From Care Manager to Researcher: Addressing Health Disparities in Long-Term Services and Supports

Abstract Racial and socioeconomic disparities are prevalent in long-term services and supports (LTSS). There is a need for innovative research with practical application informing aging and disability policies to reduce health care disparities for older adults and people with disabilities using LTSS. This presentation will provide an overview of the career trajectory of Dr. Chanee Fabius, whose research agenda is informed by applied care management experience, where she helped older adults remain at home and delay the need for nursing home care. She will also present findings from work that (1) examines networks of care used by older adults (e.g., paid care and/or support from family and unpaid caregivers) and how they vary by race and socioeconomic status and (2) describes the effect of LTSS utilization on quality of life and health service utilization across diverse groups of older adults.

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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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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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SATISFACTION WITH OUTDOOR ACTIVITIES AMONG LONG-TERM SERVICES AND SUPPORTS RECIPIENTS

Innovation in Aging ◽

10.1093/geroni/igz038.1571 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S420-S421

Author(s):

Justine S Sefcik ◽

Karen Hirschman ◽

Darina V Petrovsky ◽

Nancy Hodgson ◽

Mary Naylor

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Health Related Quality ◽

Outdoor Activity ◽

Outdoor Activities ◽

Related Quality ◽

Health Related ◽

Services And Supports

Abstract Being outdoors in nature has been associated with improved mental and physical health. There are no known studies exploring older adults’ satisfaction with outdoor activities at the start of long-term services and supports (LTSS; in nursing homes, assisted living, or at home). We examined characteristics of older adults receiving LTSS and factors associated with outdoor activities satisfaction. A secondary analysis was conducted of baseline data involving structured interviews with older adults new to LTSS (Health-Related Quality of Life: Elders in Long-Term Care; R01AG025524-05). Primary outcome was a single item on the satisfaction with outdoor activities (not at all satisfied to extremely satisfied). We conducted multivariable linear regression models controlling for the influence of the characteristics important to health-related quality of life (LTSS setting, gender, age, number of comorbidities, and sensory impairment [vision/hearing].) Among 356 people, the majority (59%) were satisfied with their outdoor activities. Of 339 participants with complete data, more depressive symptoms (higher Geriatric Depression Score; p<.001) and higher cognitive functioning (higher MMSE score; p=.038) were associated with lower ratings of satisfaction with outdoor activities. Higher self-rated physical health (p=.038) and more independence with activities of daily living (p=.017) were associated with greater satisfaction with outdoor activities. Due to the cross-sectional nature of this study it is difficult to determine causality; however, outdoor activity is important to people receiving LTSS. Interdisciplinary teams can work with older adults receiving LTSS to assess interest level with outdoor activities and create a person-centered plan to increase outdoor activity and satisfaction levels.

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Factors Associated With Perceived Worsened Physical Health Among Older Adults Who Are Newly Enrolled Long-term Services and Supports Recipients

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/0046958019900835 ◽

2020 ◽

Vol 57 ◽

pp. 004695801990083

Author(s):

Jasmine L. Travers ◽

Karen B. Hirschman ◽

Alexandra L. Hanlon ◽

Liming Huang ◽

Mary D. Naylor

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Physical Health ◽

Assisted Living ◽

Limited Information ◽

Health Care Need ◽

Related Quality ◽

Services And Supports

Limited information exists on the perceived health of older adults new to receiving long-term services and supports (LTSS) compared with the year prior, posing challenges to the anticipation of health care need and optimization of wellness efforts for this growing population. In response, we sought to identify differences in perceived worsened physical health across three LTSS types (nursing home, assisted living, and home and community-based services) along with health-related quality of life (HRQoL) characteristics associated with older adults’ ratings of perceived worsened physical health at the start of receiving LTSS. Enrolled LTSS recipients completed a single interview assessing their HRQoL. Bivariate and multivariable logistic regression analyses were performed to determine associations in LTSS types and HRQoL characteristics with perceived worsened physical health among older adults (≥60 years old) since 1 year prior to study enrollment. Among the 467 LTSS recipients, perceived physical health was rated as worse than the previous year by 36%. Bivariate analyses revealed no differences in perceived worsened physical health across LTSS types. In adjusted analyses, religiousness/spirituality and better mental and general health perception had a decreased odds of being associated with perceived worsened physical health ( P < .05). Participants with major changes in their health in the past 6 months were more likely to report perceived worsened physical health ( P < .001). Findings provide information that may be used to target efforts to enhance perceived physical health and improve quality of life among LTSS enrollees.

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Quality of Life in Older Adults Receiving Long-Term Services and Supports: Is It What We Think It Is?

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2015.10.014 ◽

2016 ◽

Vol 17 (1) ◽

pp. 16

Author(s):

Cheryl L. Phillips

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Services And Supports

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QUALITY OF LIFE AND PERCEIVED NEEDS AMONG OLDER ADULTS RECEIVING LONG-TERM SERVICES AND SUPPORTS

Innovation in Aging ◽

10.1093/geroni/igz038.2329 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S625-S625

Author(s):

Eleanor Rivera ◽

Karen Hirschman ◽

Mary Naylor

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Physical Therapy ◽

Assisted Living ◽

Secondary Analysis ◽

Social Activities ◽

Perceived Needs ◽

Services And Supports

Abstract Long term services and supports (LTSS) are vital for older adults with physical and cognitive disabilities. LTSS can be provided in settings such as nursing homes, assisted living, or via community-based services. The aim of this study is to describe the perceived needs for older adults new to LTSS, examine whether those needs are met in the first three months of LTSS, and determine the relationship with quality of life (QoL). This secondary analysis included data from 470 older adults new to LTSS (average age: 81, 71% female, 51% white, 35% black, 20% Hispanic.) The main outcome of QoL was measured using a single item (“How would you rate your overall quality of life at the present time?”). Perceived needs included supportive equipment devices, transportation, physical therapy, and social activities. Analyses at baseline and three months included t-tests, ANOVAs and simple regression modeling. LTSS recipient reported needs at baseline were: 29% supportive equipment, 31% transportation, 20% physical therapy, and 25% social activities. Those who reported needs at baseline had a lower QoL than those who reported no needs (for all). At three months reported needs decreased by an average of 6% (range: 3%-10%). QoL ratings were associated with changes in physical therapy and social activities needs at three months. The implications of these results related to LTSS recipients’ QoL in the first three months of services, with emphasis on physical therapy and social activities needs, is an opportunity to be more person-centered in delivery of care.

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Utilization and Expenditures of High-Need, High-Cost Older Adults With Disabilities

Innovation in Aging ◽

10.1093/geroni/igab046.601 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 158-158

Author(s):

Cleanthe Kordomenos ◽

Molly Knowles ◽

Micah Segelman ◽

Sarita Karon

Keyword(s):

Older Adults ◽

Nursing Home ◽

Inpatient Care ◽

Nursing Home Care ◽

Community Based ◽

Adults With Disabilities ◽

Care Models ◽

Patterns Of Utilization ◽

Services And Supports

Abstract The factors that lead people to have high needs for care can vary greatly, with implications for the best approaches to serving their needs. One high need group of interest is older adults with disabilities and multiple comorbidities. There is variation in need within this group. Of particular interest is the subset that is both high need and high cost (HNHC). We present work describing Medicare and Medicaid utilization and expenditures for this high need group and the HNHC subset. Over 7.6 million people were identified as high need; 13.6% of them also were defined as HNHC. Patterns of utilization differed between these groups, with the HNHC group more likely to use inpatient care and nursing home care, but less likely to use community-based long-term services and supports. These findings have implications for the development of care models that might best meet the needs of this population.

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CREATING NEW MODELS FOR AGING IN PLACE: DIVERSE COMMUNITIES AND THE NAVIGATION OF LONG-TERM SERVICES AND SUPPORTS

Innovation in Aging ◽

10.1093/geroni/igz038.843 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S228-S229

Author(s):

Lauren Ring ◽

Michael Liebman ◽

Allen Glicksman ◽

Misha Rodriguez

Keyword(s):

Older Adults ◽

Aging In Place ◽

Service Access ◽

Limited English Speaking ◽

Aging Services ◽

Interaction Modeling ◽

English Speaking ◽

Services And Supports

Abstract There is a growing interest among aging services providers to better understand the pathways through which older adults and their caregivers navigate LTSS. Although there have been attempts at modeling this process they are often dependent on the quality of existing data, which can result in models which are incomplete and study samples that homogenize diverse older adult populations. These models face two challenges – 1) the data may not include information about important elements of the LTSS navigation process, and 2) the actions of ethnic/cultural sub-groups may not be captured. This study uses a conceptual method called Social Interaction Modeling (SIM) to examine how older adults in two limited English-speaking communities (Spanish / Mandarin Chinese) navigate the use of LTSS and to evaluate disparities in service access. The findings will help to build a more comprehensive model which looks at service navigation among all older adults in Philadelphia.

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