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Abstracts of DALTCP REPORTS--"E" Titles

This section gives abstracts for reports produced through DALTCP-funded research or through research done by DALTCP staff. Links to Executive Summaries and/or Full Reports immediately follow most descriptions, as well to Project Descriptions (if available). (We are working towards putting ALL Full Reports online.) Reports can be ordered from the Office of Disability, Aging and Long-Term Care Policy, unless stated otherwise. Requests can be made by Fax (202-401-7733) or through email (webmaster.DALTCP@hhs.gov).

NOTE: Because of the large number of DALTCP reports, abstracts are divided into several files. Also, number of pages can vary from that given after the abstract when printing HTML versions, depending on your printer setup.

Remember, the Site Index section includes an alphabetic list of keywords you can choose to find information that is referenced throughout the DALTCP website.

EASING THE BURDEN OF CAREGIVING: THE IMPACT OF CONSUMER DIRECTION ON PRIMARY INFORMAL CAREGIVERS IN ARKANSAS

ABSTRACT: Cash and Counseling, an innovative model of consumer direction, has been implemented as a three-state demonstration designed to weigh the advantages and disadvantages of allowing Medicaid beneficiaries to assume more responsibility for the supportive services they may need. This paper presents estimates of program effects on primary informal caregivers (those providing the most unpaid supportive services at baseline) from Arkansas's Cash and Counseling demonstration, the first of three such demonstrations to enroll and randomly assign Medicaid beneficiaries to direct their own services or to rely on agencies as usual. Arkansas's consumer-directed program, known as IndependentChoices, was designed for elderly and nonelderly adults. [48 pages]

ECONOMIC IMPACT OF LONG-TERM CARE ON INDIVIDUALS

ABSTRACT: This paper summarizes data on the distributions of income and assets of the elderly. The extent to which long-term care is affordable is also examined. Data on Medicaid spenddown are discussed. Out-of-pocket payments for acute care services are also considered. Projections of public and private expenditures for long-term care in future years are also presented. The likely impacts of the growth in private long-term care are also examined.

EFFECT OF CONSUMER DIRECTION ON PERSONAL ASSISTANCE RECEIVED IN ARKANSAS

ABSTRACT: The traditional system of providing Medicaid personal care services (PCS) through home care agencies gives consumers few choices about how and when their care is provided. Because some agencies do not provide care on weekends or outside business hours, consumers may not receive care when they need it. Moreover, worker shortages make it difficult to ensure that beneficiaries receive all the care they entitled to. This study of Arkansas's Cash and Counseling Demonstration program, IndependentChoices, examines how this model of consumer direction changes the way that consumers meet their personal assistance needs. [51 pages]

EFFECT OF NURSING HOME USE ON MEDICAID ELIGIBILITY

ABSTRACT: This paper presents results of a descriptive analysis of the effects of nursing home use of Medicaid eligibility status. Data from the 1982 and 1984 National Long-Term Care Surveys were used to "track" a cohort of disabled elderly persons residing in the community in 1982 over the following two years. While 12% of the cohort spent some time in nursing homes between 1982 and 1984, about 40% were for short stays. In contrast to persons who did not use nursing homes, persons who entered nursing homes had a four to five-fold risk of spending down to Medicaid eligibility. Implications of these results for long-term care research and policies are discussed.

EFFECTS OF CASE MANAGEMENT AND COMMUNITY SERVICES ON THE IMPAIRED ELDERLY

ABSTRACT: The evaluation of the National Long-Term Care Channeling Demonstration featured a randomized design in which applicants to the program were randomly assigned to either the treatment group, which had the opportunity to receive Channeling services, and the control group, which was barred from participation. Both groups were interviewed at baseline, 6 months, 12 months and--for half the sample--18 months. Under this arrangement, some treatment group members could refuse Channeling case management and services, while some control group members might obtain similar services elsewhere in the community. This report bases its analysis not on treatment/control differences but on differences between those who received case management and those who did not (regardless of whether they were in the treatment or control group). Because of methodological problems, it is not possible to determine unambiguously whether case management and formal community services affect nursing home use or other outcomes. Reliable answers to these issues require data that is collected expressly to address them.

EFFECTS OF MEDICARE'S HOSPITAL PROSPECTIVE PAYMENT SYSTEM (PPS) ON DISABLED MEDICARE BENEFICIARIES

ABSTRACT: The purpose of this study was to determine how PPS has affected the patterns of care received by Medicare beneficiaries with chronic disabling conditions. The study used the 1982 and 1984 National Long-Term Care Surveys to provide an empirical analysis of differences in the utilization patterns of hospital, skilled nursing facility and home health services under Medicare, before and after the implementation of PPS. Findings indicate that there were overall reductions in hospital lengths of stay after PPS, although the reductions were not uniform and appeared to be concentrated in subgroups of the disabled population. Importantly, the most disabled subgroup showed no change in length of stay. Virtually no changes were observed in post-PPS Medicare skilled nursing facility use although one would have hypothesized an increase. There was an overall increase in post-PPS home health utilization. No differences were observed in overall re-admission or mortality rates pre and post-PPS.

EFFECTS OF MULTIPLE ADMISSIONS ON NURSING HOME USE: IMPLICATIONS FOR "FRONT-END" POLICIES

ABSTRACT: This study analyzes data from the 1985 National Nursing Home Survey to examine the phenomenon of multiple nursing home admissions. This is done in order to determine the number of individuals who would be fully covered if "front-end" nursing home coverage options were enacted. Analysis of nursing home stays indicates that 51% of admissions would be fully covered by a 3-month benefit, but adjusting for multiple admissions reduces this figure to 39% of cases.

EFFECTS OF SAMPLE ATTRITION ON ESTIMATES OF CHANNELING'S IMPACTS FOR AN EARLY SAMPLE

ABSTRACT: In the evaluation of the National Long-Term Care Channeling Demonstration, some members of the research sample were lost to the analysis due to sample attrition. Sample attrition could distort the treatment/control group comparison, depending on the type of attrition that occurred. This report investigates whether there was evidence of bias due to attrition in the preliminary estimates of Channeling's impacts. Essentially, the report describes the pattern of attrition, discusses how attrition bias might arise, outlines the statistical procedures used to correct for bias and contains the results obtained when this procedure is used to estimate the impacts of Channeling for key outcome measures drawn from the preliminary findings. The report concludes that no global patterns of attrition bias emerge from the analysis.

ELDERCARE: THE IMPACT OF FAMILY CAREGIVERS' EMPLOYMENT ON FORMAL AND INFORMAL HELPER HOURS

ABSTRACT: The 1989 National Long-Term Care Survey is the first nationally representative survey to collect data on weekly hours of assistance received by ADL and/or IADL disabled elders living in the community by individual caregivers, both formal and informal. Thus, it is now possible to investigate the effects of primary caregivers' employment status on the amount of help that disabled elders receive, while simultaneously controlling for disability status and other potentially confounding variables. Under an ASPE task order contract, Beth Jackson of the MEDSTAT Group carried out a series of regression analyses, using, as the dependent variables, four different measures of hours of care: hours provided by the primary informal caregiver, hours from all unpaid sources other than the primary caregiver, hours from paid caregivers, and total hours of care received by care recipients from both paid and unpaid caregivers. Primary caregivers who are employed were found to provide significantly fewer hours of help personally (7.6) than primary caregivers not in the labor force. However, there were no significant differences in the total hours of help received by care recipients associated with the employment status of their primary caregivers--except for part-time employees. That is, care recipients of part-time employed caregivers received significantly fewer total hours of care (8.4) than other caregivers (including both full-time employees and those not in the labor force). For care recipients of full-time workers, the lower number of hours that the employed caregivers personally provided was made up by comparatively greater use of a combination of other informal and paid help. The same was not true for part-time employed caregivers. (ASPE Research Notes, Volume 14) [2 pages]

ELDERLY WITH DISABILITIES: AT RISK FOR HIGH HEALTH CARE COSTS

ABSTRACT: According to the 1987 National Medical Expenditure Survey, elderly persons with severe disabilities (defined as needing assistance with one or more activities of daily living) had out-of-pocket health care expenses nearly four times greater than persons without disabilities. Approximately 9% of the elderly population was categorized as having a severe disability. Much of the difference in out-of-pocket expenditures is due to greater home health spending among those without disabilities, who also have far greater hospital and physician expenses. Older people with disabilities also spend a greater proportion of family income on health care than do older people with disabilities--12% versus 3%. However, there is substantial variation in expenditures among persons with severe disability. For instance, over 70% of the severely disabled elderly do not have any out-of-pocket expenditures for home health care. Elderly persons with severe disabilities who were enrolled in Medicaid for only part of the year had the highest out-of-pocket expenditures (nearly 20% of family income). (ASPE Research Notes, Volume 8)

EMERGING PRIVATE FINANCING SYSTEM

ABSTRACT: This paper reviews trends in the growth of private long-term care insurance, including policies features and pricing. Other private risk-pooling mechanisms, including continuing care retirement communities and social health maintenance organizations, are also considered. Sources of individual asset accumulation that can be tapped for long-term care needs included accelerated life insurance benefits, and home equity conversion programs. Various factors that have inhibited long-term care planning by consumers and the growth in the private long-term care financing industry are also discussed.

ENABLING PERSONAL PREFERENCE: THE IMPLEMENTATION OF THE CASH AND COUNSELING DEMONSTRATION IN NEW JERSEY

ABSTRACT: This report describes the design and implementation of Personal Preference, New Jersey's model of Cash and Counseling. It also draws lessons from the state's experience. The report is based primarily on in-person interviews conducted in April 2001, about 18 months after the program began enrolling beneficiaries (November 1999). Interviews were conducted with New Jersey state officials, Personal Preference program staff members, officials of organizations representing the personal care industry in New Jersey, and staff members of organizations providing outreach, enrollment, consulting, and fiscal services under Personal Preference. [171 pages]

ENCYCLOPEDIA OF FINANCIAL GERONTOLOGY: FEDERAL DISABILITY PROGRAMS

ABSTRACT: Federal disability programs, which provide services such as cash support, health care coverage, and direct supportive services to eligible people with disabilities, are typically limited to people under the age of 65. This entry of the Encyclopedia of Financial Gerontology contains information about the Americans with Disabilities Act and nine major federal programs targeted on disability which serve sizable proportions of the non-elderly population aged 50 and over.

ENROLLING ELDERLY AND DISABLED BENEFICIARIES IN MEDICAID MANAGED CARE: LESSONS LEARNED FROM THE OREGON HEALTH PLAN

ABSTRACT: In this report, the authors describe the process used by the Oregon Health Plan (OHP) to enroll elderly and disabled beneficiaries into managed care, with a special focus on dually eligible beneficiaries. This information was obtained as part of a series of interviews with state Medicaid officials, local enrollment workers, providers, managed care plans, and advocacy groups. In addition, eligibility and enrollment files from both OHP and Medicare were used to produce descriptive tables.

ENSURING THE HEALTH AND WELLNESS OF OUR NATION'S FAMILY CAREGIVERS

ABSTRACT: The Department of Health and Human Services sponsored a town hall meeting on December 16, 2003 to highlight the important role of health promotion and disease prevention activities in ensuring the health and wellness of our nation's family caregivers. Former and current family caregivers were on hand to deliver testimonials of their caregiving experiences and discuss the positive impacts that health promotion activities have had on their quality of life. Researchers and representatives from caregiving organizations also highlighted ways in which family caregivers could engage in activities to improve their overall health. The available materials (listed below) include the event agenda and summary, a special letter from Mrs. Nancy Reagan, one page factsheet and frequently asked questions concerning family caregiving, an overview of the programs that promote the health of older adults, and a compendium of studies designed to promote the health of caregivers.

EPIDEMIOLOGICAL, DEMOGRAPHIC AND SOCIAL CORRELATES OF DISABILITY AMONG THE ELDERLY

ABSTRACT: A study was conducted on elderly long-term care population characteristics and service use; it focused on functional transitions at advanced ages and the impact of long-term care services on these transitions. Analysis was done using the 1982 and 1984 National Long-Term Care Surveys and the Channeling data sets; and a later analysis was done of the 1984 National Health Interview Survey/Supplement on Aging, and the 1985 National Nursing Home Survey. These complementary data sources were used to refine and expand the understanding of health and functional status changes, as well as trends in institutionalization and community service use. The analytic procedures included event history and life table models based on Grade of Membership classifications. In this report, the magnitude and quality of the problem of disability or functional impairment for the community resident disabled and institutionalized U.S. elderly populations are considered. Discussions include: analyzing the elderly and oldest old population; projections of the growth of the disabled and institutionalized elderly population; impact of changes in health and functioning at later ages; and assessing the number of disabled elderly in need of certain services.

ESTIMATE OF THE NUMBER OF PERSONS WITH DEVELOPMENTAL DISABILITIES RECEIVING SUPPLEMENTAL SECURITY INCOME BENEFITS AND THEIR CHARACTERISTICS

ABSTRACT: This paper was prepared as part of the Project to Design a Survey of Persons with Developmental Disabilities. The overall purpose of this project was to develop a national survey design that would provide data on a nationally representative sample of persons. This paper was conducted to develop a National Survey of Mentally Retarded and Developmentally Disabled Persons in Community Settings. Analyses are conducted of various national data sets which include persons with developmental disabilities to help develop national estimates of the developmentally disabled population and to help guide the survey design effort.

ESTIMATES OF THE RISK OF LONG-TERM CARE: ASSISTED LIVING AND NURSING HOME FACILITIES

ABSTRACT: The goal of this report is to identify the individual-level factors associated with nursing home and assisted living entry and determine whether and how they differ. While it is possible to estimate a simple model of entry into these facilities at some point in the observation period, a more useful model would make use of data on elapsed time until such a transition. Such a model makes better use of the data and differentiates delayed entry from early entry into a facility. Survival analysis is a natural candidate that allows us to build into our models several key features including right censoring and competing risks. [24 pages]

ESTIMATING ELIGIBILITY FOR PUBLICLY-FINANCED HOME CARE: NOT A SIMPLE TASK...

ABSTRACT: A number of proposals have been advanced to establish a uniform home care benefit for the frail elderly. Measures of disability using the activities of daily living (ADLs) have been used to estimate the numbers of persons potentially eligible under such proposals. This article shows that, even with a common approach to eligibility based on ADLs, the estimates from national surveys vary widely--from 0.5 million to 3.8 million persons. Such differences are affected by program targeting criteria but also by each survey's sampling frame, sample size, wording of questions on ADL status and the selection of variables for analysis. (ASPE Research Notes, Volume 1) [2 pages]

ESTIMATING THE DEMAND FOR AND IMPACT OF PRIVATE SECTOR FINANCING OPTIONS FOR LONG-TERM CARE

ABSTRACT: This study was undertaken in support of the Secretary's Technical Work Group on Private Financing of Long-Term Care for the Elderly. It employed the Brookings/ICF savings for long-term care on private out-of-pocket and Medicaid expenditures (both federal and state). Some of the results are reported in Report to the Secretary on Private Financing of Long-Term Care for the Elderly, Technical Work Group on Private Financing of Long-Term Care for the Elderly, November 1986. The analyses indicated that private long-term care insurance was likely to attract far more participation than tax-sheltered savings vehicles such as Individual Medical Accounts. The analyses also suggested that broad market penetration of private long-term care insurance can most quickly be achieved by providing some tax incentives.

ESTIMATING THE PREVALENCE OF LONG-TERM DISABILITY FOR AN AGING SOCIETY

ABSTRACT: This study was designed to provide comprehensive information about future long-term care needs in the U.S. Using data from the U.S. Decennial Census of Population and Housing, National Long-Term Care Survey and National Nursing Home Survey, the study developed detailed projections of the need for long-term care among the elderly in the years 2000, 2020 and 2040. Estimates of long-term care needs have traditionally relied on static models which assume that mortality and morbidity rates will remain constant over the projection period. This study employs a dynamic projection model. Three different sets of projections were estimated based on varying assumptions about changes in life expectancy and rates of impairment.

EVALUABILITY ASSESSMENT OF CHILD CARE OPTIONS FOR WORK-WELFARE PROGRAMS

ABSTRACT: The final report (Volume I) presents the results of an evaluability assessment of child care options for work-welfare programs. The project examined current work-welfare programs in selected states across the country and explored the evaluative issues regarding the role of child care in these programs. Volume II (State Discussion Summaries, Head Start Grantee Case Studies, and Cost Examples) presents summaries of the discussions with the states and Head Start grantees participating in the study. A discussion of the effects of the various cost principles on the charges to multiple funding sources related to Head Start and Title XX/work-welfare is also provided. [Volume I, 100 pages]

EVALUATION OF THE 1989 CHILD CARE SUPPLEMENT IN THE NATIONAL LONGITUDINAL SURVEY OF YOUTH

ABSTRACT: This report summarizes the results of a special experiment in the collection (from 347 mothers) of detailed current and retrospective child care information carried out in conjunction with the 1989 (11th round) wave of the National Longitudinal Survey of Youth. It addresses a number of child care data quality and evaluation issues, and provides some recommendations for subsequent data collection. Interested readers should have access to the 1989 Child Care Supplement in order to maximally be able to interpret the results of this report.

EVALUATION OF THE DISTRICT OF COLUMBIA'S DEMONSTRATION PROGRAM, "MANAGED CARE SYSTEM FOR DISABLED AND SPECIAL NEEDS CHILDREN": YEAR ONE REPORT

ABSTRACT: This project evaluates the District of Columbia's managed care demonstration program for disabled and special needs children. The demonstration program relies on a Medicaid-financed managed care system for children in the District's Supplemental Security Income program and is offered to eligible children as an alternative to the traditional Medicaid fee-for-service system. Enhanced Medicaid benefits through the demonstration program include individual treatment plans, respite care, van transportation and taxi vouchers, care management services and limited use phones. The Medicaid payment system includes risk sharing based on 85% risk corridors (as defined by medical loss ratios) between the District's Medicaid office and the non-profit health plan operating the demonstration, a capitated payment system for the health plan, and negotiated fee schedules for providers. This evaluation considers access and cost issues, placing considerable emphasis on issues related to quality of care and satisfaction. The research design centers on three main activities: (1) analyses of the implementation of the demonstration; (2) analyses of enrollment which will describe which children enroll and disenroll in this type of system; and (3) outcomes analyses that document the experiences of the District, plan, providers, children and families. The study of the implementation of the demonstration is based on interviews, a series of site visits to the District's Medicaid office and HSCSN, and review of the documentary record.

EVALUATION OF THE DISTRICT OF COLUMBIA'S DEMONSTRATION PROGRAM, "MANAGED CARE SYSTEM FOR SPECIAL NEEDS CHILDREN": FINAL REPORT

ABSTRACT: This report summarizes evaluation of the experiences of the District of Columbia's managed care system for children and adolescents under the age of 22 who are eligible for Medicaid and who are considered disabled according to Supplemental Security Income (SSI) Program guidelines. The District of Columbia submitted a waiver-only request for a three-year demonstration project to test the efficacy of the managed care system and the operational phase of the project was initiated on December 15, 1995. The demonstration project seeks to integrate acute and long-term care services for children with disabilities into a single capacitated payment methodology and represents the first demonstration of its kind. Summary of the results from this project lists what factors go into designing, implementing, and maintaining this type of health care system; which children are willing to enter a health care system such as the one designed by this demonstration; and what kinds of experiences the organizations, providers, and clients can expect to have when a managed care system like the Demonstration is introduced.

EVALUATION OF THE NATIONAL LONG-TERM CARE DEMONSTRATION

ABSTRACT: Several years ago, HHS set in motion a major policy research initiative which came to be known as the Channeling Demonstration. Channeling was conceived as a response to widespread concern about deficiencies in existing public long-term care financing programs. Critics said the system was too skewed toward nursing home care. It was fragmented and costly. Community-based services were stepsisters of nursing home care--too limited in their supply and too hard to access. A very common perception in 1979 was that a carefully managed system of in-home and community services could be a more appropriate and less costly alternative for many older people whose chronic illness, disability, and frailty put them at risk of being placed in nursing homes. These concerns and perceptions framed the design of Channeling. This report tells Channeling's research story in a series of articles and findings. (Health Services Research Special Issue, Volume 23, Number 1)

EVALUATION OF THE NATIONAL LONG-TERM CARE DEMONSTRATION: FINAL REPORT

ABSTRACT: The National Long-Term Care Channeling Demonstration was designed as a rigorous test of comprehensive case management of community care as a way of containing long-term care costs while providing adequate care to those in need. A randomized experimental design was employed to evaluate the demonstration. Two models of Channeling were tested: (1) the Basic Case Management Model (five sites), and (2) the Financial Control Model (five sites). Channeling enrolled an extremely frail elderly group whose average age was 80 years. The intervention was implemented largely according to plan. Channeling increased formal community service use. It had no significant effect on nursing home use, hospitalization or mortality. Channeling led to reduced unmet needs, increased client confidence in receipt of care and increased life satisfaction. Neither model had a major effect on the proportion of informal caregivers giving care; however, Channeling increased informal caregivers' satisfaction with service arrangements and satisfaction with life. Overall, the evidence indicates that the expansion of case management and community services beyond what exists does not lead to cost savings. But it does yield benefits in the form of increased home care, reduced unmet need and greater life satisfaction for clients and their informal caregivers who bear most of the care burden.

EVALUATION OF THE VETERANS ADMINISTRATION HOUSEBOUND AND AID AND ATTENDANCE ALLOWANCE PROGRAM

ABSTRACT: This project had two major goals: (1) To describe the workings of a successful, large-scale, case disability allowance program from an administrative perspective. The Veterans Administration (VA) allowance program is described in detail, to provide a benchmark for future research and program design. (2) To examine the question whether recipients of a cash allowance for long-term care are worse off than similar persons who receive in-kind subsidies. This study does so by examining the life circumstances of 139 recipients of the VA Housebound Allowance or Aid and Attendance Allowance. The health, functional needs, and use of services of these persons are compared with those of 610 persons interviewed in the 1983 National Long-Term Care Survey who received services in-kind. This report represents the first outside evaluation of this program. The analytical results of the study suggest that recipients of the cash disability allowance received similar levels of long-term care and were no worse off than the comparison group with regard to acute health care utilization. Evidence on hours of care per week and the direct (non-administrative) costs of the VA cash allowance program suggest that the cast benefit may be the more cost-effective alternative for many beneficiaries.

EXAMINATION OF ISSUES RELATED TO HOW HOME AND COMMUNITY-BASED SERVICES PROGRAMS OPERATE WITHIN FIXED BUDGETS AND TO THE ADMINISTRATIVE LINKAGES BETWEEN ELIGIBILITY DETERMINATION, NEEDS ASSESSMENT AND CARE PLANNING FUNCTIONS

ABSTRACT: This paper reports the findings of an exploratory study to document and analyze selected best practices related to state-administered home and community-based services (HCBS) programs. What the programs look like and how they work provided the context for examining two interrelated areas of policy interest: (1) how states organize and deliver a range of HCBS within fixed budgets, what mechanisms they use to manage program resources, and how they deal with actual or projected budget shortfalls in relation to demand for service; and (2) how eligibility determination, needs assessment, care planning and service authorization functions are structured and linked to one another administratively.

EXAMINATION OF THE EQUIVALENCE OF TREATMENT AND CONTROL GROUPS AND THE COMPARABILITY OF BASELINE DATA

ABSTRACT: This report examines the baseline data for treatment group and control group members in the National Long-Term Care Channeling Demonstration to determine whether they are comparable and, if not comparable on some variables, what should be done to ensure that regression estimates of Channeling's impact are not biased by such differences. Although there is strong evidence that there were no true treatment/control differences at randomization due to chance (based on analysis of screening data), a substantial number of large and statistically significant differences emerged between the two groups on baseline variables. It was concluded that differential measurement largely accounted for these differences. In the regression analysis, for non-comparable baseline variables with screen counterparts, the screen version was used as a control variable. Other non-comparable baseline variables (without a screen counterpart) were excluded from the set of control variables with the exception of hospital and nursing home days, which are replaced with information from the screen on whether the sample member was in a hospital or nursing home at screen or referred to Channeling by hospital or nursing home staff.

EXCEPTIONAL NEEDS CARE COORDINATOR IN THE OREGON HEALTH PLAN

ABSTRACT: This report describes how the state of Oregon designed and implemented its Exceptional Needs Care Coordinator (ENCC) function, assesses the extent to which this role is meeting the state's objectives, and discusses design elements that support the state's objectives. In order to provide a background for the discussion, we first describe the context in which the ENCC program operates, including the Oregon Health Plan and the long-term care community case management system. We then discuss the state legislative background and objectives for the ENCC role. This is followed by an examination of how health plans implemented the ENCC role, focusing specifically on how the flexible program requirements led to significant variation in ENCC functions across plans. The authors also describe the state's approach to monitoring the services. The report concludes with a discussion of the lessons learned from the Oregon ENCC design and implementation that might be of interest to other state policy makers.

EXECUTIVE SUMMARY: ANALYSIS OF THE EFFECT OF REGULATION ON THE QUALITY OF CARE IN BOARD AND CARE HOMES

ABSTRACT: This project was designed to achieve the following objectives: (1) to determine the quality of care in board and care homes, and how it varies across states and programs and between licensed and unlicensed homes, and (2) to examine the effect of state regulations on the quality of care in board and care homes. To accomplish these objectives the project compared the quality of care in facilities operating in states with limited regulation and states with more extensive regulation. Specifically, the project: (1) identified and examined the factors associated with differences in quality, with particular emphasis on the effect of regulation; (2) described generally the regulatory systems in 50 states and described, in detail, the systems in the ten study states; (3) described the key characteristics of the board and care industry in the study sample--the homes, the owners/operators, the staff, the residents, and the care and services that residents receive; and (4) compared the performance of licensed and unlicensed board and care homes across various dimensions. [48 pages]

EXPLORATORY ANALYSIS OF THE MEDICAID EXPENDITURES OF SUBSTANCE EXPOSED CHILDREN UNDER 2 YEARS OF AGE IN CALIFORNIA

ABSTRACT: No abstract available at this time.

EXPLORATORY STUDY OF BARRIERS AND INCENTIVES TO IMPROVING LABOR FORCE PARTICIPATION AMONG PERSONS WITH SIGNIFICANT DISABILITIES

ABSTRACT: This report contains the findings from five separate exploratory studies on issues related to the labor force participation of persons with disabilities. The report draws primarily from published studies in order to identify areas of research with conflicting claims and areas in which little or no research has been conducted. Based on the review of this body of research, the authors make recommendations for needed additional research in the specific areas studied. The studies included in this report examine: (a) various aspects of the competitive labor market for persons with disabilities, including factors affecting the labor supply of and demand for disabled workers; (b) the use of personal assistance services and assistive devices by disabled workers; (c) the impact of welfare reform strategies on persons with disabilities; and (d) selected programs that offer comprehensive services to help persons with significant disabilities participate in competitive employment.

EXPLORATORY STUDY OF HEALTH CARE COVERAGE AND EMPLOYMENT OF PEOPLE WITH DISABILITIES: FINAL REPORT

ABSTRACT: Most policymakers agree that the current structure of the Social Security Administration's disability programs creates substantial work disincentives for people with disabilities. One set of policy options concerns changing the links both between Medicare and the Social Security Disability Insurance (SSDI) program, and between Medicaid and the Supplemental Security Income (SSI) program. More generally, reforms that expand access to health insurance for people with disabilities who are not SSDI or SSI recipients could have an impact on both employment and program participation. The purpose of this study was to examine empirical evidence on the relationship among health insurance, employment, and program participation of people with disabilities. Specifically, the authors present the findings of an analysis of expansions in the income threshold for the SSI work incentive program established by Section 1619 of the Social Security Act; these expansions have allowed many working SSI recipients to maintain Medicaid eligibility even after their incomes rise above the level that makes them ineligible for SSI payments. This report also presents findings from an analysis of the employment, insurance and program participation status of people with disabilities using the 1993 Survey of Income and Program Participation and the 1994 National Health Interview Survey. This analysis focuses on groups of people with disabilities who would most likely be affected by expansions in public health insurance. [76 pages]

EXPLORATORY STUDY OF HEALTH CARE COVERAGE AND EMPLOYMENT OF PEOPLE WITH DISABILITIES: LITERATURE REVIEW

ABSTRACT: This literature review examines empirical evidence on health care coverage, employment, and public program participation among people with disabilities. The review is part of a larger project investigating the relationship between health care coverage and the employment of people with disabilities contracted for by DALTCP with funds provided by the Office of Disability in the Social Security Administration. Other components of the overall project will include analyses of recent national data on employment and health care coverage, analyses of patterns of employment among Supplemental Security Income recipients in the work incentive program that allows health care benefits to continue after earnings are too high for receipt of cash benefits, and patterns of employment in two states where there have been expansions in the Medicaid program.

Last revised: October 6, 2004

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