Social and Behavioral Sciences Commons^™

An Analysis Of The Universal Home Care Program: Considerations For Implementation With The Context Of Maine's Existing Ltss Programs, Eileen J. Griffin Jd, Elizabeth C. Gattine Jd, Louise Olsen, Stuart Bratesman Mpp

Disability & Aging

A citizen initiative on the November 2018 ballot (Question 1, An Act to Establish Universal Home Care for Seniors and Persons with Disabilities) would establish a "Universal Home Care Program" (UHC Program) to serve older adults and persons with a disability living in Maine. This report does not constitute either support for or opposition to the referendum but is intended as an independent assessment of how the UHC Program could be implemented if it were to be approved by Maine voters. This analysis focuses on the implications of the UHC Program within the context of the Medicaid and …

Adults Using Long Term Services And Supports: Population And Service Use Trends In Maine, Sfy 2016, Kimberly I. Snow Mhsa, Ba, Frances Jimenez Ba, Tina Gressani, Louise Olsen

Disability & Aging

All of us have likely either used, will use, or know someone who uses long term services and support (LTSS). They enable us to live with dignity and as much independence as possible and offer us the opportunity to remain involved and productive in our communities. The need for LTSS can arise suddenly after injury or illness or a life-long condition. But how ever the need arises, the impact is the same—services such as personal care, work support, home health care, and residential care provide not just for individual health and comfort, but also for interaction, inclusion, and engagement with …

The Affordable Care Act’S Medicaid Expansion And Food Insecurity Rates, Mary Moran

Muskie School Capstones and Dissertations

Many Americans face difficult financial decisions, often regarding the allocation of limited resources. Household resources may be split among the costs of food, clothing, housing, transportation, childcare, utilities, and health care. For some households, this allocation may present a challenge to purchasing sufficient food, leading to food insecurity. Defined by the United States Department of Agriculture (USDA) as “a household-level economic and social condition of limited or uncertain access to adequate food” (2017), food insecurity may decrease when other financial-related aspects of life improve. An improvement in access to affordable health care, as seen through the recent Medicaid expansion under …

Direct Care Nursing Aide Turnover In Long-Term Care Facility, Qilian Luo

Muskie School Capstones and Dissertations

This capstone project, Direct Care Nursing Aide Retention in a Long-Term Care Facility, will uses both qualitative and quantitative analyses to identify the possible contributors to high nursing aide turnover rates in Maine. The quantitative analyses of this project are based on the staffing payroll data of one Maine assisted living facility. The final product of this capstone project will be shared with the study facility, in the hope that they may find uses for its content.

Therapeutic Riding And Psychological Health In Older Adults, Alyssa Pattison, Craig Ashford

Thinking Matters Symposium Archive

This project explores the available quantitative and qualitative research to see if there is a link between therapeutic horseback riding and the reduction in symptoms of depression in older adults. Currently, there is a gap in evidence based research surrounding older populations with depression and therapeutic riding. However, research gathered on adolescents and adults suggest that therapeutic riding may alleviate depressive symptoms in persons over 65 years of age. Studies included in this project reveal groups of themes. The first is assessments, tools and evaluations. The second is animal assisted therapy, equine assisted therapy, therapeutic riding, and the barn environment. …

“Older Adults And Their Experiences With Home Care And Assisted Living”, Faith Robinson

Thinking Matters Symposium Archive

As the state of Maine and the U.S. population at large continues to age, discussion about future care and living arrangements for older adults has become an increasingly relevant issue. Older adults are often faced with a range of options for housing, including staying in their home in their community while receiving home care services, or moving to an assisted living facility.

Currently a gap in the research exists as to the attitudes, perceptions, and lived experiences of the older adults themselves around these decisions, experiences, and the meaning of “home” in our older years. This study aims to provide …

Residential Settings And Healthcare Use Of The Rural "Oldest-Old" Medicare Population, Nathan Paluso Mph, Zachariah T. Croll Mph, Deborah Thayer Mba, Jean A. Talbot Phd, Mph, Andrew F. Coburn Phd

Long Term Services and Supports

The aging of the baby boom generation is projected to dramatically increase the population aged 65 and older in the coming decades. In particular, those aged 85 and older (the ‘oldest old’) are expanding at a faster rate than any other age group and by 2050 are expected to make up 4.5 percent of the population, compared to 1.9 percent in 2012. Faster growth in the percentage of older people (65+) in rural than in urban areas is likely to challenge the healthcare and long term services and supports (LTSS) capacity in many rural communities.

This study used Medicare Current …

Financial Exploitation Of Maine's Older Adults: An Analysis Of Maine Adult Protective Services And Legal Services For The Elderly Case Records, State Fiscal Years 2010-2016, Eileen Griffin Jd, Catherine Mcguire Bs, Kimberly I. Snow Mhsa, Ba

Disability & Aging

The goal of this study was to capture information about the amount of money Maine’s older adults have lost to financial exploitation, along with information about those exploited, the perpetrators of financial exploitation, the type of loss, and amount of money lost. This report summarizes key findings emerging from this analysis. In particular, we found that, when compared to Maine’s general population of adults age 60 and older, the victims of financial exploitation served by Maine's Adult Protective Services (APS) and Legal Services for the Elderly (LSE) are more likely to be age 80 and older, female; and widowed, single, …

Cumberland County Community Food Resources, Romeo Kimpene

Cumberland

Food resources found in Cumberland County, Maine:

• Supplemental nutrition
• Farm stands
• Farmers' markets
• Mobile markets
• Community gardens
• Educational/auxiliary programs
• Community centers

Community Paramedicine Pilot Programs: Lessons From Maine, Karen B. Pearson Mlis, Ma, George Shaler Mph

Emergency Medical Services (EMS)

Community paramedicine programs are beginning to flourish across the nation, and the need to provide demonstration or pilot programs is essential to providing a consistent and high-level standard for this model of care. While the overarching goals are to align with the Triple Aim, piloting a community paramedicine program also allows each community to develop and implement a program tailored to the healthcare needs of their specific community. A successful program builds the evidence base that can then be used to create legislative change necessary to financially sustain this model of care across the healthcare delivery system. This article provides …

Piscataquis County Community Food Resources, Tiia Kand

Piscataquis

Food resources found in Piscataquis County, Maine:

• Food banks
• Food pantries
• Food resources
• Additional resources
• Demographics

Charting A Pathway Forward: Redesigning And Realigning Supports And Services For Maine's Older Adults, Eileen Griffin Jd, Elizabeth C. Gattine Jd

Disability & Aging

The current growth of the population age 65 and older is one of the most significant demographic trends in the history of this country and is especially significant for Maine, where the number of people age 65 and older is growing even faster than the rest of the nation. By 2025, over a quarter of Maine’s population is expected to be age 65 and older. Because the cost of long term paid support is out of reach for many Mainers, public financing—particularly Medicaid financing—is an essential tool for addressing the long term support needs of older adults. But Medicaid is …

Social Isolation And Loneliness In Older People: A Closer Look At Definitions, Mary Lou Ciolfi, Frances Jimenez Ba

Disability & Aging

Social isolation and loneliness are related and the terms are often used interchangeably, but they are distinct concepts with different definitions, health impacts, and interventions. Our population is aging and older people are at increased risk for both social isolation and loneliness and the associated negative health consequences. Understanding the important differences between social isolation and loneliness will help us recognize them earlier in vulnerable populations, engage in more meaningful conversations with older adults about their own risks, and will inform the development and delivery of more individualized, meaningful, and cost-effective interventions.

A Guide For Assessing Older Adults’ Needs On Maine Islands, Beatrice Byrne

Muskie School Capstones and Dissertations

This template may help Maine island communities identify older adults’ needs and island resources, in order to allow older adults to age in the island communities.

Three interviews with island health leaders, one community conversation with older islanders, and one pilot test provided information about what to include in the template.

The template includes a demographic survey, guides for conducting semi-structured interviews and group conversations with older adults and caregivers, a guide and worksheet for analyzing the data, a guide for assessing community resources, a guide for dissemination, and a list of additional resources.

Implementing A Good Catch Program In Nursing Homes, Leigh Raposo

Muskie School Capstones and Dissertations

Rationale and processes for reporting near misses and evidence-based tools were collected by a literature search, seminal works by Sidney Dekker and James Reason, and websites for the Agency for Healthcare Research and Quality (AHRQ), the Institute for Healthcare Improvement (IHI), and the Centers for Medicare and Medicaid Services (CMS). Tools, information, and strategies found in this research were evaluated for implementation in Maine nursing homes. The tools provide a communication vehicle for nursing home staff to safely report to management near misses, or mistakes that do not harm residents. To emphasize a positive approach, the project replaces the term …

Writing Life Stories: A Phenomenological Study Of Memory And Meaning For People With Early Stage Alzheimer's Disease, Jennifer E. Dimond Msw

All Student Scholarship

There are an estimated five million Americans living with Alzheimer’s disease; experts believe that by mid-century, that number will more than triple. The disease is the sixth leading case of death in the U.S., and the only one among the top ten with no known cure, treatment or means of prevention. An emerging body of research suggests that providing people with Alzheimer’s opportunities to tell their life stories can help them negotiate their personal identities and may have positive impacts on their sense of self. A hermeneutic phenomenological approach is used to understand the lived experience of people with early …

Rural Disabled Medicare Beneficiaries Spend More Out-Of-Pocket Than Their Urban Counterparts, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Andrew F. Coburn Phd

Access / Insurance

The majority of Medicare beneficiaries experience gaps between the care they need and costs covered by Medicare and seek supplemental coverage to meet this gap, including private plans offered by former employers or purchased individually, or public coverage through Medicaid. Since rural beneficiaries are more likely to purchase supplemental indemnity coverage individually, to participate in Medicaid, or to go without supplemental coverage altogether, it is likely that their out-of-pocket spending differs from that of urban residents, although the magnitude and direction of these differences may vary for individual beneficiaries. This study used data from the 2006-2010 Medical Expenditure Panel Survey …

Out-Of-Pocket Spending Among Rural Medicare Beneficiaries, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Andrew F. Coburn Phd

Access / Insurance

The majority of Medicare beneficiaries experience gaps between the care they need and costs covered by Medicare and seek supplemental coverage to meet this gap, including private plans offered by former employers or purchased individually, or public coverage through Medicaid. Since rural beneficiaries are more likely to purchase supplemental indemnity coverage individually, to participate in Medicaid, or to go without supplemental coverage altogether, it is likely that their out-of-pocket spending differs from that of urban residents, although the magnitude and direction of these differences may vary for individual beneficiaries. This study used data from the 2006-2010 Medical Expenditure Panel Survey …

An Assessment Of The Built Environment And Inclusivity Of Older Adults In Community Planning In Portland, Maine, Elizabeth A. Bissonnette

Muskie School Capstones and Dissertations

This paper focuses on this assessment specific to four: civic participation, housing, transportation, and outdoor spaces and buildings. Four others targeted for study by others include respect and social inclusion, communication and information, community and health services, and social participation. Each domain is reviewed from the perspective of older adults and older although this assessment also benefits people of all ages and abilities. Some data and references were only available with population breakouts of those aged 65 years and older and are noted appropriately.

Adults With Intellectual Disability Or Autism Spectrum Disorder. Executive Summary, Kimberly I. Snow Mhsa, Ba, Stuart Bratesman Mpp, Taryn Bowe, Julie T. Fralich Mba

Disability & Aging

This chartbook describes Maine’s historical trends in meeting the needs of adults with ID/ASD through institutional and community based services in comparison to other states; a detailed analysis of the population’s utilization of different types of services and their costs in SFY 2010; the implementation of the Supports Intensity Scale (SIS) as a means of identifying the supports needs of the adults with ID/ASD; and the complement of providers serving this population in Maine.

Improving Home Suitability For Aging In Place: A Review Of Programs To Assist Maine's Seniors Make Necessary Home Repairs And Energy Efficiency Updates, Andrea Westbye

Muskie School Capstones and Dissertations

With its median age of 42.7 years, Maine is the oldest state in the nation and it is getting older. The population 65 and older is growing at a rapid pace and this expansion presents many challenges to communities, particularly in the area of housing. Most seniors want to stay in their homes for as long as possible and adequate, accessible, safe, and affordable housing is a primary factor for successful aging in place. Low income seniors face additional difficulties when aging in place. This paper looks at the availability of home repair/modification and energy efficiency programs for Maine’s low …

An Assessment Of The Health Needs Of Maine Veterans And Their Access To Veterans Administration Health Care Services, Kristin Brawn

Muskie School Capstones and Dissertations

On a state level, only a few assessments have been conducted, which indicate that Maine veterans are also experiencing similar mental and physical health issues; however, it does not appear that the adequacy of Maine’s VHA services to meet the needs of Maine’s veterans has been comprehensively evaluated. It is unknown whether the physical and mental health needs of Maine’s veterans are currently being met. Therefore, this project proposes to determine if there is a similar problem among Maine’s veterans in regard to health issues and lack of access to VHA health services, as has been reported at the national …

A Vision For Berwick: A Case Study Of The Citizen Initiated Visioning Process For Downtown Redevelopment In Southern Maine, John Stoll

Muskie School Capstones and Dissertations

This Capstone follows the downtown redevelopment visioning process in Berwick from the initial presentation to Town Officials up until formal adoption as an addendum to the Comprehensive Plan. Berwick has a monumental task ahead of it as the Town looks to redevelop an 11 acre abandoned factory site that is located directly where a downtown should be. Residents of Berwick had to work with Town Staff to navigate a considerable amount of lingering controversy and to rebuild trust between the public and local government. Members of the Downtown Vision Committee worked tirelessly to reach out to the community through education …

Dementia In Maine: Characteristics, Care, And Cost Across Settings [Chartbook], Julie T. Fralich Mba, Stuart Bratesman Mpp, Louise Olsen, Catherine Mcguire Bs, Tina Gressani, Karen Mauney, Catherine Gunn, Romaine Turyn

Disability & Aging

This report provides a baseline picture of the current use of services by people with and without dementia in Maine.

Measurement, Monitoring, And Evaluation Of State Demonstrations To Integrate Care For Dual Eligible Individuals: Massachusetts Evaluation Design Plan., Julie T. Fralich Mba, Maureen Booth Mrp, Ma, Edith G. Walsh Phd, Angela M. Greene Ms, Mba, Melissa Morley Phd, Wayne Anderson Phd

Disability & Aging

CMS contracted with RTI International to monitor the implementation of all State demonstrations under the Financial Alignment Initiative, and to evaluate their impact on beneficiary experience, quality, utilization, and cost. The evaluation includes an aggregate evaluation and State-specific evaluations. This report describes the State-specific Evaluation Plan for the Massachusetts demonstration as of December 16, 2013. The evaluation activities may be revised if modifications are made to either the Massachusetts demonstration or to the activities described in the Aggregate Evaluation Plan (Walsh et al., 2013). Although this document will not be revised to address all changes that may occur, the annual …

Public Pensions And Debt In The State Of Maine, Ryan Knaus

Muskie School Capstones and Dissertations

Maine has taken important steps in recent years to reduce indebtedness and adequately fund their Public Employee Pension System (MainePERS), and is well-positioned relative to other U.S. states. The challenge for the State is to continue financing MainePERS and existing UALs with the same commitment, diligence and prudence.

Managing Social Security Disability & Other Public Benefits: Development Of A Guide For Consumers And Providers, Stephanie L. Derochers

Muskie School Capstones and Dissertations

One in five Americans has a disability, making it the largest minority group in the U.S. (Soffer, McDonald, & Blanck, 2010). In 2011, 13.4 million working-aged adults received a disability cash benefit from the Social Security Administration (Kregel, 2012).

The Social Security Administration (SSA) is the federal agency responsible for managing, executing and overseeing retirement, survivor, old-age and disability benefits. There are over 1,500 Social Security offices and over 65,000 employees nationwide (SSA, 2013). SSA manages at least five disability benefit programs: Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), Disabled Widow(er) Benefit (DWB), Childhood Disability Benefit (CDB), though …

Global Budgets, Payment Reform And Single Payer: Understanding Vemont's Health Reform, Trish Riley

Population Health & Health Policy

The Muskie School of Public Service hosted two health policy colloquia this April to promote informed discussion throughout the state regarding MaineCare coverage options under the ACA and the implications of Vermont’s move toward a single-payer system.The series, sponsored by the Muskie School Board of Visitors, offers community conversations in which experts from various disciplines and perspectives inform and engage the broader public to explore and debate critical policy issues. On April 22, community and sector leaders joined for Global Budgets, Payment Reform, and Single Payer: Understanding Vermont's Health Reform. Participants discussed Vermont's recent movie toward single payer health …

Opportunities For Munjoy Hill, Anne-Michelle Arless

Muskie School Capstones and Dissertations

Keeping the elderly in their own homes is challenging. A volunteer lead group of Munjoy Hill residents have united to form "circle of friends" to connect those within the community in need with those in the community who can offer a helping hand.

Providing Long Term Services & Supports To People With Impaired Decision-Making Capacity: Results Of Data Analysis And Interviews Examining Needs And Characteristics Of Persons With Impaired Decision-Making Capacity In Maine, Eileen Griffin Jd, Louise Olsen, Julie T. Fralich Mba

Disability & Aging

This document:

• Reviews the prevalence of impaired decision-making capacity among adults and older adults receiving publicly funded home care services and supports in Maine, the characteristics of this population group, and the caregivers caring for persons with impaired decision-making capacity.
• Reports on interviews with providers describing their ideas for helping people with impaired decisionmaking capacity live in the community longer.
• Reviews the legal status of persons receiving long term services and supports in Maine, including the presence of a guardian or a Power of Attorney, among those with impaired decision-making capacity across settings.
• Reports on interviews with providers, describing kinds …