Projects

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Current Projects
Workforce Demand and Supply
Personal Care and Home Care Workforce
Alzheimer's and Dementia Care
Physicians, Nurse Practitioners, Physician Assistant, and Nurses
Emerging Care Delivery Models and New Occupations
Nursing Homes
Behavioral Health
Palliative Care

Current Projects:

Rural Long-term Care Worker Shortages: The Roles of Local Economic Conditions and the Opioid Crisis

Long-term care is facing rapid increases in worker demand as the result of an aging U.S. population.  Shortages appear more severe in rural areas, with the outflow of younger people in search of employment and lifestyle supports.  A large share of support for those who need assistance comes from families. However, the pool of potential family caregivers is shrinking due to smaller family sizes, lower marriage rates, and adult children living farther from parents. Moreover, the opioid epidemic has had a notable impact on older Americans, with increasing numbers of people whose adult children are suffering from opioid use disorder and a rising share of elders raising grandchildren. Read more...

Medical Staff Organization, and Relationships Between Directors of Nursing and Medical Staff, and Nursing Home Quality

Nursing homes are critical components of the LTC continuum. Acute care systems recognize the need for high quality and easily accessible post-acute LTC (rehabilitation).  While nursing home quality is dependent on a number of workforce factors, physicians are clearly an important part of the team. Primary care physicians often graduate and enter practice without any meaningful exposure to post-acute LTC (PA-LTC) or to geriatric medicine in general. Read more...

The Composition of Health Providers Prescribing Behavioral Health Medications to Medicare Beneficiaries with Behavioral Health Needs 

The Medicare program is anticipating an increase from 54 million beneficiaries today to over 80 million beneficiaries by 2030, many of whom will have longer life expectancies, chronic conditions, mental health problems, and substance use disorders. These population changes will challenge a primary care workforce already in need of more gero-psychiatrists.  Read more...

Impact of Electronic Visit Verification (EVV) on Medicaid Personal Care Services Workers

The 21st Century CURES Act, enacted by Congress in 2016, requires that all states implement Electronic Visit Verification (EVV) for Medicaid-funded Personal Care Services (PCS) on January 1, 2019 and for Home Health Care Services (HHCS) by January 1, 2023. EVV electronically verifies that a caregiver provides services for a client.  According to the Centers for Medicare and Medicaid Services (CMS), EVV will improve program efficiencies by validating service delivery and reducing waste, fraud, and inefficiency. Read more...

Licensed Home Care Agencies and Nursing Scope of Practice: Impacts on Persons Needing Assistance in Community Living

Unlicensed assistive personnel who help people in their homes might be employed by a licensed home care agency or can be employed directly by the person who requires assistance. State nurse practice acts and medication aide laws determine who can perform common tasks such as managing catheters, tube feeding, and medication management. Variations in state laws and regulations mean that aides working through agencies may have a more limited scope of practice than if they were hired independently. This could mean that some community-dwelling older adults and people with disabilities might not be able to get the help they need or be forced to enter institutions solely to have access to licensed personnel who can provide the required help. Read more... 

The Roles and Value of Geriatricians in Health Care Teams

The American Geriatrics Society (AGS) estimates that a total of 30,000 geriatricians will be needed to meet care needs by 2020, and there is currently a shortfall of approximately 13,000 geriatricians. The AGS projects that the shortfall will worsen without greater numbers of graduates of geriatrics training programs. However, some healthcare leaders believe that the needs of the aging population can be met by other physicians – including primary care providers – in addition to professionals such as occupational therapists and nurse practitioners. Read more...

Alzheimer's Staffing, Services, and Outcomes in Adult Day Health Centers

Alzheimer’s Disease (AD) and AD-related dementia (ADRD) is a profoundly debilitating disease with risk increasing with age (Alzheimer's Foundation of America, 2016). This disease will quickly burden a growing percentage of Americans and pose a great challenge for the U.S. health care system. Adult Day Health Centers (ADHCs) are a vital community service whose staff provide specialized care to persons with ADRD and respite to caregivers, which allows them to work, meet obligations, and recover from the daily care burden (O'Keefe & Siebenaler, 2006). It is essential that ADHCs and other LTC providers be readily equipped with the appropriate services and staffing structures to properly care for persons with ADRD. Read more...

Trends in the Social Work Long-Term Care Workforce

Depression and anxiety are common clinical features among residents of nursing homes and assisted living facilities in the United States, with prevalence estimates ranging from 20% to 30% (Mansbach, et al., 2015). Social workers are well-positioned to meet these needs because they are trained to provide both direct and indirect patient care. This project will describe trends in social worker employment in skilled nursing, residential care, and home health settings, using data from the U.S. Census Bureau and the Bureau of Labor Statistics (BLS). Read more...

Medical Staff Organization in the U.S. Nursing Homes

Nursing homes are critical components of the LTC continuum. Acute care systems recognize the need for high quality and easily accessible post-acute LTC (rehabilitation), as niche nursing homes have embraced over the past several years. Post-acute patients receiving skilled nursing facility rehabilitation now account for almost 20% of total nursing home days (Tyler et al., 2013). While nursing home quality is dependent on a number of workforce factors, physicians are clearly an important part of the team. Primary care physicians often graduate and enter practice without any meaningful exposure to post-acute LTC (PA-LTC) or to geriatric medicine in general. While the evidence linking nurse staffing, competence, and clinical quality is well-accepted, an analogous link between physician care and quality is still being defined. Read more...

 

Workforce Demand and Supply:

Sources of New Workers and Job Mobility in Long-Term Care

Project 2 analyzed job mobility of long-term care workers, specifically examining wage differences that appear between entry and exit from this field. The analysis identified the occupations and industries from which long-term care workers are drawn, and the fields that workers enter if they leave LTC. Read more...

Trends in Long-Term Care Service Use and Workforce Demand Predictions

Project 3 extended existing prediction models that forecast demand for long-term care, to understand how projected demand for different types of LTC services in the future translates to the need for LTC workers. Read more...

Time Use of Long-Term Care Workers

Whether workers exit or stay in the labor force depends not only on compensation and work satisfaction, but also on factors outside of the workplace: their ability to develop new skills, take part in social activities, engage in hobbies, and have time for leisure activities. Read more...

The Racial and Ethnic Diversity of the Long-Term Care Workforce

The proportion of the US population aged 65 and older that is non-white is projected to increase from 20% to 27% between 2010 and 2030. This increasing racial/ethnic diversity raises questions about the ability of the long-term care workforce to meet their needs. This project will provide information about the extent to which the racial/ethnic diversity of the LTC workforce mirrors the racial/ethnic diversity of the population to help HRSA identify occupations that may benefit from investment of resources to encourage more racial/ethnic minorities to complete education programs. Read more... 

Employer Demand for Physician Assistants and Nurse Practitioners in Long-Term Care Settings

By 2030, people aged 65 and older are projected to account for 20% percent of the US population. One solution to meet the demand for health care professionals with expertise in long-term care (LTC) may be to employ more nurse practitioners (NPs) and/or physician assistants (PAs) in LTC settings. To our knowledge, this will be the first study to evaluate the national job market for PAs and NPs in LTC settings. Understanding LTC demand for PAs and NPs will help to guide HRSA’s investment in LTC education versus other high-demand fields. The study will be conducted in partnership with Duke University. Read more... 

Rural Long-term Care Worker Shortages: The Roles of Local Economic Conditions and the Opioid Crisis

Long-term care is facing rapid increases in worker demand as the result of an aging U.S. population.  Shortages appear more severe in rural areas, with the outflow of younger people in search of employment and lifestyle supports.  A large share of support for those who need assistance comes from families. However, the pool of potential family caregivers is shrinking due to smaller family sizes, lower marriage rates, and adult children living farther from parents. Moreover, the opioid epidemic has had a notable impact on older Americans, with increasing numbers of people whose adult children are suffering from opioid use disorder and a rising share of elders raising grandchildren. Read more...

 

Personal Care and Home Care Workforce:

Training Requirements for Personal Care Aides Across the 50 States

This project explored differences in training requirements for Personal Care Aides, who provide assistance to older adults and people with disabilities in their homes and in long-term care facilities. Although there are nearly one million people working in this field, there is little consistency in the training requirements across the 50 states. Our study provided valuable information about regulations, as well as an assessment of the rationale underlying specific training requirements. Read more…

Remote Monitoring Technology in Long-Term Care

Remote monitoring technologies are increasingly being deployed to enable health professionals to monitor patients more closely and intervene more quickly when patients’ health deteriorates. Remote monitoring and structured telephone support have been found to improve health outcomes for chronic obstructive pulmonary disease, congestive heart failure, hypertension, and hyperlipidemia. The most common model is for registered nurses (RNs) or other health professionals to review reported data and contact patients if it appears that the patient’s treatment plan needs to be adjusted. Read more...

Family Member Caregivers for Dual-Eligible Medicare/Medicaid Enrollees

This investigation provided a natural experiment to examine these questions. We examined post-discharge utilization of long-term supports and services (LTSS) among dual-eligible Californians who were discharged from an acute inpatient hospital stay from 2006-2008. Read more...

Licensed Home Care Agencies and Nursing Scope of Practice: Impacts on Persons Needing Assistance in Community Living

Unlicensed assistive personnel who help people in their homes might be employed by a licensed home care agency or can be employed directly by the person who requires assistance. State nurse practice acts and medication aide laws determine who can perform common tasks such as managing catheters, tube feeding, and medication management. Variations in state laws and regulations mean that aides working through agencies may have a more limited scope of practice than if they were hired independently. This could mean that some community-dwelling older adults and people with disabilities might not be able to get the help they need or be forced to enter institutions solely to have access to licensed personnel who can provide the required help. Read more... 

Impact of Electronic Visit Verification (EVV) on Medicaid Personal Care Services Workers

The 21st Century CURES Act, enacted by Congress in 2016, requires that all states implement Electronic Visit Verification (EVV) for Medicaid-funded Personal Care Services (PCS) on January 1, 2019 and for Home Health Care Services (HHCS) by January 1, 2023. EVV electronically verifies that a caregiver provides services for a client.  According to the Centers for Medicare and Medicaid Services (CMS), EVV will improve program efficiencies by validating service delivery and reducing waste, fraud, and inefficiency. Read more...

 

Alzheimer’s and Dementia Care:

Alzheimer’s Patient Care Manager Practices and Policies

The goal of this project was to systematically review and analyze care manager policies and practices within health plans participating in CMS’s demonstration programs for dual-eligible Medicare/Medicaid beneficiaries in 11 states. Read more...

Dementia Care Specialist Workforce: Scope of Practice, Training, and Demand

Over five million older adults in the U.S. are currently living with Alzheimer’s disease and related dementia (ADRD); the prevalence of ADRD is expected to rise to 16 million by 2050. The costs of health care, long-term care, and hospice care for individuals with ADRD exceeded $236 billion in 2016, and will rise to $1.1 trillion by 2050. The estimated share of these costs covered by Medicare and Medicaid is expected to increase from $160 billion to over $735 billion by 2050. Read more... 

Alzheimer's Staffing, Services, and Outcomes in Adult Day Health Centers

Alzheimer’s Disease (AD) and AD-related dementia (ADRD) is a profoundly debilitating disease with risk increasing with age (Alzheimer's Foundation of America, 2016). This disease will quickly burden a growing percentage of Americans and pose a great challenge for the U.S. health care system. Adult Day Health Centers (ADHCs) are a vital community service whose staff provide specialized care to persons with ADRD and respite to caregivers, which allows them to work, meet obligations, and recover from the daily care burden (O'Keefe & Siebenaler, 2006). It is essential that ADHCs and other LTC providers be readily equipped with the appropriate services and staffing structures to properly care for persons with ADRD. Read more...

 

Physicians, Nurse Practitioners, Physician Assistants, and Nurses:

Employer Demand for Physician Assistants and Nurse Practitioners in Long-Term Care Settings

By 2030, people aged 65 and older are projected to account for 20% percent of the US population. One solution to meet the demand for health care professionals with expertise in long-term care (LTC) may be to employ more nurse practitioners (NPs) and/or physician assistants (PAs) in LTC settings. To our knowledge, this will be the first study to evaluate the national job market for PAs and NPs in LTC settings. Understanding LTC demand for PAs and NPs will help to guide HRSA’s investment in LTC education versus other high-demand fields. The study will be conducted in partnership with Duke University. Read more... 

The Roles and Value of Geriatricians in Health Care Teams

The American Geriatrics Society (AGS) estimates that a total of 30,000 geriatricians will be needed to meet care needs by 2020, and there is currently a shortfall of approximately 13,000 geriatricians. The AGS projects that the shortfall will worsen without greater numbers of graduates of geriatrics training programs. However, some healthcare leaders believe that the needs of the aging population can be met by other physicians – including primary care providers – in addition to professionals such as occupational therapists and nurse practitioners. Read more...

The Licensed Practical Nurse Workforce in Long-Term Care

This study examined changes in LPN supply, educational attainment, demographics, geographic distribution, and employment settings over the past decade. Characteristics of LPNs employed in long-term care settings were compared with characteristics of LPNs working in other health care settings. Read more...

 

Emerging Care Delivery Models and New Occupations:

Care Management and Care Coordination in Long-Term Care

Care management and care coordination is a growing field in long-term care, particularly at the interface of long-term care, acute care, and home care. The questions of how care managers are being used, how they are educated for their work, and how they interact with other members of the health care team are largely unanswered. Read more...

Mobile Integrated Healthcare and Community Paramedicine

According to a survey conducted by the National Association of Emergency Medical Technicians (NAEMT) in 2014, more than 100 emergency medical services (EMS) agencies in 33 states and the District of Columbia have implemented mobile integrated healthcare and community paramedicine (MIH-CP) initiatives. MIH-CP is a new model of care in which emergency medical technicians and paramedics (EMT-Ps) are trained to deliver a broader range of services than simply emergency response and transportation to emergency departments.. Read more...

Workforce Impact of Emerging Technologies in Long Term Care

By 2030, people 65 and older are projected to account for 20% of the U.S. population (U.S. Census Bureau, 2012); by 2017 over 70% of disposable income in the U.S. will be in the hands of those over 60 years old (World Economic Forum, 2015). Rapidly emerging technological advances hold great potential for people to navigate the social, cognitive and physical changes associated with aging (President’s Council of Advisors on Science and Technology, 2016). Read more... 

Trends in the Social Work Long-Term Care Workforce

Depression and anxiety are common clinical features among residents of nursing homes and assisted living facilities in the United States, with prevalence estimates ranging from 20% to 30% (Mansbach, et al., 2015). Social workers are well-positioned to meet these needs because they are trained to provide both direct and indirect patient care. This project will describe trends in social worker employment in skilled nursing, residential care, and home health settings, using data from the U.S. Census Bureau and the Bureau of Labor Statistics (BLS). Read more...

 

Nursing Homes:

Electronic Health Records in Nursing Homes

A growing share of nursing homes and skilled nursing facilities use electronic health records (EHRs), but its adoption is still not widespread. Prior research has reported that the need for training and the culture change associated with EHRs are important barriers to implementation. Greater satisfaction with EHRs in nursing homes is associated with good training resources and effective implementation strategies. Read more...

Medical Staff Organization in the U.S. Nursing Homes

Nursing homes are critical components of the LTC continuum. Acute care systems recognize the need for high quality and easily accessible post-acute LTC (rehabilitation), as niche nursing homes have embraced over the past several years. Post-acute patients receiving skilled nursing facility rehabilitation now account for almost 20% of total nursing home days (Tyler et al., 2013). While nursing home quality is dependent on a number of workforce factors, physicians are clearly an important part of the team. Primary care physicians often graduate and enter practice without any meaningful exposure to post-acute LTC (PA-LTC) or to geriatric medicine in general. While the evidence linking nurse staffing, competence, and clinical quality is well-accepted, an analogous link between physician care and quality is still being defined. Read more...

Medical Staff Organization, and Relationships Between Directors of Nursing and Medical Staff, and Nursing Home Quality

Nursing homes are critical components of the LTC continuum. Acute care systems recognize the need for high quality and easily accessible post-acute LTC (rehabilitation).  While nursing home quality is dependent on a number of workforce factors, physicians are clearly an important part of the team. Primary care physicians often graduate and enter practice without any meaningful exposure to post-acute LTC (PA-LTC) or to geriatric medicine in general. Read more...

 

Behavioral Health:

Peer Providers in Behavioral Health and Substance Abuse Treatment

For this study, we conducted case studies in 3 states that exemplify best practices in peer provider training, employment, and reimbursement for both Mental Health (MH) and Substance Abuse (SA) peer providers. Read more...

The Composition of Health Providers Prescribing Behavioral Health Medications to Medicare Beneficiaries with Behavioral Health Needs 

The Medicare program is anticipating an increase from 54 million beneficiaries today to over 80 million beneficiaries by 2030, many of whom will have longer life expectancies, chronic conditions, mental health problems, and substance use disorders. These population changes will challenge a primary care workforce already in need of more gero-psychiatrists.  Read more...

 

Palliative Care:

Palliative Care Workforce: Team Composition Across Settings

This project produced a detailed analysis of the data available on hospital-based programs, and also produced qualitative findings that could be used to guide a national survey of community-based programs. This study was conducted in collaboration with the Center to Advance Palliative Care. Read more...