Policy Research Challenges in Comparing Care Models for Dual-Eligible Beneficiaries.

Providing affordable, high-quality care for the 10 million persons who are dual-eligible beneficiaries of Medicare and Medicaid is an ongoing health-care policy challenge in the United States. However, the workforce and the care provided to dual-eligible beneficiaries are understudied. The purpose of this article is to provide a narrative of the challenges and lessons learned from an exploratory study in the use of clinical and administrative data to compare the workforce of two care models that deliver home- and community-based services to dual-eligible beneficiaries.

Using Ethical Frameworks in Times of Transition and Uncertainty.

Health care policy is never easy and always fraught with concerns about quality, access, and cost. Currently, uncertainty abounds regarding new federal and state policies on the horizon for older adult care and quality. Empirics undergird most policy-making decisions regarding risk/benefit, cost, and knowing the best action to put in place for the best results.

A Case Exemplar for National Policy Leadership: Expanding Program of All-Inclusive Care for the Elderly (PACE).

In November 2015, President Obama signed the Program of All-Inclusive Care for the Elderly (PACE) Innovation Act, which expands a proven model of care to serve high-cost and high-need populations. Specifically, the law provides the Centers for Medicare & Medicaid Services with the authority to waive Medicaid requirements that could not be waived without additional statutory authority. Those requirements include the age of the beneficiary to be served and nursing home eligibility as a condition for PACE enrollment.

Looking Ahead After 50 Years of Medicare.

Fifty years of Medicare have led to enormous improvements in care of older adults in the United States. Policy changes in Medicare and Medicaid have undergirded the care of older adults and the workforce and professional development of nurses and advanced practice nurses. Reflecting on the decades of change in these 50 years and the context in which these changes occurred can prepare health care providers for future strategies to address needs of the rapidly growing older adult population.

The bear and the canyon: toward an understanding of personal leadership.

Using Carper's fundamental patterns of knowing in nursing as a framework, the author reflects upon and intertwines experiences as a nurse leader and experiences in nature that called for resilience and courage.

Inflammation, functional status, and weight loss during recovery from cardiac surgery in older adults: a pilot study.

Objective: To determine the nutritional, inflammatory, and functional aspects of unintentional weight loss after cardiac surgery that warrant further investigation.

Research Methods And Procedures: Twenty community-dwelling adults > 65 years old undergoing cardiac surgery (coronary artery bypass graft [CABG] or CABG + valve) were recruited for this prospective longitudinal (preoperative and 4-6 weeks postdischarge) pilot study. Anthropometrics (weight, standing height, and mid-arm and calf circumference), nutritional status (Mini-Nutritional Assessment™ [MNA]), appetite, physical performance (timed chair stand), muscle strength (hand grip) and functional status (basic and instrumental activities of daily living), and inflammatory markers (plasma leptin, ghrelin, interleukin [IL]-6, high-sensitivity[hs] C-reactive protein, and serum albumin and prealbumin) were measured.

Is it time for a public health nursing approach to aging?

Following the enactment of Medicare in 1965, access to health care for older adults in the United States improved. At the same time, nurse researchers and policy leaders developed individual and family-centered care interventions and programs that led to improvements in quality of health and life. In the next 20 to 30 years, U.

Recruitment and retention strategies among older African American women enrolled in an exercise study at a PACE program.

Purpose: This study examined employment of specific recruitment and retention strategies in a study evaluating outcomes of a moderate activity exercise program for older African American women with functional impairments attending a Program for All-Inclusive Care of Elders (PACE).

Design And Methods: Recruitment and retention strategies focused on (1) partnership between researchers and participants, (2) partnership between researchers and clinicians, (3) overcoming administrative issues, and (4) reducing burden on clinicians and participants. The exercise protocol consisted of strength and endurance activity 2 to 3 times per week for 16 weeks.

Developing a financial framework for academic service partnerships: models of the United States and Europe.

Purpose: Academic service partnerships (ASPs) are structured linkages between academe and service which have demonstrated higher levels of innovation. In the absence of descriptions in the literature on financial frameworks to support ASPs, the purpose of this paper is to present the supporting financial frameworks of a Swiss and a U.S.

Innovative collaborations: a case study for academic owned nursing practice.

Purpose: Academic service partnerships are critical for schools of nursing to maintain credibility regarding their missions of education, research, service, and practice.

Methods: In this paper, we describe a case study of a ten year program, the Living Independently For Elders (LIFE) Program at the University of Pennsylvania School of Nursing that has provided community-based long-term care to high-risk older adults.

Findings: Quality of care and financial outcomes were met with nurse faculty engagement, administrative commitment, and integration of business practices.

Detectable changes in physical performance measures in elderly African Americans.

Background: African American older adults have higher rates of self-reported disability and lower physical performance scores compared with white older adults. Measures of physical performance are used to predict future morbidity and to determine the effect of exercise. Characteristics of performance measures are not known for African American older adults.

Lessons learned from advanced practice nursing payment.

For more than 25 years, advanced practice nurses have been incrementally included as a part of the health care financing structure. Following physician payment revisions at the federal level, advanced practice nurses were overtly recognized as Medicare providers and have participated in the establishment of current procedural terminology codes and the subsequent relative work values associated with payment. Success in this regard has been the result of business, political, and policy savvy that has important lessons for moving forward in any health care restructuring for both nurses and advanced practice nurses.

Exercise among urban-dwelling older adults at risk for health disparities.

This study assessed factors that contribute to exercise in older adults at risk for health disparities living in a predominantly African American urban community. A local health database was used to gain an understanding of these factors, which then could be used to develop programs to improve health within a specific urban community. The sample included 112 participants (mean age = 81); the majority were women and African American.

Delirium in older patients in surgical intensive care units.

Purpose: To examine the frequency and course of delirium in older adults admitted to a surgical intensive care unit (SICU).

Design And Methods: Prospective, observational cohort study of 114 English-speaking participants and their surrogates, aged 65 and older, admitted to an SICU, and managed by a surgical critical care service. Chart reviews and surrogate interviews were conducted within 24 hours of SICU admission to collect information regarding evidence of dementia using the short form of the Informant Questionnaire on Cognitive Decline in the Elderly.

Directions for the development of nursing knowledge.

Nurses and health care increasingly are embracing and guided by achievements and challenges of evidence-based practice and reflective practice. Nursing science advances have positioned nurses to move forward in the development of science. New directions for nursing knowledge need to emerge in several ways including the development of interdisciplinary knowledge, emphasis on the nursing care process, creation of new work-force patterns, and development of economic theories of nursing practice.

Art therapy: Using the creative process for healing and hope among African American older adults.

This article provides an introduction to the field of art therapy and the potential it can offer to address the emotional needs of the frail elderly. Two case studies are discussed, and examples of artwork are provided. The case studies and artwork were created under the guidance of an art therapist at a Program of All-Inclusive Care for the Elderly (PACE) site in an urban African American community.

Practice patterns and potential solutions to the shortage of providers of older adult mental health services.

Little is known about the contribution of advanced practice nurses (APNs) to the mental health care of older adults. This study describes mental health services to older adults by APNs compared with primary care physicians, psychiatrists, psychologists, and social workers. The study uses a retrospective, cross-sectional design with a 5% national sample of 1999 Medicare outpatient claims.

Functional outcomes for older adults with cognitive impairment in a comprehensive outpatient rehabilitation facility.

The purpose of the study was to examine functional outcomes of a nurse-managed, community-based Comprehensive Outpatient Rehabilitation Facility (CORF) for frail older adults and to compare the outcomes between two groups: older adults with cognitive impairment and those with intact cognition. A retrospective cohort design using healthcare record abstraction was used for the study. Two hundred and one older adults who were admitted to the CORF from the end of 1997 to early 1999 were included in the study.