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The Gerontologist Advance Access published online on July 13, 2009
The Gerontologist, doi:10.1093/geront/gnp111
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© The Author 2009. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Reforming Long-Term Care in the United States: Findings From a National Survey of Specialists

Edward Alan Miller, PhD, MPA1, Vincent Mor, PhD2 and Melissa Clark, PhD3

2 Department of Gerontology, McCormack School of Policy Studies, University of Massachusetts Boston
3 Department of Community Health, Warren Alpert Medical School, Brown University, Providence, Rhode Island

1 Address correspondence to Edward Alan Miller, PhD, MPA, Department of Gerontology, McCormack Graduate School of Policy Studies, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA 02125. E-mail: edward_a_miller{at}brown.edu


  Abstract

Purpose: Theories of the policy process recognize that policy proposals are typically generated, debated, redrafted, and accepted for consideration through the gradual accumulation of knowledge within communities of specialists. Thus, to inform long-term care (LTC) reform efforts, we conducted a Web-based survey of 1,147 LTC specialists nationwide. Design and Methods: Survey respondents included consumer advocates, provider representatives, public officials, policy experts, and others with experience in LTC. Administration took place between September 2007 and March 2008 and addressed prevailing challenges and options for reform. Results: Although differences could be discerned, constituency group views converged in several areas. There was general agreement that LTC financing needed to be socialized more and that impediments to organizational change needed to be overcome. Respondents also felt that LTC needed to be rebalanced toward home- and community-based settings, though few supported doing so by limiting nursing home (NH) bed supply. Although virtually all felt that the federal government was doing a poor job regulating LTC providers, most believed that the approaches used to oversee NHs should also be applied to assisted living. Payment incentives were highlighted as the most effective strategy for improving quality even though it suffers from the same informational deficits compromising consumer reporting. Implications: By giving voice to those who know LTC very well, and identifying areas of agreement and disagreement, this study should prove useful in promoting LTC reform where it might otherwise remain politically intransigent.

Keywords: Stakeholders, Health reform, Surveys, Financing, Quality

Received April 13, 2009; Accepted June 11, 2009

Decision Editor: William McAuley, PhD


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