scholarly journals States With Medically Needy Pathways: Differences in Long-Term and Temporary Medicaid Entry for Low-Income Medicare Beneficiaries

2017 ◽  
Vol 76 (6) ◽  
pp. 711-735 ◽  
Author(s):  
Laura M. Keohane ◽  
Amal Trivedi ◽  
Vincent Mor
Keyword(s):  
Nursing Home ◽  
Confidence Interval ◽  
Access To Care ◽  
Low Income ◽  
Hospital Services ◽  
Medicare Beneficiaries ◽  
Alternative Strategies ◽  
Catastrophic Coverage ◽  
Predicted Risk

Medically needy pathways may provide temporary catastrophic coverage for low-income Medicare beneficiaries who do not otherwise qualify for full Medicaid benefits. Between January 2009 and June 2010, states with medically needy pathways had a higher percentage of low-income beneficiaries join Medicaid than states without such programs (7.5% vs. 4.1%, p < .01). However, among new full Medicaid participants, living in a state with a medically needy pathway was associated with a 3.8 percentage point (adjusted 95% confidence interval [1.8, 5.8]) increase in the probability of switching to partial Medicaid and a 4.5 percentage point (adjusted 95% confidence interval [2.9, 6.2]) increase in the probability of exiting Medicaid within 12 months. The predicted risk of leaving Medicaid was greatest when new Medicaid participants used only hospital services, rather than nursing home services, in their first month of Medicaid benefits. Alternative strategies for protecting low-income Medicare beneficiaries’ access to care could provide more stable coverage.

Sustained SBP control and long-term nursing home admission among Medicare beneficiaries

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
C. Barrett Bowling ◽  
Richard Sloane ◽  
Carl Pieper ◽  
Alison Luciano ◽  
Barry R. Davis ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Home Admission ◽  
Medicare Beneficiaries

scholarly journals Diversity and Variation in Assisted Living Care, Nationally and Over Time

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 528-528
Author(s):  
Portia Cornell ◽  
Tetyana Shippee
Keyword(s):  
Nursing Home ◽  
Assisted Living ◽  
Long Term Care ◽  
Health Care Use ◽  
Medicare Beneficiaries ◽  
Term Care ◽  
Memory Care ◽  
State Subsidies ◽  
Over Time

Abstract Assisted living is generally understood to offer a greater degree of privacy and independence than a nursing home; most residents pay privately, with some receiving support from state subsidies and Medicaid; regulation and oversight are the purview of state agencies. Within these broad parameters, however, one assisted living community may look quite different from another across the country, or down the street, in its resident population and the regulations that govern its operating license. The purpose of this symposium is to explore that variation. The papers leverage an in-depth review of changes in assisted-living regulation from 2007 to 2019 and a methodology to identify Medicare beneficiaries in assisted living using ZIP codes. To set the stage, the first paper examines variation across assisted living licenses to identify six regulatory types and compare their populations’ characteristics and health-care use. The second paper analyzes trends over time in the clinical acuity of assisted living residents associated with changes in nursing home populations. The third paper investigates racial disparities in assisted living associated with memory-care designations and proportions of Medicaid recipients. The fourth investigates how regulation of hospice providers in assisted living affect end-of-life care and place of death. The final paper describes requirements related to care for the residents with mental illness in seven states. The symposium concludes with an expert in long-term care disparities and quality discussing the implications for policymakers, providers, and the population needing long-term care in assisted living.

Long-Term Services and Supports Use Among Older Medicare Beneficiaries in Rural and Urban Areas

2019 ◽  
Vol 41 (3) ◽  
pp. 241-264 ◽  
Author(s):  
Andrew F. Coburn ◽  
Erika C. Ziller ◽  
Nathan Paluso ◽  
Deborah Thayer ◽  
Jean A. Talbot
Keyword(s):  
Nursing Home ◽  
Urban Areas ◽  
Nursing Home Care ◽  
Medicare Beneficiaries ◽  
System Transformation ◽  
Community Based ◽  
Rural And Urban Areas ◽  
Rural Nursing ◽  
Rural And Urban

State and federal policies have shifted long-term services and support (LTSS) priorities from nursing home care to home and community-based services (HCBS). It is not clear whether the rural LTSS system reflects this system transformation. Using the Medicare Current Beneficiary Survey, we examined nursing home use among rural and urban Medicare beneficiaries aged 65 and older. Study findings indicate that even after controlling for known predictors of nursing home use, rural Medicare beneficiaries exhibited greater odds of nursing home residence and that the higher odds of rural nursing home residence are, in part, associated with higher rural nursing home bed supplies. A complex interplay of policy, LTSS infrastructure, and social, cultural, and other factors may be influencing the observed differences. Federal and state efforts to build rural HCBS capacity may be necessary to mitigate stubbornly persistent rural–urban differences in the patterns of institutional and community-based LTSS use.

Old, Frail, and Uninsured: Accounting for Features of the U.S. Long‐Term Care Insurance Market

Econometrica ◽  
2019 ◽  
Vol 87 (3) ◽  
pp. 981-1019 ◽  
Author(s):  
R. Anton Braun ◽  
Karen A. Kopecky ◽  
Tatyana Koreshkova
Keyword(s):  
Nursing Home ◽  
Low Income ◽  
Long Term Care ◽  
Risk Groups ◽  
Income Risk ◽  
Term Care ◽  
Administrative Costs ◽  
Long Term Care Insurance ◽  
Nursing Home Entry

Half of U.S. 50‐year‐olds will experience a nursing home stay before they die, and one in ten will incur out‐of‐pocket long‐term care expenses in excess of $200,000. Surprisingly, only about 10% of individuals over age 62 have private long‐term care insurance (LTCI) and LTCI takeup rates are low at all wealth levels. We analyze the contributions of Medicaid, administrative costs, and asymmetric information about nursing home entry risk to low LTCI takeup rates in a quantitative equilibrium contracting model. As in practice, the insurer in the model assigns individuals to risk groups based on noisy indicators of their nursing home entry risk. All individuals in frail and/or low‐income risk groups are denied coverage because the cost of insuring any individual in these groups exceeds that individual's willingness‐to‐pay. Individuals in insurable risk groups are offered a menu of contracts whose terms vary across risk groups. We find that Medicaid accounts for low LTCI takeup rates of poorer individuals. However, administrative costs and adverse selection are responsible for low takeup rates of the rich. The model reproduces other empirical features of the LTCI market including the fact that owners of LTCI have about the same nursing home entry rates as non‐owners.

Uitbraak COVID-19 in de verpleeghuiszorg

2020 ◽  
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Nursing Homes ◽  
Long Term Care ◽  
Informal Caregivers ◽  
Rapid Review ◽  
Daily Routine ◽  
Term Care ◽  
Care Facilities

Long-term care for older adults is highly affect by the COVID-19 outbreak. The objective of this rapid review is to understand what we can learn from previous crises or disasters worldwide to optimize the care for older adults in long term care facilities during the outbreak of COVID-19. We searched five electronic databases to identify potentially relevant articles. In total, 23 articles were included in this study. Based on the articles, it appeared that nursing homes benefit from preparing for the situation as best as they can. For instance, by having proper protocols and clear division of tasks and collaboration within the organization. In addition, it is helpful for nursing homes to collaborate closely with other healthcare organizations, general practitioners, informal caregivers and local authorities. It is recommended that nursing homes pay attention to capacity and employability of staff and that they support or relieve staff where possible. With regard to care for the older adults, it is important that staff tries to find a new daily routine in the care for residents as soon as possible. Some practical tips were found on how to communicate with people who have dementia. Furthermore, behavior of people with dementia may change during a crisis. We found tips for staff how to respond and act upon behavior change. After the COVID-19 outbreak, aftercare for staff, residents, and informal caregivers is essential to timely detect psychosocial problems. The consideration between, on the one hand, acute safety and risk reduction (e.g. by closing residential care facilities and isolating residents), and on the other hand, the psychosocial consequences for residents and staff, were discussed in case of other disasters. Furthermore, the search of how to provide good (palliative) care and to maintain quality of life for older adults who suffer from COVID-19 is also of concern to nursing home organizations. In the included articles, the perspective of older adults, informal caregivers and staff is often lacking. Especially the experiences of older adults, informal caregivers, and nursing home staff with the care for older adults in the current situation, are important in formulating lessons about how to act before, during and after the coronacrisis. This may further enhance person-centered care, even in times of crisis. Therefore, we recommend to study these experiences in future research.

Preterm Birth, Inflammation and Infection: New Alternative Strategies for their Prevention

2019 ◽  
Vol 20 (5) ◽  
pp. 354-365 ◽  
Author(s):  
Víctor M. Muñoz-Pérez ◽  
Mario I. Ortiz ◽  
Raquel Cariño-Cortés ◽  
Eduardo Fernández-Martínez ◽  
Leticia Rocha-Zavaleta ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Medicinal Plants ◽  
Low Income ◽  
Experimental Studies ◽  
Neonatal Outcomes ◽  
New Drugs ◽  
Alternative Strategies ◽  
Mortality And Morbidity ◽  
Therapeutic Benefits ◽  
Gynecology And Obstetrics

Background:Worldwide, the progress in reducing neonatal mortality has been very slow. The rate of preterm birth has increased over the last 20 years in low-income and middle-income countries. Its association with increased mortality and morbidity is based on experimental studies and neonatal outcomes from countries with socioeconomic differences, which have considered implementing alternative healthcare strategies to prevent and reduce preterm births.Methods:Currently, there is no widely effective strategy to prevent preterm birth. Pharmacological therapies are directed at inhibiting myometrial contractions to prolong parturition. Some drugs, medicinal plants and microorganisms possess myorelaxant, anti-inflammatory and immunomodulatory properties that have proved useful in preventing preterm birth associated with inflammation and infection.Results:This review focuses on the existing literature regarding the use of different drugs, medicinal plants, and microorganisms that show promising benefits for the prevention of preterm birth associated with inflammation and infection. New alternative strategies involving the use of PDE-4 inhibitors, medicinal plants and probiotics could have a great impact on improving prenatal and neonatal outcomes and give babies the best start in life, ensuring lifelong health benefits.Conclusion:Despite promising results from well-documented cases, only a small number of these alternative strategies have been studied in clinical trials. The development of new drugs and the use of medicinal plants and probiotics for the treatment and/or prevention of preterm birth is an area of growing interest due to their potential therapeutic benefits in the field of gynecology and obstetrics.

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