STATE LONG TERM CARE POLICIES AND ELDERLY WELL-BEING

描述（由申请人提供）：功能受限的老年人面临长期护理（LTC）政策选择，主要由州一级决定。各州在将几乎完全依赖机构服务的长期服务中心系统转变为在包括家庭和社区服务在内的替代环境中提供服务的系统方面所做的努力差别很大。该研究有两个主要目标：(1)调查老年人长期医疗服务使用和幸福感的变化轨迹，作为州一级政策和跨队列的函数；(2)深入了解州长期医疗服务政策背景。第一个目标将在拟议研究的第一部分中实现，该研究的重点是国家级长期资本流动政策的多层次建模以及长期资本流动使用和福祉的个人层面轨迹。分析将使用来自健康与退休研究（HRS, 1993,1995,1998,2000和2002）和国家长期护理调查（NLTCS, 1989,1994和1999）的纵向数据，这些数据将与州一级的长期护理政策数据合并，使用HRS和NLTCS数据集中可用的州标识符。由于长期照护政策和需要照护的老年队列特征随时间而变化，第一部分还涉及到HRS和NLTCS调查年份的国家级长期照护政策数据的汇编以及多队列分析。第二个目标将在第二部分中实现，其中包括两个州（纽约州和伊利诺伊州）的案例研究。这两个州的相似之处在于，它们都有一个人口多样化的大都市区，以及大片的州上或州下农村地区，但在政治背景、长期服务中心系统、HCBS支出和提供的项目/服务方面存在显著差异。深入的国家政策背景信息将通过实地访问（与州政府官员、长期服务提供商协会、倡导团体代表和其他利益相关者的访谈）以及公共文件、网站和电子数据文件获得。此外，将描述和比较两州HRS和NLTCS受访者的LTC利用和幸福感的轨迹。第一部分和第二部分将同时进行，在整个四年的研究期间相互通知。

DESCRIPTION (provided by applicant): Elderly persons with functional limitations face long term care (LTC) policy alternatives that are largely determined at the state level. States vary greatly in their efforts to transform LTC systems that rely almost exclusively on institutional services to those that provide services in alternative settings including home and community-based services (HCBS). The proposed study has two broad objectives: (1) to investigate how trajectories of LTC use and well being among elderly persons vary, as a function of state level policies and across cohorts, and (2) to obtain in-depth understanding of state LTC policy contexts. The first objective will be achieved in Part I of the proposed study, which centers on multilevel modeling of state-level LTC policies and individual-level trajectories of LTC use and well being. The analysis will use longitudinal data from the Health and Retirement Study (HRS,1993, 1995, 1998, 2000, and 2002) and National Long-Term Care Survey (NLTCS, 1989, 1994, and1999), which will be merged with state-level LTC policy data, using the state identifiers available in the HRS and NLTCS data sets. Since LTC policies and the characteristics of elderly cohorts needing care change over time, Part I also involves the compilation of state-level LTC policy data that cover the survey years of HRS and NLTCS as well as multiple cohort analysis. The second objective will be achieved in Part II, which consists of case studies of 2 states (New York and Illinois). Both states are similar in that they have a major metropolitan area with diverse populations as well as large upstate or downstate rural areas, but differ markedly in terms of political background, LTC systems, HCBS expenditures, and programs/services offered. In-depth state policy contextual information will be obtained through site visits (interviews with state officials, LTC provider associations, advocacy group representatives and other stakeholders) and from public documents, websites, and electronic data files. In addition, trajectories of LTC utilization and well being among HRS and NLTCS respondents of the 2 states will be described and compared. Part I and Part II will proceed simultaneously to inform each other throughout the four-year study period.