Adult Day Center Use among Older Mexican Americans with Dementia in California and Texas
Main Article Content
Abstract
Background. Dementia is one of the most common causes of disability and dependence in the world and is a frequent reason that older people require supportive living arrangements. Providing such arrangements on a broad scale will require a broad public dialogue and insights from social science, especially with respect to the neediest, who suffer from a profound gap in access to care. New and innovative social policy, in line with Recommendation #10 of the European Society of Medicine Policy Framework Reducing the Burden of Neurodegenerative Diseases in Europe and Beyond, is vital. The current study offers insights based on dementia care for Latinos in California and Texas, a population with a high incidence of the disease and low access to resources.
Objective. This study investigates how a growing number of Latino families use adult day care services. We focus on California and Texas, the two states with the largest Latino populations of Mexican origin with dual-eligible (Medicare and Medicaid) beneficiaries.
Methods. We employ the 2015 Hispanic Established Epidemiologic Studies of the Elderly to compare the socioeconomic characteristics of Mexican Americans 80 and over who are day care service users living with and without dementia in both states (n = 406). Logistic regressions are used to determine the likelihood of participation in adult day care programs in both states by insurance status.
Results. Compared to California, restrictive income eligibility requirements in Texas limit participation in adult day care despite a higher need for care. Multivariate analyses reveal that foreign-born dual-eligibles in Texas are particularly dependent on family, to provide dementia caregiving in comparison to the native born; they do not report using adult day health services.
Conclusion. The paper ends with a discussion of viable policy options for promoting equity in access to affordable and sustainable adult day health centers as well as other community-based long-term care services in Texas and California. A multi-faceted approach is necessary and must involve all levels of government, as well as private and charitable organizations.
Keywords:
Alzheimer's Disease and Dementia, Adult Day Care, Medicare/ Medicaid insurance, Mexican Americans, Health Equity
Article Details
How to Cite
ANGEL, Jacqueline L.; ROTE, Sunshine M..
Adult Day Center Use among Older Mexican Americans with Dementia in California and Texas.
Medical Research Archives, [S.l.], v. 12, n. 10, oct. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5936>. Date accessed: 22 dec. 2024.
doi: https://doi.org/10.18103/mra.v12i10.5936.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Alzheimer's Association. 2023 Alzheimer's disease facts and figures. Alzheimer's & Dementia. 2023;19(4):1598-1695.
2. Angel RJ, Angel JL. Latinos in an Aging World: Social, Psychological, and Economic Perspectives. New York: Routledge; 2015.
3. MEDPAC. Data Book: Beneficiaries Dually Eligible for Medicare and Medicaid. Retrieved 7/21/24 from https://www.macpac.gov/wpcontent/uploads/2024/01/Jan24MedPACMACPACDualsDataBook-508.pdf. ln:2024.
4. Angel RJ, Angel JL, Hill TD. Longer Lives, Sicker Lives? Increased Longevity and Extended Disability Among Mexican-Origin Elders. The Journals of Gerontology Series 8: Psychological Sciences and Social Sciences. 2015;70(4):639-649.
5. Garcia MA, Downer B, Chiu CT, SaenzJL, Rote S, Wong R. Racial/Ethnic and Nativity Differences in Cognitive Life Expectancies Among Older Adults in the United States. The Gerontologist. 2017;59 (2):281-289.
6. Boen CE, Hummer RA. Longer-but Harder Lives?: The Hispanic Health Paradox and the Social Determinants of Racial, Ethnic, and Immigrant Native Health Disparities from Midlife through Late Life. Journal of Health and Social Behavior. 2019; 60(4):434-452.
7. Montez JK, Angel JL, Angel RJ. Employment, Marriage, and Inequality in Health Insurance for Mexican-Origin Women. Journal of Health and Social Behavior. 2009;50(2):132-148.
8. Office of the Assistant Secretary for Planning and Evaluation. Racial and Ethnic Disparities in Alzheimer's Disease: A Literature Review. Retrieved 3/1/2020 from https://aspe.hhs.gov/report/racialand-ethnic-disparities-alzheimers-disease-1iterature-review. 2014.
9. Haan MN, Mungas DM, Gonzalez HM, Ortiz TO, Jagust WJ. Prevalence of Dementia in Older Mexican Americans: Influence of Stroke, Diabetes and Genetic Factors. Journal of the American Geriatric Society. 2003.
10. Mejia-Arango S, Aguila E, Lopez-Ortega M, et al. Health and social correlates of dementia in oldest-old Mexican-origin populations. Alzheimer's Disease and Dementia: Translational Research and Clinical Interventions. 2020.
11. Langa KM, Larson EB, Crimmins EM, et al. A Comparison of the Prevalence of Dementia in the United States in 2000 and 2012. JAMA Internal Medicine. 2017;177(1):51-58.
12. Matthews KA, Xu W, Gaglioti AH, et al. Racial and ethnic estimates of Alzheimer's disease and related dementias in the United States (2015& #x2013;2060) in adults aged ≥65 years. Alzheimer's & Dementia: The Journal of the Alzheimer's Association. 2019;15(1):17-24.
13. Alzheimer's Disease Research and Resource Foundation. Dementia Statistics. Retrieved 3/1/2020 from https://ararf.org/dementia-statistics/. 2019.
14. Brown HS, Herrera AP, Angel JL. Opportunity Costs Associated with Caring for Older Mexican Americans. 2013;28:375-389.
15. Herrera AP, George R, Angel JL, Markides K, Torres-Gil F. Variation in Older Americans Act Caregiver Service Use, Unmet Hours of Care, and Independence Among Hispanics, African Americans, and Whites. Home Health Care Services Quarterly. 2013;32(1):35-56.
16. Angel JL, Angel RJ, Aranda MP, Miles TP. Can the Family Still Cope? Social Support and Health as Determinants of Nursing Home Use in the Older Mexican-origin Population. Journal of Aging and Health. 2004;16:338-354.
17. Thomeer MB, Mudrazija S, Angel JL. How Do Race and Hispanic Ethnicity Affect Nursing Home Admission? Evidence From the Health and Retirement Study. The Journals of Gerontology Series 8: Psychological Sciences and Social Sciences. 2015;70(4):628-638.
18. National Institute on Aging. What is Long- term Care? Retrieved 7/20/20 from https://www.nia.nih.gov/health/what-long-term care. ln:2017.
19. Callahan CM, Sachs GA, Lamantia MA, Unroe KT, Arling G, Boustani MA. Redesigning systems of care for older adults with Alzheimer's disease. Health affairs (Project Hope). 2014;33(4): 626-632.
20. Torres S, Cao X. Improving Care for Elders Who Prefer Informal Spaces to Age-Separated Institutions and Health Care Settings. lnnov Aging. 2019;3(3):igz019.
21. Angel JL, Lopez-Ortega M, Chiu CT, et al. Loss of Autonomy: Likely Dementia and Living Arrangement Transitions among Mexicans and Mexican Americans. Gerontologist. 2023.
22. National Adult Day Services Association. Adult Day ServicesThe Most Cost-Effective Option in Long-Term Care Today Retrieved 3/1/2020 from https://www.nadsa.org/wp- content/uploads/2017/05/Updated-NADSA Public-Policy-Day-2017-Documents.pdf. 2017.
23. Rote SM, Angel JL, Moon H, Markides K. Caregiving Across Diverse Populations: New Evidence From the National Study of Caregiving and Hispanic EPESE. Innovation in aging. 2019;3(2):igz033 .
24. Alzheimer's and Dementia Caregiver Center. Adult Day Centers Retrived on 12/5/2016 from http://www.alz.org/care/alzheimersdementia-adult-day-centers.asp#ixzz4S02HPOWA ln:2016.
25. National Adult Day Service Association. Overview: About Day Services. Retrieved 6/23/24 from https://www.nadsa.org/research/overview/#:-:text=With%20more%20than%207%2C500%20ADS,source%20of%20Iong%2Dterm%20care.ln:2024.
26. Metlife Mature Market Institute. The 2011 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and Home Care Costs Retrieved 12/13/19 from https://www.aarp.org/content/dam/aarp/livablecommunities/old-learn/health/the-metlife-marketsurvey-of-nursing-home-assisted-living-adult-dayservices-and-home-care-costs-2011-aarp.pdf. ln:2011.
27. Lendon JP, Rome V. Variation in Adult Day Services Center Participant Characteristics, by Center Ownership: United States, 2016. Retrieved 6/23/24 from https://www.cdc.gov/nchs/data/databriefs/db296.Qili.2018.
28. Lendon JP, Singh P. Adult Day Services Center Participant Characteristics: United States, 2018. Retrieved 6/23/22 from https://www.cdc.gov/nchs/data/databriefs/db411.Qili.2021.
29. Paying for Senior Care. Medicaid & Adult Day Care: State by State Benefits & Eligibility. Retrieved 7/8/24 from https://www.payingforseniorcare.com/medicaidwaivers/aduIt-day-care. 2024.
30. Norouzi N, Angel JL. Intergenerational Day Centers: A New Wave in Adult and Child Day Care. International Journal of Environmental Research and Public Health. 2023;20(1):809.
31. California Department of Aging. CBAS Providers. Retrieved 3/15/2020 from https://www.aging.ca.gov/ProvidersandPartners/Community-BasedAdultServices/CBASProviders/. 2020.
32. California Department of Health Services. CalAIM 1115 Demonstration & 1915(6) Waiver. Retrieved 6/21/24 from https://www.dhcs.ca.gov/provgovpart/Pages/CalA IM-1115-and-19156-Waiver-Renewals.aspx. ln:2024.
33. Medicaid Waiver.org. California Medicaid Waiver Disability Services & Waivers Retrieved 2/11/2018 from http://medicaidwaiver.org/state/california.htmI.ln:2018.
34. California Department of Aging. Multipurpose Senior Services Program Narrative. Retrieved 6/22/24 from https://aging.ca.gov/download.ashx?IE0rcNUV0zZa7b30odaOzg%3d%3d.ln:2022.
35. California Department of Aging Medi-Cal Service Branch. Multipurpose Senior Services Program. Retrieved 6/22/24 from https://mcweb.apps.prd.cammis.medical.ca.gov/assets/871A7A2D-4BC7-4FA2-AC5E-B42E75935A0B/multisen.pdf?accesstoken=6UyVkRRfByXTZEWlh8j8OaYylPyP5ULO. ln:2020.
36. American Council on Aging. California Medicaid (Medi-Cal) Multipurpose Senior Services Program: Benefits, Eligibility & How to Apply. Retrieved 6/22/24 from https://www.medicaidplanningassistance.org/medi-cal-m ultipurpose-senior-services/. In:2024.
37. Texas Health and Human Services. Texas Health and Human Services Commission, Directory of Traditional DAHS and DAHS with Individualized Skills and Socialization Facilities with an Active License. Retrieved 7/8/24 from https://www.google.com/url?sa=i&url=https%3A%2F%2Fapps.hhs.texas.gov%2Fproviders%2Fdire ctories%2FDAHS.xlsx&psig=AOvVaw1MpCZmNJpxZZnRjxFlakhm&ust=1720547305676000&sourc e=images&opi=89978449. ln:2024.
38. Texas Health and Human Services. Interest List Reduction.Retrieved 7/8/2024 from https://www.hhs.texas.gov/about/recordsstatistics/interest-list-reduction. In:2024.
39. Texas Health and Human Services. STAR+ PLUS. Retrieved 7/8/24 from https://www.hhs.texas.gov/services/health/medica id-chip/medicaid-chip-members/starplus ln:2024.
40. Texas Health and Human Services. Dual Eligible Individuals Enrolled in Medicaid Managed Care. Retrieved 7/8/24 from https://www.hhs.texas.gov/sites/default/files/documents/dually-eligible-individuals-enrolledmedicaid-managed-care.pdf. ln:2022.
41. CalPace. PACE Cost-effectiveness. Retrieved 6/22/24 from https://www.calpace.org/wp content/uploads/2017/12/PACE-Cost-Effective-FactSheet.pdf#:-:text=Based%20on%20analysis%20of%20recent%20data%2C%20PACE%20costs,and%20out%20of%20expensive%20hospitals%20and%20nurs ing%20homes. 2019.
42. CalPACE. Cal PACE. Retrieved 6/22/2024 from https://calpace.org/0,000. 2024.
43. National PACE Association. PACE in the States. Retrieved 6/22/24 from https://www.npaonIine.org/docs/defauItsource/public-files/publicpaceinthestates5.1.24.pdf?sfvrsn=7041002c 1.2024.
44. Angel JL, Rote SM. Dementia Support among Older Mexican Americans: Is Adult Day Care a Viable Alternative? In: Angel JL, ed. Understanding the Context of Cognitive Aging: Mexico and the United States. Vol 5. Cham Switzerland: Springer Nature; 2021:227-245.
45. U.S. Census Bureau. OuickFacts: Rio Grande City, Texas Retrievec 3/15/2020 from https://www.census.gov/quickfacts/fact/table/riograndecitycitytexas/RHl725218#RHl725218.ln:2019.
46. California Department of Social Services. The Regions of California: Recommended Grouping of the Counties for Regional Studies. Retrieved 3/15/2020 from https://www.cdss.ca.gov/research/res/pdf/muItire ports/RegionsofCalifornia.pdf. ln:2002.
47. Angel JL, Angel RJ, Cantu P. Medicaid Use among Older Low-Income Medicare Enrollees in California and Texas: A Tale of Two States. Journal of health politics, policy and law. 2019;44(6):885- 910.
48. Texas Aging Services Council. Aging Texas Well Strategic Plan: 2020-2021. Retrieved 8/24/24 from https://www.hhs.texas.gov/sites/default/files/documents/laws-regulations/reports-presentations/2019/ag ing-tx-well-strat-plan-2020- 21-sept-2019.pdf. 2019.
49. National Archive of Computerized Data on Aging. Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE) Wave 9, 2016 [Arizona, California, Colorado, New Mexico, and Texas] (ICPSR 39038). Retrieved 6/23/24 from https://www.icpsr.umich.edu/web/NACDA/studie s/39038. ln:2024.
50. Hill T, Angel J, Balistreri K, Herrera A. Immigration Status and Cognitive Functioning in Late Life: An Examination of Gender Variations in the Healthy Immigrant Effect. Social Science & Medicine. 2012;75:2076-2084.
51. Morales LS, Flowers C, Gutierrez P, Kleinman M, Teresi JA. Item and scale differential functioning of the Mini-Mental State Exam assessed using the Differential Item and Test Functioning (DFIT) Framework. Med Care. 2006;44(11 Suppl 3):S143- 151.
52. Folstein MF, Folstein SE, McHugh PR. "Mini mental state": a practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research. 1975;12(3):189-198.
53. Tombaugh TN, McIntyre NJ. The Mini Mental State Examination: A Comprehensive Review. Journal of the American Geriatrics Society. 1992;40(9):922-935.
54. U.S. Census Bureau. Exploring Age Groups in the 2020 Census. Retrieve 7/17 /24 from https://www.census.gov/library/visualizations/interactive/exploring-age-groups-in-the-2020-census.htm I. ln:2023.
55. U.S. Admininistration for Community Living. 2020 Profile: Hispanic Americans Age 65 and Older. Retrieved 7/7 /24 from https://acl.gov/sites/default/files/Profile%20of%20OA/HispanicProfileReport2021.pdf ln:2021.
56. Texas Legislature Online. H.B. No. 728 An act relating to the statewide interagency aging services coordinating. Retrieved 7/21 /24 from https://capitol.texas.gov/tlodocs/88R/billtext/html/HB00728E.htm. ln:2023.
57. California Department of Aging. Master Plan for Aging. Retrieved 7/21 /24 from https://www.aging.ca.gov/download.ashx?IEOrcN UV0zYXf9JtT7jkAg%3D%3D Master Plan for Aging: Third MPA Annual Report (ca.gov). ln:2021.
58. California Department of Health Care Services. Dual Eligible Special Needs Plan (D-SNP) Performance Monitoring Dashboard Report – Quarter Two 2023. Retrieved 6/24/24 from https://www.dhcs.ca.gov/services/Documents/MCOMD/D-SNP-Dashboard-O2-with-narrative.pdf. ln:2024.
59. Rote S, Angel J, Hinton L. Characteristics and Consequences of Family Support in Latino Dementia Care. Journal of Cross-Cultural Gerontology. 2019;34(4):337-354.
60. U.S. Department of Labor Women's Bureau. Issue Brief: Older Women and Unpaid Caregiving in the United States. Retrieved 8/27/24 from https://www.dol.gov/sites/dolgov/files/WB/WB1ss ueBrief-OlderWomenAndUnpaidCaregiving.pdf. 2023.
61. National Adult Day Service Association. Choosing a Center Retrieved 7/8/24 from https://www.nadsa.org/for-caregivers/choosing-a center/. ln:2024.
62. Alzheimer's Association. Adult Day Centers, Retrieved 7/8/24 from https://www.alz.org/helpsupport/caregiving/care-options/aduIt-daycenters. 2024.
2. Angel RJ, Angel JL. Latinos in an Aging World: Social, Psychological, and Economic Perspectives. New York: Routledge; 2015.
3. MEDPAC. Data Book: Beneficiaries Dually Eligible for Medicare and Medicaid. Retrieved 7/21/24 from https://www.macpac.gov/wpcontent/uploads/2024/01/Jan24MedPACMACPACDualsDataBook-508.pdf. ln:2024.
4. Angel RJ, Angel JL, Hill TD. Longer Lives, Sicker Lives? Increased Longevity and Extended Disability Among Mexican-Origin Elders. The Journals of Gerontology Series 8: Psychological Sciences and Social Sciences. 2015;70(4):639-649.
5. Garcia MA, Downer B, Chiu CT, SaenzJL, Rote S, Wong R. Racial/Ethnic and Nativity Differences in Cognitive Life Expectancies Among Older Adults in the United States. The Gerontologist. 2017;59 (2):281-289.
6. Boen CE, Hummer RA. Longer-but Harder Lives?: The Hispanic Health Paradox and the Social Determinants of Racial, Ethnic, and Immigrant Native Health Disparities from Midlife through Late Life. Journal of Health and Social Behavior. 2019; 60(4):434-452.
7. Montez JK, Angel JL, Angel RJ. Employment, Marriage, and Inequality in Health Insurance for Mexican-Origin Women. Journal of Health and Social Behavior. 2009;50(2):132-148.
8. Office of the Assistant Secretary for Planning and Evaluation. Racial and Ethnic Disparities in Alzheimer's Disease: A Literature Review. Retrieved 3/1/2020 from https://aspe.hhs.gov/report/racialand-ethnic-disparities-alzheimers-disease-1iterature-review. 2014.
9. Haan MN, Mungas DM, Gonzalez HM, Ortiz TO, Jagust WJ. Prevalence of Dementia in Older Mexican Americans: Influence of Stroke, Diabetes and Genetic Factors. Journal of the American Geriatric Society. 2003.
10. Mejia-Arango S, Aguila E, Lopez-Ortega M, et al. Health and social correlates of dementia in oldest-old Mexican-origin populations. Alzheimer's Disease and Dementia: Translational Research and Clinical Interventions. 2020.
11. Langa KM, Larson EB, Crimmins EM, et al. A Comparison of the Prevalence of Dementia in the United States in 2000 and 2012. JAMA Internal Medicine. 2017;177(1):51-58.
12. Matthews KA, Xu W, Gaglioti AH, et al. Racial and ethnic estimates of Alzheimer's disease and related dementias in the United States (2015& #x2013;2060) in adults aged ≥65 years. Alzheimer's & Dementia: The Journal of the Alzheimer's Association. 2019;15(1):17-24.
13. Alzheimer's Disease Research and Resource Foundation. Dementia Statistics. Retrieved 3/1/2020 from https://ararf.org/dementia-statistics/. 2019.
14. Brown HS, Herrera AP, Angel JL. Opportunity Costs Associated with Caring for Older Mexican Americans. 2013;28:375-389.
15. Herrera AP, George R, Angel JL, Markides K, Torres-Gil F. Variation in Older Americans Act Caregiver Service Use, Unmet Hours of Care, and Independence Among Hispanics, African Americans, and Whites. Home Health Care Services Quarterly. 2013;32(1):35-56.
16. Angel JL, Angel RJ, Aranda MP, Miles TP. Can the Family Still Cope? Social Support and Health as Determinants of Nursing Home Use in the Older Mexican-origin Population. Journal of Aging and Health. 2004;16:338-354.
17. Thomeer MB, Mudrazija S, Angel JL. How Do Race and Hispanic Ethnicity Affect Nursing Home Admission? Evidence From the Health and Retirement Study. The Journals of Gerontology Series 8: Psychological Sciences and Social Sciences. 2015;70(4):628-638.
18. National Institute on Aging. What is Long- term Care? Retrieved 7/20/20 from https://www.nia.nih.gov/health/what-long-term care. ln:2017.
19. Callahan CM, Sachs GA, Lamantia MA, Unroe KT, Arling G, Boustani MA. Redesigning systems of care for older adults with Alzheimer's disease. Health affairs (Project Hope). 2014;33(4): 626-632.
20. Torres S, Cao X. Improving Care for Elders Who Prefer Informal Spaces to Age-Separated Institutions and Health Care Settings. lnnov Aging. 2019;3(3):igz019.
21. Angel JL, Lopez-Ortega M, Chiu CT, et al. Loss of Autonomy: Likely Dementia and Living Arrangement Transitions among Mexicans and Mexican Americans. Gerontologist. 2023.
22. National Adult Day Services Association. Adult Day ServicesThe Most Cost-Effective Option in Long-Term Care Today Retrieved 3/1/2020 from https://www.nadsa.org/wp- content/uploads/2017/05/Updated-NADSA Public-Policy-Day-2017-Documents.pdf. 2017.
23. Rote SM, Angel JL, Moon H, Markides K. Caregiving Across Diverse Populations: New Evidence From the National Study of Caregiving and Hispanic EPESE. Innovation in aging. 2019;3(2):igz033 .
24. Alzheimer's and Dementia Caregiver Center. Adult Day Centers Retrived on 12/5/2016 from http://www.alz.org/care/alzheimersdementia-adult-day-centers.asp#ixzz4S02HPOWA ln:2016.
25. National Adult Day Service Association. Overview: About Day Services. Retrieved 6/23/24 from https://www.nadsa.org/research/overview/#:-:text=With%20more%20than%207%2C500%20ADS,source%20of%20Iong%2Dterm%20care.ln:2024.
26. Metlife Mature Market Institute. The 2011 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and Home Care Costs Retrieved 12/13/19 from https://www.aarp.org/content/dam/aarp/livablecommunities/old-learn/health/the-metlife-marketsurvey-of-nursing-home-assisted-living-adult-dayservices-and-home-care-costs-2011-aarp.pdf. ln:2011.
27. Lendon JP, Rome V. Variation in Adult Day Services Center Participant Characteristics, by Center Ownership: United States, 2016. Retrieved 6/23/24 from https://www.cdc.gov/nchs/data/databriefs/db296.Qili.2018.
28. Lendon JP, Singh P. Adult Day Services Center Participant Characteristics: United States, 2018. Retrieved 6/23/22 from https://www.cdc.gov/nchs/data/databriefs/db411.Qili.2021.
29. Paying for Senior Care. Medicaid & Adult Day Care: State by State Benefits & Eligibility. Retrieved 7/8/24 from https://www.payingforseniorcare.com/medicaidwaivers/aduIt-day-care. 2024.
30. Norouzi N, Angel JL. Intergenerational Day Centers: A New Wave in Adult and Child Day Care. International Journal of Environmental Research and Public Health. 2023;20(1):809.
31. California Department of Aging. CBAS Providers. Retrieved 3/15/2020 from https://www.aging.ca.gov/ProvidersandPartners/Community-BasedAdultServices/CBASProviders/. 2020.
32. California Department of Health Services. CalAIM 1115 Demonstration & 1915(6) Waiver. Retrieved 6/21/24 from https://www.dhcs.ca.gov/provgovpart/Pages/CalA IM-1115-and-19156-Waiver-Renewals.aspx. ln:2024.
33. Medicaid Waiver.org. California Medicaid Waiver Disability Services & Waivers Retrieved 2/11/2018 from http://medicaidwaiver.org/state/california.htmI.ln:2018.
34. California Department of Aging. Multipurpose Senior Services Program Narrative. Retrieved 6/22/24 from https://aging.ca.gov/download.ashx?IE0rcNUV0zZa7b30odaOzg%3d%3d.ln:2022.
35. California Department of Aging Medi-Cal Service Branch. Multipurpose Senior Services Program. Retrieved 6/22/24 from https://mcweb.apps.prd.cammis.medical.ca.gov/assets/871A7A2D-4BC7-4FA2-AC5E-B42E75935A0B/multisen.pdf?accesstoken=6UyVkRRfByXTZEWlh8j8OaYylPyP5ULO. ln:2020.
36. American Council on Aging. California Medicaid (Medi-Cal) Multipurpose Senior Services Program: Benefits, Eligibility & How to Apply. Retrieved 6/22/24 from https://www.medicaidplanningassistance.org/medi-cal-m ultipurpose-senior-services/. In:2024.
37. Texas Health and Human Services. Texas Health and Human Services Commission, Directory of Traditional DAHS and DAHS with Individualized Skills and Socialization Facilities with an Active License. Retrieved 7/8/24 from https://www.google.com/url?sa=i&url=https%3A%2F%2Fapps.hhs.texas.gov%2Fproviders%2Fdire ctories%2FDAHS.xlsx&psig=AOvVaw1MpCZmNJpxZZnRjxFlakhm&ust=1720547305676000&sourc e=images&opi=89978449. ln:2024.
38. Texas Health and Human Services. Interest List Reduction.Retrieved 7/8/2024 from https://www.hhs.texas.gov/about/recordsstatistics/interest-list-reduction. In:2024.
39. Texas Health and Human Services. STAR+ PLUS. Retrieved 7/8/24 from https://www.hhs.texas.gov/services/health/medica id-chip/medicaid-chip-members/starplus ln:2024.
40. Texas Health and Human Services. Dual Eligible Individuals Enrolled in Medicaid Managed Care. Retrieved 7/8/24 from https://www.hhs.texas.gov/sites/default/files/documents/dually-eligible-individuals-enrolledmedicaid-managed-care.pdf. ln:2022.
41. CalPace. PACE Cost-effectiveness. Retrieved 6/22/24 from https://www.calpace.org/wp content/uploads/2017/12/PACE-Cost-Effective-FactSheet.pdf#:-:text=Based%20on%20analysis%20of%20recent%20data%2C%20PACE%20costs,and%20out%20of%20expensive%20hospitals%20and%20nurs ing%20homes. 2019.
42. CalPACE. Cal PACE. Retrieved 6/22/2024 from https://calpace.org/0,000. 2024.
43. National PACE Association. PACE in the States. Retrieved 6/22/24 from https://www.npaonIine.org/docs/defauItsource/public-files/publicpaceinthestates5.1.24.pdf?sfvrsn=7041002c 1.2024.
44. Angel JL, Rote SM. Dementia Support among Older Mexican Americans: Is Adult Day Care a Viable Alternative? In: Angel JL, ed. Understanding the Context of Cognitive Aging: Mexico and the United States. Vol 5. Cham Switzerland: Springer Nature; 2021:227-245.
45. U.S. Census Bureau. OuickFacts: Rio Grande City, Texas Retrievec 3/15/2020 from https://www.census.gov/quickfacts/fact/table/riograndecitycitytexas/RHl725218#RHl725218.ln:2019.
46. California Department of Social Services. The Regions of California: Recommended Grouping of the Counties for Regional Studies. Retrieved 3/15/2020 from https://www.cdss.ca.gov/research/res/pdf/muItire ports/RegionsofCalifornia.pdf. ln:2002.
47. Angel JL, Angel RJ, Cantu P. Medicaid Use among Older Low-Income Medicare Enrollees in California and Texas: A Tale of Two States. Journal of health politics, policy and law. 2019;44(6):885- 910.
48. Texas Aging Services Council. Aging Texas Well Strategic Plan: 2020-2021. Retrieved 8/24/24 from https://www.hhs.texas.gov/sites/default/files/documents/laws-regulations/reports-presentations/2019/ag ing-tx-well-strat-plan-2020- 21-sept-2019.pdf. 2019.
49. National Archive of Computerized Data on Aging. Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE) Wave 9, 2016 [Arizona, California, Colorado, New Mexico, and Texas] (ICPSR 39038). Retrieved 6/23/24 from https://www.icpsr.umich.edu/web/NACDA/studie s/39038. ln:2024.
50. Hill T, Angel J, Balistreri K, Herrera A. Immigration Status and Cognitive Functioning in Late Life: An Examination of Gender Variations in the Healthy Immigrant Effect. Social Science & Medicine. 2012;75:2076-2084.
51. Morales LS, Flowers C, Gutierrez P, Kleinman M, Teresi JA. Item and scale differential functioning of the Mini-Mental State Exam assessed using the Differential Item and Test Functioning (DFIT) Framework. Med Care. 2006;44(11 Suppl 3):S143- 151.
52. Folstein MF, Folstein SE, McHugh PR. "Mini mental state": a practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research. 1975;12(3):189-198.
53. Tombaugh TN, McIntyre NJ. The Mini Mental State Examination: A Comprehensive Review. Journal of the American Geriatrics Society. 1992;40(9):922-935.
54. U.S. Census Bureau. Exploring Age Groups in the 2020 Census. Retrieve 7/17 /24 from https://www.census.gov/library/visualizations/interactive/exploring-age-groups-in-the-2020-census.htm I. ln:2023.
55. U.S. Admininistration for Community Living. 2020 Profile: Hispanic Americans Age 65 and Older. Retrieved 7/7 /24 from https://acl.gov/sites/default/files/Profile%20of%20OA/HispanicProfileReport2021.pdf ln:2021.
56. Texas Legislature Online. H.B. No. 728 An act relating to the statewide interagency aging services coordinating. Retrieved 7/21 /24 from https://capitol.texas.gov/tlodocs/88R/billtext/html/HB00728E.htm. ln:2023.
57. California Department of Aging. Master Plan for Aging. Retrieved 7/21 /24 from https://www.aging.ca.gov/download.ashx?IEOrcN UV0zYXf9JtT7jkAg%3D%3D Master Plan for Aging: Third MPA Annual Report (ca.gov). ln:2021.
58. California Department of Health Care Services. Dual Eligible Special Needs Plan (D-SNP) Performance Monitoring Dashboard Report – Quarter Two 2023. Retrieved 6/24/24 from https://www.dhcs.ca.gov/services/Documents/MCOMD/D-SNP-Dashboard-O2-with-narrative.pdf. ln:2024.
59. Rote S, Angel J, Hinton L. Characteristics and Consequences of Family Support in Latino Dementia Care. Journal of Cross-Cultural Gerontology. 2019;34(4):337-354.
60. U.S. Department of Labor Women's Bureau. Issue Brief: Older Women and Unpaid Caregiving in the United States. Retrieved 8/27/24 from https://www.dol.gov/sites/dolgov/files/WB/WB1ss ueBrief-OlderWomenAndUnpaidCaregiving.pdf. 2023.
61. National Adult Day Service Association. Choosing a Center Retrieved 7/8/24 from https://www.nadsa.org/for-caregivers/choosing-a center/. ln:2024.
62. Alzheimer's Association. Adult Day Centers, Retrieved 7/8/24 from https://www.alz.org/helpsupport/caregiving/care-options/aduIt-daycenters. 2024.