Brooke Hollister

Normalcy, Boundaries, and Heterosexism: An Exploration of Online Lesbian Health Queries

This research examines health queries posed to an online, lesbian-centered “Ask the Doctor” service. Quantitative content analysis and grounded theory analysis techniques were used to identify prevalent health and health care concerns and identify qualitative themes. Queries primarily addressed sexual/gynecological health, conception/family planning, and culturally competent health care services. The content of queries was shaped by the desire to conform to social norms, the presence of symptoms/behaviors that transcend bodily boundaries, and encounters with heterosexist health care. These contextual factors also contributed to individuals’ conceptions of risk and health behaviors. Implications for future research and health promotion strategies are discussed.

Local Long-Term Care Ombudsman Program effectiveness and the measurement of program resources.

Local Long-Term Care Ombudsman Programs (LLTCOPs) protect the health, safety, welfare, and rights of residents in long-term care (LTC) facilities. This study examines the (a) existing resources available to LLTCOPs in Georgia, California, and New York, (b) relationship of resources to LLTCOP’s reported effectiveness in meeting its federal mandates, and (c) state-specific mediating factors influencing LLTCOPs’ resources and reported effectiveness. Quantitative and qualitative data from the National Ombudsman Reporting System (NORS) and a telephone survey of LLTCOPs in Georgia, California, and New York were collected and analyzed. Resource adequacy, as measured by beds per full-time equivalent staff (beds/FTE), is inconsistently associated with effectiveness in meeting federal mandates across and within the states studied. Analysis of alternate resource measures suggests a threshold of LLTCOP size, under which program effectiveness may be lower. LLTCOPs report the changing LTC environment and additional state mandates as factors influencing resource adequacy.

Factors associated with perceived effectiveness of local long-term care ombudsman programs in New York and California.

Objectives: Long-term care (LTC) ombudsmen advocate for the health, safety, welfare, and rights of residents in LTC facilities. This article examines factors associated with self-rated effectiveness of local LTC Ombudsman Programs (LTCOPs) in California and New York across the five statutorily mandated activities under the Older Americans Act: complaint investigation, resident/family education, community education, monitoring laws, and policy advocacy. Method: Data were collected from telephone interviews with coordinators of local LTCOPs in California and New York and from the National Ombudsman Reporting System. Analyses examined factors associated with effectiveness: program size, resource adequacy, organizational autonomy, interorganizational relationships, and program outputs. Results: Resource and autonomy measures are significantly associated with different effectiveness measures in each state. Staff full-time equivalencies and coordinator hours per week in New York and the quality of training in California are significantly associated with effectiveness in most mandated activities. Discussion: Findings highlight variability within and between the local LTCOPs in California and New York.

Dementia-Capable Care Coordination in Duals Demonstration Programs: Workforce Needs, Promising Practices, and Policy

Background and Objectives This study describes the program requirements, workforce competencies, and barriers for dementia capable care coordination within health plans from seven states participating in the Center for Medicare and Medicaid Services demonstration programs for dually-eligible Medicare and Medicaid beneficiaries. Research Design and Methods Data came from contracts, policy documents, and 24 semistructured key informant interviews with national experts and leaders from community-based organizations, advocacy organizations, researchers, federal and state government, and health plans in the seven states. Results Contracts included language mandating care coordination practices deemed dementia-capable, including workforce qualifications, training, and experience; dementia screening; involvement of a caregiver in the care planning process; and education, support groups, and referral resources for people with dementia and their caregivers. There was little consistency across states in their dementia capable requirements and informants questioned the dementia capability of the care coordination workforce and practice. However, promising practices and areas for improvement were identified. Discussion and Implications The variability of the duals demonstrations made it difficult to compare across states. The three-way contracts were often the starting point of a process to more clearly define policies and practices in each state including workforce requirements. Efforts should be made to further adopt and translate evidence-based practices into health systems and evaluate promising practices.

Dementia Cal MediConnect: Creating Partnerships Between Health Plans and Alzheimer’s Organizations to Improve Care in the Dual Eligibles Pilot

People who are living with dementia are highly reliant on family and other unpaid caregivers because of their cognitive impairment and inability to manage self-care. Family caregivers are essential members of care teams, as they carry out care plans and facilitate access to support services. Hence, health care for this population is best delivered in active partnership with family caregivers and community-based Alzheimer’s organizations. With the innovations inspired by the Affordable Care Act, there have been opportunities to implement more coordinated systems of care that seek to engage unpaid caregivers and community providers in the care process and to improve outcomes while controlling costs. One such opportunity is the Federal Centers for Medicare and Medicaid Services’ (CMS) Financial and Administrative Alignment Initiative, a national demonstration program operating in 13 states. This demonstration project (sometimes called the Duals Demonstration) seeks to better coordinate medical care and long-term services and supports (LTSS) for individuals who are dually eligible for Medicare and Medicaid. For dually eligible people living with dementia, these demonstrations have the potential to deliver care in less expensive, community-based settings, which are preferred by most patients and families. In 2013, the State of California’s Department of Aging, in partnership with Alzheimer’s Greater Los Angeles, was awarded a grant from the Alzheimer’s Disease Supportive Services Program of the federal Administration for Community Living (ACL). The aim was to better the care coordination provided to people with dementia in Cal MediConnect (CMC), California’s Financial Alignment Initiative pilot. The project, called Dementia Cal MediConnect (Dementia CMC), built upon the opportunities provided by the federal demonstration’s primary objectives: to improve health care outcomes and expand access to health care and LTSS while controlling cost. With a capitated payment for each member served, CMC incentivized plans to provide necessary care in the appropriate environment. It offered an opportunity to strengthen homeand community-based LTSS and to integrate them better with medical care with the hope of improving care processes and reducing hospitalizations and institutionalization (two of the main drivers of medical expenses for the duals population and for people living with dementia). While the Dementia CMC Project focused on dually eligible health plan members in the CMC pilot, it offered the possibility of improving dementia care more broadly, as it was well known that health plans tend to disseminate

Beneficiaries Respond To California’s Program To Integrate Medicare, Medicaid, And Long-Term Services

In 2014 California implemented a demonstration project called Cal MediConnect, which used managed care organizations to integrate Medicare and Medicaid, including long-term services and supports for beneficiaries dually eligible for Medicare and Medicaid. Postenrollment telephone surveys assessed how enrollees adjusted to Cal MediConnect over time. Results showed increased satisfaction with benefits, improved ratings of quality of care, fewer acute care visits, and increased personal care assistance hours over time. Enrollees also had somewhat better prescription medication access and lower unmet needs for personal care, compared to the comparison group. The lack of improvement in care coordination raises concerns about the implementation of the care coordination benefit, a key feature of the program. The Bipartisan Budget Act of 2018 contains provisions that permanently certify the use of managed care (such as Dual Eligible Special Needs Plans) to integrate Medicare and Medicaid, which makes the lessons learned from Californias duals demonstration especially relevant for informing other integrated programs for seniors and people with disabilities.

“LEAVE ME ALONE”: THE LIVE ALONE PROJECTS—SUPPORTING LIVING ALONE WITH DEMENTIA

IOPPN, London, United Kingdom; IOPPN, King’s College London, London, United Kingdom; NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation, London, United Kingdom; King’s College London, London, United Kingdom; Pharmacy Department, South London & Maudsley NHS Foundation Trust, London, United Kingdom. Contact e-mail: delia.bishara@slam.nhs.uk