Medication use among Medicaid users of home and community-based services

This study examines factors associated with access to medications for older persons and younger adults with physical disabilities who use Medicaid home and community-based services (HCBS). Using data from a six-State survey, we find the large majority of this population receives the medications it needs and has needed assistance in taking these drugs. However, 6.3 percent of this population reports unmet medication needs with financial access listed as the primary reason. Lack of transportation increases the probability of unmet need, while increased satisfaction with paid help lowers this probability. This study highlights the need to study the interaction of Medicaid, social services programs, and financial barriers for this disabled population.     

Disability and food access and insecurity: A scoping review of the literature

A scoping review was conducted, using a social ecological model approach, of 106 articles examining the effect of disability on food access and (in)security. Results of the review show a consistently increased risk of food insecurity among people with disabilities with a higher risk for mental health disabilities, and among disabled younger adults. Mediators of this relationship were underexplored. Disability was mainly conceptualized as a problematic category preventing food access while ignoring disabling social and environmental barriers. A social model of disability can inform future research by acknowledging the role of socio-environmental influences on the production and experience(s) of disability.     

Public housing accommodations for individuals with disabilities

The federal Housing Act of 1962 as amended and the subsequent laws of accommodations insure that all groups within American society, including those with disabilities, have access to housing opportunities. In spite of the clear provisions of various laws of accommodations enacted after 1962, it is questionable whether disabled individuals are adequately served by resident programs operated by Public Housing Agencies (PHAs) because rates of poverty, unemployment, domestic violence, and suicide are much higher among people with disabilities than in the nondisabled population. There are approximately 5 million residents living in 2.5 public housing units nationwide. New York, Puerto Rico, Chicago, Philadelphia and Baltimore have the five largest PHAs in the country. In combination, they rent 320,000 of the 1,300,495 inventory of rental properties owned by the country's 3,400 PHAs. Elderly and disabled residents without children account for 43% of all public housing families in the country.     

The impacts of ageing on connection to nature: the varied responses of older adults

Access to nature is important for wellbeing at all ages with significant benefits for older adults. This paper explores the impacts of older adults’ age-related health conditions on nature connection, their responses to the changes and identifies the types of nature connections and greenspaces available to and prioritised by older adults. It is based on the experiences of 72 New Zealand older adults aged 65-99, living in family homes, down-sized homes and rest homes. Data were gathered through interviews, photographs and assessments of the natural features of their home environment. Nearly all participants experienced age-related changes in their ways of connecting with nature as living accommodation and especially health and mobility changed. Reduced mobility was the primary factor limiting nature experiences especially for frailer adults. In contrast, for ‘younger’ older adults, retirement can provide more time and opportunities to engage with nature. Nature connection opportunities are valued by nearly all adults irrespective of age and health. Accessible nature opportunities in the nearby and home environment should be available to all adults irrespective of health and accommodation type. Dedicated resources need to be provided to ensure these opportunities are present for the frailest whose opportunities to have direct contact with nature are frequently absent.     

Comparing the effectiveness of different types of supported housing for patients with chronic schizophrenia

This longitudinal study assessed the effectiveness of different types of supported housing recently established for patients with chronic schizophrenia in the East German region of Dresden. Survey data covering a 2-year period are reported for five patient subgroups (n=244) living in a psychiatric nursing home, in social therapeutic hostels, in sheltered community residential care, at home with family and alone in their own homes. Psychopathological symptoms, social disabilities, subjective quality of life, and normative individual needs for care were the relevant outcome domains assessed. For all subgroups, changes in the outcome parameters were rather small, from a clinical perspective, demonstrating deterioration, particularly for the older and more severely disabled group living in the nursing home. Results from linear variance analytical statistical models showed that group assignment played a significant role only for the baseline-controlled development of social disabilities and subjective quality of life. Contrasts between the groups outlined the disadvantage of homes and hostels in terms of subjective quality of life and the advantage of maintaining integration in family life in terms of social disabilities. These results support health policy decisions that would invest more deliberately in forms of supported housing that endeavour to improve patients’ autonomous functioning in their own flats, as well as providing assistance to families taking care of patients with chronic schizophrenia.

Health and housing among low-income adults with physical disabilities

The purpose of this study was to understand the impact of living environment on the health and access to health care of low-income working-age adults with physical disabilities. We conducted focus groups of participants with physical disabilities in the District of Columbia living in each of three housing situations (a homeless shelter, a nursing home, and an inaccessible house or apartment). Twenty-eight people participated in the focus groups. Most were male (79%) and African American (93%). Participants from a homeless shelter expressed concerns about accessibility and sanitation at the shelter. Nursing home participants expressed a need for privacy and autonomy that would foster consumer-directed care. Participants living in inaccessible apartments or houses worried about their ability to maintain daily living and social activities. Participants perceived barrier-free housing conditions to be a prerequisite for independent living and for ensuring their basic health and well-being.     

Carers' experiences of hospital discharge and continuing care in the community

This paper presents the findings of a study of carers' perspectives on discharge procedures and continuing care arrangements for adults aged 18–65 with physical and complex disabilities. Interviews were conducted with carers of people discharged from younger disabled units (YDUs) and hospital settings. The emphasis carers place on the need to be informed and involved in the discharge planning process is described, and the adequacy of continuing care arrangements from carers' perspectives is examined. The findings of the study raise issues for policy and practice about carers' needs, vis-à-vis patients, to be included as active participants in the discharge planning process.     

Local Medicaid Home- and Community-Based Services Spending and Nursing Home Admissions of Younger Adults

We used fixed-effect models to examine the relationship between local spending on home- and community-based services (HCBSs) for cash-assisted Medicaid-only disabled (CAMOD) adults and younger adult admissions to nursing homes in the United States during 2001 through 2008, with control for facility and market characteristics and secular trends. We found that increased CAMOD Medicaid HCBS spending at the local level is associated with decreased admissions of younger adults to nursing homes. Our findings suggest that states’ efforts to expand HCBS for this population should continue.Since the 1999 Olmstead decision,1 there has been a number of initiatives aimed to provide individuals with disabilities increased access to long-term care (LTC) options, primarily through expansion in home- and community-based services (HCBSs). Although research has investigated the effect of HCBS growth on the Medicare population of nursing home residents,2–9 there has been little attention given to the relationship between younger nursing home residents and Medicaid HCBS expenditures. As states face growing pressure in how to best allocate their Medicaid budgets, it is important that we have sound research guiding these decisions.Recently, a published study suggested that younger adults’ rates of nursing home admission were not related to Medicaid HCBS spending.10 Two prominent limitations may have led to this null finding: (1) rather than measuring spending for younger adults, the 2011 study used total state Medicaid LTC spending, and (2) the analyses were conducted at the state level, thereby missing market and facility characteristics influencing this relationship. We reexamined this question by using more refined data: Medicaid LTC spending on cash-assisted Medicaid-only disabled (CAMOD) adults at the local level and nursing home admission assessment data aggregated to the facility level. We hypothesized that increasing investment in Medicaid HCBSs for CAMOD adults would be related to a decrease in the share of younger adult nursing home admissions.     

The housing needs of disabled people

This paper presents the results from a study of the housing needs of disabled people in Shropshire. The study involved interviews with disabled people, representatives of a county-wide disabled people's organization, and staff from social services, housing and health agencies. A questionnaire was sent to a sample of disabled people in the county, and quantitative data were examined. The study highlighted: the high level of unmet housing need amongst disabled people, in relation to both adaptations and more appropriate housing; the need for more involvement by disabled people in the planning and provision of services; the need for greater flexibility within the housing regulations, so that services are more responsive to people's individual needs; and the inadequacy of the resources currently available to meet those needs.     

Physical activity for individuals living with a physical disability in Quebec: Issues and opportunities of access

BackgroundIndividuals living with a physical disability have reported difficulty in meeting their healthy living and leisure needs which could be a result of poor accessibility.ObjectiveThis qualitative study aimed to understand the relative accessibility of physical activity from the perspective of individuals living with a physical disability in Quebec, Canada.MethodsTwenty semi-structured interviews were conducted with current, past, non-members, and staff members of an adapted physical activity program. A qualitative approach with an inductive thematic analysis was used to interpret the data.ResultsWe identified five overarching themes focusing on participants’ experiences related to access: (i) physical activity opportunities; (ii) social interactions; (iii) relationships; (iv) infrastructure; (v) policies and public services. Participants highlighted that access to physical activity programming is shaped by a complex interaction of these overarching themes and their sub-themes.ConclusionsAccess to physical activity opportunities for individuals living with a physical disability cannot be understood in isolation from the broader public policies, infrastructure, social interactions, and relationships that shape their experiences. Policy makers and other health and recreational professionals must consider these broader factors when recommending or creating physical activity opportunities for individuals with physical disabilities.     

Access to health care, reproductive health and disability: a large scale survey in Sierra Leone

This is the first study to compare health status and access to health care services between disabled and non-disabled men and women in urban and peri-urban areas of Sierra Leone. It pays particular attention to access to reproductive health care services and maternal health care for disabled women. A cross-sectional study was conducted in 2009 in 5 districts of Sierra Leone, randomly selecting 17 clusters for a total sample of 425 households. All adults who were identified as being disabled, as well as a control group of randomly selected non-disabled adults, were interviewed about health and reproductive health. As expected, we showed that people with severe disabilities had less access to public health care services than non-disabled people after adjustment for other socioeconomic characteristics (bivariate modelling). However, there were no significant differences in reporting use of contraception between disabled and non-disabled people; contrary to expectations, women with disabilities were as likely to report access to maternal health care services as did non-disabled women. Rather than disability, it is socioeconomic inequality that governs access to such services. We also found that disabled women were as likely as non-disabled women to report having children and to desiring another child: they are not only sexually active, but also need access to reproductive health services. We conclude that disparity in access to government-supported health care facilities constitutes a major and persisting health inequity between persons with and without disabilities in Sierra Leone. Ensuring equal access will require further strengthening of the country's health care system. Furthermore, because the morbidity and mortality rates of pregnant women are persistently high in Sierra Leone, assessing the quality of services received is an important priority for future research.     

Self-esteem and women with disabilities

This study examines the sense of self of women with physical disabilities in terms of self-esteem, self-cognition (perceptions of how others see them), and social isolation. It was hypothesized that these variables mediate the relation of precursor variables (age, education, severity of disability, and childhood experiences, including overprotection, familial affection, and school environment) and outcomes (intimacy, employment, and health promoting behaviors). Data were gathered from a sample of 881 community-dwelling women in the USA, 475 with a variety of mild to severe physical disabilities, and 406 without disabilities. Correlation analyses indicated that the women with disabilities had significantly lower self-cognition and self-esteem, and greater social isolation than the women without disabilities, as well as significantly less education, more overprotection during childhood, poorer quality of intimate relationships, and lower rates of salaried employment. Path analysis indicated that each of the sense of self mediators was significantly related to the outcome of intimacy, that both social isolation and self-esteem were significantly related to health promoting behaviors, and that only self-esteem was significantly related to employment. Respondents who were older, less disabled, less educated, less over-protected, and had more affection shown in the home tended to feel that others saw them more positively. Women with positive school environments, less over-protection, and more affection in the home experienced less social isolation; age, education, and disability severity were not significantly related to social isolation. Older respondents with less disability, a more positive school environment, less over-protection, and more affection in the home tended to have greater self-esteem; education was not significantly related to self-esteem. Older respondents tended to report less intimacy. Younger, more educated, and less disabled respondents were significantly more likely to be employed. More highly educated respondents reported engaging in more health promoting behaviors.     

Program and policy issues affecting home and community-based long-term care use: findings from a qualitative study

This paper describes a qualitative study of factors affecting decisions about use of Medicaid-funded long-term care (LTC) services in Arkansas for the elderly (aged 65+), non-elderly adults with physical disabilities (aged 21-64), and adults with developmental disabilities (aged 18+). From focus groups with LTC service providers and key informant interviews with consumers and other decision-makers, three themes for improving LTC services emerged: (1) Leveling the playing field for home and community-based services (HCBS) and institutional services; (2) information dissemination and counseling; and (3) expanding services to meet unmet needs. Policy recommendations are made to improve access to HCBS.     

Injuries among US adults with disabilities

BACKGROUND: Injury prevention among individuals with disabilities is understudied. We compared the patterns of medically treated injuries among US adults with and without disabilities for clues to prevention. METHODS: We used nationally representative data from the 2004-2005 National Health Interview Survey to compare medically attended injuries within the past 3 months among noninstitutionalized adults in the United States with no disabilities, moderate disabilities, and severe disabilities. The association between disability and injuries was examined in logistic regression analysis, taking into account sociodemographic factors. RESULTS: The 3-month cumulative incidence of injuries was 2.3% (95% confidence interval [CI] = 2.2%-2.4%) among adults with no disabilities, 3.8% (3.4%-4.2%) among adults with moderate disabilities, and 5.6% (4.9%-6.3%) among adults with severe disabilities. Falls were the leading mechanism of injury regardless of disability status, and were even more common in the severely or moderately disabled adults (68% and 47% respectively, compared with 28% among those without disabilities). The setting of the injury also differed with disability status. For the severely disabled, 57% (CI = 52%-62%) of injury episodes occurred at home, compared with only 32% (28%-37%) for the moderately disabled and 23% (21%-25%) for adults with no disabilities. CONCLUSIONS: Adults with disabilities are at an increased risk for injury. Programs specifically directed toward injury prevention may benefit adults with disabilities.     

Social integration of the physically disabled in Barbados

An emergent concern with the rehabilitation and social integration of disabled people in developing nations has created a need to identify cultural beliefs and behaviors which may affect the integration of the disabled into normative social roles. The focus of this study is the social integration of physically disabled adults among the nonelite, colored population of Barbados, West Indies. This paper analyses the role participation of 30 physically disabled adults within the context of Barbadian beliefs and behaviors related to the disabled and to the 'normal' adult. Although village Barbadians do not expect the physically disabled to fulfill normative adult roles, some disabled individuals in this study do perform adult activities, such as maintaining employment and engaging in sexual relationships. However, very few of them participate in the reciprocal relationships among peers and neighbors through which village Barbadians achieve status and 'respect' as adults.     

Experiences and perceptions of residential and home care services among older lesbian women and gay men in Australia

The needs of older lesbian and gay people regarding access and use of aged‐care services remain underresearched. This paper reports the findings of 33 qualitative interviews with older lesbian women and gay men about their perceptions and experiences of residential aged‐care and home‐based aged‐care services in Australia. The focus of this paper is their preparedness for using aged‐care services. The results highlight that participants had a number of concerns related to accessing residential‐care services in particular, including perceptions of a lack of inclusivity and concerns of potential for discrimination and hostility, loss of access to community and partners, decreased autonomy and concerns relating to quality of care and the potential for elder abuse. Participants noted a number of strategies they employed in avoiding residential‐care services, including the use of home‐care services, renovating the home for increased mobility, moving to locations with greater access to outside home‐care services, a preference for lesbian/gay‐specific housing and residential‐care options if available, and the option of voluntary euthanasia to ensure dignity and autonomy. Participants, on the whole, were hopeful that they would never require the use of residential‐care services, with some believing that having current good health or the support of friends could prevent this from happening. The findings suggest that older lesbian and gay people have a variety of concerns with aged‐care and may need additional support and education to improve their perceptions and experiences of services, whether these are needed presently or in the future.     

Child and adult disability in the 2000 Census: Disability is a household affair

BackgroundSurvey data indicate that individuals with disabilities in the United States often experience less advantageous economic and social resources than individuals without disabilities. Furthermore, they often reside with other individuals with disabilities in the same household. However, less is known about resource availability when multiple child and adult household members have a disability.ObjectiveWe use child-level data from the 2000 Census to examine the relationship between aggregation of disability in households with children and education, labor force participation, poverty level, and inadequate housing.MethodsWe utilize tabular analysis and Kruskal–Wallis tests to examine how resources in education, employment, income, and housing adequacy compare for children with disabilities who are the only member of their household with a disability, children with disabilities who live in a household with at least one other member with a disability, children without disabilities who live in a household where no other member has a disability, and children without disabilities who live in a household where at least one other member has a disability.ResultsAmong children without a disability, 86% live in a household in which no other member has a disability. Among children with a disability, 53% live in a household in which no other adult or child has a disability. Poverty, inadequate housing, and low adult education were more than two times more likely – and adult unemployment over five times more likely – in households with multiple members with disability versus households without disability.ConclusionThere is a high prevalence of aggregation of adults and children with disability in households of children with disability. These households have substantially fewer resources than households who do not have children or adults with disabilities.     

Empowered to Play: A Case Study Describing the Impact of Powered Mobility on the Exploratory Play of Disabled Children

Exploratory play is one of the most vital ways in which children learn about their environment and develop. It is well documented that limited mobility restricts a child's ability to engage in their environment through exploratory play. In this study, a qualitative, collective case study design explored the impact of powered mobility on the exploratory play of two children with physical disabilities. Data were collected from the children, their parents and their siblings through participant observation and in‐depth, informal interviews. This paper focuses on two themes: Opportunity to Play revealed how powered mobility increased opportunities for the children to become more actively engaged in exploratory play with others across a wider array of contexts, and My Child was Transformed highlighted significant changes in the affect and motivation of each child, which seemed to be linked to their increased internal control over their play choices. The findings suggest that the provision of powered mobility is a key contributor promoting the participation of physically disabled children in exploratory play. Because of undergraduate curricular constraints, a limitation of this study was that data were only confined to 2 months; affecting the depth of data gained that prolonged engagement would have offered. The study recommends for occupational therapy practice that occupational therapists advocate for easier access to powered mobility through governmental and policy means. The study also recommends further research be conducted on the experiences of the caregivers on how these powered mobility devices have influenced their day‐to‐day occupations. Copyright © 2015 John Wiley & Sons, Ltd.     

Changes in life experiences of adults with intellectual disabilities in the COVID-19 pandemics in South Korea

BackgroundThe COVID-19 pandemic has had a significant impact on adults with intellectual disabilities who are dependent on community services.ObjectiveThis study explored the experiences of adults with intellectual disabilities from their perspective during the COVID-19 pandemic in South Korea, where most community-based services were suspended.MethodsWe conducted in-depth interviews with 15 adults with intellectual disabilities who lost access to services during COVID-19 pandemic. Inductive thematic analysis was conducted.ResultsFive overarching themes emerged: changes in (a) daily life, (b) health behaviors, (c) family relationships, (d) social relationships, and (e) social participation. Most participants experienced the loss of daily routines and healthy behaviors, family conflicts, and social isolation, but they also developed new ways of adapting and finding a new normal.ConclusionsThe findings offer valuable evidence of ways to develop and stabilize community-based services during a pandemic, with insights into the experiences of people with intellectual disabilities.