Healthcare Coverage & Access

    U.S. Department of Health and Human Services   Disability, Health Insurance Coverage, and Utilization of Acute Health Services in the United States Executive Summary

Board and care homes are non-medical community-based facilities that provide at least two meals a day and routine protective oversight to one or more residents with functional limitations. Unweighted data from the 1991 National Health Provider Inventory (NHPI) indicate that there were about 30,000 licensed board and care homes in the United States serving over half a million persons.

Three studies sponsored by HHS confirm previous research linking health impairment levels, advanced age, and various indicators of caregivers' physical burden and emotional stress with individual caregivers' decisions to stop giving care and increased likelihood of nursing home placement.

The number of persons with health insurance coverage kept pace with the growth of the population between 1990 and 1991--with approximately 86% of the population insured. The most important new information regarding health insurance in the 1992 CPS is that the number of persons helped by the Medicaid program during the year rose by 2.6 million or 11% to almost 27 million in 1991.

The number of persons with no health insurance coverage rose by 4% between 1989 and 1990, while the number with insurance rose less than 1%. The increase in insurance coverage was due primarily to increases in Medicaid coverage for children under 15.

Sandra Newman, Michelle Rice and Raymond Struyk The Urban Institute This report was prepared under contract between the U.S. Department of Health and Human Services (HHS), Office of Disability, Aging and Long-Term Care Policy (DALTCP) and the Urban Institute.

Concern about inappropriate nursing home placement and rising long-term care costs led to a series of government-financed demonstrations to study whether substituting care at home for care in nursing homes could reduce costs and improve the quality of life for the frail elderly.

Over the past decade and a half, a series of demonstrations prior to the National Long-Term Care Channeling Demonstration have been fielded to test some form of case managed, community-based long-term care. Fourteen community care demonstrations funded through Federal Government waivers and similar to Channeling were identified.