Tracing the History of Medicare Home Health Care: The Impact of Policy on Benefit Use

We trace key policy changes that affected use of the Medicare home health benefit from the 1980s through the prospective payment system implemented in 2000, analyzing the impact on three measures of home care use: expenditures, users and visits. We demonstrate the impact of policies generated in the legislative, the judicial, and the executive branches of government and the gaming behavior of home health agencies in response to policy changes. Our analysis suggests that the policy itself and the implementation process are critical to understanding benefit use. The incentives in the policies and agency reactions had the potential to generate fraud in two directions, either over or underuse. Throughout this history, use of the benefit was driven less by patient need than by arbitrary interpretations of eligibility. These interpretations were in turn influenced by opposing ideologies favoring redistribution based on market principles versus those based on need

Intersectional Discrimination Attributions and Health Outcomes Among American Older Adults: A Latent Class Analysis

Guided by an intersectionality framework, this study examined intersectional discrimination attributions and their associations with health outcomes. Older respondents (aged ≥50) from the Health and Retirement Study in 2014-2015 were included (N = 6286). Their reasons for discrimination (age, gender, sexual orientation, race, national origin, religion, financial status, weight, physical appearance, disability, and others) were examined. Latent class analysis examined the subgroup profiles. Six classes were identified: class 1 (54.52% of the sample) had no/minimal discrimination; Class 2 (21.89%) experienced primarily ageism; class 3 (8.81%) reported discrimination based on age/gender/national origin/race; class 4 (7.99%) attributed discrimination to financial/other reasons; class 5 (5.87%) experienced discrimination based on age/weight/physical appearance/disability; and class 6 (0.92%) perceived high discrimination. Intersectional discrimination was associated with poorer self-rated health and higher depressive symptoms compared to the no/minimal discrimination group. Multiple marginalized identities co-occur and contribute to discrimination. An intersectional approach is recommended to understand discrimination in later life.This accepted article is published as Lu P, Kong D, Shelley M, Davitt JK. Intersectional Discrimination Attributions and Health Outcomes Among American Older Adults: A Latent Class Analysis. The International Journal of Aging and Human Development. 2022;95(3):267-285. doi:10.1177/00914150211066560. Posted with permission

PhillydotMap: The Shape of Philadelphia

This book is the outgrowth of a working group entitled, “Modeling Urban Environmental Impacts on Health, Development, and Behavior sponsored by the University of Pennsylvania Institute for Urban Research. The purpose of the working gropu was to engage faculty from across campus and to encourage their collaborative use of GIS technology in the modeling of urban form and function. These ten chapters represent a wide range of GIS applications, from community-based social services to public history to social science research

Identifying Distinct Risk Profiles to Predict Adverse Events among Community-Dwelling Older Adults

Preventing adverse events among chronically ill older adults living in the community is a national health priority. The purpose of this study was to generate distinct risk profiles and compare these profiles in time to: hospitalization, emergency department (ED) visit or death in 371 community-dwelling older adults enrolled in a Medicare demonstration project. Guided by the Behavioral Model of Health Service Use, a secondary analysis was conducted using Latent Class Analysis to generate the risk profiles with Kaplan Meier methodology and log rank statistics to compare risk profiles. The Vuong-Lo-Mendell-Rubin Likelihood Ratio Test demonstrated optimal fit for three risk profiles (High, Medium, and Low Risk). The High Risk profile had significantly shorter time to hospitalization, ED visit, and death (p \u3c 0.001 for each). These findings provide a road map for generating risk profiles that could enable more effective targeting of interventions and be instrumental in reducing health care costs for subgroups of chronically ill community-dwelling older adults

Current Practices in High-Tech Home Care

This book offers convenient access to information about the benefits, drawbacks and challenges of importing high-technology medical care into the home care programs. It is both a descriptive report of research-based observations, and an interpretive analysis of major issues and policies in the delivery of technology-enhanced care. The authors bring to the forefront evidence-based current home care practices, such as ventilator therapy and artificial nutrition infusion pumps, and develop them through complete discussions of legal, ethical and administrative issues they entail. Agency administrators as well as in-home direct service providers like nurses and social workers, will find essential information on a critical home care delivery issue presented with clarity and accessibility.https://digitalcommons.library.umaine.edu/fac_monographs/1109/thumbnail.jp

Outcomes of a Telehealth Intervention for Homebound Older Adults with Heart or Chronic Respiratory Failure: A Randomized Controlled Trial

Purpose: Telehealth care is emerging as a viable intervention model to treat complex chronic conditions, such as heart failure (HF) and chronic obstructive pulmonary disease (COPD), and to engage older adults in self-care disease management. Design and Methods:  We report on a randomized controlled trial examining the impact of a multifaceted telehealth intervention on health, mental health, and service utilization outcomes among homebound medically ill older adults diagnosed with HF or COPD. Random effects regression modeling was used, and we hypothesized that older adults in the telehealth intervention (n = 51) would receive significantly better quality of care resulting in improved scores in health-related quality of life, mental health, and satisfaction with care at 3 months follow-up as compared with controls (n = 51) and service utilization outcomes at 12 months follow-up. Results:  At follow-up, the telehealth intervention group reported greater increases in general health and social functioning, and improved in depression symptom scores as compared with usual care plus education group. The control group had significantly more visits to the emergency department than the telehealth group. There was an observed trend toward fewer hospital days for telehealth participants, but it did not reach significance at 12 months. Implications: Telehealth may be an efficient and effective method of systematically delivering integrated care in the home health sector. The use of telehealth technology may benefit homebound older adults who have difficulty accessing care due to disability, transportation, or isolation

Loneliness, Depressive Symptoms, and Cognitive Functioning Among U.S. Chinese Older Adults

Objective: Loneliness has been associated with cognitive functioning in the general older adult population. Previous studies further indicate that loneliness has a strong association with depressive symptoms and the two constructs can reinforce each other to diminish well-being. However, such relationships have not been examined in U.S. Chinese older adults. This study attempts to bridge this knowledge gap. Method: Data were drawn from a population-based study of 3,159 U.S. Chinese older adults in the Greater Chicago area. Stepwise multivariate regression analyses were conducted to examine the relationship between loneliness, depressive symptoms, and global cognitive functioning. Results: Loneliness was associated with poor global cognitive functioning in U.S. Chinese older adults, though the relationship became nonsignificant after adjustment for depressive symptoms. The interaction term between loneliness and cognitive functioning was statistically significant ( p < .01). The findings further highlight the importance of age, education, number of children, number of people in household, and length of residence in the U.S. in cognitive functioning among U.S. Chinese older adults. Discussion: The study findings indicate that loneliness and depressive symptoms act together to influence cognitive functioning in U.S. Chinese older adults. Research and clinical implications of the findings are discussed

Supplemental Material - Who Cares for Older Adults? A Cross-National Study of Care Sources for Older Adults With Functional Limitations and Associated Determinants

Supplemental Material for Who Cares for Older Adults? A Cross-National Study of Care Sources forOlder Adults With Functional Limitations and Associated Determinants by Dexia Kong, Peiyi Lu, Bei Wu, Joan K. Davitt, and Mack Shelley in Journal of Applied Gerontology</p