Toward a National Strategy for Long-Term Care of the Elderly A Study Plan (1986) / Chapter Skim
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Section III: Study Approach
Section III: Study Approach
Pages 15-24
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From page 15... ...
gatekeeping mechanisms that hold promise for keeping the system of long-term care affordable 5) analysis of the arrangements for long-term care in other advanced industrial countries with the aim of shedding new light on the policy choices facing this nation 6)
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From page 16... ...
It is widely perceived to be deficient in numerous ways, yet the lack of political pressure in the public sector for a solution suggests that the issue is not yet a salient one to most Americans. The private sector has also displayed surprisingly little entrepreneurial interest in long-term care beyond investments in nursing homes and the more profitable portion of the home care market, despite demographic forecasts suggesting substantial needs.
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From page 17... ...
Some of the factors to be explored include: · the impact of variations in organizational arrangements · the relationship between provider payment mechanisms and payment rates on quality · the impact of the uncertainty of the knowledge base guiding clinical interventions · the ability to incorporate suitable definitions and measures of quality into regulation and reimbursement. This part of the study will be able to build on the recent TOM study of the quality of care in nursing homes.
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From page 18... ...
Over the past 30 years, the proportion of elderly who live alone has increased dramatically, because Social Security has enabled the present generation of elderly to exercise more choice about their living arrangements. However, for the frail and functionally dependent elderly, living alone creates problems of access to informal care, and increases the cost of providing formal in-home long-term care services.18 The study will examine, using existing data sources, effective ways to integrate supportive and health services for the impaired elderly in the full range of housing options, such as retirement communities, congregate housing arrangements, and board and care facilities.
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From page 19... ...
The study will examine what is known about adverse selection, particularly within existing long-term care insurance programs. It will also evaluate various strategies that could be employed to minimize adverse selection in an expanded insurance program, such as purchasing insurance while young and the development of group policies.
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From page 20... ...
For example, neither individual Medical IRAs or home equity conversion seem likely to eliminate, for most families, the risk of impoverishment from a long-term disabling illness. However, both of these options would increase the disposable income available to the elderly to enable them to purchase private long-term care insurance, and to pay the co-insurance and deductible that would help keep insurance costs affordable.
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From page 21... ...
These include the Long-Term Care Channelling Demonstration, The Robert Wood Johnson Foundation's Health-Impaired Elderly Program, evaluations of prescreening programs for nursing home admissions, the Rochester Access Program, and many others. The proposed analysis should cover the following points: · functional assessment for service eligibility · case management with and without financial incentives · capitation and prospective payment systems · cost-sharing (coinsurance and deductible)
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From page 22... ...
This attention would be paid specifically to the chronically mentally ill, other functionally disabled adults, and the developmentally disabled of all ages, including the mentally retarded. General Issues Six specific areas of concern have been identified for emphasis by the study, but the project actually would proceed in an interactive process, working back and forth between the general design of the long-term care system and the design of financing options.
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From page 23... ...
The study committee will play a key role in this final step, working closely with the study director and a small core professional staff. Anticipated Study Outcomes The motivation behind this project is a desire to help inform both the public and their designated policymakers about the dimensions of the problem this nation is confronting in providing humane assistance to its disabled elderly citizens, and in doing so, to provide objective assessments of the feasibility of a range of possible national responses.
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From page 24... ...
A new administration would be taking office in Washington at that time. In establishing its domestic agenda, it is reasonable to assume that there would be an interest in a feasibility study on long-term care policy options.
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