MEDICARE CONSTRAINS HOME HEALTH NURSES ABILITY TO MEET NEEDS OF PERSONS WITH ALZHEIMER'S AND THEIR CAREGIVERS

2015 The gerontologist  
highly trained home care aides who can manage both personal care needs and other unique requirements of these individuals. The agency-based direct care workforce traditionally cares for older adult clients with physical limitations and will likely require training to successfully work with this new population. The purpose of this study was to explore the role of the aging network in the implementation of this new managed care program, with specific emphasis on home care. Three focus groups were
more » ... conducted with members of the aging network in Massachusetts with direct involvement in the delivery of home care under this managed care program. Transcripts were analyzed using Atlas Ti and a constant comparative approach by two members of the research team was employed. Results suggest that the implications for the direct care workforce have not been sufficiently addressed, even after over a year of the program being active. Second, results from this study reveal significant challenges to the direct care workers (i.e., personal care attendants and home care aides), which include a lack of prior knowledge that the consumers they serve are enrolled in such a program and desire for additional guidance on providing home care to younger disabled consumers. IntroductionThis year Germany's long term care insurance (LTCI) -which is the fourth pillar of the German social security system and which is organized according to the Bismarck model of social insurance -is celebrating it's twentieth birthday. This seems to be a good time for an interim evaluation. This paper aims at informing about both (1) details of the "success model" LTCI and (2) reforms which are necessary in the near future. Since January 2015 the fourth reform has passed Federal Parliament. MethodsThis paper is based on a literature review and on secondary data analysis. ResultsFor most Germans the LTCI is regarded as a success-model. However, this model needs to be adapted to economic, demographic and structural changes. The latter refers to persons being in need of long term care and their families. Significant challenges in the future are, for example, (1) stabilizing the financial basis of the LTCI, (2) helping caring families with new kinds of social services and (3) improving the benefits for people suffering from dementia. ConclusionsThe LTCI in Germany is indeed a success model. If it is adapted regularly to changing framework conditions it can be "good practice" for other countries which have to manage the rising need of long term care among an ageing population. An estimated 75% of individuals with intellectual or developmental disabilities (IDD) live with family members, and nearly a quarter of whom reside with caregivers over the age of 60. Caregiving responsibilities can negatively affect caregiver employment and financial well-being. Missouri's Partnership for Hope (PfH) HCBS Medicaid Waiver was developed to improve access, expand eligibility, and maximize funding for supports and services for individuals with IDD. The aim of this project is to assess the financial/material impact of PfH on families.A family impact survey was mailed out in March 2013 addressed to the family of PfH participants. This survey included demographics and financial/employment questions. Over 55% of respondents were over the age of 50 and over 20% were over the age of 60 (n=202). Almost 90% of PfH services recipients lived with family. Descriptive analysis revealed that over 30% of respondents agreed/strongly agreed that their families' financial status has improved since participating in PfH. Only 9% of respondents reported a change in the employment status of their family as a result of PfH, however, this likely does not capture the full employment impact. As one respondent added, "... because of the Waiver our son was able to transition from school to a day program with no interruption of services, otherwise I would have had to take a leave of absence or quit my job."Policies that target services to the needs of the entire family of an individual with IDD can positively impact families' financial stability.
doi:10.1093/geront/gnv510.10 fatcat:f5woi44ik5a7xpf3nveodav6la