Robert Applebaum

Robert Applebaum
Miami University | MU · Scripps Gerontology Center

About

141
Publications
5,904
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
1,222
Citations
Citations since 2017
32 Research Items
371 Citations
20172018201920202021202220230204060
20172018201920202021202220230204060
20172018201920202021202220230204060
20172018201920202021202220230204060
Introduction

Publications

Publications (141)
Article
Full-text available
In 2014, 29 of 88 Ohio counties implemented MyCare, which integrated Medicare and Medicaid for dually eligible Ohioans. Using an intent-to-treat, difference-in-difference framework we examined medical expenditures and utilization associated with the implementation of MyCare. Specifically, we compared dually eligible Ohioans in MyCare counties to th...
Article
Full-text available
Within Ohio’s MyCare demonstration, two distinct care management models were selected by the participating MyCare Ohio health plans (MCOPs): fully-delegated waiver care management and waiver service coordination. The purpose of this presentation is to describe the components of care management operating in MyCare Ohio. Qualitative interviews with n...
Article
Full-text available
Today’s Medicaid challenges, coupled with the baby boom demographics, have every state in the nation recognizing the need to do something different in their Medicaid programs. Although achieving a better balance between institutional and home and community-based services has been an important reform in many states, it does not appear to be enough t...
Article
Full-text available
Background Nursing home staff members unvaccinated against COVID-19 pose an ongoing public health risk considering their frequent contact with older adults, a population especially vulnerable to the virus. In order to address vaccine hesitancy and foster vaccine confidence effectively among nursing home staff, evidence-based health communication st...
Poster
Full-text available
Following the “ethnic cleansing” by the Bhutanese government in the 1990s, Nepali-lingual Bhutanese fled from southern Bhutan and spent about two decades in refugee camps in Nepal before resettlement in the US and other countries. During post-resettlement, this population had a high rate of suicide and mental health problems. However, studies speci...
Article
Background and objectives: Despite federal legislation requiring nursing home (NH) staff members to be vaccinated against COVID-19, unvaccinated staff pose an ongoing public health risk. The research question guiding this study is as follows: What is the relationship between strategies to address vaccine hesitancy and vaccination rates among staff...
Article
Full-text available
Objectives Some communities across the nation are utilizing alternative funding sources to better support home and community-based services for older adults. Methods A variety of methods identified local initiatives across the United States. An online survey was distributed to a total of 377 communities in 15 states identified as using locally rai...
Article
Full-text available
The majority of federal support for older people needing in-home services and supports comes from the Medicaid program. However, less than 10% of older people are eligible for Medicaid and to receive long-term services, a person must have a severe disability. Many older people with moderate levels of disability or those who are not impoverished are...
Article
Full-text available
The COVID-19 pandemic has had a drastic impact on Ohio’s long-term care facilities. Yet, months into the crisis, the financial ramifications and workforce shortage were unknown. In partnership with the Scripps Gerontology Center at Miami University, LeadingAge Ohio and the Ohio Health Care Association developed an online survey that was launched in...
Article
Full-text available
Implemented through five health plans, Ohio’s MyCare demonstration began in 2014 and was designed to coordinate primary, acute care, behavioral health and long-term services in the major urban areas of the state. Individuals who are dually eligible for both Medicaid and Medicare and who reside in specified geographic regions must enroll into a mana...
Article
Full-text available
Prior to the global pandemic, the United States struggled to coordinate, deliver, and finance quality, person-centered long-term services and supports (LTSS) through the default primary payer, Medicaid. The pandemic highlights the challenges of not having a LTSS system. LTSS workers are underpaid, overworked, and turning over at alarming rates. Fam...
Article
Background For most of us, our morning routines of taking a shower, making breakfast, and getting dressed, are simply tasks of daily life that we barely think about. But for individuals with functional or cognitive limitations, these activities cannot be completed without assistance. The vast majority of the more than six million elders and the fou...
Article
Full-text available
Despite the growing number of older adults in the U.S., federal and state funding for non-medical supportive services remains limited. Recent work reports that states with a more generous supply of supportive services, including home delivered meals and personal care, have fewer low care residents in nursing homes. To boost this supply, some local...
Article
Full-text available
Low retention of certified nursing assistants (CNAs) and direct care workers (DCWs) continues to be an unresolved problem for nursing homes (NH) and assisted living (AL) settings. While numerous studies have examined predictors of CNA retention in NHs, little attention has been paid to differences between settings of long-term care. To inform pract...
Article
With nursing homes being hit hard by the COVID-19 pandemic, it is important to know whether facilities that have any cases, or those with particularly high caseloads, are different from nursing homes that do not have any reported cases. Our analysis found that through mid-June, just under one-third of nursing homes in Ohio had at least one resident...
Article
Background and objectives: Low retention of direct care workers (DCWs), either certified nursing assistants in nursing homes (NH) or personal care assistants in assisted living (AL), continues to be an unresolved problem. While numerous studies have examined predictors of DCW retention in NHs, little attention has been paid to differences between...
Article
Background and objectives: Certified nursing assistant (CNA) turnover and retention are critical aspects of facilities' ability to provide cost-effective, high quality person-centered care. Previous studies and industry practice often treat turnover and retention as similar concepts, assuming that low turnover and high retention are synonymous. Th...
Article
Despite the growing proportion of older adults in the United States, federal and state funding for nonmedical supportive services remains limited. To meet increasing demand, some communities across the nation are exploring alternative funding sources for aging services. Although no systematic database exists to track such local programs, through an...
Article
Full-text available
The expansion of managed long-term services and supports has generated considerable interest over the last decade. However, studies on the impact of these efforts have produced mixed findings. Additionally, there is limited information about the care management models used in implementation. This lack of data makes it impossible to assess whether d...
Article
Full-text available
From its name to the type and setting of care provided, the world of long-term services and supports has changed dramatically in the last two decades. Using 26 years of longitudinal data from the state of Ohio this presentation describes how the long-term services system is different from the one that existed in the early 1990’s. Data come from 13...
Article
Attention in Washington about the sustainability of national programs supporting older people has become a major issue. This article examines how national rhetoric about the graying of the federal budget impacts the delivery of aging services in local communities. Using Ohio as an example, the article reviews county voting records for local tax lev...
Article
The long-term services system has changed substantially since the mid-1970s, when the landmark book Last Home for the Aged argued that the move to the nursing home was the last move an older person would make until death. Using detailed nursing home utilization data from the Minimum Data Set, this study tracks three cohorts of first-time nursing ho...
Article
In U.S. social welfare history, many have suggested that if benefits were too attractive, consumers would come out of the woodwork to take advantage of the opportunity. Clinical trials have provided evidence of the woodwork effect’s existence, suggesting caution when expanding home- and community-based services (HCBS). However, it is unclear whethe...
Article
States across the U.S. are faced with ever increasing long-term services expenditures in the context of a large growth in the number of older people likely to need such support. One state level policy response involves requiring all older people relying on the means tested Medicaid program, who are also Medicare eligible, to enroll in an integrated...
Article
Over the last decade several different models of publicly funded long-term care (LTC) programs, mainly through the state and federal Medicaid program, have emerged in states across the US. Presenters in this symposium will discuss four different models of LTC services that characterize the LTC systems of most states. Baozhen Luo will describe the o...
Article
The “woodwork effect”, the concern that increasing access to home and community based options (HCBS), seen as more desirable than institutional care, may result in significantly more eligible individuals seeking access to tax payer supported long-term services and supports (LTSS), has long been a concern for those interested in LTSS policy (Kemper,...
Article
Just like generations before them, the baby boomers are not one group, but many. Are they financially ready for retirement? A review of the likely income and expenditure data for baby boomers indicate that some are well-prepared financially for retirement, some are not, and for many, retirement preparation is still a work in progress. This article...
Article
Full-text available
The objective of the current study is to describe the activities long-term care facilities are undertaking to reduce hospital admissions and readmissions by working to improve health care transitions. The data were collected via an online survey from 888 nursing facilities (NFs) and 527 residential care facilities (RCFs) that completed the care int...
Article
Objective: In 2006, Ohio changed its Medicaid reimbursement methodology for nursing homes (NHs) to promote more efficient staffing levels. This study examines the impacts of this policy change on quality. Research design and subjects: Ohio NHs were categorized based on their anticipated change in reimbursement under a new reimbursement system in...
Article
Full-text available
T he changes we have experienced in the home and community-based services (HCBS) arena over the last couple of decades are extraordinary. We have gone from spending the vast majority of Medicaid long-term funds for older people in institutional settings to a much more balanced system. A number of states are now approaching a point where 50 percent...
Article
The aging services sector must foster and embrace change, evolving to meet the demands of our modern world, lest it go the way of companies like Kodak and Blockbuster-neither of which anticipated or adapted to changes in the marketplace. But when organizations change, it must be with the right strategy. If the aging services sector evolves in the w...
Article
Purpose of the study: In 2008, the Centers for Medicare and Medicaid Services (CMS) implemented a five-star rating system of nursing homes in the United States. These star ratings have been widely publicized both by CMS and the national and state media. Although the components of the star rating system take into account various dimensions of quali...
Article
Full-text available
In response to increasing Medicaid expenditures and consumer preferences, states are reforming their long-term care systems to provide more community-based services. One popular reform is renewed efforts to prevent unnecessary long-term nursing home placement (diversion) and to provide nursing home residents an opportunity to return to the communit...
Article
The strong push to integrate Medicare and Medicaid services has been driven by the federal government through the Centers for Medicare & Medicaid Services, and by states, in response to two major system concerns: quality and cost. But nationwide system change has been slow and inconsistent. This article lays out the many issues that have come forwa...
Article
Full-text available
This article defines the term long-term services and supports, explains how such services have yet to be categorized and compared cross-nationally, and offers a five-category typology for classifying approaches to long-term care services and supports. It describes the various types of coverage, from most extensive to least, with Germany, Japan and...
Article
To determine whether a distance coaching course on improving nursing home incontinence care could be replicated and brought to scale with a larger group of nursing homes without sacrificing outcomes. The study collected descriptive and comparative data. Fourteen nursing homes in the original course and 34 in the replication course. Participants in...
Article
Full-text available
 A gap between research and practice in many nursing home (NH) care areas persists despite efforts by researchers, policy makers, advocacy groups, and NHs themselves to close it. The reasons are many, but two factors that have received scant attention are the dissemination process itself and the work of the disseminators or change agents. This revi...
Article
For over three decades, there has been considerable discussion about the development of gerontology education in the United States. A debate about accreditation is a logical outgrowth in this evolution. The dialogue about accreditation raises some important questions and gives gerontology an opportunity to further define itself. Accreditation poses...
Article
Full-text available
 This article describes and evaluates a long distance coaching course aimed at improving nutritional care in nursing homes (NHs). The course was structured to provide more support than traditional training programs offer. Methods: In a series of 6 monthly teleconferences led by an expert in NH nutritional care, participating NH staff received step-...
Article
This article is based on the premise that there is inadequate attention to the link between theory and applied research in social gerontology. The article contends that applied research studies do not often or effectively employ a theoretical framework and that theory-based articles, including theory-based research, are not often focused on questio...
Article
In order for evidence-based practice to become a widely used approach, it must become a truly joint effort of both researchers and practitioners; currently many researchers, viewing evidence-based practice as a rational approach, have little understanding of why practitioners would resist implementing these approaches. Practitioners perceive the re...
Article
These authors address the increasing pressure on the aging network as a result of the Great Recession. They note that state budgets are being slashed and private philanthropy has been reduced just as the need for services is increasing. While many older people need more help for meals, heating and cooling assistance, and healthcare, the aging netwo...
Article
Full-text available
The Minimum Data Set (MDS) is a uniform instrument used in nursing homes to assess residents. In January 2008, the Centers for Medicare and Medicaid Services published a draft of a new MDS—version 3.0. This article traces the instrument's development and the design decisions that shaped it, discusses the MDS's manifest functions—data collection int...
Article
Since the 1980s, Ohio counties have pursued a somewhat unique strategy for funding services for the 60-and-older population. Using local property-tax levies, Ohio counties bring in more than $100 million yearly to support a range of services for older people. In this article we report on information from the 2005 Ohio Senior Service Levy Survey, in...
Article
As funds have increased for the provision of in-home care, so too have concerns about the quality of services. In response, care management agencies and home-care providers have developed an array of monitoring activities designed to ensure the quality of services. In this article, we show how an area agency on aging both collected and used data to...
Article
The purpose of this study is to better understand care management in integrated models of service delivery. Semistructured interviews were conducted with state- and program-level administrators and care managers from nursing and social work disciplines in eight programs providing integrated care. The professionals interviewed discussed the benefits...
Article
Care managers from local Area Agencies on Aging, operating Ohio’s home- and community based waiver program (PASSPORT), were trained as research interviewers to collect consumer satisfaction data from clients receiving in-home services using the Home Care Satisfaction Measure (Geron, Smith, Tennstedt, Jette, Chassler, & Kasten, 2000). The data for h...
Article
Based on data from an eight year longitudinal study of Ohio's long-term care use patterns, this paper describes the changes now being experienced by this industry. Although Ohio has been a state with a heavy reliance on institutional services, the data suggest a change in how long-term care is provided in the state. Over the past eight years, despi...
Article
This study evaluates a demonstration that used high intensity care management to improve integration between the acute and long-term care service systems. The demonstration intervention included the use of clinical nurse care manager, supervised by a geriatrician, to supplement an existing in-home care management system. Chronically disabled home c...
Article
Each year more than 25% of nursing home patients are taken to the hospital emergency room or hospitalized for the evaluation and treatment of infections. These transfers may have an adverse impact on the quality and the cost of patient care. Using both Medicare and Medicaid records from a sample of dually eligible elderly people in Ohio, we identif...
Article
Long-term care represents the interface between health care and social services and thus includes a multitude of services and staff that deliver long-term assistance. The range of services, consumers, and environmental circumstances under the home care umbrella creates a considerable challenge for both providers and regulators. This article examine...
Article
Long-term care represents the interface between health care and social services and thus includes a multitude of services and staff that deliver long-term assistance. The range of services, consumers, and environmental circumstances under the home care umbrella creates a considerable challenge for both providers and regulators. This article examine...
Article
Case management has increased substantially and is now an integral component of the home care system in the United States. Although case management has been implemented in home care programs since the 1970s, the core components of the intervention have remained unchanged. Standardization of practice can be important; however, it is also necessary f...
Article
Although recent efforts have attempted to study how to improve the quality of in-home care, consumers'involvement in these efforts has been rare. Using two data collection approaches, a survey and in-depth case studies, this work assesses the consumer's perspective on in-home services. Findings show that although service recipients hesitated to pro...
Article
This article presents results from the evaluation of Ohio's community-based long-term-care demonstration project. The initiative, named "Options for Elders," was an attempt to develop a more comprehensive and rational service delivery system for disabled older people. The demonstration involved a single point of entry to long-term-care services, a...
Article
Debates about regulatory efforts to monitor the delivery of health and long-term care have become commonplace in health policy. Efforts to examine the key assumptions underlying the current regulatory strategies have been limited, however. Using the board and care industry as an example, this article examines how ideology influences the regulatory...
Article
This article reports on the Ohio Quality Assurance Project, a two year demonstration. The project developed a model quality assurance system for in-home supportive services funded by Title III of the Older Americans Act including home health aide, personal care, homemaker, transportation and escort, home delivered meals, chore and home maintenance...
Article
This article reports on the Ohio Quality Assurance Project, a two year demonstration. The project developed a model quality assurance system for in-home supportive services funded by Title III of the Older Americans Act including home health aide, personal care, homemaker, transportation and escort, home delivered meals, chore and home maintenance...
Article
Using information from two national data sets, this report provides projections of disability rates for the U.S. Population age 65 and above. The research develops a series of projections based upon alternative sets of assumptions about mortality and disability. Using 1986 baseline disability data, estimates by single year of age are projected thro...
Article
Case managed community-based long-term care has now become an established component of the service delivery system in the United States. As case management has developed, it has gone through an evolutionary process. In the initial phase of case management, considerable attention was placed on gaining access to resources by the case manager. This ar...
Article
Although the growth of in-home care has been praised for expanding long-term care options for people with chronic disabilities, questions surrounding the quality of in-home care have begun to arise. This paper discusses six critical factors that complicate efforts to assure quality including client and provider characteristics, fiscal constraints,...
Article
Home-delivered care is an important development for functionally disabled clients and for the long-term care system. However, questions and concerns about home care quality have been raised. At this point, home care quality is not well understood, and most case management and provider agencies have very little experience designing and implementing...
Article
Home-delivered care is an important development for functionally disabled clients and for the long-term care system. However, questions and concerns about home care quality have been raised. At this point, home care quality is not well understood, and most case management and provider agencies have very little experience designing and implementing...
Article
A key component of the channeling evaluation was its focus on the life quality of program clients and their caregivers. In this article, life quality results in the areas of mortality, functioning, and client and caregiver well-being are presented for research treatment and control group members. Results show no significant differences in mortality...
Article
The National Long Term Care Demonstration (channeling) was designed to provide coordinated community-based long-term care services to those older persons at high risk of nursing home placement. A key component of the program was the process established to accomplish this targeting effort. In this article, the outreach and eligibility procedures dev...
Article
The channeling demonstration involved provision of comprehensive case management and direct service expansion. This article considers the former. Under both models, comprehensive case management was implemented largely as intended; moreover, channeling substantially increased the receipt of comprehensive care management. However, channeling was not...
Article
Case managers face special challenges in working with elderly clients who need long-term care. To meet these challenges they require population-specific training in understanding clients, analyzing the service environment, and in mastering techniques of case management. Ongoing support and supervision is also an essential aspect of good case manage...
Article
This article discusses issues relating to the design and internal administration of a case-management agency for community based home care for the elderly. Included in the article are issues relating to screening procedures, assessment and case management activities, cost controls, automated management information systems, and personnel matters. Th...

Network

Cited By