The Availability and Generosity of Medicaid Home & Community Based Services for Economically Vulnerable Older Adults - read free eBook in online reader or directly download on the web page. Select files or add your book in reader. Download and read online ebook The Availability and Generosity of Medicaid Home & Community Based Services for Economically Vulnerable Older Adults write by Hazal Erçin. This book was released on 2021. The Availability and Generosity of Medicaid Home & Community Based Services for Economically Vulnerable Older Adults available in PDF, EPUB and Kindle. Most older adults express a wish to age and die in their own homes, yet without a support system, dying at home can be impossible due to high needs for assistance with self-care, mobility, symptom management, and day-to-day functioning at the end of life. The care needs of economically vulnerable, community-dwelling older adults are addressed by Medicaid 1915(c) waivers which allow Medicaid funds to be used to provide home and community-based services (HCBS). Medicaid 1915(c) waivers reach the most economically vulnerable older adults -- also known as "dual eligible" older adults as they are qualified for both Medicare and Medicaid. HCBS waivers allow states to provide services that can help with symptoms, housework, daily activities, caregiver support, and with home safety. There is no federal policy regulating the services provided by Medicaid waiver programs and 1915(c) waivers are offered at the discretion of the states. As a result, states vary dramatically in the availability of the suite of services provided as well as the level of funding, or generosity of these services. These state-level differences may create disparities in the end-of-life experiences among dual-eligible older adults based on the state they live and die in. Aims: This dissertation investigated 1) state variation in Medicaid 1915(c) waiver availability and generosity of HCBS to dual-eligible older adults, and 2) the association between state variation in availability and generosity and end of life experiences. Methods: Three papers were written to answer the aims of this dissertation. First, a policy analysis was conducted to explore the availability and generosity of 1915(c) waivers utilizing three datasets: 1) waiver application documents located at CMS.Medicaid.org, 2) the Medicaid Analytic Extract - Other Services (MAX-OT) dataset, and 3) Genworth State Cost of Care Survey 2013. Analysis of these datasets resulted in summative descriptions of 8 state-level indicators for availability and generosity of HCBS. For the second and third papers, the National Health and Aging Trends Study (NHATS) (Wave 2-7, 2012-2017) was utilized in addition to state-level data summaries created for the policy analysis. For paper 2, regression analyses were used to determine the effect of waiver availability and generosity on unmet end of life needs. For paper 3, regression analyses examined the effect of HCBS on the quality of life reported at the end of life. Results: Substantial variation exists between states in available services, coverage for target groups, service slots available, ability to direct ' own care, and generosity of services. Paper 2 found that 40.26% of the sample had unmet needs for self-care and mobility activities Unmet need for assistance was associated with lower availability of HCBS and less generosity for homemaker services, having dementia, and not having participant direction option. Paper 3 found that 56.07% of low-income respondents reported having a low quality of end of life. Lower quality at the of end of life was associated with fewer available HCBS slots, living alone, higher numbers of chronic diseases, and receiving hospice during the last month of life and. Discussion: Community-dwelling dual eligible older adults nearing the end-of-life experience unmet needs with self-care and mobility activities and low quality of end of life, such as high symptom burden and lower functioning. The findings indicated that 1915(c) waivers could tailor their services for older adults at the end of life due to their higher risk for unmet needs and lower quality of end of life. Generosity for the services and slots available for dual-eligible older adults were also associated with end-of-life experiences of this sample, therefore Medicaid waivers should increase their generosity and slots to better meet the needs of economically vulnerable older adults at the end of life.
The Benefits of Medicaid Home and Community-based Services on Health
The Benefits of Medicaid Home and Community-based Services on Health - read free eBook in online reader or directly download on the web page. Select files or add your book in reader. Download and read online ebook The Benefits of Medicaid Home and Community-based Services on Health write by Yinan Liu. This book was released on 2022. The Benefits of Medicaid Home and Community-based Services on Health available in PDF, EPUB and Kindle. The Medicaid Home and Community- Based Services (HCBS) program in the United States subsidizes the long-term care provided at home or in community-based settings for older adults. Little is known about how HCBS affects the well-being of the aging population. Using detailed information about health from the Health and Retirement Study (HRS) linked with state-level HCBS policy expenditures, we show that HCBS is beneficial to improve general health outcomes of older individuals. Our results find that HCBS generosity is positively associated with the probability of older individuals self-reporting better health status, mitigating functional mobility limitations, showing better emotional feelings, and increasing cognitive skills. In addition, these health benefits of HCBS differ across groups by resources and demographic characteristics.
Social Isolation and Loneliness in Older Adults
Social Isolation and Loneliness in Older Adults - read free eBook in online reader or directly download on the web page. Select files or add your book in reader. Download and read online ebook Social Isolation and Loneliness in Older Adults write by National Academies of Sciences, Engineering, and Medicine. This book was released on 2020-05-14. Social Isolation and Loneliness in Older Adults available in PDF, EPUB and Kindle. Social isolation and loneliness are serious yet underappreciated public health risks that affect a significant portion of the older adult population. Approximately one-quarter of community-dwelling Americans aged 65 and older are considered to be socially isolated, and a significant proportion of adults in the United States report feeling lonely. People who are 50 years of age or older are more likely to experience many of the risk factors that can cause or exacerbate social isolation or loneliness, such as living alone, the loss of family or friends, chronic illness, and sensory impairments. Over a life course, social isolation and loneliness may be episodic or chronic, depending upon an individual's circumstances and perceptions. A substantial body of evidence demonstrates that social isolation presents a major risk for premature mortality, comparable to other risk factors such as high blood pressure, smoking, or obesity. As older adults are particularly high-volume and high-frequency users of the health care system, there is an opportunity for health care professionals to identify, prevent, and mitigate the adverse health impacts of social isolation and loneliness in older adults. Social Isolation and Loneliness in Older Adults summarizes the evidence base and explores how social isolation and loneliness affect health and quality of life in adults aged 50 and older, particularly among low income, underserved, and vulnerable populations. This report makes recommendations specifically for clinical settings of health care to identify those who suffer the resultant negative health impacts of social isolation and loneliness and target interventions to improve their social conditions. Social Isolation and Loneliness in Older Adults considers clinical tools and methodologies, better education and training for the health care workforce, and dissemination and implementation that will be important for translating research into practice, especially as the evidence base for effective interventions continues to flourish.
Communities in Action
Communities in Action - read free eBook in online reader or directly download on the web page. Select files or add your book in reader. Download and read online ebook Communities in Action write by National Academies of Sciences, Engineering, and Medicine. This book was released on 2017-04-27. Communities in Action available in PDF, EPUB and Kindle. In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.
Families Caring for an Aging America
Families Caring for an Aging America - read free eBook in online reader or directly download on the web page. Select files or add your book in reader. Download and read online ebook Families Caring for an Aging America write by National Academies of Sciences, Engineering, and Medicine. This book was released on 2016-11-08. Families Caring for an Aging America available in PDF, EPUB and Kindle. Family caregiving affects millions of Americans every day, in all walks of life. At least 17.7 million individuals in the United States are caregivers of an older adult with a health or functional limitation. The nation's family caregivers provide the lion's share of long-term care for our older adult population. They are also central to older adults' access to and receipt of health care and community-based social services. Yet the need to recognize and support caregivers is among the least appreciated challenges facing the aging U.S. population. Families Caring for an Aging America examines the prevalence and nature of family caregiving of older adults and the available evidence on the effectiveness of programs, supports, and other interventions designed to support family caregivers. This report also assesses and recommends policies to address the needs of family caregivers and to minimize the barriers that they encounter in trying to meet the needs of older adults.
