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HHS — Elder Justice Roadmap Project Report

July 10, 2014 Comments off

Elder Justice Roadmap Project Report (PDF)
Source: U.S. Department of Health and Human Services (National Center on Elder Abuse)

The Top Five Priorities critical to understanding and reducing elder abuse and to promoting health, independence, and justice for older adults, are:
1. Awareness: Increase public awareness of elder abuse, a multi-faceted problem that requires a holistic, well-coordinated response in services, education, policy, and research.
2. Brain health: Conduct research and enhance focus on cognitive (in)capacity and mental health – critical factors both for victims and perpetrators.
3. Caregiving: Provide better support and training for the tens of millions of paid and unpaid caregivers who play a critical role in preventing elder abuse.
4. Economics: Quantify the costs of elder abuse, which is often entwined with financial incentives and comes with huge fiscal costs to victims, families and society.
5. Resources: Strategically invest more resources in services, education, research, and expanding knowledge to reduce elder abuse.

Hat tip: PW

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From Living Arrangements to Labor Force Participation, New Analysis Looks at State of the Nation’s 65-and-Older Population

July 2, 2014 Comments off

From Living Arrangements to Labor Force Participation, New Analysis Looks at State of the Nation’s 65-and-Older Population
Source: U.S. Census Bureau

A new report released today by the U.S. Census Bureau provides the latest, comprehensive look at the nation’s population aged 65 and older, comprising 40.3 million in 2010.

The 65+ in the United States: 2010 report contains many findings about the 65-and-older population on topics such as socio-economic characteristics, size and growth, geographic distribution, and longevity and health. For example, Americans 65 and older living in a nursing home fell 20 percent between 2000 and 2010, from 1.6 million to 1.3 million. Meanwhile, the share in other care settings has been growing.

In the report, a number of trends and characteristics are separated by age, sex, race and Hispanic origin for the older population. The report incorporates research and findings from many recent studies that draw heavily from the 2010 Census and nationally representative surveys, such as the Current Population Survey, American Community Survey and National Health Interview Survey.

Improving Dementia Long-Term Care: A Policy Blueprint

June 25, 2014 Comments off

Improving Dementia Long-Term Care: A Policy Blueprint
Source: RAND Corporation

In 2010, 15 percent of Americans older than age 70 had dementia, and the number of new dementia cases among those 65 and older is expected to double by the year 2050. As the baby boomer generation ages, many older adults will require dementia-related long-term services and supports (LTSS). This blueprint is the only national document to date that engages local, state, and national stakeholders to specifically focus on policy options at the intersection of dementia and LTSS.

The authors undertook five major tasks that resulted in a prioritized list of policy options and research directions to help decisionmakers improve the dementia LTSS delivery system, workforce, and financing. These were to (1) identify weaknesses in the LTSS system that may be particularly severe for persons with dementia; (2) review national and state strategies addressing dementia or LTSS policy; (3) identify policy options from the perspective of a diverse group of stakeholders; (4) evaluate the policy options; and (5) prioritize policy options by impact and feasibility.

Stakeholders identified 38 policy options. RAND researchers independently evaluated these options against prespecified criteria, settling on 25 priority options. These policy options can be summarized into five objectives for the dementia LTSS system: (1) increase public awareness of dementia to reduce stigma and promote earlier detection; (2) improve access to and use of LTSS; (3) promote high-quality, person- and caregiver-centered care; (4) provide better support for family caregivers of people with dementia; and (5) reduce the burden of dementia LTSS costs on individuals and families.

This policy blueprint provides a foundation upon which to build consensus among a larger set of stakeholders to set priorities and the sequencing of policy recommendations.

Raising Expectations 2014: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers

June 23, 2014 Comments off

Raising Expectations 2014: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers
Source: AARP and Commonwealth Fund

This report by AARP’s Public Policy Institute, The Commonwealth Fund and The SCAN Foundation shows some states significantly out-perform others in the delivery of long-term services and supports (LTSS) to older adults and people with disabilities.

While states are making measureable progress in improving long term services and supports (LTSS) – which includes home care services, family caregiver supports, and residential services such as nursing homes – widespread disparities still exist across the country, with even top performing states requiring improvement. Further, the pace of change remains slow, threatening states’ ability to meet the needs of the aging population.

The LTSS Scorecard evaluates performance in five key dimensions: (1) affordability and access, (2) choice of setting and provider, (3) quality of life and quality of care, (4) support for family caregivers, and (5) effective transitions. New indicators this year include length of stay in nursing homes and use of anti-psychotic drugs by nursing homes, raising serious concerns about the quality of institutionalized care.

Redesigning, Redefining Work

May 7, 2014 Comments off

Redesigning, Redefining Work (PDF)
Source: Work and Occupations

The demands of today’s workplace—long hours, constant availability, self- sacrificial dedication—do not match the needs of today’s workforce, where workers struggle to reconcile competing caregiving and workplace demands. This mismatch has negative consequences for gender equality and workers’ health. Here, the authors put forth a call to action: to redesign work to better meet the needs of today’s workforce and to redefine successful work. The authors propose two avenues for future research to achieve these goals: research that (a) builds a more rigorous business case for work redesign/redefinition and (b) exposes the underlying gender and class dynamics of current work arrangements.

See also: Toward a Model of Work Redesign for Better Work and Better Life (PDF)

Family Caregivers Providing Complex Chronic Care to Their Spouses: A report of the AARP Public Policy Institute and the United Hospital Fund

May 2, 2014 Comments off

Family Caregivers Providing Complex Chronic Care to Their Spouses: A report of the AARP Public Policy Institute and the United Hospital Fund
Source: AARP and United Hospital Fund

This report shows that spouses who are caregivers not only perform many of the tasks that health care professionals do—a range of medical/nursing tasks including medication management, wound care, using meters and monitors, and more—but they are significantly more likely to do so than other family caregivers, who are mostly adult children.

According to the report, nearly two-thirds of spouses who are family caregivers performed such tasks (65 percent), compared to 42 percent of nonspousal caregivers. And despite these responsibilities, spouses were less likely than nonspousal caregivers to receive in-home support from health care professionals: 84 percent of spousal care recipients received no professional health care on site, compared to 65 percent of nonspousal care recipients. They were also less likely to receive help from family or friends or home care aides: 58 percent of the spouses reported no additional help from others, compared to 20 percent of nonspouses.

The report notes that it is unclear why spouses receive less help, hypothesizing that it could be choice, lack of awareness about resources, financial limitations, or fear of losing independence. The report calls for additional research to help tailor interventions that support but do not supplant the primary bond between spouses.

America’s Long-Term Care Crisis: Challenges in Financing and Delivery

April 10, 2014 Comments off

America’s Long-Term Care Crisis: Challenges in Financing and Delivery
Source: Bipartisan Policy Center

An estimated 12 million Americans are currently in need of long-term services and supports (LTSS)—defined as institutional or home-based assistance with activities of daily living such as bathing, dressing, or medication management—including both seniors and persons under age 65 living with physical or cognitive limitations. In the next two decades, the U.S. health care system will face a tidal wave of aging baby boomers. This, among many other factors, will create an unsustainable demand for LTSS in the coming years.

Fewer family caregivers, increasingly limited personal financial resources, and growing strains on federal, state, and family budgets will further complicate efforts to organize and finance services. Although there is tremendous variation in what is, or will be, needed, fully 70 percent of people who reach the age of 65 will require some form of LTSS at some point in their lives. The number of Americans needing LTSS at any one time is expected to more than double from 12 million today to 27 million by 2050. Indeed, the demand for LTSS will substantially outpace the rate of growth in the U.S. economy over the next decade and drive significant growth in Medicaid spending.

Canada — The economic costs of care to family/friend caregivers: A synthesis of findings

March 5, 2014 Comments off

The economic costs of care to family/friend caregivers: A synthesis of findings (PDF)
Source: University of Alberta

Findings reported here are based on a synthesis of results from a three-year program of research (2010-2013) on the economic costs of care directed by Dr. Janet Fast at the University of Alberta. Embedded within this interdisciplinary research program were five projects led by co-investigators Dr. Janet Fast (University of Alberta), Dr. Norah Keating (University of Alberta), Dr. Donna Lero (University of Guelph), and Dr. Karen Duncan (University of Manitoba). This synthesis report integrates findings from five projects that:

  • Provided a framework and literature review of the economic costs of care to caregivers
  • Examined Canadians’ caregiving trajectories across the life course and risk factors for experiencing care-related employment consequences
  • Estimated the monetary costs of eldercare-related labour market accommodations,
  • Documented the prevalence, correlates, and social and economic consequences of care- related out-of-pocket expenses, and
  • Documented the availability, accessibility and effectiveness of workplace supports for Canadian caregivers.

Guide to Patient and Family Engagement in Hospital Quality and Safety

January 13, 2014 Comments off

Guide to Patient and Family Engagement in Hospital Quality and Safety
Source: Agency for Healthcare Research and Quality

Research shows that when patients are engaged in their health care, it can lead to measurable improvements in safety and quality. To promote stronger engagement, Agency for Healthcare Research and Quality developed the Guide to Patient and Family Engagement in Hospital Quality and Safety, a tested, evidence-based resource to help hospitals work as partners with patients and families to improve quality and safety.

Long-Term Care Services in the United States: 2013 Overview

December 16, 2013 Comments off

Long-Term Care Services in the United States: 2013 Overview (PDF)
Source: National Center for Health Statistics

Long-term care services include a broad range of services that meet the needs of frail older people and other adults with functional limitations. Long-Term care services provided by paid, regulated providers are a significant component of personal health care spending in the United States. This report presents descriptive results from the first wave of the National Study of Long-Term Care Providers (NSLTCP), which was conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS). Data presented in this report are drawn from five sources: NCHS surveys of adult day services centers and residential care communities, and administrative records obtained from the Centers for Medicare & Medicaid Services on home health agencies, hospices, and nursing homes. This report provides information on the supply, organizational characteristics, staffing, and services offered by providers of long-term care services; and the demographic, health, and functional composition of users of these services. Service users include residents of nursing homes and residential care communities, patients of home health agencies and hospices, and participants of adult day services centers.

Choosing Home for Someone Else: Guardian Decisions on Long-Term Services and Supports

October 14, 2013 Comments off

Choosing Home for Someone Else: Guardian Decisions on Long-Term Services and Supports
Source: AARP Public Policy Institute

Guardians are responsible for society’s most vulnerable at-risk adults. One of their most important decisions is where the incapacitated person will live: in a personal residence, the community or a nursing facility. Their choices are limited by the options available particularly as budget cutbacks have impacted home and community based services. At the same time, guardians’ consent may be necessary to make long-term services and supports function as they should.

This report presents findings from an in-depth study of how professional guardians make this decision which goes to the core of the individual’s quality of life.

UK — Independent report: Peer support networks and dementia advisers: evaluation

October 10, 2013 Comments off

Independent report: Peer support networks and dementia advisers: evaluation
Source: Department of Health

This report, commissioned by the Department of Health, provides evidence on the importance of post diagnostic support for people with dementia and their carers, and the role that dementia advisers and peer support networks can provide in this.

Important messages from the report are:

  • people with dementia and carers saw dementia advisers and peer support networks as having a positive impact on their wellbeing and quality of life
  • demonstrator sites provided evidence of both dementia advisers and peer support networks filling a gap in service provision that often occurs after diagnosis but before
  • there is a need for more intensive support
  • both initiatives were seen as having resource saving implications for the local health and social care economy

State Legislative Enactments Supporting Relatives, Kinship Care Providers and Grandparents 2007 – 2012

October 4, 2013 Comments off

State Legislative Enactments Supporting Relatives, Kinship Care Providers and Grandparents 2007 – 2012
Source: National Conference of State Legislatures

A number of states have enacted legislation to expand support for grandparent and relative caregivers. The chart below reflects legislation enacted between 2007 and 2012. The categories identified include easing of licensure requirements, waivers and variances; expanded definition of relative;relative placement preference; school enrollment and medical consent; payment, reimbursement, subsidies; supporting relative adoption; studies, commissions and task forces; and, miscellaneous.

Unpaid Eldercare in the United States-—2011-2012 Summary

September 19, 2013 Comments off

Unpaid Eldercare in the United States-—2011-2012 Summary
Source: Bureau of Labor Statistics

Sixteen percent of the U.S. civilian noninstitutional population age 15 and over (39.6 million people) provide unpaid eldercare, the U.S. Bureau of Labor Statistics reported today. Nearly one-fourth of eldercare providers engage in unpaid eldercare on a given day, spending an average of 3.2 hours providing this care. These estimates are averages for the 2-year period of 2011-12; combining the 2 years of data facilitates a more in-depth analysis of eldercare.

Eldercare providers are defined as individuals who provide unpaid care to someone age 65 or older who needs help because of a condition related to aging. This care can be provided to household or nonhousehold members, as well as persons living in retirement homes or assisted care facilities. Eldercare can involve a range of care activities, such as assisting with grooming, preparing meals, and providing transportation. Eldercare also can involve providing companionship or being available to assist when help is needed, and thus it can be associated with nearly any activity.

The Aging of the Baby Boom and the Growing Care Gap: A Look at Future Declines in the Availability of Family Caregivers

August 26, 2013 Comments off

The Aging of the Baby Boom and the Growing Care Gap: A Look at Future Declines in the Availability of Family Caregivers
Source: AARP

Understanding the effects of the relative size of the Baby Boom compared to preceding and succeeding age groups is essential to anticipating the demand for long-term services and supports (LTSS) and the potential availability of family care in the future.

This paper uses a “caregiver support ratio” to document the declining availability of family caregivers to provide LTSS between 1990 and 2050. It defines a “caregiver support ratio” as the number of potential caregivers age 45-64 for each person age 80 and older. It documents the dramatic widening of the care gap nationally and in all 50 states and the District of Columbia, as Baby Boomers age into their 80’s, beginning in 2026. The report also highlights sociodemographic trends that may influence the future supply of family support for the frail older population.

Consumer Choices and Continuity of Care in Managed Long-Term Services and Supports: Emerging Practices and Lessons

August 21, 2013 Comments off

Consumer Choices and Continuity of Care in Managed Long-Term Services and Supports: Emerging Practices and Lessons
Source: AARP Public Policy Institute

Increasing numbers of states are transitioning their Medicaid long-term services and supports (LTSS) systems from fee-for-service models to managed care models, raising concerns among stakeholders that services will be disrupted and consumer choices diminished.

Recent managed care transitions in Kansas, New York and Wisconsin were studied. The authors found that little changed for consumers during the transition period, and services were not disrupted. The findings are limited to the transition period studied. Longer range impact on consumers of managed LTSS is unknown and should be monitored closely.

Adult Caregivers in the United States: Characteristics and Differences in Well-being, by Caregiver Age and Caregiving Status

August 19, 2013 Comments off

Adult Caregivers in the United States: Characteristics and Differences in Well-being, by Caregiver Age and Caregiving Status
Source: Preventing Chronic Disease (CDC)

We examined the characteristics of adults providing regular care or assistance to friends or family members who have health problems, long-term illnesses, or disabilities (ie, caregivers). We used data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) to examine caregiver characteristics, by age and caregiving status, and compare these characteristics with those of noncaregivers. Approximately 24.7% (95% confidence interval, 24.4%–25.0%) of respondents were caregivers. Compared with younger caregivers, older caregivers reported more fair or poor health and physical distress but more satisfaction with life and lower mental distress. Understanding the characteristics of caregivers can help enhance strategies that support their role in providing long-term care.

A Platform for Aging in Place: The Increasing Potential of High-speed Internet Connectivity

July 30, 2013 Comments off

A Platform for Aging in Place: The Increasing Potential of High-speed Internet Connectivity
Source: AARP Public Policy Institute

Information and communication services, delivered over a high-speed Internet connection, increase the potential for older adults to live independently, safely, and comfortably in their own homes. And yet, few older adults have a fast Internet connection at home.

Some of the most promising Internet-based services and applications involve virtual visits with clinicians and family caregivers, automation of routine home activities, and in-home monitoring for older adults with limitations in activities of daily living. This report presents an overview of these services. It also offers recommendations urging policymakers to ensure that affordable high-speed connectivity is available to all citizens and promoted as an aging-in-place solution.

Dignity, Death, and Dilemma: A Study of Washington Hospices and Physician-Assisted Death

July 22, 2013 Comments off

Dignity, Death, and Dilemma: A Study of Washington Hospices and Physician-Assisted Death
Source: Oregon State University

The extensive literature in biomedical ethics on physician-assisted death has represented the debate to involve three parties with significant interests. First, there are arguments regarding the legitimacy of terminally patients seeking to exercise an expanded right of self-determination. Furthermore, questions have been posed regarding the compatibility of a patient request for physician-assisted death with the professional ethics of medicine and of pharmacy, and of the ethics of individual practitioners who may or may not collaborate with this request for a prescription to end the patient’s life. Third, discussion has address the role of the state, which requires assurance in public policy of both patient decision-making capacity and professional accountability to warrant rescinding paternalistic laws that prohibit or restrict patient rights at the end-of-life.

Family Caregivers are Wired for Health

June 20, 2013 Comments off

Family Caregivers are Wired for Health

Source: Pew Internet & American Life Project

Nearly four in ten U.S. adults (39%) are caring for an adult or child with significant health issues, according to a new Pew Research Center survey. That is up from 30% of U.S. adults in 2010. Caring for a loved one is an activity that cuts across most demographic groups, but is especially prevalent among adults ages 30 to 64, a group traditionally still in the workforce.

Caregivers are heavy technology users and are much more likely than other adults to take part in a wide range of health-related activities.

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