Performance Improvement 2001. Environmental Assessments



The Low Wage Labor Market: Challenges and Opportunities for Economic Self-Sufficiency


This study represents a synthesis of current literature on the low-wage labor market. The purpose of the study is to identify labor market factors that influence the prospects of former welfare recipients finding work leading to economic self-sufficiency. The study consisted individual papers on specific labor market topics prepared by nine experts in the low wage labor market field. The study topics included (1) description of the low-wage labor market and how has it changed over time, (2) policies affecting the low wage labor market, (3) identification of barriers to entering the low-wage labor market, and (4) barriers to advancement in the low wage labor market. The nine experts highlighted several policy options for improving the wage, employment, and economic self-sufficiency outcomes of low-wage workers.

The research methodologies included a comprehensive literature review of labor market studies, evaluations of job training programs and other labor market related policies, and review of existing labor market data covering the 1960's to the present. The study also includes a compilation of labor market data from the Current Population Survey, the Bureau of Labor Statistics, and the Survey of Income and Program Participation.

The study concluded that the nation’s labor market will be able to absorb the welfare recipients leaving welfare for work as long as the economy remains strong, but there will be regional disparities in the rate of absorption. There will be fewer low-wage opportunities in urban areas and in the South and West regions of the country. In terms of economic self-sufficiency, the study makes it clear that former welfare recipients will continue to be concentrated in jobs that are low-wage, have few fringe benefits, little opportunity for advancement, and are subject to high turnover. The policy recommendations to improve the wage, employment, and economic self-sufficiency of low-wage workers include: (1) policies to improve labor market access and job retention, (2) policies to encourage or support occupational mobility/job advancement, (3) policies to raise the incomes of low wage workers and enhance employment security.


There is an increased emphasis on moving welfare recipients into employment. The labor market faced by these individuals differs from the general model of a labor market in that the jobs do not have opportunities for advancement, little job security, and the individuals are subject to gender and racial discrimination to a greater degree. Due to the substantial size of this workforce, a characterization of the workforce and the polices that affect it was undertaken.


Policy makers are concerned about the impact of moving welfare recipients into employment as a result of welfare reform. The impact of these changes on the labor market’s ability to absorb these new workers, the opportunities that are available, and the effects of changes in the larger economy are largely unknown. The U.S. Department of Health and Human Services, Office of the Assistance Secretary for Planning and Evaluation, commissioned nine papers by expert in labor market analysis, requesting they review the current literature on the low-wage labor market and highlight policy implications. This document represents a compilation and summary of those reviews. The papers characterized the low-wage labor market, how it varies over time, and how outcomes vary for different populations and regions. Three other papers addressed the impact of specific policy interventions intended to increase income or employment among the working poor. Two papers addressed the barriers to employment experienced by disadvantaged workers. The last two papers reviewed opportunities for advancement and job-related benefits in the low wage labor market.


This document represents a collection of papers by experts, who reviewed the literature relevant to their area of expertise. The literature was reviewed with the purpose of providing assessments of policies.


Each reviewer provided a number of findings and recommendations. A summary of key findings includes the following: The wage level of low income workers has declined over time. These low- wage workers are disproportionately female, minority, non-college-educated, non-union and concentrated in retail trade. Although the skill level of low-wage workers has steadily increased over time, there has not been a concomitant increase in wage share. Individuals with high school or less have higher unemployment rates, and earn less. The number of low-wage jobs is cyclical. Labor prospects for former welfare workers are less than those for other groups of workers. There is a falling demand for low-skilled labor. There are regional differences in the characterization of the job market. There has been real growth in the employment rate of single mothers, but in many cases there has been no real difference in net income. The labor market will be able to absorb the influx of individuals leaving the welfare rolls only of the economy remains strong. Specific areas of the country may experience difficulty if the economic conditions change. Jobs for welfare recipients are limited, given the skill levels and educational background of most welfare recipients. Public job creation does appear to generate new jobs for low-skill workers, if the earned Income Tax Credit does increase employment for single-parent families. Barriers to employment for low-wage workers include racial discrimination, lack of information about and access to suburban jobs, and lack of effective networks and contacts. Informal referrals may produce a segregated workforce that actually acts as a barrier to those not within the network. Training programs and work programs have only small effects. Less-educated workers are disproportionately affected by turnover.

Use of Evaluation Results

Several policies are highlighted that the authors feel will improve the wage employment and economic self-sufficiency outcomes of low-wage workers. These include:

  • Continued support for programs that improve access to the labor market, such as labor market information, and job retention, including job retention counseling and career planning. There is a recognition that other factors, such as availability of childcare and transportation assistance are also critical.
  • Policies that encourage and support job advancement. These include on the job training and career ladders for entry-level jobs.
  • Policies that raise the income of low age workers and enhance their employment security. These include the Earned Income Tax Credit, minimum wage strategies and public and community jobs strategies.

AGENCY SPONSOR: Office of the Assistant Secretary for Planning and Evaluation in the Office of the Secretary (OS)


PHONE NUMBER: 202-401-6634

PIC ID: 7425

PERFORMER ORGANIZATION: Urban Institute, Washington DC

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A National Study of Assisted Living for the Frail Elderly


This report represents the first in a series of planned reports based on data collected from surveys of a national probability sample of assisted living facilities (ALFs). The philosophy of assisted living is desirable to a variety of stakeholders, and the growth of such facilities has been extensive. Due to the variability in both the definition and regulation of such facilities across states, there are concerns about both the quality of care and consumer protection issues. This report is intended to provide a descriptive overview of a stratified random sample of such facilities, including services provided, costs, and consumer satisfaction. The overall study will review trends in demand for and supply of ALFs; identify barriers to the development of ALFs and determine the extent to which the current supply of facilities meets the concept of “Assisted living”; define what the ALF concept embodies; and look at key features that affect consumer satisfaction, autonomy, affordability, and potential to receive nursing home level of care. The current study is the first step in the process, and provides a descriptive look at basic characteristics of the industry, particularly in terms of services, accommodations, and price.

The study found there are approximately 11,432 ALFs nationwide, with about 650,000 beds. The average occupancy rate is 84%. Most ALFs offered some degree of privacy, with approximately 50% of the units comprised of a one-bedroom, single occupancy apartment. The study also determined that places called ALFs differed greatly with respect to a variety of factors. The extent to which the environment and services of the facilities match the philosophy of assisted living is mixed. Although residents can age in place to some degree, those requiring extensive help with transfers or whose cognitive impairment was moderate to severe could not remain at these facilities. In general, it was determined assisted living was not affordable for moderate and low-income persons aged 75 or older.


The purpose of the study is to describe the role assisted living facilities play in providing a residential setting and supportive long-term care services to the elderly. This initial report is primarily descriptive in nature, providing information on the size and nature of the supply of assisted living facilities, the basic characteristics of the industry, and what philosophy is embodied by the current supply of facilities.


There is an increased demand for residential facilities that offer supportive services for the frail elderly due to a rapidly growing elderly population with significant levels of physical disability and mental impairment, a preference of the elderly for in-home and community-based services, and incentives at the state level to constrain theuse of nursing homes. ALFs are defined differently across states, and are regulated by a wide variety of different state agencies.


The survey utilized a complex, multi-stage sampling design to identify and select assisted living facilities (ALFs). Of the estimated 11,472 potential ALFS identified via external sources (e.g., state licensure agencies, industry trade associations, Internet listings), a stratified random sample of 2,945 places was selected for telephone survey screening. Of these, facility administrators at 1,251 that met eligibility criteria were given an extended telephone survey. The study considered an ALF to meet criteria if it had more than ten beds; served a primarily elderly population, and offered a basic level of services, including 24-hour staff oversight, housekeeping services, at least two meals a day, and some degree of personal assistance.


The study found there are approximately 11,432 ALFs nationwide, with approximately 650,000 beds. The average occupancy rate is 84%.The average size of an ALF in the survey was 57 beds; 67% had 11-50 beds, 21 percent had 51-100 and 12% had more than 100 beds.

Most ALFs offered some degree of privacy, with approximately 50% of the units comprised of a one-bedroom, single occupancy apartment. Few of the facilities had all-private accommodation; with approximately 28% reporting bedrooms could be shared by three or more residents.

Most of the facilities offered 24-hour staff, three meals a day, and housekeeping. Most (three- quarters) also had some type of nursing staff available either full or part-time Although individuals with moderate disabilities were admitted, fewer than half of the facilities would admit residents who required help with transfers. Those residents with moderate to severe cognitive impairment were also barred from more than half of the ALFs.

The study authors categorized the facilities based on a mix of services and the amount of privacy afforded. The four groups were low/minimal privacy and low/minimal services, representing 59% of the total; high privacy but low services (18%); low privacy, high service (12%) and high privacy and high service (11%). These groups differed significantly from each other, although all called themselves assisted living facilities.

The most common basic price for the facilities ranged from $1000 to $1999 per month, with the high privacy/high service facilities at the top of the range. These rates are largely unaffordable for low- and moderate-income elderly.

Use of Evaluation Results

This report, the first in a planned series, provides a descriptive overview of ALFs, including services provided, costs, and consumer satisfaction. The findings from this report can be used in future discussions to delineate and define the concept and philosophical models of assisted living facilities. The study provides a look at the extent to which the current supply of facilities meets the concept of “assisted living,” and provides definitions of what the concept embodies. Future reports will examine trends in demand for and supply of ALFs; identify barriers to the development of ALFs; and will provide a look at key features that affect consumer satisfaction, autonomy, affordability, and potential to receive nursing home level of care.

AGENCY SPONSOR: Office of Disability. Aging and Long-Term Care Policy at Office of the Assistant Secretary for Planning and Evaluation (ASPE)


PHONE NUMBER: 202-690-6613

PIC ID: 4719.7

PERFORMER ORGANIZATION: Meyers Research Institute at Menorah Park,
Beechwood, OH

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Evaluation of the Research Centers in Minority Institutions


The Research Centers in Minority Institutions (RCMI) is a congressionally mandated program designed to expand health sciences research in predominately minority institutions. The primary goal of the program has been to enable these institutions to become more competitive in obtaining support for the conduct of biomedical and or behavioral mission of the U.S. Public Health Service. This program, initiated by the National Institutes of Health (NIH), has been underway since 1985; in 1995, NCRR began a two-phase evaluation of the program to assess the extent to which the goals and objectives of the program are being met.

The current evaluation design addressed six questions:

  • Have RCMI institutions been more successful than similar non-RCMI institution in competing for PHS grants?
  • Is this level of success affected by prior research experience?
  • Has the success been long-term?
  • Are there intermediate indicators of success?
  • What characteristics are most related to success?
  • Does the academic research environment affect success?

Information was obtained from interviewing the centers and conducting a site visit, from a review of program record documents; and database searches of secondary data sources

In general the 15 RCMI institutions showed a greater improvement in competing for research grants, with somewhat more experienced centers demonstrating a greater percentage increase in research project grant (RPG) funding per year than either inexperienced or highly experienced centers. The recommendations from the review include a set of data elements that need to be collected to enhance the quality of future evaluations of the program.


Phase I of this evaluation, begun in 1995, was intended to look at the first 10 years of RCMI program implementation. This report represents the results of Phase II of the RCMI Program evaluation, which incorporates the plan and methodology developed in Phase I.

The purpose was to provide a scientifically sound evaluation of the 15 RMCI centers that have been funded for at least 10 years to enhance understanding of the program success and program characteristics and activities; to identity best practices implemented at different centers; and develop an improved process for selecting and monitoring the progress of the RCMI centers.


The RCMI program is intended to enhance the research capabilities of institutions with predominately minority student enrollments that offer doctoral degrees in the health professions or in a health-related science. The institutions have historically not participated extensively in NIH research programs. RCMI grants have been awarded to 21 institutions to date, although only 15 have been funded for more than 10 years. The grants provide support for administrative activities, individual faculty member support, and facility enhancement and improvement. Grant recipients all have interest in minority health issues, but differ markedly in their characteristics. Institutions supported include medical schools, graduate school, schools of pharmacy and a school of veterinary medicine. The institutions are both private and state-supported, and range from completely inexperienced in the research area to those with long-standing research programs. The program was initiated in 1985, and therefore has been underway for over 10 years. It was determined a broad-based evaluation was needed to assess the extent to which the goals and objectives of the program were being reached.


The evaluation was designed as a multiple case study with cross-site analysis, addressing six areas of program characteristics and activities that were hypothesized to have an effect on RCMI success. These characteristics included years of prior research experience and characteristics of the academic research environment. The data included field observations of the RCMI (preceded by a request for specific information prior to the site visit); a review of program records; and data searches of NIH and NSF grant files, bibliometric databases, and other secondary data sources. Comparisons were made between the RCMI and non-RCMI. The comparison non-RCMI group was matched by census region, Carnegie classification, and level of NIH funding prior to 1985. The RCMI were also divided into three groups for within group comparisons based upon level of research funding prior to 1985. The three group identifications were, (1) experienced centers, (2) somewhat experienced centers, and (3) experienced center. The within group comparisons included differences in success in achieving the program outcomes, and differences in organizational and research environmental factors that influenced the outcomes. Both qualitative and quantitative data analysis were conducted to describe the activities of the RCMI, the environmental settings, and research capacity building outcomes. The primary analytical technique was pattern coding, which involved analyzing the items and possible explanations and the patterns to provide factors critical to programmatic success. The preliminary findings were presented to a panel of experts selected by area of research expertise to review the findings and make recommendations to NCRR.


A summary of the findings of the study are (1) the RCMI showed greater improvement in the completion of grants than the non-RCMI comparison institutions, (2) somewhat experienced institutions showed the best performance in securing competitive grants, (3) the RCMI increased productivity in publications, (4) RCMI increased the number and quality of shared research facilities, upgrading their facilities and equipment, and (5) factors that contributed to some RCMI being more successful than others included scientific leadership, administrative leadership, good management and communication systems, and particularly in less experience institutions, effective strategic planning and self-assessment.

Use of Evaluation Results

The recommendations from the expert panel are (1) NCRR should define and emphasize the long-term goals of the RCMI Program, (2) the NCRR should make it very clear to the administrators of the RCMI that future performance will be measured by demonstrated improvement in competitive research grants, peer-reviewed scientific publications, and successful institutionalization of research capacity to eliminate dependency on RCMI support.

AGENCY SPONSOR: National Center for Research Resources at the National Institutes of Health (NIH)

FEDERAL CONTACT: Patricia A. Vorndran

PHONE NUMBER: 301-435-0866

PIC ID: 5580.1

PERFORMER ORGANIZATION: Macro International Inc., Calverton, MD

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Prescription Drug Coverage, Spending, Utilization, and Prices


Although the use of prescription drugs are increasingly improving health outcomes and quality of life, these drugs, and in particular new drugs, are not available to everyone. The elderly and disabled Medicare beneficiaries in particular have either inadequate or no coverage for drugs. Policymakers are currently considering options to make prescription drugs available to all, particularly by expanding the Medicare program; accurate and comprehensive information on drug coverage, drug spending, and drug prices is needed to guide that discussion. The intent of this report is to provide information on drug costs and trends for Medicare beneficiaries. Using a combination of public and private databases, data on coverage, effects of coverage on spending and utilization, and prescription drug prices is provided.


The purpose of this study was to examine prescription drug costs and trends for Medicare beneficiaries. This information will be used by policymakers for development of a voluntary Medicare drug benefit as a means to extend drug coverage for senior citizens.


Prescription drugs improve health outcomes, reduce the need for surgery, and can improve the quality of life. New drugs are continually coming on the market with the promise of greater benefits. However, not everyone has access to these drugs. Medicare has never covered the vast majority of prescription outpatient drugs, a common practice for health coverage plans when Medicare was enacted. Most private insurance plans today do provide coverage, and policymakers are aware that this gap in Medicare places a heavy financial burden on beneficiaries. There is a broad plan to modernize Medicare, part of which would involve giving all beneficiaries access to affordable, high-quality drugs


The data in the report were compiled by the Agency for Healthcare Research and Quality (AHRQ, the Food and Drug Administration (FDA), the Health Care Financing Administration (HCFA) and the Office of the Assistant Secretary for Planning and Evaluation (ASPE). Data were drawn primarily from the 1996 Medical Expenditure Panel Survey (MEPS) and the Medicare Current Beneficiary Survey (MCBS). Additional data were drawn from pharmacy audits conducted by IMS Health, the ongoing Consumer Expenditure Survey (CES) conducted by the Bureau of Labor Statistics and the 1997 National Health Interview Survey. Data on operations of the drug distribution system, industry trends and other information on drug coverage, utilization, spending and pricing were drawn from informal surveys of outside sources such as drug manufacturers and pharmacies.


Although 85% of Medicare beneficiaries use at least one prescription drug annually, only 54% were covered for a full year during 1996, and 25% had no coverage. Most sources of drug coverage for these individuals are unstable; and drug benefits are becoming less generous. It is expected that drug coverage for retirees will continue to decline. The very old, those who live outside a metropolitan area, and those at the higher end of the poverty spectrum are the least likely to be covered. Currently, rates for prescriptions are higher for those with five or more chronic conditions. There are very significant differences in drug utilization and out-of-pocket spending between those with coverage and those without, regardless of health status. Prescription drugs represent a significant source of spending, taking up about one-sixth of all health spending by the elderly. Cash customers pay more for drugs than do those with third party payments.

Use of Evaluation Results

The study provides a detailed examination of multiple factors related to coverage, utilization, and spending for prescription drugs, particularly for the Medicare population. While providing the requested background, it also raised a number of questions that will require multivariate analyses and an ongoing analysis of more up-to date data to fully answer.

AGENCY SPONSOR: Office of Health Policy at the Office of the Assistant Secretary for Planning and Evaluation (ASPE)

FEDERAL CONTACT: Christy Schmidt

PHONE NUMBER: 202-690-6870

PIC ID: 7506

PERFORMER ORGANIZATION: Office of the Assistant Secretary for Planning and Evaluation at HHS, Washington, DC