Three Types of Evidence Needed to Expand and Improve Personal Care Services

1. Three Types of Evidence Needed to Expand and Improve Personal Care Services Peter Kemper Pennsylvania State University Presented at State of the Science Conference on Meeting the Nation’s Need for Personal Assistance Services April 27, 2007

2. Preview 1. Evidence on effects of public programs is needed to persuade policymakers to fund them. 2. States need trend information on costs, delivery, and outcomes of their person directed care programs to monitor and improve them. 3. Managers and policymakers need evidence on how to improve the jobs and skills of personal care workers and quality of care.

3. 1. Evidence on effects of public programs is needed to persuade policy makers to fund them.

4. Study of the Effect of Home Care Spending on Unmet Need • Estimated relationship between unmet need for personal care and state home care spending • Indicator of unmet need: Has an ADL limitation but does not receive help • Home care spending (home health, personal care, aged and aged/disabled waivers) per poor elderly person Kemper, Weaver, Short, Shea, and Kang, “Meeting the Need for Personal Care among the Elderly: Does Medicaid Home Care Spending Matter?” Health Services Research, forthcoming.

5. Distribution of Home Care Spending in 2000 Number of states Thousands of dollars

6. Effect of Home Care Spending on Unmet Need Unmet Need (%) SSI Income Eligibility Group

7. Additional Evidence Needed • Better measures of outcomes • More compelling measures unmet need • Consequences of unmet need • Quality of life benefits • Benefits to families • Inclusion in national longitudinal surveys • Better, consistent, and continuous measures of state policy • Application of stronger methods

8. 2. States need trend information on costs, delivery, and outcomes of their person directed care programs to monitor and improve them.

9. Effect of Cash and Counseling on Hours of Personal Assistance Source:Author’s interpretation of findings in Carlson et al. (2007), Dale and Brown (2007), and Foster, Dale, and Brown (2007) sStrong Evidence of Effect

10. Effect on Benefits and Expenditures Source:Author’s interpretation of findings in Carlson et al. (2007), Dale and Brown (2007), and Foster, Dale, and Brown (2007) sStrong Evidence of Effect

11. Data Needed • Expenditures by type and by program • Number of enrollees, length of enrollment • Case loads and disability levels • Adverse events • Care plan budget over time for each enrollee • Consistent information at least annually • Information by geographic area, e.g. county

12. 3. Managers and policymakers need evidence on how to improve the jobs and skills of personal care workers and quality of care.

13. Better Jobs Better Care • Five-state demonstration of management changes affecting “direct care workers” • Goal is to improve jobs and reduce turnover • Ultimate goal is to improve quality of care • Multiple provider types • Nursing facilities • “Long term care places” • Home care

14. Average Wages of Direct Care Workers

15. Health Insurance Eligibility and Take-up Rates

16. What is the single most important thing your employer could do to improve your job? Compensation 20% 21% Staffing Work Relationships

17. Recommendations by Provider Type(percent)

18. Additional Evidence Needed • Data on personal care workers who do not work in providers • Evidence on the relative effects of increasing wages vs. improving management • Rigorous evidence on the effectiveness of alternative management interventions • Evidence on the relationship between job turnover and quality of care

19. Summary 1. Evidence on effects of public programs is needed to persuade policy makers to fund them. 2. States need trend information on costs, delivery, and outcomes of their person directed care programs to monitor and improve them. 3. Managers and policymakers need evidence on how to improve the jobs and skills of personal care workers and quality of care.