Strengthening home and community-based care through Medicaid waivers

States are increasingly using the Medicaid 1915c waiver program to provide community-based long-term care (LTC). We examined state predictors of waiver utilization and expenditures for waivers serving both older and working-age individuals. State level data for the period 1992 to 2001 were used to estimate random effects panel models. States with increased community-based care (e.g., home health agencies) and decreased nursing home bed capacity were positively associated with state per capita rates of use, expenditures, and the share of Medicaid LTC dollars supporting 1915c waivers. States appeared to substitute Medicare for Medicaid services for individuals eligible for both. State per capita income was positively related to each measure. State policies that facilitate decreased institutional and increased community- based capacity appear essential to state efforts to expand access to community-based services. Federal policies that address state resource issues may also spur growth in community-based LTC, which, in most states, continues to be limited.     

Probation Training: The Experience of Learners and Teachers

Qualifying training in probation is under review and likely to be substantially changed. This article draws on a small scale study of current training arrangements designed to explore the views of trainee probation officers, practice development assessors and university tutors regarding which elements of the current Diploma in Probation Studies framework most support learning. Their comments focus on the organisational ownership of training, time and learning, the teacher–learner relationship, teaching methods and equality of access. It is argued that probation training is best supported by a series of linked qualifications across grades, integrating practice‐based and academic learning delivered through a ‘blended learning’ model.     

Ready or Not: Transitioning from Institutional Care to Community Care

Federal legislation has moved toward the support and expansion of home- and community-based alternatives to nursing home placement. Despite the seemingly positive nature of these efforts, the question remains as to whether individuals, families, and communities are prepared for this shift in long-term care. Furthermore, there has been a lack of attention to the impact of nursing home transition programs on family caregivers, community resources, and the availability of appropriate housing alternatives. Although nursing home transition programs offer a promising alternative to institutional care, the authors suggest a closer examination of the policies and practicality of these transitions is needed.     

A Systematic Review of Strengths and Resilience Outcome Literature Relevant to Children and Adolescents

The concepts of strengths and resilience are essential for understanding and promoting positive development in children and adolescents. These concepts have been studied in the research literature for many years and more recently have been applied to child and adolescent assessment and intervention research. However, strength and resilience based intervention programs have not been evaluated rigorously for their use of empirical methodology. In this article, we systematically identified and reviewed all of the outcome studies over the last decade for strength and resilience based intervention programs to assess the extent to which these studies utilized controlled empirical methodology. The results of the review yielded 11 outcome studies that examined strength and resilience based practices. Using the Quality Assessment Tool for Quantitative Studies developed by the Effective Public Health Practice Project, we found three studies to be high quality, exhibiting high levels of experimentally controlled research. The remaining 8 studies we considered to be moderate to weak quality research. We concluded that these 11 studies provide preliminary support for the efficacy of strength and resilience based interventions. Our systematic review also highlights areas where methodology in future studies can be strengthened to provide more conclusive evidence of these approaches.     

A Profile of Middle-Aged and Older Adults Admitted to Nursing Homes: 2000–2008

Middle-aged adults are becoming an increasing share of the nursing home population. Minimum Data Set assessment data for 2000 and 2008 are used to explore similarities and differences in sociodemographic, residential, medical, and psychiatric characteristics of newly admitted middle-aged adults (31–64) compared to their older counterparts (65+). Relative to their share of the state population, Black middle-aged adults are overrepresented in nursing homes across 45 states and the District of Columbia. Chronic conditions, including diabetes, renal failure, chronic obstructive pulmonary disease, asthma, and circulatory/heart disorders, appeared to contribute to the increasing presence of middle-aged adults. There were substantial increases in diagnoses of psychiatric disorders at admission; psychiatric diagnoses were significantly higher among middle-aged adults. Middle-aged adults were also more likely to have residential histories of prior stays in psychiatric facilities relative to older adults. States' rebalancing efforts need to attend to the increasing presence of disability associated with chronic medical and psychiatric conditions among middle-aged adults.     

Understanding the Impact of Early-Life Trauma in Nursing Home Residents

Reactions to early life trauma can reemerge or be exacerbated in later life as coping resources and abilities are compromised by age-related changes and declines in health. For newly admitted nursing home residents, this can impact their receptiveness to assistance with care and elicit challenging reactions to environmental and situational triggers. Unfortunately, current assessment tools fail to account for reactions to early-life trauma. In this article, we review existing literature on early-life trauma and aging and introduce a hypothetical case to illustrate the importance of identifying nursing home residents with past trauma experiences.     

Aging Well and Gay in Rural America: A Case Study

Using person–environment-fit theory as a theoretical framework, this qualitative case study examined, through in-depth interviews and thematic analysis, the lived experience of an older gay man who has lived solely in rural communities. An overarching theme of life satisfaction clearly emerged, along with themes regarding supportive social networks and disclosure management of his sexual orientation. The findings suggest that although it is important to understand the challenges faced by the lesbian, gay, bisexual, and transgender community in rural environments, it is equally important to shed light on the ways in which older adults age well within these communities.     

Auto Therapy: Using Automobiles as Vehicles for Reminiscence With Older Adults

Reminiscence can be beneficial for older adults and contribute to well-being and ego integrity. In this exploratory pilot study, researchers assessed the feasibility and tolerability of a novel reminiscence intervention using automobiles as the focal point. Nineteen older adults (N = 19) were asked to reminisce using photographs of automobiles from across their lifespan. The RE-AIM framework was used to assess the intervention in terms of reach, effectiveness, adoption, implementation, and maintenance. The intervention was well-received, quickly established rapport, and effectively fostered reminiscence. Social workers may find this intervention useful in helping older adults to explore their lives.     

Body Mass Index,Demographic and Socioeconomic Risk,and Protective Factors of Type 2 Diabetes Among Six Groups of Foreign-Born Asian Americans

ABSTRACT. This study examined the association of body mass index (BMI), demographic variables, and self-reported type 2 diabetes among Chinese, Filipino, South Asian, Japanese, Korean, and Vietnamese adults. A sample of 3,204 Asian American respondents born outside of the United States was selected from the 2007 California Health Interview Survey. Logistic regression was used to estimate the relationships between BMI, age, sex, marital status, education, poverty level, years in the United States and self-reported type 2 diabetes. The findings revealed that Koreans had the lowest prevalence for type 2 diabetes and South Asians had the highest. Type 2 diabetes had a statistically significant association with BMI and demographic variables but varied across ethnic groups. Due to sampling variations, no meaningful results were found in the Filipino and Japanese samples. BMI and older age are common risk factors for type 2 diabetes among Asians, but whether sex, marital status, education, and years in the United States are risk factors varies among ethnic groups. Culturally specific prevention programs for type 2 diabetes are important for Asian Americans. Given the diversity of cultures and demographic and socioeconomic factors across the Asian American populations, future research should not combine all ethnic Asian groups into 1 sample.