Journal of Aging & Social Policy最新文献

Despite decades of increased spending on home and community-based services (HCBS) under Medicaid, the impact of these expenditures on long-term services and supports (LTSS) utilization across racial and ethnic groups remains unclear. This study analyzes state-level HCBS expenditures from 1996 to 2016, linked to individual-level data from the Health and Retirement Study (HRS; 1998-2018). The sample includes 3,097 Medicaid beneficiaries aged 65 and older with difficulties in daily living (6,750 person-wave observations). Multivariate logit models were employed, controlling for individual socio-demographic factors, state and time fixed effects, and time-varying state-level characteristics. Among non-Hispanic White older adults, higher state-level HCBS spending was associated with a greater use of home health care services (β: 0.13, 95% CI: 0.02, 0.25) and specialized health facilities (β: 0.24, 95% CI: 0.14, 0.34). These protective effects were less evident for Black and Hispanic older adults, though limited statistical power may have prevented detecting significant effects in these subgroups. The findings suggest inequities in the benefits of increased HCBS funding, with the benefits primarily concentrated among White older adults. Further research is needed to explore mechanisms behind these patterns, including structural barriers to LTSS access.

Lack of transportation can be a barrier to healthcare access for older adults. State-administered home and community-based services (HCBS) often include transportation to aid in independent living. Indiana provides HCBS to Medicaid enrollees 60 and older through an Aged and Disabled (A&D) Waiver. A Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey collects data about these services, including transportation. Since 2021, Indiana has collected HCBS CAHPS data annually from A&D waiver participants for internal quality improvement, including demographics, self-reported overall and mental health ratings, and unmet needs. Among 4,199 CAHPS survey respondents, 22.1% reported an unmet need in transportation to medical appointments. Survey-weighted logistic regression was used to estimate how participant characteristics were associated with transportation unmet needs. Poor ratings of physical health and female sex were associated with greater unmet transportation needs. Black/African American race was associated with fewer unmet transportation needs and may reflect Black respondents were more likely to have urban residence than White respondents. These findings suggest health status and other patient characteristics should be considered when addressing older adults' unmet transportation needs.

When Minnesota passed State Statute 144 G in 2019, it fundamentally changed the licensure of assisted living facilities in the state. This new regulatory framework was developed by a group of stakeholders representing consumer advocates, provider advocates, and state government. However, assisted living providers who served culturally specific communities (Black, Indigenous, and other People of Color) in small facilities were largely absent from the development of this new license. As a result, several unintended consequences and challenges have emerged in implementation in these settings. We interviewed a sample of 14 licensed assisted living directors operating small, culturally specific communities to understand their experiences with the regulatory framework. After a qualitative analysis, four main themes emerged: (1) lack of participation in the initial license development, (2) challenges to implementation of license requirements, (3) inconsistency in and preparation for survey inspections, and (4) inadequate reimbursement and funding. To address these concerns, a number of recommendations were identified, which ranged from ensuring all stakeholders are engaged in policy development to developing a new rate setting methodology for Medicaid waivers. Although these recommendations are specific to Minnesota, they do have implications for other states and agencies who are developing similar regulations.

The importance of older adults' participation in policymaking is increasingly recognized, but the nuanced participation processes remain insufficiently understood. This scoping review aims to map existing research on older adults' participation in policymaking, focusing on who participates, their activities and contributions, resulting outputs and outcomes, and the enablers and barriers affecting their participation. A systematic search was conducted to identify peer-reviewed literature through Web of Science, SocINDEX, Academic Search Complete, Humanities International Complete, and Scopus, and gray literature through Google Scholar, institutional repositories, and expert recommendations. The eligibility criteria are original empirical studies focusing on individuals aged 50 years and older and their participation in policymaking. In total, 23 studies were included in the final review. A structured extraction form was developed to capture study characteristics, participant socio-demographics, participation activities, policy outputs and outcomes, and factors affecting participation. Descriptive analysis was performed on study characteristics, and content analysis was conducted on participation processes. Most studies (78%) were conducted in high-income countries, often overrepresenting women, younger cohorts, more educated and community-dwelling older adults. This participation was often ad hoc rather than institutionally established and supported. Older adults contributed to developing policy documents, shaping long-term outcomes, and enhancing personal well-being. The review identified participation enablers at individual and institutional levels and highlighted barriers such as time and resource constraints, health limitations, power imbalances, and ageism. The findings inform policy and program interventions to establish mechanisms for older adults' participation, address barriers for disadvantaged groups, and create meaningful pathways for translating their contributions into policy outcomes.

Unobtrusive yet indispensable services such as housekeeping, regular maintenance, and safety checks form the invisible foundations that shape the quality of life in senior living facilities. This phenomenological study explores the lived experiences of older adults, focusing on how they perceive and engage with these routine services. Utilizing Moustakas' transcendental phenomenology and the Modified Stevick-Colaizzi-Keen method, the study involved one-on-one, in-depth, semi-structured interviews with 20 older adults across six senior living facilities in an urban neighborhood. Five critical themes emerged: preservation of personal space, balance between consistency and adaptability, effective communication and meticulous execution, unobtrusive safety practices, and the everyday construction of dignity through routine care. Each theme, beyond its functional significance, carried emotional, psychological, and social importance, collectively enhancing the quality of life of older adults. By repositioning everyday services as active sites of meaning-making, this study challenges conventional assumptions about what constitutes "care" in institutional aging. These insights offer a foundation for refining service delivery guidelines and inform actionable recommendations for senior-friendly facilities, policymakers, and caregivers.

Older adults are increasingly becoming unhoused, yet homelessness and housing precarity among older adults are often invisible. Housing insecurity also disproportionately impacts communities of color and women due to decades of exclusion from home ownership and wealth inequities. Many policies addressing homelessness tend to employ a crisis-centered approach, silo health and housing and offer few culturally responsive options for an increasingly diverse clientele. This commentary argues that nonprofit homesharing programs provide an undervalued and underused upstream tool that could potentially help prevent homelessness among older adults. Homesharing presents a promising model to address housing instability by matching home providers who have a spare room or space on their property with home seekers in exchange for rent and sometimes services. Building on established research and emerging studies on homeshare programs, this article outlines several strengths from homesharing and why this housing model deserves more attention from researchers, policymakers, practitioners, and funders. Homesharing offers a potential strategy to prevent older adult homelessness by blending housing and health. It also offers culturally responsive approaches to serve an aging population facing first-time homelessness, especially older adults who are low-income and those who identify as persons of color, sexual and gender minorities, and/or women.

Nursing homes have historically struggled to maintain adequate nurse staffing. We analyzed Payroll Based Journal data linked to other publicly available sources and conducted interviews to understand changes in nurse staffing between 2019 and 2020. We found large declines in total staffing hours, but slight increases in staffing measured as hours per resident day (HPRD). Staffing was nonetheless a major challenge for nursing homes because they required increased staffing due to the impact of the pandemic. Nursing homes in higher quartiles of percentage of racial/ethnic minority residents served lost more nurse staffing HPRD relative to nursing homes in the lowest quartile of minority residents. Mitigating disparities between nursing homes is central to strengthening the workforce and improving care delivered in nursing homes. Policymakers may consider policies to address the outcome disparities resulting from COVID-19 by considering more targeted resources to nursing homes in underserved areas where these health disparities are more prominent.

Despite the varied positive outcomes associated with sense of purpose across the life span, older adults residing in long-term care settings tend to report lower levels of purpose than those living within the community. Literature specific to purpose in non-community settings is also limited. This study explored the experience of purpose from the perspective of older adults living in four Australian residential aged care services. Through analysis of data obtained through 20 semi-structured interviews, four themes of purpose emerged. A sense of purpose was realized through: a drive for life; routine, activities, and autonomy; social interaction and relationships; and faith and spirituality. Whilst scope of purposeful activity may be more constrained, opportunities to pursue purpose endure in this setting. The outcomes of this study contribute to contemporary understanding of the fulfillment of purpose in long-term care settings which may in turn inform efforts supporting its maintenance and promotion amongst this group.

China is vigorously implementing home and community-based care (HCBC) policies; however, the accessibility of HCBC service is low. Some studies point out that an imbalance between supply and demand of HCBS policies inhibits the accessibility of HCBC services. A discrete choice experiment was conducted to elicit 520 Chinese older adults' preferences regarding HCBC. The results show that older adults have different preferences related to five HCBC policy factors: community aged care facilities, medical service provision, aged care service price, older adult-family support approach, and workforce development. Further analysis yields that characteristics of HCBC policy preferences include older adults' friendly community building, health care functions, and physical support. However, the analysis also highlights that important aspects such as family support, HCBC pricing, and caregivers, are often neglected in these preferences. Accordingly, it is recommended to create friendly communities for older adults, improve the utilization of medical services, establish nonpublic and nonprofit social organizations, and set up reasonable economic subsidies.

The COVID-19 pandemic has exposed and amplified preexisting societal inequalities, including ageism, which remains an underexplored issue in Latin America. This study examines the Colombian government's response to COVID-19 by focusing on institutional ageism. Using a qualitative approach, the research reviewed government documents and interviews with institutional agents, social leaders, and participants from institutions related to older adults. These findings indicate that national policies prioritize chronological age as a primary vulnerability factor, perpetuating ageism. Extended lockdowns and economic aid measures portrayed older adults as homogenous and dependent groups, overlooking their diversity and capacity. In contrast, Bogotá's response recognized intersecting vulnerabilities, such as caregiving roles and socioeconomic status, integrating civil society input. The study highlights the "Rebellion of the Grey Hair," a movement by older adults challenging discriminatory policies and advocating for their autonomy and rights. It concludes by stressing the lack of research on institutional ageism in Latin America, particularly Colombia, and calls for future studies and emergency responses that respect the diversity and autonomy of older adults, moving beyond exclusive age-based approaches.