Paying Family Medical Caregivers for Children's Home Healthcare in Colorado: A Working Medicaid Model
children with medical complexity; Medicaid; children with special health care needs; Colorado; Caregiving
OBJECTIVE: To compare the characteristics and healthcare utilization of children with medical complexity (CMC) who receive paid certified nursing assistant (CNA) care by a family member (family CNA) and by a traditional non-family member (non-family CNA). STUDY DESIGN: This was retrospective cohort study of children who received CNA care through Colorado's Medicaid paid family caregiving program between 2017-2019 by a home healthcare agency. We compared patient characteristics between the family CNA and non-family CNA groups. A multivariable Poisson regression model was used to compare hospitalization rates (days in the hospital per year), adjusting for patient age patient sex, nursing care, and complex chronic condition. RESULTS: Of 861 patients, 79% (N=680) received family CNA care and 21% (N=181) received non-family CNA care. Patient demographics and hospitalization did not differ between the groups, although family CNA patients were less likely to receive additional nursing-level care (42% versus 60%, p<0.01). Family and non-family CNA caregivers had similar characteristics, except that family CNA caregivers had substantially better 3-year retention (82% versus 9%, p<0.01) despite lower average hourly pay ($14.60 vs. $17.60 per hour, p<0.01). Hospitalizations were rare (<10% of patients). In the adjusted model, family CNA patients experienced 1 more hospitalized day per year, compared with non-family CNA patients (p<0.001). CONCLUSIONS: Paid family caregivers provided CNA level care to CMC with a greater employee retention compared with non-family CNA caregivers, with marginally different hospitalization rates using a family-centered approach. This model may help address workforce shortages while also providing income to family caregivers.
Foster C; Kwon S; Blakely C; Carter K; Sobotka SA; Goodman DM; Agrawal R; Brittan M
The Journal of Pediatrics
2023
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jpeds.2022.12.043" target="_blank" rel="noreferrer noopener">10.1016/j.jpeds.2022.12.043</a>
The Role of Parental Monitoring in Understanding the Benefits of Parental Acceptance on Adolescent Adherence and Metabolic Control of Type 1 Diabetes
Adolescent Transitions
Objective: The study examined 1) whether the benefits of mothers' and fathers' accepting relationships with their adolescents on diabetic control were due to parental monitoring and 2) how parents together may provide sufficient acceptance and monitoring for diabetes management. Research Design and Methods: Adolescents aged 10-14 with type 1 diabetes (n = 185) and their mothers (n=185) and fathers (n =145) completed assessments of parental acceptance and monitoring of diabetes tasks. Adolescents completed a modified version of the Self-Care Inventory (1) to measure adherence. Glycosolated hemoglobin (HbA(1c)) scores were used as a marker of glycemic control. Results: Mediational analyses revealed that the benefits of adolescents' reports of fathers' acceptance on HbA(1c) and mothers' and fathers' acceptance on better adherence were partially mediated by monitoring. Both mothers' and fathers' monitoring and fathers' acceptance had independent effects in predicting adherence. However, only fathers' monitoring had an independent effect on HbA(1c). The effect of fathers' monitoring on HbA(1c) occurred as fathers were monitoring at a lower level than mothers. Mothers' and fathers' reports of their own acceptance and monitoring were not associated with HbA(1c) or adherence. Conclusions: Results reveal the importance of fathers' acceptance and monitoring in diabetes management, a role that should be encouraged, despite the little attention it has received.
2008
Berg CA; Butler JM; Osborn P; King G; Palmer DL; Butner J; Murray M; Lindsay R; Donaldson D; Foster C; Swinyard M; Wiebe DJ
Diabetes Care
2008
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.2337/dc07-1678" target="_blank" rel="noreferrer">10.2337/dc07-1678</a>