Risk of Hospitalization Among Assisted Living Residents Dually Enrolled in Medicare and Medicaid.

Objectives: To examine how risk of hospitalization among assisted living (AL) residents differs by dual enrollment in Medicare and Medicaid and by the percent of dually enrolled individuals in an AL community.

Design: Retrospective cohort study.

Setting And Participants: We used Medicare data from 2008 to 2018 and a national directory of licensed AL communities to identify Medicare beneficiaries with a change in their ZIP+4 code suggesting a new residence in an AL.

Sociodemographic and Clinical Characteristics Associated With Veterans' Digital Needs.

Importance: Telehealth can expand access to care, but digital needs present barriers for some patients.

Objective: To investigate sociodemographic and clinical associations of digital needs among veterans.

Design, Setting, And Participants: This quality improvement study used data collected between July 2021 and September 2023 from Assessing Circumstances and Offering Resources for Needs (ACORN), a Department of Veterans Affairs (VA) initiative to systematically screen for, comprehensively assess, and address social risks and social needs.

Changes in Dental Care Use Following Marital Status Change in the Health and Retirement Study.

Background And Objectives: Previous studies have indicated that married people are generally healthier than unmarried people, with lower mortality rates. Most work in this area has employed cross-sectional data, and few studies have examined change in marital status from married to unmarried as a potential social ecological determinant of dental health behavior. Here, we used longitudinal data to examine change in dental behavior over time following marital status change, and to explore whether self-reported gender may play a modifying role in any behavioral change.

Using social risks to predict unplanned hospital readmission and emergency care among hospitalized Veterans.

Objectives: (1) To estimate the association of social risk factors with unplanned readmission and emergency care after a hospital stay. (2) To create a social risk scoring index.

Data Sources And Setting: We analyzed administrative data from the Department of Veterans Affairs (VA) Corporate Data Warehouse.

Differential effects of a social work staffing intervention on social work access among rural and highly rural Veterans: A cohort study.

Objective: To evaluate the impact on rural Veterans' access to social work services of a Department of Veterans Affairs (VA) national program to increase social work staffing, by Veterans' rurality, race, and complex care needs.

Data Sources And Study Setting: Data obtained from VA Corporate Data Warehouse, including sites that participated in the social work program between October 1, 2016 and September 30, 2021.

Study Design: The study outcome was monthly number of Veterans per 1000 individuals with 1+ social work encounters.

Changes in Nursing Staff Levels and Injury-Related Emergency Department Visits among Assisted Living Residents with Alzheimers Disease and Related Dementias.

Objectives: To examine the relationship between changes in nursing staff-hours per resident-day and injury-related emergency department (ED) visits among assisted living (AL) residents with Alzheimer disease and related dementias (ADRD).

Design: Retrospective cohort study.

Setting And Participants: We leveraged a data set of AL community characteristics in Ohio linked to Medicare claims data from 2007 to 2015.

Do end-of-life outcomes differ by assisted living memory-care designation?

Background: Residential care/assisted living (RC/AL) is an increasingly common place of end-of-life care for persons with Alzheimer's disease and related dementia (ADRD), who have unique care needs as their health declines. Approximately 22% of RC/ALs provide specialized memory care (memory-care RC/AL). Understanding how end-of-life outcomes differ by memory care among residents with ADRD could facilitate aging/dying in place for this population.

Community Nursing Home Program Oversight: Can the VA Meet Increased Demand for Community-Based Care?

Background: The US Department of Veterans Affairs (VA) Community Nursing Home (CNH) program provides in-person oversight monitoring the quality of care of veterans in VA-contracted community-based skilled nursing homes. The number of veterans receiving CNH care is projected to increase by 80% by 2037.

Methods: Retrospective observational data describing the distance between contracted facilities and VA medical centers (VAMCs) were linked to Centers for Medicare and Medicaid monthly Nursing Home Compare and Brown University Long Term Care: Facts on Care in the US data.

Trends and geographic differences in social work telehealth utilization.

We plotted trends in social work telehealth use among Veterans in a U.S. national social work staffing program and examined the relationship between geographic factors (rurality and neighborhood disadvantage) and telehealth use (audio and video) using linear probability models.

Evaluating a competency framework for rheumatology nurses.

The Royal College of Nursing (RCN) competency framework for rheumatology nurses was developed in 2020. As part of the framework proposal, a service evaluation was planned following the framework's roll-out to determine its usefulness and acceptability. The aim of this evaluation was to explore rheumatology nurse specialists' answers to the research question: 'What was your experience of using the RCN's rheumatology competency framework?' A total of 14 rheumatology nurse specialists were interviewed and shared their opinions regarding the competency framework.

Benefits and challenges in the use of RE-AIM for evaluation of a national social work staffing program in the veterans health administration.

Background: In the Department of Veterans Affairs (VA) Veterans Health Administration (VHA), social workers embedded in primary care teams address social and emotional needs that are associated with health outcomes. The mission of the National Social Work PACT Staffing Program is to improve access to social work services for rural Veterans by supporting additional social work staffing in VA medical centers serving rural areas.

Methods: We obtained data from the VA corporate data warehouse on Veterans' characteristics and health care use from 2016 to 2022 for all Veterans who received primary care at a Veterans Affairs Medical Center (VAMC) or associated clinic that received funding from the program.

A National Typology of Health Service Regulation in Assisted Living.

Background And Objectives: State-regulating agencies use 350 different licenses and certifications to govern assisted living (AL), resulting in significant variation in regulations governing health services, the scope of practice, and capacity. This lack of standardization makes it difficult to compare and contrast AL operations and residents' outcomes across similarly regulated communities.

Research Design And Methods: We used qualitative and quantitative methods to empirically develop and describe a typology of state AL regulations that captures inter- and intrastate variation.

Identifying a National Cohort of Medicare Beneficiaries Residing in Assisted Living Settings: An Updated Method.

Objective: Present an updated approach to identifying Medicare beneficiaries residing in licensed assisted living (AL) settings in the United States.

Design: Retrospective cohort study using a national list of licensed AL settings, US Postal Service (USPS) data, and enrollment, claims, and assessment data from the Centers for Medicare and Medicaid Services.

Setting And Participants: A total of 403,326 beneficiaries residing in 29,905 licensed AL settings.

Adaptation of a social risk screening and referral initiative across clinical populations, settings, and contexts in the Department of Veterans Affairs Health System.

Identifying and addressing social risks and social needs in healthcare settings is an important step towards achieving health equity. Assessing Circumstances and Offering Resources for Needs (ACORN) is a Department of Veterans Affairs (VA) social risk screening and referral model that aims to systematically identify and address social needs. Since initial piloting in 2018, our team has collaborated with clinical and operations partners to implement ACORN across multiple VA clinical settings while adapting and tailoring the initiative to meet the needs of different populations, specialties, and individuals administering screening.

Decline in Veterans' Admissions to Nursing Homes during COVID-19: Fewer Beds, More Fear, and Finding Alternative Care Settings.

Objective: Examine the decline in admission to community nursing homes among Veterans that occurred following the onset of the COVID-19 pandemic.

Design: Multimethods study using Department of Veterans Affairs (VA) purchasing records to examine trends in total admissions and semistructured interviews with staff connected to the VA community nursing home program to contextualize observed trends.

Setting And Participants: All VA-paid admissions to community nursing homes (N = 56,720 admissions) and national data on nursing home admissions from LTCFocUS.

Social Work Staffing and Use of Palliative Care Among Recently Hospitalized Veterans.

Importance: Palliative care improves quality of life for patients and families but may be underused.

Objective: To assess the association of an intervention to increase social work staffing in Veterans Health Administration primary care teams with use of palliative care among veterans with a recent hospitalization.

Design, Setting, And Participants: This cohort study used differences-in-differences analyses of the change in palliative care use associated with implementation of the Social Work Patient Aligned Care Team (PACT) staffing program, conducted from October 1, 2016, to September 30, 2019.

Injury-related emergency department use among assisted living residents with Alzheimer's disease and related dementias.

Background: Injuries are a leading cause of emergency department (ED) visits among older adults, and individuals with Alzheimer's disease and related dementias (ADRD) may be at particular risk. We compared injury-related ED use among assisted living (AL) residents with and without ADRD and assessed differences in the risk of injury-related ED visits among individuals with ADRD residing in ALs with memory care designation versus general AL.

Methods: Using Medicare claims, we identified a cohort of fee-for-service beneficiaries who lived in AL in 2018 and resided in one of 20 states with site-specific information on memory care designation (n = 116,754).

Embracing the continuity of care experience: A new Australian graduate entry master of midwifery course with a student caseload of 15 women per year.

Background: Women receiving continuity of midwifery care have increased satisfaction and improved outcomes. Preparation of midwifery students to work in continuity models from the point of graduation may provide an ongoing midwifery workforce that meets rising demand from women for access to such care.

Aim Of The Paper: The aim of this paper is to describe an innovative midwifery course based on a continuity model, where students acquire more than 50 % of clinical hours through continuity of care experiences.

Excess Mortality Among Assisted Living Residents With Dementia During the COVID-19 Pandemic.

Objective: To evaluate whether assisted living (AL) residents with Alzheimer's disease and related dementias (ADRD) experienced a greater rate of excess all-cause mortality during the first several months of the COVID-19 pandemic compared to residents without ADRD, and to compare excess all-cause mortality rates in memory care vs general AL among residents with ADRD.

Design: Retrospective cohort study.

Setting And Participants: Two cohorts of AL residents enrolled in Medicare Fee-For-Service who resided in 9-digit ZIP codes corresponding to US AL communities of ≥25 beds during calendar year 2019 or 2020.

Purchasing High-Quality Community Nursing Home Care: A Will to Work With VHA Diminished by Contracting Burdens.

Objectives: The Veterans Health Administration (VHA) purchases community nursing home care; however, the administrative burden may lead nursing homes to avoid contracting with the VHA. This study aimed to describe how the VHA's purchasing policies impede or facilitate contracting with nursing homes.

Design: Semistructured interviews of key stakeholders in the VHA's community nursing home contracting process.

Memory care reduces nursing home admissions among assisted-living residents with dementia.

Introduction: We compare nursing-home and hospital admissions among residents with Alzheimer's disease and related dementias (ADRD) in memory-care assisted living to those in general assisted living.

Methods: Retrospective study of Medicare beneficiaries with ADRD in large (>25 bed) assisted-living communities. We compared admission to a hospital, to a nursing home, and long-term (>90 day) admission to a nursing home between the two groups, using risk differences and survival analysis.

Association of statewide stay-at-home orders with utilization of case management and supportive services for veterans experiencing housing insecurity.

The US Department of Housing and Urban Development-Department of Veterans Affairs (VA) Supportive Housing (HUD-VASH) program provides Veterans with a subsidy for rent and case management. In response to the Coronavirus 2019 pandemic, many states enacted stay-at-home orders that may have limited access to case managers. Therefore, we examined the association between statewide stay-at-home orders and utilization of HUD-VASH case management.

Antipsychotic initiation and new diagnoses excluded from quality-measure reporting among Veterans in community nursing homes contracted by the Veterans Health Administration in the United States.

Objectives: To assess whether prevailing antipsychotic use rates in community nursing homes (CNH) influence new initiation of antipsychotics and diagnosis with antipsychotic indications among Veterans.

Methods: We used linked 2013-2016 Veterans Administration (VA) data, Medicare claims, Nursing Home Compare, and Minimum Data Set (MDS) assessments. The exposure was the proportion (in quintiles) of all CNH residents prescribed antipsychotics in the quarter preceding a Veteran's admission date.