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OCR for page 147
EXHIBIT D-1
CRITICAL LONG-TERM CARE ISSUES FROM PERSPECTIVE OF
INVOLVED PRIVATE SECTOR ORGANIZATIONS
Daniel C. Zwick
Consultant
Analysis of Comments Provided to Planning Committee
Eighty letters were received in response to Institute of Medicine
President Frederick C. Robbins' letter of January 25, 1985 requesting
involved private organizations "to define . . . the two or three issues
that your organization believes . . . to be the most critical for
long-term care through the 1990s" that should be considered for
inclusion in the major study being planned by the Institute. Most
respondents indicated substantial interest and expressed their support
for the undertaking of such a study. Many commended the Institute for
taking leadership in this complex field and indicated
collaborate during the study on a continuing basis.
Almost 60 percent of the organizations to whom the request was sent
forwarded comments soon enough to be included in this analysis (Table
1~. The highest rates of responses were from business groups,
disease-oriented voluntary agencies and professional associations; the
response rate for these three groups exceeded 70 percent. The
organizations to whom letters were sent and from whom responses were
received are listed in Attachment 1.
The lowest rates of response were from consumer groups and provider
groups. The low rate among consumer groups - 26 percent - is
consistent with other experiences; these agencies tend to have very
limited staffs who have the time or training to handle survey
questions. The relatively low response rate among provider groups is
probably due to a similar explanation; many of the smaller national
associations of this type have only modest staffing.
The largest number of responses - about 40 percent of the total -
were from professional associations (Table 2~. Disease-oriented
voluntary associations make up the second largest group of respondents
- over 20 percent. Provider groups are third - about 15 percent.
Altogether, these three categories account for about three-quarters of
the responses. Public officials groups and consumer groups compose
over half the remainder.
- . . ~
. ~ ~ @
a wllllngness to
Nineteen issues of substantial concern were identified in analyzing
the responses (Table 3~; several are overlapping. The findings are
discussed in the subsequent sections of this paper.
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TABLE 1 Responses to Letter of January 25, 1985
Type of Organization No. Letters No. Responses Percent
Professional Associations 43 30 - 70
Provider Groups 25 11 44
Disease-Oriented
Associations 24 17 71
Consumer Organizations 19
Public Officials Groups 11
5
7
26
64
Educational Groups 4 2 50
Business Groups 3 3 100
Other ~ 5 62
Total 137 80 58
-148-
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TABLE ~ Distribution of Responses
Type of Organization
Professional Associations 30
No. Responses Percent
. . . . . . . .
38
Provider Groups 11 14
Disease-Oriented
Associations 17 -21
Consumer Organizations 5 6
Public Officials Groups 7
Educational Groups
Business Groups
Other
2
9
3
4
Total 80 100
-149-
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TABLE 3 Frequency and Intensity of Comments
Issue No. Comments Intensity Index
Financing long-term care 50 - 2.5
Ensuring continuity of care 32 2.1
Development of community-based
services 26 2~3
Extension of professional education 20 2.0
Expansion of needs assessments 18 2.6
Expansion of research 18 2.0
Adequacy of facilities 16 2.0
Ensuring quality of care 15 1.9
Maximizing roles of family members 14 2.3
\
Improvement of public regulation
8
Strengthening coordination mechanisms 8
Expansion of prevention services 7
Extension of public education
activities
7
Extension of rehabilitation
services
Impact of new technologies
Rationalization of responsibilities 5
Advancement of public and
professional attitudes
Enhancement of program management
Clarification of ethical issues
6
5
3
2.1
1.9
2.0
2.0
2.0
2.3
2.2
1.8
2.6
2.5
-150-
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In carrying out this analysis, an effort was made to evaluate the
intensity of the stated concerns as well as their frequency. This task
was difficult because most responses were rather brief, usually one or
two pages, in line with the approach suggested in Dr. Robbins' letter.
Nonetheless, an index of intensity was developed for each comment,
taking into account such factors as the length of the comment, the
apparent seriousness of concern and the detail of the presentation
Ratings were made on a four point scale, with a score of four highest;
an average index was calculated for each issue based on the comments
with respect to the particular issue. While these ratings are entirely
subjective and may often suffer from a lack of information, they may be
suggestive of the relative intensity of concern.
Excerpts from selected letters submitted by the private
organizations are presented in Attachments 2 and 3. The excerpts were
chosen to offer insights on the special concerns of individual
organizations. Information on on-going studies which appear to be of
direct relevance to the Institute's planned study that were identified
in the responses are described in Attachment 4.
The First Three Issues
The three issues identified most frequently in the responses are:
- Financing long-term care
- Ensuring continuity of care
- Development of community-based services.
Excerpts from letters discussing these three issues are presented in
Attachment 2.
The financing of long-term care was identified as a high priority
issue by more than 60 percent of the respondents e Most noted
shortcomings of Medicare, Medicaid and other existing health care
financing programs. The problems of indigent medical care and the
roles of state and local governments in supporting long-term care were
highlighted in some responses. Long term care insurance was reported
as a critical need by quite a few commentators; they urged the
development of incentives to encourage the offering and purchase of
such coverage on a widespread basis.
Continuity of care was the second most frequently identified issue.
Concerns were expressed about the lack of comprehensive systems of
care, coordinating various levels and types of institutional and
non-institutional services. The fragmentation and deficiencies of the
current approaches and conditions were often noted.
The development of additional community-based services, particularly
for persons with chronic disabilities living in their own homes, also
received considerable attention. Shortages of organized home health
services in some areas and difficulties of access and coordination in
others were cited in many instances e Many comments pointed out an
urgent need to strengthen these types of services in light of the
-151-
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increasing demands related to declines in the length of hospital stays
and the pressures for deinstitutionalization.
Financing issues received the highest overall intensity score among
the first three issues. Many respondents discussed their concerns on
this subject in relative depth. The development of community-based
services also received a comparatively high intensity score.
The Next Three Issues
Three issues that were also identified rather often are:
- Extension of professional education
- Refinement of needs assessments
- Expansion of research
Selected comments on these issues are included in Attachment 3, in
which a broad selection of illustrative comments received is presented.
The extension of health professional education activities was
identified as an essential step to enlarge the cadre of personnel with
knowledge and skills in long-term care. Some commentators pointed out
that more emphasis should be given to these subjects as part of the
basic preparation of health professionals. Others called for more
attention to advanced, specialized efforts.
Needs assessment approaches were mentioned quite often as a high
priority interest. These comments tended to be of two types. Some
focused on better estimates of projected aggregate needs and demands
for various levels of care and support which are likely to be
experienced in the future. Others emphasized better methods of
assessing individual needs, particularly with respect to functional
abilities, in order to arrange the most appropriate forms of care.
Additional research on long-term care was advocated by a substantial
number of commentators. In most cases, the focus was on health
services research designed to identify ways of improving the
organization and delivery of services. In other cases, the expansion
of research on the biological, psychological and social aspects of
aging and disability was recommended.
Among these three issues, the highest average intensity score was
for refinement of needs assessments. Respondents commenting on this
topic expressed relatively high degrees of concern.
The Third Group
The third most frequently identified set of issues are:
- Adequacy of facilities
- Ensuring quality of care
- Maximizing roles of family members
The adequacy of facilities available to provide services and support
to individuals with long-term care needs was reported as a high
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priority issue in about a fifth of the responses. A wide range of
facilities were mentioned in the comments. They included both
specialized health care resources - such as nursing home beds and
intermediate care units - as well as more general resources - such as
nouslng.
Quality of care was of specific concern to many agencies. The
appropriateness and effectiveness of existing approaches and measures
were questioned. The commentators urged the Institute to give special
attention to efforts to strengthen the procedures and capacities for
quality control.
The contributions of families and other informal caregivers in the
provision of long-term care services was emphasized by numerous groups,
including both professional associations and consumer groups. They
urged that action to enhance the effectiveness and durability of such
support be highlighted. The respondents identifying this issue tended
to express their interests with a relatively high degree of concern.
Other Issues
Ten other issues were identified by a smaller number of
respondents. Some items addressed particular health care services:
- Expansion of prevention services
- Extension of rehabilitation services
- Impact of new technologies
Others were concerned with organization and management topics:
- Improvement of public regulation
- Strengthening coordination mechanisms
- Rationalization of responsibilities
- Enhancement of program management
Still others were more general:
- Extension of public education activities
- Advancement of public and professional attitudes
- Clarification of ethical issues.
The intensity scores for certain issues, such as enhancement of program
management and clarification of ethical issues, are relatively high;
the few agencies which identified these subjects as priority concerns
tended to be strongly committed to addressing them.
-153-
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Attachment 1
PRIVATE SECTOR ORGANIZATIONS SENT LETTERS
AND THOSE RESPONDING WITH WRITTEN COMMENTS
Nota Bene: Organizations that responded with written comments are
identified by asterisks(*). The American Medical Association and the
American Nurses' Association, who provided partial financial support for
the planning effort, gave oral comments to the Institute's planning
committee. It should be noted here that oral comments also were provided
to the committee by the Office of the Assistant Secretary for Planning and
Evaluation of the Department of Health and Human Services, the
Administration on Aging, and the Veterans Administration, as well as the
Health Care Financing Administration and the National Institute on Aging
who also provided partial financial support for the planning effort.
*Alzheimer's Disease & Related Disorders
Assn, Inc.
Am Academy of Family Physicians
*Am Academy of Neurology
*Am Academy of Nursing
*Am Academy of Physician Assistants
Am Affiliation of Visiting Nurse
Associations / Services
Sam Assn for Continuity of Care
*Am Assn for Counseling and Development
Am Assn for Geriatric Psychiatry
*Am Assn of Colleges of Nursing
Am Assn of Colleges of Osteopathic Med.
Am Assn of Homes for the Aging
Am Assn on Mental Deficiency
*Am Cancer Society
Am Coalition of Citizens "/Disabilities
*Am College of Health
Care Administrators
Am College of Physicians
*Am Council of the Blind
*Am Dental Assn
*Am Dietetic Asian
*Am Federation for Aging Research
Am Federation of Home
Health Agencies
*AFL/CID
*Am Federation of State, County &
Municipal Employees
Am Foundation for the Blind
Am Geriatrics Society, Inc.
*Am Group Practice Assn
Am Health Care Assn
Sam Health Planning Assn
*Am Heart Assn
-154-
*Am
*Am
*Am
*Am
Am
Am
Am
*Am
*Am
*Am
*Am
*Am
*Am
*Am
Am
Am
Am
*Am
*Am
*Am
*Am Urological Assn, Inc.
*Arthritis Foundation
Assn of Academic Health Centers
*As sn of Am Medical Colleges
*Assn of Am Physicians
Assn for Gerontology in Higher Edu.
*Assn for Retarded Citizens
Assn of Schools of Public Health
*Assn of State & Territorial Health
Officials
*As sn of University Programs in
Health Administration
*Bless Inc. (unsolicited)
*Blue Cross and Blue Shield Assn
*Brigham & Women's Hosp. (unsolicited)
Hospital Assn
Lung Assn
Medical Care & Review Assn
Medical Directors Assn
Medical Peer Review Assn
Mental Health Counselors Assn
Neurological Assn
Occupational Therapy Assn
Orthopsychiatric Assn
Osteopathic Assn
Osteopathic Hospital Assn
Physical Therapy Assn
Podiatry Assn
Psychiatric Assn
Psychological Assn
Public Health Assn
Public Welfare Assn
Red Cross
Soc. of Allied Health Professionals
Soc. of Internal Medicine
OCR for page 155
*Catholic Health Assn of the U.S.
Council of State Administrators of
Vocational Rehabilitation
*Cystic Fibrosis Foundation
Family Service Assn of America
*Federation of American Hospitals
*Forum on Long Term Care
The Gerontological Society of America
Gray Panthers
Group Health Assn of America, Inc.
*Health Industry Manufacturers Assn
*Health Insurance Assn of America
*Home Health Services & Staffing Assn
'Huntington's Disease Foundation of Am.
*Institute for Rehabilitation and
Disability Management
Institute for Research of
Rheumatic Diseases
*Joint Commission on Accreditation
of Hospitals
Legal Research and Services
for the Elderly
Leukemia Society of America
*March of Dimes Birth Defects Foundation
*Muscular Dystrophy Assn
*Natl Alliance for the Mentally Ill
Natl Alliance of Senior Citizens
Natl Assn of Area Agencies on Aging
Natl Assn of Community Health
Centers, Inc.
*Natl Assn of Counties
Natl Assn of County Aging Programs
Natl Assn of the Deaf
Natl Assn for Hispanic Elderly
*Natl Assn for Home Care
Nail Assn of Meal Programs
Natl Assn of Nutrition
and Aging Services Programs
*Natl Assn of Private Psychiatric Hosp
Natl Assn of Public Hospitals
Natl Assn of Rehabilitation
Facilities
Natl Assn of Retired Federal Employees
Natl Assn of Social Workers
Natl Assn of State Mental
Program Directors
-155-
*Natl Assn of State Mental
Retardation Program Directors
Natl Assn of State Units
on Aging
Natl Caucus and Cntr on Black Aged
Natl Citizen's Coalition for
Nursing Home Reform
Natl Coalition of Hispanic Mental
Health and Human Services Orgns
*Natl Conf of State Legislatures
Natl Consumers League
Natl Council of Community Mental
Health Cntrs
*Natl Council of Senior Citizens
*Natl Council on the Aging
Natl Dental Assn
Natl Foundation for Hospice
and Home Care
*Natl Geriatrics Society
*Natl Governors' Assn
Natl Health Council
*Natl Health Lawyers Assn
*Natl Hispanic Council on Aging
*Natl Homecaring Council
*Natl Hospice Organization
Natl Indian Council on Aging, Inc.
Natl Institute on Adult Daycare
*Natl League for Nursing
*Natl Medical Assn
Nail Mental Health Assn
Nail Multiple Sclerosis Society
Natl Pacific-Asian Resource
Center on Aging
Natl Senior Citizens Law Center
Natl Society for Children
and Adults with Autism
Older Women's League
*Pharmaceutical Manufacturers Assn
*Public Cmte on Mental Health, Inc.
*Society of Prospective Medicine
U.S. Conf of Local Health Officers
*U.S. Conference of Mayors
*Washington Business Group on Health
Western Center for Health Planning
Western Gerontological Society
OCR for page 156
Attachment 2
Excerpts from Selected Letters Concerning the First Three Issues
Financing Long Term Care
It is unrealistic to expect that the taxpayer can or will be able to
pick up the entire cost of the needed expansion of long-term care
services. Therefore, the development of viable long-term care
insurance programs are essential.
- American Academy of Physician Assistants
The lack of adequate financing arrangements represents the most
significant barrier to receipt of dental care by the indigent, the
elderly and disabled population of this country e
- American Dental Association
Long term care insurance is an idea whose time has come. The Federal
government needs to support the private sector in stimulating the
development of long-term care insurance.
- American Hospital Association
...The current inflexibility of the third party reimbursement systems
... give little assistance to those who are partially disabled and need
ambulatory care ... Such schemes should provide incentives to maintain
the functional independence of those served.
- Arthritis Foundation
Technological developments during the next decade will provide new
services and treatments for people with chronic illnesses and
disabilities. Mechanisms must be developed to assure that everyone has
access to these technologies, regardless of their ability to pay.
- Cystic Fibrosis Foundation
A federal financial commitment to long-term care services is essential
because unique demographic and economic conditions often mean that
states with the largest number of poor frail elderly individuals have
the most constrained resources to meet those needs ... The Institute
study (should) synthesize projections and information on the variance
in long-term care needs and state and local capacity to meet those
needs.
National Governors' Association
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Ensuring Continuity of Care
A key challenge .. is the development of integrated systems of care
which dea1 with the various subpopulations needing long-term care. By
integrated we are referring to the ... mechanisms which assume
continuity of care by addressing the interface between care of various
types in one setting as well as the interface between care in one
setting and care in another.
- American Academy of Nursing
... Increasing vertical integration through the establishment of closer
linkages among organizations at related stages of the health care
delivery process ... are having and will continue to have a positive
effect on the development of continuums of services characterized by
continuity of care, the essentials of an adequate long-term care
system.
- American Hospital Association
(A) critical issue is the need to provide a continuum of care. Studies
should be directed toward providing long-term care in a variety of
settings and at various levels of care. For example, how effective are
day programs and respite care in keeping the disabled at home?
- American Occupational Therapy Association
... A continuum of care (should) allow for independence in community
based settings, such as day care, home care and various housing
alternatives that enhance the ability of the older adult to be
independent.
- Catholic Health Association
Health maintenance and preservation systems should be comprehensive
enough to include translation of the present fragmentary health care
delivery system into a visionary system of encouragement and support of
virtual continuums of care that extend from the health implications of
independent living and congregate housing through the full array of
health and medical care options ...
- Federation of American Hospitals
High quality of long-term care assumes continuity of care and
coordination with other segments of the health care provider network.
Unfortunately this assumption is often not justified.
- Joint Commission on Accreditation of Hospitals
... We must identify the continuum of services needed to maintain
individuals outside of the institutional setting. This issue is not
limited to the elderly but is important to the mentally and physically
handicapped as well ... It is important to identify the basic services
needed to support these individuals within the community ...
- National Conference of State Legislatures
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Development of Community-based Services
(There is) the need for comprehensive, coordinated commNnity-based
long-term care, especially home health, hospice and adult day care.
- The American Dietetic Association
Another area of concern for long-term management is the use of
continuous oxygen therapy in the home or at a community site for
long-term care.
- American Lung Association
The necessity for long-term care in some situations could be reduced by
investing more initially in the community support systems and in making
environmental adaptations to meet individual needs, thereby allowing
the person to function more independently.
- American Physical Therapy Association
... Alternatives, such as home care, which are cost-effective, should
be explored and encouraged.
- Health Industry Manufacturers Association
Critical issues ... are long-term home care for infants and children
with physical disabilities requiring equipment and close medical and
nursing supervision, e.g., the ventilator dependent child ... and the
effects of discharge from institutions for the mentally disabled to
environments which do not provide domiciliary and other supportive
services and facilities.
- March of Dimes
A comprehensive community support system is critical to any serious
effort to plan for and meet the long-term care needs of mentally ill...
- The National Alliance for the Mentally Ill
(There is a need for) models for community based support networks and
needs for technical assistance and training ... and how these can be
integrated with the more formal services of institutions, social
workers and medical professionals.
- National Association of Meal Programs
... Preventing unnecessary institutionalization and identifying viable
alternatives to institutionalization is crucial to the states.
- National Conference of State Legislatures
-158-
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Attachment 3
Excerpts from Selected Letters Concerning Other Issues
Assessments of Needs
. . .
We hope the Committee en. will adopt the view that all the proposals
... be evaluated first and foremost on whether the individual aged
person would not only benefit but will perceive that he or she remains
in the maximum control of the decision making.
- American Medical Care and Review Association
There is need for a more accurate system to classify long-term care
patients by functional abilities ... A more accurate system should be
used in planning for suitable levels of care and settings in which care
is given ...
- Joint Commission on Accreditation of Hospitals
(An important issue is) the prevalence of abuse, neglect and
exploitation of recipients of long-term care and what to do about it -
the incidence of this problem is unknown but many professional people
believe it is widespread. This is a complex issue requiring attention
to the social, legal, health, economic and moral implications.
- National Home Caring Council
(There is an) insufficiency and inappropriateness of long-term care
service options currently available to persons with multiple sclerosis.
- National Multiple Sclerosis Society
(The Institute should consider) the proportion of chronically mentally
ill patients who can be rehabilitated sufficiently to live
independently and join the work force ... as opposed to those needing
some degree of supervised community housing and a sheltered work
environment for the indefinite future.
- Bless Inc.
Or~anization_and Delivery of Services
We tend to equate a health body with a healthy mind ... This is a
reaction frequently noted by handicapped individuals of all ages ...
This attitude contributes to the unwillingness or perceived inability
of individuals to care for disabled family members of all ages. It
also encourages care-givers to assume responsibilities for the
individual and discourage independence.
- American Association for Counseling and
Development
-159-
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Every facet of our current long-term care delivery system needs to be
examined. Unless drastic policy changes are implemented, demographic
trends threaten to overcome a system already besieged with problems.
Currently, accountability, continuity of services, and enforcement
greatly suffer in the private long-term care sector. The public sector
system is similarly beset with budgetary constraints which limit
service delivery.
- American Federation of State, County and
Municipal Employees
Support needs to be given to the family and friends who will be
providing the major portion of care ... Studies need to be done on
types of leisure activities, and the role they play in replacing
employment for the elderly.
- The American Occupational Therapy Association
(There is) need for further delineation of the role of the physician in
providing services to long-term patients and residents. Because of the
large number of non-physician providers in long-term care settings,
there is a need for a clear delineation of those problems for which
there is no substitute for physician care and other health problems
which require, at minimum, physician supervision.
- American Osteopathic Association
We wish to see considered the potential for reducing long-term care
needs by improvement in rehabilitation services so that disabled people
have a chance to improve residual functional capacity or learn
compensatory mechanisms that will minimize functional disability.
- American Psychiatric Association
An issue of particular interest is the need to demonstrate impact or
value of health promotion and disease prevention efforts on the health
and long-term medical expenditures and care needs of the elderly.
- American Red Cross
Maintaining and supporting the involvement of families in meeting the
long-term care needs of their family members is a critical issue.
- American Society of Internal Medicine
Maintenance of effort of the client's informal support system (is) a
critical factor in maintaining ill and disabled persons in the
community.
- Association of State and Territorial Health
Officers
(A prime issue is the) implications of technology on life expectancy,
quality of life and the allocation of resources ...
- Catholic Health Association
-160-
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We still have a very limited empirical basis for making appropriate
judgments regarding the configuration and types of long-term care
services that various groupings of developmentally disabled persons
require; nor do we have a firm grasp of the relationship between
intervention strategies and the long-term consequences on the
individual's achievement of a productive social role ...
- National Association of State Mental
Retardation Program Directors
Organization and Management
There is a seeming lack of understanding of the interrelatedness of the
many component parts of long-term care. A change in financing
mechanism, availability or eligibility for one component part has
significant ramifications for utilization, capacity requirements or
intensity of services of another e
- American Health Planning Association
Currently accountability mechanisms are encumbered with ineffective
paperwork which is primarily focused on reimbursement. Accountability
which focuses on quality and continuity of care is superficial and
primarily administrative.
- American Physical Therapy Association
What is missing (in the composition of the Institute's planning
committee)? Persons with expert knowledge about what actually goes on
behind the closed doors of the most widespread existing community
support system, viz: the family home ... These missing experts are of
two kinds: (1) recovered (mentally ill) patients and (2) their
families.
- National Alliance for the Mentally Ill
The multi-discipline role in long-term care - it seems essential not
only to define these roles more clearly ... but also to find ways to
alleviate the turf problems which hinder the effectiveness of a
comprehensive care plan.
- National Home Caring Council
In a field with an expanding and explosive development of new services
and health care workers ... there must be a consensus on
multi-disciplinary roles and responsibilities based on
patient/family/significant others needs.
- National League for Nursing
Increasing needs for nursing home beds ... is more severe in Black
communities ... Increasing costs in nursing home care ... causes many
middle income patients to divest themselves of their personal assets in
order to qualify for Medicaid ... Nursing homes are generally less
available and less accessible to minorities. The number and percentage
of minorities involved in the ownership, management, and in policy and
decision making roles' including task forces, is too small and not
representative.
- National Medical Association
-161-
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Attachment 4
Excerpts Referencing Related Ongoing Studies
At the request of the Social Security Administration, the APA has
recently begun a study which will evaluate aspects of the social
security disability process. We see this study as contributing to the
stabilization and fairness of a program which provides basic economic
underpinning for a large segment of disabled persons who have or will
eventually have substantial long-term care needs.
American Psychiatric Association
-
Last year the AUPHA identified the improvement of management of
long-term care services a priority responsibility for our ...
faculties. It is our assessment that the management capacity in the
long-term care sector is a significant constraint upon efforts to
improve the quality of services of all kinds . A rmn~rt ; n The
project's third year
~ ~ .
... is to include an assessment of present and
projected management needs in the long-term care field, available and
~ ~ ~ 1 _ 1 ~ ~ ~ ~
_ _
ll=G"C" mU=~l~lidl ru~uurces co meet chose needs, recommended
strategies for expanding the pool of appropriately trained individuals
and specific recommendations to government, education and professional
bodies.
.
-
Association of University Programs in Health
Administration
The NMHA has,recently launched a comprehensive project to look at the
future of mental health services delivery system ... The two projects
have an interrelatedness which might benefit both. This (study) will
include issues relating to long-term care of the mentally ill.
- National Mental Health Association
-162-
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EXHIBIT D-2
TOM COMMITTEE TO PLAN
A MAJOR STUDY OF NATIONAL LONG-TERM CARE POLICIES
Workshop Participants
March 12-15, 1985
Key Biscayne, Florida
Committee Members
Linda H. Aiken,~Ph.D., Chairman Margaret M. Hastings, Ph.De
Vice President Executive Director
The Robert Wood Johnson Foundation Illinois Commission on Mentan Health
Princeton, New Jersey and Developmental Disabilities
Kenilworth, Illinois
Patricia G. Archbold, R.N.,F.A.A.N.
Associate Professor
Project Director, Gerontology
The Oregon Health Sciences University
School of Nursing
Portland, Oregon
Robert M. Ball, M.A.
Senior Consultant to Study Group on
Social Security
Center for the Study of Welfare Policy
Washington, D.C.
Rhetaugh G. Dumas, Ph.D.,R.N.,F.A.A.N.
Dean and Professor
School of Nursing
University of Michigan
Ann Arbor, Michigan
Amasa B. Ford, M.D.
Associate Dean for Geriatric Medicine
Case Western Reserve University
School of Medicine
Cleveland, Ohio
-163-
Susan L. Hughes, D.S.W.
Director
Program in Gerontological Health
Assistant Professor
Department of Community Health and
Preventive Medicine
The Medical School
Northwestern University
Evanston, Illinois
Robert L. Kane, M.D.
Dean
School of Public Health
University of Minnesota
Minneapolis, Minnesota
Frank B. McGlone, M.D.
Private Practice
Denver, Colorado
William A. Morrill, M.P.A.
President
Mathematica Policy Research, Inc.
Princeton, New Jersey
OCR for page 164
Alicia H. Munnell
Senior Vice President and
Director of Research
Federal Reserve Bank of Boston
Boston, Massachusetts
Robert F. Phillips
Secretary of Life & Disability
Fireman's Fund American Life
Insurance Company
San Rafael, California
Edward R. Pierce, Ph.D., M.P.H.
Dean for Allied Health Sciences
Associate Dean, Indiana University
School of Medicine
Division of Allied Health Sciences
Indianapolis, Indiana
Dorothy P. Rice
Professor
Aging Health Policy Center
University of California
Dept. of Social & Behavioral Sciences
San Francisco, California
Sponsor Liaison Participants
Thomas Ault
Acting Director for Division of
Medicaid & Long Term Care Policy
Health Care Financing Administration
Washington, D.C.
Cynthia Cieplik, R.N., M.S.N.
Senior Staff Specialist, Gerontolog,
American Nurses' Association
Kansas City, Missouri
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John C. Rother
Associate Director
Div. of Legislation, Research, and
Developmental Services
American Association of Retired Persons
Washington, DC
William J. Scanlon, Ph.D.
Co-Director
Center for Health Policy Studies
Georgetown University
Washington, DC
John A. Talbott, M.D.
Chairman, Department of Psychiatry
University of Maryland
School of Medicine
Baltimore, Maryland
Stanley S. Wallack, Ph.D.
Director, Health Policy Center
Heller School
Brandeis University
Waltham, Massachusetts
Ellen B. Sachs
Project Coordinator
American Medical Association
Chicago, Illinois
OCR for page 165
Invited Participants
Mrs. Mercia Decker
Director, Services Development and
Acting Director, Education & Training
Office of Program Development
Administration of Aging
Washington, D.C.
George Greenberg, Ph.D.
Senior Program Analyst
Office of Assistant Secretary for
Planning and Evaluation
Washington, D.C.
Institute of Medic
cine Staff
William A. Lybrand, Ph.D.
Principal Staff Officer
Leopold G. Selker, Ph.D.
NRC Fellow-In-Residence
H. Don Tiller
Senior Secretary
John H. Mather, M.D.
Assistant Chief Medical Director
for Geriatrics and Extended Care
Veterans Administration
Washington, D.C
.
Mary O. Mundinger, Dr. P. He
Associate Professor, Director
Graduate Program, School of Nursing
Columbia University
New York, New York
(1984-85 Robert Wood Johnson Health
Policy Fellow)
Sandra Newman, Ph.D.
Associate Professor and
Principal Research Scientist
Johns Hopkins University
Baltimore, Maryland
(Representing Committee Member
Raymond J. Struyk, Ph.D.)
Karl Yordy, M.A.
Director, Division of Health
Care Services
Kathleen Drennan
Research Assistant
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Representative terms from entire chapter:
mentally ill
