scholarly journals Factors Explaining State Differences in Applying for a Recent Long-Term Care Program that Promotes Aging in Place: Perspectives of Medicaid Administrators

2020 ◽  
pp. 073346482092451
Author(s):  
Esther M. Friedman ◽  
Regina A. Shih ◽  
Sangeeta C. Ahluwalia ◽  
Virginia I. Kotzias ◽  
Jessica L. Phillips ◽  
...  
Keyword(s):  
Long Term Care ◽  
Aging In Place ◽  
Care Program ◽  
Community Based ◽  
Term Care ◽  
Incentive Program ◽  
Policy Goals ◽  
Services And Supports ◽  
Community Based Services

Older adults in need of assistance often prefer to remain at home rather than receive care in an institution. To meet these preferences, Medicaid invited states to apply for the Balancing Incentive Program (BIP), a program intended to “rebalance” Medicaid-financed long-term services and supports to Home- and Community-Based Services (HCBS). However, only about half of eligible states applied. We interviewed Medicaid administrators to explore why some states applied for BIP whereas others did not. Supportive state leadership and the presence of other programs supporting community-based care were positively related to BIP application. Opposing policy priorities and programs competing for similar resources were negatively related to BIP application. Because states most likely to apply already had policy goals and programs supporting HCBS, BIP may inadvertently widen disparities across states, pushing those on the margins ahead and leaving the ones that are worst off in HCBS support to fall even further behind.

Cost Savings from Home and Community-Based Services: Arizona’s Capitated Medicaid Long-Term Care Program

1997 ◽  
Vol 22 (6) ◽  
pp. 1329-1357 ◽  
Author(s):  
William G. Weissert ◽  
Timothy Lesnick ◽  
Melissa Musliner ◽  
Kathleen A. Foley
Keyword(s):  
Long Term Care ◽  
Cost Savings ◽  
Care Program ◽  
Community Based ◽  
Term Care ◽  
Community Based Services

Functional Assessment of Elderly Clients of a Rural Community-Based Long-Term Care Program: A 10-Year Cohort Study

2002 ◽  
Vol 21 (3) ◽  
pp. 455-463 ◽  
Author(s):  
Frank J. Elgar ◽  
Graham Worrall ◽  
John C. Knight
Keyword(s):  
Home Care ◽  
Long Term Care ◽  
Care Program ◽  
The Elderly ◽  
Home Care Services ◽  
Community Based ◽  
Term Care ◽  
Risk Of Death ◽  
Affective Functioning

ABSTRACTAs the demand for home care services increases, health care agencies should be able to predict the intake capacity of community-based long-term care (CBLTC) programs. Two hundred and thirty-seven clients entering a CBLTC program were assessed for activities of daily living (ADL) and cognitive and affective functioning and were then followed to monitor attrition and reasons why clients left the program. Compromised ADL functioning at baseline increased likelihood of death and institutionalization by 2 per cent each year. Over a 10-year period, reduced cognitive functioning at baseline increased the risk of death by 9 per cent and decreased the likelihood of leaving the program due to improvement by 18 per cent. Reduced affective functioning at baseline increased the risk of institutionalization during the course of the study by 3 per cent. Routine functional assessments with the elderly may help in the management of similar home care programs.

scholarly journals Profile of Long-Term Care Recipients Receiving Home and Community-Based Services and the Factors That Influence Utilization in Taiwan

2020 ◽  
Vol 17 (8) ◽  
pp. 2649
Author(s):  
Chia-Mei Shih ◽  
Yu-Hua Wang ◽  
Li-Fan Liu ◽  
Jung-Hua Wu
Keyword(s):  
Low Income ◽  
Long Term Care ◽  
Common Factor ◽  
Behavioral Model ◽  
Care Needs ◽  
Community Based ◽  
Term Care ◽  
Care Recipients ◽  
Community Based Services

In response to the irreversible aging trend, the Taiwan government has promoted the Long-Term Care (LTC) policy 1.0 launched in 2007 and the LTC policy 2.0 reform since 2016. This study aimed to explore the utilization of formal home and community-based care under LTC policy 1.0 to add scientific support for the on-going LTC policy 2.0 reform. Methods: By using Andersen and Aday’s behavioral model of healthcare utilization, the long-term care dataset was analyzed from 2013 to 2016. A total of 101,457 care recipients were identified after data cleaning. Results: The results revealed that about 40.7% of the care recipients stayed in the care system for more than two years. A common factor influencing the length of home and community-based services (HCBS) utilization period included need factors, where more dependent recipients leave the LTC system regardless of their socio-economic status. However, the utilization period of non-low-income households is significantly affected by the level of service resources. Conclusion: For long-term care needs, the phenomenon of a short utilization period was concerning. This study adds information which suggests policy should reconsider care capacity and quality, especially for moderate to severely dependent recipients. This will allow for better understanding to help maintain care recipients in their own communities to achieve the goal of having an aging in place policy.

scholarly journals EFFECTIVENESS OF HOME- AND COMMUNITY-BASED SERVICES IN DECREASING HEALTH CARE EXPENDITURE IN TAIWAN

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S159-S159
Author(s):  
Ya-Mei Chen ◽  
Hsiao-Wei Yu ◽  
Ying-Chieh Wang
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Long Term Care ◽  
Community Based ◽  
Term Care ◽  
Care Recipients ◽  
Home Based ◽  
Number Of Visits ◽  
Community Based Services

Abstract Ideally, continuum of care involves wide-ranging health and long-term care (LTC) services. Taiwan’s National Health Insurance scheme and 10-Year Long-term Care Plan attempts to provide universal and fundamental services of continuum care. However, the accessibility of these services for care recipients remains unclear. This study aims to examine the effectiveness of continuum care in decreasing the healthcare expenditure of LTC recipients using home- and community-based services (HCBS). Data collated from the 2010–2013 Long-Term Care Service Management System (N = 77,251) were subjected to latent class analysis to identify subgroups of recipients using HCBS. Subsequently, the 1-year primary care expenditure after receiving HCBS was compared through generalized linear modeling. Three discrete HCBS subgroups were found: home-based personal care (HP), home-based health care (HH), and community-based care (CC). No difference in the number of visits to doctors and the average primary care expenses was observed between the HP and HH subgroups. However, considering physical and psychosocial confounders, care recipients in the CC subgroup recorded a higher number of visits to doctors (β = 3.05, SD = 0.25, p < 0.05) and lower primary care expenditure (β = -98.15, SD = 43.17, p = 0.02) than the other two subgroups. These findings suggest that LTC recipients in Taiwan may obtain better continuum care only for CC service recipients. Additionally, community-based LTC services may lower the cost of health expenditure after 1 year.

The Use of Community-Based Services in Long-term Care by Older Minority Persons

1979 ◽  
Vol 19 (4) ◽  
pp. 389-397 ◽  
Author(s):  
D. Holmes ◽  
M. Holmes ◽  
L. Steinbach ◽  
T. Hausner ◽  
B. Rocheleau
Keyword(s):  
Long Term Care ◽  
Community Based ◽  
Term Care ◽  
Community Based Services

scholarly journals Promises and Pitfalls of Health Information Technology for Home- and Community-Based Services

2020 ◽  
pp. 073346482094136
Author(s):  
Sangeeta C. Ahluwalia ◽  
Esther Friedman ◽  
Daniel Siconolfi ◽  
Debra Saliba ◽  
Jessica Phillips ◽  
...  
Keyword(s):  
Information Technology ◽  
Health Information Technology ◽  
Health Information ◽  
Service Agency ◽  
Community Based ◽  
Incentive Program ◽  
Services And Supports ◽  
Consumer Advocates ◽  
Community Based Services

Background: Health information technology (HIT) use in home- and community-based services (HCBS) has been hindered by inadequate resources and incentives to support modernization. We sought to understand the ways the Medicaid Balancing Incentive Program (BIP) facilitated increased use of HIT to increase access to HCBS. Method: Qualitative analysis of interviews with 30 Medicaid administrators, service agency providers, and consumer advocates. Results: Although stakeholders perceived several benefits to greater HIT use, they highlighted critical challenges to effective adoption within the long-term services and supports (LTSS) system, including lack of extant expertise/knowledge about HIT, the limited reach of HIT among rural and disabled beneficiaries, burdensome procurement processes, and the ongoing resources required to maintain up-to-date HIT solutions. Conclusion: The structural reforms required by BIP gave states an opportunity to modernize their HCBS systems through use of HIT. However, barriers to HIT adoption persist, underscoring the need for continued support as part of future rebalancing efforts.

Long-Term Care Goes to Market: Managed Competition and Ontario's Reform of Community-Based Services

1999 ◽  
Vol 18 (2) ◽  
pp. 125-153 ◽  
Author(s):  
A. Paul Williams ◽  
Jan Barnsley ◽  
Sandra Leggat ◽  
Raisa Deber ◽  
Pat Baranek
Keyword(s):  
Nous Avons ◽  
Long Term Care ◽  
Managed Competition ◽  
Community Based ◽  
Term Care ◽  
Longue Duree ◽  
Longue Durée ◽  
Community Based Services

RÉSUMÉLa désinstitutionnalisation et le virage vers les ressources communautaires posent des défis importants aux décideurs et aux dispensateurs de services, le plus important étant sans nul doute le défi de fournir un volume de services communautaires de haute qualité suffisant à répondre aux besoins de la clientèle. Ce défi est particulièrement évident dans les soins de longue durée (SLD), en raison de la complexité et de la diversité de ce champs d'action, de la vulnérabilité de la clientèle et de l'accroissement de la demande consécutive aux compressions dans le système hospitalier. Dans ce contexte, la dernière réforme des soins de longue durée en Ontario est particulièrement intéressante parce que, comme l'exprime le mot d'ordre gouvernemental «meilleure qualité au meilleur prix,» elle promet la coüt-efficacité tout en assurant le maintien ou l'amélioration de la qualité. Pour y arriver, on a recours à un modèle de «gestion de la concurrence» dans lequel les fournisseurs sans but lucratif et à but lucratif entrent en concurrence pour des contrats de services attribués par des Centres d'accès aux soins communautaires locaux, gérés par un conseil de bénévoles. Dans cette communication, nous avons utilisé les commentaires de hauts fonctionnaires et de représentants de fournisseurs de soins, ainsi que des documents du domaine public, pour mettre en lumière les questions et les problèmes soulevés par cette plus récente réforme provinciale. Nous soumettons que le modèle de gestion de la concurrence pourra entraîner la subordination de la qualité des services et du choix du consommateur aux impératifs de limitation des coûts, particulièrement dans le contexte actuel de budgets fermés et d'augmentation de la demande.

Quality Improvement in Community-Based, Long-Term Care: Theory and Reality

1994 ◽  
Vol 20 (1-2) ◽  
pp. 59-77
Author(s):  
Eleanor D. Kinney ◽  
Jay A. Freedman ◽  
Cynthia A. Loveland Cook
Keyword(s):  
Daily Living ◽  
Long Term Care ◽  
Care Service ◽  
The Elderly ◽  
Community Based ◽  
Term Care ◽  
Care Theory ◽  
Care Services ◽  
Community Based Services

Community-based, long-term care has become an increasingly popular and needed service for the aged and disabled populations in recent years. These services witnessed a major expansion in 1981 when Congress created the Home and Community-Based Waiver authority for the Medicaid program. Currently, all states offer some complement of community-based, long-term care services to their elderly and disabled populations and nearly all states have Medicaid Home and Community-Based Services waivers which extend these services to their Medicaid eligible clients.An ever increasing proportion of the population is in need of community-based, long-term care services. Between nine and eleven million Americans of all ages are chronically disabled and require some help with tasks of daily living. In 1990, thirty percent of the elderly with at least one impaired activity of daily living used a community-based, long-term care service. Not surprisingly, expenditures for community-based, long-term care have increased.

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