Journal of Aging & Social Policy最新文献

Enrollment in Medicare Advantage (MA) plans surpassed fee-for-service (FFS) Medicare beneficiaries in 2024. Still, little is known about how effectively these private plans impact Medicare beneficiaries' health and quality of life outcomes. The current study aimed to examine the associations of MA plans' characteristics with beneficiaries' health-related quality of life (EQ-5D) physical and mental health summary scores (PCS, MCS) using the Medicare Health Outcomes Survey (2015-2017). The study used two cross-sectional samples (2016 and 2018) and one repeated sample with baseline (2015) and follow-up (2017) data. I used propensity score matching analysis (PSM) and the instrumental variable approach to address the selection of MA plans. Findings suggest that PPO (Preferred Provider Organization) enrollment was significantly associated with higher EQ-5D, PCS, and MCS scores than HMO (Health Maintenance Organization) plans. Results from linear models with individual and time-fixed effects suggest that beneficiaries enrolled in PPO plans experienced an improvement in all three outcomes from baseline to follow-up compared to HMO plans. Other significant plan-level characteristics were plan enrollment, ownership status, and duration. Assessing health and quality-of-life outcomes is important for a better understanding how MA plans directly impact population health, the core of the value-based care model.

The COVID-19 pandemic highlighted the importance of infection control practices in skilled nursing facilities (SNFs). This study examined SNF administrator perspectives on implementing built environment strategies to manage and mitigate COVID-19 transmission into and within their facility. Semi-structured interviews with SNF administrators were conducted between July 2020-December 2021. Administrators emphasized (1) the effective implementation of built environment strategies for quarantine and isolation protocols, (2) facility-level modifications used to manage and mitigate COVID-19 transmission, and (3) the challenges posed by outdated or high-density building layouts. Insights from this study's findings suggest important considerations for SNF architectural modifications and design as a mechanism for infection control. Thoughtful SNF architectural planning and design are critically important for the long-term care industry to expand and successfully meet the future challenges of pandemics, severe weather events, and other public health emergencies.

Home- and community-based health services (HCBHS) play a crucial role in the management of chronic conditions and disabilities among older adults. This study identified patterns of unmet needs for HCBHS and determined the factors associated with these unmet needs using a nationally representative sample. Data derived from 9,358 older adults responding to the 2018 wave of the China Longitudinal Aging Social Survey. HCBHS included home nursing, in-home doctor visits, rehabilitation, assistive medical devices, and health lectures. Latent class analysis was used to identify patterns of unmet needs for HCBHS, and multinomial logistic models were used to determine the associated factors. Three unmet needs patterns were identified: no needs/met needs (68.4%), unmet needs (11.1%), and uncertain needs (20.5%). Experiencing pain, depression, self-rated health, higher health workforce density, and region were significantly associated with both unmet and uncertain needs. Furthermore, education, living in urban areas, type of social pension, instrumental activities of daily living, and heart disease were found to be associated with unmet needs, while age, marital status, and household income were associated with uncertain needs. The findings underscore the need to address unmet and uncertain needs, develop targeted interventions, and implement policies to support aging in place.

Self-Direction is a service delivery model rooted in choice, empowerment, and control over long-term services and supports that allows older adults to select their services and who provides them. States determine key Self-Direction characteristics including level of state commitment, services that can be self-directed, and employer and budget authority, which may affect access and use. This mixed-method study identifies cross-state differences in how states are allowing Self-Direction among the 60 fiscal year 2023 Medicaid Home and Community-Based Services (HCBS) 1915(c) waivers that serve older adults using Framework Analysis and descriptive statistics. Framework Analysis resulted in three qualitative categories for analysis: description of program values, determination of capacity, explanation of authority granted to self-directing participants. Descriptive findings showed significant cross-state differences in Self-Direction design, with high variation in goals set for Self-Direction participation, projected spending on Self-Direction eligible services, and number of waiver services eligible for Self-Direction. Findings indicate significant variation in design of Self-Direction across 1915(c) waivers. Older adults' access to and experience with Self-Direction may be significantly influenced by their state of residence. States can use these findings to learn from other waivers and enhance their own design.

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.