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Social prejudice, family nonacceptance, and lack of marriage or adoption rights often restrict the formation of conventional social ties among LGBT older adults. As a result, they often rely on families of choice constituted by other LGBT/age peers for support. Using a series of regression analyses with a national sample of LGBT older Americans, this study investigated how characteristics of social network structure (size and composition - LGBT vs. non-LGBT identity and age ≥50 vs. < 50) were related to LGBT older adults' social network function (perceived social support). Larger social networks, especially those composed of LGBT members and older adults, were associated with more perceived social support. In subgroup analyses, larger social networks composed of more LGBT members and older adults were associated with more perceived social support among lesbian and gay respondents. For bisexual + older adults, larger social network size was associated with more perceived social support, but social network composition was not related to more perceived social support. For transgender older adults, neither social network size nor network composition were significantly associated with perceived social support. This study demonstrated that having more people with similar characteristics in their social networks cues LGBT older adults about the availability of social support. Findings may inform strategies for tailoring programs intended to maintain and strengthen LGBT older adults' social support networks. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [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]

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. [ABSTRACT FROM AUTHOR]

We examine cross-spouse associations between education and financial literacy among older couples, net of own education, and whether the cross-spouse associations differ by gender. Using data from the Cognitive Economics Study, we employ multilevel actor–partner interdependence regression models to examine both the actor and partner associations between education and financial literacy (N = 205 dyads) and the moderating role of gender. Findings indicate that the partner association between education and financial literacy was moderated by gender. Husbands' education was associated with wives' financial literacy, net of own education and controls, but wives' education was not associated with husbands' financial literacy. The study adds to our knowledge of the role of the family context in financial literacy, net of own education. Results suggest that factors shaping financial knowledge may spill over from husbands to wives. Interventions to enhance older adults' financial knowledge should take into account the family context and consider couple-based approaches. [ABSTRACT FROM AUTHOR]

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.

Purpose: Theories of the policy process recognize that policy proposals are typically generated, debated, redrafted, and accepted for consideration through the gradual accumulation of knowledge within communities of specialists. Thus, to inform long-term care (LTC) reform efforts, we conducted a Web-based survey of 1,147 LTC specialists nationwide. Design and Methods: Survey respondents included consumer advocates, provider representatives, public officials, policy experts, and others with experience in LTC. Administration took place between September 2007 and March 2008 and addressed prevailing challenges and options for reform. Results: Although differences could be discerned, constituency group views converged in several areas. There was general agreement that LTC financing needed to be socialized more and that impediments to organizational change needed to be overcome. Respondents also felt that LTC needed to be rebalanced toward home- and community-based settings, though few supported doing so by limiting nursing home (NH) bed supply. Although virtually all felt that the federal government was doing a poor job regulating LTC providers, most believed that the approaches used to oversee NHs should also be applied to assisted living. Payment incentives were highlighted as the most effective strategy for improving quality even though it suffers from the same informational deficits compromising consumer reporting. Implications: By giving voice to those who know LTC very well, and identifying areas of agreement and disagreement, this study should prove useful in promoting LTC reform where it might otherwise remain politically intransigent.