The Development of A Self-Appraisal Tool for the Level of Long-Term Care Service Integration.

Abstract Introduction Taiwan is the fastest aging countries in the world. In 2016, Taiwan implemented Long-Term Care Plan 2.0 (LTC Plan 2.0), aims to provide coordinated and integrated LTC services. However, how to assess the level of integration and which integration mechanisms are better applied are still unclear in the literature. This study intended to address a research question regarding “How can agencies measure their level of service integration?” and, therefore, aimed to develop an integration assessment tool—the Taiwanese Self-Assessment for LTC Systems Integration (TwSASI)- for LTC agencies to use to self-evaluate their current “level” of providing integrating LTC services. Methods 　　TwSASI was first developed base on Connie J. Evashwick’s (2005) framework and literature review, including four domains: inter-entity planning and management, care coordination, integrated information system, and integrated financing, and 11 dimensions with 51 items. Through the Delphi method, with two rounds of investigation and feedback from 26 experts, RAND/UCLA Appropriateness Method (RAM) was used to assess the consensus regarding the dimensions and items developed and refined the tool content accordingly. Results After two rounds of investigation, four domains remained with 10, 11, 4, and 5 items in each domain respectively. All items reached good experts' consensus with medians of the 30 items’ importance, feasibility, and appropriateness all over 8. The Scale Content Validity Index (SCVI) of the 4 dimensions all over than 0.9. Conclusion The TwSASI can be feasible for evaluating the level of LTC service integration in Taiwan. LTC agencies can improve their level of service integration accordingly.


SCOPING REVIEW: HOME AND COMMUNITY-BASED SERVICE WAIVER PROGRAMS AND PERSON-REPORTED OUTCOMES
Taylor Bucy, 1 John Mulcahy, 1 Eric Jutkowitz, 2 and Tetyana Shippee, 1 1. University of Minnesota,University of Minnesota,Minnesota,United States,2. Brown University,Brown University,Rhode Island,United States State Medicaid programs are rebalancing their long-term care spending from nursing home to home and communitybased services (HCBS). Emphasis on person-centered and person-directed care warrants investigation into models of HCBS delivery that promote quality of life. We performed a scoping review of the literature to catalogue the breadth of the studies describing HCBS waiver programs targeting adults (18+). We identified 757 articles, and after duplicate removal and reconciliation, we excluded articles on children or adolescents, non-peer reviewed reports, international studies, and articles that did not describe HCBS waiver programs. After abstract and title review, 292 articles met our inclusion criteria. Most included articles (22.3%) were single state descriptive evaluations or evaluations of service use patterns among participants. 17.8% of included articles examined multi-state or national variation in program trends, while 17.1% made national program conclusions without a major focus on interstate comparison. Less common were studies examining integrated care or dual-eligibles (7.5%), PACE (3.4%), medication management (3.1%), quality and satisfaction of both consumer and caretaker perspectives (3.8%) and consumer-only perspectives (5.1%). The remaining articles focused on HIV (4.1%), TBI (1.4%) or ID/DD (14.4%) waiver programs. The 8.9% of articles addressing quality and satisfaction consisted mostly of interviews, either with state Medicaid administrators or with care recipients and/ or caregivers. Consumer reported satisfaction and unmet care needs were the primary outcomes examined. Given the heightened focus on long-term care as a result of the ongoing coronavirus pandemic, this review justifies further exploration into the delivery and outcomes of state-directed HCBS waiver programs.

THE DEVELOPMENT OF A SELF-APPRAISAL TOOL FOR THE LEVEL OF LONG-TERM CARE SERVICE INTEGRATION.
Yu-Chien Chang, 1 and Ya-Mei Chen, 2 1. National Taiwan University, Taiwan, Taipei, Taiwan (Republic of China), 2. National Taiwan University, Taipei, Taipei, Taiwan (Republic of China) Introduction Taiwan is the fastest aging countries in the world. In 2016, Taiwan implemented Long-Term Care Plan 2.0 (LTC Plan 2.0), aims to provide coordinated and integrated LTC services. However, how to assess the level of integration and which integration mechanisms are better applied are still unclear in the literature. This study intended to address a research question regarding "How can agencies measure their level of service integration?" and, therefore, aimed to develop an integration assessment tool-the Taiwanese Self-Assessment for LTC Systems Integration (TwSASI)-for LTC agencies to use to self-evaluate their current "level" of providing integrating LTC services. Methods TwSASI was first developed base on Connie J. Evashwick's (2005) framework and literature review, including four domains: inter-entity planning and management, care coordination, integrated information system, and integrated financing, and 11 dimensions with 51 items. Through the Delphi method, with two rounds of investigation and feedback from 26 experts, RAND/UCLA Appropriateness Method (RAM) was used to assess the consensus regarding the dimensions and items developed and refined the tool content accordingly. Results After two rounds of investigation, four domains remained with 10, 11, 4, and 5 items in each domain respectively. All items reached good experts' consensus with medians of the 30 items' importance, feasibility, and appropriateness all over 8. The Scale Content Validity Index (SCVI) of the 4 dimensions all over than 0.9. Conclusion The TwSASI can be feasible for evaluating the level of LTC service integration in Taiwan. LTC agencies can improve their level of service integration accordingly.

WHO IS COMING TO JAPAN UNDER THE NEW STATUS OF RESIDENCE "SPECIFIED SKILLED CARE WORKERS"?
Noriko Tsukada, Nihon University, Tokyo, Tokyo, Japan The Japanese government created a new status of residence called "Specified Skilled Workers" encompassing 14 job categories that have laborer shortages, including long-term care (LTC) workers on April 1, 2019. A survey of students (N=79) at a language institute in Manila, Philippines was conducted in February, 2020 to explore characteristics of future foreign LTC workers in Japan under this new status of residence and identify factors that may help facilitate worker retention. At the time of data collected, these students were studying both Japanese and LTC practices in order to pass skill evaluation tests to enter Japan. Students were asked their perceptions of long-term care, planned lengths of stay, concerns about staying in Japan, and future career plans. Preliminary analyses revealed that 67 (88%) were single, 74(93.7%) had graduated from universities, and a half of them had a nursing background. Most students (93.7%) showed interest in an extended stay in Japan, with some interested in taking the national certified care worker examination which permits extended work in Japan. The most cited concern about being in Japan was "weather, climate and typhoons" (28.1%), followed by "language proficiency" and "living expenses" (21.9%) respectively. As Japan has limited immigration policies but a large need for LTC workers, it is imperative to understand how to attract and retain foreigners who obtain the Specified Skilled Worker status. This includes addressing both work-related and living-related concerns and needs.

DIRECT CARE WORKERS EMPLOYED AS MEDICAL AIDES: HOME HEALTH AIDES, NURSING ASSISTANTS, AND ORDERLIES Christopher Kelly, and Jerome Deichert, University of Nebraska at Omaha, Omaha, Nebraska, United States
Purpose: This study describes the differences among direct workers (DCWs) employed as medical aides in three occupations: home health aides, nursing assistants, and orderlies. Design and Methods: Data were from the 1% Public Use Microdata Sample (PUMS) of the 2019 American Community Survey (ACS). Logistic regression was used to compare demographic and employment characteristics of DCWs employed as medical aides in three occupations: home health aides, nursing assistants and orderlies. Results: Compared to orderlies and psychiatric aides, home health aides are more likely to be foreign born, more likely to be female, less likely to work in institutional settings, less likely to be under age 25, less likely to work year-round full-time, less likely to have more education, and less likely to receive insurance from their employers. Implications: Since 2018, the PUMS of the ACS separates nursing, psychiatric, and home health aides (previously one occupational category) into three: home health aides, nursing assistants, and orderlies. This affords researchers a more precise understanding of this part of the direct care workforce. Home health aides represented more than 2/3 of DCWs employed as medical aides in 2019. Further, these workers are distinct among medical aides. More than nursing assistants and orderlies, home health aides are older, female, underinsured, foreign-born, and with limited education. This reflects both the barriers home health aides face to other occupations and also the preferences of their employers (which include private households). These findings have implications for the recruitment and retention of medical aides across all three occupations.

DO PERSONALITY AND BELIEF INFLUENCE THE OWNERSHIP OF PRIVATE LONG-TERM CARE INSURANCE?
Shu-Chuan Jennifer Yeh, 1 Hsueh-Chih Chou, 2 and Shih-Hua Sarah Chen, 3 1. National Sun Yat-sen University, Kaohsiung,Kaohsiung,Taiwan (Republic of China),2. Kaohsiung Veterans General Hospital,Kaohsiung Veterans General Hospital,Kaohsiung,Taiwan (Republic of China),

The University of Chicago, Chicago, Illinois, United States
Long-term care is the largest out-of-pocket expenditure risk for the elderly. Private long-term care insurance is one crucial source to cover the gap. The study aims to investigate (1) whether wealthy people are more likely to purchase private long-term care insurance (LTCI); (2) whether personality traits are associated with ownership of LTCI; and (3) whether individual experience influences the ownership of private LTCI. We surveyed 375 participants for three groups, including nurses, executive MBA, and MBA students. EMBA group had highest percentage of personal discretionary income (defined as greater than 1,780 US dollar per month) (77.6%), followed by MBA group (17.6%) and nurse group (8.8%). The nurse group had highest in long-term caring experience for sick family members (46.4%), self-experience catastrophic diseases (11.2%), and number of family/relatives/friends share responsibilities of caregivers (2.33 persons). The nurse group had lowest risk propensity score as well as openness to experience traits. The percentage of ownership in private LTCI was 48%, 45.6%, and 28.8% for nurse, EMBA, and MBA groups, respectively. After controlling for age and tenure, results from logistic regression indicated that MBA group was less likely to own LTCI compared with nursing group. Compared with less than 30,000, only personal discretionary income 30,001~ 50,000 had higher odds ratio to own LTCI. Wealthy is inconclusive in determining ownership of private LTCI. Nurses who were lowest risk propensity and openness traits and have more sickness experience were more likely to purchase private LTCI. Believe needing LTCI is the strongest predictor in ownership of LTCI.