Scattarelli Justine, Moeller Kelly, Urbanski Dana, DeLiema Marguerite
University of Minnesota, Minneapolis, MN, USA.
University of Tennessee Health Science Center, Knoxville, TN, USA.
J Appl Gerontol. 2025 Apr 28:7334648251333181. doi: 10.1177/07334648251333181.
Formal long-term services and supports (LTSS) are essential to support older Americans with chronic conditions, such as Alzheimer's disease and related dementias (ADRD). However, few older adults have saved enough to pay for LTSS, and navigating Medicaid eligibility criteria presents significant challenges. We conducted semi-structured, in-depth interviews with aging services professionals and caregivers of older adults with ADRD to assess challenges to planning for and accessing LTSS coverage through Medicaid and Medicaid waivers. Using concept mapping, three main themes were identified: (1) Proactive planning, (2) decision points, and (3) the application process. Participants described misconceptions about LTSS coverage, challenges with enrollment, and lack of information about eligibility affecting the LTSS planning trajectory. Results demonstrate a critical need for resources that help caregivers estimate costs and guide them through the eligibility determination, application, and spend down processes for Medicaid programs.
正式的长期服务与支持（LTSS）对于帮助患有慢性疾病的美国老年人至关重要，比如阿尔茨海默病及相关痴呆症（ADRD）。然而，很少有老年人攒够了钱来支付长期服务与支持费用，而且要弄清楚医疗补助资格标准面临重大挑战。我们对老年服务专业人员以及患有ADRD的老年人的照料者进行了半结构化的深入访谈，以评估通过医疗补助和医疗补助豁免来规划并获得长期服务与支持覆盖范围所面临的挑战。通过概念映射，确定了三个主要主题：（1）积极规划，（2）决策点，以及（3）申请流程。参与者描述了对长期服务与支持覆盖范围的误解、参保方面的挑战，以及影响长期服务与支持规划轨迹的资格信息缺失。结果表明，迫切需要资源来帮助照料者估算费用，并指导他们完成医疗补助项目的资格判定、申请及支出用尽流程。
