Innovation in Aging, 2018, Vol. 2, No. S1
entire follow-up period. There were no differences in health
services variables between the programs until the final year.
SESSION 2495 (PAPER)
LONG TERM CARE
THE EFFECT OF PRIMARY CAREGIVERS’
EMPLOYMENT STATUS ON OLDER PEOPLE’S CARE
RECEIPT FROM DIFFERENT SOURCES
P. Doty1, A. Janus2, 1. Office of the Assistant Secretary for
Planning and Evaluation, U.S. DHHS, 2. University of
Edinburgh
Social gerontologists have predicted that increased female
employment would adversely affect the ability of disabled
older people to rely on unpaid family caregivers. This paper
is one of only a few that focuses on not only whether disabled
older people receive fewer hours of help from employed primary caregivers but also whether other members of the care
network compensate for any reduction in primary caregiver
hours. We conduct a pooled cross-sectional analysis of data
on 2,268 older people and their primary caregivers from the
National Study of Caregiving I and II, which was administered as part of rounds 1 and 5 of the National Health and
Aging Trends Study. Consistent with previous studies, we
find that employed primary caregivers provide fewer hours
of help per week compared to non-working primary caregivers (27 versus 40 hours, p < .01). Secondary caregivers’
hours do not change in response to the employment status of
GSA 2018 Annual Scientific Meeting
primary caregivers. However, older people with an employed
primary caregiver make greater use of paid help compared
to older people with a non-working primary caregiver (8
versus 5 hours, p < .01). Therefore, while older people partially compensate for the reduction in hours from employed
primary caregivers through greater use of paid help, older
people with an employed primary caregiver still receive fewer
total hours of help overall (-10 hours, p < .01). We also find
that the compensatory effect of paid help is greater among
older people with 2+ ADLs, dementia, and higher incomes.
CHARACTERIZING STAFF INTERACTIONS IN
A SAMPLE OF HIGH PERFORMING NURSING
HOMES
A. Snow1, V. Clark2, S. Zhao2, P. Nash3,
R. Allen4, R. Bolton5, C. Hartmann6, 1. Tuscaloosa VA
Medical Center & University of Alabama, 2. Center for
Healthcare Organization and Implementation Research,
Edith Nourse Rogers Memorial Veterans Hospital, 3.
Tuscaloosa VA Medical Center, 4. The University of
Alabama, 5. Bedford VA Medical Center, 6. Center for
Healthcare Organization and Implementation Research,
Edith Nourse Rogers Memorial Veterans Hospital &
Boston University
Increasing evidence indicates nursing home staff interactions with residents and each other contribute to care quality.
We characterized interaction in a sample of top performing person-centered care (PCC) adopters in the Veterans
Administration (VA) system of 134 Community Living
Centers (CLCs– i.e., nursing homes). We identified 8 topperforming CLCs using a combination of quality and PCC
indices. At these 8, staff participated in a validated survey
of relational coordination. Researchers also conducted structured observations of staff and resident behavior in public
areas. Analyses were descriptive. 392 staff responded to the
survey. Researchers conducted 2,459 observations. Across all
CLCs, staff reported the quality of their interactions within
(WI) their workgroup consistently lower than the quality of
their interactions between (BW) their and other workgroups.
BW ratings: 24% strong, 34% moderate, 42% weak. WI
ratings: 92% weak. Strong ratings varied by workgroup
type and by WI and BW. Nursing was more likely to receive
strong ratings than other workgroups but less likely to assign
strong ratings to other groups. 31% of observations were
of staff performing direct resident care while communicating
with the resident and 39% were of staff having no communication with the resident during care. Results in this topperforming sample indicate potential room for continued
improvement. Given our findings of rather low relational
coordination and interaction quality, quality improvement
interventions directly targeting staff communication and
staff-resident interaction might represent opportunities for
positive impact not only in high PCC performers but across
the PCC performance spectrum.
ENHANCING STAFF-RESIDENT INTERACTIONS
THROUGH A FRONTLINE STAFF QUALITY
IMPROVEMENT INTERVENTION
C. Hartmann1, J. Palmer2, C. Pimentel3, R. Allen4,
S. Zhao5, N. Wewiorski6, K. Dillon6, A. Snow7, 1. Center
for Healthcare Organization and Implementation Research,
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WHAT DOES EXPLAIN THE REGIONAL VARIATION
IN LIVING AT HOME OR IN INSTITUTION WHEN
DEPENDENT IN FRANCE?
A. Carrere1, E. Cambois2, 1. INED, 2. French Institute for
Demographic Studies (INED)
Population aging raises the question of the long-term
care (LTC) organization for the dependent elderly. In France,
“in home” LTC is promoted to meet both individual and
policy (partly cost-related) preferences. However, LTC management is decentralized at a county level inducing variations in the type of LTC supply, partly due to (unequal) local
resources. This article aims to identify county variations
in living in institution for dependent elderly people (60+)
and how much different LTC supply contributes to these
variations. We used different data sources to estimate the
probability of living in institution versus at when having
disabilities (i.e. bathing difficulties): survey EHPA 2015 for
population living in institution (n=308,312) and survey VQS
2014 for population living at home (n=161,419). We complemented these sources with data on contextual LTC supply and socioeconomic status (SES) indicators. Multilevel
regression models are computed to assess how much of the
county variance of institutionalization decreases when controlling for in LTC supply and SES and identify the share
of variance explained by the differences in LTC supply and
SES. We found that county variation explained 21% of the
institutionalization risk: of which 40% is explained by SES
contextual differences and 7% by difference in the LTC
supply. Further researches are needed to determine whether
these differences reflect county’s unequal resources to supply
LTC or county’s different preferences.
791
792
SOCIODEMOGRAPHIC DIFFERENCES IN LONGTERM CARE USE DURING THE LAST 2 YEARS OF
LIFE IN SWEDEN
S. Kelfve1, J. Wastesson2, B. Meinow3, 1. Linkoping
University, 2. Aging Research Center, Karolinska Institutet,
3. Aging Research Center, Karolinska Institutet &
Stockholm University
Most people experience a period of poor health and dependency on long-term care (LTC) use in the end of life. However,
little is known about how the length of this period and the type
of LTC used before death varies between sociodemographic
groups in Sweden. Using register data covering all individuals
65 years and older who died in Sweden in November 2015
(n=6405), we aimed to investigate the association between
sociodemographic factors (sex, civil status, education and
migration) and LTC use (home-help service or institutional
care) during the last 2 years of life. Overall, men died without
having any LTC to larger extent than women (32% and 18%,
respectively) and a larger proportion of women (44%) died
in institutional care compared to men (28%). Married people died without having any LTC more frequently than nonmarried, (38% vs 26% among men and 33% vs 14% among
women). Persons born outside of Sweden used slightly less
LTC than Swedish born people. Among immigrant men, 38%
died without having any LTC, but only 18% among immigrant women. Corresponding numbers among Swedish born
was 32% among men and 23% among women. Finally, the
results show that persons with higher educational level more
frequently died without LTC and this difference was more
pronounced among women than men. Results from this study
show substantial differences in LTC use between sociodemographic groups in Sweden. Future studies should investigate if
the “aging-in-place policy” that has been increasingly put into
practice has affected the socioeconomic differences in LTC use.
SESSION 2500 (SYMPOSIUM)
ADVANCES IN LIFE COURSE RESEARCH ON AGING:
NEW OPPORTUNITIES AND FINDINGS FROM LARGE
REPRESENTATIVE PANEL STUDIES
Chair: J. Smith, University of Michigan, Ann Arbor,
Michigan
Discussant: D. Dannefer, Case Western Reserve University,
Cleveland, Ohio
There is increasing multidisciplinary interest in understanding the longterm influences of early-life factors on latelife health and wellbeing outcomes and differences in the
sequence and timing of events in life histories. Although life
course theories formalize propositions about pathways from
early to later life, research has been limited to date because
few existing longitudinal studies cover the entire life of individuals or include comprehensive coverage of multiple life
domains. Recent advances in the collection of retrospective life history information have opened ways to supplement the prospective life histories obtained in large panel
studies of aging. Speakers in this session illustrate some of
these new life course research opportunities. Wahrendorf
and colleagues used data from the Survey of Health, Ageing
and Retirement in Europe (SHARE) to identify sequences of
residential housing characteristics. They report associations
between early-life housing histories and late-life health outcomes. Where people live can afford different early-life educational opportunities and exposure to stressful life events.
Two papers use new retrospective life history data collected
in the Health and Retirement Study (HRS) to examine questions about these factors and late-life cognitive aging: Lee
and Smith report associations with childhood educational
contexts and experiences and Helppie-McFall and colleagues examine the cumulative role of stressful life events.
Analyses of life calendars from the Swiss Vivre Survey by
Spini and colleagues highlight the impact of historical events
on life periods participants describe as happy or vulnerable.
Dannefer concludes with an integrative discussion of current
efforts to advance life course research on aging.
HOUSING HISTORIES OVER THE LIFE COURSE AND
HEALTH AT OLDER AGES: RESULTS FROM SHARE
M. Wahrendorf1, B. Vanhoutte, PhD2, E. Courtin, PhD3,
1. Heinrich-Heine-University Düsseldorf, Düsseldorf,
GSA 2018 Annual Scientific Meeting
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Edith Nourse Rogers Memorial Veterans Hospital & Boston
University, 2. Institute for Aging Research, Hebrew SeniorLife,
3. Edith Nourse Rogers Memorial Veterans Hospital & UMass
Medical School, 4. The University of Alabama, 5. Center for
Healthcare Organization and Implementation Research, Edith
Nourse Rogers Memorial Veterans Hospital, 6. Edith Nourse
Rogers Memorial Veterans Hospital, 7. Tuscaloosa VA Medical
Center & University of Alabama
For nursing home residents, positive interactions with
staff and engagement in activity contribute meaningfully to
quality of life. We sought to improve interactions between
staff and residents, with the ultimate aim of enhancing resident engagement. We used an opportunistic, snowball sample of 6 Veterans Health Administration nursing homes
(e.g., Community Living Centers—CLCs). Our staff-based
behavior-change intervention involved staff using a set of
evidence-based practices for implementing quality improvement: frontline huddles, rapid-cycle structured observations,
a strengths-based approach, and the importance of brevity
coupled with regularity. CLC staff facilitated the intervention, with some assistance from researchers. Research data
comprised validated resident and staff surveys, researcherconducted structured pre- and post-intervention observations, and semi-structured post-intervention staff interviews.
62 CLC residents and 308 staff members responded to the
surveys. Researchers conducted 1,490 discrete observations
and 66 interviews. In generalized linear models using observation and survey data, intervention implementation was
associated with increased staff-resident communication during the provision of direct care activities (β = 0.083, 95% CI:
0.04–0.126, adjusted P=.0012) and decreased negative staff
interactions with residents (β = -0.035, 95% CI: -0.062 –
-0.009, adjusted P=0.0288). In interviews, staff consistently
credited the intervention with helping them (a) develop
awareness of the importance of identifying opportunities
for engagement and (b) improve the quality of their interactions with residents. Overall, the intervention proved feasible.
The combination of rapid-cycle observations, huddles, and a
focus on identified strengths influenced staff to make simple
enhancements to their behaviors that improved staff-resident
interactions and staff-assessed resident engagement.
Innovation in Aging, 2018, Vol. 2, No. S1