Community-based Long-term Care Research Articles

Effects of the COVID-19 Pandemic on Individuals, Families, and Community-Based Long-Term Care Centers and Corresponding Measures

<p>臺灣居家服務提供人員包括居服員與居服督導，但居服員有職能基準規定，居服督導則欠缺。本研究編制居服督導職能行為指標適合度問卷，將2022年全台灣辦理居家服務單位作為母群體，運用分層比例抽樣方法，了解居服主管對居服督導職能各項行為指標的重視程度。</p> <p>結果顯示這些指標具有很大程度的內部一致性（Cronbach’s alpha = .967）。 修訂後的居服督導職能基準分為四類，包括12項主要職能和57項行為指標。 研究結果表明，居服督導的角色更多的是管理性而非行政性；此外，督導任務的規劃缺乏全面品質管理方法。建議包括實施居服督導職能標準、明確其職責／責任以及製定相關培訓計劃。</p> <p> </p><p>This study examined the effect of the COVID-19 pandemic on individuals and families by using stratified random sampling to perform a telephone survey with Nantou County residents over 20 years of age. The results revealed the impact of the COVID-19 pandemic across multiple dimensions, including leisure and social activities, economic incomes, psychological adaptation, convenience in routine activities, interpersonal interactions, and caregiving burden. To explore how long-term care centers and service users were affected by service suspension following the issuance of the nationwide Level 3 epidemic alert in 2021, in-depth interviews were arranged with institutional workers in Nantou County and Taichung City. The service suspension adversely affected the physiology, psychology, and social participation of service users, as well as increased the caregiving burden on families. These long-term care centers also encountered challenges when attempting to resume their operations. Finally, we propose specific recommendations for subsequent pandemic prevention policies and relief measures.</p> <p> </p>

Services in public long-term care insurance in Japan.

In Japan, a public long-term care insurance system was launched in 2000. Residents can receive long-term care according to their care needs, as determined by a nationally standardized certification system. The present report describes the details of the long-term care services covered by public insurance. The Long-Term Care Insurance Act categorizes services into three major types: in-home, nursing-home, and community-based long-term care services. In-home care services include visiting, commuting, short-stay, and other services. Welfare, health, and medical facilities provide nursing-home care services for the elderly. Community-based care services were categorized into visiting, commuting, nursing-home, and composite services.

THE ADULT DAY CENTER: UNTAPPED TERRITORY FOR AGING RESEARCH

Abstract Adult day service centers (ADCs) in the United States are a vital, but overlooked source of community-based long-term care for diverse older adults with multiple chronic conditions, including dementia. The National Institute on Aging has called for more research on ADCs. In this interdisciplinary symposium, we present challenges and opportunities in conducting research in these congregate settings. First, we look at the operating status of ADCs nationally in the aftermath of the COVID-19 pandemic and disparities in access to care using longitudinal data from the National Post-acute and Long-term Care Study. Then we examine the lack of electronic health record utilization and clinical data capture in 4,035 ADCs nationally and discuss strategies to modernize technology in these settings to facilitate data collection. We subsequently present a new database, developed vis a vis an academic/community partnership between the National Adult Day Services Association and researchers, that centralizes and makes data collection feasible in ADCs with limited resources. We will also explore factors supporting intervention research that are unique to ADCs. Finally, we present a protocol adapted for the ADC setting, to test a mobile application that facilitates data collection and enables communication between ADCs, caregivers, and healthcare providers. Our findings show that, while research in ADCs has been limited historically, academic, government, and community partners are working together to spur pragmatic innovations that modernize these settings and better resource them to elevate standards of care.

A POLICY COMPARISON OF THE EVOLUTION OF COMMUNITY-BASED LONG-TERM CARE POLICY BETWEEN TAIWAN AND THE UNITED STATES

Abstract Governments globally have been facing pressure to develop and implement effective policies to support population aging. This approach was historically rooted in a perception that as we age we become increasingly incapacitated. This research seeks to understand how policies in two countries valuing unpaid care differently, developed and implemented Long-term services and supports (LTSS). We compare the federal level efforts of implementing LTSS within the United States (U.S.) and Taiwan. Relying on a pre-established comparative framework developed by Richard Rose, we utilized a deductive analytical approach to assess the differences in policy options and timelines across Taiwan and the U.S.. After attending this session, participants will develop a deeper understanding of how Taiwan and the U.S. are working to offer home and community-based long-term care services. It wasn’t until the 1980s for the U.S. and late 1990s for Taiwan that LTSS were introduced with the intention of supporting people to live as independently as possible in their own homes for as long as possible (e.g., Department of Health and Human Services, 3-year Care Service Development Plan). It is likely that the delay in LTSS delivery between the two countries is rooted in the role that unpaid support is expected to play. There is increasing evidence that countries are shifting their policy efforts to focus less on aging as a social dependency and more on policies that encourage healthy longevity.

A Competency Framework for Community-based Long-term Care Supervisors in Taiwan

<p>本研究旨在探討我國社區式長照服務督導人員的角色定位與職能要求，以提升整體服務品質，為長期照顧服務人才培育提供重要啟示。首先以焦點團體訪談進行資料蒐集，其次進行德懷術問卷調查，以建構社區式照顧服務督導的職能，並使指標達到一致性與完整性。受訪者認為，社區式長照服務督導的角色定位於照顧服務員的直屬主管，以監督服務實施、確保服務品質、連結跨專業服務及管理基層人員等為職務內涵。職責架構可分為督導服務、跨專業協調及部門管理三大層面，共涵蓋七項主要職責、十六項工作任務及三十七項行為指標。本研究建構的督導職能具有完整架構，可提供長照政策發展之依據，以健全長期照顧的人才培育制度。</p> <p> </p><p>This study aimed to examine the role definition and required competencies of community-based long-term care service supervisors in Taiwan to enhance service quality and offer valuable insights for workforce development in long-term care. First, focus group interviews were conducted to gather data. Second, Delphi technique-based questionnaire surveys were performed, which helped establish the supervisors’ competencies and ensured the consistency and completeness of the indicators.</p> <p>The interviewees suggested that supervisors should act as direct managers of care attendants, overseeing service delivery, maintaining service quality, facilitating interdisciplinary services, and managing entry-level personnel. The job responsibility framework is categorized into three tiers: supervisory services, interdisciplinary coordination, and department management. These include seven key responsibilities, 16 work tasks, and 37 behavioral indicators. The comprehensive competency framework developed by this study can inform long-term care policy and improve the talent development system within the sector.</p> <p> </p>

Factors associated with perceived caregivers' willingness to provide care among older adults with disabilities in China.

The aim of this study was to analyze the status quo and associated factors of care recipients' perceptions of caregivers' willingness to provide care among disabled older adults in China. Thus, this study contributes to our understanding of vulnerable older populations who are at a high risk of receiving support from informal caregivers who are unable or unwilling to take the caregiver role. We analyzed the cross-sectional data of 3,539 disabled older adults who received informal care at home from the seventh wave of the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Multiple logistic regression models were used to examine the variables associated with the respondents' perceived caregivers' willingness to care from five aspects: respondents' sociodemographic attributes, health-related data, family endowment, access to health care services and community-based long-term care services (CBLTCS). This study found that the majority of disabled older adults (90.9%) had a positive attitude toward their caregivers' willingness to care and the care they received; however, 7.0% of the adults were concerned about their caregivers' ability to handle the care. Moreover, there was a small number of disabled older people (2.1%) who felt that their caregivers were reluctant to care or lacked patience. The results from the multiple logistic regression showed that disabled older adults with socioeconomic disadvantages (living in rural areas, being poor and with no children who frequently visited) or high demand (with severe disabilities or cognitive impairment) were more likely to consider that their caregivers needed respite care. Those adults with anxiety symptoms, a lower amount of care time, poor self-rated financial status and poor accessibility to health care services were more likely to report that their caregivers were reluctant to administer care. This study found that living in rural areas, being poor, with no children who frequently visited, severe disabilities or CI were positively associated the care recipients' perception that caregivers needed respite care. While anxiety symptoms, a lower amount of care time, poor self-rated financial status and poor accessibility to health care services were significantly associated with care recipients' perception of caregivers' reluctance to care. Our findings highlight the awareness of monitoring informal carers' willingness to care or capability to enact caring tasks.

Measuring spatial accessibility to adult day services for older adults using GIS

Adult day services (ADS) provide community-based long-term care for older adults with chronic medical, cognitive, or mental health conditions and/or disabilities that are at risk of needing institutional care. This study aims to (a) measure and compare the spatial accessibility to ADS across major racial and ethnic minority older adult groups, and to (b) identify underserved urban areas which have limited access to ADS. Using Geographic Information Systems (GIS), we found little variation across ethnic and racial groups in accessibility to ADS; instead, most differences are between rural and urban areas. Underserved areas with a high older adult population in Los Angeles County were identified. Future research should incorporate other factors such as the organization’s capability, culture compatibility, types of services, and quality of services which may impact on ADS use among older adults.

PSYCHIATRIC HISTORY AND LATER-LIFE COGNITIVE CHANGE: EFFECT MODIFICATION BY SEX, RACE, AND ETHNICITY

Abstract Objective To better understand life course influences affecting cognitive function and decline in later life, we explored sex and race/ethnicity differentials in the relationship between a history of psychiatric, emotional, or nervous problems and cognitive functioning in later life, while accounting for early life disadvantage and relevant covariates. Methods Multi-level growth curve models examined associations between psychiatric history and cognitive functioning, and differences by sex and race/ethnicity (SRE), in 20,155 Health and Retirement Study (1995-2014) participants aged 65 or older, by estimating cognition scores and plotting trajectories of change with age by SRE. Results A history of psychiatric, emotional, or nervous problems was significantly related to cognition scores and rates of decline. Hispanic and Black participants had significantly lower cognition scores at age 75 and steeper rates of decline than White females, and Black race and the Hispanic race-sex interaction erased the protective effects of being female. Conclusions Our findings indicate that members of minority groups with a history of psychiatric problems evidence lower cognitive function in later life, and as a result, have a greater need for community-based long-term care than their peers without this history. Future research should include longitudinal analyses of different components of cognitive function, specific psychiatric diagnoses, and life history data that capture socioeconomic and psychosocial experiences throughout the life course. Population level findings as reported here, along with aggregate findings from similar studies, can inform interventions and policies regarding support for populations that are vulnerable to mental illness and to subsequent cognitive decline.

Veterans Health Administration Models of Community-Based Long-Term Care: State of the Science.

The complex care needs of older adults arising at the intersection of age-related illnesses, military service, and social barriers have presented challenges to the US Department of Veterans Affairs (VA) for decades. In response, the VA has invested in centers that integrate research, education, and clinical innovation, using approaches aligned with a learning health care system, to create, evaluate, and implement new care models. This article presents an integrative review of 6 community care models developed within the VA to manage multimorbidity, complex social needs, and avoid institutional care, examining how these models address complex care needs among older adults. The models reviewed include Home Based Primary Care, Medical Foster Home, the VA Caregiver Support Program, the Resources Enhancing Alzheimer's Caregiver Health (REACH)-VA program, the Caregivers of Older Adults Cared for at Home (COACH) program, and Veteran Directed Care. Core components and evaluation outcomes for each model are summarized, along with implications for more widespread implementation and research. Each model promotes coordinated care, integrates behavioral health, and leverages interprofessional expertise. All models are cost-neutral or incur only modest cost increases to improve outcomes. Broader implementation will require interprofessional workforce development, payment model realignment, and infrastructure to evaluate outcomes in new settings. The VA provides a blueprint for infrastructure that could be adapted to other domestic and international settings. Care models successfully implemented within the VA's single-payer system hold promise to address persistent dilemmas in long-term care, such as management of multimorbidity and social drivers of health, integration and support of family caregivers, and mental health integration. These models also demonstrate the value of incorporating care approaches that have been developed or tested outside the United States and argue for greater cross-fertilization of ideas from different health systems.

The Experience and Enlightenment of the Community-Based Long-Term Care in Japan.

(1) Background: China’s population aging situation is severe, but the construction of the long-term care insurance system is still in its infancy. Through summarizing the long-term care experience in Japan, this paper explores the suggestions for the development of long-term care in China. (2) Methods: Based on literature research and policy review, we sorted out the relevant practices and safeguard measures of the long-term care insurance system in Japan, and summarized the characteristics of Japanese community care. (3) Results: In the development of long-term care services, Japan has gradually established a multi-level, systematic, and precise elderly care service model. Its community care has the characteristics of policy support, intensive intervention, complete elements, and strict evaluation. China’s long-term care services should learn from Japan’s experience, strengthen institutional guarantees, improve relevant supporting policies, encourage multiple subjects to participate in community care based on integrating community resources, and establish community care evaluation mechanism.

Tribal Community-based Long-Term Care Center under COVID-19: Impact and Response

社區式長照是國家社會福利發展方針，這兩年因為受到疫情影響，在各部落社區長照站也產生了服務上的變化。部落社區長照評鑑評分表中，社工專業有三大指標及十項細則，為本研究主要項目。研究採用內容分析法及焦點座談法，研究期間採設定在2020～2021年評鑑甲等以上服務站。研究結果顯示：疫情下能夠達到服務指標，關鍵在人員反應出應變的能力。社區式部落長照站的生活已取代長者日常生活模式為社區防疫守護站、因疫情所迫開發多元「數位課程」。並建議可導入部份工時制，補充各站臨時人力，在鄰近部落間作資訊的互通與共享，也要增加照顧服務人員的教學技巧、課程設計能力，與教材開發的相關教育訓練。Community-based long-term care is the national social welfare development policy. Due to the impact of the epidemic in the past two years, each tribal community-based long-term care center has also undergone service changes. In the evaluation score table, the social work profession has three major indicators, which are the main projects of this research. The research adopts the content analysis and focus discussion method. During the research period, the service centers rated A and above in 2020-2021 will be collected. Results: Under the epidemic, the key to achieving service indicators is staff resilience. The life of the service center has replaced the daily life mode of the elderly. A variety of ＂digital courses＂ have been developed. Also recommended: part of the working hour system can be imported, supplementary temporary staff at each center, exchanges and sharing information among neighboring tribes. Caregivers should also increase educational training in teaching skills.

Challenges and Burden on the Physical Health of Older Adults

Health care providers, gerontologists, psychologists, social workers, and policymakers are all focused on preventing elder abuse, improving life for the elderly, and reducing caregiver stress. Asian countries, which have a large population of older individuals, have a greater demand for in-place care for older adults because of their high rate.. An advocate for a community-based long-term care support system for older individuals and their carers is a major goal for this study article. To address the growing demand for in-home care for the elderly in India, this paper reviews secondary and tertiary sources of literature to establish a framework.

Approaching person-centered long-term care: The trajectories of intrinsic capacity and functional decline in Taiwan.

To examine the longitudinal trajectory of intrinsic capacity over a 3-year period among long-term care recipients in Taiwan, its association with functional decline and the onset of severe dependency. A total of 9448 individuals aged ≥50 years utilizing home and community-based long-term care services with complete data from three separate evaluations in Taiwan were included in the study. We carried out a latent class linear mixed model to identify heterogeneous patterns of intrinsic capacity over time, a mixed-effects model to investigate their impact on activities of daily living and a Kaplan-Meier analysis to examine the onset year of severe dependency among different intrinsic capacity classes. The results identified four classes sharing similar longitudinal the intrinsic capacity trajectories: "high-stable" (20.13%), "normal-stable" (40.58%), "sensory-dysfunction" (29.53%) and "all-dysfunction" (9.76%). Individuals with predisposing characteristics were associated with lower activities of daily living, with the exception of age and education level. In addition, the poor intrinsic capacity class (b from -16.94 to -6.61, P < 0.001) had a worse evolution in terms of activity of daily living scores, and was associated with an earlier onset of severe dependency in 2.5 years in the all-dysfunction class. Heterogeneous patterns of intrinsic capacity that delay further functional decline are promising markers of function trajectories for a person-centered care approach in long-term care services. Targeting the needs of intrinsic capacity groups to prevent functional decline offer insights into: (i) strengthening function-centered care modalities to delay severe dependency as individuals get older; and (ii) validating regular monitoring intrinsic capacity as an early warning system to achieve healthy aging. Geriatr Gerontol Int 2022; 22: 516-522.

Impact of COVID-19 on Structure and Function of Program of All-Inclusive Care for the Elderly (PACE) Sites in North Carolina.

ObjectivesThe novel coronavirus disease 2019 (COVID-19) deeply affected all forms of long-term care for older adults, highlighting infection control issues, provider and staff shortages, and other challenges. As a comparatively new, community-based long-term care option, the Program of All-Inclusive Care for the Elderly (PACE) faced unique challenges. This project investigated the impact of COVID-19 on operations in all PACE programs in one US state.DesignQualitative study.Setting and ParticipantsStructured interviews with administrators of all 12 PACE programs in North Carolina.MethodsInterviews were conducted December 2020 to January 2021 by trained interviewers over Zoom; they were transcribed, coded, and qualitatively analyzed using thematic analysis.ResultsReported COVID-19 infection rates among PACE participants for 2020 averaged 12.3 cases, 4.6 hospitalizations, and 1.9 deaths per 100 enrollees. Six themes emerged from analyses: new, unprecedented administrative challenges; insufficient access to and integration with other health care providers; reevaluation of the core PACE model, resulting in a transition to home-based care; reorientation to be more family-focused in care provision; implementation of new, creative strategies to address participant and family psychological and social well-being in the home; and major reconfiguration of staffing, including transitions to new and different roles and a concomitant effort to provide support and relief to staff.Conclusions and ImplicationsWhile facing many challenges that required major changes in care provision, PACE was successful in mounting a COVID-19 response that upheld safety, promoted the physical and mental well-being of participants, and responded to the needs of family caregivers. Administrators felt that, after the pandemic, the PACE service model is likely to remain more home-based and less reliant on the day center than in the past. As a result, PACE may have changed for the better and be well-positioned to play an expanded role in our evolving long-term care system.

Community services for older people: a cross-sectional study to explore awareness and the degree of need for long-term care resources

Background: Dementia can lead to family, medical, and social burdens. Long-term care issues of older adults in Taiwan and the burdens of caregivers are beginning to be taken seriously by the government. Relevant resources for older adults have gradually increased; however, older adults and caregivers are often not likely to seek resources and might not know what resources are available. Aims: In this study, we screened for cognitive impairment among community-dwelling older adults, and investigated knowledge of dementia among older adults, awareness of long-term care resources, and the degree of need from caregivers’ perspectives. Design: A cross-sectional research design with purposive sampling was used. Methods: This study was carried out in a city in northern Taiwan. In total, 137 older adults completed the surveys with the following inclusion criteria: (1) being 65 years or older and (2) living at home. Additionally, 128 caregivers were also interviewed. Face-to-face interviews were conducted and self-administered questionnaires were delivered to all enrolled participants including: (1) a questionnaire of knowledge of dementia, (2) the Ascertain Dementia (AD)-8 questionnaire; and (3) awareness of community-based long-term care resources and needs questionnaire. Results: Results showed that 16.8% of older adults required a further definite diagnosis of dementia and had relatively low knowledge regarding dementia. Caregivers reported a low level of awareness regarding available long-term care resources despite needing and/or using those resources. Conclusions: Policymakers and practitioners should proactively promote supportive services for older adults and caregivers in the community. Future research should explore strategies for enhancing resource utilization and accessing tailored support to meet the needs of older adults with dementia.

Community-Based Long-Term Care in Taiwan: The Service Experiences of Tier B Centers

This qualitative study explored the community-based long-term care in Taiwan, examining the service experiences of Taiwan’s Tier B centers. Semi-structured interviews were conducted with seven Tier B service centers managers. The interview transcripts were analyzed by comparing the participants’ responses to find similarities and inducted into three themes. It was found that the adversities encountered include frequent policy revisions, the lack of systematized training programs, the high turnover rate among service providers, as well as differing perceptions between family members and service providers. They tried to solve problems and suggested policy improvement, including establishing platforms for government-citizen dialogue as well as creating supervision and evaluation mechanisms. Consequently, Tier B service centers benefit the community and the long-term care industry as elderly people can age in place and reduce families’ caregiving burden. Also, the practical experiences provide the real situation of differences between policies, training, and social service promotion. For future research, it is suggested to use this study’s results as a blueprint and conduct a questionnaire survey on all Tier B service centers in the country to understand the overall service outcomes. And propose suggestions for policy revision and formulating training programs for service providers.

Smoke-Free Policy Disparities in Long-Term Care Facilities.

Older adults in long-term care (LTC) facilities suffer disproportionately from health conditions caused or worsened by secondhand smoke. Long-term care facilities in many states and municipalities permit smoking. Americans for Nonsmokers' Rights compiles data on smoke-free policies only in institutional facilities (e.g., nursing homes), but not in transitional (e.g., independent living) or community-based settings (e.g., adult day). A cross-sectional, observational study was conducted of smoke-free policies using cluster random sampling in Kentucky to compare differences in policy location of coverage and strength of smoke-free policies in institutional, transitional, and community-based LTC facilities by rural/urban status. Online or phone surveys of LTC administrators representing 306 facilities were conducted. Of the facilities sampled, 35.5% were institutional, 33.4% transitional, 25.1% community-based, and 6.0% multi-type. Only one in five (19.6%) facilities restricted smoking indoors and outdoors. Only 17.3% of the policies were comprehensive (i.e., prohibiting use of all tobacco products by all persons living, frequenting, or working in LTC facilities). Compared to transitional facilities, institutional and community-based facilities were more likely to have comprehensive policies and restrict smoking indoors and outdoors. Facilities located in rural communities were less likely to restrict smoking indoors or outdoors and less likely to have comprehensive smoke-free policies, reflecting a disparity in policy protections. Strong, consistent smoke-free policies and policy enforcement are needed to reduce the disparity in smoke-free protections for older adults, LTC employees, and visitors. More research is needed to investigate the best strategies for implementing and enforcing policies that completely restrict smoking in all LTC facilities.

Fewer potentially avoidable health care events in rural veterans with self-directed care versus other personal care services.

Rural residents face more barriers to healthcare access, including challenges in receiving home- and community-based long-term services, compared to urban residents. Self-directed services provide flexibility and choice in care options and may be particularly well suited to help older adults with multiple chronic conditions and functional limitations who reside in rural areas remain independent and live in the community. We conducted a retrospective observational study to understand whether differences in health outcomes between Veteran-Directed Care (VDC), a self-directed Veterans Health Administration (VHA)-paid care program, and other VHA-paid home- and community-based personal care services vary in rural/urban location. The sample included 37,395 veterans receiving VHA-paid home- and community-based long-term care services in FY17. Our primary outcomes were changes in monthly incidence of VHA or VHA-paid community acute care admissions, nursing home admissions, and emergency department (ED) visits. We used fixed effects logistic regression models on unmatched and coarsened exact matched cohorts, stratified by rural/urban location. Both urban and rural VDC recipients were significantly less likely to be admitted to VHA-paid nursing homes, compared to those receiving other VHA-paid personal care services (rural: incremental effect=-0.22, [-0.30, -0.14]; urban: incremental effect=-0.14, [-0.20, -0.07]). Rural, but not urban, VDC enrollees had significantly fewer VHA-paid acute care admissions and ED visits, relative to recipients of other VHA-paid personal care services (acute care, rural: incremental effect=-0.07, 95% CI=[-0.14, -0.01], urban: incremental effect=-0.01, [-0.06, 0.03]; ED, rural: incremental effect=-0.08, [-0.14, -0.02], urban: incremental effect=0.01, [-0.03, 0.05]). VDC recipients had fewer incidents of potentially avoidable VHA-paid health care use, compared to similar veterans receiving other VHA-paid personal care services. These differences were more pronounced among rural VDC recipients than urban VDC recipients.

Preference of Older Adults for Flexibility in Service and Providers in Community-Based Social Care: A Discrete Choice Experiment.

Empowerment of control and choice of the service users in health and social care has been incorporated into service provision in various countries. This study aimed to elicit the preference of community-based long-term care (LTC) service users on levels of flexibility in service provision. A discrete choice experiment was performed among older community care service users to measure their preference for attributes of LTC services identified from a prior qualitative study. Each participant was asked to make choices in six choice tasks with two alternatives of hypothetical LTC services that were generated from the attributes. A generalized multinomial logistic model was applied to determine the relative importance and willingness to pay for the attributes. It found that the participants preferred multiple flexible providers, determining services by themselves, meeting case managers every month and social workers as sources of information on service provision. Significant preference heterogeneity was found for flexibility in providers and flexibility in services between those with and without activity of daily living impairment. The findings highlighted the preference of older adults for greater flexibility in LTC, while they rely heavily on social workers in decision making. The enhancement of flexibility in LTC should be supported by policies that allow the older service users to make decisions based on their own preferences or communication with social workers instead of determining the services and providers for them. Options should be offered to users to decide their preferred level of flexibility to better reflect their divided preferences.

Behavioral Health, Social Engagement, and Long-Term Care Services Use Among Community Older Adults: USA vs. Taiwan

As healthcare advances, older adults are living longer. While 90% of older adults prefer aging in their own homes and communities, it is important to examine key factors influencing healthy aging-in-community and community-based long-term care (LTC) services available in different countries. This symposium examines behavioral health, social engagement, and LTC services utilization among community-dwelling older adults in the USA and Taiwan. Lessons learned from older adults across countries will provide insights for tailored community-based LTC services and program development. Dr. Hou from The University of Central Florida (UCF) will highlight similarities and differences in behavioral health profiles and the topics that most interest community-dwelling older Americans participating in three aging-in-community programs in Central Florida. Dr. Wang from Case Western Reserve University will examine the impact of neighborhood social cohesion on mobility among community-dwelling older Americans aged 65 and older from the national Health and Retirement Study. Dr. Liu from National Cheng-Kung University in Taiwan will share results of healthy lifestyle on quality of life among community-dwelling older adults in southern Taiwan. Dr. Young from State University of New York at Albany will compare long-term care use among community-dwelling older adults with and without dementia in Central Taiwan. Finally, Drs. Cao and Hou from UCF will analyze home and community-based services in the USA versus Taiwan. This symposium will further discuss similarities and differences of key factors related to healthy aging-in-community, along with practical recommendations and lessons learned across countries and cultural environments to improve community-based long-term care services and programs.