Social Isolation and Loneliness in Older People: A Closer Look at Definitions

Social isolation and loneliness are related and the terms are often used interchangeably, but they are distinct concepts with different definitions, health impacts, and interventions. Our population is aging and older people are at increased risk for both social isolation and loneliness and the associated negative health consequences. Understanding the important differences between social isolation and loneliness will help us recognize them earlier in vulnerable populations, engage in more meaningful conversations with older adults about their own risks, and will inform the development and delivery of more individualized, meaningful, and cost-effective interventions

Adults Using Long Term Services and Supports: Population and Service Use Trends in Maine, SFY 2016

All of us have likely either used, will use, or know someone who uses long term services and support (LTSS). They enable us to live with dignity and as much independence as possible and offer us the opportunity to remain involved and productive in our communities. The need for LTSS can arise suddenly after injury or illness or a life-long condition. But how ever the need arises, the impact is the same—services such as personal care, work support, home health care, and residential care provide not just for individual health and comfort, but also for interaction, inclusion, and engagement with each other. While many of us have provided help with daily living for our family and friends or have relied on our own family ourselves, there are times when formal support from professional caregivers is necessary. Private health insurance and Medicare do not typically cover extended LTSS, leaving payment for services up to the individual. Medicaid, known as MaineCare in this state, on the other hand, does cover this type of care for adults meeting financial and medical eligibility requirements. This chartbook describes the MaineCare LTSS available to adult members, the number of members who used them in state fiscal year 2016, and the amount of spending on these services as a proportion of all spending on adult MaineCare members. In addition, this book provides demographic trends regarding Maine’s older adults; Census estimates on poverty, housing, and employment among Maine’s adults with disabilities; characteristics of Maine adults using nursing, residential care, or home and community based services; and an analysis of MaineCare spending and service utilization among adults using different types of LTSS. The information on the services available, the trends in use, and the dollars spent on them presents a snapshot of the LTSS system in State fiscal year 2016, and it can help us plan for the system we want for ourselves and our family and friends in the future

Financial Alignment Initiative Massachusetts One Care: Third Evaluation Report

The Medicare-Medicaid Coordination Office and the Innovation Center at the Centers for Medicare & Medicaid Services (CMS) have created the Medicare-Medicaid Financial Alignment Initiative to test, in partnerships with States, integrated care models for Medicare-Medicaid enrollees. The demonstration in Massachusetts, known as One Care, was implemented October 1, 2013. Three health plans were competitively selected by the Commonwealth and CMS to operate Medicare-Medicaid Plans (MMPs), but one health plan withdrew from participation in the demonstration as of September 30, 2015. One MMP operates in nine counties, with partial coverage in one county; the second MMP operates in three counties, with partial coverage in one county. MMPs provide care coordination and flexible benefits under a capitated payment model. CMS and the Commonwealth provide payments to finance all Medicare and Medicaid services. This Third Evaluation Report for the Massachusetts One Care demonstration describes the demonstration’s implementation and early analysis of its impacts. The report includes findings from qualitative data for 2017 and quantitative results for October 1, 2013, through December 31, 2016. Data sources include key informant interviews, beneficiary focus groups, the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey results, Medicare claims data, the Minimum Data Set nursing facility assessments, MMP encounter data for Medicare and Medicaid services, and other demonstration data. Future analyses also will include Medicaid claims and encounters as those data become available

Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic.

BACKGROUND: Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery. METHODS: This international cohort study included adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020. Patients suspected of SARS-CoV-2 infection before operation were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Preoperative testing strategies were adjusted for confounding using mixed-effects models. RESULTS: Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2 per cent) underwent preoperative testing: 1458 (16.6 per cent) had a swab test, 521 (5.9 per cent) CT only, and 324 (3.7 per cent) swab and CT. Pulmonary complications occurred in 3.9 per cent, whereas SARS-CoV-2 infection was confirmed in 2.6 per cent. After risk adjustment, having at least one negative preoperative nasopharyngeal swab test (adjusted odds ratio 0.68, 95 per cent confidence interval 0.68 to 0.98; P = 0.040) was associated with a lower rate of pulmonary complications. Swab testing was beneficial before major surgery and in areas with a high 14-day SARS-CoV-2 case notification rate, but not before minor surgery or in low-risk areas. To prevent one pulmonary complication, the number needed to swab test before major or minor surgery was 18 and 48 respectively in high-risk areas, and 73 and 387 in low-risk areas. CONCLUSION: Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 risk areas. There was no proven benefit of swab testing before minor surgery in low-risk areas