State strategies to support community based long term care for the elderly

Factors Explaining State Differences in Applying for a Recent Long-Term Care Program that Promotes Aging in Place: Perspectives of Medicaid Administrators

Older adults in need of assistance often prefer to remain at home rather than receive care in an institution. To meet these preferences, Medicaid invited states to apply for the Balancing Incentive Program (BIP), a program intended to "rebalance" Medicaid-financed long-term services and supports to Home- and Community-Based Services (HCBS). However, only about half of eligible states applied. We interviewed Medicaid administrators to explore why some states applied for BIP whereas others did not. Supportive state leadership and the presence of other programs supporting community-based care were positively related to BIP application. Opposing policy priorities and programs competing for similar resources were negatively related to BIP application. Because states most likely to apply already had policy goals and programs supporting HCBS, BIP may inadvertently widen disparities across states, pushing those on the margins ahead and leaving the ones that are worst off in HCBS support to fall even further behind.

Social support and depressive symptom disparity between urban and rural older adults in China

BACKGROUND

Depressive symptom disparity between urban and rural older adults is an important public health issue in China. Social support is considered as an effective way to alleviate depression of older adults. This study aimed to investigate the extent to which social support could explain the depressive symptom disparity between urban and rural older adults in China.

METHODS

This study used data drawn from the 2011 China Health and Retirement Longitudinal Study with 6,772 observations. Multiple data analysis strategies were adopted, including descriptive analyses, bivariate analyses, regression analyses and decomposition analyses.

RESULTS

There were significant depressive symptom disparities between urban and rural older adults in China. Social support had significant association with depressive symptom of older adults while adjusting for covariates. About 25%-28% of the depressive symptom disparities could be attributed to urban-rural gaps in social support, in which community support contributed 21%-25%. Educational level and physical health status also contributed to the disparities.

LIMITATION

This study only established correlations between social support and depressive symptom disparity rather than casual relationships; and the self-reported measurement of depressive symptom and the unobservable cultural factors might cause limitations.

CONCLUSIONS

The urban-rural gap in social support, especially community support was a prime explanation for depressive symptom disparities between urban and rural older adults in China. To reduce the depressive symptom disparities, effective community construction in rural China should be put into place, including improving the infrastructure construction, strengthening the role of social organizations, and encouraging community interpersonal interactions for older adults.

A profile of middle-aged and older adults admitted to nursing homes: 2000-2008

Middle-aged adults are becoming an increasing share of the nursing home population. Minimum Data Set assessment data for 2000 and 2008 are used to explore similarities and differences in sociodemographic, residential, medical, and psychiatric characteristics of newly admitted middle-aged adults (31-64) compared to their older counterparts (65+). Relative to their share of the state population, Black middle-aged adults are overrepresented in nursing homes across 45 states and the District of Columbia. Chronic conditions, including diabetes, renal failure, chronic obstructive pulmonary disease, asthma, and circulatory/heart disorders, appeared to contribute to the increasing presence of middle-aged adults. There were substantial increases in diagnoses of psychiatric disorders at admission; psychiatric diagnoses were significantly higher among middle-aged adults. Middle-aged adults were also more likely to have residential histories of prior stays in psychiatric facilities relative to older adults. States' rebalancing efforts need to attend to the increasing presence of disability associated with chronic medical and psychiatric conditions among middle-aged adults.

Relations among home- and community-based services investment and nursing home rates of use for working-age and older adults: a state-level analysis

OBJECTIVES

I examined state-level rates of nursing home use for the period from 2000 to 2007.

METHODS

I used multivariate fixed-effects models to examine associations between state sociodemographic, economic, supply, and programmatic characteristics and rates of use.

RESULTS

Nursing home use declined among older adults (aged ≥65 years) in more than two thirds of states and the District of Columbia but increased among older working-age adults (aged 31-64 years) in all but 2 states. State characteristics associated with these trends differed by age group. Although relatively greater state investment in Medicaid home- and community-based services coupled with reduced nursing home capacity was associated with reduced rates of nursing home care for adults aged 65 years and older, neither characteristic was associated with use among older working-age adults. Their use was associated with state sociodemographic characteristics, as well as chronic disease prevalence.

CONCLUSIONS

Policy efforts to expand home- and community-based services and to reduce nursing facility capacity appear warranted. To more fully extend the Supreme Court's Olmstead decision's promise to older working-age adults, additional efforts to understand factors driving their increasing use are required.

Participation and knowledge related to a nursing home admission decision among a working age population

The number of nursing home admissions for working age people (age 18-64) in the USA has increased. Minimal attention has been given to examining their participation in the admission decision. We use a conceptual framework proposed by Ong and colleagues to examine patient and provider predictors of perceived involvement in the admission decision and their relationship to both knowledge and preferences for continued care. In-person interviews were conducted with an admissions cohort of 205 working age individuals in 17 Maryland, USA nursing homes. Similar to previous profiles, participants were predominately male, of minority ethnic status, and of lower socioeconomic status. Common clinical conditions included cardiac disease (49.8%) and diabetes (27.3%). Slightly over half reported a lot (42.1%) or a moderate (15.2%) level of involvement in the admission decision, while 27.9% reported no involvement. Patient race, insurance source and knowledge of the health care decision maker were related to perceived involvement. Minority ethnic group patients were less likely to be aware of alternate settings for care, while patients who knew the medical decision maker were more aware of alternate settings, as well as their expected length of stay. Participants who perceived greater involvement in the decision more often preferred continued care in the nursing home, relative to their own home or other settings. Ethical, practical and legal concerns support involving individuals in this health care decision. Ways to foster improved communication and interpersonal relationships between patients and their health care provider(s) are thus required.