Older Adults Post-Incarceration: Restructuring Long-term Services and Supports in the Time of COVID-19.

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To describe long-term care services and supports (LTSS) in the United States, note their limitations in serving older adults post-incarceration, and offer potential solutions, with special consideration for the Coronavirus Disease 2019 pandemic.


Narrative review.

Setting and participants

LTSS for older adults post-incarceration.


Literature review and policy analysis.


Skilled nursing facilities, nursing homes, assisted living, adult foster homes, and informal care from family and friends compose LTSS for older adults, but their utilization suffers from access and payment complexities, especially for older adults post-incarceration. A combination of public-private partnerships, utilization of health professional trainees, and unique approaches to informal caregiver support, including direct compensation to caregivers, could help older adults reentering our communities following prison.

Conclusions and implications

Long-standing gaps in US LTSS are revealed by the coronavirus (severe acute respiratory syndrome coronavirus 2) pandemic. Older adults entering our communities from prison are particularly vulnerable and need unique solutions to aging care as they face stigma and access challenges not typically encountered by the general population. Our review and discussion offer guidance to systems, practitioners, and policy makers on how to improve the care of older adults after incarceration.





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Publication Info

Boucher, Nathan A, Courtney H Van Houtven and Walter D Dawson (2021). Older Adults Post-Incarceration: Restructuring Long-term Services and Supports in the Time of COVID-19. Journal of the American Medical Directors Association, 22(3). pp. 504–509. 10.1016/j.jamda.2020.09.030 Retrieved from https://hdl.handle.net/10161/26134.

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Nathan Adam Boucher

Associate Research Professor in the Sanford School of Public Policy

I am a Research Health Scientist at Durham VA Health System’s Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) and Duke University faculty at Sanford School of Public Policy, the Medical School, and the Nursing School. I am also a Senior Fellow at the Duke Center for the Study of Aging & Human Development as well as Duke-Margolis Center for Health Policy Core Faculty. 

I have extensive experience in clinical medicine (licensed physician assistant in critical care and emergency medicine), health care administration, health professions education, hospice and palliative care quality improvement, and community-based research. Challenges and opportunities at the intersection of social care and health care inform my research agenda. My collaborations across disciplines at VA and Duke and with community organizations have afforded me deep insights into the lives and challenges of community members and family/friend care partners.

My research has been funded by Veterans Administration, NIH, Centers for Medicare/Medicaid Services, several foundations, and Duke University. Recent research includes 1) describing care partners’ social and health needs related to caring for older adults re-entering the community from prison; 2) designing and testing community health worker programs focused on older adults; 3) characterizing concerns care partners and people living with dementia have regarding the quality of care settings as well as emerging technologies; 4) systems approaches to homelessness among Veterans, and 5) defining and realigning training and employment for NC direct care workers serving in home- and community-based services.

Let's collaborate: nathan.boucher@duke.edu

Van Houtven

Courtney Harold Van Houtven

Professor in Population Health Sciences

Dr. Courtney Van Houtven is a Professor in The Department of Population Health Science, Duke University School of Medicine and Duke-Margolis Center for Health Policy. She is also a Research Career Scientist in The Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System. Dr. Van Houtven’s aging and economics research interests encompass long-term care financing, intra-household decision-making, unpaid family and friend care, and home- and community-based services. She examines how family caregiving affects health care utilization, expenditures, health and work outcomes of care recipients and caregivers. She is also interested in understanding how best to support family caregivers to optimize caregiver and care recipient outcomes.

Dr. Van Houtven  is co-PI on the QUERI Program Project, “Optimizing Function and Independence”, in which her caregiver skills training program developed as an RCT in VA, now called Caregivers FIRST, has been implemented at 125 VA sites nationally. The team will evaluate how intensification of an implementation strategy changes adoption. She directs the VA-CARES Evaluation Center, which evaluates the VA’s Caregiver Support Program. She leads a mixed methods R01 study as PI from the National Institute on Aging that will assess the value of "home time" for persons living with dementia and their caregivers (RF1 AG072364).

Areas of expertise: Health Services Research and Health Economics

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