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This study examined the approaches used in six states (Arkansas, Illinois, Maine, Maryland, Oregon and Wisconsin) to make their long-term care systems more responsive to the needs of older people. According to the study, each of the states was able to expand community-based care services without generating runaway costs in total long-term care spe

The purpose of this paper is to describe the diverse strategies that have been proposed for long-term care reform (for persons age 65+), and to present a balanced discussion of the points that have been made in support of, and in opposition to, each proposal. What the authors believe is "balanced" may not be perceived to be so by those who advocat

This study focused on electronic health records (EHRs) and information systems used to exchange clinical information across providers. The only clinical information systems that were identified that exchanged information across settings that include PAC/LTC providers were health delivery systems that were highly integrated either because of their

Twenty-one states have implemented "wage pass-through" programs with the stated expectation that doing so will help address the shortage of direct care workers employed by long-term care providers in their states. A wage pass-through is an additional allocation of funds provided through Medicaid reimbursement for the express purpose of increasing

This report compares the medication use of Medicare beneficiaries living in nursing homes and assisted living facilities. Descriptions of Medicare use include mean number of drug mentions per month of stay (scheduled and PRN drugs), and prevalence and duration of therapy by major drug classes. Characteristics of institutionalized beneficiaries inc

Findings presented in this report are based on information derived from three sources — a review of the literature, discussions with national experts on naturally occurring retirement communities (NORCs), and case studies of NORCs and their associated services programs in five Agency on Aging demonstration sites. In each of the five demonstrati

This report examines the differences in estimates of the older population in residential care by analyzing key national surveys. In it the authors present results of a review of existing estimates of the number of residential care settings, generally divided into nursing homes and alternative residential care settings, and the number of persons r

This report presents information on Medicare's hospice benefit — who is using it, how it is being used, what costs are associated with its use, what costs precede hospice enrollment and how these vary by type of enrollee. This information will be important for understanding the role of Medicare's hospice benefit in the context of the other benef

This report contains six main sections. The first focuses on hospice coverage policies and reviews the history of the Medicare hospice benefit, its current structure, and its influence on care of the dying. Also included is a description of hospice care covered by other insurers including state Medicaid programs and private employers. The second s

This study is part of a larger project exploring the use of hospice benefits and services provided by the Medicare program and to those who are privately insured. The MEDSTAT Group's contribution to the larger study is an examination of hospice benefits in commercial plans and the use of hospice benefits by persons commercially insured. In particu

This comparative study first identifies and describes two cohorts of nursing facility decedents, those that did and did not elect Medicare hospice. Then, using data for up to one year prior to death, the study characterizes utilization and quality of care for these two cohorts. The influence of Medicare hospice on hospital utilization and symptom

ASPE funded the Urban Institute to synthesize trends and issues with Medicare post-acute care benefits. Rapidly rising expenditures for home health, skilled nursing facility, and rehabilitation and long-term care hospital services have caused policymakers to focus considerable attention on these benefits. The Balanced Budget Act (BBA) of 1997 mand

Widespread interest in Medicare post-acute care issues, particularly after the Balanced Budget Act (BBA) passed, prompted DALTCP to sponsor an "early indication" qualitative study of the potential effects of the BBA provisions and other related issues. To obtain timely information on such issues, this study collected information through interviews

This report describes selected trends in the assisted living industry. It is intended to supplement ongoing research being conducted as part of the National Study of Assisted Living. In this supplementary study, detailed interviews were conducted with 29 carefully selected persons from 21 states who are involved in various aspects of the developme

This paper provides an overview of public financing of long-term care services for the elderly under Medicare, Medicaid and other public programs. Recent program data on public spending for both nursing home and home care services are presented, as well as selected data on recent expenditure trends, particularly under Medicare and Medicaid. Long-t

After discusion about the possible approaches for conducting the international analysis, the International Collaborative Effort on Age research team concluded that the initial step in analysis should be to establish the 'context' of the research on outcomes of nursing home care. The purpose of this report is to describe the context of nursing home

The project examined how states have used Medicaid's Personal Care Services Optional Benefit (also called the PC Option), assessed whether coverage regulations for these services be revised, and discussed the ways in which the program might affect public debate about the expansion of public funding for long-term care. The project entailed reviewin

In Chapter 14 (United States), the long development of long-term care policy is described, giving particular emphasis to the functioning of the main programs introduced in the 1960s, and their progressive modification up to the 1990s. Finally, an outline is given of the main reform debates of the late 1980s and 1990s. [38 PDF pages]

This study analyzes how federal policies and programs influenced state policy choices with respect to expanding family and community care. The study presents an in-depth review of six state mental retardation/developmentally disabled service systems (Colorado, Illinois, Michigan, Nebraska, Texas and Virginia). Data collection and analysis emphasiz

During the 1980s, HHS fielded several major surveys which substantially enhanced the breadth and quality of data available to the general public on the utilization and costs of long-term care services.