Small balances from tax-preferred retiremet accounts such as 401s and IRAs can render some older adults ineligible for Medicaid, an important supplement to Medicare for older and disabled Americans who have low income and assets. The purpose of this study is to understand whether older low-income adults have assets in these tax-preferred accounts, hereafter defined contribution wealth, and whether DC wealth has implications for Medicaid eligibility. Using 2015-19 Medicare Current Beneficiary Survey data, the study finds half of all older adults with low income have either DC wealth or income from defined benefit pension plans and DC wealth is becoming more prevalent among younger cohorts of older adults, who are more likely to have DC wealth than DB income. Older adults with DC wealth are 5.5 percentage points less likely to be eligible for Medicaid than similar peers with DB income. In an exercise where DC wealth is hypothetically converted to an annuity, this eligibility gap falls by one-third to nearly one half. A possible policy solution would be to exclude DC wealth from the asset test, which would target the least advantaged beneficiaries and mimic the current eligibility criteria of the Supplemental Nutrition Assistance Program.

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A prescribing cascade occurs when a medication is prescribed to manage a side effect of another medication. Prescribing cascades represent a key component of problematic prescribing and can result in harm to patients, especially older adults with multimorbidity and polypharmacy.

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A key principle of best practice dementia care is providing access to support for making, communicating and participating in decisions affecting a person's life, whether for day-to-day activities or more complex decisions. Implementing a fit-for-purpose tool into routine care has challenges and requires careful planning to ensure success and sustainability. This project aimed to utilise implementation science principles to embed a dementia-focused risk negotiation conversation tool. Interview themes for care managers were augmenting care; flexible and supportive training; articulating target audience; and overcoming hesitancy. Implementation of into routine community aged care practice offered valuable insights into the critical role of inner and outer contextual barriers and enablers. Sufficient attention on capability, opportunity and motivational components of behaviour change was important, with the link identified between acceptability, feasibility and appropriateness, for reach and adoption of an innovation.

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