Social exclusion at the intersections of immigration, employment, and healthcare policy: A qualitative study of Mexican and Chinese immigrants in California.

While immigrants in the US suffer poor access to healthcare in general, access within immigrant populations varies notably by legal status and employment. Intersections between immigration, employment, and healthcare policy have shaped immigrants' access or exclusion from healthcare; however, little research has examined how immigrants experience and navigate these intersections. Drawing on social exclusion theory and the theory of bounded agency, we aimed to investigate Mexican and Chinese immigrants' experiences of exclusion from healthcare as one key dimension of social exclusion-and how this was shaped by interactions with the institutions of immigration and employment.

Linking primary care and community organizations to increase colorectal cancer screening rates: the HAPPI project.

Objective: The Healthy Aging Partnerships in Prevention Initiative (HAPPI) aims to increase the use of clinical preventive services (CPS) among underserved Latinos and African Americans in South Los Angeles who are 50+ years old.

Materials And Methods: HAPPI uses an evidencebased model, SPARC, to leverage existing resources and link community resources. HAPPI's multi-sectoral partnerships include local non-governmental organizations (NGOs), community health centers (CHCs), aging and public health agencies serving the City and County of Los Angeles, and a university.

Healthcare Decision-Making Among Dual-Eligible Immigrants: Implications from a Study of an Integrated Medicare-Medicaid Demonstration Program in California.

To improve the coordination of long-term services and supports for dual-eligibles (those with both Medicare and Medicaid), California created Cal MediConnect (CMC), an Affordable Care Act-authorized managed care demonstration program. Beneficiaries were "passively enrolled" into CMC, meaning they were automatically enrolled unless they actively opted out. The aim of this study was to examine differences in factors influencing the enrollment decisions of U.

Multisectoral Collaborations to Increase the Use of Recommended Cancer Screening and Other Clinical Preventive Services by Older Adults.

The Healthy Aging Partnerships in Prevention Initiative (HAPPI) is a multisectoral collaboration that aims to increase use of recommended cancer screening and other clinical preventive services (CPS) among underserved African American and Latino adults aged 50 and older in South Los Angeles. HAPPI uses the principles of the evidence-based model Sickness Prevention Achieved through Regional Collaboration to increase capacity for the delivery of breast, cervical, and colorectal cancer screening, as well as influenza and pneumococcal immunizations, and cholesterol screening. This article describes HAPPI's collaborative efforts to enhance local capacity by training personnel from community health centers (CHCs) and community-based organizations (CBOs), implementing a small grants program, and forming a community advisory council.

California's Behavioral Health Services Workforce is Inadequate for Older Adults.

The Workforce Education and Training component of California's Mental Health Services Act, which passed in 2004, has infused funding into the public mental health system. However, funding has not kept pace with an existing behavioral health workforce shortage crisis, the rapid growth of an aging population, and the historical lack of geriatric training in higher education for the helping professions. This policy brief draws on recent study findings, state planning documents, and a review of the literature to describe gaps and deficiencies in the behavioral health workforce that serves older adults in California.

Older Californians and the Mental Health Services Act: Is an Older Adult System of Care Supported?

This policy brief summarizes findings from the first study to evaluate how California's public mental health delivery system has served older adults (60 years of age and over) since the passage of the Mental Health Services Act (MHSA) in 2004. Study findings indicate that there are unmet needs among older adults with mental illness in the public mental health delivery system. There are deficits in the involvement of older adults in the required MHSA planning processes and in outreach and service delivery, workforce development, and outcomes measurement and reporting.

Cal MediConnect Enrollment: Why Are Dual-Eligible Consumers in Los Angeles County Opting Out?

Los Angeles County has the state’s lowest rate of consumer enrollment in Cal MediConnect, a program that is responsible for the delivery and coordination of medical, behavioral health, and long-term services and support benefits for individuals who are dually eligible for Medicare and Medi-Cal. This policy brief examines the factors that influence consumer decisions and may contribute to low enrollment rates. Influential factors include consumer knowledge of health care options, perception of choice, and disruption of existing care.

Enhancing Evidence-Based Public Health Policy: Developing and Using Policy Narratives.

Academic researchers and clinicians have a critical role in shaping public policies to improve the health of an aging America. Policy narratives that pair personal stories with research statistics are a powerful tool to share knowledge generated in academic and clinical settings with policymakers. Effective policy narratives rely on a trustworthy and competent narrator and a compelling story that highlights the personal impact of policies under consideration and academic research that bolsters the story.

Pathways to Advancing Aging Policy-Relevant Research in Academic Settings.

Policy-level changes have a significant influence on the health and well-being of aging populations. Yet there is often a gap between scientific knowledge and policy action. Although previous research has identified barriers and facilitators to effective knowledge translation, little attention has been given to the role of academic institutions in knowledge generation.

Walking the Line: Navigating Market and Gift Economies of Care in a Consumer-Directed Home-Based Care Program for Older Adults.

Context: Paid caregivers of low-income older adults navigate their role at what Hochschild calls the "market frontier": the fuzzy line between the "world of the market," in which services are exchanged for monetary compensation, and the "world of the gift," in which caregiving is uncompensated and motivated by emotional attachment. We examine how political and economic forces, including the reduction of long-term services and supports, shape the practice of "walking the line" among caregivers of older adults.

Methods: We used data from a longitudinal qualitative study with related and nonrelated caregivers (n = 33) paid through California's In-Home Supportive Services (IHSS) program and consumers of IHSS care (n = 49).

Bringing it to the community: successful programs that increase the use of clinical preventive services by vulnerable older populations.

This policy brief reports the findings of a systematic review conducted by the Community Health Innovations in Prevention for Seniors (CHIPS) project. The project identified successful programs for increasing the use of two or more clinical preventive services for vulnerable, underserved populations ages 50 years and older within community settings. The CHIPS project also used the RE-AIM Framework to evaluate the readiness and feasibility of implementing these programs within real-world settings.

A portrait of older californians with disabilities who rely on public services to remain independent.

Low-income older adults with disabilities in California depend on a variety of public programs to help them remain in their own homes. The availability of those services has been in flux since 2009 because of cuts caused by the recession. This article reports on a qualitative study of 33 California seniors who depend on fragile arrangements of paid and unpaid assistance.

Independence at risk: older Californians with disabilities struggle to remain at home as public supports shrink.

This policy brief presents findings from a yearlong study that closely followed a small but typical set of older Californians with disabilities who depend on fragile arrangements of paid public programs and unpaid help to live safely and independently at home. Many of these older adults have physical and mental health needs that can rise or fall with little warning; most are struggling with increasing disability as they age. In spite of these challenges, most display resilience and fortitude, and all share a common determination to maintain their independence at almost any cost.

Influencing public policy to improve the lives of older Americans.

Aging of the U.S. population raises numerous public policy issues about which gerontological researchers, policy experts, and practitioners have much to contribute.

Of family, friends, and strangers: caregiving satisfaction across three types of paid caregivers.

This study examines the experiences of 609 family, friend, and unrelated caregivers hired directly by clients under a consumer-directed model of home care. Using telephone survey data of clients and workers in California's In-Home Supportive Services program, this research compares outcomes and identifies predictors of caregiving work satisfaction across these three groups. In the total sample, feeling well prepared for the work predicted higher levels of satisfaction, while being Latino/Hispanic (as compared to being White or Black) predicted lower levels of satisfaction.