Abstracts of DALTCP REPORTS--"I" Titles

This section gives abstracts for reports produced through DALTCP-funded research or through research done by DALTCP staff. Links to Executive Summaries and/or Full Reports immediately follow most descriptions, as well to Project Descriptions (if available). (We are working towards putting ALL Full Reports online.) Reports can be ordered from the Office of Disability, Aging and Long-Term Care Policy, unless stated otherwise. Requests can be made by Fax (202-401-7733) or through email (webmaster.DALTCP@hhs.gov).

NOTE: Because of the large number of DALTCP reports, abstracts are divided into several files.

Remember, the Site Index section includes an alphabetic list of keywords you can choose to find information that is referenced throughout the DALTCP website.

IDENTIFYING THE SERVICES, COSTS, AND REIMBURSEMENTS FOR YOUNG CHILDREN WITH DISABILITIES THROUGH DATA COLLECTED BY TENNESSEE PART H IDEA PROGRAM

ABSTRACT: The goal of this project was to better identify what services are provided to young children with disabilities and what factors affect how they are financed. This was accomplished by: (1) identifying the services received by children with chronic disabilities who are age 36 months and under; (2) identifying who paid for those services; and (3) identifying how factors such as referral sources, diagnosis, types of service, health insurance coverage, socioeconomic status and geographical region related to the decisions about what services the children receive and who pays for them. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov]

IMPACT OF FEMALE CAREGIVERS' EMPLOYMENT STATE ON PATTERNS OF FORMAL AND INFORMAL ELDERCARE

ABSTRACT: This article uses data from the 1989 National Long-Term Care Survey and its companion Informal Caregivers Survey to investigate how the employment of female primary caregivers (FPCGs) affects hours of care received by disabled elderly care recipients (CRs). Multivariate analyses controlling for key FPCG and CR characteristics indicate that when FPCGs are employed they provide significantly fewer hours of care personally; however, their CRs also receive significantly more hours of help from other sources. When FPCGs work more than 17 hours per week, their CRs receive significantly fewer total weekly hours of care than would otherwise be the case. (The Gerontologist, Volume 38, Number 3, Pages 331-341) [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov]

IMPACT OF PRIVATE LONG-TERM CARE INSURANCE BENEFITS ON SELECTED MEDICARE SERVICES

ABSTRACT: The purpose of this analysis is to gain a better understanding of how having a private LTC insurance policy interacts with and affects the use of Medicare financed home health, skilled nursing and inpatient services. The authors used Medicare claims data and linked it to a sample of 578 community-based disabled elders receiving benefits under their LTC insurance policies. The sample of claimants, who comprised the 2000 LTC Insurance Panel, was developed for an ASPE-sponsored study completed in 2000. By linking Medicare claims data to these individuals, the authors were able to examine the relationship between LTC and acute or post-acute care service utilization in the year prior to and after the time when private insurance benefits were paid. Comparisons were made of Medicare use and expenditures to a sample of 1,349 disabled non-insured community residents in the general population. Information about this sample is derived from the 1994 National Long-Term Care Survey. [29 pages]

IMPORTANT QUESTIONS FOR HOSPICE IN THE NEXT CENTURY

ABSTRACT: This report contains six main sections. The first focuses on hospice coverage policies and reviews the history of the Medicare hospice benefit, its current structure, and its influence on care of the dying. Also included is a description of hospice care covered by other insurers including state Medicaid programs and private employers. The second section provides a literature review of the issues surrounding access to hospice and the provision of hospice care in nursing facilities. This is followed by a brief description of current end of life initiatives to improve care of the terminally ill. The next section summarizes discussions with hospice and nursing facility providers, federal and state certification surveyors, and state Medicaid officials regarding overlapping areas in caring for the terminally ill. The final section summarizes the issues and provides a framework for the four subsequent reports in this study.

IMPROVING FEDERAL STATISTICS ON FAMILIES: ASSESSING FAMILY STRENGTHS IN NATIONAL SAMPLE SURVEYS

ABSTRACT: This is a combination of three final reports that discuss characteristics of healthy, well-functioning families, or "family strengths." Each report looks at the family strengths from a different national survey: the National Survey of Children, the National Survey of Families and Households, and the General Social Survey. Lastly, is a compilation of survey questions that measure family strengths. This comprehensive group of questions was compiled in order to provide options for a new survey module of family strengths. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov, Accession #PB93-147072, 227 pages]

INDEPENDENT CHOICES: A NATIONAL SYMPOSIUM ON CONSUMER-DIRECTION AND SELF-DETERMINATION FOR THE ELDERLY AND PERSONS WITH DISABILITIES--CONFERENCE PACKAGE

ABSTRACT: The goal of this conference was to bring together policymakers, program administrators, consumer advocates, service providers, and researchers to identify future directions for policy development and research and demonstration projects to promote effective and responsive consumer-directed services systems for the elderly and people with disabilities. Governor Mike Huckabee was a keynote speaker because, under his leadership, the State of Arkansas has greatly expanded access to home and community-based services, and is a pioneer in testing new models of consumer-directed care for the elderly and for younger persons with physical disabilities and/or cognitive disabilities. Arkansas is currently participating, along with Florida and New Jersey, in the "Cash and Counseling Demonstration and Evaluation", co-sponsored by HHS and the Robert Wood Johnson Foundation. These conference materials contain information from the panel discussions and presentations and in intensive workshops around particular themes.

INDEPENDENT CHOICES: NATIONAL SYMPOSIUM ON CONSUMER-DIRECTED CARE AND SELF-DETERMINATION FOR THE ELDERLY AND PERSONS WITH DISABILITIES--SUMMARY REPORT

ABSTRACT: This report presents a summary of major findings and outcomes from the dialogues that took place at "Independent Choices: A National Symposium on Consumer-Direction and Self-Determination for the Elderly and Persons with Disabilities" held in Washington, DC in June 2001. Rather than attempt to abstract individual panel presentations, this report highlights the major themes that came up again and again in the plenary sessions with illustrative quotes or paraphrases of speakers’ remarks that address these specific themes.

INFANT ATTACHMENT: WHAT WE KNOW NOW

ABSTRACT: In February 1991, ASPE sponsored a two-day research seminar on infant attachment. This final report has three major sections. The first part is a brief summary of an extensive literature review on infant attachment. The second section summarizes the proceedings of the seminar, which was based on the topics outlined in the literature review. The Research Agenda, the third part of the report, outlines the areas that the participants identified for future research. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov, Accession #PB92-135995, 172 pages]

INFORMAL CARE TO THE IMPAIRED ELDERLY: REPORT OF THE NATIONAL LONG-TERM CARE DEMONSTRATION SURVEY OF INFORMAL CAREGIVERS

ABSTRACT: This report makes use of baseline data on informal caregivers to explore several issues central to informal caregiving, including the composition of the informal care network, the types and level of care provided by that network, financial assistance provided by informal caregivers, and their well-being. A total of 1,940 primary informal caregiver baseline interviews was conducted between November 1982 and May 1983 with an overall response rate of 87%. The caregivers were in most cases the wives, daughters or daughters-in-law of the elderly recipients of care. One-third were active in the labor market, mostly full-time; almost 40% were 65 years or older. Primary caregivers averaged almost 6 hours per day on care-related activities. In general, the more that care was provided under stressful circumstances, the greater was the perceived burden and the lower the rating given by primary caregivers to their quality of life. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov, Accession #PB86-240058]

INFORMAL CAREGIVER "BURNOUT": PREDICTORS AND PREVENTION

ABSTRACT: Three studies sponsored by HHS confirm previous research linking health impairment levels, advanced age, and various indicators of caregivers' physical burden and emotional stress with individual caregivers' decisions to stop giving care and increased likelihood of nursing home placement. In contrast, the lack of association between caregivers' employment status and withdrawal from caregiving or decisions to institutionalize fails to support some widely held theories about the effects of female labor force participation on informal elder care. Finally, informal care networks add paid helpers to cope with more intensive demands for assistance and/or losses in membership. Over time, however, formal services become less effective in preventing nursing home use. (ASPE Research Notes, Volume 5)

INFORMAL CAREGIVERS OF DISABLED ELDERS WITH LONG-TERM CARE INSURANCE

ABSTRACT: The purpose of this report is to provide basic descriptive statistics on the primary informal caregivers of disabled private long-term care insurance policyholders who have accessed long-term care benefits and are living in the community. Also compared are key characteristics of these individuals to informal caregivers of non-privately insured disabled elders.

INFORMAL CAREGIVING: COMPASSIONS IN ACTION

ABSTRACT: This booklet, developed by HHS, is about informal caregiving--unpaid care given voluntarily to ill or disabled persons by their families and friends. Informal caregiving by families and friends is the backbone of America's long-term care system. According to recent surveys sponsored by HHS, 52 million Americans are informal caregivers. These caregivers provide help to individuals of all ages. Two important lessons can be drawn from the data in this booklet. The first is that the contributions of informal caregivers are irreplaceable. The second lesson is that informal caregiving cannot be taken for granted. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov, Accession #]

INFORMAL SERVICES AND SUPPORTS

ABSTRACT: This is a collection of practice-oriented papers dealing with the various ways in which informal services and supports were encouraged and utilized in Channeling. Written primarily by case managers and supervisors from the Channeling sites, topics range from the development of family support groups to the development of a volunteer network. An extensive bibliography on informal supports is included. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov, Accession #PB86-244233]

INITIAL RESEARCH DESIGN OF THE NATIONAL LONG-TERM CARE DEMONSTRATION

ABSTRACT: The primary objective of the research in the National Long-Term Care Channeling Demonstration was to determine the impacts of the demonstration on service utilization, public and private costs, clients and caregivers. The demonstration employed a randomized experimental design with random assignment of eligible participants to either treatment group or control group status. The sample was designed so that six percentage points was the minimum reduction in the nursing home institutionalization rate that could be detected (with 90% power). The statistical technique used for much of the impact estimation was multiple regression. Potential problems such as non-comparability of baseline data and sample attrition were examined separately. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov, Accession #PB86-234366]

INTERDISCIPLINARY EDUCATION AND TRAINING OF PROFESSIONALS CARING FOR PERSONS WITH DISABILITIES: CURRENT APPROACHES AND IMPLICATIONS FOR A CHANGING HEALTH CARE SYSTEM

ABSTRACT: This project looked at interdisciplinary training programs around the country which train professionals to provide the wide range of services needed by people with disabilities. The report includes a discussion of the implications of interdisciplinary training for trends in managed care, case studies of nine training programs, and a review of the general literature on interdisciplinary training. The report concludes that the ability of health care and social service professionals to work together and to know about each other's expertise and about community services is critical to the provision of a full continuum of care. Professionals from a variety of disciplines will be increasingly called upon to work interactively. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov, Accession #PB97-136832]

INTERNATIONAL EVIDENCE ON DISABILITY TRENDS AMONG THE ELDERLY

ABSTRACT: Are today's elderly healthier than previous generations or does increased longevity come with increased risk of disability and reduced quality of life? In the ongoing search for a definitive answer, this paper provides a comprehensive review of the evidence, both for the U.S. and internationally. The basic conclusion is that disability rates are falling in most industrialized countries. For the countries where no decline is apparent, there is no consistent evidence that disability rates are rising. How fast they are falling, and what this may mean for national budgets are still unclear, however, because wide disparities in the disability measures, field procedures, and sample designs prevent comparability across data sources. After reviewing and assessing the quality of the evidence, this report ends with recommendations for future data collection and analysis to increase comparability and narrow the range of the estimates. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov, Accession #]

INTERNATIONAL LONG-TERM CARE REFORM: A DEMOGRAPHIC, ECONOMIC, AND POLICY OVERVIEW

ABSTRACT: No abstract available at this time. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov]

INTRODUCTION TO THE NATIONAL LONG-TERM CARE SURVEY

ABSTRACT: This paper updates an earlier summary of the National Long-Term Care Surveys (NLTCS) entitled National Long-Term Care Surveys (1982, 1984, 1989) (1992). The NLTCS--conducted in 1982, 1984, 1989 and 1994--are nationally representative surveys of Medicare beneficiaries aged 65 or over with chronic functional disabilities (sometimes referred to as the "frail elderly"). These surveys are the major source of nationally representative information on changes in the health and functioning of the elderly population. The survey will be administered again in 1999. The NLTCS is a unique resource for examining demographic, health and functional status changes in the disabled elderly living in the community and in nursing homes along with the trajectory of service use and costs over time. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov, Accession #]

IN-HOME SUPPORTIVE SERVICES FOR THE ELDERLY AND DISABLED: A COMPARISON OF CLIENT-DIRECTED AND PROFESSIONAL MANAGEMENT MODELS OF SERVICE DELIVERY--NON-TECHNICAL SUMMARY REPORT

ABSTRACT: Elderly and younger persons with disabilities who require help from others to perform many of the most ordinary activities of daily living are said to require "long-term care." These services, when provided in the home or other non-institutional settings, may be termed personal assistance services, home and community-based services, or in-home supportive services. This report presents the findings of a study comparing alternative approaches to delivering such services. The purpose of the study was to determine whether there are significant differences, on a wide range of outcome indicators, when publicly-funded supportive services for the elderly and disabled are provided through a consumer-directed as compared to a professional management model of service financing and delivery.

ISSUES IN DEVELOPING THE CLIENT ASSESSMENT INSTRUMENT FOR THE NATIONAL LONG-TERM CARE CHANNELING DEMONSTRATION

ABSTRACT: This preliminary report addresses a number of issues pertaining to the development of a combined research and clinical instrument for assessing the functional status of clients in the National Long-Term Care Channeling Demonstration. The report contains an extensive literature review, evaluation of existing instruments and appraisal of the experiences of others--both practitioners and researchers--who have used similar instruments. Recommendations are made with respect to the assessment of physical health, activities of daily living, mental functioning, social functioning, physical environment and living arrangements, service use, and financial resources. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov, Accession #PB86-236759]

Last revised: February 25, 2003

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