Publication Date
U.S. Department of Health and Human Services
Tables Comparing Channeling to Other Community Care Demonstrations
Robert A. Applebaum, Margaret N. Harrigan and Peter Kemper
Mathematica Policy Research
May 1986
This report was prepared under contract #HHS-100-80-0157 between the U.S. Department of Health and Human Services (HHS), Office of Social Services Policy (now known as the Office of Disability, Aging and Long-Term Care Policy) and Mathematica Policy Research, Inc. Additional funding was provided by the Health Care Financing Administration and the Administration on Aging. For additional information about the study, you may visit the DALTCP home page at http://aspe.hhs.gov/daltcp/home.htm or contact the office at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, SW, Washington, DC 20201. The e-mail address is: webmaster.DALTCP@hhs.gov. The DALTCP Project Officer was Robert Clark.
The channeling demonstration was an intradepartmental long term care initiative funded by the Health Care Financing Administration (HCFA), Administration on Aging (AoA), and the Assistant Secretary for Planning and Evaluation (ASPE).
Over the past decade and a half, a series of demonstrations in addition to channeling have been fielded to test some form of case managed, community-based long term care. After a comprehensive review of these studies, we identified 14 community care demonstrations funded through federal government waivers which had interventions and research designs most relevant to the channeling demonstration. The purpose of this supplementary report is to facilitate comparisons of the interventions, evaluation designs, and estimated effects of these 14 demonstrations with one another and with the two models of channeling.
The demonstrations and the sources from which we draw the information appearing in the remaining tables of the report are presented in Table 1. Differences in methodology, level of detail with respect to the presentation, as well as differences in the treatment and evaluation designs themselves, make it impossible to produce completely comparable table entries.1 In addition, some of the reports from which the tables are compiled were in draft form and may be superceded in the future. Even if these problems did not exist, it still would be a matter of some judgment which specific variables and estimates best reflect in summary form outcomes which were typically measured differently across demonstrations.
For all these reasons, the point estimates appearing in these tables and the absolute differences among them should be interpreted with caution. However, we have used our best judgment about which estimates to display; and we believe that the basic direction of effects and relative differences indicated by the estimates shown are reliable indications of the differences among the demosntrations.
NOTES
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Berkeley Planning Associates (1985) made this task somewhat easier with their cross-demosntration study, but only a subset of the demonstrations was included in that work.
LIST OF TABLES
TABLE 1. Prior Community Care Demonstrations and Sources Used for Report
TABLE 2. Evaluation Methodologies
TABLE 3. Cost Controls and Eligibility Criteria
TABLE 4. Sample Characteristics
TABLE 5. Percent Receiving Direct Services from the Demonstrations
TABLE 6. Direct Services Covered
TABLE 7. Caseload Per Case Manager
TABLE 8. Informal Caregiving
TABLE 9. Nursing Home and Hospital Use During the 12 Months Following Enrollment
TABLE 10. Physician and Other Medical Service Expenditures
TABLE 11. Mortality Rates 12 Months After Enrollment
TABLE 12. Unmet Needs
TABLE 13. Social/Psychological Well-Being
TABLE 14. Functioning
TABLE 15. Case Management Costs
TABLE 16. Direct Service Costs
| TABLE 1. Prior Community Care Demonstrations and Sources Used for Report | |
| Demonstration(evaluation period) | Source |
| RANDOMIZED DESIGN | |
| Worcester Home Care (1973-1975) | Commonwealth of Massachusetts. "Final Report, Home Care : An Alternative to Institutionalization." Boston, MA: The Commonwealth of Massachusetts, Department of Elder Affairs, 1975. See also Sherwood, Sylvia, John N. Morris, and Claire E. Gutkin. "Final Report Concerning the Impact of Services on Health and Well-Being." Boston, MA: Department of Social Gerontological Research, Hebrew Rehabilitation Center for the Aged, 1975. |
| NCHSR Day Care/Homemaker Experiment (1975-1977) | Weissert, William G., Thomas T.H. Wan, and Barbara B. Livieratos. "Effects and Costs of Day Care and Homemaker Services for the Chronically Ill: A Randomized Experiment." Washington, DC: U.S. Department of Health, Education and Welfare, Office of Health Research, Statistics, and Technology, National Center for Health Services Research (Publication No. PHS 79-3258), February 1980. |
| Georgia AHS (1977-1980) | Georgia Department of Medical Assistance. "Alternative Health Services Project Final Report." Atlanta, GA: Georgia Department of Medical Assistance, January 1982. |
| Wisconsin CCO (1978-1980) | Seidl, F., et al. "Delivering In-Home Services to the Aged and Disabled--the Wisconsin Experience." Madison, WI: Fay McBeath Institute, University of Wisconsin, 1980. |
| Project OPEN (1980-1983) | Mt. Zion Hospital and Medical Center. "Project OPEN: Final Report." San Francisco, CA: Mt. Zion Hospital and Medical Center, December 1983. |
| Berkeley Planning Associates. "Evaluation of Coordinated Community Oriented Long Term Care Demonstrations." Berkeley, CA: Berkeley Planning Associates, May 1985. | |
| South Carolina LTC (1980-1984) | Blackman, Donald, et al. "South Carolina Commuity Long Term Care Project: Reports of Findings." Spartanburg, SC: South Carolina State Health and Human Services Finance Commission, July, 1985 (Draft). |
| Florida Pentastar (1981-1983) | Florida Department of Health and Rehabilitative Services. "Final Report and Evaluation of the Florida Pentastar Project" Tallahassee, FL: Florida Department of Health and Rehabilitative Services (Report E-84-7), 1984. |
| San Diego LTC (1981-1983) | Allied Home Health Association. "Long Term Care Demonstration Project of North San Diego: Final Report." Washington, DC: U.S. Department of Health and Human Services, Health Care Financing Administration, April 15, 1984. |
| Berkeley Planning Associates. "Evaluation of Coordinated Community Oriented Long Term Care Demonstrations." Berkeley, CA: Berkeley Planning Associates, May 1985. | |
| NONRANDOMIZED DESIGN | |
| ACCESS (1977-1980) | Price, Lewis C. and Hinda M. Ripp. "Third Year Evaluation of the Monroe County Long Term Care Program, Inc." Silver Springs, MD: Macro Systems, Inc., November 1980 (Draft). |
| Triage (1976-1979) | Triage, Inc. "Triage Coordinated Delivery of Services to the Elderly: Final Report." Plainville, CT: Triage, Inc., December 1979. |
| On Lok (1979-1983) | On Lok. "On Lok's CCODA: A Cost Competitive Model of Community-Based Long Term Care." San Francisco, CA: On Lok, February 1983. |
| Berkeley Planning Associates. "Evaluation of Coordinated Community Oriented Long Term Care Demonstrations." Berkeley, CA: Berkeleye Planning Associates, May 1985. | |
| MSSP (1980-1983) | Miller, Leonard, Marleen L. Clark, and William F. Clark. "The Comparative Evaluation of California's Multipurpose Senior Services Project." Berkeley, CA: Berkeley Planning Associates, 1984. |
| Nursing Home Without Walls (1980-1983) | Birnbaum, Howard et al. "Nursing Home Without Walls: Evaluation of the New York State Long Term Home Health Program." Cambridge, MA: Abt Associates, January 23, 1984 (Draft). |
| New York City Home Care (1980-1983) | City of New York. "Delivery of Medical and Social Services to the Homebound Elderly: A Demonstration of Intersystem Coordination." New York, NY: New York City Department for the Aging, 1984. |
| Berkeley Planning Associates. "Evaluation of Coordinated Community Oriented Long Term Care Demonstrations." Berekeley, CA: Berkeley Planning Associates, May 1985. | |
| TABLE 2. Evaluation Methodologies | ||||||
| Demonstration(evaluation period) | States | Sites | ComparisonMethodology | SampleSize | Months ofFollowup | Data Sources |
| Worcester Home Care (1973-1975) | 1 | 1 | Random assignment | 485 | 12 | Individual interviewsProject records |
| NCHSR Day Care/Homemaker Experiment (1975-1977) | 4 | 6 | Random assignment | 1,566 | 3, 6, 9, 12 | Individual interviewsMedicare recordsProject records |
| Triage (1976-1979) | 1 | 1 | Comparison group outside area (age differences) | 502 | 6, 12, 18, 24 | Individual interviewsDiariesProject recordsMedicare recordsMedicaid records |
| Georgia AHS (1977-1980) | 1 | 1 | Random assignment | 1,332 | 6, 12, 18, 24 | Individual interviewsProject recordsMedicaid records (with Medicare crossover) |
| ACCESS (1977-1980) | 1 | 1 | County-level comparison | -- | 24 | Department of Social Service records |
| Wisconsin CCO (1978-1980) | 1 | 1a | Random assignment | 417 | 6, 12 | Individual interviewsMedicaid recordsDeath records |
| On Lok (1979-1983) | 1 | 1 | Comparison group outside area, matched on characteristics (race, sex, and institutionalization differences) | 140 | 6, 12, 18, 24 | Individual interviewsProject recordsProvider records |
| MSSP (1980-1983) | 1 | 8 | Comparison group within and outside area, matched on whether in hospital, nursing home, or community (impairment differences) | 4,200 | 6, 12 | Individual interviewsMedicaid recordsMedicare records |
| South Carolina LTC (1980-1984) | 1 | 1 | Random assignment | 1,867 | 3, 6, 12, 18, 24, 36 | Individual interviewsProject recordsMedicaid recordsMedicare records |
| Project OPEN (1980-1983) | 1 | 1 | Random assignment | 335 | 6, 12, 18, 24, 30, 36 | Individual interviewsProject recordsMedicare records |
| Nursing Home Without Walls (1980-1983) | 1 | 9 | Comparison group within and outside area (age, race differences) | 1,373 | 6, 12 | Individual interviewsMedicaid recordsMedicare recordsFood stamp recordsSSI records |
| New York City Home Care (1980-1983) | 1 | 1 | Comparison group outside area (impairment differences) | 704 | 6, 12 | Individual interviewsDiariesMedicaid recordsMedicare records |
| Florida Pentastar (1981-1983) | 1 | 5 | Random assignment (plus comparison group outside area) | 1,046 | 12, 18 | Individual interviewsMedicaid recordsMedicare recordsFood stamp records |
| San Diego LTC (1981-1983) | 1 | 1 | Random assignment | 819 | 3, 6, 12, 18 | Individual interviewsMedicare records |
| Channeling (1982-1985) | 10b | 10b | Random assignment | 6,326 | 6, 12, 18 | Individual interviewsProject recordsMedicaid recordsMedicare recordsProvider recordsDeath recordsCaregiver interviews |
| ||||||
| TABLE 3. Cost Controls and Eligibility Criteria | ||||
| Demonstration(evaluation period) | CommunityServiceAuthorizationPower | CostMaximums | CostSharing | Eligibility Criteria |
| RANDOMIZED DESIGN | ||||
| Worcester Home Care (1973-1975) | Expanded services | No | No | 57 years or overMedicaid-eligibleAt risk of nursing home placementLiving in community but have high need for services |
| NCHSR Day Care/Homemaker Experiment (1975-1977) | Expanded day care coverage/ homemaker coverage or combined | No | No | At risk of nursing home placementMedicare-eligibleNeed services to maintain functioningFor homemaker and combined sites 3-day hospital stay in previous 14 days |
| Georgia AHS (1977-1980) | Expanded services | Maximum of 85 percent of the average of the Medicaid rates | No | Medicaid-eligible50 years or overEligible for nursing home placement as certified by professional review organization |
| Wisconsin CCO (1978-1980) | Expanded services | Maximum of $425 a month per care plan (equivalent to roughly 60 percent of the Medicaid cost of skilled nursing care for the period) | No | Over 18 yearsAt risk measured by functional criteriaMedicaid-eligible |
| Project OPEN (1980-1983) | Expanded services | No | No | 65 years or overAt risk as measured by functional criteriaMedicare-eligible |
| South Carolina LTC (1980-1984) | Expanded services | Maximum of 75 percent of the average of the Medicaid ICF and SNF rates | Yes | Medicaid-eligible18 years or overAt risk measured by nursing home preadmission screen |
| Florida Pentastar (1981-1983) | Expanded services | No | No | Medicaid-eligibleOver 60 yearsAt risk as measured by functional criteria |
| San Diego LTC (1981-1983) | Expanded services | No | No | Medicare-eligible65 years or overAt risk as measured by functional criteria |
| Channeling (1982-1984) | ||||
| -- Basic Case Management Model | Expanded services | Limited aggregate project funds for gap-filling services; specific cost control mechanisms at descretion of the local project | Cost sharing used at discretion of local project | 65 or overService needAt risk as measured by functional criteria |
| -- Financial Control Model | Medicaid/Medicare, expanded services | Cap of 60 percent of the average of Medicaid ICF and SNF rates for the average care plan; maximum of 85 percent for individual care plan | Yes | 65 or overService needAt risk as measured by functional criteriaEligible for Medicare Part A |
| NONRANDOMIZED DESIGN | ||||
| Triage (1976-1979)a | Expanded services (plus dental, glasses, hearing aids) | No | No | Over 60, Medicaid-eligibleNeed multiple servicesReside in unstable situation |
| ACCESS (1977-1980)a | Medicaid and expanded services | Maximum of 75 percent of the average of the Medicaid ICF and SNF rates | Yes | 18 years or overService need; at risk measured by nursing home preadmission screenMedicaid-eligible (Phase I) |
| On Lok (1979-1983) | Expanded servicesb | No | No | 55 years or overEligible for nursing home placement as measured by need for 24-hour nursingNursing-home certifiable |
| MSSP (1980-1983) | Expanded services | Maximum of 70 percent of the Medicaid SNF rate | No | Medicaid-eligible65 years or overAt risk of nursing home placement as measured by:Nursing home placement or applicationRecent hospitalizationOver 75Mental disorientation or loss of major caregiver |
| Nursing Home Without Walls (1980-1983) | Expanded services | Maximum of 75 percent of the average of the Medicaid ICF and SNF rates | No | No age requirementEligible for nursing home placement based on New York state nursing home preadmission assessment instrument (not actual applicant) |
| New York City Home Care (1980-1983) | Expanded services | No | No | Medicare, Part B65 years or overAt risk measured by functional criteria |
| ||||
| TABLE 4. Sample Characteristics | |||||||||
| Demonstration(evaluation period) | Percent75+a | PercentWhite | PercentFemale | PercentMarried | PercentLivingAlone | PercentDisabled onAt LeastOne ADL | PercentImpaired onAt LeastOne IADL | PercentIncontinent | Mental Status(Average NumberWrong 0-10) |
| RANDOMIZED DESIGN | |||||||||
| Worcester Home Care (1973-1975) | -- | -- | 71 | 29 | 43 | 41 | -- | -- | -- |
| NCHSR 222 (1975-1977)b | 55 | 91 | 75 | -- | 53 | 77 | -- | -- | -- |
| Georgia AHS (1977-1980) | -- | 53 | 74 | 25 | 33 | 60 | -- | -- | 3.1 |
| Wisconsin CCO (1978-1980)c | 37 | 71 | 80 | 12 | 48 | 62 | 97 | -- | -- |
| Project OPEN (1980-1983)c | -- | 69 | 70 | 31 | 55 | 50 | 81 | 24 | 0.6 |
| South Carolina LTC (1980-1984) | -- | 77 | 69 | 28 | 28 | 95d | 97d | 58d | 3.6 |
| Florida Pentastar (1981-1983)c | -- | 56 | 83 | 18 | 53 | 58 | 97 | 22 | 1.4 |
| San Diego LTC (1981-1983)c | 67 | 98 | 69 | 44 | 52 | 55 | 97 | 43 | 2.3 |
| Channeling (1982-1984) | 73 | 73 | 71 | 32 | 37 | 84 | 100 | 53 | 3.5 |
| NONRANDOMIZED DESIGN | |||||||||
| Triage (1976-1979)c | 73 | -- | 72 | 44 | 39 | 54 | 94 | -- | 1.7 |
| ACCESS (1977-1980)c | 80 | 70 | 92 | 23 | -- | 82 | 99 | 44 | 2.4 |
| On Lok (1979-1983)c | -- | 22 | 49 | 30 | 46 | 85 | 93 | 60 | 3.2 |
| MSSP (1980-1983)c | -- | 68 | 71 | 23 | 51 | 61 | 80 | 47 | 1.7 |
| Nursing Home Without Walls (1980-1983) | -- | 82 | 79 | 16 | 46 | 76 | -- | -- | -- |
| New York City Home Care (1980-1983)c | 68 | 69 | 78 | 45 | 35 | 78 | 100 | 38 | 2.6 |
| |||||||||
| TABLE 5. Percent Receiving Direct Services from the Demonstrations | |
| Demonstration(evaluation period) | Direct Services Received(percent) |
| RANDOMIZED DESIGN | |
| Worcester Home Care (1973-1975) | 59 |
| NCHSR Day Care/Homemaker Experiment (1975-1977) Day care Homemaker Combined | 758092 |
| Georgia AHS (1977-1980) | 80 |
| Wisconsin CCO (1978-1980) | 75 |
| Project OPEN (1980-1983) | 94 |
| South Carolina LTC (1980-1984) | 52 |
| Florida Pentastar (1981-1983) | -- |
| San Diego LTC (1981-1983) | 100 |
| Channeling (1982-1984) Basic model Financial model | 7882 |
| NONRANDOMIZED DESIGN | |
| Triage (1976-1979) | -- |
| ACCESS (1977-1980) | -- |
| On Lok (1979-1983) | -- |
| MSSP (1980-1983) | -- |
| Nursing Home Without Walls (1980-1983) | -- |
| New York City Home Care (1980-1983) | 98 |
| NOTE: Receipt of direct services is defined as receipt of a formal service which is arranged and paid for by the project. For channeling, it was defined as completing the initial care plan. Some comparisons across projects are potentially misleading because some projects were designed to rely on existing programs before spending project funds, while others (including the channeling financial control model) were to use project funds for all services. | |
| TABLE 6. Direct Services Covered | ||||||||
| Demonstration(evaluation period) | Services Paid for by Project | Direct Service Expenditures Per Client Per Month (dollars)c | Major Categories of Service Expenditures (percent receiving service) | |||||
| Physicians Hospitals and Nursing Homes | MedicalDay Care and Other Medical Services | Nursing, Therapy, and Mental Health Counseling | Home Health Aide, Personal Care, Homemaker, and Other In-Home Carea | Means and Transportation | Otherb | |||
| RANDOMIZED DESIGN | ||||||||
| Worcester Home Care (1973-1975) | No | No | Visiting nurse | Homemaker, chore, escort | Transportation | Linen | 54 | Transportation (35)Homemaker (33)Chore (27)Visiting Nurse (22)Linen (7)Escort (1) |
| NCHSR Day Care/Homemaker Experiment (1975-1977) | ||||||||
| -- Day Care | No | Medical day care | Part of medical day care | No | Transportation to day care, meals at day care | -- | 281 | -- |
| -- Homemaker | No | No | No | Homemaker, personal care, help with shopping, escort | Transportation as part of escort service | -- | 232 | -- |
| -- Combined | No | Medical day care | Part of medical day care | Homemaker, personal care, help with shopping escort | Transportation to day care or as part of escort service | 243 | -- | |
| Georgia AHS (1977-1980) | No | Medical day care | Skilled nursing, therapies | Personal care, homemaker, home health aidesd | Home-delivered meals | 152 | Home-delivered meals (50)Adult day care (11)In-home personal service (11) | |
| Wisconsin CCO (1978-1980) | No | Medical day care | Skilled nursing, therapies | Personal care, home health aides, companions | Transportation, home-delivered meals | Respite | 131 | Transportation (57)Home-delivered meals (56)Homemaker (52)Personal care (46)Social or medical day care (32)Home health aide (13) |
| Project OPEN (1980-1983) | No | Medical day care | Mental health counseling,e nursing,e therapiese | Homemaker/ chore,e home health aidese | Home-delivered meals, transportation | Respite, Interpreter | 342 | Homemaker (63)Escort transportation (57)Eyeglasses/ prosthetic devices (55)Physician services (50)Drugs (46) |
| South Carolina LTC (1980-1984) | No | Medical day care | Medical social services, therapies | Personal care | Home-delivered meals | Respite | 77 | Personal care (34)Medical day care (5)Therapies (3)Home-delivered meals (2)Medical social services (7)Respite (4) |
| Florida Pentastar (1981-1983) | No | Medical day care | Skilled nursing care, therapies | Personal care, home health aides | Medical transportation | Pest control, respite | 202 | Homemaker (78)Medical transportation (72)Personal care (51)Medical therapies (29) |
| San Diego LTC (1981-1983) | No | Medical day care | Skilled nursing | Home health aide, homemaker | Transportation, home-delivered meals | Health education | 333 | Home education (95)Homemaker/ home health aide (80)Transportation (47)Skilled nursing (35) |
| Channeling (1982-1984) | ||||||||
| -- Basic Model | No | Medical day care, medical equipment | Skilled nursing, therapies, mental health counseling | Homemakers/ personal care, home health aides, companions, housekeeping/ chore | Home-delivered meals, transportation | Respite care, foster care, housing assistance | 38 | Homemaker/ home health aide (75)hMeals (4.5)Transportation (4.5)Day Care (3.7)Other (12.3) |
| -- Financial Model | No | Medical day care, medical equipment | Skilled nursing, therapies, mental health counseling | Homemakers/ personal care, home health aides, companions, housekeeping/ chore | Home-delivered meals, transportation | Respite | 471 | Homemaker/ home health aide (70)hSkilled nursing (11)Home-delivered meals (5)Therapies (4)Other (10) |
| NONRANDOMIZED DESIGN | ||||||||
| Triage (1976-1979) | No | Dental care, glasses, hearing aids | Nursing, therapies | Homemaker, home health aide | Home-delivered meals | -- | -- | |
| ACCESS (1977-1980) | Increased physician reimbursement for home visitsf | No | Traditional Medicaid coverage | Homemaker, chore, friendly visiting | Transportation | Respite care, housing improvement, foster care | -- | -- |
| On Lok (1979-1983) | Hospitalization, nursing home use, hospice | Medical day care services, physician services | Nursing, therapies | Homemaker, home health aide, personal care | Home-delivered meals, transportation | Nutrition group exercise | 1,518g | -- |
| MSSP (1980-1983) | No | Day care | Nursing | In-home supportive services, personal care | Transportation, home-delivered meals | Protective services, legal services, housing | -- | Homemaker/ chore (67)Medical transportation (40)Nonmedical transportation (35)Personal care (27)Meals (16) |
| Nursing Home Without Walls (1980-1983) | No | No | Skilled nursing, therapies, respiratory therapies, medical social services | Homemaker, home health aide | Transportation, congregate meals, home-delivered meals | Moving assistance, housing improvements, respite, nutrition counseling | 12 | -- |
| New York City Home Care (1980-1983) | No | Prescription drugs | No | Homemaker, personal care | Transportation | 446 | Homemaker (99.8)Transportation (67)Drugs (67) | |
| ||||||||
| TABLE 7. Caseload Per Case Manager | |
| Demonstration(evaluation period) | Caseload per Case Manager |
| RANDOMIZED DESIGN | |
| Worcester Home Care (1973-1975) | -- |
| NCHSR Day Care/Homemaker Experiment (1975-1977) | -- |
| Georgia AHS (1977-1980) | -- |
| Wisconsin CCO (1978-1980) | 55-60 |
| Project OPEN (1980-1983) | 45-60 |
| South Carolina LTC (1980-1984) | 75-80 |
| Florida Pentastar (1981-1983) | -- |
| San Diego LTC (1981-1983) | -- |
| Channeling (1982-1984)-- Basic model-- Financial model | 4549 |
| NONRANDOMIZED DESIGN | |
| Triage (1976-1979) | 125 |
| ACCESS (1977-1980) | -- |
| On Lok (1979-1983) | -- |
| MSSP (1980-1983) | 55 |
| Nursing Home Without Walls (1980-1983) | -- |
| New York City Home Care (1980-1983) | 50 |
| TABLE 8. Informal Caregiving | ||
| Demonstration(evaluation period) | Measure | Results |
| RANDOMIZED DESIGN | ||
| Worcester Home Care (1973-1975) | Availability of and resiliency of informal support system (7 items) | No difference |
| NCHSR Day Care/Homemaker Experiment (1975-1977) | -- | -- |
| Georgia AHS (1977-1980) | -- | -- |
| Wisconsin CCO (1978-1980) | -- | -- |
| Project OPEN (1980-1983) | Type and amount of informal services received | No differences |
| South Carolina LTC (1980-1984)a | Type and amount (days per month) of informal assistance for ADL and IADL tasks | No differences |
| Florida Pentastar (1981-1983) | -- | -- |
| San Diego LTC (1981-1983)a | Type and amount (episodes) of informal assistance for ADL and IADL tasks | No difference in ADL help, significant decline in amount of IADL help especially in housekeeping and meal preparation |
| Channeling (1982-1984) | ||
| -- Basic Model | Type and amount of informal care received | No differences |
| Effects on caregivers (life quality, stress, personal and employment limitations) | Caregivers of treatment group members reported significantly higher life quality and fewer limitations on privacy and social lives at 6 months | |
| -- Financial Control Model | Type and amount of informal care received | No differences in number of visits received or hours of care from primary caregivers. Reductions (significant at 6 or 12 months or both) in the percent receiving care from visiting caregivers and from friends and neighbors, or relatives other than spouses or children; and in the percent receiving help with housework/laundry/shopping, meal preparation, money management, delivery of prepared meals, transportation, and general supervision.Increases in the percent receiving help with medical treatments (significant at 6 months). |
| Effects on caregivers (life quality, stress, personal and employment limitations) | Caregivers of treatment group members reported higher life quality (significant at 6 and 12 months), greater satisfaction with service arrangements (significant at 6 and 12 months), and greater confidence in receipt of care (significant at 6 months). | |
| NONRANDOMIZED DESIGN | ||
| Triage (1976-1979) | -- | -- |
| ACCESS (1977-1980) | -- | -- |
| On Lok (1979-1983) | -- | -- |
| MSSP (1980-1983) | -- | -- |
| Nursing Home Without Walls (1980-1983) | -- | -- |
| New York City Home Care (1980-1983) | Availability of caregivers | No difference |
| Type and amount (days per week) of informal assistance for ADL and IADL tasks | Treatment group members of subgroup with higher level of informal support at baseline had more informal help with ADL tasks -- significant at 6 and 12 months; treatment group members of subgroup with lower level of impairment received less informal help with IADL tasks -- significant at 6 months. | |
| Type and amount of informal assistance for ADL and IADL tasksa | Treatment group members had more days of informal help with ADL tasks -- significant at 12 months; treatment group members in subgroup with low impairment had fewer days of informal help with IADL tasks -- significant at 12 months. | |
| ||
| TABLE 9. Nursing Home and Hospital Use During the 12 Months Following Enrollment | ||||||||
| Demonstration(evaluation period) | Nursing Home Use | Hospital Use | ||||||
| Percentage Admitted | Number of Daysa | Percentage Admitted | Number of Daysa | |||||
| Treatment Group Mean | Nonprogram Group Mean | Treatment Group Mean | Nonprogram Group Mean | Treatment Group Mean | Nonprogram Group Mean | Treatment Group Mean | Nonprogram Group Mean | |
| RANDOMIZED DESIGN | ||||||||
| Worcester Home Care (1973-1975)b | -- | -- | 49 | 50 | -- | -- | 4 | 4 |
| NCHSR Day Care/Homemaker Experiment (1975-1977)c | ||||||||
| -- Day care-- Homemaker-- Combined | ------ | ------ | 534 | 745 | ------ | ------ | 111615 | 121616 |
| Georgia AHS (1977-1980) | 15 | 16 | 22 | 29 | -- | -- | 6 | 4 |
| Wisconsin CCO (1978-1980)d | 15 | 16 | 25 | 33 | 11* | 17 | 3* | 12 |
| Project OPEN (1980-1983)e,f | 4 | 5 | .1 | .3 | 19 | 26 | 9 | 12 |
| South Carolina LTC (1980-1984) | 42* | 58 | 90* | 130 | 44 | 39 | 18 | 20 |
| Florida Pentastar (1981-1983)g | 8 | 8 | -- | -- | -- | -- | -- | -- |
| San Diego LTC (1981-1983)c | -- | -- | .5 | .9 | 46 | 46 | 9 | 10 |
| Channeling (1982-1984)f,h | ||||||||
| -- Basic Model-- Financial Model | 811 | 1111 | 2926 | 3230 | 3639 | 3638 | 1926 | 2027 |
| NONRANDOMIZED DESIGN | ||||||||
| Triage (1976-1979)e,j | 10 | 4 | 6 | 4 | 37 | 21 | 8 | 6 |
| ACCESS (1977-1980)l | -- | -- | -- | -- | -- | -- | -- | -- |
| On Lok (1979-1983)j,k | 49 | 56 | 20* | 117 | 20 | 57 | 6 | 8 |
| MSSP (1980-1983)j,l | -- | -- | 39 | 22 | -- | -- | 20 | 9 |
| Nursing Home Without Walls (1980-1983)l | ||||||||
| -- Upstate Project-- New York City Project | ---- | ---- | 6*5* | 9940 | ---- | ---- | 1918 | 1616 |
| New York City Home Care (1980-1983)l | 7 | 7 | -- | -- | 39 | 42 | 11 | 15 |
* Different from zero statistically at the 5 percent significance level, using a two-tail test. | ||||||||
| TABLE 10. Physician and Other Medical Service Expenditures(dollars per month) | ||||||
| Demonstration(evaluation period) | Physician Expenditures | Outpatient Expenditures | Other Expenditures | |||
| Treatment Group Mean | Nonprogram Group Mean | Treatment Group Mean | Nonprogram Group Mean | Treatment Group Mean | Nonprogram Group Mean | |
| RANDOMIZED DESIGN | ||||||
| Worcester Home Care (1973-1975) | -- | -- | -- | -- | -- | -- |
| NCHSR Day Care/Homemaker Experiment (1975-1977) | -- | -- | -- | -- | -- | -- |
| Georgia AHS (1977-1980) (Medicare and Medicaid) | 29 | 47 | 10 | 10 | 29a | 26a |
| Wisconsin CCO (1978-1980) (Medicaid) | -- | -- | 569b | 740b | 212c | 263c |
| Project OPEN (1980-1983) | -- | -- | -- | -- | -- | -- |
| South Carolina LTC (1980-1984) | 89 | 61 | 25 | 9 | 231c | 179c |
| Florida Pentastar (1981-1983) | -- | -- | -- | -- | -- | -- |
| San Diego LTC (1981-1983) | -- | -- | -- | -- | -- | -- |
| Channeling (1982-1984)d | ||||||
| -- Basic Model-- Financial Model | 102138 | 97136 | ---- | ---- | 4758 | 43e56e |
| NONRANDOMIZED DESIGN | ||||||
| ACCESS (1977-1980) | -- | -- | -- | -- | -- | -- |
| Triage (1976-1979) | 45 | 21 | 8 | 2 | 60 | 24 |
| On Lok (1979-1983) | -- | -- | -- | -- | -- | -- |
| MSSP (1980-1983) | -- | -- | -- | -- | -- | -- |
| Nursing Home Without Walls (1980-1983) | ||||||
| -- Upstate-- New York City | ---- | ---- | ---- | ---- | ---- | ---- |
| New York City Home Care (1980-1983) | -- | -- | -- | -- | -- | -- |
NOTE: All dollar amounts are converted to constant dollars for the first quarter of 1984, using the GNP implicit price deflator. Time periods to which the original cost data apply are shown in Table 16.
| ||||||
| TABLE 11. Mortality Rates 12 Months After Enrollment | ||
| Demonstration(evaluation period) | Percentage Deceased | |
| Treatmen/EnrolleeGroup Mean | NonprogramGroup Mean | |
| RANDOMIZED DESIGN | ||
| Worcester Home Care (1973-1975) | 13 | 16 |
| NCHSR Day Care/Homemaker Experiment (1975-1977) | ||
| -- Day Care-- Homemaker-- Combined | 173021 | 183524 |
| Georgia AHS (1977-1980) | 13 | 21* |
| Wisconsin CCO (1978-1980) | 6 | 8 |
| Project OPEN (1980-1983) | 7 | 10 |
| South Carolina LTC (1980-1984) | 30 | 32 |
| Florida Pentastar (1981-1983) | 11 | 16a,b |
| San Diego LTC (1981-1983) | 21 | 23 |
| Channeling (1982-1984) | ||
| -- Basic Model-- Financial Model | 2727 | 3027 |
| NONRANDOMIZED DESIGN | ||
| Triage (1976-1979) | 8 | 7b |
| ACCESS (1977-1980) | -- | -- |
| On Lok (1979-1983) | 15 | 23 |
| MSSP (1980-1983) | -- | -- |
| Nursing Home Without Walls (1980-1983) | ||
| -- Upstate-- New York City | 1217 | 22*24 |
| New York City Home Care (1980-1983) | 19 | 16 |
*Different from zero statistically at the 5 percent significant level, using a two tail test.
| ||
| TABLE 12. Unmet Needs | ||
| Demonstration(evaluation period) | Measure | Results |
| RANDOMIZED DESIGN | ||
| Worcester Home Care (1973-1975) | New needs developed after baseline | No differences |
| Architectural barriers | No differences | |
| NCHSR Day Care/Homemaker Experiment (1975-1977) | -- | -- |
| Georgia AHS (1977-1980) | Satisfaction with service arrangements | Treatments more satisfied -- significant 12 months |
| Wisconsin CCO (1978-1980) | -- | -- |
| Project OPEN (1980-1983) | Physical environment checklist (20 item) | No differences |
| South Carolina LTC (1980-1984) | Berkeley PlanningaDependency in ADL and IADL and inadequate informal help | Treatments with more unmet needs at 12 months -- significant |
| Florida Pentastar (1981-1983) | -- | -- |
| San Diego LTC (1981-1983) | Berkeley PlanningaDependency in ADL and IADL and inadequate informal help | Treatments with more unmet needs in ADL at 12 months and IADL at 6 and 12 months -- significant |
| Channeling (1982-1984) | ||
| -- Basic Model | Unmet need index (8 item) | Treatments with fewer unmet needs at 12 months -- significant |
| Physical environment checklist (6 item) | Treatments with fewer environmental hazards at 12 months -- significant | |
| Confidence and satisfaction with receipt of care | Treatments more confident and satisfied with care arrangements at 6 and 12 months -- significant both time periods | |
| -- Financial Control Model | Unmet need index (8 item) | Treatments with fewer unmet needs at 6 and 12 months -- significant both time periods |
| Physical environment checklist (6 item) | No differences | |
| Confidence and satisfaction with receipt of care | Treatments with more confidence and satisfaction with care arrangements at 6 and 12 months -- significant both time periods | |
| NONRANDOMIZED DESIGN | ||
| Triage (1976-1979) | -- | -- |
| ACCESS (1977-1980) | -- | -- |
| On Lok (1979-1983) | -- | -- |
| MSSP (1980-1983) | -- | -- |
| Nursing Home Without Walls (1980-1983) | -- | -- |
| New York City Home Care (1980-1983) | Unmet ADL needs | Treatments with fewer unmet needs at 6 months -- significant |
| Unmet IADL needs | Treatments with fewer unmet needs at 6 and 12 months -- significant | |
| Unmet medical needs | Treatments with fewer unmet needs at 6 and 12 months -- significant | |
| Physical environment (16 items) | Treatments with few problems with physical environment at 6 and 12 months -- significant | |
| Berkeley PlanningaDependence in ADL and inadequate informal help | Treatments with more unmet needs at 6 and 12 months -- significant | |
| Dependence in IADL and inadequate informal help | Treatments with more unmet needs at 6 and 12 months -- significant | |
| ||
| TABLE 13. Social/Psychological Well-Being | ||
| Demonstration(evaluation period) | Measure | Results |
| RANDOMIZED DESIGN | ||
| Worcester Home Care (1973-1975) | Emotional/psychological domain (35 items) | No differences |
| Isolation/social contacts (15 items) | No differences | |
| Social activities (16 items) | No differences | |
| NCHSR Day Care/Homemaker Experiment (1975-1977) | Contentment index | Day care, combined, and homemaker had higher contentment at 12 months -- significant for homemaker and combined samplesa |
| Social activities | No differences for homemaker sample. Day care and combined had higher percent with maintained/improved social activity -- significant for combined sample.a | |
| Georgia AHS (1977-1980) | 12-item morale scale | No differences |
| Wisconsin CCO (1978-1980) | 8-item life quality measure | No differences |
| Project OPEN (1980-1983) | Social network scale checklist (20 items) | Treatment had more social contact -- significant at 6, 12, and 18 months |
| Morale | No differences | |
| Psychological status | Treatments had higher scores at 6 months -- significant (but a significant difference at baseline) | |
| South Carolina LTC (1980-1984) | -- | -- |
| Florida Pentastar (1981-1983) | Social activities (5 items) | Treatments reported more activities at 18 months -- significant |
| San Diego LTC (1981-1983) | PGC morale scale | Treatments had higher morale at 6 months -- significant |
| Social resources and activities | No differences | |
| Self-perceived health | Treatments had higher self-perceived health at 6 months -- significant | |
| Channeling (1982-1984) | ||
| -- Basic Model | Global life satisfaction (2 items) | Treatments had higher self-reported life quality at 6 months -- significant |
| Contentment index (5 items) | No differences | |
| Self perceived health | No differences | |
| Social interaction and loneliness (2 items) | Treatments were less lonely at 12 months -- significant | |
| -- Financial Control Model | Global life satisfaction (2 items) | Treatments had higher self-reported life quality at 6 and 12 months -- significant both time periods |
| Contentment index (5 items) | No differences | |
| Self perceived health | No differences | |
| Social interaction and loneliness (2 items) | No differences | |
| NONRANDOMIZED DESIGN | ||
| Triage (1976-1979) | -- | -- |
| ACCESS (1977-1980) | -- | -- |
| On Lok (1979-1983) | Social requirements of living (social network, communication, personal fulfillment, service agency orientation) | Treatments had higher scores at 12 and 24 months -- significant |
| MSSP (1980-1983) | -- | -- |
| Nursing Home Without Walls (1980-1983) | -- | -- |
| New York City Home Care (1980-1983) | 9-item morale scale | Treatments had higher morale at 12 months -- significant |
| Social contacts | Treatments with more social contacts at 6 and 12 months -- significant | |
| ||
| TABLE 14. Functioning | ||
| Demonstration(evaluation period) | Measure | Results |
| RANDOMIZED DESIGN | ||
| Worcester Home Care (1973-1975) | ADL (measure not known) | No differences |
| NCHSR Day Care/Homemaker Experiment (1975-1977) | ADL (Katz)a | No differences |
| Georgia AHS (1977-1980) | ADL (OARS) | No differences |
| IADL | No differences | |
| Wisconsin CCO (1978-1980) | ADL (OARS) | No differences |
| Project OPEN (1980-1983) | ADL (Katz) | No differences |
| IADL | No differences | |
| South Carolina LTC (1980-1984) | ADL (measure not known) | Treatments significantly less disabled than controls at 6 months only |
| IADL | No differences | |
| Florida Pentastar (1981-1983) | ADL (measure not known) | No differences |
| IADL | Treatments significantly more impaired at 12 months | |
| San Diego LTC (1981-1983) | ADL (Katz)b | Treatments significantly more disabled at 12 monthsTreatments significantly less disabled at 18 months |
| Restricted Days | Treatments reporting lower number of restricted days -- significant at 6 months | |
| Channeling (1982-1984) | ||
| -- Basic Model | ADL (Katz) | No differences |
| IADL | No differences | |
| Restricted days | Treatments with fewer restricted days at 6 months -- significant | |
| -- Financial Control Model | ADL (Katz) | Treatments more disabled at 6 and 12 months -- significant both time periods |
| IADL | No differences | |
| Restricted days | No differences | |
| NONRANDOMIZED DESIGN | ||
| ACCESS (1977-1980) | -- | -- |
| Triage (1976-1979) | ADL (Katz) | No differences |
| IADL | No differences | |
| On Lok (1979-1983) | ADL (measure not known) | No differences |
| IADL | Treatments less impaired at 12 months -- significant | |
| MSSP (1980-1983) | ADL (Katz) | No differences |
| IADL | Treatments less impaired at 6 months -- significant | |
| Nursing Home Without Walls (1980-1983) | ADL (Katz) | Treatments less disabled at 6 and 12 months -- significant for New York City sample |
| New York City Home Care (1980-1983) | ADL (Katz)b | Treatments significantly more disabled at 12 months |
| IADL | Treatments significantly mroe impaired at 12 months | |
| ||
| TABLE 15. Case Management Costs(dollars) | |
| Demonstration(evaluation period) | Case Management Costper Client per Month |
| RANDOMIZED DESIGN | |
| Worcester Home Care (1973-1975) | -- |
| NCHSR Day Care/Homemaker Experiment (1975-1977) | -- |
| Georgia AHS (1977-1980) | -- |
| Wisconsin CCO (1978-1980) | -- |
| Project OPEN (1980-1983) | 128 |
| South Carolina LTC (1980-1984) | 49 |
| Florida Pentastar (1981-1983) | -- |
| San Diego LTC (1981-1983) | 145 |
| Channeling (1982-1984)a-- Basic Model-- Financial Model | 10699 |
| NONRANDOMIZED DESIGN | |
| Triage (1976-1979) | -- |
| ACCESS (1977-1980) | -- |
| On Lok (1979-1983) | 85 |
| MSSP (1980-1983) | -- |
| Nursing Home Without Walls (1980-1983) | -- |
| New York City Home Care (1980-1983) | 104 |
| |
| TABLE 16. Direct Service Costs(dollars per month) | ||||||||||||
| Demonstration(evaluation period) | TimePeriod | FundingSources | Nursing Home | Hospital | Communitya | Physician andOther Medical | Total | |||||
| Treatment | Control | Treatment | Control | Treatment | Control | Treatment | Control | Treatment | Control | |||
| RANDOMIZED DESIGN | ||||||||||||
| Worcester Home Care (1973-1975) | 26 months | Project | 0 | 0 | 0 | 0 | 54 | 0 | 0 | 0 | 54 | 0 |
| NCHSR 222 (1975-1977) | ||||||||||||
| -- Day Care | 12 months | ProjectMedicareTotal | 0---- | 0---- | 0---- | 0---- | 281--281 | 0---- | 0---- | 0---- | 281533813 | 0534534 |
| -- Homemaker | 12 months | ProjectMedicareTotal | 0---- | 0---- | 0---- | 0---- | 232--232 | 0---- | 0---- | 0---- | 2328641095 | 0786786 |
| -- Combinedb | 12 months | ProjectMedicareTotal | 0---- | 0---- | 0---- | 0---- | 243---- | 0---- | 0---- | 0---- | 24310001243 | 0847847 |
| Georgia AHS (1977-1980) | 24 months | ProjectMedicaidMedicareTotal | 072172 | 075075 | 02973101 | 0117890 | 13151137 | 0617 | 0373067 | 0503182 | 131143104377 | 0143111254 |
| Wisconsin CCO (1978-1980) | 14 months | ProjectMedicaidTotal | 07070 | 09797 | 05858 | 0158158 | 18884271 | 0133133 | 09292 | 0119119 | 188307494 | 0507507 |
| Project OPEN (1980-1983)c | 35 months | ProjectMedicareTotal | 022 | 01616 | 0489489 | 0628628 | 34243385 | 05353 | 000 | 000 | 342534876 | 0697697 |
| South Carolina LTC (1980-1984) | 36 months | ProjectMedicaidMedicareTotal | 01644168 | 02536259 | 01095105 | 067682 | 7751395 | 021012 | 0213152 | 0132841 | 77200143420 | 0274119393 |
| Florida Pentastar (1981-1983)d | 12 months | ProjectFood stampsHousing assistanceMedicare/ MedicaidOther PublicTotal | 000--0-- | 000--0-- | 000--0-- | 000--0-- | 2024327--18290 | 194228--21110 | 000--0-- | 000--0-- | 202432720718497 | 19422819921312 |
| San Diego LTC (1981-1983)c | 12 months | ProjectMedicareMedicaidTotal | 05--5 | 08--8 | 0444--444 | 0473--473 | 47813--491 | 063--63 | 0------ | 0------ | 478462781018 | 0543129672 |
| Channeling (1982-1984) | ||||||||||||
| -- Basic Case Management Model | 18 months | ProjectMedicareMedicaidOther PublicClients and FamiliesTotal | 01167045123 | 01562168145 | 044017029486 | 042623028477 | 1081282763324650 | --1133079341563 | --11613024153 | --10816022145 | 108695124634221412 | 0661131804591330 |
| -- Financial Control Model | 18 months | ProjectMedicareMedicaidOther PublicClients and FamiliesTotal | 01760154132 | 01559166141 | 059735043675 | 057536039650 | 4081011433308864 | 01813067322600 | 016217029208 | 015715029201 | 408877125344341878 | 0928140684561592 |
| NONRANDOMIZED DESIGN | ||||||||||||
| ACCESS (1977-1980) | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- |
| Triage (1976-1979) | 12 months | Diary accounting of costs (Total) | 35 | 2 | 213 | 124 | 93 | 18 | 114 | 47 | 455 | 191 |
| On Lok (1979-1983)c | 12 months | ProjectDiary accounting of costsTotal | 0143143 | 0679679 | 0469469 | 011451145 | 98387485 | 0263263 | 0421421 | 0110110 | 9814201518 | 021982198 |
| MSSP (1980-1983) | 12 months | MedicaidMedicareTotal | ------ | ------ | ------ | ------ | ------ | ------ | ------ | ------ | 2489061154 | 164362606 |
| Nursing Home Without Walls (1980-1983) | ||||||||||||
| -- Upstate project | 12 months | MedicareMedicaidTotal | ------ | ------ | ------ | ------ | ------ | ------ | ------ | ------ | 299533825 | 2248941117 |
| -- New York City project | 12 months | MedicareMedicaidTotal | ------ | ------ | ------ | ------ | ------ | ------ | ------ | ------ | 51811431633 | 5285391159 |
| New York City Home Care (1980-1983)b | 8 months | ProjectMedicareMedicaidTotal | --3--3 | --10--10 | --554--554 | --527--527 | 55147--598 | 050--50 | -------- | -------- | 551603601215 | 0598124713 |
NOTE: Costs per month were calculated by dividing costs reported for the time period by the number of months in the time period. All dollar amounts are converted to constant dollars for the first quarter of 1984, using the GNP implicit price deflator. Detail may not sum to total due to rounding.
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