Variation in elderly friendliness across the U.S. States: Operationalization, rankings, and selected consequences

Publius: The Journal of Federalism

Volumn 35, Issue 3, 2005, Pages 425-447

  Lockhart, Charles ^a   Giles Sims, Jean ^a  

^a TEXAS CHRISTIAN UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 26644472428     PISSN: 00485950     EISSN: None     Source Type: Journal    
DOI: 10.1093/publius/pji025     Document Type: Review

References (53)

1. Steven R. Gregory and Mary Jo Gibson, Across the States 2002: Profiles of Long-Term Care (Washington, DC: American Association of Retired Persons Public Policy Institute, 2002).
2. Charlene Harrington, Helen Carrillo, and Valerie Wellin, Nursing Facilities, Staffing, Residents, and Facility Deficiencies, 1994-2000, Report prepared for the U.S. Health Care Financing Administration and the Agency for Health Care Policy Research (San Francisco: University of California, Department of Behavioral Sciences, 2001), p. 18.
3. William H. Crown, "State Economic Implications of Elderly Interstate Migration," Gerontologist 28 (August 1988): 533-539;
4. William H. Frey, "Elderly Demographic Profiles of the U.S. States: Impacts of 'New Elderly Birth,' Migration, and Immigration," Gerontologist 35 (December 1995): 761-770;
5. William Serow, "Unanswered Questions and New Direction in Research on Elderly Migration: Economic and Demographic Perspectives," Journal of Aging and Social Policy 4 (Fall/Winter 1992): 73-89. The "young old" (generally under age seventy-five) who migrate for climate and recreation opportunities often migrate again later for proximity to family.
6. William W. Lammers and David Klingman, State Policies and the Aging: Sources, Trends and Options (Lexington, MA: D.C. Heath, 1984), represent an early comparison of cross-state aging policy.
7. Penny H. Feldman, Mia R. Oberlink, Elisabeth Simantov, and Michal D. Gursen, A Tale of Two Older Americas: Community Opportunities and Challenges (New York: Center for Home Care Policy and Research, 2004), offer a useful example of related research on "elder-friendly communities."
8. Marc Miringoff and Marque-Luisa Miringoff, The Social Health of the Nation: How America Is Really Doing (New York: Oxford University Press, 1999).
9. On convergent and discriminant analysis, see Donald T. Campbell and Donald W. Fiske, "Convergent and Discriminant Validation by the Multi-Method-Multi-Trait Matrix," Psychological Bulletin 65 (March 1959): 81-105.
10. U.S. Department of Commerce, Bureau of the Census, State-to-State Migration flows: 1995-2000 (Washington, DC: U.S. Department of Commerce, 2003).
11. See http://www5.ncdc.noaa.gov/climate, accessed 13 September 2004.
12. Gregory and Gibson, Across the States 2002, p. 19.
13. Gregory and Gibson, Across the States 2002, Ibid., 10.
14. U.S. Department of Commerce, Bureau of the Census, Statistical Abstract of the United States: The National Data Book (Washington, DC: U.S. Department of Commerce, 2001), tables 663 and 1259.
15. See http://www.census.gov/hhes/income/histinc/state/state4.html, accessed 17 September 2004.
16. See http://www.census.gov/hhes/poverty/100pct98-00.html, accessed 20 September 2004.
17. Robert D. Putnam, Bowling Alone: The Collapse and Revival of American Community (New York: Simon and Schuster, 2000).
18. See http://www.census.gov/population/socdemo/voting/96cps.tab4B.txt, accessed 27 July 2004.
19. Sidney Verba, Steven Kelman, Garry R. Orren, Ichire Miyake, Joji Watanuki, Ikuo Kabashima, and G. Donald Ferree Jr., Elites and the Idea of Equality: A Comparison of Japan, Sweden, and the United States (Cambridge, MA: Harvard University Press, 1987)
20. and Gabriel A. Almond and Sidney Verba, The Civic Culture: Political Attitudes and Democracy in Five Nations (Princeton, NJ: Princeton University Press, 1963), among others, find socioeconomic equality and a relative absence of poverty to be positively associated with political efficacy.
21. Robert H. Binstock, "Older People and Voting Participation: Past and Future," Gerontologist 40 (February 2000): 18-31, argues that elderly voters do not represent a bloc that votes together. He also argues that many candidates for elected office perceive the elderly as a voting bloc. This perception is likely enhanced in states, such as Minnesota, in which a particularly high proportion of the elderly vote, as opposed to Mississippi, in which a relatively low proportion of the elderly exercise this right.
22. American Association of Retired Persons, The State of 50+ America (Washington, DC: American Association of Retired Persons, 2004), p. 5.
23. U.S. Department of Commerce, Bureau of the Census, Demographic Trends in the 20th Century (Washington, DC: U.S. Department of Commerce, 2002), p. 5.
24. See http://www.census.gov/acs/www/Products/Profiles/Single/2000/ACS, accessed 16 August 2004.
25. Office of the Secretary, U.S. Department of Health and Human Services, "Federal Medical Assistance Percentages," Federal Register 67 (15 November 2002): 69223-69225.
26. For median income, see Gregory and Gibson, Across the States 2002, p. 7 (rankings section);
27. for state cost of living, see William D. Berry, Richard C. Fording, and Russell L. Hanson, "An Annual Cost of Living Index for the American States, 1960-1995," Journal of Politics 62 (May 2000): 550-567.
28. Merck Institute of Aging and Health, The State of Aging and Health in America 2004 (Washington, DC: U.S. Centers for Disease Control, 2004), pp. 18-20.
29. Stephen F. Jencks, Edwin D. Huff, and Timothy Guerdon, "Change in the Quality of Care Delivered to Medicare Beneficiaries, 1998-2000, 2000-2001," Journal of the American Medical Association 289 (15 January 2003): 305-312.
30. Katherine Baicker and Amitabh Chandra, "Medicare Spending, the Physician Workforce, and Beneficiaries' Quality of Care," Health Affairs Web Exclusive, 7 April 2004 (W4-184); http://www.healthaffairs.org, accessed 23 September 2004.
31. "The Best Places to Die," http://moneycentral.msn.com/content/ invest/forbes/P92292.asp, accessed 24 August 2004.
32. U.S. General Accounting Office, Medicaid Nursing Home Payments: States' Payment Rates Largely Unaffected by Recent Fiscal Pressures (Washington, DC: U.S. General Accounting Office, 2003), p. 1.
33. Joseph L. Matthews, Beat the Nursing Home Trap: A Consumer's Guide to Assisted Living and Long-term Care, 3rd ed. (Berkeley, CA: Nolo Publishing, 2001), pp. 10/3-10/27.
34. Harrington et al., Nursing Facilities, p. 18.
35. U.S. Department of Health and Human Services, Health Care Financing Administration, A Profile of Medicaid: Chart Book 2000 (Washington, DC: U.S. Department of Health and Human Services, 2000), p. 68.
36. Despite data limitations, Rosalie A. Kane and others have begun studies of these other forms of long-term care. See, e.g., Rosalie A. Kane and Keren Brown Wilson, Assisted Living in the United States: A New Paradigm for Residential Care for Frail Older Persons? (Washington, DC: American Association of Retired Persons Public Policy Institute, 1993).
37. Gregory and Gibson, Across the States 2002, p. 19 (rankings section).
38. Gregory and Gibson, Across the States 2002, p. 25 (rankings section);
39. Berry et al., "Annual Cost of Living Index."
40. The Alpha index for this scale is 0.73. The four items are the percentage of state Medicaid-certified nursing facilities that are nonprofit, the number of Medicaid-certified nursing facility beds per 1,000 state residents aged sixty-five or older, the percentage of state Medicaid expenditures devoted to nursing facilities, and state Medicaid nursing facility expenditures per state resident aged sixty-five or older, corrected for state cost of living. Data for the first item come from Gregory and Gibson, Across the States 2002, p. 33 (rankings section);
41. for the second item, from American Health Care Association, The State Long Term Health Care Sector 2002: Nursing Homes, ICFs/MR, and Government Funding (Washington, DC: American Health Care Association, 2003);
42. for the third and fourth items, from American Health Care Association, The State Long Term Health Care Sector 2003: Nursing Homes, ICFs/MR, and Government Funding (Washington, DC: American Health Care Association, 2004).
43. The Alpha index for this scale is 0.82. The four items that compose the scale are the percentage of state nursing facilities with deficiencies with respect to preserving residents' dignity, maintaining food sanitation, preventing residents from having accidents, and sustaining housekeeping. Data for these four items come from Harrington et al., Nursing Facilities, pp. 84, 83, 83, and 84, respectively.
44. Avedis Donabedian, An Introduction to Quality Assurance, in Health Care (New York: Oxford University Press, 2003).
45. Both an unrelated and a varimax confirmatory principal component analysis produce five factors with eigenvalues greater than 1.00. Unfortunately, in neither case can the fifth factor be clearly associated with one of our five a priori dimensions. The unrelated instance is difficult to interpret. The varimax rotation is more encouraging. In this case, the recreational lifestyle, modest socioeconomic milieu, and long-term care and Medicaid scales all clearly load on distinct factors. However, the political organization and mobilization of the elderly scale and the health and acute medical care scale both load on a single factor. We termed this result "provisionally acceptable in practice, though a little unsettling theoretically" above. Conceptually, these two dimensions appear closely related, each perhaps drawing on a deeper commonality. In the practical world, however, these two aspects of life are clearly distinct and nonfungible.
46. U.S. Department of Commerce, State-to-State Migration flaws, p. 4.
47. Daniel J. Elazar, American Federalism: A View from the States, 2nd ed. (New York: Thomas Y. Crowell, 1972), p. 117.
48. For explication and applications, see John Kincaid, ed. Political Culture, Public Policy, and the American States (Philadelphia, PA: ISHA Press, 1982).
49. This index is drawn from data provided in David Baer, State Programs and Practices for Reducing Residential Property Taxes (Washington, DC: American Association of Retired Persons Public Policy Institute, 2003).
50. The Alpha index for this scale is 0.76. The four items that compose the scale are the percentage of state nursing facility residents who have pressure sores (only residents at high risk for pressure sores are included), are restrained, spend most of their time in a bed or chair, or are cognitively impaired as well as fed through a feeding tube. Data for the first three come from the Centers for Medicare and Medicaid web site (http://www.medicare.gov, accessed 6 August 2004).
51. Data for the last item come from Susan L. Mitchell, Joan M. Teno, Jason Roy, Glen Kabumoto, and Vincent Mor, "Clinical and Organizational Factors Associated with Feeding Tube Use among Nursing Home Residents with Advanced Cognitive Impairment," Journal of the American Medical Association 290 (2 July 2003): 73-80.
52. With one exception, all thirty of our variables come from 1995-2004, most fairly close to 2000. The exception is average lifetime. The U.S. Center for Health Statistics at the Centers for Disease Control produces decennial data on average lifetime by state. The methodology for generating these data is complex, and the figures for 1999-2001 are not yet available. Consequently, we use the data for 1989-1991. These data have a correlation of 0.93 with the data for 1979-1981, so we anticipate that the 1999-2001 data, when available, will not deviate sharply from the 1989-1991 data used here.
53. Two of these scales (modest socioeconomic milieu and health and acute medical care) also meet an alternative test. They contribute more heavily to the outcome associated with them than do any of the five other scales (including the control variable, our Elazar political culture scale). The scale for the political organization and mobilization of the elderly fails to live up to our expectations in this regard. Indeed, its contribution to senior tax relief is negligible. Elazar's cultural distinctions appear to capture relative degrees of political efficacy among the elderly more effectively than our efforts. The long-term care and Medicaid scale makes the second largest contribution to state nursing facility residents' quality-of-life outcomes. The recreational lifestyle scale also makes the second largest contribution to a relative influx of migrants aged sixty-five or older. However, in this instance, the largest contribution is made by our control variable, and culture's negative coefficient signifies that its contribution is not elderly friendly.