Service Use and Transitions: Decisions, Choices and Care Management among an Admissions Cohort of Privately Insured Disabled Elders. Notes


  1. We know that there is a great deal of movement across service modalities. In a recent study of disabled elders receiving benefits under private insurance policies, 38% of individuals observed in nursing homes had used home care prior to their nursing home entry. Moreover, 23% of assisted living residents had been in a nursing home prior to their moving to an assisted living residence (Cohen, et al. 1999 & 2000).

  2. Nurses were trained to always observe the claimant (unless the family or proxy expressly forbade it) in order to understand functional and cognitive status. However, for questions related to decision-making and insurance, many claimants either requested a family member be present with them or that the nurse talk to a family member. We also allowed claimants to have us contact familiy members via telephone regarding the decision making questions. Only a small percentage of claimants exercised this option.

  3. It is important to note that the in-force measure is a “stock” whereas the newly admitted measure could represent the beginning of a “flow”. That is, it may be the case that many of the individuals who enter the system as assisted living residents go on to enter nursing homes at later periods of their disability spell.

  4. It is often the case that facility policy requires medication be given to all residents, regardless of their level of dependence with medication management. Those who indicated that this was the case were removed from the sample (33% of people in nursing homes and 24% of people in ALF). Therefore, medication management is truly those who require assistance with it.

  5. If it was determined that a person was cognitively impaired (by failing the SPMSQ or a diagnosis of Dementia or Alzheimer’s) the interviewer terminated the interview with the insured and continued with their designated proxy.

  6. These could include devices like canes, walkers, wheelchairs, raised toilet seats, grab bars, etc. Although a number of people reported using furniture to assist with mobility and transferring, we did not classify this as equipment.

  7. This is true for all policies that have durational limitations. This incentive does not exist when a policy provides lifetime protection, that is, unlimited policy benefits.

  8. We were only able to conduct interviews with seven of the ten participating companies. There were companies added at later stages of the fieldwork who were not able to be interviewed and conversely, there were companies interviewed who did not end up providing sample for the study. The discussion of care management that appears here is reflective only of the seven participating companies who were available for interview. It is also important to note that what may have been the care management and/or philosophy of a particular company at the time of interview (2002) may not be the current philosophy or structure of care management for those companies today.

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