Need For Long-term Care Services Research Articles

RURAL HEALTH, FAMILY CAREGIVING, AND DEMENTIA: CHARACTERISTICS AND NEEDS ACROSS POPULATIONS

Abstract The rural population in the US is aging faster, more likely to live alone, and has more comorbidities than the overall aging population. Despite the greater need for long-term care services, rural residents may experience the most barriers to formal services (hospital, home health) and availability of family caregivers. Unfortunately, there is a dearth of research on aging and end-of-life care in rural areas. This symposium includes 4 presentations focused on rural health, family caregiving and dementia and the characteristics and needs across these diverse populations. The first presentation examines rural disparities in use of family and formal caregiving for older adults with disabilities using data from the Health and Retirement Study. The second presentation describes the unmet services needs among people with dementia and their caregivers living in rural Appalachia, and highlights contextual factors that shape service access and utilization. The last two presentations use data from the Utah Population Caregiving Database to examine the characteristics of families of nursing home (NH) residents who die with dementia and of those who die in rural NHs. Understanding the unique characteristics and needs of these underserved populations will help inform rural health practice and policy considerations to better serve this population, especially as we continue to see changes in the hospital and NH landscape across the US. Moreover, it is critical that even as federal and state policies rebalance long-term care from institutional settings to home- and community-based settings, the unique needs of those living in more rural areas are considered.

Development and content of a community-based reablement programme (I-MANAGE): a co-creation study

ObjectivesAs age increases, people generally start experiencing problems related to independent living, resulting in an increased need for long-term care services. Investing in sustainable solutions to promote independent living is...

The consequences for unpaid carers of unmet need for long-term care services in England

Under-provision of long-term care services for people with support needs may have consequences for both them and their unpaid carers. Using in-depth interviews with 23 co-resident carers living in England, our study aimed to explore the impacts of unmet need on unpaid carers and how such impacts occur. Unmet need for services – services not being received or gaps between provision and need – had multidimensional impacts on carers. Key mechanisms were constrained opportunities through limited time or emotional resources, and constrained choices about whether and how to provide care, as well as over multiple other aspects of their lives.

Retrospective Evaluation of Discharge Planning Linked to a Long-Term Care 2.0 Project in a Medical Center.

Background: Although there are several studies on discharge planning and long-term care systems in individual programs, research on the connection between discharge planning and the usage of long-term care is scanty. This study aims to evaluate the nature of the association between discharge planning (DP) and long-term care (LTC) and whether the utilization of LTC services improved after being discharged. Methods: This was a single-center retrospective medical record review study. Secondary data analysis was conducted of DP–LTC participation data between 2018 and 2019. The objectives were to clarify the distinct characteristics of each part of the service to explore the utility rate by overall users and users with willingness and to determine the factors influencing their usage. Medical claims were used to identify inpatients receiving discharge services, and data were matched with LTC system engagement data (n = 2155). Backward stepwise regression was used to explore the attributes associated with each type of service use. Results: A total of 94% (2042/2155) of inpatients expressed a perceived need for LTC services, of which 14% (285/2042) were users of LTC services after discharge. When assessed by case-mix system (CMS) and willingness to use services during hospitalization, inpatients had higher rates of service utilization after discharge. Using LTC services was most likely to be associated with obesity, disability, high CMS level, higher education, and women. Conclusion: The study confirms that the utilization of LTC services has improved under the integrated DP–LTC system. The gap between willing and actual users is worth considering. In the assessment stage, special attention should be paid to the service needs of persons with BMI ≥ 27 and disabilities. Future research with a larger sample could comprehensively evaluate the impact of integrated DP services on the use of LTC 2.0 service resources.

The main characteristics of the insurance market for longevity risk: a literature review

Longevity risk is the probability of surviving more than own financial resources. This paper aims to define the characteristics of the insurance market for longevity risk. First, it identifies the aging of the population between the OECD countries and the need for long-term care services (i.e., their quality of life). Second, it tries to summarize the main characteristics of the insurance market for longevity risk from the literature point of view. According to the financial literature, the market to ensure the aging population's long-term needs can be considered a puzzle as there are some constraints from the two sides of the market. From the demand point of view, two issues limit the request for insurance products: the role of the State and misunderstanding about the exposure at risk by the population. At the same time, there are other constraints from the supply point of view: the adverse selection and moral hazard issues that impact the pricing of longevity risk. All these constraints limit the growth of this market. Third, it identifies some suggestions for further investigation in the growing field of financial literature. This paper contributes to the existing literature by identifying the constraints that avoid the insurance market's growth for longevity risk and by remembering some solutions to reassess the role of the welfare state.

The cost effectiveness of aging in place: A literature review

The objective of this paper is to discover the evidence supporting or refuting the cost-effectiveness of Assisted Living Technology (ALT) in aging in place of older adults through a comprehensive presentation of cost studies and economic analyses. The search was conducted on two main databases for health economic valuation: The NHS economic valuation database (NHS EED) and the health economic valuation database (HEED). The study was evaluated using the protocol required by Campbell and Cochrane Economic Methods. As an aging society evolves, the need for long-term care services increases. The prevalence of chronic diseases increases in the older population; seniors may have to abandon their bative social life and need long-term care in a nursing home. Aging is a global phenomenon. Asia is aging rapidly. By 2030, the number of Asians aged 65 and over will increase from the current 300 million to 565 million. By 2050, this number will increase to 900 million, about one-sixth of the number of people in Asia. Aging trends are regional, but demographic changes are diverse. Countries such as Japan, South Korea, Singapore, and China, whose populations are steadily aging, are in extreme situations. Research has shown that ALT can reduce costs in some cases, but with little precise data and low quality. Later developments, e.g., capacity methods, should be used for further research. Qualitative research is needed to assess the cost-effectiveness of ALT before making reliable conclusions about the application.

Private Long-Term Care Insurance Decision: The Role of Income, Risk Propensity, Personality, and Life Experience.

The rising aging population contributes to increased caregiver burden and a greater need for long-term care services, thereby posing stronger financial burden. The current study aimed to examine the effect of income, risk-taking propensity, personality traits, and life experience on the ownership of and intention to own private long-term care insurance (LTCI). Primary data were collected from 1373 registered nurses with a minimum of two years of full-time working experience. Multinomial logistic regression was used to examine the relationships between ownership of LTCI and personal discretionary income, risk propensity, openness to experience, and life experience. Personal discretionary income was a crucial positive indicator in predicting ownership of LTCI. Higher risk-taking propensity was found to be negatively related to both currently own and future intention to own private LTCI. Participants who currently live with elders and who agree to caregiving responsibilities with government-provided cash allowance showed future intention to purchase LTCI. Little evidence was found for an association between life experience and future intention to own LTCI. Income, risk-taking propensity, and personality traits differ in their impact on ownership of and future intention to own LTCI. Our results provide policy makers with a better understanding of the forces driving demand in the private LTCI market, as well as the accompanying implications for public LTCI.

Physical Activity Programming and Physical Function of Older Adults in Adult Day Centers: A Mixed-Methods Approach

With increased prevalence of Alzheimer’s disease, there is a need for long-term care services (e.g., Adult Day Centers (ADCs)) to provide physical activity (PA) programs to maintain physical function of older adults. ADCs report offering PA programs; however, information on PA programs and physical function of participants attending ADCs is limited. The study aims to a) explore perspectives of ADC directors on PA programming; b) examine physical function in older adults attending ADCs. A cross-sectional mixed-methods study was conducted among ADC directors and attending participants. Interviews were conducted with ADC directors to assess barriers and facilitators of PA programming. Physical function was assessed among ADC participants via the Short Physical Performance Battery (SPPB) and Timed Up and Go (TUG). Five director interviews were conducted and three major themes emerged; 1) current PA programming limited by fear of falls, 2) staff training and retention, and 3) diversifying PA programming. Twenty-nine ADC participants enrolled in the study, Mage= 74.5±8.2 years; BMI= 29.2 ±7.4 kg/m2; MMSE= 25.6 ±3.3; 51.7% (n=15) African American; 79.3% (n=23) males. ADC participants scored 6.7±3.1 on the SPPB and 15.4±5.3 seconds on the TUG. Directors expressed the importance of PA; however, mentioned current programming was limited due to risk of falls and untrained staff in PA. Findings indicate that older adults attending ADCs have physical function scores indicative of high fall risk. Future PA programming may consider including alternative forms of PA while embedding falls prevention strategies to reduce risk of falls and improve physical function among ADC participants.

Mass evacuation and increases in long-term care benefits: Lessons from the Fukushima nuclear disaster.

BackgroundThough mass evacuation may increase the need for long-term care (LTC) services, how the need for LTC services increases and how the public LTC system affects it is not well understood. We evaluated changes in public LTC benefits for the people living in the mandatory evacuation areas established after the 2011 Fukushima nuclear disaster and examined the roles of the universal LTC insurance system in Japan.MethodsIn order to evaluate the effect of the mandatory evacuation on LTC benefits, we examined the trends of LTC benefits in the Fukushima evacuation group and the nationwide non-evacuation group. We first decomposed per-elderly-individual benefits at the municipality level into the LTC certification rate and per-certified-individual benefits, and then implemented difference-in-differences analysis using these variables as outcomes.ResultsPer-elderly-individual benefits significantly increased from 2012 onward in the evacuation group, and this was explained by an increase in the certification rate rather than in per-certified-individual benefits. Increases in per-elderly-individual benefits and the certification rate in the post-disaster period were observed in all but the highest care level, and the corresponding outcomes for the highest care level decreased immediately after the disaster. We also found that the increase in the certification rate had been mostly realized by an increase in the number of certified individuals.ConclusionsThe increase in LTC benefits can be associated with the impact of the increase in the number of people newly certified to receive LTC benefits after the mandatory evacuation. In order to cope with the increase in utilization of long-term care and associated costs after disasters in aging societies, both formal long-term care services and social support for informal care for evacuees should be considered important.

Measuring the Awareness on Financing Long Term Care Cost among Public and Private Sector Employees in Malaysia

Financing long-term care for elderly people is a crucial issue, either towards the family members or the care institution. Corresponding with the growing number of ageing population in Malaysia, there’s a need of concern on the uncertaintiness of future family care and the need for long-term care services. This changing pattern of healthcare and cost over individual’s lifetime is a key component in actuarial field in developing assumptions and projecting the costs. This paper examined the determinants of awareness towards long-term care preparation among employed adults in Malaysia, between public and private sector employees and also between men and women. 1,000 close-ended questionnaires were distributed to random employees in Malaysia and 450 responds were collected. Two tests were analysed using multiple regression analysis. The results from the regression among employees from different sector shows that dependency and health status are significant towards the awareness of preparing for long-term care cost. However, their financial literacy for long-term care cost during old age are still very low. Another result shows that only health status shows a significant result among women compared to men. These results indicate the level of awareness on financing long-term care cost among employees in Malaysia are still low and needs attention.

The Awareness Level on Financing Long Term Care Cost Among Rural-Urban and Marital Status in Malaysia

The increase in the number of older populations has raised concerns globally. This demographic changes is due to the increase in life expectancy and declines in fertility as well as mortality rates. Malaysia is also currently experiencing the demographic changes and these changes leads to concerns on the uncertaintiness of future family care and the need for long-term care services. Therefore, this study investigates on the level of awareness on financing long term care cost between rural and urban residential area and marital status amomg respondents in Malaysia. 452 responds were analysed using multiple linear regiression model to identify the variables that influenced the level of acceptance and awareness towards long-term care cost. Findings show that dependency towards retirement income is significant from urban-rural residents and among single respondents. Health status is also significant for both rural-urban and marital status. However, literacy towards the long term care cost is significant among respondents residing in urban areas only and also married couples. The findings are beneficial and relevant to demonstrate on the importance of financial planning to fund for future long-term care costs.

Predictors of long-term care among nonagenarians: the Vitality 90 + Study with linked data of the care registers.

The need for long-term care services increases with age. However, little is known about the predictors of long-term care (LTC) entry among the oldest old. Aim of this study was to assess predictors of LTC entry in a sample of men and women aged 90years and older. This study was based on the Vitality 90 + Study, a population-based study of nonagenarians in the city of Tampere, Finland. Baseline information about health, functioning and living conditions were collected by mailed questionnaires. Information about LTC was drawn from care registers during the follow-up period extending up to 11years. Cox regression models were used for the analyses, taking into account the competing risk of mortality. During the mean follow-up period of 2.3 years, 844 (43%) subjects entered first time into LTC. Female gender (HR 1.39, 95% CI 1.14-1.69), having at least two chronic conditions (HR 1.24, 95% CI 1.07-1.44), living alone (HR 1.37, 95% CI 1.15-1.63) and help received sometimes (HR 1.23, 95% CI 1.02-1.49) or daily (HR 1.68, 95% CI 1.38-2.04) were independent predictors of LTC entry. Risk of entering into LTC was increased among women, subjects with at least two chronic conditions, those living alone and with higher level of received help. Since number of nonagenarians will increase and the need of care thereby, it is essential to understand predictors of LTC entry to offer appropriate care for the oldest old in future.

Effectiveness of Reablement: A Systematic Review

The ageing of the population and the increasing need for long-term care services are global issues. Some countries have adapted homecare programs by introducing an intervention called reablement, which is aimed at optimizing independence. The effectiveness of reablement, as well as its different service models, was examined. A systematic literature review was conducted using MEDLINE, CINAHL, PsycINFO and EBM Reviews to search from 2001 to 2014. Core characteristics and facilitators of reablement implementation were identified from international experiences. Ten studies comprising a total of 14,742 participants (including four randomized trials, most of excellent or good quality) showed a positive impact of reablement, especially on health-related quality of life and service utilization. The implementation of reablement was studied in three regions, and all observed a reduction in healthcare service utilization. Considering its effectiveness and positive impact observed in several countries, the implementation of reablement is a promising avenue to be pursued by policy makers.

Pricing reverse mortgages in Spain

In Spain, as in other European countries, the continuous ageing of the population creates a need for long-term care services and their financing. However, in Spain the development of this kind of services is still embryonic. The aim of this article is to obtain a calculation method for reverse mortgages in Spain based on the fit and projection of dynamic tables for Spanish mortality, using the Lee and Carter model. Mortality and life expectancy for the next 20 years are predicted using the fitted model, and confidence intervals are obtained from the prediction errors of parameters for the mortality index of the model. The last part of the article illustrates an application of the results to calculate the reverse mortgage model promoted by the Spanish Instituto de Crédito Oficial (Spanish State Financial Agency), for which the authors have developed a computer application.

Health-related quality of life and long-term care needs among elderly individuals living alone: a cross-sectional study in rural areas of Shaanxi Province, China

BackgroundThe number of elderly individuals living alone is rising, especially in rural areas of China, and their health-related quality of life (HRQoL) is an increasing public health concern. However, little is known about factors that influence HRQoL and the need for long-term care services. The aim of the study was to identify these factors and the long-term care requirements of persons aged 60 and older living alone in rural areas of Shaanxi Province, China.MethodsThe study included 424 older subjects, selected by stratified random sampling. Logistic regression adjusted for age was conducted to analyze factors influencing HRQoL and the need for long-term care services. Pearson correlative analysis was conducted to assess the correlation between HRQoL score and long-term care needs.ResultsHRQoL among elderly subjects living alone declined with age in both males and females. The main diseases influencing HRQoL among the elderly were hypertension, cardiac disease, chronic bronchitis, neurological disease and cancer. Cataract disease was the most important factor related to HRQoL. This was followed by long-term care needs, living conditions, economic status, Cardiovascular disease, osteoporosis and age. Factors affecting long-term care needs were economic status, education level, alcohol intake, living conditions, general health and age. HRQoL and long-term care needs among this elderly population were significantly correlated (r=−0.204, p<0.01).ConclusionsFor elderly persons living alone, factors such as chronic disease, lower income level and living in a rural area may limit their ability to form social relationships. Reducing the level of loneliness, with better care and support, may be helpful in improving their HRQoL. There is a need for an overall improvement in the planning, provision and financing of long-term care and psychogeriatric services for elderly individuals living alone in China.

The Impact of Financial Incentives on the Composition of Long‐term Care in Norway

AbstractIn Norway, municipalities have economic incentives for choosing residential care in nursing homes for high‐income clients and home‐based care for low‐income clients. Using a three‐year panel, 2007‐2009, on 427 municipalities we provide an analysis of the effect of the Norwegian long‐term care (LTC) financing system on the composition of LTC services at the municipality level. Our main result is that the composition of service is determined by local government revenue and local need for LTC services. We cannot identify an effect of average income among older people in a municipality regarding the balance between home‐based care and nursing home care. Hence, the results do not provide evidence of a service distortion.

Service Provider Perceptions of Long-Term Care Access in American Indian and Alaska Native Communities

The need for long-term care services for American Indians and Alaska Natives (AI/ANs) is great since this population is experiencing some of the highest rates in the United States of chronic disease and disability. Between 2005 and 2007, a survey on access and barriers to long-term care was mailed to key informants at 305 tribes and tribal consortia. Targeted key informants included Health Directors, Social Service Directors, Older Americans Act Title VI Directors, and Community Health Representative or Community Health Aide Directors. Survey-adjusted data were analyzed descriptively. Four hundred and forty-two respondents returned surveys representing 220 tribes and consortia. Human services were overall more available than health services. There was a high level of interest for long-term care services among consumers and tribal leaders. Funding issues were the most prevalent reported factors adversely affecting long-term care development. Efforts are needed to improve AI/ANs access to these services.

The Difference of the Need for Long-term Care Services between the Younger Aged and the Older Aged

The Difference of the Need for Long-term Care Services between the Younger Aged and the Older Aged

Consumer-Directed Care for Beneficiaries With Mental Illness: Lessons From New Jersey's Cash and Counseling Program

Previous research from the Cash and Counseling Demonstration and Evaluation (CCDE) programs in New Jersey, Arkansas, and Florida suggests that consumers' control over personal care greatly improves their satisfaction with care arrangements and their outlook on life. Still, some argue that consumer-directed care may not be appropriate for consumers with a diagnosis of mental illness. This study examined the effectiveness of the CCDE program for those with a diagnosis of mental illness. This study examined nonelderly Medicaid beneficiaries in New Jersey with a diagnosis of mental illness and compared and contrasted the experiences of those in New Jersey's CCDE program (N=109) and those who received services provided by an agency (N=119). Logistic regression analyses were performed on baseline and nine-month follow-up data. By examining outcome measures--including satisfaction with care arrangements, consumers' perceptions of paid caregivers' attitudes, unmet needs, adverse events, and satisfaction with life--this study offers evidence that, from the perspective of consumers, the CCDE program is appropriate for participants with a mental illness diagnosis. For most outcome measures the CCDE program demonstrated a positive effect after baseline characteristics were controlled for. The analysis of measures of adverse events, health problems, and general health status did not yield statistically significant differences between the control group and the treatment group, indicating that CCDE care was at least as safe as agency-directed care. Considering the growing need for long-term care services and the limited resources available, a consumer-directed option can be a valuable alternative for persons with a diagnosis of mental illness.

Consumer-Directed Care for Beneficiaries With Mental Illness: Lessons From New Jersey's Cash and Counseling Program

Previous research from the Cash and Counseling Demonstration and Evaluation (CCDE) programs in New Jersey, Arkansas, and Florida suggests that consumers' control over personal care greatly improves their satisfaction with care arrangements and their outlook on life. Still, some argue that consumer-directed care may not be appropriate for consumers with a diagnosis of mental illness. This study examined the effectiveness of the CCDE program for those with a diagnosis of mental illness.This study examined nonelderly Medicaid beneficiaries in New Jersey with a diagnosis of mental illness and compared and contrasted the experiences of those in New Jersey's CCDE program (N=109) and those who received services provided by an agency (N=119). Logistic regression analyses were performed on baseline and nine-month follow-up data.By examining outcome measures--including satisfaction with care arrangements, consumers' perceptions of paid caregivers' attitudes, unmet needs, adverse events, and satisfaction with life--this study offers evidence that, from the perspective of consumers, the CCDE program is appropriate for participants with a mental illness diagnosis. For most outcome measures the CCDE program demonstrated a positive effect after baseline characteristics were controlled for. The analysis of measures of adverse events, health problems, and general health status did not yield statistically significant differences between the control group and the treatment group, indicating that CCDE care was at least as safe as agency-directed care.Considering the growing need for long-term care services and the limited resources available, a consumer-directed option can be a valuable alternative for persons with a diagnosis of mental illness.