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Kokorelias KM, Singh HK, Abdelhalim R, Saragosa M, Fat GL, Sheppard C. Exploring the roles and functions of champions within community-based interventions to support older adults with chronic conditions: A scoping review protocol. PLoS One 2023; 18:e0291252. [PMID: 37831680 PMCID: PMC10575514 DOI: 10.1371/journal.pone.0291252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/03/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Health care solutions are needed to meet the need of an ageing population. Health care champions are people who endorse the adoption of new initiatives being implemented within health care settings. Although the role of champions has been cited as key to the success of numerous community-based interventions implemented to improve the care of older adults with chronic conditions, no synthesis of their implementation experiences have been conducted. We report on a scoping review protocol that will be applied to collect evidence on the role of champions within community-based health interventions to support older adults with chronic conditions. Specifically, we will identify how the term 'champion' is used and defined (i.e., conceptualized) and identify the roles (i.e., professional background) and functions of champions (i.e., responsibilities). We will also explore how this role impacts program implementation. METHODS This is a scoping review protocol informed by guidelines for Scoping Reviews (PRISMA-ScR) and a six-stage scoping review methodology. Peer-review literature will be retrieved from Medline, CINAHL, PubMed, PsycInfo, Cochrane JBI and Scopus databases, using a peer-reviewed search strategy developed in collaboration with an Information Specialist. The scoping review will consider all empirical studies published in English. Two reviewers will pilot-test the screening criteria and data abstraction forms, and then independently screen the literature. Extracted data will be analyzed numerically and thematically. Self-identified champions will be consulted to refine the practice recommendations from this work. DISCUSSION This scoping review will broadly and systematically identify, define and expand existing knowledge on champions' impact in implementing community-based interventions to support older adults with chronic conditions. We anticipate that our results will lead to a greater understanding of the characteristics and role champions play within these interventions, which will be relevant to a wide range of knowledge users, including researchers, decision-makers, and health care providers.
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Affiliation(s)
- Kristina M. Kokorelias
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- National Institute on Ageing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Hardeep K. Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- KITE Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Reham Abdelhalim
- Joseph Brant Hospital, Burlington, Canada
- Burlington OHT, Burlington, ON, Canada
| | - Marianne Saragosa
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
| | - Guillaume Lim Fat
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Toronto, Ontario, Canada
| | - Christine Sheppard
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
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Ne’eman A, Stein M, Grabowski DC. Nursing Home Residents Younger Than Age Sixty-Five Are Unique And Would Benefit From Targeted Policy Making. Health Aff (Millwood) 2022; 41:1449-1459. [DOI: 10.1377/hlthaff.2022.00548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ari Ne’eman
- Ari Ne’eman , Harvard University, Cambridge, Massachusetts
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Quinlan C, McKibbin C, Cuffney C, Brownson R, Brownson C, Clark J, Osvold L. Barriers to Aging in Place for Rural, Institutionalized Older Adults: A Qualitative Exploration. Clin Gerontol 2022; 45:1167-1179. [PMID: 32981469 DOI: 10.1080/07317115.2020.1820651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Although the majority of older adults wish to "age in place" in their communities, rural contexts pose challenges to maintaining long-term independence. The purpose of this study was to develop an understanding of the experiences of rural older adults who live in Skilled Nursing Facilities (SNFs) and thus have not aged in place. By retrospectively analyzing their pre-institution care situation, we aim to generate foundational knowledge on the barriers to aging in place in rural settings. METHODS A series of individual and group interviews was conducted in SNFs across seven rural communities. A grounded, thematic analysis was used to interpret interview findings, and coding was informed by the socio-ecological model (SEM). RESULTS Participants were 32 adults with a mean age of 72 years (SD = 5.7 years) and an average SNF residence of 3.9 years. Two themes emerged as primary barriers to successful aging in place: (1) Caregiver-related support issues and (2) Present focus, or lack of advanced care-planning. CONCLUSIONS Findings suggest the importance of specifically supporting caregivers, to ease burden and allow for increased agency for rural older adults. A lack of access to caregiver supports and other services limits the ability of community-dwelling rural older adults to age in place or plan for the future. CLINICAL IMPLICATIONS Existing networks of rural community resources and innovative solutions should be leveraged to improve access to services for older adults and their informal caregivers.
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Affiliation(s)
- Claire Quinlan
- Aging Division, Department of Health, Cheyenne, Wyoming, USA
| | | | - Cari Cuffney
- Wyoming Department of Family Services, Cheyenne, Wyoming, USA
| | - Ross Brownson
- Division of Public Health Sciences and Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Carol Brownson
- Division of Public Health Sciences and Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jeff Clark
- Aging Division, Department of Health, Cheyenne, Wyoming, USA
| | - Lisa Osvold
- Aging Division, Department of Health, Cheyenne, Wyoming, USA
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Yu Y, Zhang J, Song C, Petrovic M, Pei X, Zhang WH. Perceived availability of home- and community-based services and self-reported depression among Chinese older adults: A cross-sectional study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2827-e2837. [PMID: 35040216 DOI: 10.1111/hsc.13726] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 12/23/2021] [Accepted: 12/31/2021] [Indexed: 06/14/2023]
Abstract
Few studies have assessed the association between perceived availability of home- and community-based services (HCBSs) and self-reported depression among Chinese older adults, which the present study attempts to rectify. This cross-sectional study enrolled 11,941 participants aged 65 and older from the Chinese Longitudinal Healthy Longevity Survey 2018 wave. The 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) was used to evaluate depression, and perceived availability was measured for four categories of HCBSs: daily life assistance, medical care services, emotional support and social services, and other. These four categories and the number of services in each were used to represent the perceived availability of service provision. Binary logistic models were used to explore the relationship between perceived availability of HCBSs and depression in older adults. Perceived daily life assistance was found to be negatively associated with depression symptoms among Chinese older adults in both urban and rural areas [rural: OR (95%CI) = 0.66 (0.55-0.78), p < 0.001; urban: OR (95% CI) = 0.69(0.60-0.79), p < 0.001], while perceived levels of medical care services, emotional support and social services, and other were not associated with depression symptoms in rural or urban areas. Our primary finding was that providing daily life assistance at the community level may help to meet more older adults' daily needs, thus potentially decreasing the risk of depression.
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Affiliation(s)
- Yushan Yu
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jun Zhang
- The Research Center for Public Health, Tsinghua University, Beijing, China
| | - Chao Song
- Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Xiaomei Pei
- Department of Sociology, School of Social Sciences, Tsinghua University, Beijing, China
| | - Wei-Hong Zhang
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- School of Public Health, Université libre de Bruxelles (ULB), Bruxelles, Belgium
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Yu Y, Yuan C, Zhang Q, Song C, Cui S, Ye J, Zhang X, Chen C. Longitudinal association between home and community-based services provision and cognitive function in Chinese older adults: Evidence from the Chinese Longitudinal Healthy Longevity Survey. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:e288-e298. [PMID: 33761178 DOI: 10.1111/hsc.13353] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 09/24/2020] [Accepted: 02/15/2021] [Indexed: 06/12/2023]
Abstract
Few studies have assessed the impact of home and community-based services (HCBSs) provision on cognitive function among older adults over time. This study examined the longitudinal association between HCBSs provision and cognitive function in Chinese older adults. The study included 5,134 participants aged 65 years and older in the Chinese Longitudinal Healthy Longevity Survey from 2008 to 2014. The Mini-Mental State Examination (MMSE) was used to evaluate cognitive function over the same time period. Participants were asked what kind of HCBSs were provided in his or her community. However, they were not asked whether services were utilised. The study used the number of HCBSs provided each wave to represent the strength of HCBSs, and used the MMSE score of each wave to represent the older adults' cognitive function status. A latent growth model was used to explore the relationship between HCBSs provision and cognitive function of older adults. The number of HCBSs provided was positively associated with older adults' cognitive function (2008: β = 0.03, p = 0.031; 2011: β = 0.06, p < 0.001; 2014: β = 0.06, p < 0.001) after controlling for gender, age, residence, education, income, medical insurance, activities of daily living disability, instrumental activities of daily living disability, serious illness, living arrangement and marital status. Results provided longitudinal evidence that an increase in HCBSs provision at a national level can result in better cognitive function in Chinese older adults.
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Affiliation(s)
- Yushan Yu
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Changzheng Yuan
- Department of Big Data in Health Science, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qi Zhang
- School of Community and Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, VA, USA
| | - Chao Song
- Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Shichen Cui
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Jun Ye
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Xiangyang Zhang
- First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chun Chen
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
- Center for Health Assessment, Wenzhou Medical University, Wenzhou, China
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Basu R, Steiner AC, Stevens AB. Long-Term Care Market Trend and Patterns of Caregiving in the U.S. J Aging Soc Policy 2021; 34:20-37. [PMID: 34016034 DOI: 10.1080/08959420.2021.1926209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Informal care is a major source of long-term services and supports (LTSS) for older adults in the U.S. However, the increasing gap between available family caregivers and those needing LTSS in coming years warrants better understanding of the balance between informal and formal home or community-based LTSS to meet the growing demand. The current study aimed to 1) identify patterns of informal and formal LTSS use among community-dwelling individuals, and 2) examine if the supply of formal LTSS predicts the use of informal care. These aims were investigated by linking the market supply of formal LTSS at the state-level to the Health and Retirement Survey data (N = 7,781). Results provide important empirical evidence that patterns of informal and formal LTSS use among older adults are heterogeneous and market supply of formal home and community-based services (HCBS) significantly predicts the use of informal care. Most older adults rely on informal care in combination with some formal supports, suggesting that the two systems work in tandem to meet the growing needs of LTSS. This offers important implications for states allocating resources to meet the LTSS needs of older adults and individuals with disabilities since states play key roles in U.S. long-term care policies.
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Affiliation(s)
- Rashmita Basu
- Assistant Professor, Department of Public Health, East Carolina University, Greenville, North Carolina, USA
| | - Adrienne C Steiner
- Assistant Professor, Department of Music Education/Therapy, East Carolina University, Greenville, North Carolina, USA
| | - Alan B Stevens
- Professor and Director, Center for Applied Health Research, Baylor Scott & White Healthm, Temple, Texas, USA
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Inacio MC, Khadka J, Lang C, Harrison S, Crotty M, Whitehead C, Wesselingh S. Young people in aged care: trends in the use of aged care services by younger Australians, 2008-2016. Disabil Rehabil 2019; 43:1153-1161. [PMID: 31460813 DOI: 10.1080/09638288.2019.1652703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
MATERIAL AND METHODS A population-based epidemiological study was conducted using publicly available datasets from the Australian Institute of Health and Welfare and Australian Bureau of Statistics. The incidence of service utilization by younger people (<65 year) and per 10,000 citizens 0-49, 50-54, 55-59, and 60-64 years old per year was estimated. Negative binomial regression models were used to estimate incidence rate ratios. RESULTS Between 2008-2009 and 2015-2016 the number of younger people accessing services increased for home care services by 103.2% and transition care by 131.9% but decreased for permanent residential care by 0.4%, and respite care by 2.4%. Permanent residential care incidence use decreased for the overall population (incidence rate ratio = 0.98, p < 0.001) and in those 55-59 years old (incidence rate ratio = 0.97, p < 0.001) and for respite care incidence use decreased in those 0-49 years old (incidence rate ratio = 0.93, p = 0.001). The incidence use of home care increased in the overall group (incidence rate ratio = 1.04, p < 0.001) and in those 50-54 (1.08, p < 0.001) and in those 55-59 years old (incidence rate ratio = 1.03, p < 0.001). The use of transition care services increased significantly in all age groups (overall incidence rate ratio = 1.09, p < 0.001). CONCLUSIONS The overall use of permanent residential care has decreased along with the use of respite in the youngest people, and the use of home and transition care services have increased. Efforts to keep young people out of residential aged care may have redirected them to home care services.Implications for rehabilitationThe number of young people (<65 years old) with disability using aged cares services in Australia has increased significantly between 2008-2009 and 2015-2016.The overall use of permanent residential care has decreased along with the use of respite care, and the use of home and transition care services have increased, which should be encouraged.Development of targeted rehabilitation support programs to support young people with disability housed in residential aged care may help to better cater their care needs.Development of transition pathways to shift young people with disability to appropriate support programs may help to reduce the number of younger people with disability in aged care services.
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Affiliation(s)
- Maria C Inacio
- Healthy Ageing Research Consortium, Registry of Older South Australians, South Australian Health and Medical Research Institute, Adelaide, Australia.,Division of Health Sciences, University of South Australia, Adelaide, Australia
| | - Jyoti Khadka
- Healthy Ageing Research Consortium, Registry of Older South Australians, South Australian Health and Medical Research Institute, Adelaide, Australia.,Institute for Choice, University of South Australia, Adelaide, Australia.,Flinders University, Adelaide, Australia
| | - Catherine Lang
- Healthy Ageing Research Consortium, Registry of Older South Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Stephanie Harrison
- Healthy Ageing Research Consortium, Registry of Older South Australians, South Australian Health and Medical Research Institute, Adelaide, Australia.,Flinders University, Adelaide, Australia
| | | | | | - Steve Wesselingh
- Healthy Ageing Research Consortium, Registry of Older South Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
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Gonçalves J, Weaver F, Konetzka RT. Measuring State Medicaid Home Care Participation and Intensity Using Latent Variables. J Appl Gerontol 2018; 39:731-744. [DOI: 10.1177/0733464818786396] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Population aging and policies to redirect long-term care toward home- and community-based services have led to increases in Medicaid home care spending in most states. Changes in state Medicaid home care policy generosity may result from changes in the number of persons served (i.e., Participation) and/or changes in quantities of services covered (i.e., Intensity). This study measures state Medicaid home care Participation and Intensity comprehensively using latent variables, and uses those latent variables to describe changes in Medicaid home care policy generosity over time and across states. Yearly state-level data from the Medicaid Statistical Information System (1999-2012) are analyzed using exploratory and confirmatory factor analyses. Between 1999 and 2012, 29 states expanded both Participation and Intensity, whereas six states reduced both. In the remaining states, a trade-off occurred. Distinguishing between Medicaid home care Participation and Intensity deserves attention, as expansions along these two dimensions represent potentially different implications for beneficiaries.
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Henning-Smith C, Kozhimannil K, Prasad S. Barriers to Nursing Home Care for Nonelderly Rural Residents. J Appl Gerontol 2017; 38:1708-1727. [PMID: 29249190 DOI: 10.1177/0733464817746772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rural residents experience higher disability, mortality, and poverty rates than their urban counterparts; they also have more barriers to accessing care, including nursing home care. Meanwhile, the proportion of nonelderly adult nursing home residents (<65 years old) is growing, yet little is known about this population and barriers they face trying to access care, especially in rural areas. This qualitative study uses data from 23 semistructured interviews with rural hospital discharge planners in five states to identify specific barriers to finding nursing home care for nonelderly rural residents. We grouped those barriers into three primary themes-payment status, fit, and medical complexity-as well as two minor themes-caregivers and bureaucratic processes-and discuss each in the article, along with potential policy and programmatic interventions to improve access to nursing home care for nonelderly rural residents.
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"We don't have the infrastructure to support them at home": How health system inadequacies impact on long-term care admissions of people with dementia. Health Policy 2017; 121:1280-1287. [PMID: 29031934 DOI: 10.1016/j.healthpol.2017.09.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/18/2017] [Accepted: 09/27/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The influence of healthcare system factors on long-term care admissions has received relatively little attention. We address this by examining how inadequacies in the healthcare system impact on long-term care admissions of people with dementia. This is done in the context of the Irish healthcare system. METHODS Thirty-eight qualitative in-depth interviews with healthcare professionals and family carers were conducted. Interviews focused on participants' perceptions of the main factors which influence admission to long-term care. Interviews were analysed thematically. RESULTS The findings suggest that long-term care admissions of people with dementia may be affected by inadequacies in the healthcare system in three ways. Firstly, participants regarded the economic crisis in Ireland to have exacerbated the under-resourcing of community care services. These services were also reported to be inequitable. Consequently, the effectiveness of community care was seen to be limited. Secondly, such limits in community care appear to increase acute hospital admissions. Finally, admission of people with dementia to acute hospitals was believed to accelerate the journey towards long-term care. CONCLUSIONS Inadequacies in the healthcare system are reported to have a substantial impact on the threshold for long-term care admissions. The findings indicate that we cannot fully understand the factors that predict long-term care admission of people with dementia without accounting for healthcare system factors on the continuation of homecare.
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Segelman M, Intrator O, Li Y, Mukamel D, Veazie P, Temkin-Greener H. HCBS Spending and Nursing Home Admissions for 1915(c) Waiver Enrollees. J Aging Soc Policy 2017; 29:395-412. [DOI: 10.1080/08959420.2017.1319714] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Micah Segelman
- Researcher, RTI International, Washington, District of Columbia, USA
| | - Orna Intrator
- Professor, Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Director, Geriatrics & Extended Care Data Analysis Center, Canandaigua VA Medical Center, Canandaigua, New York, USA
| | - Yue Li
- Professor, Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Dana Mukamel
- Professor, Department of Medicine, University of California, Irvine, Irvine, California, USA
| | - Peter Veazie
- Associate Professor, Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Helena Temkin-Greener
- Professor, Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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Miller NA, Kirk A. Predicting State Investment in Medicaid Home- and Community-Based Services, 2000-2011. J Aging Soc Policy 2017; 28:49-64. [PMID: 26549155 DOI: 10.1080/08959420.2016.1111729] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Although state use of Medicaid home- and community-based services (HCBS) to provide long-term services and supports to older adults and individuals with physical disabilities continues to increase, progress is uneven across states. We used generalized linear models to examine state factors associated with increased allocation of Medicaid dollars to HCBS for the period 2000 to 2011. We observed enhanced growth in states that began the period with limited investment in HCBS, as reflected in significant year trends among these states. The political environment appeared to be an important influence on states' investment for states with limited initial allocation to HCBS, as was housing affordability, a policy amenable variable. There continues to be wide variation in states' relative investment, calling for additional policy attention and research.
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Affiliation(s)
- Nancy A Miller
- a School of Public Policy, Intercampus Doctoral Program in Gerontology , University of Maryland , Baltimore County, Baltimore , Maryland , USA
| | - Adele Kirk
- a School of Public Policy, Intercampus Doctoral Program in Gerontology , University of Maryland , Baltimore County, Baltimore , Maryland , USA
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13
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Sonnega A, Robinson K, Levy H. Home and community-based service and other senior service use: Prevalence and characteristics in a national sample. Home Health Care Serv Q 2016; 36:16-28. [PMID: 27925859 DOI: 10.1080/01621424.2016.1268552] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We report on the use of home and community-based services (HCBS) and other senior services and factors affecting utilization of both among Americans over age 60 in the Health and Retirement Study (HRS). Those using HCBS were more likely to be older, single, Black, lower income, receiving Medicaid, and in worse health. Past use of less traditional senior services, such as exercise classes and help with tax preparation, were found to be associated with current use of HCBS. These findings suggest use of less traditional senior services may serve as a "gateway" to HCBS that can help keep older adults living in the community.
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Affiliation(s)
- Amanda Sonnega
- a Institute for Social Research , University of Michigan , Ann Arbor , Michigan , USA
| | - Kristen Robinson
- b Social & Scientific Systems, Inc. , Silver Spring , Maryland , USA
| | - Helen Levy
- a Institute for Social Research , University of Michigan , Ann Arbor , Michigan , USA
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14
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Blackburn J, Locher JL, Morrisey MA, Becker DJ, Kilgore ML. The effects of state-level expenditures for home- and community-based services on the risk of becoming a long-stay nursing home resident after hip fracture. Osteoporos Int 2016; 27:953-961. [PMID: 26400010 DOI: 10.1007/s00198-015-3327-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 09/15/2015] [Indexed: 10/23/2022]
Abstract
SUMMARY This study measures the effect of spending policies for long-term care services on the risk of becoming a long-stay nursing home resident after a hip fracture. Relative spending on community-based services may reduce the risk of long-term nursing home residence. Policies favoring alternative sources of care may provide opportunities for older adults to remain community-bound. INTRODUCTION This study aims to understand how long-term care policies affect outcomes by investigating the effect of state-level spending for home- and community-based services (HCBSs) on the likelihood of an individual's nursing home placement following hip fracture. METHODS This study uses data from the 5% sample of Medicare beneficiaries from 2005 to 2010 to identify incident hip fractures among dual-eligibility, community-dwelling adults aged at least 65 years. A multilevel generalized estimating equation (GEE) model estimated the association between an individual's risk of nursing home residence within 1 year and the percent of states' Medicaid long-term support service (LTSS) budget allocated to HCBS. Other covariates included expenditures for Title III services and individual demographic and health status characteristics. RESULTS States vary considerably in HCBS spending, ranging from 17.7 to 83.8% of the Medicaid LTSS budget in 2009. Hip fractures were observed from claims among 7778 beneficiaries; 34% were admitted to a nursing home and 25% died within 1 year. HCBS spending was associated with a decreased risk of nursing home residence by 0.17 percentage points (p 0.056). CONCLUSIONS Consistent with other studies, our findings suggest that state policies favoring an emphasis on HCBS may reduce nursing home residence among low-income older adults with hip fracture who are at high risk for institutionalization.
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Affiliation(s)
- J Blackburn
- Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, RPHB 330K, 1720 2nd Ave S, Birmingham, AL, 35294-0022, USA.
| | - J L Locher
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham School of Medicine, 933 19th Street South, CH19 218, Birmingham, AL, 35294-2041, USA
| | - M A Morrisey
- Department of Health Policy and Management, School of Public Health, 306 SPH Administration Building, Texas A&M University, College Station, TX, 77843-1266, USA
| | - D J Becker
- Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, RPHB 330K, 1720 2nd Ave S, Birmingham, AL, 35294-0022, USA
| | - M L Kilgore
- Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, RPHB 330K, 1720 2nd Ave S, Birmingham, AL, 35294-0022, USA
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Ko M, Newcomer R, Kang T, Hulett D, Chu P, Bindman AB. Payment rates for personal care assistants and the use of long-term services and supports among those dually eligible for Medicare and Medicaid. Health Serv Res 2014; 49:1812-31. [PMID: 25327166 DOI: 10.1111/1475-6773.12249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine the association between payment rates for personal care assistants and use of long-term services and supports (LTSS) following hospital discharge among dual eligible Medicare and Medicaid beneficiaries. DATA SOURCES State hospital discharge, Medicaid and Medicare claims, and assessment data on California Medicaid LTSS users from 2006 to 2008. STUDY DESIGN Cross-sectional study. We used multinomial logistic regression to analyze county personal care assistant payment rates and postdischarge LTSS use, and estimate marginal probabilities of each outcome across the range of rates paid in California. DATA EXTRACTION METHODS We identified dual eligible Medicare and Medicaid adult beneficiaries discharged from an acute care hospital with no hospitalizations or LTSS use in the preceding 12 months. PRINCIPAL FINDINGS Personal care assistant payment rates were modestly associated with home and community-based services (HCBS) use versus nursing facility entry following hospital discharge (RRR 1.2, 95 percent CI: 1.0-1.4). For a rate of $6.75 per hour, the probability of HCBS use was 5.6 percent (95 percent CI: 4.2-7.1); at $11.75 per hour, 18.0 percent (95 percent CI: 12.5-23.4). Payment rate was not associated with the probability of nursing facility entry. CONCLUSIONS Higher payment rates for personal care assistants may increase utilization of HCBS, but with limited substitution for nursing facility care.
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Affiliation(s)
- Michelle Ko
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA
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Turjamaa R, Hartikainen S, Kangasniemi M, Pietilä AM. Is it time for a comprehensive approach in older home care clients’ care planning in Finland? Scand J Caring Sci 2014; 29:317-24. [DOI: 10.1111/scs.12165] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 06/15/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Riitta Turjamaa
- Department of Nursing Science; Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
| | - Sirpa Hartikainen
- Faculty of Health Sciences; Research Centre of Geriatric Care; School of Pharmacy; University of Eastern Finland; Kuopio Finland
| | - Mari Kangasniemi
- Department of Nursing Science; Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
| | - Anna-Maija Pietilä
- Department of Nursing Science; Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
- Department of Nursing Science; Faculty of Health Sciences; University of Eastern Finland and Health Care Services; Kuopio Finland
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Thomas KS, Keohane L, Mor V. Local Medicaid home- and community-based services spending and nursing home admissions of younger adults. Am J Public Health 2014; 104:e15-7. [PMID: 25211711 DOI: 10.2105/ajph.2014.302144] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We used fixed-effect models to examine the relationship between local spending on home- and community-based services (HCBSs) for cash-assisted Medicaid-only disabled (CAMOD) adults and younger adult admissions to nursing homes in the United States during 2001 through 2008, with control for facility and market characteristics and secular trends. We found that increased CAMOD Medicaid HCBS spending at the local level is associated with decreased admissions of younger adults to nursing homes. Our findings suggest that states' efforts to expand HCBS for this population should continue.
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Affiliation(s)
- Kali S Thomas
- Kali S. Thomas and Vincent Mor are with the Department of Veterans Affairs Medical Center, and Center for Gerontology and Healthcare Research, Brown University, Providence, RI. Laura Keohane is with the Department of Health Services, Policy, and Practice, Brown University
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Turjamaa R, Hartikainen S, Kangasniemi M, Pietilä AM. Living longer at home: a qualitative study of older clients' and practical nurses' perceptions of home care. J Clin Nurs 2014; 23:3206-17. [PMID: 25453125 DOI: 10.1111/jocn.12569] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To identify descriptions of older (75+) home care clients and practical nurses regarding the current structure of home care available for older clients and the elements promoting the ability of clients to continue living at home. BACKGROUND The ageing population is a major global challenge in social and health care. In many countries, the focus of care for older clients has shifted from institutional care towards a model of home care. Increasing attention has been paid to maximising the resources of older clients and aiming to support their living at home for as long as possible. DESIGN A descriptive qualitative study METHODS Data were collected from individual interviews by using videotaped home care visits as a tool for stimulated recall interviews. Two groups of participants were interviewed: 14 practical nurses and 23 older clients. Data were analysed by using the inductive content analysis. RESULTS Both participant groups, practical nurses and older home care clients, described home care as organisationally driven, but highlighted the importance of individual encounters. In addition, both groups noted that clients' living at home can be supported by offering individually designed care. Individually designed care refers to showing respect to clients' opinions and promoting their individual resources. CONCLUSION In order to be able to promote older home clients' living at home, the provided home care needs to be individually designed and must take into account clients' resources and their perspectives of meaningful and inspirational activities. RELEVANCE TO CLINICAL PRACTICE The information produced by this study can be used to promote older clients' living at home for as long as possible. Therefore, practical nurses are required the ability to recognise older clients' individual resources and design individual care plans accordingly.
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Parker E, Zimmerman S, Rodriguez S, Lee T. Exploring Best Practices in Home Health Care. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2013. [DOI: 10.1177/1084822313499916] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article summarizes publicly available research related to outcomes and best practices in skilled home health and other kinds of home-based care. As the population ages and the home health care sector grows, the home health community must address current deficiencies in care and expand the use of evidence-based strategies to improve the quality and efficiency of care. Many promising innovations in service delivery currently exist, a wide variety of which have been tested and evaluated in postacute and long-term care settings. Our review found that home health agencies are well positioned to improve patient outcomes through a variety of approaches, including care coordination, telehealth, and data-driven quality of care monitoring. For the most part, evaluations of these interventions show that they can improve patient outcomes and/or cost-effectiveness.
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Affiliation(s)
| | | | | | - Teresa Lee
- Alliance for Home Health Quality and Innovation, Washington, DC, USA
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Turjamaa R, Hartikainen S, Pietilä AM. Forgotten resources of older home care clients: Focus group study in Finland. Nurs Health Sci 2013; 15:333-9. [DOI: 10.1111/nhs.12037] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 12/19/2012] [Accepted: 12/30/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Riitta Turjamaa
- Department of Nursing Science; University of Eastern Finland; Kuopio; Finland
| | - Sirpa Hartikainen
- Research Centre of Geriatric Care; School of Pharmacy; University of Eastern Finland; Kuopio; Finland
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Miller NA, Pinet-Peralta LM, Elder KT. A profile of middle-aged and older adults admitted to nursing homes: 2000-2008. J Aging Soc Policy 2012; 24:271-90. [PMID: 22720887 DOI: 10.1080/08959420.2012.684528] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
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.
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Affiliation(s)
- Nancy A Miller
- Department of Public Policy, Intercampus Doctoral Program in Gerontology, University of Maryland, Baltimore County, Baltimore, Maryland 20250, USA.
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