Research / Journal abstracts

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The Classic Measure of Disability in Activities of Daily Living Is Biased ...

Policy makers desire a uniform assessment tool that works well for adults of all ages, but disability assessment can only be as uniform as the underlying measurement is. If ADL or IADL/ADL measures are biased by age, their use with adults of different ages could be misleading. Findings of this study indicate that as demand for community services increases among adults of all ages, an expanded IADL/ADL measure is more useful than ADL.

Short URL: http://www.advancingstates.org/node/52467

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Long-Term Care: Who Gets It, Who Provides It, Who Pays, And How Much?

Many assume that most of the long-term care population is elderly. Not so, according to this study. About half of community-dwelling Americans needing long-term care are younger than sixty five. Research and data collection focusing solely on older adults with long-term care needs misses half of the story. Recommendations of the study include a redistribution in long-term care spending from institutional to non-institutional settings, and from agencies to independent providers.

Short URL: http://www.advancingstates.org/node/52351

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Understanding Factors That Influence Success of Home- and Community-Based Services in Keeping Older Adults in Community Settings

Read this study that found two significant supportive factors for older adults to remain in communities were use of paid instrumental activities of daily living (IADL) personal care services and awareness of unmet needs. Findings suggest the importance of encouraging older adults to acknowledge their unmet needs and to seek community-based support services early, rather than wait until they have developed more serious needs.

Short URL: http://www.advancingstates.org/node/52338

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New State Strategies To Meet Long-Term Care Needs

States’ efforts to expand consumer-directed long-term care service programs, are often hindered by challenges related to costs, staffing and organizational issues, infrastructure requirements, and resistance from stakeholders. Yet states have developed a number of successful strategies for overcoming these challenges. Their experiences offer valuable insights, guidance, and encouragement to other states considering CDS. The abstract (free) and full report (subscription required) are available.

Short URL: http://www.advancingstates.org/node/52302

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State Experiences with Implementing the Cash & Counseling Project

This article describes two primary interactions between key policy implementation instruments and internal and external stakeholders that made New York's participation in CCDE not possible. This case study also provides some lessons for other states interested in developing Cash & Counseling models. The abstract for this article is available here.

Short URL: http://www.advancingstates.org/node/52293

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Consumer Enrollment and Experiences in the Cash & Counseling Program

This report details the enrollment issues faced during implementation of the program. In addition, the report looks at consumer experiences including issues resulting from acting as an employer and effects on quality of life. The abstract (free) and full report (subscription required) are available.

Short URL: http://www.advancingstates.org/node/52171

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Improving Direct Care Work: Integrating Theory, Research and Practice

This paper presents a broad overview of the direct-care workforce. The authors examine issues such as wages, benefits, training, worker retention rates, staff satisfaction, and the importance of worker-focused "culture change" initiatives in long-term care settings. They conclude that the quality of direct-care jobs must be increased in order to attract a "stable and competent" workforce, and point to research that suggests ways to create more collaborative, effective, and satisfying jobs.

Short URL: http://www.advancingstates.org/node/52094

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Medicaid Home and Community Based Services: Proposed Policies to Improve Access, Costs, and Quality

The population is aging & the demand for long term care and services at home is increasing. Medicaid is the most critical program for individuals who are aged & disabled because it pays for almost 46% of all nursing home care & 38% of home health. Medicaid HCBS have been the focus of efforts by the federal & state governments to expand access for several reasons. The focus of this article is to examine issues of access, cost, & quality for Medicaid HCBS programs and to suggest policy changes.

Short URL: http://www.advancingstates.org/node/52058

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Do Non-institutional Long-Term Care Services Reduce Medicaid Spending?

Spending on HCBS has grown in recent years, but little is known about what effect alternatives have on overall costs. An analysis of state data from 1995-2005 shows that for two population groups, spending growth was greater for states offering limited noninstitutional services than for states with large, well-established noninstitutional programs. Expansion of HCBS appears to entail a short-term increase in spending, followed by a reduction in institutional spending and long-term cost savings.

Short URL: http://www.advancingstates.org/node/52030

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