bluuebunny/crossref_metadata_2025_split huggingface dataset:
Family Spillovers and Long-Term Care Insurance
Authors: Coe Norma , Van Houtven Courtney , Goda Gopi 
Published: December 2020

Abstract
We examine how the presence of long-term care insurance (LTCI) spills over to family outcomes, including informal care, co-residence, and labor supply of adult children. We instrument for long-term care insurance with changes in state tax policies to address the endogeneity of LTCI coverage. We find that for tax-filing families in the top third of the income distribution, LTCI coverage leads to a 50 percent reduction the parents’ perceptions of the willingness of people to care for them in the future, including their adult children. We also find that LTCI causes changes in the residential decisions of adult children, with lower co-residence rates and higher likelihood of living within 10 miles of the parent. We also find small decreases in part-time work among adult children. Our findings provide empirical support for the presence of family spillovers of LTCI on the economic behaviors of family members. Part of a symposium sponsored by the Economics of Aging Interest Group.
Enriching Future Research: The Power of Qualitative Methods in Cancer-Related Health Services Research
Authors: Halpin Sean 
Published: December 2020

Abstract
The ever-changing landscape of cancer care for older adults—with novel treatments, increasing survival rates, and growing population diversity—makes effective cancer care delivery increasingly complex. Qualitative research is uniquely poised to make sense of this complexity and shape potential interventions and their implementation. While the potential power of qualitative methods in cancer-related health services research and implementation science is great, as recognized in a recent National Cancer Institute report, the range of qualitative methods can make identifying and applying the most appropriate method(s) challenging. To meet this challenge, this symposium will bring together researchers across disciplines to report on three qualitative techniques and how each was applied in cancer research with older adults. Halpin will present on the use of applied conversation analysis to study medical education delivery to patients with multiple myeloma. The method is particularly well-suited to investigate health education and communicative efficacy. Carrion will discuss in-depth qualitative interviews that were conducted to understand the cancer beliefs and attitudes of older Latinx adults. The interviews, conducted in Spanish, offer an opportunity to consider how qualitative methods are key to illuminating the experiences of underrepresented populations. Seaman will report on the multiple qualitative methods used, including questionnaires, interviews, and site observations, to document survivorship care practices among head and neck cancer programs. The triangulation of qualitative methods allowed for an unparalleled understanding of guideline implementation and program variation. Exploring a range of methods, the presentations make a powerful argument for qualitative methods in cancer-related health services research.
The Implementation of Birdsong: A Non-Pharmacological Intervention for Persons With Dementia
Authors: Tompkins Catherine , Thomas Joan , Cole Christina , Qiu Mei 
Published: December 2020

Abstract
Birdsong is a person-centered, nonpharmacological intervention for people with dementia. Using a touch-screen tablet, residents with dementia are stimulated with content customized based on individual interests such as sports, videos, music or brain games. The increased stimulation is expected to redirect negative behaviors, decrease the use of anti-psychotic medications and increase positive emotions. Birdsong is being implemented in a 100% Medicaid funded, long-term care facility. Two 10-week experimental design studies were implemented with 39 residents. Preliminary findings suggest a lack of independence with the tablets among the residents, but positive stimulation of emotions and redirection of negative behaviors with assistance of staff or volunteers. A team of practitioners, faculty and student researchers continue to examine the intervention, its implementation and effects on this population by examining the Minimum Data Set (MDS data) and observations of the residents as they utilize Birdsong.
In the Red: Debt, Financial Well-Being, and Retirement Preparedness Among Older Adults
Authors: Miller Julie , Miller Julie 
Published: December 2020

Abstract
Over the past twenty years, total debt for Americans ages 70 and over has increased more relative to all other ages group- by 543% according to the Federal Reserve Bank of New York (2019). Higher rates of debt among older adults have been attributed to a range of factors including expanded access to consumer credit, the capability for people to borrow from 401(k) plans, increases in costs of living, and limited financial literacy, among others. Related research of adults nearing retirement age who carry debt points to delayed retirement timing, lower levels of retirement savings, and higher risk and rates of bankruptcy. This symposium introduces timely investigations of retirement planning and economic security among older adults with debt. The first presentation will provide an overview of the impact of financial hardship on health among older adults in the United States over a recent ten-year period. The second presentation will focus on over-indebtedness among pre-retirees. The third presentation will examine the role of safety net services and borrowing from retirement plans among older adults with debt, particularly among older adults of color. The fourth and final presentation will focus on student loan debt as a hurdle to near-term and long-term financial security for older women in particular. A discussant will comment on how, together, the aforementioned papers contribute to our understanding of economic wellbeing and retirement preparedness in this era of increasing longevity. The session will integrate policy and programming implications for gerontological professionals.
Nurses Working in and With Adult Protective Services: Agency Characteristics and Job Responsibilities
Authors: Liu Pi-Ju , Chilatra Jessica Hernandez 
Published: December 2020

Abstract
The majority of Adult Protective Services (APS) workforce is staffed by social workers, though some agencies have recognized the need to address clients’ medical needs such as wounds, injuries, nutrition issues, hydration issues, premature death and more. Using survey data from the National Adult Protective Services Association (NAPSA), we analyzed 99 nurses’ responses on their role in working in/with APS to help abused, neglect, and exploited adults. Out of the 99 nurses, 65 were direct employees of APS, and 61 did not report directly to a nurse supervisor. Forty-nine nurses carry a caseload like social workers, and 27 carry a caseload in conjunction with social workers. The most common services nurses provide are home visits, evaluations of clients and their medications, and client education. Qualitative data revealed the benefits of having nurses on staff, including assessing medical needs, preventing medical emergencies, providing holistic care, and navigating the healthcare system. Part of a symposium sponsored by Abuse, Neglect and Exploitation of Elderly People Interest Group.
The Process of Developing a WHO Dementia-Friendly Community Global Toolkit: Input From Multiple Stakeholders
Authors: Sun Fei , Seeher Katrin , Fréel Stéfanie , Dua Tarun 
Published: December 2020

Abstract
This study examined the process that the Department of Mental Health and Substance Abuse of WHO used to develop a global toolkit for dementia friendly initiatives (DFI). Data were collected through a mix-method approach consisting of individual interviews of 20 DFI leaders, four focus group interviews of persons living with dementia (PWD), three group interviews of professionals, and an online survey of 129 participants from 46 countries. Data from multiple sources were examined. The meaning of DFIs centered on the needs of PWD, multi-sector collaboration, and physical and social environmental changes. Over 70% participants in the survey reported their DFIs targeted PWD and included PWD as important partners. The EASTT model can be used to summarize DFI strategies including Education, Advocacy, Support, Training and Transforming environment. Countries advanced in DFI tended to focus on enhancing professional capacity and environmental adaptation, while countries launching DFI appeared to prioritize dementia awareness campaigns.
The Association of Nursing Home Staffing Levels With Consumer Complaints
Authors: Peterson Lindsay , Bowblis John , Jester Dylan , Hyer Kathryn 
Published: December 2020

Abstract
Nursing homes (NH) are inspected annually, however, residents and others can file complaints any time. Complaints are critical to NH oversight. Another important quality factor is staffing. Our objective was to examine the association of complaints and staffing levels in a 2017 sample of 14,194 freestanding NHs. We used federal data on NH complaints, quality, staffing, and other characteristics. The outcomes were having received at least one complaint (or not) and numbers of complaints. Using logit and negative binomial regression, controlling for facility and resident characteristics, we found greater registered nurse, nursing assistant, and social services staffing were associated with fewer complaints. Interestingly, licensed practical nurse (LPN) staffing was associated with a higher likelihood of receiving a complaint. Results are consistent with literature on nurse staffing and quality. LPN results raise questions about substituting LPNs for RNs. The social services results show social services staffing may be important for quality.
Pathways to and Consequences of Surrogate Decision-Making for Older Adults
Authors: Teaster Pamela , Bolkan Cory , Meyers Shawn 
Published: December 2020

Abstract
With a burgeoning aging population, there is a growing need for surrogate decision makers, yet oversight of and guidance for them remains inadequate. People needing surrogate decision makers are an especially vulnerable population because they rely on others for care and/or are unable to advocate for themselves. Their vulnerability leaves them susceptible to elder abuse (e.g., physical, sexual, psychological abuse; active and passive neglect; financial exploitation), which affects approximately five million older Americans each year. Personal, financial, and societal impacts can be devastating and are estimated to cost billions annually. The issue of abuse, neglect and exploitation by surrogates has been highly visible nationally, evidence indicates that some surrogate decision makers perpetrate abuse. One purpose of this symposium is to discuss ways in which surrogates do and do not make decisions for older adults. Ramsey-Klawsnik and Burnett present data at the systemic level to illustrate how self-neglect sequelae can result in placement under surrogate decision-making authority of either well-intended or opportunistic others. Bolkan, Teaster, Ramsey-Klawsnik, and Gerow present findings from a six-state study on surrogate decision maker victims and perpetrators who were substantiated in Adult Protective Services cases. Zhao, Katz, and Teaster show, using a survey of M-Turk participants, how a general population makes and is comfortable with surrogate decisions. Discussant Shawn Meyers will pull together the findings by exploring their translation to judicial best practices for making determinations regarding surrogate decision makers and the effects of their decisions on the surrogate as well as collaterals.
A Scenario-Based Investigation of Surrogate Decision Making for Older Adults
Authors: Zhao Yuxin , Katz Benjamin , Teaster Pamela 
Published: December 2020

Abstract
Surrogate decisions involve complex, challenging choices; surrogate decision-makers make treatment decisions for approximately 40% of hospitalized adults and 70% of older adults, and up to 95% of critically ill adults of any age. The purpose of our study was to understand how people make decisions for others and how surrogate decision making is linked to people’s cognition, self-efficacy, and demographics, especially differences in acute (e.g., health and medical care, financial management, and end of life) versus general scenarios (spending time with family, contacting an insurance company on behalf of a family member). Participants were recruited through Amazon’s Mechanical Turk. We collected data from 290 adult participants aged 18 years or older. On average, people reported a higher level of confidence in general versus acute scenario. The differences of confidence in scenario-based surrogate decision-making links to decision-makers’ cognition, self-efficacy, the experience of decision-making, the experience of caregiving, and demographic factors.
Disparities in the Access to Different Types of Long-Term Care Services in Taiwan
Authors: Chen Ya-Mei , Young Yuchi , Wu Shih-Cyuan , Chen Hsiu-Hsi , Yeh Yen-Po , Chiu Wan-Yu , Chung Kuo-Piao 
Published: December 2020

Abstract
Taiwan implemented version 1.0 of its 10-Year Long-Term Care Plan (TLTCP 1.0) in 2007, and version 2.0 (TLTCP 2.0) in 2017. The aim was to develop a system of home- and community-based services (HCBS) for long-term care (LTC). This study assessed and compared disparities in access to LTC services using one county’s database that claims made by 14,051 older adults who applied for LTC services from TLTCP 1.0 (n = 5,025) and TLTCP 2.0 (n = 9,026). We assessed LTC disparities related to five sociodemographic factors (age, gender, living status, urbanization, income status) and seven types of LTC services. Older adults who lived in a city were more likely to use multiple HCBS and transportation services. Older adults who lived alone were more likely to use home care and meal services but not other types of LTC services. All disparities in service use increased from TLTCP 1.0 to TLTCP 2.0. Part of a symposium sponsored by International Comparisons of Healthy Aging Interest Group.
Antipsychotic and Psychotropic Prescribing in Assisted Living
Authors: Zimmerman Sheryl , Sloane Philip , Wretman Christopher , Miller Stephanie , Preisser John 
Published: December 2020

Abstract
The Center for Medicare & Medicaid Services has brought national attention to potentially inappropriate antipsychotic prescribing for residents with dementia in nursing homes, but no such attention has been paid to prescribing in assisted living (AL), despite the fact that more than 40% of AL residents have moderate/severe dementia. This study examined antipsychotic and other psychotropic prescribing in AL using a seven-state sample of 250 communities, and examined correlates of prescribing; analyses used weights based on probability proportional to bed size to derive state-level estimates. Overall, 19% of residents were taking an antipsychotic medication (27% of those with dementia); corresponding numbers for antidepressants were 46% (54%) and for anxiolytics/hypnotics were 24% (28%; both p &lt;.001). By way of example, communities that did not have an RN or LPN were more likely to prescribe antipsychotics (34% vs. 17%; p&lt;.001). The discussion will highlight next steps regarding practice, policy, and research.
Reframing Aging-in-the-Right-Place for Housing Insecure Older Adults
Authors: Canham Sarah , Wada Mineko , Golant Stephen 
Published: December 2020

Abstract
Amidst rising costs of housing and changing personal needs, considerations of the availability of appropriate and accessible housing are becoming increasingly salient for older adults. While it has been widely acknowledged that older adults would prefer to age-in-place, recent reframing of this trend promotes the ideal as aging-in-the-right-place. This symposium will provide an updated understanding of how to support older adults’ ability to age-in-the-right-place, regardless of income or physical, mental, or social status. Presenters include international and interdisciplinary researchers representing perspectives from gerontology, social work, community planning, and health sciences. The symposium will begin with Wada examining resilience scholarship, with a focus on older people who are experiencing homelessness, which has been largely neglected. In the next presentation, Humphries will outline distinct, senior-specific needs and shelter/housing solutions for newly and chronically homeless older adults. Following, Canham will describe promising practices of shelter/housing to support aging-in-the-right-place for older people experiencing homelessness in Montréal, Calgary, and Vancouver identified through an environmental scan. Extending these efforts to an international scale, Mahmood will outline findings from a scoping review of supportive shelter/housing options, supports, and interventions. A final presentation will report on how community development practices implemented by a not-for-profit affordable housing provider promote older tenants’ food security and social support needs. Stephen Golant, a leading expert on housing, geography, and long-term needs on older adults, will discuss implications of these studies for policy and practice for supporting housing insecure older adults while advancing scholarship on aging-in-the-right-place for this marginalized population. Environmental Gerontology Interest Group Sponsored Symposium.
Lessons From an Evaluation of a Training Program of Paid Eldercare Workers
Authors: Ayalon Liat 
Published: December 2020

Abstract
The present study is based on a three-year evaluation of an Israeli training program for local paid elder care workers, called “community care.” Interviews were conducted with all stakeholders involved in the program, including program developers, facilitators, funders, trainees, dropouts, employers, and older care recipients. Qualitative thematic analysis was used, supplemented by quantitative data concerning the program’s inputs, outputs and outcomes. The program had multiple strengths, including a substantial funding stream and a highly skilled and committed team. Yet, out of 130 participants (in the 7 training programs evaluated), only 94 completed the program and 31 were later employed as care workers. Three main challenges to the efficacy of the training program were identified. The findings stress the importance of adequately conducting the appropriate needs assessment prior to embarking on a new social program and illustrate the tension between an ideal prototype and real-life constraints.
How Long Do Older Adults Remain Homebound in the Community? Implications for Long-Term Services and Support Systems
Authors: Ornstein Katherine , Reckrey Jennifer , Bollens-Lund Evan , Ferreira Katelyn , Husain Mohammed , Liu Shelley , Siu Albert 
Published: December 2020

Abstract
A large and growing population of older adults with multimorbidity, cognitive impairment, and functional disability live in the community but are homebound (never/rarely leave home). While homebound status is associated with decreased access to medical services and poor health outcomes, it is unclear how long individuals remain homebound. We used the National Health and Aging Trends Study (NHATS), a nationally representative sample of Medicare beneficiaries age 65 and over, with survey weighting to assess duration of homebound status in the community. Among the incident homebound in 2016 (n=253) , only 28% remained homebound after 1 year. 21% died, 18% were recovered, and one-third left the home but still reported difficulty. As the locus of long-term care shifts from nursing homes to the community and models of care expand to serve the needs of the homebound, it is critical that we better understand the heterogeneity and transitions of the homebound population.
Variation in Assisted Living Regulations Within and Across States
Authors: Carder Paula , Smith Lindsey , Bucy Taylor , Winfree Jaclyn , Zhang Wenhan , Thomas Kali 
Published: December 2020

Abstract
Assisted living (AL) regulations have been long recognized as being highly variable across states. A new approach developed by our team, Health Services Regulatory Analysis, allows for a more granular identification of within-state variation in AL regulation. We identified 172 licensing classifications from the 50 states and DC representing 58 primary license types, 48 sub-types, and 66 designations that can modify a primary or sub-license. Over two-thirds (72%) of dementia-specific classifications require that all staff receive initial dementia training, compared to only one-third (33%) of general AL classifications. This trend is similarly reflected in cognitive-screening requirements, present in 67% of dementia-specific classifications and 42% of general AL classifications. Regulatory theory describes how licensing agencies respond to various forces and values. Within-state AL regulatory variation reflects a combination of oversight mandates, population-specific needs (e.g., people with dementia), historic policies, and provider influence, with implications for consumers, policy-makers and researchers. Part of a symposium sponsored by Assisted Living Interest Group.
Financing Long-Term Services and Supports: Opportunities for Overcoming Historical Roadblocks to Reform
Authors: Miller Edward , Nadash Pamela , Cohen Marc 
Published: December 2020

Abstract
This presentation documents the continuing failure to tackle the problem of financing long-term services and supports (LTSS)—a failure most recently seen in the only national legislation ever enacted to comprehensively address LTSS costs: the Community Living Assistance Services and Supports (CLASS) Act. The CLASS Act was included in the Affordable Care Act, but was repealed in 2013. Subsequently, policy experts and some Democrats have made proposals for addressing the LTSS financing crisis. Moreover, significant government action is taking place at the state level, both to relieve financial and emotional burdens on LTSS recipients and their families and to ease pressure on state budgets. Lessons from these initiatives could serve as opportunities for learning how to overcome roadblocks to successful policy development, adoption, and implementation across states and for traversing the policy and political tradeoffs should a policy window open once again for addressing the problem of LTSS financing nationally.
Learning From New State Initiatives in Financing Long-Term Services and Supports
Authors: Cohen Marc , Tell Eiileen , Albright Bonnie 
Published: December 2020

Abstract
A number of states are taking concrete action on long-term services and supports (LTSS) financing which provides an opportunity to learn about the reasons why they are doing so, to identify the coalitions that have come together in support of such actions, and to understand factors associated with the choice of particular strategies and approaches. The purpose of the presentation is to report on a comparative qualitative study across six leading-edge states—Washington State, Hawaii, Maine, Minnesota, California, and Michigan—in order to describe their activities and identify and analyze commonalities and differences in their specific approaches and programs. An overarching goal is to help state officials, consumer advocates, and interested LTSS providers understand the strategies and approaches that other states—who may be further along in their development—are taking in this area so that they might have insights into strategies that might be a fit for their state.