Shahla Mehdizadeh

Fall Risk Factors in Community-Dwelling Elderly Who Receive Medicaid-Supported Home- and Community-Based Care Services

Objective: This study identifies fall risk factors in an understudied population of older people who receive community-based care services. Method: Data were collected from enrollees of Ohio’s Medicaid home- and community-based waiver program (preadmission screening system providing options and resources today [PASSPORT]). A total of 23,182 participants receiving PASSPORT services in 2005/2006 was classified as fallers and nonfallers, and a variety of risk factors for falling was analyzed using logistic regressions. Results: The following factors were identified as risk factors for falling: previous fall history, older age, White race, incontinence, higher number of medications, fewer numbers of activity of daily living limitations, unsteady gait, tremor, grasping strength, and absence of supervision. Discussion: Identifying risk factors for the participants of a Medicaid home- and community-based waiver program are useful for a fall risk assessment, but it would be most helpful if the community-based care service programs incorporate measurements of known fall risk factors into their regular data collection, if not already included.

Using high-intensity care management to integrate acute and long-term care services: substitute for large scale system reform?

This study evaluates a demonstration that used high intensity care management to improve integration between the acute and long-term care service systems. The demonstration intervention included the use of clinical nurse care manager, supervised by a geriatrician, to supplement an existing in-home care management system. Chronically disabled home care clients age 60 and over were randomly assigned (N = 308) to receive enhanced clinical services plus traditional care management, or to the control group, to receive the normal care management services provided. Treatment group members were expected to experience lower use of hospitals and nursing homes and lower overall health and long-term care costs. Research subjects were followed for up to 18 months using Medicare records and mortality data. A sub-sample (N = 150) also received in-person interviews to cover a range of health and social outcomes anticipated as a result of the intervention. Although there was some variation in health use and cost across treatment and control groups over the 18 month time period, the overall conclusion is that there were no differences between groups on any of the outcome variables examined. Efforts to integrate the acute and long-term care systems have proven to be difficult. This intervention, which attempted to create integration through high intensity care managers, but without financial or regulatory incentives, was simply unable to create enough change in the care system to produce significant change for the clients served.

The changing world of long-term care: a state perspective.

Abstract Based on data from an eight year longitudinal study of Ohios long-term care use patterns, this paper describes the changes now being experienced by this industry. Although Ohio has been a state with a heavy reliance on institutional services, the data suggest a change in how long-term care is provided in the state. Over the past eight years, despite an increasing disabled older population, nursing home occupancy rates have fallen from 92.5% to 83.5%. At the same time, in-home service and assisted living use has increased. The paper concludes by describing how such changes are likely to impact the system of the future.

Worker Injuries and Safety Equipment in Ohio Nursing Homes

A survey of Ohio nursing homes was conducted in 2007 to examine whether injury rates were related to facility characteristics and availability of safety equipment. The median rate of injury in the 898 facilities was 5.7 injuries per 100 workers per year. Although 95% of the facilities had written resident lift-ing policies, only 22% of these were zero-lift policies. Gait transfer belts(99%) and portable total-lift hoists(96%) were common, whereas ceiling-mounted total-lift hoists were rarely reported (7%). In a multivariable analysis, injury rate ratios increased with the proportion of residents using wheel-chairs and were lower in smaller facilities. Facilities without a lifting policy had a higher estimated injury rate than facilities without such a policy; however, none of the safety equipment was associated with significant changes in injury rates. More information, such as frequency of use and access to ver-sus availability of equipment, may be needed to better understand the im-pact of safety equipment on nursing home worker injury rates.

Functional Status and Adaptation: Measuring Activities of Daily Living and Device Use in the National Health and Aging Trends Study:

Objective: The objective of this study is to evaluate the functional status and adaptation of older Americans and discover the factors that contribute to device use. Method: Using the community participants’ portion of the first round of National Health and Aging Trends Study (NHATS), we demonstrate the prevalence of device use and reduction in activities, creating a multilevel measure of activities of daily living (ADL) functionality as compared with Katz’s dichotomous measure. In determining whether adaptation is universal irrespective of age, sex, race, living arrangement, and income, or dependent on these variables, we create a measure of device use, performing a path analysis of the device use measure and sociodemographic variables, with disability score as an intervening measure. Results: ADL functionality becomes more nuanced between the Katz-ADL and NHATS-ADL. Age, sex, and living arrangement were predictors of device use; income was indirectly, whereas race was not. Discussion: When assessors design service plans, consideration should be given to older adults’ ability, capacity, and resources to adapt.

Here's to Your Health: Will They Stay or Will They Go? Predicting disenrollment from home care services to nursing homes using classification trees

According to the U.S. Department of Health and Human Services, there are 36 million adults over age 65 living in the United States, representing 12% of the population. This segment of the population is expected to increase to more than 70 million by 2030. The number of individuals age 85 and older—who are more likely to be disabled and in need of services for chronic disability than members of the general population—is predicted to increase by 44% between 2005 and 2020. Although the majority of daily custodial care (referred to as long-term care) is paid privately, Medicaid plays a major role. Long-term care services are provided in a variety of settings, including homes, residential care, and nursing facilities. A high proportion of people who disenroll from homecare services leave for nursing homes, and nursing homes are the most expensive option. Policymakers naturally would like to know if any policy interventions would make it possible for the elderly to stay at home longer. A related important question that can be assessed with available data is: Among those individuals who have been enrolled in a homecare services program, who is most likely to disenroll and enter a nursing home? Something Other Than Logistic Regression?