Aging in Place: A National Analysis of Home- and Community-Based Medicaid Services for Older Adults

2018 ◽  
Vol 29 (4) ◽  
pp. 245-256 ◽  
Author(s):  
Carli Friedman ◽  
Joe Caldwell ◽  
Angela Rapp Kennedy ◽  
Mary C. Rizzolo
Keyword(s):  
Older Adults ◽  
Aging In Place ◽  
Nursing Facilities ◽  
Community Based ◽  
Age In Place ◽  
Services And Supports ◽  
Aging Adults ◽  
National Analysis ◽  
Community Based Services

The number of Americans needing long-term services and supports (LTSS) is projected to more than double in the coming decades largely due to an aging baby boomer population, meaning paying for LTSS will become an even greater challenge for American families and the country. Despite the benefits of aging in place, there remains a long-standing institutional bias within the Medicaid program, where services in nursing facilities are mandatory while home- and community-based services (HCBS) are mostly optional for states to cover. This study examined HCBS 1915(c) waivers ( n = 61 waivers) for older adults to categorize and compare service priorities. Findings revealed waivers for older adults were primarily focused on supporting individuals in their own homes to age in place. However, findings also revealed HCBS waivers are an underutilized mechanism for funding the LTSS of older adults. As states continue to deal with an increasing population of aging adults, with and without disabilities, the HCBS waiver option will continue to be an important component of a state’s service system.

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

2015 ◽  
pp. 150527102958001 ◽  
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

scholarly journals AGING IN PLACE: REVISITING OLD ASSUMPTIONS ABOUT WHAT PEOPLE WANT AS THEY GROW OLD

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S601-S601
Author(s):  
Marc A Cohen ◽  
Robyn Stone ◽  
Ruth Katz
Keyword(s):  
Nursing Homes ◽  
Representative Sample ◽  
Aging In Place ◽  
Cognitively Impaired ◽  
Community Based ◽  
Age In Place ◽  
Institutional Services ◽  
Nationally Representative ◽  
Services And Supports

Abstract When people are asked how and where they would like to age, they overwhelmingly indicate they want to “age in place”, that is, in their own homes. To support this desire, a range of home and community-based service options have been developed accompanied with major declines in the use of nursing homes and other institutional services. However, what if we’ve been asking the wrong question? Or asking the wrong people? Given that upwards of 70% of people turning age 65 will have a need for long-term services and supports (LTSS) and 52% will have significant need, the more relevant question is: how might you want to age in the presence of LTSS needs? In this research we explore the attitudes and expectations of a nationally representative sample of 1,200 “late Boomers” age 60 to 72 (instead of all adults) regarding how they want their life to look should they become physically or cognitively impaired and need LTSS. The analytic sample was derived from NORC’s AmeriSpeak® Panel. We found that in the presence of significant LTSS need, many people -- 40% if physically disabled and 71% if cognitively impaired -- do not want to remain at home. More than anything else they value safety and do not want to burden their families. They are also concerned about feeling alone. Clearly, late boomers understand that there are circumstances where aging in place may not be right for them and implications for the way we invest resources in the service infrastructure.

scholarly journals Factors Explaining State Differences in Applying for a Recent Long-Term Care Program that Promotes Aging in Place: Perspectives of Medicaid Administrators

2020 ◽  
pp. 073346482092451
Author(s):  
Esther M. Friedman ◽  
Regina A. Shih ◽  
Sangeeta C. Ahluwalia ◽  
Virginia I. Kotzias ◽  
Jessica L. Phillips ◽  
...  
Keyword(s):  
Long Term Care ◽  
Aging In Place ◽  
Care Program ◽  
Community Based ◽  
Term Care ◽  
Incentive Program ◽  
Policy Goals ◽  
Services And Supports ◽  
Community Based Services

Older adults in need of assistance often prefer to remain at home rather than receive care in an institution. To meet these preferences, Medicaid invited states to apply for the Balancing Incentive Program (BIP), a program intended to “rebalance” Medicaid-financed long-term services and supports to Home- and Community-Based Services (HCBS). However, only about half of eligible states applied. We interviewed Medicaid administrators to explore why some states applied for BIP whereas others did not. Supportive state leadership and the presence of other programs supporting community-based care were positively related to BIP application. Opposing policy priorities and programs competing for similar resources were negatively related to BIP application. Because states most likely to apply already had policy goals and programs supporting HCBS, BIP may inadvertently widen disparities across states, pushing those on the margins ahead and leaving the ones that are worst off in HCBS support to fall even further behind.

A National Analysis of Medicaid Home and Community Based Services Waivers for People With Intellectual and Developmental Disabilities: FY 2015

2017 ◽  
Vol 55 (5) ◽  
pp. 281-302 ◽  
Author(s):  
Carli Friedman
Keyword(s):  
Developmental Disabilities ◽  
National Level ◽  
Intellectual And Developmental Disabilities ◽  
Community Based ◽  
Day Habilitation ◽  
Services And Supports ◽  
National Analysis ◽  
Regulation Changes ◽  
Community Based Services

Abstract Medicaid Home and Community Based Services (HCBS) 1915(c) waivers are the largest source of funding for the long term services and supports of people with intellectual and developmental disabilities (IDD). National-level analyses of HCBS IDD waivers are crucial because of the large variance across states, the recent CMS rule and regulation changes (CMS 2249-F/2296-F), and the ever changing economic and political landscape. Therefore, the aim of this study was to examine state waiver priorities for people with IDD. In FY 2015, 111 waivers projected spending $25.6 billion for approximately 630,000 people with IDD. The services with the most funding were residential habilitation, supports to live in one's own home, and day habilitation. However, our analysis revealed large discrepancies across states and services.

Community-Based Services for People With Brain Injury: A National Analysis

2018 ◽  
Vol 32 (2) ◽  
pp. 123-138 ◽  
Author(s):  
Carli Friedman ◽  
Laura VanPuymbrouck
Keyword(s):  
Brain Injury ◽  
Underserved Populations ◽  
Fiscal Year ◽  
Community Based ◽  
Institutional Settings ◽  
Services And Supports ◽  
National Analysis ◽  
Community Based Services

Purpose:Where and how rehabilitation and long-term services and supports (LTSS) occur for individuals with brain injury (BI) has shifted dramatically over the last few decades. Medicaid Home and Community Based Services (HCBS) 1915(c) waivers allow states to offer LTSS that is tailored to the needs of underserved populations in the community rather than institutional settings.Method:This study examined how states utilized waivers to provide for people with BI.Results:Findings revealed only 15 states had waivers for people with BI in fiscal year 2016.Conclusions:Of those waivers for people with BI, there were vast differences across states and services.

Community-Based Aging Services

2020 ◽  
Author(s):  
Jan Ivery
Keyword(s):  
Older Adults ◽  
Health Status ◽  
Social Workers ◽  
Healthy Aging ◽  
Community Based ◽  
Limited Mobility ◽  
Age In Place ◽  
Increased Risk ◽  
Aging Services ◽  
Community Based Services

As individuals age, their physical community continues to be a primary entry point of intervention because of their attachment to place, social connections, and limited mobility to travel as far and as often as they would like or desire. The environment provides a context for understanding an older adult’s social interactions and the availability of and access to supportive services that reduce isolation and increased risk for reduced health status. When individuals age in place, social workers need to understand how community-based services can work with older adults in their community where they have lived for some time and have developed social networks. This knowledge will better assist social workers in their ability to effectively connect clients with appropriate resources. Unfortunately, it is not uncommon for an older adult’s environment to not reflect or adapt to their changing health status and physical mobility. Healthy aging (also referred to as age-friendly) and NORC (naturally occurring retirement communities) initiatives have emerged as examples of how to provide supportive, community-based services that will enable older adults to remain engaged in their community as they experience changes in their health status, mobility, and financial security. These community-level interventions emphasize the adaptability to an older adult’s changing lifestyle factors that influence how they navigate their community. These initiatives engage older adults in planning and implementing strategies to connect older adults with services and activities that promote aging in place. Social workers play a very important role in the provision of community-based aging services because they can serve as a bridge between older adults and the local, state, and federal level programs that may be available to them.

scholarly journals Promises and Pitfalls of Health Information Technology for Home- and Community-Based Services

2020 ◽  
pp. 073346482094136
Author(s):  
Sangeeta C. Ahluwalia ◽  
Esther Friedman ◽  
Daniel Siconolfi ◽  
Debra Saliba ◽  
Jessica Phillips ◽  
...  
Keyword(s):  
Information Technology ◽  
Health Information Technology ◽  
Health Information ◽  
Service Agency ◽  
Community Based ◽  
Incentive Program ◽  
Services And Supports ◽  
Consumer Advocates ◽  
Community Based Services

Background: Health information technology (HIT) use in home- and community-based services (HCBS) has been hindered by inadequate resources and incentives to support modernization. We sought to understand the ways the Medicaid Balancing Incentive Program (BIP) facilitated increased use of HIT to increase access to HCBS. Method: Qualitative analysis of interviews with 30 Medicaid administrators, service agency providers, and consumer advocates. Results: Although stakeholders perceived several benefits to greater HIT use, they highlighted critical challenges to effective adoption within the long-term services and supports (LTSS) system, including lack of extant expertise/knowledge about HIT, the limited reach of HIT among rural and disabled beneficiaries, burdensome procurement processes, and the ongoing resources required to maintain up-to-date HIT solutions. Conclusion: The structural reforms required by BIP gave states an opportunity to modernize their HCBS systems through use of HIT. However, barriers to HIT adoption persist, underscoring the need for continued support as part of future rebalancing efforts.

scholarly journals Predictors of Nursing Facility Entry by Medicaid-Only Older Adults and Persons With Disabilities in California

2018 ◽  
Vol 55 ◽  
pp. 004695801876831 ◽  
Author(s):  
Michelle Ko ◽  
Robert J. Newcomer ◽  
Charlene Harrington ◽  
Denis Hulett ◽  
Taewoon Kang ◽  
...  
Keyword(s):  
Older Adults ◽  
Institutional Care ◽  
Nursing Facilities ◽  
Medicare Beneficiaries ◽  
Nursing Facility ◽  
Persons With Disabilities ◽  
Cognitive Limitations ◽  
Substance Abuse Disorders ◽  
Services And Supports

Nearly one-third of adult Medicaid beneficiaries who receive long-term services and supports (LTSS) consist of older adults and persons with disabilities who are not eligible for Medicare. Beneficiaries, advocates, and policymakers have all sought to shift LTSS to home and community settings as an alternative to institutional care. We conducted a retrospective cohort study of Medicaid-only adults in California with new use of LTSS in 2006-2007 (N = 31 849) to identify unique predictors of entering nursing facilities versus receiving Medicaid home and community-based services (HCBS). Among new users, 18.3% entered into nursing facilities, whereas 81.7% initiated HCBS. In addition to chronic conditions, functional and cognitive limitations, substance abuse disorders (odds ratio [OR] 1.35; 95% confidence interval [CI]: 1.23, 1.48), and homelessness (OR: 4.35, 9% CI: 3.72, 5.08) were associated with higher odds of nursing facility entry. For older adults and persons with disabilities covered by Medicaid only, integration with housing and behavioral health services may be key to enabling beneficiaries to receive LTSS in noninstitutional settings.

Day Habilitation Services for People With Intellectual and Developmental Disabilities in Medicaid Home and Community-Based Services Waivers

2016 ◽  
Vol 41 (4) ◽  
pp. 244-255 ◽  
Author(s):  
Carli Friedman
Keyword(s):  
Developmental Disabilities ◽  
Service Utilization ◽  
Fiscal Year ◽  
Intellectual And Developmental Disabilities ◽  
Community Based ◽  
Total Spending ◽  
Day Habilitation ◽  
Services And Supports ◽  
Community Based Services

Medicaid Home and Community-Based Services (HCBS) 1915(c) waivers are one of the largest providers of long-term services and supports for people with intellectual and developmental disabilities (IDD). HCBS waivers also play a prominent role in providing day habilitation services for people with IDD. The purpose of this study was to examine how HCBS waivers allocate day habilitation services for people with IDD. HCBS waivers providing day habilitation services for people with IDD were analyzed to determine service utilization and projected expenditures. In fiscal year 2014, HCBS waivers projected US$5.62 billion of funding for day habilitation services; however, there was wide variance across services in terms of projected total spending, spending per participant, and reimbursement rates.

scholarly journals PROMOTING AGING IN PLACE VIA RESEARCH, POLICY, AND PRACTICE IN AGE-FRIENDLY COMMUNITIES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S26-S26
Author(s):  
Kathy Black
Keyword(s):  
Older Adults ◽  
Research Policy ◽  
Aging In Place ◽  
Policy And Practice ◽  
Community Based ◽  
Professional Groups ◽  
Age In Place ◽  
Community Model ◽  
The Social ◽  
Global Age

Abstract The majority of Americans overwhelmingly prefer to age in place and in the communities in which they reside. Age-friendly communities support aging in place by focusing attention on features both inside and outside of the home. The global age-friendly community model provides a framework that requires assessing community-based older adults’ needs and preferences about, and developing subsequent action towards, features of the social, service and built environment including housing and transportation which are considered essential to aging successfully at home. This presentation discusses the intersect between research, policy and practice in an age-friendly community which utilized micro-level findings from older adults (n = 1, 172) to enact macro-level collaborations across local and statewide government and professional groups to facilitate aging in place across the domains of housing and transportation.

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