Digital Commons Network^™

A Primer For Consumer Involvement In Medicaid Nursing Facility Reimbursement: Lessons From New York And Minnesota, Edward Alan Miller, Cynthia Rudder

Gerontology Institute Publications

Medicaid is the major purchaser of nursing home care in the United States. To ensure that providers behave appropriately, the federal and state governments have established an extensive set of regulations that nursing homes must comply with if they are to be reimbursed for patients insured by Medicaid. Consumers exert considerable influence here by focusing on regulations and enforcement of non-compliance.

States also seek to align providers’ interests with those of other interested parties through controls and incentives built into state reimbursement systems, including with respect to facility cost and quality, access to care, payment equity, service capacity, and budgetary …

Consumer Involvement In Medicaid Nursing Facility Reimbursement: Lessons From New York And Minnesota For State Policymakers, Edward Alan Miller, Cynthia Rudder

Gerontology Institute Publications

Medicaid is the major purchaser of nursing home care in the United States. State governments design their methods of reimbursing nursing homes to achieve desired policy objectives related to facility cost and quality, access to care, payment equity, service capacity, and budgetary control.

Often, participation in the process of developing Medicaid payment policy is limited to state agency officials and providers of care and, occasionally, union representatives and state legislative staff. Invited less frequently to reimbursement policy discussions are consumer representatives. Lack of consumer involvement in the development of state rate setting systems has the potential to result in the …

Senior Transportation Abstracts: A Focus On Options, Helen Kerschner, Nina M. Silverstein

Gerontology Institute Publications

This collection of abstracts represents a publication of importance for understanding the needs, challenges, solutions, and/or every day issues related to senior transportation services. While several of the abstracts include information about senior driver safety, the collection’s primary purpose is to present a holistic approach to transportation options for older adults. Such a collection is timely because, although the practice of providing transportation to older adults is not new, research and preparation of practical informational and technical materials related to older adult transportation service needs and service delivery are quite recent.

Coming Of Age In Marshfield: A Needs Assessment Of Aging Services, Jan Mutchler, Sandra Mccoskrie Blanchette

Gerontology Institute Publications

The purpose of this needs assessment is to investigate the needs, interests, and opinions of mature residents of Marshfield, Massachusetts, relating to their aging experiences and needs for age‐related services. On behalf of the Marshfield Council on Aging (COA), this assessment was conducted by the Collins Center for Public Management and the Gerontology Institute of the McCormack Graduate School at UMass Boston. The focus of this report is on Marshfield residents aged 60+ (referred to here as “Seniors”) and residents aged 45‐59 (referred to here as “Boomers”). Information about these two age groups was obtained both through the U.S. Census …

Massachusetts Senior Legal Assistance Project Needs Evaluation: Current Demand For Legal Services, Alison Gottlieb, Lauren A. Martin, Ellen A. Bruce

Gerontology Institute Publications

The Gerontology Institute at the University of Massachusetts Boston was contracted to conduct a statewide needs assessment for the MSLAP. As agreed upon by the MSLAP Advisory Board, the focus of this assessment was to analyze the demand for services Massachusetts legal service providers have experienced recently as a means to understanding the legal needs of Massachusetts elders (age 60 and older). A second needs assessment was conducted by the Massachusetts Executive Office of Elder Affairs. That needs assessment surveyed home care workers and other elder agency personnel to gauge their assessment of elders’ legal needs in Massachusetts. Read together, …

Chronic Disease Self-Management Programs: Relevance For Persons With Dementia, Nina M. Silverstein, Alison S. Gottlieb

Gerontology Institute Publications

The context for this study is the work of the Healthy Brain Initiative. The CDC has established a cooperative agreement with the Alzheimer’s Association to develop and implement a multifaceted approach to look at cognitive health as a public health issue. Late in 2010, the Association commissioned a review of the major chronic disease prevention programs from a systems approach to begin to understand the source of findings that Medicare beneficiaries with Alzheimer’s and related disorders are much higher cost than those simply with a single chronic disease and no AD. This led to the conclusion that Chronic Disease Self‐Management …

Fun With Numbers: Disclosing Risk To Individual Investors, Christian A. Weller

Gerontology Institute Publications

This paper discusses the need for better information on investment risks. The information should be relevant, concise, and accessible to individual investors. More and better information on factors that are likely to influence an investment’s performance and investors’ decisions should eventually lead to better investment decisions – more savings and higher retirement incomes. This paper presents a number of ways to disclose risk to individual investors. There are three numerical and three visual representations to risk. The discussion centers on the pros and cons of each risk representation. All risk descriptions show relevant information, are concise, and more or less …

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, …

Massachusetts State Public Worker Retirees: How Are They Doing?, Ellen A. Bruce, Lauren A. Martin

Gerontology Institute Publications

Although much has been made of the Massachusetts State Retirement System’s funding and abuses, little has been written about the benefits it provides. A retirement system should be judged first on whether it meets its goal of providing for workers in retirement.

The Elder Economic Security Initiative™ Program: The Elder Economic Security Standard™ Index For Washington, Gerontology Institute, University Of Massachusetts Boston, Wider Opportunities For Women

Gerontology Institute Publications

This report addresses income adequacy for Washington’s older adults using the national WOW-GI National Elder Economic Security Standard Index (Elder Index) methodology. The Elder Index benchmarks basic costs of living for elder households and illustrates how costs of living vary geographically and are based on the characteristics of elder households, including household size, home ownership or renter status and health status. The costs are based on market costs for basic needs of elder households and do not assume any public or private supports.

The Elder Economic Security Initiative™: The Elder Economic Security Standard™ Index For Iowa, Gerontology Institute, University Of Massachusetts Boston, Wider Opportunities For Women

Gerontology Institute Publications

This report addresses income adequacy for Iowa’s older adults using the national WOW-GI National Elder Economic Security Standard Index (Elder Index) methodology. The Elder Index benchmarks basic costs of living for elder households and illustrates how costs of living vary geographically and are based on the characteristics of elder households, including household size, home ownership or renter status and health status. The costs are based on market costs for basic needs of elder households and do not assume any public or private supports.

Risk Factors For Driving Cessation Vary By Race And Ethnicity, Elizabeth Dugan, Frank Porell, Chae Man Lee

Gerontology Institute Publications

Driving is related to our identity and independence as well as allowing us to get needed goods, services, and social opportunities that enrich daily life. Yet with increasing age, the risk for developing threats to medical fitness to drive increases. Driving cessation is related to a long list of negative outcomes, such as: depression, social isolation, diminished access to health care, and diminished quality of life. We investigated risks for driving cessation, paying close attention to racial differences. This study used data from the Health and Retirement Study (HRS), 1998-2008. The study included N=46, 528 older people (age 65 and …

The Elder Economic Security Initiative™: The Elder Economic Security Standard™ Index For Colorado, Gerontology Institute, University Of Massachusetts Boston, Wider Opportunities For Women

Gerontology Institute Publications

This report addresses income adequacy for Colorado’s older adults using the national WOW-GI National Elder Economic Security Standard Index (Elder Index) methodology. The Elder Index benchmarks basic costs of living for elder households and illustrates how costs of living vary geographically and are based on the characteristics of elder households, including household size, home ownership or renter status and health status. The costs are based on market costs for basic needs of elder households and do not assume any public or private supports.

Program Evaluation Of A Community-Based Door-Through-Door Medical Escort Service, Lauren A. Martin

Gerontology Institute Publications

This report summarizes the program evaluation findings of a Boston-based organization’s Medical Escort program. This “door-through-door” service strives to provide medical transportation, physical assistance, and emotional support to elders on their way to the doctor’s office, during medical appointments and on the way back home again. By offering added assistance the program attempts to remove environmental barriers associated with access to health care. This evaluation combines previously collected program statistics with surveys (32) from program volunteers and phone interviews (78) with recipients.

States To The Rescue: Policy Options For State Government To Promote Private Sector Retirement Savings, Christian A. Weller, Amy Helburn

Gerontology Institute Publications

We provide an overview of retirement plan proposals that could be implemented at the state level. All aim to increase participation in retirement savings, mainly by lowering the cost of doing so and possibly by offering some employer or government matches to employee contributions. The proposals vary widely on how much risk employees are exposed to. Some proposals leave most of the risks of saving for retirement – investment, market, and longevity risk – with the employee, while others try to eliminate them all. The tools of risk management range from well-diversified index funds and default investments to required offers …

The Elder Economic Security Initiative™ Program: The Elder Economic Security Standard™ Index For New York, Gerontology Institute, University Of Massachusetts Boston, Wider Opportunities For Women

Gerontology Institute Publications

This report addresses income adequacy for New York’s older adults using the national WOW-GI National Elder Economic Security Standard Index (Elder Index) methodology. The Elder Index benchmarks basic costs of living for elder households and illustrates how costs of living vary geographically and are based on the characteristics of elder households, including household size, home ownership or renter status, and health status. The costs are based on market costs for basic needs of elder households and do not assume any public or private supports.

The Elder Economic Security Initiative™ Program: The Elder Economic Security Standard™ Index For West Virginia, Gerontology Institute, University Of Massachusetts Boston, Wider Opportunities For Women

Gerontology Institute Publications

This report addresses income adequacy for West Virginia’s older adults using the WOW-GI national Elder Economic Security Standard Index (Elder Index) methodology. The Elder Index benchmarks basic costs of living for elder households and illustrates how costs of living vary geographically and are based on the characteristics of elder households, including household size, home ownership or renter status, and health status. The costs are based on market costs for basic needs of elder households and do not assume any public or private supports.

The Elder Economic Security Initiative™ Program: The Elder Economic Security Standard™ Index For New Mexico, Gerontology Institute, University Of Massachusetts Boston, Wider Opportunities For Women

Gerontology Institute Publications

This report addresses income adequacy for New Mexico’s older adults using the WOW-GI National Elder Economic Security Standard Index (Elder Index) methodology. The Elder Index benchmarks basic costs of living for elder households and illustrates how costs of living vary geographically and are based on the characteristics of elder households, including household size, home ownership or renter status and health status. The costs are based on market costs for basic needs of elder households and do not assume any public or private supports.

Assessing Stakeholder Opinions Of Medical Review Of Impaired Drivers And Fitness To Drive: Recommendations For Massachusetts, Nina M. Silverstein, Kelli Barton

Gerontology Institute Publications

Driving is the main mode of travel for Americans age 65 and older, and although older adults are generally found to be safe drivers, aging often brings about functional limitations and an increase in medications that can impede safe driving and fitness to drive (Rosenbloom, 2003; Kissinger, 2008; Adler & Silverstein, 2008). Effective licensing policies and Medical Advisory Board practices are critical components in identifying medically at-risk drivers and may even have a role in the transition to alternative transportation options; yet, states vary greatly in their approach to licensing and renewal practices and in the utilization, composition, and function …

The Pension Factor: Assessing The Role Of Defined Benefit Plans In Reducing Elder Hardships, Frank Porell, Beth Almeida

Gerontology Institute Publications

Traditional defined benefit (DB) pension plans have long been an important source of income for elder households seeking to maintain a middle-class standard of living after a lifetime of work. Under traditional DB plans, retirees receive a guaranteed, regular stream of income after retirement that continues until death.

The monthly pension benefit is typically based on years of service to the employer, age, and salary history. Retirees also have the option to elect a joint-and-survivor benefit, to ensure that pension payments continue to a surviving spouse. DB plan participation rates among private sector American workers have sharply decreased from about …

Using Internet‐Based Vignette Methods To Understand Elder Residential Choices, Francis G. Caro, Teck Ho, Daniel Mcfadden, Alison Gottlieb, Christine Yee, Taizan Chan, Joachim Winter

Gerontology Institute Publications

This paper illustrates an innovative method of administering fractional factorial surveys (vignettes) using the internet. The approach makes it possible to use video clips to deliver information. The method also provides subjects with interactive options before making judgments. A study to determine the views of older people regarding residential options is used to illustrate the method. The study found that the following characteristics of vignette persons affected subject recommendations: personal introduction, functional status, social network, and current housing characteristics. However, characteristics of retirement community features and personal financial status did not affect recommendations.

Elder Activities: Patterns, Motives, And Interpretation. Massachusetts Lifestyles Study Iii, Francis G. Caro, Jeffrey A. Burr, Eilon Caspi, Jan E. Mutchler

Gerontology Institute Publications

We are engaged in a continuing effort to understand the scope of elder activity and the implications of activity for well-being. We are particularly interested in the forces that encourage or inhibit multiple forms of activity, the ways in which participation in some activities influences participation in other activities, and the cumulative implications of activities for well being. Our interest in multiple forms of activities sets us somewhat apart from Gerontologists who focus on single forms of activity such as volunteering, taking classes, caring for grandchildren, working, or exercising.

Elder Economic Security Initiative™ Program: The Elder Economic Security Standard™ Index For Minnesota, Gerontology Institute, University Of Massachusetts Boston, Wider Opportunities For Women

Gerontology Institute Publications

This report addresses income adequacy for Minnesota’s older adults using the national WOW-GI National Elder Economic Security Standard Index (“the Elder Index”) methodology. The Elder Index benchmarks basic costs of living for elder households and illustrates how costs of living vary geographically and are based on the characteristics of elder households, including household size, home ownership or renter status, and health status. The costs are based on market costs for basic needs of elder households and do not assume any public or private supports.

The Elder Economic Security Initiative™: The Elder Economic Security Standard™ Index For Michigan, Gerontology Institute, University Of Massachusetts Boston, Wider Opportunities For Women

Gerontology Institute Publications

This report addresses income adequacy for Michigan’s older adults using the national WOW-GI National Elder Economic Security Standard Index (Elder Index) methodology. The Elder Index benchmarks basic costs of living for elder households and illustrates how costs of living vary geographically and are based on the characteristics of elder households, including household size, home ownership or renter status, and health status. The costs are based on market costs for basic needs of elder households and do not assume any public or private supports.

The Elder Economic Security Initiative™ Program: The Elder Economic Security Standard™ Index For New Jersey, Gerontology Institute, University Of Massachusetts Boston, Wider Opportunities For Women

Gerontology Institute Publications

This report addresses income adequacy for New Jersey’s older adults using the national WOW-GI National Elder Economic Security Standard Index (Elder Index) methodology. The Elder Index benchmarks basic costs of living for elder households and illustrates how costs of living vary geographically and are based on the characteristics of elder households, including household size, home ownership or renter status, and health status. The costs are based on market costs for basic needs of elder households and do not assume any public or private supports.

Enhancing Employment Opportunities For Mature Workers Through Training: Case Studies Of Employment Services In Massachusetts, Francis G. Caro, Andrea T. Tull

Gerontology Institute Publications

Extension of working years among those approaching “normal” retirement ages is receiving increased attention. Much of the impetus is financial. The weakening of private pension systems is leaving increasing numbers of those approaching retirement with inadequate savings. Rising health care costs and the erosion of retiree health benefits also encourages older workers to remain in the workforce. The current recession has greatly escalated the financial concerns of those who are late in their working lives. With the deterioration of financial markets, the values of 401K portfolios have declined enormously. Further, the decline in home prices has left many with substantial …

The Elder Economic Security Initiative™ Program: The Elder Economic Security Standard™ Index For Connecticut, Gerontology Institute, University Of Massachusetts Boston, Wider Opportunities For Women

Gerontology Institute Publications

This report addresses income adequacy for Connecticut’s older adults using the national WOW-GI National Elder Economic Security Standard Index (Elder Index) methodology. The Index benchmarks basic costs of living for elder households and illustrates how costs of living vary geographically and are based on the characteristics of elder households, including household size, home ownership or renter status, and health status. The costs are based on market costs for basic needs of elder households and do not assume any public or private supports.

The Massachusetts Elder Economic Security Initiative, Gerontology Institute, University Of Massachusetts Boston, Wider Opportunities For Women

Gerontology Institute Publications

The Massachusetts Elder Econamic Security Initiative offers concrete tools to shape public policies and programs to promote the economic well-being of elders. The Initiative uses the Elder Economic Security Standard Index (Elder Index) to reveal the economic vulnerability of older adults on a county-by-county basis. The Elder Index will change the way we address the economic needs of Massachusetts' older adults.

Lifelines For Elders Living On The Edge: How Elder Support Programs Compare To Living Costs. The Elder Economic Standard Index™ For Massachusetts, Laura Henze Russell

Gerontology Institute Publications

This report examines the array of federal and state support programs for elders in Massachusetts. It asks how well the lifelines - the support programs that have been set up to help low- and modest-income elders meet basic needs when costs exceed incomes – work in today’s economy. Which programs are serving elders well? Have they kept pace with inflation? Which lifelines are frayed, or about to rupture? Do seniors know about the programs, and use them when needed?

Living With Alzheimer’S Disease: A Study Of Adult Day Health Services In Massachusetts, Nina M. Silverstein, Cathy M. Wong, Kristen E. Brueck

Gerontology Institute Publications

The role of adult day health care (ADHC) is gaining increased attention as the nation prepares for the large cohort of baby boomers entering their later years. Many boomers are aging with physical and cognitive impairments, including Alzheimer's disease and related dementias. Projections indicate that Massachusetts, along with the nation as a whole, is experiencing an increasing rate of older persons as baby boomers enter late-life. The Commonwealth can expect that persons with Alzheimer's disease and their care partners will need community-based services that are specifically designed for adults with cognitive impairments. However, a report by the Robert Wood Johnson …