Impact of state HCBS generosity on dementia outcomes and disparities

国家 HCBS 慷慨对痴呆症结果和差异的影响

• 批准号: 10091228
• 负责人: YUE LI
• 金额: $ 32.43万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10091228
• 关键词: Accounting; Acute; Adult; Affect; Alzheimer' s Disease; American; Bathing; Caregiver Burden; Caring; Communities; Data; Data Files; Dementia; Disabled Persons; Economics; Effectiveness; Elderly; Eligibility Determination; Emergency department visit; Ethnic Origin; Expenditure; Future; Health; Health and Retirement Study; Home Nursing Care; Home environment; Hospitalization; Hospitals; Impaired cognition; Income; Individual; Knowledge; Language; Link; Literature; Low income; Measures; Medicaid; Medicare; Medicare claim; Memory; Nursing Homes; Older Population; Outcome; Participant; Patient-Focused Outcomes; Patients; Performance; Persons; Policies; Poverty; Problem Solving; Quality of life; Race; Reporting; Rural; Sampling; Services; Sterile coverings; Subgroup; Surveys; Testing; Time; United States; aged; aging in place; beneficiary; care outcomes; cognitive function; cognitive skill; community based service; community living; cost; delivered meals; disparity reduction; ethnic minority population; expectation; health difference; health disparity; human old age (65+); improved; improved outcome; income disparities; older patient; preference; programs; racial and ethnic; racial and ethnic disparities; rural area; rural disparities; rural dwellers; rural residence; service programs; social; urban area; urban disparity

Project Summary/Abstract Nearly 6 million people in the United States currently live with Alzheimer's disease or related dementia (ADRD) and this number will be more than doubled by 2050. Patients with ADRD have difficulties with memory, language, problem-solving and other cognitive skills that affect their abilities to perform daily activities. Since over 70% of older patients with ADRD live at home and receive the majority of their care in the community, appropriate home- and community-based services (HCBS) for patients with dementia are critical to meet their preference to age in place, avoid unnecessary institutional care use, and reduce caregiver burdens. About 19% of older adults live in rural areas in the US, and older adults living in rural areas tend to have higher rate of dementia and worse cognitive functioning performance than those living in urban areas. Moreover, about 24% of community-living older adults with ADRD are low income and qualify for state Medicaid financial eligibility criteria, and an increasing percentage of people with ADRD are racial/ethnic minorities. A vast body of literature in the past several decades has reported rural-urban, racial/ethnic, and income disparities in important health outcomes, such as unmet needs for basic daily activities, and hospitalizations among community-living older adults with ADRD. These disparities persist in recent years. The two major state programs that support HCBS for older/disabled adults – Medicaid long-term services and supports (LTSS) coverage and Title III programs under the Older Americans Act (OAA) of 1965 – are shown to help improve health outcomes and quality of life for community-living older adults. These two programs together target low- income aged/disabled persons and others with the greatest economic and social needs. It is thus expected that the increased generosity of the two state HCBS programs will benefit the most vulnerable subgroups of older adults in particular, such as those with severe cognitive impairments or rural residents, and help reduce disparities in health outcomes. However, empirical evidence does not exist on whether more generous state HCBS policies help reduce the differences in health outcomes between ADRD and non-ADRD patients or redress the persistent outcome disparities related to rural residence, race/ethnicity, and poverty among community-living ADRD patients. This study proposes to fill this knowledge gap by determining the longitudinal and cross sectional impact of overall state generosity in supporting HCBS through the two major programs, as well as the generosity of individual subtypes of HCBS programs (e.g. home-delivered meals under the OAA), on gaps in health outcomes among a nationally representative sample of Medicare beneficiaries (age≥65 years) with or without ADRD living in the community. Findings of this project will illuminate the ways with which major state HCBS policies impact the equity and outcomes of care received by community-living ADRD patients, and inform future efforts aimed to improve the effectiveness of state HCBS programs.

项目总结/文摘