PUBLICATIONS: Reports / Studies

APR 2013 Poll Findings -- Associated Press-NORC Center for Public Affairs Research

LONG-TERM CARE: Perceptions, and Attitudes among Americans 40 or Older

APRIL 2013 -- According to a new poll, Americans underestimate their chances of needing long-term care as they get older - and are taking few steps to get ready. Conducted by the Associated Press-NORC Center for Public Affairs Research, funded by The SCAN Foundation, the poll examined how people 40 and over are preparing for this difficult and often pricey reality of aging. Related articles:
> Poll: Aging US in denial about long-term care need | AP Mobile | 4/24/2013
> Americans Seriously Unprepared for Long-Term Care, Survey Finds | PBS NEWSHOUR | 4/24/2013

MAR 22, 2013 Survey Findings -- Genworth

Genworth 2013 Cost of Care Survey

Home Care Providers, Adult Day Health Care Facilities, Assisted Living Facilities and Nursing Homes
For the 10th consecutive year, Genworth has examined the cost of long term care across the U.S. to help Americans plan for these expenses. The most comprehensive study of its kind, Genworth’s 2013 Cost of Care Survey (conducted by CareScout®) covers nearly 15,000 long term care providers across all 50 states and the District of Columbia, in 437 regions nationwide. This unique level of detail can help consumers plan for long term care costs in their preferred location and care setting. (96 pages)

FEB 2013 Health Policy Brief -- UCLA Center for Health Policy Research

Limited English Proficient HMO Enrollees Remain Vulnerable to Communication Barriers Despite Language Assistance Regulations

HMO enrollees with limited English proficiency, and particularly those in fair to poor health, face communication barriers despite language assistance regulations. More than 1.3 million California HMO enrollees ages 18 to 64 do not speak English well enough to communicate with medical providers and may experience reduced access to high-quality health care if they do not receive appropriate language assistance services.

Based on analysis of the 2007 and 2009 California Health Interview Surveys (CHIS), commercial HMO enrollees with limited English proficiency (LEP) in poorer health are more likely to have difficulty understanding their doctors, placing this already vulnerable population at even greater risk. The analysis also uses CHIS to examine the potential impact of health plan monitoring starting in 2009 (due to a 2003 amendment to the Knox-Keene Health Care Services Act) requiring health plans to provide free qualified interpretation and translation services to HMO enrollees.

The authors recommend that California’s health plans continue to incorporate trained interpreters into their contracted networks and delivery systems, paying special attention to enrollees in poorer health. The results may serve as a planning tool for health plans, providing a detailed snapshot of enrollee characteristics that will help design effective programs now and prepare for a likely increase in insured LEP populations in the future, as full implementation of the Affordable Care Act takes place over the next decade.

JAN 2013 Fact Sheet -- The SCAN Foundation

California’s Proposed 2013-14 Budget: Impact on California’s Seniors and People with Disabilities

On January 10, 2013, California Edmund G. Brown, Jr. released his proposed budget, outlining his spending plan for fiscal year beginning on July 1, 2013 and ending June 30, 2014. The proposed budget includes initiatives and program adjustments that would impact California's seniors and people with disabilities.

NOV 13, 2012 Study Findings -- MetLife Mature Market Institute®

2012 MetLife Mature Market Study of Long Term Care Costs

The MetLife Mature Market Institute® has released its annual national survey of charges for adult day services, home care, nursing homes and assisted living. The study found that the national average daily rate for adult day services is $70, unchanged from 2011 after being $67 in 2009 and 2010. The median daily rate for adult day services rate nationally remained at $65.

Home health aide rates were unchanged at $21, although homemaker rates increased by 5.3% to $20 per hour from $19 per hour in 2011. National average rates for a private nursing home room increased 3.8% to $248 daily from $239 daily in 2011. Assisted living base rates rose by 2.1% to $3,550 monthly from $3,477 in 2011.

OCT 12, 2012 -- AARP Public Policy Institute

Across the States 2012: Profiles of Long-Term Services and Supports

From the AARP Public Policy Institute, Across the States 2012: Profiles of Long-Term Services and Supports presents comparable state-level and national data for more than 140 indicators, drawn together from a wide variety of sources into a single reference. The full report provides a comprehensive picture of long-term services and supports in each state.
[ In-Brief 2 pgs || Executive Summary 92 pgs || CA 8 pgs || Full Report 370 pgs ]

OCT 10, 2012 Report -- Center of Budget and Policy Priorities

Moving “Dual Eligibles” Into Mandatory Managed Care and Capping Their Federal Funding Would Risk Significant Harm to Poor Seniors and People With Disabilities

As policymakers seek to reduce federal budget deficits, they may face proposals to reduce spending on low-income Medicare beneficiaries who also are eligible for Medicaid (the “dual eligibles”) by 1) requiring them to receive both their Medicare- and Medicaid-covered services through a single managed care plan that would operate under a contract with their state, and 2) imposing a cap on the funding their state would receive for that purpose. Such proposals would be ill-advised at this time.

Experts agree that we should try to find ways to better coordinate care for these beneficiaries that would improve quality of care while producing savings. But, we do not yet know how to do this.

MAY 2012 Policy Brief - Center for Health Care Strategies

Medicaid Rate-Setting Strategies to Promote Home- and Community-Based Services

In creating managed long-term services and supports approaches that foster home- and community-based services, states need to explore rate-setting strategies that reward health plans for promoting the use of such services. This brief discusses strategies for structuring rates for managed long-term services and supports programs to encourage the use of home- and community-based services and details state experiences in setting rates for these programs.

MAY 24, 2012 Survey Findings - Jackson Healthcare

A Tough Time for Physicians: 2012 Medical Practice & Attitude Report

This report summarizes Jackson’s findings from a series of surveys conducted between May and June 2012. Topics surveyed and included in this report:

• Current practice environment (p 5)
• Current retirement plans (p 7)
• Current access for Medicaid and Medicare patients (p 10)
• Current use of physician assistants and nurse practitioners (p 13)
• Current participation in Accountable Care Organizations or Medical Homes (p 15)
• Current attitudes on the Affordable Care Act (p 17)

FEB 17, 2012 Report - LAO

The 2012-13 Budget: Integrating Care for Seniors and Persons With Disabilities

In a February 17, 2012 LAO report, the Legislative Analyst found that it is premature to expand the Care Coordination Initiative demonstration statewide and make LTSS managed care benefits, since the demonstration has not yet been implemented—much less evaluated—and many key implementation details remain to be determined. The report recommends the Legislature reject the Governor’s proposal to expand the demonstration statewide before the results from the demonstration have been properly evaluated, but proceed instead with the four-county demonstration. Additional recommendations are made with the intent to help the state move toward a more integrated system of care delivery for SPDs.

DEC 2011 Health Policy Brief -- UCLA Center for Health Policy Research

Independence at Risk: Older Californians with Disabilities Struggle to Remain at Home as Public Supports Shrink

Researchers spent a year following and documenting the lives of a typical group of seniors with disabilities who are enrolled in Medicare and Medi-Cal and receive in-home and community care in Los Angeles, San Diego, San Francisco and Santa Clara counties. The seniors depend on fragile networks of paid public programs and unpaid help to live safely and independently at home. In spite of these challenges, most display resilience and fortitude, and all share a common determination to maintain their independence at almost any cost.

OCT 2011 Study -- Centers for Disease Control and Prevention National Center for Health Statistics

National Study of Long Term Care Providers

The National Study of Long-Term Care Providers (NSLTCP) is a new integrated initiative sponsored by the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS). The NSLTCP will replace the NCHS’ National Nursing Home Survey, National Home and Hospice Care Survey, and National Survey of Residential Care Facilities.

NCHS plans to field the residential care and adult day care components of NSLTCP in late 2012. Participants will be selected randomly from among all residential care communities and adult day services centers in the United States. The main goals of NSLTCP are to:

1. Estimate the U.S. national supply of paid, regulated LTC providers (i.e., nursing home, home health care, residential care, adult day care, and hospice).
2. Estimate key policy-relevant characteristics and practices of these providers.
3. Estimate the use of these providers.
4. Estimate key policy-relevant characteristics of these users.
5. Monitor national trends in these estimates of LTC supply and use, overall and by provider type.

NCHS plans to release the first NSLTCP overview report in late 2013, using a combination of survey and administrative data. This first report will include nursing homes, home health care agencies, hospices, residential care facilities, and adult day services centers. To learn more, visit http://www.cdc.gov/nchs/nsltcp.htm or contact: Dr. Lauren Harris-Kojetin, Chief, Long-Term Care Statistics Branch, LHarrisKojetin@cdc.gov, 301-458-4369.

OCT 27, 2011 Chart -- Medi-Cal Provider Payment Reductions

Medi-Cal Provider Payment Reductions in SPAs Approved by CMS

On October 27, 2011 the Centers for Medicare and Medicaid Services approved California’s request to reduce Medi-Cal reimbursement rates for providers of health care services. To view documents related to approval of the State Plan Amendment (SPA), visit: www.dhcs.ca.gov.

Additional details about implementation of the retroactive 5% and 10% rate reductions for ADHC providers in urban areas of the state are not yet available from the state. The 5% rate reduction is currently enjoined by federal court order, but the new 10% rate reduction was approved by the California Legislature in March 2011 to be retroactive to June 1, 2011 and, therefore, is not currently part of any litigation proceedings.
>> October 27, 2011 CAADS Industry Alert

OCT 2011 Study Findings -- California Association for Adult Day Services

A Study of Patient Discharge Outcomes Resulting from California's Elimination of Adult Day Health Care on December 1, 2011CAADS Report on ADHC Patient Discharge Outcomes

CAADS surveyed ADHC providers for the purpose of analyzing overall services needed and services available for typical ADHC patients attending 4 or 5 days per week who will be involuntarily discharged from ADHC when Medi-Cal funding for the program ends December 1. The findings focus on:

• Post-ADHC Discharge Prognosis
• Multi-Disciplinary Team Recommendation for Discharge
• Patient Needs
• Services Needed / Available
• Significant Risk Factors

In compliance with HIPAA, the ADHC Involuntary Discharge Form was developed as an e-form which transmitted the data without patient identifying information.

SEP 21, 2011 Policy Brief -- UCLA Center for Health Policy Research

Stressed and strapped: Caregivers in California

Family members or friends caring for aging or disabled individuals in California are under both financial and emotional strain and are likely to face even greater burdens, given recent cuts in state support for programs and services that support in-home care, write the authors of a new policy brief by the UCLA Center for Health Policy Research.

JUN 2011 Survey Findings - California Association for Adult Day Services

Elimination of ADHC as a Medi-Cal Optional Benefit

CAADS surveyed California's ADHC providers on the impact the elimination of ADHC as a Medi-Cal optional benefit would have on their center, patients and community. The findings focus on:

• Adult Day Health Care Providers Ability To Stay Open Without Medi-Cal Reimbursement
• Nursing Facility Placements and Access to Medi-Cal Nursing Home Beds
• Psychiatric Facility Placements and Access to Medi-Cal Psychiatric Beds
• Consequences For Patients With Developmental Disabilities
• Cost Shift to Emergency Rooms and Emergency Room Visits Over One Year
• Consequences for IHSS Caregivers and Consequences for Working Caregivers
• Availability of Alternative Services

MAY 10, 2011 -- HMA / Health Management Associates

Keeping Adults Free from Institutions (KAFI): Medicaid Options to Guide Program Design

The 2010-2011 California Legislature enacted AB 97 eliminating Adult Day Health Care as a Medi-Cal covered service. The legislature is instead proposing to transition individuals no longer eligible for ADHC services to other service options including California’s In-Home Supportive Services program, (which provides personal care and related services) or to existing home and community-based services (HCBS) waivers.

MAR 2011 Policy Brief -- UCLA Center for Health Policy Research

The Health of Aging Lesbian, Gay and Bisexual Adults in California

Members of California's aging lesbian, gay and bisexual population are more likely to suffer from certain chronic conditions, even as they wrestle with the challenges of living alone in far higher numbers than the heterosexual population, according to a new policy brief from the UCLA Center for Health Policy Research.

2011 Survey Findings -- Genworth

Genworth 2011 Cost of Care Survey: Home Care Providers, Adult Day Health Care Facilities, Assisted Living Facilities and Nursing Homes

Across 437 regions, surveyors polled more than 34 percent of adult day health care facilities, resulting in more than 1,300 completed surveys. ADH is designed to meet the needs of adults who are functionally and/or severely cognitively impaired. Programs are intended to be structured and comprehensive, and to take place in a protective setting that promotes well-being through a variety of health, social and other support services.

JAN 2010 Report -- Case Western Reserve University

Evaluation of the Parma D.A.Y. (Designed Around You) Program

Facilitating the safe transition of persons from the acute care hospital to home is a priority issue, given the frequency with which individuals are readmitted and/or visit the emergency department within 30 days of discharge. Many of these individuals require rehabilitation services, but reimbursement policy currently limits available options for continuing care. Furthermore, families may need more comprehensive education about health care needs of their family member, and home environments may need to be modified to ensure safety once the person returns home. One strategy for meeting these needs of patients and family members is an expanded adult day services program.

DEC 9, 2010 Investigative Report -- National Public Radio

A New Nursing Home Population: The Young

There's one age group that's going into nursing homes at a higher rate. And it's not the elderly. Young people ages 31 to 64 now make up 14 percent of the nursing home population, an analysis of federal data from the Department of Health and Human Services by NPR's Investigative Unit found. That's up from 10 percent just 10 years ago.

MAY 18, 2010 Report -- The Lewin Group

Projected Economic Impact of Eliminating California's Medi-Cal Adult Day Health Care Program

Our analysis indicates that the savings associated with eliminating this program would be more than offset by cost-shifting to other services and reductions to State revenue resulting from the program elimination. In total, we estimate the State would lose $51 million in 2010-11 over and above the estimated savings that would come from eliminating the program (excluding the loss of federal matching funds). Annual losses to the State are projected to increase to $72 million in 2020-21, $198 million in 2030-31 and over $412 million in 2040-41.

FEB 2010 Policy Note -- UCLA Center for Health Policy Research

Budget Proposals Turn Back Clock 30 Years in Long-Term Care Services for California Seniors

The 2010-2011 California budget proposal released in January by Governor Arnold Schwarzenegger’s office proposes deep cuts in community-based services available to low-income seniors and low-income Californians of all ages with disabilities. The cuts will make it much more difficult for many older adults to continue to live safely in their own homes, create hardships for their families, lead to a loss of jobs and health insurance by direct service providers, and close many adult day care centers. Increased use of emergency rooms, hospital in-patient care and nursing facilities by affected older adults are likely to erode the financial savings of the reductions.

OCT 2009 Policy Brief -- UCLA Center for Health Policy Research

California Budget Cuts Fray the Long-Term Care Safety Net

The deep budget cuts enacted by California’s legislature in the summer of 2009 will be felt especially among the elderly and infirm. Disabled older adults with low incomes will find it harder to access services and, ultimately, harder to live safely at home.

JUL 2006 Report -- U.S. Department of Health and Human Services

Adult Day Services: A Key Community Service for Older Adults

Adult day health services are part of the continuum of both health and long-term care services. In the states we visited, ADS providers are furnishing preventive care, health monitoring, and skilled nursing services to individuals with chronic illnesses and physical and cognitive impairments. Some providers are also serving adults under age 65, depending on regulatory requirements and the funding streams for this population.

OCT 2003 County Data Book -- UCLA Center for Health Policy Research

Health of Older Californians: County Data Book

Data from the 2001 California Health Interview Survey and 2000 U.S. Census

This data book provides important information about the health behaviors, health status, and the use of health services by Older Californians. The first section contains a narrative summary about the health of the older people in California. The second section has maps that show the distribution of the older population along several of the basic demographic characteristics used in this report, including race/ethnicity, low-income, and limited-English proficiency. The third section provides a series of two-page tables with the rates of selected health behaviors, the health status, and the use of health services of older Californians. Each geographic area has columns with information for elders of different races and ethnicities, older women, older people with low-incomes, older people with limited-English abilities, and for Medi-Cal recipients age 65 and over. This section ends with a summry table that makes comparisons between counties easier for the total county populations of older adults. The fourth section has demographic data for the state, substate regions, and each of the 58 counties. The fifth section contains technical appendices and acknowledgments.

California Association for Adult Day Services
1107 9th Street, Suite 701
Sacramento, California 95814-3610
TEL: (916) 552-7400 || FAX: (866) 725-3123
EMAIL: caads@caads.org