Personal Care Aides: Assessing Self-Care Needs And Worker Shortages In Rural Areas

Chapman, Susan; Greiman, Lillie; Bates, Timothy C.; Wagner, Laura M.; Lissau, Ari; Toivanen-Atilla, Kirsi; Sage, Rayna

doi:10.1377/hlthaff.2022.00483

Cited by 11 publications

(14 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The presence of these housing characteristics has implications for exercise, socialization, and ability to attend appointments. This is especially true in under-resourced rural communities, where access to home and community based services and home health care workforce may be more limited (Chapman et al, 2022), and for low-income older adults in both rural and urban settings who may not be able to access or afford home modifications (Henning-Smith et al, 2017). Additionally, given that rural older adults aging in place were also more likely to be worried about falling and to have unmet needs for help with mobility limitations, such differences in housing characteristics likely have serious implications for their experience of aging in place because the home environment may not be sufficiently safe or accessible.…”

Section: Discussionmentioning

confidence: 99%

“…Rural populations are, on average, older than urban populations (Cromartie, 2021;Tuttle et al, 2020). In some cases, this is because of out-migration of younger and middle-aged adults, which can lead to shortages of home health care workforce and informal caregivers to provide care and support if it is needed (Chapman et al, 2022;Cromartie, 2021). Rural older adults themselves differ from urban older adults in meaningful ways.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Unmet Needs for Help With Mobility Limitations Among Older Adults Aging in Place: The Role of Rurality

et al. 2023

View full text Add to dashboard Cite

Objectives This study identifies differences in unmet mobility needs among older adults living in rural versus urban areas. Methods We used data from Round 9 of the National Health and Aging Trends Study (NHATS), limiting our analyses to respondents who had not moved since baseline (average housing tenure of 27 years; n = 3343). We conducted bivariate and multivariate analyses to detect rural/urban differences in unmet mobility needs, adjusting for socio-demographics, health status, and housing characteristics. Results Rural residence was associated with higher odds of any unmet mobility needs for older adults aging in place (adjusted odds ratio: 1.64, 95% confidence interval: 1.10–2.44, p < .05). The relationship between rurality and unmet needs for help with mobility limitations remained significant in fully adjusted models. Discussion Rural older adults aging in place have greater unmet needs for help with mobility limitations. This study highlights several important gaps in supporting rural older adults aging in place.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Unmet Needs for Help With Mobility Limitations Among Older Adults Aging in Place: The Role of Rurality

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Recent research has also highlighted substantial differences in the supply of the LTSS workforce across US states and regions, and this extends to rural and urban areas in US regions. For example, a recent study by Chapman et al (2022) found that the ratio of personal care aides relative to the number of adults with a self-care disability was lower in rural areas in the Southeast and in the Midwest, and higher on the Pacific Coast, in some parts of the Northeast, and in the Mid-North Central region. State-wide and regional LTSS policies underlie the supply and demand for direct care workers in rural and urban areas (Friedman et al, 2021).…”

Section: Applications Of Study Findingsmentioning

confidence: 99%

“…The goal of this paper is to describe rural and urban differences in the supply of direct care workers relative to the older adult population. We also explore differences in the supply of direct care workers across rural and urban areas in the different Census regions of the US because, as described above, past research has demonstrated substantial regional variation (Chapman et al, 2022; Friedman et al, 2021). Our study contributes to ongoing and necessary research that demonstrates variation in the supply of direct care workforce needed to care for older rural adults in institutional and home-based settings.…”

mentioning

confidence: 99%

Who Will Care for Rural Older Adults? Measuring the Direct Care Workforce in Rural Areas

et al. 2023

View full text Add to dashboard Cite

Using the 2021 Occupational Employment and Wage Statistics (OEWS) dataset, we calculate the ratio of direct care workers relative to the population of older adults (ages 65+) across rural and urban areas in the US. We find that there are, on average, 32.9 home health aides per 1000 older adults (age 65+) in rural areas and 50.4 home health aides per 1000 older adults in urban areas. There are, on average, 20.9 nursing assistants per 1000 older adults in rural areas and 25.3 nursing assistants per 1000 older adults in urban areas. There is substantial regional variation. Greater investment needs to be made in improving wages and job quality for direct care workers to attract workers to these critical occupations, especially in rural areas where the need for direct care is greater.

show abstract

“…Studies have shown inequities in the overall risk of unmet needs for older adults-including for those who are Medicaid beneficiarieswith a greater risk of unmet needs for racially and ethnically minoritized older adults and those living in rural settings. [18][19][20][21][22][23][24] Analyses of national Medicaid claims data from 2012 indicated that among HCBS users, white older adults spent more on HCBS and also had lower hospitalization rates and hospital spending than Black and Hispanic older adults. 25 These and other findings suggest that HCBS beneficiaries from minoritized groups may not be capturing an equitable share of HCBS spending-or that other factors (e.g., inequities in the quality of HCBS) may in turn yield inequities in adverse outcomes.…”

Section: Introductionmentioning

confidence: 99%

State home and community‐based services expenditures and unmet care needs in the United States: Has everyone benefitted equally?

Yang,

Lee,

Rapp

et al. 2023

Health Services Research

View full text Add to dashboard Cite

ObjectiveTo test whether the impacts of Medicaid's Home and Community‐Based Services (HCBS) expenditures have been equitable.Data Sources and Study SettingThis is a secondary data analysis. We linked annual data on state‐level Medicaid HCBS expenditures with individual data from U.S. Health and Retirement Study (HRS; 2006–2016).Study DesignWe evaluated the association between state‐level HCBS expenditure quartiles and the risk of experiencing challenges in basic or instrumental activities of daily living (I/ADLs) without assistance (unmet needs for care). We fitted generalized estimating equations (GEE) with a Poisson distribution, log link function, and an unstructured covariance matrix. We controlled demographics, time, and place‐based fixed effects and estimated models stratified by race and ethnicity, gender, and urbanicity. We tested the robustness of results with negative controls.Data Collection/Extraction MethodsOur analytic sample included HRS Medicaid beneficiaries, aged 55+, who had difficulty with ≥1 I/ADL (n = 2607 unique respondents contributing 4719 person‐wave observations).Principal FindingsAmong adults with IADL difficulty, higher quartiles of HCBS expenditure (vs. the lowest quartile) were associated with a lower overall prevalence of unmet needs for care (e.g., Prevalence Ratio [PR], Q4 vs. Q1: 0.91, 95% CI: 0.84–0.98). This protective association was concentrated among non‐Hispanic white respondents (Q4 vs. Q1: 0.82, 95% CI: 0.73–0.93); estimates were imprecise for Hispanic individuals and largely null for non‐Hispanic Black participants. We found no evidence of heterogeneity by gender or urbanicity. Negative control robustness checks indicated that higher quartiles of HCBS expenditure were not associated with (1) the risk of reporting I/ADL difficulty among 55+ Medicaid beneficiaries, and (2) the risk of unmet care needs among non‐Medicaid beneficiaries.ConclusionThe returns to higher state‐level HCBS expenditures under Medicaid for older adults with I/ADL disability do not appear to have been equitable by race and ethnicity.

show abstract

Personal Care Aides: Assessing Self-Care Needs And Worker Shortages In Rural Areas

Cited by 11 publications

References 11 publications

Unmet Needs for Help With Mobility Limitations Among Older Adults Aging in Place: The Role of Rurality

Unmet Needs for Help With Mobility Limitations Among Older Adults Aging in Place: The Role of Rurality

Who Will Care for Rural Older Adults? Measuring the Direct Care Workforce in Rural Areas

State home and community‐based services expenditures and unmet care needs in the United States: Has everyone benefitted equally?

Contact Info

Product

Resources

About