Regression-adjusted small area estimates of functional dependency in the noninstitutionalized American population age 65 and over.

Health planning efforts for the population age 65 and over have been hampered continually by the lack of reliable estimates of the noninstitutionalized long-term care population. Until recently national estimates were virtually nonexistent, and reliable small area estimates remain unavailable. However, with the recent publication of several national surveys and the 1990 Census, synthetic estimates can be made for states and counties by using multivariate methods to model functional dependency at the national level, and then applying the predicted probabilities to corresponding state and county data. Using the 1984 National Health Interview Survey's Supplement on Aging and the 1986 Area Health Resources File System, we have produced log-linear regression models that include demographic and contextual variables as predictors of functional dependency among the noninstitutionalized population age 65 and over. Age, sex, race, and the percent of the 65 and over population who reside in poverty were found to be significant predictors of functional dependency. Applying these models to 1986 Medicare Enrollment Statistics, regression-adjusted synthetic estimates of two levels of functional dependency were produced for all states and--as examples of how the rates can be used to produce additional synthetic estimates--the largest county in each state. We also produced point estimates and standard errors for the national prevalence of functional dependency among the noninstitutionalized population age 65 and over.

Adult day care regulation: "Déjà vu all over again"?

We investigate what aspects of adult day care are regulated by licensure and certification requirements, whether differences exist among centers according to their regulatory status, and the relationship between regulatory status and satisfaction. The data come from a national survey of adult day care center. We find that adult day care regulations are primarily structural in nature and that differences do exist among centers by regulatory status. Participants are very satisfied with the centers and their staff overall, especially at centers that are regulated; their satisfaction with milieu is less at regulated centers and with amenities is unaffected. Day care regulations have not been extended to the processes and outcomes of care as nursing home regulations recently have been. The choice that now faces policymakers is between increasing these regulations or relying on market mechanisms to protect day care participants.

Financial aspects of adult day care: national survey results.

Using data from a national survey of adult day care centers, it was found that a typical center had revenues of approximately $140,000 and expenses that were slightly higher. Most of the revenue was from Federal sources, with Medicaid being the largest single source. The median cost per participant day was $29.50, over one-half of which was attributable to labor expenses. To the extent that adult day care programs can better utilize their capacity, considerable savings could be made in cost per participant day.

Models of adult day care: findings from a national survey.

We examined a nationally representative sample of 60 adult day care centers to describe the state of this evolving care modality after a decade's growth. Results indicate that day care centers can be categorized into three models of care, each of which serves a distinctive subpopulation. Model appropriateness was tested with analysis of variance of differences in participant characteristics. Services, staffing, costs, and other program features are contrasted among the three models.