• More than three in four Nebraska registered likely voters (77%) say that Nebraska is spending too little or just the right amount of money on state services such as keeping people safe, providing health and long-term care, repairing roads and highways, maintaining parks, and providing education. • More than two in three Nebraska registered likely voters (68%) think that property taxes in Nebraska are too high. • Half of Nebraska registered likely voters (50%) say maintaining and improving state services is a higher priority than limiting taxes. • Two in three Nebraska registered likely voters (66%) have not seen, read, or heard anything about Nebraska’s Stop Over Spending or SOS proposal in the last year. • More than three in four Nebraska registered likely voters (78%), when asked at the end of the survey, say they are concerned about out of state groups and corporations funding the SOS amendment to Nebraska’s constitution.
Abstract The body of recent evidence-based interventions for pain self-management targeted at community-dwelling older adults is limited. The aim of this ongoing pilot study is to determine the efficacy of a six-week curriculum in promoting knowledge, attitudes, and behaviors related to wellness and safe pain management among older adults who were recruited via community-based organizations. Interim results from a sample survey analysis of 6 out of 8 cohorts (n=87) in a quasi-experimental crossover design showed that majority of the participants (91%) were White (63%) and Black (28%) women between the ages of 60 to 79. On a scale of 1 to 5 where “4” indicates that the knowledge or behavior is being implemented, 100% of the pain prevention strategies (i.e., maintaining a healthy weight or losing weight; engaging in physical activity; getting adequate sleep; and avoiding/limiting caffeine, tobacco, or alcohol) and two pain management strategies (“using topical therapies such as gels and creams” and “cleaning out old and expired medicines”) met this threshold post-curriculum. There were statistically significant differences observed in participants’ individual acceptance and commitment to cognitive behavior therapy (p=0.0015); adoption of meditation and/or mindfulness techniques to manage pain (p=0.0118); and reported more effective pain management (p=0.0109) between the post-curriculum and 6-week follow-up period. These preliminary findings suggest that the curriculum was an effective intervention for safe pain management among community-dwelling older adults. It has potential to be replicated across multiple community-based organizations and to target other underrepresented groups in the older adult population.
Abstract While much is known about the relationship between Congress and regulatory agencies, there has been little examination of the role state legislatures play in the activities of state regulatory bodies, particularly those activities related to timely, salient policy issues. This article explores the relationship of state legislatures to medical boards, which are increasingly becoming more policy active. We find that state legislative involvement and influence are the most important determinants of policy‐active state medical boards; institutional elements play a secondary role. Major changes in the private health care delivery system affect legislative involvement and play an indirect role in predicting policy activism. We drew our data from a 50‐state survey of executive directors of state medical boards.
In the past few years, eleven states have directed medical schools in their states to produce more primary care practitioners or to change the training of physicians to make careers in primary care more attractive to medical students. This article outlines the progress and politics of the states’ desire to hold medical schools accountable for producing more primary care practitioners. It analyzes the coerciveness and scope of the laws, including the provisions for implementation and accountability. Interviews with legislative staff, legislators, and university and medical school lobbyists provide information on the measures’ political rationale and expectations. Most striking was the signaling nature of the provisions. The laws were not strident or especially onerous; they contained many loopholes and no real sanctions. They were important, however, in the message they conveyed. In state after state, legislatures sent a message to the medical schools that they were part of the solution to distributional problems of health care delivery and must be responsive to legislative desires for action. State legislators sent apolicy signal, and most medical schools apparently understood its significance.
Chronic health conditions affect the physical and financial well-being of millions of older adults, including those who themselves provide care to relatives and friends. As well, certain conditions cost more than others to manage, and older caregivers may be especially at risk of experiencing financial burden from an illness. This study investigated the association between caregiving and longitudinal change in health cost burden by measuring condition-specific expenses in a nationally-representative sample of older caregivers and non-caregivers. Three waves of the Health and Retirement Study (HRS) were used in the analysis. Caregiver socio-demographic and financial status was matched with updated treatment and lost-wage costs for chronic conditions developed by the Milken Institute. Profiles of health cost burden were created for community-dwelling adults 60 years and older who completed the HRS core survey for all three wave years from 2016 through 2020 (N = 10,540). Bivariate and regression analyses were used to examine differences in health cost burden between caregivers and non-caregivers over time. Compared to non-caregivers, caregivers were healthier and less burdened at baseline. Yet, holding other variables constant, caregivers showed steeper increases in chronic condition prevalence and costs over a four-year period after initiating caregiving activities. Findings suggest that whereas older caregivers may appear to select into the caregiving role while healthier, they are more likely to experience increased economic and health burdens over time - both from medical treatment and lost wages - related to chronic conditions.
With over fifteen million older adults in the United States relying on the means-tested Medicaid program for healthcare coverage, there has been concern over rising Medicaid costs among this rapidly growing age group. Few studies have longitudinally examined trends among older beneficiaries over time to identify factors related to Medicaid utilization and to better understand how potential coverage changes might impact this group. This study used the 1998 to 2014 waves of the Health and Retirement Study (N = 8,162) to analyze a representative sample of those aged 50 and older to ascertain demographic, health, and economic factors associated with Medicaid utilization over a sixteen-year period. The analyses showed stable probabilities of accessing the program over time and observed that the most vulnerable older adults make up the pool of Medicaid beneficiaries. There is no evidence of significant asset divestment in order to qualify for benefits. Multivariate analyses further revealed those who were older, female, minority race/ethnicity, less educated, in poorer health, below the federal poverty line, and with lower net wealth had a higher risk of utilizing Medicaid during the observed time period than their counterparts. Findings highlight the importance of monitoring changes in the documented risk factors over time in terms of their impact on Medicaid utilization and underscore the need to consider how these factors may be interrelated.
Abstract This presentation will feature how the National Council on Aging (NCOA) has advanced a program of work on data mapping and visualization. It will explain how this work is part of NCOA’s mission to improve the lives of millions of older adults, especially those who are struggling. Guided by the idea that how we age should not be determined by gender, color, sexuality, income, or zip code, the mapping tools display area-level data to highlight different aspects of the lives of low-income older adults. This presentation will describe two of NCOA’s mapping tools and how they can influence policy and advocacy efforts toward aging equity at the local, regional, state, and national levels. The first tool, released in 2021, displays, in part, area-level access to smartphones and high-speed internet among low-income older adults. This map makes visible the invisible by demonstrating low rates of access even in geo-spatial areas with overall high levels of connectivity. The second tool, to be released in the third quarter of 2023, presents sub-state level data to identify gaps between area-level eligibility for each of three essential benefit programs [Supplemental Nutrition Assistance Program (SNAP)], Supplemental Security Income (SSI), and Medicare Savings Program (MSP)] and area-level enrollment rates. This map demonstrates how socio-spatial positions influence access to these national benefits, and how maps can be used to identify regions and communities to prioritize as part of strategic efforts to improve benefit access and promote aging equity.
