State Legislation, Policy & Reports
Arkansas, Florida, New Jersey: Final Report on Cash and Counseling Programs
Mathematica Policy Research, Inc. released its final report of the Cash and Counseling programs in Arkansas, Florida and New Jersey. The report, "Cash and Counseling: Improving the Lives of Medicaid Beneficiaries Who Need Personal Care or Home- and Community-Based Services" by Randall Brown and his colleagues, summarizes the findings from five years of research on how each of the three demonstration states implemented their Cash and Counseling programs. The report reveals how the programs, which allow Medicaid recipients to manage their own budget for home care and other services, affected the participating care recipients, their family caregivers, their hired home care workers, and the costs to Medicaid. For more information, visit:
Mathematica Policy Research, Inc.
Updated State Data in Family Caregiver Alliance's "Caregiving Across the States" Interactive Database
The National Center on Caregiving at Family Caregiver Alliance (FCA) has updated and added new information to its online resource, "Caregiving Across the States." New and/ or updated data in the state profiles include the number of family caregivers, the annual number of caregiving hours, the monetary value of family caregiving, the average daily cost in a nursing home, the average monthly cost for assisted living, the average daily cost for adult day services, the average hourly costs for home health care and personal care, and the median hourly wages for certified nursing assistants, home health aides and personal care aides. This interactive database is a valuable resource to inform state administrators and policymakers about support programs for family caregivers. For more information, visit:
Family Caregiver Alliance
Federal Legislation, Policy & Reports
Federal Spending Bill for FY 2008 Signed Into Law: Decreases Funding for NFCSP, No Funding for Lifespan Respite Care Act
After President Bush vetoed the Fiscal Year (FY) 2008 Labor, Health and Human Services and Education Appropriations legislation (H.R. 3043) sent to him in November, he signed a newly drafted omnibus appropriations bill (H.R. 2764) that Congress passed in December. While the new law increases the Administration on Aging (AoA) budget by $30.4 million, about 2.2% above last year's budget, it also cuts funding for some important programs. The bill decreases funding for the National Family Caregiver Support Program by $2.7 million, down from $156 million in FY 2007. Furthermore, the bill does not include any funding for the Lifespan Respite Care Act, although the vetoed bill had included $2 million for this new program. The new law slightly increases funding for various senior nutrition programs. The final appropriation for AoA is $78.3 million above the President's original request. For more information, visit:
Data Report on Medicaid Home and Community-Based Service Programs
The Kaiser Family Foundation released a Data Update in December, "Medicaid Home and Community-Based Service Programs," which presents trends in expenditures and participation in home and community-based services (HCBS) according to the most recent Medicaid data. "Total enrollment in Medicaid HCBS programs increased 5 percent with more than 2.7 million individuals being served through these programs in 2004." Overall spending on Medicaid HCBS increased 11 percent to $31.2 billion. The report examines Medicaid's optional 1915(c) HCBS waivers, the mandatory home health benefit and the optional state plan personal care services benefit. For more information, visit:
Kaiser Family Foundation
International Review of Family Caregivers and Labor Force Participation
An article in the December 2007 issue of the The Milbank Quarterly (Volume 85, Number 4) evaluates international research on family caregivers and their labor market choices. The article by Meredith Lilly and her colleagues, "Labor Market Work and Home Care's Unpaid Caregivers: A Systematic Review of Labor Force Participation Rates, Predictors of Labor Market Withdrawal, and Hours of Work," reveals that caregivers are equally likely to be in the labor market compared to noncaregivers, caregivers tend to work fewer hours than noncaregivers, and only those with intense caregiving responsibilities are significantly more likely than noncaregivers to withdraw from the labor market. For more information, visit:
The Milbank Quarterly
Research Reports & Journal Articles
Geriatric Care Management Program Shows Beneficial Results
An article in the December 12, 2007 issue of JAMA, the Journal of the American Medical Association, reveals that a home-based geriatric care program for low-income older adults resulted in higher quality medical care, improvement in quality of life and fewer emergency department visits. The article, "Geriatric Care Management for Low-Income Seniors" by Dr. Steven Counsell and his colleagues, examines a model of care called Geriatric Resources for Assessment and Care of Elders (GRACE). This model features in-home assessment and care management, extensive use of specific care protocols for evaluation and management of common geriatric conditions, electronic medical records, an online care management tool, and integration of an array of geriatric care services. The intervention did not appear to prevent decline in patients' physical functioning. For more information, visit:
"Medicare and Medicaid: Conflicting Incentives for Long-Term Care"
The December 2007 issue of the The Milbank Quarterly (Volume 85, Number 4) includes an article by David Grabowski , "Medicare and Medicaid: Conflicting Incentives for Long-Term Care," which examines the conflicts within the structure of Medicare and Medicaid that result in a lack of care coordination for dually eligible beneficiaries. The article explains that various factors, including Medicare's cost-sharing rules, cost shifting within home health care and nursing homes and across chronic and acute care settings, contribute to a system in which neither program "has an incentive to take responsibility for the management or quality of care." The article provides several policy proposals, along with their strengths and weaknesses, which address those factors. For more information, visit:
The Milbank Quarterly
Study Shows Cost Benefits from Consumer-Directed Care Model
An article in the most recent issue of the Care Management Journals (Volume 8, Number 4) reports on a study that compared the cost differences between three approaches to care management within the same home care context. In the first approach, the system's case manager had decision-making authority and control over service provision. In the second, case managers and care recipients shared the responsibility and accountability for the management of care and services. In the third approach, care recipients, and in some cases their family caregivers, directed their own case management. The article, called "Can We Afford Consumers Choice in Home Care?" by Carol McWilliam and her colleagues, revealed that the average costs per month for services in the three groups did not differ significantly over 6 or more months, but care recipients with direct involvement in their case management had significantly lower cost increases from month to month compared to clients with little control over their care. For more information, visit:
Care Management Journals
Conferences & Trainings
Save the Date: n4a Aging Policy Briefing and Capitol Hill Day April 28-30
The National Association of Area Agencies on Aging (n4a) is hosting an Aging Policy Briefing and Capitol Hill Day April 28-30, 2008 in Washington, DC. The event will inform participants about the outlook in Congress on issues related to Older Americans Act funding, the Medicare prescription drug program, long-term care and more. It will also include a day of advocacy with Members of Congress. For more information, visit:
Funding, Media & Miscellaneous
AARP Profiles Presidential Candidates' Caregiving Experiences and Views on Long-Term Care
An article in the December 2007 issue of the AARP Bulletin profiles the presidential candidates' experiences with caring for their aging parents and their views on long-term care reform. In discussing the candidates' varied family caregiving situations, the article, "Candidates as Caregivers" by Frank Cook and Pat Remick, touches on issues related to in-home care, affordability of services, Medicaid and Medicare reform, long-term care insurance, residential facilities, and family and medical leave. The article covers 13 of the top candidates in the Republican and Democratic primaries. For more information, visit:
"Since You Care: Hiring An Independent Caregiver"
MetLife recently released a consumer guide called "Hiring an Independent Caregiver," one in a series of guides called "Since You Care" done in cooperation with the National Alliance for Caregiving. It provides information for family caregivers about locating potential home care aides, screening applications, conducting interviews, running background checks and administering payroll, including social security and other taxes. It also provides helpful resources, including books, publications, websites and a sample contract. For more information, visit:
MetLife Mature Market Institute
©2008 Family Caregiver Alliance. All rights reserved.
The National Center on Caregiving at Family Caregiver Alliance works to advance the development of high-quality and cost-effective policies and programs for caregivers in every state in the country. The National Center is a central source of information and technical assistance on family caregiving for policymakers, health and service providers, program developers, funders, media and families. For questions or further information about the National Center on Caregiving, contact [email protected] or visit the Family Caregiver Alliance website at www.caregiver.org.
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