Managed care is reshaping our health care system, although long-term care is only beginning to feel its effects. We report on the managed care involvement of 492 multilevel, long-term care facilities (MLFs; including skilled nursing and assisted/independent living) nationally. Organizational structure and culture and especially environmental characteristics are associated with whether facilities have contracts with managed care organizations (MCOs), plan to have contracts, are only gathering information on MCOs, or intend to do nothing in the near future. Resource dependence theory best explains MCO contracting patterns with MLFs appearing to be responding more to survival than to growth.
This study analyzes home- and community-based services (HCBS) use patterns and determines the costs of purchasing in-home services comparable to those offered by SCAN(R), a Social HMO. METHODS. Administrative data on 8,229 nursing home certifiable members were used to profile use patterns; a telephone survey gathered data on the market value of these services. RESULTS. Frail Social HMO members used a variety of HCBS to remain independent at home. These individuals would spend an average of $4,900 out of pocket per year to purchase equivalent HCBS, if they were not enrolled in the Social HMO. DISCUSSION. Findings suggest that the costs of maintaining a Social HMO member at home are modest and affordable, yet offer a substantial benefit, particularly to low- and moderate-income older people. With the aging of the population, an integrated medical and social program, such as the Social HMO, offers a viable policy solution.
Obtaining useful information to improve services for older, multi-ethnic populations requires a nontraditional approach to assessing needs that can overcome both cultural barriers and natural suspicions about research. This case study describes a multimethod needs assessment conducted in a large senior housing facility, where 58% of residents were non-English-speaking. Methods of data collection were both qualitative and quantitative. Data were gathered by focus groups, interviews, and a written survey (N = 874) on topics of need for personal care assistance, level of assistance required for instrumental activities of daily living, and mobility. Qualitative inquiry yielded information about facilities and safety, and culturally specific needs, particularly communication. The case study concludes by discussing how the research findings translated into on-site programmatic changes, and delineating the factors that contributed to the success of this approach.
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