Abstracts of DALTCP REPORTS--"R" 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.

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

RATIONING CASE MANAGEMENT: SIX CASE STUDIES

ABSTRACT: Two county-based community long-term care programs in Ohio are included in this report--Franklin County's Senior Options program in the Columbus area and Hamilton County's Elderly Services Program in the greater Cincinnati area. Both programs are an outgrowth of a demonstration program funded by the Ohio Department of Aging in 1990-1991, and operated in Franklin County and nine rural counties in southeast Ohio. The goal of this demonstration was to test a community-based long-term care model that included a single point of entry combined with a triage approach to case management that would provide an integrated continuum of community-based long-term care for elders. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov]

RECENT CHANGES IN SERVICE USE PATTERNS OF DISABLED MEDICARE BENEFICIARIES

ABSTRACT: An analysis was made of the pre and post-patterns of Medicare Part A service use using the samples of the 1982 and 1984 National Long-Term Care Surveys linked to the Medicare Part A bill files and mortality reports. The analysis was conducted both for the total elderly Medicare beneficiary population and for the community resident disabled population--a group felt to be particularly vulnerable to any adverse effect of prospective payment system induced change in service use. The expected changes in Medicare service patterns were identified but there was no evidence of adverse changes in outcome--even for select vulnerable populations. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov, Accession #PB91-224873]

REDUCING NURSING HOME USE THROUGH COMMUNITY LONG-TERM CARE: AN OPTIMIZATION ANALYSIS USING DATA FROM THE NATIONAL CHANNELING DEMONSTRATION

ABSTRACT: A generally consistent finding of community-based long-term care demonstrations, including Channeling, is that these programs do not lead to net reductions in long-term care expenditures. Even though reducing nursing home costs was a goal of these demonstrations, none involved systematic managerial and resource allocation strategies specifically designed to research this goal. Rather, resource allocation decisions were left largely to the professional judgment of case managers. This study addressed whether long-term care resources can in fact be allocated strategically among clients to reduce nursing home use and costs. It made use of the techniques of econometrics and mathematical optimization to address this question, using data from the Channeling Demonstration. Essentially, the study found that higher skilled rather than lower skilled care in the community was a more cost-effective way to delay or prevent institutionalization. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov, Accession #PB94-144391, 47 pages]

RELIABILITY AND VALIDITY OF THE NATIONAL INCIDENCE OF CHILD ABUSE AND NEGLECT STUDY CONDUCTED BY WESTAT ASSOCIATES IN 1988: METHODOLOGICAL REVIEW

ABSTRACT: This report summarizes a methodological review of the 1988 National Incidence of Child Abuse and Neglect Study (NIS-2) and highlights the review's implications. The review includes an analysis by two expert statisticians concerning the validity of NIS-2 and the reliability of its results, alternative explanations of the data posed by several child abuse researchers and policymakers, and a secondary analysis of the NIS-2 data which determines its utility to address key policy and program issues. The report identifies a number of possible problems with NIS-2 and recommends ways to increase the accuracy and effectiveness of future studies on child maltreatment. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov]

REPORT FROM THE SECRETARY'S TASK FORCE ON ELDER ABUSE

ABSTRACT: The purpose of this paper is to provide background information which summarizes various perspectives on the definitions, incidence and causes of abuse of elderly citizens in institutional and domestic settings. Also, this paper will describe the range of programs, both in HHS and in the states, that address elder abuse. Finally, the paper identifies issues that have been raised by practitioners, policymakers and other which should be considered by the members of the Task Force on Elder Abuse. Among the issues are: lack of reliable data and a consistent data collection system; lack of coordination among state, federal, and local agencies involved in elder abuse; lack of resources to carry out existing mandates; lack of accurate public knowledge about elder abuse; and lack of a uniform definition of elder abuse. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov, 18 pages]

REPORT FROM THE WORKING GROUP ON IMPROVING PUBLIC POLICIES AND PROGRAMS AFFECTING PERSONS WITH MENTAL RETARDATION AND OTHER DEVELOPMENTAL DISABILITIES

ABSTRACT: This report analyzes the impact of current federal policies and programs on the growth of community living arrangements and supportive services for people with mental retardation and other developmental disabilities (MR/DD). It draws the following conclusions: (1) the principal federal financing mechanism for MR/DD services, the ICF/MR program, is institution-based and has not kept pace with the significant changes in the field of developmental disabilities particularly the movement toward community-based services; (2) the lack of federal participation in the financing of community services is widely perceived as a barrier to independence, productivity, and community integration of developmentally disabled people; and (3) the Medicaid program, with its open-ended financing and medical and welfare orientation, is not a promising vehicle for cost-effective federal policy reform. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov, Accession #PB91-113571, 51 pages]

REPORT ON INFANTS AND CHILDREN WITH HIV INFECTION IN FOSTER CARE

ABSTRACT: Approximately 800 HIV-infected children nationally were in foster care placement as of June 1989. This study was designed to define the specific problems related to providing foster care to children with HIV infection. A major element of the project was to conduct site visits to areas with a high incidence of AIDS in children and to learn how organizations have grappled with the issues of providing foster care for HIV-infected children. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov, Accession #PB91-2244493, 95 pages]

REPORT ON PROBLEMS AND SUGGESTIONS FOR IMPROVING THE NLTCS FILES FOR 1982 AND 1984

ABSTRACT: This paper summarizes the problems with and suggestions for improving the National Long-Term Care Survey (NLTCS) files. It incorporates many of the concerns and ideas users stated at a Forum on the NLTCS. It outlines concrete areas where improvements and increased technical support are needed so that the research community can conduct the most useful and credible studies possible. Eliminating as many of these problems as possible will go a long way toward freeing analysts to do more research with the data, rather than having to do research about the data. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov, Accession #PB91-122606, 16 pages]

REPORT ON STUDY METHODS: ANALYSIS OF THE EFFECT OF REGULATION ON THE QUALITY OF CARE IN BOARD AND CARE HOMES

ABSTRACT: The goals of this project were to describe the quality of care in board and care homes and how it varies across licensure and regulatory systems. Accomplishment of these objectives required a study design that incorporated several activities, including a major collection of new data. This report provides a detailed discussion of methods used in this project. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov]

REPORT ON THE EFFECTS OF REGULATION ON QUALITY OF CARE: ANALYSIS OF THE EFFECT OF REGULATION ON THE QUALITY OF CARE IN BOARD AND CARE HOMES

ABSTRACT: This report presents the analysis of the effect of regulation and licensure on the quality of care in board and care homes. It also briefly reviews the study purpose and methodology, as well as a description of the homes and residents; however, these topics are addressed in greater detail in two other project reports: Description of Board and Care Facilities, Operators, and Residents and Report on Study Methods. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov]

REPORT TO CONGRESS AND THE SECRETARY BY THE TASK FORCE ON LONG-TERM HEALTH CARE POLICIES

ABSTRACT: The Task Force on Long-Term Health Care Policies conducted a comprehensive examination of the issues relating to the private financing of long-term care. This report discusses issues such as consumer confidence, state involvement, marketing ethics, and data needs and offers Congress and the Secretary of HHS 41 recommendations that provide practical directions for strengthening long-term care financing through private insurance. The most important recommendations are: (1) inform consumers that Medicare, Medigap, and acute health care insurance do not cover long-term care; (2) encourage states to adopt the National Association of Insurance Commissioners' Long-Term Care Insurance Model Act; (3) promote the availability of long-term care insurance through employment; (4) develop long-term care insurance financing through vested pension funds; (5) use federal and state tax codes to encourage the purchase of long-term care insurance; (6) encourage new approaches to determine eligibility for long-term care insurance benefits; and (7) encourage greater cooperation in the collection and sharing of long-term care data. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov, Accession #PB90-201781]

REPORT TO CONGRESS ON IDENTIFYING INDIVIDUALS AT RISK OF INSTITUTIONALIZATION

ABSTRACT: This report to Congress responds to a mandate of the Orphan Drug Act (P.L.97-414, January 4, 1983), which called for the Secretary of HHS to conduct demonstration projects to test methods for identifying individuals at risk of institutional placement who could be treated more cost-effectively with home health and other non-institutional services. This report considers whether it is possible to make community care programs cost-effective by defining the target groups more rigorously. Evidence is reviewed from a number of demonstrations, but particularly the results of the National Long-Term Care Channeling Demonstration, which provides the most complete data available on a large sample of frail elderly persons. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov, Accession #PB90-228719, 87 pages]

REPORT TO THE SECRETARY ON PRIVATE FINANCING OF LONG-TERM CARE FOR THE ELDERLY

ABSTRACT: The purposes of this report is to: describe the characteristics of elderly people who need long-term care and how these characteristics will change over time; assess the potential of private financing mechanisms to lessen the catastrophic impact of nursing home and home care expenses which can wipe out individual and family savings; develop actions that would increase the availability and use of private financing mechanisms for the long-term care of older persons. This report addresses only one critical part of the problem of long-term care, albeit a highly neglected part. The focus on private financing strategies is not to deny the very real needs of persons who must rely on public programs to provide their long-term care because they cannot afford private alternatives. Such persons are and will continue to be the legitimate concern of government. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov]

RESEARCH AGENDA: DISABILITY DATA

ABSTRACT: DALTCP sponsored an expert meeting to advise them on policy issues and available data related to several populations of persons with disabilities: working age adults, children, persons age 65 and older, and special populations (e.g., persons with developmental disabilities, persons with mental illness). The meeting focused on: (1) assessment of available data sets pertaining to persons with disabilities; (2) identifying usage state, area, and private data bases including data from large-scale demonstrations; (3) specifying next steps in accessing and analyzing available disability data; and (4) discussing a minimum set of disability-related variables for inclusion in surveys. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov]

RESEARCH AGENDA: MANAGED CARE

ABSTRACT: DALTCP sponsored an expert meeting on research related to managed care and people with disabilities. This day long meeting was the second of a series of expert meetings on disability topic areas that DALTCP considered for inclusion in its research agenda. National experts who are academicians, researchers, and service providers versed in the topic area were brought together with representatives of related federal agencies. Their charge was to review the implications of the movement toward managed health care for people with physical and mental disabilities; and flesh out a program of research and demonstration which improves the understanding of managed care's impact on people with disabilities and how it can become more responsive to their needs. In particular, DALTCP asked their help to: (1) assess the benefits and risks that managed care may pose to people with disabilities; (2) identify key policy concerns that the Federal Government and states must consider in designing managed care initiatives for people with disabilities; (3) highlight relevant research that has been done or is currently underway; and (4) suggest policy relevant projects and studies which ASPE might pursue. This package includes the background paper which was used for discussion purposes at the meeting and a report of the meeting proceedings. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov, Accession #PB93-147056]

RESEARCH AGENDA: PERSONAL ASSISTANCE SERVICES AND RELATED SUPPORTS

ABSTRACT: DALTCP sponsored an expert meeting on research related to personal assistance services. This day long meeting was the first of three expert meetings on disability topic areas that DALTCP was considering for inclusion in its research agenda. Issues addressed at the meeting included: (1) personal assistance services need, use and costs, particularly for persons under age 65; (2) quality assurance and related issues of liability, risk and assessment of ability to manage one's own care; (3) paid and unpaid assistance; (4) cash payments to consumers verses public reimbursement of providers; (5) assistive technology; and (6) financing and service delivery system infrastructure. This package includes the background paper which was used for discussion purposes at the meeting and a report of the meeting proceedings. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov]

RESEARCH AND OTHER DEVELOPMENTS OF INTEREST IN EMPLOYER GROUP LONG-TERM CARE INSURANCE

ABSTRACT: This article explains new research and policy initiatives undertaken by the White House and HHS. These initiatives, including a new study of the employer group market, will provide the information policymakers and consumers need to make informed decisions about long-term care insurance. The study of the group market will examine the employer long-term care insurance market and identifies products being offered to employees. A second but later component of the group market study will use this information to construct various designs for a group product that could be made available to federal employees. (ASPE Research Notes, Volume 19)

RESEARCH ON EMPLOYMENT SUPPORTS FOR PEOPLE WITH DISABILITIES: EMPLOYMENT SUPPORTS FOR INDIVIDUALS WITH PSYCHIATRIC DISORDERS

ABSTRACT: The purpose of this paper is to describe the employment environment for persons with psychiatric disabilities. Background information on persons with psychiatric disabilities is offered, and employment programs and other supports utilized by persons with psychiatric disabilities are summarized, as are workplace accommodations of particular interest or use for this population. Findings are then presented from focus groups composed of competitively employed persons with psychiatric disabilities. During the focus groups participants talk about supports they find useful and others that hinder their employment efforts or need improvement. The final section discusses the public policy implications of the literature review and focus group findings.

RESEARCH ON EMPLOYMENT SUPPORTS FOR PEOPLE WITH DISABILITIES: SUMMARY OF THE FOCUS GROUP FINDINGS

ABSTRACT: This report summarizes the findings from information collected during three sets of focus groups conducted for a study on employment supports for people with disabilities. The study was intended to increase the understanding of the role of various supports in helping people with disabilities find and maintain employment. The findings in this report are from focus groups conducted with nearly 300 participants with significant disabilities, all of whom had obtained some measure of employment success, in Los Angeles, California; Newark, New Jersey; and Seattle/Tacoma, Washington, between April and December 2000. [120 pages]

RESIDENTS LEAVING ASSISTED LIVING: DESCRIPTIVE AND ANALYTIC RESULTS FROM A NATIONAL SURVEY

ABSTRACT: This report provides information on departures from assisted living, the reasons for departure, and those resident and facility characteristics that affected the likelihood of various resident outcomes associated with departure. The report focuses on a nationally-representative sample of assisted living facilities in 1998 that offered either a relatively high level of services, or a relatively high level of privacy, or both high services and high privacy. This special group of assisted living facilities represents about 40% of places calling themselves assisted living facilities.

REVIEW OF STATE QUALITY ASSURANCE PROGRAMS FOR HOME CARE

ABSTRACT: The purpose of this project was to examine state activities designed to assure the quality of home care. Nineteen states were surveyed to identify activities related to the assessment and monitoring of home care quality. This included Older Americans Act Long-Term Care Ombudsman Programs in five states that have expanded to cover home care services. Study findings indicate that: a wide variety of mechanisms addressing home care quality are in place in the study sites; quality in home care programs is not perceived to be a major public or political issue in most of the states; the lack of a standardized framework for defining and measuring quality is a major barrier to understanding and ensuring the quality of home care services; and expansion of the Long-Term Care Ombudsman Program to include home care clients is an untested and unproven quality mechanism. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov]

RE-CHARTING THE COURSE: FIRST REPORT OF THE PRESIDENTIAL TASK FORCE ON EMPLOYMENT OF ADULTS WITH DISABILITY

ABSTRACT: "Re-charting the Course" is intended to inform the President and the public about progress made by the Task Force to date in response to the Executive Order. Readers should regard this as an "interim report." Task Force members and staff are eager for interested parties to use this document as an invitation to engage in dialogue with the Task Force about issues important to adults with disabilities and the nation. [Order this report from Office of Disability Employment Policy, 1331 F Street, N.W., Suite 300, Washington, DC 20004, Website http://www.dol.gov/dol/odep]

RISK OF INSTITUTIONALIZATION: 1977-1985

ABSTRACT: This analysis compares predictors of institutional residency in 1977 and 1985 among two national cohorts of individuals who responded to national surveys of nursing home and community-dwelling elderly persons. A state-level analysis of change in predictors of state nursing home use rates for 1976 and 1986 was also conducted using aggregate state sociodemographic and Medicaid policy variables. Finally, a model was estimated to predict state-to-state variation in nursing home use in 1986. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov]

RISK SELECTION AMONG SSI ENROLLEES IN TENNCARE

ABSTRACT: This paper examines risk selection among managed care plans for Supplemental Security Income (SSI) beneficiaries in Tennessee's Medicaid managed care program, TennCare, focusing in particular on TennCare's first two years (starting January 1994 and ending January 1996). Analysis starts with a review of the TennCare program, especially the characteristics of the participating managed care plans that may have affected the choices of blind and disabled SSI beneficiaries and the nature of the payment system. Then the authors summarize processes that Tennessee used to enroll beneficiaries in managed care plans and the overall distribution of SSI beneficiaries among the plans. Next, data available for analyzing risk selection and the study's analytic approach is described. Finally, risk selection evidence is reviewed, and the paper concludes with a review of the lessons the Tennessee's experience provides for future payment and policies.

RISKS OF ENTERING NURSING HOMES FOR LONG AND SHORT STAYS

ABSTRACT: This paper describes research to estimate the rates of nursing home admissions and to identify the determinants of long and short stays in nursing homes. The research employed data available from the 1982 and 1984 National Long-Term Care Surveys. Hence, the results are both nationally representative and indicative of nursing home use patterns by the disabled elderly population. The information presented has implications for public and private long-term care policies. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov, Accession #PB92-119577, 22 pages]

ROLE OF HEALTH INSURANCE IN SUCCESSFUL LABOR FORCE ENTRY AND EMPLOYMENT RETENTION

ABSTRACT: This report provides a summary of the health insurance issues affecting employment of people with disabilities, including a discussion of the current programs and policies that are available. The authors present findings from focus groups conducted with individuals with disabilities who have achieved a reasonable measure of employment success. During these focus groups, the extent to which access to health care influenced employment decision of participants was discovered, as well as various strategies participants employed for securing access both to employment and needed health care. [39 pages]

ROLE OF HOME AND COMMUNITY-BASED SERVICES IN MEETING THE HEALTH CARE NEEDS OF PEOPLE WITH AIDS: FINAL REPORT

ABSTRACT: This is the final report for the project, Role of Home and Community-Based Services in Meeting the Health Care Needs of People with AIDS, conducted by Mathematica Policy Research, Inc., for ASPE. The goal of the project was to assist ASPE in developing a research agenda for studying home and community-based service use among people with AIDS. The project had three components: (1) a review of the recent literature describing the delivery and financing of home and community-based services for people with AIDS; (2) case studies of service provision in New York City and Los Angeles; and (3) an analysis of use and reimbursement patterns for New Jersey Medicaid beneficiaries with AIDS (conducted by the AIDS Research Group of the Institute for Health, Health Care Policy, and Aging Research at Rutgers University). [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov, Accession #PB98-174469]

ROLE OF HOME AND COMMUNITY-BASED SERVICES IN MEETING THE HEALTH CARE NEEDS OF PEOPLE WITH AIDS: LITERATURE REVIEW

ABSTRACT: This report provides an overview of the literature describing the delivery and financing of home and community-based services for people with AIDS, focusing on the literature of the past five years. Its primary conclusion are: (1) The need for publicly funded home and community-based services is likely to increase as the number of people grows who have low incomes and multiple problems (such as drug abuse, homelessness, and serious mental illness) in addition to AIDS. (2) Promising new treatments for AIDS may change the mix of home and community-based services required, increasing the need for assistance with complex medication regimens for people with AIDS who may have few functional limitations. (3) Data to support key home and community-based service program design decisions are extremely limited. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov, Accession #PB97-203566, 92 pages]

ROLE OF SUPPORTS IN SUCCESSFUL LABOR FORCE ENTRY FOR YOUTH WITH DISABILITIES

ABSTRACT: This paper first summarizes programs that provide support during the school-to-work transition period, and how they have evolved in recent years. It then presents findings from focus groups conducted with individuals who acquired a significant disability during childhood or prior to gaining significant employment experience and who subsequently achieved a measure of employment success. During these focus groups, the authors learned about the supports that, in the participants' view, contributed to their success, and about some of the challenges they faced in using them.

Last revised: February 25, 2003

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