The Patient Protection and Affordable Care Act attempts to address prevailing deficiencies in long-term care (LTC) financing through the Community Living Assistance Services and Supports (CLASS) Act, a national voluntary LTC insurance program administered by the Federal government. The CLASS Act is intended to supplement rather than supplant…

Purpose: This study compared the official poverty rate for adults aged 65 years and older with alternative measures that portray the true resources and needs of older adults. Design and Methods: The analysis used data from the 2004 Health and Retirement Study on income, assets, in-kind transfers, and out-of-pocket medical expenses. It also…

Purpose: Although declines in memory and attention are hallmark symptoms of Alzheimer's disease (AD), noncognitive symptoms are prevalent. Over 80% of individuals will experience neuropsychiatric symptoms, which complicates symptom profiles. Research indicates a community-integrated response to dementia crisis can reduce negative consequences…

Purpose: When government funding for long-term care is reduced, participant outcomes may be adversely affected. We investigated the effect of program resources on individuals enrolled in the Michigan Home- and Community-Based Services (HCBS) waiver program for elderly and disabled adults. Design and Methods: Using dates of major policy and budget…

Purpose: On average, adults aged 60 years or older have 2.2 chronic diseases, contributing to the over 60 million Americans with multiple morbidities. We aimed to understand the financial implications of the most frequent multiple morbidities among older adults. Design and Methods: We analyzed Health and Retirement Study data, determining…

Purpose: We determined the prognostic value of self-reported and performance-based measurement of function, including functional transitions and combining different measurement approaches, on utilization. Design and Methods: Our cohort study used the 6th, 7th, and 10th waves of three sites of the Established Populations for Epidemiologic Studies…

Purpose: Little is known about whether an association exists between agency ownership and length of service among home care patients with different payment sources. This study investigated how for-profit and not-for-profit agencies responded to policy changes in the 1990s with respect to length of service. Design and Methods: We examined length of…

Estimated impoverishment risk for two samples of community-living elderly (N=900+). Found that for elders over age 75, 46 percent of those living alone and 2 percent of couples would spend lifetime assets and current income, becoming impoverished in 13 weeks if institutionalized in skilled nursing facility. Rates were comparable for elders over…

Using data from 1981-82 Channeling Demonstration project, examined types of health care costs (hospital, physician and ancillary care, nursing home, and prescription medicine) that contributed to overall expenses to determine sources of financially catastrophic health care expenses among disabled elderly persons. Found expenses for prescription…

Calculated financial ratios for 109 Continuing Care Retirement Communities (CCRCs). Noted problems with regard to asset productivity, profitability, and equity levels. Found that a risk-spreading charge structure for financing health care needs appeared to exist among CCRCs providing a full-care contract. (Author/ABL)

Notes that recent studies challenge assumption that Medicaid requires impoverishment; although two-thirds of elderly poor are not covered by Medicaid, many nursing home Medicaid recipients retain sizeable assets. Asserts that magnitude of asset spenddown is much smaller than previously believed. Discusses these findings and explores their…

Of 189 nursing homes, 83 percent reported that Medicare's hospital Prospective Payment System (PPS) affected patient needs, 53 percent said it affected patients and services provided, and 25 percent said it affected referrals to hospitals. PPS effects depended on facility factors of size, Medicare certification, tax status, and on local market…

Used data from 1982 and 1984 National Long-Term Care Surveys to track cohort of disabled elderly persons residing in community in 1982 over the two years that followed. In contrast to persons who did not use nursing homes, persons who entered nursing homes had a four- to five-fold risk of spending down to Medicaid eligibility. (Author/NB)

Examined incidence and causes of Medicaid spenddown among disabled elderly persons. Found that approximately 10 percent of nursing home discharges experienced asset spenddown, process of converting from private pay to Medicaid, whereas over 50 percent of nursing home patients remained private pay throughout their stays. Becoming Medicaid patient…

Purpose: This study had two goals: (a) to assess the validity of the Online Survey Certification and Reporting (OSCAR) staffing data by comparing them to staffing measures from audited Medicaid Cost Reports and (b) to identify systematic differences between facilities that over-report or underreport staffing in the OSCAR. Design and Methods: We…