The State of Oregon is using the Placement Information Base, PIB, as part of an assessment process to determine the type of placement needed by Medicaid clients. While used for functional assessment, PIB has not been empirically studied for its use as a screening or predictive instrument to differentiate between the need for nursing home care and community care. This dissertation addresses the question of whether PIB is suitable for use as a screening instrument for nursing home placement decisions. Both PIB's measurement and predictive capabilities are examined. Using secondary PIB data on 2287 elderly Department of Human Resources clients, four highly reliable scales were developed. Alpha coefficients range from .75 to .90. These scales were found to measure the theoretically important dimensions of Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Social functioning and Mental functioning. Ten discriminant function equations, using PIB items and scales as predictors, were developed and cross-validated to compare those elderly currently residing in the community and those currently residing in nursing homes (n = 1772). For each of the functions the predictive accuracy was at least 79 percent with the derivation sample and even higher with the cross-validation sample. Functions containing only single items predicted as well or better than those containing scales. A comparison between the discriminant function equations and three a priori decision rules accompanying the PIB indicate that each of the discriminant function equations is predictively equivalent to one of the a priori decision rules and superior to the other two. The findings of this dissertation suggest that any one of the discriminant functions or the very high probability a priori decision rule could be used as an equitable and economically feasible screening instrument for nursing home placement. The choice of a particular function or the decision rule should be guided by practical and theoretical considerations. Policy implications and suggestions for future research are discussed.

The Social/HMO Demonstration evaluates the feasibility of expanding Medicare Supplemental Insurance benefits to cover a limited amount of ICF and community based long-term care (LTC) services provided under a comprehensive HMO benefit package for capitated Medicare beneficiaries. The policy research question addressed by this study is whether adding an Expanded Care Benefit (ECB) to the capitated HMO benefit package offered by Kaiser Permanente (KP) changes utilization patterns and costs of ICF services, and the probability of becoming Medicaid eligible. This study provides descriptive information regarding this policy research question. The research goal of this study is to measure the extent to which collective ICF use rates and expenditure patterns for S/HMO members are consistently the same, greater or less than baseline data of Risk HMO Medicare members who do not have the S/HMO ECB. The purpose of such measurement is to determine if an empirical basis exists for postulating an ICF utilization and expenditures outcome effect which is influenced by the S/HMO ECB. Utilization and financial data are collected from all SNF and ICF level nursing homes in Multnomah County for all Medicare beneficiaries enrolled in KP between June 1, 1986 and July 31, 1988. Eligibility data are assembled on all Medicare beneficiaries enrolled in KP during the same time period who were residents of Multnomah County. Nursing home use rates and rates for related expenditures are determined for all nursing home residents (1, 331) by their eligibility status in KP during the time of each nursing home stay. Days in an ICF are censored by transfers between Cost, Risk and S/HMO enrollment status. Rates are standardized by the age and gender distribution of research population members (19, 261) to adjust use rates for differences in age cohort distribution of Risk members and S/HMO members. Risk rates and S/HMO rates are compared and differences in utilization and expenditures are evaluated. Conclusions about such patterns are used to formulate hypotheses for testing and confirming descriptive observations. Findings show that overall S/HMO member rates are less than Risk member rates for five of the six Research Questions addressed in this study. Specifically, the probability of admission to an ICF is substantially greater for S/HMO members than for Risk members. However, S/HMO members remained in ICFs fewer days than Risk members, over the two year study period, as measured by age adjusted rates for ICF days per member year of eligibility during the study period. Difference in the mean length of ICF stay is statistically significant between Risk and S/HMO. The rate of total payments received by nursing homes for S/HMO ICF residents per 1000 S/HMO members was substantially less than that for Risk members. The rate of spend-down to welfare status was substantially lower for S/HMO members than for Risk members who became ICF residents. Higher proportions of S/HMO members were discharged from ICFs to home than were Risk members, which is consistent with S/HMO Expanded Care Benefit objectives.

This is a study of twenty-six patients aged sixty years and over residing in a nursing care facility in Portland, Oregon in the fall of 1973, which explores the relationship of their morale and selected environmental and social factors. There are three major aims of the study. The first is to measure variances in morale states as experienced and reported by the respondents. The second aim is to determine how a given set of factors correlate with the self-reported morale of each of the respondents. Selected for consideration are 1) attitudes: expectations upon entering the home and choice, comparison of one’s self-assessed age and health status with that of others, feelings of financial and physical security, feelings of happiness vis a vis their life’s course; 2) activities: enjoyment of solitary activities, i.e. reading, writing, television, and radio, participation in group activities such as games, crafts, movies, and discussion groups, and visits outside the home; and 3) interpersonal relationships: interaction with peers, the presence or absence of friendships, the frequency of visitors, satisfaction with family relationships, and anticipation of events and contacts with others. The third aim of the study is to identify from the above information, points and strategies for social work intervention.

Originally, the focus of this project was to be a policy analysis and survey of the new procedures and regulations established by the state of Oregon for the protection and management of nursing home residents' Personal Incidental Funds (PIF). The analysis was to be divided into four phases, according to a pre-planned timetable. The last phase was to be a field survey of the policy's impact upon nursing homes and adult service workers. The timetable was synchronized with that of the Congregate Care Consultant from the Public Welfare Division's (PWD) Adult Services Unit, whose responsibility it was to develop and write a new policy for the state. Although the PIF is a miniscule segment of the total policy which the state of Oregon has developed for nursing facilities, it is submitted here as representative of public policy formulation in that area.