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Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan (1986)

Chapter: Exhibit C: Overview of Existing Data Bases

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Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
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Page 95
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 96
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 97
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 98
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 99
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 100
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 101
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 102
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 103
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 104
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 105
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 106
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 107
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 108
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 109
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 110
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 111
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 112
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 113
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 114
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 115
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 116
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 117
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 118
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 119
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 120
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 121
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 122
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 123
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 124
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 125
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 126
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 127
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 128
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 129
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 130
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 131
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 132
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 133
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 134
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 135
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 136
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 137
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 138
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 139
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 140
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 141
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 142
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 143
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 144
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 145
Suggested Citation:"Exhibit C: Overview of Existing Data Bases." Institute of Medicine. 1986. Toward a National Strategy for Long-Term Care of the Elderly: A Study Plan. Washington, DC: The National Academies Press. doi: 10.17226/9922.
×
Page 146

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

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-

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-

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-

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-

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 _

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-

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-

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-

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-

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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-

ASPE Study A recent study prepared by David L. Kennell of ICE, Inc., Private Financing of Lone Term Care: Current Methods and Resources, for the . . Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, provides additional data which would be useful to assess alternative long-term care options.7 The study was designed to consider two forms of private long-term care (LTC) financing--pooled financial arrangements and increased use of family resources. As background, it was necessary to estimate the current and future financial resources of the elderly population. The first step in the analysis was to compare the income of the . . . --—~ r—r~~ elderly from the 1981 CPS Survey with the current cost of long-term care insurance to determine the proportion of the elderly for whom such an expense would be affordable. The results of this exercise, summarized in Table 6, indicate that in the group aged 65-69, 63 percent of married couples and 56 percent of single individuals would face insurance premiums that would amount to less than 10 percent of their cash income. For the group aged 75-79, these percentages fall to 22 percent and 26 percent, respectively. If this insurance were purchased at age 65-69, however, the percentages for the 75-79 group rise to 44 percent and 66 percent, respectively. In addition to assessing the affordability of long-term care using current cash income, the ASPE study included an innovative measure of current income that includes the annuitized value of illiquid assets, such as home equity and long-term bonds. Including income from home equity as a long-term care financing resource raises the percentages of married couples and single individuals who would be required to spend less than 10 percent of their income for long-term care insurance. The projections of future affordability of long-term care were based on the income estimates generated by a microsimulation of the PRISM model to the year 2015. Because the projections of future income levels include both productivity and price increases, while long-term care costs were adjusted only for inflation, the percentage for whom long-term care premiums appeared affordable in 2005 rose significantly (see Table 7~. While this study is far from perfect, it does represent a good starting point for estimating the financial burden of alternative ways of paying for long-term care. -106-

TABLE 6 ASPE Study: Percentage of Families for Whom Potential LTC Insurance Premiums Would be Less than 10 Percent (5 percent) of Cash Income, 1980 Unit 65-69 70-74 75-79 80 and over Purchased Currentlya Married Couples 63% (26%) 36% (10%) 22% (7%) 14% (3%) Single Persons 56% (25%) 35% (13%) 26% (8%) 19% (6%) Total 60% (26%) 36% (11%) 24% (7%) 18% (~%) Number in Millions 3.5 (1.5) 1.7 (0.5) 0.8 (0.3) 0.6 (0.2) Purchased at Age 65-69, 1980b Married Couples 63% (26%) 51% (17%) 44% (15%) 36% (11%) Single Persons 56% (25%) 50% (19%) 46% (19%) 41% (16%) Total 60% (26%) 51% (18%) 45% (17%) 40% (14%) Number in Millions 3.5 (1.5) 2.4 (0.9) 1.6 (0.6) 1.3 (0.5) aAssumes an annual premium (in 1983 dollars) for an individual age 65-69 of $700, 70-74 of $900, 75-79 of $1,100, and 80 and over of $1,200. Premiums for couples are twice these levels. bAssumes an annual premium (in 1983 dollars) of $700 and $1,400 for individuals and couples age 65-69 respectively. SOURCE: ICE, Inc., Private Financing of Long Term Care: Current Methods and Resources, Phase 1, submitted to the Office of Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services (January 1985), Tables 26 and 29, pp. 71 and 73. -107-

TABLE 7 ASPE Study: Percentage of Families for Whom LTC Insurance Premiums Would be Less than 5 Percent of Cash Income at Age 65 in 2005a Unit 1985 1995 2005 2015 Married Couples 78% 83% 93% 97% Single Persons 24% 37% 58% 65% Total 56% 65% 79% 84% aAssumes a level annual premium (in 1989 dollars) at age 65 of $450 for an individual and $900 for a couple. This understates the percentage because the income levels used here do not include income from assets. Source: ICE, Inc., Private Financing of Lone Term Care: Current Methods am and Resources, Phase 1, submitted to the Office of Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services (January 1985), Table 34, p. 79. -108-

REFERENCES I. See Susan Grad, Income of the Population 55 and Over, 1982, U.S. Department of Health and Human Services, Social Security Administration Publication No. 13-11871 (March 1984) and Bureau of the Census, Money Income of Households, Families and Persons in the United States: 1982, Current Population Reports, Series P-60, No. 142 (GPO, 1984~. 2. See Linda Drazga Maxfield, "The 1982 New Beneficiary Survey: An Introduction," Social Security Bulletin, vol. 46, no. 11 (November 1983), pp. 3-11, and Linda Drazga Maxfield and Virginia P. Rena, "Distribution of Income Sources of Recent Retirees: Findings from the New Beneficiarv Survev." Social SecuriLv Bulletin vn1 . OR no 1 (January 1985), pp. 4-13. 3. See Robert B. Avery, Gregory E. Elliehausen and Glenn B. Canner, "Survey of Consumer Finances, 1983." Federal Reserve Bulletin , _ ~ _ _ (September 1984), pp. 857-868, and 'iSurvey of Consumer Finances, 1983: A Second Report," Federal Reserve Bulletin (December 1984), pp. 857-868. 4. "Economic Status of the Elderly." Economic Recort of the President (GPO, 1985), pp. 159-186. 5. See Jon Johnson, Richard Wertheimer and Sheila R. Zedlewski, The Dynamic Simulation of Income Model (DYNASIM), Volumes I and II, The Urban Institute, Washington, D.C. (December 1982 and April 1983~; ICE, Inc., Future Retirement Benefits Under Employer Retirement Plans, Final . Report, prepared for the American Council of Life Insurance (June 1984~; and Sheila R. Year 2020," in Retirement and _ _ . ~ , ~ _ . ~ Zedlewski, "The Private Pension System to the Economic Behavior, Henry J. Aaron and Gary curtness, ens. (the Brookings institution, 1984), pp. 315-344. 6. Others have also attempted to develop a model of job change behavior for use in pension policy simulation. See James H. Schulz, Allan Borowski, Leslie C. Kelly, William Spector and Thomas D. Leavitt, Private Pension Policy Simulations, The Florence Heller Graduate School for Advanced Studies in Social Welfare, Brandeis University (January 1980). 7. ICE, Inc., Private Financing of Long Term Care: Current Methods and Resources, Phases I and II, submitted to the Office of Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services (January 1985~. -109-

EXHIBIT C-2 OVERVIEW OF THE ADEQUACY OF EXISTING LONG-TERM CARE DATA SETS FOR POLICY-RELEVANT ANALYSES William Scanlon This paper provides an overview of the adequacy of existing long-term care data sets addressing the questions that might be examined in the study being planned. A major portion of what I will say is based on an earlier Urban Institute study of long-term care that made use of existing data sets. That study was completed in 1983 and largely employed data sets that were available by 1980 and 1981 e Since then, there have several useful additions to data available on long-term care. I will incorporate some information on these newer data sets into my remarks. In terms of the significant questions regarding long-term care that this study will try to address, it is important to make a distinction between those involving the prevalence of certain conditions or circumstances and those involving behavioral relationships between policy interventions, other variables and the phenomena of primary study interest, such as the demand for care or the willingness of informal care suppliers to serve persons in need. Data available at the national level, while useful for making prevalence estimates, are not nearly as useful for understanding the behavioral relationships among different variables and the phenomena of interest. In our previous study using existing long-term care data sets, we relied very heavily on the national data sets and used local area data sets when they involved representative samples of sufficient size to provide reliable estimates. There have been a number of inventories of long-term care data which indicate that more than 100 different data sets are available. However, when one examines them closely, it becomes clear that many of these are purposive samples involving a very skewed segment of the population and therefore can not provide reliable information on the broad impacts of a policy intervention. The earlier study excluded data gathered by various demonstration programs involving home and community care. That exclusion was not because such data were not valuable or interesting to the topic. However, simultaneous with our project, Berkeley Planning Associates conducted a cross-cutting evaluation of several demonstrations. To avoid duplicating their effort, we did not include the demonstration data in our study. Demonstration data, however, represent a potentially valuable source for the study being planned. In particular, the information -111-

available on the control populations and their experience under the existing service system is a valuable guide to how long-term care use and provision is affected by current policies. The last caveat about my remarks is that my focus is on the elderly and the persons receiving long-term care because of physical handicaps. We did not analyze extensively the mentally retarded, the developmentally disabled or the chronically mentally ill outside of nursing homes. In the case of the mentally retarded and developmentally disabled, these are very different populations that involve different service systems other than nursing homes. The data sets that we used do not cover these populations or their services well. Excluding the chronically mentally ill living in the community also was necessary because reliable data on that population were not available. The national surveys that depend upon individual self reporting are believed to undercount the numbers of the chronically mentally ill. I will review what is contained in the national data sets that might be utilized in the proposed study, focusing on both their strengths and some of their weaknesses. The discussion is generic--identifying generally what is available, not particular data sets. The national data sets will support reasonably reliable estimates of the size of the long-term care population and the types of needs of that population. In particular, information about Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) dependencies are available. It is static information, however. That is, the size of the population at a point in time is known. Very little is known at the national level about the dynamics of dependence--given a certain level of dependency at one point in time, what does that imply for the level of dependency and the likely needs for different types of services in the future. The second area of strength of the national data sets involves the use of nursing homes. While this information is somewhat dated, coming from the year 1977, there is extensive information on the personal characteristics of the users, some of their prior service use, their dependencies, and the types of services that they are receiving, and some information on turnover and length of stay. The information on turnover and length of stay is that associated with a single stay, not on repeated use by the same person. Again, there is no longitudinal information which would permit examination of where people go when they are discharged from a nursing home and how long they stay at that first discharge destination; whether or not patients have repeated nursing home stays, leaving the nursing home to go to the hospital or home only to return again to a nursing home. Those kinds of information which are important in terms of estimating how large a fraction of the population uses nursing homes over time are not available currently in national data. The national data identify the care sources for community residents and some information about the adequacy of received services. The Health Interview Surveys in the late 70s, specifically 1977, 1979 and 1980, asked questions about who was the care giver and whether or not people received needed services all, most, or some of the time.

An area of interest is the financial capacity of the long-term care population and their families with respect to long-term care, in health data sets. This information is limited, but is covered by other data sources. As Alicia Munnell has indicated, there is ample information on financial capacity that's available from some very reliable data sets. In terms of the significant weaknesses of the national data sets, the first is the limited information on the prevalence of behavioral problems and mental illness. While we know among the nursing home population those who have a mental diagnosis and some information about behavior, we do not have comparable information about the community population. The belief is that when people are asked to list diagnoses in the Health Interview Survey that mental diagnoses and mental problems are under-reported. Even when a mental diagnosis is reported in the Health Interview Survey, the information about how that mental diagnosis translates to service needs, or what behavioral problems are associated with the mental diagnosis, are not available. A second concern and potential weakness of the national data sets is the major discrepancy between prevalence estimates based on the national data compared with those based on local area samples. We may expect some differences in estimates of prevalence in a cross-area. However, we find that the national data sets produce substantially lower estimates of prevalence than do representative local area samples. The discrepancies persist even when the age distribution of the population is controlled. The discrepancies are too large to be regarded as random variation; for example, in four local surveys based on a common instrument, the prevalence for ADL dependency was three times higher than that reported in the National Health Interview Survey. The differences are of concern since the higher local estimates suggest a much larger population needing long-term care. What causes these differences is currently unknown and whether there reason to challenge the reliability of the national data remains an important issue. A third weakness of the national data sets is that information about the quantity of community service use is very limited. What is available, as indicated earlier, is information about sources. However, the share of total services that a source provides to an individual or the volume from that source to a given individual is not available. The fourth area of weakness in the national data sets is the lack of information of what correlates with the utilization of community services. In particular, there is no information on the impact of supply constraints on service utilization, or how use responds to either price or income. For the community long-term care population, there is very limited information on the informal support system. There are good data on the composition of households and considerable long-term care research has made certain assumptions about the availability of informal care based on one's household relationship. However, inter-household care giving may be a very important phenomenon, and on a national basis, what -113-

resources are available outside the household for informal care for individuals is unknown. The national data sets are cross-sectional observations at a point in time. The single exception is the recent Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation (ASPE) survey of long-tenm care in the community, which will provide information on two points in time. Unfortunately, there is almost a three year interval in the ASPE survey. Among the potentially most frail, whom have very high mortality rates, therefore, the number that will be available for follow-up in the second survey will be very limited. With regard to the local data sets, their primary value, as indicated earlier, is the capacity to study how various factors affect the use and costs of long-term caret By having data on the quantities of services consumed and their costs, and more details about the circumstances of the user and his environment, one can begin to examine behavior of users and caregivers. While permitting a much more detailed examination of use and costs than the national data, local area data are still significantly limited. A major gap, for example, is information on prices paid by users for services. Significant to plans to provide services either by the public or the private sector would be the issue of how price affects use. The data available do not permit analyzing this question. Several longitudinal data sets are also available for local areas. In particular, the Cleveland-OARS survey has three different waves; the Massachusetts elderly sample, has four waves, and data from different demonstrations include monitoring of individuals for between 12 and 24 months. There is a great deal of information in some of these area data sets. The final strength of the local area data sets is the mental status information; it is superior to that available in the national data sets, involving dimensions besides diagnoses. A number of local area data sets collect information both on behavior and thorough use of instruments such as mental status questionnaires on mental functioning as well. The principal problem with the local area data sets is that many of them, as indicated earlier, are unrepresentative or purposive samples. However, there are a few that are representative and of sufficient size that they can be used for analysis. An additional concern about using a single area data set is that the role of supply constraints cannot be analyzed since the supply is relatively constant in a given area even for the longitudinal studies mentioned. A broad problem with local area data sets is that their suitability and potential for secondary analysis are not as strong as the national sets in that their developers often did not have as a goal the preparation of public use data files. The consequence is that a number of these data sets are under-documented and may contain inaccurate or miscoded data. The last topic that I would like to discuss involves some recent data sets that have not yet been fully analyzed and which have significant potential for the proposed project. Two of them are the ASPE long-term care survey note previously and the 1984 National Health -114-

Interview Survey, which includes a special Supplement on Aging. As I indicated, the ASPE long-term care survey will involve two rounds, or two points in time, focusing on an impaired elderly population. Most other surveys of the elderly are random samples of the full elderly population, which means that the number of impaired is relatively small. The ASPE long-term care survey includes only persons who are impaired. It was conducted in two stages. A screener was first administered to a sample of all elderly and then those responding as impaired to the screener were reinterviewed with an extensive interview. This survey contains more information about the quantity of services consumed by people in the community, the sources of those services, and some of the impacts on informal care givers, than was available then in any other survey. It represents a very strong source for examination of the community-residing long-term care population. The 1984 National Health Interview Survey Supplement on Aging includes more extensive information than available previously on the sources of social support and on lifetime nursing home utilization. Unfortunately, the Health Interview Survey does not have information on the quantities of services being consumed by the persons remaining in the community. An area where it would be desirable to have additional data is nursing home utilization. The data that are available on the national level are from 1977. By this time, there have been enough changes, even though change is not occurring rapidly, that those data are considerably dated. There is a plan for a 1985 National Nursing Home Survey. But that survey will not be useful for the proposed study since its availability before 1987 is somewhat problematic. For instance, with the 1977 National Nursing Home Survey, the earliest tabulations became available in 1979 and a public use tape became available in 1981. Therefore, we should not count on being able to use the results of the 198S National Nursing Home Survey in the study being planned. -115-

EXHIBIT C- 3 INVENTORY SELECTED MAJOR PRIMARY DATA BASES AND ANALYTICAL STUDIES, EXISTING/CYCLICAL AND N1£W/COMING-ON-LINE _ _ _ . . _ _ _ Leopold G. Selker PREFACE The listings herein were identified within the limited time frame of the planning effort. The planning committee's initial emphasis- focused on the functionally limited elderly and chronic mentally ill. Therefore the search for entries on the other disabled populations was not as comprehensive and coverage of all populations could not be exhaustive. Classification of data bases and analytic studies was based on their primary thrust. In a few cases the breadth of that thrust led to classification under more than one population. In some instances the sponsoring agency is listed, in others the organization conducting the work. The choice was made on the most readily available information. Although occasional entries include state level data, or data assembled from states, no coverage of state data bases or analytic studies is here intended, although these sources are potentially very relevant to the major study. Other existing and forthcoming inventories are included as entries in the listings. Entries are organized as follows: Adult Disabled A) Functionally Limited Elderly B) Chronic Mentally Ill C) Physically Disabled II. Developmentally Disabled III. General Long Term Care/Cross-cutting & Other -117-

Acronyms AARP ADAM ADD AJP ADA ASPE BLS CBO CDC CMHS CMI CSP DBE DD DEIS DHUD DOE DRG HCFA ~0 ICF-MR TOM LTC MR NAP NAS NCHS NCHSR NHANES NHIS NIA NIHR NIMH NINCDS NRC OASDI OMB OSEP OTA RWJ SSA SSDI SSI VA American Association of Retired Persons Alcohol, Drug Abuse & Mental Health Administration Administration on Developmental Disabilities American Journal of Psychiatry Administration on Aging Assistant Secretary for Planning & Evaluation Bureau of Health Manpower Congressional Budget Office Centers for Disease Control Community Mental Health Centers Chronic Mental Illness Community Support Program Division of Biometry & Epidemiology Developmentally Disabled Department of Health & Human Services Department of Housing & Urban Development Department of Education Diagnostic Related Groups Health Care Financing Administration Health Maintenance Organization Intensive Care Facilities for Mentally Retarded Institute of Medicine Long Term Care Mentally Retarded National Academy Press National Academy of Sciences National Center for Health Statistics National Center for Health Services Research National Health & Nutrition Examination Survey National Health Interview Survey National Institute on Aging National Institute for Handicapped Research National Institute on Mental Health National Institute of Neurological & Communicatial Disorders & Stroke National Research Council Old Age & Survivors, & Disability, Insurances Office of Management & Budget Office of Special Education Programs Office of Technology Assessment Robert Wood Johnson Foundation Social Security Administration Social Security Disability Insurance Supplemental Security Income Veterans Administration -118-

I. ADULT DISABLED: A. Functionally Limited Elderly Major Primary Data Bases Existing/Cyclic - - National Nursing Home Survey (1977) - NCHS - National Health Interview Survey (1981) - NCHS - Epidemiological Catchment Area Study with over sampling of Elderly in 3 Sites (longitudinal to 1985) - NIMH - Medicare Statistical Files Manual (1983) - HCFA - Longitudinal Sample of Disability Insurance Applications and program statistics for SSI and SSDI - SSA - Current Medicare Survey File - SSA Inpatient Extended Care Facility stay records with benefits exhausted File - SSA - Inventory of Data Sources on Functionally Limited Elderly (1980) - OMB - National Archive of Computerized Data on Aging (1982) - U. of Michigan National Survey of Aged (1975) - ADA Retirement History Survey, Div. of Disability Studies (1979) - SSA National Survey of Stroke - NINCDS Framingham Functional Disability Survey (1978) - NIB - Baltimore Longitudinal Survey of Human Aging - NIA - Survey of Aging Veterans (1983) - Research Division, VA - New Beneficiary Survey (1982) - SSA -119- New/Coming on Line - National Nursing Home Survey with HCFA Admissions Cohort (1987~-NCHS - Merger of 3 large data bases on functional ability (1985) - Cmte. on Nursing Home Reg. IOM/NAS - LTC Survey of non-institutionalized functionally disabled elderly (Medicare beneficiaries) and their care-givers (1982), with follow up (1984) - ASPE & HCFA - Pension Data - Survey of Consumer Finances - Special Supplement to Current Population Survey - Bureau of Census - Data on Channeling Agency Clients and Care-givers in 10 States (1985) - ASPE, HCFA & ADA - Aging Supplement to NHIS (1984) - NCHS - Four Longitudinal Community-based Epidemiologic Studies (Panels) of Elderly Populations, Boston, Iowa, New Haven and Durham - NIA - NHANES I - Epidemiological Follow-up Study (1984) - NCHS - Survey of Income and Program Participation - Third Wave (1984) - Bureau of Census - Inventory of Existing Data Bases on the Aging Population (1985-6) - Panel on Statistics for an Aging Population - NRC - National Mortality Follow Back Survey (planned for 1986) - NCHS

Major Analytical Studies Existing/Cyclic - Evaluation of Hospice Demonstrations - HCFA - Impact of deficit reduction options on aged & poor (ongoing) - House Select Cmte. on Aging; Senate Special Cmte. on Aging Private Health Insurance for LTC of Elderly - NCHSR - Aging Trends & Projections (1984) - AARP & Senate Special Cmte. on Aging - Well-Being of Elderly in Cleveland, Ohio, Kentucky & Oregon (1976-77) - GAO-merged data set (1982) - Urban Institute - Demographic & Socio-economic (includes health) Aspects of Aging in U.S. (1984) - Bureau of Census - Systems Analyses of Care for Elderly in State Hospitals - ADAMHA - Medigap data - Health Insurance Assoc. of America - Annual Survey of Elderly who have insurance supplemental to Medicare - HCFA - Inventory of Longitudinal Studies of Middle and Old Age (1981) - Social Science Research Council - State LTC Ombudsman Report (ongoing from 1981) , Alternate paths to LTC (1978), Nationwide Study of Domiciliary Care (1980) - ADA - Data Coverage of the Functionally Limited Elderly (1980) - OMB - Evaluation of Nursing Homes Without Walls - HCFA - Survey of Pension Plan Coverage (1983) - Employee Benefit Research. Institute -120- New/Coming on Line Analysis of Research Priorities for LTC in Report on Technology & Aging (1985) - OTA Retirement Medical Benefits Survey (1985) - Washington Business Group on Health Study of Nursing Home Reimbursement Systems - Urban Institute Health Care in an Aging Society - The Aging Society Project - The Carnegie Corp. of New York - Study of Prospective Retirement Income - Urban Institute Report & Commissioned Papers of Cmte. on Nursing Home Regulation (1985) - IOM/NAS - Report & Commissioned Papers of Cmte. on an Aging Society Subgroup on Health (1985~-IOM/NRC Evaluation of Existing Data bases on Elderly (1985-6) - Panel on Statistics for an Aging Population - NRC - Evaluation of LTC Channeling Demonstrations (1985) - HCFA

I. ADULT DISABLED: B. Chronic Mentally Ill Major Primary Data Bases Existing/Cyclic Annual Census of patient characteristics & state & county mental hospital inpatient services - NIMH - Survey of Admissions to Private & Public Psychiatric Hospitals (1980) - NIMH - Panel Survey of Federally Funded Community Mental Health Centers (CMHS) - DBE, NIMH - Inventory of Mental Health Facilities & Related Surveys (1983-4) - DBE, NIMH - Epidemiological Catchment Area Study (longitudinal to 1985) - NIMH Existing/Cyclic Estimates of size & characteristics of adult chronic mentally ill in U.S. households - Res. in Community . & Mental Health, Vol. 3, (1983) - Estimates for small geographic areas of community residents chronically mentally ill (1980) - DBE, NIMH - Study of Long-term care for chronically mentally ill - Urban Inst. - Young Adult Chronic Patients - Analytical Review of Literature, Bachrach, Hosp. & Commun. Psych. - Meta-analyses of outcome studies on deinstitutionalization - Braun, et. al. - AJP, (1981~; Straw - doctoral dissertation - Northwestern U. (1982) Studies of comm. res. & Board & Care pop. - Denver Research Institute - Meta-analyses of effectiveness of alternatives in hospital & community - Kirshner, J. Nervous Mental Dis. (1982~; Kiesler, Am Psychologist (1982) - Mental Health in the Year 2000 (1984) - N.Y. State Health Planning Commission Health Advisory Council -121- Major Analytical Studies - - New/Com~ng on Line - Client Survey of Participants in Community Support Program (CSP) & Follow-up - DBE, NIMH - Several Prospective cohort studies of new admissions to inpatient units of general hospitals, & state county hospitals, private & VA hospitals - DBE, NIMH New/Coming on Line - Report to the Secretary on the homeless & emergency shelters (1984) - Office of Policy Development & Research, U.S. DHUD - Study of Residential Services offered by Community Mental Health Centers - National Council of Corm. Mental Health Ctrs. "Meta-analysis of meta-analyses" on effectiveness of institutional & alternate settings - AJP State Service System Research on CMI (8 grants) - NIMH Research & Evaluation Projects on CSP & synopses of CSP-supported research - NIMH

I. ADULT DISABI.F.n: C. Physically Disabled Maior Primary Data Bases & Analytical Studies Existing/Cyclic - National Multiple Sclerosis Survey - NINCDS National Head & Spinal Cord Injury Survey - NINCDS Survey of Disability & Work (1978) - Office of Policy & Office of Research & Statistics, SSA File on Sheltered Workshops holding licenses - Wage & Hour Division, Bureau of Spec. Minimum Wages, Dept. of Labor - Case load Statistics of State Vocational Rehabilitation Agencies - Rehab. Services Administration, U.S. Dept. of Education - Data on Disabled Veterans - VA - Labor Force Status & Other Characteristics of persons with work disability - Bureau of Census - Data of the National Spinal Cord Injury Statistical Center - School of Medicine, U.~of Alabama, Birmingham - National Household Survey Segment of National Med. Utilization & Expend. Survey (1981) - NCHS - National Survey of Residential Facilities (1982) - U. of Minn. - National Survey of Transportation Handicapped (1979) - Urban Mass Transportation Administration, Dept. of Transportation - Work Disability, Labor Force Status & Transportation Disability of Non-institutionalized - Bureau of Census -122- New/Coming on Line - Inventory of Data Files on Handicapped Adults (1985) - Human Services Research for NIHR Disabled Worker Projections - OASDI Cost Estimates (1984) - Office of Actuary - SSA Digest of Data on Persons with Disabilities (1984) - NIHR Disabled on SSDI - Sac. Sec. Bulletin - Annual Statistical Supplement - SSA

II. DEVELOPMENTALLY DISABLED Major Primary Data Bases Existing/Cyclic - Longitudinal data set on MR population & institutional costs - HCFA & U. of Minn. National Survey of Children, Wave II (1981) - Child Trends, Inc. Child Health Supplement to NHIS (1981)- NCHS - Survey of Income & Education - special information on handicapped population (1976) - Population Division, Bureau of Census - Compendium of Existing Data Sources for Researchers in Children of Working Parents (1983) - NAP - National Survey of Residential Facilities (1982~; Survey of state & private facilities & state licensed foster care homes (1977~; Surveys of state statistical offices (78-82~; Natl. probability sample of state & private facility residents (1979~; Data on state Medicaid Waiver App. (to 1983) - Center for Residential & Community Services - U. of Minn. - Numerical & Functional Description of DD population - Admin. on D.D. - Data on handicapped children served under Educ. for All Handicapped Children Act - Off. Spec. Educ. & Rehab. Services, DOE - Statistics reported by State agencies under P.L. 94-142 & P.L. 89-313 - in Fifth Annual Report to Congress on The Implementation of P.L. 94-142 (1983-4) - Public Residential Services for MR - Nat. Assoc. of Superintendents of Public Residential Facilities for MR - Census of Persons in Institutions & Other Group Quarters (1980) Bureau of Census - Annual Survey of Hearing Impaired Students enrolled in Special Education (1983-4) - Gallaudet Coll. - Registration of Blind Pupils (annual) - Amer. Printing House for the Blind -123- New/Coming on Line - Data on handicapped children & youth - including numbers leaving school by graduation, drop out, etc. & types of services needed 1 yr. post exit - OSEP, Admin. on DD - Inventory of data activities of (54) Univ. Affiliated Programs for Persons with DD - Amer. Assoc. of University Affiliated Programs National Statistics on Children, Youth & Their Families - A Guide to Federal Data Programs - Child Trends Inc. - Public Expenditures for MR & DD in the U.S. - State Profiles (1984) - Institute for the Study of DD - U. of Ill. at Chicago - Digest of Data on Persons with Disabilities (1984) - NIHR MR population data base - Manpower Demonstration Research Corp. - NY Inventory of National Data Files on Handicapped Children & Youth (1985) - NIHR

Existing/Cyclic - - Financing Community Services in the U.S. - Analysis of Trends (1984) - Institute for Study of DD - U. of Ill. at Chicago Summary & analysis of recent national data on LTC of DD (MR) population - Center for Residential & Community Services - U. of Minn. Racial Composition of Special Educ. Enrollment (1979) - Off. for Civil Rights - U.S. DOE Children & Youth Referral Survey (1980) - Off. for Civil Rights, DENS Birth Defects Monitoring Program (1984) - CDC Annual Reports to Congress on Status of Handicapped Children in Head Start Programs - Admin. on Children, Youth & Families Selected services of state maternal & child health units; selected surveys of state crippled children agencies (1983) - Assoc. of State & Territorial Health Officials American College Testing Program (1982-3) - U. of Iowa Ongoing Data & analysis - Medicaid ICF-MR program - HCFA - -124- Maior Analytica1 Studies New/Coming on Line - - Inventory of analyses of (54) University Affiliated Programs for Persons with DD - Amer. Assoc. of Univ. Affiliated Programs Survey of cost studies for DD & handicapped populations - (list of 72 studies & research in progress) - ASPE - Data & analysis of supported employment plans for adult MR population - Off. of Education & Off. of Research, Statistics & Policy - SSA Public Expenditures for MR & DD - analytical summary - analysis of federal spending - Institute for Study of DD (1985) - U. of Ill. at Chicago

III. GENERAL LTC/CROSSCUTTING & OTHER Major Primary Data Bases Existing/Cyclic Data Archive for LTC Policy - NCHSR National Health Care Expenditure Surveys (1980) - NCHSR Ongoing Survey of Consumer Expenditures (since 1980) - BLS Master Facility Inventory (1978) - NCHS Longitudinal Sample of Disability Insurance Applications; program statistics for SSI & SSDI - SSA Data tapes: Current Population Survey Series & Census tapes (1980) - Bureau of Census Panel Study of Income Dynamics (1984) - Survey Research Center - U. of Mich. & ASPE National Hospital Discharge Survey (1982~; National Ambulatory Medical Care Survey (1981) - NCHS Patient Treatment File, Annual Patent Census, Outpatient Treatment File - VA Disability Census; characteristics of newly allowed & continuous disability history sample (annual) - SSDI, Div. Of Disability Studies, Off. of Disability - SSA Survey ~ Study of Board & Care Populations (1980) - ADA National Nursing Home Survey (1977) - NCHS Data on health manpower shortage areas (ongoing) - HRSA - BHP -125- New/Coming on Line - Statewide Behavioral Risk Factor Surveys (1984-5) - CDC - National Medical Care Utilization & Expenditure Survey follow-up NCHSR, HCPA, NCHS Survey of Income & Program Participation (1984) - Third Wave - Bureau of Census Data File on Availability of Community Services & Utilization - VA Revision of Master Facility Inventory - NCHS Social Security Area Population Projections (1984) - Off. of Actuary - SSA Annual Housing Survey - DHUD National Ambulatory Medical Care Survey (1985) - NCHS -

Major Analytical Studies Existing/Cyclic Evaluation of Impact of home & community based waivers on Medicaid program - Bureau of Reimbursement, Off. of Coverage, HCFA - Evaluation of LTC Survey & certification demonstrations - HCFA - Study of DRG's & LTC Services - NCHSR - LTC Alternatives: Day Care & Home maker demonstrations - NCHSR - Private Financing of LIC: Current Methods & Resources (1985) - ICE, Inc. for ASPE - Project to Analyze Existing LTC Data (1984) - Urban Institute - Comparative Analysis of costs of Residential Day & Other programs within Institutional & Community Studies (1984) - Human Services Research - National Survey of Access to Medical Care (1982) - RWJ & U. of Chicago - Annual Survey of Independent Prepaid & Self-Insured Health Plans - HCFA - Supplementary Insurance (ongoing) - Health Insurance Association of America -126- New/Coming on Line - - Demonstration: Hospital Initiatives in LTC (23 sites) - RWJ Foundation Study of LTC Financing & Organization - Brookings Study of Income Distribution Gaps Between Rich & Poor - American Council of Life Insurance LTC Insurance Report - ASPE - Medicaid Evaluation Project & Medicaid Expenditure Data - Urban Institute for HCFA - Strategies for Evaluation of Impact of DRG's on LTC - Urban Institute - Financing LTC Services, Federal program expenditures, needs for next decade, expenditure projections, alternative funding - CBO - Encouragement of Long-term-life cycle saving (5 Foci: reverse mortgage equity; family responsibility; private insurance for LTC; pensions & savings; labor & retirement laws) - Amer. Enterprise Institute - Review & analysis of training programs designed to improve quality of care to residents of Board & Care programs - Matrix Research Institute for Project SHARE, DHHS Evaluation of LTC Channeling Demonstrations & HMO Demonstrations - HCFA

EXHIBIT C-4 RECENT ADDITIONS TO THE INFORMATION BASE Policy Oriented Books and Major Reports, 1980-1985 Callahan, James J., Jr. and Stanley S. Wallack, eds. 1981. Reforming the Long-Term-Care System: Financial and Organizational Options. Lexington: Lexington Books. Crystal, Stephen. 1982. America's Old Age Crisis: the Two Worlds of Aging. New York: Basic Books. Public Policy and Department of Health and H~,m~n Services, Steering Committee on the Chronically Mentally Ill. 1980. Toward a National Plan for the Chronically Mentally Ill. Report to the Secretary of DHHS. Department of Health and Herman Services, Office of the Assistant Secretary for Planning and Evaluation. 1981. Working papers on Long Term Care. Prepared for the 1980 Undersecretary's Task Forc on Long Term Care. Feinstein, Patrice H., Marian Gornick, and Jay N. Greenberg eds. 1984. Long-Term Care Financing and Delivery Systems: Exploring Some Alternatives. Conference Proceedings. Sponsored by Health Care Financing Administration. 1/24/84. General Accounting Office. 1983. Medicaid and Nursing Home Care: Cost Increases and the Need for Services are Creating Problems for the States and the Elderly. Report to the Chairman of the Subcommittee on Health and the Environment, Committee on Energy and Commerce, U.S. House of Representatives. Harrington, Charlene, Robert J. Newcomer, Carroll Estes, and Associates. 1985. Long Term Care of the Elderly: Public Policy Issues. Beverly Hills: Sage Publications. International Social Security Association. 1984. Long-Term Care and Social Security. Studies and Research No. 21. -127-

Kane, Robert L. and Rosalie A. Kane. (In Press.) A Will and a Way: What the United States Can Learn from Canada about Caring for the Elderly. New York: Columbia University Press. Working Draft. Kane, Robert L. and Kane, Rosalie A. eds. 1982. Values and Long-Term Care. Lexington, Massachusetts: Lexington Books. Lamb, H. Richard ed. 1984. The Homeless Mentally Ill: A Task Force Report of the American Psychiatric Association. Washington, D.C.: American Psychiatric Association. Mundinger, Mary O'Neil. 1983. Home Care Controversy: Too Little, Too Late, Too Costly. Rockville, MD: Aspen Publication. Neugarten, Bernice L. ed. 1982. Age or Need? Public Policies for Older People. Beverly Hills, CA: Sage Publications. Perlman, Robert ed. 1983. Family Home Care: Critical Issues for Services and Policies. New York, NY: The Haworth Press. Somers, Anne R. and Fabian, Dorothy R. eds. 1981. The Geriatric Imperative: An Introduction to Gerontology and Clinical Geriatrics. New York: Appleton-Century. Sullivan, Sean, and Polly M. Ehrenhaft. 1984. Managing Health Care Costs:- Private Sector Innovations. Washington, D.C.:American Enterprise Institute Studies in Health Policy. Veterans Administration. 1984. Caring for the Older Veteran. Vladeck, Bruce C. 1980. Unloving Care: The Nursing Home Tragedy. New York, NY: Basic Books. Vogel, Ronald J. and Hans C. Palmer, eds. 1983. Long-Term Care: Perspectives from Research and Demonstrations. Health Care Financing Administration. Journal Articles, Reports, and Policy-Related Statements, 1984-1985 Alpha Center. Long-Term Care Alternatives: Innovations in Financing Chronic Care for the Elderly. 1984. Alpha Centerpiece, May. 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. -128-

American College of Physicians, Health and Public Policy Committee. 1984. Long-Term Care of the Elderly. 1984. Position Paper. Annals of Internal Medicine 100:760-763. American Dental Association. 1983. Oral Health Care in the Long Term Care Facility. ISBN #0-934510-27-X. American Health Care Association. 1984. Policy Forum: Private Insurance for Long Term Care--Summary of Proceedings. American Medical Association and American Nurses' Association. 1983. Report of the Joint AMA/ANA Task Force to Address the Improvement of Health Care of the Aged Chronically Ill. Association of American Medical Colleges. 1983. Proceedings of the Regional Institutes on Geriatrics and Medical Education. Avorn, Jerry. 1984. Benefit and Cost Analysis in Geriatric Care: Turning Age Discrimination into Health Policy. NEJM 310:20:1294-1301. 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(Summer). 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. Birnbaum, Howard, Gary Gaumer, 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. Brady, Howard and Joanne Lynn. 1984. The Physician's Responsibility Under the New Medicare Reimbursement for Hospice Care. NEJM 310:14:920-22. Brooks, C. H. and Kathleen Smyth-Staruch. 1984. Hospice Home Care Cost Savings to Third-Party Insurers. Medical Care 22:8:691-703. Bureau of the Census, U.S. Department of Commerce. 1984. Demographic and Socioeconomic Aspects of Aging in the United States. 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. 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 the Robert Wood Johnson Foundation. -129-

Congressional Budget Office, Congress of the United States. 1984. Aging America: Trends and Projections. Statement of Eric A. Hanushek, Deputy Director, before the Subcommittee on Health, Committee on Ways and Means, U.S. House of Representatives, on Solvency of Medicare Hospital Trust Fund. 9/13/84. Doty, Pamela. 1984. Can Home and Community-Based Services Provide Lower Cost Alternatives to Nursing Homes? Health Care Financing Administration Working Paper. Draft. Doty, Pamela. 1984. Family Care of the Elderly: Is it Declining? Can Public Policy Promote It? Health Care Financing Administration Working Paper. Draft. Etheredge, Lynn. 1984. An Aging Society and the Federal Deficit: Trends, Questions, and Options for Future Policy. Milbank Memorial Fund Quarterly 62:4:521-543. Freedman, Ruth I. and Ann Moran. 1984. Wanderers in a Promised Land: The Chronically Mentally Ill and Deinstitutionalization. Supplement to Medical Care 22:12. Friedman, Bernard. 1983. Private Insurance for LTC: How Large are the Unmet and Potential Demands by the Elderly? Paper prepared for annual meeting of American Public Health Association. Fuchs-, Victor R. 1984. Though Much is Taken: Reflections on Aging, Health, and Medical Care. National Bureau of Economic Research, Inc. Working Paper #1269. Gillick, Muriel R. 1984. Is the Care of the Chronically Ill a Medical Prerogative? NEJM 310:3:190-193. Hahn, H., ed. 1985. Disability and Rehabilitation Policy. American Behavioral Scientist 28:3. Haug, Marie R. 1985. Home Care for the Ill Elderly: Who Benefits? AJPH 75:2:127-128. Health Insurance Association of America. 1984. Long Term Care: The Challenge to Society 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-~. Hughes, Susan L., David S. Cordray, and V. Alan Spiker. 1984. Evaluation of a Long Term Home Care Program. Medical Care 22:5:460-475. -130-

ICE Incorporated. 1985. Private Financing of Long Term Care: Current Methods and Resources, Phases I and II. Report submitted to U.S. Department of Health and Human Services. International Social Security Association, Permanent Committee on Medical Care and Sickness Insurance. 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. Kane, Rosalie A. and Robert L. Kane. 1985. The Feasibility of Universal Long Term Care Benefits. NEJM 312:21:1357-1364. Libow, L. S., M. Waife and R. N. Butler. 1985. Threat to the Development of the Teaching Nursing Home. JAMA 253:8:1166. Macken, Candace 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. Pre-publication Draft. Manton, Kenneth G. and Korbin 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: the Future World of Long Term Care. Washington, D.C. Meiners, Mark R. and Gordon R. Trapnell. 1984. Long Term Care Insurance: Premium Estimates for Prototype Policies. Medical Care 22:10:901-911. - 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. National Association for Home Care. 1985. Toward a National Home Care Policy: A Blueprint for Action. 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. 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. Preston, Samuel H. 1984. Children and the Elderly in the U.S. Scientific American. 251:6:44-49. -131-

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. NEJM 311:26:1664-1670. Scott, J. L. 1984. Long Term Care Provided within the Framework of Health Care Services (United States). Reply to International Social Security Association Questionnaire. Health Care Financing Administration. Swartz, Katherine. 1983. Utilization of Medical Care and Health Status of the Near Poor. Urban Institute project report #3197-03. Torrens, Paul R. 1984. Studies of Hospice Economics. Medical Care 22:8:689-690. 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. U.S. Senate Special Committee on Aging. 1984. Long-Term Care in Western Europe and Canada: Implications for the United States. An Information Paper. U.S. Senate Special Committee on Aging. 1984. Turning Home Equity into Income for Older Homeowners. An Information Paper. 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. NEJM 310:15:955-959. 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. Willging, Paul R., Paul Kerschner, and Judith R. Peres. 1984. Long-Ter-m Care: The Malthusian Dilemma. Healthcare Financial Management 12/84. Zimmer, James G., Annemarie Groth-Junck, and Jane McCusker. 1985. A Randomized Controlled Study of a Home Health Care Team. AJPH 75:2:134-141. Zimmer, James G., Annemarie Groth-Juncker, and Jane McCusker. 1984. Effects of a Physician-Led Home Care Team on Terminal Care. Journal of the American Geriatrics Society 32:4:288-292. -132-

REFERENCES Aiken Linda H. and K. D. Bays. 1984. The Medicare Debate--Round One. New England Journal of Medicine 311:1196-~200. 2 Alpha Center. Long-Term Care Alternatives: Innovations in Financing Chronic Care for the Elderly. 1984. Alpha Centerpiece, May. 3 Hahn, H., ed. 1985. Disability and Rehabilitation Policy. American Behavioral Scientist 28:3, Sage Publications. American College of Physicians, Health and Public Policy Committee. 1984. Long-Term Care of the Elderly. 1984. Position Paper. Annals of Internal Medicine 100:760-763. 5 American Medical Association and American Nurses' Association. 1983. Report of the Joint AMA/ANA Task Force to Address the Improvement of Health Care of the Aged Chronically Ill. Ball, Robert M. 1984. A Ten-point health care and deficit reduction plan. (prepared for the Study Group on Social Security, discussion draft only). 7 Ball, Robert M. 1984. The Future of Medicare. (memorandum). 8 Brooks, C. H. and Kathleen Smyth-Staruch. 1984. Hospice Home Care Cost Savings to Third-Party Insurers. Medical Care 22:8:691-703. Callahan, James J., Jr. and Stanley S. Wallack, eds. 1981. Reforming the Long-Term-Care System: Financial and Organizational Options. Lexington: Lexington Books. 10 Crystal, Stephen. 1982. America's Old Age Crisis: Public Policy and the Two Worlds of Aging. New York: Basic Books. 11 Department of Health and Human Services, Steering Committee on the Chronically Mentally Ill. 1980. Toward a National Plan for the Chronically Mentally Ill. Report to the Secretary of DUBS. 12 Doty, Pamela. 1984. Can Home and Community-Based Services Provide Lower Cost Alternatives to Nursing Homes? Health Care Financing Administration Working Paper. Draft. 13 Doty, Pamela. 1984. Family Care of the Elderly: Is it Declining? Can Public Policy Promote It? Health Care Financing Administration Working Paper. Draft. 14 Fuchs, Victor R. 1984. Though Much is Taken--Reflections on Aging, Health, and Medical Care. National Bureau of Economic Research, Inc. Working Paper #1269. -133-

15 Gibbons, John H. 1982. Thoughts on a Technology Assessment of the "Graying of America. Letter to The Honorable Ted Stevens Gillick, Muriel R. 1984. Is the Care of the Chronically Ill a Medical Prerogative? New England Journal of Medicine 310:3:190-193. 17 Barrington, Charlene and Leslie Grant. 1985. Nursing Home Bed Supply, Access, and Quality of Care. Paper prepared for the Institute of Medicine Committee to Study Nursing Home Regulation. 18 Harrington, Charlene, Robert J. Newcomer, Carroll Estes, and Associates. 1985. Long Term Care of the Elderly: Public Policy Issues. Beverly Hills: Sage Publications. 19 Hang, Marie R. 1985. Home Care for the Ill Elderly--Who Benefits? American Journal of Public Health 75:2:127-128. - 20 Health Care Financing Administration. 1984. Long-Term Care Financing and Delivery Systems: Exploring Some Alternatives. Conference Proceedings. 21 Health Insurance Association of America. 1984. Long Term Care: The Challenge to Society 22 ICE Incorporated. 1985. Private Financing of Long Term Care: Current Methods and Resources, Phases I and II. Report submitted to U.S. Department of Health and Human Services. 23 Iglehart, John K. 1983. Medicaid Turns to Prepaid Managed Cases. New England Journal of Medicine 308:16:976-980. 24 General Accounting Office. 1983. Medicaid and Nursing Home Care: Cost Increases and the Need for Services are Creating Problems for the States and the Elderly. Report to the Chairman of the Subcommittee on Health and the Environment, Committee on Energy and Commerce, U.S. House of Representatives. 25 Kane, Robert L. and Rosalie A. Kane. In Press. A Will and a Way: What the United States Can Learn from Canada about Caring for the Elderly. New York:Columbia University Press. Working draft. 26 Hadley, Jack and Judith Feder. 1983. Hospitals' Financial Status and Care to the Poor in 1980: Executive Summary. Working paper #3179-02~0ctober, revised) for Urban Institute. 27 Brady, Howard and Joanne Lynn. 1984. The Physician's Responsibility Under the New Medicare Reimbursement for Hospice Care. New England Journal of Medicine 310:14:920-22. 28 Association of American Medical Colleges. 1983. Proceedings of the Regional Institutes on Geriatrics and Medical Education. -134-

29 Kane, Robert L. and Kane, Rosalie A. eds. 1982. Values and Long-Term Care. Lexington, MA: Lexington Books. 30 Lamb, H. Richard ed. 1984. The Homeless Mentally Ill: A Task Force Report of the American Psychiatric Association. Washington, D.C.: American Psychiatric Association. 31 Lohr, Kathleen N. and Susan M. Marquis. 1984. Medicare and Medicaid: Past, Present, and Future. a Rand report prepared for the U.S. Department of Health and Human Services. 32 Lubitz, James and Ronald Prihoda. 1982. Use and Costs of Medicare Services in the Last Years of Life. Draft report--Health Care Financing Administration. 33 Manton, Kenneth G. 1982. Changing Concepts of Morbidity and Mortality in the Elderly Population. Milbank Memorial Quarterly 60:2:183-244. 34 Manton, Kenneth G. 1984. Changing Health Status and the Need for Institutional and Noninstitutional Long-Term Care Services. Paper prepared for the Institute of Medicine Committee on Nursing Home Regulation. 35 Mechanic, David and Linda Aiken. 1982. A Cooperative Agenda for Medicine and Nursing. New England Journal of Medicine 307:12:747-750. 36 Meiners, Mark R. and Gordon R. Trapnell. 1984. Long Term Care Insurance: Premium Estimates for Prototype Policies. Medical Care 22:10:901-911. 37 Meltzer, Judith, Frank Farrow and Harold Richman eds. 1981. Policy Options in Long-Term Care. Chicago, IL: U. of Chicago Press. 38 Meyer, Jack A., William R. Johnson and Sean Sullivan. 1983. Passing the Health Care Buck: Who Pays the Hidden Cost? Washington, D.C.: American Enterprise Institute. 39 Willis, David P. ed. 1984. Health and Society. Milbank Memorial Fund Quarterly 62:4. 40 Mundinger, Mary O'Neil. 1983. Home Care Controversy: Too Little, Too Late, Too Costly. Rockville, MD: Aspen Publication. 41 Myers, George C. Demographic Imperatives: Changes in Aging, Families and Children. Background paper prepared for Institute of Medicine ad hoc committee to advise U. S. Public Health Service on Future Program Planning for Fiscal Year 1987. -135-

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-

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-

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-

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-

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-

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-

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-

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-

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-

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-

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-

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