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Office of Program Policy Analysis and Government Accountability

Performance Audit of the Comprehensive Assessment and Review for Long Term Care Services (CARES) Program Administered by the Department of Health and Rehabilitative Services , Report No. 94-33, February 1995
 


  • The Department measures the effectiveness of CARES by the percentage of individuals in community placements after 30 days. This overstates the diversions attributable to CARES because it includes clients who are in the community despite a recommendation for nursing home placement. However, the Program diverts enough people from nursing home care to cover its cost and produce a net savings to the state.
  • CARES could be more effective in diverting individuals if it assessed them earlier. CARES assessments are required only for clients seeking Medicaid coverage for nursing home costs. In 1993, nearly half of all CARES clients were already in nursing homes; CARES teams were able to recommend community placements for only 1% of them. Thus, CARES assessments are rarely effective in diverting individuals who are already in nursing homes.
  • The CARES Program's ability to divert clients from nursing homes could be improved if the state expanded the availability of placement alternatives and community services. If such state-funded options were more available, the number of individuals seeking Medicaid coverage for long term care would probably increase. However, because of Florida's anticipated growth of elders needing financial assistance for long-term care, an investment in community services now may help the state avoid future costs.
  • DHRS and DOEA programs perform similar functions and serve similar populations. Both assess elderly and disabled clients who apply for Medicaid coverage of long-term care; both maintain data bases with demographic and service information about clients receiving long-term care services. This duplication of function creates operating inefficiencies, confuses clients seeking services, and impedes the ability of CARES and DOEA to plan for and evaluate community-based long-term care services.
  • The management information system used in the CARES Program does not meet current information needs. The age of the system and computer equipment has resulted in the loss of data and limited the use of validity edits; as a result, the accuracy and completeness of CARES data has been impaired. In addition, the system does not contain complete data on the workload of CARES staff. Upgrades to the computer system were being installed at the time we concluded our fieldwork.

Which Government Program Summaries contain related information?

Medicaid Aged and Disabled Adult Waiver
Volunteer and Community Initiatives
Department of Elder Affairs
Home and Community-Based Services Program
Nursing Home Pre-Admission Screening (CARES)

What other OPPAGA-related materials are available?

  • Report No. 99-51 Progress Report: Other Initiatives to Decrease Long-Term Care Costs Should Accompany Medicaid Waiver Expansion, published in May 2000.
  • Report No. 97-74  Supplemental Analyses of the Pilot Project Authorizing Direct Admission to Extended Congregate Care, published in June 1998.
  • Report No. 97-26 Review of the Pilot Project Authorizing Direct Admission to Extended Congregate Care, published in December 1997.
  • Report No. 97-01 Follow-up Report on the Comprehensive Assessment and Review for Long Term Care Services (CARES) Program Administered by the Department of Elder Affairs, published in July 1997.
  • Report No. 96-26 Second Status Report on the Pilot Project Authorizing Direct Admission to Extended Congregate Care, published in December 1996.
  • Report No. 95-19 Status Report on the Pilot Project Authorizing Direct Admission to Extended Congregate Care, published in December 1995.

Copies of this report in print or alternate accessible format may be obtained by telephone (850/488-0021), by FAX (850/487-9213), in person, or by mail (OPPAGA Report Production, Claude Pepper Building, Room 312, 111 W. Madison St., Tallahassee, FL 32399-1475).
e-mail address: oppaga@oppaga.fl.gov


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