A Primer on Managed Care: Multiple Chronic Conditions

HCBS are important prevention and inter- vention strategies that can reduce the impact of social determinants of health upon the health and well-being of older adults. This is especially the case for poor and minority older adults, who have an increased risk of being placed in low- quality skilled nursing facilities for care that they could otherwise receive at home or in the community (Lincoln, 2014, 2015b). Conclusion The United States spends far more money per capita on medical services than do other nations, while spending less on social services (Tran, Zimmerman, and Fielding, 2017). Residents of nations that have higher ratios of spending on social services to spending on healthcare ser- vices have better health and live longer (Brad- ley et al., 2016) than do residents of the United States. More investment in addressing social determinants of health would, in contrast to cur- rent policies, achieve better population health, lessen inequality, and lower healthcare costs. Such an investment could expand programs, improve quality, and increase access to cultur- ally relevant, coordinated services for older adults—elevating their and their families’ quality of life and significantly reducing healthcare costs by helping them remain in their homes and com- munities for as long as possible. Karen D. Lincoln, Ph.D., M.S.W., is associate professor and director at the University of Southern California, Suzanne Dworak-Peck School of Social Work, in Los Angeles. She can be contacted at .

lights the Benefits of Community Programs for Older African Americans in Los Angeles County , findings indicated that participation in programs and services for older adults was associated with higher quality of life, less loneliness and isola- tion, and less food insufficiency (Lincoln, 2015a). One of the most significant service-related fac- Residents of nations with higher ratios of spending on social services versus healthcare have better health and live longer. tors associated with the health and well-being of African American older adults was whether they felt that services were missing from their neigh- borhood. African American older adults who felt that services were missing, such as home-deliv- ered meals, transportation, In-Home Supportive Services, and adult daycare, were more likely to report fair or poor mental health, a lower qual- ity of life, more loneliness and isolation, food insufficiency, and poor medication adherence compared to those who had services in their neighborhood. The effectiveness of HCBS for older adults and their families cannot be captured solely with measures of cost-effectiveness. However, if cost is the primary measure, then the cost reductions associated with improved subjective well-being and quality of life, less loneliness and isolation, less depression and food insufficiency, bet- ter medication adherence, and lower mortality should be taken into account.

References Allen, J., et al. 2017. “Social Deter- minants of Health.” International Review of Psychiatry 26(4): 392– 407.

Barrett, A., and Schimmel, J. 2010. OAA Title III Services Tar- get the Most Vulnerable Elderly in the United States. Washington, DC: Administration on Aging.

Berkowitz, S. A., et al. 2015. “Mate- rial Need Insecurities, Control of Diabetes Mellitus, and Use of Health Care Resources Results of the Measuring Economic Inse- curity in Diabetes Study.” JAMA Internal Medicine 175(2): 257–65.

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