Gerontology Commons^™

The Effect Of State Policy On Individuals With Mental Illness In Nursing Homes: A Multilevel Analysis, Adrita Barooah

Graduate Doctoral Dissertations

ABSTRACT

THE EFFECT OF STATE POLICY ON INDIVIDUALS WITH MENTAL ILLNESS IN NURSING HOMES: A MULTILEVEL ANALYSIS

August 2026

Adrita Barooah, B.Sc., University of Delhi, India

M.S., University of Massachusetts Boston

Ph.D., University of Massachusetts Boston

Directed by Professor Pamela Nadash

The proportion of individuals living with a mental illness in U.S. nursing homes has grown substantially over the past few decades (Fashaw et al., 2020), raising serious concerns about care quality, resource adequacy, and costs to both nursing homes and government payers. The lack of adequate resources and knowledge has resulted in sub-par mental health care (O'Connor et al., …

Quality Improvement (Qi) Project Aimed At Reducing Unnecessary Antibiotic Usage Among Older Adult Patients By Addressing Inappropriate Antibiotic Prescribing In Primary And Long-Term Care Settings, Pamela M. Thomas

Seton Hall University Dissertations and Theses (ETDs)

Antibiotic overuse among older adults remains a significant patient safety and public health concern. Recent national data indicate that approximately 30%–50% of outpatient antibiotic prescriptions may be unnecessary, particularly for viral or self-limiting conditions (Chua et al., 2021). Antimicrobial resistance has been associated with more than 1.27 million deaths globally (Murray et al., 2022). This quality improvement project evaluated a multifaceted antimicrobial stewardship intervention in primary and long-term care settings. Baseline review of 167 antibiotic cases revealed 37.1% were inappropriate or questionable, and 28.7% lacked adequate diagnostic documentation. The intervention incorporated provider education, electronic health record decision-support tools, audit and …

Exploring The Homeless Persons Perception Of Living In A Long-Term Care Facility, Janice Woods

Dissertations

Objective:The purpose of this study was to explore the lived experiences of homeless persons admitted to a nursing home facility. Originally, the study was to explore their understanding of and their experience with advance health care planning; coincidently, the participants were more open to their experience of living in a long-term care facility.

Method:A convenience sample of 13 participants (12 male, 1 female) at four long-term care facilities in Southern California were interviewed about their perception of advanced health care planning, including the physician’s orders for life sustaining treatment (POLST); a consent form required in all nursing homes. …

Certified Nursing Assistant Turnover & Impacts On Rural Skilled Nursing Facilities A Qualitative Study & Recommendations For Practitioners, Marisa E. Hansen

All Graduate Theses, Dissertations, and Other Capstone Projects

The cumulative growth in the aging population in the U.S. calls for a high demand for long-term care (LTC) facilities. Furthermore, the LTC (e.g., nursing homes and assisted living facilities, etc.) consumers have become widely diverse (i.e., not just limited to older groups but now included children and adults with disabilities); demand for wide range of needs and support services. In coping with this changing environment, the LTCs, especially operating in rural settings, are faced with multifaceted challenges related to direct care staffing and turnover. In response to this outlook, the present study explores a research question to understand, how …

Caring For Thai Older Persons With Long-Term Care Needs, John Knodel, Bussarawan Teerawichitchainan, Wiraporn Pothisiri

Research Collection School of Social Sciences

Objective: To provide a situation analysis of recent long-term care (LTC) needs among older persons in Thailand. Method: The 2014 Survey of Older Persons in Thailand (SOPT) provides data to assess patterns of caregiving,whether care needs are met, and who are main caregivers for older Thais. We examine how types of familial and non-familial caregivers are associated with the wellbeing of older persons. Results:The need for LTC increases sharply with age and is more common among women than men. Spouses and children constitute approximately 90% of main caregivers. The association of a family member as the main caregiver and education …

Long-Term Care Needs In The Context Of Poverty And Population Aging: The Case Of Older Persons In Myanmar, Bussarawan Teerawichitchainan, John Knodel

Research Collection School of Social Sciences

Myanmar is one of the poorest and least healthy countries in Southeast Asia. As elsewhere in the region, population aging is occurring. Yet the government welfare and health systems have done little to address the long-term care (LTC) needs of the increasing number of older persons thus leaving families to cope on their own. Our study, based on the 2012 Myanmar Aging Survey, documents the LTC needs of persons aged 60 and older and how they are met within the context of the family. Nearly 40% of persons in their early 60s and 90% of those 80 and older reported …

Narratives Of Baby Boomers: Envisioning Late Life Spiritual Resources, Jane A. Kuepfer

Theses and Dissertations (Comprehensive)

ABSTRACT:

In this narrative inquiry, first-wave baby boomers (six males and six females born between 1946 and 1955) reflected on their lives and envisioned living into old age. While literature has focused on trends in baby boomer spirituality, issues of aging, and spiritual needs and tasks among elders, this study listened for “spiritual resources.” Initially defined broadly as that which has sustained a person throughout their life and will sustain them in the future, spiritual resources came to be understood as those things, both internal and external, that address deep human need for such spiritual values as love, hope, peace, …

The Use Of Physical Restraints In Long-Term Care In Spain: A Multi-Center Cross-Sectional Study, Gabriel J. Estévez-Guerra, Emilio Fariña-López, Eduardo Núñez-González, Manuel Gandoy-Crego, Fernando Calvo-Francés, Elizabeth Capezuti

Publications and Research

Background: Physical restraint is a procedure used frequently in long-term care. It is a controversial practice because its use is associated with numerous complications and also affects freedom and individual autonomy. The objective of this study was to examine the use of physical restraint of long-term care residents with the ability to move voluntarily.

Methods: We conducted a cross-sectional observational and correlational multi-center study. Nine centers agreed to participate. Of the 1,200 people present at the time of data collection, those without voluntary movement or in the facility for less than a month were excluded. Thus, the final sample was …

Caring For Thai Older Persons With Long-Term Care Needs, John Knodel, Bussarawan Teerawichitchainan, Wiraporn Pothisiri

Research Collection School of Social Sciences

Thailand is experiencing more acute population aging than most developing Asian countries. Its population aged 60 and older is anticipated to grow from 10% in 2000 to 38% by 2050. Meanwhile, the oldest-old population that is most likely to require long-term care (LTC) is estimated to increase tenfold during the first half of the 21st century. Family has remained a linchpin of support for Thai elders with LTC needs. Given population aging and other demographic trends such as smaller family size, migration of adult children, and lengthening survival at older ages, policy makers are concerned how such socio-demographic changes may …

Long-Term Care Needs In The Context Of Poverty And Population Aging: The Case Of Older Persons In Myanmar, Bussarawan Puk Teerawichitchainan, John Knodel

Research Collection School of Social Sciences

Myanmar is one of the poorest and least healthy countries in Southeast Asia. Nevertheless, population aging is taking place. Myanmar's policy makers have only begun to pay attention to the implications of population aging for its economy and society, including the health system. There is virtually no official policy or program in place to provide long-term care (LTC) for older persons. Family has thus been the mainstay of financial and instrumental support for elderly with LTC needs. Myanmar's demographic transitions likely challenge the current form of family caregiving for frail older persons, especially in the coming decades. This study aims …

A Phenomenological Study Of Anticipated Intimacy And Sexual Expression Needs Of Aging Male And Female Baby Boomers., Charles Shawn Oak

Electronic Theses and Dissertations

The purpose of this study was to understand the phenomenon of how heterosexual Baby Boomers define and understand intimacy, sexual expression, along expectations and desires relating to their respective expressions across the lifespan through their individual experiences and reflections. A set of guiding questions were used in a hermeneutic phenomenological qualitative research design. Data was gathered from thirteen subjects (n=13) using the Rappaport Time Line (RTL) that was used to develop individualized semi-structured interviews and follow-up interviews that were professionally transcribed. These were coded to identify emergent themes. Results of the study provided insight into the phenomenon of how heterosexual …

Disaggregating Activities Of Daily Living Limitations For Predicting Nursing Home Admission, Joelle H. Y. Fong, Olivia S. Mitchell, Benedict S. K. Koh

Research Collection Lee Kong Chian School Of Business

Objective: To examine whether disaggregated activities of daily living (ADL) limitations better predict the risk of nursing home admission compared to conventionally used ADL disability counts. Data Sources: We used panel data from the Health and Retirement Study (HRS) for years 1998–2010. The HRS is a nationally representative survey of adults older than 50 years (n = 18,801). Study Design: We fitted Cox regressions in a continuous time survival model with age at first nursing home admission as the outcome. Time-varying ADL disability types were the key explanatory variables. Principal Findings: Of the six ADL limitations, bathing difficulty emerged as …

Sex, Dementia, And Long-Term Care: Public Perspectives, Erin L. Yelland

Theses and Dissertations--Family Sciences

The current mixed methods study utilized an ecological framework to examine public perspectives toward sexual behaviors among long-term care residents with dementia. Analyzing attitudes of the public is an integral component of understanding the entire ecological system that affects the development and overall well-being of a long-term care resident. Attitudes were examined using a multiple segment factorial vignette with a probability sample of 329 respondents from a southern state. Results indicate that attitudes were not statistically affected by sex or the elapsed time since diagnosis, and age, spousal disposition, and degree of intimacy predicted attitudes. A respondent’s education level also …

Hood's Theory Of Aging, Drew Michael Hood

All Graduate Theses, Dissertations, and Other Capstone Projects

This thesis proposes that the theory of gerotranscendence can be improved by emphasizing life course events that influence the gerotranscendence process. Further, this paper proposes that teaching gerotranscendence to long-term care staff and residents with Hood's theory of aging and with a departmental framework will yield better results in staff following gerotranscendence best practices and thus result in increased resident development towards gerotranscendence.

Financial Security Scorecard: A State-By-State Analysis Of Economic Pressures Facing Future Retirees, Christian Weller, Nari Rhee, Carolyn Arcand

Public Policy and Public Affairs Faculty Publication Series

As Americans increasingly worry about their retirement prospects, states play an important and growing role in retirement security policy. States already manage long-term care programs for the elderly through Medicaid. Concerned about the impact of future elder poverty on state and local budgets and their local economies, a number of states are exploring the creation of low-cost and low-risk retirement savings plans for private sector workers who lack access to pensions or 401(k)s on the job. Some states have developed programs to help older workers find work.

This report presents the Financial Security Scorecard, designed to inform state-level stakeholders and …

The Effects Of Geriatric Sexual Orientation On Caregiver Reactions To Resident Sexual Behavior Within Long-Term Care Facilities, Andrew Jonathan Ahrendt

All Graduate Theses, Dissertations, and Other Capstone Projects

Within the paucity of literature regarding older adult sexuality, a larger dearth exists concerning biases of long-term care facility staff toward gay and lesbian older adult residents. Prior literature has documented that LGBT (lesbian, gay, bisexual, and transgender) individuals' perceive that they do not receive the same quality of care as that of heterosexual individuals within long-term care facilities. Thus researchers aimed to evaluate whether these biases truly exist within care facilities that can prevent holistic care from being comprehensively provided to everyone regardless of sexual orientation. 153 residential care facility staff members from two separate facilities read one of …

Implications Of Rhode Island’S Global Consumer Choice Compact Medicaid Waiver For Rebalancing Long-Term Care Under The Affordable Care Act, Edward Alan Miller, Divya Samuel, Susan Allen, Amal Trivedi, Vincent Mor

Gerontology Institute Publications

Federal approval of Rhode Island’s Global Consumer Choice Compact Global Waiver in 2009 provided Rhode Island with greater flexibility to modify its Medicaid program. Because 96% of long-term care expenditures in Rhode Island were directed toward institutional settings, a primary goal was to facilitate the state’s efforts to shift the locus of long-term care to non-institutional settings. This study draws lessons from Rhode Island’s experience with the Global Waiver for the long-term care rebalancing provisions of the Patient Protection and Affordable Care Act of 2010. Data derive from 325 archival sources and 26 semi-structured interviews. Results suggest that prospectively documenting …

Implications Of Rhode Island’S Global Consumer Choice Compact Medicaid Waiver For Designing And Implementing State Health Reform, Edward Alan Miller, Divya Samuel, Susan Allen, Amal Trivedi, Vincent Mor

Gerontology Institute Publications

Provisions in the Medicaid statute permit states to apply for waivers from traditional program requirements. On January 16, 2009, the federal government approved Rhode Island's Global Consumer Choice Compact Waiver. In exchange for a cap on combined federal and state spending of $12.075 billion through 2013, Rhode Island received greater flexibility to adopt certain Medicaid program changes. This study analyzes the design and implementation of the Global Waiver to draw general lessons for health reform at the state-level, a key concern given ongoing state discretion to improve their health care systems under the Patient Protection and Affordable Care Act. Data …

Leadership And The Implementation Of Culture Change In Long-Term Care, Alexandra Natasha Garklavs

All Graduate Theses, Dissertations, and Other Capstone Projects

In understanding the culture change movement in long-term care and the factors that either foster or impede its sustainability, it is important to consider a number of factors. Since leadership is important in any organization and has been identified as crucial in the implementation of culture change in long-term care, this alternate plan paper focuses on the leadership factors that either facilitate or impede the implementation of culture change. Included in this alternate plan paper is a brief overview of the culture change movement in long-term care, the role of leadership versus management in the long-term care environment, types of …

A New Approach To An Old Problem: Defining Nursing’S Role In Successful Transitions To Long-Term Residential Care, Kyleen Aldrich

Honors College Theses

A growing body of nursing research addresses the transitional period for older adults entering long-term residential care. However, gaps exist in our understanding of nursing’s role in the transition process. Our aim is to examine the available evidence and develop a model of nursing strategies and interventions to ease the transition to long-term care. This model describes interventions that nurses can incorporate into everyday practice.

A literature review was conducted to examine the transitional care needs and interventions for older adults with a goal of developing a model addressing transitions to long-term care.

Most nursing studies provided descriptive information about …

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 …

The Relationship Of Financial Performance, Quality Indicators, And The Role Of Nurse Executives In Virginia Nursing Homes, Jeany V. Murphy

Health Services Research Dissertations

Problem statement. The dynamic nature of the healthcare industry has triggered changes in nurse executive functions. The job has expanded into entrepreneurial roles to be able to provide the most cost effective services while maintaining good quality outcomes for the residents. The new responsibility requires a different set of knowledge and competencies that is usually achieved through advanced education. It is not known whether nurse executives in long term care in Virginia possess the skills to influence both the financial and quality outcomes of the facility.

Methods. This descriptive research study examined the relationship of the nurse executives' technical, human, …

Llmhs Elderly Services Outreach Program: Lincoln, Lyon & Murray Human Services, Jamie Olson

All Graduate Theses, Dissertations, and Other Capstone Projects

Right now there is a lack of professional and community knowledge regarding the services LLMHS provides to those over age 65. Thus, there are elderly who are in need of help who are not getting connected to a county long term care social worker. The elderly may need help to simply get connected to resources, have questions answered, correct misconceptions about long term care, get recommendations, or assistance paying for home and community based services. There are also many providers and professionals with questions about what LLMHS does and does not do as well as what the assistance programs can …

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. …

Back To The Future: The Future Of Long-Term Care In Massachusetts, Deborah H. Thomson, John J. Ford

Gerontology Institute Publications

The state of Massachusetts, like the rest of the United States, is facing an approaching crisis in long-term care. Over the next few decades the number of Massachusetts residents age 65 and older will soar. As these numbers increase, so will the need for long-term care.

Massachusetts is ill prepared to provide the services that will be needed. Our current system of health care benefits leaves many elders with gaps in coverage. Those individuals who need long-term services often impoverish themselves and their spouses before the state pays for their care. Others languish on waiting lists to receive services. Our …

Long-Term Care: Informed By Research, Francis G. Caro

Gerontology Institute Publications

Health services research has contributed to health policy and service developments that have led to major improvements in the quality of long-term care in the United States. This policy brief highlights a few areas in which publicly and privately funded research has informed the long-term care field.

Working Paper: Elders In Massachusetts Prefer Paid Caregivers, Francis G. Caro

Gerontology Institute Publications

Older Massachusetts residents would rather have paid professionals provide their long-term care than their own children, according to a recent UMass Poll of 461 Massachusetts residents.

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.

Long-Term Care Policy: Where Are We Going?, Gerontology Institute, University Of Massachusetts Boston, Omb Watch

Gerontology Institute Publications

Millions of Americans suffer from physical or mental conditions that make it difficult for them to live fully independent lives. These are the frail elderly, disabled and chronically ill persons of all ages, and many mentally ill or mentally retarded persons. They need help to manage daily activities, whether they live in their own homes or in nursing homes.

Such care can be extremely expensive, since it often must be provided for many years, even a lifetime. Today, those costs are met largely by the individuals themselves or by their families and by public programs for low-income persons.

For many …