Effects of Care Setting on Persons with Alzheimer's Disease and their Spouses

护理环境对阿尔茨海默病患者及其配偶的影响

• 批准号: 9383443
• 负责人: RITA TAMARA KONETZKA
• 金额: $ 178.95万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9383443
• 关键词: Address; Advocate; Affect; Alzheimer' s Disease; Area; Caregivers; Caring; Communities; Costs and Benefits; Data; Dementia; Discipline of Nursing; Environment; Evolution; Family; Family member; Friends; Funding; Growth; Health Benefit; Health Care Sector; Health and Retirement Study; Home Nursing Care; Home environment; Individual; Interview; Knowledge; Long-Term Care; Measures; Medicaid; Medicare claim; Mental Health; Methods; Modification; Nurses; Nursing Homes; Outcome; Persons; Policies; Population; Prevalence; Quality of Care; Research; Research Design; Services; Spouses; Structure; Time; Time trend; United States; Vulnerable Populations; base; beneficiary; care recipients; community based care; community based service; cost; experimental study; improved outcome; informal care; informal caregiver; patient home care; physical conditioning; preference; programs; response

Project Summary Projected growth in the prevalence of Alzheimer’s Disease and other dementias will intensify the challenges of financing and delivering appropriate long-term care, a health care sector traditionally dominated by informal care and Medicaid-funded nursing home care. Developing and expanding home- and community-based care (HCBS) alternatives to institutional long-term care has been a priority for many state Medicaid programs for at least the last two decades. This policy objective is in part a response to people’s widespread preference to receive long-term care in their homes or communities rather than in nursing facilities or other institutional settings. In addition, many policymakers believe that providing home care can help control long-term care costs by enabling people to live in less expensive settings than nursing homes. The desirability of shifting Medicaid recipients from institutional care to HCBS is taken as self-evident in the current policy environment. However, this shift toward HCBS has potentially huge, but unstudied, implications for long-term care recipients and their families, especially those with Alzheimer’s Disease or other dementias. Little empirical evidence exists on the consequences of care setting for this population. Advocates for HCBS laud the policy shift as providing increased access to a preferred mode of care. Critics of HBCS, however, worry that individuals in need of more intensive services are inappropriately shifted into HBCS, and that such shifts reduce care quality. At the same time, HCBS inevitably involves placing substantial responsibility on family (especially spouses) and other informal caregivers, a burden that may involve greater hardships for family members of individuals with Alzheimer’s Disease or other dementia, and may or may not be welcome. This policy debate is based on very little evidence about actual benefits and burdens to the care recipient or the family. If persons with Alzheimer’s Disease or other dementias are shifted into inappropriate modes of HCBS instead of higher-intensity settings, the result may be a substantial exacerbation of challenges affecting both individuals and the family. This area of Medicaid policy – which affects one of the most vulnerable among us -- is currently evolving, high on the national agenda, and prime for modification. Evidence is required to inform these modifications. In this mixed-methods study, we seek to provide a more nuanced examination of the effects of care setting on individuals with Alzheimer’s Disease or other dementias and their spouses. We propose to examine the landscape of HCBS utilization and then empirically assess the consequences of receiving HCBS (rather than institutional care) on both individuals and the spouse, across a range of outcomes, for persons with Alzheimer’s Disease or other dementias. Our results will inform the evolution of Medicaid long-term care policy and point to specific policy modifications that can mitigate the unintended effects of these policies.

项目摘要 预计阿尔茨海默氏病和其他痴呆症患病率的增长将加剧 融资和熟悉适当的长期护理，这是由非正式主导的医疗保健交易 护理和医疗补助资助的疗养院护理。 （HCBS）替代机构长期护理已成为许多州医疗补助计划的优先事项 最近二十年 在他们的家或社区而不是在护理设施或其他机构中获得长期护理 此外，许多政策制定者认为，提供家庭护理可以帮助控制长期护理 通过使人们能够在疗养院不太高致的环境中生活在生活中的费用。 将医疗补助接收者从机构护理转移到HCB的可取性在脚趾中被认为是不言而喻的 但是，当前的政策环境。 对于长期护理接受者及其家人，尤其是那些患有阿尔茨海默氏病或​​其他痴呆症的人。 关于人群的后果设置的经验证据很少 赞扬政策转变，因为它可以增加对HBC的批评者的访问权限。 担心需要更密集服务的个人被不合适地转移到HBC中，因此 轮班同时降低了护理质量。 家庭（尤其是配偶）和其他非正式护理人员，这可能涉及更多困难的负担 患有阿尔茨海默氏病或​​其他痴呆症的人的家庭成员，可能会也可能不受欢迎。 该政策辩论是基于有关护理实际收益的非常证据的证据 家庭。 HCB而不是更高强度的设置，结果可能是影响影响的挑战 个人和家庭都按照医疗补助政策 美国 - 目前是进化，在国家议程上很高，并进行了修改。 告知这些修改。 在这项混合方法的研究中，我们寻求更多地研究护理设置对 患有阿尔茨海默氏病或​​其他痴呆症和配偶的人。 HCBS利用的景观和经验评估接受HCB的后果（而不是） 对个人和配偶的启发） 阿尔茨海默氏病或​​其他痴呆症。 并指出特定的政策修改，可以减轻这些epolicies的意外影响。

项目成果

Predicting Hospitalization among Medicaid Home- and Community-Based Services Users Using Machine Learning Methods.

• DOI: 10.1177/07334648221129548
• 发表时间: 2023-02
• 期刊: JOURNAL OF APPLIED GERONTOLOGY
• 影响因子: 3
• 作者: Jung, Daniel;Pollack, Harold A.;Konetzka, R. Tamara
• 通讯作者: Konetzka, R. Tamara

The relationship between Medicaid policy and realized access to home- and community-based services.

医疗补助政策与实现的家庭和社区服务之间的关系。

• DOI: 10.1080/01621424.2023.2300672
• 发表时间: 2024
• 期刊: Home health care services quarterly
• 影响因子: 1.4
• 作者: Konetzka,RTamara;Ellis,Emily;Ghazali,Nadia;Wang,Sijiu
• 通讯作者: Wang,Sijiu

Trends In Medicaid Home And Community-Based Services Waivers For Older Adults.

• DOI: 10.1377/hlthaff.2022.00149
• 发表时间: 2022-08-01
• 期刊: Health affairs (Project Hope)
• 作者: Skira, Meghan M;Wang, Sijiu;Konetzka, R Tamara
• 通讯作者: Konetzka, R Tamara

Caregiving for Older Adults With Dementia During the Time of COVID-19: A Multi-State Exploratory Qualitative Study.

• DOI: 10.1177/07334648231175414
• 发表时间: 2023-10
• 期刊: JOURNAL OF APPLIED GERONTOLOGY
• 影响因子: 3
• 作者: Yan, Kevin;Sadler, Tonie;Brauner, Daniel;Pollack, Harold A.;Konetzka, R. Tamara
• 通讯作者: Konetzka, R. Tamara