The Older Americans Act and Family Caregiving: Perspectives from Federal and State Levels

An investigation into the acceptance of intelligent care systems: an extended technology acceptance model (TAM)

With the aging population trend becoming increasingly pronounced, the health issues of elderly individuals living alone have become a focal point of societal concern. This study aims to investigate guardians of the elderly's acceptance of intelligent care systems for the elderly. This system integrates millimeter-wave radar and image recognition technologies to monitor the health status of seniors in real time and automatically alert their children in emergency situations. To evaluate the market acceptance of this emerging technology, we employed a Covariance-Based Structural Equation Modeling (CB-SEM) approach and constructed an acceptance model for the intelligent care system. Survey data were collected from 386 respondents in China. The results indicate that users of this system are more concerned with task completion rather than ease of use. Enhancements in information trust significantly promote perceived usefulness (PU), perceived ease of use (PEOU), and behavioral intention to use (BI). Individuals with higher risk perception sensitivity exhibit greater perceptions of the system's usefulness and ease of use. Aesthetics emerged as a significant factor influencing PU, PEOU, and BI, second only to information trust. When the system is perceived as well-designed, it is also deemed acceptable. An aesthetically pleasing system is not only considered useful but also easier to use. Interestingly, opinions from social circles did not directly impact BI or PEOU. they only influenced perceived usefulness. Moreover, higher privacy security requirements correlate with lower perceptions of the system's usefulness. Overall, improvements in perceived usefulness, information trust, and aesthetics significantly enhance user acceptance of the system. These findings provide theoretical support for developing more appealing intelligent care systems for the elderly and contribute new perspectives on understanding the key factors driving the adoption of such systems. Additionally, they enrich and refine the knowledge base within the TAM framework.

A historical overview of policy perspectives towards informal care in Taiwan (1996-2023)

This paper examines the evolution of policy perspectives towards informal care in Taiwan, focusing on the development of carer support services. It traces the transition from self-funded services by the Taiwan Association of Family Caregivers (a nonprofit organisation), to services funded by the government. Taiwan's approach highlights the considerable changes brought about by the implementation of the Long-Term Care Services Act which elevated the legal status of carers. Other reforms include the establishment of community-based carer support centres, the introduction of a carer referral mechanisms, and the decentralisation of services to local governments. Carer policies in Taiwan have increasingly embraced the perspective of carers as co-clients, not only recognising their crucial role in the care ecosystem but also raising the profile of informal care in public policy. However, ensuring sustainable funding from the central government, which is vital for the continuation and expansion of carer support, presents a considerable challenge for future policy considerations. The Taiwanese experiences of integrating carers into the long-term care policy context and of decentralisation of carer support services to local governments, serve as a reference for other countries developing carer policies.

A Networked Intelligent Elderly Care Model Based on Nursing Robots to Achieve Healthy Aging

As global populations become increasingly aged, existing elderly care models are proving insufficient. The development and application of nursing robots have shown potential in addressing the challenges of elder care in aging societies. This perspective outlines current state and potential applications of nursing robots in promoting healthy aging. Given this background, a networked intelligent elderly care model for nursing robots, which integrates technologies such as big data, artificial intelligence, the Internet of Things, and nursing robotics, is proposed. This model would synergistically combine elderly health monitoring, capability assessment, and intelligent allocation functions to revolutionize global elderly care practices and promote healthy aging.

Improving Transitions in Care for Patients and Family Caregivers Living in Rural and Underserved Areas: The Caregiver Advise, Record, Enable (CARE) Act

In this Perspective, we contend bold action is needed to improve transitions from hospitals to home for aging patients and their family caregivers living in rural and underserved areas. The Caregiver Advise, Record, Enable (CARE) Act, passed in over 40 US states, is intended to provide family caregivers of hospitalized patients with the knowledge and skills needed for safe and efficient transitions. It has broken important ground for family caregivers who assist with transitions in patient care. It may fall short, however, in addressing the unique needs of family caregivers living in rural and underserved areas. We contend that to realize the intended safety, cost, and care quality benefits of the CARE Act, especially for those living in rural and underserved areas, states need to expand the Act's scope. We provide three recommendations: 1) modify hospital information systems to support the care provided by family caregivers; 2) require assessments of family caregivers that reflect the challenges of family caregiving in rural and underserved areas; and 3) identify local resources to improve discharge planning. We describe the rationale for each recommendation and the potential ways that an expanded CARE Act could reduce the risks associated with transitions in care for aging patients.

Examining predictors of loneliness among Older Americans Act National Family Caregiver Support Program participants

Family caregivers may be at particular risk for social isolation and loneliness. Multiple factors can impact caregivers' health and well-being outcomes, including loneliness. Guided by an adaptation of the Stress Process Model of Caregiving, this study uses the 2019 National Survey of Older Americans Act Participants (NSOAAP)-Family Caregiver Support module to inform efforts to reduce loneliness through family caregiver support programs. A hierarchical multiple regression model reveals that caregivers who report more loneliness are more likely to be female, Hispanic, living alone, not a child or other caregiver of the care recipient, have a care recipient with 3+ ADL needs, experience more social life conflict related to caregiving, experience less joy in caregiving, feel less appreciated by the care recipient, feel less support in caregiving, and attend counseling. This study helps advance the goals of the National Strategy to Support Family Caregivers, and the findings underscore the importance of continuing and expanding efforts to address loneliness and related well-being outcomes among family caregivers.

Leveraging the Contribution of Volunteers: The Critical Role and Economic Value of Volunteers in Older Americans Act Programs

The United States is facing a surge in the aging population, which will increase the demand for services and supports that allow older adults to age independently. This study assessed the size and value of the volunteer labor force in two home- and community-based programs funded under the Older Americans Act (OAA). Using publicly available program data for fiscal years 2015-2019, we calculated the annual contribution of volunteers, based on the total number of volunteer hours and share of labor effort, and estimated the economic value of volunteers in these OAA programs. In fiscal year 2019, volunteers contributed a total value of $1.7 billion in the OAA Title III program and $14.0 million in the Title VII long-term care ombudsman program. These results highlight the value of volunteers in OAA programs and the need for policies to support volunteers in the aging services network.

Nationally funded health management projects for older adults in China and the United States: Comparative analysis based on data from two principal institutions

Objectives

To systematically summarize and compare the health management projects on the aged population funded by the National Institutes of Health (NIH) in the US and the National Natural Science Foundation of China (NSFC) in China.

Methods

All elderly-related projects from 2007 to 2022 were retrieved by searching the project titles, abstracts, and keywords such as "older adults," "elderly," "aged," "health management," and so on. Python, CiteSpace, and VOSviewer were used to extract, integrate, and visualize the relevant information.

Results

A total of 499 NSFC projects and 242 NIH projects were retrieved. For both countries, prestigious universities and institutions received the most funded projects; the projects that got the most funds were longitudinal studies. Both countries attach great importance to investment in the health management of the aged population. However, different focuses existed in health management projects for older adults in the two countries due to distinct national conditions and development levels.

Conclusions

The analysis results of this study can provide a reference for other countries with similar challenges of population aging. Effective measures should be taken to promote the transformation and implementation practice of the project achievements. Nurses can benefit from these projects and facilitate the translation of relevant research findings into clinical practice to improve nursing quality for older adults.

Quality of Life and Related Outcomes Among Unpaid Caregivers of Older Adults With Visual Impairment

Caregivers of older adults with visual impairments are often family members who spend many hours caring for loved ones at the expense of their personal needs. The purpose of this study was to examine the quality of life of unpaid caregivers of older adults with visual impairments and determine the barriers and facilitators for improving their quality of life. To examine this population, 130 unpaid caregivers of older adults with visual impairments were surveyed using the Satisfaction with Life Scale, Living Arrangement and Indicators of Social Interaction Survey, the Geriatric Depression Scale (GDS), Caregiver Quality of Life (EQ-5D), and the Perceived Change Index (PCI). Results revealed that the unpaid caregivers face many challenges, but inexperience/difficulty with tasks and balancing their personal life were the biggest obstacles. Interventions could help improve quality of life and well-being as well as provide support services and access to community resources to reduce the family caregiver burden.

Unpaid Caregiving and Aging in Place in the United States: Advancing the Value of Occupational Therapy

Unpaid caregivers are often expected to help family members or friends overcome activity limitations and participation restrictions to successfully age in place. Caregivers assume multiple responsibilities, such as managing their own physical and psychosocial needs and navigating a complex health care system, and many feel ill equipped to fulfill the necessary health care responsibilities for their care recipients. Underprepared caregivers may cause poor outcomes for care recipients. Federal and state policy proposals call attention to the need to better support caregivers, especially as their numbers increase. Occupational therapy practitioners are well positioned to effectively engage caregivers as they navigate the health care system. The occupational therapy process looks broadly at the functional abilities, environmental contexts, and occupational demands that play a pivotal role in successful aging in place for clients and better outcomes for their caregivers. Now is the time to define occupational therapy's distinct value to this area.

Association Between New-Onset Medicaid Home Care and Family Caregivers' Health

Importance

More than 17 million people in the US provide uncompensated care for adults with physical or cognitive limitations. Such caregiving is associated with worse mental and physical health, yet little research has investigated how publicly funded home care might ameliorate these harms.

Objective

To investigate the association between Medicaid home care services and family caregivers' health.

Design Setting and Participants

This longitudinal cohort study used data from the 1996 to 2017 Medical Expenditures Panel Survey. Data on all household members were collected in 5 interviews over 2 years. Person-level difference-in-difference models were used to isolate within-person changes associated with new onset of Medicaid home care. The Medical Expenditures Panel Survey longitudinal data sets included 331 202 individuals (approximately 10% excluded owing to loss to follow-up). Adult (age ≥21 years) members of households that contained at least 1 person with limited activities of daily living were included in our study. The analysis itself was performed from March to August of 2020.

Exposures

New onset of regular (≥1 time per month) Medicaid home care in the household.

Main Outcomes and Measures

Self-rated mental and physical health (planned prior to beginning the study).

Results

The study population was 14 013 adults; 7232 were "likely caregivers," or nondisabled adult coresidents of someone with activities of daily living limitations. Overall, 962 likely caregivers were ever exposed to Medicaid home care in the household; for 563, we observed the onset. Of likely caregivers exposed to Medicaid home care, 479 (50%) were women; 296 (31%) were White non-Hispanic, 309 (31%) were Hispanic or Latinx, and 279 (29%) were Black non-Hispanic individuals, respectively; 326 (34%) had less than a high school education; and 300 (31%) were in or near poverty. Median age of participants was 51 (interquartile range, 39-62) years. New-onset Medicaid home care was associated with a 0.08 standard deviation improvement in likely caregivers' self-rated mental health (95% CI, 0.01-0.14; P = .02) measured 1 to 6 months after onset, equivalent to a 3.39% improvement (95% CI, 0.05%-6.33%) over their average preonset mental health. No association with self-rated physical health was found (<0.001 standard deviations; 95% CI, -0.06 to 0.06; P = .99).

Conclusions and Relevance

In this cohort study, Medicaid home care was associated with improvement in caregiver self-rated mental health, but not with any short-term change in self-rated physical health. When evaluating the social value of home care programs, policy makers should consider spillover benefits to caregivers.

Caregiver Eligibility for Support Services: Correlates and Consequences for Resource Utilization

Policymakers and community organizations have implemented numerous programs and services to support the more than 40 million family caregivers in the United States. However, the existence of such services is not sufficient to ensure equitable and optimal access and utilization. Using data from the Caregiving in the US study (2015; n = 1,185), we estimated that nearly one in five family caregivers do not meet broad eligibility criteria for support services. This resource gap was particularly likely to affect high-priority populations such as those caring for someone with a mental health problem. Furthermore, ineligible caregivers had lower service utilization and increased financial strain. The findings highlight a pattern of vulnerability among caregivers who do not meet broad eligibility criteria for financial support resources. Careful policy consideration is needed to determine how support services should be allocated to maximize caregiver and care recipient outcomes at the population level.