IN THE ABSTRACT
ACCESS
Long-Term Care for the Elderly: Profiles of Thirteen States
STUDY AND RESULTS Joshua Wiener and David Stevenson of the Urban Institute examined long-term care use, supply and control of expenditures in 13 states-Alabama, California, Colorado, Florida, Massachusetts, Michigan, Minnesota, Mississippi, New Jersey, New York, Texas, Washingotn and Wisconsin. For each of the 13, the report outlines the major features of the state's long-term care system. It describes the extent to which the states are revamping their programs through expanded home and community-based care, managed care, reimbursement changes, and Medicare maximization.
WHAT'S IMPORTANT The report provides a useful summary of diverse approaches to long-term care in 13 states.
FIND THIS STUDY Long-Term Care for the Elderly: Profiles of Thirteen States (Occasional Paper Number 12), published in August 1998 by the Urban Institute, can be ordered by calling (202) 833-7200 and can be downloaded from http://newfederalism.urban.org/html/occa12.html.
RELATED STUDIES State Initiatives on Long-term Care for the Elderly, available in Summer 2000, can be ordered from the Urban Institute by calling (202) 833-7200 In addition, individual state reports can be downloaded from http://newfederalism.urban.org/html/reports.html.
State Assisted Living Policy: 1998
STUDY AND RESULTS Robert Mollica at the National Academy of State Health Policy reviews current state assisted living policies and discusses the issues involved, including licensing, living unit definitions, admission/retention standards, quality assurance and monitoring, staff training, and public subsidies and Medicaid reimbursement.
WHAT'S IMPORTANT The report describes assisted living and board-and-care policies in each of the 50 states. It includes descriptions of key issues, summaries of what "most" states are doing and many useful state-by-state policy charts.
FIND THIS STUDY State Assisted Living Policy: 1998, published in June 1998 by the National Academy for State Health Policy can be ordered by calling (207) 874-6524. Cost is $35 for government and nonprofit organizations and $60 for all others. An updated copy of the report will be available in the summer of 2000.
Determining the Need for Long-Term Care Services
STUDY AND RESULTS Janet O'Keeffe at the American Association of Retired Persons examined the criteria states use to determine eligibility for home and community-based long-term care services in Medicaid waiver programs. The criteria fall into three categories: those that require a minimum score on an assessment tool, those that require a minimum number of impairments and/or needs, and those that base eligibility on level of care guidelines.
WHAT'S IMPORTANT. Eligibility criteria in individual states are outlined in the appendices. Policymakers can use the findings to see what others are doing as they assess eligibility requirements in their own states.
FIND THIS STUDY Determining the Need for Long-Term Care Services: An Analysis of Health and Functional Eligibility Criteria in Medicaid Home and Community-Based Waiver Programs, published in December 1996 by the Public Policy Institute at AARP, can be ordered by calling (202) 434-3860.
RELATED STUDIES Taking Care of Their Own: State-Funded Home and Community-Based Care Programs for Older Persons, published in September 1997 by the Public Policy Institute at AARP, can be ordered by calling (202) 434-3860.
QUALITY
Assuring Homecare Quality: A Case Study of State Strategies
STUDY AND RESULTS Robert Applebaum, Robert Mollica and Jane Tilly looked at strategies for assuring quality in home-based care in three states that have a strong commitment to quality: Massachusetts, South Carolina and Washington. Among other things, they examined approaches to quality at the state, regional and provider levels. Among the issues that affect quality of care are practice issues (reimbursement rates and wages for workers, independent providers versus agency workers) and research issues (lack of a universal definition of "quality," lack of information systems).
WHAT'S IMPORTANT Several issues-including determining appropriate wages for home care workers and creating a universal definition for "quality"-need to be addressed before a working quality assurance system can be developed.
FIND THIS STUDY "Assuring Homecare Quality: A Case Study of State Strategies" was published in the Winter 1997-1998 issue of Generations (pp. 57-63), a publication of the American Society on Aging. This periodical can be ordered by calling (415) 974-9605.
Survey of Fifteen States' Caregiver Support Programs
STUDY AND RESULTS Researchers at the Family Caregiver Alliance in San Francisco, California studied state-funded programs that serve families and informal caregivers of frail elders and the disabled in 15 states. Of the lot, five programs provided "best practice" models: 1) California's Caregiver Resource Centers, 2) New Jersey's Statewide Respite Program, 3) New York's Consumer and Family Support Services, 4) Oregon's Lifespan Respite Care Program and 5) Pennsylvania's Family Caregiver Support Program.
WHAT'S IMPORTANT Family caregiving programs often rely heavily upon state financial support. State policymakers can look to the exemplary programs described in this report if they choose to implement such programs.
CAVEAT The study did not examine all 50 states and U.S. territories and therefore is not comprehensive. Researchers studied the 15 states and 33 programs within them that were most innovative. However, AARP has contracted with the National Association of State Units on Aging to study caregiving programs in additional states.
FIND THIS STUDY Survey of Fifteen States' Caregiver Support Programs, published in 1999, can be ordered from the Family Caregiver Alliance at (800) 445-8106. Cost is $30. The executive summary of the report is available at http://www.caregiver.org
Quality Assurance of In-Home Care Services
STUDY AND RESULTS The Joint Legislative and Audit Review Committee in Washington examined the quality assurance practices of home health agencies and independent providers (IPs). Quality assurance practices in place include required and standardized training for all caregivers, mandatory yearly case manager visits and licensure for home health agencies, although those practices were more widely used for home health agencies than for IPs. Because IP caseloads are increasing faster than agency caseloads, the committee recommended increased quality assurance mechanisms for IPs.
WHAT'S IMPORTANT This is one of the few studies to evaluate quality assessment for in-home care services carried out at the state level. Independent provider caseloads are increasing, in large part because IPs are less expensive and are able to work more extensive and more flexible hours than are home health agency personnel. To protect the state's vulnerable in-home care clients, quality assurance regulations for IPs need to be improved.
FIND THIS STUDY Quality Assurance of In-Home Care Services (Report 99-2), published in February 1999, can be ordered from the Washington Joint Legislative Audit and Review Committee at (360) 786-5171 or downloaded from http://jlarc.leg.wa.gov/Reports.htm.
RELATED STUDIES Long-Term Care: Providing Compassion Without Confusion, published in December 1996 by the Little Hoover Commission, can be ordered by calling (916) 445-2125 and can be downloaded from http://www.lhc.ca.gov/lhcdir/elderca.html.
In-Home Supportive Services for the Elderly and Disabled
STUDY AND RESULTS Researchers at the U.S. Department of Health and Human Services and the University of California, Los Angeles, explored whether there are quality differences between home and community-based services delivered by personnel chosen, hired and paid by the client compared with personnel chosen, hired and paid by organizations.
WHAT'S IMPORTANT Clients who chose their own personnel had better outcomes on three measures: satisfaction with services, empowerment and quality of life. There were, however, no significant differences between the two models on client safety and unmet needs.
FIND THIS STUDY In-Home Supportive Services for the Elderly and Disabled: A Comparison of Client-Directed and Professional Management Models of Service Delivery (prepared under contract #100-94-0022), published in April 1999 by the U.S. Department of Health and Human Services and the University of California, Los Angeles, can be downloaded from http://aspe.os.dhhs.gov/daltcp/reports/ihss.htm.
COST
Estimated Cost Savings from the Use of Home and Community-Based Alternatives to Nursing Facility Care in Three States
STUDY AND RESULTS Researchers at The Lewin Group studied Medicaid long-term care spending in Colorado, Oregon and Washington from the early 1980s until 1994 to shed light on the cost-effectiveness of home and community-based services. The three states have been successful in controlling growth in Medicaid long-term care spending.
WHAT'S IMPORTANT Colorado, Oregon and Washington spent less on long-term care services through aggressive use of HCBS as an alternative to nursing homes.
FIND THIS STUDY Estimated Cost Savings from the Use of Home and Community-Based Alternatives to Nursing Facility Care in Three States (item #9618) was published in November 1996. Order from AARP Public Policy Institute at (202) 434-3860.
RELATED STUDIES Public Costs of Serving a Long-Term Care Client in a Nursing Home or in a Community-Based Program, published in April 1997 by the Wisconsin's Department of Health and Family Services, can be ordered by calling (608) 266-5572. The General Accounting Office's report on Oregon, Washington and Wisconsin, Medicaid Long-Term Care: Successful State Efforts to Expand Home Services While Limiting Costs, can be ordered by calling (202) 512-6000.
ASSESSING STATE SYSTEMS
State LTC Profiles Report, 1996
STUDY AND RESULTS Richard Ladd, Robert Kane and Rosalie Kane measured and ranked states based on four summary measures: control of nursing home use, control of nursing home expenditures, commitment to home and community-based services (HCBS) use and commitment to HCBS expenditures.
WHAT'S IMPORTANT The report provides a handy snapshot of states' long-term care systems. The data include demographics, nursing home bed supply and utilization, growth rate of Medicaid nursing home cases and HCBS expenditures.
FIND THIS STUDY State LTC Profiles Report, 1996 was published in April 1999. Order by sending a check for $25 and your name and address to Minnesota Chair in LTC and Aging, School of Public Health, University of Minnesota, 420 Delaware St. SE, Box 197 Mayo, Minneapolis, MN 55455.
RELATED STUDIES The 1998 Data Book on Long-Term Care Program and Market Characteristics, published in November 1999 by the Department of Social and Behavioral Sciences at the University of California, San Francisco, can be downloaded from http://www.hcfa.gov/medicaid/98sdbltc.pdf Across the States 1998: Profiles of Long-Term Care Systems, Third Edition, published by the AARP, can be ordered by calling (202) 434-3860.
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