Scripps Gerontology Center Publications
Recent Submissions
Item Home- and Community-Based Services in Ohio: 1993-2023
Applebaum, Robert; Nelson, Matt; Dikhtyar, Oksana; Bowblis, John R.This report provides an overview of the home-and community-based services system in Ohio. The study documents the substantial growth in home services and assisted living facilities over the past three decades.Item Nursing Homes in Ohio: A Profile
Nelson, Matt; Bowblis, John R.; Applebaum, Robert; Dikhtyar, OksanaProvides an overview of the nursing home industry in Ohio using the 2023 Biennial Survey of Long-Term Care Facilities.Item Financial Retention Strategies Associated with Nurse Aide Turnover in Ohio Nursing Homes
Bowblis, John R.; Brunt, Christopher S.; Applebaum, RobertHaving an adequate number of workers to provide services has been a continuing challenge across the array of long-term services settings. While nursing homes, assisted living, and home care each have unique workforce challenges, the nursing home environment has individuals with the highest levels of need and they are very much dependent on nurse aides and nurses to deliver quality care. Studies consistently identify nursing home staffing as a critical component in achieving quality of care. However, nursing homes have historically experienced high rates of turnover among direct care staff, particularly nurse aides, who provide most of the direct care to residents. Not only are high turnover rates associated with lower quality, they can potentially increase costs due to recruitment expenditures and wage increases necessary to fill open positions. During the COVID-19 pandemic, the nursing home industry experienced a substantial increase in the proportion of nursing homes that used temporary staffing agencies, which was much more costly than internal organizational employees. In this brief, we examine financial retention strategies nursing home utilized to determine if they are associated with lower turnover rates among nurse aides.Item Evaluation report: Expansion of dementia-capable communities within urban and rural settings in Ohio using evidence-based and evidence-informed programming
Heston-Mullins, Jennifer; Kunkel, Suzanne R.; Dikhtyar, OksanaThis report shares the methods, instruments, and findings of an evaluation of dementia-capable community efforts in urban and rural Ohio regions conducted by Miami University’s Scripps Gerontology Center. With funding from the Administration for Community Living Alzheimer’s Disease Programs Initiative (ADPI), partner organizations from the aging and intellectual and developmental disabilities (IDD) networks collaborated to improve the dementia-capability of their local communities, with a specific focus on individuals with dementia who live alone and individuals with IDD who have, or may be at risk of developing, dementia.Item Understanding the Financial Performance of Ohio's Nursing Homes During and After the COVID-19 Pandemic
Bowblis, John R.; Brunt, Christopher S.; Applebaum, RobertBrief examines the financial viability of Ohio's nursing home industry.Item “We’re a hidden secret, and we won’t want to be hidden anymore:” 2024 landscape of adult day services in Ohio
Menne, Heather L.; McLaughlin, Sara J.; Noble, Molly; Udeh, Kingsley C.Adult day services (ADS) provide participating adults with social activities, meals or snacks, personal care, or therapeutic activities. These services also allow caregivers some respite from providing care. In Ohio, ADS were greatly impacted by the pandemic. In response to growing concerns about access to ADS, the Ohio Department of Aging (ODA) made available $6 million in grant funds to bolster these needed services in 2024. Through focus groups and a survey of Ohio ADS providers, this project examines the current landscape of ADS in Ohio and highlights the challenges faced by providers as well as potential solutions.Item Embracing the Shift: The Impact of Health Care Contracting on Community-Based Organizations
Kunkel, Suzanne R.; Lackmeyer, Abbe E.; Karmacharya, IshaGrowing evidence for the impact of social drivers of health (SDOH) on health outcomes has underscored the value of social care, defined here as community-based programs and services that address health-related social needs such as transportation, food security, and social connection. One model for aligning health and social care is contracting between health care entities (including hospital systems and managed care plans) and community-based organizations (CBOs), such as Area Agencies on Aging (AAAs) and Centers for Independent Living (CILs). The prevalence of these arrangements is increasing, but there is little documentation about the ways in which contracting with health care impacts the organizational operations and culture of a CBO. This qualitative study was designed to add depth to our understanding of these impacts. A focus group and interviews with 13 individuals representing 10 organizations (all of which were AAAs) yielded the following major findings: 1. Mission alignment was frequently discussed as an important component in the decision to contract, and in communication about the value of the new endeavor with staff, board members, and other stakeholders. 2. There was variability in the extent to which contract-related business practices were kept separate or integrated into existing staffing, funding, and work flow processes. The extremes of that variability were organizations that established a separate business entity (such as a 501c3 or an LLC), to those that blended the new contract-related work into existing staffing and work flow operations. Between those extremes, several organizations described the need to hire new staff to address increased volume and sometimes different skills that were required for the new work. 3. Data infrastructure and processes were often affected by contracting, particularly when data privacy standards meant that the CBO staff did not have access to the data they were entering; in these cases, information about program and staff performance was available only through reports provided by the healthcare partner. 4. The impact of healthcare contracting on the organizational culture of the CBO was partly shaped by the existing culture. Some participants highlighted their long-standing organizational culture of innovation, growth, and change. Others outlined strategies for communicating the mission alignment and sustainability benefits of the new ventures. 5. Valuable lessons learned and advice for other CBOs emerged from this study, including encouragement to embrace this opportunity to strengthen the alignment of social care and health care, and the importance of making a strong business case that appropriately values the essential role of the work they do and rewards them for the quality of the services they provide.Item At The Nexus of Social Care: Successful Contracting Between CBOs and Health Care Entities.
Kunkel, Suzanne R.; Lackmeyer, Abbe E.This research brief explores how the integration of social care and health care is evolving through contracting partnerships between community-based organizations (CBOs) and health care entities. Findings from the fifth CBO Health Care Contracting survey (formerly referred to as the Request for Information Survey) help to highlight the key components of contracting including trends, populations served, partnerships, the role of networks and addressing social determinants of health. In addition, the brief provides insight into what successful contracting looks like for CBOs as they broaden their reach, improve internal operations, generate revenue while expanding payment models and manage data interoperability.Item Process Evaluation of MyCare Ohio
Heston-Mullins, Jennifer; Applebaum, Robert; Abbott, Katherine M.; Koumoutzis, Athena; Nelson, Matt; Bennett, Dayna S.Process Evaluation Report of Ohio's MyCare DemonstrationItem Evaluation of Ohio’s MyCare Demonstration
Bowblis, John R.; Applebaum, Robert; Heston-Mullins, Jennifer; Nelson, Matt; Abbott, Katherine M.; Ranbom, Lorin; Nivar, Virginia A. Folcik; Nau, MichaelImpact evaluation of Ohio's MyCare Program.Item Enhancing Caring Communities: A Toolkit for Organizations to Better Support Caregivers
Heston-Mullins, JenniferItem Substance Use Disorders Among Older Ohioans - The Need for Policy Change
Brekke, Bailee; Menne, Heather L.Nearly four million older Americans are struggling with substance use disorders (SUDs). This report reviews the current political landscape surrounding this crisis at the local, state, and federal levels. Recommendations are provided to better address SUDs among older adults in the future.Item A Profile of Home and Community-Based Services in Ohio
Applebaum, Robert; Nelson, Matt; Dikhtyar, Oksana; Bowblis, John R.Report provides 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 3o years. The report also includes a detailed overview of Ohio's residential care facilities, including assisted living facilities which comprise about 85% of residential care facilities in the state.Item A Profile of Nursing Homes in Ohio
Applebaum, Robert; Nelson, Matt; Dikhtyar, Oksana; Bowblis, John R.; McClure, MaKenna; Nik Bakht, NegarBased on data collected from an array of sources including the Biennial Survey of Long-Term Care Facilities, the study provides a comprehensive overview of the nursing home industry in Ohio. Information on staffing, occupancy and quality are presented.Item Greene County Council on Aging: 2021 Community Survey Findings
McLaughlin, Sara J.To gain a better understanding of the needs and interests of older Greene County residents, the Greene County Council on Aging partnered with the Scripps Gerontology Center at Miami University to conduct a mail survey of older Greene County residents. The information gathered will be used to inform initiatives aimed at improving the lives of older residents of Greene County. Findings will be shared with area senior centers, Greene County Parks & Trails and other park and recreation entities, the Greene County Library, Greene CATs, Miami Valley Regional Planning Commission, and leadership within the various Greene County municipalities.Item The National Survey of Area Agencies on Aging: 2022 Results
Kunkel, Suzanne R.; Graham, Robert J.; Karmacharya, IshaThis report presents the findings from the 2022 National Survey of Area Agencies on Aging. This report provides key findings from the survey related to the following topics: service provision and populations served, social engagement, workforce and staffing, partnerships, evidence-based programming, livable communities, COVID-19 partnerships and flexibilities, budget, and training and technical assistance needs.Item The Federal Proposed Standard for Nursing Home Staffing: How Does It Impact Ohio's Nursing Homes?
Elliot, Amy; Bowblis, John R; Nelson, Matt; Applebaum, RobertIn 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 rules to establish minimum nursing staff standards for nursing homes. The proposed CMS changes could have a substantial impact on nursing homes both in Ohio and across the nation.Item Lifting the Veil: How Networks Form, Operate, Struggle, and Succeed
Kunkel, Suzanne R.; Lackmeyer, Abbe E.; Graham, Robert J.Organizational networks have become an increasingly prominent approach to the provision of services for complex, multi-dimensional needs such as behavioral and mental health needs, HIV/AIDS, substance use disorders, and services for people who are unhoused. This model is also taking hold among community-based organizations (CBOs) seeking to work with each other and to contract with health care entities to improve coordination, reduce fragmentation, and increase the efficacious integration of health and social support services for older adults and people with disabilities. There are very few studies that document how networks form, operate, and succeed in these cross-sectoral collaborations. This qualitative study was designed to fill that gap. Interviews with 23 representatives of 8 distinct CBO networks (including network hubs and network members) yielded the following major findings: 1. The formation of CBO networks for contracting with health care entity partners is an evolving and expanding approach. The perceived values of a network include the opportunity to collaborate, to build a more integrated system, to centralize administrative functions, and to better serve clients. Networks emerge in response to context-based opportunity, necessity, or both. 2. The level of formality in network roles, relationships, and governance structure varies, sometimes related to the newness of the network and the legal structure of the network hub. 3. A very common challenge for networks is the efficiency, functionality, and accessibility of the data ecosystem. Many networks build their data infrastructure on existing systems used by the CBO members and/or the network hub, which does not always map well to the needs of the entire network (health care entity, hub, and members). 4. Important tips for network success emerged from this study, including the need for value propositions and cost-benefit analyses for the network hub and members; the importance of transparency and accountability in all network operations such as referral volume and process, and contract negotiations; and the need for data systems that create data channels that are efficient and accessible for all organizational participants. The rich information shared by the participants in this study also pointed to best practices and to technical assistance and resource needs that require further study and action.Item Current Workforce and Quality Challenges in New York State Nursing Homes
Bowblis, John R.; Applebaum, Robert A.This study provides background information about the current workforce and quality challenges faced by New York’s nursing homes. Findings show New York nursing homes saw an increase of 23% in operating expenditures, which include nurses and certified nurse aides, between 2017 and 2021 in response to the COVID-19 pandemic. During this time period nursing home Medicaid payments, a large source of revenue for nursing homes, increased by 3.5%. These financial pressures could have an impact on New York nursing homes.Item Evaluating Enhanced Service Coordination in Ohio’s Housing for Low-Income Older Adults and People with Disabilities
Kunkel, Suzanne R.; Mehdizadeh, Shahla; de Medeiros, Kate; Nelson, Matt; Hua, CassandraThis project was designed to evaluate the implementation and impact of Enhanced Service Coordination (ESC) in affordable housing for older adults and people with disabilities. The ESC model emphasizes proactive outreach and ongoing monitoring and engagement with residents to provide service coordination that enhances their abilities to remain as healthy and independent as possible.