Online Program

Improving the delivery of health and social care to “dual eligible” older adults in the community: Lessons from the HOME study

Wednesday, November 6, 2013 : 11:08 a.m. - 11:20 a.m.

Kathryn G. Kietzman, PhD, MSW, UCLA Center for Health Policy Research, Los Angeles, CA
Steven P. Wallace, PhD, UCLA Center for Health Policy Research, Los Angeles, CA
Jacqueline M. Torres, MPH, MA, School of Public Health, University of California, Los Angeles, Los Angeles, CA
Anne Soon Choi, PhD, MPH, MSW, Department of Interdisciplinary Studies, California State University Dominguez Hills, Carson, CA
Charlene Chang, MA, Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, CA
Carolyn A. Mendez-Luck, PhD, MPH, School of Public Health; Center for Health Improvement in Minority Elders/Resource Centers for Minority Aging Research, UCLA, Los Angeles, CA
A.E. Benjamin, PhD, School of Public Affairs, UCLA, Los Angeles, CA
Numerous states are engaged in efforts to better provide for the complex health and social care needs of the “dual-eligible” (Medicare-Medicaid) population. In California, the Coordinated Care Initiative (CCI) offers the complete continuum of acute, primary, institutional and community-based care through a single benefit package administered by an organized service delivery system. The Helping Older-adults Maintain independencE (HOME) study investigates how older adult “dual-eligibles” have managed a fragmented network of informal and formal care, along with unlinked medical care, to continue to live independently at home. Implementation of the CCI lends urgency to efforts to understand more about their immediate health, social and information needs. In-depth interviews were conducted over two years with more than three dozen “dual-eligible” older adults and their caregivers. Information was gathered about the composition and quality of their health and social care networks, and changes experienced over time. Data were transcribed and independently coded to identify key patterns and themes.

We find that the health and social care needs of these vulnerable older adults are complex and inextricably linked. For some, the CCI holds the promise of reducing fragmentation and improving coordination of services. For others, the transition to a new delivery system is a threat to their fragile, yet familiar, status quo. Any service delivery changes need to be handled with careful attention to the specific needs of the individual. Getting the right package of services and supports may require multiple attempts and more than a “one size fits all” approach.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Other professions or practice related to public health
Program planning
Provision of health care to the public
Public health or related public policy
Public health or related research

Learning Objectives:
Describe how older adults who are eligible for both Medicare and Medicaid manage the services and supports they need to continue to live in their own homes. Identify the changing health, social, and information needs of this population as they anticipate or experience a transition to a new service delivery network. Explain how care that assesses and responds to the individualized care needs of community-dwelling “dual-eligibles” can improve the coordination and delivery of health and social care.

Keyword(s): Aging, Medicare/Medicaid

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been researching and publishing on the community care needs of older adults for more than 10 years. I have been involved in all aspects of the HOME study, including the conceptualization, design, implementation, data analyses and interpretation of results.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.