Purpose of the Study: To examine the components of cost that drive increased total costs after a medical fall over time, stratified by injury severity. Design and Methods: We used 2004-2007 cost and utilization data for persons enrolled in an integrated care delivery system. We used a longitudinal cohort study design, where each individual…

Purpose: We compared a primary-care-based psychotherapy, that is, problem-solving therapy for primary care (PST-PC), to community-based psychotherapy in treating late-life major depression and dysthymia. Design and Methods: The data here are from the IMPACT study, which compared collaborative care within a primary care clinic to care as usual in…

Describes variations in case management approaches based on a national evaluation of Medicaid 1115 and Medicare 222 community-based care demonstrations. Presents the costs of producing case management services for selected programs. Less professionalization and less specialization of case management functions are associated with lower service…

Evaluated Connecticut's Medicaid Home and Community-Based Care program which allowed elderly persons to remain in community with home and community-based services instead of entering nursing homes. Results did not reveal if the program was cost effective. Recommends rigorous preadmission screening of nursing home applicants to increase likelihood…

Purpose: This article describes early efforts of four community partnerships in Boston, El Paso, Houston, and Milwaukee to address governance and management structures in ways that promote the sustainability of innovative community-based long-term care system improvements. The four communities are grantees of the Community Partnerships for Older…

Assessed service utilization and cost impacts of a consolidated model of long-term care for functionally impaired elders. Compared to traditional long-term care, this model reduces hospital and nursing home stays, redistributes funds to broad range of community-based services, and reduces overall cost of long-term care. (Author/NRB)

Studies community services in long-term care used by older minority adults and concludes that the extent to which minority older persons are receiving a proportionate share of services is not consistent across targeted minority populations. The strongest predictors of older minority persons served are staffing patterns and location. (Author)

Purpose: States are increasingly using the Medicaid 1915c waiver program to provide community-based long-term care. A substantially greater share of long-term-care dollars supports community-based care for individuals with intellectual and developmental disabilities, relative to older and working-age persons with primarily physical disabilities.…

Purpose: This study analyzed the effect of consumer-directed versus agency-directed home care on satisfaction with paid personal assistance services among Medicaid beneficiaries in Washington State. Design and Methods: The study analyzed a survey of 513 Medicaid beneficiaries receiving home- and community-based services. As part of a larger study,…

Compared first- and second-generation interorganizational service system serving the elderly. Found that integration of Medicaid programs with Administration on Aging-funded system was changing structure of community-based elderly services. Second-generation system served larger volume of clients, being more centralized, differentiated,…

Describes the process of implementing the New York State Long-Term Home Health Care Program (LTHHCP) during its initial three years of operation. Sponsors of similar programs should be aware of the need for program flexibility and the length of time required for start-up and implementation. (JAC)

Suggests an innovative group structure and process for integrating health care providers and elderly consumers in community health care planning, implementation, and evaluation. The Elderly Health Advocacy Group is described and its developmental processes outlined. Further demonstration for long-range impact is suggested. (Author)

Offers proposed definitions of "frail elderly" and "range of institutional care", and argues that an active problem-solving, treatment-oriented approach can reduce unnecessary institutionalization and that the movement to deinstitutionalize the elderly can learn from the history of the deinstitutionalization of other groups.…

Describes the Massachusetts Home Care Corporation network, which provides alternatives to institutional long-term care. This investigation confirms that home-based support service can be targeted to selected subgroups, that targeting can be maintained, and that the recipients of these services are indeed the individuals who risk…

Describes the intervention approaches, clients groups, and impacts on use of Medicaid and Medicare reimbursed services for five demonstrations included in the national evaluation of community-based long-term care. Only one project produced significant reductions in nursing home use. Unlike other projects, it identified potential clients through…