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The contribution of managed long-term services and supports to aging in place: an evaluation of the use of attendant care services to avoid nursing facility admissions

Tramujas Vasconcellos Neumann, Lycia (2019) The contribution of managed long-term services and supports to aging in place: an evaluation of the use of attendant care services to avoid nursing facility admissions. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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More than 13 million individuals in the US use long-term-services and supports (LTSS) to help them with daily activities they cannot perform by themselves, and Medicaid is the primary payer. Recently, Medicaid Managed Long Term Services and Supports (MLTSS) programs have spread, and enrollment reached 1.8 million in 2017. In MLTSS programs, participants are eligible for benefits that include home and community-based services (HCBS), such as personal/attendant care services. These services can enable older adults to continue living in their homes, maintaining their independence and community participation. This dissertation investigated (1) the effectiveness of attendant care (AC) services to avoid long-term institutionalization of older adults, when provided as part of an MLTSS program; and (2) whether the dosage and type of attendant care influence the results of AC. Using enrollment and claims data of 491 community-dwelling older adults enrolled in an MLTSS program for at least six months, multivariate logistic regression was used to test the association between long-stay nursing facility (LSNF) admissions (>=90 days) and the use of AC services. Findings confirmed the hypothesis that those receiving AC services are less likely to have LSNF admissions. Participants with attendant care had at least 75 percent lower odds of an LSNF admission than those who did not receive AC services. As the dosage increases, the odds of LSNF decreased, with those receiving 5h/day or more of AC services being 81 percent less likely of having an LSNF admission than those with no AC. In addition, participants who used only self-directed AC services (where care recipients choose and hire their care providers) were 93 percent less likely to have an LSNF admission than those receiving no AC services, and 23.5 percent less likely to have this outcome than those who received only agency AC services. These preliminary findings give a basis for policy and program discussions about MLTSS resources allocation, as they demonstrated the public health importance of attendant care services in the context of increasing demand for LTSS and older adults’ desire to age in place.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Tramujas Vasconcellos Neumann, Lycialyt8@pitt.edulyt80000-0001-7875-0336
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairDocumet, Patricia
Committee MemberAlbert, Steven
Committee MemberBryce, Cindy
Committee MemberEgan, James
Committee MemberHawk, Mary
Committee MemberKilgore,
Date: 27 June 2019
Date Type: Publication
Defense Date: 8 April 2019
Approval Date: 27 June 2019
Submission Date: 27 March 2019
Access Restriction: 3 year -- Restrict access to University of Pittsburgh for a period of 3 years.
Number of Pages: 117
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Behavioral and Community Health Sciences
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Long-Term Care, MLTSS, Aging, Attendant Care,
Date Deposited: 27 Jun 2019 20:01
Last Modified: 01 May 2022 05:15


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