Research

National Endowment for the Arts 
Principal Investigator: Elizabeth Lokon 
September 1, 2022 through August 31, 2024

Council on Aging of Southwestern Ohio
Principal Investigator: Leah Janssen, Robert Applebaum
December 29, 2022 through June 30, 2024

The prevalence of substance abuse among older adults has been steadily increasing. However, older adults are screened, assessed, and treated for substance use disorders (SUDs) at a much lower rate than their younger counterparts. Those who are treated for SUDs face an array of barriers including limited resources, lacking recognition from medical professionals, and stigma. As a result, the Positive Choices program was developed to provide care-management for older adults with SUDs and help them achieve their long-term health-related goals. Through the use of 12 in-depth interviews with day-to-day program personnel, this study sought to better understand the program, highlight strengths, and identify opportunities for growth. Descriptive data was also collected to describe the demographic characteristics of Positive Choices enrollees. Thematic analysis revealed the program succeeded in building trust with members, providing resources, utilizing evidence-based tools, and providing timely communication. These strengths are coupled with opportunities to improve the program by continuing to destigmatize SUDs among older people. These findings reveal the critical role care-management plays in supporting older people with SUDs. Other programs working with this population should consider the results of this evaluation to ensure older adults with SUDs are best supported in the future.

Pennsylvania State University, pass through from Alzheimer's Association
Principal Investigator: Katherine Abbott
May 1, 2023 through April 30, 2025

The Preference Match Tracker (PMT) is a pragmatic tool that measures recreational preference congruence (RPC), that is the number of recreational activities nursing home (NH) residents attend that match their stated preferences, across the continuum of cognitive ability. The objectives of this project are to utilize an existing dataset to: (1) test the impact of RPC as measured by PMT on well-being (depressive symptoms, functional ability, pain) for NH residents with varying levels of cognitive ability; and (2) determine if typologies of NH residents based on PMT data differ on well-being outcomes. We are using a de-identified dataset with 5 years of RPC data from 593 residents from a NH that has been tracking RPC data for over 8 years.

The aims of this project are as follows: AIM 1: Determine the association of activity attendance and RPC attendance with depressive symptoms, functional ability, and pain over time for persons at different levels of cognitive ability. We hypothesize that more frequent activity attendance will be associated with fewer depressive symptoms, greater functional ability, and less pain. More frequent RPC attendance will be associated with even lower depressive symptoms, greater functional ability, and less pain. Preliminary studies suggest that results will not differ by baseline resident cognitive ability. AIM 2: Determine if typologies of NH residents based on attendance patterns experience differential levels of depressive symptoms, functional ability, and/or pain over time. We hypothesize that preferred attenders (i.e., those who attend what they prefer and do not attend what they do not prefer) will display the highest levels of well-being over time when compared to individuals who decline activities at a higher rate (i.e., decliners) or attend a greater proportion of non-preferred activities (i.e., general attenders). If differences are present, we will describe groups based on demographic and baseline clinical attributes, including cognition.

Regents of the University of California, San Francisco, pass through funds from the National Institute on Aging
Principal Investigator: Suzanne Kunkel 
April 1, 2022 through January 31, 2023

USAging, pass through funds from The John A. Hartford Foundation
Principal Investigator: Suzanne Kunkel 
April 1, 2022 through March 31, 2025

With funding from The John A. Hartford Foundation, USAging is creating and implementing a series of business acumen resources, trainings, learning collaboratives and consultancies to support the development of new lines of business, including contracting with health care providers, among the network of agencies servicing older adults and younger people with disabilities. Scripps Gerontology Center is contracting with USAging to evaluate the effectiveness and overall impact of the resources and interventions offered through this project.

Ohio Department of Aging
Principal Investigators: Robert Applebaum, Ian Matthew Nelson, and John Bowblis 
October 23, 2023 through June 30, 2025

The Scripps Gerontology Center has been involved in studying the long-term services system in Ohio for the past three decades. In this phase of the project, we will provide data in three areas as part of our ongoing effort to assist Ohio Department of Aging (ODA) in efforts to improve the lives of older Ohioans with disability. Study components include; a continuation of the Biennial Survey (15th wave), an in-depth analysis and recommendations addressing the direct care workforce challenges in the long-term services area, and a description and understanding of the impacts of Ohio’s locally funded initiatives for older people. The study investigators are Robert Applebaum, Matt Nelson, and John Bowblis. 

The Ohio State University (OSU), pass through funds from Department of Health & Human Services and Ohio Department of Medicaid.
Principal Investigators: Robert Applebaum, Jennifer Heston-Mullins, and John Bowblis 
July 1, 2023 through June 30, 2025

In 2014, Ohio implemented a demonstration designed to integrate Medicare and Medicaid services for older adults. This study is an evaluation of the MyCare demonstration effort to assist state policy makers in determining program effectiveness.

Brown University, pass through from NIH
Principal Investigator: Katherine Abbott 
March 1, 2023 through June 30, 2024

Over 75% of people living with dementia (PLWD) experience psychological and behavioral symptoms of distress. Expressions of distress can be both upsetting to the individual and care providers. Symptoms of distress can include wandering, persistent vocalizations, and resistance or refusal of care. In addition, depressive symptoms are common among nursing home (NH) residents living with dementia. However, easy to use evidence-based interventions that take a person-centered approach to addressing these concerns are limited. Care partners (e.g., Certified Nursing Assistants) in NHs struggle to prevent or positively respond to distress and/or depressive symptoms experienced by PLWD. The Individualized Positive Psychosocial Intervention (IPPI) is an evidence-based program that engages PLWD in brief (i.e.,10 minute) one-to-one preference-based activities 2 times a week. To provide IPPI, care partners first complete an online course on emotion-focused communication. This course improves care partners’ emotional communication skills to be able to build stronger relationships and provide more positive care experiences for PLWD and care partners, alike. The care partners are then trained to deliver IPPI activities via short protocols to guide brief one-on-one interactions with PLWD. The 59 unique protocols give concrete ways to interact with PLWD and are matched to important preferences that are routinely assessed by NH staff. For example, if a person says it is important to be able to listen to music she likes, the care partner can select a protocol to interact with the individual around music. The interactions provide meaningful, preferred activities to PLWD and seek to decrease distress and/or depressive symptoms in PLWD. A previous Hybrid III trial of the IPPI program in NH found PLWD had fewer negative emotional and behavioral responses when receiving IPPI compared to those receiving usual care interventions. Our goal with this proposal is to deploy the IPPI program so that care providers use this program as a part of their routine care delivery. We will partner with United Church Homes, a 106-year-old nonprofit national senior living provider to train staff to use the IPPI program in 9 NHs. Staff in each nursing home will identify any resident, regardless of age, race, gender, or ethnicity, who is ideal for the IPPI program, that is, residents who have cognitive impairment and have experienced symptoms of distress or depressive symptoms within the past 2 weeks. This study will include 108-135 residents and care partners, working any shift, who provide routine care to them. We will (1) track fidelity in staff doing key intervention tasks, (2) track symptoms of distress and/or depression in PLWD over time and (3) examine facilitators and barriers from the perspective of the stakeholder teams doing the IPPI program. Our goal is that the IPPI program will be feasible to deliver and done with fidelity comparable to the original trial. We anticipate that PLWD receiving the IPPI program will experience a decrease in symptoms of distress and/or depressive symptoms. Findings from this study will help us develop a larger project that tests the use of the IPPI program in a fully powered NH trial.

The Ohio State University, pass through funds from the Ohio Department of Medicaid and the U.S. Department of Health and Human Service
Principal Investigator: Matt Nelson
October 1, 2023 through June 30, 2025

This study will involve the development of a chart book highlighting older people in Ohio using data generated from the 2023 Ohio Medicaid Assessment Survey. In addition to being an author on the Chart book, the study investigator will work with OMAS researchers on the design of future survey questions and on analysis.

Arthur N. Rupe Foundation
Principal Investigator: Meghan Young
January 1, 2024 through December 31, 2024

This project focuses on expanding OMA’s reach into respite care while highlighting an important collaboration between OMA and the Respite For All Foundation. The project, ultimately, seeks to equip respite care providers with more training and education on best practices when working with people living with dementia.

Retirement Research Foundation (RRF)
Principal Investigator: Meghan Young and Elizabeth Lokon 
January 1, 2024 through December 31, 2025

This study aims to measure the impact of ScrippsAVID, an Arts-based, Virtual, Intergenerational, and Dementia-friendly video-chat platform, on reducing loneliness and addressing ageism. This study is essential in ScrippsAVID’s national dissemination while offering insights into the viability of virtual programming in promoting social and intergenerational connections for older adults, including those living with dementia and their care partners.

Ohio Department of Aging (ODA)
Principal Investigator: Katherine Abbott 
February 22, 2024 through June 30, 2025

We submit a proposal for consulting services and deliverables to assist the Ohio Department of Aging in building a curriculum addressing one of the four key topic areas identified in the recent The Ohio Governor’s Nursing Home Quality and Accountability Task Force’s report: Medication Optimization. Our proposal outlines the scope of work, timeline, and deliverables to meet your desired outcomes. Scope of Work: We propose developing the first module of a comprehensive curriculum, promoting a person-centered, QAPI-informed approach, focusing on the following first key area:Medication Optimization

Timeline: Given the ambitious timeline, we propose a phased approach:
March 1, 2024: Delivery of QAPI materials for the introduction material 
March 22, 2024: Completion of content for the first two modules (Introduction to Medications and Prescribing Medications)
April 26, 2024: Completion of content for the remaining two modules (Medication Review/Assessment and Behavior Monitoring)
Deliverables: Each module within the first topic/content area will consist of the following components:

1. Webinar Content: A PowerPoint presentation that can be used for live and recorded sessions, covering essential information on each topic area Each module on the respective content area will include one hour narrated slide presentations for target audience
2. Practical Demonstration: Role-playing scenarios using case studies in the form of demonstrations, discussions and best practices. Interactive conversations to reinforce practical skillsReadings/resources as comprehensive collection of existing and trusted resources to enhance understanding
3. Evaluation Include pretest and post test for each module  Questions for reflection throughout each module

Learning Outcomes: Objectives and topics for Medication Optimization Module will include:
Module 1: Introduction to Unnecessary Medications

• Objective 1: Introduction to Medications
• Objective 2: Polypharmacy and Best Standards of Care

Module 2: Prescribing Medications

• Objective 1: Commonly Used Medications
• Objective 2: Monitoring and Assessing

Module 3: Medication Review and Assessment

• Objective 1: Best Practices Medication Management, Storage and Use
• Objective 2: Staff Education on Appropriate Medication Use (QAPI)

Module 4: Behavior Monitoring

• Objective 1: Classification of Medications and Reason for Use
  
  
  

The Ohio State University (OSU), pass through from DHHS and ARPA
Principal Investigators: Robert Applebaum, Ian Matthew Nelson
July 1, 2024 through March 31, 2025

The Survey of Home Care Agencies in Ohio is a joint study being conducted by Scripps and the Ohio State University College of Medicine Government Resource Center. The project will conduct a baseline and one year follow-up survey designed to track changes in home care worker changes that may have occurred as a result of an increase in Medicaid reimbursement funds. The study also includes interviews with home care agency administrators. The Scripps study team includes Bob Applebaum, Matt Nelson, Heather Menne, Kate Singer and Abbe Lackmeyer.

LeadingAge Ohio
Principal Investigators: Heather Menne, Sara McLaughlin
March 1, 2024 through December 31, 2024

For this project, we will investigate the current landscape of adult day care in Ohio. In particular, we seek to advance understanding of the characteristics of adult day centers (e.g., size, user characteristics, funding source) as well as challenges faced by adult day care providers and potential solutions. Findings will inform future efforts to support Ohio providers of adult day services.

The Donaghue Foundation
Principal Investigator: Katherine Abbott 
March 15, 2024 through September 15, 2025

1. The original project allowed us to advance understanding of the impact of implementing the Preferences for Everyday Living Inventory (PELI) in Ohio nursing homes. We validated a pragmatic indicator of extent of PELI implementation and explored the organizational characteristics associated with communities that fully implement the PELI. We found that NHs fully implementing the PELI were more likely to have a 4- or 5- star deficiency star rating, lower deficiency scores, and were more likely to be deficiency-free. NHs fully implementing the PELI were less likely to have any complaints and any substantiated complaints compared to partial PELI implementers.
2. We can confidently state that providers who fully implement the PELI through assessing resident preferences, integrating preferences into care plans, and evaluating their efforts have better outcomes than providers who do none or only partial PELI implementation. This is a systemic approach to preference-based care that we intend to advance using the R3 funds to disseminate and broaden adoption. While the data we used comes from Ohio nursing homes, we have evidence to show that Ohio providers are representative of providers nationwide. The nature of nursing home regulations create continuity from state to state.
3. We have limited information on the implementation strategies nursing homes use to fully implement the PELI. A detailed description (e.g., case study) of how organizations of different resource levels (e.g., star ratings) approach implementation would assist us in developing necessary tools and resources for NH providers seeking to adopt this approach. Identifying the strategies necessary to achieve full PELI implementation will promote replication and scalability. In addition, our stakeholders have consistently told us that we need to better
   communicate our findings. However, our dissemination through peer-review journals is not an effective mode to communicate to providers. We need to be able to effectively communicate the value proposition of fully implementing the PELI and determine the optimal communication channels to reach NH decision makers.
4. We propose to conduct in-depth qualitative interviews with approximately 10% of Ohio NHs that have fully implemented the PELI. The 2021 Ohio Biennial Survey that is completed by all NHs in the state, had n=182 communities who self-identified as Full PELI implementors (e.g., use information gathered from the PELI in care management and/or quality initiatives). We would start by reaching out to the Nursing Home Administrators of these communities via a Qualtrics survey to identify if they still consider themselves full PELI implementors. If they respond “yes” we will ask if they would be willing to participate in the study in exchange for $500. To the extent possible, we will attempt to stratify the sample by the organizational characteristics we found predictive of full PELI implementation. 2 For example, our implementation work thus far has indicated that the feasibility of uptake is related to resources (e.g., proxy indicator is star ratings). Therefore, our goal would be to highlight implementation case studies for low, medium, and highly resourced communities. Of the OH NHs that are still fully implementing the PELI, we would ask to do a one day, in-person visit to conduct interviews with the individuals who were most closely involved in the PELI implementation at the care community. We would compensate each provider $500 for the visit and craft a semi-structured interview guide using the Consolidated Framework for Implementation Research (CFIR). Interviews could be in the form of focus
   groups or individual interviews, depending upon staff availability. We would conduct a thematic analysis across the cases (cross-case analysis) to identify the logical steps or stages of full implementation that can be replicated or followed by other communities. Our knowledge owners (a.k.a. stakeholders) have consistently told us that we need to communicate our findings more widely. However, our training to disseminate through peer-review journals is not an effective mode to communicate to NH providers. Therefore, we would then work with John Beilenson, president of Strategic Communications and Planning (SCP), to craft a clear and compelling value proposition for nursing home leaders and associated print and digital communications that would be shared with provider decision makers through a variety of channels.
   
   The steps or stages of full PELI implementation could guide policymakers on how to evaluate and incentivize provider participation/adoption. For example, pay for performance initiatives could be tied to evidence that providers are making progress through the steps or stages of implementation. Higher levels of implementation could receive more reimbursement than lower levels of implementation as evidenced by the Kansas PEAK 2.0 initiative. In addition, the case studies would be useful to policymakers and providers as examples of how nursing home providers were able to implement the PELI given the similar contexts of the regulatory environment and nation-wide staffing shortages. Other stakeholders we have worked with include Ombudsmen and family members. Ombudsmen are well-positioned to recommend our work to nursing home providers when they visit communities about a complaint. Family members can advocate for their loved ones who live in the nursing home setting and can complete a PELI on behalf of their loved one who many not be able to communicate their preferences to care partners. We know we need both the 30,000-foot view for decision makers as well as the specific details for how providers successfully implemented in order to increase uptake of our evidence-based program.

Ohio Department of Aging (ODA)
Principal Investigator: Jennifer Heston-Mullins
May 31, 2024 through June 30, 2025

Brown University, pass through funds from the U.S. Department of Health and Human Services
Principal Investigator: Denise Tyler
September 1, 2024 through February 28, 2025

The goals of this NIH-funded study are to: 1. Examine Medicare Advantage (MA) plans' approaches to managing care for persons with end stage renal disease (ESRD) by conducting qualitative interviews with representatives from MA plans, dialysis organizations, and dialysis facility staff in geographically diverse markets; 2. Estimate the impact of expanding MA coverage to patients with ESRD on mode of kidney replacement therapy, hospitalizations and mortality; and 3. Identify variations in the impact of Medicare Advantage on ESRD outcomes by patient and plan characteristics.