hypothesis was that community participation, global functioning, and life satisfaction will be higher on average among people with TBI living in states with more brain injury specific programs and resources and better LTSS. The results of multilevel and fixed-effects modeling indicated that state supports have a small but significant impact on participation and life satisfaction. The most consistent finding indicated that states with better LTSS had higher levels of community participation and life satisfaction on average for people with TBI over and above individual-level differences and fluctuations in these outcomes over time. There was some indication that more brain injury specific supports also result in better participation in the community. These findings deserve replication and extension to include other environmental factors, particularly community level characteristics, that might affect outcomes from TBI.
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Affiliation(s)
| | - Mike Vuolo
- The Ohio State University, Columbus, OH, USA
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Gaugler JE, Marx K, Dabelko-Schoeny H, Parker L, Anderson KA, Albers E, Gitlin LN. COVID-19 and the Need for Adult Day Services. J Am Med Dir Assoc 2021; 22:1333-1337. [PMID: 34044009 PMCID: PMC8103140 DOI: 10.1016/j.jamda.2021.04.025] [Citation(s) in RCA: 6] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 12/31/2022]
Abstract
COVID-19 has shone a harsh light on the inequities of health care in the United States, particularly in how we care for older people. We summarize some of the effects of lockdown orders on clients, family caregivers, and staff of adult day service programs throughout the United States, which may serve as a counterpoint to scientific evidence suggesting a lack of efficacy of these programs. Given the ramifications of state lockdown orders for users and staff of the long-term services and support system, we provide recommendations to better support community-based programs and those they serve. Specifically, (1) adult day programs should be classified as essential, (2) a focus on the value of adult day and similar programs is needed, and (3) an exploration of new ways to finance home and community-based services is warranted. Such advances in policy and science would help to integrate adult day services more effectively into the broader health care landscape.
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Affiliation(s)
- Joseph E Gaugler
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
| | - Katherine Marx
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | | | - Lauren Parker
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Keith A Anderson
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
| | - Elizabeth Albers
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
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Fabius CD, Wolff JL, Kasper JD. Race Differences in Characteristics and Experiences of Black and White Caregivers of Older Americans. Gerontologist 2021; 60:1244-1253. [PMID: 32400881 DOI: 10.1093/geront/gnaa042] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [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: 10/31/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Racial disparities in health and socioeconomic characteristics of older adults have implications for the experiences of their family and unpaid caregivers, but knowledge to date has primarily drawn from convenience samples. Using a population-based sample, we examine associations between caregiver race and caregiving-related effects. RESEARCH DESIGN AND METHODS Study participants include white (n = 992) and black (n = 556) respondents to the 2015 National Study of Caregiving who assisted community-dwelling older adults with disabilities who participated in the National Health and Aging Trends Study. Guided by Pearlin's Stress Process Model, hierarchical logistic regression models were constructed to examine race differences in caregiving-related effects after adjusting for caregiving context, stressors, and resources. RESULTS Relative to white caregivers, blacks more often provided in excess of 40 hr of care per week (54.3% vs 38.6%) and more often cared for an older adult with dementia (27.1% vs 20.7%) who was living below the federal poverty line (31.7% vs 11.9%) or was Medicaid-eligible (42.2% vs 11.8%). Black caregivers more often used supportive services (32.9% vs 24.8%). In fully adjusted regression models, black caregivers were more likely to report gains and less likely to report emotional difficulty than whites. Service utilization did not attenuate caregiving-related emotional difficulty or participation restrictions, regardless of race. DISCUSSION AND IMPLICATIONS Findings highlight caregiving disparities and counterintuitive differences in experiences and indicate the importance of identifying supports such as paid family leave and faith and community-based programming to better support community-dwelling low-income older adults and their family and unpaid caregivers.
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Affiliation(s)
- Chanee D Fabius
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Jennifer L Wolff
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Judith D Kasper
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Peng C, Burr JA, Kim K, Lu N. Home and Community-Based Service Utilization among Older Adults in Urban China: The Role of Social Capital. J Gerontol Soc Work 2020; 63:790-806. [PMID: 32669058 DOI: 10.1080/01634372.2020.1787574] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 06/11/2023]
Abstract
Home and community-based service (HCBS) utilization is considered important for older adults who want to maintain their independence and remain in their communities. This study examined the relationship between structural (e.g., citizenship activities, volunteering) and cognitive (e.g., social trust, a sense of belonging) social capital and HCBS utilization among older Chinese adults. We analyzed survey data from 441 community-dwelling older adults in the Gusu district of the city of Suzhou, China in 2015. Quota sampling was used to select respondents. Negative binomial regression was used within the structural equation modeling framework to test the proposed model for HCBS utilization. Structural social capital had a direct association with HCBS utilization, controlling for predisposing, enabling, and need factors in the model. Further, cognitive social capital showed an indirect association with HCBS utilization via structural social capital. The results suggested the importance of establishing intervention programs that foster structural social capital to promote HCBS utilization.
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Affiliation(s)
- Changmin Peng
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston , Boston, MA, USA
| | - Jeffrey A Burr
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston , Boston, MA, USA
| | - Kyungmin Kim
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston , Boston, MA, USA
| | - Nan Lu
- Department of Social Work and Social Policy, School of Sociology and Population StudiesRenmin University of China , Beijing, China
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15
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16
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Caceres BA, Travers J, Primiano JE, Luscombe RE, Dorsen C. Provider and LGBT Individuals' Perspectives on LGBT Issues in Long-Term Care: A Systematic Review. Gerontologist 2020; 60:e169-e183. [PMID: 30726910 PMCID: PMC7117618 DOI: 10.1093/geront/gnz012] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [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: 10/09/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Discrimination toward the lesbian, gay, bisexual and transgender (LGBT) population has raised concerns about the type of long-term services and supports (LTSS) that will be available to them as they age. To understand the unique needs of aging LGBT populations, we sought to synthesize and critique the evidence related to LTSS providers and LGBT individuals' perspectives of LGBT issues in LTSS in the United States. RESEARCH DESIGN AND METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic review of the literature was conducted. The Crowe Critical Appraisal Tool was used to appraise the quality of the included studies. RESULTS Nineteen studies met inclusion criteria. Seven studies that examined the perspectives of LTSS providers identified two themes, including that they lack knowledge and training on LGBT health issues and generally report negative attitudes toward same-sex relations among older adults. In addition, 12 studies that examined the perspectives of LGBT individuals found that they (i) are concerned about LTSS planning, (ii) fear discrimination from providers in LTSS, and (iii) identify several strategies for improving care of LGBT older adults receiving LTSS. DISCUSSION AND IMPLICATIONS This systematic review highlights the importance for LTSS providers to receive training in LGBT health and be reflective of potential biases toward the LGBT population. LGBT individuals identified concerns related to LTSS planning and fear of discrimination from LTSS providers. LGBT individuals also identified a need for increased training of providers to improve the care of LGBT older adults in LTSS.
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Affiliation(s)
- Billy A Caceres
- Program for the Study of LGBT Health, Columbia University School of Nursing, New York, New York
- Hartford Institute for Geriatric Nursing, New York University Rory Meyers College of Nursing, New York
| | - Jasmine Travers
- National Clinician Scholars Program, Yale University, New Haven, Connecticut
| | | | | | - Caroline Dorsen
- New York University Rory Meyers, College of Nursing, New York
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17
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Abstract
Background and Objectives Spending in the Medicaid program is a significant concern to both state and federal policy makers. Medicaid spending is driven by program enrollment and services use. Older adults with high health care needs incur a disproportionate proportion of program spending. This analysis identifies factors that place older Medicare beneficiaries at increased risk for entering into Medicaid. Research Design and Methods We use multinomial logistic regression and the 2011–2017 National Health and Aging Trends Study (NHATS) to examine the risks among older Medicare beneficiaries for entering into Medicaid over a 6-year follow-up period. We examine both time-invariant and time-varying factors to measure the impact of social and health and functioning changes at older ages. Results The risk of entry into Medicaid was higher for older adults who relocated to a nursing home (relative risk ratio [RRR]: 7.75; 95% confidence interval [CI]: 5.33–11.26) or other residential care setting (RRR: 1.36; 95% CI: 0.96–1.92) compared to those who remained in traditional community settings. Older adults who reported skipping a meal in the last month because there was not enough money to buy food were 2.4 times (95% CI: 1.10–5.21) more likely to enter Medicaid than those who did not. Similarly, older adults who reported not having enough money to pay household utility bills in the last year were 1.89 times (95% CI: 1.08–3.30) more likely to enter Medicaid. Discussion and Implications Study findings suggest that trouble paying for basic needs increases the risk of entry into Medicaid. Further research is required to examine whether addressing these needs through improved access to social services that enable older adults to live safely in their home may delay or mitigate entry into Medicaid.
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Affiliation(s)
- Amber Willink
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - John Mulcahy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Karen Davis
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Judith D Kasper
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Caffrey C, Harris-Kojetin L, Rome V, Schwartz L. Relationships Between Residential Care Community Characteristics and Overnight Hospital Stays and Readmissions: Results From the National Study of Long-Term Care Providers. Seniors Hous Care J 2018; 26:38-49. [PMID: 31105807 PMCID: PMC6520986] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
THE PROBLEM Hospitalizations and subsequent readmissions can produce significant challenges when trying to reduce costs and improve quality of care. This study describes hospitalizations and readmissions using residential care community data from the 2012 National Study of Long-Term Care Providers. THE RESOLUTION About 61.0% of residential care communities had hospitalizations, and among these communities, 39.3% had readmissions. Residential care communities in the Northeast were more likely to have had hospitalizations and readmissions. Residential care communities located in a continuing care retirement community (CCRC) had a lower likelihood of hospitalizations, and communities that provided therapeutic services had a lower likelihood of readmissions. TIPS FOR SUCCESS An association with a CCRC and provision of therapeutic services were found to be protective against hospitalizations and readmissions, respectively.
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Affiliation(s)
- Christine Caffrey
- Social Scientist, Long-Term Care Statistics Branch, National Center for Health Statistics, 3311 Toledo Road, #3518, Hyattsville, MD 20782,
| | - Lauren Harris-Kojetin
- Chief, Long-Term Care Statistics Branch, National Center for Health Statistics, 3311 Toledo Road, #3483, Hyattsville, MD 20782,
| | - Vincent Rome
- Health Scientist, Long-Term Care Statistics Branch, National Center for Health Statistics, 3311 Toledo Road, #3517 Hyattsville, MD 20782,
| | - Lindsay Schwartz
- Associate Vice President, Workforce and Quality, Improvement, American Health Care Association/National Center for Assisted Living, 1201 L Street N.W., Washington, DC 20005,
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Putnam M. Bridging network divides: building capacity to support aging with disability populations through research. Disabil Health J 2014; 7:S51-9. [PMID: 24456686 PMCID: PMC4156880 DOI: 10.1016/j.dhjo.2013.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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: 01/07/2013] [Revised: 07/29/2013] [Accepted: 08/14/2013] [Indexed: 11/28/2022]
Abstract
Federal and state efforts to rebalance long-term services and supports (LTSS) in favor of home and community based over institutional settings has helped create structural bridges between the historically separated aging and disability LTSS networks by integrating and/or linking aging and disability systems. These changes present new opportunities to study bridging mechanisms and program related outcomes at national and local levels through federally sponsored LTSS initiatives termed Rebalancing programs. Rebalancing programs also offer opportunities to explore and understand the capacity of LTSS networks (age integrated or linked aging and disability systems) to serve aging with disability populations, persons who live with long-term chronic conditions or impairments such as multiple sclerosis, spinal cord injury, intellectual or developmental disabilities. To date, there is limited evidence based LTSS program and practice knowledge about this heterogeneous population such as met and unmet needs or interventions to support healthy aging. Efforts that center on bridging the larger fields of aging and disability in order to build new knowledge and engage in knowledge translation and translational research are critical for building capacity to support persons aging with disability in LTSS. Generating the investment in bridging aging and disability research across stakeholder group, including researchers and funders, is vital for these efforts.
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Affiliation(s)
- Michelle Putnam
- Simmons College, School of Social Work, 300 The Fenway, Boston, MA 02115, USA.
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