What works? Maine's statewide uniform assessment and home care planning system tells all.

Abstract

Maine’s state-funded home-based care (HBC) program succeeds in aligning resources with the care needs of consumers. Using trained nurse assessors who develop and authorize service plans, the Maine HBC program targets home care services to those most in need. A recent analysis of the program found that authorized service plan costs increased consistently and in a linear relationship with levels of impairment. From a state policy perspective, this finding provides a basis for developing policies that more equitably distribute limited state-funded home- and community-based resources to those most in need of care. Background In their meta-analysis of 27 home- and community-based care service studies, Weissert, Cready, and Pavelak (1988) concluded that home- and community-based resources are not adequately targeted to those in greatest need. This failure to align resources with need, combined with the growth in home health expenditures, leaves state policy makers struggling with “how to provide needed services on an equitable basis and do so in such a manner that family caregivers do not try to substitute publicly-funded [sic] care for the care they have been long providing” (Hudson, 1996, p. 456). Although case mix classification systems (Fries & Cooney, 1985) and payment methods have been developed to identify and allocate resources in nursing facilities, methods for aligning home care need with resource requirements remain relatively unknown.