COVID-19 Pandemic Spurs Policy Changes Benefiting Older Adults.

This article reviews recent federal and state policy changes in response to the COVID-19 pandemic that affect health care and quality of life for older adults. Specific regulations and guidelines issued at the state and federal level have increased access and provided additional funding for essential services and supports. Many of these changes are temporary and have the potential to improve care beyond the immediate crisis. This period of greater flexibility offers the opportunity to accrue evidence on quality and access to influence sustained change. [Journal of Gerontological Nursing, 46(6), 19-23.].

Rating the importance of nursing home residents' quality of life.

OBJECTIVES: To assess how various stakeholders involved with nursing home care rate the importance of various quality-of-life (QoL) items for hypothetical residents with varying types of impairment. DESIGN: A community-based exploratory description of a convenience sample. SETTING: Eleven nursing homes in Florida, New Jersey, and Minnesota. PARTICIPANTS: Samples of registered and licensed nurses (RNs and LPNs), certified nursing assistants (CNAs), activities personnel, social workers, physicians, residents, and family members. MEASUREMENTS: Using a magnitude estimation approach, 17 QoL items were rated in order of importance on each of three hypothetical types of nursing home residents. RESULTS: Overall, there was little variation in the ratings for individual items. Ratings for persons with cognitive impairment were consistently lower. RNs'/LPNs' and CNAs' ratings were generally higher than the others, and physicians' ratings were generally lower. Residents' and families' ratings were generally lower than nurses' ratings. CONCLUSION: All stakeholders considered QoL to be important and felt that it deserves more attention in practice and regulation. A summary QoL score need not be weighted. Respondents (who were not cognitively impaired) considered QoL less important for residents with cognitive impairment. Value differences between those involved in nursing home care deserve more exploration.

Medicaid home care services and survival in New York City.

PURPOSE: New York City's Medicaid Home Care Services Program provides an integrated program of housekeeping and personal assistance care along with regular nursing assessments. We sought to determine if this program of supportive care offers a survival benefit to older adults. DESIGN AND METHODS: Administrative data from New York City's Medicaid Home Care Services Program were merged with epidemiologic and diagnostic data collected in a community study of older adults living in northern Manhattan. Of 866 older adults with Medicaid coverage living in the community, 288 (33.3%) received Medicaid home care services in the period from 1994 to 1996. Mortality was tracked through the end of 1999. RESULTS: In proportional hazards models that adjusted for differences in sociodemographic, medical, and functional status, use of Medicaid home care service was associated with a significantly reduced risk of death in people with disability in activities of daily living. IMPLICATIONS: Because the program has distinctive features (greater number of weekly hours than other programs, integration with nursing assessments), it is a special case of community-based long-term care. Still, results from this observational cohort suggest that mortality risk in the most vulnerable elderly population can be reduced through a program of supportive care.

Older adults' reports of formal care hours and administrative records.

PURPOSE: Personal assistance care is a Medicaid benefit in New York, but few data are available on its prevalence and contribution to home care. We examined these issues in a New York City sample by assessing older adults' reports of weekly home care hours and Medicaid billing records. DESIGN AND METHODS: With help from New York City's Human Resources Administration, we identified all respondents in an ongoing population-based survey of Medicare enrollees who were receiving Medicaid-reimbursed personal assistance care in 1996. RESULTS: Of respondents in the sample, 10.3% (185 of 1,902 alive through 1996) had Medicaid claims for personal assistance care. The mean was 46.1 hr/week for reported hours and 40.1 hr/week for administrative claims. Accuracy of reported hours was evident in a high correlation (r =.91; p <.001) between respondent reports and authorized claims, and a consistently high and mostly constant ratio of billed to reported hours across all categories of activities of daily living disability. IMPLICATIONS: In this urban, low income, and mostly minority sample, older adults' reports of weekly formal care hours were valid when matched against administrative records. Respondent reports of formal care hours were valid even in complex care situations.

Identification of patients at risk of ischemic events for long-term secondary prevention.

PURPOSE: To review the identification of patients at risk of secondary ischemic events, discuss the therapies available for their medical management, and identify the role of the nurse practitioner (NP) in their primary and long-term care. DATA SOURCES: ACC/AHA 2007 guidelines for the management of patients with unstable angina and non-ST-elevation myocardial infarction, ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease, AHA/ASA 2006 guidelines for patients with ischemic stroke, AHA/ACC 2006 guidelines update for patients with coronary and other atherosclerotic vascular disease, and selected clinical articles identified through PubMed. CONCLUSIONS: Preventive therapy in patients with atherothrombotic vascular disease is critical for reducing the risk of recurrent events. Almost all patients with atherosclerotic disease will benefit from general lifestyle modifications, and most will also benefit from appropriate pharmacotherapies targeting dyslipidemia, diabetes, hypertension, and platelet function. However, evidence suggests that secondary prevention strategies may not be utilized effectively. IMPLICATIONS FOR PRACTICE: Increased awareness and implementation of clinical practice guidelines can reduce the risk of recurrent atherothrombotic events. NPs in primary care settings or in long-term care facilities are well placed to determine whether patients are receiving appropriate preventive care and to implement improvements in their management.

Nursing home staff's perceived ability to influence quality of life.

Nurses, certified nursing assistants, activity personnel, social workers, and physicians in 5 cities rated their ability to affect each of 17 quality of life (QoL) items for 2 hypothetical cases. Those closest to the residents feel the most empowered to make a difference. Overall, certified nursing assistants were consistently the most optimistic about their ability to influence QoL. Perceptions of ability to influence QoL were correlated with attitudes about nursing homes. These perceptions may be helpful in retaining such staff.

Cognitive impairment and quality-of-life: views of providers of long-term care services.

Quality-of-life (QoL) is now recognized as a principal outcome marker for long-term care. However, QoL is difficult to define and measure, especially in residents with dementia. Providers of long-term care services (n = 182) were asked to rate the importance of 19 psychosocial quality-of-life elements for hypothetical residents with physical impairment and for residents with cognitive impairment. Respondents also were asked to rate their ability to influence these elements for each type of resident. Respondents rated the importance of 18 of the 19 elements and their ability to influence 17 of 19 elements lower for residents with cognitive impairment. Of the five types of respondents, certified nursing assistants (CNAs) rated their ability to influence these QoL elements the highest for both types of residents; physicians' ratings were the lowest. Pain management was given high ratings for both importance and ability to influence for both resident types; the lowest ratings were given for elements that pertained to residents' understanding. A strong correlation between ratings for importance and ability to influence was observed. Additional research is needed on the psychosocial aspects of long-term care residents' QoL, especially those with cognitive impairment.