Click for next page ( 96


The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page 95
EXHIBIT C-1 INCOME AND ASSETS OF THE ELDERLY: A BRIEF SURVEY OF EXISTING INFORMATION * Alicia H. Munnell In order to devise an appropriate public response to the long-term care needs of the elderly, it is essential to assess the personal financial resources available to this group to cover the cost of this form of care. Such an assessment requires not only information on existing sources and levels of income and assets, but also projections of the financial status of the elderly in the future. This memo summarizes the existing survey data on the income and assets of older people and discusses attempts, using microsimulation techniques, to project the financial status of the elderly after the turn of the century. The overall conclusion that emerges from this survey is that good data exist on the current financial resources available to today's elderly and, although the studies have not yet been done, both the data and technology are available to make useful projections of the income and assets of the elderly IS years from now. The survey also reveals two specific areas where the existing methodology needs some improvement. First, while the modules used to project income are widely accepted and produce consistent results across models, the asset modules are still relatively unrefined. The problem is that economists have not reached agreement on how savings behavior is determined. Second, none of the models take account of the possibility of intergenerational transfers within extended families. In this case, the problem arises because the models are incapable of maintaining the linkages between the two families that are created when a child leaves one family and creates another. Despite these limitations, however, we should be able to construct a reasonably reliable picture of the future financial status of the elderly. Senior Vice President and Director of Research, Federal Reserve Bank of Boston. The views expressed are solely those of the author and do not necessarily reflect the official position of the Federal Reserve Bank of Boston or the Federal Reserve System. -95-

OCR for page 95
Surveys of the Income and Assets of Today's Elderly Surveys of the income and assets of today's elderly serve two important functions. First, they provide detailed information on the level and sources of financial resources available to the current generation of elderly with which to finance long-term care services. Second, these surveys provide the initial data bases for the microsimulation projections of income and assets of the elderly population in the future. For each of these purposes, the ideal survey would collect very detailed information from a large, representative sample of the United States population. While none of the existing surveys is ideal, the Current Population Survey, the New Beneficiary Survey and the Survey of Consumer Finances each provide important information for both purposes. Current Population Survey The most comprehensive and widely used source of information on the income situation of the elderly are the findings of the Census Bureau's Current Population Survey (CPS). The survey is conducted annually by the Census Bureau, and a detailed analysis of the results for the population age 55 and older is published biennially by the Bureau of the Census and the Social Security Administration. For the CPS, the Census Bureau samples a large cross-section of households in the United States, gathering detailed information on income and labor force participation for each person 14 years of age or older. The Special Pension Supplement to this survey samples those 55 years old or older to elicit additional information about pension coverage from this subset. Results of the supplemental survey provide income and wealth information for a representative sample of the working and non-working elderly population. Table 1 contains a synopsis of the results of the most recent survey. Although the CPS data base is thought to be superior to other information sources because of its broad coverage, it does suffer from some problems. First, the definition of income used by the CPS does not include certain types of non-money income, such as wages received in kind and the net rental value of owner-occupied homes. Income from these sources is thought to account for approximately 4 percent of total personal income. Second, the field surveys underlying the CPS reports inevitably produce some under-reporting of income. Even after compensating for noninterviews and nonresponses, the March 1982 CPS estimates of the total amount of income received by elderly persons is somewhat lower than estimates of other independent sources. Comparisons of the 1982 CPS estimates with the other totals reveal that overall income in the survey is underreported by approximately 11 percent. Underreporting varied from about 58 percent for interest income to only about 3 percent for wage and salary income. In addition to the CPS, two other surveys provide detailed income and asset information based on smaller, less comprehensive samples of -96-

OCR for page 95
TABLE 1 Current Population Survey: Sources and Levels of Income for the Elderly, 1982a Median IncomeC - Income Source Percent Receiving Nonmarried Married All Incomeb Persons Couples Elderly Social Security 90% $4,450 $7,560 $5,170 Private Pensions 23 1,880 3,160 2,560 Government Pensions 12 4,360 7,320 5,560 Earnings 23 4,060 7,270 5,670 Assets 66 1,120 2,160 1,540 Total N.A. 5,880 15,130 8,790 , . aElderly includes married couples living together, at least one of whom is 65 years old or older, and single persons 6S years old or older. ball elderly. CHedian income calculations exclude those units with no income from source. SOURCE: Current Population Survey data, published in Susan Grad, Income of the Population 55 and Over, 1982 (Social Security Administration, 1984~. -97-

OCR for page 95
the population. The results of these samples can be used to provide insight into issues that require very detailed individual data. New Beneficiary Survey The New Beneficiary Survey (NBS) is performed every decade by the Social Security Administration.2 The survey is designed to provide social security policy analysts with sufficient information to evaluate the current benefits provided by the social security program in terms of both equity and adequacy, and to permit estimation of the effects of proposed program changes. The NBS is a national, cross-sectional survey of retired and disabled workers who first began receiving social security benefits approximately one year before the survey date. Thus, the results of this survey provide detailed information about the economic status of the retired portion of the younger elderly population. Table 2 summarizes some of the published results from the most recent survey. The data offer the first conclusive evidence that supplementary pension plans will provide an increasing portion of _ retirement income of future elderly cohorts. By focusing on recent retirees, this survey presents a better indication of financial resources of future retirees than cross-sectional surveys of the entire elderly population. Of course, the future role of pensions for this group will depend on the rate of inflation over the group's retirement lifetime, since most private pensions are not linked to increases in the cost-of-living and state and local plans are only partially adjusted for inflation. Survey of Consumer Finances A Survey of Consumer Finances (SCF) has been sponsored periodically by the Board of Governors of the Federal Reserve System and other agencies since 1947.3 The 1983 survey collected detailed information about income, assets, pension rights and benefits, and consumer attitudes from a relatively small sample of American families. The SCF provides particularly useful detail on the liquidity of financial assets and home equity that is not found in other surveys. Because of the limited sample size (particularly when the sample is divided into subgroups such as persons 65 years old or older), care must be exercised in interpreting this data. However, careful use of the results can provide supplementary wealth and income data that are not available elsewhere (see Table 3~. A comprehensive report on the results of the SCF will be available from the Board of Governors by July 1985. -98-

OCR for page 95
TABLE 2 New Beneficiary Survey: Sources and Levels of Income for New Retirees, 1982 Percent Receiving Income Median Income Nonmarried Married Nonmarried Married Income Source Persons Coup1es Persons Couples Social Security 98% 97% $5,052 $7,752 Pensions 44 27 3~492 5,880 Earnings 56 42 4,704 7,404 Assets 84 69 1,188 2,160 SOURCE: Linda Drazga Maxfield and Virginia P. Rena, "Distribution of Income Sources of Recent Retirees: Findings from the New Beneficiary Survey," Social Security Bulletin, vol. 48, no. 1 (January 1985), Table 4, p. 11. _99 _

OCR for page 95
TABLE 3 -Survey of Consumer Finances: Levels of Income and Assets of Elderly Families by Age, 1983 . Item 55-64 ~ 65-74 75 and Over Income Mean $32,292 $21,818 $11,334 Median 21,855 12,538 7,176 Financial Assetsa Mean 54~951 65,339 37,060 Median 9,338 Il,400 10,350 65 and Over Home Ownershicb _, Percent Owning 73% 70Z Net Equity Mean $73,578 $58,269 Median 55,000 41,857 aMean and median figures exclude families with no assets. bNonfarm families only. SOURCE: Robert B. Avery, Gregory E. Elliehausen and Glenn B. Canner, "Survey of Consumer Finances, 1983," Federal Reserve Bulletin vol. 70 (September 1984), Tables 3, 5, 7 and 10, pp. 682~686e -100-

OCR for page 95
Overall Results As far as they are comparable, the results of the CPS, the NBS and the SCF are remarkably consistent. Total median income for the elderly is estimated by each survey to be approximately $9,000 in 1982. Both the CPS and the NBS report virtually universal social security benefit receipt, with social security income providing over 50 percent of total income for almost 60 percent of the elderly population. Unfortunately, biases introduced by differences in sample universes and inconsistencies in reporting techniques preclude a smooth merger of the results into one comprehensive, detailed data base. However, each survey provides a unique contribution to the development of a complete portrait of the economic status of today's elderly population. An excellent synopsis of the available data is presented in Chapter 5, "Economic Status of the Elderly," of the 1985 Economic Report of the President (see attachment).4 Projected Data For policy purposes, it is important to consider the economic status of the elderly in the future, in addition to the current situation. Some information on this issue could be gained by simulating the changes in the income and asset situation of the young elderly sample in the New Beneficiary Survey as they grow older, but a more comprehensive picture would be provided by aging a representative sample of today's non-elderly population in order to determine the income and asset status of tomorrow's elderly. Projections created by ICE Inc.'s PRISM model and the DYNASIM model of the Urban Institute provide the most complete and accurate estimates of retirement income sources and levels in the United States in the early 21st century.5 Ideally, each of these sources could be tapped to fill gaps in the other, thereby creating one comprehensive projection of retirement income to serve as a guideline for developing long-term care policies. However, several differences in the structure and components of the individual modules incorporated into the models and irreconcilable parameter differences used in the simulations prevent an easy integration (or even comparison) of the two sets of results. Thus, policymakers are required to rely primarily on one model for projections of retirement income data. Methodology The basic methodology underlying the two models is very similar. Both models begin with an initial cross-sectional sample of the United States. Population and dynamically age each unit in the sample to create a longitudinal data base. The dynamic aging process uses a series of sequential equations to determine how each unit's family composition, wage, and labor force characteristics change from year to year. These annual changes are restricted, in aggregate, to conform to -101-

OCR for page 95
exogenously determined macroeconomic trends. The resulting data base includes family, work, and earnings histories. Hence, either model could be used to project the future income and assets of the elderly. In their present state, however, the PRISM model appears to offer some advantages over DYNASIM for the task at hand. First, the PRISM model simulates participation in supplemental pension plans, such as IRAs and thrift plans, while DYNASIM does not. Although less than half the population is expected to receive benefits from supplemental plans by the year 2000 ? these benefits could account for a significant portion of future retirement income, since supplemental pension plans tend to be relatively generous and have quicker vesting than basic plans. Second, PRISM uses seemingly more realistic assumptions concerning vesting periods than the DYNASIM model. The PRISM model assumes a shorter vesting schedule, and contains a restriction that does not allow a worker to change jobs within two years of the vesting point e Third, the PRISM model assigns a complete package of pension plan characteristics to covered workers based on the provisions of - actual retirement plans. These provisions are drawn from a sample of 315 plans sponsored by firms of all sizes in all industries. The DYNASIM model, on the other hand, assigns each individual plan characteristic to covered workers stochastically. It is not clear that the PRISM methodology results in more accurate projections of aggregate (and, thus, mean) benefit levels. However, since there is no control in the DYNASIM model over assigning some workers to plans that tend to be generous (or meager) in all respects, the micro level projections developed by the PRISM model are probably more realistic than those generated by the DYNASIM model. A final consideration in an evaluation of the relative strengths of the PRISM and DYNASIM projections is the quality of the initial data base. All microsimulation techniques are plagued by insufficient initial data. Both the PRISM and the DYNASIM simulations began with data from the Current Population Survey matched with Social Security Administration earnings records (CPS-SER). However, the PRISM projections are based on the 1979 CPS-SER, while the DYNASIM estimates rely on the 1973 CPS-SER. Although the 1973 CPS-SER sample includes more observations than the 1979 survey, the latter is widely accepted as the largest and most current statistically representative sample of the U.S. population that provides extensive information on pension coverage and work characteristics. Some of the PRISM projections for the turn of the century are summarized in Tables 4 and 5. Even though the PRISM model has some obvious advantages over DYNASIM in projecting the level and sources of financial resources available to the elderly in the future, all microsimulation projections are beset with problems and it is probably useful to keep them in mind: 1) As discussed earlier, the Current Population Survey suffers from both undercoverage and nonreporting in the initial sample and underreporting of income in the final data base. Underreporting and nonreporting of income can cause serious obstacles to the accurate simulation of retirement income sources and levels. Other general data base limitations which affect all models include: (a) Panel surveys -102-

OCR for page 95
TABLE 4 Sources and Levels of Family Retirement Income for the Elder~y,a PRISM Projections, 2002-2011 Dollars in 1983 dollars - Percentage of - Families Receiving Income from Source Income Source Average Income or Receivers Average Incomeb for all Families Social Security 94% $8,700 $S, 200 Employer Pensions 71 9,300 6,600 Earnings from Employment 30 14,700 4,400 Individual Retirement Accounts 41 1,800 700 Supplemental Security Income 2 2,300 100 SavingsC N.A. N.A. N.A. All Sources 20,000 20,000 aRetirement income at age 67 for individuals age 35-44 in 1979. bIncludes families who do not receiveincome from the source. CIn 1979, 71 percent of elderly families containeing individuals age 65-69 received an average of $3,000 in income from assets. SOURCE: ICE, Inc., Future Retirement Benefits Under Employer Retirement Plans Final Report, prepared for the American Council of Life Insurance (June 1984), p. 46, Table IV-3. -103-

OCR for page 95
so~ ~ ~ ~ - v ~ ~ lo- - ~ o ~ ~ o u - : On cn ~ - ~ - ~ o 1 lo lo o ~ o c., At ~ ~ o I ~ H - C) Cal rl > - v - A 0 4- ~ C) SO U ~ O Ed In ~4 lo- - C) lo- - ~ V C) C) ~ ~ O ~ P4 ~ an En O U] . ~ o ~ ~ C~ rl s" cn ~ m ~ =-,1 ~ C ~o ~ - 0 - S" ~: ~n o :~ ~ 0 C~ C~ - U) s~ o 0 U) - ~ ~ rl = - ~Q ~ .- ~q a 0 0 0 0 0 0 0 0 0 0 0 0 0 _ oo 0 r~ ~ ~ ~ l_ 0 00 0 oo ~ ~o ~n oo C~ 0~ 0\ ~ a~ 0 0 0 o' 0 0 0 0 0 o' 0 0 ~o ~ 0 _ o' ~o ~ o' _ . O `0 ~ ~ 0 1 ~ u~ ~ 0 a' O U. ~ ~ ~ 0 _ ~ _ _ ~ 0 - 0 0 0 ^ o' a' ~ ~ 0 o' ~ C~ 0 _ a~ o~ o~ ~ ~ . ~ ~ ~ o' o' :~` - ~ ~ o 1 . I ~ o o o~ o = ~ o o ~ o ~ ~ o o ~ o o ~ ~ ~ ~ ~ ~ ] o o o' o c ~ ~ - ~ ~ ~ C' ~ ~ ~ ~ ~ -104 - :- C) ~q o' r~ o~ - ~ . .,4 cn :- 1 ~n o - U] 3 o 3 o U] In - O ~ cn C) 04 C' - 3 C ~q .,1 .,' ,1 ~ I cn ^, . Ut ~1 ,1 ~ t~ t~ H U) :^ - ~ ~ u v] c 8 ~: :^ a :D .,.' ~: ~r: ~ 1 C H U] E" 0\ `0 0 _ _~ C o rl C) o C) ~C ~ Q) H o .. S o CO ~0 I

OCR for page 95
such as the CPS collect income information for the year preceding the survey so that the survey reflects demographic characteristics of the household for the current year and income data for the previous year; (b) Income generally includes only money income, excluding in-kind income or intra-family transfers, etc.; (c) Data on assets and health limitations are limited on many of the files; and (d) Expenditure data are almost nonexistent. 2) The modeling of job change behavior is still relatively unrefined in comparison to other components of microsimulation models. Most models have no mechanism for incorporating the influence of pension plan characteristics on job change decisions that do not involve retirement. The PRISM model was recently revised to allow for some linkage between plan characteristics and job change behavior.6 However, the accuracy of the job change module is still restricted by the assumption that job change behavior in the next 30 years will be exactly the some as it was in the 1977-79 period. 3) Validation techniques used to measure the accuracy of microsimulation models remain imprecise. Models are currently monitored on both an individual and an aggregate level> to make sure that the individual histories appear plausible while the aggregate results conform to historical realities. In addition, standard statistical techniques are used to determine the levels of confidence for individual equations within each model. However, these techniques measure the likelihood that the observed data were indeed derived from the population in the model, and thus say nothing about the congruence of the model with the real world. In addition to these general problems, two deficiencies remain in microsimulation techniques that have a particular impact on their use for evaluating long-term care policies. First, the theoretical framework required to build a module that simulates wealth characteristics has not been satisfactorily developed. Thus, wealth data is usually excluded from simulation results or imputed according to current relationships between wealth and income from various sources. Second, current models have limited abilities to handle the intergenerational transfer of resources. Most models have two types of units in their sample population: families and persons. Families are taken to be nuclear families, which include married couples and their dependent children and single persons with their dependent children. No current models are capable of maintaining linkages between the two families when a child leaves one family and creates another. For issues of long-term care, the intergenerational transfer of resources is highly significant and, therefore, it would be important to try to create the desired linkages. -105-

OCR for page 95
42 Steiner, Paula A. and Jack NeedlPman. 1981. Cost Containment in Long Term Care: Options and Issues in State Program Design: A Synthesis of Findings from Research and Demonstration Projects. Executive Summary. National Center for Health Services Research. 43 Welssert, William G., Thomas T. H. Wan and Barbara B. Livieratos. 1980. Effects and Costs of Day Care and Homemaker Services for the Chronically Ill: A Randomized Experiment. National Center for Health Services Research. 44 Steiner, Paula A. and Jack Needleman. 1981. Expanding Long Term Care Efforts: Options and Issues in State Program Design: A Synthesis of Findings from Research and Demonstration Projects. Executive Summary. National Center for Health Services Research 45 Berk, Marc. L., G. L. Cafferata, and M. M. Hagen. 1984. Persons with Limitations of Activity: Health Insurance, Expenditures and Use of Services. National Center for Health Services Research, National Health Care Expenditures Study, Data Preview 19. 46 National Center for Health Services Research, User Liaison Program. 1984. Conference on Long Term Care: Past, Present and Future. Held 11/15-16, Biloxi, Mississippi. 47 National Center for Health Statistics, National Medical Care Utilization and Expenditure Survey. 1984. Access to Health Care Among Aged Medicare Beneficiaries. Series B. Descriptive Rpt. #3. 48 Neugarten, Bernice L. ed. 1982. Age or Need? Public Policies for Older People. Beverly Hills, CA: Sage Publications. 49 Perlman, Robert ed. 1983. Family Home Care: Critical Issues for Services and Policies. New York, NY: The Haworth Press. 50 Perspectives. 1984. Hospice Struggles into Second Year. Washington Report on Medicine and Health. 51 Perspectives. 1984. Long Term Care Alternatives. Washington Report on Medicine and Health. 52 Rango, Nicholas. 1982. Nursing-Home Care in the United States: Prevailing Conditions and Policy Implications. New England Journal of Medicine 307:14:833-889. 53 Rice, Dorothy P. and Carroll L. Estes. 1984. Health of the Elderly: Policy Issues and Challenges. Health Affairs, December. 54 Rice, Dorothy P. and Jacob J. Feldman. 1983. Living Longer in the United States: Demographic Changes and Health Needs of the Elderly. Milbank Memorial Fund Quarterly 61:3:362-396. -136-

OCR for page 95
55 Rogers, David E., Robert J. Blendon, and Thomas W. Maloney. 1982. Who Needs Medicaid? New England Journal of Medicine 307:1:13-18. 56 Rubenstein, Laurence Z., Karen R. Josephson, G. Darryl Wieland, Patricia A. English, James A. Sayre, and Robert L. Kane. 1984. Effectiveness of a Geriatric Evaluation Unit: a Randomized Clinical Trial. New England Journal of Medicine 311:26:1664-1670. 57 The Urban Institute. 1982. Project to Analyze Existing Long-Term Care Data. Vol I: Summary and Conclusions Vol II: The Long-Term Care Population: Definition and Measurement Vol III: Long-Term Care Service Utilization and Outcomes Vol IV: Financing Long-Term Care Vol V: Long-Term Care Service Supply: Levels and Behavior Vol VI: Long-Term Care Costs Appendix: Long-Term Care Instrument and Definition Review 58 Smits, Helen L., Judith Feder, and William Scanlon. 1982. Medicare's Nursing-Home Benefit: Variations in Interpretation. New England Journal of Medicine 307:14:855-862. 59 Somers, Anne R. 1983. Financing Long-Term Care for the Elderly: Institutions, Incentives, Issues. Paper prepared for Institute of Medicine Committee on an Aging Society. 60 Somers, Anne R. and Fabian, Dorothy R. eds. 1981. The Geriatric Imperative: An Introduction to Gerontology and Clinical Geriatrics. New York: Appleton-Century. 61 Spitzer, Walter O. 1984. The Nurse Practitioner Revisited: Slow Death of a Good Idea. New England Journal of Medicine 310:16:1049-1051. 62 Swartz, Katherine. 1983. Estimating the Health Insurance Coverage of the Near Poor. Urban Institute project report #3197-01. 63 Swartz, Katherine. 1983. Utilization of Medical Care and Health Status of the Near Poor. Urban Institute project report #3197-03 e 64 Talbott, John A. ed. 1978. The Chronic Mental Patient: Problems, Solutions, and Recommendations for a Public Policy. Washington, D.C.:The American Psychiatric Association 65 U.S. Senate Special Committee on Aging. 1984. Turning Home Equity into Income for Older Homeowners. An Information Paper. 66 Vladeck, Bruce C. 1980. Unloving Care: The Nursing Home Tragedy. New York, NY: Basic Books. -137-

OCR for page 95
67 Vogel, Ronald J. and Hans C. Palmer, eds. 1983. Long-Term Care: Perspectives from Research and Demonstrations. Health Care Financing Administration. 68 Wanzer, Sidney H. S. James, Adelstein, Ronald E. Cranford, Daniel D. Federman, Edward D. Hook, Charles G. Moertel, Peter Safar, Alan Stone, Helen B. Taussig, and Jan van Eys. 1984. The Physician's Responsibility Toward Hopelessly Ill Patients. New England Journal of Medicine 310:15:955-959. 69 Weicher, John C. ed. 1984. Maintaining the Safety Net: Income Redistribution Programs in the Reagan Administration. Washington, D.C.:American Enterprise Institute Studies in Economic Policy. 70 Weissert, William G. 1982. Size and Characteristics of the Noninstitutionalized Long-Term Care Population. Working paper for The Urban Institute #1466-20, September. Weissert, William G. ed.l983. Source Book on Long-Term Care Data. Compiled by staff and consultants of the Health Policy Center, The Urban Institute. 72 Zimmer, James G., Annemarie Groth-Junck, and Jane McCusker. 1985. A Randomized Controlled Study of a Home Health Care Team. American Journal of Public Health 75:2:134-141. 73 Zimmer, James G., Annemarie Groth-Juncker, and Jane McCusker. 1984. Effects of a Physician-Led Home Care Team on Ter-minal Care. Journal of the American Geriatrics Society 32:4:288-292. 74 International Social Security Association. 1984. Long-Term Care and Social Security. Studies and Research No. 21. 7S Kovar, Edward B. 1983. Public Policy Issues in Medical Care: Long-Term Care at the Crossroads. Presented at the 1983 Annual Meeting of the Eastern Sociological Society. 76 Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health. 1984. Research on Mental Iliness in Nursing Homes. Blue Sheet 27:43:S-1-S-4. 77 American Health Care Association. 1984. Policy Forum: Private Insurance for Long Term Care--S''mmary of Proceedings. 78 American Medical Association, Council on Scientific Affairs. 1984. Exercise Programs for the Elderly. Journal of the American Medical Association 252:4:544-546. 79 Anlyan, William G., Jr. and Joseph Lipacomb. 1984. The National Health Care Trust Plan: Blueprint for Inflation Control and Long-Term Care Provision. Executive Summary. -138-

OCR for page 95
80 Avorn, Jerry. 1984. Benefit and Cost Analysis in Geriatric Care: Turning Age Discrimination into Health Policy. New England Journal of Medicine 310:20:1294-1301. 81 Baldwin, Carliss Y. and Christine E. Bishop. 1984. Return to Nursing Home Investment: Issues for Public Policy. Health Care Financing Review 5:4:43-52(S~,mmer). 82 Beall, G. T. 1984. Long-Term Care Cost Crisis: Can Private Insurance Bail Us Out? Perspective on Aging(Sept./Oct.~:20-23. 83 Birnbaum, Howard, Gary Gamer, Frederick Pratter and Robert Burke. 1984. Nursing Homes Without Walls: Evaluation of the New York State Long Term Home Health Care Program. Prepared for HCFA BY Abt Associates Inc. 84 Buchanan, Joan. 1984. Inquiry Board Finds Costs Thwart Access to Quality Health Care. Perspective on Aging (Sept./Oct.~:12 & 26. 85 Burke, Robert E. and Burton D. Dunlop. 1981. Analysis of the Impact of Government Programs on Long-Term Care Services. Prepared by ABT Associates for American Health Care Association. 86 Cameron, J. M., and R. A. Knauf. Application of CHIC (California Health Facilities Commission) Data to LTC Facility Case-Mix Analysis. Presented at the Fifth Annual Symposium: Using Uniform Reporting Data for Health Planning. 87 Campion, Edward W., Axel Bang and Maurie I. May. 1983. Why acute-care hospitals must undertake long-term care. New England Journal of Medicine 308:2:71-75. 88 Center for the Study of Social Policy. 1983. Summary of Recommendations of the National Study Group on State Medicaid Strategies 89 Berg, Robert L. 1983. Prevention: Can We Reduce the Demand for Long-Term Care? Prepared for Conference on The Impact of Technology on Aging in America sponsored by the Office of Technology Assessment, Project HOPE, National Health Policy Forum, and the Institute of Medicine. 90 Comptroller General of the United States (Acting). 1977. The Well-Being of Older People in Cleveland, Ohio. Presented to President of the Senate and the Speaker of the House of Representatives. 91 Congressional Budget Office, Congress of the United States. 1981. Medicaid: Choices for 1982 and Beyond. -139-

OCR for page 95
92 DeJong, Gerben and Raymond Lifchez. 1983. Physical Disability and Public Policy. Scientific American. 248:6:40-49. 93 Demkovich, Linda E. 1984. Margaret Heckler Shows Fighting Style, Proving She Came to Stay at HHS. National Journal (May):977-982. 95 Eisenberg, Leon. 1979. Is Health a State of Mind? New England Journal of Medicine 301:23:1282-1283. 96 Eggert, Gerald. 1984.~Reformihg Long Term Care: A Proposal for a Catastrophic, Managed Care Plan. Paper prepared for Institute of Medicine. 97 Ellwood, Paul M., Jr. 1984. Cost, Access and Organization of Medical Care. Background paper prepared for the ad hoc Institute of Medicine Committee to Advise the U. S. Public Health Service on Future Program Planning. 98 Etheredge, Lynn. 1984. An Aging Society and the Federal Deficit: Trends, Questions, and Options for Future Policy. Milbank Memorial Fund Quarterly, Health and Society 62:4:521-543(Fall). 99 Cafferata, G. L. 1984. Private Health Insurance Coverage of the Medicare Population. National Center for Health Services Research, National Health Care Expenditures Study. Data Preview 18. 100 Federal Council on the Aging. 1979. Key Issues in Long Term Care: Progress Report. 101 Feinstein, Patrice Hirsch, 1983. Statement before the Senate Finance Committee Subcommittee on Health. 102 Feller, Barbara A. 1983. Americans Needing Help to Function at Home. NCHS Advancedata 92(September 14~. 103 Freedman, Ruth I. and Ann Moran. 1984. Wanderers in a Promised Land: The Chronically Mentally Ill and Deinstitutionalization. Supplement to Medical Care 22:12. 104 Pries, James F. 1980. Aging, Natural Death, and the Compression of Morbidity. New England Journal of Medicine 303:3:130-135. - 10S Frankel, Debra. 1984. Long-Term Care Issues in Multiple Sclerosis. Rehabilitation Literature 45:9-10:282-285. 106 Garber, Alan M., Victor R. Fuchs, and James F. Silverman. 1984. Case Mix, Costs, and Outcomes: Differences Between Faculty and Community Services in a University Hospital. New England Journal of Medicine 310:19:1231-1237. -140-

OCR for page 95
107 Getzel, George S. and M. Joanna Mellor, eds. 1983. Gerontological Social Work Practice in Long Term Care. New York: The Haworth Press. 108 Ginzberg, Eli. 1982. The Social Security System. Scientific American 246:1:51-57. 109 American Dental Association. Dental Care in Nursing Homes: Getting Involved. Brochure. 111 110 American Dental Association. 1984. Regulation of Nursing Homes. Statement to National Academy of Sciences Committee on Nursing Home Regulation. American Dental Association. 1979. Prevention and Control of Dental Disease Through Improved Access to Comprehensive Care. Presented and approved by ADA House of Delegates and Board of Trustees. 112 American Dental Association's Special Committee on the Future of Dentistry. 1983. Issue papers on Dental Research, Manpower, Education, Practice and Public and Professional Concerns and Recommendations for Action. 113 American Dental Association. 1983. Oral Health Care in the Long Term Care Facility. ISBN #0-934510-27-X. 114 117 American Dental Association. Portable Dentistry Information. Prepared by ADA's Council on Dental Health and Health Planning. 115 American Association of Retired Persons, American Health Care Assn., National Assn. for Home Care, National Governor's Association. 1984. How to Pay for Long Term Care: The Need for Insurance. Summary of Proceedings, New York, December 11-12. 116 Carnegie Corporation of New York and The Aging Society Project. 1983. Human Resource Implications of an Aging Work Force. From conference, September 21-23, New Paltz, New York. Cohen, Saul, Susan McDermott, Julie Smith, and Diana Loomis. 1984. Adult Residential Day Care: A Program Development and Operations Guide. 118 Harkey, P. Wayland and Herbert G. Traxler. 1982. Share-A-Home: A Unique Community-Based Residential Alternative for the Dependent Elderly. J. Applied Gerontology l(June):90-94. 119 Hawes, Catherine. 1983. Quality Assurance in Long-Term Care: Major Problems and Issues. Paper prepared for Institute of Medicine Committee on Nursing Home Regulation. -141-

OCR for page 95
120 Healthcare Financial Management Association. 1985. Long-Term Care: Challenges and Opportunities. A compilation of 16 articles on long-term care from Healthcare Financial Management ISBN 0-930228-27-~. 121 Hodgson, Joseph H., Jr. and Joan L. Quinn. 1980. The Impact of the Triage Health Care Delivery System Upon Client Morale, Independent Living and the Cost of Care. The Gerontologist 20:3:364-371. 122 Kahn, Alfred J. 1984. Long-Term Care Issue More Demanding as Other Pressures Mount. Perspective on Aging, May/June. 123 Kane, Robert L. and Rosalie A. Kane. 1978. Care of the Aged: Old Problems in Need of New Solutions. Science 200:913-919. 124 Macken, C. L. In Press. 1982 Long Term Care Survey: National estimates of the Number and Degree of Functional Impairments and Sources of Support among Elderly Medicare Beneficiaries Living in the Community. 125 Little, Virginia. 1979. Open Care for the Aging: Alternate Approaches. Aging 301-302:10-23. 126 Meiners, Mark R. 1984. The State of the Art in Long Term Care Insurance. Prepared for the national conference entitled Long-Term Care Financing and Delivery Systems: Exploring some Alternatives, sponsored by the Health Care Financing Administration, Washington, D.C. 1/24/84. 127 National Center for Health Statistics. 1983. Catalog of Publications of the National Center for Health Statistics, 1978-82. 128 National Center for Health Statistics. 1981. Social and Economic Implications of Cancer in the United States. Vital and Health Statistics 3:20. 129 National Council on the Aging, Inc. 1984. Current Literature on Aging. 27:3. 130 Perspectives. 1984. What's Next for Medi-Cal? Washington Report on Medicine and Health. 131 Lane, Laurence F. In press. The Potential of Private Long Term Care Insurance. For Pride Institute Journal of Home Care. 132 Libow, L. S., M. m. Waite and R. N. Butler. 1985. Threat to the Development of the Teaching Nursing Home. Journal of the American Medical Association 253:8:1166. 133 National Council on the Aging, Inc. 1984. Publications Catalogue. -142-

OCR for page 95
134 National Association for Home Care. 1985. Toward a National Home Care Policy: A Blueprint for Action. 135 Preston, Samuel H. 1984. Children and the Elderly in the U.S. Scientific American. 251:6:44-49. 136 Center for Health Information, Research and Analysis Project HOPE. 1984. Long Term Care in Western Europe and Canada: Implications for the U.S. Report to the U.S. Senate Special Committee on Aging. Draft report. 137 Reilly, Donald F. 1984. Older Americans Act Reauthorization. Perspective on Aging, Sept/Oct. 138 Rittel, Horst W. and Melvin M. Webber. 1973. Dilemmas in a General Theory of Planning. Policy Sciences 4:155-169. 139 Roberts, Lowell. 1983. A Case Against Government Incentives for Home Care of Dependent Adults. New England Journal of Human Services, Fall Issue. - 140 Roybal, Edward R. 1984. Future Deficit Reduction: Impact on Aged and Poor. Background paper presented to the Select Committee on Aging, House of Representatives. 141 Ruchlin, Hirsch S., John N. Morris and Gerald M. Eggert. 1982. Management and Financing of Long-Term-Care Services: A New Approach to a Chronic Problem. New England Journal of Medicine 306:2:101-106. 142 Samuelson, Robert J. 1984. Hiding From Health Costs. Newsweek, 5/14/84. 143 Schneider, Edward L. and Jacob A. Brady. 1983. Aging, Natural Death, and the Compression of Morbidity: Another View. New England Journal of Medicine 309:14:854-856. 144 International Social Security Association, Permanent Committee on Medical Care and Sickness Insurance e 1984. Long-Term Care Provided Within the Framework of Health Care Schemes. J. L. Scott, Acting Deputy Administrator, Health Care Financing Administration, reporter; Pamela Doty, supervisor. 145 Skellie, F. Albert, and Ruth E. Coan. 1980. Community-Based Long-Term Care and Mortality: Preliminary Findings of Georgia's Alternative Health Services Project. The Gerontologist 20:3:372-379. 146 Striner, Herbert E. 1984. Quality, Efficiency and Profits in the Nursing Home Industry. Prepared for Institute of Medicine Committee on Nursing Home Regulation. -143-

OCR for page 95
147 Sullivan, Sean, and Polly M. Ehrenhaft. 1984. Managing Health Care Costs: Private Sector Innovations. Washington, D.C.:American Enterprise Institute Studies in Health Policy. 148 Swartz, Katherine. 1983. Health Insurance Coverage Among the Near Poor in Massachusetts in 1982. Urban Institute project report #3197-02. 149 Swartz, Katherine. 1983. The Uninsured Near Poor in Massachusetts: A Summary Report. Urban Institute project report #3197-04. 150 Siebel, Robert V. 1984. Testimony before the Committee on nursing Home Regulation of the Institute of Medicine, National Academy of Sciences. 151 Taylor, Elizabeth A. lg84. A Consumer's Guide to Nursing Homes. Perspective on Aging Sept/Oct.:7-9. 152 Torrens, Paul R. 1984. Studies of Hospice Economics. Medical Care 22:8:689-690. 153 Traxler, Herbert G. 1983. Share-A-Home: Economics and Logistics of Unrelated Elderly Living as a "Family". National Center for Health Services Research. 1S4 Triage. An Alternative Approach to Care for the Elderly, 1974-1979 155 U.S. House of Representatives, Select Committee on Aging. 1984. Administration's Announcement of "No Social Security Cuts" Still Raises Spectre of Massive Cuts in the Elderly's Medicare and Medicaid Benefits, Pact Sheet, 10/11. 156 U.S. House of Representatives, Select Committee on Aging 1984. Elderly Health Care Costs Projected to Rise Twice as Fast as Income. Press Release, 9/24. 157 U.S. House of Representatives, Select Committee on Aging, Subcommittee on Human Services. 1980. Future Directions for Aging Policy: A Human Service Model. Comm. Pub. No. 96-226. 158 U.S. House of Representatives, Select Committee on Aging, Subcommittee on Health and Long-Term Care. 1983. Long-Term Care: Need for a National Policy. Hearing, Comm. Pub. No. 98-444. 159 U.S. Senate Special Committee on Aging. 1984. Long-Term Care in Western Europe and Canada: Implications for the United States. An Information Paper. 160 Valle, Juan Ramon. 1984. Long Term Care and the U. S. Hispanic Population: Trends and Future Projections. Report issued by the National Hispanic Council on Aging. -144-

OCR for page 95
161 White House Conference on Aging. 1981. Report of Technical Committee on Social and Health Aspects of Long Term Care. 162 Willging, Paul R., Paul Kerschner, and Judith R. Peres. 1984. Long-Term Care: The Malthusian Dilemma. Healthcare Financial Management 12/84. 163 Zeckhauser, Richard and Donald Shepard. 1976. Where Now For Saving Lives? Law and Contemporary Problems, Duke University School of Law, Autumn. 164 Zedlewski, Sheila R. The Private Pension System to the Year 2020. From Retirement and Economic Behavior, Aaron, Henry J. and Gary Burtless, eds. Washington, DC: The Brookings Institution. 165 Veterans Administration. 1984. Caring for the Older Veteran. 166 Scott, J. L. 1984. Long Term Care Provided within the Framework of Health Care Services (United States). Reply to International Social Security Association Questionnairee Health Care Financing Administration. 167 Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluationand American Association of Retired Persons. 1981. Working papers on Long Term Care. Prepared for the 1980 Undersecretary's Task Forc on Long Term Care. 168 Center for the Study of Social Policy. 1984. Restructuring Medicaid: An Agenda for Change. Report of a National Study Group on State Medicaid Strategies, sponsored by Robert Wood Johnson Foundation. 169 Hanushek, Eric A. 1984. Statement of Director, before the Subcommittee on Health, Committee on Ways and Means, U.S. House of Representatives. 170 Fries, J. F. 1983. The Compression of Morbidity. Milbank Memorial Fund Quarterly: Health and Society 61:3:397-419 171 Kane, Rosalie A. and Robert L. Kane. 1985. The Feasibility of Universal Long-term care Benefits. New England Journal of Medicine 312:21:1357-1364. ORDERED, NOT RECEIVED 172 Manton, K. G. and K. Liu. 1984. The Future Growth of the Long Term Care Population: Projections Based on the 1977 National Nursing Home Survey and the 1982 Long Term Care Survey. Presented at the Third National Leadership Conference on Long Term Care Issues, Washington, DC, 3/7-9/84. -145-

OCR for page 95
173 Freidmen, B. 1983. Private Insurance for LTC: How Large are the Unmet and Potential Demands by the Elderly? Presented at 1983 annual meetings of American Public Health Association. 174 Hughes, S. L., David S. Cordray and V. A. Spiker. 1984. Evaluation of a Long Term Home Care Program. Medical Care 22 5 460~475e 175 Slater, R. J. and Niels E. Raun eds. 1984. Symposium on a Minimal Record of Disability for Multiple Sclerosis, International federation of Multiple Sclerosis Societies. Acta Neurologica Scandinavica, Supplementum No. 101, Vol. 70. 176 Feldman, J. J. 1983. Work Ability of the Aged under Conditions of Impriving Mortality. Milbank Memorial Fund Quarterly: Health and Society 61:3:430-444 177 Reichel, W. 1983. The Future of Family Medicine in Response to Demographic Changes and Increasing Specialization. Journal of the American Medical Association 249:11:1445-1447. 178 Sommers, A. R. 1982. Long Term Care for the Elderly and Disabled: A New Health Priority. New England Journal of Medicine 307:4:221:226. 179 Paringer, Lynn. 1983. The Forgotten Costs of Informal Long-Term Care. Urban Institute Working Paper #1455-28 (June):35-39. 180 Urban Institute Study on Housing cited under (2) Fragmentation and access. -146-