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Journal article
Associations Between Use of Paid Help and Care Experiences Among Medicare-Medicaid Enrolled Older Adults With and Without Dementia
The journals of gerontology. Series B, Psychological sciences and social sciences, v 77(12), pp e216-E225
29 Dec 2022
PMID: 35554530
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Community-living older Medicare and Medicaid enrollees ("dual-enrollees") have high care needs and commonly receive paid and unpaid long-term services and supports (LTSS) to help with routine activities. Little is known about whether receiving paid help or individuals' state and neighborhood environmental context ("LTSS environment") relates to dual-enrollees' care experiences.
We examine a sample of n = 979 community-dwelling dual-enrollees with disabilities from 2011 to 2015 National Health and Aging Trends Study, linked to measures of neighborhood disadvantage and state Medicaid home and community-based services (HCBS) generosity. Logistic regression models stratified by dementia status assess associations between paid help and: (a) adverse consequences due to unmet care needs, and (b) participation restrictions in valued activities, among dual-enrollees with and without dementia, adjusting for individual and LTSS environmental characteristics.
Use of paid help was greater for those with (versus without) dementia (46.9% vs. 37.8%). Neighborhood disadvantage was associated with greater use of paid help among dual-enrollees living with dementia. High state Medicaid HCBS generosity was associated with the use of paid help, regardless of dementia status. Dual-enrollees with dementia receiving paid help had higher odds of experiencing adverse consequences due to unmet need (adjusted odds ratio = 2.05; 95% confidence interval 1.16-3.61; p = .02)-no significant associations were observed for participation restrictions. Use of paid help and LTSS environment were not significantly associated with care experiences for dual-enrollees without dementia.
Findings highlight the complexities of caring for dual-enrollees, particularly those with dementia, and emphasize the need to strengthen the delivery of paid care with considerations for the LTSS environment.
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Details
- Title
- Associations Between Use of Paid Help and Care Experiences Among Medicare-Medicaid Enrolled Older Adults With and Without Dementia
- Creators
- Chanee D Fabius - Johns Hopkins UniversitySafiyyah M Okoye - Johns Hopkins UniversityJohn Mulcahy - University of MinnesotaJulia G Burgdorf - Johns Hopkins UniversityJennifer L Wolff - Johns Hopkins University
- Publication Details
- The journals of gerontology. Series B, Psychological sciences and social sciences, v 77(12), pp e216-E225
- Publisher
- Oxford University Press
- Grant note
- U54MD000214 / NIMHD NIH HHS R01 AG054004 / NIA NIH HHS T32 AG066576 / NIA NIH HHS P30 AG012846 / NIA NIH HHS T32 AG000247 / NIA NIH HHS U54 MD000214 / NIMHD NIH HHS P30 AG066587 / NIA NIH HHS P30 AG059298 / NIA NIH HHS P30AG066587 / NIA NIH HHS
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Doctoral Nursing
- Web of Science ID
- WOS:000811785700001
- Scopus ID
- 2-s2.0-85145092143
- Other Identifier
- 991021867183904721
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InCites Highlights
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Geriatrics & Gerontology
- Gerontology
- Psychology
- Psychology, Multidisciplinary