No description available.

Home and community based services (HCBS) are designed to provide services that meet the increasing and diverse needs of the older adult population who wish to age-in-place for as long as possible in their homes and community. Yet, little is known about the choices people make when selecting services. The purpose of this study was to assess HCBS use among vulnerable older adults. Andersen’s (1995) behavioral model of health services use provided theoretical guidance for selecting and explaining predisposing, enabling, and need-based variables associated with service use within the Community Living Program (CLP) federal initiative. Through consumer direction of services, 18 routine or one-time services were offered to 76 participants enrolled in the Virginia CLP. Two-step cluster analysis identified four distinct profiles of service users, ranging in size from 7 to 34 members. Services used within the groups ranged from 11 to 16 services. Use of personal care services (p=.033) and respite (p=.010) were significantly associated with group membership differentiation. Within each cluster, the percentage of participants using each service varied greatly. The most important variables that differentiated service user membership were caregiver relationship to participant, participant living arrangement, participant disability type, and length of time caregiver provided care. Between-cluster membership was significantly different with regard to average service cost per day for services used (p=.002) and the likelihood of moving to a nursing home if services were not provided (p=.034). Findings inform future research and have implications for practitioners assisting vulnerable older adults in selecting services to meet different care needs. / Master of Science

Older adults are living longer than ever before. By 2060, the U.S. population aged 65 or older is projected to reach 98 million. As adults age, the prevalence of chronic diseases and disabilities increases. The need for Meals on Wheels (MOW) services is growing alongside the aging population. Yet, little is known about the geographic variation of services. Little is documented about the organizational capacity of MOW organizations in terms of geography. The current policies supporting home-and community-based services, including MOW, may be insufficient to support all older adults in all types of communities. An analysis of the More Than a Meal® Comprehensive Network Study was conducted to determine geographic variation in services delivered through MOW programs and to document organizational capacity by geography. Chi-squared analyses were performed to identify relationships between twenty services offered through MOW organizations and categorial offerings within nutrition, in-home safety, socialization, and community connections categories. Spidergrams were created to document organizational capacity holistically and for three individual organizations for each of the geographic areas: Rural Only, Partial Rural, and Non-rural Service Areas. Using these findings, a policy analysis was conducted to determine policy recommendations to inclusively support rural older adults. Older adults living in rural areas access the full complement of services provided by MOW programs differently than do their non-rural counterparts. Specifically, a statistically significant relationship was found between the stratified component of in-home safety for rural, partial rural and non-rural service areas. When evaluated on the individual service offering level, statistically significant relationships between rurality and congregate meals, nutrition education, nutrition assessment, coordination of USDA food assistance programs, and telephone reassurance were seen. Spidergram documentation of capacity created visual representations of geographic similarities and differences. The policy analysis produced three potentially viable policy additions for the Older Americans Act around a provision for innovation programs, a report on in-home safety, and business acumen provisions. This work lays the foundation for further analysis of existing data with a lens of geographic specificity, as well as articulates the importance of looking at organizational capacity as a part of policy recommendations for understanding rural community-based organizations.

No description available.

Self-directed supports, as a method of service delivery, have grown from small pilot programs in a handful of states to at least one program in every state. For individuals with intellectual and developmental disabilities (IDD), self-direction presents unique opportunities to engage in self-determined behavior and shape the services upon which they rely. Although the evidence base for self-direction is relatively robust, there is a significant lack of information on how implementation of self-direction is faring on the national level. The purpose of this study is to understand how the political and economic factors within and across states have impacted the implementation of a self-directed service delivery system.

No description available.

No description available.

This study examines state variations in health care services for children with Autism and other developmental disabilities across the fifty states through the Autism and Developmental Disabilities Monitoring Network (ADDM). The ADDM network monitors and tracks the number of children with Autism and other developmental disabilities. The purpose of this study is, first, to understand the differences between the states in the implementation of the ADDM network and, second, to determine what state factors (political variable, i.e., party identification; structural administrative variables, i.e., Medicaid Home and Community Based Service Waiver, HCBS (Section1915C) and the number of pediatricians per 10,000 children; Autism prevalence variable, i.e., Autism among children in special education per 10,000 children; and state economic variables, i.e., spending per pupil for children with Autism in special education, children in poverty, and state financial health) influence the likelihood of a state applying for the ADDM network. Furthermore, the purpose of this study is to consider the potential impact of these various state characteristics in order to understand what state factors might contribute to such differences. The results reveal that structural administrative and economic factors influence a state’s decision to apply for the ADDM network. Furthermore, political factors (e.g., Democratic party control of governorship and legislature) did not influence a state’s decision to apply for the ADDM network. However, when controlling for Republican political party identification, the structural administrative, economic, and political (Republican-controlled legislature) state characteristics influence whether a state applying for the ADDM network. The results indicate that political party control does not play a significant role in determining whether a state will apply for the ADDM network. In expanding the research, to include another structural administrative factor (prior application), political party control (i.e., Republican-controlled legislature) was no longer significant. Thus, the bureaucratic environment is not influencing the actions of state administrators. Instead the individual characteristics of the state is influencing whether a state will apply for the ADDM network. Understanding the differences between the states in the implementation of the ADDM network provides a comprehensive model for establishing the ADDM network or similar programs in other states.