Ohio's Dual Eligible Population: Effects of Program Design and Implementation on Care Management

Abstract MyCare Ohio is a prospective blended managed care payment model program tasked to provide comprehensive and coordinated care to Ohio residents who are dully eligible for Medicare and Medicaid. To understand the administration and day-to-day implementation of care management within MyCare Ohio, n=75 interviews with a total of n=331 personnel from Area Agencies on Aging, Managed Care Plans, and service providers were conducted. Interviews were audio recorded, transcribed, and checked for accuracy. Data were analyzed by iterative reviews and deductive coding in Dedoose. Respondents provided insights on how care management activities are affected by program design features (e.g., ability to opt-out of the Medicare component), transitions between acute and long-term care settings, documentation systems and data-sharing, and high numbers of beneficiaries with behavioral health diagnoses. Implications for practice and policy will be discussed.</jats:p

Community Options to Fund Aging Services: A National Study to Track Local Initiatives

Abstract The majority of federal support for older people needing in-home services and supports comes from the Medicaid program. However, less than 10% of older people are eligible for Medicaid and to receive long-term services, a person must have a severe disability. Many older people with moderate levels of disability or those who are not impoverished are not eligible. In response to these system limitations, some counties across the nation have developed alternative funding strategies, such as property tax levies, to better serve older members of their communities. After identifying 15 states with such initiatives, a survey was distributed to 414 contacts within these states, with a response rate of 55%. Respondents included organizations such as area agencies on aging, councils on aging, and county departments on aging. Local funding varied within and across states, with annual funding ranging from $8,000-$47 million. Most commonly provided services with local funds include home-delivered (81%) and congregate (73%) meals, transportation (61%), and homemaker services (49%). A majority of programs (63%) indicated that local funds are used to provide at least one family or friend caregiver service. This study is the first compilation and description of locally-funded elder service initiatives in the U.S. Locally-funded initiatives can help older people with long-term services needs continue to live in their own homes and communities. On the other hand, some have raised questions about whether this is a good approach to funding aging services, raising concerns that this will lead to further inequities across states and communities.</jats:p

If You Ask Them, They Will Support: A National Study of Local Initiatives Developed to Provide Social Care to Older Adults in the Community

Objectives: Some communities across the nation are utilizing alternative funding sources to better support home and community-based services for older adults. Methods: A variety of methods identified local initiatives across the United States. An online survey was distributed to a total of 377 communities in 15 states identified as using locally raised funds to provide aging services, yielding a 55% response rate. Results: Total funding from programs generated almost 400 million dollars annually with funding ranging from $8000-$47 million. Commonly provided services with local funds include home-delivered and congregate meals, transportation, and homemaker services with provision varying by the size of the levy initiative. Additionally, six in 10 initiatives reported local funds being used to provide at least one family or friend caregiver service. Conclusion: Locally-funded initiatives fill a gap in long-term services needs for older adults, yet policy concerns regarding potential inequities across states and communities warrant attention. </jats:sec

Nursing Home Social Work During COVID-19

As the impacts of COVID-19 on nursing facilities became apparent, the members of the U.S. based National Nursing Home Social Work Network (NNHSWN) immediately considered what it could offer as a useful response to assist nursing home social workers working in facilities. The NNHSWN was brought together nearly a decade ago by Dr. Mercedes Bern-Klug at the University of Iowa School of Social Work and Bob Connolly, a social worker and Centers for Medicare and Medicaid Services (CMS) retiree who had worked on developing the Minimum Data Set or MDS. Membership consists primarily of social work researchers interested in nursing homes, most of whom have work experience in that setting. Readers of this journal may be familiar with Dr. Bern-Klug’s and Mr. Connolly’s publication and work on obtaining comments and policy suggestions on the proposed nursing home regulations in 2016 (Bern-Klug et al, 2016).https://www.tandfonline.com/doi/abs/10.1080/01634372.2020.1787577?journalCode=wger2

Local Initiatives to Fund Services for Elders: Increased Community Recognition of the Importance of Social Care

Abstract Despite the growing number of older adults in the U.S., federal and state funding for non-medical supportive services remains limited. Recent work reports that states with a more generous supply of supportive services, including home delivered meals and personal care, have fewer low care residents in nursing homes. To boost this supply, some local communities across the nation are exploring alternative funding sources. Our review found 400 local communities across 15 states using voter-approved local revenue streams to fund aging services, such as property tax levies and payroll and sales taxes, and that this strategy has been politically popular. In this paper we provide results from the first national survey of these local communities. Study results found considerable variation by state in number and scope of local initiatives, with Ohio and Michigan each reporting about 70 communities with local property tax levies, while California and Washington had only one community each using this approach. Local programs ranged in size from generating less than $25,000 in annual revenue to more than$35 million. The organizational structure for these programs, and the administrative approaches, such as the use of care managers, varied by state and community. Programs provided an array of services, but typically included traditional social care services such as home delivered meals, homemaker/personal care, transportation, and home emergency response systems. Criteria for program participation also varied, but most were targeted to serve older adults with disability who did not meet Medicaid financial or functional eligibility criteria.</jats:p

sj-docx-2-jag-10.1177_07334648221090945 – Supplemental material for If You Ask Them, They Will Support: A National Study of Local Initiatives Developed to Provide Social Care to Older Adults in the Community

Supplemental material, sj-docx-2-jag-10.1177_07334648221090945 for If You Ask Them, They Will Support: A National Study of Local Initiatives Developed to Provide Social Care to Older Adults in the Community by Athena Koumoutzis, Jennifer Heston-Mullins, Pamela S. Mayberry and Robert Applebaum in Journal of Applied Gerontology</p

sj-docx-1-jag-10.1177_07334648221090945 – Supplemental material for If You Ask Them, They Will Support: A National Study of Local Initiatives Developed to Provide Social Care to Older Adults in the Community

Supplemental material, sj-docx-1-jag-10.1177_07334648221090945 for If You Ask Them, They Will Support: A National Study of Local Initiatives Developed to Provide Social Care to Older Adults in the Community by Athena Koumoutzis, Jennifer Heston-Mullins, Pamela S. Mayberry and Robert Applebaum in Journal of Applied Gerontology</p

Local Initiatives to Fund Services for Older Americans: Community Recognition of the Importance of Social Care

Despite the growing proportion of older adults in the United States, federal and state funding for nonmedical supportive services remains limited. To meet increasing demand, some communities across the nation are exploring alternative funding sources for aging services. Although no systematic database exists to track such local programs, through an array of data sources including a national survey, telephone contacts, and a web review, we identified 15 states that are using local funding to support aging services. Communities are using a variety of local revenue streams, such as property tax levies, payroll, and sales taxes to provide services for older adults and/or their family or friend caregivers. There are considerable differences in community approaches including the following: amount of revenue generated, service eligibility criterion, type of services covered, and management infrastructure. Critical policy questions surrounding equity issues within and across states are raised as communities create these alternative funding mechanisms. </jats:p