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Low Levels of Self-Reported Literacy and Numeracy Create Barriers to Obtaining and Using Health Insurance Coverage (Policy Briefs/Health Policy Briefs)
Melissa Long, Adele Shartzer, Mary Politi

Limited health insurance literacy can lead to challenges navigating insurance plan enrollment, accessing health care, and using health care under the health plan. For some newly insured, using health insurance coverage will be a new experience that requires an understanding of such insurance terms as coinsurance, premiums, and deductibles. Once insured, using health insurance often requires adequate numeracy to understand risk and assess the value of different treatment options. These skills may be particularly difficult for adults who have historically had less contact with the health care system. This brief uses data from the June 2014 Health Reform Monitoring Survey (HRMS) to describe literacy and numeracy among nonelderly adults overall and for the population targeted by coverage expansions under the ACA.

Posted to Web: November 06, 2014Publication Date: October 27, 2014

Older Adults Receiving Assistance With Physician Visits and Prescribed Medications and Their Family Caregivers: Prevalence, Characteristics, and Hours of Care (Article)
Jennifer L. Wolff, Brenda Spillman

This study profiles older adults receiving assistance with physician visits and prescribed medications and the time demands associated with their care, using nationally representative data on Americans age 65 or older from the 2011 National Health and Trends Study. More than one in three older adults receives assistance with either physician visits or prescribed medications or both. Those receiving assistance with both physician visits and medications are a high-need subgroup: 60% have possible or probable dementia and 75% receive help with mobility, self-care, or household activities. They receive more than twice as many weekly hours of help with all activities as those receiving help with either physician visits or prescribed medications, and three times as many hours as those receiving neither type of assistance. Older adults receiving help with both physician visits and prescribed medications are assisted by 7.2 million helpers, most often adult children or spouses. The 3.1 million helpers who assist with both physician visits and prescribed medications provide an average of 45.4 hours of help per week; nearly two thirds also assist with mobility or self-care.

Posted to Web: October 31, 2014Publication Date: October 31, 2014

The Residential Continuum From Home to Nursing Home: Size, Characteristics and Unmet Needs of Older Adults (Article)
Vicki Freedman, Brenda Spillman

Older adults with physical or cognitive limitations live in a variety of settings from traditional community housing to nursing homes. This analysis of data from the 2011 National Health and Aging Trends Study provides new estimates of the older population across settings and examines unmet needs for assistance. Of 38.1 million Medicare beneficiaries ages 65 or older, 2.5 million live in retirement/senior housing communities, nearly 1 million in independent- and 1 million in assisted-living settings, and 1.1 million in nursing homes. The prevalence of assistance is higher and physical and cognitive capacity lower in each successive setting. Unmet needs are common in traditional housing (31%), but most prevalent in retirement/senior housing (37%) and assisted living settings (42%). Different resident characteristics account for some of the differences across settings, but after controls for individual characteristics, those in retirement/senior housing still have a higher likelihood of unmet needs than those in traditional community. Prevalent unmet needs among older adults with limitations across all settings warrant further investigation and monitoring.

Posted to Web: October 31, 2014Publication Date: October 31, 2014

Disability and Care Needs of Older Americans: An Analysis of the 2011 National Health and Aging Trends Study (Research Report)
Vicki Freedman, Brenda Spillman

Nearly half of U.S. adults over age 65 (18 million) have difficulty or receive help with daily activities, according to data from the National Health and Aging Trends Study. Nearly all who receive help in settings other than nursing homes—including assisted living and other supportive care settings—receive informal care, and about 30% receive some paid care. Those receiving assistance from paid, non-staff caregivers have especially high rate of adverse consequences related to unmet needs (nearly 60%). Nearly 3 million older adults live in settings other than nursing homes and receive help with three or more self-care or mobility activities, exceeding the level of need typically associated with eligibility for benefits under private insurance or public programs. A disproportionate share of this group is in the lowest income quartile. Although publicly and privately paid care continues to be an important source of assistance to older adults with extensive needs, the higher level of adverse consequences linked to unmet need among those receiving paid care warrants further investigation, particularly because of continuing shifts of long-term care from nursing homes to other settings.

Posted to Web: October 31, 2014Publication Date: April 11, 2014

Disability and Care Needs of Older Americans by Dementia Status: An Analysis of the 2011 National Health and Aging Trends Study (Research Report)
Judith D. Kasper, Vicki Freedman, Brenda Spillman

Results in this study underscore the substantial role of dementia in late-life disability and caregiving to older people. Data are from the 2011 National Health and Aging Trends Study. Among persons not residing in nursing homes, 78% of those with probable dementia received assistance with self-care or mobility activities or household activities for health or functioning reasons, compared with 42% of those with possible dementia and 18% of those with no dementia. Almost half of the 2.7 million older adults receiving help with three or more self-care or mobility activities have probable dementia. Relative to those with no dementia, they are more likely to live in supportive settings and to be low income, non-White, and widowed. One third of informal caregivers are assisting someone with probable dementia and account for 40% of informal care hours. They are three times as likely to report substantial negative impacts of caregiving as those caring for persons with no dementia. They are more likely to use some caregiver support services (respite, training, financial help) and also more likely to be looking for support services.

Posted to Web: October 31, 2014Publication Date: April 29, 2014

Informal Caregiving for Older Americans: An Analysis of the 2011 National Study of Caregiving (Research Report)
Brenda Spillman, Jennifer L. Wolff, Vicki Freedman, Judith D. Kasper

In 2011, 18 million informal caregivers provided 1.3 billion hours of care monthly to about 9 million older adults receiving informal assistance with daily activities, according to estimates from the new National Survey of Caregiving. Family members continue to be the main source of informal care, and hours of care are concentrated among caregivers for higher need recipients. Informal caregivers provide an average 75 hours per month; hours are significantly more for spouses, other co-resident caregivers, and those assisting high-need recipients. Most caregivers reported substantial positive aspects of caregiving. Those who provide high levels of care, assist recipients with dementia, or have health problems themselves are most likely to report substantial negative aspects of caregiving. Beyond supportive care, most informal caregivers assist with a range of medically-oriented tasks or help recipients navigate the health system, making them an essential part of the workforce for maintaining health and well-being in the older population, as recognized by both the Administration for Community Living (ACL) and the National Plan to Address Alzheimer's Disease.

Posted to Web: October 31, 2014Publication Date: April 01, 2014

Narrow Networks, Access to Hospitals and Premiums: An Analysis of Marketplace Products in Six Cities (Research Report)
Rebecca Peters, John Holahan

This report examines which hospitals are included within marketplace plans in six cities (Denver; New York City (Manhattan); Portland, Ore.; Providence; Baltimore; and Richmond, Va.). The report finds that nearly all insurers offering plans through the insurance Marketplaces in six cities include many highly ranked hospitals within their provider networks. The report also concludes that every hospital in the cities studied is included in at least one Marketplace plan network. The authors also looked at how the size of a plan's provider network affected the cost of premiums. The report shows that the size of a plan's network is not necessarily tied to premiums. The authors note that although narrowing networks (i.e., limiting the amount of providers covered under a specific plan) generally led to more-competitive, lower-cost premiums, some plans with broader networks had low premiums and some plans with narrow networks had high premiums.

Posted to Web: October 31, 2014Publication Date: October 31, 2014

Designing a Home Visiting Framework for Families in Public and Mixed-Income Communities (Research Report)
Marla McDaniel, Caroline Heller, Gina Adams, Susan J. Popkin

Though young children in public and mixed-income housing are exposed to some of the deepest poverty and developmental and educational risks in the United States, they are usually out of reach of many interventions that might help. Home visiting programs hold promise for helping vulnerable families, but most are not designed to fully address the needs of public and mixed-income housing residents. This brief describes important issues that program planners and early childhood leaders should consider when designing appropriate and responsive home visiting programs that reach young children in these communities.

Posted to Web: October 30, 2014Publication Date: October 30, 2014

Analyzing Different Enrollment Outcomes in Select States that Used the Federally Facilitated Marketplace in 2014 (Research Report)
Jane B. Wishner, Anna C. Spencer, Erik Wengle

This paper analyzes two pairs of states—North Carolina and South Carolina, and Wisconsin and Ohio—that achieved very different enrollment rates in the federally facilitated Marketplace (FFM) during the 2014 open enrollment period; North Carolina and Wisconsin exceeded enrollment projections, while South Carolina and Ohio fell short of FFM averages. Demographics, uninsurance rates and FFM premium rates did not appear to explain the significant enrollment differences. Intense anti-Affordable Care Act environments in the two states that did less well, however, and a coordinated coalition of diverse stakeholders in the states that performed better did appear to improve FFM enrollment outcomes.

Posted to Web: October 30, 2014Publication Date: October 30, 2014

Is Bigger Better? The Implications of Health Care Provider Consolidation: An Interview with Atul Gawande (Policy Briefs/Timely Analysis of Health Policy Issues)
Robert A. Berenson, Atul Gawande

In this paper, the Urban Institute's Robert Berenson interviews surgeon and The New Yorker columnist Atul Gawande to explore the potential benefits and drawbacks of "Big Medicine"—standardized, evidence-based health care delivered by large health care chains.

Posted to Web: October 29, 2014Publication Date: October 29, 2014

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