Examining variation in state spending on medicaid long-term services and supports for older adults

Abstract Even with forethought and planning, a lot can threaten economic wellbeing in the years ahead for older adults retiring at typical retirement ages. Although results for any individual cannot be predicted with certainty, some risks are quantifiable: for example, mortality/ longevity and disability risks are reasonably well-defined. Risk of dementia is not so well understood, and may be changing. Financial risk might be seen as manageable, but older adults relying on retirement income sources can be especially vulnerable to unprecedented shocks to the general economy. We consider four aspects of this dilemma. First, older adults retiring with outstanding debts may have difficulty weathering financial shocks. Our first presentation provides up-to-date information about trends in indebtedness at older ages, especially focusing on newly salient types of indebtedness: medical and student loan debt, and debt incurred to smooth finances in the recent recession. Stewardship of finances during retirement can be a challenging personal management undertaking. Our second presentation will consider how dementia can complicate this process. Protection against outliving one’s resources is more complex and costlier in the era of defined contribution retirement accounts. Our third presentation will discuss strategies to combine retirement assets, including Social Security claiming, to hedge longevity risk. Finally, needs for long-term services and supports may be met with either paid or informal (family) care, or both, but cannot be predicted with certainty. Our fourth presentation examines the long-term impacts on families due to the difficulty in insuring against this risk. Economics of Aging Interest Group Sponsored Symposium.

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Older Adults Post-Incarceration: Restructuring Long-term Services and Supports in the Time of COVID-19

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2020.09.030 ◽

2020 ◽

Author(s):

Nathan A. Boucher ◽

Courtney H. Van Houtven ◽

Walter D. Dawson

Keyword(s):

Older Adults ◽

Services And Supports

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WHAT PREDICTS TRANSITIONS IN CARE FOR OLDER ADULTS NEW TO LONG-TERM SERVICES AND SUPPORTS?

Innovation in Aging ◽

10.1093/geroni/igx004.3421 ◽

2017 ◽

Vol 1 (suppl_1) ◽

pp. 951-951

Author(s):

K.B. Hirschman ◽

M. Toles ◽

A. Hanlon ◽

B.K. Daly ◽

M.D. Naylor

Keyword(s):

Older Adults ◽

Transitions In Care ◽

Services And Supports

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Predictors of change over time in subjective daytime sleepiness among older adult recipients of long-term services and supports

International Psychogeriatrics ◽

10.1017/s1041610220000782 ◽

2020 ◽

Vol 32 (7) ◽

pp. 849-861

Author(s):

Darina V. Petrovsky ◽

Karen B. Hirschman ◽

Miranda Varrasse McPhillips ◽

Justine S. Sefcik ◽

Alexandra L. Hanlon ◽

...

Keyword(s):

Quality Of Life ◽

Social Support ◽

Older Adults ◽

Depressive Symptoms ◽

Daytime Sleepiness ◽

Daily Living ◽

Services And Supports ◽

Over Time

ABSTRACTObjectives:Daytime sleepiness is associated with multiple negative outcomes in older adults receiving long-term services and supports (LTSS) including reduced cognitive performance, need for greater assistance with activities of daily living and decreased social engagement. The purpose of this study was to identify predictors of change in subjective daytime sleepiness among older adults during their first 2 years of receiving LTSS.Design and Setting:Secondary analysis of data from a prospective longitudinal study of older adults who received LTSS in their homes, assisted living communities or nursing homes interviewed at baseline and every 3 months for 24 months.Participants:470 older adults (60 years and older) newly enrolled in LTSS (mean = 81, SD = 8.7; range 60–98; 71% women).Measurements:Subjective daytime sleepiness was assessed every 3 months through 2 years using the Epworth Sleepiness Scale. Multiple validated measures were used to capture health-related quality of life characteristics of enrollees and their environment, including symptom status (Symptom Bother Scale), cognition (Mini Mental Status Exam), physical function (Basic Activities of Daily Living), physical and mental general health, quality of life (Dementia Quality of Life, D-QoL), depressive symptoms (Geriatric Depression Scale) and social support (Medical Outcomes Survey-Social Support).Results:Longitudinal mixed effects modeling was used to examine the relationship between independent variables and continuous measure of daytime sleepiness. Increased feelings of belonging, subscale of the D-QoL (effect size = −0.006, 95% CI: −0.013 to −0.0001, p = 0.045) and higher number of depressive symptoms (effect size = −0.002, 95% CI: −0.004 to −0.001, p = 0.001) at baseline were associated with slower rates of increase in daytime sleepiness over time.Conclusions:Comprehensive baseline and longitudinal screening for changes in daytime sleepiness along with depression and perceived quality of life should be used to inform interventions aimed at reducing daytime sleepiness among older adults receiving LTSS.

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Long-Term Services and Supports for Older Adults: A Review of Home and Community-Based Services Versus Institutional Care

Journal of Aging & Social Policy ◽

10.1080/08959420.2015.1024545 ◽

2015 ◽

pp. 150527102958001 ◽

Cited By ~ 7

Author(s):

Andrea Wysocki ◽

Mary Butler ◽

Robert L. Kane ◽

Rosalie A. Kane ◽

Tetyana Shippee ◽

...

Keyword(s):

Older Adults ◽

Institutional Care ◽

Community Based ◽

Services And Supports ◽

Community Based Services

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Health-related Quality of Life: Expanding a Conceptual Framework to Include Older Adults Who Receive Long-term Services and Supports

The Gerontologist ◽

10.1093/geront/gns093 ◽

2012 ◽

Vol 53 (2) ◽

pp. 205-210 ◽

Cited By ~ 33

Author(s):

C. Zubritsky ◽

K. M. Abbott ◽

K. B. Hirschman ◽

K. H. Bowles ◽

J. B. Foust ◽

...

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Conceptual Framework ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

Services And Supports

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Satisfaction With Outdoor Activities Over Time Among Long-Term Services and Supports Recipients

Innovation in Aging ◽

10.1093/geroni/igaa057.614 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 189-190

Author(s):

Justine Sefcik ◽

Karen Hirschman ◽

Darina Petrovsky ◽

Liming Huang ◽

Nancy Hodgson ◽

...

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Assisted Living ◽

Term Care ◽

Chronic Health ◽

Outdoor Activities ◽

Services And Supports ◽

Over Time

Abstract Approximately 85% of older adults have at least one chronic health condition. The onset of chronic health conditions and mobility issues can constrain activities, including outdoor recreation. There is limited knowledge of older adults receiving long-term services and supports (LTSS) and their satisfaction with outdoor activities over time after enrolling in services. This study examined predictors of change in ratings of satisfaction with outdoor activities. A secondary analysis was conducted of data involving structured interviews with older adults (N=470) over the first two years of receiving LTSS (Health-Related Quality of Life: Elders in Long-Term Care; R01AG025524). Participants lived in assisted living communities, nursing homes, or their home. A single item on satisfaction with outdoor activities (assessed using a 5-point Likert scale: not at all to extremely satisfied) was the primary outcome. Mixed effects linear regression modeling using a backward elimination process was used for building a final multivariable model. In the final model, older age (p<0.001) and higher overall quality of life ratings (p<0.001) at baseline were associated with slower rates of increase in outdoor satisfaction over time. Higher education level (p=0.035) at baseline was associated with a faster rate of increase in outdoor satisfaction over time. Additionally, those who moved into an assisted living community (p=0.024) or nursing home (p=0.016) at baseline were associated with faster rates of increase in outdoor satisfaction over time compared to those in the home. Knowledge of factors influencing satisfaction with outdoor activities can assist interdisciplinary teams implement interventions for individual or organizational changes.

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