A medicare adult day care model: proposed criteria and available supply

The study on which this article is based addressed the issue of the proportion of adult day care centers (ADCs) existing in 1986 that would qualify for Medicare funding under the 1989 U.S. Senate Medicare Adult Day Care Amendments. It also estimated the impact of the criteria on two policy-relevant subgroups of ADCs-that is, Alzheimer's vs. non-Alzheimer's and rural vs. urban-using data from a 1986 national census survey of ADCs. The five proposed Medicare criteria and the percentage of ADCs meeting them were: services to be provided directly, 14.6%; multi-disciplinary team, 20%; services to be provided directly or indirectly, 16%; program activities, 42%; and other, 53%. Only 3% met all five criteria while 13% met four out of five. Alzheimer's centers met the criteria more often than non-Alzheimer's centers, while urban centers qualified more often than rural centers. Based on the findings, implications for Medicare funding policy are discussed.     

Financial Exploitation of Older Adults in Rural Settings: A Family Perspective

Federal agencies responsible for funding protective services to older adults are increasingly concerned with the growing incidence of financial exploitation in rural areas. The Wall Street Journal recently has reported an increasing trend of unemployed adult children migrating from urban centers to smaller rural towns and countrysides to live with their parents since 2008. This current study explores the attitudes of family caregivers regarding management of financial matters for their elderly care recipients. The major findings of the study include that adult children often (1) overestimate their parents' ability to manage their finances; (2) prefer to manage their parents' finances informally, as opposed to using legal options like power of attorney; and (3) tend to think of their parents' assets as “almost theirs.” The study concludes with recommendations on the critical need for information to help families make important decisions about helping elderly parents with their finances. This information would not only promote the use of safeguards against abuse, but could potentially provide caregivers with greater confidence and protection.     

Staffing,retention, and government funding: A case study

This study analyzes the implications of government‐contract funding on the staffing pattern of a nonprofit agency, the Canadian Red Cross, Toronto Region. Furthermore, the study explains the implications of the staffing pattern on services and on the agency's organization. Staffing is one area that the literature on nonprofit organizations has not adequately addressed. The findings indicate that contract‐based funding leads to the hiring of temporary staff and affects the retention of employees. Although contract funding has some benefits, temporary staffing is detrimental to the agency's services. It affects not only employee recruitment and retention but also training. The results highlight how change in government funding from grants to contracts resulted in the agency's new staffing strategy and ultimately reduced the effectiveness of the services the agency provided to the community.     

Challenges of Interdisciplinary Collaboration

Abstract

The realities of the 1990s, which include reduced funding and resources, the public's impatience with bureaucratic rigidity, and the empowerment of families who want timely and appropriate services, have created a favorable climate for collaborative, interdisciplinary practice. Collaborative, family-centered practice models are being promoted by family/child advocates and professionals. Yet child and family services, for the most part, continue to be provided in traditional ways using individual treatment and categorical services. However, federal child mental health funding is supporting community-wide, collaborative practice in twenty-one sites scattered across the United States. One site, in rural northeastern North Carolina, is unique as it includes a graduate-level, interdisciplinary academic component [East Carolina University's (ECU) Social Sciences Training Consortium (SSTC)] to train and support service providers and families, and to prepare master's level graduates to work in such innovative programs. Called PEN-PAL [an acronym for Pitt-Edgecombe-Nash (three NC counties) Public Academic Liaison] this university/interagency collaborative effort works in partnership with families to coordinate public and community services into a seamless system of care for children with severe emotional disturbances. This article is based upon a qualitative study of SSTC faculty members, and it chronicles the successes and difficulties encountered by faculty in the first year of a five-year collaborative process.     

The Status of Nutrition Education in ACHA College and University Health Centers

Abstract

An assessment of the prevalence and scope of nutrition services offered through 208 randomly selected American College Health Association member student health centers revealed that 79% of the 160 respondents provided some type of nutrition education for students. One-to-one counseling, available at 96% of the institutions, was the most common approach. The larger the school's enrollment, the more likely it was to provide programs in nutrition. All of the institutions with student populations of more than 35,000 offered some type of nutrition service, as did 52% of the 19 schools with enrollments between 2,000 and 5,000. Health educators, nurses, doctors, dietitians, and trained peer educators provided the services, with registered dietitians the most common providers and often coordinators of the programs. Costs to students for nutrition interventions were nominal; weightmanagement programs were the most expensive and showed the greatest variation in content.     

Alzheimer's Disease:

Alzheimer's disease and other dementias are increasingly being recognized as important problems for older persons and their caregivers, but these disorders are rarely discussed in the context of elder abuse and neglect. This paper reviews information on the prevalence and clinical characteristics of Alzheimer's and other dementias and on the unique stresses experienced by Alzheimer's caregivers. Patients with Alzheimer's are often misdiagnosed and not accurately identified within medical and social service systems, and the special problems faced by caregivers and patients are not sufficiently addressed. Recommendations that would make clinicians and policy makers more responsive to Alzheimer's patients and their families are discussed.     

Inclusion of Caregiver Supports and Services in Home- and Community-Based Service Programs: Recent Reports from State Units on Aging

Caregivers have an important role in assisting frail and/or disabled individuals to maintain their independence in the community. Support to assist caregivers in this often stressful and demanding role is critical to sustaining the caregivers' health and ability to provide care. This paper reviews federal policy changes since 2000 that have expanded and enhanced services for informal caregivers. Next, data collected from State Units on Aging and other state agencies are presented to describe the extent to which caregiver services are included in home- and community-based programs under three funding streams (Medicaid waivers, Centers for Medicare and Medicaid Services–funded programs, and state-funded programs). Program characteristics, such as eligibility and consumer-directed options, are included. Finally, the accomplishments and initiatives reported by state respondents related to supporting informal caregivers are also explained. Results indicate that services for informal caregivers are receiving greater attention and are frequently offered under home- and community-based service programs by the states that participated in this study.     

Intensity of Case Management Services

ABSTRACT

In a systematic sample of Florida-licensed clinical social workers (N = 273), this study investigated the correlates of perceived adequacy to work with elders with Alzheimer's disease and other types of dementia. Five predictor variables were identified from a standard regression analysis that account for 35.7% of the model's adjusted variance: (a) employment with elders (Beta = .225, p = .000), (b) years of experience (Beta = -.125, p = .018), (c) attitude toward working with elders with Alzheimer's disease (Beta = .351, p = .000), (d) perceived sufficiency of professional education to work with elders with Alzheimer's disease (Beta = .178, p = .002), and (e) attitude toward the delivery of nonclinical services to elders with Alzheimer's disease (Beta = .192, p = .000). Overall, respondents perceived their abilities to work with elders as slightly less than adequate. Implications are discussed.     

Las Comadres and adult day care centers: The perceived impact of socialization on mental wellness

Using a semi-structured interview format, this study examined the narratives of 24 Mexican-American, elderly impoverished women in order to gain their perception of the effects of adult day care centers (ADCs) on their mental and physical wellness. Some of the emergent themes and categories included 1) popular activities, crafts, dances, prayers and services, 2) depression, isolation and boredom 3) family stress, children living far away, history of verbal and physical abuse, 4) reliance on other comadres, and 5) perceived positive affect of ADCs and socialization on health, easing of depression, and relying on other comadres. Pearlin's Stress Process Model [Pearlin, L. I. 1999. “The Stress Process Revisited: Reflections on Concepts and their Interrelationships”. Pp. 395–415 in Handbook of the Sociology of Mental Health, edited by C. S. Aneshensel and J. C. Phelan. New York: Kluwer Academic/Plenum Publishers.] provides explanations for the buffering effects of socialization and activities that ADCs provide. Data suggests that ADC activities buffer stress related to growing old and play an important role in alleviating depression.     

Mapping Elder Mistreatment Cases: Interactions Between Mistreatment,Dementia, Service Utilization,Access to Services,and Disadvantage

Typical explanations of elder mistreatment have focused on individual-level models. The current study adds to the literature by considering the neighborhood context in which reports of elder mistreatment are made to protective services. Using geographic information system software, the distribution of 751 adult protective services (APS) reports from three cities in southeastern Virginia is analyzed. Results suggest that Alzheimer's cases are distributed differentially across cities and that in one city, reports primarily come from disadvantaged areas. The results also suggest that clients from disadvantaged areas are more likely to refuse services. Implications for policy, theory, and future research are provided.     

Briefly Noted

The Centers for Medicare & Medicaid Services (CMS) has expanded Medicare beneficiaries' access to telehealth, allowing payment for individual psychotherapy, patient education and group psychotherapy that are delivered in “temporary expansion locations, including patients' homes.” In addition, it will consider adding more services if providers show they are interested in doing this. The April 30 decision will temporarily allow Community Mental Health Centers to offer partial hospitalization and other mental health services to clients in their homes. The CMS previously announced that Medicare would pay for certain services conducted by audio‐only telephone between beneficiaries and their doctors, but has broadened that list to include many behavioral health and patient education services. The payments for telephone visits now match payments for similar office and outpatient visits, retroactive to March 1, 2020. Instead of using a rulemaking process to add Medicare services that may be furnished via telehealth, the CMS will continue to add these during the COVID‐19 emergency on a subregulatory basis, taking into consideration “requests by practitioners now learning to use telehealth as broadly as possible.” And the CMS is waiving the video requirement for certain “evaluation and management services” — the office visits with the doctor — and now these can be provided by telephone only. Some beneficiaries don't have access to the technology for video, or don't want to use it. For more information, go to https://www.cms.gov/newsroom/press‐releases/trump‐administration‐issues‐second‐round‐sweeping‐changes‐support‐us‐healthcare‐system‐during‐covid .     

Service Changes in a Central-Place System: County Tipperary,Ireland, 1966–19861

Shifts occurred in the availability of rural services in a central-place system of 143 centers in County Tipperary, Ireland, between 1966 and 1986. While there were considerable changes in the degree of availability of individual services, the overall range of services remained relatively stable at the level of the central-place system. Within the hierarchy, there was some evidence of polarization with villages recording the greatest losses and major towns recording the highest increases. New services that had emerged were strongly concentrated in the larger towns at the top of the hierarchy. Aggressive rural development policies had positive effects on the stability of the overall central-place system, although these policies may have had the unintended consequence of increasing polarization within the hierarchy.     

The Program of All-Inclusive Care for the Elderly (PACE)

Summary

This article examines the long-term care service system in the United States, its problems, and an improved long-term care model. Problematic quality of care in institutional settings and fragmentation of service coordination in community-based settings are two major issues in the traditional long-term care system. The Program of All-Inclusive Care for the Elderly (PACE) has been emerging since the 1970s to address these issues, particularly because most frail elders prefer community-based to institutional care. The Balanced Budget Act of 1997 made PACE a permanent provider type under Medicare and granted states the option of paying a capitation rate for PACE services under Medicaid. The PACE model is a managed long-term care system that provides frail elders alternatives to nursing home life. The PACE program's primary goals are to maximize each frail elderly participant's autonomy and continued community residence, and to provide quality care at a lower cost than Medicare, Medicaid, and private-pay participants, who pay in the traditional fee-for-service system. In exchange for Medicare and Medicaid fixed monthly payments for each participating frail elder, PACE service systems provide a continuum of long-term care services, including hospital and nursing home care, and bear full financial risk. Integration of acute and long-term care services in the PACE model allows care of frail elders with multiple problems by a single service organization that can provide a full range of services. PACE's range of services and organizational features are discussed.     

A Survey of Campus Peer Counseling Activities

Abstract

The directors of counseling services at 200 colleges and universities were contacted by mail and asked to complete a survey regarding peer counseling activities on their campuses. One hundred fifty-six responses to this questionnaire were received; one hundred twenty-two indicated ongoing peer counseling activities in a wide variety of settings at their respective campuses. The most common client concerns confronted by peer counselors involved academic difficulties and relationships with friends and lovers. The survey identified a variety of peer counseling training programs, from one-weekend, intensive encounter-type experiences to full-year credit courses in counseling and therapy. Also examined were the funding resources available for peer counseling centers, which often proved quite marginal, and the amount of interaction between student counselors and professional mental health service staff members. Although the authors have been able to uncover a great many peer counseling programs on college campuses, there is a dearth of systematic research evaluating the effectiveness of the services provided by these centers or the appropriateness of various peer counselor training programs. Such work should be encouraged.     

Responding to economic change in remote, rural regions: federal installations in Idaho and Washington

The federal government's massive spending on nuclear weapons materials and research generated tens of thousands of jobs and pumped billions of dollars into a small number of regions during the 1940s and 1950s. This concentration of financial and physical resources caused the almost overnight formation of small urban centers in what formerly had been remote, rural areas, and made the economies of the regions that surround the two physically largest sites at Hanford and INEEL heavily dependent on nuclear-related government funding. With the end of the Cold War and global agreement to reduce nuclear arsenals, most of these facilities have been made obsolete. More than 10,000 jobs have been recently eliminated and thousands more were lost at private companies providing support services to these facilities and the displaced workers and their families. Further reductions will likely occur within the next 7–10 years. Our research looked at how local leaders in the still largely rural regions surrounding these two Department of Energy (DOE) sites responded to these economic changes, how have the communities reacted to the likelihood that these facilities would never again be a significant economic engine for the region, and what actions are being taken to reduce the impact of significant DOE cutbacks expected in the future? The results raise critical questions regarding the long-term economic future of the two regions and whether a more aggressive multi-faceted effort is required to stave off a long-term decline.     

Estimating the cost of direct reimbursement of marriage and family therapy under Medicare

In this article, we investigated the estimated cost to the Medicare program for covering psychotherapy services provided by marriage and family therapists (MFTs). Historical trends were identified by using psychotherapy cost and utilization data for the years 1999-2001. Using these trends, projections for the years 2002-2006 were made with MFTs included as providers. Employing this methodology, the 5-year estimated net increase and gross increase in cost due to the provision of psychotherapy services by MFTs was found to be approximately dollar 10.5 million (or dollar 2.1 million per year) and dollar 13.9 million (or dollar 2.8 million per year), respectively. This represents an increase of less than 1/2 of 1% of the Medicare mental health budget, and less than .0015% of Medicare expenditures overall.     

Criteria for Assessing the Case for Overseas Aid: A Note

This note derives minimum appraisal criteria for foreign aid consistent with those used by donor governments for domestic spending, and discusses implications for the level, allocation and financing of aid programmes. One finding is that aid is only welfare‐enhancing when the recipient country's social time preference rate is higher than the donor's, as will normally be the case. This implies that endowment financing is inferior to funding aid from current income, though borrowing against future aid as proposed by the International Financing Facility can be worthwhile provided returns exceed the borrowing cost.     

Motivations to Pursue Accreditation in Children's Mental Health Care: A Multiple Case Study

Accreditation is a growing, worldwide phenomenon that has spread to a range of industries and fields, including nonprofit social services and mental health care. Thousands of organizations are accredited, but it is not known what is driving the growth of this phenomenon. Using a multiple case study design, this exploratory study aimed to understand children's mental health agencies' motivations to pursue accreditation. In‐depth interviews, focus groups, document reviews, and limited observations were conducted at five children's mental health agencies that had recently undergone or were undergoing the Council on Accreditation process. Agencies were influenced by external factors, such as policies that require accreditation, wanting to assert their positions in the field, and the need to increase funding opportunities. Other factors were internal, related to agency leadership using accreditation as a platform for change and agencies' genuine intent to improve services. Implications for agencies, accreditors, and future research are offered.