Journal of Applied Gerontology

New York City is currently experiencing an outbreak of COVID-19, a highly contagious and potentially deadly virus, which is particularly dangerous for older adults. This pandemic has led to public health policies including social distancing and stay-at-home orders. We explore here the impact of this unique crisis on victims of elder mistreatment and people at risk of victimization. The COVID-19 outbreak has also had a profound impact on the organizations from many sectors that typically respond to protect and serve victims of elder mistreatment. We examine this impact and describe creative solutions developed by these organizations and initial lessons learned in New York City to help inform other communities facing this pandemic and provide guidance for future crises.

Objective: To determine predictors of health care transitions (i.e., acute care service use, transfers from lower to higher intensity services) among older adults new to long-term services and supports [LTSS]. Method: 470 new LTSS recipients followed for 24 months. Multivariable Poisson regression modeling within a generalized estimating equation framework. Results: Being male, having multiple chronic conditions, lower self-reported physical health ratings and lower quality of life ratings at baseline were associated with increased risk of health care transitions. Older adults in assisted living communities and nursing homes experienced decreases in health care transitions over time, while LTSS recipients at home had no change in risk. LTSS recipients who had orders to receive therapy, compared with those who did not, had a lower relative risk of transitions over time. Discussion: Predictors of future health care transitions support the need for LTSS providers to anticipate and monitor this risk for LTSS recipients.

This study aims to identify older people’s home- and community-based care (HCBC) service need patterns and explore the role of living arrangement and filial piety in affecting such patterns. A total of 556 older people were selected in Beijing, China. Latent class analysis and multinomial logistic regression were adopted to identify the service need patterns and the influencing factors. A three-class model of service need patterns was explored (high-needs group, moderate-needs group, and low-needs group). Living arrangement was related to HCBC service need patterns. Compared with the high-needs group, those living with at least two family members were more likely to express low needs or moderate needs. Living arrangement was a moderator for the effect of filial piety on HCBC needs. Greater recognition of the effects of living arrangement and filial piety should enrich the Andersen model and provide a robust stimulus for long-term care policy development and for service delivery and social work.

We aimed to understand the relationships between care recipients’ profiles and home- and community-based services (HCBS use patterns. Data were from the 2010 to 2013 Long-Term Care Service Management System in Taiwan (N = 78,205). We used latent class analysis and multinomial logistic regression analyses. Three HCBS use patterns were found. Care recipients who lived alone, lived in less urbanized areas, and had instrumental activities of daily living disabilities were more likely to be in the home-based personal care group. Those in the home-based personal and medical care group were more likely than others to have a primary caregiver. Care recipients who had poorer abilities at basic activities of daily living and cognitive function, better household income, and lived in a more urbanized area were more likely to be in the non-personal care multiple services group. The findings suggest that policymakers alleviate barriers to accessing various patterns of HCBS should be encouraged.

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.

Community First Choice (CFC) is a Medicaid state plan option authorized through the Affordable Care Act (ACA) that supports the delivery of long-term services and supports in home and community settings. We interviewed stakeholders in Maryland, one of the first states to adopt CFC, to assess challenges, benefits, and potential implications of this Medicaid option for state and federal policy makers. Study findings suggest that expanding coverage for home- and community-based services through CFC in Maryland has been financially feasible, expanded the personal care workforce, and supported a more equitable approach to personal care services. We conclude that greater coverage for home- and community-based long-term services is a promising avenue to improve access to care for high-need Medicaid beneficiaries.

In this study, the authors evaluate the 2013 consolidation of Iowa’s Area Agencies on Aging (AAA) on the delivery of home and community-based services (HCBS) to older adults in the state. A mixed-methods approach combined a quasi-experimental design using longitudinal service delivery data with qualitative analyses of surveys and interviews with AAA staff and clients. Overall, consolidation had no detectable effect on the proportion of older adults served by the AAAs. Subgroup analysis showed that consolidation increased the average proportion of older adults served in nonmetropolitan counties and the proportion served through congregate meals. AAA staff and clients described both positive and negative aspects of consolidation: better collaboration across agencies, improved consistency in services, significant challenges with completing consolidation processes, and serving expanded geographic areas. As the American population ages and budgetary allocations tighten, findings from this evaluation can inform other states considering similar restructuring efforts.

Convenience stores play an important role in supporting community-dwelling older adults’ lives. This study aimed to describe the development of and to evaluate an educational program to promote collaboration between communities and convenience stores in Japan. We developed the educational program based on interviews of convenience store staff to encourage them to collaborate with health/social care professionals for helping older adults. We conducted pre- and post-program questionnaire surveys of 184 participants to evaluate the program. After the program, the total score for attitudes toward dementia (p = .010) improved significantly among the convenience store staff. On the contrary, the score for “solidarity and proactiveness,” a subscale for sense of community, improved significantly among health/social care professionals (p = .003). This educational program can have a significant effect on the perceptions and attitudes for supporting older adults, depending on the participants’ occupations. This educational program could foster community networks, leading to an age-friendly community.

Caregivers play an important role in the in-home care of community dwelling older adults living with Alzheimer’s disease or related dementias (ADRD); however, many of these caregivers lack training in caring for this vulnerable population. In 2015, we developed and implemented an interactive, community-based, knowledge and skills-based training program for In-Home Supportive Services (IHSS) caregivers. This report shares the results of a process evaluation of this training program as it evolved over the course of three training sessions in Riverside County, California. Our iterative evaluation process reveals the unique needs of training and assessing a population of demographically diverse adult learners and provides guidance for those planning to implement similar training in underserved communities. Factors such as reliance on self-reported abilities, language readability level, and test anxiety may have confounded attempts to capture learner feedback and actual knowledge gains from our caregiver training program.

Medicaid home and community-based services (HCBS) care plans should be person-centered, yet there is little research on how to ascertain this information in practice. The purpose of this study was to investigate the feasibility of a home care aide (HCA)–led health interview with clients during usual HCBS. We provided interview training, and HCAs (n = 21) conducted five interviews with one client each using a card sort methodology to elicit client care preferences. HCAs audio-recorded interviews and photographed card sorts for analysis. We used a mixed-methods approach of semistructured interviews and focus groups with clients and HCAs to evaluate the health interviewing experience and client surveys of Your Health Orientation, Willingness to Communicate, and PROMIS (Patient-Reported Outcomes Measurement Information System) global health and HCA surveys of the Active Empathetic Listening Scale. We used t tests to investigate changes in survey outcomes pre and post interviews. Results show HCAs can conduct health interviews, and doing so contributes new knowledge on client preferences for care. Clients desire HCAs who provide empathy, compassion, and motivation, and HCAs felt interviewing clients helped them to better understand their care recipient’s needs.

This study examines the association between nursing assistants’ perceptions of their psychosocial work environment and satisfaction among older people receiving care in nursing homes and home care. Cross-sectional surveys were conducted among people receiving care (N = 1,535) and nursing assistants (N = 1,132) in 45 nursing homes and 21 home care units within municipal old-age care. Better psychosocial work environment was related to higher satisfaction in old-age care among the recipients. Significant and stronger associations were more common in nursing homes than in home care. Perception of mastery and positive challenges at work were associated with higher recipient satisfaction both in home care and in nursing homes: social climate, perception of group work, perception of mastery, and positive challenges at work only in nursing homes. Findings suggest that recipient satisfaction may be increased by improving the psychosocial work environment for nursing assistants, both in nursing homes and in home care.

Objective: This study examined post-acute care (PAC) rehabilitation practitioner’s perspectives on communication. Method: This is a secondary data analysis of a larger qualitative study, which included PAC rehabilitation provider (n = 99) focus groups that were held in a purposive sample of 13 skilled nursing facilities (SNFs). Results: Participants emphasized the importance of bidirectional communication between rehabilitation and nursing. Three themes were identified: (a) communication between rehabilitation practitioners and registered nurses or licensed practical nurses, (b) communication between rehabilitation practitioners and certified nursing assistants, and (c) communication between rehabilitation practitioners and nursing leaders. Two subthemes within each of the three themes were further characterized to understand how information was exchanged: (a) static communication and (b) action-oriented communication. Conclusion: Our findings highlight opportunities for better communication in PAC between rehabilitation practitioners and nursing and thus lay a foundation for future efforts to improve care coordination through enhancing interdisciplinary communication.