The Impact of a Community-Based Long-Term Care Demonstration Project on the Functioning Outcomes of Frail, Elderly People: a Cost-Effectiveness Analysis.

Community-based long term care demonstration projects have been created as one response to rising Medicaid expenditures for nursing home care. These projects have substituted case-managed, community-based long term care services for nursing home services in an attempt to reduce government costs and improve functioning and well-being outcomes of clients relative to the existing system. The California Multipurpose Senior Services Project (MSSP) served over 2,000 clients between 1980 and 1983. This dissertation examines the impact of this demonstration project on older persons' functioning outcomes, as measured by the Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), and Short Portable Mental Status Questionnaire (SPMSQ) indices. I also examine project impact on self-rated health. The ADL and IADL functioning indices directly measure, and the SPMSQ indices indirectly measure, the level of self-produced services. If project services served as complements in the production of self-produced services, the project impact on functioning outcomes would be positive. If project services served as substitutes in consumption for self-produced services, the project impact would be negative. I estimate the project impact using linear and ordered probit models. Over twenty independent variables adjust for differences in characteristics between the client and comparison groups. The project had no statistically significant impact on functioning outcomes or self-rated health of all clients combined. The project may have had a significant, negative impact on ADL functioning of male clients. Since client costs exceeded comparison costs, the project was not cost-effective, in terms of the outcomes examined. The findings for all clients combined are generally consistent with findings from other, similar projects. I observe that: (a) an outcomes-based reimbursement mechanism that can help achieve quality of care policy goals must use other outcome measures, which are more sensitive to the intervention of providers of differing quality, and (b) program design changes--including long term care capitation rates, outcomes-based reimbursement mechanisms, and sub-group targetting--are essential if noninstitutional long term care projects/programs are to improve outcomes for a given cost.PhDEconomic theoryGerontologyPublic healthUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/161437/1/8712177.pd