Donald L. Redfoot, Ph.D., has been a strategic policy advisor with the AARP Public Policy Institute for 18 years, conducting and supervising policy research on: financing options for long-term services and supports; trends in disability, institutional care, and family caregiving; and international comparisons of long-term care systems.

Improving the Performance of State Systems of Long-Term Services and Supports

Imagine that you have been named CEO of an underperforming major corporation. Your competitors outperform your company on some measures by ratios of 3 or 4 to 1. Consumers prefer the products of your competitors by similar lopsided margins. Your operating costs are lower than most, but your equipment and management processes are antiquated and result in unnecessary inefficiencies and poor quality products. What would you do? In the business world, you would need to match the efforts of your …

There’s No Place Like Home – But How Do You Define It?

How would you describe what “home” means to you? When do you feel most engaged in a “community”? If you struggle to answer those questions, imagine a federal agency trying to define what “home” and “community” mean for the purposes of important public benefits. That is essentially the task that the Centers for Medicare & Medicaid Services (CMS) set for itself several years ago as it began the long path to its recently released rule related to home- and community-based …

Modernizing Medicaid: Putting Home- and Community-Based Services on Equal Footing with Nursing Homes

The AARP Public Policy Institute (PPI) had a Solutions Forum on Oct. 30 to discuss ways to ensure that Medicaid beneficiaries get the supportive services they need in settings that they choose (See Twitter conversation at #MedMod and event transcript). AARP Executive Vice President Debra Whitman remarked that “the need for long-term services and supports is not a partisan issue. It affects Democrats. It affects Republicans. It affects wealthy people. It affects poor people. It affects old and young, all …

The Future Supply of Family Caregivers

   Shakespeare declared, “What’s past is prologue.” This statement captures the demographic trends that predict the future supply of family caregivers in the United States. The past may be prologue, but the future ability of families to care for their aging members who encounter disabilities will be a “brave new world,” to quote the Bard again. In a recently released paper, we defined a “caregiver support ratio” as the number of potential caregivers ages 45-64 for each person age 80 …

Do the Rich Benefit from Medicaid?

Do the rich benefit from the welfare-based Medicaid program? Not according to much of the testimony presented at a recent hearing of the federal Commission on Long-Term Care. Here are key questions the hearing addressed: Do wealthy people transfer or shelter assets in order to qualify for Medicaid? At the hearing, Ellen O’Brien, formerly from MACPAC, described the evidence from several major studies and concluded: “There is little basis for the assertion that people with substantial incomes or assets are …

Just How Valuable Is Family Caregiving?

A welcome recognition of the value of family caregiving came in a recent report by the Congressional Budget Office (CBO), which estimated the economic value of caregiving for older persons in 2011 to be $234 billion. This estimate vastly exceeds the total amount of paid care from all sources (Medicaid, Medicare, private pay and others) for both institutional care ($134 billion) and home and community-based services ($58 billion). The AARP Public Policy Institute has made similar estimates of family caregiving …