Research on Aging and Human Development

No abstract available for this article.     

Broadening the Array of Services: Integrating Legal and Social Work Services for Youth and Families

ABSTRACT

The Community Justice and Legal Assistance Clinic (CJLA) is a unique community-based legal clinic developed through a partnership between a law school and a child and family service agency embedded within a low-income community. This article describes the development of this clinic through a community assessment process; its unique multidisciplinary features; the services provided to clients in three of the agency's service areas; the benefits of the partnership for clients, the social service agency, the participating law students, and the law school; and lessons learned for replication of this type of clinic in other communities.     

Comparing States' Medicaid Nursing Facilities and Home and Community-Based Services Long-Term Care Programs: Quality and Fit with Inclination,Capacity, and Need

States employ home and community-based services (HCBS) increasingly in Medicaid support of long-term care and rely less on nursing facilities. We examine how states' nursing facilities and HCBS programs compare and whether states' long-term care responses match their ideological inclination toward, material capacity for supporting, and their citizens' need for these public social programs. We use cross-sectional panel data on structural, process, and outcome quality for nursing facilities and HCBS congregate residential programs. We rank states, correlate these measures, and use regression to link inclination, capacity, and need to quality. We find that states' nursing facility and HCBS program quality are not closely related and that state HCBS congregate residential program quality is independent of inclination, capacity, and need. This latter result underscores a need for uniform HCBS standards and better data on quality.     

A Focus on the Program of All-Inclusive Care for the Elderly (PACE)

For over four decades, the Program of All-Inclusive Care for the Elderly (PACE) has been operated by nonprofit organizations. Research has demonstrated that nonprofit PACE provides quality, cost-effective community-based care to older adults who would otherwise require a nursing home level of care. Recently, the U.S. Secretary of the Department of Health and Human Services has authorized for-profit entities to operate PACE, contingent on their ability to demonstrate that they can provide care that is similar to nonprofit PACE with regard to access to care, quality of care, and cost-effectiveness. In 2013, a study was conducted to evaluate how PACE operates under for-profit versus nonprofit status. The results were presented to Congress which, in turn, authorized for-profit PACE providers. This article critiques the 2013 study, offers a comparison to for-profit hospice, and argues that at best there is not enough evidence to conclude that for-profit PACE provides the same quality of care as existing nonprofit operators.     

Incentives Programs for Girl Children in India: Global Experiences,Local Reflections

ABSTRACT

Success of incentive transfers programs in South America has encouraged policymakers in India to adopt similar demand-driven approaches to reward behaviors that invest in girls and eventually change negative cultural attitudes toward them. Embrace of this approach, however, needs to be nuanced by a closer scrutiny of the gendered impact of such programs; an understanding of the differential sociocultural and public policy contexts; and a questioning of the design of the incentive transfer programs in India. Despite their political uptake, such programs address the practical needs of girls and women while neglecting their strategic interests. Furthermore, without adequate critical engagement, the programs can have unintended consequence of reinforcing gender stereotypes. Rather than importing developmental shortcuts, India should turn its gaze inward to supply-side interventions and homegrown mobilization experiences of the women’s movement.     

Medicaid Managed Care Programs for High-Risk Older People in Massachusetts

The Commonwealth of Massachusetts has undertaken a major initiative in the development of comprehensive managed health care programs for two sets of high-risk older people: those who are frail and homebound and those who reside in nursing homes. This effort has been coordinated by the state's Department of Public Welfare (DPW; Medical Assistance [Medicaid] Program) and Executive Office of Elder Affairs, and expedited ba a set of Health Care Financy Administration (HCFA) waivers and by the state's revised Nurse Practice Act (MGS Chapter 56). Than act allows nurse-practioners and physician assistants expanded roles as primary providers in home care and nursing home settings. The managed care initiatives have supplemented other efforts (1) to coordinate health and social services for older people, (2) to provide as broad a range as possible of community-based services for older people, and (3) to enroll as many older adults as possible in Health Maintenance Organization (HMO) "Senior Plans" and other similar "Competive Medical Plans."

Though there is still no evidence of the managed care programs' effects, this article summarizes some of the possible risks and benefits of managed care programs for those kinds of populations and presents an agenda of questions that evaluations of managed care programs must address.     

Experience,Knowledge, and Concerns About Long-Term Services and Supports: Implications for Financing Reform

Using the 2014 Survey of Long-Term Care Awareness and Planning, this article examines Americans’ experiences, knowledge, and concerns about long-term services and supports (LTSS) and actions they are willing to take if they become disabled. The survey included 15,298 non-institutionalized respondents aged 40 to 70 years drawn from a nationally representative sample. Although many reported some experience with LTSS, knowledge of how LTSS worked was low. Respondents reported widespread concerns about becoming disabled. They preferred informal care over paid care, with a strong desire to remain in their homes. These results can be used to design reform initiatives and to motivate political support.     

Dealing with Resistance: Working with Involuntary Clients in Community-Based Drug Treatment Programs in China

ABSTRACT

This study explores strategies for dealing with client resistance that are commonly used by a group of selected counsellors who work closely with illicit drug users in the community-based compulsory treatment programs in China. Through semistructured in-depth interviews with 16 counsellors, this study finds that different forms of client resistance were experienced in their day-to-day practice, encompassing passive and active behaviours. Five typical strategies are used by Chinese counsellors in this study to deal with client resistance: showing respect and caring and expressing empathy; attending to the needs of the clients; making effective use of peer influence; altering clients’ unwillingness to change; and strategically enhancing clients’ self-determination. Considering these strategies can also be seen as general principles for dealing with involuntary clients in other fields of social work services, the findings of this study may have broader impact.

IMPLICATIONS

• Effective ways that can be used by counsellors for reducing illicit drug users’ resistance during treatment include: showing respect and caring, and expressing empathy; attending to the needs of the clients; making effective use of peer influence; altering clients’ unwillingness to change; and strategically enhancing clients’ self-determination.

• Professional social work training is urgently needed among community-based drug treatment social work practitioners in China, to achieve efficient practices and better outcomes.

     

Understanding the functionality of housing-related support services through mapping methods and dialogue

This article describes the experience and process of using community mapping as a tool for collecting data on the functioning of housing-related support services in Metro Vancouver. We outline our mapping methods and discuss strengths and challenges encountered during workshops aimed at understandings how the system of housing-related supports function. Strengths were that workshops provided a forum for social participation and engagement. In addition, mapping is a research tool that enables local knowledge of service functioning and service gaps to be accessed and exchanged. Challenges include ensuring diverse representation; reducing power imbalances; and having adequate space to accommodate interested participants.     

Medicaid Funding for Assisted Living Care: A Five-State Examination

Medicaid waiver programs financing assisted living care are examined in five states to gain insights about program implementation, accomplishments, and challenges. Documents, augmented with stakeholder interviews, are used to describe income eligibility, options for supplementing payments to facilities, risk adjustment payment levels, and participation. Needs determination and waiver-based payments are in place. Eligibility and funding levels are complicated by room and board allocations that are linked to the federal benefit rate for Supplemental Security Income. Provider participation may be diminishing. Many recipients have to accept shared occupancy as program payments are insufficient for single units.     

Evaluation of Occupational Health Promotion Programs

The purpose of this study was to determine the extent of Corporate Health Promotion Program proliferation and to propose a methodology to determine the effectiveness of these programs from a benefit to cost perspective. A national survey of firms sponsoring health promotion activities was conducted to ascertain a variety of information. The specific goal of this study was to determine the extent to which firms were actually conducting financial analyses in order to ascertain whether their health promotion programs were generating benefits that justified continued program funding. The results of the study showed that although the concept of Corporate Health Promotion Programs is rather popular, there is very little concern on the part of the sponsoring firms for measuring the effectiveness of their programs, particularly from a financial perspective. This suggests a vulnerability insofar as those programs are concerned. If such program costs cannot be justified on some quantifiable basis, the possibility of their cancellation seems rather likely if it becomes necessary to reduce expenditures.     

Emerging Trends: Holistic,Comprehensive Family Support Programs

ABSTRACT

The results of a qualitative study funded by the Annie E. Casey Foundation indicate that a promising path to improving the lives of disadvantaged families is through more holistic, comprehensive approaches to family support. These approaches combine traditional family support activities with the development of human and economic capital. The effectiveness of comprehensive programs is based on the premise that adult and child well-being are interconnected with the physical, economic, and social aspects of their lives. Recommendations are provided for improving existing family support programs through the implementation of holistic strategies.     

HCBS Spending and Nursing Home Admissions for 1915(c) Waiver Enrollees

Medicaid waiver programs for home- and community-based services (HCBS) have grown rapidly and serve a population at high risk for nursing home (NH) admission. This study utilized the Medicaid Analytic Extract Personal Summary File and the NH Minimum Data Set and tested whether higher levels of per-beneficiary HCBS spending were associated with (1) lower risk of long-term (90+ days) NH admission and (2) higher functional/cognitive impairment at admission for new enrollees in 1915(c) aged or aged and disabled waiver programs. Waiver enrollees in states and counties with higher HCBS spending were found to have lower risk of long-term NH admission and greater functional impairment at NH admission compared to waiver enrollees in states and counties with lower spending. This indicates that higher per-enrollee HCBS spending may enable waiver enrollees to remain in the community until their functional impairment becomes more severe.     

An Examination of the Woodwork Effect Using National Medicaid Long-Term Services and Supports Data

A common concern in long-term services and supports (LTSS) policy is the “woodwork effect,” which has two components: (1) more people will use publicly funded services if access to home- and community-based services (HCBS) is expanded; and (2) the additional beneficiaries will increase the growth rate of LTSS expenditures. Medicaid LTSS beneficiary and utilization data starting in 1999 indicate modest growth in beneficiaries and expenditures, after adjusting for inflation and the number of people with functional impairments. The data do not provide strong evidence that the shift in Medicaid funding toward HCBS significantly increased or decreased overall Medicaid LTSS spending.     

Workforce Issues in Residential Care Facilities in Rural China

This study examined contemporary frontline workforce issues related to residential care for elders in rural China. Residential facilities in rural China are in transition from exclusively providing shelter to childless elders to providing long-term care for frail elders. These facilities are also under pressure to improve the quality of services that they provide. The study is based on in-depth interviews with administrators and field observations of facilities. The study focused on the following issues related to the workforce: recruitment and retention, training, work environment, workforce organization, regulations, compensation, and career ladders. The implications of resident characteristics for demands on the work force were examined. The study found that lack of skilled personnel is one of the major reasons that the overwhelming majority of facilities deny admission to frail and demented elders. Improving workers’ skill is critical if these facilities are to meet the increasing demand for institutional long-term care needs.     

Medicaid Beneficiaries' Access to Residential Care Settings

Residential care settings (RCSs) are community-based housing and supportive services providers. Medicaid beneficiaries' access to RCSs is of concern to policymakers and other stakeholders because most people prefer community-based to institutional services and RCSs are generally less expensive than nursing homes. To better understand Medicaid beneficiaries' access to state-licensed RCSs, we examined Medicaid policies in 50 states and the District of Columbia, interviewed seven subject-matter experts, and conducted four state case studies informed by reviews of state policies and interviews with 27 stakeholders. Factors identified as influencing Medicaid beneficiaries' access to RCSs include Medicaid reimbursement rates for RCS services, the supply of Medicaid-certified RCSs and RCS beds, and policies that affect RCS room and board costs for Medicaid beneficiaries. Shifting Medicaid spending toward community-based instead of institutional care may require attention to these interrelated issues of RCS payment, supply, and room and board costs.     

Belief Systems in Faith-Based Human Service Programs

Abstract

Using a grounded theory design and methods, 65 key informants in 15 faith-based organizations having promising programs in four urban areas were interviewed. Respondents were asked what makes their direct service programs faith-based. A story emerges, motivated by mission-driven visions tied to forces beyond local programs and steeped in deep traditions. A major implication of the findings is that in teaching people about the various practices of diverse religious groups, we are only giving them the visible elements. While the expressed values of acts and faith are integral in the faith-based discussion, they do not tell the full story. The deep drivers of human behavior and practice are found in the specific beliefs and interpretations of individuals who are involved either as leaders or participants in faith-based organizations. For many of these individuals in faith-based organizations, mission and accountability to God trumps secular or professional expectations.     

Predicting State Investment in Medicaid Home- and Community-Based Services, 2000–2011

Although state use of Medicaid home- and community-based services (HCBS) to provide long-term services and supports to older adults and individuals with physical disabilities continues to increase, progress is uneven across states. We used generalized linear models to examine state factors associated with increased allocation of Medicaid dollars to HCBS for the period 2000 to 2011. We observed enhanced growth in states that began the period with limited investment in HCBS, as reflected in significant year trends among these states. The political environment appeared to be an important influence on states’ investment for states with limited initial allocation to HCBS, as was housing affordability, a policy amenable variable. There continues to be wide variation in states’ relative investment, calling for additional policy attention and research.     

Issues and Challenges in Gatekeeping: A Framework for Implementation

Social work educators' role in gatekeeping within BSW and MSW academic programs continues to be a concern and challenge for the profession. Social work programs are the entry point in which students develop the required competencies to practice within the field. The social work literature on gatekeeping is extensive and expansive. The literature reviews and addresses the importance and need for gatekeeping as well as challenges in implementing gatekeeping within social work programs. This paper reviews the literature on gatekeeping in social work programs, discusses the legal issues pertinent to gatekeeping, and identifies the challenges faced by social work programs in implementing gatekeeping procedures. The paper suggests an integrated conceptual framework using the Council on Social Work Education's Educational Policy and Accreditation Standards (EPAS) for competencies in gatekeeping in social work programs.