Free tuition for elders: intentions and effects of the Massachusetts policy

This analysis explores the development of the elder tuition waiver in Massachusetts, a policy that established an age-based entitlement to higher education. The research concludes that the original purpose of the waiver was to encourage participation, but that there was no expectation that large numbers of older adults would take advantage of this benefit. Nor, apparently, did advocates of the waiver seek to assure that a diverse group of older adults would take advantage of higher education opportunities through the waiver. A review of the history of the waiver is linked with data on implementation and the results of an exploratory study of motivations of older college students. The discussion points to a need for fundamental examination of the practice of providing social benefits based on age rather than need or universal criteria.     

Race and gender differences in the distribution of home and community-based services in Florida

This article examines the distribution of home and community-based services (HCBS) under Florida's Medicaid waiver program. Controlling for personal and community characteristics, it was found that gender and race significantly affect the access of the disabled adult population to HCBS services, with women and nonwhites significantly more likely to be receiving HCBS services. At the county level, the likelihood of one's being in the waiver program is contingent on the racial composition and level of segregation of the county. People residing in counties with substantial proportions of nonwhites are less likely to receive HCBS services--whatever their race. However, the higher the rate of racial segregation in the county, the higher the probability that the Medicaid disabled adult population will receive HCBS services. The Medicaid waiver program allows older, disabled black women to remain in their home neighborhoods rather than having to move to predominantly white areas where nursing homes are concentrated. Thus, the HCBS program not only provides them with a form of care that is preferred by most older people but also resolves market problems stemming from the lack of nursing homes in segregated areas by taking advantage of support systems in black households.     

Race and Gender Differences in the Distribution of Home and Community-Based Services in Florida

This article examines the distribution of home and community-based services (HCBS) under Florida's Medicaid waiver program. Controlling for personal and commnunity characteristics, it was found that gender and race significantly affect the access of the disabled adult population to HCBS services, with women and nonwhites significantly more likely to be receiving HCBS services. At the county level, the likelihood of one's being in the waiver program is contingent on the racial composition and level of segregation of the county. People residing in counties with substantial proportions of nonwhites are less likely to receive HCBS services– whatever their race. However, the higher the rate of racial segregation in the county, the higher the probability that the Medicaid disabled adult population will receive HCBS services. The Medicaid waiver program allows older, disabled black womcn to remain in their home neighborhoods rather than having to move to predominantly white areas where nursing homcs are concentrated. Thus, the HCBS program not only provides them with a form of care that is preferred by most older people but also resolves market problems stemming from the lack of nursing homes in segregated areas by taking advantage of support systems in black households.     

Gambling and the Older Chinese in Canada

In Canada, there is a lack of research on gambling among the older adults from ethnic minority groups, especially the older Chinese. In this study, two research questions were used to examine gambling among the older Chinese: (1) What is the pattern of gambling among the older Chinese in Canada? (2) What are the predictors associated with gambling among the older Chinese in Canada? The data for this study were collected as part of a multi-site study on health and well-being of 2272 older Chinese in Canada. Four main questions related to gambling were used in this study. Among the 2257 participants who answered the questions on gambling, 26.6% of them reported that they gambled. Results of the hierarchical logistic regression analysis showed that being male, having lived in Canada longer, having a higher level of social support, having more service barriers, and having a stronger level of Chinese ethnic identity would increase the probability for an older Chinese to participate in gambling. Conversely, having a post-secondary and above level of education and having a higher level of life satisfaction would reduce one’s probability of gambling. Although city of residency was also significant in predicting gambling, further analysis showed that its effect was actually caused by other factors including services barriers, social support, life satisfaction, Chinese ethnic identity, and education.     

Anxiety and Depression: Implications for Older Adults

By the year 2030, it is projected that one in every three Americans will be 55-years-old or older. This age group is by far the fastest growing segment of the population. With the growing number of older adults, the importance of understanding aging and common disorders of later life is essential. In particular, anxiety and depression are among the most common problems in older adults. However, differentiating anxiety and depression at the mood, symptom, and syndromal levels has been a long-standing problem in psychopathology research. In addition to a growing need for research, clinicians will also need to take an active role in the development and implementation of treatment as the population of older adults increases. In particular, mental health service providers must become informed about the economic implications for older adults as the structure of health insurance continues to change.     

Anxiety and Depression: Implications for Older Adults

By the year 2030, it is projected that one in every three Americans will be 55-years-old or older. This age group is by far thefastest growing segment of the population. With the growing number of older adults, the importance of understanding aging and common disorders of laterlife is essential. In particular, anxiety anddepression are among the most common problems in older adults. However, differentiating anxiety and depression at the mood, symptom, and syndromal levels has been a long-standing problem in psychopathology research. In addition to a growing need for research, clinicians will also need to take an active role in the development and implementation of treatment as the population of older adults increases. In particular, mental health service providers must become informed about the economic implications for older adults as the structure of health insurance continues to change.     

Elders with Serious Mental Illness: Lost Opportunities and New Policy Options

This article reviews key federal Medicaid policies affecting older adults with serious, long-term mental illness: (a) the Medicaid exclusion of coverage for Institutions for Mental Diseases, (b) the Preadmission Screening and Resident Review Process, and (c) the Medicaid Home and Community Based Services waiver policy. Documenting the incentives and restrictions in these policies provides an historical context for understanding the current gaps in treatment for elders with mental illness. New federal options under the Deficit Reduction Act may provide opportunities for reducing the institutional bias for older adults with mental illness and for improving mental health services for elders under Medicaid.     

Older Adults’ Receipt of Financial Help: Does Personality Matter?

This study examined the role of personality traits in the receipt of financial help at older ages using the 2006 and 2008 waves of Health and Retirement Study data. An investigation of (1) how the five domains of personality traits (openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism) are associated with the receipt of financial help among older adults and (2) the relationship between personality traits and the source of financial help received was examined. Three sets of probit analyses were conducted. The results indicated that personality can predict financial help and the source of financial help. Specifically, older adults who exhibited relatively higher levels of neuroticism and agreeableness were more likely to receive financial help, whereas those who exhibited relatively higher levels of conscientiousness were less likely to receive financial help regardless of the source. Furthermore, older adults who had relatively higher levels of neuroticism were more likely to help themselves with individual sources such as credit cards whereas agreeable older adults were more likely to receive financial help from family members. These findings have implications for financial counseling, planning and education professionals, public assistance program directors, and policy makers. Understanding the effect of personality on financial decision-making can help with financial planning throughout life and inform outreach efforts for those in need of financial help.     

Planning and execution of a successful hepatitis B immunization program

Today's college students occupy a "window" between older adults, whose need for hepatitis B vaccination is minimal, and younger people who receive the vaccine as part of their childhood immunization series. However, because of the high-risk activities that are often part of student behavior, college students are among the individuals who are at the highest risk for this disease; 75% of all reported hepatitis B cases occur in persons between the ages of 15 and 39 years. It is therefore imperative that college health professionals take seriously their responsibility to educate students about issues related to hepatitis B and make available programs that enable the students to receive immunizations. This article briefly describes a successful hepatitis B education and immunization program at an institution that has no mandatory prematriculation immunization requirements.     

Gambling among culturally diverse older adults: a systematic review of qualitative and quantitative data

Culturally diverse older gamblers may face multiple jeopardies and socially structured challenges. In this first systematic review of empirical evidence of gambling in this population, the authors examined both quantitative and qualitative studies published between 1996 and June 2016. A thorough search of 7 databases yielded 18 articles with a total sample of 11,296 culturally diverse older adults. The review revealed contrary findings on the correlation between gender, education, income and gambling behaviour. Early onset was more frequently found among older adults who belonged to a culture that promoted tolerance of gambling activities; however, some developed a gambling habit after they had moved to a western society. Using an analytical framework, the authors demonstrate interrelated factors: enabling factors (cultural acceptance of gambling, supportive social networks, accessibility to gambling facilities and venues, and external cues); motivational factors (desire for excitement and winning money, coping with boredom, and stress due to structural issues); and buffering factors for culturally diverse older gamblers . Both environmental and personal factors could be triggered as buffers between gambling and culturally diverse older adults. In light of the motivational and enabling factors, practitioners and policy makers may need to step beyond focusing on ‘correction’ during intervention.     

Rethinking motivational challenges amongst young adults on the margin

This article is concerned with how motivation to take an education can be stimulated in young adults who are on the margins of the labour market and educational system. It is widely accepted that young adults in such a position have motivational problems regarding education because of negative schooling experiences, interrupted education, absenteeism, etc. Despite this, in Europe, education is commonly proposed as the solution to the problem of the high proportion of 15–29 year-olds who are not in employment, education or training (NEET). This paradox of having to motivate young adults under pressure is the focus of the article. The article argues that there is a need to theoretically redefine motivation as a phenomenon linked to the individual to a more contextually embedded understanding of motivation as the result of a process between the young and their surroundings, opportunities and perspectives. The article presents a model with five motivational orientations suggesting a new perspective on re-motivating young adults on the margin of the labour market and educational system, while it also discusses the challenges connected to promoting a focus on motivation at a time when the liberalisation of education is increasingly central to the welfare state strategy.     

Does Home- and Community-Based Care Affect Nursing Home Use?

A study was conducted to assess change in numbers, expenditures, and case mix of nursing home residents as Medicaid investment in home- and community-based services (HCBS) 1915(c) waivers increased in seven states. The seven states provided Medicaid expenditure and utilization data from 2001 to 2005, including waiver and state plan utilization. The Minimum Data Set was used for nursing home residents. For three states, community assessment data were also used. In six states, the number of nursing home clients decreased as the numbers of HCBS clients grew. However, in most states, the number of additional waiver clients often greatly exceeded reductions in nursing home residents. Nursing home payments decreased moderately, but this decrease was offset by increases in HCBS waiver and state plan expenditures, leading to a net increase in long-term support services (LTSS) expenditures from 2001 to 2005. Increases in waiver expenditures outpaced increases in waiver clients, indicating expansion of services on top of expansion in clients. States that showed substantial increases in HCBS showed only modest increases in nursing home case mix. The case mix for nursing home residents was more acute than that for HCBS users. The expectation that greater HCBS use would siphon off less severe LTSS users and hence lead to a higher case mix in nursing homes was partially met. The more acute case mix in nursing homes suggests that HCBS serves some individuals who were previously cared for in nursing homes but many who were not. Efforts to promote substitution of HCBS for institutional care will require more proactive strategies such as diversion.     

Impediments to Health Care for the Foreign Student

Abstract

Today's college students occupy a “window” between older adults, whose need for hepatitis B vaccination is minimal, and younger people who receive the vaccine as part of their childhood immunization series. However, because of the high-risk activities that are often part of student behavior, college students are among the individuals who are at the highest risk for this disease; 75% of all reported hepatitis B cases occur in persons between the ages of 15 and 39 years. It is therefore imperative that college health professionals take seriously their responsibility to educate students about issues related to hepatitis B and make available programs that enable the students to receive immunizations. This article briefly describes a successful hepatitis B education and immunization program at an institution that has no mandatory prematriculation immunization requirements.     

Functional Ability,Neighborhood Resources and Housing Satisfaction among Older Adults in the U.S.

The purpose of this study was to explore neighborhood resources that influence the housing satisfaction of older adults. The study included 10,146 participants from the 2009 panel of the American Housing Survey who were 65 years and older. Hierarchical regression modeling was performed to examine older adults’ perceptions of neighborhood resources and consequently the role these resources play in predicting housing satisfaction among community dwelling and residents of assisted living, controlling for age, sex, ethnicity, education, and housing maintenance. In addition, three levels of physical functioning among residents of assisted living were examined. Results showed that there were differences in housing satisfaction by residences and levels of physical functioning. Subjective evaluations of neighborhoods and the near surrounds were significant predictors of housing satisfaction. Results of the study suggest that policy makers and housing professionals need to continue to consider the role of supportive neighborhoods and social environments in promoting successful aging particularly for frail older adults.     

The effects of strength training on memory in older adults

The authors examined whether resistance training has an effect on working memory span. Participants included 210 community-residing older adults with at least one disability from the Strong for Life program, a randomized controlled trial that examined the effects of home-based resistance exercise. Memory was assessed with the WAIS backward digit span at baseline and 3 and 6 months into the intervention. Although there were no differences between the experimental treatment and control groups in average levels of memory change, within the treatment group change in resistance level during the intervention was a significant predictor of memory change, controlling for age, education, sex, and disability level. The results suggest that strength training can benefit memory among older adults, especially when using higher resistance levels.     

The gatekeeper model: implications for social policy

One of the most important needs of an aging population is to insure that older adults are able to live as independently and safely as possible. The question for social policymakers is how to meet this goal in an era of shrinking resources and growing numbers of older adults. The Gatekeeper Model is highlighted as a method to insure that older adults at risk of problems that impact their ability to live independently can be helped by existing systems of care. The model trains employees of community businesses and corporations who work with the public to serve as community gatekeepers by identifying and referring community-dwelling older adults who may be in need of help. A research project was conducted at Spokane Mental Health, Elder Services Division, where the model was developed. The results indicate that community-based gatekeepers found 40% of clients. Gatekeepers find a distinct population of community-dwelling older adults who are not found by more traditional referral sources. The social policy implications of the Gatekeeper Model are discussed.     

Childless Elders in Assisted Living: Findings from the Maryland Assisted Living Study

We compared data drawn from a random sample of 399 current assisted living residents and a subsample of 222 newly admitted residents for two groups: childless residents and residents with children. The percentage of childless residents (26%) in our study was slightly higher than U.S. population estimates of childless individuals aged 65 years and older (20%). In the overall sample, the two groups differed significantly by age, race, and women's years of education. The childless group was slightly younger, had a higher percentage of African American residents, and had more years of education than the group with children. In the subsample, we looked at demographic, functional, financial, and social characteristics and found that childless residents reported fewer diagnoses of dementia and fewer visits from a relative but more reported paying less money per month for assisted living and having private insurance than residents with children. As childlessness among older adults continues to increase, it will become increasingly important to understand how child status affects the need for and experience of long-term care.     

Detouring Nursing Home Entrants

Under the Omnibus Budget Reconciliation Bill of 1981, states can apply for waivers to underwrite nonmedical home care services for Medicaid clients who would otherwise enter nursing homes. Ideally, subsidized home services should improve the quality of life for older people, relieve the demand on nursing homes, and reduce overall Medicaid expenditures; yet in Rhode Island the program has served few people. This discussion proposes reasons for the minor impact of "waiver channeling."     

Perceived Need for Home- and Community-Based Services: Experiences of Urban Chinese Older Adults With Functional Impairments

Guided by Cantor’s social care model, this study identified individual, family, and social support factors that influence urban older adults’ need for home- and community-based services, including medical and rehabilitation, instrumental care and support, and psychosocial services. The data were extracted from the Sample Survey on Aged Population in Urban/Rural China conducted by the China Research Center on Aging in 2006. Results from multiple logistic regression show that older adults’ need for medical and rehabilitation services is significantly related to instrumental activities of daily living, depression, not having filial children, friend support networks, and having a confidant. Older adults’ need for instrumental care and support is related to their educational attainment, financial strain, instrumental activities of daily living, not living with children, and friend support networks. Finally, older adults’ need for psychosocial services is significantly related to educational attainment, depression, not being married, friend support networks, and having a confidant. Implications for social service development are discussed.     

Inequitable Access to Health Services for Older Adults with Diabetes: Potential Solutions on a State Level

Diabetes is a serious global public health challenge. The cost for health services for diabetes care has increased 41% over the past 5 years. Despite escalating health expenditure, the United States continues to have higher rates of diabetes than many other developed countries. There is a need for health care reform in the United States not only in reducing health care costs but also in improving the quality of preventative care. This study presents the testing of a multilevel model investigating variables on the individual and state levels to develop a better understanding of the most important contextual pathways that can lead to providing older adults (50+) with type 2 diabetes with the recommended preventative quality care they require. The model was tested using a three-level repeated cross-sectional design with data from various existing data sources, using a national sample of 181,870 individuals aged 50 years and older. Results showed that differences in state health care systems contributed to inequitable access. Specifically, in a state where there was a higher percentage of adults 65 and older coupled with a shortage of health care professionals, the likelihood of receiving the recommended preventative quality care decreased. Also, older adults living in states with a higher percentage of people with diagnosed diabetes but with a lower-than-average annual per capita health care expenditure fared worse in receiving quality preventative care. Last, older adults in wealthy states with higher percentages of uninsured people had the lowest odds of receiving quality preventative care. Health care reform, similar to what is currently promoted by the Patient Protection and Affordable Care Act of 2010, is recommended to improve the performance of all health care systems in all states.