This paper outlines the legislative history of MA and efforts to contain inappropriate payments and provides an overview of the relevant research findings. It concludes that the lack of encounter data and program accountability has incentivized private insurers to game the system and generate profits without significantly improving value in the Medicare program.
This issue brief argues that PACE’s success is largely attributable to its non-profit operation, that a recent ruling allowing for-profit operation was made contrary to the evidence that non-profits have better outcomes, and that the decision will undermine the program’s efficacy.
The pandemic revealed that nursing homes were woefully unprepared in terms of their physical plant design, supply of personal protective equipment (PPE), staffing, and infection control and prevention. Data show that 40 percent of nursing homes had at least 1 infection control and prevention deficiency in any given year, and that over 60 percent had at least 1 over a period of several years.
COVID-19 is responsible for a disproportionate share of deaths among residents and staff living and working in long-term care (LTC) settings. While 8 percent of all COVID-19 infections have occurred in LTC, over 40 percent of all COVID-19 deaths are among those in LTC settings (KFF, 2020). The close quartered living combined with residents who are living with multiple health conditions and staff who are serving multiple residents and households makes LTC settings vulnerable to infection outbreaks.
Nursing home residents, many of whom are living with chronic illness, are at a high risk of infections because they live in close quarters. The average U.S. nursing home has 108 beds and it’s common for residents to have roommates and share bathrooms. Each year, as many as 3.8 million infections and up to 200,000 hospitalizations occur among the 1.3 million people living in nursing homes.
Assisted living is one of the least regulated industries among the continuum of long-term care. It’s largely regulated by state agencies with no uniform standards. In Florida, legislation has been introduced to further deregulate assisted living, removing important resident rights and rules related to basic standards of care. This issue brief summarizes recent ALF legislation and recommendations that were made in 2011 by the Agency for Health Care Administration’s Assisted Living Workgroup.
Prior to the nursing home regulations set forth in the Federal Nursing Home Reform Act or the Omnibus Budget Reconciliation Act (OBRA) of 1987, many institutionalized Elders had little protection in nursing homes. It wasn’t, however, until 2016 when significant protections were added to nursing home regulation. The powerful nursing home industry is declaring that these new regulations are too “burdensome” to comply.
This issue brief explores Florida’s older migrants. Florida has historically been a migratory state and this is especially true among the older population. Florida’s 60 and older population is increasing and is projected to do so for the next several decades to over 30 percent in 2030. This population will likely need long-term care at some point in their lives, however, Florida’s long-term care system is already having trouble keeping up with the current population. Florida has a growing community-based services waitlist and has not expanded Medicaid–the primary payer for long-term care. It has also adopted more stringent Medicaid eligibility requirements. With Florida’s rising long-term care expenditures it is important to understand how the influx of retirees to Florida could affect future demographics, and health care use and availability.
The most significant trend in hospice is the growth in the number of for-profit providers–which has tripled in the last 15 years. Until recently, hospices were run by non-profit or community groups, with extensive volunteer participation. Rising profits and increased Medicare expenditures raise questions about the effects on hospice quality and cost. This issue brief examines the research literature on hospice and profit status.
The Older Americans Act has provided essential community services for older people for over 40 years. The program capacity, however, to meet the needs of older people for services like Meals on Wheels and caregiver support is declining as funding fails to keep pace with the growing population of older Americans. This growing gap between OAA resources and the need for them in communities across America threaten the quality of life of millions of older persons today and many more in the future.
Parts of the Affordable Care Act (ACA) or Obamacare recently faced repeal-leaving many including some older adults-unsure of what would become of their health benefits. The ACA covers about 20 million individuals through the Marketplace, Medicaid expansion, young adults staying on their parents’ plan, and other coverages. Among older adults (aged 55-64), 4.5 million gained coverage since ACA was enacted. This issue brief describes the ACA, how it may be repealed, and how its repeal could affect the health of millions of older adults.
Sixty nine percent of Americans will need some form of Long-Term Care with 40 percent needing nursing home care (Mollot, 2015; SeniorCare.com), and yet, nursing homes are places that most people would like to avoid. Nursing homes tend to be more like hospitals than homes and are characterized by long hallways, nurses’ carts, overhead call systems, a lack of privacy, double occupancy rooms, unpleasant odors (sometimes) and impersonal treatment.
The Older Americans Act of 1965 (OAA) is one of the nation’s most comprehensive set of programs aimed at improving the lives of older adults. This issue brief explains the goals of the OAA and its programs, describes funding formulas and gives recommendations for the future of the OAA.
For over a decade, Green Houses have provided elders with person-centered elder care in a small, homelike environment. Today, 185 Green Houses operate in 27 states across the U.S. This issue brief describes the Green House Project and summarizes the latest research on the model.
The Program of All-Inclusive Care for the Elderly (PACE) has operated for decades and has proven itself to be a program that provides quality care that is also cost effective, but a recent shift to allow for-profit operators threatens the program’s effectiveness. PACE keeps those who would otherwise need a nursing home level of care in the community by providing comprehensive, cost effective care. This issue brief describes the PACE program, recent changes, and offers a comparison to for-profit hospice.
There is a growing consensus that America’s long-term care system faces a crisis in providing sufficient health care and social needs to an aging society. At present, there are multiple factors that negatively affect the LTC workforce and quality of care, which will continue in the future if the issues are not addressed. This issue brief provides a description of the issues and explains how it is problematic for the LTC labor force system and the recipients.
This issue brief offers information about senior center participation and reinforces the important role of senior centers in providing activities that promote social interaction. The findings come from a previous study of the author that examined who participates, how different people used the center in various ways, and what participants gained from attending.
Research has shown that many older adults prefer to age in place. Their ability to do so depends partly on the availability of home and community based-services provided by the federal government, and state and local agencies. This issue brief discusses the Older Americans Act Home-Delivered Nutrition Program (HDNP) with a focus on its effectiveness in providing services to home-bound older adults.
Since 1980, the aging prison population in the U.S. has grown over 1,300 percent and the total annual prison spending has increased over tenfold. This issue brief focuses on the characteristics of the aging inmate population in Florida and compares the incarceration costs between the younger and older prisoners.
This issue brief illustrates the need for a new CNA program by comparing their educational and training requirements to other health care professionals. The concluding remarks provide recommendations for educational reform.
Over the past two decades, assisted living has become the fastest growing sector of long-term care, and with rapid growth comes many challenges. This issue brief presents some of the challenges that the ALFs face with particular focus on ALFs for the less affluent, function-focused care in ALFs, and aging in place.
Florida’s mental health system has remained significantly and chronically underfunded. This issue brief documents Florida’s mental health expenditures, in comparison with national expenditures, throughout the past decade.
Mental illness is a serious and prevalent condition in the United States, yet access to quality mental health services remains inadequate for far too many individuals in need. This issue brief focuses on why the condition of the mental health system has continued to deteriorate over the past 50 years and how this occurrence has placed tremendous burden on the criminal justice system.
A significant percentage of older adults in the United States experience mental illness, and it is expected that as the number of older adults continues to increase, so too will the number of older adults experiencing mental health issues. This issue brief explains why the existing U.S. geriatric mental health system is unprepared for this growth.
One of the most harmful misconceptions about mental illness is the exaggerated association of mental illness with violence. This issue brief provides information on the relationship between mental illness and violence and the negative consequences of the stigma of mental illness.
Florida has long struggled to provide adequate mental health care for its residents and to develop a stronger mental health system. This issue brief describes problems surrounding mental health care in Florida and includes recommendations for improvements.
The White House released a proposal of executive actions intended to reduce gun violence in the United States. This issue brief reviews these executive actions with regard to mental health issues and offers recommendations for continued mental health reform.
The world is getting hotter, and Americans are getting older, compounding the problem and threatening more American lives every year. This issue brief discusses the effect climate change and specifically heat waves are having on America’s oldest citizens.