The aging of the population is creating unprecedented challenges for health systems in the US and worldwide. Meeting the care needs of older adults goes beyond ensuring there are enough clinicians and direct care workers – the healthcare workforce needs to be equipped with robust infrastructure, well-aligned financial incentives, and education about the needs of people living with disabilities, multiple health conditions, and Alzheimer’s disease and related dementia. Healthcare policy leaders play an important role by developing and refining policies related to Medicaid and Medicare, establishing regulations that support high-quality care, and allocating financial resources to the long-term care system. This month we highlight IHPS research that informs and guides policy and practice leaders in this complex space. Our Associate Director for Faculty Development, Dan Dohan, also shares how his personal experience has shaped his own research.
Joanne Spetz
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A Personal Family Perspective of Long-Term Care |
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I’ve found few experiences more dispiriting than long term care. My ethnographic research examines how older adults navigate dementia in diverse communities. In fieldwork, I’ve seen how people living with dementia face tragic options around long term care. Too often, they become entangled in a catch-22 of impossible choices.
My mother has lived with dementia since 2017. In 2019, she broke her arm in a fall, forgot pots on the stove, and started a fire in the microwave. In 2020, she moved into assisted care. My brothers and I hired a home health aide three mornings a week. Then five mornings. Then every night. Today, my mother has near-constant assistance.
My mother has long term care insurance. After hiring the night aides, we decided to use the LTC policy. We applied to her insurer who asked us for documents. After weeks of work, we sent in her application with all the paperwork. A few weeks later, the insurer said they had not received the materials and were denying the application. We started over, mailed everything again, and faxed it too. Weeks passed. More documents were said to be missing. We mailed and faxed again.
My mother’s financial advisor said he knew a guy who could help. The guy got our the insurer to approve the application. He taught us how to file claims, but as fast as we faxed them in the insurer rejected them. There was no care note, the note was not signed, the date was illegible. They had studied every page. The guy knows our mother is declining, her needs only increasing over time, but he reminds us to be vigilant about her LTC claims.
I know my family is fortunate. She has insurance, we can pay up-front, and we have a guy. Our family does not face the tragic and impossible choices I see in the field: your husband needs institutional care, but if he goes into a facility, you lose the house; Medicaid finally agrees to provide at-home care, but their wages are so paltry no one will work for them.
As a health policy researcher, I know my mother’s care is expensive, and the insurer has every incentive to reject claims. That doesn’t make the everyday experience of it in the field and in my family any less dispiriting.
Dan Dohan, PhD
IHPS Associate Director for Faculty Development
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IHPS Focus On: Aging and
Long-Term Care
Many IHPS faculty are researching and working on policies related to the health of older adults and those in long-term care. Alissa Bernstein Sideman, PhD, MPH, MA is working to improve the assessment, diagnosis, and care of people with Alzheimer’s disease and related dementias, with a specific focus on primary care in safety net setting. Krista Harrison, PhD works to understand how dementia fits into palliative care and hospice. Julia Adler-Milstein, PhD is conducting research at the intersection of health information technology and people with AARD. Anil Makam, MD, MAS studies the role of long-term acute care hospitals (LTACHs) in the post-acute care of hospitalized older adults. Susan Chapman, RN, PhD, FAAN, Joanne Spetz, PhD and Laura Wagner, PhD, RN, FAAN are looking at the direct care workforce for dementia. Anthony DiGiorgio, DO researches traumatic brain injury and long-term care. Elan Guterman, MD studies the care of neurological issues that affect older adults such as stroke and dementia to improve quality. Dan Dohan, PhD looks how older adults in different communities navigate dementia.
Learn more about how the health care system affects older adults and their families, why it matters and IHPS's current work to improve health and healthcare for this population. Read more
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IHPS 50th Anniversary Symposium
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Oct 6, 10 am - 2:30 pm
More information and registration here
Please register by September 28
Panel: How Research Helps Government Craft Policy
Panel: How Research Helps Health Journalists Communicate
Harold S. Luft Mentoring Award Presentation 2020-2022 Awardees
2020 - Mary Whooley, MD
2021 - Pamela Ling, MD
2022 - Urmimala Sarkar, MD
Poster Session
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IHPS How to Impact Policy Webinar Series
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Navigating and Impacting the State Budget Process
Scott Ogus, Deputy Staff Director, California State Senate Committee on Budget and Fiscal Review
Oct 12, 12 - 1 pm
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IHPS Health Policy Grand Rounds
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Applying systems thinking in health policy research: examples from obesity politics and healthcare's administrative burden
Luc Hagenaars, PhD
2022-23 Harkness Fellow in
Health Care Policy and Practice
Oct 19, 12 - 1 pm
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In a recent article in the Journal of Health Politics, Policy and Law, the findings of Dorie Apollonio, PhD, MPP and colleagues provide new insight into the marketing strategies used by opioid manufacturers that contributed to widespread opioid dependency. Veterans and older adults have experienced disproportionate health risks associated with opioid use, and we hypothesized that this disproportionate risk reflected efforts by the pharmaceutical industry to encourage opioid use. They found that opioid manufacturers sought to increase sales by explicitly targeting these groups in marketing campaigns that claimed, with limited or no evidence, that opioids were effective in reducing postwar trauma and preserving function among older adults. Read more
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In a recent JAMA Neurology article, Renee Hsia, MD, MSc and colleagues analyzed stroke certification adoption across acute care hospitals in the US from 2009 to 2019. Hospitals in low-income and rural communities had a lower likelihood of receiving stroke certification than hospitals in general communities. Hospitals operating in Black, racially segregated communities had the highest likelihood of adopting stroke care, but because these communities had the largest population, patients in these communities had the lowest likelihood of access to stroke-certified hospitals when the model controlled for population size. These findings provide empirical evidence that the provision of acute neurological services is structurally inequitable across historically underserved communities. Read more
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Advance care planning (ACP) prepares patients and caregivers for medical decision-making, yet it is underused in the perioperative surgical setting, particularly among older adults undergoing high-risk procedures who are at risk for postoperative complications. In a recent JAMA Surgery article, Emily Finlayson, MD, MPH, MS, Liza Wick, MD, and their colleagues found perioperative advance care planning (ACP) was uncommon, particularly in men, individuals with a non-English preferred language, and those without Medicare insurance coverage. The perioperative setting may represent a missed opportunity for ACP for older surgical patients. Read more
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In a recent International Journal of Gynecology and Obstetrics editorial, Robert Hiatt, MD, PhD discusses the impact of climate change on women's cancers. Climate change—a product of human societal activity and the consumption of fossil fuels—is a major social determinant of health, including cancer. As we consider the impact of climate change on women's health, we direct our attention to its effect on cancer as the second most common cause of death in women in much of the world. Read more
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IHPS faculty are responding to policy challenges raised by the
COVID-19 pandemic with rapid-cycle research and technical assistance.
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Lena Winestone, MD, is an assistant professor in Pediatrics and affiliated faculty at the Philip R. Lee Institute for Health Policy Studies. Her research explores racial, ethnic, and socioeconomic disparities in access to care and outcome of leukemia and lymphoma treatment. Winestone studies access to care across the continuum of pediatric cancer from diagnosis and clinical trial enrollment through treatment and relapse to salvage therapies. Her research has shown that African American children with acute lymphoblastic leukemia, acute myeloid leukemia, and mature B cell lymphoma are two times more likely to present with organ failure at the time of a new cancer diagnosis. Her ongoing work investigates access to highly specialized and complex therapies such as stem cell transplant, chimeric antigen receptor T cells, and MIBG therapy. |
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Janet Coffman:
(KQED)
Hilary Seligman:
(NPR)
Tracey Woodruff:
(The Hill)
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