Digital Commons Network^™

Challenges And Opportunities For Improving Mental Health Services In Rural Long-Term Care, Jean A. Talbot Phd, Andrew F. Coburn Phd

Long Term Services and Supports

Despite high levels of need, individuals in long-term care often fail to receive appropriate mental health services, especially in rural areas. In this report (and accompanying Research & Policy Brief), we consider challenges and opportunities for improving mental health treatment delivered to long-term care recipients in rural settings. As background, we note the prevalence of mental health problems in long-term care populations, describe deficiencies in the mental health care afforded to long-term care recipients, and identify barriers that hinder the remediation of these deficiencies in rural settings. We also outline a rationale for enhancing mental health services in long-term …

The Role Of Organizational Change In Health System And Payment Reform, Barbara Shaw Jd, Andrew F. Coburn Phd, Kimberley S. Fox Mpa, E. Rogers

Population Health & Health Policy

The Maine Health Access Foundation (MeHAF) has awarded grants to 14 Maine health organizations to date to mitigate the increasing cost of health care in Maine through innovative delivery system and payment reform strategies that preserve access, improve quality, and offer better value. As part of the evaluation of this initiative, the University of Southern Maine Muskie School of Public Service (Muskie School) is producing a series of issue briefs that capture common themes and challenges across grantees in achieving payment reform and health system delivery change to assess lessons learned. This is the first issue brief which describes our …

Managing Social Security Disability & Other Public Benefits: Development Of A Guide For Consumers And Providers, Stephanie L. Derochers

Muskie School Capstones and Dissertations

One in five Americans has a disability, making it the largest minority group in the U.S. (Soffer, McDonald, & Blanck, 2010). In 2011, 13.4 million working-aged adults received a disability cash benefit from the Social Security Administration (Kregel, 2012).

The Social Security Administration (SSA) is the federal agency responsible for managing, executing and overseeing retirement, survivor, old-age and disability benefits. There are over 1,500 Social Security offices and over 65,000 employees nationwide (SSA, 2013). SSA manages at least five disability benefit programs: Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), Disabled Widow(er) Benefit (DWB), Childhood Disability Benefit (CDB), though …

Global Budgets, Payment Reform And Single Payer: Understanding Vemont's Health Reform, Trish Riley

Population Health & Health Policy

The Muskie School of Public Service hosted two health policy colloquia this April to promote informed discussion throughout the state regarding MaineCare coverage options under the ACA and the implications of Vermont’s move toward a single-payer system.The series, sponsored by the Muskie School Board of Visitors, offers community conversations in which experts from various disciplines and perspectives inform and engage the broader public to explore and debate critical policy issues. On April 22, community and sector leaders joined for Global Budgets, Payment Reform, and Single Payer: Understanding Vermont's Health Reform. Participants discussed Vermont's recent movie toward single payer health …

Opportunities For Munjoy Hill, Anne-Michelle Arless

Muskie School Capstones and Dissertations

Keeping the elderly in their own homes is challenging. A volunteer lead group of Munjoy Hill residents have united to form "circle of friends" to connect those within the community in need with those in the community who can offer a helping hand.

Providing Long Term Services & Supports To People With Impaired Decision-Making Capacity: Results Of Data Analysis And Interviews Examining Needs And Characteristics Of Persons With Impaired Decision-Making Capacity In Maine, Eileen Griffin Jd, Louise Olsen, Julie T. Fralich Mba

Disability & Aging

This document:

• Reviews the prevalence of impaired decision-making capacity among adults and older adults receiving publicly funded home care services and supports in Maine, the characteristics of this population group, and the caregivers caring for persons with impaired decision-making capacity.
• Reports on interviews with providers describing their ideas for helping people with impaired decisionmaking capacity live in the community longer.
• Reviews the legal status of persons receiving long term services and supports in Maine, including the presence of a guardian or a Power of Attorney, among those with impaired decision-making capacity across settings.
• Reports on interviews with providers, describing kinds …

Federal Health Care Reform: An Overview, Andrew F. Coburn Phd

Population Health & Health Policy

This policy brief discusses three of the main components of the Patient Protection and Affordable Care Act (ACA), also known as "Obamacare". These components are helath insurance coverage, delivery system improvement, and cost containment. The policy brief highlights some of the provision of the law that have already been implemented and those where importnat implementation decisions will have to be made. The brief is authored by Dr. Andrew Coburn, PhD, Professor of Public Health and Director of the Population Health and Health Policy program at the USM Muskie School, and was presented at the Maine Policy Leaders Academy Health Care …

Managing A High-Performance Medicaid Program, Eileen Griffin Jd, Trish Riley, Vikki Wachino, Robin Rudowitz

Disability & Aging

Today, the Medicaid program is evolving more rapidly than at any other time in its fifty-year history. States and the federal government are working to maximize the value and efficiency of Medicaid by reforming payment to reward value over volume, integrating effective care coordination across payers, and streamlining key processes like eligibility determinations across coverage programs. Underpinning a state’s ability to implement these reforms is its capacity to manage its Medicaid program effectively and efficiently.

This paper discusses key responsibilities that the federal government and states hold for managing the Medicaid program and identifies the key issues and challenges states …

Children And Adults With Long Term Services And Support Needs: Mainecare And Medicare Expenditures And Utilization, State Fiscal Year 2010, Stuart Bratesman Mpp, Julie T. Fralich Mba, Tina Gressani, Eileen Griffin Jd

Disability & Aging

This report is one of a series of reports prepared by the USM Muskie School on MaineCare members who are dually eligible for MaineCare and Medicare Services. An earlier report provided a high level overview of the MaineCare and Medicare use and expenditure patterns for all members who were dually eligible in state fiscal years (SFY) 2008 to 2010. Both reports were prepared as part of the Maine State Profile Tool grant funded by the Centers for Medicare & Medicaid Services. This second report analyzes the characteristics, use and expenditure patterns of sub-populations of long term service users including adults …

Satisfaction Survey Results And Lessons Learned: Maine's Aging & Disability Resource Center (Adrc) Project, Julie T. Fralich Mba, Louise Olsen, Mark Richards Bs, Jennifer Pratt, Taryn Bowe

Disability & Aging

The primary goal of Maine’s Aging and Disability Resource Center (ADRC) Project was to empower consumers to make informed decisions about long-term services and supports and to streamline access to existing services and supports through an integrated system. With funding from the Administration on Aging to strengthen and expand the number of Aging and Disability Resource Centers (ADRCs) in the state, all five of the Area Agencies on Aging were committed to becoming and/or strengthening their capacity to be fully functioning ADRCs.

This report provides a summary of the results of consumer satisfaction surveys that were conducted for three years …

Maine Direct Service Workforce Survey Results 2012 [Chartbook], Julie T. Fralich Mba, Eileen Griffin Jd, Danielle Wescott

Disability & Aging

Direct service workers play a central role in the quality of the long-term services and supports provided to older people and people with disabilities in home and community settings. Nationally, and at the state level, there is a critical need for more information about this workforce in order to inform workforce policy and measure improvements in workforce quality and stability over time. Maine was one of seven states to administer baseline surveys under a grant funded by the U.S. Centers for Medicare and Medicaid Service. Survey questions focused on workforce volume, stability, and compensation, as well as, cultural competence, workforce …

"Homelike" Characteristics Of Maine's Residential Services: A Survey Of Maine's Residential Service Settings (2010), Julie T. Fralich Mba, Eileen Griffin Jd, Catherine Mcguire Bs

Disability & Aging

To better understand the nature of the residential facilities serving more than 19 percent of Maine’s Long Term Services and Supports (LTSS) population, the Maine Department of Health and Human Services commissioned the Muskie School to conduct a survey of residential facilities as part of its update to Maine’s LTSS profile. The goal of the Maine Residential Settings Characteristics Survey, conducted between July and September 2010, was to measure the "homelike" characteristics of residential settings.

The survey sample comprised a total of 636 facilities which included all licensed residential care facilities or private non-medical licensed institutions. The survey response rate …

Members Dually Eligible For Mainecare And Medicare Benefits: Mainecare And Medicare Expenditures And Utilization, State Fiscal Year 2010., Catherine Mcguire Bs, Tina Gressani, Stuart Bratesman Mpp, Julie T. Fralich Mba, Eileen Griffin Jd

Disability & Aging

This report is one of a series of reports prepared by the USM Muskie School on MaineCare members who are dually eligible for MaineCare and Medicare Services. This first report provides a high level overview of the MaineCare and Medicare use and expenditure patterns for all members who were dually eligible in state fiscal years (SFY) 2008-2010. This report provides baseline data on the characteristics of Medicare-MaineCare members who are dually eligible, the distribution of expenditures across categories of service for MaineCare and Medicare, and the cost of care for people with select chronic conditions. The report includes information on …

Walking And Cycling In Waterville: Bike And Pedestrian Planning For An Active Community, Scott E. Workman

Muskie School Capstones and Dissertations

This is an initial plan for the City of Waterville focused on making realistic headway in building a safer city that accommodates even the most vulnerable transportation system users. While it makes strides to capture every needed improvement and opportunity, it is by no means a complete document and should be accepted as a first of a continuing effort. Future efforts will make evaluations of accomplishments and failures of this plan, and continue this effort.

Personal Experiences With Mainecare Services From People Who Use Elder And Adults With Disabilities Waiver And Private Duty Nursing/Personal Care Services., Julie T. Fralich Mba, Katherine Rosingana, Mark Richards Bs, Louise Olsen, Vanessa Bell, Jennifer Pratt

Disability & Aging

This report provides the results from a survey and personal interviews that were conducted with MaineCare members who use long term services and supports -- specifically those who are on the Elder and Adults with Disabilities Waiver and those using Private Duty Nursing (PDN) Services. People who are eligible for these services generally need nursing care and assistance with a combination of activities of daily living (e.g. eating, toileting, mobility, transfer) and instrumental activities of daily living (e.g. meal preparation, grocery shopping, housework). People on the Waiver are medically eligible to be in a nursing home. The purpose of the …

Older Adults And Adults With Disabilities: Population And Service Use Trends In Maine, 2012 Edition, Julie T. Fralich Mba, Stuart Bratesman Mpp, Louise Olsen, Catherine Mcguire Bs, Jasper Ziller, Karen Mauney, Catherine Gunn

Disability & Aging

This Chartbook is an update to the Chartbook: Older Adults and Adults with Physical Disabilities: Population and Service Use Trends in Maine 2010. With the aging of Maine’s population and its status as the “oldest” state in the nation, the use of long term services continues to be a critical public policy issue in the State and nationally. The information in this Chartbook is provided to help inform state policy makers, legislators, providers, advocates and others with an interest in this subject.

Using Pen Source Data Inputs To Map Food Insecurity In Cumberland County, Maine, Daniel Wallace

Muskie School Capstones and Dissertations

In 2010, Mapping Food Insecurity’s Project Director (PD) participated in “The Campaign to Promote Food Security in Cumberland County, Maine.” The Campaign drew together a 60 member coalition to address rapidly increasing food insecurity challenges in the county. It produced a report with a series of recommendations grouped under six strategic community goals. One of the recommendations called for the use of ‘mapping and connectivity software to determine location of vulnerable populations and services in order to plan best future delivery and use of food access services in Cumberland County

Maine's Community Living Program: Implementation And Outcomes, Julie T. Fralich Mba, Mark Richards Bs, Louise Olsen

Disability & Aging

In 2009, the Office of Elder Services, Maine Department of Health and Human Services (DHHS), was awarded a grant from the Administration on Aging (AoA) under its Community Living Program (CLP). The overall goal of the CLP announcement was to strengthen the capacity of the Aging Network to target and serve individuals at highest risk of residential facility placement by offering flexible services including consumer directed options. Over the last five years, options counseling has evolved from a general set of activities and functions within AAAs/ADRCs to a more standardized and generally accepted role within the Aging Network. With the …

Financing Maine's State Employees And Teachers Retirement System: Comparative Trends And Progress, 1982 - 2010, Moargan Beschle, Eric Davis, Tim Feeley

Muskie School Capstones and Dissertations

Among the many tough choices states must make is how to address funding shortfalls in public employee pension systems. In public sector employment, pensions have long been a key component of the compensation system and an integral way to attract and retain talent in public service positions. The pension is considered a form of deferred compensation, which means that workers receive a salary lower than the going rate for their education, skills and job requirements in exchange for an enhanced retirement package (Bender & Heywood, 2010). State employees incur an opportunity cost by taking a lower-salaried state job over a …

Medicaid Managed Care: Background, Issues, And Options, Julie T. Fralich Mba

Disability & Aging

Managed care is a fundamental shift from the historical fee-for-service payment systems. It provides opportunities for states to transform the delivery and financing of Medicaid financed services and promote and reward improved care outcomes. Implementation of such programs requires thoughtful planning, active stakeholder engagement and an effective administrative infrastructure to manage and operate in a value based purchasing environment.

Summary Report Of The Mainecare Listening Sessions, Anush Yousefian Hansen Ms,Ma, Katherine Rosingana, Nadine Edris Msw

Disability & Aging

In September of 2010, the Muskie School of Public Service conducted four Listening Sessions with MaineCare members to gather in-depth information about their experiences on MaineCare, their likes and dislikes, and suggestions, needs and wants for improving the program. The overall goal of these sessions was to provide rich information to help inform DHHS in their design of a new managed care initiative. Funding for this project was provided by the Maine Health Access Foundation (MeHAF).

Impact Of Employment Transitions On Health Insurance Coverage Of Rural Residents, Nathaniel J. Anderson Ms, Mph, Erika C. Ziller Phd, Melanie M. Race Ms, Andrew F. Coburn Phd

Access / Insurance

Numerous studies have found that rural residents are more likely to be uninsured than urban residents. This coverage difference is generally due to more limited access for rural workers to employer-sponsored health insurance. Lower wages, and the tendency for rural residents to work for small employers, account for this reduced access. While we have substantial information on static insurance coverage rates for rural residents, our knowledge about how coverage changes with employment transitions is limited. Prior research indicates that loss of a job puts workers at greater risk of becoming uninsured, and there is some evidence that this risk is …

Are Rural Health Clinics Part Of The Rural Safety Net?, David Hartley Phd, Mha, John A. Gale Ms, Al Leighton Ba, Stuart Bratesman Mpp

Rural Health Clinics

Key Findings: 86% of independent RHCs offer free care, sliding fee scales, or both; 97% were currently accepting new Medicaid/SCHIP patients; RHCs' patient mix has a higher proportion of Medicaid/SCHIP patients in counties not served by a federally funded Community Health Center (CHC). Lacking the grant funds and federal technical assistance provided to CHCs to build service capacity, few RHCs have had the resources to expand their scope of services. The Affordable Care Act has made it clear that partnering with CHCs is an option for RHCs that find themselves serving safety net populations. More study is needed laying out …

Safety Net Activities Of Independent Rural Health Clinics, David Hartley Phd, Mha, John A. Gale Ms, Al Leighton Ba, Stuart Bratesman Mpp

Rural Health Clinics

Rural Health Clinics (RHCs) are an important part of the rural health care infrastructure as they provide a wide range of primary care services to the rural residents of 45 states. Since RHCs are located in underserved rural areas and serve vulnerable populations, many consider them safety net providers. In this paper we explore whether and to what extent independent RHCs are serving a safety net role, or have the capacity to serve that role. We address this question through a telephone survey of 392 randomly selected independent RHCs. Response rate for the survey was 93%. We investigated whether and …

The Provision Of Mental Health Services By Rural Health Clinics, John A. Gale Ms, Stephanie L. Loux Ms, Barbara Shaw Jd, David Hartley Phd, Mha

Rural Health Clinics

The number of Rural Health Clinics (RHCs) providing specialty mental health services remains limited. This study examined changes in the delivery of mental health services by RHCs, their operational characteristics, barriers to the development of services, and policy options to encourage more RHCs to deliver mental health services. Key Findings: Approximately 6% of independent and 2% of provider-based RHCs offer mental health services by doctoral-level psychologists and/or clinical social workers. Models used to provide mental health services include contracted and/or employed clinicians housed in the same facility as primary care providers. A key element in the development of mental health …

Older Adults And Adults With Disabilities: Population And Service Use Trends In Maine, 2010 Edition, Julie T. Fralich Mba, Stuart Bratesman Mpp, Cathy Mcguire Bs, Louise Olsen

Disability & Aging

This chartbook is an update to the “Assessment of Maine’s Long-term Care Needs Baseline Report: Demographics and Use of Long Term Care Services in Maine” report that was produced in 2007. The Chartbook provides historical and projected trends in the demographics of Maine’s population. With the aging of Maine’s population and its status as the “oldest” state in the nation, the use of long term services and supports surfaces as a key issue of public policy. We hope that the information contained in this report will be useful to state policy makers, legislators, providers, advocates and others with an interest …

Brain Injury In Maine: A Needs Assessment, Eileen Griffin Jd

Disability & Aging

This document reviews existing Maine policy and programs to evaluate how well they meet the needs of persons with brain injury.

Profiling Maine’S Long Term Support System [Project Brief], Eileen Griffin Jd

Disability & Aging

A recent report by the Muskie School and the Maine Department of Health and Human Services provides a new way of looking at the state’s long term support system. With an emphasis on developing a common approach for description and analysis across programs, the profile reveals that users of long term services and supports in Maine span all age groups and types of service users. In fact, 28% are ages 17 or younger and 29% are between the age of 35 and 64. Long term service users include people with physical impairments, cognitive and intellectual disabilities, and people who need …

Health Insurance Profile Indicates Need To Expand Coverage In Rural Areas, Jennifer D. Lenardson Mhs, Erika C. Ziller Phd, Andrew F. Coburn Phd, Nathaniel J. Anderson Ms, Mph

Access / Insurance

Key Findings: A greater percentage of rural residents than urban residents are uninsured, especially those living in remote areas Among adults over age 50, uninsured rates are highest in the most remote rural places Compared to urban adults, rural adults are less likely to be in employment situations where private coverage is offered.

Profile Of Rural Health Insurance Coverage: A Chartbook, Jennifer D. Lenardson Mhs, Erika C. Ziller Phd, Andrew F. Coburn Phd

Access / Insurance

More than twenty years of research has demonstrated that rural residents are at greater risk of being uninsured compared to urban residents and more recent studies point to problems of underinsurance as well. Most studies have shown that the problems of uninsurance and underinsurance are greatest among rural residents living in smaller communities located further from more urbanized areas. Section I examines recent estimates and changes since 1997 in rural health insurance coverage. Section II explores differences in the demographic, socio-economic, employment and other risk factors for uninsurance among rural and urban residents. Section III profiles the demographic and economic …