Medicine and Health Sciences Commons^™

The Alzheimer’S Association Dementia Care Coordination Program: A Process Evaluation, Executive Summary, Nina Silverstein, Frank Porell, Pamela Nadash

Gerontology Institute Publications

The Massachusetts/New Hampshire (MA/NH) Chapter of the Alzheimer's Association has long sought ways to systematically increase the number of families who utilize its services and support. According to the Alzheimer’s Association’s 2015 Alzheimer’s Disease Facts and Figures, there are 142,000 individuals living with Alzheimer’s disease in Massachusetts and New Hampshire, and the Alzheimer’s Association estimates that less than 30% of those individuals and their caregivers take advantage of its programs (Alzheimer’s Association, 2015). The MA/NH Chapter recognized that one major barrier to accessing services is a model that relies on families taking the initiative to seek out assistance.

In …

Puerto Rican Mother-Child Communication About Sexuality And Sexual Health: Results From An Ethnographic Community Survey In Springfield, Ma, María Idalí Torres, Phillip Granberry, Sarah Rustan

Gastón Institute Publications

This bilingual report presents data from an ethnographic survey on the experiences of Spanish-speaking Puerto Rican mothers communicating with children ages 10 to 19 regarding sexuality and sexual health. Results of this survey will be used as baseline data to evaluate a media campaign promoting Puerto Rican mother-child communication. This Spanish media campaign was implemented from March to May, 2015 using public service announcements in television, radio, and newspapers and on public transportation.

In this report, we use three main concepts with specific definitions: mother, sexuality, and sexual health protection, defined as follows. Mother is defined as the female adult …

Effects Of Video Enhancement In A Stated-Choice Experiment On Medical Decision Making, Susanne Hoffmann, Joachim Winter, Francis G. Caro, Alison Gottlieb

Gerontology Institute Publications

Background. The internet can be useful in administering stated-choice experiments to understand medical decision making and refine the content of patient decision aids. In internet-based stated-choice experiments, video and audio files can be used to provide information to respondents. Quality of data may or may not be affected.

Objectives. In a methodological experiment concerned with administration of a stated-choice experiment on the internet concerned with knee-replacement surgery, we compared the data quality obtained with video-enhanced and conventional text formats.

Methods. Members of the RAND Corporation’s American Life Panel and 50 years of age or older (n=1616) were randomly assigned to …

Black Is Decidedly Not Just Black: A Case Study On Hiv Among African-Born Populations Living In Massachusetts, Chioma Nnaji, Nzinga Metzger

Trotter Review

Black or African American is a racial category that includes the descendants of enslaved Africans as well as members of foreign-born black communities who migrated to the United States from places abroad, such as Africa, the Caribbean, and Latin America. Grouping native-born and foreign-born blacks into a single homogeneous racial category may make it easier to track disease and health outcomes; however, it masks the different cultural experiences, histories, languages, social and moral values, and expectations that influence health beliefs, attitudes, practices, and behaviors. It also ignores such factors as migration, which forces foreign-born populations to examine both their traditional …

Social Actors Fight The Rising Tide Of Hiv In U.S. Southern Poor, Courtenay Sprague, Sara E. Simon

Center for Peace, Democracy and Development Publications

The greatest number of persons living with HIV in the United States are now living in the South, and they face poorer health outcomes and increased AIDS-related deaths as compared to the rest of the country. The southern United States has a disproportionate share of low-income individuals, with many lacking access to health care and health insurance. Health facilities are also comparatively fewer and more difficult to reach than in other areas of the United States. The impacts of this already poor health infrastructure on low-income people living with HIV in the South can be life-threatening.

This policy brief summarizes …

Understanding Hiv Care Delays In The Us South And The Role Of The Social-Level In Hiv Care Engagement/Retention: A Qualitative Study, Courtenay Sprague, Sara E. Simon

Center for Peace, Democracy and Development Publications

Introduction: In a significant geographical shift in the distribution of HIV infection, the US South - comprising 17 states - now has the greatest number of adults and adolescents with HIV (PLHIV) in the nation. More than 60% of PLHIV are not in HIV care in Alabama and Mississippi, contrasted with a national figure of 25%. Poorer HIV outcomes raise concerns about HIV-related inequities for southern PLHIV, which warrant further study. This qualitative study sought to understand experiences of low-income PLHIV on the AIDS Drug Assistance Program in engagement and retention in continuous HIV care in two sites in Alabama. …

Expanding Women’S Healthcare Access In The United States: The Patchwork “Universalism” Of The Affordable Care Act, Randy Albelda, Diana Salas Coronado

Center for Social Policy Publications

This paper explores the promise of the Patient Protection and Affordable Care Act, commonly called “Obamacare” (referred to here as the ACA), with attention to the ways gender matter by tracing the development and implementation of key US social protection systems, an examination of the current health system with particular attention to women’s coverage, and the potential impacts of the ACA, including how it conforms to international human rights norms for health care. The ACA promises to vastly improve the key dimensions of health coverage in the US, but it conforms with other US social policy by relying on market-based …

Evaluation Of The Jewish Community Housing For The Elderly Memory Support Initiative, Joan Hyde

Gerontology Institute Publications

Jewish Community Housing for the Elderly (JCHE) is a large, multi-campus organization that houses and serves 1,500 residents (80 market rate and 1,420 low income). The average age is 80 years old, with one-third of residents 85 and older. Three quarters of the residents are not native English speakers. Through HUD and other funding, JCHE offers a range of supports to these residents, including translators, interpreters and staff with language and cultural competence, meals, transportation and, through their Service Coordinators, facilitation of resident access to government benefits, home care and other services.

According to the Alzheimer’s Association’s 2012 special report …

United States Acculturation And Cancer Patients’ End-Of-Life Care, Alexi A. Wright, Heather Stieglitz, Yankel M. Kupersztoch, M. Elizabeth Paulk, Yookyung Kim, Ingrid T. Katz, Francisco Munoz, Rachel B. Jimenez, Jan Mutchler, Lorna Rivera, Anthony L. Back, Holly G. Prigerson

Women’s and Gender Studies Faculty Publication Series

Background: Culture shapes how people understand illness and death, but few studies examine whether acculturation influences patients’ end-of-life treatment preferences and medical care.

Methods and Findings: In this multi-site, prospective, longitudinal cohort study of terminally-ill cancer patients and their caregivers (n = 171 dyads), trained interviewers administered the United States Acculturation Scale (USAS). The USAS is a 19- item scale developed to assess the degree of ‘‘Americanization’’ in first generation or non-US born caregivers of terminally-ill cancer patients. We evaluated the internal consistency, concurrent, criterion, and content validity of the USAS. We also examined whether caregivers’ USAS scores predicted patients’ …

The American Public’S Perception Of Illegal Steroid Use: A National Survey, 2013, Gary Siperstein, Neil Romano, Gizem Iskenderoglu, Anthony Roman, Floyd J. Fowler Jr., Max Drascher

Center for Social Development and Education Publications

Through the surge of news about doping scandals in the media, it is expected that the public is aware of the magnitude of the problem among professional athletes; however, it is uncertain whether the public is aware that the problem often starts when athletes are younger. To this end, the National Baseball Hall of Fame and Museum, the Taylor Hooton Foundation, and the Professional Baseball Athletic Trainers Society partnered with the Center for Social Development and Education and the Center for Survey Research at the University of Massachusetts Boston to conduct the most comprehensive national opinion survey to date to …

Cultural Competency In Health Care: Framework, Training And Evaluation - A Review Of The Literature, Diana Salas Coronado

Center for Social Policy Publications

Healthcare professionals are now more aware of the challenges they face when providing healthcare services to a culturally and racially diverse population. Cultural competency has emerged as a framework for understanding health disparities among racial and ethnic groups in particular, but also for women, the elderly, sexual orientation and gender identity, people with disabilities, and religious minorities. Although there are several definitions of cultural competency, each emphasizes the need for healthcare systems and providers to be aware of and responsive to patients’ cultural perspectives and backgrounds. One example defines cultural competency as “a set of congruent behaviors, attitudes, and policies …

Increasing Consumer Involvement In Medicaid Nursing Facility Reimbursement: Lessons From New York And Minnesota, Edward M. Miller, Cynthia Rudder

Office of Community Partnerships Posters

This project identified the facts about Nursing Facility Reimbursement by Medicaid in the states of New York and Minnesota. The results of this project are as follows: Medicaid is the main purchaser of nursing home (NH) care in the United States; States design their methods of reimbursing NHs to achieve desired policy objectives; Few consumers or resident advocates have been involved in the development or modification of state methods for reimbursing NHs; Lack of consumer involvement has resulted in payment systems that favor industry and government interests at the expense of issues important to residents and families.

Pay-For-Performance In Five State Medicaid Programs: Lessons For The Nursing Home Sector, Edward M. Miller, Julia Doherty

Office of Community Partnerships Posters

This project looks at the pay-for-performance program in five state Medicaid programs and lists the lessons that the Nursing Home Sector can learn from. They are: The federal government has traditionally sought to ensure quality outcomes through nursing home (NH) surveys conducted by state officials; Some states have begun to experiment with pay-for-performance (P4P) incentives, which provider higher Medicaid reimbursement to those facilities achieving desired outcomes; By 2007, there were 9 state P4P programs covering 20% of NHs and 16.7% of residents; Little is known about the use of P4P to promote quality and efficiency in the NH sector.

Leaving Home Care: Decision Making, Risk Scenarios & Services Gaps In The Home Care System, Jacey J. Vaughan, Nina M. Silverstein

Gerontology Institute Publications

Home and community-based services (HCBS) enable older and disabled adults to age-in-place in their homes and communities by helping them function independently for as long as possible (Grabowski et al., 2010; Wong & Silverstein, 2011). Previous studies well document that older adults prefer receiving HCBS rather than institutional care at a nursing home (e.g., Walker, 2010; Fox-Grage, Coleman, & Freiman, 2006). Medicaid is a major source of funding for long-term care. Currently, a large proportion of Medicaid funds in most states has been spent on institutional care (National Conference of State Legislatures & AARP, 2009), and older adults and their …

Massachusetts’ Home Care Programs And Reasons For Discharge Into Nursing Homes, Cathy M. Wong, Nina M. Silverstein

Gerontology Institute Publications

Home and community-based services (HCBS) are a range of long-term care services intended to enable older adults and persons with disabilities to “age in place” in their own homes and communities. Previous studies well document that older adults prefer receiving HCBS rather than institutional care at a nursing home. One study concluded that 84 percent of older Americans, aged 50 years and older, want to remain in their homes for as long as possible. Medicaid is a major source of funding for long term care. Currently, a large proportion of Medicaid funds in most states has been spent on institutional, …

Preps Surveillance: Summary Of Existing Survey Measures And Recommendations For Ongoing Efforts, Lois Biener, Karen Bogen, Catherine A. Garrett

Center for Survey Research Publications

Over the past decade or more, tobacco companies have introduced cigarettes with lower content of some toxins than regular and light cigarettes. These new cigarettes, referred to as a class as Potential Reduced Exposure Products (PREPs), have typically been introduced into test markets, not nationwide, which means they are not yet widely known or recognized by name or description by most consumers. However, the introduction of these products is of great concern to public health advocates, who do not believe that enough research, particularly long term research, has been done to know whether or not the PREPs, even if proven …

A Trade-Off Proposal For Funding Long-Term Care, Yung-Ping Chen

Gerontology Institute Publications

Long-term care can be a depressing subject. Most of us tend not to think about it. However, we cannot long avoid it as the 76 million baby boomers begin reaching older ages in a few short years. According to projections, in 40 years, those aged 65 to 84 (numbering 31.6 million in 2005) will more than double, and those 85 plus (about 5.1 million in 2005), who are more at risk of dependency, will more than triple (U.S. Census Bureau, 2004 and 2006). Heavy reliance on Medicaid, already the second largest budget item in most states, would not appear viable. …

Preps Surveillance: Summary Of Cognitive Interviews And Recommendations For Preps Surveillance Measures, Lois Biener, Karen Bogen

Center for Survey Research Publications

A review of existing research on population awareness of potentially reduced exposure tobacco products (PREPs) as well as results of cognitive interviews suggest that awareness of PREPs is quite low at this time, except in active test-markets. In order to monitor changes in awareness and perceptions of, and receptivity to these products over time, we have proposed using a set of questions as well as coding conventions that appear to result in reasonably accurate estimates of awareness of a particular group of products. The recommended items, which performed will in cognitive interviews, are presented in Appendix D of this report. …

Finding The Fastest Way To Her Heart: Linking Clinical And Policy Pathways, Paula Johnson, Brian R. Schuetz, Shelley M. Stark, Dora Tovar

New England Journal of Public Policy

The Mary Horrigan Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital in Boston, integrates research, clinical practice, and policy analysis with practical application to emerging women’s health issues. Recently, an interdisciplinary team of practitioners examined pathways to improving women’s heart health. Beginning with the evidence that a heart-healthy diet leads to improved health outcomes for women with cardiovascular disease, the Connors Center team charted a course of intellectual exploration that culminated in a broader community dialogue on how to improve access to healthy and affordable food. Through clinical experiences, research activities, and an ongoing interchange …

A Primer On Eva For Healthcare Providers, James L. Grant

Financial Services Forum Publications

The concept of economic profit (EVA) has proved successful in the field of corporate finance since its adoption by several U.S. and International companies over the past 25 years. Unlike accounting earnings, EVA is a measure of a company’s true earnings because it fully “accounts” for the costs of all forms of financing, including debt and equity. In the EVA view, a company is not truly profitable unless it earns a return on capital that bests the opportunity cost of capital. That being said, the question that we address here is how to measure the economic profit of providers in …

Aging In Place At Harbor Point: Outreach Follow-Up Of Older Adults Living In Independent Mixed-Income Apartments, Judith M. Conahan, Nina M. Silverstein, Kelly Fitzgerald

Gerontology Institute Publications

Most older people, despite functional impairments, plan to stay in their homes and/or communities as long as possible. According to an AARP survey, 82% of adults 65+ reported that they believe that they are “very likely” or “somewhat likely” to stay in their current homes or apartments for the rest of their lives. With increasing age, housing and community characteristics and services gain importance in meeting the challenges of “aging in place.” Staying in their homes maximizes elder’s independence, sustains their social connections, and reaffirms their identity and value.

The Frank J. Manning Certificate In Gerontology Alumni Survey: 21 Years Of Service To Elders, Nina M. Silverstein, Jenai Murtha, Donna Sullivan, May Jawad

Gerontology Institute Publications

The Certificate Program in Gerontology at the University of Massachusetts Boston, a large urban university, was established in 1979 as part of an Administration on Aging (AoA) grant to develop and expand services to the elderly citizens of the Commonwealth of Massachusetts. In 1984, a line item was added to the state budget by the legislature and governor establishing the Gerontology Institute at the University of Massachusetts Boston and ensuring the continuation of training, research, and policy and advocacy work on behalf of and with Massachusetts’ elders (O’Brien, 1996). Upon Frank J. Manning’s death in 1986, the program was renamed …

Seniors Count Follow-Up Study, Nina M. Silverstein, Heather Connors, May Jawad

Gerontology Institute Publications

Seniors Count is an ongoing outreach initiative under the direction of Boston Mayor Thomas M. Menino with the leadership and support of Joyce Williams, Boston's Commissioner on Affairs of the Elderly. The program's purpose is to "identify and reach out to those members of the city's elderly population who live in private housing arrangements and help provide them with the information and services they [may] need" (Boston Commission on Affairs of the Elderly, 2002). Since the program's inception in 1999, it has reached over 5,500 community-dwelling elders in the City of Boston (Boston Commission on Affairs of the Elderly, 2002). …

A Survey Of Health Services And Identification Of Needs For Asian American Elderly Women In The Greater Boston Area, Connie S. Chan, Lin Zhan

Institute for Asian American Studies Publications

Over one hundred Asian American and mainstream health care providers in the greater Boston area were surveyed for this study. The authors have identified critical gaps in services for elderly Asian American women.

Massachusetts Adult Tobacco Survey: Tobacco Use And Attitudes After Seven Years Of The Massachusetts Tobacco Control Program, Technical Report & Tables 1993 — 2000, Lois Biener, Amy Nyman, Anthony M. Roman, Catherine A. Flynn, Alison B. Albers

Center for Survey Research Publications

The Massachusetts Tobacco Control Program was launched in October of 1993. At that time, the Center for Survey Research conducted the Massachusetts Tobacco Survey (MTS), a comprehensive survey of adults and teens living in Massachusetts. The purpose of the survey was to collect baseline data on the prevalence of tobacco use among adults and teens in the Commonwealth and on issues related to the likelihood of smoking cessation or initiation. The survey also assessed the prevalence of restrictive smoking policies, and attitudes about tobacco control measures. The baseline data serve as a standard against which the impact of various programs …

Toward Improved Support For Research On Delivery Of Home- And Community-Based Long-Term Care, Francis G. Caro

Gerontology Institute Publications

Stronger and more consistent support is needed for research on long-term care. A greater investment in research will strengthen the ability of public and private organizations to provide effective and efficient assistance to people with disabilities and their informal caregivers. This paper provides a rationale for stronger research funding for the field and outlines several options to strengthen research.

Providing Low-Cost Assistive Equipment Through Home Care Services: The Massachusetts Assistive Equipment Demonstration, Alison S. Gottlieb, Francis G. Caro

Gerontology Institute Publications

This report describes the Massachusetts Assistive Equipment Demonstration, a collaborative project funded by the Robert Wood Johnson’s Home Care Research Initiative and carried out collaboratively by the Gerontology Institute at the University of Massachusetts Boston and the Executive Office of Elder Affairs (EOEA). The purpose of the demonstration was to systematically encourage the use of low-cost assistive equipment among elderly clients through existing case management resources, thereby extending the effectiveness of the Massachusetts home care program by supplementing formal services with expanded use of assistive equipment.

Nursing Homes To Medicare Waiver Programs In Vermont, Joseph Murray

New England Journal of Public Policy

This research examines the differences between nursing home residents and those who were able to leave nursing homes with the help of the Medicaid Waiver Program in Vermont. Ninety individuals who reentered the community with the aid of such waivers were compared with a random sample of nursing home residents through the use of the Nursing Home Minimum Data Set. The researchers found divergence in four key areas: cognition, continence, treatment categories, and desire to return to the community. Typically, those who left nursing homes for the community were cognitively intact, had moderate continence, received rehabilitative or clinically complex treatments, …

Nursing Home Ownership And Public Policy: An Historical Analysis, K. R. Kaffenberger

Graduate Doctoral Dissertations

In the early days of the United States, care of the disabled elderly outside the home meant the public almshouse. By the 1920s, private, nonprofit homes for the aged were prevalent. More recently, private, for-profit facilities have grown to dominate the field.

For-profit ownership has been controversial. Underlying the controversy is the concern that quality might be lowered in order to enhance profit.

This study asks why most nursing homes are privately owned and why most privately owned nursing homes are operated for profit. It does so with reference to The Nonprofit Economy, in which Burton Weisbrod describes a …

Job Satisfaction Of Home Care Case Managers: An Evaluative Look At One Home Care Corporation, Scott A. Bass, Richard Rowland

Gerontology Faculty Publication Series

Senior Home Care Services — Boston III, Inc. is a six year old private non-profit corporation with an annual budget of nearly $5 million. The agency currently delivers services to approximately 2,500 functionally impaired senior citizens per month in the Boston neighborhoods of South Boston, East Dorchester/Mattapan, East Boston, Beacon Hill, West End, North End, Charlestown, and South Cove. Over 5 7% of the case management staff has worked at the agency less than one year and 92.9% of the case management staff has worked at SHC for less than two years. The high turnover rate is well known to …