Enhancing Federal Revenue under the American Rescue Plan Act: An Opportunity to Bolster State Medicaid Home and Community-Based Services Programs

ObjectivesTo investigate individual, practice and area level variation in patient-reported unmet need among those with long-term conditions, in the context of general practice (GP) appointments and support from community-based services in England.DesignCross-sectional study using data from 199 150 survey responses.SettingPrimary care and community-based services.ParticipantsRespondents to the 2018 English General Practice Patient Survey with at least one long-term condition.Primary and secondary outcome measuresThe primary outcomes were the levels of unmet need in GP and local services among patients with multiple long-term conditions. Secondary outcomes were the proportion of variation explained by practice and area-level factors.ResultsThere was no relationship between needs being fully met in patients’ last practice appointment and number of long-term conditions once sociodemographic characteristics and health status were taken into account (5+conditions−OR=1.04, 95% CI 0.99 to 1.09), but there was a relationship for having enough support from local services to manage conditions (5+conditions−OR=0.84, 95% CI 0.80 to 0.88). Patients with multimorbidity that were younger, non-white or frail were less likely to have their needs fully met, both in GP and from local services. Differences between practices and local authorities explained minimal variation in unmet need.ConclusionsLevels of unmet need are high, particularly for support from community services to manage multiple conditions. Patients who could be targeted for support include people who feel socially isolated, and those who have difficulties with their day-to-day living. Younger patients and certain ethnic groups with multimorbidity are also more likely to have unmet needs. Increased personalisation and coordination of care among these groups may help in addressing their needs.

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Screening and Priority-Setting to Determine Home- and Community-Based Aging Services for Older Floridians

Journal of Applied Gerontology ◽

10.1177/07334648211012508 ◽

2021 ◽

pp. 073346482110125

Author(s):

Lawrence Schonfeld ◽

Jesse Bell ◽

Mary Goldsworthy ◽

Kevin Kip ◽

Amber M. Gum ◽

...

Keyword(s):

Service Delivery ◽

National Standards ◽

Third Party ◽

Community Based ◽

Older Americans ◽

Caregiver Support ◽

Aging Services ◽

Optimal Health ◽

Aging Network ◽

Community Based Services

The National Aging Network serves millions of older Americans seeking home- and community-based services, but places others on waitlists due to limited resources. Little is known about how states determine service delivery and waitlists. We therefore conducted a process evaluation and analyzed data from one five-county Area Agency on Aging in Florida, where an algorithm calculates clients’ priority scores for service delivery. From 23,225 screenings over 5.5 years, clients with higher priority scores were older, married, living with caregivers, and had more health problems and needs for assistance. Approximately 51% received services (e.g., meals/nutrition, case management, caregiver support), 11% were eligible/being enrolled, and 38% remained on waitlists. Service status was complex due to multiple service enrollments and terminations, funding priorities, and transfers to third-party providers. More research is needed regarding how other states determine eligibility and deliver services, potentially informing national standards that promote optimal health in older Americans.

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All Is Good, but Not Really: Daily Reports of Satisfaction With Home- and Community-Based Services

Innovation in Aging ◽

10.1093/geroni/igaa057.2194 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 639-640

Author(s):

Jyoti Savla ◽

Karen Roberto ◽

Aubrey Knight ◽

Rosemary Blieszner ◽

Brandy Renee McCann ◽

...

Keyword(s):

Service Use ◽

Service Providers ◽

Theory And Practice ◽

Community Based ◽

Daily Diaries ◽

Rural Caregivers ◽

Service Expectations ◽

Extensive Body ◽

Barriers To Health ◽

Community Based Services

Abstract An extensive body of literature documents correlates of and barriers to health service use, yet much less is known about satisfaction with home- and community-based services for persons with dementia (PwD). Daily diary data from 122 rural caregivers (CG) of PwD (814 daily diaries) were used to assess everyday service use experiences. At the last diary interview, CG identified areas where service use expectations were and were not being met. CGs reported problems with services used on fewer than 5% of study days (e.g., service provider was delayed because of car trouble). In contrast, 82% of CG identified areas where service expectations were not being met. Their most common concerns were lack of control over service availability and lack of adequate training among service providers. Recommendations for alternative ways for capturing service use satisfaction will be offered, and implications for theory and practice will be discussed.

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Advancing States Through the OAA Reauthorization

Innovation in Aging ◽

10.1093/geroni/igaa057.2573 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 725-726

Author(s):

Damon Terzaghi

Keyword(s):

Significant Role ◽

Services Research ◽

Community Based ◽

Older Americans ◽

Community Based Services

Abstract States are major policymakers and funders of community-based services for older Americans and ADvancing States played a significant role in supporting the OAA authorization this year. This presentation will provide the states' perspective regarding funding, services, research and demonstrations, and more.

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Perceived barriers and supports to accessing community-based services for Uganda’s pediatric post-surgical population

Disability and Rehabilitation ◽

10.1080/09638288.2019.1694999 ◽

2019 ◽

pp. 1-12

Author(s):

Sarah Jean Barton ◽

Sahil Sandhu ◽

Isabelle Doan ◽

Lillian Blanchard ◽

Alex Dai ◽

...

Keyword(s):

Perceived Barriers ◽

Community Based ◽

Community Based Services

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Models of home care services for persons with dementia: a narrative review

International Psychogeriatrics ◽

10.1017/s1041610215000137 ◽

2015 ◽

Vol 27 (10) ◽

pp. 1593-1600 ◽

Cited By ~ 14

Author(s):

Lee-Fay Low ◽

Jennifer Fletcher

Keyword(s):

Case Management ◽

Home Care ◽

Integrated Care ◽

Community Dwelling ◽

Narrative Review ◽

Nursing Home Admission ◽

Community Based ◽

People With Dementia ◽

The Impact ◽

Community Based Services

ABSTRACTBackground:Worldwide trends of increasing dementia prevalence, have put economic and workforce pressures to shifting care for persons with dementia from residential care to home care.Methods:We reviewed the effects of the four dominant models of home care delivery on outcomes for community-dwelling persons with dementia. These models are: case management, integrated care, consumer directed care, and restorative care. This narrative review describes benefits and possible drawbacks for persons with dementia outcomes and elements that comprise successful programs.Results:Case management for persons with dementia may increase use of community-based services and delay nursing home admission. Integrated care is associated with greater client satisfaction, increased use of community based services, and reduced hospital days however the clinical impacts on persons with dementia and their carers are not known. Consumer directed care increases satisfaction with care and service usage, but had little effect on clinical outcomes. Restorative models of home care have been shown to improve function and quality of life however these trials have excluded persons with dementia, with the exception of a pilot study.Conclusions:There has been a little research into models of home care for people with dementia, and no head-to-head comparison of the different models. Research to inform evidence-based policy and service delivery for people with dementia needs to evaluate both the impact of different models on outcomes, and investigate how to best deliver these models to maximize outcomes.

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