Access Barriers to and Unmet Needs for Home- and Community-Based Services Among Older Korean Americans

This cross-sectional survey study of 146 caregivers of older Korean Americans explored access barriers to and unmet needs for home- and community-based services (HCBS) programs (respite care, adult day care, personal care, home health, housekeeping, and transportation). Most often reported access barriers were lack of awareness and care recipient refusal. Predictors of unmet needs varied depending on the type of service, but included caregiver gender, relationship, education, caregiving duration, Medicaid coverage, English proficiency, caregiver self-efficacy, care recipient functional dependency, cognitive impairment, and caregiving hours. This study highlighted unmet needs for HCBS in Korean American communities, pointing to the pressing need for a collaborative effort to develop plans that modify and expand HCBS programs for older Korean Americans.     

Comparison of hospice use and demographics among European Americans,African Americans,and Latinos

The goals of this study were to compare the rate of use of hospice services and other relevant characteristics of European American, African American, and Latino hospice patients. Information on length of stay in hospice, marital status, age, disposition at termination, living situation, caregiver, referral source, and payment method was collected on patients who used hospice care in southern New Jersey between the years 1995 and 2001 (N = 1958). African Americans and Latinos were both found to use services at significantly lower rates than European Americans. In addition, African American use of hospice declined significantly during this time period, while European American use increased. Differences were also found among the groups in marital status, living situation, caregiver, referral source, and payment method. These differences highlight the need for hospice providers to recognize issues unique to minority groups. The reasons for these disparities need to be clarified by further research.     

An Outreach Intervention for Older Rural African Americans

This article describes the process, approaches, and selected outcomes of a rural care management outreach intervention for older African Americans in South Carolina. The model is a community-academic partnership between a federally qualified community health center, a rural health clinic, and the Medical University of South Carolina. Its aim is to improve access to and utilization of health care and social services to enhance the quality of life of older African Americans. This is being accomplished by using paid, trained outreach workers (called geriatric coordinators), who function as advocates in linking clients to needed health and social services through activities such as arranging transportation to health care, rescheduling missed medical appointments, providing health promotion, and making referrals to public benefits and indigent drug programs. Outcomes demonstrated that the use of geriatric coordinators as care managers is a feasible way of increasing quality of life for older African Americans. The most notable outcome showed that 54% of clients who were eligible but not receiving benefits prior to this intervention were signed on for programs such as Supplemental Security Income, Specified Low-Income Medicare Beneficiary (SLMB), Qualified Medicare Beneficiary (QMB), disability, railroad pensions, and Veterans Administration benefits. Health centers realized an increase in reimbursable services and new clients. Increased capacity for older adult services is being accomplished through geriatric-coordinator-directed collaborations with social service agencies and participation in community events and committees.     

Access barriers to and unmet needs for home- and community-based services among older korean americans

This cross-sectional survey study of 146 caregivers of older Korean Americans explored access barriers to and unmet needs for home- and community-based services (HCBS) programs (respite care, adult day care, personal care, home health, housekeeping, and transportation). Most often reported access barriers were lack of awareness and care recipient refusal. Predictors of unmet needs varied depending on the type of service, but included caregiver gender, relationship, education, caregiving duration, Medicaid coverage, English proficiency, caregiver self-efficacy, care recipient functional dependency, cognitive impairment, and caregiving hours. This study highlighted unmet needs for HCBS in Korean American communities, pointing to the pressing need for a collaborative effort to develop plans that modify and expand HCBS programs for older Korean Americans.     

Caregivers' unmet needs for support in caring for functionally impaired elderly persons: a community sample

Few estimates have been made of the extent to which the needs of caregivers are met. In addition to the inadequate capacity of services, many caregivers lack adequate financial resources, social resources, or other means to access them. Caregivers who provide services to minority or poor elderly may be particularly needy since their care receivers tend to be less healthy and are less likely to use institutional facilities. To address this issue, the authors studied a community sample of 124 caregivers who identified correlates of their perceived unmet caregiver needs and their use of supportive services available for their caregiving. Results indicated that 51.8 percent of women and 67.4 percent of men reported needs for one or more community services that were not met. It was concluded that caregivers who are poor or who required financial assistance are at the highest risk for needing assistance while providing caregiving services. Community services may more effectively target potential needs of caregivers through routine screenings.     

Sudden cardiac death in Hispanic Americans and African Americans.

OBJECTIVES: The goal of this study was to estimate rates of sudden cardiac death in US Hispanics and African Americans. METHODS: Data on coronary deaths occurring outside of the hospital or in emergency rooms were examined for 1992. RESULTS: In 1992, 53% (8194) of coronary heart disease deaths among Hispanic Americans 25 years of age and older occurred outside of the hospital or in emergency rooms. The percentage was lower among Hispanics than among non-Hispanic Whites and Blacks. Age-adjusted rates per 100,000 were lower in Hispanics than in non-Hispanic Whites or Blacks (Hispanic men, 75; White men, 166; Black men, 209; Hispanic women, 35; White women, 74; Black women, 108). The percentages dying outside of the hospital or in emergency rooms were higher in young persons, those living in nonurban areas, and those who were single. CONCLUSIONS: The percentage and rate of coronary deaths occurring outside of the hospital or in emergency rooms were lower in Hispanics than in non-Hispanics; African Americans had the highest rates. Further research is needed on sudden coronary death in Hispanic Americans and African Americans.     

Evidence to support church-based health promotion programmes for African Canadians at risk for cardiovascular disease

High quality management of cardiovascular disease is a critical health issue for people of African descent as this group is more likely than the general population to have greater coexisting cardiovascular comorbidities. The higher than average rates of cardiovascular conditions among Black populations are a cause for concern. In an effort to combat the disproportionate number of African Americans experiencing cardiovascular conditions a significant number of churches within the African American community have initiated health promotion programmes and/or services. Health organisations and agencies in the United States are keen to support and encourage these programmes for cardiovascular disease risk populations (i.e. African Americans and other minority groups, such as the Hispanic community). Indeed these health organisations and agencies recognise the need to promote healthier habits among African Americans and other minority groups as statistics continue to show health disparities among these populations within the US health care system. This paper attempts to encourage Canadian health agencies, organizations and practitioners to support similar CBHPPs initiatives for the African Canadian population. The historical significance of the church in Black Canadian communities is also examined.     

Early Life Predictors of Adult Depression in a Community Cohort of Urban African Americans

Depression among African Americans residing in urban communities is a complex, major public health problem; however, few studies identify early life risk factors for depression among urban African American men and women. To better inform prevention programming, this study uses data from the Woodlawn Study, a well-defined community cohort of urban African Americans followed from age 6 to 42 years, to determine depression prevalence through midlife and identify childhood and adolescent risk factors for adult depression separately by gender. Results indicate that lifetime depression rates do not differ significantly by gender (16.2 % of men, 18.8 % of women) in contrast to findings of a higher prevalence for women in national studies. Furthermore, rates of depression in this urban African American population are higher than those found in national samples of African Americans and more comparable to the higher rates found nationally among Whites. Regarding early predictors, for both men and women, family conflict in adolescence is a risk factor for adult depression in multivariate regression models. For women, vulnerability to depression has roots in early life, specifically, low maternal aspirations for school attainment. Females displaying more aggressive and delinquent behavior and those growing up in a female-headed household and a household with low maternal education have elevated rates of depression. Males growing up in persistent poverty, those engaging in greater delinquent behavior, and those with low parental supervision in adolescence also have elevated rates of depression. Effective prevention programming for urban African Americans must consider both individual characteristics and the family dynamic.     

Opinions of African Americans about tobacco industry philanthropy

OBJECTIVES: To investigate African Americans' opinions about the philanthropic contributions of the tobacco industry to Black organizations. METHODS: One thousand African Americans were randomly selected using a stratified cluster sample design of 10 U.S. congressional districts represented by African Americans. RESULTS: Almost two-thirds of African Americans favored accepting tobacco industry philanthropy as long as the recipients do not support smoking. A majority agreed that the tobacco industry gives money to African American communities to improve its image (71.2%), make money (83.2%), and to encourage people to smoke (60.5%). About one-third stated they believed it gave money to help the community (34.4%). Multiple logistic regression showed that women, the college educated, and current smokers were significantly (p<0.05) more likely to favor accepting tobacco industry philanthropy. Multiple logistic regression revealed significant differences by education, smoking status, and selective attitudinal and behavioral variables with regard to tobacco industry philanthropy. The 18-34 age group was significantly less likely to agree that the tobacco industry gives money to help the community, with or without covariate adjustment. CONCLUSION: Results of this study are important because despite the perceived benefits to these communities, tobacco industry contributions could mitigate community concerns about tobacco-related diseases, mask their significance, and undermine tobacco control strategies and policies.     

Delivery Complications Associated With Prenatal Care Access for Medicaid-Insured Mothers in Rural and Urban Hospitals

CONTEXT: Pregnancy complications affect many women. It is likely that some complications can be avoided through routine primary and prenatal care of reasonable quality. PURPOSE: The authors examined access to health care during pregnancy for mothers insured by Medicaid. The access indicator is potentially avoidable maternity complications (PAMCs). Potentially avoidable maternity complications are often preventable through routine prenatal care, such as infection screening and treatment. The authors examined the risks of potentially avoidable maternity complications among rural and urban hospital deliveries for groups of mothers defined by race or ethnicity. METHODS: Data are from the year 2000 Nationwide Inpatient Sample (NIS). The stratified sample represents all discharges from 20.5% of community hospitals in the United States. The Nationwide Inpatient Sample identifies hospital locations, but not patients' areas of residence. Analyses, which accounted for the sample design, included calculation of potentially avoidable maternity complication rates by race or ethnicity, chi2, t tests, and multivariate logistic regression. FINDINGS: Within groups defined by race or ethnicity, unadjusted rates for potentially avoidable maternity complications did not differ significantly by hospital location. Holding other factors constant, potentially avoidable maternity complications were less common in rural hospitals than in urban hospitals (odds ratio, 0.78; CI, 0.62 to 0.99). In rural hospitals, African Americans had notably higher risk for potentially avoidable maternity complications than did non-Hispanic whites (odds ratio, 1.72; CI, 1.26 to 2.36). In urban hospitals, risk of potentially avoidable maternity complications was not significantly higher for African Americans. Hispanics and Asians had notably lower risks of potentially avoidable maternity complications in urban hospitals than did non-Hispanic whites. CONCLUSIONS: Providers and policymakers should work to reduce the risks of potentially avoidable maternity complications for African American women in rural areas who are insured by Medicaid.     

Prenatal Care Utilization Among Non-Hispanic Whites,African Americans,and Mexican Americans

Objectives: The general objective of this study is to explain differentials in prenatal care (PNC) utilization in a nationally representative sample of non-Hispanic White (Anglo), African American, and Mexican American women. Method: The analysis is based on the National Maternal and Infant Health Survey. Multivariate, multinomial logistic regression models were employed to adjust for demographic, socioeconomic, medical risk, and program participation factors, as well as for perceived barriers. Both race/ethnic-specific models and models with race/ethnicity as a covariate were estimated. Results: Inadequate PNC use was much less common among Anglos (10.4%) as compared to African Americans and Mexican Americans (22.1% and 25.0%, respectively). In fully adjusted models, the odds ratio (OR) of African Americans receiving inadequate PNC was 1.46, while the risk for Mexican Americans was greater (OR = 1.93). Perception of obstacles to PNC access doubled the odds of receiving inadequate care, but this psychosocial variable had little impact on race/ethnic differentials. Race/ethnic-specific models uncovered potentially important racial/ethnic variations associated with perception of barriers, marital status, and program participation. Conclusions: Although the same risk factors sometimes have different effects across race/ethnic groups, and while certain findings indicate a beneficial impact of health outreach efforts and program participation, our findings support the conclusion that PNC utilization continues to be stratified along race/ethnic lines.     

The contribution of insurance coverage and community resources to reducing racial/ethnic disparities in access to care

OBJECTIVE: To examine the extent to which health insurance coverage and available safety net resources reduced racial and ethnic disparities in access to care. DATA SOURCES: Nationally representative sample of 11,692 African American, 10,325 Hispanic, and 74,397 white persons. Nonelderly persons with public or private health insurance and those who were uninsured. STUDY DESIGN: Two cross-sectional surveys of households conducted during 1996-1997 and 1998-1999. DATA COLLECTION: Commonly used measures of access to and utilization of medical care were constructed for individuals. These measures include the following. (1) percent reporting unmet medical needs, (2) percent without a regular health care provider, and (3) no visit with a physician in the past year. FINDINGS: More than 6.5 percent of Hispanic and African Americans reported having unmet medical needs compared to less than 5.6 percent of white Americans. Hispanics were least likely to see the same doctor at their usual source of care (59 percent), compared to African Americans (66 percent) and whites (75 percent). Similarly, Hispanics were less likely than either African Americans or whites to have seen a doctor in the last year (65 percent compared to 76 percent or 79 percent). For Hispanics, more than 80 percent of the difference from whites was due to differences in measured characteristics (e.g., insurance coverage, income, and available safety net services). Differences in measured characteristics between African Americans and whites explained less than 80 percent of the access disparities. CONCLUSION: Lack of health insurance was the single most important factor in white-Hispanic differences for all three measures and for two of the white-African American differences. Income differences were the second most important factor, with one exception. Community characteristics generally were much less important, with one exception. The positive effects of insurance coverage in reducing disparities outweigh benefits of increasing physician charity care or access to emergency rooms.     

Disability and Care Needs Among Older Americans

Context

The cost of late-life dependency is projected to grow rapidly as the number of older adults in the United States increases in the coming decades. To provide a context for framing relevant policy discussions, we investigated activity limitations and assistance, care resources, and unmet need for a national sample of older adults.

Methods

We analyzed the 2011 National Health and Aging Trends Study, a new national panel study of more than 8,000 Medicare enrollees.

Findings

Nearly one-half of older adults, or 18 million people, had difficulty or received help in the last month with daily activities. Altogether, 1 in 4 older adults receiving help lived in either a supportive care (15%) or a nursing home (10%) setting. Nearly 3 million received assistance with 3 or more self-care or mobility activities in settings other than nursing homes, and a disproportionate share of persons at this level had low incomes. Nearly all older adults in settings other than nursing homes had at least 1 potential informal care network member (family or household member or close friend), and the average number of network members was 4. Levels of informal assistance, primarily from family caregivers, were substantial for older adults receiving help in the community (164 hours/month) and living in supportive care settings (50 hours/month). Nearly all of those getting help received informal care, and about 3 in 10 received paid care. Of those who had difficulty or received help in settings other than nursing homes, 32% had an adverse consequence in the last month related to an unmet need; for community residents with a paid caregiver, the figure was nearly 60%.

Conclusions

The older population—especially those with few economic resources—has substantial late-life care needs. Policies to improve long-term services and supports and reduce unmet need could benefit both older adults and those who care for them.     

Racial and Ethnic Disparities in the Use of Mental Health Services

The authors used data from the 1998-1999 Community Tracking Study (CTS) household survey to examine variations in predictors of use of mental health services among different racial and ethnic groups (white, African American, Hispanic, and other). African Americans and Hispanics were less likely to have visited a mental health professional (MHP) in the prior year than were whites. Independent of health insurance and health status, low- to middle-income African Americans may be at particular risk for inadequate use of an MHP compared to higher-income African Americans. Similarly, upper-income Hispanics were more likely to have visited an MHP than Hispanics in the lowest income range. Adults aged 50 and older were less likely to visit an MHP than individuals aged 18-49. Depressed men were more likely to visit an MHP than depressed women. Efforts to reduce disparities should focus on lower-income racial and ethnic minorities.     

Psychiatric home care of elderly persons with depression: unmet caregiver needs

The purpose of this study was to explore what nursing interventions are currently being provided to family caregivers of elderly persons with depression as a part of standard home health care; and identify unmet needs of these family caregivers. Unmet caregiver needs were examined from both the family caregiver and staff nurse perspective, using caregiver structured interviews and staff focus groups. Ten caregivers participated in structured interviews and nine staff nurses participated in three focus groups. Caregivers reported unmet needs concerning support and respite, dealing with their own feelings, learning more about care-related tasks and role changes, and stress management. Similarly, nurses speculated that nursing interventions should focus on increased counseling, family and community support, assisting caregivers with their learning needs and care-related responsibilities. These findings contribute toward a better understanding of interventions currently provided to caregivers of depressed elderly persons, as a part of standard psychiatric home care; identify unmet caregiver needs; and suggest areas for future psychiatric research in home care settings.     

Support for family caregivers: what do service providers say about accessibility,availability and affordability of services?

This paper reports on a survey of providers of caregiver support services in Singapore ( N  =   36). The overall aim of the survey was to provide feedback to service planners and programme staff on the delivery of services to caregivers and opportunities for improvement. A questionnaire, comprising both closed and open-ended questions, was used to collect data. The results showed that most health and social service providers offer counselling, case management, caregiver assessment, financial assistance and information. A minority provide emergency, short-stay respite care and day care. About one in three provide transportation services, which featured as a barrier to service utilisation. Other barriers identified were time commitments, lack of awareness of services, cost of care, caregivers' sense of responsibility, lack of alternate care arrangements and distrust. The survey also characterises the hard-to-reach caregivers as homebound, illiterate, socially shy and isolated, of low income and poorly educated. Most service providers emphasise that financial support is necessary in order to improve the prospects of family caregivers.     

Improving dementia care through community linkages: a multi-site demonstration project.

The purpose of the multi-site project was to develop and implement a model for dementia care which improved linkages of caregivers to community services. Key components of the model included a single point of informational contact, provider education, case-finding, caregiver education and support, internal linkages, and linkages with community services. The model was implemented at six medical centers. Outcome measures included caregiver, provider, and community agency satisfaction. Caregivers reported high satisfaction with information provided to them about community resources. Primary care providers reported that dementia services had improved from one year earlier. Community agencies reported high satisfaction with the dementia program initiatives.     

Geography Should Not Be Destiny: Focusing HIV/AIDS Implementation Research and Programs on Microepidemics in US Neighborhoods

African Americans and Hispanics are disproportionately affected by the HIV/AIDS epidemic. Within the most heavily affected cities, a few neighborhoods account for a large share of new HIV infections.Addressing racial and economic disparities in HIV infection requires an implementation program and research agenda that assess the impact of HIV prevention interventions focused on increasing HIV testing, treatment, and retention in care in the most heavily affected neighborhoods in urban areas of the United States.Neighborhood-based implementation research should evaluate programs that focus on community mobilization, media campaigns, routine testing, linkage to and retention in care, and block-by-block outreach strategies.Although HIV incidence in the United States has remained relatively stable since the mid-1990s, rates among African Americans and Hispanics are 8 and 3 times those among Whites, respectively.1 Approximately 65% of new HIV infections in the United States occur in non-White populations. Individual behavioral risk factors, including unprotected sex and substance use, do not fully explain racial disparities in HIV infection; minority populations do not engage in higher rates of HIV risk behaviors than individuals of other races.2     

Influence of Place of Residence in Access to Specialized Cancer Care for African Americans

Context: Disparities in cancer care for rural residents and for African Americans have been documented, but the interaction of these factors is not well understood.
Purpose: The authors examined the simultaneous influence of race and place of residence on access to and utilization of specialized cancer care in the United States.
Methods: Access to specialized cancer care was measured using: (1) travel time to National Cancer Institute (NCI) Cancer Centers, academic medical centers, and any oncologist for the entire continental US population, and (2) per capita availability of oncologists for the entire United States. Utilization was measured as attendance at NCI Cancer Centers, specialized hospitals, and other hospitals in the Surveillance, Epidemiology, and End Results (SEER) program Medicare population from 1998-2004.
Findings: In urban settings, travel times were shorter for African Americans compared with Caucasians for all three cancer care settings, but they were longer for rural African Americans traveling to NCI Cancer Centers. Per capita oncologist availability was not significantly different by race or place of residence. Urban African American patients were almost 70% more likely to attend an NCI Cancer Center than urban Caucasian patients (OR = 1.66; 95% CI 1.51-1.83), whereas rural African American patients were 58% less likely to attend an NCI Cancer Center than rural Caucasian patients (OR = 0.42; 95% CI 0.26-0.66).
Conclusions: Urban African Americans have similar or better access to specialized cancer care than urban Caucasians, but rural African Americans have relatively poor access and lower utilization compared with all other groups.     

Diabetes-related mortality among Mexican Americans, Puerto Ricans, and Cuban Americans in the United States.

OBJECTIVES: Hispanics are the most rapidly growing minority group in the United States, and Mexican Americans, Puerto Ricans and Cuban Americans are the three largest Hispanic subgroups. Among Hispanics, type 2 diabetes is the fifth leading cause of death. This paper examines diabetes-related mortality in Mexican Americans, Puerto Ricans, and Cuban Americans over 35 years of age in the United States during 1996 and 1997. METHODS: Using data from the National Vital Statistics System and the 1990 and 2000 censuses, we calculated age-adjusted and age-specific diabetes-related death rates for Mexican Americans, Puerto Ricans, and Cuban Americans over 35 years of age. Diabetes-related deaths were determined to be any death for which diabetes was coded as either the underlying or contributing cause of death. RESULTS: The diabetes-related mortality rate for Mexican Americans (251 per 100,000) and Puerto Ricans (204 deaths per 100,000) was twice as high as the diabetes-related mortality rate for Cuban Americans (101 deaths per 100,000). Cuban American decedents had the highest proportion of deaths with diabetes coded as the underlying cause of death (44%). After diabetes, heart disease (31%) followed by cancer (8%) and stroke (6%) were the most frequent primary underlying causes of diabetes-related deaths in all three ethnic groups. CONCLUSION: Our analyses of these data demonstrate that diabetes-related mortality differed among Mexican Americans, Puerto Ricans and Cuban Americans more than 35 years of age in the United States in 1996 and 1997. Socioeconomic factors such as low educational attainment and low income may be factors that contributed to the disparities in these mortality rates for different subgroups. Further research is needed to update these findings and to investigate explanatory risk factors. Diversity among Hispanic subgroups has persisted in recent years and should be considered when health policies and services targeted at these populations are developed.