Policy Intersections or Policy Chasms – State Elder Mobility Policy, Practice and Long-Term Care Reform

Abstract

This dissertation research assessed whether a relationship exists between state initiatives to increase elder mobility through transportation policy, planning and collaboration, and state long-term care reform. The policy domains of aging, long-term care and transportation are stove-piped; most federal programs and academic research delve deeply into each domain but seldom address the interrelationships between the three policy areas. Thus, this study sought to establish a baseline from which to begin cross-policy domain measurement between aging, long-term care and transportation. The study found a statistically significant relationship between state systems change in long-term care reform and state elder mobility policy, planning, and collaboration when both policy and practice are assessed: Over this 10-year period for every 10% increase in a state’s level of elder mobility policy and planning, a state had a 1.5% greater shift in its level of Medicaid expenditures to home and community-based services (HCBS); when controlling for nursing home institutionalization rates. With U.S. long-term care Medicaid spending in excess of $93 billion in the United States in 2006 (Burwell, Sredl, & Eiken, 2007), a 1.5 percentage point change in long-term care Medicaid dollars to the more cost-efficient and consumer-preferred community-based care would equate to a shift of $1.5 billion to HCBS. This finding suggests that there is a relationship between state transportation coordination actions and increases in home and community based services, and that merit exists in drilling further into the relationships between elder mobility and long-term care reform. Policy domains can intersect; and in this case, evidence suggests transportation, aging, and long-term care do. Perhaps it is time to increase the level of policy focus on the essential role community transportation plays in Medicaid reform. Even as economic challenges intensify across communities, it may be important to consider investment in transportation infrastructure as an important enabler of community based care, rather than bow to short-term budget pressures.