Geoffrey J. Hoffman

Employment, Family Leave, and Parents of Newborns or Seriously Ill Children

OBJECTIVES Parents of newborns and children with special health care needs (CSHCN) often experience conflict between employment and family responsibilities. Family leave benefits such as the federal Family and Medical Leave Act and Californias Paid Family Leave Insurance program help employed parents miss work to bond with a newborn or care for an ill child. The use of these benefits, however, is rare among mothers of CSHCN and fathers in general and limited even among mothers of newborns. We explored barriers to and experiences with leave-taking among parents of newborns and CSHCN. METHODS We conducted semistructured qualitative interviews in 2008 with 10 mothers and 10 fathers of newborns and 10 mothers and 10 fathers of CSHCN in Los Angeles to explore their need for and experiences with family leave. Qualitative analytical techniques were used to identify themes in the transcripts. RESULTS All parents reported difficulties in accessing and using benefits, including lack of knowledge by employers, complexity of rules and processes, and inadequacy of the benefits themselves. Parents of CSHCN also described being too overwhelmed to rapidly seek and process information in the setting of urgent and often unexpected health crises. Most parents expressed a clear desire for expert guidance and saw hospitals and clinics as potentially important providers. CONCLUSIONS Even when parents are aware of family leave options, substantial barriers prevent many, especially parents of CSHCN, from learning about or applying for benefits. Clinics and hospitals might be opportune settings to reach vulnerable parents at times of need.

Receipt of caregiving and fall risk in us community-dwelling older adults

Background: Falls and fall-related injuries (FRI) are common and costly occurrences among older adults living in the community, with increased risk for those with physical and cognitive limitations. Caregivers provide support for older adults with physical functioning limitations, which are associated with fall risk. Design: Using the 2004–2012 waves of the Health and Retirement Study, we examined whether receipt of low (0–13 weekly hours) and high levels (≥14 weekly hours) of informal care or any formal care is associated with lower risk of falls and FRIs among community-dwelling older adults. We additionally tested whether serious physical functioning (≥3 activities of daily living) or cognitive limitations moderated this relationship. Results: Caregiving receipt categories were jointly significant in predicting noninjurious falls (P=0.03) but not FRIs (P=0.30). High levels of informal care category (P=0.001) and formal care (P<0.001) had stronger associations with reduced fall risk relative to low levels of informal care. Among individuals with ≥3 activities of daily living, fall risks were reduced by 21% for those receiving high levels of informal care; additionally, FRIs were reduced by 42% and 58% for those receiving high levels of informal care and any formal care. High levels of informal care receipt were also associated with a 54% FRI risk reduction among the cognitively impaired. Conclusions: Fall risk reductions among older adults occurred predominantly among those with significant physical and cognitive limitations. Accordingly, policy efforts involving fall prevention should target populations with increased physical functioning and cognitive limitations. They should also reduce financial barriers to informal and formal caregiving.

Claims-based Identification Methods and the Cost of Fall-related Injuries Among US Older Adults

Objectives:Compare expenditures of fall-related injuries (FRIs) using several methods to identify FRIs in administrative claims data. Research Design:Using 2007–2009 Medicare claims and 2008 Health and Retirement Survey data, FRIs were identified using external-cause-of-injury (e-codes 880/881/882/884/885/888) only, e-codes plus a broad set of primary diagnosis codes, and a newer approach using e-codes and diagnostic and procedural codes. Linear regression models adjusted for sociodemographic, health, and geographic characteristics were used to estimate per-FRI, service component, patient cost share, expenditures by type of initial FRI treatment (inpatient, emergency department only, outpatient), and total annual FRI-related Medicare expenditures. Subjects:The analysis included 5497 community-dwelling adults ≥65 (228 FRI, 5269 non-FRI individuals) with continuous Medicare coverage and alive during the 24-month study. Results:The 3 FRI identification methods produced differing distributions of index FRI type and varying estimated expenditures:

The Cost of Caring: Economic Vulnerability, Serious Emotional Distress, and Poor Health Behaviors Among Paid and Unpaid Family and Friend Caregivers

12,171 [95% confidence interval (CI),

Underreporting of Fall Injuries of Older Adults: Implications for Wellness Visit Fall Risk Screening: Accuracy of Self-Reported Fall Injuries

4662–

Depressive symptomatology and fall risk among community-dwelling older adults

19,680],

Examining contextual influences on fall-related injuries among older adults for population health management

5648 (95% CI,

Cost-Sharing, Physician Utilization, and Adverse Selection Among Medicare Beneficiaries With Chronic Health Conditions

3819–

Interdependence in Health and Functioning Among Older Spousal Caregivers and Care Recipients

7476), and

The Financial Impact of an Avoided Readmission for Teaching and Safety-Net Hospitals Under Medicare’s Hospital Readmission Reduction Program

9388 (95% CI,