Health Care and Long-Term Care in Older Adults, Investigates the strain that aging societies place on the health care system, both acute care and long-term services and support (LTSS), how to best meet the needs of older and disabled adults, and how to measure and finance the medical burden of aging societies. PARC priorities and the domestic and global need for evidence to inform policy-responses to population and the increasing need for research to inform health care services, especially among individuals with long-term care needs is explicitly reflected in this theme. Penn is a global leader in this space, especially with research on the need, use, quality and financing of health care and Long-Term Care (LTC) for older adults. This theme leverages for PARC existing Penn infrastructure and faculty resources to facilitate cross-disciplinary collaboration among demographers, sociologists, health economists and physicians on LTC and related health care aspects.

Health care and aging are closely intertwined, with people age 55 and over consuming half of total health care spending. Burke, Neuman, and Werner’s work has focused on post-acute care, one of the main drivers of geographic differences in medical spending. Alpert and Gupta’s work on payment reform and regulation in the health care industry leads to new insights on how to improve health while decreasing costs. Ersek and Halpern’s work examines access to care and the role of palliative care in end-of-life decisions. Groeneveld’s work highlights the overuse in health care. Distinct from these – often disease-related – health care costs, long-term care services and support (LTSS) encompasses care from paid or unpaid caregivers (including family members) and it may take place in the person’s home or in an institutional setting. Most individuals will need some form of LTSS during their lifetime. Brown and Cacchione’s research focuses on improving functional status among older adults in both clinic and home-based settings. Unpaid family and paid caregivers play a vital, and often overlooked, role in aging (Gonalons-Pons). Coe’s work on estimating the causal effects of caregiving for an elderly parent on the care provider’s health and well-being provides critical insights on the impact of caregiving. Pauly, Lavizzo-Mourey, and Naylor’s Transitional Care Model (TCM) is used to assist older adults and their caregivers and to improve their health outcomes. McHugh and Lasater, in turn, investigate the effects of nursing home organization on patient outcomes, and Pauly, Coe, and Fang’s research on insurance markets sheds light on the provision of long-term care insurance for the elderly. Hoffman’s work focuses on the legal beginnings and underpinnings of our current fragmented long-term care system and its economic ramifications. David and Candon examine the factors related to the quality and staffing of home health care, as highlighted in one of the proposed pilot projects. Gonalons-Pons is extending her research on work, families, and how public policies structure economic inequalities to questions about the organization of caregiving for the elderly across high income countries. Hodgson’s work focuses on improving the life of people with dementia and their families. Trojanowski, as the director of the Penn’s Institute on Aging, and Halpern, as the director of the Palliative and Advanced Illness Research Center, bring collaboration opportunities among medical researchers, neuroscientists, economists and demographers. PARC Associates are also engaged on these topics internationally. For example, Aiken has directed a series of large-scale studies in the U.S. and abroad about the impact of nursing on outcomes for patients with chronic illnesses, those undergoing common and specialty surgical procedures, and for persons with AIDS, cancer, and the seriously mentally ill. She is currently a PI of a panel study on the effects of changes in nursing on patient outcomes in Chile. Atal is investigating the spatial distribution of health care services in LMICs with support from a Quartet pilot grant, and I Kohler is collecting aging- and NCD-related nursing, health care provider and health facility data linked to individual-level MLSFH data to document health care utilization and needs among mature adults in the LIC context of Malawi.