CAADS - California Association for Adult Day Services

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Publications -- Reports / Studies

Updated: MARCH 4, 2015


MAR 2015 | Issue Brief | Justice in Aging | co-authored by Advocates for African American Elders (AAAE)

Changes to health care coverage are happening rapidly and can be confusing for advocates to understand and explain to beneficiaries.

This issue brief discusses, in general, the importance of effective outreach and education during any complex health care transition. As a real world example, it focuses on how AAAE’s culturally competent outreach model communicates changes under California’s Coordinated Care Initiative to dual eligible beneficiaries, who are being moved into managed care plans.

The brief offers insight into and instruction on how to communicate changes in a person-centered and engaging manner. It concludes with practical tips for advocates and stakeholders and should be of use to those who are preparing their own communities for complex health care transitions.


FEB 23, 2015 | California Healthline Article

A snapshot in time just ahead of ACA implementation

FEB 2015 | Report | Infographic | CHCF

This report provides a snapshot of the insurance market in California at the end of 2013, just before the major provisions of the Affordable Care Act (ACA) took effect. It also includes some initial figures from 2014 that point to large shifts in both Medi-Cal and individual coverage levels.

The Universal Assessment Tool: Improving Care for Recipients of Home- and Community-Based Services

JAN 22, 2015 | Report | Legislative Analyst's Office (LAO)

Unfinished Business: Designing Appeals Procedures in the Dual-Eligible Demonstrations

DEC 2014 | Issue Brief | National Senior Citizens Law Center (NSCLC)

Under the Affordable Care Act, a number of states are participating in financial alignment demonstrations that combine the delivery of Medicare and Medicaid services for dual eligible beneficiaries. Even though financial alignment demonstrations are already “live” in five states with tens of thousands receiving services through demonstration plans, the appeal systems for the demonstrations in all participating states are still a work in progress, making it difficult for beneficiaries to navigate.

This tool, Unfinished Business, is an update on NSCLC’s September 2013 analysis of appeals processes in demonstrations in six states. Unfinished Business helps stakeholders focus their advocacy about appeals on areas where a consumer voice can have the most potential to affect programs, by highlighting the many areas where appeal rights and procedures have not yet been fully developed.

Ten states are participating (CA, IL, MA, MI, NY, OH, SC, TX, VA and WA), with one more, Minnesota, pursuing a similar but alternate model.

Working in Concert: A How-To Guide to Reducing Unwarranted Variations in Care

NOV 25, 2014 | Report | California Improvement Network / California HealthCare Foundation

Patients should receive the appropriate level of care — no more and no less. But how is that sweet spot determined? This How-To Guide to Reducing Unwarranted Variations in Care, the result of the CIN's first action group, helps organizations get started.

What's In A Notice? How Notices Of Action Protect Consumers in Medicaid Managed Long-Term Services and Supports

NOV 2014 | Guide | NSCLC

As Managed Long Term Services and Supports (MLTSS) rolls out nationwide, advocates on the ground have seen due process violations in appeals and notices of action. In this tool for advocates and consumers, NSCLC focuses on notice and appeal rights in MLTSS. NSCLC provides background information on notices of action, including an explanation of what type of Managed Care Organization (MCO) behavior constitutes an action that could give rise to due process violations.

This tool also provides advocates with the specific information that must be included in each notice of action to meet due process requirements, and outlines how continuation of services and aid-paid-pending plays out in the managed LTSS context.

State Transition Plans for New Medicaid HCBS Regulations: Four Tips for Consumer Advocates

OCT 2014 | Four Tips for Consumer Advocates | NSCLC

States now are beginning to release their transition plans to bring their Medicaid HCBS systems into compliance with the new federal regulations on community-based settings. It is essential that consumers and their representatives be prepared to evaluate those plans and advocate for improvements. NSCLC’s Four Tips for Consumer Advocates, produced with the National Disability Rights Network, offers advice for assessing a state’s compliance progress.

Adult Day Services: A Model of Person- and Family-Centered Care

OCT 2, 2014 | BLOG by Lynn Friss Feinberg | AARP

A recent study found that more than a quarter million participants attend an estimated 4,800 community-based adult day service (ADS) centers in the U.S. Although most participants are older people, more than one-third of ADS participants are younger than 65. Nearly one in three ADS participants has Alzheimer’s disease or another form of dementia.

ADS centers provide coordinated and reliable services and supports. Services for participants include social activities, meals, personal care (such as help with toileting), a limited array of health services (such as medication management) and supervision during the day. Read more . . .

Shared Decisionmaking

OCT 2014 | Report | California Improvement Network / California HealthCare Foundation

It is not always easy for providers and patients to make treatment decisions jointly. A new CIN partner report details effective strategies shared by the Gordon and Betty Moore Foundation, Humboldt-Del Norte IPA, and Sharp HealthCare.

Up Close: A Field Guide to Community-Based Palliative Care in California

SEPT 2014 | Field Guide | California HealthCare Foundation (CHCF)

Health systems across the US are recognizing the importance of palliative care — specialized, interdisciplinary care that attends to the physical, psychological, emotional, and spiritual needs of people with serious illnesses and their family members. While inpatient palliative care programs have proliferated, community-based programs — those that offer services at a clinic, in a patient's residence, or over the phone — are far less prevalent, and those that do exist have developed in relative isolation.

In 2013 the California HealthCare Foundation (CHCF) launched the Palliative Care Action Community to promote collaboration among organizations working to strengthen or expand their community-based palliative care (CBPC) services. Participating provider teams represented diverse types of organizations, provided services in a variety of settings, and came with varying levels of CBPC experience. Despite these differences, the teams shared common approaches and challenges in program planning, operations, and evaluation.

Up Close: A Field Guide to Community-Based Palliative Care in California describes the main characteristics of these programs, the challenges they face, and the promising practices they have developed. It also includes the opinions and experiences of many of the experts who interact with the action community participants. The field guide is intended for providers interested in starting new CBPC programs, as well as those who want to sustain, strengthen, or expand existing ones.

Data Briefs Released for 2012 National Study of Long Term Care Providers (NSLTCP)

SEPT 2014 | National Study of Long Term Care Providers (NSLTCP)

The Long-Term Care Statistics Branch released adult day services-specific state web tables, using data from the first wave of the National Study of Long-Term Care Providers (NSLTCP) conducted in 2012. NSLTCP is a new initiative by the National Center for Health Statistics (NCHS) to provide reliable, accurate, relevant and timely statistical information to support and inform long-term care services policy, research, and practice.

The main goals of NSLTCP are to: (1) estimate the supply and use of paid, regulated long-term care services providers; (2) estimate key policy-relevant characteristics and practices; (3) produce national and state-level estimates, where feasible; (4) compare estimates among sectors; and (5) monitor trends over time.

Can Reality Match Rhetoric? Person Centered Service Planning in Managed Long-Term Services and Supports

AUG 2014 | Policy Issues Brief | National Senior Citizens Law Center (NSCLC)

Person-centered planning is critical to the well-being of consumers of long-term services and supports. It works by identifying the strengths preferences, needs, and desired outcomes of the individual. In order for person-centeredness to be more than an empty slogan, it must be accompanied by substantive standards set forth in managed care organization (MCO) contract language. Some states have begun to include person-centered planning requirements in their contracts, but more work is needed before all states have a full framework.

This brief begins with a short description of service planning in the Medicaid managed care context. Next, it provides an analysis of what states are doing in their managed care contracts to ensure person-centered planning. Finally, the brief describes how the new federal home and community-based services (HCBS) rule will provide service planning protections for consumers that should be included in and built upon in MCO contracts.

Family Caregivers Providing Complex Chronic Care to People with Cognitive and Behavioral Health Conditions

AUG 19, 2014 | Report | News Release | AARP | United Hospital Fund

The United Hospital Fund and AARP Public Policy Institute issued a report with compelling new evidence that family caregivers who provide complex chronic care to people who also have cognitive and behavioral health conditions face particularly demanding challenges, including high levels of self-reported depression. As a result, a majority of them (61 percent) reported feeling stress “sometimes to always,” between their caregiving responsibilities and trying to meet other work or family obligations. Read more . . .

Poverty and Opportunity Profile (from Half in 10: The Campaign to Cut Poverty in Half in Ten Years)

AUG, 2014 | Profile | Half in 10 |National Senior Citizens Law Center (NSCLC)

By 2050, one-fifth of the total U.S. population will be 65 or older—up from 12 percent in 2000—with the number of people aged 85 and older growing the fastest over the next few decades. As the aging population continues to rise, several indicators of economic security are projected to be bleak unless we provide proper assistance and support. Read more. . .

Physician Participation in Medi-Cal: Ready for the Enrollment Boom?

AUG 5, 2014 | Report | InfoGraphic | California HealthCare Foundation (CHCF)

By the end of 2015, the Affordable Care Act will add more than two million enrollees to Medi-Cal, the nation's largest state Medicaid program. This estimate has heightened concerns about whether there are enough doctors to care for them all. Californians are likely to have difficulty accessing health care through Medi-Cal unless the number of participating physicians grows or California finds other ways to deliver services. The percentage of physicians treating any Medi-Cal patients increased between 2011 and 2013 from 64% to 69%, according to a new report prepared by researchers at the University of California, San Francisco. Yet their findings suggest that Medi-Cal enrollees face significant challenges due to statewide variations in physician availability.

Among the findings from the 2013 survey:

  • The ratio of primary care doctors participating in Medi-Cal was 35 to 49 per 100,000 enrollees, well short of the 60 to 80 that the federal government estimates are needed. The ratio of non-primary physicians participating in Medi-Cal was between 68 and 102 physicians per 100,000 enrollees, within the federal estimate of need (85 to 105 per 100,000).
  • The percentage of physicians with any Medi-Cal patients (69%) was significantly lower than the share with any Medicare patients (77%) and much lower than the percentage with any privately insured patients (92%).
  • The distribution of Medi-Cal visits among California physicians is highly skewed. About one-third accounted for 80% of Medi-Cal visits, and about another third accounted for the remaining 20% of Medi-Cal patients.
  • Physicians at community health centers and public clinics had the highest rate of Medi-Cal participation (92%), and those in solo practice had the lowest (54%).

Here's Looking At You: How Personal Health Information is Being Tracked and Used

JUL 15, 2014 | Report | InfoGraphic | California HealthCare Foundation (CHCF)

Last month, in a US Supreme Court decision barring the warrantless searches of cellphones, Chief Justice John Roberts declared that a cellphone "contains the sum of an individual's private life" and can reveal more information than the search of an entire house.

Every day, in the course of using cell phones, credit cards, search engines, websites, and an array of medical devices, we leave behind digital footprints. These data flows, which often occur without our knowledge, have the potential to paint an individual health profile, as well as describe whole communities based on location, health conditions, or other factors.

A new CHCF report by Jane Sarasohn-Kahn looks into emerging issues around consumer-generated health data. It is based on numerous interviews with technology and health care experts, several of whom offer strategies for protecting privacy. A related infographic offers contrasting examples of how health care and other data are already being collected and used.

Health Care Costs 101: Slow Growth Persists

JUL 8, 2014 | Report | InfoGraphic | California HealthCare Foundation (CHCF)

Even with the slow growth in national health spending in recent years, the US continued to spend a greater percentage of its wealth on health care than any other industrialized nation, according to the latest edition of Health Care Costs 101. In 2012, the US spent an average of $8,915 per person on health care, reaching a total of $2.8 trillion. An interactive graphic shows the change in health care spending by payer from 1960 to 2012.

This report is published as part of the CHCF California Health Care Almanac, an online clearinghouse for key data and analysis examining California's health care marketplace. Find all Almanac reports at

ACA 411: An Interactive Tool for Tracking Health Reform in California

JUN 17, 2014 | ACA 411 | California HealthCare Foundation (CHCF)

The California HealthCare Foundation (CHCF) has created ACA 411, an interactive data tool to keep tabs on the trends that emerge as California continues to implement the Affordable Care Act (ACA) legislation. The tool tracks health care reform's effects in three areas: insurance coverage, access to health care services, and affordability.

2014 Scorecard: California's Long-Term Services and Supports for Older Adults, People with Disabilities, and Family Caregivers

JUN 17, 2014 | Scorecard | Policy Brief | California's Results | AARP | SCAN Foundation | The Commonwealth Fund

The 2nd State Scorecard on Long-Term Services and Supports shows California ranked 9th overall. While California ranks higher than most states, much work remains to be done to improve affordability, quality, and coordination of services within the state’s system of care to ensure that older adults and people with disabilities can access needed services to support independence and quality of life. The Scorecard is the first step in initiating a conversation about system performance, areas for opportunity, and the importance of continued system transformation in California.

Visitors to the Long-Term Services and Supports website can interact with the data by drilling into performance indicators for a single state, comparing data across states, or using a map to quickly compare overall state rankings.

Estate Recovery Under Medi-Cal

MAY 2014 | Issue Brief | California HealthCare Foundation (CHCF)

Medi-Cal estate recovery refers to state action to reclaim certain Medi-Cal costs from the estates of beneficiaries after their death. This program, which has been in place for decades, has received renewed attention from policymakers because of reports that some individuals newly eligible for Medi-Cal as expanded under the Affordable Care Act (ACA) may not enroll for fear that their house and assets could later be seized. The purpose of this issue brief is to describe Medi-Cal estate recovery and to clarify who could be subject to it and under what circumstances.

2014 Alzheimer's Facts & Figures Report

MAR 19, 2014 | 2014 Alzheimer’s Disease Facts and Figures | Alzheimer's Association

2014 Alzheimer’s Disease Facts and Figures is a statistical resource for U.S. data related to Alzheimer’s disease, the most common type of dementia, as well as other dementias. Background and context for interpretation of the data are contained in the Overview. This information includes definitions of the various types of dementia and a summary of current knowledge about Alzheimer’s disease. Additional sections address prevalence, mortality and morbidity, caregiving and use and costs of care and services. The Special Report discusses women and Alzheimer’s disease.

California and its Counties Under Health Reform: A Leadership Framework

MAY 2014 | Complete Report | California HealthCare Foundation (CHCF)

As California moves to fully implement the Affordable Care Act, it is making major health program, policy, and fiscal changes that are transforming the way the state and its 58 counties share responsibility for the health care of nearly 40 million residents. CHCF has published a report for policymakers and stakeholders that highlights important program and policy changes and lays out a framework for evaluating their effects.

Long-Term Care in America: Expectations and Reality

MAY 19, 2014 | Findings | AP/NORC Center for Public Affairs Research

Findings from the 2nd long-term care poll by AP-NORC have been released. These polls are being conducted in order to produce new and actionable data about the aging population to inform the national dialogue surrounding long-term care issues.

Just Like Home: An Advocate's Guide to Consumer Rights in Medicaid HCBS

MAY 2014 | Guide | National Senior Citizens Law Center (NSCLC)

New federal Medicaid rules, for the first time, set standards to ensure that Medicaid-funded home and community-based services (HCBS) are provided in settings that are non-institutional in nature. These standards, which took effect in March 2014, apply to residential settings, such as houses, apartments, and residential care facilities like assisted living facilities. The standards also apply to non-residential settings, such as adult day health care programs.

Monitoring Access: Measures to Ensure Medi-Cal Enrollees Get the Care They Need

MAY 2014 | Report | California Healthcare Foundation (CHCF)

This report offers a framework and a targeted set of measures for monitoring access to ambulatory care for individuals enrolled in the Medi-Cal program. It is intended as an actionable starting point for elected leaders, state and federal program officials, and other stakeholders, to help them monitor changes in access to care over time, to identify disparities in access to care across subgroups or geographic regions, and to compare access between Medi-Cal enrollees and other insured populations in California and nationally.

In Transition: Seniors and Persons with Disabilities Reflect on Their Move to Medi-Cal Managed Care

APR 23, 2014 | Report | California Healthcare Foundation (CHCF)

Researchers from the University of California, Berkeley, present findings from a survey of more than 1,500 SPD Medi-Cal enrollees who made the transition to Medi-Cal Managed Care. The report offers suggestions for improving transitions to managed care involving populations with complex needs, including those dually eligible for Medicare and Medicaid, and examples of actions taken by DHCS in response to the study's findings.

2014 Alzheimer's Disease Facts and Figures

APR 2014 | Report | Alzheimer's Association

Includes a Special Report on Women and Alzheimer’s Disease

An estimated 5.2 million Americans have Alzheimer's disease in 2014, including approximately 200,000 individuals younger than age 65 who have younger-onset Alzheimer's. By 2050, the number of people age 65 and older with Alzheimer's disease may nearly triple, from 5 million to as many as 16 million, barring the development of medical breakthroughs to prevent, slow or stop the disease.

America's Long-Term Care Crisis: Challenges in Financing and Delivery

APR 2014 | Report | Bipartisan Policy Center (BPC)

America's Long-Term Care Crisis: BPC Launches Initiative to Find a Politically and Fiscally Viable Path Forward to Improve the Financing and Delivery of Long-Term Care

This report sets the stage for BPC’s recommendations by identifying the major challenges and key questions in the financing and delivery of LTSS for both seniors and individuals under age 65.

NSCLC 2013 Annual Report

APR 1, 2014 | 2013 Annual Report | National Senior Citizens Law Center (NSCLC)

The National Senior Citizens Law Center (NSCLC), committed to providing a voice for the millions of low-income seniors who struggle everyday to meet their basic needs, released the NSCLC 2013 Annual Report.

Genworth 2014 Cost of Care Study

MAR 25, 2014 | Executive Summary and Full Report | Genworth

Over the past 11 years, Genworth has been able to recognize and identify trends across the long term care services landscape. The 2014 Genworth Cost of Care study looked at Homemaker Services, Home Health Aide Services, Adult Day Health Care (ADC), Assisted Living Facility (ALF) and Nursing Home Care.

Among the key findings for Adult Day Health Care (ADC): National Median Daily Rate: $65 | Increase Over 2013: 0% | Five Year Annual Growth: 3.4%*.

*Percentage increase represents the compound annual growth rate for surveys conducted from 2009 to 2014.

California's Health Care Workforce: Examining Supply and Demand

MAR 2014 | California Health Care Almanac

New reports feature physicians, nurses, and allied health professionals

An influx of new patients, a result of the Affordable Care Act (ACA), along with an aging population, is expected to increase demands on California's health care workforce. Will providers be ready?

Daily Stressors and Adult Day Service Use by Family Caregivers: Effects on Depressive Symptoms, Positive Mood, and Dehydroepiandrosterone-Sulfate

FEB 3, 2014 | Abstract | The American Journal of Geriatric Psychiatry | Steven H. Zarit, PhD

This study examines effects of daily use of adult day service (ADS) programs by caregivers of individuals with dementia (IWD) on a salivary biomarker of stress reactivity, dehydroepiandrosterone-sulfate (DHEA-S), and whether these effects on DHEA-S are associated with daily variability in positive mood and depressive symptoms.

Long-Term Care: What Are The Issues?

FEB 2014 | Issue Brief | Robert Wood Johnson Foundation

The demand for long-term care services will explode as the population ages and more people live longer with chronic conditions. Who will pay for these services and how will they be delivered?

A State-by-State Snapshot of Poverty Among Seniors: Findings From Analysis of the Supplemental Poverty Measure

MAY 20, 2013 | Issue Brief | Kaiser Family Foundation

Key Findings:

  • The share of seniors living in poverty is higher in every state under the supplemental measure than under the official measure, and at least twice as high in 12 states, including California.
  • The share of seniors living in poverty under the supplemental measure is especially high in some areas. Based on the supplemental measure, about one in four seniors (26%) are living in poverty in DC and roughly one in five seniors are living in poverty in six states, including California (20%).
  • Nationally, nearly half of all seniors (48%) live with incomes below 200 percent of the poverty threshold under the supplemental measure, compared to 34 percent under the official measure.
  • At least half of seniors have incomes below 200 percent of poverty in 10 states and DC based on the supplemental measure, including California (56%).

California's Uninsured: By the Numbers

DEC 19, 2013 | Report | California HealthCare Foundation (CHCF)

California's Uninsured: By the Numbers provides a look at California's uninsured population before full implementation of the ACA.

Monitoring Performance: A Dashboard of Medi-Cal Managed Care

DEC 18, 2013 | Report | California HealthCare Foundation (CHCF)

This first public performance dashboard of Medi-Cal managed care shows areas of strength and opportunities for improvement. Among the key findings:

  • Medi-Cal managed care performs at or above the national Medicaid median on 17 of 19 quality indicators. On the two measures for which Medi-Cal lags behind the national median — postpartum care and timeliness of prenatal care — the gap has persisted over the last four years.
  • On most measures of consumer experience, the program performs below the national Medicaid median.
  • Across all measures of quality, access, and consumer satisfaction, there are considerable differences in performance among participating plans, including significant variation in plan performance within counties.
  • Most plans participating in Medi-Cal appear to be in sound financial health. Two plans, however, have had net losses in each of the last two years.

Long-Term Care Services in the United States: 2013 Overview

DEC 12, 2013 | Report | National Center for Health Statistics (NCHS)

The National Center for Health Statistics released a 93-page report based on findings from the National Study of Long-Term Care Providers (NSLTCP). The study considered long-term care services provided by adult day services centers, home health agencies, hospices, nursing homes, and assisted living and similar residential care communities. The key goals of the periodic study are to:

  • Estimate the supply of paid, regulated long-term care services providers
  • Estimate key policy-relevant characteristics of these providers
  • Estimate the number of long-term care services users
  • Estimate key policy-relevant characteristics of these users
  • Compare provider sectors
  • Produce national and state estimates, where feasible
  • Monitor trends over time

Medicaid Expansion in California: Opportunities and Challenges for Older Adults and People with Disabilities

NOV 2013 | Issue Brief | National Senior Citizens Law Center (NSCLC)

A new NSCLC issue brief provides an overview of new coverage options and how they impact low-income older adults and people with disabilities. The brief also explores how people receiving coverage under Medicaid expansion and exchanges will transition into Medicare coverage when they turn 65 or otherwise become eligible. While the issue brief focuses on how these issues play out in California, much of the information is relevant to advocates and policymakers in other states as well.

Health Information Technology in California: Milestones and Miles to Go

NOV 2013 | Report | California HealthCare Foundation (CHCF)

This report shows interest continues to grow among Californians in using technology to support their health care needs, with 60% saying they would like online access to their health information. Similar percentages want the ability to schedule appointments online, receive appointment reminders, and email their medical professionals.

Primary Care: Proposed Solutions to the Physician Shortage Without Training More Physicians

NOV 2013 | Article | California HealthCare Foundation (CHCF)

This article asserts that as demand for adult health care services surges, the number of primary care physicians entering medicine continues to decrease, with shortages predicted to reach as high as 40,000 to 52,000 over the next decade. Recruiting new physicians is a logical solution, but one that won't close the care gap anytime soon.

Quality of Care: Steps in the Right Direction

OCT 2013 | Report | California HealthCare Foundation (CHCF)

This report looks at the quality of care in California on a variety of measures, including childbirth, children's health, and management of patients with common chronic conditions. It also provides data on patient safety, nursing homes, home health, and end-of-life care.

Health Care in the Two Americas: Findings from the Scorecard on State Health System Performance for Low-Income Populations, 2013

SEPT 2013 | Scorecard | The Commonwealth Fund

Of all the challenges we face in health care, variation in system performance and disparities in health outcomes are among the most persistent and troubling. The Commonwealth Fund's new Scorecard on State Health System Performance for Low-Income Populations, 2013 sheds light on these problems and identifies opportunities for states to improve their health systems for economically disadvantaged populations.

New HIPAA Privacy Policies and Procedures Manual

SEPT 2013 | Regulatory Alert | Order Form | CAADS

On September 23, ALL Adult Day Health Care / CBAS facilities that are subject to the HIPAA privacy and security rules must come into compliance with the “HIPAA Omnibus Rule” which implements changes required by the HITECH Act of 2009. Any facility engaging in electronic transmission of protected health information is included. Failure to have internal guidelines in place that comply with the new Rule can lead to fines and other sanctions after September 23, 2013.

A fully updated Privacy Policies and Procedures Manual, designed to be easily customizable to your center, is available from CAADS. This manual replaces the previous CAADS HIPAA Policy and Procedures Manual in its entirety.

Health Care Costs 101 -- Slow Growth: A New Trend?

SEPT 2013 | Report | Infographic | California HealthCare Foundation (CHCF)

Relying on the latest data available, Health Care Costs 101, part of CHCF's California Health Care Almanac, details how much is spent on health care in the US; which services are purchased; and what proportions are financed by households, government, and business.

Long Term Care in California: Ready for Tomorrow's Seniors?

AUG 2013 | Report | All Almanac Reports | California HealthCare Foundation (CHCF)

The leading edge of the baby-boom generation is beginning to flood California's long term care system. And the population of residents 65 and older is projected to triple by 2060. This report describes the state's supply and use of long term care services, including Medicare and Medicaid spending on services, and quality of care. The oversight and regulation of long term care services varies by provider, resulting in limited information — especially quality data — about assisted living facilities, personal care providers, and other home- and community-based services.

*Correction: The graphic on page 49 of  Long Term Care in California: Ready for Tomorrow's Seniors? mischaracterized the frequency of reviews for assisted living facilities. These facilities are subject to annual compliance reviews and investigations of serious complaints, but are not subject to annual site inspections.

Pathways to Progress in Planning for Long-Term Care

AUG 13, 2013 | Survey Results | AP/NORC Center for Public Affairs Research

Langer Research Associates launched an in-depth analysis of the April 2013 AP/NORC Center for Public Affairs Research poll. Findings show that people who know where to get information on long-term care are more apt to prepare for those needs. Funded by The SCAN Foundation, the survey results detailed in Pathways to Progress in Planning for Long-Term Care, explore why this avoidance occurs – with useful conclusions for policymakers, practitioners and the public alike.

State-by-State Profiles on Direct-Care Workforce

AUG 2013 | Web Tool | PHI Data Center

This unique state-by-state web tool now includes standards for home health, personal care, and nursing aides. View California's profile of Workforce Size, Employment Projections, Wages, Health Coverage, Public Assistance, Training, Legislation/Regulation, Best Practices and Resources.

The Effects of Adult Day Services on Family Caregivers' Daily Stress, Affect, and Health: Outcomes From the Daily Stress and Health (DaSH) Study

MAY 20, 2013 | Study | The Gerontologist

In this study, we examine the effects of use of adult day service (ADS) by caregivers of individuals with dementia (IWD) on daily stressors, affect, and health symptoms. Participants were interviewed for 8 consecutive days. On some days, the IWD attended an ADS program and on the other days caregivers provide most or all of the care at home.

Tracking ACA Implementation in California

APR 2013 | Guide | California HealthCare Foundation (CHCF)

The California HealthCare Foundation (CHCF) has updated its guide, which details California's progress toward meeting the Affordable Care Act's (ACA) four main objectives — expanding coverage in public programs; streamlining eligibility and enrollment; protecting health insurance consumers; and creating a user-friendly marketplace for consumers to shop for private health insurance.

Long-Term Care: Perceptions, and Attitudes among Americans 40 or Older

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

According to this 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)

Cal MediConnect Program

APR 2013 | Fact Sheet -- The SCAN Foundation

Cal MediConnect: A Summary of the Memorandum of Understanding Between California and the Centers for Medicare and Medicaid Services is a 13 page fact sheet issued by the SCAN Foundation. The fact sheet provides background information and summarizes key points of the MOU that formalized a federal-state partnership to implement the Dual Eligibles Integration Demonstration known as "Cal MediConnect."

California's Health Care Safety Net: A Complex Web

APR 17, 2013 | Report -- California HealthCare Foundation (CHCF)

The health care safety net is a complicated web of programs and providers that serve low-income Californians without private health insurance. Changes in the economy, government budgets, and health care policy can influence how the safety-net population obtains medical care. An updated report by the California HealthCare Foundation, California's Health Care Safety Net: A Complex Web, provides a snapshot of California's safety net at a critical juncture ahead of the full implementation of the federal Affordable Care Act (ACA) in 2014. Stakeholders are preparing for important ACA deadlines, such as the expansion of Medi-Cal, the state's largest safety-net program, while legal and political battles wage on over the future of health care reform.

Long Term Services and Supports Program Compendium

APR 17, 2013 | Compendium -- The SCAN Foundation

The Long Term Services and Support Program Compendium, issued by The SCAN Foundation, is a compendium of federal and state agencies and departments supporting Long-Term Services and Supports Systems (LTSS), including:

  • U.S. Department of Health and Human Services (DHHS)
  • Centers for Medicare and Medicaid Services (CMS)
  • Administration on Aging (AoA)
  • California Health and Human Services Agency Program Initiatives
  • California Department of Health Care Services (DHCS) Programs/Services
  • California Department of Aging (CDA) Programs/Services
  • California Department of Rehabilitation (DOR) LTC Programs/Services
  • California Department of Social Services (CDSS) Programs/Services
  • California Department of Public Health (CDPH) LTC Programs/Services
  • California Department of Developmental Services (DSS) Programs/Services

LTC Commission Should Right Imbalance in How Medicaid Pays for LTSS

MAR 2013 | National Senior Citizens Law Center (NSCLC)

President Obama recently appointed the final members of the Commission on Long Term Care. Over the next six months the Commission must accomplish one objective: develop a plan for the establishment, implementation and financing of a comprehensive, coordinated, and high-quality system that ensures the availability of long-term services and supports (LTSS) for individuals who need LTSS. Read The HCBS Opportunity: Recommendations for the Commission on Long-Term Care

Transitioning the SPD Population to Medi-Cal Managed Care: Examining the Experiences of Beneficiaries

MAR 28, 2013 | California HealthCare Foundation (CHCF)

The video and slides from the March 28, 2013 California HealthCare Foundation briefing, Transitioning the SPD Population to Medi-Cal Managed Care: Examining the Experiences of Beneficiaries, may be viewed on the State Health Policy page of the CHCF website.

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

FEB 20, 2013 | Health Policy Brief -- UCLA Center for Health Policy Research

The policy brief, Limited English Proficient HMO Enrollees Remain Vulnerable to Communication Barriers Despite Language Assistance Regulations, reveals that 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.

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

JAN 2013 | Fact Sheet -- The SCAN Foundation

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. This fact, California's Proposed 2013-14 Budget: Impact on California's Seniors and People with Disabilties, looks at the initiatives and program adjustments that would impact California's seniors and people with disabilities.

2012 MetLife Mature Market Study of Long Term Care Costs

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

The MetLife Mature Market Institute® has released the 2012 MetLife Mature Market Study of Long Term Care Costs, 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.

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

OCT 12, 2012 | In-Brief 2 pgs | Executive Summary 92 pgs | CA 8 pgs | Full Report 370 pgs | AARP Public Policy Institute

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.

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

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

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, as the report Moving "Dual Eligibiles" Into Mandatory Managed Care and Capping Their Federal Funding Would Risk Significant Harm to Poor Seniors and People with Disabilities shows, we do not yet know how to do this.

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

MAY 2012 | Policy Brief - Center for Health Care Strategies

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. The brief, Medicaid Rate-Setting Strategies to Promote Home- and Community-Based Services, 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.

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

MAY 24, 2012 | Survey Findings - Jackson Healthcare

In A Tough Time for Physicians: 2012 Medical Practice & Attitude Report, Jackson's findings from a series of surveys conducted between May and June 2012 are summarized. 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)

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

FEB 17, 2012 | Report - LAO

In a February 17, 2012 LAO report, The 2012-13 Budget: Integrating Care for Seniors and Persons With Disabilities, 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.

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

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

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

National Study of Long Term Care Providers

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

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 or contact: Dr. Lauren Harris-Kojetin, Chief, Long-Term Care Statistics Branch,, 301-458-4369.

Medi-Cal Provider Payment Reductions in SPAs Approved by CMS

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

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:

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. Also see: OCT 27, 2011 | CAADS Industry Alert.

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

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

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

Stressed and Strapped: Caregivers in California

SEPT 21, 2011 | Policy Brief -- UCLA Center for Health Policy Research

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, according to the authors of a new policy brief, Stressed and strapped: Caregivers in California, by the UCLA Center for Health Policy Research.

Elimination of ADHC as a Medi-Cal Optional Benefit

JUN 2011 | Survey Findings - California Association for Adult Day Services

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 survey 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

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

MAY 10, 2011 | Report -- HMA / Health Management Associates

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.

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

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

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.

Getting Serious About Delirium: Hospitalists amp up screening, treatment and prevention

JAN 2011 | Today's Hospitalist Article | Bonnie Darves

Adult Day Services providers who attended the CAADS Conference at which keynoter Cordula Dick-Muehlke, PhD spoke about the importance of distinguishing delirium from Alzheimer's and related dementia will find this article of particular interest, and be pleased to see that hospitalists are being encouraged to watch for delirium. This piece also covers how to prevent and treat delirium without meds and offers insights to those working in the community setting with high risk consumers.

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

JAN 2010 | Report -- Case Western Reserve University

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.

A New Nursing Home Population: The Young

DEC 9, 2010 | Investigative Report -- National Public Radio

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.

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

MAY 18, 2010 | Report -- The Lewin Group

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.

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

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

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.

California Budget Cuts Fray the Long-Term Care Safety Net

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

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.

Adult Day Services: A Key Community Service for Older Adults

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

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.

Health of Older Californians: County Data Book

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

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.



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