Trends in Private Equity Acquisitions of Assisted Living Facilities
Assisted living (AL) is a widely used long-term care option, serving nearly 1 million older adults across more than 32 000 US facilities.
Sean Shenghsiu Huang • Momotazur Rahman • John R. Bowblis • Kali S. Thomas
Quality of life (QOL) is an important indicator of the influence nonpharmacological interventions have on the well-being of persons living with dementia and their family care partners. In the realm...
Kate Perepezko • Heather L. Menne • Molly Noble
Nursing Home Staffing Expenditures and Levels are Impaired by High Medicaid Payer-Mix
Medicaid is the primary payer for most nursing home residents and reimburses below the cost of care, limiting the ability of nursing homes to increase staffing levels.
Christopher Brunt • John R. Bowblis
To assess cost-effective strategies to reduce nurse aide turnover, this study examines the relationship between turnover and compensation, including wage rates, spending on fringe benefits, and spe...
John R. Bowblis • Robert A. Applebaum • Christopher Brunt
Lifting Federal Visitation Restriction and COVID-19 Infections in Nursing Homes
Early in the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) recommended restricting visitors from entering nursing homes as a precaution.
John R. Bowblis • Huiwen Xu • Jennifer Heston-Mullins (Jennifer L. Heston)
The 21st Century Cures Act opened Medicare Advantage (MA) enrollment to people with end-stage renal disease (ESRD).
Emily A. Gadbois • Amal N. Trivedi • Denise A. Tyler • Joan F. Brazier
Expansion and Marketing of Medicare Advantage to Persons With End-Stage Kidney Disease
How do representatives from Medicare Advantage (MA) plans, kidney care management companies, and dialysis organizations perceive the expansion and marketing of MA products for persons with end-stag...
Renee R. Shield • Amal N. Trivedi • Joan F. Brazier • Denise A. Tyler • Emily A. Gadbois
Expansion and Marketing of Medicare Advantage to Persons With End-Stage Kidney Disease
The 21st Century Cures Act expanded Medicare Advantage (MA) to include persons with kidney failure. Little is known about the impact of increased MA marketing for persons with end-stage kidney dise...
Joan F. Brazier • Renee R. Shield • Amal N. Trivedi • Emily A. Gadbois • Denise A. Tyler
Visitation restrictions in nursing homes were a major policy intervention in response to the COVID-19 pandemic.
John R. Bowblis • Huiwen Xu • Jennifer Heston-Mullins (Jennifer L. Heston)
The share of patients with kidney failure enrolled in Medicare Advantage (MA) increased from 27 percent to 47 percent after the implementation of the 21st Century Cures Act, which expanded MA eligi...
Eunhae Grace Oh • Denise A. Tyler • David J. Meyers • Kevin H. Nguyen • Momotazur Rahman • Laura M. Keohane • Joan F. Brazier • Amal N. Trivedi • Emily A. Gadbois
The National Survey of Older Americans Act Participants (NSOAAP) is collected for programs funded by Title III of the Older Americans Act (OAA; i.e., case management, congregate meals, home-deliver...
Heather L. Menne • Tochukwu J. Okolie
Before the COVID-19 pandemic, for-profit nursing homes’ revenue generally covered their costs, whereas not-for-profit nursing homes often needed donations and other nonpatient revenue to cove...
Robert A. Applebaum • Christopher Brunt • John R. Bowblis
In the United States, long-term care providers, such as nursing homes and assisted living communities, are meeting consumer demand through housing and care options designed to support the growing p...
John R. Bowblis • Heather L. Menne • Ian Matt Nelson • Amy E. Elliot
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Molly Noble • Heather L. Menne • Sara J. McLaughlin
The Impact of Health Care Contracting on Community-Based Organizations
Abbe E. Lackmeyer (Abbe Linscott) • Suzanne R. Kunkel • Isha Karmacharya
Brief examines the financial viability of Ohio's nursing home industry.
John R. Bowblis • Robert A. Applebaum • Christopher Brunt
The Intersection of Successful Aging and Family Caregiving
For the millions of older adults who rely on the support of a family caregiver, successful aging is not an individual achievement but a cooperative process between a care receiver and a caregiver.
Beth Fields • Kate Perepezko • Michael Reese Wittke • Yijung Kim • Lauren R. Bangerter
The Intersection of Successful Aging and Family Caregiving
For the millions of older adults who rely on the support of a family caregiver, successful aging is not an individual achievement but a cooperative process between a care receiver and a caregiver.
Yijung Kim • Beth Fields • Lauren R. Bangerter • Michael Reese Wittke • Kate Perepezko
The Nursing Home Administrator (NHA) Pipeline—Obstacles and Opportunities
As the baby boomers retire, the number of older Americans who require long-term services and support in an assisted living or nursing home (NH) is expected to increase.
Robert Tyler Braun • Cass Hames • John R. Bowblis • Dunc Williams
Association Between Self-Direction and Personal Care Aide Wages
The supply of personal care aides (PCAs), who assist people receiving home care, is a growing concern.
Susan A. Chapman • Miku Fujita • Denise A. Tyler
Successful Contracting Between CBOs and Health Care Entities
Suzanne R. Kunkel • Abbe E. Lackmeyer (Abbe Linscott)
Bottoms Up: Local Support for Aging Services
An increasing population of older adults is one indicator of societal progress—a demographic shift that comes with both benefits and challenges to individuals, families, and communities.
Robert A. Applebaum • Bailee Brekke • Chelsea N. Goldstein
Family caregivers may be at particular risk for social isolation and loneliness.
Heather L. Menne • Claire Pendergrast
Increases in loneliness among Older Americans Act participants during COVID-19
Loneliness is increasingly understood as a public health crisis, and older adults are experiencing particularly severe impacts.
Jason W. Osborne • Claire Pendergrast • Heather L. Menne
A Profile of Home and Community-Based Services in Ohio
The report tracks the changes in home care use in the state over the past 30 years.
Ian Matt Nelson • Robert A. Applebaum • Oksana Dikhtyar • John R. Bowblis
A Profile of Nursing Homes in Ohio
This study provides a comprehensive overview of the nursing home industry in Ohio.
Robert A. Applebaum • Ian Matt Nelson • Oksana Dikhtyar • Negar Nik Bakht • John R. Bowblis • MaKenna McClure
The Federal Proposed Standard for Nursing Home Staffing
In response to concerns about direct care staffing challenges in nursing homes across the nation, on September 6, 2023, the Centers for Medicare and Medicaid Services (CMS) proposed new federal rul...
Ian Matt Nelson • John R. Bowblis • Amy E. Elliot • Robert A. Applebaum
Current Workforce and Quality Challenges in New York State Nursing Homes
This study provides background information about the current workforce and quality challenges faced by New York’s nursing homes.
Exploring the Criterion Validity of Pragmatic Person-Centered Care/Culture Change Measures
This study aims to assess the criterion validity of the Preferences for Everyday Living Inventory (PELI) Implementation Indicator with other culture change measures.
John R. Bowblis • Reese Moore • Jane Straker • Caroline Madrigal • Kimberly Van Haitsma • Miranda C. Kunkel • Katherine M. Abbott • Ian Matt Nelson
A Rising Tide Lifts All Boats: Equitable Nursing Home Policy Through Implementation Science
Nursing home policies built around equity and person-centered care can transform the industry to allow all Americans access to quality care.
Kimberly Van Haitsma • Natalie Douglas • Katherine M. Abbott
Using Local Initiatives to Fund In-Home Services: Ohio Leads the Nation
As a result of limitations in federal and state funding for nonmedical supportive services, some communities across 15 states are utilizing local funding sources to support aging services for older...
Jennifer Heston-Mullins (Jennifer L. Heston) • Athena Koumoutzis • Robert A. Applebaum • Pamela S. Mayberry
Residential Care: An Emerging Sector of the Ohio System of Long-Term Services
This report utilized data from the Biennial Survey of Long-Term Care Facilities to show the expansive growth of residential care facilities and assisted living in Ohio over the last couple decades.
Jessica Yauk • Meghan Young • Ian Matt Nelson • Robert A. Applebaum • Jane Straker
The Older Adult Population of Greene County Ohio
This report provides a socio-demographic snapshot of the older adult population of Greene County, Ohio
Abigail Helsinger • Ian Matt Nelson
Family satisfaction: Differences between nursing homes and residential care facilities
This study compared differences in overall family satisfaction, specific satisfaction domains, and correlates of satisfaction between nursing homes (NHs) and residential care facilities (RCFs), usi...
Nytasia M. Hicks • Katherine Wood • Jonathon M. Vivoda • Nader Mehri
Local initiatives to fund services for older Americans: A growing option for states
This report is part of a series of promising practices and emerging innovations from the AARP Public Policy Institute 2020 LTSS State Scorecard.
Jennifer Heston-Mullins (Jennifer L. Heston) • Robert A. Applebaum
Prevalence of COVID-19 in Ohio nursing homes: What's quality got to do with it?
With nursing homes being hit hard by the COVID-19 pandemic, it is important to know whether facilities that have any cases, or those with particularly high caseloads, are different from nursing hom...
Despite the growing proportion of older adults in the United States, federal and state funding for nonmedical supportive services remains limited.
Sara E. Stemen • Jennifer Heston-Mullins (Jennifer L. Heston) • Renusha Maharjan • Athena Koumoutzis • Pamela S. Mayberry • Robert A. Applebaum
Fast-track innovation: Area Agencies on Aging respond to the COVID-19 pandemic
Millions of older Americans depend on services provided by Area Agencies on Aging to support their nutritional, social, and health needs.
Traci L. Wilson • Amanda L. Brewster • Suzanne R. Kunkel • Marisa Scala-Foley
Policy does matter: Changing an unchangeable long-term services system
Because long-term services policy is largely driven by state decisions, this study examines the impact of state-level changes on Ohio's long-term services system.
Jane Straker • Katherine A. Kennedy • Robert A. Applebaum • Ian Matt Nelson
Long-stay nursing home (NH) residents are at high risk of having emergency department (ED) visits, but current knowledge regarding risk-adjusted ED rates is limited.
Orna Intrator • Huiwen Xu • Thomas V. Caprio • John R. Bowblis • Yue Li
This report provides findings from a study of long-term services and supports utilization trends from 1993 to 2017.
Ian Matt Nelson • John R. Bowblis • Robert A. Applebaum • Jane Straker • A. Katherine Harrington
This research brief compares the quality of Ohio's nursing homes to the nation over three time periods from 2013 to 2017.
Skilled nursing facilities (SNFs) have received regulatory attention in relation to their emergency preparedness.
Cassandra L. Hua • Ian Matt Nelson • Katherine A. Kennedy
Culture change (CC) is an innovation to improve nursing home resident quality of life. Inconsistencies in how CC is measured make the interpretation of findings inconclusive.
J. Scott Brown • Katherine M. Abbott • Anjali B. K. • Jane Straker
This study examines the associations between the motivation to learn, basic skills, and organized adult education and training participation among the middle-aged and older adults in the USA.
John R. Bowblis • Austin C. Smith
Care managing together: A review of the Aetna and Area Agency on Aging MyCare partnership in Ohio
This study was a first step in gaining a better understanding of the care management plan models used in the Ohio MyCare Demonstration, focusing on the Aetna unified care management model implement...
Luyna Ducay • Robert A. Applebaum • Jennifer Heston-Mullins (Jennifer L. Heston) • Ian Matt Nelson
The impact of long-term care ombudsman presence on nursing home survey deficiencies
This study examines whether deficiency outcomes from nursing home annual survey inspections vary with the presence of a long-term care ombudsman at the survey.
Josh Bornstein • John R. Bowblis • Diane Berish
It is not your parents' long-term services system: Nursing homes in a changing world
The article argues that administrative and regulatory practices have not kept pace with the dramatic changes in how nursing homes are now being used in the long-term services system.
Robert A. Applebaum • Shahla Mehdizadeh • Diane Berish
Is the quality of nursing homes countercyclical? Evidence from 2001 through 2015
This study examines whether nursing homes (NHs) provide better quality when unemployment rates rise (countercyclical) and explores mechanisms contributing to the relationship between quality and un...
Sean Shenghsiu Huang • John R. Bowblis
Private equity ownership and nursing home quality: An instrumental variable approach
There is a concern that when private equity firms purchase nursing homes, they will lower quality of care in order to increase profits.
John R. Bowblis • Sean Shenghsiu Huang
Cost-effective adjustments to nursing home staffing to improve quality
This study holistically examines which type of nursing home staffing (nursing, social service, activities) yields better quality as measured by number of deficiencies and deficiency scores.
The impact of state nursing home bed relocation policy in Ohio
As Ohio's population aged and shifted across county lines, an imbalance in the supply of nursing home beds to 65+ population has occurred.
Ian Matt Nelson • Shahla Mehdizadeh • Cassandra L. Hua • Philip E. Sauer
Although assessing individual consumer preferences is an important first step in providing person-centered care, the purpose of this study was to identify the top 10 shared preferences that are imp...
Rachel Klumpp • Katherine M. Abbott • Gerald C. Gannod • Jane Straker • Kimberly Van Haitsma • Kendall Leser
Typically thought of as a long-term care option for older residents, the proportion of Ohio’s long-stay Medicaid nursing home residents under the age of 65 has tripled over the last 20 years.
Report tracks use long-term services and supports utilization trends from 1993 to 2015.
Shahla Mehdizadeh • Robert A. Applebaum • Jane Straker • Ian Matt Nelson
Managerial ownership in nursing homes: Staffing, quality, and financial performance
This paper uses facility-level data to determine whether staffing levels, quality, and financial performance is different among nursing homes operated as a nonprofit, a for-profit with an owner-man...
John R. Bowblis • Sean Shenghsiu Huang
Using National Data to Examine the Quality of Care in Ohio's Skilled Nursing Facilities
This study compares the quality of Ohio's skilled nursing facilities to the nation overall.
Expanding Self Direction and Its Impact on Quality
The premise of this paper is that self-direction has impacted service and system design and approaches to quality.
Unpaid Caregivers: Growing Demand and Limited Supply
Several recent studies indicate that the supply of informal caregivers is declining and this change in potential support could have major policy implications.
Shahla Mehdizadeh
Ohio faces a demographic and financing challenge as its population ages in the next 20 years.
Shahla Mehdizadeh
In 2006, Ohio changed its Medicaid reimbursement methodology for nursing homes (NHs) to promote more efficient staffing levels.
Neighborhood Assistants Pilot: A Program Evaluation of Person-Centered Staffing
The purpose of this study was to pilot test and evaluate an innovative staffing approach called the Neighborhood Assistant (NA) at the Francis E. Parker Memorial Home.
Carol Burt • Katherine M. Abbott • Justine Sefcik • Lisa Slator
How Does Medicaid Reimbursement Impact the Quality of Ohio Nursing Homes?
Study examines the changes in Medicaid nursing home reimbursement between 2007 and 2012 as Ohio moved to a "new price system".
Long-term services and supports (LTSS): A growing challenge for an aging America
Because most Americans do not plan for the likelihood that we will need formal assistance because of a disability, many end up using the public assistance Medicaid program as the safety net for LTSS.
Long-term care facilities have been impacted by the economic downturn and other changes in the long-term care system.
Phyllis A. Cummins • Jane Straker
This longitudinal study, initiated by the General Assembly in 1993 and continuously funded by the Ohio Department of Aging, tracks how long-term utilization has changed over the past two decades in...
Jane Straker • Ian Matt Nelson • Malinda Deacon • Robert A. Applebaum • Shahla Mehdizadeh
Integrated Care and the Aging Network: The Next Frontier or the End of an Era?
The strong push to integrate Medicare and Medicaid services has been driven by the federal government through the Centers for Medicare & Medicaid Services, and by states, in response to two maj...
International Approaches to Long-term Services and Supports
For older adults who may experience significant disability from injury or disease, the daily activities present challenges that may require ongoing assistance from family members, friends, or a for...
Anthony R. Bardo • Robert A. Applebaum • Emily Robbins
Delivering Long-Term Services to Ohio Elders: Good Progress, But Challenges Await
The study describes the changes in Ohio's approach to delivering long-term care services that have occurred from 1993 to 2011.
Robert A. Applebaum • Ian Matt Nelson • Shahla Mehdizadeh
Evaluation of Ohio's Program of All Inclusive Care for the Elderly (PACE)
In 2011, the Ohio Legislature asked the Scripps Gerontology Center to evaluate Ohio's two PACE sites and make recommendations for further expansion.
Shahla Mehdizadeh • Suzanne R. Kunkel • Robert A. Applebaum • Patricia Faust
Providing Data to Improve Ohio's Long-Term Services and Supports System (First three indicators)
This project tracks Ohio’s progress toward a more balanced system of long-term care services and support. The study, funded by the Ohio Department of Job and family Services, began in 2010 an...
Robert A. Applebaum • Shahla Mehdizadeh
This report provides findings from a survey of Ohio's counties operating senior-service property-tax levies. Results cover services, expenditures, clients served, eligibility, election strateg...
Jane Straker • Robert A. Applebaum • Michael Payne
In a 16 year tracking of utilization trends for institutional and home and community-based services, we learned that Ohio has made considerable change in its approach to delivering and funding long...
Shahla Mehdizadeh • Ian Matt Nelson • Robert A. Applebaum • Jane Straker
A Review of Ohio's Nursing Home Certificate of Need Program: Implications for Practice and Policy
One of the critical questions states like Ohio face as they plan for an aging population involves estimates about the optimum number of nursing homes that will be needed in the future.
Robert A. Applebaum • Shahla Mehdizadeh • Takashi Yamashita
Nursing Home Use in Ohio: Who Stays, Who Pays?
This research brief follows a cohort of nursing home residents over a three-year period-- beginning with their first ever admission to a nursing home --in order to determine their stay patterns and...
Robert A. Applebaum • Shahla Mehdizadeh • Ian Matt Nelson
Disability in Ohio: Managing The Projected Need for Long-Term Services and Supports
This report examines Ohio's projected long-term care needs and its implications for the state budget.
Shahla Mehdizadeh
Providing Long-Term Services and Supports to an Aging Ohio: Progress and Challenges
This report details trends in Ohio long-term care service utilization over 14 years.
Malinda Deacon • Robert A. Applebaum • Jane Straker • Shahla Mehdizadeh
Aging and Long-Term Care Issues in Ohio
This summary report focuses on aging and disability in Ohio as well as on utilization and Medicaid costs of long-term care for older Ohioans.
Michael Payne • Jane Straker • Robert A. Applebaum
Disability in Ohio: Current and Future Demand for Services
In an effort to project the size of Ohio’s Medicaid long-term care expenditures between now and the year 2020, this report first projected the size of the population with severe physical and/...
Shahla Mehdizadeh
Evolution of the Aging Network: Modernization and Long-Term Care Initiatives
This article examines how the aging network has evolved since its inception, mandated by the Older Americans Act of 1965.
Abbe E. Lackmeyer (Abbe Linscott) • Suzanne R. Kunkel
This report examined the PASSPORT population for nursing home level of care and Medicaid financial eligibility.
Ian Matt Nelson • Shahla Mehdizadeh • Lauren Thieman
This report is one among four that represents an evaluation of Ohio’s Assisted Living Medicaid Waiver program.
Farida Ejaz • Heather L. Menne
Evaluation of Ohio's Assisted Living Medicaid Waiver Program: Report on Program Costs
This report is one among four that represents an evaluation of Ohio's Assisted Living Medicaid Waiver program.
Evaluation of Ohio's Assisted Living Medicaid Waiver Program: Final Summary Report
This study evaluated the performance of Ohio’s Assisted Living Medicaid Waiver program during its initial implementation period; it is one report among four.
Valerie Wellin • J. Scott Brown • Keren Brown Wilson • Cary Kart • Robert A. Applebaum • Farida Ejaz • Heather L. Menne
Evaluation of Ohio's Assisted Living Medicaid Waiver Program: Consumer Access and Satisfaction
This report is one among four that represents an evaluation of Ohio's Assisted Living Medicaid Waiver program.
Valerie Wellin • Jennifer M. Kinney • Cary Kart
PASSPORT Assessment and Services
The purpose of our evaluation component was to determine the effectiveness of the PASSPORT assessment process in ensuring that PASSPORT consumers are supported in making informed choices about long...
Denise Brothers-McPhail • Kathryn McGrew
Program Evaluation of PASSPORT: Ohio's Home and Community-Based Medicaid Waiver
The goal for the evaluation of the PASSPORT program was to determine whether the program is providing efficient and cost-neutral services as an alternative to facility-based long-term care, and to ...
Jane Straker • Kathryn McGrew • Valerie Wellin • Shahla Mehdizadeh • William Ciferri • Suzanne R. Kunkel
This report explores the costs of caring for a person age 60 and older in the community (through PASSPORT) versus caring for a person age 60 and older in a nursing home.
Shahla Mehdizadeh
PASSPORT Evaluation: Accountability for Finances, Compliance, and Fairness
This research is an evaluation of the mechanisms and processes in place to assure that PASSPORT funds are managed properly and procurements are undertaken in a fair and open manner.
William Ciferri
PASSPORT Quality Assurance and Quality Management
This report addresses findings related to the quality standards of the PASSPORT program.
Dawn Carr • Suzanne R. Kunkel • Jane Straker
Providing Quality Home and Community-Based Services Through PASSPORT
This report is part of a larger evaluation of Ohio's PASSPORT Program. It examines issues of provider tenure, provider certification, and provider quality assurance.
Dawn Carr • Jane Straker • Karl Chow • Elizabeth Like Lokon
Nursing home use in Ohio: Who stays, who pays?
This research brief follows a cohort of nursing home residents over a three-year period-- beginning with their first ever admission to a nursing home --in order to determine their stay patterns and...
Shahla Mehdizadeh • Ian Matt Nelson • Robert A. Applebaum
An overview of Ohio's In-Home Service Program for Older People (PASSPORT)
This research presents an overview of Ohio's Medicaid waiver program, known as PASSPORT, which serves Ohioans who are 60 years and older, who are chronically disabled, and who meet the eligibi...
Robert A. Applebaum • Shahla Mehdizadeh
A review of nursing home resident characteristics in Ohio: Tracking changes from 1994-2004
This briefing paper presents the profile of Ohio nursing home residents in both 2004 and 1994, and describes trends over the past decade.
Robert A. Applebaum • Shahla Mehdizadeh
