Trajectories of disability and long-term care utilization after acute health events

Funding Information: Judite Gonçalves acknowledges funding from the Portuguese National Funding Agency for Science, Research, and Technology (FCT, grant number CEECIND/03117/2018) and Luís Filipe from the National Institute for Health Research Applied Research Collaboration North West Coast (NIHR ARC NWC). The views expressed are those of the authors and not necessarily those of their institutions. We appreciate comments from two anonymous reviewers, Joana Pestana, France Weaver, Joan Costa-Font, Helena Telles, Álvaro Almeida, Pedro Pita Barros, and participants at the Conference of the Portuguese Health Economics Association, a Lisbon Microgroup meeting, the European Health Economics Association Conference, the Workshop of the Portuguese Health Economics Association, and the Public Sector Economics Conference on Ageing and Long-Term Care. Publisher Copyright: © 2023 The Author(s). Published with license by Taylor & Francis Group, LLC.Hip fractures, strokes, and heart attacks are common acute health events that can lead to long-term disability, care utilization, and unmet needs. However, such impacts, especially in the long term, are not fully understood. Using data from the Health and Retirement Study, 1992–2018, this study examines the long-term trajectories of individuals suffering such health shocks, comparing with individuals not experiencing health shocks. Hip fracture, stroke, and heart attack are confirmed to have severe implications for disability. In most cases of stroke and heart attack, informal caregivers provide the daily support needed by survivors, whereas following hip fracture, nursing home care is more relevant. These health shocks put individuals on worse trajectories of disability, care utilization, and unmet needs. There is no long-term recovery or convergence with individuals who do not suffer shocks. Unmet need is prevalent, even pre-shock and among individuals who do not experience health shocks, emphasizing the importance of preventative care measures. These findings support policy action to ensure hospitalized individuals, especially those aged 50 and above, receive rehabilitative services and other post-acute care. Furthermore, hospitalization is an event that requires the detection and addressing of unmet care needs beyond the short run.publishersversioninpres

Correction to: Medicaid expansion and the mental health of spousal caregivers

Correction to: Review of Economics of the Household https://doi.org/10.1007/s11150-023-09673-7 The original version of this article unfortunately contained errors in Author group, Abstract and in the text

Long-Term Care Insurance: Does Experience Matter?

We examine whether long-term care (LTC) experience helps explain the low demand for long-term care insurance (LTCI). We test if expectations about future informal care receipt, expectations about inheritance receipt, and LTCI purchase decisions vary between individuals whose parents or in-laws have used LTC versus those who have not. We find parental use of a nursing home decreases expectations that one\u27s children will provide informal care, consistent with the demonstration effect. Nursing home use by in-laws does not have the same impact, suggesting that individuals are responding to information gained about their own aging trajectory. Nursing home use by either a parent or in-law increases LTCI purchase probability by 0.8 percentage points, with no significant difference in response between parents\u27 and in-laws\u27 use. The estimated increase in purchase probability from experience with LTC is about half the previously estimated increase from tax policy-induced price decreases

Family Structure and Long-Term Care Insurance Purchase

While it has long been assumed that family structure and potential sources of informal care play a large role in the purchase decisions for long-term care insurance (LTCI), current empirical evidence is inconclusive. Our study examines the relationship between family structure and LTCI purchase and addresses several major limitations of the prior literature by using a long panel of data and considering modern family relationships, such as the presence of stepchildren. We find that family structure characteristics from one\u27s own generation, particularly about one\u27s spouse, are associated with purchase, but that few family structure attributes from the younger generation have an influence. Family factors that may indicate future caregiver supply are negatively associated with purchase: having a coresidential child, signaling close proximity, and having a currently working spouse, signaling a healthy and able spouse, that long-term care planning has not occurred yet or that there is less need for asset protection afforded by LTCI. Dynamic factors, such as increasing wealth or turning 65, are associated with higher likelihood of LTCI purchase

Informal Care and Caregiver's Health

This study aims to measure the causal effect of informal caregiving on the health and health care use of women who are caregivers, using instrumental variables. We use data from South Korea, where daughters and daughters‐in‐law are the prevalent source of caregivers for frail elderly parents and parents‐in‐law. A key insight of our instrumental variable approach is that having a parent‐in‐law with functional limitations increases the probability of providing informal care to that parent‐in‐law, but a parent‐in‐law's functional limitation does not directly affect the daughter‐in‐law's health. We compare results for the daughter‐in‐law and daughter samples to check the assumption of the excludability of the instruments for the daughter sample. Our results show that providing informal care has significant adverse effects along multiple dimensions of health for daughter‐in‐law and daughter caregivers in South Korea. Copyright © 2013 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110580/1/hec3012.pd

Impact of TBI on caregivers of veterans with TBI: Burden and interventions

Objectives: Describe State-of-the-Art in practice and research in caregiving with individuals, specifically, Veterans with traumatic brain injury (TBI) and the implications for current practice and future research. Sources: Professional literature and personal experience of review panel.Main Outcomes: Unpaid caregiving for individuals with TBI is most often provided by a spouse, parent or other blood relative; the majority of caregivers are women. Although caregiving can be rewarding, it also may create financial burden and psychological stress. Depression among family caregivers occurs four times more frequently than in the general population. Positive coping can help reduce the impact of stress, and Department of Veterans Affairs (VA) programmes are available to ease financial burden. Group interventions show promise in reinforcing and improving positive coping for both family caregivers and Veterans with TBI.Conclusions: Identifying the specific needs of caregivers and families of Veterans with TBI and other traumatic injuries, including post-traumatic stress syndrome (PTSD), will require further longitudinal research. Currently available group interventions and programmes appear to benefit injured Veterans and their family caregivers financially and psychologically. Increased understanding of characteristics of quality family caregiving and its long term costs and benefits is likely to lead to additional improvements in these interventions and programmes

Rural-Urban Differences in Preventable Hospitalizations Among Community-Dwelling Veterans With Dementia

Alzheimer’s patients living in rural communities may face significant barriers to effective outpatient medical care

Informal Care and Caregiver's Health: INFORMAL CARE AND CAREGIVER'S HEALTH

This study aims to measure the causal effect of informal caregiving on the health and health care use of women who are caregivers, using instrumental variables. We use data from South Korea, where daughters and daughters-in-law are the prevalent source of caregivers for frail elderly parents and parents-in-law. A key insight of our instrumental variable approach is that having a parent-in-law with functional limitations increases the probability of providing informal care to that parent-in-law, but a parent-in-law’s functional limitation does not directly affect the daughter-in-law’s health. We compare results for the daughter-in-law and daughter samples to check the assumption of the excludability of the instruments for the daughter sample. Our results show that providing informal care has significant adverse effects along multiple dimensions of health for daughter-in-law and daughter caregivers in South Korea

Early Mobility in the Hospital: Lessons Learned from the STRIDE Program

Immobility during hospitalization is widely recognized as a contributor to deconditioning, functional loss, and increased need for institutional post-acute care. Several studies have demonstrated that inpatient walking programs can mitigate some of these negative outcomes, yet hospital mobility programs are not widely available in U.S. hospitals. STRIDE (assiSTed eaRly mobIlity for hospitalizeD older vEterans) is a supervised walking program for hospitalized older adults that fills this important gap in clinical care. This paper describes how STRIDE works and how it is being disseminated to other hospitals using the Replicating Effective Programs (REP) framework. Guided by REP, we define core components of the program and areas where the program can be tailored to better fit the needs and local conditions of its new context (hospital). We describe key adaptations made by four hospitals who have implemented the STRIDE program and discuss lessons learned for successful implementation of hospital mobility programs

Risk Recognition Policies for the Long-Term Care Workforce during the First Year of the COVID-19 Pandemic: A Multi-Country Study

Context: The precarious work arrangements experienced by many long-term care workers have led to the creation of a “shared” workforce across residential, home, and community aging care sectors. This shared workforce was identified as a contributor to the spread of COVID-19 early in the pandemic. Objective: This analysis sought to review policy measures targeting the long-term care workforce across seven high income jurisdictions during the first year of the COVID-19 pandemic. The focus was on financial supports introduced to recognize long-term care workers for the increased risks they faced, including both (1) health risks posed by direct care provision during the pandemic and (2) economic risks associated with restrictions to multi-site work. Method: Environmental scan of publicly available policy documents and government news releases published between March 1, 2020 and March 31, 2021, across seven high income jurisdictions. Findings: While there was limited use of financial measures in the United States to compensate long-term care workers for the increased health risks they faced, these measures were widely used across Canada, as well as in Wales, Scotland, and Australia. Moreover, there was a corresponding use of financial measures to protect workers from income loss in parts of Canada, Australia and the UK. Limitations: Our analysis did not include additional policy measures such as sick pay or recruitment incentives. We also relied primarily on publicly available policy documentation. In some cases, documents had been archived or revised, making it difficult to ascertain and clarify original information and amendments. Implications: While these financial measures are temporary, they brought to light long-standing issues related to the supply of and support for workers providing care to older adults in long-term care homes