Program of All-Inclusive Care for the Elderly (PACE) Organizations Flip the Script in Response to the COVID-19 Pandemic.

OBJECTIVES: Program of All-Inclusive Care (PACE) organizations faced unique challenges during the COVID-19 pandemic, particularly given PACE participants are frail older adults who often live with multiple disabilities and chronic conditions. This study describes how PACE programs leveraged their unique program flexibilities and adapted services to manage this crisis. DESIGN: Mixed methods. SETTING AND PARTICIPANTS: This study leveraged 2 national surveys of PACE directors (with response rates of 71.2% and 67.8%) and 6 qualitative interviews. METHODS: Descriptive and univariate analyses of survey response data and thematic analyses of qualitative data from interviews and open-ended survey questions were conducted. RESULTS: Results indicated that PACE organizations responded rapidly to the COVID-19 pandemic, implementing a range of adaptations that shifted the PACE model from primarily center-based to a home-based model of care. Most PACE organizations reported increasing the in-home services they provided, often accomplishing this through the redeployment of center-based staff. PACE organizations likewise leveraged telehealth and remote monitoring to increase support to beneficiaries in their home, implemented various COVID-19 vaccine and infection prevention efforts, increased food and nutrition services provided in the home, and took steps to address social isolation and boredom, among other initiatives. Most PACE organizations indicated they plan to continue delivering more services in the home, consistent with participant preferences. CONCLUSIONS AND IMPLICATIONS: The findings from this study indicate that PACE organizations continued to keep participants at the forefront as they transitioned to a home-based model during the COVID-19 pandemic. Key characteristics of PACE, including its strong emphasis on person-centered team-based care, its fully integrated service model, and its flexible capitated payment structure, contributed to the resilience of the program. These findings highlight PACE organizations' ability to empower nursing home-eligible older adults to remain living in their preferred residential setting and have implications for how best to serve this population.

The development and correlates of gender role attitudes in African American youth.

This research examined the longitudinal trajectories and family correlates of gender role attitudes in African American youth in a sample of 166 sibling pairs residing with their mothers and fathers. Multilevel modelling revealed that (1) girls and boys exhibited significant declines in gender attitude traditionality from ages 9 to 15 that levelled off through age 18, (2) mothers' (but not fathers') gender role attitude traditionality was positively related to youth's attitude traditionality, and (3) within-person variation in mothers' (but not fathers') racial discrimination experiences was negatively related to within-person variation in youth's gender role attitude traditionality. The utility of applying a cultural ecological framework within an ethnic homogenous, accelerated longitudinal design to understand African American family processes, in conjunction with the intersectionality between race and gender, is the focus of the discussion. Statement of contribution What is already known on this subject? Gender role attitude traditionality declined for girls, but not for boys, in European and Mexican American families. Little is known about the roles of African American parents in shaping their children's gender development. What does this study add? For African American girls and boys, gender role attitude traditionality declined from ages 9 to 15 and then levelled off through age 18. At the between-person level, African American mothers', but not fathers', attitude traditionality was positively linked to that of their children. At the within-person level, African American mothers', but not fathers', experiences of racial discrimination were negatively linked to their children's attitude traditionality.

Links Between Sibling Experiences and Romantic Competence from Adolescence Through Young Adulthood.

Although previous research has linked sibling relationship experiences to youth's social competencies with peers, we know little about the role of siblings in youth's romantic relationship experiences. Drawing on data from a longitudinal sample of 190 families, this study examined the links between sibling experiences and the development of perceived romantic competence from early adolescence into young adulthood (ages 12-20). The data were collected from 373 youth (50.7 % female) in home interviews on up to five annual occasions. Multi-level models tested the moderating role of sibling gender constellation in romantic competence development and the links between (changes in) sibling intimacy and conflict, and romantic competence. The results revealed that youth with same-sex siblings showed no change in their perceived romantic competence, but those with opposite-sex siblings exhibited increases in romantic competence over time. Controlling for parent-child intimacy, at times when youth reported more sibling intimacy, they also reported greater romantic competence, and youth with higher cross-time average sibling conflict were lower in romantic competence, on average. This study illustrates that sibling experiences remain important in social development into early adulthood and suggests directions for application and future research.

Gender Dynamics Predict Changes in Marital Love Among African American Couples.

This study examined the implications of gender attitudes and spouses' divisions of household labor, time with children, and parental knowledge for their trajectories of love in a sample of 146 African American couples. Multilevel modeling in the context of an accelerated longitudinal design accommodated 3 annual waves of data. The results revealed that traditionality in husbands' gender attitudes was linked to lower levels of love. Furthermore, divisions of household labor and parental knowledge moderated changes in love such that couples with more egalitarian divisions exhibited higher and more stable patterns of love, whereas more traditional couples exhibited significant declines in love over time. Finally, greater similarity between spouses' time with their children was linked to higher levels of marital love. The authors highlight the implications of gender dynamics for marital harmony among African American couples and discuss ways that this work may be applied and extended in practice and future research.

Parent - Adolescent Relationship Qualities and Adolescent Adjustment in Two-Parent African American Families.

Using multi-informant data from 134 two-parent African American families, the goals of this study were to (a) describe parent - adolescent warmth and shared time as a function of parent and youth gender and (b) assess links between these indices of relationship quality and adolescent adjustment. Mixed-model ANCOVAs revealed that mothers reported warmer relationships with adolescents than fathers, and both parents reported warmer relationships with younger versus older offspring. Interparental differences in time spent with sons and daughters and older and younger siblings were also found. Tests of multilevel models indicated that greater maternal warmth was associated with fewer depressive symptoms and less risky behavior for sons, and more paternal warmth and shared time with fathers were associated with less risky behavior in youth. Discussion highlights the utility of cultural ecological and family systems perspectives for understanding parent-adolescent relationships and youth adjustment in African American families.

Sexual satisfaction, perceived availability of alternative partners, and marital quality in newlywed African American couples.

The goal for this project was to examine the manner in which husbands' and wives' sexual satisfaction was related to their perceptions of the availability of alternative partners and overall marital quality. Participants were 470 newlywed African American couples residing in the southern region of the United States. Path analysis was used to simultaneously examine actor (individuals' sexual satisfaction on their own outcomes) and partner (individuals' sexual satisfaction on their partners' outcomes) effects. Wives' and husbands' sexual satisfaction was strongly and positively associated with their own reports of marital quality, although it was not associated with their partners' reports of marital quality. For both wives and husbands, higher sexual satisfaction was associated with lowered perceptions that they would be able to find other acceptable partners should their current relationship end. Perceived availability of alternative partners was, in turn, negatively associated with reports of marital quality.

Marital Quality of Newlywed African American Couples: Implications of Egalitarian Gender Role Dynamics.

This research examined associations between husbands' and wives' gender role attitudes, division of household labor, and marital quality in a sample of 697 newlywed African American couples residing in the southern region of the United States. Guided by a cultural ecological framework, we tested hypotheses specific to the unique socio-cultural context of African Americans using a mixed model ANCOVA design. Results revealed that: (1) couples reported lower marital quality when husbands had relatively more traditional gender role attitudes; (2) husbands reported lower marital quality when the couple engaged in a relatively more traditional division of household labor; and (3) husbands with more traditional attitudes who also engaged in a traditional division of labor reported lower marital quality compared to all other husbands. Although African Americans are thought to have more flexible gender role orientations than other racial/ethnic groups within the U.S., these results document within group variability in couple gender dynamics and its association with variability in marital quality.

Rejection hurts: the effect of being dumped on subsequent mating efforts.

Many of the qualities that people seek in a long-term partner are not directly observable. As a consequence, information gathered through social learning may be important in partner assessment. Here, we tested the hypothesis that finding out potential partners were rejected by their last partner would negatively affect participants' desire to pursue a romantic relationship with them. Results support this hypothesis, and this effect was, as predicted, greater when the target was being evaluated for a potential long-term relationship compared to a sexual relationship. In a more exploratory vein, we tested the effect of the target having rejected their last partner and failing to disclose how their last relationship ended. These scenarios produced intriguing sex differences, such that men's ratings of women fell after learning she had rejected her last partner, but women's ratings of men increased after the same information was introduced. Failing to disclose information about a past relationship was unappealing to both men and women, though particularly so for women.