bluuebunny/crossref_metadata_2025_split huggingface dataset:
Meaningful Assessment or Minimum Compliance: PASRR for Nursing Home Residents with Mental Illness
Authors: Bucy Taylor , Moeller Kelly , Bowblis John , Shippee Tetyana 
Published: December 2021

Abstract
The Omnibus Budget Reconciliation Act (OBRA) of 1987 included provisions for the Preadmission Screening and Resident Review (PASRR) program, which requires states to create and maintain systems to assess persons with serious mental illness (SMI) seeking NH care. The prevalence of SMI in NHs is increasing, and little is known about the effectiveness of the PASRR program intervention. We conducted 20 interviews with state and national PASRR stakeholders, including assessors, hospital discharge planners, mental health advocates, geriatricians and geriatric psychiatrists. Interview data were triangulated with state provided materials on PASRR collection and implementation. Based on these interviews, we identified four themes: 1) variation in the implementation of federal PASRR legislation across states and jurisdictions, 2) the need for investment in professional development and workforce capacity, 3) lack of usefulness of PASRR in ongoing care planning, and 4) the need to consider the role of age, race/ethnicity, and stigma on quality of care for NH residents with SMI. Stakeholders agree that PASRR legislation was well intentioned, but also expressed concern regarding the completion of PASRR as an issue of compliance versus meaningful assessment. More work is needed to determine how best to develop and support the care needs of people with SMI, while being mindful of the original goals of deinstitutionalization that prompted OBRA passage. In order to assess the impact of the PASRR program on quality of care and mental health outcomes, further research should take an evaluative approach through meaningful use of PASRR data.
Direct Care Workers Employed as Medical Aides: Home Health Aides, Nursing Assistants, and Orderlies
Authors: Kelly Christopher , Deichert Jerome 
Published: December 2021

Abstract
Purpose: This study describes the differences among direct workers (DCWs) employed as medical aides in three occupations: home health aides, nursing assistants, and orderlies. Design and Methods: Data were from the 1% Public Use Microdata Sample (PUMS) of the 2019 American Community Survey (ACS). Logistic regression was used to compare demographic and employment characteristics of DCWs employed as medical aides in three occupations: home health aides, nursing assistants and orderlies. Results: Compared to orderlies and psychiatric aides, home health aides are more likely to be foreign born, more likely to be female, less likely to work in institutional settings, less likely to be under age 25, less likely to work year-round full-time, less likely to have more education, and less likely to receive insurance from their employers. Implications: Since 2018, the PUMS of the ACS separates nursing, psychiatric, and home health aides (previously one occupational category) into three: home health aides, nursing assistants, and orderlies. This affords researchers a more precise understanding of this part of the direct care workforce. Home health aides represented more than 2/3 of DCWs employed as medical aides in 2019. Further, these workers are distinct among medical aides. More than nursing assistants and orderlies, home health aides are older, female, underinsured, foreign-born, and with limited education. This reflects both the barriers home health aides face to other occupations and also the preferences of their employers (which include private households). These findings have implications for the recruitment and retention of medical aides across all three occupations.
The Preservation of Spousal and Partner Relationships Among Nursing Home Residents
Authors: Shaw Shanae , Csikai Ellen 
Published: December 2021

Abstract
The decision to seek placement in a nursing home may be especially difficult for spouses or partners of the potential nursing home residents. Disruption of the attachment relationship following placement may influence the psychosocial well-being of nursing home residents. Although the responsibility of nursing home staff is to ensure psychosocial well-being, including awareness of the influence that separation can have on a spousal or partner relationship, little is known about services offered for the maintenance of spousal and partner relationships. This study was conducted to identify nursing home practices that had preservation of spouse/partner relationships as the goal. A mixed methods approach utilized both an online survey (81 respondents) with nursing home social workers in four Southern states and ten telephone interviews (from among the respondents). Survey results revealed that 49% of respondents’ facilities had a written policy to preserve these relationships, however, only 22% reported having a specific formal program to carry this out. In the interviews, participants expanded on survey topics and shared that facilitating outings and encouraging participation in routine facility activities were commonly used to preserve relationships. Privacy was discussed as being important in maintaining relationships and also found to be a barrier to doing so. Nursing home social workers can utilize the results in the design and implementation of specific services to preserve relationships and maintain strong attachment between residents and their spouses/partners. These will be best carried out in a coordinated, collaborative manner among multiple disciplines within the nursing home setting.
When Advocates are Forced to go Virtual: The Long-Term Care Ombudsman Response to COVID 19
Authors: Nelson H Wayne , Netting F Ellen , Carter Mary W , Yang Bo Kyum 
Published: December 2021

Abstract
This study explores strategies used by the nation’s Long-Term Care (LTC) Ombudsman Programs (LTCOP) to perform their grass roots, investigatory, sentinel defense advocacy during the near total COVID LTC lock out from March 13th 2020 through September 17th, when the “ban” was conditionally lifted. Our layered systematic searches by title, subject, and total text for unrestricted allusions to the LTCOP used the multi-disciplinary database Academic Search Ultimate that includes mass media. Selection criteria included print and broadcast news. Search keywords were “ombudsman” singly and with 10 other terms. This was augmented by reviewing the National LTC Ombudsman Resource Center (NORC) clearinghouse information website and by interviewing NORC staff. Resulting (172) media entries (92% print) were manually coded independently by a team of five, and iteratively reconciled according to a simple flat frame format to identify key words and associated themes. Four main LTCOP lock out strategies emerged: (1) virtual resident interventions (via phone, Skype, Zoom, in-facility allies); (2) public outreach (services provided, sharing COVID data and best practices, social isolation threats and mitigation efforts [window visits], need for volunteers); (3) systems advocacy (state/federal; CMS, legislative and other testimony about social isolation, CARES Act check problems, visitation issues; and (4) partnering with others (multi-agency planning groups, task forces, Zoom town halls, interstate information sharing). NORC interviews revealed that older LTCOP volunteers are seizing the COVID lock-out to retire undermining an already short-staffed network—so calls for volunteers were evident in about 25% of all stories regardless of any other focus.
When Is a Nursing Home Complaint Really a Complaint? Making Sense Out of Increased Complaints in U.S. Nursing Homes
Authors: Qiu Xiao , Straker Jane , Abbott Katherine 
Published: December 2021

Abstract
Official complaints are one tool for addressing nursing home quality concerns in a timely manner. Similar to trends nationwide, the Ohio Department of Health (ODH) has noticed a trend in increasing nursing home complaints and has partnered with the Scripps Gerontology Center to learn more about facilities that receive complaints. Greater understanding may lead to proactive approaches to addressing and preventing issues. This study relies on two years of statewide Ohio nursing home complaint data. Between 2018 and 2019, the average complaint rate per 100 residents went from 6.59 to 7.06, with more than 70% of complaints unsubstantiated. Complaint information from 629 Ohio nursing homes in 2018 was linked with Centers for Medicare and Medicaid Services Nursing Home Compare data, the Ohio Biennial Survey of Long-Term Care Facilities, and Ohio Nursing Home Resident and Family Satisfaction Surveys. Using ordered logistic regression analyses, we investigated nursing home providers' characteristics using different levels of complaints and substantiated complaints. Findings suggest that providers with higher complaint rates are located in urban areas, had administrator and/or director of nursing (DON) turnover in the previous 3 years, experienced decreased occupancy rates, had reduced nurse aide retention, and received lower family satisfaction scores. Additionally, providers with administrator and/or DON turnover, and low family satisfaction scores are more likely to have substantiated complaints. Because increasing numbers of complaints are accompanied by relatively low substantiation rates, policy interventions targeted to specific types of providers may improve the cost-effectiveness of complaint resolution, as well as the quality of care.
Perceptions and Impacts of COVID-19 on Family Caregivers
Authors: Balmuth Alexa 
Published: December 2021

Abstract
For many family caregivers, COVID-19 has presented new obstacles to providing elder-care while balancing additional responsibilities such as work or childcare. Three survey waves explored impacts over the course of the pandemic. Family caregivers demonstrated resilience, taking a variety of measures to care for and protect family; caregivers were also more confident in their ability to protect loved ones age 60+ from contracting COVID-19 than non-caregivers. However, COVID-19’s toll on caregivers was evident. Caregivers reported higher personal burnout than non-caregivers, and across all three survey waves, consistently reported greater degrees of worry in regards to COVID-19 in general, as well as its impacts on domains including the health and wellbeing of themselves and family members, and near and far term finances. This presentation will highlight how caregivers’ perceptions and impacts of COVID-19 have evolved over the course of the pandemic, and implications of these findings for life tomorrow.
Personal Care Aides in residential care and adult day centers: differences in training, benefits, and roles
Authors: Sengupta Manisha , Ejaz Farida 
Published: December 2021

Abstract
Personal care aides (PCAs), along with other direct care workers, provide the hands-on care, including help with activities of daily living for individuals receiving care in residential care communities (RCC) and adult day services centers (ADSC). Recruitment and retention of such workers is a challenge as low pay, inadequate training, unsatisfactory roles and lack of benefits contribute to turnover. Using data from the 2018 National Study of Long-Term Care Providers, the only nationally representative data about PCAs in RCCs and ADSCs, this study will assess differences in training hours, benefits, and work roles among PCAs in these settings. About 76% of RCCs and 66% of ADSCs employed aides. On average, PCAs received 32 hours and 51 hours of initial training in ADSCs and RCCs, respectively. Results from bivariate analyses (accounting for complex survey design), showed that benefits received by PCAs varied by sector. A higher percentage of PCAs in ADSCs than in RCCs received health insurance for employees (60% vs. 46%), and pension (51% vs. 40%). About 51% of ADSCs and 46% of RCCs reported that PCAs rarely or sometimes attended care plan meetings. Further, 11% of RCCs and 15% of ADSCs reported that aides rarely or sometimes worked with the same care recipient. This overview of PCA activities, training and benefits may provide insights into approaches to improve the retention of PCAs and subsequently the quality of care provided across sectors.
The Impacts of COVID-19 on Technology Use and Experience Across Generations
Authors: Lee Chaiwoo , FakhrHosseini Shabnam , Rudnik John 
Published: December 2021

Abstract
Among its many downstream effects, the COVID-19 pandemic has influenced how people think about and interact with technology. With limitations and restrictions around in-person interactions and use of public spaces, people are increasingly relying on technology to support everyday activities including work, communication and care. Results from the survey series showed an increased adoption of and interest in home, health and communication technologies. The changes may be long-lived, with the majority of the new adopters saying that they will continue to use the technologies that they started using in response to the pandemic. A generational comparison showed that while baby boomers and the silent generation were less likely than younger adults to have made recent adoptions, the older generations did not significantly differ in terms of interest in using new technologies. This presentation will also report on how COVID-19-related changes in technology experience varied by other demographic and socio-economic characteristics.
Different Statistical Approaches to Develop a Guideline for Improvement of Caregiver’s Mental Health
Authors: Leggett Amanda , Koo Hyun Jung 
Published: December 2021

Abstract
Caregiver burden is common, and improvement of caregivers’ mental health could lead to better quality of care and well-being for both caregivers and care recipients. We investigate ways to develop a guideline to enhance caregiver’s mental well-being by applying and comparing regression tree and ensemble tree models. Data comes from the 2017 National Health and Aging Trends Study and National Study of Caregiving. Dementia caregivers’ (n=945) aspects of caregiving, care activities, support environment, and participation along with basic demographics and health are considered. First, insignificant predictors are preselected using linear regression with backward selection, which will not be included in the tree models. Using the predetermined predictors that are not excluded in the backward selection method, regression tree and ensemble tree models are generated to predict emotional difficulty of caregivers. The regression tree with the preselected predictors predicts caregivers with low to moderate levels of overload and high levels of joy being with their care recipient associated with the lowest level of emotional difficulty. On the other hand, if caregivers have high levels of overload and low to moderately high levels of positive affect, this is linked with the highest level of emotional difficulty. Ensemble tree models showed similar results with lower error measures. Using tree-based methods can help determine the most important predictors of caregiver mental health. Easily interpretable results with applicable decision rules can provide a guideline for intervention developers.
Sleep Health, Depression, Pain and Quality of Life among Older Adults during the First Months of the Covid-19 Pandemic
Authors: Lorenz Rebecca , Stallings Devita , Palmer Janice , Lach Helen 
Published: December 2021

Abstract
To slow the spread of Covid-19, many states instituted restrictions on group size for religious services, exercise, and social engagement. We are beginning to understand the effect of these mandates on older adults. The purpose of this study was to examine the relationships between sleep health, depression, pain, and quality of life (QOL) among older adults during the initial months of the Covid-19 pandemic. Older adults completed an anonymous online survey to collect data including personal characteristics, behaviors, and health conditions during May-September 2020. Sleep Health was assessed with a survey of satisfaction, timing, efficiency, and duration of sleep along with daytime alertness. Pearson correlations were used to explore relationships between age, education, socioeconomic status, pain, depression, and QOL. Participants (N=509) were primarily female (n=392, 77%), white (n=466; 92%), college educated (n=471, 93%) and with a mean age of 75.6 years (SD=5.0; range 63-93 years). Mean Sleep Health score was 7.4 (SD=2.1; range 0-10). Higher (better) Sleep Health scores were associated with education (r=.15, p&lt;01) and socioeconomic status (r=.17, p&lt;.01) and lower scores with depression (r= -.35, p&lt;.01), pain (r= -.23, p&lt;.01), and QOL (r= -.26, p&lt;.01). Poorer Sleep Health among older adults during the initial months of the pandemic were associated with depression, pain, and reduced QOL. Sleep, depression, and pain have reciprocal relationships that may have lasting consequences on physical and mental health among older adults. These findings suggest that poor sleep health should be identified and treated to improve QOL among older adults.
The Interplay Between Retirement Transition Sequences and Mental Health: Focusing on Gender Differences
Authors: Shin Oejin , Park Sojung , Kim BoRin 
Published: December 2021

Abstract
Although retirement has been given a substantial amount of attention, there are gaps in the literature on 1) the various forms of retirement (nature= voluntary/involuntary, timing= early/ late, type= full/ partial) using with previous employment history, and 2) gender differences in retirement transition. Drawing on the life course perspective, this study examined the gender differences in retirement transition sequences using the labor participation history and various forms of retirement. Data are from the 2004 to 2016 HRS with 1,653 older workers. Sequence analysis was used to answer how individuals experienced retirement in the extended time frame. OLS regression analysis was used to estimate the relationship between retirement transition sequences and depression. For both genders, eight clusters of retirement transition sequences were identified. However, the most prevalent group for males was those who experience voluntary retirement transition from full-time work in mid-time point (19%), while the most prevalent group was a gradual involuntary retirement (21%) for females. Regarding the association with depression, those who experienced voluntary retirement after full-time work in all different time points (early, mid, late) and those who retired from self-employment were less likely to have depressive symptoms for males. For females, only those who experienced voluntary retirement from full-time work in mid-time point were less likely to have depressive symptoms. This result contributes to identifying the heterogeneity of retirement transition sequences and their association with depression. The result suggests important implications of gender-specified intervention programs to prevent involuntary retirement and mental health support program for involuntary retirees.
Exploring the Impact of Alcohol and Other Drug Use on HIV Care Among African American Older Adults Living with HIV/AIDS
Authors: Harris Lesley , Silverstein Sydney , Crawford Timothy , Kerr Jelani , Ball Diana 
Published: December 2021

Abstract
For people living with HIV, there are multiple barriers to engagement with care. This study qualitatively examines the role of use of alcohol and other drugs (AOD) on the health and management of Human Immunodeficiency Virus (HIV) disease among older African Americans (≥50 years). It draws on interviews conducted with twenty-seven older African Americans living with HIV in the Louisville, Kentucky area. Interviews were transcribed verbatim and then analyzed using constructivist grounded theory analytic techniques. Participants’ understandings of their AOD use fell on a continuum of problematic use to use for self-care. Regardless of where participants fell on this continuum, they faced a) environmental impacts of AOD use and b) current or historic discrimination from the health care system. The analysis focused on gaining a deeper understanding of the intersection of AOD use and engagement in the HIV care continuum. This revealed six major phases, which occurred at various stages of the continuum: (1) Linking AOD use as the cause of HIV diagnosis (2) Having AOD use facilitate denial of HIV, (3) Experiencing problematic use, (4) “Testing the Waters,” (5) Relying on AIDS Service Organizations (ASO) and medical providers and (6) Maintaining health and/or using AOD for self-care. We discuss the ways that stigma along the lines of race, gender, and age intersect with co-occurring conditions such as substance use disorders in complex and multifaceted ways. Recommendations include assessing a patients’ AOD use in relationship to the HIV care continuum to assess patients’ experiences and barriers within systems of care.
Motivation to Learn at the Intersections of Age, Gender, and Race
Authors: Yamashita Takashi , Smith Thomas , Sahoo Shalini , Cummins Phyllis 
Published: December 2021

Abstract
Continuing adult education and training, or lifelong learning, has become increasingly important to fully engage in rapidly changing technology and information-rich societies. However, without motivation to learn (MtL), lifelong learning participation is unlikely to occur. Although previous research has identified lifelong learning gaps by various demographic characteristics, including age, gender, and race/ethnicity, little is known about the intersectionality or differences in MtL across specific sub-groups (e.g., older Black women vs. older Black men) at the national level. The current study analyzed U.S. data from the 2012/2014/2017 Program for International Assessment of Adult Competencies (PIAAC) to examine MtL at the intersections of age (five 10-year age groups), gender (women vs. men), and race (White vs. Black). The previously established 4-item latent MtL construct was evaluated for twenty sub-groups using the alignment optimization method, which is a machine learning algorithm for latent mean estimation and simultaneous multiple group comparisons. Results showed that the latent MtL construct was validly measured across the sub-groups, and the estimated sub-group means were then used to develop a national MtL profile. Overall, older adults tended to have lower MtL than younger age groups. Notably, compared to than older Black men age 66+ years, older White men aged 55-65 and 66+ years old had lower MtL (latent mean differences of -0.29 and -0.41, respectively, p &lt; .05). Additionally, older Black women had significantly lower MtL than older Black men (latent mean difference = -0.50, p &lt; .05). The national MtL profiles, the intersectionality and policy implications were discussed.