The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #54514

M. Christine Tonner, MPH, Institute for Health and Aging, University of California, San Francisco, 3333 California Street, Suite 340, Box 0646, San Francisco, CA 94118-0646, 415-502-6204, ctonner@itsa.ucsf.edu and Charlene Harrington, PhD, Department of Social & Behavioral Sciences, University of California San Francisco, 3333 California St, Suite 455, San Francisco, CA 94143-0612.

Over the past two decades, states have expanded the delivery of long term care from institutions to the home and community. Although state Medicaid need criteria for the home and community based services (HCBS) waiver program must be equivalent to those for nursing facility (NF) criteria, other screening procedures for these services are not specified. The purpose of this study was to describe the variations in need criteria, methods for screening and assessment, and the assessment forms for NFs and HCBS waivers for the elderly and disabled populations in each state in 1999. The NF minimum need criteria was most often (31 states) based on a combination of nursing, medical, functional, or other psychosocial criteria, whereas 10 states used nursing criteria, and 10 used limitations in functional activities criteria. Two states had no specific criteria and relied on physicians' judgment, whereas one state required limitations in 4 ADLs. Most states used either explicit criteria (25 states) or point systems (7 states), but 19 states used guidelines that allowed for judgment by those conducting the assessment. In some states, the HCBS waivers for the aged and disabled have higher need criteria, more comprehensive assessments for eligibility, and longer assessment forms than for NFs. Wide variability in need criteria, screening methods, and forms creates potential inequities in access to LTC services across and within states.

Learning Objectives:

• Participants should be able to: identify screening methods for determining long term care eligibility; recognize variations in state screening methods; design strategies to ensure equity in access to LTC services.

Keywords: Screening, Long-Term Care

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.