Search

Policy PointsLittle attention to date has been directed at examining how the long‐term services and supports (LTSS) environmental context affects the health and well‐being of older adults with disabilities.We develop a conceptual framework identifying environmental domains that contribute to LTSS use, care quality, and care experiences.We find the LTSS environment is highly associated with person‐reported care experiences, but the direction of the relationship varies by domain; increased neighborhood social and economic deprivation are highly associated with experiencing adverse consequences due to unmet need, whereas availability and generosity of the health care and social services delivery environment are inversely associated with participation restrictions in valued activities.Policies targeting local and state‐level LTSS‐relevant environmental characteristics stand to improve the health and well‐being of older adults with disabilities, particularly as it relates to adverse consequences due to unmet need and participation restrictions. Context: Long‐term services and supports (LTSS) in the United States are characterized by their patchwork and unequal nature. The lack of generalizable person‐reported information on LTSS care experiences connected to place of community residence has obscured our understanding of inequities and factors that may attenuate them. Methods: We advance a conceptual framework of LTSS‐relevant environmental domains, drawing on newly available data linkages from the 2015 National Health and Aging Trends Study to connect person‐reported care experiences with public use spatial data. We assess relationships between LTSS‐relevant environmental characteristic domains and person‐reported care adverse consequences due to unmet need, participation restrictions, and subjective well‐being for 2,411 older adults with disabilities and for key population subgroups by race, dementia, and Medicaid enrollment status. Findings: We find the LTSS environment is highly associated with person‐reported care experiences, but the direction of the relationship varies by domain. Measures of neighborhood social and economic deprivation (e.g., poverty, public assistance, social cohesion) are highly associated with experiencing adverse consequences due to unmet care needs. Measures of the health care and social services delivery environment (e.g., Medicaid Home and Community‐Based Service Generosity, managed LTSS [MLTSS] presence, average direct care worker wage, availability of paid family leave) are inversely associated with experiencing participation restrictions in valued activities. Select measures of the built and natural environment (e.g., housing affordability) are associated with participation restrictions and lower subjective well‐being. Observed relationships between measures of LTSS‐relevant environmental characteristics and care experiences were generally held in directionality but were attenuated for key subpopulations. Conclusions: We present a framework and analyses describing the variable relationships between LTSS‐relevant environmental factors and person‐reported care experiences. LTSS‐relevant environmental characteristics are differentially relevant to the care experiences of older adults with disabilities. Greater attention should be devoted to strengthening state‐ and community‐based policies and practices that support aging in place. [ABSTRACT FROM AUTHOR]

Purpose: Despite the efforts of numerous medical schools to produce rural physicians, many rural communities in the United States still experience physician shortages. This study describes the current landscape of rural efforts in US undergraduate medical education and catalogs medical school characteristics and activities that evidence has suggested, and that many experts in rural medical education believe, may result in more graduates choosing rural practice. Methods: This is a descriptive study of publicly available and rurally relevant characteristics of all 182 allopathic and osteopathic medical schools operating in the 50 states and the District of Columbia in 2016, with rural program information for these schools updated in 2019. The authors constructed a "rural program" definition in order to systematically catalog coordinated and strategic medical school efforts to produce a rural physician workforce. Findings: Few (8.2%) medical schools expressed an explicit commitment to producing rural physicians in public mission statements. However, most (64.8%) provided rural clinical experiences and many demonstrated their commitment in other ways. Only 39 (21.4%) did so through a formal rural program. Conclusions: In establishing an explicit rural program definition and documenting other markers of rural commitment, this paper provides a baseline for future studies of rural workforce production and medical school investment in these programs, activities, and personnel. Demonstrating the effectiveness of schools' rural physician education efforts will require collaboration across institutions and more intensive evaluations of programs involving students who, though relatively few in number, have great potential for contributing to the health of rural communities across the nation. [ABSTRACT FROM AUTHOR]