Front-line workers who conduct eligibility determinations for home and community-based care (HCBC), in effect translate upper-level policy initiatives into actual service practices. Thus, accurate understanding of their work practices is vital to appropriate HCBC policy development and implementation. This research examines how case managers in the Massachusetts State Home Care Program (MHCP) determine service eligibility levels for elders receiving Medicare home health care. Despite uniform state-level eligibility criteria, variability in the work environment of MHCP agencies allows modeling of front-line resource allocation patterns as a function of agency-level work environment characteristics. Utilizing Rossi & Nock’s (1982) factorial vignette survey methodology, 355 case managers employed by 26 MHCP agencies assessed 1,934 vignette clients for care plan eligibility levels. Hierarchical linear models estimated the effects of work environment on the relationship between client receipt of Medicare home health care and case manager-determined care plan levels while controlling for agency case mix differences in client populations. Results indicate significant effects of an elder’s home health care status on MHCP service authorizations (p<.05). Multi-level modeling suggests significant differences in these relationships by agency. Work environment characteristics such as whether or not case managers are unionized, overall agency staff turnover rate, and the proportion of case managers who are licensed social workers, affect both the service level provided to the average client, and the amount of change in service level assessed in response to Medicare home health care status. Results illustrate how non-uniform implementation of upper-level initiatives may be partially attributed to work environment characteristics.
Learning Objectives:
Keywords: Aging, Community-Based Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Commonwealth of Massachusetts: Executive Office of Elder Affairs, State Home Care Program for the Elderly
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.