Long-Term Care for Older Adults: Future Research Needs: Future Research Needs Paper Number 44
Long-Term Care for Older Adults: Future Research Needs: Future Research Needs Paper Number 44
Overview
This future research needs (FRN) report is a follow-up to the 2012 comparative effectiveness review (CER) “Long-Term Care for Older Adults: A Review of Home and Community-Based Services Versus Institutional Care.” The review was intended to support policy and research decisionmaking. FRN projects identify gaps in the current research that limit the conclusions in CERs and inform researchers and research funders about these gaps. They aim to encourage research likely to fill the gaps and make the body of evidence more useful to decisionmakers. The CER addressed the following two Key Questions targeting direct comparisons of long-term care (LTC) provided through home and community-based services (HCBS) and in nursing homes (NHs) to older adults aged 60 and older: Key Question 1: What are the benefits and harms of LTC provided through HCBS compared with institutions such as NHs for older adults, aged 60 and older, who need LTC? a. To what extent do HCBS and NHs serve similar populations? b. How do the outcomes of the services differ when tested on similar populations? c. What are the harms to older adults as a result of HCBS and NHs? Key Question 2: What are the costs (at the societal and personal levels) of HCBS and NHs (per recipient and in the aggregate) for adults age 60 and older? Costs may include direct costs of care as well as resource use and family burden. Direct costs of care refer to public program and individual spending on LTC services for HCBS recipients and NH residents. Resource use includes program and individual spending on acute care services such as physician and hospital care as well as spending by other subsidy or transfer programs. Family burden includes the opportunity costs of care. LTC refers to a broad range of services designed to provide assistance over prolonged periods to compensate for loss of function due to chronic illness or physical or mental disability. LTC includes hands-on, direct care as well as general supervisory assistance. HCBS refers to services provided in an array of non-institutional settings. These include recipients' homes; community-based group-living arrangements such as congregate housing, adult foster care, and residential care and assisted living (AL) facilities (the last two terms are sometimes used interchangeably, but we refer to AL exclusively); and community settings such as adult day care and adult day health. NHs are state-licensed institutional facilities offering 24-hour room and board, supervision, and nursing care. Results from relevant observational studies were qualitatively synthesized; no relevant randomized controlled trials (RCTs) were identified. The authors found that on average, NH residents had more limitations in physical and cognitive function than both HCBS recipients and AL residents, but mental health and clinical status were mixed. The studies that compared the outcome trajectories of HCBS recipients or AL residents with NH residents over time had high risk of bias, resulting in low or insufficient evidence for all outcomes examined. In comparing AL with NH, low-strength evidence suggested no differences in outcomes for physical function, cognition, mental health, and mortality. In comparing HCBS with NHs, low-strength evidence suggested that HCBS recipients experienced higher rates of some harms while NH residents experienced higher rates of other harms. Evidence was insufficient for other outcome domains and comparisons. Evidence was also insufficient for cost comparisons. Overall, the CER concluded that it is difficult to determine whether and how the delivery of LTC through HCBS versus NHs affects outcome trajectories of older adults due to scant evidence and the methodological limitations of studies reviewed. The authors concluded that more and better research is needed to draw robust conclusions about how care settings influence outcomes and costs of LTC for older adults.Description
Condition Guidelines
Books - New and Used
The following guidelines apply to books:
- New: A brand-new copy with cover and original protective wrapping intact. Books with markings of any kind on the cover or pages, books marked as "Bargain" or "Remainder," or with any other labels attached, may not be listed as New condition.
- Used - Good: All pages and cover are intact (including the dust cover, if applicable). Spine may show signs of wear. Pages may include limited notes and highlighting. May include "From the library of" labels. Shrink wrap, dust covers, or boxed set case may be missing. Item may be missing bundled media.
- Used - Acceptable: All pages and the cover are intact, but shrink wrap, dust covers, or boxed set case may be missing. Pages may include limited notes, highlighting, or minor water damage but the text is readable. Item may but the dust cover may be missing. Pages may include limited notes and highlighting, but the text cannot be obscured or unreadable.
Note: Some electronic material access codes are valid only for one user. For this reason, used books, including books listed in the Used – Like New condition, may not come with functional electronic material access codes.
Shipping & Delivery
Shipping Fees
- Stevens Books offers FREE SHIPPING everywhere in the United States for ALL non-book orders, and $3.99 for each book.
- Packages are shipped from Monday to Friday.
- No additional fees and charges.
Delivery Times
The usual time for processing an order is 24 hours (1 business day), but may vary depending on the availability of products ordered. This period excludes delivery times, which depend on your geographic location.
Estimated delivery times:
- Standard Shipping: 5-8 business days
- Expedited Shipping: 3-5 business days
Shipping method varies depending on what is being shipped.
Tracking
All orders are shipped with a tracking number. Once your order has left our warehouse, a confirmation e-mail with a tracking number will be sent to you. You will be able to track your package at all times.
Damaged Parcel
If your package has been delivered in a PO Box, please note that we are not responsible for any damage that may result (consequences of extreme temperatures, theft, etc.).
If you have any questions regarding shipping or want to know about the status of an order, please contact us or email to support@stevensbooks.com.
Returns & Refunds
You may return most items within 30 days of delivery for a full refund.
To be eligible for a return, your item must be unused and in the same condition that you received it. It must also be in the original packaging.
Several types of goods are exempt from being returned. Perishable goods such as food, flowers, newspapers or magazines cannot be returned. We also do not accept products that are intimate or sanitary goods, hazardous materials, or flammable liquids or gases.
Additional non-returnable items:
- Gift cards
- Downloadable software products
- Some health and personal care items
To complete your return, we require a tracking number, which shows the items which you already returned to us.
There are certain situations where only partial refunds are granted (if applicable)
- Book with obvious signs of use
- CD, DVD, VHS tape, software, video game, cassette tape, or vinyl record that has been opened
- Any item not in its original condition, is damaged or missing parts for reasons not due to our error
- Any item that is returned more than 30 days after delivery
Items returned to us as a result of our error will receive a full refund,some returns may be subject to a restocking fee of 7% of the total item price, please contact a customer care team member to see if your return is subject. Returns that arrived on time and were as described are subject to a restocking fee.
Items returned to us that were not the result of our error, including items returned to us due to an invalid or incomplete address, will be refunded the original item price less our standard restocking fees.
If the item is returned to us for any of the following reasons, a 15% restocking fee will be applied to your refund total and you will be asked to pay for return shipping:
- Item(s) no longer needed or wanted.
- Item(s) returned to us due to an invalid or incomplete address.
- Item(s) returned to us that were not a result of our error.
You should expect to receive your refund within four weeks of giving your package to the return shipper, however, in many cases you will receive a refund more quickly. This time period includes the transit time for us to receive your return from the shipper (5 to 10 business days), the time it takes us to process your return once we receive it (3 to 5 business days), and the time it takes your bank to process our refund request (5 to 10 business days).
If you need to return an item, please Contact Us with your order number and details about the product you would like to return. We will respond quickly with instructions for how to return items from your order.
Shipping Cost
We'll pay the return shipping costs if the return is a result of our error (you received an incorrect or defective item, etc.). In other cases, you will be responsible for paying for your own shipping costs for returning your item. Shipping costs are non-refundable. If you receive a refund, the cost of return shipping will be deducted from your refund.
Depending on where you live, the time it may take for your exchanged product to reach you, may vary.
If you are shipping an item over $75, you should consider using a trackable shipping service or purchasing shipping insurance. We don’t guarantee that we will receive your returned item.
Overview
This future research needs (FRN) report is a follow-up to the 2012 comparative effectiveness review (CER) “Long-Term Care for Older Adults: A Review of Home and Community-Based Services Versus Institutional Care.” The review was intended to support policy and research decisionmaking. FRN projects identify gaps in the current research that limit the conclusions in CERs and inform researchers and research funders about these gaps. They aim to encourage research likely to fill the gaps and make the body of evidence more useful to decisionmakers. The CER addressed the following two Key Questions targeting direct comparisons of long-term care (LTC) provided through home and community-based services (HCBS) and in nursing homes (NHs) to older adults aged 60 and older: Key Question 1: What are the benefits and harms of LTC provided through HCBS compared with institutions such as NHs for older adults, aged 60 and older, who need LTC? a. To what extent do HCBS and NHs serve similar populations? b. How do the outcomes of the services differ when tested on similar populations? c. What are the harms to older adults as a result of HCBS and NHs? Key Question 2: What are the costs (at the societal and personal levels) of HCBS and NHs (per recipient and in the aggregate) for adults age 60 and older? Costs may include direct costs of care as well as resource use and family burden. Direct costs of care refer to public program and individual spending on LTC services for HCBS recipients and NH residents. Resource use includes program and individual spending on acute care services such as physician and hospital care as well as spending by other subsidy or transfer programs. Family burden includes the opportunity costs of care. LTC refers to a broad range of services designed to provide assistance over prolonged periods to compensate for loss of function due to chronic illness or physical or mental disability. LTC includes hands-on, direct care as well as general supervisory assistance. HCBS refers to services provided in an array of non-institutional settings. These include recipients' homes; community-based group-living arrangements such as congregate housing, adult foster care, and residential care and assisted living (AL) facilities (the last two terms are sometimes used interchangeably, but we refer to AL exclusively); and community settings such as adult day care and adult day health. NHs are state-licensed institutional facilities offering 24-hour room and board, supervision, and nursing care. Results from relevant observational studies were qualitatively synthesized; no relevant randomized controlled trials (RCTs) were identified. The authors found that on average, NH residents had more limitations in physical and cognitive function than both HCBS recipients and AL residents, but mental health and clinical status were mixed. The studies that compared the outcome trajectories of HCBS recipients or AL residents with NH residents over time had high risk of bias, resulting in low or insufficient evidence for all outcomes examined. In comparing AL with NH, low-strength evidence suggested no differences in outcomes for physical function, cognition, mental health, and mortality. In comparing HCBS with NHs, low-strength evidence suggested that HCBS recipients experienced higher rates of some harms while NH residents experienced higher rates of other harms. Evidence was insufficient for other outcome domains and comparisons. Evidence was also insufficient for cost comparisons. Overall, the CER concluded that it is difficult to determine whether and how the delivery of LTC through HCBS versus NHs affects outcome trajectories of older adults due to scant evidence and the methodological limitations of studies reviewed. The authors concluded that more and better research is needed to draw robust conclusions about how care settings influence outcomes and costs of LTC for older adults.Description
Condition Guidelines
Books - New and Used
The following guidelines apply to books:
- New: A brand-new copy with cover and original protective wrapping intact. Books with markings of any kind on the cover or pages, books marked as "Bargain" or "Remainder," or with any other labels attached, may not be listed as New condition.
- Used - Good: All pages and cover are intact (including the dust cover, if applicable). Spine may show signs of wear. Pages may include limited notes and highlighting. May include "From the library of" labels. Shrink wrap, dust covers, or boxed set case may be missing. Item may be missing bundled media.
- Used - Acceptable: All pages and the cover are intact, but shrink wrap, dust covers, or boxed set case may be missing. Pages may include limited notes, highlighting, or minor water damage but the text is readable. Item may but the dust cover may be missing. Pages may include limited notes and highlighting, but the text cannot be obscured or unreadable.
Note: Some electronic material access codes are valid only for one user. For this reason, used books, including books listed in the Used – Like New condition, may not come with functional electronic material access codes.
Shipping & Delivery
Shipping Fees
- Stevens Books offers FREE SHIPPING everywhere in the United States for ALL non-book orders, and $3.99 for each book.
- Packages are shipped from Monday to Friday.
- No additional fees and charges.
Delivery Times
The usual time for processing an order is 24 hours (1 business day), but may vary depending on the availability of products ordered. This period excludes delivery times, which depend on your geographic location.
Estimated delivery times:
- Standard Shipping: 5-8 business days
- Expedited Shipping: 3-5 business days
Shipping method varies depending on what is being shipped.
Tracking
All orders are shipped with a tracking number. Once your order has left our warehouse, a confirmation e-mail with a tracking number will be sent to you. You will be able to track your package at all times.
Damaged Parcel
If your package has been delivered in a PO Box, please note that we are not responsible for any damage that may result (consequences of extreme temperatures, theft, etc.).
If you have any questions regarding shipping or want to know about the status of an order, please contact us or email to support@stevensbooks.com.
Returns & Refunds
You may return most items within 30 days of delivery for a full refund.
To be eligible for a return, your item must be unused and in the same condition that you received it. It must also be in the original packaging.
Several types of goods are exempt from being returned. Perishable goods such as food, flowers, newspapers or magazines cannot be returned. We also do not accept products that are intimate or sanitary goods, hazardous materials, or flammable liquids or gases.
Additional non-returnable items:
- Gift cards
- Downloadable software products
- Some health and personal care items
To complete your return, we require a tracking number, which shows the items which you already returned to us.
There are certain situations where only partial refunds are granted (if applicable)
- Book with obvious signs of use
- CD, DVD, VHS tape, software, video game, cassette tape, or vinyl record that has been opened
- Any item not in its original condition, is damaged or missing parts for reasons not due to our error
- Any item that is returned more than 30 days after delivery
Items returned to us as a result of our error will receive a full refund,some returns may be subject to a restocking fee of 7% of the total item price, please contact a customer care team member to see if your return is subject. Returns that arrived on time and were as described are subject to a restocking fee.
Items returned to us that were not the result of our error, including items returned to us due to an invalid or incomplete address, will be refunded the original item price less our standard restocking fees.
If the item is returned to us for any of the following reasons, a 15% restocking fee will be applied to your refund total and you will be asked to pay for return shipping:
- Item(s) no longer needed or wanted.
- Item(s) returned to us due to an invalid or incomplete address.
- Item(s) returned to us that were not a result of our error.
You should expect to receive your refund within four weeks of giving your package to the return shipper, however, in many cases you will receive a refund more quickly. This time period includes the transit time for us to receive your return from the shipper (5 to 10 business days), the time it takes us to process your return once we receive it (3 to 5 business days), and the time it takes your bank to process our refund request (5 to 10 business days).
If you need to return an item, please Contact Us with your order number and details about the product you would like to return. We will respond quickly with instructions for how to return items from your order.
Shipping Cost
We'll pay the return shipping costs if the return is a result of our error (you received an incorrect or defective item, etc.). In other cases, you will be responsible for paying for your own shipping costs for returning your item. Shipping costs are non-refundable. If you receive a refund, the cost of return shipping will be deducted from your refund.
Depending on where you live, the time it may take for your exchanged product to reach you, may vary.
If you are shipping an item over $75, you should consider using a trackable shipping service or purchasing shipping insurance. We don’t guarantee that we will receive your returned item.
Oops!
Sorry, it looks like some products are not available in selected quantity.
