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Future Directions for Residential Long-Term Care Health Services Research

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Table 1. Framework for Long-Term Care (LTC) Research Priorities


  • Comparing cost and benefits of alternatives.


  • Approaches to care (e.g., primary care, rehabilitation, prescription drugs) within settings and service types.
  • Special care units.
  • Identifying best practices and distribution by payment.


  • Staffing issues (e.g., mix,training, communication).
  • Ownership (e.g., for-profit/nonprofit, chain/or not, increasing vertical integration).
  • Impact of amenities and home environment (on quality of life).


  • Monitoring the distribution of LTC expenditures across payment sources Medicare, Medicaid, private pay).
  • Measuring financial burden (e.g., LTC insurance, out-of-pocket costs) relative to income and assets.
  • Assessing the impact of growth in assisted living on financial burden source.

Financial and Market Incentives

  • Studies of impact of the level and type (prospective vs. retrospective, flat vs. cost-based) of reimbursement on:
    • Patient mix.
    • Quality.
    • Outcomes.
    • Cost.
  • Impact of prospective payment on quality and cost.
  • Understanding the impact of increasing market competition on health outcomes.
  • Understanding barriers to diffusion of new technology.

Consumer Issues

  • Improving quality information to consumers (e.g., quality report cards).
  • Understanding factors affecting consumers' choice of setting and care.
  • Understanding consumers' willingness to pay for higher quality.
  • Designing facilities to match housing and LTC needs.

Quality Assurance

  • Using outcomes to target facilities.
  • Developing ways to monitor quality of life.
  • Developing ways to assess the quality of the long-term care system as a whole.


Improving Measures

  • Characterizing processes of care.
  • Characterizing changing facility structures.
  • Outcome measurement.
    • Quality of life.
    • Risk adjustment.
    • Matching outcome measures to types of care/setting.
  • Measuring patient preferences.
  • Measuring private prices and reimbursement.
  • Assessing consumer preferences and satisfaction.

Data collection

  • Feasibility of linking MDS data to survey data.
  • Strategies for screening person at high risk of long-term care use.
  • Development of a broad residential care frame.


  • Projecting future LTC service needs, demographics, and disabilities.

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