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Reports & Studies


NUTRITION ASSISTANCE PROGRAMS - Agencies Could Do More to Help Address the Nutritional Needs of Older Adults

DEC 23, 2019 | U.S. Government Accountability Office (GAO) | FULL GAO-20-18 REPORT

Federal nutrition guidelines are the basis for nutrition assistance programs that serve older adults. However, the guidelines focus on a healthy population and not on the needs of many older adults, such as those with common health conditions and those over age 70. Most older adults have more than one chronic condition, such as diabetes or heart disease.

As the population ages, demand for federal nutrition assistance programs will increase. We recommended that the Department of Health and Human Services develop a plan to focus on older adults’ needs in a future update to the guidelines.

Click HERE to read about the Highlights of the report or check out the U.S. GAO website for more information


What motivates informal caregivers of people with dementia (PWD): a qualitative study

NOV 28, 2019 | BMC Palliative Care | Full Study


The burden of caring for People with Dementia (PWD) is heavy; identifying incentives that motivate them in providing care is essential in facilitating and optimizing care. This study aims to explore and describe these motivating factors.

We conducted this qualitative study between January 2016 and January 2017 in Isfahan, Iran. Data were extracted through in-depth, semi-structured interviews with 19 caregivers of PWD. These data were then examined through thematic content analysis.

We identified four categories of psychological motives based on the caregivers’ feedback and experience. These include 1) Moral-based motives, 2) Religious, and spiritual motives; 3) Financial motives, and 4) Wicked motives.

Our results revealed several aspects of caregivers’ motives. They include moral, religious, and spiritual aspects; sharing housing accommodations, and the likelihood of inheriting a portion of the patient’s assets based on unspoken rules and informal arrangements in the family, and wicked and immoral aspects. These findings can inform future efforts in enhancing the experiences of caregivers of PWD, and subsequently, the quality of care these patients receive. It further suggests that family members, members of a religious and spiritual organization, as well as social media, could play important roles in setting the stage.


New ten-year study shows lagging quality improvement in Medi-Cal managed care

SEPT 25, 2019 | CA Health Care Foundation (CHCF) | FULL PUBLICATION

More than 10 million Californians — mostly children, their parents and caretakers, people with disabilities, and adults typically in low-wage jobs — get their health care through a managed care plan in Medi-Cal, the state’s Medicaid program. Today CHCF released a new study on the quality of care provided by Medi-Cal managed care plans over the last decade. It examined rates of preventive health screenings, pre- and post-natal care for women, and access to primary care for kids, among many others measures.

Among its key findings, the study shows that quality of care, on average, stayed the same or declined for over half of the measures analyzed, with some particularly disappointing declines in quality of care for children. Furthermore, the study showed that those enrolled in nonprofit or public managed care plans received, on average, better quality than those in for-profit plans. Those who lived in counties with a County Organized Health System received, on average, better quality than those who lived in counties with any of the other five models of managed care.

In CHCF’s latest blog, Chris Perrone, director of Improving Access at CHCF, responds to these findings by outlining five recommendations California can pursue to ensure that all Medi-Cal managed care enrollees, regardless of where they live or their plan, have timely access to high-quality care. This includes establishing measurable plan-specific quality goals with a focus on continuous improvement, as well as starting to pay plans for quality.


Community Health Workers Working with Older Adults: Webinar

SEPT 23, 2019 | National Council on Aging (NCOA) | Webinar in: English & Spanish

This webinar was specifically targeted to community health workers (promotoras) who want to gain greater insight into working with older adults. It focuses on the social, emotional, and physical natural changes that all older adults experience


Issue Brief: What’s at Stake for Older Adults When States Eliminate Retroactive Medicaid Coverage?

SEPT 9, 2019 | Justice in Aging | Issue Brief | Fact Sheet | Webinar

Retroactive Medicaid coverage is a key financial protection that helps older adults and others who develop sudden illnesses or long-term care needs access the care they need right away. It is a smart policy intended to protect low-income people from crushing medical debt in instances where they need emergency medical or long-term care and cannot apply for Medicaid immediately. But several states are eliminating this protection through Medicaid demonstration waivers approved by the federal government.

A new Justice in Aging issue brief—Medicaid Retroactive Coverage: What’s at Stake for Older Adults When States Eliminate This Protection?—discusses typical situations that cause older adults to need Medicaid retroactive coverage, and how the policy helps them access care, while protecting them from financial hardship. The issue brief also delves into how states are using waivers to eliminate this coverage, which states are doing so, and how older adults, their families, and health care providers are harmed when the coverage is eliminated. A companion fact sheet provides a higher level view of the issue.

Additionally, Justice in Aging and the AARP Public Policy Institute are presenting a webinar on the topic on October 1, 2019. Sign up for the webinar.


Preparing for an Aging Population

AUG 2019 | World Health Organization - Western Pacific Region | Fact Sheet

Key facts: The population of the WHO Western Pacific Region is ageing rapidly. More than 290 million people aged 60 years and older live in the Region, and older people make up the fastest growing age group. Within the Region, 80% of older people live in middle income countries. To ensure health and well-being for older persons, a transformation of society overall – not just health systems – will be essential.


Association Between Caregiver Depression and Emergency Department Use Among Patients With Dementia

JUL 8, 2019 | JAMA Neurology | ABSTRACT


Is caregiver depression associated with emergency department use among patients with dementia?

This cohort study of patients with dementia and their caregivers included 663 caregiver-patient dyads. A total of 84 caregivers had depression at baseline and the presence of caregiver depression was associated with a 73% increase in the rates of emergency department use among patients with dementia.

Caregiver depression appears to be an important risk factor associated with increased health care use among community-dwelling individuals with dementia.

Complete abstract is available HERE. (Additional login required for full text.)


Adult Day Service Use Decreases Likelihood of a Missed Physician's Appointment Among Dementia Caregivers

JUN 20, 2019 | Journal of the American Geriatrics Society | ABSTRACT

Adult day services (ADSs) that provide community-based supervised support for persons with dementia (PWD) may also function as a respite for familial caregivers to attend to self-care needs. Guided by a revised version of the Andersen Healthcare Utilization Model, the objective of this study was to identify the association between use of ADSs and a missed physician's appointment among family caregivers for community-dwelling familial PWD. A secondary objective was to identify other predisposing, enabling, and need factors associated with a missed physician's appointment.

ADSs’ provision of respite enables caregivers the time to address self-care needs by decreasing the likelihood that caregivers miss a physician's appointment. Findings suggest that ADSs may promote positive health behaviors for caregivers and should be expanded as part of comprehensive dementia care for families. Factors associated with missed physician appointments need further examination and intervention to support black caregivers.


New Issue Brief: Implementing Jimmo v. Sebelius: An Overview

JUN 2019 | Center for Medicare Advocacy, Inc | Issue Brief

In 2013, a federal district court approved a settlement agreement in Jimmo v. Sebelius, No. 5:11-CV-17 (D. VT). The Jimmo Settlement confirmed that Medicare coverage should be determined based on a beneficiary’s need for skilled care (nursing or therapy), not on the individual’s potential for improvement. The Jimmo Settlement and court decisions pertain to all Medicare beneficiaries throughout the country and apply regardless of whether an individual is in traditional Medicare or a Medicare Advantage plan.

Unfortunately, more than six years after the Settlement’s approval, the Center still regularly hears from Medicare beneficiaries and providers about problems with its implementation in home health, skilled nursing facility, outpatient therapy, and inpatient rehabilitation hospital settings across the country.

In the face of enduring barriers to Medicare-covered care, and with support from the John A. Hartford Foundation, the Center compiled this Issue Brief to provide Medicare stakeholders with an overview of the Jimmo Settlement, what it means in different care settings, some of the Center’s key implementation work, and links and references to helpful resource materials. The Center hopes this information will help Medicare beneficiaries, families, providers, contractors, adjudicators, and other stakeholders learn about the principles articulated in Jimmo and access relevant resources to ensure the Settlement is properly implemented.


Alliance for Aging Research Study Finds that Alzheimer's Disease Is Not Bankrupting Medicare, But It Is Taking a Huge Toll on State Medicaid Programs and Family Caregivers

JUNE 2019 | PRNewswire | ARTICLE | Full Study

A Medicare Claims Study Conducted by the Alliance for Aging Research and Milliman, Published in the Journal of Managed Care and Specialty Pharmacy, finds that Families and State Medicaid Programs, Not Medicare, Are Burdened with the Costs of Alzheimer's Disease.

Today, the Alliance for Aging Research (the "Alliance") announced the results of a Medicare claims study which found that families and state Medicaid programs, not Medicare, are burdened with the majority of costs associated with Alzheimer's disease ("Alzheimer's", or AD). The study, conducted by the Alliance and Milliman, was published in the July issue of Journal of Managed Care and Specialty Pharmacy . The results, which will be discussed in-depth this Thursday at an event in Washington, D.C. , demonstrate the importance of better diagnosis, treatment, and care of individuals with Alzheimer's, which could lead to more favorable patient outcomes and improved costs for state Medicaid programs and caregivers.


The Financial Burden Of Paid Home Care On Older Adults: Oldest And Sickest Are Least Likely To Have Enough Income

JUNE 2019 | Health Affairs | VOL. 38, NO. 6: Community Care for High-Need Patients
Richard W. Johnson,Claire Xiaozhi Wang | Full Study

Paid home care can significantly improve the lives of older adults with disabilities and their families, but recipients often incur substantial out-of-pocket spending. We simulated the financial burden of paid home care for a nationally representative sample of non-Medicaid community-dwelling adults ages sixty-five and older. We found that 74 percent could fund at least two years of a moderate amount of paid home care if they liquidated all of their assets, and 58 percent could fund at least two years of an extensive amount of paid home care. Among older adults with significant disabilities, however, only 57 percent could fund at least two years of moderate paid home care by liquidating all of their assets, and 40 percent could fund at least two years of extensive paid home care. Paid home care could become less affordable if growing labor shortages raise future costs.


The 2019 OASDI Trustees Report

APR 19, 2019 | Justice in Aging | Full Report

The 2019 OASDI Trustees Report, officially called "The 2019 Annual Report of the Board of Trustees of the Federal Old-Age and Survivors Insurance and Federal Disability Insurance Trust Funds," presents the current and projected financial status of the trust funds.


Addressing Social Factors That Affect Health: Emerging Trends and Leading Edge Practices in Medicaid

APR 2019 | Authored by Manatt Health

Medicaid programs are increasingly considering how best to address the social factors, such as housing, healthy food, and economic security, that can affect health and medical expenditures. Often referred to as social determinants of health (SDOH), these factors drive as much as 80 percent of population health outcomes.1 With Medicaid programs looking to contain costs and to pay for health outcomes—not simply the volume of health care services delivered—there is a growing focus on addressing these social factors in both Medicaid fee-for-service and managed care programs. While states historically have had some experience tackling such issues for specialized, high-need populations (e.g., disabled enrollees with mental illness or HIV/AIDs), they are now confronting whether, and how, Medicaid should address SDOH for a broader population of Medicaid enrollees in order to achieve better health outcomes. MORE


The Return of Churn: State Paperwork Barriers Caused More Than 1.5 Million Low-Income People to Lose Their Medicaid Coverage in 2018

APR 2019 | Families USA | Emmett Rugg, Eliot Fishman | Full Analysis

In 2018, enrollment in Medicaid and the Children's Health Insurance Program decreased by about 1.6 million enrollees, 744,000 of which were children. The three states with the largest percentage drops in enrollment were Tennessee, Arkansas, and Missouri. Texas also saw a large nominal drops in Medicaid and CHIP enrollment. There is strong evidence that a driving factor of the decline in enrollment is state policy decisions to engage in punitive annual (or even monthly) eligibility redetermination processes in which large percentages of Medicaid enrollees lose coverage.

Eligibility redetermination enrollment losses—often called enrollment “churn” in health policy and politics—are an old problem in Medicaid, but a problem that should have been greatly reduced by the Affordable Care Act (ACA). Federal law and regulations put in place by the ACA likely prohibit many of the processes described in this report. More than five years after these requirements came into force, some states do not comply with all federal regulations for redetermining eligibility and use outdated processes for verifying income and state residence that put an unnecessary burden on beneficiaries and create additional barriers to health insurance coverage. As a result, beneficiaries struggle to navigate their renewal processes and lose their Medicaid eligibility even though they may qualify.


Older Immigrants and Medicare

APR 19, 2019 | Justice in Aging | Issue Brief
Fact Sheet: CMS Regulations Set Ground Rules for D-SNPs

Justice in Aging’s new issue brief, Older Immigrants and Medicare, summarizes the complicated web of Medicare eligibility and enrollment policies for immigrants and offers examples and practice tips for advocates to use in helping older immigrants navigate Medicare and other coverage options. The topics covered include: eligibility and enrollment, help paying for coverage, post-enrollment issues, and language access rights and resources.

Justice in Aging also has a new fact sheet summarizing the recently finalized CMS regulations that set ground rules for Dual Eligible Special Needs Plans (D-SNPs). D-SNPs are Medicare Advantage plans that limit enrollment to individuals who are dually eligible for Medicare and Medicaid. The Bipartisan Budget Act of 2018 permanently authorized D-SNPs, so we expect to see more entering MA markets across the country. This factsheet summarizes the main Medicare-Medicaid integration requirements, including: minimum responsibilities for D-SNPs to coordinate Medicaid benefits, requirements for integrating Medicare and Medicaid appeals, duty to notify state Medicaid programs of hospital admissions, enrollment of partial duals in D-SNPs, and enforcement options for CMS.


Quick Reference Guide: Californians with Low Incomes

APR 17, 2019 | California Health Care Foundation (CHCF) | Quick Reference Guide

Californians with low incomes often face greater barriers to care than those with higher incomes. This Almanac quick reference guide provides a look at the data provided by the 2017 California Health Interview Survey.


Something to Chew On: Highlights of Findings from an AARP Oral Health Survey of Older Americans

APR 12, 2019 | AARP Public Policy Institute | Lynda Flowers, Olivia Dean, Teresa Keenan | Article

Oral health conditions—like untreated cavities, gum disease, and tooth loss—are not inevitable consequences of aging. Access to adequate dental care among older adults can prevent or delay these problems and may lead to overall improvements in health and well-being among seniors.

A robust body of literature—including a seminal report by the U.S. Surgeon General—finds a clear connection between oral health and physical health, including health conditions that are prevalent among older adults—like diabetes and heart disease. Yet, many older adults go without the care they need to maintain healthy teeth and gums. Despite this evidence, Medicare does not cover commonly needed oral health procedures like routine cleanings, treatment for cavities (a fertile breeding ground for bad bacteria), or tooth extractions. MORE


Study: Medicaid, uninsured more likely for ED discharge than privately insured

APR 3, 2019 | Fierce Healthcare | Jacqueline Renfrow | Article | JAMA International Medicine Study

When it comes either being directly discharged from the emergency department or transferred to another hospital after being stabilized, patients who are uninsured or on Medicaid are more likely to be discharged than privately insured patients are, a recently published JAMA International Medicine study found. MORE


Here's What the Cheapest LTC Option Looks Like Now
A new CDC report shows that the supply of adult day services slots has doubled

MAR 1, 2019 | | Allison Bell | Article
CDC LTC provider report, slidedeck and related resources

U.S. adult day centers had the capacity to serve about 300,000 people in 2016, according to a new long-term care (LTC) report published by an arm of the U.S. Centers for Disease Control and Prevention (CDC). That’s up from about 150,000 in 2010, according to an earlier survey conducted by an affiliate of MetLife.

Researchers at the CDC’s National Center for Health Statistics have included some data on adult day services providers, along with data on nursing homes, assisted living facilities and other LTC services providers and users, in the new LTC report, which is based on a survey of LTC providers and users.

The researchers found that:

The supply of adult day services slots is still much smaller than the supply of nursing home beds. Nursing homes have about 1.7 million certified beds.

The average adult day services center has 66 slots. The average nursing home has 106 certified beds.

The Midwest, the region with the fewest adult day services slots, has 15 nursing home beds per adult day services slot. The West, which is the region with the most adult day services slots, has just 2.5 nursing home beds per adult day services slot.


What Are Medicare Advantage Plans' New Mini LTC Benefits Really Like?
Actuaries found that efforts to help caregivers are already popular. Wandering support services might be a benefit to watch.

FEB 15, 2019 | ThinkAdvisor | Article | Millman Report

A team of actuaries at Milliman says 577 Medicare Advantage plans are now providing at least one benefit that’s similar to the type of benefit a long-term care insurance policy might offer.

The most popular “long-term care type benefit” is for support for caregivers: 421 plans offer caregiver hotlines, respite services or other caregiver support benefits.

The most unusual LTC type benefits are benefits for housekeeping and therapeutic massage. Just one plan offers either of those benefits, the actuaries found. MORE


How to Address California's Health Workforce Shortage

FEB 13, 2019 | California Health Care Foundation (CHCF) | Blog | Report

California must take bold steps to ensure there are enough health care providers trained to provide the care necessary to meet the needs of all Californians. That’s the takeaway of the final report — titled Meeting the Demand for Health — of the California Future Health Workforce Commission. Convened in 2017 to address California’s looming health workforce crisis, the commission’s report lays out a concrete plan to eliminate the state’s primary care shortage, nearly eliminate the psychiatry shortage, and dramatically improve the diversity of the health workforce — all by 2030.


California Health Policy Poll
Mental Health Care Access Is Top Concern

JAN 24, 2019 | California Health Care Foundation (CHCF) and Kaiser Family Foundation (KFF) | Findings

After the Golden State elected a new governor in November 2018, CHCF and KFF (Kaiser Family Foundation) jointly conducted a statewide poll of California residents. The goal was to assess their views of health priorities as the governor and legislature got to work early in 2019.

In the poll, released Thursday morning [JAN 23, 2019], Californians rank making health care more affordable among their top overall priorities for the state’s governor and legislature, with 45% describing it as “extremely important,” just behind improving public education (48%) and ahead of affordable housing (40%).

Among health issues, Californians’ top priorities are ensuring people with mental health problems can get treatment (49% say it is “extremely important”), making sure all Californians have access to health coverage (45%), and reducing what people pay for their health care (41%).

Mental health access ranks in the top two health priorities for Democrats, Republicans, and independents alike. Half of all Californians (52%) say their community does not have enough mental health providers to meet its needs.


California's Behavioral Health Services Workforce is Inadequate for Older Adults

JAN 2019 | UCLA Center for Health Policy Research | Brief by Janet C. Frank, Kathryn G. Kietzman, and Alina Palimaru

The Workforce Education and Training component of California’s Mental Health Services Act, which passed in 2004, has infused funding into the public mental health system. However, funding has not kept pace with an existing behavioral health workforce shortage crisis, the rapid growth of an aging population, and the historical lack of geriatric training in higher education for the helping professions. This policy brief draws on recent study findings, state planning documents, and a review of the literature to describe gaps and deficiencies in the behavioral health workforce that serves older adults in California. The brief offers recommendations to the following specific audiences for improving workforce preparation and distribution: state policymakers and administrators; educational institutions, accrediting bodies, and licensing boards; and county mental health/behavioral health departments and their contracted providers.