Alzheimer's disease and related dementias (ADRD) create challenges for hospital-to-home transitions, caregiver preparation, and home health care coordination. This cross-sectional study examined socioeconomic and geographic inequalities in hospital-level ADRD burden among 3,027 U.S. hospitals serving Medicare fee-for-service beneficiaries. Multivariable quasibinomial regression assessed associations between ADRD prevalence and hospital characteristics, rurality, census region, and patient composition. An age-adjusted sensitivity analysis was conducted among 3,003 hospitals with complete age-composition data. Mean hospital-level ADRD prevalence was 22.00% among patients and 24.00% among events. In the primary model, ADRD prevalence was higher in hospitals in the South and among hospitals serving higher proportions of dual-eligible, female, and White patients. In the age-adjusted sensitivity model, dual eligibility remained strongly associated with ADRD prevalence, while the female-composition association was attenuated. These hospital-level patterns may help identify settings where enhanced discharge planning and home health care coordination should be considered.
Home and community-based services (HCBS) in the United States are required to deliver person-centered practice (PCP) under the HCBS Settings Rule, yet peer-reviewed literature provides limited insight into how PCP workforce competencies are operationalized in HCBS practice. This scoping review synthesized gray literature, including policy briefs, training guides, government documents, and practice resources, to describe PCP competencies and explore barriers and facilitators to implementation in the HCBS workforce. Twenty-eight documents met the inclusion criteria. Most competencies aligned with the five competency domains of the National Center on Advancing Person-Centered Practices and Systems, while additional competencies related to trauma-informed practice, health and safety, staff attributes, and crisis intervention also emerged. Implementation barriers included variation in training requirements, workforce shortages, inconsistent documentation and monitoring, and administrative challenges. Facilitators included standardized training, organizational support, and competency development opportunities. Findings complement evidence from academic research, highlighting recommendations to improve PCP in the HCBS workforce.
Self-rated health (SRH) is an important indicator of overall well-being and is associated with morbidity, functional decline, and mortality. This study examined temporal trends, sociodemographic and behavioral determinants, and age-related differences in fair or poor SRH among adults in Missouri. A repeated cross-sectional analysis was conducted among 56,970 adults aged ≥ 18 years. Survey-weighted logistic regression models were used to assess associations between physical activity and SRH, adjusting for sociodemographic and health-related factors. The prevalence of fair or poor SRH declined from 20.5% in 2018 to 16.2% in 2020 before increasing to 20.1% in 2024. Lower income and unemployment were strongly associated with poor SRH. Physical activity was associated with lower odds of poor SRH, with a stronger protective association observed among adults aged ≥ 65 years. These findings highlight the importance of promoting physical activity to support healthy aging and improve health outcomes among community-dwelling adults.
Telehealth, accelerated by the COVID-19 pandemic, has become essential in-home health care, particularly for individuals with spinal cord injury (SCI). However, traditional telehealth often lacks adequate remote intervention and monitoring for SCI patients. This study evaluated a novel telehealth trial using transcutaneous electrical stimulation (TES) with innovative approaches to improve bladder function in SCI patients. Fifteen participants completed daily 15-minute TES sessions over four weeks, supported by courier-delivered equipment, video conferencing, and online assessments with self-reported monitoring at home. The trial achieved 100% adherence, with 80% of participants expressing confidence in device use and 87% indicating willingness to continue TES. Most participants found the device user-friendly, and 66% reported symptom improvement. This study highlights the potential of telehealth trials to enhance access to care, improve patient outcomes, and promote health equity in home care settings, particularly during periods of restricted in-person healthcare delivery.
The COVID-19 pandemic has had serious consequences for older adults and individuals with chronic conditions, many of whom rely on long-term services and supports. In response to the pandemic, the federal government invested nearly $13 billion dollars for states to expand home and community-based services (HCBS) for older adults and persons with disabilities. States have several options to provide Medicaid-funded HCBS benefits including the 1915(i) HCBS benefit and 1915(k) Community First Choice program. This research uses event history analysis to model state adoption of these two optional Medicaid benefits. The results indicate that a Democratic governor and the state's unemployment rate were associated with states' adoption of the 1915(k) program, while the unemployment rate and the supply of home health agencies were associated with states' adoption of the 1915(i) benefit. Findings highlight similarities in factors associated with Medicaid HCBS program adoption as well as differences stemming from unique program attributes.
