Quality Indicators for Home and Community-based Services [Working Paper]

In 2001, the Maine Department of Human Services received a three year grant from the U.S. Department of Health and Human Service to improve services for people with disabilities. This grant was part of the Real Choice Systems Change Initiative funded by the Centers for Medicare & Medicaid. The grant funded work in four major areas: Person-centered services, Quality, Access, and Data Integration

Compendium of Quality Indicators: Older Adults, Adults with Physical Disabilities, Adults with Mental Retardation/Autism Living at Home, in the Community or in Long Term Care Facilities

Researchers at the Muskie School of Public Service compiled over 15 tools and surveys. Included in the report are Participant Experience Surveys, Performance Indicators, Experience Surveys, Core Indicators, Consumer Surveys, Behavioral Risk Factors, Outcome Measures, and a variety of Quality Measures. Sample questions and tools are shown in this Compendium of Quality Indicator

The Role of the Opioid Crisis in Elder Abuse

As the opioid crisis has deepened over the past twenty years, its effect on individuals and families, including older adults, has grown. To find out how the opioid crisis might be impacting elder abuse, neglect, and exploitation in Maine, we conducted a mixed methods analysis of 2015-2018 Maine Adult Protective Services (APS) investigations to determine: 1) Did opioid-related investigations increase over time? 2) Do investigations involving opioid misuse or abuse differ from investigations that don’t involve opioids? 3) What themes or features of cases involving opioid misuse or abuse by clients and/or perpetrators emerge from the data? Key Findings: The annual number of opioid-related investigations increased 2015-2018, but the rate of increase was parallel to the general increase of elder abuse investigations over the time period. Opioid-related investigations ranged between 2.5-2.9% of all elder abuse investigations over the time period. Clients in opioid-related investigations tended to be younger than clients in non-drug-related investigations. Forty percent of clients in Opioid-related investigations were 60-69 years old compared to twenty-three percent of clients in Non-drug-related investigations. Opioid-related investigations were more likely to have three or more allegations and include an allegation of exploitation compared to Non-drug-related investigations. Common themes in the opioid-related investigations included: Clients with opioid prescriptions also exhibited signs of substance use disorder (SUD) or opioid use disorder (OUD); clients with opioid prescriptions had difficulties managing their prescriptions, including taking too much or too little, or needing to hide their medication to keep them away from family members or others.; clients with opioid prescriptions encountered barriers to obtaining the medications such as not being able to have their pharmacy deliver them, having to travel to appointments for pill counts, or being denied access to an opioid medication due to the behavior of a family member. In exploitation investigations, there were instances of the perpetrator stealing the client\u27s money or property to purchase drugs elsewhere as well as instances of stealing the client\u27s money and the client\u27s opioid prescription. Client use of opioids can put them at risk of exploitation through impaired physical and cognitive ability

Children and Adults With Long Term Services and Support Needs: MaineCare and Medicare Expenditures and Utilization, State Fiscal Year 2010

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 with mental illness, adults with brain injury, adults with developmental disabilities, older adults and adults with disabilities and children with mental illness and children with developmental disabilities. The report includes information on MaineCare-only members and members who are dually eligible for MaineCare and Medicare. Dually eligible members in this report are those considered full benefit members

Older Adults and Adults with Disabilities: Population and Service Use Trends in Maine, 2010 Edition

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 in this subject. The use and expenditure data show historical trends while the population data includes projections. Where possible, national comparisons are provided to show Maine relative to other states

Reporting: Managing and Using Home and Community-based Services Data for Quality Improvement

The Data Management and Use Series represents the third in a group of papers synthesizing the ideas and practices of states as they improve the quality of home and community based services (HCBS) and supports for older persons and persons with disabilities

An Analysis of the Universal Home Care Program: Considerations for Implementation with the Context of Maine\u27s Existing LTSS Programs

A citizen initiative on the November 2018 ballot (Question 1, An Act to Establish Universal Home Care for Seniors and Persons with Disabilities) would establish a Universal Home Care Program (UHC Program) to serve older adults and persons with a disability living in Maine. This report does not constitute either support for or opposition to the referendum but is intended as an independent assessment of how the UHC Program could be implemented if it were to be approved by Maine voters. This analysis focuses on the implications of the UHC Program within the context of the Medicaid and state-funded long term services and supports programs currently administered by the Maine Department of Health and Human Services. The analysis assumes implementation would be guided by three goals: 1) avoiding an unintended negative impact on existing programs, 2) optimizing the use of public resources, and 3) advancing a community first model of care that promotes living at home when appropriate and preferred. This report does not address the financing or governance of the UHC Program as those are defined under the proposed legislation

Safety Net Activities of Independent 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 to what extent RHCs offer free or discounted care and serve Medicaid populations. We also sought to determine if the proximity of a federally funded Community Health Center might have an effect on the extent to which an RHC serves the safety net role. Key Findings: 86% of the RHCs surveyed provide free or discounted care, and an estimated 27% of their visits are from Medicaid patients, although only 47% reported that they help their patients enroll in Medicaid; proximity of a Community Health Center, either in the same county or in the same zip code, was not associated with offering free or discounted care, but was associated with the percentage of total patient visits attributable to Medicaid patients; using 30% or more of patients on Medicaid as a threshold, we found that RHCs with a CHC in the same county were significantly less likely to meet this threshold (38%) as compared with RHCs without a CHC in their county (65%)

Adults with Intellectual Disability or Autism Spectrum Disorder. Executive Summary

This chartbook describes Maine’s historical trends in meeting the needs of adults with ID/ASD through institutional and community based services in comparison to other states; a detailed analysis of the population’s utilization of different types of services and their costs in SFY 2010; the implementation of the Supports Intensity Scale (SIS) as a means of identifying the supports needs of the adults with ID/ASD; and the complement of providers serving this population in Maine

Maine Pediatric and Family Practice Survey Chartbook: Improving Health Outcomes for Children

As part of the IHOC initiative, the Muskie School of Public Service at the University of Southern Maine surveyed pediatric and family practices about how they use data, clinical guidelines and office systems to monitor and improve children’s healthcare quality. The purpose of the survey is to provide baseline information about quality improvement activities in primary care practices serving children in Maine. Survey data will be used to inform IHOC activities and to monitor changes over time. The web-based survey was conducted in the winter of 2011-2012 and sent to practice managers at a sample of 168 practice sites, of which 64% responded. Responding practices represent more than one-quarter of family practices and nearly two-thirds of all pediatric practices in the state. This report summarizes the results of the initial survey and assesses quality improvement activities in pediatric and family practices at baseline