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Although comparative state policy frameworks consider the role of societal norms, few account for cognitive and normative imperatives that originate outside a state's boundaries and are specific to promoting or impeding the adoption of particular policies. One approach that does so is the new institutionalism in sociology, which emphasizes legitimacy-seeking actors who face pressures to conform to cultural rules, norms, and expectations, regardless of outcomes. This article introduces comparative state policy researchers to the sociological institutionalism, emphasizing basic concepts and arguments and suggesting how reliance on this framework can enable researchers to better integrate rational-actor and cultural-based views for understanding why states choose particular public policies. Interviews with national and state experts in Medicaid nursing-facility reimbursement illustrate the utility of the sociological institutionalism for comparative state policy research. [ABSTRACT FROM AUTHOR]

The adoption of the new Medicare prescription drug benefit in 2003 added yet another iteration to the action-reaction or interactive style of federalism that has characterized this complex policy area for three decades. Though the federal government benefited from state-level policy learning, it penalizes states that were most generous and innovative in their experimentation with pharmaceutical assistance by making them pay for much of the program's costs. The federal government will administer the new benefit, leveling many state-to-state differences in drug coverage, but at the price of standardizing the program under federal rules and punishing pioneering states for their initiative. This precedent may come back to haunt federal-state relationships by discouraging risk taking that might lead to similarly adverse outcomes for innovative states in the future. [ABSTRACT FROM AUTHOR]

The bifurcation of responsibility for caring for dual eligibles has helped create a fragmented service delivery system, fraught with administrative inefficiencies, barriers to more effective care, and incentives to shift costs. To better serve this population, the federal government and several states have developed a number of pilot initiatives that promote integration by relying on capitated managed care. However, evidence suggests that this approach may be plagued by certain problems, including lack of experience with persons who are chronically ill, incentives to under provide care, favorable selection, limited plan availability, and mixed outcome and satisfaction performance. Although case-managed approaches pursue integration without capitation, they must typically rely on voluntary provider cooperation to be successful, something that is difficult to achieve. Given the recent nature of most integration initiatives, it is recommended that policy makers continue to promote innovation in each of the following areas: care coordination, administration, provider payment, plan participation, and evaluation. [ABSTRACT FROM PUBLISHER]

Although federal statutes and regulations establish the broad parameters within which state Medicaid programs operate, the federal government grants states substantial discretion over Medicaid and Medicaid-funded long-term care. An appreciation of resulting cross-state variation in Medicaid program characteristics, however, has been lacking in the ongoing debate over whether the federal government should further devolve responsibility for caring for the poor and disabled elderly to the states. To better inform this discussion, therefore, this article documents considerable variation, not only in terms of Medicaid program spending and recipients, but also in terms of strategies chosen to reform long-term care services and financing. Since there is little doubt that states take full advantage of current levels of discretion, advocates of devolution may want to reassess their views to consider whether existing variation has resulted in inequities addressable only through more, not less, federal involvement. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of an affordable housing‐based supportive services intervention, which partnered with health and community service providers, on Medicare health service use among residents. Data Sources: Analyses used aggregated fee‐for‐service Medicare claims data from 2017 to 2020 for beneficiaries living in 34 buildings in eastern Massachusetts. Study Design: Using a quasi‐experimental design, a "difference‐in‐differences" framework was employed to isolate changes in outcomes, focusing on changes in pre‐ and post‐intervention health service use across two stages of the intervention. Phase 1 encompassed the initial implementation period, and Phase 2 introduced a strategy to target residents at high risk of poor health outcomes. Key health service outcomes included hospitalizations, 30‐day hospital readmission, and emergency department use. Data Collection: Medicare claims data for 10,412 individuals were obtained from a Quality Improvement Organization and aggregated at the building level. Principal Findings: Analyses for Phase 1 found that hospital admission rates, emergency department admissions and payments, and hospital readmission rates grew more slowly for intervention sites than comparison sites. These findings were strengthened after the introduction of risk‐targeting in Phase 2. Compared to selected control buildings, residents in intervention buildings experienced significantly lower rates of increases in inpatient hospitalization rates (−16% vs. +6%), hospital admission days (−25% vs. +29%), average hospital days (−12% vs. +14%), hospital admission payments (−22% vs. +33%), and 30‐day hospital readmission rates (−22% vs. +54%). When accounting for the older age of the intervention residents, the size of the decline recorded in emergency department admissions was 6.7% greater for the intervention sites than the decline in comparison sites. Conclusions: A wellness‐focused supportive services intervention was effective in reducing select health service use. The introduction of risk‐targeting further strengthened this effect. Age‐friendly health systems would benefit from enhanced partnerships with affordable housing sites to improve care and reduce service use for older residents. [ABSTRACT FROM AUTHOR]

Objectives This study examined the relationships between chronic diseases, functional limitations, sense of control, and subjective age. Older adults may evaluate their subjective age by reference to their younger healthier selves and thus health and functional status are likely to be determinants of subjective age. Although sense of control is also a potential predictor of subjective age, stress-inducing factors associated with disease and functional limitations may reduce older adults' sense of control, making them feel older. Methods Using the 2010 and 2014 waves of the Health and Retirement Study , structural equation modeling was performed on a sample of 6,329 respondents older than 50 years to determine whether sense of control mediated the relationship between chronic diseases, limitations in instrumental/basic activities of daily living (ADLs, IADLs), and subjective age. Results Chronic diseases and limitations in ADLs had a positive, direct association with subjective age (β = 0.037, p =.005; β = 0.068, p =.001, respectively). In addition, chronic diseases and limitations in ADLs and IADLs were positively, indirectly associated with subjective age via a diminished sense of control (β = 0.006, p =.000; β = 0.007, p =.003; β = 0.019, p =.000, respectively). Discussion As predicted by the Deterioration model, the findings showed that chronic diseases and functional impairment are associated with older adults feeling older by challenging the psychological resource of sense of control. Appropriate interventions for dealing with health challenges and preserving sense of control may help prevent the adverse downstream effects of older subjective age. [ABSTRACT FROM AUTHOR]

The article reports that the News and Notes section in the "Journal of Health Politics, Policy and Law" has been renamed as the Social Media section to attract more audiences online.

Extant research offers limited understanding of the context in which economic resource and hardship at older ages are assessed. This study investigates the association between location-specific income security and hardship, and the moderating role of financial knowledge, using data from the Understanding America Study. We found that respondents with better location-specific income security were less likely to experience hardship and that financial knowledge strengthened the negative association between income security and hardship. Findings suggest that interventions to improve later-life financial knowledge may offer protection against hardship and that evaluations of later-life income adequacy may benefit from location-specific assessments of cost-of-living. [ABSTRACT FROM AUTHOR]

Intergenerational tutoring programs can leverage technology to address the instructional needs of students. This study describes a novel online intergenerational tutoring program designed to target kindergarten students’ literacy skills. Older adult volunteers delivered evidence-based instructional strategies via Zoom. The study used a two-group, quasi-experimental design with students assigned to an intervention (n = 23) or waitlist control (n = 18) group. Five early literacy fluency skills were measured (letter naming, letter sound, phoneme segmentation, nonsense word, and real word). Tutors implemented the program with high fidelity. At posttest, the intervention group scored higher than the control group on each of the five skills and the group differences were statistically significant with a medium effect size for letter sound fluency and nonsense word fluency. Both tutors and parents reported high program acceptability. This study demonstrated how older adults can use online technology to disseminate evidence-based instructional interventions to children. [ABSTRACT FROM AUTHOR]

The article presents an obituary for Robert Geary, the former Managing Editor of the "Journal of Aging & Social Policy," who died on September 10, 2016 in the U.S. due to pancreatic cancer.

Background and Objectives Veterans enter nursing homes (NHs) for short-term postacute, rehabilitation, respite, or end-of-life care. They also enter NHs on a long-term basis due to frailty, disability, functional deficits, and cognitive impairment. Little is known about how a particular NH is chosen once the decision to enter a NH has been made. This study identified VA staff perceptions of the key factors influencing the search and selection of NHs within the Veterans Health Administration (VHA). Research Design and Methods Data derived from 35 semistructured interviews with discharge planning and contracting staff from 12 Veterans Affairs Medical Centers (VAMCs). Results VA staff placed a premium on Veteran and family preferences in the NH selection process, though VA staff knowledge and familiarity with placement options established the general parameters within which NH placement decisions were made. Geographic proximity to Veterans’ homes and families was a major factor in NH choice. Other key considerations included Veterans’ specialty care needs (psychiatric, postacute, ventilator) and Veteran/facility demographics (age, race/ethnicity, Veteran status). VA staff tried to remain neutral in NH selection, thus instructing families to visit facilities and review publicly available quality data. VA staff report that amenities (private rooms, activities, smoking) and aesthetics (cleanliness, smell, layout, décor) often outweighed objective quality indicators in Veteran and family decision making. Discussion and Implications Findings suggest that VAMCs facilitate Veteran and family decision making around NH selection. They also suggest that VAMCs endeavor to identify and recruit a broader array of higher quality NHs to better match the specific needs of Veterans and families to the choice set available. [ABSTRACT FROM AUTHOR]

The Online Intergenerational Tutoring Program addresses a service delivery gap in schools because older adult volunteers expand schools' capacity to implement evidence-based instruction with students in need of individual support. Tutoring includes dialogic reading with digital books and Tutoring Buddy, a web-based program used to improve children's letter sound fluency. Developed during the school closures resulting from COVID-19, the program uses online technology to deliver individual instruction to students after school. Our preliminary research found online intergenerational tutoring is a promising, socially valid model for addressing students' learning loss resulting from the pandemic. [ABSTRACT FROM AUTHOR]

This longitudinal study analyzed data from the 2006–2016 waves of the nationally representative Health and Retirement Study (HRS). Trajectories of depression among older adults ≥ 50 years (N = 1254) were examined over time to explore patterns of depression among those entering widowhood and the potential impact of religiosity on depressive symptoms during various stages of widowhood. Ordinary least squares (OLS) regression analysis was used to examine the association between widowhood and depression and the role of religiosity as a moderator of this association. Older adults experienced a statistically significant increase in depressive symptomology after the onset of widowhood, and depressive symptomology decreased post widowhood, but did not return to pre-widowhood levels. Additionally, high religious service attendance and higher intrinsic religiosity were both associated with lower depressive symptomology. High religious service attendance moderated the relationship between widowhood and depression among widowed older adults living alone. [ABSTRACT FROM AUTHOR]

Objective: To test the impact of placing a wellness team (nurse and social worker) in senior housing on ambulance transfers and visits to emergency departments over 18 months. Data sources/study setting: Intervention sites included seven Boston‐area buildings, with five buildings at comparable settings acting as controls. Data derive from building‐level ambulance data from emergency responders; building‐level Medicare claims data on emergency department utilization; and individual‐level baseline assessment data from participants in the intervention (n = 353) and control (n = 208) sites. Study design: We used a pre/postdifference in difference quasi‐experimental design applying several analytic methods. The preintervention period was January 2016‐March 2017, while the intervention period was July 2017‐December 2018. Data collection/extraction methods: Emergency responders provided aggregate transfer data on a daily basis for intervention and control buildings; the Quality Improvement Organization provided quarterly aggregate data on emergency department visit rates; and assessment data came from a modified Vitalize 360 assessment and coaching tool. Principal findings: The study found an 18.2% statistically significant decline in ambulance transfers in intervention buildings, with greater declines in buildings that had fewer services available at baseline, compared to other intervention sites. Analysis of Medicare claims data, adjusted for the proportion of residents over 75 per building, found fewer visits to emergency departments in intervention buildings. Conclusions: Health‐related supports in senior housing sites can be effective in reducing emergency transfers and visits to emergency departments. [ABSTRACT FROM AUTHOR]

Background and Objectives: Older adult-focused housing with services programs seek to improve access to supportive services, particularly among individuals residing in subsidized housing. The Right Care, Right Place, Right Time (R3) program comprises 2 on-site wellness teams responsible for 400 participants across 7 housing sites in Greater Boston. These embedded teams work directly with residents to address health-related needs and access to services. This study reports on the perceived benefits of participating in the R3 program from the perspective of housing staff and community partners., Research Design and Methods: Data were derived from 24 semistructured interviews conducted as part of a program evaluation. Participants described resident, housing, and system-related reasons for deciding to participate in the R3 program and their experiences of their participation., Results: In addition to positive overall assessments, housing partner interviewees reported concrete and psychosocial benefits for housing residents (e.g., connecting with resources, enabling longer stays, empowering residents, alleviating distress) and staffing and resident-related benefits. Community partners perceived more appropriate utilization of services by residents (e.g., reducing emergency transports)., Discussion and Implications: Findings elucidate why housing and community partners might be motivated to integrate housing, health, and supportive care into affordable housing for older adults using a wellness team., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

The rapid onset of the COVID-19 pandemic presented a multi-faceted challenge to older adults, carers, and care institutions globally. A wide range of policies aimed at protecting older adults from serious illness and death from COVID-19 - including prioritizing vaccination for older adults, mandating vaccination among health care workers, and stringent isolation measures - achieved some success in mitigating these outcomes. However, older adults continue to bear the burden of risk for these most severe outcomes. Additionally, some early efforts to protect older adults, often via extreme isolation measures both within care facilities and in the community, yielded unanticipated health and psychosocial impacts on older adults and care and service networks and revealed systemic ageism in health and social policies worldwide. This special issue of the Journal of Aging & Social Policy compiles research conducted both during and after the height of the pandemic on the impacts of immediate response efforts, while delving into the longer-term differential effects across population subgroups and organizations. Governments, agencies, and aging services organizations will benefit from fully considering lessons learned and incorporating them into future emergency response efforts.

Background and Objectives: Proxy respondents are an important tool in survey research, especially among people with cognitive impairment. However, proxy respondents may be unable to accurately answer subjective survey instruments for cognitively impaired persons. This study investigates the mediating effect of proxy status on the relationship between cognitive impairment and subjectively rated health., Research Design and Methods: Respondents from the 2018 wave of the Health and Retirement Study (N = 17,146) were included, and the Baron and Kenny method assessed the potential mediating role of having a proxy on subjectively rated health. Subjectively rated health and proxy status were dichotomously coded, and relationships between cognitive impairment, proxy status, and subjectively rated health were assessed using logistic regression., Results: Findings indicate that cognitive impairment is inversely associated with subjectively rated health, and it is directly associated with having a proxy. They also indicate that having a proxy is inversely related to subjectively rated health. When including proxy status and cognitive impairment in the same model, cognitive impairment no longer predicted subjectively rated health. This indicates that proxy status perfectly mediated the relationship between cognitive impairment and subjectively rated health., Discussion and Implications: Measuring the experiences of people with cognitive impairment is challenging in survey research due to the limiting features of cognitive impairment. Although having a proxy respondent helps address attrition-related measurement challenges in survey research, findings indicate that proxies report worse subjectively rated health for people with cognitive impairment compared to individuals with comparable levels of cognitive impairment without a proxy. Future research may benefit from exploring optimal proxy-respondent characteristics., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background and Objectives: Perceived control is an important psychological resource for middle-aged and older adults. Aging in place may help foster feelings of control, yet many community-dwelling older adults must rely on others-whether family, friends, or professionals-for physical assistance. This study investigated how receiving home care from different sources was associated with two facets of perceived control (mastery and perceived constraints) among adults with varying levels of physical disability., Research Design and Methods: Data were drawn from the 2012 and 2014 waves of the Health and Retirement Study. Community-dwelling adults aged 50 years and older receiving help for at least one activity of daily living (ADL) impairment (N = 884) reported their relationship to each respective caregiver (formal professional and/or informal family or friend), level of ADL impairment, and ratings of perceived control. Ordinary least squares regression was used to examine the association between type of support and perceived control, as well as the moderating effect of physical disability on that relationship., Results: Compared to receipt of informal support alone, receiving a combination of formal and informal support was related to perceptions of greater control over one's life, but only in terms of mastery. The level of one's ADL impairment did not have a moderating effect on the relationship between support type and perceived control., Discussion and Implications: Findings suggested that the type of instrumental support adults receive in their home has implications for specific facets of perceived control. These findings can help inform home care program development., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The need to bolster Medicaid home and community-based services (HCBS) became more evident during the COVID-19 pandemic. This recognition stemmed from the challenges of keeping people safe in nursing homes and the acute workforce shortages in the HCBS sector. This article examines two major federal developments and state responses in HCBS options as a result of the pandemic. The first initiative entails a one-year increase of the federal Medicaid matching rate for HCBS included in the American Rescue Plan Act championed by the Biden administration. The second initiative encompasses administrative flexibilities that permitted states to temporarily expand and modify their existing Medicaid HCBS programs. The article concludes that the effects of the pandemic flexibilities and enhanced federal funding on most state HCBS programs will be limited without continued investment and leadership on the part of the federal government, which is a Biden administration priority. States that make the American Rescue Act and COVID-19 flexibilities initiatives permanent are states that have the fiscal resources and political commitment to expanding HCBS benefits that other states lack. States' different approaches to bolstering Medicaid HCBS during the pandemic may contribute to widening disparities in access and quality of HCBS across states and populations who depend on Medicaid HCBS., (Copyright © 2024 by Duke University Press.)

Despite the widely-acknowledged potential of housing with services for improving the lives of low-income older adults, ensuring their financial sustainability has been challenging. This study aimed to address this issue, drawing on 31 key informant interviews and three focus groups with payers, housing providers, and community partners involved in the Boston-area Right Care, Right Place, Right Time Program, which enrolled about 400 older adults. Transcripts were qualitatively analyzed using thematic coding. Participants agreed on the program's value, but there was little consensus on mechanisms for securing ongoing funding. The broadly distributed responsibility for individuals in housing sites, which involves health insurers, hospitals, and community service providers, provides little incentive for investment by these entities. Findings suggest that governmental mechanisms, probably at the federal level, are needed to channel funding toward these supportive services. Without such reliable funding sources, replication of supportive housing models for low-income older people will prove difficult., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The American Rescue Plan Act (ARPA) includes a one-year 10 percentage point increase in the Federal Medical Assistance Percentage for Medicaid-funded home and community-based services (HCBS). The goal is to strengthen state efforts to help older adults and people with disabilities live safely in their homes and communities rather than in institutional settings during the COVID-19 pandemic. This essay provides a detailed description and analysis of this provision, including issues state governments need to consider when expending the additional federal revenue provided. It also draws lessons from the Affordable Care Act's Balancing Incentive Program to suggest insights for the potential of ARPA to promote further growth in Medicaid HCBS programs. It argues that key to success will be consultation with community stakeholders under the auspices of clear and frequent federal guidance and the development of concrete plans with which to expend the additional revenues in the most effective way possible in the limited time frame provided. The essay concludes by highlighting the importance of instituting strategies and processes for maximizing enhanced federal matching funds under ARPA in preparation for subsequent availability of substantial additional federal resources targeting Medicaid HCBS under other proposed initiatives.

Home Health Aides (HHAs) are one of the fastest growing workforces in the country, yet the industry struggles to recruit and retain workers. This study explored HHAs' experiences with the level of control, autonomy, and decision-making authority in their work. Six focus groups with 37 HHAs were conducted in Massachusetts. Findings showed that HHAs viewed control as a positive job characteristic, which attracted them to and led them to remain in the position. Positive benefits included having control over client selection, location, hours, and the ability to determine their day-to-day tasks and schedules. The study results highlight the value that HHAs place on autonomy and control and the potential benefit that these job qualities have for greater recruitment and retention of these workers. Amplifying control by bolstering training and expanding scope of practice may entice new individuals to pursue a HHA career and help maintain those currently in the position.

The Patient Protection and Affordable Care Act included Community First Choice (CFC), a new optional Medicaid home and community-based services (HCBS) state plan benefit which states could adopt. Through the CFC program, states can provide expanded home and community-based attendant services and supports to older adults and persons with disabilities. A benefit of CFC is that states receive a higher federal match rate than other HCBS programs. Thus far, eights states have adopted CFC. This comparative case study analysis examines state-level implementation of CFC to identify what facilitated implementation and what created challenges. The results suggest that consulting with the Centers for Medicare and Medicaid Services facilitated implementation while existing programs, insufficient engagement with stakeholders, aggressive timelines, and limited staff resources presented challenges. Based on these findings, states may want to consider how they approach implementing expansions or enhancements to HCBS benefits under the American Rescue Plan Act.

The Affordable Care Act included the opportunity for states to increase spending on Medicaid home and community-based services (HCBS) for older adults and persons with disabilities through the Balancing Incentive Program (BIP). This study utilized comparative case studies to identify the factors that facilitated or impeded states' implementation of BIP. Findings indicate factors that facilitated the implementation of BIP were communication with the federal government and its contractor, merging BIP with existing HCBS programs, and enhanced federal revenue. On the other hand, the short duration of BIP, state procurement and contracting processes, and the need to incorporate feedback from non-governmental stakeholders and determining how to spend the enhanced revenue proved challenging for some states. This research suggests ways federal and state officials can implement new initiatives to achieve greater rebalancing of Medicaid long-term services and supports for older adults.

Background and Objectives: Health is a predictor of subjective age, and although inconclusive, the strength of this association is not uniform across different age groups. This study investigates if new diagnoses of chronic health conditions are associated with a change in subjective age and if chronological age moderates this relationship., Research Design and Methods: Using data from the Health and Retirement Study, residualized change regression analysis was performed for a sample of 5,158 respondents older than 50 years to examine their subjective age in 2014 relative to that reported in 2010. The main predictor was the number of chronic health conditions newly diagnosed between 2010 and 2014. Chronological age in 2010 was the moderator., Results: Results showed that each new diagnosis of a chronic health condition was significantly associated with a 0.68-year increase in subjective age reported in 2014, compared to subjective age reported in 2010. However, this increase in subjective age was attenuated by 0.05 years for each additional year in 2010 chronological age., Discussion and Implications: According to Social and Temporal Comparison theories, people compare themselves to their age peers and earlier selves. Given expectations for better health at younger chronological ages, being diagnosed with chronic health conditions may have a stronger association with subjective age among middle-aged persons when compared with older persons. The findings suggest that subjective age may be used as a screening tool to predict how chronic disease diagnosis may influence peoples' sense of self, which in turn shapes future health., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: The Balancing Incentive Program (BIP) was an optional program for states within the Patient Protection and Affordable Care Act to promote Medicaid-funded home and community-based services (HCBS) for older adults and persons with disabilities. Twenty-one states opted to participate in BIP, including several states steadfastly opposed to the health insurance provisions of the Affordable Care Act. This study focused on identifying what factors were associated with states' participation in this program., Methods: Event history analysis was used to model state adoption of BIP from 2011 to 2014. A range of potential factors was considered representing states' economic, political, and programmatic conditions., Results: The results indicate that states with a higher percentage of Democrats in the state legislature, fewer state employees per capita, and more nursing facility beds were more likely to adopt BIP. In addition, states with fewer home health agencies per capita, that devoted smaller proportions of Medicaid long-term care spending to HCBS, and that had more Money Follows the Person transitions were also more likely to pursue BIP., Discussion: The findings highlight the role of partisanship, administrative capacity, and program history in state BIP adoption decisions. The inclusion of BIP in the Affordable Care Act may have deterred some states from participating in the program due to partisan opposition to the legislation. To encourage the adoption of optional HCBS programs, federal policymakers should consider the role of financial incentives, especially for states with limited bureaucratic capacity and that have made less progress rebalancing Medicaid long-term services and supports., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The COVID-19 pandemic has disrupted life globally through virus-related mortality and morbidity and the social and economic impacts of actions taken to stop the virus' spread. It became evident early in the pandemic that COVID-19 and the strategies adopted to mitigate its effects would have a disproportionate impact on older adults. This special issue of the Journal of Aging & Social Policy reports original empirical research and perspectives on the ramifications of the COVID-19 pandemic for this population. This introductory essay highlights key issues pertaining to the impact of COVID-19 on older adults and their families, caregivers, and communities. The prevalence and susceptibility of COVID-19 infection in the older adult population is discussed, including the devastating consequences of the pandemic for residents and staff of long-term care facilities. This is followed by a brief examination of ageism and social isolation brought to the fore during the pandemic, as well as the adverse effects of the pandemic for the economy and racial and ethnic minority populations. It concludes with an overview of issue content.

Over the last several decades, policymakers have focused on rebalancing Medicaid-funded long-term services and supports toward home and community-based services (HCBS). The Patient Protection and Affordable Care Act (ACA) included several opportunities for states to further promote HCBS options. One optional opportunity for states to expand Medicaid HCBS was the 1915(k) Community First Choice (CFC) program. To date, eight states have elected to add CFC as a Medicaid benefit. This study utilized comparative case studies to identify the factors that influenced states' adoption of CFC. Results highlight the important role that state bureaucrats, economic concerns, and existing HCBS programs had on states' decisions to adopt CFC.

Background and Objectives: This study examined relationships between the level of control and support and home health aides (HHAs) job satisfaction and intent to leave the job., Research Design and Methods: Data derive from a survey of 512 HHAs in Massachusetts. Logistic regression using generalized estimating equations was employed for the analysis. Dependent variables included satisfaction and intent to leave the job as a home care aide generally and satisfaction and intent to leave the job at the aide's current agency., Results: The findings showed that greater control and support on the job were important predictors of positive work outcomes, controlling for job demands and other covariates. The odds of HHAs being satisfied with their job as a home care aide increased with the degree of control, whereas the odds of HHAs being satisfied with their job at their current agency increased with the extent of support. Control was negatively associated with HHAs' intent to leave the job as an aide; no relationship was found between control or support and HHAs' intent to leave their current agency., Discussion and Implications: The results from this study illustrate the importance for HHAs of having control and autonomy in their work, as well as the benefit of support from supervisors and the home care agency, on satisfaction and intent to leave. Expanding HHA's ability to maintain control over their day-to-day work, as well as enhancing the supports available to them, is likely to benefit home care workers, clients, and agencies through increased retention., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The Trump administration's Healthy Adult Opportunity waiver follows a long history of Republican attempts to retrench the Medicaid program through block grants and to markedly reduce federal spending while providing states with substantially greater flexibility over program structure. Previous block grant proposals were promulgated during the presidential administrations of Ronald Reagan and George W. Bush and majorities in Congress led by House Speaker Newt Gingrich and House Budget Committee Chair and then Speaker Paul Ryan. Most recently, Medicaid block grants featured prominently in Republican efforts to repeal and replace the Affordable Care Act. This essay traces the history of Republican Medicaid block grant proposals, culminating in the Trump administration's Healthy Adult Opportunity initiative. It concludes that the Trump administration's attempt to convert Medicaid into a block grant program through the waiver process is illegal and, if implemented, would leave thousands of people without necessary medical care. This fact, combined with failed legislative efforts to block grant Medicaid during the last forty years, highlights the substantial roadblocks to radically restructuring a popular program that helps millions of Americans., (Copyright © 2021 by Duke University Press.)

The growing need for long-term services and supports (LTSS) poses significant challenges to both individuals and government. This article documents the continuing failure to tackle this problem at the national level-a failure that was most recently seen in the fallout from the Affordable Care Act (ACA), which included the single piece of national legislation ever enacted to comprehensively address LTSS costs: the Community Living Assistance Services and Supports (CLASS) Act. The CLASS Act was passed as part of the ACA (Title 8) but was repealed in 2013. Following its demise, policy experts and some Democrats have made additional proposals for addressing the LTSS financing crisis. Moreover, significant government action is taking place at the state level, both to relieve financial and emotional burdens on LTSS recipients and their families and to ease pressure on state Medicaid budgets. Lessons from these initiatives could serve as opportunities for learning how to overcome roadblocks to successful policy development, adoption, and implementation across states and for traversing the policy and political tradeoffs should a policy window once again open for addressing the problem of LTSS financing nationally., (Copyright © 2020 by Duke University Press.)

The COVID-19 pandemic has impacted the lives of people throughout the world, either directly, due to exposure to the virus, or indirectly, due to measures taken to mitigate the virus' effects. Older adults have been particularly hard hit, dying in disproportionately higher numbers, especially in long-term care facilities. Local, regional, and national government actions taken to mitigate the spread of COVID-19 have thus served, in part, to shield older adults from the virus, though not without adverse side effects, including increased social isolation, enhanced economic risk, revealed ageism, delayed medical treatment, and challenges getting basic needs met. This special issue of the Journal of Aging & Social Policy explores the myriad ways in which the COVID-19 pandemic has affected older adults and their families, caregivers, and communities. It proposes policies and strategies for protecting and improving the lives of older people during the pandemic. It draws lessons for aging policy and practice more generally, given underlying challenges brought to the fore by government, provider, community, and individual responses to the pandemic.

Objective: To examine nurse practitioner (NP) and physician assistant (PA) practice in nursing homes (NHs) during 2000-2010., Data Sources: Data were derived from the Online Survey Certification and Reporting system and Medicare Part B claims (20 percent sample)., Methods: NP/PA state average employment, visit per bed year (VPBY), and providers per NH were examined. State fixed-effect models examined the association between state regulations and NP/PA use., Principal Findings: NHs using any NPs/PAs increased from 20.4 to 35.0 percent during 2000-2010. Average NP/PA VPBY increased from 1.0/0.3 to 3.0/0.6 during 2000-2010. Average number of NPs/PAs per NH increased from 0.2/0.09 to 0.5/0.14 during 2000-2010. The impact of state scope-of-practice regulations was mixed., Conclusions: NP and PA scope-of-practice regulations impact their practice in NHs, not always as intended., (© Health Research and Educational Trust.)

Purpose of the Study: This study draws lessons for successful consumer engagement in Medicaid nursing home (NH) reimbursement policy from New York and Minnesota. In these two states, resident advocates have influenced reimbursement policy to better encourage access, care quality, and quality of life., Design and Methods: Twenty-four semi-structured interviews were conducted, including consumer advocates, state agency officials, legislators/legislative staff, and NH industry representatives. Transcripts were coded to identify recurring themes and patterns in responses. Related documents were reviewed as well., Findings: Interviewees report that consumer advocates should participate in NH reimbursement policy making to provide a unique perspective distinct from other stakeholder groups. Skills necessary for successful participation include developing, demonstrating, and sharing expertise to gain credibility as a legitimate actor. Effective strategies include participating on state workgroups and taskforces and developing and accessing relationships with key legislative and executive branch officials. A division of labor may be useful with those consumer advocates possessing expertise in NH reimbursement policy partnering with other organizations with the experience and resources necessary to marshal grassroots support., Implications: State and federal reimbursement reform provide opportunities for consumer advocacy influence during the design and implementation process. The experience of consumer groups in New York and Minnesota provide lessons for advocates looking to influence these and other reimbursement initiatives.

Context: Although observers have long highlighted the relationship of public distrust, government regulation, and media depictions of nursing-home scandals, no study has systematically analyzed the way in which nursing homes have been portrayed in the national media. This study examines how nursing homes were depicted in four leading national newspapers-the New York Times, Washington Post, Chicago Tribune, and Los Angeles Times-from 1999 to 2008., Methods: We used keyword searches of the LexisNexis database to identify 1,704 articles pertaining to nursing homes. We then analyzed the content of each article and assessed its tone, themes, prominence, and central actor. We used basic frequencies and descriptive statistics to examine the articles' content, both cross-sectionally and over time., Findings: Approximately one-third of the articles were published in 1999/2000, and a comparatively high percentage (12.4%) appeared in 2005. Most were news stories (89.8%), and about one-quarter were on the front page of the newspaper or section. Most focused on government (42.3%) or industry (39.2%) interests, with very few on residents/family (13.3%) and community (5.3%) concerns. Most were negative (45.1%) or neutral (37.0%) in tone, and very few were positive (9.6%) or mixed (8.3%). Common themes were quality (57.0%), financing (33.4%), and negligence/fraud (28.1%). Both tone and themes varied across newspapers and years., Conclusions: Overall, our findings highlight the longitudinal variation in the four widely read newspapers' framing of nursing-home coverage, regarding not only tone but also shifts in media attention from one aspect of this complex policy area to another. The predominantly negative media reports contribute to the poor public opinion of nursing homes and, in turn, of the people who live and work in them. These reports also place nursing homes at a competitive disadvantage and may pose challenges to health delivery reform, including care integration across settings., (© 2012 Milbank Memorial Fund.)

The Patient Protection and Affordable Care Act attempts to address prevailing deficiencies in long-term care (LTC) financing through the Community Living Assistance Services and Supports (CLASS) Act, a national voluntary LTC insurance program administered by the Federal government. The CLASS Act is intended to supplement rather than supplant assistance received from other payers. Furthermore, its reliance on a cash benefit allocated by beneficiaries with the assistance of counseling services makes it consistent with the consumer-directed philosophy increasingly favored by the LTC advocacy community. Largely due to inadequate take-up, however, particularly among better than average risks, it is unlikely that implementation of the CLASS Act will fundamentally alter the current public-private partnership for LTC financing. Instead, voluntary enrollment combined with a lack of medical underwriting could lead to disproportionate numbers of high-cost enrollees. This could result in premium increases that further discourage participation on the part of the broader population. Barring making the program mandatory, there are a number of comparatively minor changes policymakers could make to strengthen the risk pool, though doing so will involve a trade-off between attracting better-off risks while eschewing those likely to need the benefit most. Thus, although the CLASS Act may provide a meaningful benefit for those who enroll, its impact on improving the affordability of LTC for most Americans will likely be limited. Most will continue to rely on substantial unpaid care, out-of-pocket payments when formal care is required, and Medicaid when all other money has run out.

Objective: This study analyzes what design elements inhibited enrollment in HEALTHpact., Study Setting: HEALTHpact is a high deductible plan with a premium capped at 10 percent of the average Rhode Island wage. Deductibles are reduced if enrollees meet wellness criteria., Study Design: Qualitative case study., Data Collection: Archival documents and 23 interviews., Principal Findings: Inclusion of a subsidy would have led to lower premiums and more generous coverage. Although priced lower than other plans, HEALTHpact still did not offer good value for most firms. Wellness incentives also were too complex., Conclusions: Subsidies for purchase of insurance coverage are critical to national reform of the small group market. Designers also will need to carefully balance program complexity with innovation in encouraging wellness and product appeal., (© Health Research and Educational Trust.)

The lack of systematically collected and analysed data about the effect of telemedicine on patient-provider communication is a frequently cited barrier for why video communication has yet to reach its full potential. Existing research provides little information about the subtle and detailed changes in communication that take place over video. Comprehensive investigations of actual medical encounter behaviour are therefore required, including verbal content analysis, which uses interaction analysis systems (IAS) to describe and categorize the communication that has taken place. Ten IAS studies were identified in the literature. Although it is difficult to generalize due to differences in methodology and context, some tentative conclusions can be drawn. First, on-site providers tend to be substantially less active than off-site providers, suggesting that the former typically serve as facilitators and observers, rather than active participants. Second, just as in the conventional face-to-face setting, providers' utterances tend to predominate in telemedicine. Third, conventional patterns of more task-focused than socio-emotional utterances tend to persist in telemedicine. However, some studies found telemedicine to be more patient-centred than conventional medicine, and others found it less so. We do not yet have a full understanding of the subtractive and enhancing effects of telemedicine on provider-patient relations and outcomes.

In 2009, as the United States moved toward health care reform, the government of Bermuda implemented its FutureCare program to make health care for seniors more affordable. This article investigates how preferences for reform and its eventual design were shaped by the country's social history and commitment to free market values. Data derive from 36 in-depth interviews with key stakeholders deemed knowledgeable about health care financing and delivery in Bermuda, including government officials, provider representatives, insurance executives, and consumer advocates. Data also derive from a variety of documentary sources. Results indicate that although a clear need for health care and the ability to finance it for seniors exists in Bermuda, the scope of reform was circumscribed by preferences for prior policy decisions, creating a favorable tax and business environment for international corporations and a minimalist social welfare state for addressing racial and economic inequality. This suggests that widespread agreement on the challenges in meeting the health and long-term care needs of the elderly does not necessarily lead to equally commensurable solutions to addressing it.

Objectives: We analyzed the content and characteristics of influential health blogs and bloggers to provide a more thorough understanding of the health blogosphere than was previously available., Methods: We identified, through a purposive-snowball approach, 951 health blogs in 2007 and 2008. All blogs were US focused and updated regularly. We described their features, topics, perspectives, and blogger demographics., Results: Approximately half of the bloggers in our sample were employed in the health field. A majority were female, aged in their 30s, and highly educated. Two thirds posted at least weekly; one quarter accepted advertisements. Most blogs were established after 2004. They typically focused on bloggers' experiences with 1 disease or condition or on the personal experiences of health professionals. Half were written from a professional perspective, one third from a patient-consumer perspective, and a few from the perspective of an unpaid caregiver., Conclusions: Data collected from health blogs could be aggregated for large-scale empirical investigations. Future research should assess the quality of the information posted and identify what blog features and elements best reflect adherence to prevailing norms of conduct.