Research / Journal abstracts

In this case study, the authors examined the decisions and experiences of parents/guardians who directed supports and services for an adult with significant intellectual and developmental disabilities (SIDD). Respondents included the parents/guardian of the adult as well as others in the circle of support identified by the parents/guardians.

This paper aims at testing the relationship between older Americans Act (OAA) program expenditures and the prevalence of low-care residents in nursing homes (NHs). Principal findings indicate that increased spending on home-delivered meals was associated with fewer residents in NHs with low-care needs. States that have invested in their community-based service networks, particularly home-delivered meal programs, have proportionally fewer low-care NH residents.

The November 2012 issue of Health Affairs contains nine articles offering early insights on ACO and patient-centered medical home care delivery models. Both of these models have significantly developed in a relatively short period of time. Their goal is to further coordinate care and improve the health of patients. The nine articles examine whether either model will deliver major cost savings, especially in the short term.

This report serves as a follow-up to the 1995 Institute on Medicine (IOM) report which argued for an ombudsman program to address the quality of care in long-term institutional settings. This study investigates the role and effectiveness of the State Long-Term Care Ombudsman Programs (LTCOPs) in improving care. Surveys with all states/territories reveal new findings on the structure of the program in different states as well as their own perceived effectiveness. Comprehensive data and analysis.

The Affordable Care Act (ACA) established a voluntary public insurance program for long-term care: the Community Living Assistance Services and Supports (CLASS) Act. In October 2011, the Obama Administration suspended the CLASS Act because of the high risk of fiscal insolvency. This article discusses several CLASS Act design and implementation issues, including the voluntary enrollment, the weak work requirement, the lifetime and cash benefits, and the premium subsidy for low-income workers.

This critical essay examines how effectively the Patient Protection and Affordable Care Act (ACA) addresses prevailing deficiencies in the nation's long-term care system and whether the ACA will result in meaningful reform. This article also reviews the basic problems plaguing the long-term care sector and the provisions within the ACA meant to address them, including incentives/options for expanding home- and community-based care and a number of research and demonstration projects.

The coordination of Medicare and Medicaid benefits and services for dually eligible enrollees has been a longstanding policy challenge. Several provisions of the Affordable Care Act (ACA) attempt to address this lack of coordination. This paper reviews the major changes under the ACA directed at care coordination for the dually eligible population and then concludes with a discussion of the continuing legislative and legal challenges in integrating care for the dually eligible.

A statistical model was developed to assess the effect of rebalancing on overall spending for long-term services and supports (LTSS). The model indicates that spending is affected by the way rebalancing is implemented: Gradual rebalancing can reduce spending by about 15 percent over ten years. Because many states continue to experience budget crises, policy makers must think carefully before altering spending patterns for LTSS and adopt strategies to successfully reduce overall spending.

This study addresses issues related to the provisions of home and community-based services (HCBS) under the Affordable care Act (ACA) legislation of 2010. ACA allowed important voluntary provisions for the expansion of HCBS under Medicaid. Although the new provisions are valuable, the law does not set minimum standards for access to HCBS, and the new financial incentives are limited especially for the many states facing serious budget problems.

As state and federal policymakers move to develop and test integrated care models for people dually eligible for Medicare and Medicaid, two new Kaiser Family Foundation articles in the June 2012 issue of Health Affairs highlight the diverse needs and challenges facing these 9 million beneficiaries, describe their current care arrangements, and raise issues to consider for proposed reforms aimed at better coordinating their care and reducing health care spending.