Jarmin Yeh

Background and Objectives: This study evaluated the IHSS+ ADRD Training Project, a multilingual intervention for caregivers serving individuals living with Alzheimer’s disease and related dementias (ADRD) through California’s In-Home Supportive Services (IHSS) program, using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Research Design and Methods: A quasi-experimental, mixed-methods evaluation was conducted from July 2019 to June 2024 across Alameda and Los Angeles counties. By applying the RE-AIM framework, Reach and Effectiveness dimensions were assessed through surveys completed by 488 caregivers in English (n = 297), Spanish (n = 102), and Chinese (n = 89) at pre-training, post-training, and 3-month follow-up. Caregivers were diverse among English speakers (38% Black/African American, 23% Hispanic/Latino, and 20% Asian), averaged 49.9 years old, and were predominantly women (88%). Quantitative measures assessed dementia knowledge, self-efficacy, distress, and depression. Qualitative interviews with stakeholders (n = 11) and open-ended caregiver survey responses explored Adoption, Implementation, and Maintenance dimensions Results: RE-AIM findings demonstrated: Reach across diverse caregiver populations in multilingual formats; Effectiveness with significant improvements in dementia knowledge and self-efficacy sustained at 3-month follow-up, plus 88-99% satisfaction; Adoption facilitated by union partnership; Implementation successfully transitioned to virtual delivery during COVID-19 despite technology barriers; and Maintenance supported by increased caregiver confidence, self-care awareness, and stress management skills, though sustainability required ongoing funding. Discussion and Implications: Language-concordant training produced meaningful, sustained improvements across a diverse paid caregiver workforce, demonstrating its value as an equity strategy in home care workforce development. While virtual delivery was feasible and cost-effective, long-term success depends on securing dedicated funding and reliable technology infrastructure.

Exposure to violence, a significant adverse childhood experience (ACE), can undermine physical safety and disrupt brain development, increasing the risk of mental health issues and chronic disease later in life. While extensive research on ACEs has focused on individual resilience, family dynamics, and neighborhood support in relation to specific health and behavioral outcomes, the role of neighborhood amenities remains underexplored. These public spaces outside of home or school such as libraries, parks, and recreational centers, referred to as “third places” may foster resilience by providing children with opportunities for safe, positive social interactions with peers and adults. Using data from California’s 2022–2023 enhanced National Survey of Children’s Health (NSCH), we explored the relationship between the presence of third places in a neighborhood and children’s exposure to violence-related ACEs. Violence-related ACEs were defined based on caregiver reports of children’s exposure to domestic or community violence. The availability of third places was assessed through caregiver-reported presence of libraries, parks, or recreational centers within the neighborhood. Our findings suggest that third places may serve as a protective buffer against the negative effects of violence-related ACEs. By offering safe environments, educational resources, and opportunities for positive social engagement, third places could play a crucial role in fostering resilience. Public health initiatives that prioritize the development and accessibility of such community assets may help mitigate children’s exposure to violence, while enhancing family and community well-being.

Elder abuse and neglect affect approximately 10% of Americans over age 60, with incidences rising as the population ages. Outcomes depend on frontline Adult Protective Services (APS) professionals' interpretation and implementation of policies and protocols, with historical reliance on subjective judgment causing variation in case handling. APS faces growing challenges including increasing case volumes, insufficient funding, and inconsistent practices. Recent improvement efforts have focused on structured decision-making tools and data analytics like the Identification, Services, and Outcomes (ISO) Matrix, designed to integrate empirical data collection with practice. This qualitative study examined ISO Matrix implementation in two APS programs in a West Coast state, analyzing APS professionals' experiences through focus groups. The analysis revealed tensions during the transition to standardized, data-driven decision-making, including optimism about using data to secure funding, challenges balancing standardized practices with complex case realities, staff-developed workarounds, and technological pitfalls. Findings highlight the need for greater flexibility in standardized tools to accommodate nuanced decision-making and emphasize humanizing approaches to technological innovation. By incorporating insights from frontline APS professionals, informatics systems can simultaneously serve institutional objectives by balancing administrative burdens with client needs while preserving professional discretion and enhancing accountability in safeguarding vulnerable older adults from abuse.

INTRODUCTION: The rising prevalence of Alzheimer's disease and related dementias (ADRD) in California's aging population necessitates a well‐trained dementia care workforce.METHODS: This study evaluated a multi‐week, competency‐based, online training for caregivers in California's Medicaid‐funded In‐Home Supportive Services (IHSS) program. Using a quasi‐experimental design, we assessed caregivers’ dementia knowledge, self‐efficacy, distress, depression, and care recipients’ healthcare use before and after the intervention.RESULTS: The training significantly improved caregivers’ dementia knowledge and self‐efficacy but did not reduce caregivers’ distress and depression, nor decrease care recipients’ emergency room visits and hospitalizations.DISCUSSION: The findings highlight the value of specialized dementia training in enhancing caregiver knowledge and skills, which could be implemented outside California. Clinical implications include bolstering caregiver well‐being to improve the quality of their support of care recipients with cognitive impairment. Policy implications include expanding access to training programs and bolstering workforce development initiatives that improve caregiver and care recipient outcomes.Highlights: Multiweek online training improved home care workers’ dementia caregiving skills. Home care workers’ dementia knowledge improved significantly post‐training. Self‐efficacy to manage care recipients’ dementia symptoms improved significantly.

Recent policy shifts in the United States have created opportunities for managed care organizations (MCOs) to put in place care navigators, like Dementia Care Specialists (DCS), to coordinate care for older adults living with dementia and their families. This paper presents findings of the DCS training model developed primarily for nurse and social work care managers within ten MCOs that participated in California’s pilot program serving Medicare–Medicaid dual-eligible members as part of a contracted collaboration with state agencies and the Centers for Medicare and Medicaid Services between 2013 and 2018, along with updated training model resources for replication.

Older adults in Native American, rural, and homeless communities have been disproportionately affected by the Coronavirus Disease 2019 (COVID-19) pandemic due to structural and systemic inequities. However, community-based organizations (CBOs) serving these older adults are well positioned as frontline responders and trusted messengers to support their needs and provide vital services that enable them to stay safe. This commentary argues that CBOs are essential for engaging with and responding to community needs during a pandemic. The work of three CBOs is spotlighted to elucidate the importance of partnerships and trust in disseminating strategies for responding to and mitigating pandemic impacts.

Direct care workers who provide in‐home care – such as caregivers hired by consumers of California’s Medicaid‐funded In‐Home Supportive Services (IHSS) program – are well positioned to observe changes in their consumer’s cognition, health, or behaviors to report to family members and healthcare partners, thereby helping to reduce risk of emergency department visits, avoidable hospitalizations, and other adverse outcomes that are disproportionately high among people living with Alzheimer’s disease and related dementias (ADRD) (Alzheimer’s Association, 2023). Despite their vital role in supporting people living with ADRD, direct care workers receive low wages and minimal training or supportive supervision. Strengthening the dementia care workforce is a public health priority; failure to do so will add health, social, and economic burdens to individuals, families, and society (American Public Health Association, 2020). An innovative initiative to bolster the direct care workforce is the IHSS+ADRD Training Project, which provides a 10‐week, instructor‐led, competency‐based, online training in English, Spanish, and Cantonese. The goal is to train 600 IHSS caregivers in Alameda County, California between 2020‐2024. We use a quasi‐experimental, longitudinal design to evaluate outcomes. Pre‐training, post‐training, and 3‐month follow‐up surveys are used to compare changes in IHSS caregivers’ dementia knowledge and self‐efficacy. Administrative records pulled one‐year before and after training are used to compare healthcare utilization patterns of IHSS consumers whose caregiver completed the training. This poster presents updated preliminary results from an analytic sample of 165 IHSS caregivers and consumers for whom we have complete follow‐up data to‐date. Dementia knowledge and self‐efficacy significantly increased at post‐training (p≤ 0.05), with trends suggesting retention at follow‐up. Most IHSS caregivers were very satisfied with the training (83%). Healthcare utilization data followed expected trends given COVID‐19 pandemic protocols in Alameda County. These results reveal promising signs that direct care workers do value training opportunities to better support consumers at home; however, the results need to be further understood in the context of COVID‐19 and the ADRD illness trajectory. Implications include replicating this training to other counties and beyond California to help meet the estimated 1.2 million additional direct care workers needed in the U.S. by 2030 (PHI, 2022).

This commentary argues that precarity and inequity across the life course and aging has accelerated via the COVID-19 pandemic. President Biden’s vaccination efforts, $1.9 trillion American Rescue Plan Act, and Build Back Better framework reflect a paradigm shift to restore faith and trust in government that boldly confronts entrenched austerity ideologues. We offer emancipatory sciences as a conceptual framework to analyze and promote social structural change and epic theory development. Emancipatory sciences aim to advance knowledge and the realization of dignity, access, equity, respect, healing, social justice, and social change through individual and collective agency and social institutions. Epic theory development moves beyond isolated incidents as single events and, instead, grasps and advances theory through attempts to change the world itself by demanding attention to inequality, power, and action. Gerontology with an emancipatory science lens offers a framework and vocabulary to understand the individual and collective consequences of the institutional and policy forces that shape aging and generations within and across the life course. It locates an ethical and moral philosophy engaged in the Biden Administration’s approach, which proposes redistributing – from bottom-up – material and symbolic resources via family, public, community, and environmental benefits.