@article {13877, title = {Informal care provided in US nursing homes: Reduced from 2010 to 2021 and lower for Medicaid residents.}, journal = {Journal of the American Geriatrics Society}, year = {Forthcoming}, abstract = {

BACKGROUND: Little is known about the trend of informal care (unpaid care provided by family or other caregivers) provided to nursing home residents before or during the COVID-19 pandemic. This study assessed this trend during 2010-2021, for all and Medicaid versus non-Medicaid residents.

METHODS: Using data from the RAND Health and Retirement Study longitudinal file, our study sample included a total of 2025 resident-years (860 for Medicaid and 1165 for non-Medicaid residents). We fit two-part regression models to determine adjusted trends in average amount of informal care over time, and difference by resident Medicaid status.

RESULTS: Informal care received by residents reduced substantially over time, from an average of 39.2 h in the past month of interview in 2010-11 to 23.2 h in 2018-19, and then to 11.2 h in the COVID-19 pandemic (2020-21). The reduced hours were due to both reduced percentages of nursing home residents who received any informal care and reduced hours of care among those who did receive it over time. Multivariable analyses confirmed this trend and similar downward trends for Medicaid versus non-Medicaid residents. Medicaid residents on average received 10.02 fewer hours of informal care per month (95\% confidence interval -17.16, -2.87; p = 0.006) than non-Medicaid residents after adjustment for resident characteristics and time trends.

CONCLUSION: Informal care provided to nursing home residents during 2010-2021 reduced over time, especially during the COVID-19 pandemic (2020-21). Medicaid residents tended to receive less informal care than non-Medicaid residents.

}, keywords = {COVID-19, Family care, Informal care, Medicaid, nursing home, trend}, issn = {1532-5415}, doi = {10.1111/jgs.18904}, author = {Li, Yue and Cai, Xueya and Kim, Yeunkyung Yoon and Kim, Jihye} } @article {11565, title = {Anticipated Need for Future Nursing Home Placement by Sexual Orientation: Early Findings from the Health and Retirement Study}, journal = {Sexuality Research and Social Policy}, volume = {19}, year = {2022}, pages = {656{\textendash}662}, abstract = {Background With a growing population of lesbian, gay, bisexual, and transgender (LGBT) older adults, it is critical to better understand the future long-term care needs of this population. This study compares anticipated need for future nursing home placement, as well as health characteristics of lesbian, gay, and bisexual (LGB) and heterosexual adults. Methods Using data from the 2016 wave of the Health and Retirement Study, descriptive and bivariate analyses were conducted to examine anticipated nursing home placement and health characteristics of LGB (n = 137) and heterosexual (n = 3469) adults. Results There was a marginally significant difference in anticipated need for nursing home placement. LGB (34\%, SD = 29.2) adults reported a higher percent chance of ever having to move to a nursing home compared to heterosexual adults (27\%, SD = 27.3; p = 0.055). LGB respondents were less likely to have a living child/children (37\% vs 82\%, p < .001), but no other demographic differences were found between the samples. Conclusion/Policy Implication Findings from this early research add to the literature on the future care needs of older sexual minorities. Given the differing family structures of LGB adults and other factors, long-term care facilities must ensure their workforce is prepared to support a growing, diverse older adult population.}, keywords = {Health Disparities, Long-term Care, nursing home, sexual minorities}, isbn = {1553-6610}, doi = {10.1007/s13178-021-00581-y}, author = {Singleton, Mekiayla and Zachary Gassoumis and Enguidanos, Susan} } @article {12021, title = {Caregiver Support Can Lower the Risk of a Prolonged Nursing Home Stay}, journal = {Personal Home Care}, year = {2021}, publisher = {Home Health Care News}, abstract = {For the majority of seniors living alone, recovering from an acute illness at home is preferable to doing so in a long-term care facility.}, keywords = {caregiver, nursing home, support}, url = {https://homehealthcarenews.com/2021/11/report-caregiver-support-can-lower-the-risk-of-a-prolonged-nursing-home-stay/}, author = {Famakinwa, Joyce} } @article {12290, title = {The Lifetime Risk of Spousal Nursing Home Use and its Economic Impact on the Community-Dwelling Spouse}, number = {WP 2021-433}, year = {2021}, institution = {Michigan Retirement and Disability Research Center, University of Michigan}, address = {Ann Arbor, MI}, abstract = {A single person in a nursing home is relatively well-protected financially from nursing home expenses because Medicaid covers these once assets are depleted. Couples, however, are less well protected, because the high cost of nursing homes rapidly depletes household assets, possibly impoverishing the spouse living in the community, despite Medicaid provisions that shield spousal assets up to some threshold. In this paper, we estimate the lifetime risk that one spouse will reside in the community while the other resides in a nursing home, and the distribution of the accumulated number of days spent in a nursing home and costs. We use data from the longitudinal Health and Retirement Study and follow individuals and their spouses from age 70 to death. We also examine how spousal nursing home use affects families{\textquoteright} financial outcomes and to what extent Social Security income protects the community-residing spouse from the adverse effects of spousal nursing home use. We find that a 70- to 74-year-old married person who lives in the community faces a 34.3\% chance that his or her spouse would move to a nursing home before death. When they do, spouses spend about nine months, on average, in nursing homes, and the average out-of-pocket cost is about $19,800 (2019 dollars). We find that spousal nursing home use significantly decreases households{\textquoteright} assets and increases the risk of further impoverishment. While Social Security income has an overall positive impact on families{\textquoteright} financial outcomes, it does not mitigate the financial effects of spousal nursing home use.}, keywords = {Community-dwelling, economic impact, lifetime risk, nursing home, spouse}, url = {https://deepblue.lib.umich.edu/bitstream/handle/2027.42/171803/wp433.pdf?sequence=1}, author = {Susann Rohwedder and P{\'e}ter Hudomiet and Michael D Hurd} } @article {10996, title = {Making the Decision to Move to a Nursing Home: Longitudinal Evidence From the Health and Retirement Study}, journal = {Journal of Applied Gerontology}, volume = {40}, year = {2021}, pages = {1197-1205}, abstract = {This study applied the theory of planned behavior to examine predictors of U.S. older adults? (65+ years) intention and behavior of moving to a nursing home. Two waves of Health and Retirement Study data were used (N = 9,969). Moving intention was measured by respondents? self-reported probability to move in the next 5 years in Wave 1. Moving behavior was measured by whether they actually moved in Wave 2. Structural equation modeling was used to examine the relationships of demographic and health predictors with moving intention and behavior. For both genders, advanced age, poorer health, having fewer children, and long-term care insurance were associated with higher levels of moving intention and behavior. Men?s intention was a significant predictor of subsequent moving behavior. However, women?s intention was not associated with moving behavior, probably due to inadequate resources to support their preference. The findings provide meaningful personhood-centered insights into nursing home entry decisions.}, keywords = {decision-making, moving, nursing home, theory of planned behavior}, isbn = {0733-4648}, doi = {https://doi.org/10.1177/0733464820949042}, author = {Lu, Peiyi and Kong, Dexia and Shelley, Mack} } @article {11536, title = {Wealth and the utilization of long-term care services: evidence from the United States.}, journal = {International Journal of Health Economics and Management}, volume = {21}, year = {2021}, pages = {345-366}, abstract = {

Long-term care (LTC) provision and financing has become a major challenge for policymakers in the United States and worldwide. To inform associated policies and more efficiently allocate LTC resources, it is important to understand how demand for different types of LTC services responds to increased wealth. We use data from the United States Health and Retirement Study to examine the use of LTC services following plausibly exogenous positive shocks to wealth. We further account for time-invariant household-level characteristics, including the expectation of a wealth shock at an unknown future time, by employing household fixed effects. We find that large positive wealth shocks lead to a greater probability of purchase of paid home care but not of nursing home care. Our results imply that expanding home and community-based services and insurance coverage of home care for people without sufficient wealth is likely to be efficient and welfare improving and should be considered by policymakers.Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 4 Given name: [R. Tamara] Last name: [Konetzka]. Also, kindly confirm the details in the metadata are correct.confirmedPlease confirm the city are correct and amend if necessary in Affiliations 1, 2, 3, 4.confirmed.

}, keywords = {home care, Long-term care financing, nursing home, Wealth effect}, issn = {2199-9031}, doi = {10.1007/s10754-021-09299-1}, author = {Dong, Jing and Daifeng He and John A. Nyman and R. Tamara Konetzka} } @article {11374, title = {Nursing Homes in Equilibrium: Implications for Long-term Care Policies}, number = {MRDRC WP 2020-414}, year = {2020}, institution = {Michigan Retirement and Disability Research Center, University of Michigan}, address = {Ann Arbor, MI}, abstract = {We build an equilibrium model of the market for nursing home care with decision-makers on both sides of the market. The nursing home demand arises as a result of stochastic dynamic optimizations by households heterogeneous in age, health, wealth; and the cost of home-andcommunity-based care. On the supply side, locally competitive nursing homes decide prices and care intensity. The government pays for the long-term care of the poorest. We estimate the model parameters using Health and Retirement Survey and simulate the model to quantitatively evaluate the effects of long-term care policies on prices, intensities, care allocation, and welfare.}, keywords = {Long-term Care, nursing home}, url = {https://mrdrc.isr.umich.edu/publications/papers/pdf/wp414.pdf}, author = {Koreshkova, Tatyana and Lee, Minjoon} } @article {doi:10.1111/jgs.16414, title = {Residential Setting and the Cumulative Financial Burden of Dementia in the 7 Years Before Death}, journal = {Journal of the American Geriatrics Society}, year = {2020}, type = {Journal}, abstract = {OBJECTIVES Care for older adults with dementia during the final years of life is costly, and families shoulder much of this burden. We aimed to assess the financial burden of care for those with and without dementia, and to explore differences across residential settings. DESIGN Using the Health and Retirement Study (HRS) and linked claims, we examined total healthcare spending and proportion by payer{\textemdash}Medicare, Medicaid, out-of-pocket, and calculated costs of informal caregiving{\textemdash}over the last 7 years of life, comparing those with and without dementia and stratifying by residential setting. SETTING The HRS is a nationally representative longitudinal study of older adults in the United States. PARTICIPANTS We sampled HRS decedents from 2004 to 2015. To ensure complete data, we limited the sample to those 72 years or older at death who had continuous fee-for-service Medicare Parts A and B coverage during the 7-year period (n = 2909). MEASUREMENTS We compared decedents with dementia at last HRS assessment with those without dementia across annual and cumulative 7-year spending measures, and personal characteristics. We present annual and cumulative spending by payer, and the changing proportion of spending by payer over time, comparing those with and without dementia and stratifying results by residential setting. RESULTS We found that, consistent with prior studies, people with dementia experience significantly higher costs, with a disproportionate share falling on patients and families. This pattern is most striking among community residents with dementia, whose families shoulder 64\% of total expenditures (including \$176,180 informal caregiving costs and \$55,550 out-of-pocket costs), compared with 43\% for people with dementia residing in nursing homes (\$60,320 informal caregiving costs and \$105,590 out-of-pocket costs). CONCLUSION These findings demonstrate disparities in financial burden shouldered by families of those with dementia, particularly among those residing in the community. They highlight the importance of considering the residential setting in research, programs, and policies.}, keywords = {community-dwelling older adults, Dementia, health-related costs, Medicare and Medicaid, nursing home}, doi = {10.1111/jgs.16414}, url = {https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16414}, author = {Amy Kelley and Kathleen McGarry and Bollens-Lund, Evan and Rahman, Omari-Khalid and Husain, Mohammed and Ferreira, Katelyn B. and Jonathan S Skinner} } @article {11442, title = {The Link between Individual Expectations and Savings: Do Nursing Home Expectations Matter?}, number = {2006-5}, year = {2006}, institution = {University of Aarhus}, address = {Aarhus, Denmark}, abstract = {Preparing for the end of life, especially for the prospect of needing long-term are, is an important issue facing older Americans. Those who reach age 65 have a 40\% chance of going into a nursing home in their remaining lifetime, and about 10\% of those who do will stay there for at least five years. The costs of a stay are high with on average US$70,000 annually for a private room. Long-term stays in nursing homes are, therefore, not likely, but very expensive. In this paper, we examine individual expectations about future nursing home entry and study the relationship between these expectations and savings behavior, using data from the Health and Retirement Study. We find a clear relation between subjective expectations and probability of future nursing home entry, and a positive effect of these expectations on savings behavior. Surprisingly, we find no difference of this effect by wealth group, so it seems that Medicaid eligibility in the context of nursing home entry plays no factor in the decision to save.}, keywords = {Expectations, nursing home, Savings}, doi = {http://dx.doi.org/10.2139/ssrn.1147034}, author = {Kristin J. Kleinjans and Jinkook Lee} }