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Biomedical subjects

J M Wiener

Publications and source records attributed to J M Wiener.

At least 37 records · Page 2Linked to original sources
PubMed1991

High quality private long-term care insurance: can we get there from here?

The private long-term care insurance market has undergone rapid change in the last several years. Although the quality of policies has generally improved, problems remain. Consumer protection issues include the lack of adequate inflation protection features, how activities of daily living are measured, potentially high lapse rates and lack of nonforfeiture values, how home care benefits are defined, and the appropriate loss ratio standards. The concerns of consumer and elderly advocates about the quality of private long-term care insurance have prompted congress to consider the need for federal intervention. While there are numerous approaches that the federal government could take, mandatory standards substantially higher than the current model standards of the National Association of Insurance Commissioners may prove the most effective in improving the quality of policies on a nationwide basis.

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PubMed1991

Regulation of private long-term care insurance.

There has been a significant improvement in the quality of private long-term care insurance policies in the past five years. As the market continues to mature, national standards need to be assessed and strengthened to protect the consumer.

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PubMed1991

Will paid home care erode informal support?

One of the main barriers to the expansion of paid home care for the chronically disabled is the fear that policymakers have that it will cause friends and relatives to curtail their informal caregiving efforts. Using the first wave of the National Long-Term Care Survey, we examine whether the amount of paid home care used by disabled elderly persons had a significant influence on the amount of informal support they were receiving. Results from a two-stage least squares regression analysis suggest that the amount of informal home care received was not significantly affected by the level of formal care. This conclusion held for subgroups of formal care users most likely to exhibit substitution: those without cognitive problems, the disabled elderly with above average income, and persons who lived alone. Even the more severely disabled elderly, who are the target of most proposals to expand paid home care, did not substitute paid care for unpaid. Thus, our study suggests that an increase in paid home care will not erode informal support.

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PubMed1990

Measuring the activities of daily living: comparisons across national surveys.

The "activities of daily living," or ADLs, are the basic tasks of everyday life, such as eating, bathing, dressing, toileting, and transferring. Reported estimates of the size of the elderly population with ADL disabilities differ substantially across national surveys. Differences in which ADL items are being measured and in what constitutes a disability account for much of the variation. Other likely explanations are differences in sample design, sample size, survey methodology, and age structure of the population to which the sample refers. When essentially equivalent ADL measures are compared, estimates for the community-based population vary by up to 3.1 percentage points; and for the institutionalized population, with the exception of toileting, by no more than 3.2 percentage points. As small as these differences are in absolute terms, they can be large in percent differences across surveys. For example, the National Medical Expenditure Survey estimates that there are 60 percent more elderly people with ADL problems than does the Supplement on Aging.

Activities of Daily Living↗
PubMed1990

Nursing home length of stay patterns: results from the 1985 National Nursing Home Survey.

Length of stay (LOS) for elderly nursing home patients is estimated by converting discharges from the 1985 National Nursing Home Survey into an admission cohort and by adding reported immediate previous nursing home LOS to the surveyed LOS. The ultimate length of aggregated stays is longer than unaggregated estimates for elderly discharged residents. Although the mean length of aggregated stays is 19 months, the mean unaggregated stay is only 13 months.

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PubMed1990

Predicting elderly nursing home admissions. Results from the 1982-1984 National Long-Term Care Survey.

Predictors of elderly nursing home admissions were identified using the 1982-1984 National Long-Term Care Survey. The authors found age and health factors were important predictors. Gender was not a significant predictor for disabled elderly admissions when controlling for other variables, even though women constitute the vast majority of nursing home residents. Three of four measures of informal support availability and use were not significantly related to nursing home admission by the disabled. Income and asset wealth were also nonsignificant predictors of institutionalization by the disabled community population.

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PubMed1990

Estimating the extent of Medicaid spend-down in nursing homes.

Although it is commonly thought that a very high proportion of private-pay nursing home patients become eligible for Medicaid during their stay, few national studies have been conducted to determine the extent of Medicaid "spend-down." The discharged resident survey of the 1985 National Nursing Home Survey was analyzed to determine the extent of spend-down among elderly nursing home patients during a single nursing home episode, the proportion of patients who remained Medicaid or private payers throughout their stay, and how the measures varied by patient characteristics. Overall, during a single nursing home episode only 10 percent of nursing home patients who entered as private payers received Medicaid at discharge. Roughly one-third of nursing home patients remained on Medicaid throughout their stay, and another third remained private payers throughout their stay.

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