Context:The US Congress in 2010 established the Program of Comprehensive Assistance for Family Caregivers (PCAFC) in the Department of Veterans Affairs’ (VA) healthcare system, expanding services for ...family caregivers of eligible veterans with injuries sustained or aggravated in the line of duty on or after 11 September 2001. The program includes a Caregiver Support Coordinator, stipends for caregivers, education/training, and additional services.Objective: The primary goal of this study was to examine the types of services that family caregivers of veterans use and value, how services are used and any limitations family caregivers’ experienced. Given that few interventions assess caregiver satisfaction with services, there is a gap in the existing literature addressing these outcomes.Methods: We assessed how caregivers use and value services with a national, web-based survey (N=1,407 caregivers) and semi-structured phone interviews (N=50 caregivers).Findings: Caregivers rated all services as helpful and especially valued financial support to be with the veteran, training in skills for symptom management, and assistance with navigating the healthcare system. A majority reported more confidence in caregiving, knowing about resources for caregiving and feeling better prepared to support the veteran’s progress and healthcare engagement. However, only a minority reported awareness of the full range of PCAFC services.Limitations: There was a low response rate to the survey, which may have implications for generalisability to the whole population of caregivers accessing PCAFC. Additionally, we rely on self-report rather than objective measures of service use and outcomes.Implications: This is the first in-depth examination of experiences of caregivers of using the innovative PCAFC model of support. It acknowledges the important role of caregivers in health and long-term (social) care delivery and can be used to inform development of strategies outside the VA healthcare system to recognise caregivers. Findings suggest that a system-wide program to effectively include caregivers as part of the care team should include mechanisms to help connect caregivers with an array of resources, options from which to find those which best fit their personal needs and preferences.
This article identifies and assesses gaps and deficits in the provision of long‐term care (LTC) services in nine middle‐income countries (MIC) across Africa (Algeria, Nigeria, South Africa), Latin ...America (Brazil, Colombia, Mexico) and Asia (China, India, Turkey). Legislation and entitlement to, conditions for access to and availability of publicly financed or co‐financed LTC services for elderly persons are assessed.
Across the nine selected MIC, it is revealed that hardly any legal entitlements to specific LTC services exist for elderly persons. The most common conditions for access to institutional care are a minimum age and little or no income. With respect to availability, it can be concluded that institutional care facilities are usually concentrated in urban or wealthy areas. In many cases they exist in the capital region only, but even their capacities are limited. Home‐based care is hardly available at all.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
To achieve optimal, equitable health outcomes for all older adults, the United States desperately needs equity in access to, quality of, and cost of aging care. To illustrate these needs, we discuss ...the current inequitable state of frailty care. Frailty disproportionately affects marginalized
populations, yet these populations struggle to access high-quality geriatrics care and long-term care services and supports (LTSS) that mitigate frailty, leading to accelerated frailty trajectories. Health services research can provide the data needed to document, elucidate, and address health
inequities in frailty care, including early identification and referral of frail adults to specialized care and financing LTSS.
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BFBNIB, DOBA, IZUM, KILJ, NMLJ, NUK, ODKLJ, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
This paper uses an accessibility index based on the 2SFCA method, which describes the supply-demand balance of long-term care services, to understand the characteristics of the regional supply-demand ...balance and to examine issues and policies in each region. Local cities with a marked population decline were selected for this analysis. We quantitatively grasped the supply-demand balance of long-term care services in each subregion, and confirmed whether the demand for services considered necessary based on the characteristics of the supply-demand balance in each municipality is compatible with the existing policies for plans of long-term care services.
The aim of this study was to identify the combination of patients with dementia and their caregivers' characteristics associated with long-term care (LTC) services usage.
A cross-sectional study was ...conducted with 475 patients with mild, moderate, and severe dementia at Changhua Christian Hospital, Taiwan. Eleven types of variables from patients with dementia, nine types of variables from patients' caregivers, and 15 types of LTC services were used for this study. The Apriori algorithm was employed to identify the attributes from the patients and their caregivers who used a particular LTC service from a comprehensive viewpoint.
A total of 75 rules were generated by the Apriori algorithm with support of 2%, confidence of 80%, and lift >1. Among these rules, 25 rules belonged to home personal care services which were summarized further into four general rules for home personal care services. On the other hand, 50 rules belonged to assistive devices that were summarized further into 21 general rules based on their similarities. Patient's walking ability, patient's emotional liability, unemployed or retired caregivers, caregivers' feelings with either helplessness or hopelessness, and caregivers who cared for patients with dementia solely were found to be the critical variables to use home personal care services. In contrast, patient's walking ability, age, and severity as well as caregivers' age, mood, marital status, caregiving burden, and the patient being cared for mainly by a foreign care helper were found to be the critical variables to use assistive devices.
This study showed preliminary results on the LTC service usage from patients with dementia and their caregivers residing in the community. Understanding the patient-caregiver dyad's profile leads the service providers, policymakers, and the referral team to tailor service provisions better to meet the needs and identify the potential target groups. The findings in this study serve as references to reduce caregivers' burden as well as to improve the quality of care for patients with dementia.
Along with the rapid increase in older adult population in South Korea, the management of dementia is becoming important. Higher dementia prevalence inevitably leads to an excessive burden on medical ...expenditure throughout one's life, so the catastrophic health expenditure for dementia should be protected in the aspect of both nation and family. Therefore, this study attempted to estimate the lifetime medical expenditures (LE) of older adults with dementia, and confirmed if the long-term care insurance (LTCI) is effective in reducing their medical expenses. The study analyzed LE of adults, aged over 70 years, using a cohort database and simulated the total LE per capita. In order to compare the differences in LE due to dementia, propensity score matching (PSM) was performed. As of 2015, the total LE per capita for older adults with dementia and without dementia was estimated to be 76,973 thousand won ($65,427) and 31,105 thousand won ($26,439). Older adults with dementia had 2.4 times more expenditure than those without dementia. In particular, the LE per capita for hospitalization of dementia patients was 63,945 thousand won ($54,353), which was about 5 times higher than LE per capita for outpatient treatment. In addition, as a result of confirming the political effectiveness of LTCI, the LE for older adults with dementia, who had not used the long-term care service (LTCS), was estimated to be about 85,769 thousand won ($72,904). Conversely, LTCS users were estimated to spend 70,487 thousand won ($59,914), which means that LTCS non-users spent about 22% more on total LE than LTCS users. Non-users spent about half of their LE after the age of 80. Based on these findings, this study confirmed that the LTCI system had the desired effect of reducing the total LE for older adults with dementia.
•Older adults with dementia will spend more on lifetime medical costs compared to those without dementia.•Regarding gender, females with dementia spend more on lifetime medical costs than males.•Hospitalization accounts for increasing in the lifetime medical costs as compared to outpatient care.•Implementation of LTCS can contribute to reducing the lifetime cost for older adults with dementia.•14 years of longitudinal data was used including when the coverage of LTCI was expanded.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Zusammenfassung
Rund 6 von 100 gesetzlich Versicherten gelten gemäß amtlicher Statistik der Sozialen Pflegeversicherung (SPV) als pflegebedürftig. Pflegebedürftigkeit folgt hierbei analog zum ...öffentlichen Diskurs der sozialrechtlichen Definition und damit einem nachfrageinduzierten Verständnis von Pflege.
Um dem insbesondere demografisch bedingten Anstieg der Anzahl Pflegebedürftiger mit bedarfsgerechten Angebotsstrukturen zu begegnen, sind Kenntnis und Bewertung mehrerer Faktoren notwendig: die Häufigkeit der nach dem Elften Buch Sozialgesetzbuch (SGB XI) definierten Pflegebedürftigkeit und der unterschiedlichen Schweregrade sowie die Inanspruchnahme von Leistungen der Pflegeversicherung und der gesundheitlichen Versorgung.
Der Beitrag stellt insofern Erkenntnisse und Berechnungen aus aktuell verfügbaren administrativen Sekundärdaten der Gesetzlichen Krankenversicherung (GKV) und SPV in Deutschland vor und benennt die Limitationen dieser Daten. Im Sinne einer epidemiologischen Näherung an das Thema Versorgung Pflegebedürftiger ist eine breitere Berichterstattung auf Basis von Primärerhebungen anzustreben.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background
With continued growth in the older adult population, US federal and state costs for long-term care services are projected to increase. Recent policy changes have shifted funding to home ...and community-based services (HCBS), but it remains unclear whether HCBS can prevent or delay long-term nursing home placement (NHP).
Methods
We searched MEDLINE (OVID), Sociological Abstracts, PsycINFO, CINAHL, and Embase (from inception through September 2018); and Cochrane Database of Systematic Reviews, Joanna Briggs Institute Database, AHRQ Evidence-based Practice Center, and VA Evidence Synthesis Program reports (from inception through November 2018) for English-language systematic reviews. We also sought expert referrals. Eligible reviews addressed HCBS for community-dwelling adults with, or at risk of developing, physical and/or cognitive impairments. Two individuals rated quality (using modified AMSTAR 2) and abstracted review characteristics, including definition of NHP and interventions. From a prioritized subset of the highest-quality and most recent reviews, we abstracted intervention effects and strength of evidence (as reported by review authors).
Results
Of 47 eligible reviews, most focused on caregiver support (
n
= 10), respite care and adult day programs (
n
= 9), case management (
n
= 8), and preventive home visits (
n
= 6). Among 20 prioritized reviews, 12 exclusively included randomized controlled trials, while the rest also included observational studies. Prioritized reviews found no overall benefit or inconsistent effects for caregiver support (
n
= 2), respite care and adult day programs (
n
= 3), case management (
n
= 4), and preventive home visits (
n
= 2). For caregiver support, case management, and preventive home visits, some reviews highlighted that a few studies of higher-intensity models reduced NHP. Reviews on other interventions (
n
= 9) generally found a lack of evidence examining NHP.
Discussion
Evidence indicated no benefit or inconsistent effects of HCBS in preventing or delaying NHP. Demonstration of substantial impacts on NHP may require longer-term studies of higher-intensity interventions that can be adapted for a variety of settings.
Registration
PROSPERO # CRD42018116198
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The COVID-19 pandemic has impacted peoples' health-related behaviors, especially those of older adults, who have restricted their activities in order to avoid contact with others. Moreover, the ...pandemic has caused concerns in long-term care insurance (LTCI) providers regarding management and financial issues. This study aimed to examine the changes in revenues among LTCI service providers in Japan during the pandemic and analyze its impact on different types of services.
In this study, we used anonymized data from "Kaipoke," a management support platform for older adult care operators provided by SMS Co., Ltd. Kaipoke provides management support services to more than 27,400 care service offices nationwide and has been introduced in many home-care support offices. The data used in this study were extracted from care plans created by care managers on the Kaipoke platform. To examine the impact of the pandemic, an interrupted time-series analysis was conducted in which the date of the beginning of the pandemic was set as the prior independent variable.
The participating providers were care management providers (n = 5,767), home-visit care providers (n = 3,506), home-visit nursing providers (n = 971), and adult day care providers (n = 4,650). The results revealed that LTCI revenues decreased significantly for care management providers, home-visit nursing providers, and adult day care providers after the COVID-19 pandemic began. The largest decrease was an average base of USD - 1668.8 in adult day care.
The decrease in revenue among adult day care providers was particularly concerning in terms of the sustainability of their business. This decrease in revenue may have made it difficult to retain personnel, and staff may have needed to be laid off as a result. Although this study has limitations, it may provide useful suggestions for countermeasures in such scenarios, in addition to support conducted measures.
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Individuals are susceptible to financial uncertainty across the financial life cycle. The last of three financial life cycle stages is the distribution of accumulated wealth to fund retirement. ...Individuals maximize utility by smoothing consumption over the life cycle while managing uncertainty events. Life cycle events include the potential need and financial cost for long-term care support and services. Pre-cautionary savings are used to exchange insurance premiums for the coverage of high uncertainty events.
Despite the theoretical need for uncertainty protection, consumer demand for insurance that mitigates or eliminates risk exposure to uncertainty events is historically low. This conundrum is commonly referred to as uncertainty “puzzles.” The empirical and descriptive literature examines many potential factors for these protection gaps that range from financial, health, social insurance, substitute and complimentary assets, socio-demographic factors, individual preferences, behavioral, and psychosocial factors, which this current paper controls for a majority.
Research is growing yet limited when considering individuals personality traits as potential explanations for personal finance behaviors. This study investigates and provides results that suggest that personality traits could partially explain the low demand for financial uncertainty insurance. Of the five personality traits, an individual who more strongly identifies with conscientiousness, holding all else equal, was found to associate positively with long-term care insurance ownership.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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