Thesis (M.S.)--University of Wisconsin-Madison, 1989. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 78-81).

Thesis (M.A.)--Acadia University, 1999. / Includes bibliographical references. Also available on the Internet via the World Wide Web.

Thesis (M.A.)--Acadia University, 1999. / Includes bibliographical references. Also available on the Internet via the World Wide Web.

Thesis--University of California, San Francisco. / On spine: The Status passage of elderly persons. eContent provider-neutral record in process. Description based on print version record.

Thesis (Ph. D.)--University of Idaho, 2005. / Also available online in PDF format. Abstract. "Spring 2005." Includes bibliographical references (leaves 117-125).

Thesis (Ph. D.)--University of Washington, 2006. / Vita. Includes bibliographical references (leaves 93-102).

Thesis (Ph.D.)--University of Tennessee Health Science Center, 2008. / Title from title page screen (viewed on February 18, 2008). Research advisor: Teresa M. Waters, Ph.D. Document formatted into pages (viii, 88 p. : ill.). Vita. Abstract. Includes bibliographical references (p. 67-79).

Background: Individuals with intellectual and/or developmental disabilities (IDD) are experiencing longer life expectancies with the majority requiring the ongoing support of family caregivers into adulthood. Medicaid is the primary funding source for supports and services for adults with IDD. Growing Medicaid expenditures and goals to improve quality of care are driving more states to move their Medicaid fee-for-service programs into a managed care model. The stated goals of Medicaid managed long-term services and supports (MLTSS) are to improve care coordination and access to care while controlling costs, but the evidence regarding these outcomes is limited and mixed. Given the level of uncertainty about MLTSS for adults with IDD and their family caregivers, best practices recommendations have been produced by the federal government and advocacy agencies to help guide future MLTSS implementation efforts. These best practice recommendations combined with the continued expansion of MLTSS in the states, provided an opportunity to further explore implementation of MLTSS to inform both policy and practice. One state which recently reformed their Medicaid program to MLTSS and which has been referred to as a bellwether state is Kansas. The MLTSS program in Kansas, titled “KanCare”, is the first for adults with IDD to integrate across health, behavioral health, and LTSS while also contracting through three private-for-profit managed care organizations (MCOs). Aims: The objective of this study was to describe the current implementation of MLTSS for adults with IDD and their family caregivers in one state, Kansas. Study aims were as follows: 1) To understand the rationale behind and what actually happened with MLTSS implementation for adults with IDD in Kansas; 2) To understand how service coordination providers and family caregivers perceived care coordination and access to services for adults with IDD in MLTSS; 3) To understand how family caregivers and their roles were recognized in MLTSS for adults with IDD. Methods: A single case embedded design case study approach was used with in-depth semi-structured interviews completed with state/regional level representatives (N=13), MLTSS service coordination providers (N=7), and family caregivers of adults with IDD (N=11). Data collection and analysis were guided by the unified theory of family quality of life (FQOL) and Bronfenbrenner’s ecological model. The framework method was used to structure the data analysis process. Member checking was completed to ensure accuracy of results. Findings: Regarding aim one, respondents identified reducing costs and improving care quality as the rationale behind MLTSS, but these were outcomes not yet realized given the early stages of implementation. At the time of this study, the Managed Care Organizations (MCOs) were continuing to work on expanding provider networks and to provide additional services to address health disparities amongst individuals with IDD. Study participants identified the importance of adequate planning and stakeholder engagement to reduce confusion and fear when transitioning into MLTSS. Addressing aim two, timely and accessible consumer education, clear care coordination processes, and provider network adequacy were identified as important to influence the challenges experienced to date in care coordination and access to services. Regarding aim three, participants acknowledged the important role of family caregivers. At the current stage of the KanCare implementation, participants reported lack of formal processes for family caregiver assessment and a need for more proactive family support services planning. Conclusion: Lessons learned from this implementation experience include the importance of having long planning timelines and including stakeholder feedback into the design of MLTSS programs. Care coordination holds promise to better integrate care, but more research is needed to understand best practices for the provision of care coordination in MLTSS. In order to address access to services, MLTSS programs will need to work and build provider capacity and provider networks. MLTSS programs will also need to formally recognize the role of family caregivers by incorporating the use of family caregiver assessments to proactively plan for support needs.

Background: There is little information on how the quality of oral health services in long-term care (LTC) facilities is conceptualized or assessed. Objectives: This study aims to develop a model for assessing the quality of oral healthcare services in LTC facilities. Methods: This study is divided into four main steps. Firstly, I examined literature for existing concepts relating to program evaluation and quality assessment in healthcare to build a theoretical framework appropriate to dental geriatrics. Secondly, I explored as an ethnographic case study a comprehensive oral healthcare program within a single administrative group of 5 LTC facilities in a large metropolis by interviewing 33 participants, including residents and their families, nursing staff, administrators and dental personnel. I also examined policy documents and made site visits to identify other attributes influencing the quality of the program. Thirdly, I drafted the assessment model combining a theoretical framework with empirical information from the case study. And lastly, I tested the feasibility and usability of the model in another dental geriatric program in northern British Columbia. I applied the assessment model by conducting 15 interviews with participants in the program, made site-visits to the 5 facilities, and reviewed documents on the development and operation of the program. Results: A combination of theory-based evaluation and quality assurance provided six sequential and iterative steps for quality assessment of oral health services in LTC. The empirical information supported the theoretical framework that a program of oral healthcare in a LTC context should be assessed for quality from multiple perspectives; it should be comprehensive; and it should include the three main attributes of quality - capacity, performance, and outcomes. Participants revealed 20 quality indicators along with suggested program objectives which encompass eight quality dimensions such as effectiveness, efficiency, and patient-centered. Conclusion: The model provides a unique system for assessing the quality of dental services in LTC facilities that seems to meet the needs of dental and non-dental personnel in LTC. / Dentistry, Faculty of / Graduate

Background: Persons with developmental disabilities (DDs) represent about 1-3% of the total population in Canada; however, very little statistical data exists regarding this population in the context of long-term care (LTC). As the life expectation of these individuals increases, the distinct needs they have that are associated with aging should be addressed in LTC to help improve the quality and relevancy of the care they receive. Methods: An exploratory qualitative study. Semi-structured interviews were conducted. Open coding of interview transcripts, and content analysis was completed. Descriptive statistics of the sample were calculated using Excel. Results: All participants had experienced earlier functional decline which resulted in changes in their care needs. Often this meant needing to change their assistive devices. Many participants feared losing their independence as they aged. Conclusion: There is insufficient understanding of the unique needs that face people aging with DDs or how they access LTC. The preference for these individuals is to age in place, their independence must be maintained in order for this to be successful. Three factors help to facilitate this: assistive devices, attendant care and accessibility of health care services. Contexte: Les personnes ayant un handicaps developmental représentent environ 1-3% de la population totale au Canada. Cependant, très peu de données statistiques concernant cette population existent dans le contexte de soins de longue durée. L’espérance de vie de ces personnes augmente, les besoins distincts associés au vieillissement devraient être examinés pour aider à améliorer la qualité et la pertinence des soins qu'ils reçoivent dans les soins de longue durée. Méthodes: Une étude qualitative exploratoire. Des entrevues semi-structurées ont été menées. Les transcriptions d'entrevues ont été codées en utilisant un style de codage ouvert et l'analyse de contenu a été accomplie. Les statistiques descriptives des participants ont été calculées. Résultats: Plusieurs thèmes sont devenus apparents. Tous les participants avaient connu un déclin fonctionnel à un jeune âge qui a entraîné des changements dans leurs besoins de soins. Souvent, cela signifit avoir à changer leurs appareils et accessoires fonctionnels. De nombreux participants craignaient de perdre leur indépendance en vieillissant. Conclusion: Il y a une méconnaissance des besoins uniques auxquels font face les personnes vieillissant avec un handicap developmental et la façon dont ils accident aux soins de longue durée. La préférence pour ces personnes est de viellir en place, leur indépendance devant être maintenue pour que ce soit un succès. Trois facteurs contribuent à faciliter ceci: les appareils et accessoires fonctionnels, les soins auxiliaires et l'accessibilité aux services santé.