Expedited service delivery: helping case managers to increase access to services for the poorest older adults.

Low-income older adults have historically received institutionally based care when they were unable to care for themselves and there was a lack of sufficient formal and informal support to allow them to remain in their own homes. In 1981, revision of federal Medicaid legislation permitted states to provide home- and community-based services (HCBS) for older adults at risk of nursing facility placement in an attempt to prevent unnecessary placement and to offer choice. However, Medicaid-HCBS applicants may have to wait up to 45 days or longer for approval of their financial application. During those 45 days, the applicant may enter a nursing facility because Medicaid-HCBS was not available soon enough to prevent placement. This article presents research on an instrument to help case managers initiate community-based in-home services for the lowest-income Medicaid applicants within 3 to 5 days of initial assessment.

Going home: community reentry of light care nursing facility residents age 65 and over.

Issues of consumer choice, and rising public expenditures of nursing facility care for the rapidly increasing elderly population have fueled interest in community reentry of nursing facility residents. The Minimum Data Set Plus (MDS+) contains a wealth of information which can be used to provide a better understanding of nursing facility residents including those who discharge. This study employs the Andersen model of health services utilization and logistical regression on MDS+ data to examine characteristics of higher functioning nursing facility residents age 65 and over related to community reentry in one midwestern state. Findings include having Medicaid as a payer source significantly decreased the likelihood of discharge. In contrast, being younger than 85, retaining decision making responsibilities, and having no cognitive impairments were found to increase the likelihood of discharge. Policy and program implications related to identifying and assisting nursing facility residents in resuming community living are discussed.