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Ge Y, Xu S, Capron AM, Keller MS, Hlávka JP. Exploring the Impact of COVID-19 Restrictions on Nursing Home Residents', Families', and Staff's Perceptions of Bioethical Principles: A Qualitative Study. J Appl Gerontol 2024:7334648241249626. [PMID: 38742826 DOI: 10.1177/07334648241249626] [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: 05/16/2024] Open
Abstract
In this study, we employed a pre-interview survey and conducted interviews with nursing home staff members and residents/family members to understand their perceptions of whether the COVID-19 restrictions fulfilled obligations to nursing home residents under various principles, including autonomy, beneficence, nonmaleficence, justice, and privacy. We conducted 20 semi-structured interviews with staff members from 14 facilities, and 20 with residents and/or family members from 13 facilities. We used a qualitative descriptive study design and thematic analysis methodology to analyze the interviews. Findings from the pre-interview survey indicated that, compared to nursing home staff, residents and their families perceived lower adherence to bioethics principles during the pandemic. Qualitative analysis themes included specific restrictions, challenges, facility notifications, consequences, communication, and relationships between staff and residents/family members. Our study exposes the struggle to balance infection control with respecting bioethical principles in nursing homes, suggesting avenues for improving processes and policies during public health emergencies.
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Affiliation(s)
- Yimin Ge
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
| | - Shengjia Xu
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
| | - Alexander M Capron
- Gould School of Law, University of Southern California, Los Angeles, CA, USA
| | - Michelle S Keller
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jakub P Hlávka
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
- Health Economics, Policy and Innovation Institute, Faculty of Economics and Administration, Masaryk University, Brno, Czech Republic
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Shippee T, Simon Rosser BR, Wright MM, Aumock C, Moone R, Talley KMC, Duran P, Henning-Smith C, Cahill S, Flatt JD, Slaughter-Acey J, Greenwald S, McCarthy T, Ross MW. Scoping Literature Review: Experiences of Sexual and Gender Minority Older Adults, With Diagnoses of Dementia, Who Use Residential Long-Term Services and Supports. J Appl Gerontol 2024; 43:562-576. [PMID: 37975683 PMCID: PMC10981565 DOI: 10.1177/07334648231213532] [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] [Indexed: 11/19/2023] Open
Abstract
The number of sexual and gender minority (SGM) older adults utilizing residential long-term supports and services (LTSS) will increase in the forthcoming decades. Paradoxically, while requiring more LTSS services than their non-SGM counterparts, SGM older adults are less likely to access these services, partly due to fears of discrimination. Furthermore, SGM older adults living with Alzheimer's disease and related dementias (AD/ADRD) present unique challenges and opportunities for LTSS facilities. This article provides a scoping review on the intersection between experiences of SGM older adults with AD/ADRD who use residential LTSS. This review identified three themes: (1) the experiences of discrimination among SGM residents in LTSS facilities, (2) the need for comprehensive staff training in residential LTSS to ensure proper care of SGM populations, and (3) the crucial role of inclusive facility policies. As the number of SGM older adults is expected to increase, further research is necessary.
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Affiliation(s)
| | | | | | | | | | | | - Phil Duran
- Aging and Gender Care Access, Saint Paul, MN, USA
| | | | - Sean Cahill
- Fenway Institute, Fenway Health, Boston, MA, USA
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Wang S, Temkin-Greener H, Simning A, Konetzka RT, Cai S. Outcomes After Community Discharge From Skilled Nursing Facilities: The Role of Medicaid Home and Community-Based Services. J Appl Gerontol 2024:7334648241242942. [PMID: 38581163 DOI: 10.1177/07334648241242942] [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: 04/08/2024] Open
Abstract
This study investigated the association between Medicaid Home and Community-Based Services (HCBS) generosity and post-discharge outcomes among dual-eligible beneficiaries discharged from skilled nursing facilities (SNFs). We linked multiple national datasets for duals discharged from SNFs between 2010 and 2013. Accounting for SNF fixed effects, we estimated the effect of HCBS generosity, measured by its breadth and intensity, on the likelihood of remaining in the community, risks of death, nursing home (NH) admission, and hospitalizations within 30 and 180 days after SNF discharge. We found that higher HCBS generosity was associated with an increased likelihood of remaining in the community. HCBS breadth and intensity were both significantly associated with reduced risks of NH admission, while higher HCBS intensity was related to a reduced risk of acute hospitalizations within 30 days after discharge. Our findings suggest that more generous HCBS programs may facilitate smoother transitions and sustainable community living following SNF discharge.
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Affiliation(s)
- Sijiu Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | | | - Adam Simning
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | | | - Shubing Cai
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
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Carlson SR, Munandar V, Thompson JR. Outcomes for Adults With Intellectual and Developmental Disabilities Receiving Long-Term Services and Supports: A Systematic Review of the Literature. Intellect Dev Disabil 2024; 62:137-150. [PMID: 38545817 DOI: 10.1352/1934-9556-62.2.137] [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] [Received: 11/05/2022] [Accepted: 04/10/2023] [Indexed: 04/05/2024]
Abstract
The impact of long-term services and supports on the quality of life of adults with intellectual and developmental disabilities (IDD) is not well understood given the highly complex nature of researching this topic. To support future research addressing this topic, we conducted a systematic literature review of studies addressing outcomes of adults with IDD receiving long-term services and supports. Results of this review describe current outcomes for adults with IDD who receive long-term services and supports and can be used to inform program evaluation, policy development, and future research.
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Affiliation(s)
- Sarah R Carlson
- Sarah R. Carlson, University of New Mexico; Vidya Munandar, Kennesaw State University; and James R. Thompson, University of Kansas
| | - Vidya Munandar
- Sarah R. Carlson, University of New Mexico; Vidya Munandar, Kennesaw State University; and James R. Thompson, University of Kansas
| | - James R Thompson
- Sarah R. Carlson, University of New Mexico; Vidya Munandar, Kennesaw State University; and James R. Thompson, University of Kansas
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5
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Jopson AD, Fabius CD, Shen K, Ornstein KA, Wolff JL. Profile of Older Dual-Enrollees Living in Areas with Managed Long-Term Services and Supports. J Am Med Dir Assoc 2024; 25:722-728. [PMID: 38103571 PMCID: PMC10990790 DOI: 10.1016/j.jamda.2023.11.004] [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: 08/28/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES Nearly half of all state Medicaid agencies in the United States have implemented managed long-term services and supports (MLTSS). Data gaps have inhibited our understanding of MLTSS experiences to date. We draw on a national survey with novel data linkages to develop a profile of older dual-enrollees with significant LTSS needs by MLTSS program presence. DESIGN Cross-sectional observational study using the 2015 round of the National Health and Aging Trends Study (NHATS), a longitudinal study of a nationally representative sample of Medicare beneficiaries aged 65 years and older. SETTING AND PARTICIPANTS The sample comprised 275 participants who self-reported Medicaid enrollment and met our definition of significant LTSS need as defined by receiving help with 2 or more self-care or mobility activities (eating, bathing, toileting, dressing, bed transfer, indoor mobility). METHODS Bivariate analyses were used to comparatively examine differences in demographic, health, and care circumstances by MLTSS, as defined by living in a county with MLTSS program presence. RESULTS Among approximately 1 million (weighted sample) older dual-enrollees with significant LTSS needs, 56.2% (weighted percentage) lived in counties with MLTSS and 43.7% lived in counties with mandatory MLTSS enrollment in 2015. Those living in areas with MLTSS were much more likely to be of Hispanic or other race and ethnicity (50.5% vs 15.1%, P < .001) yet less likely to live in a rural location (8.7% vs 31.4%, P < .05) or in a residential care facility or nursing home (18.4% vs 34.7%, P < .05). The majority (78.5%) received assistance from 2 or more helpers and received more than 70 hours of care per week. CONCLUSIONS AND IMPLICATIONS Our findings reinforce the growing reach of MLTSS programs and importance of filling evidence gaps about who these programs are serving.
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Affiliation(s)
- Andrew D Jopson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Chanee D Fabius
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karen Shen
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Katherine A Ornstein
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 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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Thai GH, Rivette S, Sharman J, Epps F, Masoud S. Dementia Caregiver Experiences: Insights From a Telephone-Based Support Program. J Appl Gerontol 2024:7334648241234745. [PMID: 38459827 DOI: 10.1177/07334648241234745] [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: 03/10/2024] Open
Abstract
Dementia caregivers face daunting challenges as both the oldest subpopulation of those providing unpaid care and the most at risk of adverse health outcomes as a result of their role, including depression, anxiety, and increased mortality. To better understand the experiences and needs of dementia caregivers, a qualitative content analysis was conducted of secondary data extracted from call logs (N = 569) recorded by a provider-initiated, telephone-based support program. Experiences identified from the call logs were coded, categorized, and ranked to determine the most prevalent dementia caregiving-related experiences. Features of the program, particularly the semi-structured call format and directionality of calls, helped to uniquely capture common experiences of family caregivers and their day-to-day concerns. Findings from this analysis reflect the high prevalence of caregiver mental and emotional health-related concerns. This analysis supports the development of interventions that align with the experiences of dementia caregivers.
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Affiliation(s)
- Glory H Thai
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | | | | | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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8
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Sun PC, Shen HW. The Effect of Home- and Community-Based Services on Social Engagement. J Appl Gerontol 2024; 43:242-250. [PMID: 37914279 DOI: 10.1177/07334648231205386] [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: 11/03/2023] Open
Abstract
Objectives: Home- and community-based services (HCBS) help older adults to remain active in community settings. However, it is not known if there is a causal relationship between HCBS and social engagement. Methods: We used data from the 2010 and 2012 Health and Retirement Study and measured the effect of HCBS on social engagement via nearest-neighbor Mahalanobis matching, optimal pair matching, genetic matching, and optimal full matching. Results: Genetic matching showed that the odds of social engagement for participants who received at least one HCBS (congregate meal, home-delivered meal, transportation service, case management, homemaker or housekeeping services, or caregiver services) in the prior two years was 1.07 times more likely than participants who have not received any HCBS (robust SE = .030, p = .040). Discussion: HCBS may remove barriers to social engagement through increasing older adults' personal resources and personal networks.
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Affiliation(s)
- Peter C Sun
- Brown School, Washington University in St. Louis, St Louis, MO, USA
| | - Huei-Wern Shen
- Department of Social Work, College of Health and Public Service, University of North Texas, Denton, TX, USA
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9
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Ne'eman A. Tracking long-term services and supports rebalancing through workforce data. Health Serv Res 2024. [PMID: 38384002 DOI: 10.1111/1475-6773.14293] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE To understand trends in the long-term services and supports (LTSS) workforce and assess workforce data as a measure of progress in shifting LTSS resources from institutional to community-based settings. DATA SOURCES/STUDY SETTING Workforce data from the American Community Survey from 2008 to 2022. STUDY DESIGN Measures of LTSS rebalancing and institutional and community workforce supply per 1000 persons with LTSS needs were constructed. After showing national trends over the study period, state fixed effects regressions were used to evaluate the within-state relationship of these measures with existing measures of LTSS utilization. Workforce supply measures were compared to the percentage of state Medicaid LTSS spending spent in the community to assess their utility for across state comparisons. Each state's progress in LTSS rebalancing over the study period was then shown using workforce data. DATA COLLECTION/EXTRACTION METHODS A sample of 336,316 LTSS workers and 3,015,284 people with LTSS needs over the study period was derived from American Community Survey data. PRINCIPAL FINDINGS From 2008 to 2022, the percentage of the LTSS workforce employed in the community rose from 44% to 58%. Thirty states saw more than a 10 percentage point increase. From 2008 to 2013, the size of the community workforce expanded dramatically but has since stagnated. In contrast, the institutional workforce entered a long-term decline beginning in 2015 that accelerated during the COVID-19 pandemic. State fixed effects regressions showed that measures of workforce supply have a strong relationship with LTSS utilization measures for older adults, but not for younger people with disabilities. CONCLUSIONS Workforce data can serve as an effective measure of changes in LTSS utilization for older adults. This offers researchers and policymakers a useful alternative to administrative claims, bypassing threats to comparability from coding changes and the shift to managed care. Additional data is needed on workforce trends in services for younger LTSS consumers.
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Affiliation(s)
- Ari Ne'eman
- Harvard University, Cambridge, Massachusetts, USA
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10
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Kong D, Lu P, Wu B, Davitt JK, Shelley M. Who Cares for Older Adults? A Cross-National Study of Care Sources for Older Adults With Functional Limitations and Associated Determinants. J Appl Gerontol 2024:7334648241232759. [PMID: 38355157 DOI: 10.1177/07334648241232759] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
The study compared care source typologies for older adults in China and the United States. Data from the 2014 U.S. Health and Retirement Study and the 2013 China Health and Retirement Longitudinal Study were used. The respondents included community-dwelling older adults aged 65 years or older with at least one limitation in activities of daily living (ADLs) or instrumental ADLs (IADLs) (NChina = 2476, NUS = 2898). Respondents reported whether they received assistance from spouse, child/grandchild, relatives, others, and formal helpers. Latent class analysis and multinomial logistic regression were applied. Four classes were identified in China and the U.S, separately. In both countries, ADLs and IADLs were strong determinants of care source typologies. Care sources were more diverse and included formal assistance among older Americans. Older Chinese relied largely on their spouses and children/grandchildren for support. Policy efforts are needed to expand formal long-term services and supports, particularly in China.
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Affiliation(s)
- Dexia Kong
- The Chinese University of Hong Kong, Hong Kong, China
| | - Peiyi Lu
- University of Hong Kong, Hong Kong, China
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Joan K Davitt
- School of Social Work, University of Maryland, Baltimore, MD, USA
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Finan JM, Landes SD. Educational Attainment and Perceived Need for Future ADL Assistance. J Appl Gerontol 2024:7334648241227716. [PMID: 38298096 DOI: 10.1177/07334648241227716] [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: 02/02/2024] Open
Abstract
The current study examined whether educational attainment was associated with perceived need of assistance with future activities of daily living (ADL) among middle-aged and early older-aged adults in the United States. Data for 54,946 adults aged 40-65 years from the 2011-2014 National Health Interview Survey (NHIS) were analyzed using ordered logistic regression. Adults with more education will on average need less ADL assistance than adults with less education. Paradoxically, this study found that higher levels of formal education were associated with perceiving more need for future ADL assistance. This association was also found to vary between males and females. Building knowledge of long-term care planning into existing public educational structures and providing this knowledge to adults no longer involved in the formal educational system through medical providers may lead to better anticipation of future care needs.
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FABIUS CHANEED, OKOYE SAFIYYAHM, WU MINGCHEMJ, JOPSON ANDREWD, CHYR LINDAC, BURGDORF JULIAG, BALLREICH JEROMIE, SCERPELLA DANNY, WOLFF JENNIFERL. The Role of Place in Person- and Family-Oriented Long-Term Services and Supports. Milbank Q 2023; 101:1076-1138. [PMID: 37503792 PMCID: PMC10726875 DOI: 10.1111/1468-0009.12664] [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: 12/22/2022] [Revised: 06/13/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023] Open
Abstract
Policy Points Little attention to date has been directed at examining how the long-term services and supports (LTSS) environmental context affects the health and well-being of older adults with disabilities. We develop a conceptual framework identifying environmental domains that contribute to LTSS use, care quality, and care experiences. We find the LTSS environment is highly associated with person-reported care experiences, but the direction of the relationship varies by domain; increased neighborhood social and economic deprivation are highly associated with experiencing adverse consequences due to unmet need, whereas availability and generosity of the health care and social services delivery environment are inversely associated with participation restrictions in valued activities. Policies targeting local and state-level LTSS-relevant environmental characteristics stand to improve the health and well-being of older adults with disabilities, particularly as it relates to adverse consequences due to unmet need and participation restrictions. CONTEXT Long-term services and supports (LTSS) in the United States are characterized by their patchwork and unequal nature. The lack of generalizable person-reported information on LTSS care experiences connected to place of community residence has obscured our understanding of inequities and factors that may attenuate them. METHODS We advance a conceptual framework of LTSS-relevant environmental domains, drawing on newly available data linkages from the 2015 National Health and Aging Trends Study to connect person-reported care experiences with public use spatial data. We assess relationships between LTSS-relevant environmental characteristic domains and person-reported care adverse consequences due to unmet need, participation restrictions, and subjective well-being for 2,411 older adults with disabilities and for key population subgroups by race, dementia, and Medicaid enrollment status. FINDINGS We find the LTSS environment is highly associated with person-reported care experiences, but the direction of the relationship varies by domain. Measures of neighborhood social and economic deprivation (e.g., poverty, public assistance, social cohesion) are highly associated with experiencing adverse consequences due to unmet care needs. Measures of the health care and social services delivery environment (e.g., Medicaid Home and Community-Based Service Generosity, managed LTSS [MLTSS] presence, average direct care worker wage, availability of paid family leave) are inversely associated with experiencing participation restrictions in valued activities. Select measures of the built and natural environment (e.g., housing affordability) are associated with participation restrictions and lower subjective well-being. Observed relationships between measures of LTSS-relevant environmental characteristics and care experiences were generally held in directionality but were attenuated for key subpopulations. CONCLUSIONS We present a framework and analyses describing the variable relationships between LTSS-relevant environmental factors and person-reported care experiences. LTSS-relevant environmental characteristics are differentially relevant to the care experiences of older adults with disabilities. Greater attention should be devoted to strengthening state- and community-based policies and practices that support aging in place.
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Gaugler JE, Borson S, Epps F, Shih RA, Parker LJ, McGuire LC. The intersection of social determinants of health and family care of people living with Alzheimer's disease and related dementias: A public health opportunity. Alzheimers Dement 2023; 19:5837-5846. [PMID: 37698187 PMCID: PMC10840787 DOI: 10.1002/alz.13437] [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] [Received: 02/22/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 09/13/2023]
Abstract
In this Perspective article, we highlight current research to illustrate the intersection of social determinants of health (SDOHs) and Alzheimer's disease and related dementia (ADRD) caregiving. We then outline how public health can support ADRD family caregivers in the United States. Emerging research suggests that family care for persons with ADRD is influenced by SDOHs. Public health actions that address these intersections such as improved surveillance and identification of ADRD caregivers; building and enhancing community partnerships; advancing dementia-capable health care and related payment incentives; and reducing the stigma of dementia and ADRD caregiving can potentially enhance the health and well-being of dementia caregivers. By engaging in one or all of these actions, public health practitioners could more effectively address the myriad of challenges facing ADRD caregivers most at risk for emotional, social, financial, psychological, and health disruption.
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Affiliation(s)
- Joseph E. Gaugler
- Building Our Largest Dementia Infrastructure (BOLD) Public Health Center of Excellence on Dementia Caregiving, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Soo Borson
- BOLD Public Health Center of Excellence on Early Detection, NYU Grossman School of Medicine, New York, New York, USA
| | - Fayron Epps
- BOLD Public Health Center of Excellence on Dementia Caregiving, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Regina A. Shih
- BOLD Public Health Center of Excellence on Dementia Caregiving, RAND Social and Behavioral Policy Program, RAND Corporation, Santa Monica, California, USA
| | - Lauren J. Parker
- BOLD Public Health Center of Excellence on Dementia Caregiving, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lisa C. McGuire
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Yan K, Sadler T, Brauner D, Pollack HA, Konetzka RT. Caregiving for Older Adults With Dementia During the Time of COVID-19: A Multi-State Exploratory Qualitative Study. J Appl Gerontol 2023; 42:2078-2088. [PMID: 37231705 PMCID: PMC10214026 DOI: 10.1177/07334648231175414] [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] [Received: 11/17/2022] [Indexed: 05/27/2023] Open
Abstract
This qualitative semi-structured interview study explores how 64 family caregivers for older adults with Alzheimer's Disease and related dementias across eight states experienced and executed caregiving decisions before and during the COVID-19 pandemic. First, caregivers experienced challenges communicating with loved ones and healthcare workers in all care settings. Second, caregivers displayed resilient coping strategies in adapting to pandemic restrictions, finding novel strategies to balance risks while preserving communication, oversight, and safety. Third, many caregivers modified care arrangements, with some avoiding and others embracing institutional care. Finally, caregivers reflected on the benefits and challenges of pandemic-related innovations. Certain policy changes reduced caregiver burden and could improve care access if made permanent. Telemedicine's increasing use highlights the need for reliable internet access and accommodations for individuals with cognitive deficits. Public policies must pay greater attention to challenges faced by family caregivers, whose labor is both essential and undervalued.
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Affiliation(s)
- Kevin Yan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tonie Sadler
- Shirley Ryan AbilityLab, Feinberg School of Medicine, Institute for Public Health and Medicine, Northwestern University, Chicago, IL, USA
| | - Daniel Brauner
- Departments of Medicine, Family and Community Medicine and Medical Ethics, Humanities and Law, Division of Geriatrics, Homer Stryker M.D. School of Medicine, Western Michigan University, Kalamazoo, MI, USA
| | - Harold A. Pollack
- Crown Family School of Social Work, Policy, and Practice, Public Health Sciences, Urban Health Lab, University of Chicago, Chicago, IL, USA
| | - R. Tamara Konetzka
- Department of Medicine, Section of Geriatrics and Palliative Medicine, Public Health Sciences, University of Chicago, Chicago, IL, USA
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Kelly CM, Deichert JA. A Profile of the Direct Care Workforce in Home- and Community-Based Services. J Appl Gerontol 2023; 42:1921-1929. [PMID: 37100419 DOI: 10.1177/07334648231173580] [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: 04/28/2023] Open
Abstract
We used data from the 2020 American Community Survey to compare direct care workers (DCWs) in home and community-based services (HCBS) with workers in other long-term supportive services (LTSS), such as skilled nursing facilities (SNFs) and assisted living facilities (ALFs). Compared to DCWs in SNFs and ALFs, a higher proportion of DCWs in HCBS were over age 65, Latino/a, and single. A lower proportion of DCWs in HCBS worked for a for-profit company, worked year-round and full-time, and had employer-based health insurance.
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Affiliation(s)
- Christopher M Kelly
- Center for Public Affairs Research, University of Nebraska at Omaha, Omaha, NE, USA
| | - Jerome A Deichert
- Center for Public Affairs Research, University of Nebraska at Omaha, Omaha, NE, USA
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Rosser BRS, Shippee T, Wright MM, Aumock C, Moone R, Talley KM, Duran P, Henning-Smith C, Cahill S, Flatt JD, Slaughter-Acey J, Greenwald S, McCarthy T, Ross MW. "Going Back in the Closet": Addressing Discrimination Against Sexual and Gender Minority Residents in Long-Term Services and Supports by Providing Culturally Responsive Care. J Aging Soc Policy 2023:1-13. [PMID: 37348486 PMCID: PMC10739643 DOI: 10.1080/08959420.2023.2226300] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 12/27/2022] [Indexed: 06/24/2023]
Abstract
Sexual and gender minority (SGM) older adults face discrimination in long-term services and supports (LTSS). Yet, SGM older adults use LTSS disproportionately higher relative to their non-SGM counterparts. The discrimination is compounded by existing disparities, resulting in worse health outcomes and well-being for SGM older adults. Guided by socioecological model, we posit that training LTSS staff in SGM responsive care and implementing SGM anti-discrimination policies will be needed to improve care. Considering accessibility and turnover challenges, training should be online, interactive, and easily accessible. Studies that assess interventions for SGM responsive care are needed to guide policy and practice.
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Affiliation(s)
- B. R. Simon Rosser
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tetyana Shippee
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Morgan M. Wright
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cailynn Aumock
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rajean Moone
- Long Term Care Administration Program, College of Continuing and Professional Studies, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kristine M.C. Talley
- Adult and Gerontological Health Cooperative, University of Minnesota School of Nursing, Minneapolis, Minnesota, USA
| | | | - Carrie Henning-Smith
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sean Cahill
- Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Jason D. Flatt
- Department of Social and Behavior Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV
| | - Jaime Slaughter-Acey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Samuel Greenwald
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Teresa McCarthy
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Michael W. Ross
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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17
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Janssen LM, Abbott KM. "It Hits Me Right Here at my Heart": Promoting Emotional Health of Home Care Workers. J Appl Gerontol 2023; 42:680-688. [PMID: 36305376 DOI: 10.1177/07334648221127690] [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] Open
Abstract
Demand for home and community-based services continues to outpace employment of home care workers (HCWs) who provide this vital assistance. HCWs face challenges that contribute to inadequate staff retention. Of particular concern is the lack of research on HCWs' emotional health. This research describes facilitators and resources that support HCW emotional health. Qualitative descriptive interviews were conducted with a purposive sample of HCWs (n = 17) who were formally recognized for their success. Interviews were audio recorded, transcribed verbatim, and coded in Dedoose. Thematic analysis revealed three facilitators of emotional health that HCWs link to their professional success: "right state of mind," practicing self-care, and a combined sense of appreciation and support. HCWs highlight specific, practicable resources that promote their emotional health. Policy implications connects low wages and benefits to HCW emotional health, and practice implications for enhancing training and support to retain these important workers.
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Affiliation(s)
- Leah M Janssen
- Scripps Gerontology Center, 6403Miami University, Oxford, OH, USA
| | - Katherine M Abbott
- Scripps Gerontology Center, Department of Sociology & Gerontology, 6403Miami University, Oxford, OH, USA
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18
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Zagrodney K, Deber R, Saks M, Laporte A. The Disadvantaged Home Care Personal Support Worker: Differences in Job Characteristics, Unionization, Pensions, Participation, and Wages by Care Sector in Canada. J Appl Gerontol 2023; 42:758-767. [PMID: 36524373 PMCID: PMC9996786 DOI: 10.1177/07334648221146260] [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
Personal Support Worker (PSW) supply is struggling to match the rising demand within many countries, particularly in the home and community (HC) sector. Although care demand projections are often sector-specific, our understanding of sector discrepancies on the PSW labour supply side is limited. This paper compares PSW job characteristics by means, proportions, and tests of significance across HC, nursing and long-term care home (LTC), and hospital sectors utilizing a sample of Canadian PSWs (1996-2010). Compared to LTC and hospital sectors, HC PSWs had significantly lower average wages, labour participation levels, permanent positions, job duration, and unionization rates. Relative wage distribution graphs showed how sector wage discrepancies existed across the wage distribution. These distinctions made the comparatively disadvantaged HC PSW position particularly salient, with important labour supply implications by sector. The relative attractiveness of HC sector jobs will become more critical as the rise in HC demand is projected to continue.
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Affiliation(s)
- Katherine Zagrodney
- Institute of Health Policy, Management and Evaluation, 7938University of Toronto, Toronto, ON, Canada.,Canadian Centre for Health Economics (CCHE), Toronto, ON, Canada.,612784VHA Home HealthCare, Toronto, ON, Canada.,Canadian Health Workforce Network (CHWN), Ottawa, ON, Canada.,6363University of Ottawa, Ottawa, ON, Canada
| | - Raisa Deber
- Institute of Health Policy, Management and Evaluation, 7938University of Toronto, Toronto, ON, Canada.,Canadian Centre for Health Economics (CCHE), Toronto, ON, Canada
| | - Mike Saks
- Institute of Health Policy, Management and Evaluation, 7938University of Toronto, Toronto, ON, Canada.,102099University of Suffolk, Ipswich, UK.,4547University of Lincoln, Lincoln, UK.,4921University of Westminster, London, UK
| | - Audrey Laporte
- Institute of Health Policy, Management and Evaluation, 7938University of Toronto, Toronto, ON, Canada.,Canadian Centre for Health Economics (CCHE), Toronto, ON, Canada
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19
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Mellor J, Cunningham P, Britton E, Walker L. Use of Home and Community-Based Services After Implementation of Medicaid Managed Long Term Services and Supports in Virginia. J Aging Soc Policy 2023:1-19. [PMID: 36857515 DOI: 10.1080/08959420.2023.2183678] [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: 03/17/2022] [Accepted: 09/19/2022] [Indexed: 03/03/2023]
Abstract
Many state Medicaid programs contract with managed care organizations to deliver long-term services and supports (LTSS) to seniors and persons with disabilities. Managed LTSS (MLTSS) programs are often intended to increase access to and utilization of home- and community-based services (HCBS), yet there are few empirical studies of their effects. In this retrospective observational study, we used administrative data from Virginia Medicaid to compare HCBS waiver enrollment and service utilization pre- and post-implementation of MLTSS. Compared to the prior fee-for-service system, Medicaid beneficiaries with long-term care needs who were enrolled in Virginia's MLTSS program were more likely to be enrolled in Virginia's 1915(c) waivers for home and community-based services. Further, the likelihood of using personal care increased by nearly 5%, and the likelihood of using respite care increased by about 10%. These findings are pertinent to ongoing policy changes that use private managed care organizations to deliver long-term services and supports to seniors and persons with disabilities. Policymakers in states and the federal government should note these initial increases in service use under Medicaid MLTSS, while supporting evaluations of the long-term impacts of MLTSS on HCBS use and beneficiary health and satisfaction.
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Affiliation(s)
- Jennifer Mellor
- Department of Economics, School of Arts & Sciences, William & Mary, Williamsburg, VA, USA
| | - Peter Cunningham
- Department of Health Behavior and Policy, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA
| | - Erin Britton
- Department of Health Behavior and Policy, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA
| | - Lauryn Walker
- Health Economics and Economic Policy, Virginia Department of Medical Assistance Services, Richmond, VA, USA
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20
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Lindmark T, Engström M, Trygged S. Psychosocial Work Environment and Well-Being of Direct-Care Staff Under Different Nursing Home Ownership Types: A Systematic Review. J Appl Gerontol 2023; 42:347-359. [PMID: 36214292 PMCID: PMC9841825 DOI: 10.1177/07334648221131468] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
This systematic review investigated the psychosocial work environment and well-being of direct-care staff under different nursing home ownership types. Databases searched: Scopus, Web of Science, Cinahl, and PubMed, 1990-2020. Inclusion criteria: quantitative or mixed-method studies; population: direct-care staff in nursing homes; exposure: for-profit and non-profit ownership; and outcomes: psychosocial work environment and well-being. In total, 3896 articles were screened and 17(n = 12,843 participants) were assessed using the Joanna Briggs Institute Critical Appraisal tools and included in the narrative synthesis. The results were inconsistent, but findings favored non-profit over for-profit settings, for example, regarding leaving intentions, organizational commitment, and stress-related outcomes. There were no clear differences concerning job satisfaction. Job demands were higher in non-profit nursing homes but alleviated by better job resources in one study. The result highlights work environment issues, with regulations concerning for-profit incentives being discussed in terms of staff benefits.
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Affiliation(s)
- Tomas Lindmark
- Faculty of Health and Occupational Studies, Department of Social Work, University of Gävle, Gävle, Sweden,Tomas Lindmark, Faculty of Health and Occupational Studies, Department of Social work, University of Gävle, Kungsbäcksvägen 47, Gävle 801 76, Sweden.
| | - Maria Engström
- Faculty of Health and Occupational Studies, Department of Caring Science, University of Gävle, Gävle, Sweden
| | - Sven Trygged
- Faculty of Health and Occupational Studies, Department of Social Work, University of Gävle, Gävle, Sweden
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21
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Kim H, Senders A, Simeon E, Juarez C, Huang S, Dodge H, McConnell KJ. Use of long-term services and supports among dual-eligible beneficiaries with Alzheimer's disease and related dementias. J Am Geriatr Soc 2023; 71:432-442. [PMID: 36334026 PMCID: PMC9957784 DOI: 10.1111/jgs.18115] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/09/2022] [Accepted: 10/09/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND To respect people's preference for aging in place and control costs, many state Medicaid programs have enacted policies to expand home and community-based services as an alternative to nursing facility care. However, little is known about the use of Medicaid long-term services and supports (LTSS) at a national level, particularly among dual-eligible beneficiaries with Alzheimer's disease and related dementias (ADRD). METHODS Using Medicare and Medicaid claims of 30 states from 2016, we focused on dual-eligible beneficiaries 65 years or older with ADRD and described their use of any form of LTSS and sub-types of LTSS (home-based, community-based, and nursing facility services) across states. RESULTS We found that 80.5% of dual-eligible beneficiaries with ADRD received some form of Medicaid LTSS in 2016. The most common LTSS setting was nursing facility (46.7%), followed by home (31.5%) and community (12.2%). There was sizeable state variation in the percentage of dual-eligible beneficiaries with ADRD who used any form of LTSS (ranging from 61% in Maine to 96% in Montana). The type of LTSS used also varied widely across states. For example, home-based service use ranged from 9% in Maine, Arizona, and South Dakota to 62% in Oregon. Nursing facility services were the most common type of LTSS in most states. However, home-based service use exceeded nursing facility use in Oregon, Alaska, and California. CONCLUSIONS Our findings suggest substantially different use of LTSS across states among dual-eligible beneficiaries with ADRD. Given the importance of LTSS for this population and their families, a deeper understanding of state LTSS policies and other factors that contribute to wide state variation in LTSS use will be necessary to improve access to LTSS across states.
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Affiliation(s)
- Hyunjee Kim
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon, USA
| | - Angela Senders
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon, USA
| | - Erika Simeon
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon, USA
| | - Cesar Juarez
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon, USA
| | - Sean Huang
- Department of Health Systems Administration, Georgetown University, Washington, District of Columbia, USA
| | - Hiroko Dodge
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - K John McConnell
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon, USA
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22
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Goldman AS, Abbott KM, Huang L, Naylor MD, Hirschman KB. Changes in Tangible Social Support Over Time Among Older Adults Receiving Long-Term Services and Supports. J Appl Gerontol 2023; 42:981-991. [PMID: 36650926 PMCID: PMC10081952 DOI: 10.1177/07334648221150966] [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: 01/19/2023] Open
Abstract
The purpose of this study was to examine changes in and predictors of perceived tangible social support over a 2-year period among older adults new to LTSS. Linear mixed effects models were used to model repeated measures of tangible social support as a function of LTSS type [NH, AL, HCBS], personal, clinical, and health-related quality of life variables. AL residents reported greater initial tangible social support, but NH and HCBS residents improved more over time. Predictors of increased tangible social support over time included greater positive affect, sense of aesthetics, education, satisfaction with family relationships, and total number of close friends and family. Decreased tangible support over time was associated with greater depressive symptoms. Findings indicate the positive influence of NH and HCBS services on perception of tangible social support, and the importance of addressing depressive symptoms and assisting with the maintenance of important relationships.
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Affiliation(s)
| | - Katherine M Abbott
- Scripps Gerontology Center, Department of Sociology and Gerontology, Miami University, Oxford, OH, USA
| | - Liming Huang
- School of Nursing, 16142University of Pennsylvania, Philadelphia, PA, USA
| | - Mary D Naylor
- School of Nursing, 16142University of Pennsylvania, Philadelphia, PA, USA
| | - Karen B Hirschman
- School of Nursing, 16142University of Pennsylvania, Philadelphia, PA, USA
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23
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Abstract
OBJECTIVES We examine associations between use of paid help and caregiving-related experiences (emotional, financial, and physical difficulty) of Black family and unpaid caregivers of older adults. METHODS We examine a sample of N = 572 non-Hispanic Black caregivers of community-dwelling older adults receiving help with daily activities from the 2015 National Health and Aging Trends Study (NHATS) and National Study of Caregiving (NSOC). Guided by Pearlin's Stress Process Model, logistic regression models examine associations between assisting with finding paid help and caregiver experiences. RESULTS Black caregivers who helped care recipients find paid help more often had a college degree or higher, were helping older adults who received assistance with three or more self-care/mobility activities or who were living in poverty and were not receiving help with caregiving from family and friends. In fully-adjusted models, assisting with finding paid help was associated with emotional (AOR 1.92, 95% CI 1.27, 2.92 p < .01) and physical (AOR 2.16, 95% CI 1.04, 4.51; p = .04) difficulty. CONCLUSIONS Greater efforts are needed to support Black family and unpaid caregivers who are caring for older adults using paid help. CLINICAL IMPLICATIONS Future interventions that target Black caregivers of older adults using paid help could be useful for improving caregiving experiences.
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Affiliation(s)
- Chanee D Fabius
- Department of Health Policy and Management (Fabius), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lauren J Parker
- Department of Health Policy and Management (Fabius), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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24
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Carlson SR, Thompson JR, Shaw L. The Impact of Administration Formats on SIS-A Scores. Am J Intellect Dev Disabil 2023; 128:66-81. [PMID: 36548374 DOI: 10.1352/1944-7558-128.1.66] [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] [Received: 12/10/2021] [Accepted: 04/12/2022] [Indexed: 06/17/2023]
Abstract
Many U.S. states use the Supports Intensity Scale-Adult Version (SIS-A; Thompson et al., 2015) to inform the distribution of public funds for long-term services and supports. Throughout the COVID-19 pandemic, many states began administering the SIS-A virtually instead of in person. Because administration format has the potential to influence SIS-A scores and, consequently, impact the funding people receive for long-term services and supports, this study examined the stability of support need scores, as measured by the SIS-A, over two time periods: (a) when assessments were conducted in person and (b) when assessments were conducted virtually using remote technology. Specifically, the influence of assessment administration formats on SIS-A scores and on the perceptions of SIS-A assessors were investigated. Results revealed that the virtual administration format impacted SIS-A scores, but the impact was of little to no practical importance.
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25
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Keita Fakeye MB, Samuel LJ, Wolff JL. Financial Contributions and Experiences of Non-Spousal, Employed Family Caregivers. J Appl Gerontol 2022; 41:2459-2468. [PMID: 35838604 PMCID: PMC9671815 DOI: 10.1177/07334648221115261] [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] [Indexed: 11/17/2022] Open
Abstract
The economic impacts of caring for an older adult may be amplified for employed family and unpaid caregivers. We examine out-of-pocket spending among employed, retired, and unemployed caregivers. Among employed caregivers, we identify correlates of spending and assess whether spending and work productivity loss contribute to financial burden. Analyses use the 2015 National Health and Aging Trends Study (NHATS) and National Study of Caregiving. We find that employed caregivers incur more out-of-pocket spending on caregiving than retired and unemployed counterparts. Employed caregivers spending more than $500 out-of-pocket provide more hours of care and assist older adults with greater impairment. Among employed family caregivers, caregiver and care recipient Medicaid enrollment, spending, and work productivity loss are associated with financial burden. Findings suggest that caregiving exacerbates economic well-being among employed caregivers, particularly for those with socioeconomic vulnerability.
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Affiliation(s)
- Maningbè B. Keita Fakeye
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Jennifer L. Wolff
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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26
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Hest R, Alarcon G, Blewett LA. Modeling Financial Eligibility for Medicaid Long-term Services and Supports. J Aging Soc Policy 2022; 34:923-937. [PMID: 32223523 PMCID: PMC11097399 DOI: 10.1080/08959420.2020.1740638] [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: 01/15/2019] [Accepted: 10/02/2019] [Indexed: 10/24/2022]
Abstract
Medicaid plays a significant role in financing long-term services and supports (LTSS) for low-income elderly (65+) in the United States. We modeled the impact of changing income, home equity, and asset limitations on Medicaid eligibility across states. We found that one in five elderly adults (10 million individuals) meet all three tests and would be financially eligible for Medicaid LTSS. Imposing additional restrictions on income allowances and eligibility thresholds had greatest impact on financial eligibility for Medicaid LTSS. Few states have opted to restrict financial eligibility and are instead looking for ways to keep people living independently in the community.
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Affiliation(s)
- Robert Hest
- School of Public Health, Division of Health Policy and Management, State Health Access Data Assistance Center (SHADAC), University of Minnesota, Minneapolis, Minnesota, USA
| | - Giovaan Alarcon
- School of Public Health, Division of Health Policy and Management, State Health Access Data Assistance Center (SHADAC), University of Minnesota, Minneapolis, Minnesota, USA
| | - Lynn A. Blewett
- Professor of Health Policy, Director, School of Public Health, Division of Health Policy and Management, State Health Access Data Assistance Center (SHADAC), University of Minnesota, Minneapolis, Minnesota, USA
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27
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MILLER KATHERINEEM, STEARNS SALLYC, VAN HOUTVEN COURTNEYH, GILLESKIE DONNA, HOLMES GEORGEM, KENT ERINE. The Landscape of State Policies Supporting Family Caregivers as Aligned With the National Academy of Medicine Recommendations. Milbank Q 2022; 100:854-878. [PMID: 35579187 PMCID: PMC9576229 DOI: 10.1111/1468-0009.12567] [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: 12/30/2022] Open
Abstract
Policy Points In the absence of federal policy, states adopted policies to support family caregivers, but availability and level of support varies. We describe, compare, and rank state policies to support family caregivers as aligned with National Academy of Medicine recommendations. Although the landscape of state policies supporting caregivers has improved over time, few states provide financial supports as recommended, and benefit restrictions hinder accessibility for all types of family caregivers. Implementing policies supporting family caregivers will become more critical over time, as the reliance on family caregivers as essential providers of long-term care is only expected to grow as the population ages. CONTEXT In the United States in 2020, approximately 26 million individuals provided unpaid care to a family member or friend. On average, 60% of caregivers were employed, and they provided 20.4 hours of care per week on top of employment. Although a handful of patchwork laws exist to aid family caregivers, systematic supports, including comprehensive training, respite, and financial support, remain limited. In the absence of federal supports, states have adopted policies to provide assistance, but they vary in availability and level of support provided. Our objectives were to describe, compare, and rank state policies to support family caregivers over time. METHODS We used publicly available data from the AARP Long-Term Services and Supports State Scorecard, the National Academy for State Health Policy, and Tax Credits for Workers and Families for all 50 states and the District of Columbia (2015-2019). FINDINGS We found that states had increased supports to family caregivers over this five-year period, although significant variability in adoption and implementation of policies persists. Approximately 20% of states had enacted policies that exceed the federal Family and Medical Leave Act requirements, and 18% offered paid family leave. However, most states had not improved spousal impoverishment protections for Medicaid beneficiaries. For example, from 2016 to 2019, 24% of states provided fewer or no protections, while 71% of states did not improve spousal impoverishment protections over time. Access to training for caregivers varied based on eligibility criteria (e.g., select populations and/or only co-residing caregivers). CONCLUSIONS Overall, state approaches to support family caregivers vary by eligibility and scope of services. Substantial gaps in support of caregivers, particularly economic supports, persist. Although the landscape of state policies supporting caregivers has improved over time, few states provide financial supports as recommended by the National Academy of Medicine, and benefit restrictions hinder accessibility for all family caregivers.
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Affiliation(s)
- KATHERINE E. M. MILLER
- Durham Center of Innovation to Accelerate Discovery and Practice TransformationDurham VA Health Care System
- Gillings School of Global Public HealthUniversity of North Carolina at Chapel Hill
- Author affiliation at time work was conducted
| | - SALLY C. STEARNS
- Gillings School of Global Public HealthUniversity of North Carolina at Chapel Hill
- University of North Carolina at Chapel Hill
| | - COURTNEY H. VAN HOUTVEN
- Durham Center of Innovation to Accelerate Discovery and Practice TransformationDurham VA Health Care System
- Population Health SciencesDuke University School of Medicine
- Duke Margolis Center for Health PolicyDuke University
| | | | - GEORGE M. HOLMES
- Gillings School of Global Public HealthUniversity of North Carolina at Chapel Hill
- Cecil G. Sheps Center for Health Services ResearchUniversity of North Carolina at Chapel Hill
| | - ERIN E. KENT
- Gillings School of Global Public HealthUniversity of North Carolina at Chapel Hill
- Cecil G. Sheps Center for Health Services ResearchUniversity of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel Hill
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28
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Kunkel MC, Madrigal C, Moore R, Bowblis JR, Straker J, Nelson M, Van Haitsma K, Abbott KM. Exploring the Criterion Validity of Pragmatic Person-Centered Care/Culture Change Measures. J Appl Gerontol 2022; 41:2542-2548. [PMID: 35930796 DOI: 10.1177/07334648221117528] [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] Open
Abstract
BACKGROUND Nursing homes (NHs) are required to provide person-centered care, efforts often folded into broader culture change initiatives. Despite the known benefits of culture change, it is difficult to measure. This study aims to assess the criterion validity of the Preferences for Everyday Living Inventory (PELI) Implementation Indicator with other culture change measures. METHODS Using data from Ohio-based NHs (n = 771), logistic regression techniques demonstrated the relationship between the PELI Implementation Indicator and two validated culture change measures, the Resident Preferences for Care (RPC) and Certified Nursing Assistant (CNA) Empowerment scales. RESULTS There was a significant relationship between the two scales and complete PELI implementation holding all other variables constant. The RPC and CNA Empowerment scales were significantly associated with complete PELI implementation. DISCUSSION Findings suggest that the PELI Implementation Indicator can be used as a pragmatic indicator of a community's adoption of person-centered care and culture change.
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Affiliation(s)
- Miranda C Kunkel
- Department of Sociology and Gerontology, 6403Miami University, Oxford, OH, USA
| | - Caroline Madrigal
- Center of Innovation in Long Term Services and Supports, 20100Providence VA Medical Center, Providence, RI, USA
| | - Reese Moore
- Department of Sociology and Gerontology, 6403Miami University, Oxford, OH, USA
| | - John R Bowblis
- Scripps Gerontology Center, 6403Miami University, Oxford, OH, USA.,Department of Economics, Farmer School of Business, 6403Miami University, Oxford, OH, USA
| | - Jane Straker
- Scripps Gerontology Center, 6403Miami University, Oxford, OH, USA
| | - Matt Nelson
- Scripps Gerontology Center, 6403Miami University, Oxford, OH, USA
| | - Kimberly Van Haitsma
- The Pennsylvania State University, Ross and Carol Nese College of Nursing, Program for Person Centered Living Systems of Care.,The Polisher Research Institute at Abramson Senior Care, 201 Nursing Sciences Building, University Park, PA, USA
| | - Katherine M Abbott
- Department of Sociology and Gerontology, 6403Miami University, Oxford, OH, USA.,Scripps Gerontology Center, 6403Miami University, Oxford, OH, USA
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29
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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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Li Y, Liu J, Sun F, Xu L. Adult Day Service Use Among Minority Older Adults: Facilitators, Barriers, and Outcomes From an Updated Integrative Literature Review Between 2010 to 2021. J Appl Gerontol 2022; 41:2253-2263. [PMID: 35652698 DOI: 10.1177/07334648221106772] [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: 11/17/2022] Open
Abstract
Adult day services (ADS) are one of the more popular long-term care options for racial and ethnic minority older Americans. Focusing on minority older adults, this study aims to (a) identify both the individual and structural/organizational levels factors associated with ADS use and to (b) examine ADS' effect on health and well-being. Using the integrative review approach of Whittemore and Knafl, we found 14 studies published between 2010 to 2021. Findings concluded that individual-level needs and enabling factors were associated with ADS use and outcomes among minority older adults centered mostly on quality of life. Organizational/structural characteristics of ADS were never empirically examined in relation to service use or health outcomes. Future research should move beyond the individual level to identify and address the impact of the institutional structure, culture and practice on access, quality, and use.
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Affiliation(s)
- Yawen Li
- School of Social Work, 14672California State University San Bernardino, San Bernardino, CA, USA
| | - Jinyu Liu
- School of Social Work, 139058Columbia University, New York City, NY, USA
| | - Fei Sun
- School of Social Work, 3078Michigan State University, East Lansing, MI, USA
| | - Ling Xu
- School of Social Work, University of Texas Arlington, Arlington, TX, USA
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Hawes FM, Wang S. The Impact of Supervisor Support on the Job Satisfaction of Immigrant and Minority Long-Term Care Workers. J Appl Gerontol 2022; 41:2157-2166. [PMID: 35609234 DOI: 10.1177/07334648221104088] [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] Open
Abstract
Previous research has demonstrated the effect of supervisor support on the job satisfaction of long-term care workers (LTCW); however, much less is known about how this effect differs among race/ethnicity or immigration groups. We examined how supervisor support mediates the associations between race/ethnicity, immigration status, and job satisfaction among nursing assistants (NAs). Data of 2749 NAs were extracted from the National Nursing Assistant Survey (2004). Findings indicated that NAs of non-Hispanic Black and other races and immigrant workers were more likely to be satisfied with their jobs compared to White and non-immigrant workers, and the associations were mediated by NAs' perceived supervisor support. Minority or immigrant LTCW may be more sensitive to supervisory support and more grateful if they received support from supervisors. Managers should be aware of these racial differences and by being supportive they may improve NAs job satisfaction and reduce turnover rates.
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Affiliation(s)
- Frances M Hawes
- Health Care Administration Department, 14747University of Wisconsin Eau Claire, Eau Claire, WI, USA
| | - Shuangshuang Wang
- School of Public Administration, 66555Southwest Jiaotong University, Chengdu, China.,Gerontology Institute, University of Massachusetts Boston, Boston, MA, USA
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Portacolone E, Torres JM, Johnson JK, Benton D, Rapp T, Tran T, Martinez P, Graham C. The Living Alone with Cognitive Impairment Project's Policy Advisory Group on Long-Term Services and Supports: Setting a Research Equity Agenda. Int J Environ Res Public Health 2022; 19:6021. [PMID: 35627558 PMCID: PMC9141001 DOI: 10.3390/ijerph19106021] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 12/17/2022]
Abstract
(1) Background: A United States national policy advisory group (PAG) was convened to identify barriers and facilitators to expand formal long-term services and support (LTSS) for people living alone with cognitive impairment (PLACI), with a focus on equitable access among diverse older adults. The PAG's insights will inform the research activities of the Living Alone with Cognitive Impairment Project, which is aimed at ensuring the equitable treatment of PLACI. (2) Methods: The PAG identified barriers and facilitators of providing effective and culturally relevant LTSS to PLACI via one-on-one meetings with researchers, followed by professionally facilitated discussions among themselves. (3) Results: The PAG identified three factors that were relevant to providing effective and culturally relevant LTSS to PLACI: (i) better characterization of PLACI, (ii) leveraging the diagnosis of cognitive impairment, and (iii) expanding and enhancing services. For each factor, the PAG identified barriers and facilitators, as well as directions for future research. (4) Conclusions: The barriers and facilitators the PAG identified inform an equity research agenda that will help inform policy change.
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Affiliation(s)
- Elena Portacolone
- Institute for Health & Aging, University of California, San Francisco, CA 94158, USA; (J.K.J.); (T.T.); (P.M.); (C.G.)
- Philip Lee Institute for Health Policy Studies, University of California, San Francisco, CA 94158, USA
| | - Jacqueline M. Torres
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94158, USA;
| | - Julene K. Johnson
- Institute for Health & Aging, University of California, San Francisco, CA 94158, USA; (J.K.J.); (T.T.); (P.M.); (C.G.)
| | - Donna Benton
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA;
| | - Thomas Rapp
- LIRAES, Université Paris Cité, 75006 Paris, France;
- Sciences Po Paris, LIEPP, 75006 Paris, France
| | - Thi Tran
- Institute for Health & Aging, University of California, San Francisco, CA 94158, USA; (J.K.J.); (T.T.); (P.M.); (C.G.)
| | - Paula Martinez
- Institute for Health & Aging, University of California, San Francisco, CA 94158, USA; (J.K.J.); (T.T.); (P.M.); (C.G.)
| | - Carrie Graham
- Institute for Health & Aging, University of California, San Francisco, CA 94158, USA; (J.K.J.); (T.T.); (P.M.); (C.G.)
- Center for Health Care Strategies, Hamilton, NJ 08619, USA
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Abstract
Dr. Francis G. Caro, retired Professor of Gerontology at the University of Massachusetts Boston, Co-editor (1996-2005) and Editor-in-Chief (2005-2016) of the Journal of Aging and Social Policy, passed away on October 2, 2020. Caro dedicated most of his nearly 60 years of academic and professional activity to gerontology and services for older adults. This article offers a review of his contributions in four central areas of gerontology: the strengthening of long-term services and supports through integration of home care services with other domains, the expansion of how productive aging was socially understood and economically valued, the importance of rigorous program evaluation and ongoing methodological innovation, and the significance of age-friendly cities and communities, both in the United States and internationally. This review of Caro's work highlights his integral role in helping to place several topics on the gerontological agenda that are still relevant today, establishing him as an important contributor to the field. He also exemplified productive aging and how scholarship can be theoretically rigorous but also applied in meaningful ways to make a difference in individual lives and within communities.
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Affiliation(s)
- Mariano Sánchez
- Associate Professor, Department of Sociology, Faculty of Political Sciences and Sociology, University of Granada, Granada, Spain
| | | | - Pamela Nadash
- Associate Professor, Department of Gerontology, Gerontology Institute, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Kelly Fitzgerald
- Associate Lecturer, Department of Gerontology, Gerontology Institute, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Kimberly S Stoeckel
- Affiliate Associate Professor, Erickson School of Aging Studies, University of Maryland Baltimore County, Baltimore County, Maryland, USA
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Foster CC, Shaunfield S, Black LE, Labellarte PZ, Davis MM. Improving Support for Care at Home: Parental Needs and Preferences When Caring for Children with Medical Complexity. J Pediatr Health Care 2022; 36:154-164. [PMID: 34688541 DOI: 10.1016/j.pedhc.2020.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/12/2020] [Accepted: 08/20/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We sought to characterize the current supports used by parents to care for children with medical complexity (CMC) at home and parental preferences for additional supports to meet identified gaps. METHOD Semistructured interviews were conducted with parents of 18 CMC. Interviews were transcribed then analyzed using a constant comparative approach. RESULTS Extended family and community offloaded nonmedical tasks, assisted financially, gave emotional reinforcement, and cared for CMC. Home health providers also directly cared for CMC, but access and quality varied. Government programs paid for in-home care, but eligibility varied. Parents wanted more paid home care but also more support completing nonmedical tasks, mitigating financial strains, and accessing mental health services. DISCUSSION Parents of CMC relied on family and community members to help fill existing gaps in-home care, but gaps remained, suggesting the need for more medical and social supports for the in-home care of CMC and their families.
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Juckett LA, Hariharan G, Dodonova DC, Klaus J, Rowe M, Burak E, Mason B, Bunck L. Implementing a Community-Based Initiative to Improve Nutritional Intake among Home-Delivered Meal Recipients. Nutrients 2022; 14:nu14050944. [PMID: 35267919 PMCID: PMC8912420 DOI: 10.3390/nu14050944] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/27/2022] Open
Abstract
Home-delivered meal (HDM) recipients are a highly vulnerable group of older adults at risk for malnutrition and subsequent health decline. To help HDM recipients increase their nutritional intake, HDM agencies may provide expanded meal options that allow older adults to have greater autonomy over their meal selection; however, the extent to which recipients are able to select nutritious meals that are responsive to their health complexities is unknown. This study examined the nutritional content of meals selected by HDM recipients enrolled in an expanded menu plan through a large HDM agency. Data were drawn from a retrospective chart review of 130 HDM recipients who had the option of selecting their own HDM meals and frequency of meal delivery. Findings indicate that older adults who selected their own meals chose meals that were significantly lower in protein, potassium, fat, and calories. The lack of these nutrients suggests that older adults enrolled in expanded menu plans should be referred to registered dietitian nutritionists who can provide skilled guidance in meal selection. To address this need, we also describe and provide preliminary data representing a referral program designed to connect HDM recipients to dietetic services with the goal of optimizing older adult nutrition and health-related outcomes.
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Affiliation(s)
- Lisa A. Juckett
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH 43210-2205, USA
- Correspondence: ; Tel.: +1-614-366-7543
| | - Govind Hariharan
- Coles College of Business, Kennesaw State University, Kennesaw, GA 30144-0405, USA; (G.H.); (D.C.D.)
| | - Dimitri Camargo Dodonova
- Coles College of Business, Kennesaw State University, Kennesaw, GA 30144-0405, USA; (G.H.); (D.C.D.)
| | - Jared Klaus
- Lifecare Alliance, Columbus, OH 43223-1809, USA; (J.K.); (M.R.); (E.B.); (B.M.); (L.B.)
| | - Melinda Rowe
- Lifecare Alliance, Columbus, OH 43223-1809, USA; (J.K.); (M.R.); (E.B.); (B.M.); (L.B.)
| | - Elana Burak
- Lifecare Alliance, Columbus, OH 43223-1809, USA; (J.K.); (M.R.); (E.B.); (B.M.); (L.B.)
| | - Benetta Mason
- Lifecare Alliance, Columbus, OH 43223-1809, USA; (J.K.); (M.R.); (E.B.); (B.M.); (L.B.)
| | - Leah Bunck
- Lifecare Alliance, Columbus, OH 43223-1809, USA; (J.K.); (M.R.); (E.B.); (B.M.); (L.B.)
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36
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Shippee TP, Fabius CD, Fashaw-Walters S, Bowblis JR, Nkimbeng M, Bucy TI, Duan Y, Ng W, Akosionu O, Travers JL. Evidence for Action: Addressing Systemic Racism Across Long-Term Services and Supports. J Am Med Dir Assoc 2022; 23:214-219. [PMID: 34958742 PMCID: PMC8821413 DOI: 10.1016/j.jamda.2021.12.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [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: 08/20/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 02/03/2023]
Abstract
Long-term services and supports (LTSS), including care received at home and in residential settings such as nursing homes, are highly racially segregated; Black, Indigenous, and persons of color (BIPOC) users have less access to quality care and report poorer quality of life compared to their White counterparts. Systemic racism lies at the root of these disparities, manifesting via racially segregated care, low Medicaid reimbursement, and lack of livable wages for staff, along with other policies and processes that exacerbate disparities. We reviewed Medicaid reimbursement, pay-for-performance, public reporting of quality of care, and culture change in nursing homes and integrated home- and community-based service (HCBS) programs as possible mechanisms for addressing racial and ethnic disparities. We developed a set of recommendations for LTSS based on existing evidence, including (1) increase Medicaid and Medicare reimbursement rates, especially for providers serving high proportions of Medicaid-eligible and BIPOC older adults; (2) reconsider the design of pay-for-performance programs as they relate to providers who serve underserved groups; (3) include culturally sensitive measures, such as quality of life, in public reporting of quality of care, and develop and report health equity measures in outcomes of care for BIPOC individuals; (4) implement culture change so services are more person-centered and homelike, alongside improvements in staff wages and benefits in high-proportion BIPOC nursing homes; (5) expand access to Medicaid-waivered HCBS services; (6) adopt culturally appropriate HCBS practices, with special attention to family caregivers; (7) and increase promotion of integrated HCBS programs that can be targeted to BIPOC consumers, and implement models that value community health workers. Multipronged solutions may help diminish the role of systemic racism in existing racial disparities in LTSS, and these recommendations provide steps for action that are needed to reimagine how long-term care is delivered, especially for BIPOC populations.
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Affiliation(s)
| | - Chanee D. Fabius
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - John R. Bowblis
- Miami University, Farmer School of Business and Scripps Gerontology Center, Oxford, Ohio, USA
| | - Manka Nkimbeng
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Taylor I. Bucy
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Yinfei Duan
- University of Alberta Faculty of Nursing, Edmonton, Alberta, Canada
| | - Weiwen Ng
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Odichinma Akosionu
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Jasmine L. Travers
- New York University Rory Meyers College of Nursing, New York, New York, USA
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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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Ohikere K, Veracruz N, Wong RJ. Cognitive Impairment and Cirrhosis in Older Patients: A Systematic Review. Gerontol Geriatr Med 2022; 8:23337214221122520. [PMID: 36105374 PMCID: PMC9465583 DOI: 10.1177/23337214221122520] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/27/2022] [Accepted: 08/08/2022] [Indexed: 11/15/2022] Open
Abstract
Prevalence of cirrhosis and hepatic encephalopathy (HE) in older patients receiving care in long-term care settings is unknown. This systematic review aimed to identify potential factors associated with HE and cognitive impairment in older patients with cirrhosis. A PubMed search of English-language articles published between January 1, 2000, and November 3, 2021, was conducted to identify studies in adults with cirrhosis relevant to cognitive impairment and/or HE (e.g., fall, frailty, and sarcopenia). Of 2,879 English-language publications, 24 were included. In patients with cirrhosis, falls were increased in the presence of HE and were associated with increased injury risk. Frailty was associated with HE development and cognitive impairment in patients with cirrhosis. Further, cognitive impairment and frailty were predictive of HE-related hospitalizations. Sarcopenia increased the risk of developing HE. Furthermore, specific medications increased the risk of developing HE. Risk reduction and management of patients with HE are critical to prevent negative outcomes.
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Affiliation(s)
- Kabiru Ohikere
- San Francisco Department of Public Health, San Francisco, CA, USA
| | | | - Robert J Wong
- Stanford University School of Medicine and Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, USA
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Dickson L, Bunting S, Nanna A, Taylor M, Spencer M, Hein L. Older Lesbian, Gay, Bisexual, Transgender, and Queer Adults' Experiences With Discrimination and Impacts on Expectations for Long-Term Care: Results of a Survey in the Southern United States. J Appl Gerontol 2021; 41:650-660. [PMID: 34634949 DOI: 10.1177/07334648211048189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/17/2022] Open
Abstract
The number of older adults in the United States is projected to increase in coming years, including the number of lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ+) older adults requiring long-term care (LTC) services. We conducted an online survey of older LGBTQ+ adults living in the Southern United States between January and March of 2018 to inquire about their anticipation of discrimination in and willingness to utilize LTC services. We found that 78.6% of respondents (N = 789) anticipated discrimination in LTC. Previous experiences with discrimination, higher educational attainment, and queer/questioning sexual orientation were associated with greater expectation of discrimination. Higher anticipation of discrimination was also associated with a greater preference for utilizing LTC services offered by LGBTQ+ providers or for LGBTQ+ older adults. These findings suggest that LTC staff and researchers may be uniquely positioned to craft outreach and policies to protect LGBTQ+ LTC residents.
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Affiliation(s)
- Lexus Dickson
- School of Medicine, 12322University of South Carolina, Columbia, SC, USA
| | - Samuel Bunting
- Chicago Medical School, 97174Rosalind Franklin University, North Chicago, IL, USA
| | - Alexis Nanna
- College of Arts and Sciences, 124479University of South Carolina, Columbia, SC, USA
| | - Megan Taylor
- College of Arts and Sciences, 124479University of South Carolina, Columbia, SC, USA
| | - Mindi Spencer
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Liam Hein
- College of Nursing, 16155University of South Carolina, Columbia, SC, USA
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Abstract
OBJECTIVES The objective of this study was to examine the relationship between high wages and empowerment practices on certified nursing assistant (CNA) retention, necessary for providing high-quality care for nursing home (NH) residents. METHODS Measures of provider-level CNA empowerment and wages from the 2015 Ohio Biennial Survey were used to estimate two regression models on retention (n = 719), one without and one with an interaction term of high wages and high empowerment. RESULTS Only in the context of the interacted model were NHs that provided both high wages and high empowerment associated with a 7.09 percentage-point improvement in the CNA retention rate (p = .0003). Individually, high wages and a high empowerment score were not statistically significant in either regression model. DISCUSSION Retaining CNAs in NH communities requires a combination of empowerment practices (e.g., involving CNAs in decision-making about hiring other staff) and high hourly wages.
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41
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Venkatesh AK, Gettel CJ, Mei H, Chou SC, Rothenberg C, Liu SL, D'Onofrio G, Lin Z, Krumholz HM. Where Skilled Nursing Facility Residents Get Acute Care: Is the Emergency Department the Medical Home? J Appl Gerontol 2021; 40:828-836. [PMID: 32842827 PMCID: PMC7904961 DOI: 10.1177/0733464820950125] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES This study aimed to characterize the distribution of acute care visits among Medicare beneficiaries receiving skilled nursing facility (SNF) services. METHODS We conducted a cross-sectional analysis of a 20% sample of continuously enrolled Medicare beneficiaries in the 2012 Chronic Condition Warehouse data set. Beneficiaries were grouped by the number of days of SNF services, and acute care visits were categorized as "before SNF," "during SNF," or "after SNF." RESULTS Among the 10,717,786 Medicare beneficiaries analyzed, 384,312 (3.6%) had at least one SNF stay. DISCUSSION Beneficiaries who received SNF services had a higher proportion of acute care visits made to emergency departments (EDs) than beneficiaries who did not receive SNF services. Also, a higher proportion of acute care visits were made to EDs by beneficiaries after a SNF stay in comparison to residents actively residing in a SNF. The acute care capabilities of SNFs and post-SNF transitions of care to the community setting are discussed.
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Affiliation(s)
| | | | - Hao Mei
- Yale School of Medicine, New Haven, CT, USA
| | - Shih-Chuan Chou
- Yale School of Medicine, New Haven, CT, USA
- Brigham and Women's Hospital, Boston, MA, USA
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Friedman C, Rizzolo MC. Value-Based Payments: Intellectual and Developmental Disabilities Quality Indicators Associated With Billing Expenditures. Intellect Dev Disabil 2021; 59:295-314. [PMID: 34284494 DOI: 10.1352/1934-9556-59.4.295] [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] [Received: 02/11/2020] [Accepted: 07/03/2020] [Indexed: 06/13/2023]
Abstract
Although managed care is expanding into the intellectual and developmental disabilities (IDD) service system, there is little agreement about measurable and meaningful outcomes for people with IDD, including for use in value-based payments (VBP). In this study, we examined potential VBP metrics for people with IDD-relationships between quality and costs. We analyzed Basic Assurances data and long-term services and supports billing data from 68 human service organizations that supported 6,608 people with IDD. Our final hierarchical regression model predicted 66.40% of the variance of annual long-term services and supports (LTSS) billing per person. Our findings suggest quality assurance indicators can account for a significant portion of cost variance-quality metrics represent a potential for cost savings and efficient service delivery.
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Affiliation(s)
- Carli Friedman
- Carli Friedman and Mary C Rizzolo, CQL | The Council on Quality and Leadership
| | - Mary C Rizzolo
- Carli Friedman and Mary C Rizzolo, CQL | The Council on Quality and Leadership
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43
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Ezell JM, Hamdi S, Borrero N. Approaches to Addressing Nonmedical Services and Care Coordination Needs for Older Adults. Res Aging 2021; 44:323-333. [PMID: 34291677 DOI: 10.1177/01640275211033929] [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: 11/17/2022]
Abstract
OBJECTIVE Non-medical services care coordination for daily activities of living is crucial in improving older adults' health and enabling them to age in place, but little is known about specific practices and barriers in this space. METHODS Semi-structured interviews were conducted with 41 professionals serving older adults in greater Chicago, Illinois-which consists of diverse urban, suburban, and semi-rural communities-to contextualize non-medical services needs and care coordination processes. RESULTS In-home care, home-delivered meals, non-emergency transportation, and housing support were cited as the most commonly needed services, all requiring complex coordination support. Respondents noted a reliance on inefficient phone/fax usage for referral-making and cited major challenges in inter-professional communication, service funding/reimbursement, and HIPAA. CONCLUSIONS Non-medical services delivery for older adults is severely impacted by general siloing throughout the care continuum. Interventions are needed to enhance communication pathways and improve the salience and interdisciplinarity of non-medical services coordination for this population.
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Affiliation(s)
- Jerel M Ezell
- Africana Studies and Research Center, Cornell University, Ithaca, NY, USA.,Cornell Center for Health Equity, Cornell University, Ithaca, NY, USA
| | - Samiha Hamdi
- Department of Global Development, Cornell University, Ithaca, NY, USA
| | - Natasha Borrero
- Department of Family and Social Medicine, Montefiore Medical System, Bronx, NY, USA
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Potter AJ, Bowblis JR. Nursing home care under Medicaid managed long-term services and supports. Health Serv Res 2021; 56:1179-1189. [PMID: 34263450 DOI: 10.1111/1475-6773.13701] [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] [Received: 02/03/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To measure the impact of Medicaid managed long-term services and supports (MLTSS) on nursing home (NH) quality and rebalancing. DATA SOURCES/STUDY SETTING This study analyzes secondary data from annual NH recertification surveys and the minimum dataset (MDS) in three states that implemented MLTSS: Massachusetts (2001-2007), Kansas and Ohio (2011-2017). STUDY DESIGN We utilized a difference-in-difference approach comparing NHs in border counties of states that implemented MLTSS with a control group of NHs in neighboring border counties in states that did not implement MLTSS. Sensitivity analyses included a triple-difference model (stratified by Medicaid payer mix) and a within-state comparison. We examined changes in six NH-level outcomes (percentage of low-care NH residents, facility occupancy, and four NH quality measures) after MLTSS implementation. DATA COLLECTION/EXTRACTION METHODS For each state, all freestanding NHs in border counties were included, as were NHs in neighboring counties located in other states. Information on low-care residents was aggregated to the NH level from MDS data, then combined with Online Survey Certification and Reporting (OSCAR) and Certification and Survey Provider Enhanced Reporting (CASPER) data. PRINCIPAL FINDINGS MLTSS had no statistically significant effects on NH quality outcomes in Massachusetts or Kansas. In Ohio, MLTSS led to an increase of 0.21 nursing hours per resident day [95% CI: 0.03, 0.40], and a decrease of 1.47 deficiencies [95% CI: -2.52, -0.42] and 9.38 deficiency points [95% CI: -18.53, -0.24] per certification survey. After MLTSS, occupancy decreased by 1.52 percentage points [95% CI: -2.92, -0.12] in Massachusetts, but increased by 3.17 percentage points [95% CI: 0.36, 5.99] in Ohio. We found no effect on low-care residents in any state. Findings were moderately sensitive to the choice of comparator group. CONCLUSION The study provides little evidence that MLTSS reduces quality of care, occupancy, or the percentage of low-care residents in NHs.
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Affiliation(s)
- Andrew J Potter
- Department of Political Science & Criminal Justice, California State University, Chico, California, USA
| | - John R Bowblis
- Department of Economics, Miami University, Oxford, Ohio, USA
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Abstract
To coordinate Medicare and Medicaid benefits, multiple states are creating opportunities for dual-eligible beneficiaries to join Medicare Advantage Dual-Eligible Special Needs Plans (D-SNPs) and Medicaid plans operated by the same insurer. Tennessee implemented this approach by requiring insurers who offered Medicaid plans to also offer a D-SNP by 2015. Tennessee's aligned D-SNP participation increased from 7% to 24% of dual-eligible beneficiaries aged 65 years and above between 2011 and 2017. Within a county, a 10-percentage-point increase in aligned D-SNP participation was associated with 0.3 fewer inpatient admissions (p = .048), 13.9 fewer prescription drugs per month (p = .048), and 0.3 fewer nursing home users (p = .06) per 100 dual-eligible beneficiaries aged 65 years and older. Increased aligned plan participation was associated with 0.2 more inpatient admissions (p = .004) per 100 dual-eligible beneficiaries younger than 65 years. For some dual-eligible beneficiaries, increasing Medicare and Medicaid managed plan alignment has the potential to promote more efficient service use.
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Affiliation(s)
- Laura M Keohane
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Zilu Zhou
- Vanderbilt University Medical Center, Nashville, TN, USA
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Sefcik JS, Hirschman KB, Petrovsky DV, Hodgson NA, Naylor MD. Satisfaction With Outdoor Activities Among Northeastern U.S. Newly Enrolled Long-Term Services and Supports Recipients. J Appl Gerontol 2021; 40:590-597. [PMID: 32608313 PMCID: PMC7775289 DOI: 10.1177/0733464820933774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/16/2022] Open
Abstract
Older adults receiving long-term services and supports (LTSS) experience barriers to outdoor activities and satisfaction ratings with such experiences are not well understood. Our study used cross-sectional data (n = 329) to (a) examine whether those new to LTSS were satisfied with their outdoor activities and (b) describe the characteristics and factors associated with satisfaction levels. Self-report of satisfaction with outdoor activities was the outcome variable. Multivariable linear regression modeling of the outcome was conducted. Fifty-nine percent were satisfied with their outdoor activities. More depressive symptoms (p < .001) and higher cognitive functioning (p = .011) were associated with lower ratings. Higher self-rated physical health (p = .009) and more independence with activities of daily living (p = .022) were associated with greater satisfaction. Findings suggest an unmet need among four in 10 new recipients of LTSS (41%) related to their outdoor activities. LTSS interdisciplinary teams can use these findings to inform their assessments, develop person-centered care plans, and address barriers.
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Affiliation(s)
- Justine S Sefcik
- Drexel University College of Nursing and Health Professions, Philadelphia, PA, USA
| | | | | | - Nancy A Hodgson
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Mary D Naylor
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Duan Y, Shippee TP, Baker ZG, Olsen Baker M. Age Differences in Determinants of Self-Rated Health among Recipients of Publicly Funded Home-and-Community-Based Services. J Aging Soc Policy 2021; 35:374-392. [PMID: 34058963 DOI: 10.1080/08959420.2021.1930815] [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: 10/21/2022]
Abstract
This research examined determinants of self-rated health (SRH) of publicly funded home-and-community-based services (HCBS) recipients and tested if the effects of determinants differ between older recipients and younger recipients with disabilities. Using Minnesota's data of 2015-2016 National Core Indicators - Aging and Disabilities survey (n = 3,426), this study revealed that functional status and community inclusion had both direct and indirect effects on SRH, with negative mood as a mediator. Community inclusion had a more pronounced effect on SRH in younger recipients than in older recipients. HCBS should address psychosocial needs and be tailored for recipients of different age groups.
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Affiliation(s)
- Yinfei Duan
- PhD candidate, School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tetyana P Shippee
- Associate Professor, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Zachary G Baker
- Robert L. Kane Postdoctoral Fellow, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mary Olsen Baker
- Manager, Quality Assurance & Information Unit, Aging and Adult Services Division, Minnesota Department of Human Services and Minnesota Board on Aging, St Paul, Minnesota, USA
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Toth M, Palmer L, Bercaw L, Voltmer H, Karon SL. Trends in the Use of Residential Settings among Older Adults. J Gerontol B Psychol Sci Soc Sci 2021; 77:424-428. [PMID: 33999126 DOI: 10.1093/geronb/gbab092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/23/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES As the U.S. population ages, the prevalence of disability and functional limitations, and demand for long-term services and supports (LTSS), will increase. This study identified the distribution of older adults across different residential settings, and how their health characteristics have changed over time. METHODS A cross-sectional analysis of older adults residing in traditional housing, community-based residential facilities (CBRF), and nursing facilities using three data sources: The Medicare Current Beneficiary, 2008 and 2013; the Health and Retirement Study, 2008 and 2014; and the National Health and Aging Trends Study, 2011 and 2015. We calculated age-standardized prevalence of older adults by setting, functional limitations, and comorbidities, and tested for health characteristics changes relative to the baseline year (2002). RESULTS The proportion of older adults in traditional housing increased over time, relative to baseline (p < 0.05), while the proportion of older adults in CBRF was unchanged. The proportion of nursing facility residents declined from 2002 to 2013 in the MCBS (p < 0.05). The prevalence of dementia and functional limitations among traditional housing residents increased, relative to the baseline year in the HRS and MCBS (p < 0.05). DISCUSSION The proportion of older adults residing in traditional housing is increasing, while the nursing facility population is decreasing. This change may not be due to better health; rather, older adults may be relying on non-institutional LTSS.
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Affiliation(s)
- Matt Toth
- RTI International, Research Triangle Park, NC
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Sadarangani T, Anderson K, Vora P, Missaelides L, Zagorski W. A National Survey of Data Currently being Collected by Adult Day Service Centers Across the United States. J Appl Gerontol 2021; 41:729-735. [PMID: 33985380 DOI: 10.1177/07334648211013974] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
An understanding of adult day service centers' (ADC) impacts on clients' health and well-being has been hampered by a lack of large-scale data. Standardizing data collection is critical to strengthening ADC programs, demonstrating their effectiveness, and enabling them to leverage additional funding streams beyond Medicaid. We distributed an electronic survey on current data collection efforts to ADCs nationally to determine categories of data ADCs are collecting related to clients' health. In our sample (N = 248), only 32% of ADCs collected patient-level data for research and analysis-most commonly on activities of daily living, cognition, nutrition, and caregiver strain. However, validated assessment tools were used in less than 50% of the cases. ADCs are willing to collect data: More than 70% reported a willingness to participate in future studies. National studies piloting data collection protocols with uniform outcome measures are needed to advance the understanding of ADCs' capabilities and impacts.
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Affiliation(s)
| | - Keith Anderson
- University of Texas at Arlington School of Social Work, USA
| | - Paayal Vora
- Northeast Ohio Medical University, Rootstown, USA
| | - Lydia Missaelides
- Alliance for Leadership and Education/California Association of Adult Day Services, Sacramento, USA
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Oishi MM, Childs CA, Gluch JI, Marchini L. Delivery and financing of oral health care in long-term services and supports: A scoping review. J Am Dent Assoc 2021; 152:215-223.e2. [PMID: 33632411 DOI: 10.1016/j.adaj.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 11/22/2020] [Accepted: 12/11/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The oral health of older adults requiring long-term services and supports is reported to be poor as there is no national standard of care for the provision of oral health care. The purpose of this scoping review was to understand the breadth of models of delivery and financing of oral health care in the full spectrum of long-term services and supports. TYPES OF STUDIES REVIEWED A literature search was performed in 4 electronic databases: MEDLINE via PubMed interface, Embase, Cumulative Index to Nursing and Allied Health Literature, and AgeLine. Included articles were those that were regarding a nursing home population or dependent older adults living in the community, included a delivery or financing model for oral health care, and included an outcome measurement. RESULTS Sixteen articles were included in the review. Delivery mechanisms included onsite mobile oral health care at nursing homes and adult day health care centers for those living in the community or home visits for those who were homebound. Other mechanisms included teledentistry or using alternative workforce models such as certified public health dental hygienists. Numerous studies reported positive oral health outcomes when comprehensive care was provided in a variety of settings. Other reported outcomes included oral health stability, caries indexes, cost, and oral health-related quality of life. CONCLUSIONS AND PRACTICAL IMPLICATIONS If providing onsite oral health care is not possible at facilities, programs can consider home visits, teledentistry, and alternative workforce models.
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