Debra J. Lipson

Organizing Care for Complex Patients in the Patient-Centered Medical Home

The patient-centered medical home (PCMH) is a model for strengthening primary care through the reorganization of existing practices to provide patient-centered, comprehensive, coordinated, and accessible care that is continuously improved through a systems-based approach to quality and safety.[1][1

Mental disorders among non-elderly nursing home residents.

Many Medicaid beneficiaries aged 22 to 64 with serious mental illness may be admitted to nursing facilities rather than psychiatric facilities as a result of Medicaid policies prohibiting coverage of inpatient psychiatric care in institutions of mental disease while requiring states to cover nursing facility care. Using nationwide Medicaid Analytic Extract claims from 2002, we found that nearly 16% of nursing home residents aged 22 to 64 had a diagnosed mental disorder, while 45.5% received antipsychotic medication, but these rates varied widely across states. Further research is necessary to determine whether, among the nations youngest nursing home residents, care in nursing homes is potentially substituting for care in institutions for mental disease or community-based settings.

The Missing Link: Examining the Impact of Housing Vouchers and Community-Based Services and Supports on Transitions From Nursing Facilities to the Community

Several government initiatives aim to increase the availability of home and community-based services. These efforts have helped facilitate the transition of individuals with disabilities living in institutions such as nursing facilities to community living, resulting in improved quality of life and potential health care savings. However, evidence suggests that a lack of affordable housing remains a key barrier that keeps some individuals living in institutions from transitioning to community living. This study evaluated the effect on transition rates among nursing home residents eligible for the Non-Elderly Disabled Housing Choice Voucher Program. The program provided housing vouchers that subsidized rental costs along with access to home and community-based services to nonelderly institutionalized residents with a disability. We assessed this program’s impact on the likelihood of community transitions among the target population in five areas for which these vouchers were made available. In a pooled sample of three of the five areas, the program increased community transition rates by 8.7 percentage points. This finding suggests that targeting housing vouchers to people with disabilities living in institutions could help facilitate or expedite transitions to community living.

The Policy and Political Environment of Family Caregiving: A Glass Half Full

This chapter briefly reviews the evolution and current status of US family care-giver policy from 1990 to 2013 in several areas, including employment leave, respite and other supports and services to relieve the burden of caregiving, as well as cash benefits and tax policies designed to reduce the financial drain related to family care provision. Despite notable policy advances, economic concerns and political forces have restrained policy makers’ willingness to provide greater support. Stronger evidence that investments in family caregiving yield savings in public spending, as well as increasing numbers of politicians having personal experiences in family caregiving, may help to raise public policy support for family caregivers in the future.