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 阿尔茨海默病和其他痴呆症患病率的预计增长将加剧以下挑战： 提供适当的长期护理，这是一个传统上由非正规部门主导的保健部门， 护理和医疗补助资助的疗养院护理。发展和扩大家庭和社区护理 （HCBS）机构长期护理的替代方案一直是许多州医疗补助计划的优先事项， 至少在过去的二十年里。这一政策目标部分是为了回应人们普遍倾向于 在家中或社区接受长期护理，而不是在护理机构或其他机构 设置.此外，许多决策者认为，提供家庭护理有助于控制长期护理 使人们能够生活在比养老院更便宜的环境中。 将医疗补助接受者从机构护理转移到HCBS的可取性在本报告中是不言而喻的。 目前的政策环境。然而，这种向HCBS的转变可能会产生巨大但未经研究的影响 为长期护理接受者及其家人，特别是那些患有阿尔茨海默病或其他痴呆症的人。 很少有经验证据存在的后果，护理设置为这一人口。HCBS的倡导者 称赞政策的转变，因为它提供了更多的机会获得一种首选的护理模式。然而，HBCS的批评者， 担心需要更密集服务的个人被不适当地转移到HBCS， 轮班会降低护理质量。与此同时，HCBS不可避免地涉及将大量责任放在 家庭（特别是配偶）和其他非正式照顾者，这一负担可能使他们面临更大的困难， 阿尔茨海默病或其他痴呆症患者的家庭成员，可能受欢迎，也可能不受欢迎。 这一政策辩论的基础是很少有证据表明，实际利益和负担的照顾接受者或 家里如果患有阿尔茨海默病或其他痴呆症的人被转移到不适当的模式， HCBS而不是更高强度的设置，其结果可能是挑战的实质性加剧， 无论是个人还是家庭。医疗补助政策的这一领域-影响着最脆弱的人群之一， 美国-目前正在发展，在国家议程上处于优先地位，是修改的首要条件。证据须 通知这些修改。 在这项混合方法的研究中，我们试图提供一个更细致入微的检查护理环境的影响， 患有阿尔茨海默病或其他痴呆症的人及其配偶。我们建议研究 景观的HCBS利用，然后实证评估的后果，接受HCBS（而不是 机构护理）对个人和配偶的影响，在一系列结果中， 阿尔茨海默病或其他痴呆症。我们的研究结果将为医疗补助长期护理政策的演变提供信息 并指出具体的政策修改，可以减轻这些政策的意外影响。

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