AARP Public Policy Institute Research Articles

Effects of art therapy for family caregivers of cancer patients: a systematic review protocol

Effects of art therapy for family caregivers of cancer patients: a systematic review protocol

Person-centered Planning and Participant Decision Making

It is a humbling experience to try to capture those critical elements in the Patient Protection and Affordable Care Act (P.L. 111-148) (now more commonly called the Affordable Care Act [ACA]) that have the most import for our profession of social work. I focus my remarks on one theme that is woven throughout health care reform: person-centered planning and participant direction. Whereas that theme appears in both the acute and long-term care portions of the legislation, here I zero in on the provisions dealing with long-term supports and services in the community. Participant-directed services are long-term care services that help people of all ages, across all types of disabilities, to maintain their independence and determine for themselves what mixture of personal care services and supports works best for them. Sometimes these are referred to as consumer-directed or self-directed services. Under the participant-directed model, individuals have control over who helps them with the basic, personal activities of daily living (ADLs) such as bathing, dressing, and getting out of bed (employer authority) and how their funds are used (budget authority). Within the constraints of their budget, they can purchase any combination of goods, services, and human assistance that meets their personal assistance needs and helps them stay independent in the community. If they need help in managing, they can appoint an unpaid family member or friend to be their representative; and they have readily available support services to help them handle bookkeeping, taxpaying, and check-writing responsibilities (financial management services) and to develop person-centered plans, find resources, develop backup plans, meet training needs, and so forth (support broker or counseling services). This approach not only meets present and future needs for flexibility and choice, but also (under the Cash & Counseling demonstration [see http://www. bc.edu/schools/gssw/nrcpds/cash_and_counseling. html]) has proven itself under rigorous comparative effectiveness testing. Here is a summary of what the research, conducted by Mathematica Policy Research, provides: * improved access; * improved quality of care: * increased satisfaction, * reduced unmet needs, and * same or better health outcomes; * caregiver benefits; * controllable costs; and * the potential for reduced nursing facility usage. Clearly, interest in participant direction is increasing. The National Survey of Participant Direction Programs, which Boston College's National Resource Center for Participant-Directed Services (NRCPDS) is completing, shows that all states have at least one program offering employer authority, and 41 states have at least one program with the budget authority option. This movement will only expand. In 2003, AARP's Public Policy Institute released a survey in which they asked a representative group of members (over the age of 50 years) how they would like to receive services if, in the future, they needed help in basic ADLs like bathing, dressing, or getting out of bed (Gibson, 2003). Seventy-five percent indicated that they would prefer managing for themselves over receiving care from agencies. Furthermore, no one needs to remind us of the increasing diversity of our nation's older population. Between 1990 and 2030, elders in four ethnic groups are expected to grow from 14 percent to 25 percent of the over-65 population. Our nation is diverse in terms of race, gender, ethnicity, sexual orientation, functional ability, and cognitive ability, to name but a few dimensions. We need a system that is flexible. Let me repeat, it is clear that one size does not fit all. Participant direction allows individuals and families to tailor supports to their unique needs and preferences. No wonder the 2008 Commonwealth Fund Survey of Long-Term Care Opinion Leaders (Miller, Mor, & Clark, 2008) found that 61 percent of 1,147 leaders responding favored expansion of participant direction efforts like Cash & Counseling as a potential strategy for reform of publically funded services. …

Migrant Care Workers or Migrants Working in Long-Term Care? A Review of Australian Experience

Discussion of the role of migrant care workers in long-term care (LTC) that has gained increasing attention in the United States and other developed countries in recent years is of particular relevance to Australia, where 24% of the total population is overseas-born, two-thirds of them coming from countries where English is not the primary language. Issues of interest arise regarding meeting LTC workforce demands in general and responding to the particular cultural and linguistic needs of postwar immigrants who are now reaching old age in increasing numbers. This review begins with an account of the overseas-born components of the aged care workforce and then examines this representation with reference to the four factors identified as shaping international flows of care workers in the comparative study carried out for the AARP Public Policy Institute in 2005: migration policies, LTC financing arrangements, worker recruitment and training, and credentialing. The ways in which these factors play out in Australia mean that while overseas-born workers are overrepresented in the LTC workforce, migrant care workers are not identifiable as a marginalized group experiencing disadvantage in employment conditions, nor do they offer a solution to workforce shortages. The Australian experience is different from those of other countries in many respects, but it does show that the experience of migrant care workers is not unique to LTC and points to the need to extend the search for solutions to workforce shortages and improving conditions of all care workers well beyond LTC systems to wider policy settings.

Supporting Family Caregivers

Supporting Family Caregivers

Medicare Part D and Preferred Provider Pharmacy Networks

The purpose of this note is to present the case that a provision in Medicare Part D has contributed significantly to the interest in sponsorship. This provision allows for the creation of preferred provider retail pharmacy networks with highly differentiated co-payments. PBMs of large drugstore chains are in the best position to take advantage of this provision. Battered by discriminatory practices used by independent PBMs to swing business away from retail pharmacies to their captive mail order operations, the drugstore chains are poised to unleash their PBMs in a counterattack.Although the Medicare discount card program was not designed specifically to be a steppingstone to the full benefit plan, it has provided a showcase for the cost-reducing potential of preferred provider retail pharmacy networks. Evidence of this potential comes from data compiled by the AARP Public Policy Institute.