Supporting the Behavioral Health of Older Adults: Evaluating a Multi-Site, Multi-Actor, Multi-Agency Initiative.

Policymakers often overlook people living with physical disabilities and older adults' behavioral health (BH) needs. Older adults experience alarmingly high rates of mental illness and substance use disorders, which often intersect with neurocognitive challenges. Emerging evidence suggests the SARS-COV-2 pandemic has exacerbated these disparities. BH needs amongst older adults and people living with physical disabilities have major implications for policy and service delivery. While a multitude of local interventions to support BH exist, few state-level programs focus on this population. In 2015, Oregon established the Behavioral Health Initiative for Older Adults and People with Physical Disabilities (referred to as the Initiative) with this specific purpose. A multi-year evaluation of this Initiative suggests several important improvements have occurred. Yet, barriers remain that hinder optimal service provision and enable siloed aging and BH services between agencies. The findings indicate ways the Initiative can leverage initial successes to further support this population.

U.S. long-term services and supports, Covid-19, & dementia: Impacts and opportunities for policy change

Background The COVID-19 pandemic brings the many historical challenges of the long-term services and supports (LTSS) system in the United States (U.S.) into clear focus. Inequalities across race, ethnicity, and socioeconomic status (SES) as well as an increased burden on family care partners have been amplified by the pandemic. In spite of multiple reform attempts and an increasing population of older adults living with multiple, chronic health conditions including Alzheimer?s disease and other forms of dementia (ADRD), who will need some form of long-term care during their lifetime policy reform has remained elusive. Primary blame for the high rates of COVID-19 infections and deaths have largely been assigned to formal LTSS care settings. Yet, more systemic problems have become clear during the pandemic: the failure of coordination of the U.S. public health system at the federal level and the effects of long-term disinvestment and neglect of state and local level public health programs. Taken together, these failures contributed to an inability to coordinate with the LTSS system and act early to protect residents and staff in the LTSS care settings. Method We analyze several impacts of the COVID-19 pandemic on the U.S. LTSS system and existing policy arrangements. Result Policies U.S. policymakers can implement include uniform public reporting of COVID-19 cases in licensed LTSS settings, identifying and supporting unpaid care partners, increased support for the direct care workforce, increased coordination between public health departments and LTSS agencies and providers, enhancing collaboration and communication across health, LTSS, and public health systems, further reducing barriers to telehealth in LTSS, and providing incentives to care for our most vulnerable populations. The analysis also demonstrates that comprehensive reform is required in order to build the LTSS system that is needed through comprehensive workforce development, universal coverage through comprehensive financing reform, and the creation of an age-friendly public health system. Conclusion The COVID-19 pandemic has exposed the deficits of the U.S. LTSS system and made clear the interdependence of LTSS with public health. Several policy responses to the pandemic would help provide the LTSS system that is needed to care for people living with dementia.

Building brain capital.

Brains are indispensable drivers of human progress. Why not invest more heavily in them? We seek to place Brain Capital at the center of a new narrative to fuel economic and societal recovery and resilience.

COVID-19: The Time for Collaboration Between Long-Term Services and Supports, Health Care Systems, and Public Health Is Now.

Policy Points To address systemic problems amplified by COVID-19, we need to restructure US long-term services and supports (LTSS) as they relate to both the health care systems and public health systems. We present both near-term and long-term policy solutions. Seven near-term policy recommendations include requiring the uniform public reporting of COVID-19 cases in all LTSS settings; identifying and supporting unpaid caregivers; bolstering protections for the direct care workforce; increasing coordination between public health departments and LTSS agencies and providers; enhancing collaboration and communication across health, LTSS, and public health systems; further reducing barriers to telehealth in LTSS; and providing incentives to care for vulnerable populations. Long-term reform should focus on comprehensive workforce development, comprehensive LTSS financing reform, and the creation of an age-friendly public health system. CONTEXT: The heavy toll of COVID-19 brings the failings of the long-term services and supports (LTSS) system in the United States into sharp focus. Although these are not new problems, the pandemic has exacerbated and amplified their impact to a point that they are impossible to ignore. The primary blame for the high rates of COVID-19 infections and deaths has been assigned to formal LTSS care settings, specifically nursing homes. Yet other systemic problems have been unearthed during this pandemic: the failure to coordinate the US public health system at the federal level and the effects of long-term disinvestment and neglect of state- and local-level public health programs. Together these failures have contributed to an inability to coordinate with the LTSS system and to act early to protect residents and staff in the LTSS care settings that are hotspots for infection, spread, and serious negative health outcomes. METHODS: We analyze several impacts of the COVID-19 pandemic on the US LTSS system and policy arrangements. The economic toll on state budgets has been multifaceted, and the pandemic has had a direct impact on Medicaid, the primary funder of LTSS, which in turn has further exacerbated the states' fiscal problems. Both the inequalities across race, ethnicity, and socioeconomic status as well as the increased burden on unpaid caregivers are clear. So too is the need to better integrate LTSS with the health, social care, and public health systems. FINDINGS: We propose seven near-term actions that US policymakers could take: implementing a uniform public reporting of COVID-19 cases in LTSS settings; identifying and supporting unpaid caregivers; bolstering support for the direct care workforce; increasing coordination between public health departments and LTSS agencies and providers; enhancing collaboration and communication across health, LTSS, and public health systems; further reducing the barriers to telehealth in LTSS; and providing incentives to care for our most vulnerable populations. Our analysis also demonstrates that our nation requires comprehensive reform to build the LTSS system we need through comprehensive workforce development, universal coverage through comprehensive financing reform, and the creation of an age-friendly public health system. CONCLUSIONS: COVID-19 has exposed the many deficits of the US LTSS system and made clear the interdependence of LTSS with public health. Policymakers have an opportunity to address these failings through a substantive reform of the LTSS system and increased collaboration with public health agencies and leaders. The opportunity for reform is now.

Older Adults Post-Incarceration: Restructuring Long-term Services and Supports in the Time of COVID-19.

OBJECTIVES: To describe long-term care services and supports (LTSS) in the United States, note their limitations in serving older adults post-incarceration, and offer potential solutions, with special consideration for the Coronavirus Disease 2019 pandemic. DESIGN: Narrative review. SETTING AND PARTICIPANTS: LTSS for older adults post-incarceration. METHODS: Literature review and policy analysis. RESULTS: Skilled nursing facilities, nursing homes, assisted living, adult foster homes, and informal care from family and friends compose LTSS for older adults, but their utilization suffers from access and payment complexities, especially for older adults post-incarceration. A combination of public-private partnerships, utilization of health professional trainees, and unique approaches to informal caregiver support, including direct compensation to caregivers, could help older adults reentering our communities following prison. CONCLUSIONS AND IMPLICATIONS: Long-standing gaps in US LTSS are revealed by the coronavirus (severe acute respiratory syndrome coronavirus 2) pandemic. Older adults entering our communities from prison are particularly vulnerable and need unique solutions to aging care as they face stigma and access challenges not typically encountered by the general population. Our review and discussion offer guidance to systems, practitioners, and policy makers on how to improve the care of older adults after incarceration.