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Tables Comparing Channeling to Other Community Care Demonstrations

Robert A. Applebaum, Margaret N. Harrigan and Peter Kemper

Mathematica Policy Research

May 1986

This report was prepared under contract #HHS-100-80-0157 between the U.S. Department of Health and Human Services (HHS), Office of Social Services Policy (now known as the Office of Disability, Aging and Long-Term Care Policy) and Mathematica Policy Research, Inc. Additional funding was provided by the Health Care Financing Administration and the Administration on Aging. For additional information about the study, you may visit the DALTCP home page at http://aspe.hhs.gov/daltcp/home.htm or contact the office at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, SW, Washington, DC 20201. The e-mail address is: webmaster.DALTCP@hhs.gov. The DALTCP Project Officer was Robert Clark.

The channeling demonstration was an intradepartmental long term care initiative funded by the Health Care Financing Administration (HCFA), Administration on Aging (AoA), and the Assistant Secretary for Planning and Evaluation (ASPE).

Over the past decade and a half, a series of demonstrations in addition to channeling have been fielded to test some form of case managed, community-based long term care. After a comprehensive review of these studies, we identified 14 community care demonstrations funded through federal government waivers which had interventions and research designs most relevant to the channeling demonstration. The purpose of this supplementary report is to facilitate comparisons of the interventions, evaluation designs, and estimated effects of these 14 demonstrations with one another and with the two models of channeling.

The demonstrations and the sources from which we draw the information appearing in the remaining tables of the report are presented in Table 1. Differences in methodology, level of detail with respect to the presentation, as well as differences in the treatment and evaluation designs themselves, make it impossible to produce completely comparable table entries.¹ In addition, some of the reports from which the tables are compiled were in draft form and may be superceded in the future. Even if these problems did not exist, it still would be a matter of some judgment which specific variables and estimates best reflect in summary form outcomes which were typically measured differently across demonstrations.

For all these reasons, the point estimates appearing in these tables and the absolute differences among them should be interpreted with caution. However, we have used our best judgment about which estimates to display; and we believe that the basic direction of effects and relative differences indicated by the estimates shown are reliable indications of the differences among the demosntrations.

NOTES

Berkeley Planning Associates (1985) made this task somewhat easier with their cross-demosntration study, but only a subset of the demonstrations was included in that work.

LIST OF TABLES

TABLE 1. Prior Community Care Demonstrations and Sources Used for Report

TABLE 2. Evaluation Methodologies

TABLE 3. Cost Controls and Eligibility Criteria

TABLE 4. Sample Characteristics

TABLE 5. Percent Receiving Direct Services from the Demonstrations

TABLE 6. Direct Services Covered

TABLE 7. Caseload Per Case Manager

TABLE 8. Informal Caregiving

TABLE 9. Nursing Home and Hospital Use During the 12 Months Following Enrollment

TABLE 10. Physician and Other Medical Service Expenditures

TABLE 11. Mortality Rates 12 Months After Enrollment

TABLE 12. Unmet Needs

TABLE 13. Social/Psychological Well-Being

TABLE 14. Functioning

TABLE 15. Case Management Costs

TABLE 16. Direct Service Costs

TABLE 1. Prior Community Care Demonstrations and Sources Used for Report
Demonstration (evaluation period)	Source
RANDOMIZED DESIGN
Worcester Home Care (1973-1975)	Commonwealth of Massachusetts. "Final Report, Home Care : An Alternative to Institutionalization." Boston, MA: The Commonwealth of Massachusetts, Department of Elder Affairs, 1975. See also Sherwood, Sylvia, John N. Morris, and Claire E. Gutkin. "Final Report Concerning the Impact of Services on Health and Well-Being." Boston, MA: Department of Social Gerontological Research, Hebrew Rehabilitation Center for the Aged, 1975.
NCHSR Day Care/Homemaker Experiment (1975-1977)	Weissert, William G., Thomas T.H. Wan, and Barbara B. Livieratos. "Effects and Costs of Day Care and Homemaker Services for the Chronically Ill: A Randomized Experiment." Washington, DC: U.S. Department of Health, Education and Welfare, Office of Health Research, Statistics, and Technology, National Center for Health Services Research (Publication No. PHS 79-3258), February 1980.
Georgia AHS (1977-1980)	Georgia Department of Medical Assistance. "Alternative Health Services Project Final Report." Atlanta, GA: Georgia Department of Medical Assistance, January 1982.
Wisconsin CCO (1978-1980)	Seidl, F., et al. "Delivering In-Home Services to the Aged and Disabled--the Wisconsin Experience." Madison, WI: Fay McBeath Institute, University of Wisconsin, 1980.
Project OPEN (1980-1983)	Mt. Zion Hospital and Medical Center. "Project OPEN: Final Report." San Francisco, CA: Mt. Zion Hospital and Medical Center, December 1983.
Project OPEN (1980-1983)	Berkeley Planning Associates. "Evaluation of Coordinated Community Oriented Long Term Care Demonstrations." Berkeley, CA: Berkeley Planning Associates, May 1985.
South Carolina LTC (1980-1984)	Blackman, Donald, et al. "South Carolina Commuity Long Term Care Project: Reports of Findings." Spartanburg, SC: South Carolina State Health and Human Services Finance Commission, July, 1985 (Draft).
Florida Pentastar (1981-1983)	Florida Department of Health and Rehabilitative Services. "Final Report and Evaluation of the Florida Pentastar Project" Tallahassee, FL: Florida Department of Health and Rehabilitative Services (Report E-84-7), 1984.
San Diego LTC (1981-1983)	Allied Home Health Association. "Long Term Care Demonstration Project of North San Diego: Final Report." Washington, DC: U.S. Department of Health and Human Services, Health Care Financing Administration, April 15, 1984.
San Diego LTC (1981-1983)	Berkeley Planning Associates. "Evaluation of Coordinated Community Oriented Long Term Care Demonstrations." Berkeley, CA: Berkeley Planning Associates, May 1985.
NONRANDOMIZED DESIGN
ACCESS (1977-1980)	Price, Lewis C. and Hinda M. Ripp. "Third Year Evaluation of the Monroe County Long Term Care Program, Inc." Silver Springs, MD: Macro Systems, Inc., November 1980 (Draft).
Triage (1976-1979)	Triage, Inc. "Triage Coordinated Delivery of Services to the Elderly: Final Report." Plainville, CT: Triage, Inc., December 1979.
On Lok (1979-1983)	On Lok. "On Lok's CCODA: A Cost Competitive Model of Community-Based Long Term Care." San Francisco, CA: On Lok, February 1983.
On Lok (1979-1983)	Berkeley Planning Associates. "Evaluation of Coordinated Community Oriented Long Term Care Demonstrations." Berkeley, CA: Berkeleye Planning Associates, May 1985.
MSSP (1980-1983)	Miller, Leonard, Marleen L. Clark, and William F. Clark. "The Comparative Evaluation of California's Multipurpose Senior Services Project." Berkeley, CA: Berkeley Planning Associates, 1984.
Nursing Home Without Walls (1980-1983)	Birnbaum, Howard et al. "Nursing Home Without Walls: Evaluation of the New York State Long Term Home Health Program." Cambridge, MA: Abt Associates, January 23, 1984 (Draft).
New York City Home Care (1980-1983)	City of New York. "Delivery of Medical and Social Services to the Homebound Elderly: A Demonstration of Intersystem Coordination." New York, NY: New York City Department for the Aging, 1984.
New York City Home Care (1980-1983)	Berkeley Planning Associates. "Evaluation of Coordinated Community Oriented Long Term Care Demonstrations." Berekeley, CA: Berkeley Planning Associates, May 1985.

TABLE 2. Evaluation Methodologies
Demonstration (evaluation period)	States	Sites	Comparison Methodology	Sample Size	Months of Followup	Data Sources
Worcester Home Care (1973-1975)	1	1	Random assignment	485	12	Individual interviews Project records
NCHSR Day Care/Homemaker Experiment (1975-1977)	4	6	Random assignment	1,566	3, 6, 9, 12	Individual interviews Medicare records Project records
Triage (1976-1979)	1	1	Comparison group outside area (age differences)	502	6, 12, 18, 24	Individual interviews Diaries Project records Medicare records Medicaid records
Georgia AHS (1977-1980)	1	1	Random assignment	1,332	6, 12, 18, 24	Individual interviews Project records Medicaid records (with Medicare crossover)
ACCESS (1977-1980)	1	1	County-level comparison	--	24	Department of Social Service records
Wisconsin CCO (1978-1980)	1	1^a	Random assignment	417	6, 12	Individual interviews Medicaid records Death records
On Lok (1979-1983)	1	1	Comparison group outside area, matched on characteristics (race, sex, and institutionalization differences)	140	6, 12, 18, 24	Individual interviews Project records Provider records
MSSP (1980-1983)	1	8	Comparison group within and outside area, matched on whether in hospital, nursing home, or community (impairment differences)	4,200	6, 12	Individual interviews Medicaid records Medicare records
South Carolina LTC (1980-1984)	1	1	Random assignment	1,867	3, 6, 12, 18, 24, 36	Individual interviews Project records Medicaid records Medicare records
Project OPEN (1980-1983)	1	1	Random assignment	335	6, 12, 18, 24, 30, 36	Individual interviews Project records Medicare records
Nursing Home Without Walls (1980-1983)	1	9	Comparison group within and outside area (age, race differences)	1,373	6, 12	Individual interviews Medicaid records Medicare records Food stamp records SSI records
New York City Home Care (1980-1983)	1	1	Comparison group outside area (impairment differences)	704	6, 12	Individual interviews Diaries Medicaid records Medicare records
Florida Pentastar (1981-1983)	1	5	Random assignment (plus comparison group outside area)	1,046	12, 18	Individual interviews Medicaid records Medicare records Food stamp records
San Diego LTC (1981-1983)	1	1	Random assignment	819	3, 6, 12, 18	Individual interviews Medicare records
Channeling (1982-1985)	10^b	10^b	Random assignment	6,326	6, 12, 18	Individual interviews Project records Medicaid records Medicare records Provider records Death records Caregiver interviews
Wisconsin CCO was administered in 3 sites. Only one site (Milwaukee) is included in our comparisons. Channeling included 2 other sites not part of this evaluation, in Hawaii and Missouri.

TABLE 3. Cost Controls and Eligibility Criteria
Demonstration (evaluation period)	Community Service Authorization Power	Cost Maximums	Cost Sharing	Eligibility Criteria
RANDOMIZED DESIGN
Worcester Home Care (1973-1975)	Expanded services	No	No	57 years or over Medicaid-eligible At risk of nursing home placement Living in community but have high need for services
NCHSR Day Care/Homemaker Experiment (1975-1977)	Expanded day care coverage/ homemaker coverage or combined	No	No	At risk of nursing home placement Medicare-eligible Need services to maintain functioning For homemaker and combined sites 3-day hospital stay in previous 14 days
Georgia AHS (1977-1980)	Expanded services	Maximum of 85 percent of the average of the Medicaid rates	No	Medicaid-eligible 50 years or over Eligible for nursing home placement as certified by professional review organization
Wisconsin CCO (1978-1980)	Expanded services	Maximum of $425 a month per care plan (equivalent to roughly 60 percent of the Medicaid cost of skilled nursing care for the period)	No	Over 18 years At risk measured by functional criteria Medicaid-eligible
Project OPEN (1980-1983)	Expanded services	No	No	65 years or over At risk as measured by functional criteria Medicare-eligible
South Carolina LTC (1980-1984)	Expanded services	Maximum of 75 percent of the average of the Medicaid ICF and SNF rates	Yes	Medicaid-eligible 18 years or over At risk measured by nursing home preadmission screen
Florida Pentastar (1981-1983)	Expanded services	No	No	Medicaid-eligible Over 60 years At risk as measured by functional criteria
San Diego LTC (1981-1983)	Expanded services	No	No	Medicare-eligible 65 years or over At risk as measured by functional criteria
Channeling (1982-1984)
-- Basic Case Management Model	Expanded services	Limited aggregate project funds for gap-filling services; specific cost control mechanisms at descretion of the local project	Cost sharing used at discretion of local project	65 or over Service need At risk as measured by functional criteria
-- Financial Control Model	Medicaid/Medicare, expanded services	Cap of 60 percent of the average of Medicaid ICF and SNF rates for the average care plan; maximum of 85 percent for individual care plan	Yes	65 or over Service need At risk as measured by functional criteria Eligible for Medicare Part A
NONRANDOMIZED DESIGN
Triage (1976-1979)^a	Expanded services (plus dental, glasses, hearing aids)	No	No	Over 60, Medicaid-eligible Need multiple services Reside in unstable situation
ACCESS (1977-1980)^a	Medicaid and expanded services	Maximum of 75 percent of the average of the Medicaid ICF and SNF rates	Yes	18 years or over Service need; at risk measured by nursing home preadmission screen Medicaid-eligible (Phase I)
On Lok (1979-1983)	Expanded services^b	No	No	55 years or over Eligible for nursing home placement as measured by need for 24-hour nursing Nursing-home certifiable
MSSP (1980-1983)	Expanded services	Maximum of 70 percent of the Medicaid SNF rate	No	Medicaid-eligible 65 years or over At risk of nursing home placement as measured by: Nursing home placement or application Recent hospitalization Over 75 Mental disorientation or loss of major caregiver
Nursing Home Without Walls (1980-1983)	Expanded services	Maximum of 75 percent of the average of the Medicaid ICF and SNF rates	No	No age requirement Eligible for nursing home placement based on New York state nursing home preadmission assessment instrument (not actual applicant)
New York City Home Care (1980-1983)	Expanded services	No	No	Medicare, Part B 65 years or over At risk measured by functional criteria
These demonstrations also included second generation projects which altered the original interventions. For example, ACCESS received a Medicare waiver to serve a broader target group in its second generation. The Access waiver also allowed the project to reimburse nursing homes at a higher rate in cases of high care clients awaiting hospital discharge without other options. On Lok also included authorization for institutional long term care services.

TABLE 4. Sample Characteristics
Demonstration (evaluation period)	Percent 75+^a	Percent White	Percent Female	Percent Married	Percent Living Alone	Percent Disabled on At Least One ADL	Percent Impaired on At Least One IADL	Percent Incontinent	Mental Status (Average Number Wrong 0-10)
RANDOMIZED DESIGN
Worcester Home Care (1973-1975)	--	--	71	29	43	41	--	--	--
NCHSR 222 (1975-1977)^b	55	91	75	--	53	77	--	--	--
Georgia AHS (1977-1980)	--	53	74	25	33	60	--	--	3.1
Wisconsin CCO (1978-1980)^c	37	71	80	12	48	62	97	--	--
Project OPEN (1980-1983)^c	--	69	70	31	55	50	81	24	0.6
South Carolina LTC (1980-1984)	--	77	69	28	28	95^d	97^d	58^d	3.6
Florida Pentastar (1981-1983)^c	--	56	83	18	53	58	97	22	1.4
San Diego LTC (1981-1983)^c	67	98	69	44	52	55	97	43	2.3
Channeling (1982-1984)	73	73	71	32	37	84	100	53	3.5
NONRANDOMIZED DESIGN
Triage (1976-1979)^c	73	--	72	44	39	54	94	--	1.7
ACCESS (1977-1980)^c	80	70	92	23	--	82	99	44	2.4
On Lok (1979-1983)^c	--	22	49	30	46	85	93	60	3.2
MSSP (1980-1983)^c	--	68	71	23	51	61	80	47	1.7
Nursing Home Without Walls (1980-1983)	--	82	79	16	46	76	--	--	--
New York City Home Care (1980-1983)^c	68	69	78	45	35	78	100	38	2.6
Not given for programs admitting clients under 65 unless data for 65 and over sample were available. Percentages refer to homemaker services sample. Data for this project come from the final report of Berkeley Planning Associates, 1985. For South Carolina, percent disabled on at least one ADL, percent impaired on at least one IADL, and percent incontinent are from the final report of Berkeley Planning Associates, 1985.

TABLE 5. Percent Receiving Direct Services from the Demonstrations
Demonstration (evaluation period)	Direct Services Received (percent)
RANDOMIZED DESIGN
Worcester Home Care (1973-1975)	59
NCHSR Day Care/Homemaker Experiment (1975-1977) Day care Homemaker Combined	75 80 92
Georgia AHS (1977-1980)	80
Wisconsin CCO (1978-1980)	75
Project OPEN (1980-1983)	94
South Carolina LTC (1980-1984)	52
Florida Pentastar (1981-1983)	--
San Diego LTC (1981-1983)	100
Channeling (1982-1984) Basic model Financial model	78 82
NONRANDOMIZED DESIGN
Triage (1976-1979)	--
ACCESS (1977-1980)	--
On Lok (1979-1983)	--
MSSP (1980-1983)	--
Nursing Home Without Walls (1980-1983)	--
New York City Home Care (1980-1983)	98
NOTE: Receipt of direct services is defined as receipt of a formal service which is arranged and paid for by the project. For channeling, it was defined as completing the initial care plan. Some comparisons across projects are potentially misleading because some projects were designed to rely on existing programs before spending project funds, while others (including the channeling financial control model) were to use project funds for all services.

TABLE 6. Direct Services Covered
Demonstration (evaluation period)	Services Paid for by Project						Direct Service Expenditures Per Client Per Month (dollars)^c	Major Categories of Service Expenditures (percent receiving service)
Demonstration (evaluation period)	Physicians Hospitals and Nursing Homes	Medical Day Care and Other Medical Services	Nursing, Therapy, and Mental Health Counseling	Home Health Aide, Personal Care, Homemaker, and Other In-Home Care^a	Means and Transportation	Other^b
RANDOMIZED DESIGN
Worcester Home Care (1973-1975)	No	No	Visiting nurse	Homemaker, chore, escort	Transportation	Linen	54	Transportation (35) Homemaker (33) Chore (27) Visiting Nurse (22) Linen (7) Escort (1)
NCHSR Day Care/Homemaker Experiment (1975-1977)
-- Day Care	No	Medical day care	Part of medical day care	No	Transportation to day care, meals at day care	--	281	--
-- Homemaker	No	No	No	Homemaker, personal care, help with shopping, escort	Transportation as part of escort service	--	232	--
-- Combined	No	Medical day care	Part of medical day care	Homemaker, personal care, help with shopping escort	Transportation to day care or as part of escort service		243	--
Georgia AHS (1977-1980)	No	Medical day care	Skilled nursing, therapies	Personal care, homemaker, home health aides^d	Home-delivered meals		152	Home-delivered meals (50) Adult day care (11) In-home personal service (11)
Wisconsin CCO (1978-1980)	No	Medical day care	Skilled nursing, therapies	Personal care, home health aides, companions	Transportation, home-delivered meals	Respite	131	Transportation (57) Home-delivered meals (56) Homemaker (52) Personal care (46) Social or medical day care (32) Home health aide (13)
Project OPEN (1980-1983)	No	Medical day care	Mental health counseling,^e nursing,^e therapies^e	Homemaker/ chore,^e home health aides^e	Home-delivered meals, transportation	Respite, Interpreter	342	Homemaker (63) Escort transportation (57) Eyeglasses/ prosthetic devices (55) Physician services (50) Drugs (46)
South Carolina LTC (1980-1984)	No	Medical day care	Medical social services, therapies	Personal care	Home-delivered meals	Respite	77	Personal care (34) Medical day care (5) Therapies (3) Home-delivered meals (2) Medical social services (7) Respite (4)
Florida Pentastar (1981-1983)	No	Medical day care	Skilled nursing care, therapies	Personal care, home health aides	Medical transportation	Pest control, respite	202	Homemaker (78) Medical transportation (72) Personal care (51) Medical therapies (29)
San Diego LTC (1981-1983)	No	Medical day care	Skilled nursing	Home health aide, homemaker	Transportation, home-delivered meals	Health education	333	Home education (95) Homemaker/ home health aide (80) Transportation (47) Skilled nursing (35)
Channeling (1982-1984)
-- Basic Model	No	Medical day care, medical equipment	Skilled nursing, therapies, mental health counseling	Homemakers/ personal care, home health aides, companions, housekeeping/ chore	Home-delivered meals, transportation	Respite care, foster care, housing assistance	38	Homemaker/ home health aide (75)^h Meals (4.5) Transportation (4.5) Day Care (3.7) Other (12.3)
-- Financial Model	No	Medical day care, medical equipment	Skilled nursing, therapies, mental health counseling	Homemakers/ personal care, home health aides, companions, housekeeping/ chore	Home-delivered meals, transportation	Respite	471	Homemaker/ home health aide (70)^h Skilled nursing (11) Home-delivered meals (5) Therapies (4) Other (10)
NONRANDOMIZED DESIGN
Triage (1976-1979)	No	Dental care, glasses, hearing aids	Nursing, therapies	Homemaker, home health aide	Home-delivered meals		--	--
ACCESS (1977-1980)	Increased physician reimbursement for home visits^f	No	Traditional Medicaid coverage	Homemaker, chore, friendly visiting	Transportation	Respite care, housing improvement, foster care	--	--
On Lok (1979-1983)	Hospitalization, nursing home use, hospice	Medical day care services, physician services	Nursing, therapies	Homemaker, home health aide, personal care	Home-delivered meals, transportation	Nutrition group exercise	1,518^g	--
MSSP (1980-1983)	No	Day care	Nursing	In-home supportive services, personal care	Transportation, home-delivered meals	Protective services, legal services, housing	--	Homemaker/ chore (67) Medical transportation (40) Nonmedical transportation (35) Personal care (27) Meals (16)
Nursing Home Without Walls (1980-1983)	No	No	Skilled nursing, therapies, respiratory therapies, medical social services	Homemaker, home health aide	Transportation, congregate meals, home-delivered meals	Moving assistance, housing improvements, respite, nutrition counseling	12	--
New York City Home Care (1980-1983)	No	Prescription drugs	No	Homemaker, personal care	Transportation		446	Homemaker (99.8) Transportation (67) Drugs (67)
Also includes companion, chore, and other in-home services. Includes a range of services such as linen service, various types of respite care, housing assistance, legal assistance, nutrition counseling, and foster care. Some comparisons across projects are potentially misleading because some projects were designed to rely on existing programs before spending project funds, while others (including the channeling financial control model) were to use project funds for all services. Dollar amounts are converted to constant dollars for the first quarter of 1984, using the GNP implicit price deflator. Georgia AHS offered these services in-home and in alternative living arrangements such as personal care homes. Project OPEN also paid deductibles and copayments on these services. In a second phase, ACCESS added funds to pay nursing homes for high care hospital patients. On Lok expenditures include all long term services in both community and institutions. Channeling data are percent of total project expenditures for the service rather than percent of clients receiving the service.

TABLE 7. Caseload Per Case Manager
Demonstration (evaluation period)	Caseload per Case Manager
RANDOMIZED DESIGN
Worcester Home Care (1973-1975)	--
NCHSR Day Care/Homemaker Experiment (1975-1977)	--
Georgia AHS (1977-1980)	--
Wisconsin CCO (1978-1980)	55-60
Project OPEN (1980-1983)	45-60
South Carolina LTC (1980-1984)	75-80
Florida Pentastar (1981-1983)	--
San Diego LTC (1981-1983)	--
Channeling (1982-1984) -- Basic model -- Financial model	45 49
NONRANDOMIZED DESIGN
Triage (1976-1979)	125
ACCESS (1977-1980)	--
On Lok (1979-1983)	--
MSSP (1980-1983)	55
Nursing Home Without Walls (1980-1983)	--
New York City Home Care (1980-1983)	50

TABLE 8. Informal Caregiving
Demonstration (evaluation period)	Measure	Results
RANDOMIZED DESIGN
Worcester Home Care (1973-1975)	Availability of and resiliency of informal support system (7 items)	No difference
NCHSR Day Care/Homemaker Experiment (1975-1977)	--	--
Georgia AHS (1977-1980)	--	--
Wisconsin CCO (1978-1980)	--	--
Project OPEN (1980-1983)	Type and amount of informal services received	No differences
South Carolina LTC (1980-1984)^a	Type and amount (days per month) of informal assistance for ADL and IADL tasks	No differences
Florida Pentastar (1981-1983)	--	--
San Diego LTC (1981-1983)^a	Type and amount (episodes) of informal assistance for ADL and IADL tasks	No difference in ADL help, significant decline in amount of IADL help especially in housekeeping and meal preparation
Channeling (1982-1984)
-- Basic Model	Type and amount of informal care received	No differences
-- Basic Model	Effects on caregivers (life quality, stress, personal and employment limitations)	Caregivers of treatment group members reported significantly higher life quality and fewer limitations on privacy and social lives at 6 months
-- Financial Control Model	Type and amount of informal care received	No differences in number of visits received or hours of care from primary caregivers. Reductions (significant at 6 or 12 months or both) in the percent receiving care from visiting caregivers and from friends and neighbors, or relatives other than spouses or children; and in the percent receiving help with housework/laundry/shopping, meal preparation, money management, delivery of prepared meals, transportation, and general supervision. Increases in the percent receiving help with medical treatments (significant at 6 months).
-- Financial Control Model	Effects on caregivers (life quality, stress, personal and employment limitations)	Caregivers of treatment group members reported higher life quality (significant at 6 and 12 months), greater satisfaction with service arrangements (significant at 6 and 12 months), and greater confidence in receipt of care (significant at 6 months).
NONRANDOMIZED DESIGN
Triage (1976-1979)	--	--
ACCESS (1977-1980)	--	--
On Lok (1979-1983)	--	--
MSSP (1980-1983)	--	--
Nursing Home Without Walls (1980-1983)	--	--
New York City Home Care (1980-1983)	Availability of caregivers	No difference
	Type and amount (days per week) of informal assistance for ADL and IADL tasks	Treatment group members of subgroup with higher level of informal support at baseline had more informal help with ADL tasks -- significant at 6 and 12 months; treatment group members of subgroup with lower level of impairment received less informal help with IADL tasks -- significant at 6 months.
	Type and amount of informal assistance for ADL and IADL tasks^a	Treatment group members had more days of informal help with ADL tasks -- significant at 12 months; treatment group members in subgroup with low impairment had fewer days of informal help with IADL tasks -- significant at 12 months.
Results reported are from the final report of Berkeley Planning Associates, 1985.

TABLE 9. Nursing Home and Hospital Use During the 12 Months Following Enrollment
Demonstration (evaluation period)	Nursing Home Use				Hospital Use
	Percentage Admitted		Number of Days^a		Percentage Admitted		Number of Days^a
	Treatment Group Mean	Nonprogram Group Mean	Treatment Group Mean	Nonprogram Group Mean	Treatment Group Mean	Nonprogram Group Mean	Treatment Group Mean	Nonprogram Group Mean
RANDOMIZED DESIGN
Worcester Home Care (1973-1975)^b	--	--	49	50	--	--	4	4
NCHSR Day Care/Homemaker Experiment (1975-1977)^c
-- Day care -- Homemaker -- Combined	-- -- --	-- -- --	5 3 4	7 4 5	-- -- --	-- -- --	11 16 15	12 16 16
Georgia AHS (1977-1980)	15	16	22	29	--	--	6	4
Wisconsin CCO (1978-1980)^d	15	16	25	33	11*	17	3*	12
Project OPEN (1980-1983)^e,f	4	5	.1	.3	19	26	9	12
South Carolina LTC (1980-1984)	42*	58	90*	130	44	39	18	20
Florida Pentastar (1981-1983)^g	8	8	--	--	--	--	--	--
San Diego LTC (1981-1983)^c	--	--	.5	.9	46	46	9	10
Channeling (1982-1984)^f,h
-- Basic Model -- Financial Model	8 11	11 11	29 26	32 30	36 39	36 38	19 26	20 27
NONRANDOMIZED DESIGN
Triage (1976-1979)^e,j	10	4	6	4	37	21	8	6
ACCESS (1977-1980)^l	--	--	--	--	--	--	--	--
On Lok (1979-1983)^j,k	49	56	20*	117	20	57	6	8
MSSP (1980-1983)^j,l	--	--	39	22	--	--	20	9
Nursing Home Without Walls (1980-1983)^l
-- Upstate Project -- New York City Project	-- --	-- --	6* 5*	99 40	-- --	-- --	19 18	16 16
New York City Home Care (1980-1983)^l	7	7	--	--	39	42	11	15
Estimates of number of days are from the final report of the Berkeley Planning Associates 1985 for Project OPEN, San Diego, on On Lok. Worcester Home Care estimates are converted to days from mean percent of time institutionalized (or hospitalized) which was reported. San Diego LTC and NCHSR day care/homemaker results are based on Medicare data. Wisconsin measured outcomes over a 14-month period using only Medicaid data. The 14-month unadjusted figures for percent admitted are reported. Number of days have been prorated to 12 months. For Project OPEN and Triage, nursing home days include skilled facility days only. For Project OPEN and channeling, percent admitted to a hospital or a nursing home are for the 6-12 month period. Florida Pentastar data on percent admitted are for the 1-18 month period. Channeling estimates of days are the sum of estimates for the first and second six months after randomization for those alive at the beginning of the period. Standard comparisons were not made for the Access project; rather the study compared Medicaid costs in Monroe County to six comparison counties. Medicaid costs for nursing homes rose 5.7 percent in Monroe County compared to 26.8 percent for the six comparison counties between 1976 and 1980, suggesting nursing home placement may have been reduced. Hospital expenditures increased 36.3 percent from 1976 to 1980 in Monroe County as compared with 37 percent in the six comparison counties. No statistical tests were reported. On Lok data on percent admitted are for the 1-24 month period. For MSSP and Nursing Home Without Walls, days are average per month for one year period multiplied by 12. * Different from zero statistically at the 5 percent significance level, using a two-tail test.

TABLE 10. Physician and Other Medical Service Expenditures (dollars per month)
Demonstration (evaluation period)	Physician Expenditures		Outpatient Expenditures		Other Expenditures
Demonstration (evaluation period)	Treatment Group Mean	Nonprogram Group Mean	Treatment Group Mean	Nonprogram Group Mean	Treatment Group Mean	Nonprogram Group Mean
RANDOMIZED DESIGN
Worcester Home Care (1973-1975)	--	--	--	--	--	--
NCHSR Day Care/Homemaker Experiment (1975-1977)	--	--	--	--	--	--
Georgia AHS (1977-1980) (Medicare and Medicaid)	29	47	10	10	29^a	26^a
Wisconsin CCO (1978-1980) (Medicaid)	--	--	569^b	740^b	212^c	263^c
Project OPEN (1980-1983)	--	--	--	--	--	--
South Carolina LTC (1980-1984)	89	61	25	9	231^c	179^c
Florida Pentastar (1981-1983)	--	--	--	--	--	--
San Diego LTC (1981-1983)	--	--	--	--	--	--
Channeling (1982-1984)^d
-- Basic Model -- Financial Model	102 138	97 136	-- --	-- --	47 58	43^e 56^e
NONRANDOMIZED DESIGN
ACCESS (1977-1980)	--	--	--	--	--	--
Triage (1976-1979)	45	21	8	2	60	24
On Lok (1979-1983)	--	--	--	--	--	--
MSSP (1980-1983)	--	--	--	--	--	--
Nursing Home Without Walls (1980-1983)
-- Upstate -- New York City	-- --	-- --	-- --	-- --	-- --	-- --
New York City Home Care (1980-1983)	--	--	--	--	--	--
NOTE: All dollar amounts are converted to constant dollars for the first quarter of 1984, using the GNP implicit price deflator. Time periods to which the original cost data apply are shown in Table 16. Drugs and Other. Physician and outpatient. Drugs. Channeling estimates include services covered by Medicaid and Medicare and estimated deductibles and coinsurance associated with them. These include expenditures as well as other medical services.

TABLE 11. Mortality Rates 12 Months After Enrollment
Demonstration (evaluation period)	Percentage Deceased
Demonstration (evaluation period)	Treatmen/Enrollee Group Mean	Nonprogram Group Mean
RANDOMIZED DESIGN
Worcester Home Care (1973-1975)	13	16
NCHSR Day Care/Homemaker Experiment (1975-1977)
-- Day Care -- Homemaker -- Combined	17 30 21	18 35 24
Georgia AHS (1977-1980)	13	21*
Wisconsin CCO (1978-1980)	6	8
Project OPEN (1980-1983)	7	10
South Carolina LTC (1980-1984)	30	32
Florida Pentastar (1981-1983)	11	16^a,b
San Diego LTC (1981-1983)	21	23
Channeling (1982-1984)
-- Basic Model -- Financial Model	27 27	30 27
NONRANDOMIZED DESIGN
Triage (1976-1979)	8	7^b
ACCESS (1977-1980)	--	--
On Lok (1979-1983)	15	23
MSSP (1980-1983)	--	--
Nursing Home Without Walls (1980-1983)
-- Upstate -- New York City	12 17	22* 24
New York City Home Care (1980-1983)	19	16
*Different from zero statistically at the 5 percent significant level, using a two tail test. At 18 months. No statistical tests reported.

TABLE 12. Unmet Needs
Demonstration (evaluation period)	Measure	Results
RANDOMIZED DESIGN
Worcester Home Care (1973-1975)	New needs developed after baseline	No differences
Worcester Home Care (1973-1975)	Architectural barriers	No differences
NCHSR Day Care/Homemaker Experiment (1975-1977)	--	--
Georgia AHS (1977-1980)	Satisfaction with service arrangements	Treatments more satisfied -- significant 12 months
Wisconsin CCO (1978-1980)	--	--
Project OPEN (1980-1983)	Physical environment checklist (20 item)	No differences
South Carolina LTC (1980-1984)	Berkeley Planning^a Dependency in ADL and IADL and inadequate informal help	Treatments with more unmet needs at 12 months -- significant
Florida Pentastar (1981-1983)	--	--
San Diego LTC (1981-1983)	Berkeley Planning^a Dependency in ADL and IADL and inadequate informal help	Treatments with more unmet needs in ADL at 12 months and IADL at 6 and 12 months -- significant
Channeling (1982-1984)
-- Basic Model	Unmet need index (8 item)	Treatments with fewer unmet needs at 12 months -- significant
	Physical environment checklist (6 item)	Treatments with fewer environmental hazards at 12 months -- significant
	Confidence and satisfaction with receipt of care	Treatments more confident and satisfied with care arrangements at 6 and 12 months -- significant both time periods
-- Financial Control Model	Unmet need index (8 item)	Treatments with fewer unmet needs at 6 and 12 months -- significant both time periods
	Physical environment checklist (6 item)	No differences
	Confidence and satisfaction with receipt of care	Treatments with more confidence and satisfaction with care arrangements at 6 and 12 months -- significant both time periods
NONRANDOMIZED DESIGN
Triage (1976-1979)	--	--
ACCESS (1977-1980)	--	--
On Lok (1979-1983)	--	--
MSSP (1980-1983)	--	--
Nursing Home Without Walls (1980-1983)	--	--
New York City Home Care (1980-1983)	Unmet ADL needs	Treatments with fewer unmet needs at 6 months -- significant
	Unmet IADL needs	Treatments with fewer unmet needs at 6 and 12 months -- significant
	Unmet medical needs	Treatments with fewer unmet needs at 6 and 12 months -- significant
	Physical environment (16 items)	Treatments with few problems with physical environment at 6 and 12 months -- significant
	Berkeley Planning^a Dependence in ADL and inadequate informal help	Treatments with more unmet needs at 6 and 12 months -- significant
	Dependence in IADL and inadequate informal help	Treatments with more unmet needs at 6 and 12 months -- significant
These measures were constructed by Berkeley Planning Associates in the context of measuring substitution of formal for informal care. For example, one of the categories of unmet needs was the presence of formal care (which was taken to imply that the available informal care was inadequate).

TABLE 13. Social/Psychological Well-Being
Demonstration (evaluation period)	Measure	Results
RANDOMIZED DESIGN
Worcester Home Care (1973-1975)	Emotional/psychological domain (35 items)	No differences
	Isolation/social contacts (15 items)	No differences
	Social activities (16 items)	No differences
NCHSR Day Care/Homemaker Experiment (1975-1977)	Contentment index	Day care, combined, and homemaker had higher contentment at 12 months -- significant for homemaker and combined samples^a
NCHSR Day Care/Homemaker Experiment (1975-1977)	Social activities	No differences for homemaker sample. Day care and combined had higher percent with maintained/improved social activity -- significant for combined sample.^a
Georgia AHS (1977-1980)	12-item morale scale	No differences
Wisconsin CCO (1978-1980)	8-item life quality measure	No differences
Project OPEN (1980-1983)	Social network scale checklist (20 items)	Treatment had more social contact -- significant at 6, 12, and 18 months
	Morale	No differences
	Psychological status	Treatments had higher scores at 6 months -- significant (but a significant difference at baseline)
South Carolina LTC (1980-1984)	--	--
Florida Pentastar (1981-1983)	Social activities (5 items)	Treatments reported more activities at 18 months -- significant
San Diego LTC (1981-1983)	PGC morale scale	Treatments had higher morale at 6 months -- significant
	Social resources and activities	No differences
	Self-perceived health	Treatments had higher self-perceived health at 6 months -- significant
Channeling (1982-1984)
-- Basic Model	Global life satisfaction (2 items)	Treatments had higher self-reported life quality at 6 months -- significant
	Contentment index (5 items)	No differences
	Self perceived health	No differences
	Social interaction and loneliness (2 items)	Treatments were less lonely at 12 months -- significant
-- Financial Control Model	Global life satisfaction (2 items)	Treatments had higher self-reported life quality at 6 and 12 months -- significant both time periods
	Contentment index (5 items)	No differences
	Self perceived health	No differences
	Social interaction and loneliness (2 items)	No differences
NONRANDOMIZED DESIGN
Triage (1976-1979)	--	--
ACCESS (1977-1980)	--	--
On Lok (1979-1983)	Social requirements of living (social network, communication, personal fulfillment, service agency orientation)	Treatments had higher scores at 12 and 24 months -- significant
MSSP (1980-1983)	--	--
Nursing Home Without Walls (1980-1983)	--	--
New York City Home Care (1980-1983)	9-item morale scale	Treatments had higher morale at 12 months -- significant
New York City Home Care (1980-1983)	Social contacts	Treatments with more social contacts at 6 and 12 months -- significant
The analysis sample included only those members of the treatment group who received program services and only those controls who did not receive services similar to the program.

TABLE 14. Functioning
Demonstration (evaluation period)	Measure	Results
RANDOMIZED DESIGN
Worcester Home Care (1973-1975)	ADL (measure not known)	No differences
NCHSR Day Care/Homemaker Experiment (1975-1977)	ADL (Katz)^a	No differences
Georgia AHS (1977-1980)	ADL (OARS)	No differences
Georgia AHS (1977-1980)	IADL	No differences
Wisconsin CCO (1978-1980)	ADL (OARS)	No differences
Project OPEN (1980-1983)	ADL (Katz)	No differences
Project OPEN (1980-1983)	IADL	No differences
South Carolina LTC (1980-1984)	ADL (measure not known)	Treatments significantly less disabled than controls at 6 months only
South Carolina LTC (1980-1984)	IADL	No differences
Florida Pentastar (1981-1983)	ADL (measure not known)	No differences
Florida Pentastar (1981-1983)	IADL	Treatments significantly more impaired at 12 months
San Diego LTC (1981-1983)	ADL (Katz)^b	Treatments significantly more disabled at 12 months Treatments significantly less disabled at 18 months
San Diego LTC (1981-1983)	Restricted Days	Treatments reporting lower number of restricted days -- significant at 6 months
Channeling (1982-1984)
-- Basic Model	ADL (Katz)	No differences
	IADL	No differences
	Restricted days	Treatments with fewer restricted days at 6 months -- significant
-- Financial Control Model	ADL (Katz)	Treatments more disabled at 6 and 12 months -- significant both time periods
	IADL	No differences
	Restricted days	No differences
NONRANDOMIZED DESIGN
ACCESS (1977-1980)	--	--
Triage (1976-1979)	ADL (Katz)	No differences
Triage (1976-1979)	IADL	No differences
On Lok (1979-1983)	ADL (measure not known)	No differences
On Lok (1979-1983)	IADL	Treatments less impaired at 12 months -- significant
MSSP (1980-1983)	ADL (Katz)	No differences
MSSP (1980-1983)	IADL	Treatments less impaired at 6 months -- significant
Nursing Home Without Walls (1980-1983)	ADL (Katz)	Treatments less disabled at 6 and 12 months -- significant for New York City sample
New York City Home Care (1980-1983)	ADL (Katz)^b	Treatments significantly more disabled at 12 months
New York City Home Care (1980-1983)	IADL	Treatments significantly mroe impaired at 12 months
The Katz measure was originally developed to be completed by clinicians (Katz et al. 1970). However, in most studies a self-reported measure asking whether the individual does perform the task was used. The OARS in contrast asks capacity, whether the respondent can perform the task. In these two studies both clinical observation and self-report measures were used, and no major differences in results were reported for the two approaches (personal communication, Capitman, October 1985).

TABLE 15. Case Management Costs (dollars)
Demonstration (evaluation period)	Case Management Cost per Client per Month
RANDOMIZED DESIGN
Worcester Home Care (1973-1975)	--
NCHSR Day Care/Homemaker Experiment (1975-1977)	--
Georgia AHS (1977-1980)	--
Wisconsin CCO (1978-1980)	--
Project OPEN (1980-1983)	128
South Carolina LTC (1980-1984)	49
Florida Pentastar (1981-1983)	--
San Diego LTC (1981-1983)	145
Channeling (1982-1984)^a -- Basic Model -- Financial Model	106 99
NONRANDOMIZED DESIGN
Triage (1976-1979)	--
ACCESS (1977-1980)	--
On Lok (1979-1983)	85
MSSP (1980-1983)	--
Nursing Home Without Walls (1980-1983)	--
New York City Home Care (1980-1983)	104
Channeling cost estimates differ from estimates persented elsewhere. For comparability with estimates available for other demonstrations, channeling case management costs have been divided by all months clients spent in channeling. They include reported in-kind costs and demonstration-related costs. Other estimates are based on Berkeley Planning Associates (1985) and have been converted to 1984 dollars. See Thornton, Will, and Davies. *The Evaluation of the National Long Term Care Demonstration: Analysis of Channeling Project Costs*. Table VI.1. [Executive Summary]

TABLE 16. Direct Service Costs (dollars per month)
Demonstration (evaluation period)	Time Period	Funding Sources	Nursing Home		Hospital		Community^a		Physician and Other Medical		Total
Demonstration (evaluation period)	Time Period	Funding Sources	Treatment	Control	Treatment	Control	Treatment	Control	Treatment	Control	Treatment	Control
RANDOMIZED DESIGN
Worcester Home Care (1973-1975)	26 months	Project	0	0	0	0	54	0	0	0	54	0
NCHSR 222 (1975-1977)
-- Day Care	12 months	Project Medicare Total	0 -- --	0 -- --	0 -- --	0 -- --	281 -- 281	0 -- --	0 -- --	0 -- --	281 533 813	0 534 534
-- Homemaker	12 months	Project Medicare Total	0 -- --	0 -- --	0 -- --	0 -- --	232 -- 232	0 -- --	0 -- --	0 -- --	232 864 1095	0 786 786
-- Combined^b	12 months	Project Medicare Total	0 -- --	0 -- --	0 -- --	0 -- --	243 -- --	0 -- --	0 -- --	0 -- --	243 1000 1243	0 847 847
Georgia AHS (1977-1980)	24 months	Project Medicaid Medicare Total	0 72 1 72	0 75 0 75	0 29 73 101	0 11 78 90	131 5 1 137	0 6 1 7	0 37 30 67	0 50 31 82	131 143 104 377	0 143 111 254
Wisconsin CCO (1978-1980)	14 months	Project Medicaid Total	0 70 70	0 97 97	0 58 58	0 158 158	188 84 271	0 133 133	0 92 92	0 119 119	188 307 494	0 507 507
Project OPEN (1980-1983)^c	35 months	Project Medicare Total	0 2 2	0 16 16	0 489 489	0 628 628	342 43 385	0 53 53	0 0 0	0 0 0	342 534 876	0 697 697
South Carolina LTC (1980-1984)	36 months	Project Medicaid Medicare Total	0 164 4 168	0 253 6 259	0 10 95 105	0 6 76 82	77 5 13 95	0 2 10 12	0 21 31 52	0 13 28 41	77 200 143 420	0 274 119 393
Florida Pentastar (1981-1983)^d	12 months	Project Food stamps Housing assistance Medicare/ Medicaid Other Public Total	0 0 0 -- 0 --	0 0 0 -- 0 --	0 0 0 -- 0 --	0 0 0 -- 0 --	202 43 27 -- 18 290	19 42 28 -- 21 110	0 0 0 -- 0 --	0 0 0 -- 0 --	202 43 27 207 18 497	19 42 28 199 21 312
San Diego LTC (1981-1983)^c	12 months	Project Medicare Medicaid Total	0 5 -- 5	0 8 -- 8	0 444 -- 444	0 473 -- 473	478 13 -- 491	0 63 -- 63	0 -- -- --	0 -- -- --	478 462 78 1018	0 543 129 672
Channeling (1982-1984)
-- Basic Case Management Model	18 months	Project Medicare Medicaid Other Public Clients and Families Total	0 11 67 0 45 123	0 15 62 1 68 145	0 440 17 0 29 486	0 426 23 0 28 477	108 128 27 63 324 650	-- 113 30 79 341 563	-- 116 13 0 24 153	-- 108 16 0 22 145	108 695 124 63 422 1412	0 661 131 80 459 1330
-- Financial Control Model	18 months	Project Medicare Medicaid Other Public Clients and Families Total	0 17 60 1 54 132	0 15 59 1 66 141	0 597 35 0 43 675	0 575 36 0 39 650	408 101 14 33 308 864	0 181 30 67 322 600	0 162 17 0 29 208	0 157 15 0 29 201	408 877 125 34 434 1878	0 928 140 68 456 1592
NONRANDOMIZED DESIGN
ACCESS (1977-1980)	--	--	--	--	--	--	--	--	--	--	--	--
Triage (1976-1979)	12 months	Diary accounting of costs (Total)	35	2	213	124	93	18	114	47	455	191
On Lok (1979-1983)^c	12 months	Project Diary accounting of costs Total	0 143 143	0 679 679	0 469 469	0 1145 1145	98 387 485	0 263 263	0 421 421	0 110 110	98 1420 1518	0 2198 2198
MSSP (1980-1983)	12 months	Medicaid Medicare Total	-- -- --	-- -- --	-- -- --	-- -- --	-- -- --	-- -- --	-- -- --	-- -- --	248 906 1154	164 362 606
Nursing Home Without Walls (1980-1983)
-- Upstate project	12 months	Medicare Medicaid Total	-- -- --	-- -- --	-- -- --	-- -- --	-- -- --	-- -- --	-- -- --	-- -- --	299 533 825	224 894 1117
-- New York City project	12 months	Medicare Medicaid Total	-- -- --	-- -- --	-- -- --	-- -- --	-- -- --	-- -- --	-- -- --	-- -- --	518 1143 1633	528 539 1159
New York City Home Care (1980-1983)^b	8 months	Project Medicare Medicaid Total	-- 3 -- 3	-- 10 -- 10	-- 554 -- 554	-- 527 -- 527	551 47 -- 598	0 50 -- 50	-- -- -- --	-- -- -- --	551 603 60 1215	0 598 124 713
NOTE: Costs per month were calculated by dividing costs reported for the time period by the number of months in the time period. All dollar amounts are converted to constant dollars for the first quarter of 1984, using the GNP implicit price deflator. Detail may not sum to total due to rounding. Includes case management and formal community services, wherever available. In the case of channeling, this column also includes room and board in the community. Project costs are understated and Medicare costs overstated by the costs of services received when a client was assigned to both services but received only one. Data came from the final report of Berkeley Planning Associates, 1985. The data from Project OPEN's final report (Skiar and Weiss, 1983) show treatments to have lower total costs, however. The Pentastar project reported the costs of the initial assessment for the control group members as project services for controls.