Howard Degenholtz

University of Pittsburgh

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Nicholas G. Castle

West Virginia University

Rosalie A. Kane

University of Minnesota

Jules Rosen

Fox Learning Systems (United States)

Vikas Mittal

Chandigarh University

Steven M. Albert

The Institute for Bird Populations

Benoit H. Mulsant

Centre for Addiction and Mental Health

Margaret Calkins

Innovative Designs in Environments for an Aging Society

Jamila Bookwala

Lafayette College

Barbara J. Bowers

University of Wisconsin–Madison

Robert L Kane

Medical University of South Carolina

Cooperative Institutions

University of Pittsburgh

123

University of Pittsburgh Medical Center

University of Minnesota

Johns Hopkins University

University of Pennsylvania

UPMC Health System

University of Michigan–Ann Arbor

Geriatric Research Education and Clinical Center

Emory University

National Institutes of Health

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Edboard

The Gerontologist (2011)

Steven M. Albert Rebecca S. Allen Jacqueline L. Angel Tamara A. Baker Mercedes Bern‐Klug

10.1093/geront/gnr057

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Improving Quality of Life in Nursing Homes: The Structured Resident Interview Approach

Journal of Aging Research (2014)

Howard Degenholtz Abby L. Resnick Natalie Bulger Lichun Chia

The quality of life (QOL) of the approximately 1.5 million nursing facility (NF) residents in the US is undoubtedly lower than desired by residents, families, providers, and policy makers. Although there have been important advances in defining and measuring QOL for this population, there is a need for interventions that are tied to standardized measurement and quality improvement programs. This paper describes the development and testing of a structured, tailored assessment and care planning process for improving the QOL of nursing home residents. The Quality of Life Structured Resident Interview and Care Plan (QOL.SRI/CP) builds on a decade of research on measuring QOL and is designed to be easily implemented in any US nursing home. The approach was developed through extensive and iterative pilot testing and then tested in a randomized controlled trial in three nursing homes. Residents were randomly assigned to receive the assessment alone or both the assessment and an individualized QOL care plan task. The results show that residents assigned to the intervention group experienced improved QOL at 90- and 180-day follow-up, while QOL of residents in the control group was unchanged.

10.1155/2014/892679

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Citations (21)

Nursing Home Reform in the Context of National Long-Term Care Services and Policy: The Devil in the Details of the National Academies Report

Public Policy & Aging Report (2023)

Howard Degenholtz Jasmine Travers Sheryl Zimmerman Jeanne A. Teresi Margaret Calkins

National Policy

10.1093/ppar/prac036

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Family at the Bedside: Supporting Family Caregiving in Nursing Homes.

PsycCRITIQUES (2006)

Howard Degenholtz

10.1037/a0003138

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Long-Term Care Case Managers’ Out-of-Home Placement Decisions

Research on Aging (1999)

Howard Degenholtz Rosalie A. Kane Robert L Kane Michael Finch

Hierarchical logistic regression was used with the results of a factorial vignette survey of a national sample of case managers for the disabled elderly in Medicaid home- and community-based services waiver programs. The effects of client, case manager, and agency factors on case managers’out-of-home placement decisions in response to hypothetical case studies were estimated. Results show that client preferences, workload, and division of labor affect the probability that a case manager will recommend an out-of-home placement, controlling for client’s physical and cognitive disability and the available resources. Significant variation among individuals was found. Implications of the findings are discussed.

Vignette

Affect

Sample (material)

Waiver

10.1177/0164027599212005

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Citations (21)

PALLIATIVE CARE USE AMONG INDIVIDUALS WITH ALZHEIMER’S DISEASE AND RELATED DEMENTIAS IN THE LAST 12 MONTHS OF LIFE

Innovation in Aging (2018)

Rebecca Butler Howard Degenholtz Jennifer B. Seaman

Palliative care has been shown to relieve physical, psychological, and spiritual distress for individuals with serious illnesses. Alzheimer’s disease and related dementias (ADRD) are terminal, debilitating conditions, yet little is known about the use of palliative care in this population. Using Pennsylvania Medicaid claims for dual-eligible beneficiaries over age 65 merged with Medicare enrollment data and restricted to beneficiaries who were dually-eligible and not in a Medicare managed care plan, we identified individuals who: died in 2014 or 2015 and were diagnosed with ADRD at least 12 months prior to death. We used multivariate logistic regression to examine the association between having a diagnosis of ADRD and use of palliative care, controlling for age, gender, race, use of long-term services and supports, region, and comorbidities. We found that people with ADRD were less likely to use any palliative care than people without a diagnosis (OR .74; CI .60 to .91).

10.1093/geroni/igy023.1273

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Case Management as a Force for Quality Assurance and Quality Improvement in Home Care

Journal of Aging & Social Policy (1998)

Rosalie A. Kane Howard Degenholtz

ABSTRACT To examine the extent to which case managers engage consciously in quality assurance activities for the services they purchase or arrange, semi-structured interviews were conducted with representatives of 75 case management agencies responsible for allocating home and community-based services with public funds, and 17 private, fee-for-service case management agencies. Relatively few agencies had developed formal criteria for defining quality, or systematic ways to assess it. Several types of quality oversight provided by case managers were identified: on-site review by case managers themselves, administrative review, and independent review by quality assurance staff. This article contains examples of best practices and discusses the policy implications of having case managers adopt a more explicit and rigorous role in assuring the quality of the services their clients receive.

Best practice

10.1300/j031v09n04_02

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Citations (6)

Two and a half weeks: Time enough for end-of-life care planning?*

Critical Care Medicine (2009)

Howard Degenholtz

Center for Bioethics and Health Law, and Department of Health Policy and Management; Graduate School of Public Health; University of Pittsburgh; Pittsburgh, PA The author has not disclosed any potential conflicts of interest.

Bioethics

Center (category theory)

End-of-Life Care

Advance Care Planning

10.1097/ccm.0b013e31819bb80d

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Citations (1)

Persistence of Racial Disparities in Advance Care Plan Documents Among Nursing Home Residents

Journal of the American Geriatrics Society (2002)

Howard Degenholtz Robert Arnold Alan Meisel Judith R. Lave

This paper analyzes the association between race and the presence of advance care plan documents (living wills, do not resuscitate (DNR) orders, and do not hospitalize (DNH) orders) in nursing home residents. We conducted secondary analysis of publicly available survey data from the 1996 Medical Expenditure Panel Survey—Nursing Home Component, a nationally representative survey of nursing home residents in the United States. There were 3,747 participants in the survey, weighted to represent 1.56 million nursing home residents in the United States. We found that 20% of U.S. nursing home residents in 1996 had documentation of living wills, 48% had DNR orders, and 4% had DNH orders. African Americans are about one‐third as likely as Caucasians to have living wills and one‐fifth as likely as Caucasians to have DNR orders; Hispanics are about one‐third as likely as Caucasians to have DNR orders and just as likely as Caucasians to have living wills. In conclusion, we found that the presence of advance care plans is related to race, even after controlling for health and other demographic factors. These findings call attention to an area where further research is needed to determine whether residents' (and their families') preferences are being elicited and documented.

Living Wills

Assisted Living Facility

10.1046/j.1532-5415.2002.50073.x

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Citations (163)

Pennsylvania's Transition to Medicaid Managed Long-Term Services and Supports

Innovation in Aging (2021)

Howard Degenholtz

Abstract Implemented through five health plans, Ohio’s MyCare demonstration began in 2014 and was designed to coordinate primary, acute care, behavioral health and long-term services in the major urban areas of the state. Individuals who are dually eligible for both Medicaid and Medicare and who reside in specified geographic regions must enroll into a managed MyCare plan. MyCare beneficiaries are assigned to two primary categories: community well and those needing long-term services and supports (LTSS). Individuals receiving the integrated MyCare intervention were expected to have lower acute care hospitalizations, lower long-term nursing home use, better longevity and lower overall health and long-term care costs. Using a propensity score matching design, the evaluation compared MyCare enrollees to comparison group members in non-MyCare counties of the state, using Medicaid and Medicare claims data. The 120,000 MyCare program participants represented about half of the dual eligible individuals in the state.

Medicaid managed care

10.1093/geroni/igab046.1751

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