Research / Journal abstracts

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.

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.

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.

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.

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.

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.

The study examines the association of state HCBS expenditures with use of formal and informal personal assistance by Americans aged 70 and older with functional limitations. After controlling for other factors, the authors find that persons residing in states with higher HCBS expenditures were more likely to use formal personal assistance, but not less likely to use informal assistance. Data were from state expenditures and the Assets and Health Dynamics among the Oldest Old Survey.

How do finance institutions and HCBS influence asset building among persons with disabilities? This article explores patterns of and barriers to utilization of banking services using a case study of an Iowa credit union that has enrolled persons with disabilities under a HCBS waiver. Although not widely used by program participants, the credit union model provides savings opportunities to purchase goods and services that facilitate independent living.

The question posed in the title is answered by analyzing state spending data from 1995-2005. The report shows that, for two distinct populations receiving long-term care services, 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.

The experience of the Cobb and Douglas Counties Community Services Boards in Georgia in shifting from a segregated traditional service system to an innovative system focusing on economic development for persons with disabilities illustrates some common aspects of system change. The 7-year organizational evolution is analyzed here. The main points that emerged are: staff development; partnerships and funding; sustainability; management and HR practices; and expanding coverage to new populations.