The COVID-19 pandemic has impacted the lives of people throughout the world, either directly, due to exposure to the virus, or indirectly, due to measures taken to mitigate the virus’ effects. Older adults have been particularly hard hit, dying in disproportionately higher numbers, especially in long-term care facilities. Local, regional, and national government actions taken to mitigate the spread of COVID-19 have thus served, in part, to shield older adults from the virus, though not without adverse side effects, including increased social isolation, enhanced economic risk, revealed ageism, delayed medical treatment, and challenges getting basic needs met. This book explores the myriad ways in which the COVID-19 pandemic has affected older adults and their families, caregivers, and communities. It proposes policies and strategies for protecting and improving the lives of older people during the pandemic. It draws lessons for aging policy and practice more generally, given underlying challenges brought to the fore by government, provider, community, and individual responses to the pandemic. This book was originally published as a special issue of the Journal of Aging & Social Policy.

The COVID-19 pandemic has disrupted life globally through virus-related mortality and morbidity and the social and economic impacts of actions taken to stop the virus' spread. It became evident early on during the pandemic that older adults are especially vulnerable to morbidity and mortality from COVID-19, and the adverse consequences of strategies taken to mitigate its effects. While no more likely to become infected than younger populations, the risk for hospitalization and death rises considerably with age. Residents of long-term care facilities have been among the hardest hit. The pandemic has brought many facets of ageism to the fore. Community stay-at-home messages, lockdowns, social distancing requirements, and visitation restrictions contributed to a concomitant epidemic in social isolation and loneliness. Economic and social impacts have been dramatic; so too has been the disproportionate hardship experienced by members of racial and ethnic minority communities. This book reports original empirical research and perspectives on the ramifications of the COVID-19 pandemic for the older adult population, and draws lessons for policy, research, and practice. Key issues pertaining to the impact of COVID-19 on older adults and their families, caregivers, and communities are highlighted. Four main areas are examined: personal experiences with COVID-19; long-term care system impacts; end-of-life care; and technology and innovation. The chapters in this book were originally published as a special issue of the Journal of Aging & Social Policy.

The surprise election of Donald J. Trump to the presidency of the United States marks a singular turning point in the American republic - not only because of his idiosyncratic approach to the office, but also because the Republican Party now holds the presidency and both houses of Congress, presenting a historic opportunity for change. The role of older Americans has been critical in both shaping and reacting to this political moment. Their political orientations and behaviors have shaped it through their electoral support for Republican candidates. But, older Americans stand as highly invested stakeholders in the policy decisions made by the very officials they elected and as beneficiaries of the programs that Republicans have targeted for cuts or elimination. This comprehensive volume explores the ways in which Trump administration policies are likely to significantly undermine the social safety net for near-elderly and older Americans, including long-term care, housing, health care, and retirement. The authors also explore how the Trump administration might shape politics and political behavior through the policy changes made. The response of older voters, in upcoming elections, to efforts by the Trump administration and its Republican allies in Congress to draw back on the federal government's commitment to programs and policies affecting them will shape the direction of aging policy and politics for years to come. This book was originally published as a special issue of the Journal of Aging & Social Policy.

Medicaid is the largest grant-in-aid program in the United States. Reform in this area, therefore, provides a unique opportunity to study the intersection between federal and state policy making in an area recently characterized by substantial uncertainty deriving from the lingering effects of the Great Recession, ongoing debate over the federal budget, and implementation of the Patient Protection and Affordable Care Act. Invariably states reform the way health care is delivered, regulated, and financed within broader parameters established by federal statutes and regulations. It is critical therefore that effective strategies be put into place if both current and future health and long-term care reform efforts are to have their greatest chances at success. Rhode Island is the first state to receive permission to operate its entire Medicaid program under a global cap. As a consequence, it has entered the national consciousness as a key data point potentially supporting the block grant approach to Medicaid reform. In this book, Edward Alan Miller identifies factors that either facilitated or impeded the design and implementation of Rhode Island's Global Consumer Choice Compact Medicaid Waiver in order to draw broader lessons for the Medicaid block grant debate and health and long-term care reform more generally. Evidence gathered from archival sources and in-depth interviews with key stakeholders exposes the role that provider capacity has played in the implementation process, including adult day care, assisted living, home maker, and other home- and community-based services. The impact of the Global Waiver on the nursing home sector is examined as well, in addition to new authority to obtain federal matching dollars for previously state-only funded programs. By providing a sophisticated understanding of factors enhancing or impeding state health reform, this book will contribute to improvements in the development and administration of policy development at both the state- and federal-levels.

Medicaid is the largest grant-in-aid program in the United States. Reform in this area, therefore, provides a unique opportunity to study the intersection between federal and state policy making in an area recently characterized by substantial uncertainty deriving from the lingering effects of the Great Recession, ongoing debate over the federal budget, and implementation of the Patient Protection and Affordable Care Act. Invariably states reform the way health care is delivered, regulated, and financed within broader parameters established by federal statutes and regulations. It is critical therefore that effective strategies be put into place if both current and future health and long-term care reform efforts are to have their greatest chances at success. Rhode Island is the first state to receive permission to operate its entire Medicaid program under a global cap. As a consequence, it has entered the national consciousness as a key data point potentially supporting the block grant approach to Medicaid reform. In this book, Edward Alan Miller identifies factors that either facilitated or impeded the design and implementation of Rhode Island's Global Consumer Choice Compact Medicaid Waiver in order to draw broader lessons for the Medicaid block grant debate and health and long-term care reform more generally. Evidence gathered from archival sources and in-depth interviews with key stakeholders exposes the role that provider capacity has played in the implementation process, including adult day care, assisted living, home maker, and other home- and community-based services. The impact of the Global Waiver on the nursing home sector is examined as well, in addition to new authority to obtain federal matching dollars for previously state-only funded programs. By providing a sophisticated understanding of factors enhancing or impeding state health reform, this book will contribute to improvements in the development and administration of policy development at both the state- and federal-levels.

The COVID-19 pandemic has impacted the lives of people throughout the world, either directly, due to exposure to the virus, or indirectly, due to measures taken to mitigate the virus' effects. Older adults have been particularly hard hit, dying in disproportionately higher numbers, especially in long-term care facilities. Local, regional, and national government actions taken to mitigate the spread of COVID-19 have thus served, in part, to shield older adults from the virus, though not without adverse side effects, including increased social isolation, enhanced economic risk, revealed ageism, delayed medical treatment, and challenges getting basic needs met. This book explores the myriad ways in which the COVID-19 pandemic has affected older adults and their families, caregivers, and communities. It proposes policies and strategies for protecting and improving the lives of older people during the pandemic. It draws lessons for aging policy and practice more generally, given underlying challenges brought to the fore by government, provider, community, and individual responses to the pandemic. This book was originally published as a special issue of the Journal of Aging & Social Policy.

The surprise election of Donald J. Trump to the presidency of the United States marks a singular turning point in the American republic - not only because of his idiosyncratic approach to the office, but also because the Republican Party now holds the presidency and both houses of Congress, presenting a historic opportunity for change. The role of older Americans has been critical in both shaping and reacting to this political moment. Their political orientations and behaviors have shaped it through their electoral support for Republican candidates. But, older Americans stand as highly invested stakeholders in the policy decisions made by the very officials they elected and as beneficiaries of the programs that Republicans have targeted for cuts or elimination. This comprehensive volume explores the ways in which Trump administration policies are likely to significantly undermine the social safety net for near-elderly and older Americans, including long-term care, housing, health care, and retirement. The authors also explore how the Trump administration might shape politics and political behavior through the policy changes made. The response of older voters, in upcoming elections, to efforts by the Trump administration and its Republican allies in Congress to draw back on the federal government's commitment to programs and policies affecting them will shape the direction of aging policy and politics for years to come. This book was originally published as a special issue of the Journal of Aging & Social Policy.

Shortly after the beginning of the 20th century, the federal government entered a new phase -- the rise of the administrative state. Among the forces propelling this development was the Progressive Movement, which sought greater government engagement with and regulation of various sectors of American society. An autonomous Department of Labor, with Cabinet status, was established in 1913, along with the Federal Reserve. The Federal Trade Commission was created the following year. With the entry of the United States into World War I, regulatory activities further expanded, and the number of administrative agencies and federal employees increased. With the post-war era, the expansion of the federal government momentarily slowed, but began again with the onset of the Great Depression and the launching of the New Deal. The colossus that was constructed to combat the national economic emergency was soon refashioned and augmented to enable the United States to victoriously end a world war. With the return to peace in 1945, the federal government stood as a giant complex organisation, with over 3.8 million employees. During the next 45 years, it would continue to expand in terms of both its principal units and resources. In the immediate past few years, however, some downsizing has occurred. This book reviews trends regarding various aspects of the operations of the federal government during the past 50 years, as evidenced by personnel, budget, and other data. It also identifies and discusses, in cameo form, various developments during the period that are considered significant for federal operations during the next century. Some of these are crafted innovations, such as mission performance planning and measurement; some are imposed restraints, such as the Supreme Court's Chadha decision rendering so-called congressional or legislative vetoes unconstitutional. Some developments are still evolving, such as the electronic government phenomenon, and await conclusive assessment.

In exploring integration of acute and long-tern care, this book begins by characterising the dually eligible population, and describing problems associated with meeting their health and social service needs in an uncoordinated system. It continues by analysing the advantages of using capitation and care management as a vehicle for integrating those services, and by discussing concerns about care integration strategies. It concludes by profiling nine federal and state programs that to varying degrees, integrate the acute and long-term care services that people who are dually eligible for Medicare-Medicaid, often require. They are: Federal initiatives such as the Program for All-inclusive Care of the Elderly (PACE), which capitates both Medicare and Medicaid acute and long-term care services for those who are dually eligible, and the Social/Health Maintenance Organization (S/HMO) and EverCare demonstrations, which capitate Medicare benefits only; Comprehensive state demonstrations such as Minnesota Senior Health Options, the Wisconsin Partnership Program, and the Continuing Care Network Demonstration of Monroe County, New York, which, like PACE, capitates both Medicare and Medicaid benefits; and Capitated state Medicaid demonstrations such as the Arizona Long-Term Care System, Oregon Health Plan, and Florida's Community-Based Diversion Pilot Project, which capitate Medicaid only, but actively pursue various Medicare co-ordination strategies. Proposals that explore using care management techniques to integrate Medicare and Medicaid services delivery, without capitation, are also discussed briefly. The book concludes with the observation that although federal and state initiatives to integrate acute and long-term care for those who are dually eligible, only serve a relatively small percentage of this population, they provide a set of options which Congress may want to examine when formulating long-term care policy in the future.

Information technology has dramatically changed the way we live our lives in areas ranging from commerce and entertainment to voting. Now, policy advocates and government officials hope to bring the benefits of information technology to health care. Governments, hospitals, doctors, and pharmaceutical manufacturers have placed a tremendous amount of medical information, data, and services online in recent years. Many consumers can visit health department sites and compare performance data on health care providers. Some physicians encourage patients to use e-mail or web messaging as opposed to phone calls or in-office visits for simple medical issues. Increasingly, medical equipment and prescription drug manufacturers are making their products available online. Yet despite this growth in activity, the promise of "e-health"remains largely unfulfilled.

"Digital Medicine" investigates the factors limiting the ability of digital technology to remake health care in the United States and around the world. What political, social, and ethical challenges are presented by online health care? How are racial, ethnic, and other disparities limiting the e-health revolution? How accessible are health-related Internet websites to the disabled, those at basic or below basic levels of literacy, or with limited English proficiency? Are there differences between websites sponsored by public, private and nonprofit organizations that limit technology utilization? How can we close the disparity gap and deal with conflicts of interest that contribute to distrust in theinformation presented?

Darrell West and Edward Miller analyze multiple data sources, including original survey research and website analysis, to study the content of health care-related websites, sponsorship status, public usage, and the relationship between e-health utilization and attitudes about health care in America. They also analyze the different ways in which officials in other countries have implemented health information technology. By drawing on these experiences, "Digital Medicine" helps us understand health care information innovation in a variety of political, social, and economic settings.