Methodological Issues in the Evaluation of the National Long Term Care Demonstration. II. THE BASIC DESIGN OF THE EVALUATION

04/01/1986

The evaluation was designed to avoid the methodological shortcomings of many of the previous studies of long term care programs. The key features of the design were:

  • Use of a control group that was randomly selected from eligible channeling applicants
  • The collection of high quality data on a large number of observations
  • Implementation of the demonstration in a number of different settings

The last point requires little elaboration. The demonstration was implemented in 10 sites, 5 implementing the basic model and 5 the financial control model. While the set of demonstration sites may not be representative of the nation as a whole and was heavily concentrated in the northeast, it did include both urban and rural areas, and there was considerable variation across sites in the availability of case management, community services, and nursing home beds. The sites and sample sizes drawn from each are given in Table II.1. The variation in sample sizes reflects the differences between sites in the size of the elderly population. (See Carcagno et al., 1986 for comparison of characteristics of the demonstration sites and a discussion of the process by which they were selected.)

The other key features of the design require somewhat more discussion. One of the most important aspects of the evaluation design is that the use of random assignment means that throughout the evaluation, impacts of channeling are defined as the difference between what actually happened to treatment group members and what would have happened to them in the absence of the demonstration. Since other forms of case management are available in the demonstration sites and since many individuals receive needed community-based services without any case management, the estimated channeling impacts are not the effects of channeling as compared to nothing, but rather channeling as compared to whatever case management and services were already available in the demonstration sites. It is equally clear then that the estimates cannot be interpreted more broadly as the effects of case management and community services in general. With this in mind, the random assignment procedures and the data sources used in the evaluation are described briefly below.

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