How state-funded home care programs respond to changes in Medicare home health care: resource allocation decisions on the front line.

Journal Article (Journal Article)

OBJECTIVE:To examine how case managers in a state-funded home care program allocate home care services in response to information about a client's Medicare home health care status, with particular attention to the influence of work environment. DATA SOURCES/STUDY SETTING:Primary data collected on 355 case managers and 26 agency directors employed in June 1999 by 26 of the 27 regional agencies administering the Massachusetts Home Care Program for low-income elders. STUDY DESIGN:Data were collected in a cross-sectional survey study design. A case manager survey included measures of work environment, demographics, and factorial survey vignette clients (N = 2,054), for which case managers assessed service eligibility levels. An agency director survey included measures of management practices. DATA COLLECTION/EXTRACTION METHODS:Hierarchical linear models estimated the effects of work environment on the relationship between client receipt of Medicare home health care and care plan levels while controlling for case-mix differences in agencies' clients. PRINCIPAL FINDINGS:Case managers did not supplement extant Medicare home health services, but did allocate more generous service plans to clients who have had Medicare home health care services recently terminated. This finding persisted when controlling for case mix and did not vary by work environment. Work environment affected overall care plan levels. CONCLUSIONS:Study findings indicate systematic patterns of frontline resource allocation shaping the relationships among community-based long-term care payment sources. Further, results illustrate how nonuniform implementation of upper-level initiatives may be partially attributed to work environment characteristics.

Full Text

Duke Authors

Cited Authors

  • Corazzini, K

Published Date

  • October 1, 2003

Published In

Volume / Issue

  • 38 / 5

Start / End Page

  • 1263 - 1281

PubMed ID

  • 14596390

Pubmed Central ID

  • PMC1360946

Electronic International Standard Serial Number (EISSN)

  • 1475-6773

International Standard Serial Number (ISSN)

  • 0017-9124

Digital Object Identifier (DOI)

  • 10.1111/1475-6773.00176


  • eng