“We’re Preventing People From Going Into the Most Expensive Level of Care in Every Way that We Can”: Barriers and Recommendations for Use of Local Funds

Abstract

Most older Americans do not financially qualify for Medicaid and support provided through the Older Americans Act is quite limited. In response, Ohio has generated funds for services for older adults through the use of local county tax levy programs. Ohio currently leads the nation in the utilization and support of local levy funding, generating more than US$200 million annually. This study conducted qualitative descriptive interviews with 15 locally funded programs across the state. Thematic analysis revealed that local programs encounter an array of implementation barriers, including increased state and federal eligibility requirements, staffing issues, lack of access to services in rural locations, and low reimbursement rates. These barriers are coupled with added pressure from county officials to move individuals onto state-funded programs, rather than locally funded programs. This paper also provides recommendations for how these programs can be better supported to ensure their sustainability for the future.

Keywords

policy community home and community-based care and services politics

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References

Administration for Children & Families . (2022). Social services block grant (SSBG). https://www.acf.hhs.gov/sites/default/files/documents/ocs/COMM_OCS_SSBG_FactSheet_FY2022.pdf

American Association for Retired People (AARP) . (2021). Where we live, where we age: Trends in home and community preferences. https://livablecommunities.aarpinternational.org

Applebaum

Bowblis

J. R.

Janssen

L. M.

Nelson

Dikhtyar

Brekke

(2023). Local initiatives to fund services for older people: Building on an Ohio area of strength. Scripps Gerontology Center.

Applebaum

Goldstein

(2019). Local support for aging services: An island of progress in a sea of uncertainty. Generations, 42(4), 20–25. https://www.jstor.org/stable/26608425

Applebaum

Heston-Mullins

(2020). Local initiatives to fund services for older Americans: A growing option for states. AARP Public Policy Institute: Promising Practices and Emerging Innovations.

Birks

Chapman

Francis

(2008). Memoing in qualitative research: Probing data and processes. Journal of Research in Nursing, 13(1), 68–75. https://doi.org/10.1177/1744987107081254

Braun

Clarke

(2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa

Centers for Medicare & Medicaid Services (CMS) . (2023). Nhe fact sheet. https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet#:∼:text=Medicare_spending_grew_5.9%25_to,29_percent_of_total_NHE

Congressional Research Service . (2018). Older Americans act: COVID-19 response [CRS report prepared for members and committees of congress]. Congressional Research Service.

10.

Congressional Research Service . (2023). Older Americans act: Overview and funding [CRS report prepared for members and committees of congress]. Congressional Research Service.

11.

Eiken

Sredl

Burwell

Amos

(2018). Medicaid expenditures for long-term services and supports in FY 2016. https://www.medicaid.gov/medicaid/long-term-services-supports/reports-evaluations/index.html

12.

Gallo

H. B.

(2023). “The real impacts that AAAs are making:” developing measures of area agency on aging success. Journal of Aging & Social Policy, 36(3), 399–422. https://doi.org/10.1080/08959420.2023.2197563

13.

Heston-Mullins

(2021). Straight from the source: Consumers’ take on care management. Generations: Journal of the American Society on Aging, 45(1), 1–5. https://www.jstor.org/stable/48631217

14.

Koumoutzis

Heston-Mullins

Mayberry

P. S.

Applebaum

(2022). If you ask them, they will support: A national study of local initiatives developed to provide social care to older adults in the community. Journal of Applied Gerontology, 41(8), 1860–1869. https://doi.org/10.1177/07334648221090945

15.

Koumoutzis

Mayberry

P. S.

Heston-Mullins

Applebaum

(2021). Using local initiatives to fund in-home services: Ohio leads the nation. Scripps Gerontology Center.

16.

Koumoutzis

Stemen

S. E.

Maharjan

Heston-Mullins

Mayberry

P. S.

Applebaum

(2021). Local initiatives to fund services for older Americans: Community recognition of the importance of social care. Journal of Applied Gerontology, 40(9), 980–984. https://doi.org/10.1177/0733464820944325

17.

Lee

Jarosz

(2017). Majority of people covered by Medicaid and similar programs are children, older adults, or disabled. https://www.Prb.Org/resources/majority-of-people-covered-by-medicaid-and-similar-programs-are-children-older-adults-or-disabled

18.

Maxwell

J. A.

(2013). Qualitative research design: An interactive approach (3rd ed.). Sage Publications, Inc.

19.

Ohio Department of Aging . (2023). Healthy aging grants. https://aging.ohio.gov/care-and-living/healthy-aging#:∼:text=Established_through_House_Bill_33,longer%2C_and_maintain_their_independence

20.

Ohio Department of Developmental Disabilities . (2023). DSP and provider resources for historic rate increases. https://dodd.ohio.gov/communication/news/dsp+and+provider+resources+for+historic+rate+increases#:∼:text=The_DeWine%2Dhusted_administration_and,at_least_%2418_per_hour

21.

Paraprofessional Healthcare Institute . (2023). Understanding the direct care workforce. https://www.phinational.org/policy-research/key-facts-faq/

22.

Pavetti

Floyd

(2016). Eliminating social services block grant would weaken services for vulnerable children, adults, and disabled. Center for Budget & Policy Priorities.

23.

Payne

Applebaum

Molea

Ross

D. E.

(2007). Funding services from the bottom up: An overview of senior services levy programs in Ohio. The Gerontologist, 47(4), 555–558. https://doi.org/10.1093/geront/47.4.555

24.

Sheth

Cogle

C. R.

(2023). Home modifications for older adults: A systematic review. Journal of Applied Gerontology, 42(5), 1151–1164. https://doi.org/10.1177/07334648231151669

25.

Squires

Anderson

(2015). U.S. health care from a global perspective: Spending, use of services, prices, and health in 13 countries. Commonwealth Fund.

26.

Thomas

K. S.

Applebaum

(2015). Long-term services and supports (ltss): A growing challenge for an aging America. Public Policy & Aging Report, 25(2), 56–62. https://doi.org/10.1093/ppar/prv003

27.

Thomas

K. S.

Mor

(2013). The relationship between older Americans Act Title III state expenditures and prevalence of low‐care nursing home residents. Health Services Research, 48(3), 1215–1226. https://doi.org/10.1111/1475-6773.12015

28.

United States Department of the Treasury . (2023). Assistance listing 21.027 Coronavirus state and local fiscal Recovery funds. https://home.treasury.gov/system/files/136/2023-SLFRF-Compliance-Supplement-21-027.pdf

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