Oregon Community-Based Care Survey 2016: Adult Foster Homes

This report describes adult foster homes in Oregon. An adult foster home (AFH) is a type of licensed community-based care (CBC) setting that provides residential, personal care, and health-related services, primarily to older adults. The study collected information from adult foster homes to achieve the following four main goals. Describe adult foster home characteristics, including staffing types and levels, policies, and monthly charges and fees Describe current residents’ health and social characteristics Compare current results to prior Oregon surveys and to national studies of similar setting types to identify changes and possible trends Compare setting types for differences that might affect access, quality, or costs The study findings are intended to provide information that state agency staff, legislators, community-based care providers, and consumers may use to guide their decisions. Providing state-level information was one of the goals of Oregon’s LTC 3.0 planning process

Socioeconomic Determinants of Health Disparities by Race and Ethnicity: the Mediating Role of Social, Psychological and Behavioral Factors

Socioeconomic status (SES) is inversely related to health status. Disparities in health status among races and ethnic groups are partly attributable to differences in SES, but the indirect pathways by which SES may influence health status are not widely studied. Using the Health and Retirement Study (HRS) data, this dissertation examined the pathways by which SES, via social, psychological, and behavioral factors predicted physical impairment and overnight hospitalization, and asked whether these indirect relationships differed by race/ethnicity. The HRS is a nationally representative multistage area probability sample administered biennially to respondents over the age of 51 and their spouses. Data collected between 2002 and 2010, covering five waves of the original HRS cohort born between the years 1931 and 1941, were used. Two analysis approaches, Structural Equation Modeling (SEM) and Reconstructability Analysis (RA), were used. Adjustments for the complex survey design were made in the SEM analysis, whereas, data were matched for the RA method using propensity scores. Results of the SEM analyses supported most of the hypothesized indirect relationships between SES variables and physical impairment via social and psychological factors, but the indirect effect of SES on physical impairment via behavioral factors was weak. Multiple group analyses of path equality using nested chi-square tests indicated that the indirect effect of SES on physical impairment status did not vary by race/ethnicity. Social, psychological and behavioral factors were weakly related to overnight hospitalization, and SES was not indirectly related to overnight hospitalization. While these results supported several hypothesized indirect relationships between SES variables and physical health status, the indirect effect sizes were small. However, because this study examined predictive paths across groups rather than compare mean differences, and because indirect effects are products of individual path coefficients, small effect sizes are not uncommon in mediation analysis. Moreover, over a lifetime, small effects may gradually add up increasing group differences in health status with greater benefits accruing to higher SES individuals via social and psychological factors, as observed in this study. The RA results showed that indirect relationships between SES and physical impairment were similar across races/ethnicities for identical variables with a few exceptions. In several cases, however, selected SES variables related to social and psychological variables were different for different groups. Cross-sectional indirect relationships were stronger than longitudinal indirect relationships. As in the SEM study, SES was not related to physical impairment via behavioral factors; and, across groups, SES was also not related to overnight hospitalization either directly or via social, psychological or behavioral factors. Variables predicting physical impairment exhibited differences across groups; these differences were detected because RA, unlike SEM, used disaggregated social, psychological and behavioral factors. Where predictive variables overlapped, the effects of identical independent variable (IV) states on physical impairment were similar across groups with a few exceptions. In summary, both the SEM and RA results indicated that SES was indirectly related to physical impairment via social and psychological factors, and results from both methods also showed that SES was not indirectly related to overnight hospitalization via these factors. SEM did not find that these indirect effects varied by race/ethnicity; RA found a few differences

Data Sources Regarding the Nonmedical Use of Pharmaceutical Opioids in the United States

Objective—Recent increases in the nonmedical use of pharmaceutical opioids and the adverse outcomes associated with them have stimulated a large amount of research and data collection on this public health problem. Systematic organization of the available data sources is needed to facilitate ongoing research, analysis, and evaluation. This work offers a systematic categorization of data sources regarding the nonmedical use of pharmaceutical opioids in the United States. Methods—A list of keywords regarding the nonmedical use of pharmaceutical opioids was used to conduct systematic searches in PubMed®. Filtration of search results generated 92 peer-reviewed academic articles, published between January 1995 and April 2012, as well as a number of primary data sources. Lists of topics were developed independently by two researchers which were later compared and consolidated. All sources were then categorized according to their relevance to each of these topics and according to their capacity for geographical and longitudinal trend analysis. Results—Tables cataloging data sources can be used to identify data relevant to specific topics in diversion, nonmedical use, and adverse outcomes associated with pharmaceutical opioids, and they illustrate global trends in data coverage, identifying several topics that have minimal data. A network diagram illustrates global trends in data coverage, showing variation among sources in the number of topics they cover, as well as variation among topics in the number of sources that cover them. Conclusions—The categorization of data sources is hoped to facilitate ongoing research, analysis, and evaluation of this public health problem by serving as a guide for researchers, policy makers, and others who seek data regarding the nonmedical use of pharmaceutical opioids in the United States

Data on the Diversion, Nonmedical Use and Adverse Outcomes Associated with Pharmaceutical Opioids

Background: Recent increases in the nonmedical use of pharmaceutical opioids and the adverse outcomes associated with them have stimulated a large amount of research and data collection on this public health problem. Systematic organization of the available data sources is needed to facilitate ongoing research, analysis, and evaluation. Method: A list of keywords associated with diversion, nonmedical use, and adverse outcomes of pharmaceutical opioid use generated 94 peer-reviewed academic articles and a number of governmental and nongovernmental sources. All sources were in English, contained quantitative data, and were published between January 1995 and April 2012. A list of 20 topics was developed independently by two researchers and differences were resolved through discussion. Sources were examined for relevance to each topic and categorized according to the scale which they were collected. Results: The configuration of data indicates the diverse array of information currently available on the nonmedical use of pharmaceutical opioids in the US. Data appear relatively sparse regarding nonmedical polydrug use, availability of opioids via the black market, and mechanisms of opioid diversion, such as doctor shopping and forgery. Conclusion: This index serves as a reference for researchers and policymakers who seek to further our understanding of the public health problems associated with pharmaceutical opioids and ameliorate associated adverse outcomes. Outlining the array of available data provides a global perspective and identifies topics that contain more and less quantitative information to guide our understanding and inform future research directions for the pharmaceutical opioid system in the US

Resident and Community Characteristics Report 2014: Assisted Living, Residential Care, Memory Care

This report provides an overview of community-based care settings in Oregon. The results presented here are derived from surveys completed by 243 facilities serving 9,485 residents. Key changes between the 2008 OOHPR survey and 2014 include: Compared to 2008, the number of facilities increased by 13%, with the largest growth in MCCs (41%). The proportion of for-profit facilities and facilities managed by a third party increased from 2008 by 8%. The acuity level of residents increased on most measures compared to 2008. Compared to 2008, residents across all three community types required more assistance with ADLs and used more health services. Residents of MCCs required the most assistance with ADLs and use of health services, which is similar to 2008. The percent of residents who used hospice services increased from 2008 by 2%. The percent of residents who visited the hospital or an emergency department increased from 10% in 2008 to 28% in 2014. The percent of residents using Medicaid increased from 2008 by 10%

Oregon Community-Based Care Survey: Assisted Living, Residential Care, and Memory Care

This report, prepared by the Institute on Aging (IOA) at Portland State University (PSU) in collaboration with the Oregon Department of Human Services, describes community-based care (CBC) settings that provide residential, personal care, and health-related services, primarily to older adults. The study collected information from assisted living, residential care, and memory care communities to achieve the following four main goals. Describe assisted living, residential care, and memory care community characteristics, including staffing types and levels, policies, and monthly charges and fees Describe current residents’ health and social characteristics Compare current results to prior Oregon surveys and to national studies of similar setting types to identify changes and possible trends Compare setting types for differences that might affect access, quality, or costs The study findings are intended to provide information that state agency staff, legislators, community-based care providers, and consumers might use to guide their decisions. Providing state-level information was one of the goals of Oregon’s LTC 3.0 planning process (Oregon Department of Human Services, n.d.). In addition, as possible, comparisons are made to national surveys of residential care and assisted living conducted by the National Center for Health Statistics. Because of state variation in licensure categories, the national surveys combine residential and assisted living settings and use the term residential care to describe both. It should also be noted that regulatory standards and the types of residents that can be served in AL and RC settings vary by state, as well

Characteristics of Medicaid Clients in Assisted Living, Residential Care, Memory Care, and Adult Foster Homes 2013-2014

In collaboration with the Aging and People with Disabilities (APD) program of Oregon’s Department of Human Services (DHS), Portland State University’s Institute on Aging generated this report of Medicaid clients living in community-based care (CBC) settings in the state of Oregon. The Oregon legislature appropriated funds for DHS to collect information about these community-based care providers which will allow DHS, providers, and the public to better understand characteristics of Medicaid clients living in different CBC settings. This report is based on an analysis of Medicaid data provided by DHS. The study goals were to: describe Medicaid clients’ health-related needs, service use, and demographic characteristics; provide a baseline for future reports. In addition, this information about Medicaid clients can be compared to the recently completed summary of assisted living facilities (ALF), residential care facilities (RCF), memory care communities (MCC), and adult foster homes (AFH) completed by Portland State University’s Institute on Aging. All three CBC reports and a report recently completed by Oregon State University on nursing facilities in Oregon, provide an important overview of community-based and long-term care settings in Oregon that can be used by policymakers, providers, and consumers

Resident and Home Characteristics Report 2014: Adult Foster Homes

In collaboration with the Aging and People with Disabilities program of Oregon’s Department of Human Services (DHS), Portland State University’s Institute on Aging conducted this research study of adult foster homes (AFH) throughout the state of Oregon. The Oregon legislature appropriated funds for DHS to collect information from these community-based care providers that will allow DHS, providers, and the public to better understand resident characteristics and adult foster home services. This report summarizes findings from the first state-wide survey of licensed adult foster homes in Oregon. The survey goals were to: describe resident health-related needs, service use, and demographic characteristics; describe AFH provider characteristics (e.g., number of years as a provider, professional training); describe adult foster homes (e.g., occupancy, monthly charges, staffing); and provide a baseline for future surveys. In addition, this information about AFHs can be compared to the recently completed summary of assisted living, residential care, and memory care facilities completed by Portland State University’s Institute on Aging. Both surveys, along with a report that summarizes characteristics of Medicaid clients based on data provided by DHS and a report recently completed by Oregon State University on nursing facilities in Oregon, provide an important overview of community-based care settings in Oregon that can be used by policymakers, providers, and consumers