D. Aging & Disability (The Hilltop Institue, UMBC)

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    Nursing Home Characteristics and Resident Quality of Care Outcomes: A Scoping Review of Recent Empirical Research
    (LSE Press, 2024-05-01) Millar, Roberto J.; Diehl, Christin; Blake, Elizabeth; Fakeye, Oludolapo; Kusmaul, Nancy
    Context: Nursing facilities are an essential part of the long-term care continuum, providing a setting where older adults and persons with disabilities receive critical services and supports. Despite extensive research linking facility characteristics to resident outcomes, the facility and resident factors under investigation vary in the context of a diverse industry landscape and poor understanding of key quality of care outcomes.Objectives: This scoping review focused on identifying key concepts, summarising existing findings, and identifying gaps in research linking nursing facility characteristics and resident outcomes.Methods: Guided by PRISMA-ScR guidelines, this scoping review focused on empirical, English-language research published in five databases between 2005 and 2022. The research studies meeting specified inclusion criteria were subjected to thematic analysis for the extraction of key concepts and synthesis of findings.Findings: The 91 research studies in the final analytic sample conceptualised facility-level characteristics and resident outcomes using six and nine broad domains, respectively. The subcategories making up these discrete domains varied widely across studies. While evidence of linkages between facility environments and resident outcomes varied, there was general support that higher staffing capacity and home-like environments with support for autonomy and social integration were linked to better functional outcomes and higher overall subjective well-being of residents.Implications: It is imperative to understand how facility-level characteristics influence resident outcomes, and this scoping review provides insight into these complex relationships. A better understanding of this area is key to improving policies and regulatory oversight, as well as more broadly inform data driven decision-making.
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    A Facility-Level Analysis of Nursing Home Compare Five Star Rating and Maryland’s Family Satisfaction with Care Survey Get access Arrow
    (Oxford University Press, 2023-12-18) Kusmaul, Nancy; Millar, Roberto J; Diehl, Christin; Stockwell, Ian
    Background and Objectives: Nursing facilities care for individuals with cognitive and/or physical disabilities. Poor quality is associated with greater disease and mortality. Quality comprises many factors and different stakeholders value different factors. This study aimed to compare two care quality frameworks, one based on observable factors and one on family satisfaction. Research Design and Methods: We merged publicly available 2021 Maryland nursing facility data. The Maryland Health Care Commission surveys long-term care residents’ family satisfaction across seven domains. CMS’ five-star ratings aggregate inspections, staffing, and quality measures. We used univariate and bivariate statistics to compare the frameworks. Results: The dataset included 220 facilities and 4,610 survey respondents. The average facility rating was 7.70/10 and overall 77% of respondents would recommend the facility. Eighty-six percent of respondents from 5-star facilities, 79% from 4-star facilities, and 76% from 3-star facilities would recommend the facility compared to 65% from 1-star facilities (p < 0.001, p < 0.01 and p < 0.05, respectively). Four or 5-star facilities received significantly higher ratings (8.33, p < 0.001; 7.75, p < 0.05, respectively) than 1-star facilities (7.07). Discussion and Implications: Our results corroborated earlier findings of strong associations between CMS ratings and satisfaction at the extremes of the five-star system. These associations are inconsistent across family-reported domains. This suggests overlap between the frameworks. CMS ratings address care quality; family satisfaction measures quality of life and care quality. High satisfaction is associated with high care quality and quality of life; lower satisfaction is associated with lower care quality.
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    The Role of Dementia and Residential Service Agency Characteristics in the Care Experiences of Maryland Medicaid Home and Community-Based Service Participants and Family and Unpaid Caregivers
    (Sage, 2022-10-06) Fabius, Chanee; Millar, Roberto; Geil, Erick; Stockwell, Ian; Diehl, Christin; Johnston, Deirdre; Gallo, Joseph J.; Wolff, Jennifer L
    In Maryland, residential service agencies deliver Medicaid Home and Community-Based Services (HCBS) to older adults with disabilities through direct care workers (e.g., personal care aides). Leveraging survey data from residential service agency administrators, linked to interRAI Home Care assessments for 1144 participants, we describe agency characteristics, and participant and family caregiver experiences by participant dementia status. Most (61.7%) participants experienced low social engagement, and roughly 10.0% experienced a hospitalization or emergency room visit within 90 days. Few (14.4%) participants were served by agencies requiring dementia-specific direct care worker training, and most were served by agencies offering supplemental services, or in which direct care workers helped with health information technology (81.2% and 72.8%, respectively). Few caregivers reported negative care experiences. Participants with dementia and those served by agencies with training and support more often reported negative care experiences. Findings lay the foundation for future longitudinal and embedded interventions within Medicaid HCBS.
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    Summary Report: Assistance in Community Integration Services (ACIS) Program Assessment, CY 2018 to CY 2021
    (The Hilltop Institute, 2023-09-15) The Hilltop Institute
    Assistance in Community Integration Services (ACIS) is a pilot program that is operated under Maryland’s §1115 demonstration waiver for HealthChoice, the state’s Medicaid managed care program launched in 1997. Under this pilot, the state provides a set of home and community-based services (HCBS) to a population that meets certain needs-based health and housing eligibility criteria. This summary report discusses ACIS program goals, eligibility criteria, services, and participating lead entities, followed by the study objectives, research methodology, key findings, and study limitations.
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    Medicaid Long-Term Services and Supports in Maryland: FY 2017 to FY 2021, Nursing Facility Services. A Chart Book.
    (The Hilltop Institute, 2023-05-01) The Hilltop Institute
    This chart book explores utilization and expenditures for Medicaid-funded LTSS in Maryland for state fiscal years (FYs) 2017 through 2021. The focus of this chart book is on Medicaid nursing facility services, with one chapter that illustrates Maryland’s efforts at providing home and community-based services (HCBS) to an increasing number of Medicaid recipients who may otherwise be served in nursing facilities.
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    Family Supports Waiver Infographic: FY 2019 to FY 2020
    (The Hilltop Institute, 2022-10-01) The Hilltop Institute
    The Family Supports Waiver (FSW) provides community-based services and supports to individuals aged 21 years or younger with developmental or intellectual disabilities. Implemented on January 1, 2018,* this waiver includes both self-directed and traditional service delivery models.
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    Community Supports Waiver Infographic: FY 2019 to FY 2020
    (The Hilltop Institute, 2022-10-01) The Hilltop Institute
    The Community Supports Waiver (CSW) provides community-based services and supports to individuals of all ages with developmental or intellectual disabilities. Implemented on January 1, 2018,* the waiver includes both self-directed and traditional delivery models.
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    Community Pathways Waiver Infographic: FY 2016 to FY 2020
    (The Hilltop Institute, 2022-07-01) The Hilltop Institute
    The Community Pathways Waiver provides community-based services and supports to individuals with developmental or intellectual disabilities. The waiver includes both self-directed and traditional service delivery models.
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    Autism Waiver Registry Data Infographic: FY 2018 to FY 2022
    (The Hilltop Institute, 2022-10-01) The Hilltop Institute
    The Autism Waiver enables individuals who have autism spectrum disorder and who meet an institutional level of care to be supported in their own homes or community-based settings. Due to the high demand for Autism Waiver services and a defined capacity, individuals wishing to receive waiver services must have their name placed on the Autism Waiver Registry. As waiver capacity permits, invitations to apply are sent to interested families as their names approach the top of the registry list. Once individuals turn 21, the Maryland Department of Health provides notification that they will be removed from the registry.
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    Medicaid Long-Term Services and Supports in Maryland: FY 2014 to FY 2018, Nursing Facility Services. A Chart Book.
    (The Hilltop Institute, 2021-01-21) The Hilltop Institute
    This is the first chart book in a series that explores utilization and expenditures for Medicaid-funded LTSS in Maryland for state fiscal year (FY) 2014 through FY 2018. The focus of this chart book is on Medicaid nursing facility services, with one chapter that illustrates Maryland’s efforts at providing home and community-based services (HCBS)* to an increasing number of Medicaid recipients who may otherwise be served in nursing facilities.
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    Medicaid Long‐Term Services and Supports in Maryland: The Model Waiver Infographic, FY 2014 to FY 2019
    (The Hilltop Institute, 2021-09-01) The Hilltop Institute
    The Model Waiver provides services to individuals with medically complex needs and a chronic hospital or nursing facility level of care to be supported in their own homes or community-based setting. A unique aspect of the Model Waiver is that, due to the medically complex needs of its participants, non-waiver expenditures typically far exceed waiver expenditures.
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    Medicaid Long‐Term Services and Supports in Maryland: The Brain Injury Waiver, FY 2014 to FY 2019
    (The Hilltop Institute, 2021-09-01) The Hilltop Institute
    The Brain Injury (BI) Waiver provides services to individuals aged 22 or older with a brain injury diagnosis who require specialty hospital or nursing facility level of care to be supported in their own homes or community-based setting. Each year, the Maryland Department of Health strives to serve an additional ten participants through the BI Waiver. This infographic provides a brief overview of Hilltop’s review of the program.
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    Autism Waiver Registry Data, FY 2018 to FY 2021
    (The Hilltop Institute, 2021-10-01) The Hilltop Institute
    Autism Waiver services enable individuals who have autism spectrum disorder and who meet an institutional level of care to be supported in their own homes or community-based settings. Due to the high demand for Autism Waiver services and a defined capacity, individuals wishing to receive waiver services must have their name placed on the Autism Waiver Registry. As waiver capacity permits, invitations to apply are sent to interested families as their names approach the top of the list. Once individuals turn 21, the Maryland Department of Health provides notification that they will be removed from the registry.
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    Annual Report to UMBC, 2020 – 2021
    (The Hilltop Institute, 2021-11-30) The Hilltop Institute
    The mission of The Hilltop Institute at UMBC is to advance the health and wellbeing of people and communities through research and analysis. We conduct cutting-edge data analytics and translational research on behalf of government agencies, foundations, and nonprofit organizations to inform public policy at the national, state, and local levels. This annual report covers two years of activities: FY 2020 and FY 2021.
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    Medicaid Long‐Term Services and Supports in Maryland: The Brain Injury Waiver, FY 2016 to FY 2020
    (The Hilltop Institute, 2022-07-01) The Hilltop Institute
    The Brain Injury (BI) Waiver provides services to individuals aged 22 or older with a brain injury diagnosis who require specialty hospital or nursing facility level of care to be supported in their own homes or community-based settings. Each year, the Maryland Department of Health strives to serve an additional ten participants through the BI Waiver. This infographic presents information for fiscal years (FYs) 2016 through 2020.
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    Medicaid Long‐Term Services and Supports in Maryland: The Model Waiver. FY 2016 to FY 2020.
    (The Hilltop Institute, 2022-07-01) The Hilltop Institute; The Hilltop Institute
    The Model Waiver provides services to individuals with medically complex needs and a chronic hospital or nursing facility level of care to be supported in their own homes or community-based settings. A unique aspect of the Model Waiver is that, due to the medically complex needs of its participants, non-waiver expenditures typically far exceed waiver expenditures. This infographic provides information for fiscal years (FYs) 2016 through 2020.
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    Medicaid Long‐Term Services and Supports in Maryland: The Brain Injury Waiver. FY 2016 to FY 2020,
    (The Hilltop Institute, 2022-07-01) The Hilltop Institute; The Hilltop Institute
    The Brain Injury (BI) Waiver provides services to individuals aged 22 or older with a brain injury diagnosis who require specialty hospital or nursing facility level of care to be supported in their own homes or community-based settings. Each year, the Maryland Department of Health strives to serve an additional ten participants through the BI Waiver. This infographic presents information for fiscal years (FYs) 2016 through 2020.
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    Medicaid Long‐Term Services and Supports in Maryland: The Autism Waiver: FY 2016 to FY 2020
    (The Hilltop Institute, 2022-07-01) The Hilltop Institute; The Hilltop Institute
    Autism Waiver services enable individuals who have Autism Spectrum Disorder and who meet an institutional level of care to be supported in their own homes or community-based settings. This infographic provides information about Maryland Medicaid participants who received services through the Autism Waiver in fiscal years (FYs) 2016 through 2020.
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    Risk-Based Prioritization List
    (The Hilltop Institute UMBC, 2019-06-03) Stockwell, Ian
    Hilltop staff presented at the 2019 AcademyHealth Annual Research Meeting (ARM). On June 3, Senior Director of Analytics and Research and Chief Data Scientist Ian Stockwell, PhD, presented this poster, which summarizes the work he led to identify factors found in clinical and functional assessment tools that increase the risk of a future nursing home (NH) admission and apply those risk-scoring coefficients to individuals on Maryland’s Home and Community-Based Services (HCBS) waiting list.
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    Medicaid Long‐Term Services and Supports in Maryland: The Autism Waiver Infographic, FY 2014 to FY 2019
    (The Hilltop Institute UMBC, 2021-03-24) The Hilltop Institute
    As part of its routine analyses of long-term services and supports users for the Maryland Department of Health, Hilltop created this infographic to present information about Maryland Medicaid participants who received services through the Autism Waiver in fiscal years 2014 through 2019.