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Purpose of the Study: Medicaid service use and expenditure and quality of care outcomes in California's personal care program known as In-Home Supportive Service (IHSS) are described. Analyses investigated Medicaid expenditures, hospital use, and nursing home stays, comparing recipients who have paid spouse caregivers with those having other relatives or unrelated individuals as their caregivers. Design and Methods: Medicaid claims and IHSS assessment data for calendar year 2005 were linked for IHSS recipients aged 18 years or older (n = 386,447). Results: The rates of ambulatory care-sensitive hospital admissions and Medicaid-covered nursing home placements were at least comparable among IHSS recipients' with spouse, parent, other relative, or nonrelative caregivers. Statistically significant differences reflected more desirable outcomes for those with relatives as paid caregivers. In no comparisons did those with spouse providers have worse outcomes than those with nonrelative providers. Average monthly Medicaid expenditures for all services were also lower for IHSS recipients with family provider. Implications: There were no financial disadvantages and some advantages to Medicaid in terms of lower average Medicaid expenditures and fewer nursing home admissions when using spouses, parents, and other relatives as paid IHSS providers. This argues in favor of honoring the recipient's and family's preference for such providers.

Purpose: The purpose of this study was to obtain a profile of individuals with private long-term care (LTC) insurance as they begin using paid LTC services and track their patterns of service use, satisfaction with services and insurance, claims denial rates, and transitions over a 28-month period. Design and Methods: Ten LTC insurance companies contributed a random sample of 1,474 qualified individuals who were interviewed in-person by a trained nurse and then interviewed telephonically every 4 month for a 28-month period. Used in the analysis were descriptive statistics and techniques for analyzing longitudinal panel data. Results: About 96% of those filing claims were approved for payment. At baseline, 37% received home care, 23% assisted living care, 14% were in a nursing home, and 26% had not yet begun using paid care. Few claimants reported that their policies restricted their choice of providers and most care costs were covered. The average number of care transitions was 1, typically occurring within 4 month of baseline. The less impaired and those in home care settings were most likely to transition between service settings. Implications: Having private LTC coverage enabled claimants to exercise their preference for alternatives to nursing home care.

Purpose: The purpose of this study was to obtain a profile of individuals with private long-term care (LTC) insurance as they begin using paid LTC services and track their patterns of service use, satisfaction with services and insurance, claims denial rates, and transitions over a 28-month period. Design and Methods: Ten LTC insurance companies contributed a random sample of 1,474 qualified individuals who were interviewed in-person by a trained nurse and then interviewed telephonically every 4 month for a 28-month period. Used in the analysis were descriptive statistics and techniques for analyzing longitudinal panel data. Results: About 96% of those filing claims were approved for payment. At baseline, 37% received home care, 23% assisted living care, 14% were in a nursing home, and 26% had not yet begun using paid care. Few claimants reported that their policies restricted their choice of providers and most care costs were covered. The average number of care transitions was 1, typically occurring within 4 month of baseline. The less impaired and those in home care settings were most likely to transition between service settings. Implications: Having private LTC coverage enabled claimants to exercise their preference for alternatives to nursing home care. Key Words: LTC insurance, LTC services use and transitions, claims denial rates, care management doi: 10.1093/geront/gnq021

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). Multivariage 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. Key Words: Work, Weekly hours of care, Paid care, Female labor force participation

Medicaid spenddown is the process by which people in need of long-term or catastrophic care must use all of their assets before they are eligible for Medicaid coverage. Medicaid is an important source of long-term care financing because of the high costs of obtaining services such as nursing home or community care. It is of concern that the elderly are being forced into poverty before Medicaid steps in to help them. There has been little research performed to investigate the time it takes to spenddown assets, and just how frequently this occurs. In an effort to gain further information, the 1982 and 1984 National Long-Term Care Surveys (NLTCS) were consulted. The 1985 National Nursing Home Survey was evaluated as well for data on payment sources of nursing home residents upon admission and upon discharge. Analysis of the data suggests that over 90 percent of people discharged from nursing homes either had Medicaid when they were admitted or never spenddown to become eligible. There is evidence that most nursing home stays are short, which may be one explanation. The problem is that while these people may not have spent-down to Medicaid eligibility, their life-savings may have been wiped out. Interesting, private-pay patients fall into the short-stay category, while Medicaid recipients tend to have longer stays. There is evidence that it is more common for persons receiving community care, rather than nursing home residents, to spenddown sufficiently to become Medicaid eligible. The 1988 Medicare Catastrophic Coverage Act will help to reduce the risk of spending down to the point of impoverishment by providing assistance before people are eligible for Medicaid. Hopefully, this will help decrease the number of people who may be reduced to poverty, and are still ineligible for Medicaid. (Consumer Summary produced by Reliance Medical Information, Inc.)

In its role as a broker between the scientific community and the Congress, the Office of Technology Assessment evaluates the soundness of scientific conclusions for policy makers and ensures that research findings are included in formative policy analysis. (Author)