Long Term Care

“Health Care Organization and Incentives Under Emerging Models of Elderly Health Care” – Dept. of Health Administration and Policy [no date], 10 p. David R. Graber, Ph.D., M.P.H. and Anne Osborne Kilpatrick, D.P.A. Medical University of South Carolina, 171 Ashley Ave., Charleston, SC 29425

Brief article describing existing models of elderly health care that receive capitated payments, including:

    • Social HMOs (health maintenance organizations),
    • TEFRA (Tax Equity and Fiscal Responsibility Act) or risk-contract HMOs, and
    • PACE (Program for All-Inclusive Care for the Elderly) programs.

The potential significance of these programs for providing financial incentives, comprehensiveness of health care, volume of institutional services, and primary care orientation is analyzed. The three programs are compared with each other in terms of organizational issues, health care issues, and financial systems. A two-page reference list is included at the article’s end.

“The Olmstead Decision and Long-Term Care in California: Lessons on Services, Access, and Costs from Colorado, Washington, and Wisconsin” – California Health Care Foundation, December, 2003, 46 p.
Eliot Z. Fishman, Ph.D., Bruce C. Vladeck, Ph.D., Ann-Gel S. Palermo, M.P.H., and Margaret H. Davis, M.H.S.

In response to the 1999 Supreme Court decision in Olmstead v. L.C., this comprehensive report details positive programs in California which support the court’s findings and goes into more depth about the glaring problems in the state. These problems are:

  • Lack of intensive community services and residential options for frail elders and people with serious physical disabilities;
  • Lack of intensive outpatient and community mental illness treatments;
  • Lack of a substantial housing component to disabilities services; and
  • A fragmented state administrative structure.

Ultimately the authors recommend that the state could address these problems by redirecting resources currently spent on institutional care or by drawing federal Medicaid funds more effectively. The narrative includes information about Olmstead, the policy context in California, descriptions of programs for various disability groups; comparison of California’s program to similar ones in Colorado, Washington, and Wisconsin. Includes helpful graphs, charts, appendices, and endnotes. Recommendations for policy-makers and advocates are written in detail.