Suchergebnisse

The United States (US) currently has the most confirmed cases of COVID-19 of any country. Yet, adequate testing for the virus remains a major issue. Approximately 51.6 million Americans are over the age of 65 and 56 percent of adults over 65 are living with two or more chronic conditions (23 percent have 3 or more). Given the higher risk of death and complications associated with advanced age and underlying health conditions, COVID-19 has had an immense impact upon LTC in the United States. Yet, the level and intensity of impact has been sporadic in application. This is due in part to a highly disparate and fractured long-term care system and perennial systemic challenges that have been exacerbated by the pandemic. In terms of financing care, the US relies on a mix of public and private funding sources. Further, individual states and the federal government have overlapping responsibility for funding and regulation of care. Meanwhile, fragmentation between financing and ownership of health care entities versus long-term care entities hinders coordinated delivery of care across sectors; and social sectors and health care sectors are also not integrated. The challenges of the system's design suggest that both a near-term and long-term response is needed to mitigate the impact of COVID-19 on the approximately 13 million Americans who require long-term care. This report provides an overview of the current challenges facing LTC and outlines several potential policy responses to the pandemic as well as for life post-pandemic.

Support policies for caregivers improves care-recipient access to care and effects may generalize to nonhealth services. Using administrative data from the U.S. Department of Veterans Affairs (VA) for veterans <55 years, we assessed the association between enrollment in a VA caregiver support program and veteran use of vocational assistance services: the post-9/11 GI Bill, VA vocational rehabilitation and employment (VR&E), and supported employment. We applied instrumental variables to Cox proportional hazards models. Caregiver enrollment in the program increased veteran supported employment use (hazard ratio = 1.35, 95% confidence interval [1.14, 1.53]), decreased VR&E use (hazard ratio = 0.84, 95% confidence interval [0.76, 0.92]), and had no effect on the post-9/11 GI Bill. Caregiver support policies could increase access to some vocational assistance for individuals with disabilities, particularly supported employment, which is integrated into health care. Limited coordination between health and employment sectors and misaligned incentives may have inhibited effects for the post-9/11 GI Bill and VR&E.

Reducing postdischarge Medicare expenditures is a key focus for hospitals. Early follow-up care is an important piece of this focus, but it is unclear whether there are rural–urban differences in the impact of follow-up care on Medicare expenditures. To assess this difference, we use the Medicare Current Beneficiary Survey, Cost and Use Files, 2000-2010. We conduct a retrospective analysis of 30-day postdischarge Medicare expenditures using two-stage residual inclusion with a quantile regression, where the receipt of 7-day follow-up care was the main independent variable. Postdischarge follow-up care increased the 25th percentile of 30-day expenditures, decreased the 75th percentile, and there were no rural–urban differences. Partial effects show postdischarge follow-up care resulted in higher 30-day expenditures among low-cost rural beneficiaries. Ensuring early follow-up care for high-cost beneficiaries may be advantageous to both rural and urban providers in helping reduce postdischarge Medicare expenditures.

Evolving family structure and economic conditions may affect individuals' ability and willingness to plan for future long-term care (LTC) needs. We applied life course constructs to analyze focus group data from a study of family decision making about LTC insurance. Participants described how past exposure to caregiving motivated them to engage in LTC planning; in contrast, child rearing discouraged LTC planning. Perceived institutional and economic instability drove individuals to regard financial LTC planning as either a wise precaution or another risk. Perceived economic instability also shaped opinions that adult children are ill-equipped to support parents' LTC. Despite concerns about viability of social insurance programs, some participants described strategies to maximize gains from them. Changing norms around aging and family roles also affected expectations of an active older age, innovative LTC options, and limitations to adult children's involvement. Understanding life course context can inform policy efforts to encourage LTC planning.

This article examines the relative merit of augmenting an electronic health record (EHR)-derived predictive model of institutional long-term care (LTC) use with patient-reported measures not commonly found in EHRs. We used survey and administrative data from 3,478 high-risk Veterans aged ≥65 in the U.S. Department of Veterans Affairs, comparing a model based on a Veterans Health Administration (VA) geriatrics dashboard, a model with additional EHR-derived variables, and a model that added survey-based measures (i.e., activities of daily living [ADL] limitations, social support, and finances). Model performance was assessed via Akaike information criteria, C-statistics, sensitivity, and specificity. Age, a dementia diagnosis, Nosos risk score, social support, and ADL limitations were consistent predictors of institutional LTC use. Survey-based variables significantly improved model performance. Although demographic and clinical characteristics found in many EHRs are predictive of institutional LTC, patient-reported function and partnership status improve identification of patients who may benefit from home- and community-based services.

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.

More direct inclusion of informal caregivers (i.e., family, friends) in patients' care will make care more patient- and family-centered and has the potential to improve overall quality of care for patients. We need to understand what potentially comprises "inclusive care" so that we can define what "inclusive care" is and develop targets for care quality metrics. We conducted a critical literature review to identify key components of "caregiver inclusion." Focusing on extant literature from 2005 to 2017, 35 papers met inclusion criteria. Directed content analysis with constant comparison was used to identify major themes related to a concept of "inclusive care." Our analysis indicates that "inclusive care" entails five components: clear definition of caregiver role, system level policies for inclusion, explicit involvement of caregiver, provider assessment of caregiver capability, and mutuality in caregiver–provider communication. We discuss the evidence behind these five components using the Donabedian health care quality conceptual model.

Despite the important role that family caregivers play managing the care of persons with complex health needs, little is known about how caregivers perceive themselves to be recognized and valued by health care professionals. Our objective was to develop and validate a novel measure, the CAregiver Perceptions About Commun Ication with Clinical Team members (CAPACITY) instrument. Questions focus on perceived quality of communication with the health care team and the extent to which caregivers believe that the health care team considers their capacity and preferences in decision making. A confirmatory factor analysis supported a two-factor solution addressing communication and capacity. Internal consistency reliability was .90 for the communication domain and .93 for the capacity domain. Correlations between these two subscales and individual difference measures provided evidence of convergent and discriminant validity. The CAPACITY instrument may be a useful performance measure that quantifies the extent to which caregivers' experience person- and family-centered health care.