Administration for Community Living
 

National Study of Aging and Disability Resource Centers
 

HHSP233201000692G 

Process and Outcome Study Report 

November 30, 2014 

Authors 

IMPAQ International, LLC: 

Tina Barretto, Dr. Rekha Varghese, Sarah Pedersen, Dr. Leanne Clark-Shirley, 

Dr. Sandeep Shetty, Dr. Manan Roy, Sharanjit Toor, Michael Siers
 

Abt Associates: 

Dr. Rosanna Bertrand, Luisa Buatti 

Submitted to: Submitted by: 

Dr. Susan Jenkins Ms. Tina Barretto 

Project Officer Project Director 

Office of Performance and Evaluation IMPAQ International, LLC 

Administration for Community Living 10420 Little Patuxent Pkwy. Suite 300 

Department of Health and Human Services Columbia, MD 21044 

330 Independence Ave SW # 4760 Phone: 443.367.0088 

Washington, DC 20201 Fax: 443.367.0477 

www.impaqint.com 
 

 

TABLE OF CONTENTS 

FOREWORD BY THE ADMINISTRATION FOR COMMUNITY LIVING...................... iv
 

CHAPTER 1. EXECUTIVE SUMMARY...................................................................................1
 

1.1 Background............................................................................................................................ 1
 

1.2 Overview of the National Process and Outcome Studies ...................................................... 1
 

1.3 Implementation of Process and Outcome Studies ................................................................. 2
 

1.4 Highlights of Process and Outcome Study Findings ............................................................. 3
 

1.4.1 Process Study............................................................................................................ 3
 

1.4.2 Outcome Study.......................................................................................................... 4
 

1.5 Conclusion ............................................................................................................................. 6
 

CHAPTER 2. INTRODUCTION.................................................................................................8
 

2.1 ADRC Program Background ............................................................................................... 10
 

2.2 Overview of the National ADRC Study .............................................................................. 12
 

2.2.1 Overview of the Process Study............................................................................... 13
 

2.2.2 Overview of the Outcome Study............................................................................. 13
 

2.3 Organization of the Report................................................................................................... 14
 

CHAPTER 3. PROCESS AND OUTCOME STUDY METHODOLOGY ............................15
 

3.1 Agency Sample Selection and Recruitment......................................................................... 15
 

3.1.1 Agency Sample Selection and Recruitment for the Process Study......................... 15
 

3.1.2 Agency Sample Selection for the Outcome Study.................................................. 15
 

3.1.3 Agency Recruitment for the Outcome Study.......................................................... 17
 

3.2 Process Study Methodology ................................................................................................ 19
 

3.2.1 Survey ..................................................................................................................... 19
 

3.2.2 Response Rates ....................................................................................................... 20
 

3.2.3 Analytic Approach .................................................................................................. 21
 

3.3 Outcome Study Methodology.............................................................................................. 24
 

3.3.1 Staff Screening and Recruitment Training ............................................................. 24
 

3.3.2 Client Screening and Recruitment .......................................................................... 24
 

3.3.3 Participant Experience Survey................................................................................ 25
 

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3.3.4 Administration of the Participant Experience Survey ............................................ 26
 

3.3.5 Response Rates ....................................................................................................... 27
 

3.3.6 Analytic Approach .................................................................................................. 27
 

3.4 Core Integration Dimensions ............................................................................................... 35
 

3.4.1 Level of Core Service Provision............................................................................. 36
 

3.4.2 Extent of Site Integration ........................................................................................ 38
 

3.4.3 Status of Medicaid Integration ................................................................................ 45
 

CHAPTER 4. PROCESS STUDY FINDINGS AND IMPLICATIONS ................................47
 

4.1 Process Study Purpose, Research Questions, and Research Domains................................. 47
 

4.1.1 Purpose.................................................................................................................... 47
 

4.1.2 Research Questions................................................................................................. 47
 

4.1.3 Research Domains .................................................................................................. 48
 

4.2 Process Study Findings........................................................................................................ 48
 

4.2.1 Motivation and Objectives...................................................................................... 48
 

4.2.2 Funding ................................................................................................................... 55
 

4.2.3 Community and Consumer Information ................................................................. 73
 

4.2.4 Organizational Information..................................................................................... 92
 

4.2.5 Partnerships........................................................................................................... 112
 

4.2.6 Comparison by Core Integration Dimensions ...................................................... 118
 

4.3 Process Study Discussion and Implications....................................................................... 130
 

4.3.1 Motivation to Become an ADRC.......................................................................... 130
 

4.3.2 Diversion as an Outcome ...................................................................................... 131
 

4.3.3 Impacts of ADRC Grant Funds and Sources of Funding ..................................... 132
 

4.3.4 Community Characteristics and Consumer Information ...................................... 135
 

4.3.5 Key Services Provided.......................................................................................... 137
 

4.3.6 Partnerships........................................................................................................... 139
 

4.3.7 Comparison by Core Integration Dimensions....................................................... 140
 

CHAPTER 5. OUTCOME STUDY FINDINGS AND IMPLICATIONS............................144
 

5.1 Outcome Study Purpose, Research Questions, and Research Domains ............................ 144
 

5.1.1 Purpose.................................................................................................................. 144
 

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5.1.2 Research Questions............................................................................................... 144
 

5.1.3 Research Domains ................................................................................................ 145
 

5.2 Outcome Study Findings.................................................................................................... 145
 

5.2.1 Profile of Participating ADRCs, Clients, and Respondents.................................. 147
 

5.2.2 Agency Responsiveness and Effectiveness .......................................................... 162
 

5.2.3 Assistance with Services....................................................................................... 170
 

5.2.4 Access to Services................................................................................................. 206
 

5.2.5 Participant Satisfaction ......................................................................................... 227
 

5.2.6 Comparison by Core Integration Dimensions....................................................... 252
 

5.3 Outcome Study Discussion and Implications .................................................................... 265
 

5.3.1 Profile of Participating ADRCs and Consumers .................................................. 266
 

5.3.2 Agency Responsiveness and Effectiveness .......................................................... 266
 

5.3.3 Access to Services................................................................................................. 271
 

5.3.4 Participant Satisfaction ......................................................................................... 273
 

5.3.5 Usefulness of Services .......................................................................................... 275
 

5.3.6 Value of ADRCs to Respondents ......................................................................... 275
 

5.3.7 Comparison by Core Integration Dimensions....................................................... 276
 

CHAPTER 6. CONCLUSIONS FROM THE PROCESS AND OUTCOME STUDIES....281
 

6.1 Progress in Achieving the Goals and Vision of the ADRC Program ................................ 281
 

6.1.1 Providing Access to LTSS through Key Services ................................................ 281
 

6.1.2 Effects of Funding on Achieving Mission and Goals........................................... 283
 

6.2 Partnerships........................................................................................................................ 283
 

6.3 ADRC Client Satisfaction.................................................................................................. 284
 

6.4 LTSS Supply and Availability........................................................................................... 285
 

6.5 Consumer Characteristics .................................................................................................. 285
 

6.6 Limitations ......................................................................................................................... 286
 

6.7 Conclusions and Considerations for the Future ................................................................. 287
 

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FOREWORD BY THE ADMINISTRATION FOR COMMUNITY LIVING
 

The Administration for Community Living (ACL) and the Centers for Medicare & Medicaid 

Services (CMS) came together in 2003 to create a joint funding opportunity to support state efforts 

to create “one-stop-shop” access programs for people seeking long term services and supports. This 

initiative, known as the Aging and Disability Resource Center (ADRC) Program, was designed to 

provide consumers with “visible and trusted” sources of information, one-on-one counseling, and 

streamlined access to services and supports. 

Finding and accessing the right long-tern supports and services (LTSS) can be a daunting task for 

individuals and their families. The current LTSS System involves numerous funding streams 

administered by multiple federal, state and local agencies using different, often fragmented and 

duplicative, access processes involving screening, intake, needs assessment, service planning, and 

eligibility determination. Individuals trying to access LTSS frequently find themselves confronted 

with a bewildering maze of organizations and bureaucratic requirements at a time when they are 

vulnerable or in crisis. This often results in people making decisions based on incomplete, and 

sometimes inaccurate, information about their options. This can lead to decisions to purchase 

and/or use LTSS options that are less than optimal for the individual and more expensive than 

necessary, including decisions to use expensive options such as nursing facility care that can 

quickly exhaust an individual’s personal resources and result in their spending down to Medicaid. 

The consequences of an LTSS System that makes it difficult for people to make informed decisions 

about their LTSS options has a direct impact on the health, well-being and financial status of our 

citizens, and it also has a direct impact on our state and federal budgets. This situation will only be 

compounded as the number of people who need LTSS increases and more and more LTSS products 

come onto the market. Currently, about 11 million Americans need some form of LTSS each year, 

and about 70% of all the people now turning age 65 will need LTSS at some point during their life. 

Recognizing thatthe LTSS System will always involve multiple payers and providers, and therefore 

always have some degree of fragmentation, the ADRC Program was a “system change” initiative 

to help states better coordinate and integrate their access functions and create a new "interface" 

between consumers and the LTSS System in order to make it easier for people to learn about and 

quickly access the LTSS options that would best meet their needs. The ADRC grant program was 

based on the most promising practices being implemented at the time by states, including 

Washington, Oregon and Wisconsin. ADRC grants were awarded to 12 states which were jointly 

funded across ACL and CMS in 2003, and each year the number of states participating in the 

program grew and eventually almost all states and several of the territories received funding to 

develop ADRC Programs. As the number of participating states grew, the ADRC initiative started 

to evolve, and several key functions were strengthened. For example, in 2007 CMS made special 

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Hospital Discharge Planning grants available to 10 state ADRC programs to strengthen their 

involvement in hospital to home care transitions. Then in 2009, supporting care transitions was 

recognized as a functional component of the ADRC initiative. This work expanded again in 2010 

when the Administration on Aging (AoA), now a part of ACL, made special grants available to 16 

states to partner with hospitals to build evidence-based care transition programs into their ADRC 

programs. The capacity of ADRCs to help nursing home residents transition back to the community 

was significantly bolstered when state Medicaid agencies started to invest in ADRCs to assist with 

Money Follows the Person transitions, and, then, under the new CMS guidance for minimum data 

set (MDS) Section Q, many Medicaid agencies designated ADRCs to serve as a Local Contact 

Agency to assist nursing home residents expressing a desire to return home. 

Another major development in the evolution of the ADRC model occurred in 2008 when the 

Veterans Health Administration (VHA) – the nation’s largest health care system - recognized the 

value of ADRCs in helping consumers develop person-centered plans and direct their own care. In 

that year, the VHA entered into formal funding agreements with ADRCs to serve as the VHA’s 

designated entity for delivering the Veterans-Directed Home and Community Based Services 

Program (VD-HCBS). Another development in 2008 included Nursing Home 

Diversion/Community Living grants to states to strengthen the role of the ADRC in serving nonMedicaid eligible individuals in an effort to reduce the rate that they spend down to Medicaid by 

diverting them from higher cost LTSS. Then, in 2010 the Affordable Care Act provided $50 

million dollars over five years to support the further development of the ADRC Program. The 

Affordable Care Act also funded the CMS Balancing Incentive Program to incentivize states to 

rebalance their Medicaid LTSS spending and required participating states to make changes to their 

LTSS Systems, including developing statewide “No Wrong Door” (NWD) programs. 

In 2012, recognizing the accomplishments and lessons learned of both the ADRC and Balancing 

Incentive Program initiatives, ACL, CMS and the VHA decided to work with a select number of high 

performing ADRC states to develop national standards for ADRCs going forward. With the 2012 

Funding Opportunity, ACL officially adopted the “No Wrong Door” System for the ADRC Part A 

grants. Part A grants were awarded to 8 states to develop an NWD System in their state so the 

federal partners could leverage the experience and models emerging in these states. Key 

deliverables from these 8 states and national partners by the end of 2015 will include: 

 Draft National Standards for a No Wrong Door System 

 Specification for a data management tool to document the capacity of the No Wrong Door 

System to carry out its functional responsibilities 

 A model Person Centered Counseling Training Program 

 A strategy for implementing a National Credentialing Program for Person Centered 

Counseling 

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 A Medicaid Claiming Guide for the No Wrong Door System 

 A web based catalog of No Wrong Door System/ADRC best practices 

 A draft Toolkit to expand Veterans access to Veteran Directed Home and Community 

Based Services through the No Wrong Door System 

To date, the federal government and states have invested over $100 million in the development of 

the Aging & Disability Resource Centers. Since the program started, state innovations, feedback 

from key stakeholders, and consumer experiences have shaped the ongoing development of the 

Aging & Disability Resource Center and the national vision for a No Wrong Door System for all 

populations and all payers. This study is part of the continuous quality improvement approach that 

ACL, CMS and VHA have always used to strengthen the program’s design. The findings in this 

report support the current direction and vision that ACL, CMS and VHA are advancing for the 

program. 

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CHAPTER 1. EXECUTIVE SUMMARY
 

1.1 Background 

The Aging and Disability Resource Center (ADRC) program, a funding initiative jointly launched 

in 2003 by the Administration on Aging (AoA) and Centers for Medicare & Medicaid Services 

(CMS), was initially designed around a vision of providing consumers in every community with a 

single point of access to long-term services and supports (LTSS). Specifically, this program 

encouraged states to implement ADRCs to act as “visible and trusted” sources of information and 

referral, provide one-on-one options counseling, assist with Medicaid eligibility determination, 

and streamline access to the full range of services and supports that older individuals, persons with 

disabilities, and family caregivers need, in the settings they prefer. As part of the larger “systems 

change” effort, ADRCs were intended to be coordinated systems for public- and private-pay clients 

that minimized confusion while supporting informed decision-making. They were also envisioned 

to prevent or delay spend-down and enrollment into Medicaid and other public programs. 

Initial awards were granted to 12 states in 2003; over the past decade, the ADRC program has 

grown to 525 ADRC sites established in 53 states and territories. With this growth, the program 

has also evolved in important ways. Special grants have been funded to encourage partnerships 

with hospitals to provide discharge planning, to encourage diversion from high-cost LTSS, and to 

formalize consumer-directed programming with the Veterans Health Administration. Most 

recently, funding has been awarded toward the establishment of true “No Wrong Door” systems 

characterized by coordinating and integrating access to LTSS for all age and disability populations, 

across all payers through full partnership of state and local agencies involved in ADRCs’ networks. 

1.2 Overview of the National Process and Outcome Studies 

Throughout the evolution of the ADRC program, data on aspects of operations and performance 

have been regularly collected through the Semi-Annual Reporting Tool (SART), but there have 

been no systematic national studies to examine how ADRCs provide access to LTSS, the 

environments within which they operate, or outcomes of individuals who use them. In order to 

understand how well ADRC sites are facilitating access to LTSS and whether clients report 

positive experiences, the Administration for Community Living (ACL) contracted with IMPAQ 

International, LLC, and Abt Associates, Inc., to conduct a national process and outcome study of 

the ADRC program. 

Both state- and local-level ADRCs participated in this research. The primary goals of the process 

study were to explore the motivations of state and local ADRCs for seeking ADRC grants and the 

effect of the grants on local sites’ performance; understand contextual factors (e.g., level of 

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community service capacity) identified from a local perspective; learn about the operational 

characteristics of ADRCs from state and local perspectives; and capture aspects of LTSS service 

delivery that influence participant experience that may not be captured in the outcome study. These 

data were collected through an online survey that was administered through the spring 2013 

version of the SART. 

The outcome study was conducted using a smaller sample of ADRC sites from which the study 

team recruited individuals who had utilized the ADRC to access LTSS. These individuals were 

administered a telephone-based participant experience survey (PES). The PES was designed to 

capture how well ADRCs helped older adults and persons with disabilities access needed LTSS, 

factors that led clients to seek information from ADRCs, the type of access and services that 

ADRCs provided, challenges that clients faced in accessing LTSS through ADRCs, and, finally, 

client satisfaction with ADRCs. 

1.3 Implementation of Process and Outcome Studies 

All state- and local-level ADRCs were invited to participate in the process study, with the 

exception of three states and one U.S. territory that either did not have ADRC grants or were not 

required by ACL to report data through the SART. Forty-eight state-level and 472 local-level sites 

participated. Data collection occurred from April 1 through September 15, 2013, via a web-based 

survey. 

For local-level ADRCs, the survey had a total of 60 items grouped into five sections: 

 Section A – Baseline Characteristics 

 Section B – Populations Served 

 Section C – Service Provision 

 Section D – Organizational Characteristics 

 Section E – LTSS Environment 

The survey given to state-level ADRCs was shorter, with 15 questions in three sections: 

 Baseline Characteristics 

 Organizational Characteristics 

 LTSS Environment 

A smaller sample of 18 local and two statewide ADRC sites participated in the outcome study. 

Staff from each of these sites were trained to screen their clients for participation in the PES. 

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Eligible clients from each site were identified by staff based on age, disability status, and receipt 

of specific services. Eligible clients were invited to participate in the study and asked to provide 

contact information in order to be contacted to complete the telephone-based PES. A total of 552 

ADRC clients completed the PES. 

The PES instrument contained 60 questions regarding: 

 Experience with initial contact  Assistance with Medicaid eligibility 

determination  Agency efficiency  Assistance with one-on-one counseling  Agency effectiveness  Care transition services  Institutional diversion  Support received from the agency  Assistance with services  Health and demographic information 

1.4 Highlights of Process and Outcome Study Findings 

Descriptive analyses were used to examine process and outcome study data. Bi-variable crosstabulations and chi square tests were used to examine a number of subgroup differences at both 

the ADRC level and the client level. Data from the outcome study were assigned a sampling 

weight, based on the sampling design used in the larger study. Details on the sample and weighting 

approach are provided in Chapter 3. A number of interesting and relevant results were found in 

both the process and outcome studies that highlight the success of the ADRC program as well as 

some challenges and areas that may be improved as the ADRC program continues to evolve in the 

future. 

1.4.1 Process Study 

Overall, ADRCs appear to be making progress towards their mission of providing seamless access 

to LTSS and strengthening sustainability by increasing funding sources. For example: 

 Nearly all local ADRCs reported improvement in their ability to provide integrated, 

comprehensive access to LTSS since the start of the ADRC program. 

 The majority of state ADRCs reported that ADRC program funding enabled them to 

increase the number of partnerships and the skills of staff members. Local ADRCs said 

that ADRC funding enabled them to increase the level of coordination with aging and 

disability network organizations and improve staff training opportunities. 

 There was an increase in the number of funding sources reported by ADRCs from prior 

fiscal years. 

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Most ADRCs were found to provide options counseling and to conduct initial screenings for 

Medicaid eligibility—two services deemed key to the original vision of ADRCs. In addition, the 

majority of local ADRCs said they always use a standard consumer needs assessment procedure, 

and over one-half reported utilizing a standard tool to provide options counseling. However, fewer 

indicated that these tools are shared across partners. Although a majority of ADRCs appear to be 

moving in the direction of a common assessment instrument, more progress needs to be made to 

ensure that these tools and the information they inventory are shared efficiently across all agencies 

with which individuals interact to obtain LTSS. 

ADRCs understand the importance of aging, disability, and other organizations in providing 

integrated and streamlined access to LTSS. They reported an average of four core operating 

organizations and 16 partners. The most frequently identified partnerships were between ADRCs 

and state units on aging (SUA), centers for independent living (CIL), area agencies on aging 

(AAA), state Medicaid agencies, and local veterans administration (VA) offices. In general, most 

indicated that these partnerships were highly functional; a notable exception, however, was found 

in partnerships with the local VA. While nearly half of local ADRC sites reported having formal 

partnerships with their local VA, fewer considered this partnership as highly functional. This was 

seen at the state level as well, as less than one-quarter of state-level respondents reporting a highly 

functional relationship with the VA. Given the increasing partnerships between the Veterans 

Health Administration (VHA) and the federal ADRC program, understanding reasons for this 

discrepancy and determining strategies for improving partnerships, through technical assistance or 

another means, may be vital to ensuring success of these recent initiatives. 

Local ADRCs seem to be located in service areas with a disproportionate number of White and 

non-Hispanic populations. Further, an average of nearly 20 percent of the population is living at 

or below the poverty level, and, for many ADRCs, a significant portion of their population does 

not have health insurance coverage. Not surprisingly, ADRCs serve more clients over age 60 than 

younger persons with disabilities. In addition, they serve more persons with physical disabilities 

and their caregivers than other disability groups. The disproportion of populations served by the 

ADRC indicates a potential disparity in access to ADRC services, underscoring an area in need of 

improvement. Enhancing the ability of ADRCs to reach and appropriately serve diverse 

communities around the country is an ADRC goal that should be soundly reinforced by ACL. 

1.4.2 Outcome Study 

The outcome study provided a glimpse into the experiences of older adults and adults with 

disabilities when they contact an ADRC. The results revealed many positive aspects of the 

program, illustrating that the ADRCs are meeting their goal of providing seamless access to and 

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information about needed LTSS. On the other hand, results also identified a number of consistently 

challenging aspects of delivering integrated access to LTSS. 

Overall, clients were positive about their interactions with the ADRC. For example, they were very 

satisfied that the ADRC met their needs and said they would contact an ADRC in the future to 

obtain LTSS. A vast majority of clients indicated that the ADRC representative was professional, 

knowledgeable, paid close attention, correctly assessed their LTSS needs, and provided clear and 

understandable information. Further, clients were satisfied with the completeness and accuracy of 

the information that they received, and the vast majority indicated that they would recommend the 

ADRC to friends or family. 

However, important challenges were also observed in the data. Of particular importance is the fact 

that more than one-half of respondents said that they had not received the services requested by 

the time of the survey, which was conducted approximately three to four weeks after contact with 

the ADRC. However, it is important to note that most of the services requested by clients— 

transportation, housing, and the like—are not provided directly by the ADRC. The ADRC instead 

serves to provide integrated access to these services. This finding may reflect a lack of availability 

of needed services, as discussed earlier, or a longer duration of time may be needed to determine 

whether services were indeed eventually received. Notwithstanding, this is an area that requires 

further review to determine what technical assistance or potential future initiatives may be 

provided to more fully explore the reasons for non-receipt of requested services and to ensure that 

ADRC consumers are able to access LTSS. 

Similarly, as discussed earlier, diversion from public programs, including Medicaid, has been a 

central aspect of the ADRC program vision. Delaying or preventing individuals from having to 

spend-down to meet Medicaid eligibility requirements or to rely on more expensive LTSS options 

by helping them learn about low-cost options and make better use of their own resources has been 

a focus of ADRC grants since their inception in 2003. Although ADRC respondents indicated that 

diversion from nursing homes or other residential settings is an outcome their agency sought to 

achieve, ADRC representatives helped less than one-third of responding clients understand their 

options for staying in the community and, thereby, avoiding or delaying a move into a nursing 

home or another long-term care setting. It may be that ADRC representatives did not have reason 

to assist in this way, but further work is needed in this area to determine if a mismatch exists 

between citing diversion as a goal and providing information and assessments accordingly. 

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Finally, a number of interesting subgroup differences were observed in the outcome study: 

 Individuals with disabilities were less likely to report that the ADRC staff paid close 

attention to what they said, but more likely to report that the ADRC staff talked to them 

about options for staying in the community. 

 Individuals with disabilities were more likely to report that services were not accessible, 

that the information they received from the ADRC was not helpful, and that they had 

difficulty filling out the paperwork. 

 Individuals who rated their health as poor were more likely to say that ADRC staff talked 

with them about options for staying in the community. 

 Individuals with disabilities and those who rated their health as poor were less likely to 

report that service was unavailable. 

These subgroup results are mixed in nature. On one hand, persons with disabilities and poorer 

health were more likely to report that ADRC staff discussed community options. This is a positive 

finding, as these groups may be at increased risk for institutionalization. On the other hand, it 

appears that ADRC staff may need to be more attentive to these groups and their needs and to 

provide additional support in completing necessary paperwork. Again, service availability for 

these groups is likely to be dependent not on what the ADRC can provide, but on what is available 

in the community; while ADRCs may not have direct control over solutions to this problem, it is 

still in the interest of ADRCs at the local, state, and federal level to advocate for increased LTSS 

and outreach to help persons with disabilities and poorer health remain in the community as long 

as possible. 

1.5 Conclusion 

Overall, findings from the process and outcome study of ADRCs suggest that local and state 

ADRC programs are, at their foundation, true systems change initiatives and that they are 

achieving their goal of providing seamless access to LTSS. There is evidence that ADRCs are 

increasing partnerships; standardizing and sharing information, including assessment tools, across 

stakeholders; and providing highly satisfactory access even in the environment of inadequate 

LTSS. ADRC clients feel that they are listened to, that their care plans reflect their needs and 

desires, and that the ADRCs are providing the core aspects of integrated access to LTSS, including 

information and referral, options counseling, and Medicaid eligibility determination. However, 

there is still room for progress in many areas, including increasing care transition service provision, 

improving aspects of participant satisfaction for specific groups of people, expanding the reach of 

ADRCs to underserved populations, and solidifying partnerships with key stakeholders such as 

local VAs. 

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As evidenced from this study and other sources, the ADRC program is continuing to evolve. ACL, 

CMS, and VHA have created funding opportunities to encourage a high-performing ADRC 

options counseling program with the capacity to serve persons of all ages, disabilities, and income 

levels; build stronger partnerships between health and LTSS systems; develop financially 

sustainable ADRC models with multiple revenue streams; and adopt a set of national performance 

and outcome standards. These efforts demonstrate the progress made since the inception of the 

ADRC program, which began with 12 states in 2003. The ADRC program has strengthened and 

grown into a national model of integrated access to LTSS; it is successfully moving toward 

seamless access to comprehensively meet the needs and desires of individuals in communities 

across the country. 

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CHAPTER 2. INTRODUCTION
 

The Aging and Disability Resource Center (ADRC) program, launched in 2003, encourages states’ 

efforts to integrate the full range of long-term supports and services (LTSS) into a single 

streamlined, coordinated No Wrong Door (NWD) system. The ADRC program was initially a 

collaborative effort of the Administration for Community Living (ACL; formerly the 

Administration on Aging)1 and the Centers for Medicare & Medicaid Services (CMS) in response 

to a mandate in the 1965 Older Americans Act (OAA). The effort is now also supported by the 

Veterans Health Association (VHA). 

As amended in 2006,2 the OAA defines the ADRCs as entities established by a state as part of the 

state system of long-term care to provide: 

‘‘(A) comprehensive information on the full range of available public and private long-term 

care programs, options, service providers, and resources within a community, including 

information on the availability of integrated long-term care; 

(B) personal counseling to assist individuals in assessing their existing or anticipated longterm care needs, and developing and implementing a plan for long-term care designed to 

meet their specific needs and circumstances; and 

(C) consumers access to the range of publicly-supported long-term care programs for which 

consumers may be eligible, by serving as a convenient point of entry for such programs.” 

(PUBLIC LAW 109–365—OCT. 17, 2006, Title I, Section 101[44]). 

Title II, Section 206, of the OAA specifies that the Assistant Secretary for Aging “shall measure 

and evaluate the impact of all programs authorized by this Act.... Evaluations shall be conducted 

by persons not immediately involved in the administration of the program or project evaluated.”3 

Although ADRC program grantees are required to include a local program evaluation in their grant 

activities, there has not been a national program study since the program’s inception in 2003. The 

collection of information through a national study was deemed necessary to determine the overall 

effect of ADRCs on LTSS and individuals and to show whether or not ADRCs are fulfilling their 

mission. 

1 As of April 2012, the Administration on Aging, the Office on Disability, and the Administration on Developmental 

Disabilities were combined into a single agency, the Administration for Community Living (ACL), which supports 

both cross-cutting initiatives and efforts focused on the unique needs of individual groups, such as children with 

developmental disabilities or seniors with dementia. For more information see https://federalregister.gov/a/2012-

9238 or http://hhs.gov/acl 2 http://www.doleta.gov/seniors/other_docs/PublicLaw109-356.pdf; accessed on 10/5/14 3 http://infousa.state.gov/government/branches/docs/oldamact.pdf, accessed on 10/6/2014 

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Motivated by the OAA mandate and a strong commitment to the ADRC program and its essential 

role in the future of fully integrated, coordinated NWD systems across states, the ACL contracted 

with IMPAQ International, LLC, and Abt Associates, Inc., to implement a rigorous national study 

of the ADRC program. Through this study, ACL sought to understand how well ADRCs are 

supporting members of the aging and disability populations in making informed choices and 

accessing LTSS. ACL was also interested in understanding whether consumers who access 

ADRCs report positive experiences and issue resolution. 

The national study has two components: a process study and an outcome study. This report presents 

the results and discussion based on the analyses of the data collected as part of the national ADRC 

process and outcome studies. Specifically, the report presents the findings outlined below. 

Process study 

 The motivation to become an ADRC and institutional diversion as an outcome sought 

 Funding sources and the effects of funding 

 The profile of the communities in which ADRCs operate such as their service capacity and 

availability; population race, medical insurance, and poverty level; and consumer 

demographics 

 Organizational structure such as staffing levels and services provided (i.e., options 

counseling, care transitions, and Medicaid eligibility); number and quality of ADRC 

partnerships 

 Assessment of the level of service provision, extent of site integration, and Medicaid 

integration status 

Outcome study 

 The profile of agencies and respondents participating in the participant experience survey 

(PES) 

 ADRC consumer respondents’ perspectives on the efficiency and effectiveness of the 

ADRC 

 The types of services for which ADRC consumer respondents request assistance 

 Consumer respondents’ experiences when accessing the requested services 

 Consumer respondents’ satisfaction with their ADRC experience 

 Key outcomes by each of the three ADRC dimensions: service provision, site integration, 

and Medicaid integration 

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2.1 ADRC Program Background 

Over 10 million community‐dwelling Americans currently need or receive LTSS to help them 

remain independent and avoid placement in institutional settings such as nursing homes.4 LTSS 

can include a range of assistive services provided to individuals who have limitations in 

performing activities of daily living, such as eating, bathing, or transportation; instrumental 

activities of daily living, such as shopping, food preparation, or managing finances; and medication 

management. Receiving these supports and services is often essential to an individual’s ability to 

live in the community. Ensuring that individuals can easily access these services in a coordinated 

and integrated manner is, therefore, fundamental to LTSS delivery systems. 

Unfortunately, the multiple and separate public funding streams and disparate assessment and 

tracking systems for determining LTSS eligibility complicate the coordination and delivery of 

LTSS. Those with multiple or complex needs may have to reach out to a number of different 

agencies or organizations to ensure that their needs are met. They may also have to go through 

multiple eligibility screenings to access services and benefits. Streamlining these systems and 

integrating access to LTSS allows LTSS users and their caregivers to connect to a broad and 

comprehensive range of services more easily and efficiently. 

The ADRC grant program is one vehicle for achieving integrated access to LTSS in response to 

these challenges facing persons in need of LTSS. Designed as a “systems change” initiative to help 

states better coordinate and integrate access functions, ACL and CMS envision ADRCs to be 

highly visible and trusted places, available in every community across the country, where all 

people, regardless of their age, income, or disability, can go to obtain information on the full range 

of long-term support options. Initially, ADRCs were required, at a minimum, to target older adults 

and at least one additional subpopulation, including people with physical disabilities, serious 

mental illness, and/or developmental/intellectual disabilities. They were also envisioned to reach 

people before they became Medicaid-eligible to prevent or delay spend-down and enrollment into 

Medicaid and other public programs. 

Initial awards were granted to 12 states in 2003; over the past decade, the ADRC program has 

grown to 525 ADRC sites established in 53 states and territories. With this growth, the program 

has also evolved and expanded in important ways. Special grants have been funded to encourage 

partnerships with hospitals to provide discharge planning, to encourage diversion from high-cost 

LTSS, and to formalize consumer-directed programming with the Veterans Health Administration. 

Most recently, funding has been awarded toward the establishment of true “No Wrong Door” 

4 Kaiser Commission on Medicaid and the Uninsured (Kaiser) (2009). Medicaid and long‐term services and supports. 

The Henry J. Kaiser Family Foundation, CA. 

10 
 

 

 

 

 

 

 

 

 

 

 

 

 

systems characterized by coordinating and integrating access to LTSS for all age and disability 

populations, across all payers through full partnership of state and local agencies involved in 

ADRCs’ networks. Due to the timing of this study, it does not measure the effects of this effort 

started with the 2012 awards, but rather documents the ADRCs as they were based on the 2010 

funding. Exhibit 2.1 visually depicts this evolution of the ADRC program. 

As stated by ACL and CMS in program funding announcements, three key services should be 

provided to facilitate integrated access to LTSS: 

1)	 Visible and trusted information and referral (I&R) to available and appropriate programs, 

supports, and services 

2)	 One-on-one options counseling to support LTSS decision‐making 

3)	 Streamlined linkages to available LTSS across multiple funding streams 

Since the first grants were awarded in 2003, ADRC programs have grown nationwide, evolving to 

include innovative models linking hospital discharge planning with ADRCs, supporting care 

transitions as functions of ADRCs, and forming consumer-directed and person-centered planning 

partnerships with the VHA through the Veterans Directed-Home and Community Based Services 

program. NWD systems are actively serving older adults and persons with disabilities across the 

nation, and, since the inception of the program, NWD systems have made over 25 million contacts, 

helping to answer questions related to health and LTSS.5 

5 http://www.acl.gov/Programs/CDAP/OIP/ADRC/index.aspx, accessed on 10/5/2014 

11 
 

 

 

 

 

 

 

 

 

 

Source: Administration for Community Living, 2014 

Looking toward the future, ACL and its federal partners are working to develop a set of national 

standards, tools, and metrics for states to use as they continue to improve their ADRC programs 

and create high-performing, streamlined access systems for all populations in need of LTSS. To 

be successful in this mission, ACL needs the information obtained from the national ADRC study 

to understand the current landscape of the program, including the degree to which ADRCs have 

integrated and simplified access to LTSS, and to identify best practices that will lead to program 

refinement and continuous quality improvement. 

2.2 Overview of the National ADRC Study 

The purpose of the national ADRC study is to understand how well ADRCs are facilitating access 

that meets the LTSS needs of the aging and disability populations and to determine whether clients 

who access ADRCs report positive experiences. Specifically, the goals of the study are to: 

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 Identify strategies that ADRCs are implementing that help to efficiently and effectively 

integrate access to LTSS in the communities they serve 

 Reveal approaches that may lead to program refinement and continuous quality 

management 

 Enable ACL to more accurately report on the effectiveness of the ADRC program to 

governmental agencies and to the public 

The national ADRC study received the Office of Management and Budget’s approval under the 

Paperwork Reduction Act of 1995 and Abt Institutional Review Board approval; data collection 

was conducted between 2013 and 2014. The process study included representatives of all state and 

local ADRCs; the outcome study included a convenience sample of consumers of ADRCs selected 

with intention. A matched sample of AAAs was also selected for inclusion in the process and 

outcome study, but a low response rate among AAA consumers prevented meaningful analytic 

comparison. 

2.2.1 Overview of the Process Study 

The process study data were collected from state and local ADRCs and recruited AAAs, as 

described above. The data were obtained using the web-based tool that is currently used by ADRC 

grantees for submission of their semi-annual grant reports (i.e., the Semi-Annual Reporting Tool 

or SART); the tool is HIPAA compliant. Responses were analyzed using descriptive statistics as 

well as bivariate and chi-square analyses to explore subgroup differences. From the process study 

data, we also created three core measures to assess the ADRC program’s degree of provision of 

core services, site integration, and Medicaid integration. 

2.2.2 Overview of the Outcome Study 

Data for the consumer-level outcome study were collected using a participant experience survey 

(PES). These data were analyzed in aggregate form to determine the overall impact of ADRCs 

regarding access to services and respondent experiences in contacting ADRCs. Outcome data were 

analyzed in conjunction with the process study data to determine whether there are certain types 

of ADRC approaches that are most beneficial to consumers overall or that are best suited to specific 

types or subpopulations of consumers or to certain community characteristics. As in the process 

study, descriptive statistics were used to analyze the data collected via the PES. In addition, bivariable analyses were performed to identify statistically significant differences among subgroups, 

and regression analyses were employed to estimate the associations among respondent, ADRC, 

and community characteristics and outcomes of interest. Note that because we did not have a viable 

comparison group, we were unable to conduct an impact estimation of ADRCs on client experience 

13 
 

 

 

 

 

 

 

 

 

 

 

 

 

or make causal inferences. The core measures developed from the process study data were also 

used in analyses and interpretation of the findings from the outcome study data. 

2.3 Organization of the Report 

In the remainder of this report, we present the methodology, findings, and discussion of the 

national ADRC process and outcome studies. Specifically, Chapter 3 provides the methodological 

approach followed for the process and outcome studies, including the development of the three 

core ADRC measures. We describe our sample selection, data collection tools, recruitment of 

survey participants, administration of the survey, and analytic approach. We then discuss the 

approaches utilized to analyze the process and outcome study data. Chapter 4 focuses on the 

process study. We first present the research questions addressed by the process study and then 

present the results of the process study analyses and a discussion of the implications of the findings. 

Chapter 5 begins with an introduction to the outcome study research questions. It then presents a 

summary of findings from the outcome study data and their implications. Finally, in Chapter 6 we 

offer a discussion of the synthesized results of the process and outcome studies and place these 

findings in the context of the evolving ADRC program. 

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CHAPTER 3. PROCESS AND OUTCOME STUDY METHODOLOGY
 

This chapter presents the methodology followed for the process and outcome studies. It describes 

the sample selection, recruitment, surveys, data collection, and analytical approach for each study. 

We also describe the technical specifications of the three core measures developed using the 

process study data. 

3.1 Agency Sample Selection and Recruitment 

This section describes the sample selection and recruitment of ADRCs and AAAs participating in 

the process and outcome studies. We describe the agency sample selection and recruitment 

strategies at the outset because some of the methodology is common to both the ADRC process 

and outcome studies. Specifically, the sample of AAAs is used in both studies, and since 

participating AAAs were matched to selected ADRCs, the selection and recruitment of the ADRCs 

and AAAs are described below. We note, however, that due to the small sample size and the 

similarity of service delivery between the ADRCs and AAAs, selected AAAs were not used as a 

comparison group in either the process or outcome study analyses. 

3.1.1 Agency Sample Selection and Recruitment for the Process Study 

All the state and local ADRCs were invited to participate in the process study survey. ADRCs 

from three states and a U.S. territory were the only exceptions. Mississippi, Missouri, Wyoming, 

and Northern Mariana Islands were not expected to participate in the process study survey, as they 

are not required by ACL to participate in the ADRC SART. In addition to the state and local 

ADRCs, 14 AAAs agreed to participate in the survey. The sampling and recruitment of these 

AAAs and ADRCs are described in Sections 3.1.2 and 3.1.3. 

3.1.2 Agency Sample Selection for the Outcome Study 

The sampling strategy followed for the selection and recruitment of a sample of ADRCs and AAAs 

for the outcome study is described below. 

Drawing a Sample of ADRCs. Power calculations were conducted and revealed that a sample of 

40 agencies (20 ADRCs and 20 AAAs) would result in an adequate sample size to detect 

statistically significant group differences, if they existed. As a result, we attempted to draw a 

sample of 23 ADRCs from the population of all ADRCs. At the time that the study was initiated, 

three large statewide ADRCs were identified in the population (i.e., Arkansas, Minnesota, and 

New Mexico). Since statewide ADRCs are likely to be different from non-statewide ADRCs with 

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regard to characteristics of interest, we included these statewide ADRCs in the sample with 

certainty. A probability sample of 20 ADRCs was then selected from the remaining population. 

For selection of the sample, the population of ADRCs was stratified by 10 geographic regions. 

Within each region, the population of ADRCs was further stratified into two groups, rural or urban, 

based on the urbanicity ratio of the population in their service areas. Per the urbanicity ratio, an 

urban ADRC is one that has over 50 percent of the population in its service area residing in urban 

areas, according to the 2010 U.S. Census. Similarly, rural ADRCs are ADRCs that have less than 

50 percent of the population in their service area residing in urban areas. Since there were not 

enough rural ADRCs in Region IX, the urbanicity ratio was relaxed from 50 percent to 60 percent. 

For each of the resulting 20 strata, one ADRC was selected at random and a second was designated 

as reserve to be used in case the first selected ADRC turned out to be a non-respondent, as was 

often the case. Since it was found that some strata had no respondents, agencies from adjacent 

regions were recruited (see Appendix A, Exhibit 1) and the strata collapsed. The assumption was 

that ADRCs in adjacent regions are likely to be more similar with regard to characteristics as 

compared to other regions. In some cases, the collapsed stratum consisted of regions that were not 

adjacent to the responding region. 

Drawing a Sample of AAAs. In January 2013, the research team obtained updated data on AAAs 

and their coverage areas from the ACL’s www.eldercare.gov web site. At that time, the total 

number of AAAs was 634. Working with this dataset and the ADRC dataset, the research team 

compared the coverage areas of AAAs and ADRCs in order to come up with a list of AAAs whose 

coverage areas did not overlap with the coverage areas of ADRCs. The result was a total of 134 

AAAs that did not have overlapping coverage areas with ADRCs. Exhibit 2 in Appendix A 

displays these AAAs by region and urban/rural status. Since there was only one AAA each in 

Regions IX and X that could be classified as rural based on a 50 percent threshold for urbanicity, 

we raised the threshold to 60 percent. This yielded five rural AAAs in Region IX and eight rural 

AAAs in Region X. 

Because of the inadequate number of AAAs in Regions I and III and their geographic proximity 

to Region II, we selected all three rural and all three urban AAAs available in Regions II and III 

into the sample with certainty (see Appendix A, Exhibit 3). From the remaining AAAs, the 

research team selected a probability sample of AAAs using a similar design to the one used for the 

selection of ADRCs. Two AAAs were randomly selected from each of the remaining seven regions 

(one rural and one urban AAA from each region) as primary AAAs, for a total number of 14 AAAs. 

Back-up AAAs were randomly selected from among the remaining AAAs in each strata. To select 

back-up sites for Regions I – III, three AAAs were selected from the rural stratum and three AAAs 

were selected from the urban stratum in Region IV. 

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3.1.3 Agency Recruitment for the Outcome Study 

First, electronic letters of support from ACL (see Appendix B), signed by the project officer, Susan 

Jenkins, were emailed to the directors of ADRCs and AAAs to encourage their participation in the 

study. Within a week or two of sending the letters from ACL, the research team made recruitment 

calls to the directors of the selected agencies, providing them with background about the study and 

asking for their agreement to participate. In order to track these communications, team members 

developed a detailed spreadsheet where they recorded the date and content of each call. 

If an agency agreed to participate, the team obtained the contact information for designated 

primary and secondary site coordinators. The recruiter then sent a brief follow-up email to the 

proposed agency coordinator thanking him/her for agreeing to fill that role. Agency coordinators 

were also asked to provide the names and email addresses of staff who would be involved in 

screening and recruitment of clients. This contact information would enable the team to invite staff 

to sign up for a webinar presentation on screening and recruiting clients. 

The study team conducted follow-up calls to site coordinators to confirm their commitment during 

the agency recruitment. These calls entailed sharing further details of the role of study sites and 

answering any questions site coordinators had. This step was particularly important if the 

designated site coordinator was not the agency director and therefore had not yet received 

communication from ACL or the IMPAQ recruitment team. In such cases, these individuals 

required an initial introduction to the study and had questions about what their agency’s 

involvement would entail. Several sites decided that they did not wish to participate in the study, 

and no further communication ensued. For sites that agreed to remain involved, a follow-up email 

was sent to the site coordinator. The email reviewed the main points covered in the phone 

conversation and encouraged the site coordinator to contact the research team at any time during 

the study should she/he have any questions or concerns. 

At the start of data collection, in mid-June 2013, 40 agencies agreed to participate. However, 

numerous sites dropped out during the first few months, primarily as a result of limited resources. 

Also, one agency that initially did not respond to the team’s communications ultimately joined and 

began sending data in early October 2013. Exhibit 4 in Appendix A provides a list of sites that 

dropped out of the study. The final sample of participating agencies was 33, with two statewide 

ADRCs, 18 local ADRCs, and 13 AAAs agreeing to participate in the outcome study. To recruit 

18 local ADRCs, we contacted 33 ADRCs for a response rate of 55 percent. The response rate for 

AAAs was 41 percent, with 13 out of 32 AAAs agreeing to participate. Exhibits 3.1 and 3.2 show 

the distribution of participating ADRCs and AAAs by region and rural versus urban status. 

17 
18 

Exhibit 3.1: Final Distribution of ADRCs Stratified by Region and by Rural Versus Urban 

Status

Region Selected with Certainty Rural Urban

I: CT, NH 0 1 1 

II: NJ 0 0 1 

III: VA, WV 0 1 1 

IV 0 0 0 

V: IN, MN 1 1 1 

VI: AR, OK, TX 1 2 1 

VII: IA, MO 0 1 1 

VIII: CO, MT 0 2 1 

IX: CA 0 1 0 

X: ID, OR 0 0 2 

Total 2 9 9 

Exhibit 3.2: Final Distribution of AAAs by Region and by Rural Versus Urban Status

Region Rural Urban

I 0 0 

II 0 0 

III 0 0 

IV: MS, NC 3 2 

V 0 0 

VI: TX 2 2 

VII: IA, NE 1 2 

VIII: MT 1 0 

IX 0 0 

X 0 0 

Total 7 6 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.2 Process Study Methodology 

3.2.1 Survey 

We collected the data for the process study through a web-based survey administered to all state 

and local ADRCs. Three versions of the survey were administered: 

 State-level survey (one survey per state) 

 Local-level survey (one survey per site) 

 AAA survey (those selected for the outcome study) 

The state ADRC directors or their representatives were the respondents of the state-level survey. 

Similarly, the respondents of the local-level survey were the local ADRC directors or their 

representatives. 

The agencies participated in the process study survey through the SART that is administered on a 

semi-annual basis by the Lewin Group, ACL’s technical assistance contractor for the ADRC 

program. The SART is an online tool that allows ADRCs to create and submit their required semiannual performance reports through one integrated system. The process study survey replaced the 

spring 2013 version of the SART semi-annual performance report survey. 

The data collection period for the process study survey was from April 1, 2013, through September 

15, 2013. ACL invited the agencies to participate in the survey and periodically sent follow-up 

letters to encourage participation. Three webinars were held to familiarize the ADRCs with the 

survey administration. Lewin and IMPAQ also operated a help desk to address questions from the 

agencies throughout the data collection period. 

The process study survey was a modification of the semi-annual performance report survey 

regularly administered through the SART. The process study survey was designed to (1) provide 

an understanding of LTSS programs from state and local perspectives, (2) inform the analysis of 

client outcomes, and (3) collect information that will guide recommendations for continuous 

quality improvement for the LTSS field. 

The local ADRC survey had 60 questions grouped into five sections: 

Section A – Baseline Characteristics 

Section B – Populations Served 

Section C – Service Provision 

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Section D – Organizational Characteristics 

Section E – LTSS Environment 

The survey questions in Section A collected ADRCs’ perspectives on their motivations for 

applying for an ADRC grant and the impact of ADRC funding on resources, services, and 

outcomes. Section B questions were designed to collect information on the barriers and facilitators 

for LTSS in the community, as well as the types of consumers ADRCs serve. Section C delved 

into the types of services provided by the agencies. In Section D, information on the organizational 

characteristics and operational processes of the agencies was gathered. Section E included an openended question on the LTSS environment. The AAAs were administered the local ADRC survey 

with slight modifications. 

The state ADRC survey was shorter than the local survey, with 15 questions in three sections: 

Section A – Baseline Characteristics 

Section B – Organizational Characteristics 

Section C – LTSS Environment 

The survey questionnaires are provided in Appendix C (local survey) and Appendix D (state 

survey). 

3.2.2 Response Rates 

The process study survey achieved a high response rate for both the state and local ADRC surveys. 

The state ADRC survey had a 100 percent response rate among the states and territories expected 

to participate in the process study, which excluded Mississippi, Missouri, Wyoming, and Northern 

Mariana Islands, as noted earlier. 

As shown in Exhibit 3.3, the local ADRC survey also achieved a high response rate. Twenty-seven 

states had a 100 percent response rate. Twelve states had a response rate between 75 and 99 

percent, and Guam’s single ADRC did not respond to the survey (i.e., it had a zero response rate). 

The overall response rate for the local ADRC survey was 83 percent, with 472 out of 567 local 

ADRCs participating in the survey. Appendix E provides the complete state-specific response rates 

for the local ADRC survey. Thirteen out of the 14 AAAs that agreed to participate in the survey 

responded, achieving a response rate of 93 percent. 

20 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.2.3 Analytic Approach 

The process study findings are presented primarily as descriptive statistics. We also conducted bivariable analyses and chi-square tests to explore subgroup differences. Following is a detailed 

description of our analytic approach. 

Tabulation. We tabulated the responses to the survey questions and generated frequencies and 

percentages. For questions with continuous numbers as responses (e.g., number of consumers 

served), we grouped the responses into logical categories and generated frequencies and 

percentages. In addition, we summarized the responses and generated the minimum, maximum, 

mean, median, and mode. We provide the results of the tabulations in Appendix F (local survey) 

and Appendix H (state survey). 

Free-text survey responses were coded and summarized. These summaries and the verbatim 

responses are provided in Appendix G (local survey) and Appendix I (state survey). Selected 

examples are presented in Chapter 4. 

Closed-ended and open-ended survey responses from AAAs are provided in Appendix J and 

Appendix K, respectively. Note that survey findings specific to AAAs are not discussed in this 

report, as they were collected for use as covariates in the outcome regression analyses and not to 

serve as a comparison group in the process study. 

Bi-Variable Analysis. In addition to tabulating the survey data, we conducted bi-variable analyses 

to gain a deeper understanding of the performance of ADRCs in the context of their organizational 

and community characteristics. This involved conducting subgroup analyses of key questions 

using cross-tabulations to see whether survey responses varied by subgroups (e.g., whether the 

types of services offered varied by urban or rural local ADRCs). We employed chi-square tests for 

identifying statistically significant differences in survey response among subgroups. We used one 

21 

Exhibit 3.3: Response Rate on the Local ADRC Process Study Survey

Response Rate Number of States/Territories

100% 27 

99% – 75% 12 

74% – 50% 5 

49% – 25% 3 

24% – 1% 0 

0% 1 
 

 

 

 

 

 

set of subgroup variables that represented ADRC characteristics and a second set of variables based 

on the environment in which ADRCs operate. 

The subgroups examined in the process study include: 

 Categories based on the number of ADRC consumers 

 Government or independent non-profit ADRCs 

 Rural versus urban ADRC service areas 

 ADRCs from centralized, decentralized, or mixed-model states 

 Level of core service provision categories 

 Extent of site integration categories 

 Status of Medicaid integration categories 

Below we provide the definitions and distributions (see Exhibit 3.4) of the various subgroup 

analysis categories. The distribution is from the process study dataset with ADRCs that have nonmissing data. 

Number of ADRC consumers. This is the only subgroup variable that is based on a continuous 

variable, the total number of older adults and individuals with disabilities served by a local ADRC. 

For the purposes of subgroup analysis, we created a categorical variable of ADRC size based on 

the number of consumers. We split the ADRCs into those serving 0 to 500 (small), 501 to 2500 

(medium), or 2500+ (large) consumers. These categories were defined based on having a 

comparable number of ADRCs in the various categories. 

22 

Exhibit 3.1: Distribution of Local ADRCs by Subgroup Analysis Categories 

Number Percentage

Size

0 – 500 84 20.90 

501 – 2500 171 42.54 

2500 + 147 36.57 

Organizational Structure

Government 265 56.14 

Independent Non-Profit 207 43.86 

Urbanicity*

Rural 129 27.98 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Government or independent non-profit ADRCs. This variable is based on the organizational 

structure of ADRCs, that is, whether they were part of a government (e.g., county or city) or an 

independent non-profit agency. 

Rural or urban ADRC service areas. An urban ADRC is one that has over 50 percent of the 

population in its service area residing in urban areas, according to the 2010 U.S Census. Similarly, 

a rural ADRC is an ADRCs that has less than 50 percent of the population in its service area 

residing in urban areas. 

Centralized, decentralized, or mixed-model states. ADRCs were categorized as centralized, 

decentralized, or mixed-model ADRCs based on the number of operating organizations. This 

categorization was provided by the ACL. ADRCs were defined as centralized if they had only one 

operating organization, whereas ADRCs were defined as decentralized if they had more than one 

operating organization. The largest proportion of states (24 states) had a mix of centralized and 

decentralized ADRCs. Seventeen states or territories had only centralized ADRCs, and 12 states 

or territories had only decentralized ADRCs. 

The findings from the subgroup analyses are discussed in the corresponding sub-sections of this 

report if they were found to be statistically significant. The cross-tabulations are provided in 

Appendices L – O, with a separate appendix for each major subgroup category. 

Item Non-Response. The survey response tabulations indicated high levels of item non-response 

on certain questions, such as those requiring specific numbers as responses. For example, nonresponse ranged from 45 to 95 percent on questions asking local ADRC representatives to provide 

the number of consumers with disabilities by type. Similarly, on questions asking local ADRC 

representatives to report funding amounts by type, non-response ranged from 51 percent to 97 

percent. Therefore, we did not consider imputation of missing values as an appropriate method to 

23 

Number Percentage

Note: ADRCs with missing data on a variable were excluded from the related categorization. For example, an ADRC

with missing information on number of consumers served is excluded from the size categorization. 

*Statewide ADRCs were excluded from the urbanicity-based categorization.

Urban 332 72.02 

Operational Model

Centralized 72 15.25 

Decentralized 85 18.01 

Mixed 315 66.74 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

address item non-response. The survey response tabulations provided in the appendices include a 

“No response” row or column, as applicable. 

3.3 Outcome Study Methodology 

In this section of the report, we describe the methodological approach utilized in the outcome study 

for the sample selection, survey development, and collection of ADRC client experience data using 

the PES. Thereafter, we discuss our analytic approach for the outcome study data analysis. 

3.3.1 Staff Screening and Recruitment Training 

Once agencies were recruited and designated site coordinators were determined, agency staff were 

sent an email inviting them to attend a webinar presentation on how to screen and recruit clients 

to participate in the study by responding to a 20-minute telephone PES. The one-hour training was 

offered on four different days (May 28, June 3, June 6, and June 10) at different times to 

accommodate staff availability. Attendance was strongly encouraged in order to ensure that all 

staff were properly trained on how to accurately screen and recruit clients. If staff were not 

available for any of the four sessions, they were asked to view the recorded webinar that was posted 

on the ACL website. They were also encouraged to review the Reference Guide (see Appendix P) 

that all agency staff received via email with instructions on how to register for the webinar. 

3.3.2 Client Screening and Recruitment 

Concurrently with the training sessions, the research team mailed to each participating agency a 

packet of data collection forms and pre-paid FedEx envelopes in which to return completed forms 

to Abt. Additional forms and envelopes were shipped to agencies as needed throughout the 

recruitment period, approximately June 1, 2013, through March 31, 2014. Immediately following 

the training, staff were asked to begin client screening to determine eligibility of clients and recruit 

eligible clients. Clients and client proxies were eligible for the study. Staff were asked to complete 

a client screening tool (see page 41 of Appendix P) to determine eligibility. In general, client 

eligibility was determined by age, disability status, receipt of certain information or counseling 

services, and the professional status of the caregiver. Details on screening including eligibility 

requirements and recruitment procedures can be found in the Reference Guide (Appendix P). 

Individuals who were deemed eligible were invited to participate in the study. Clients who agreed 

were read an agreement-to-participate statement (see page 46 of Appendix P) and then were asked 

to provide contact information, which was recorded by staff on a data collection tool (see page 48 

of Appendix P). Every week or so, agencies forwarded to Abt the three agency data collection 

forms for data entry and tracking. Forms were sent whether or not clients were deemed eligible 

24 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

and whether or not all data fields were complete. Data were entered into an Access database and 

saved to a secure FTP system, Move-It DMZ. Abt SRBI retrieved the data from the secure server 

to conduct the administration of the PES (described below). 

Efforts to Improve Client Recruitment. In mid-July 2013, six weeks after recruitment had 

commenced, sites that had sent data were sent an email thanking them for their participation and 

encouraging them to continue to screen and recruit clients and send data on a weekly basis. Sites 

that had not sent data were thanked for their participation and strongly encouraged to send their 

data and to let the research team know if they had any questions or concerns. Approximately two 

months after client recruitment had commenced, several sites had sent only 10 or fewer data 

collection forms. These sites were contacted over the phone to ensure that they understood the 

process, to answer any questions they had, and to facilitate data collection. Reasons for sending 

limited amounts of data varied, from some sites being in rural locations and seeing very few clients, 

to being understaffed or having to meet competing demands. Then, approximately a month later, 

in mid-September, all sites were sent postcards (see Appendix Q), which thanked them for their 

involvement in the study and also served as a reminder to continue with data collection. They also 

received personalized letters from the ACL, signed by the project officer, thanking them for their 

valuable contribution to the study and requesting that they send data on a regular basis. 

Because the number of clients eligible for the PES continued to be lower than expected, eligibility 

criteria were relaxed as of October 1, 2013. Agencies were sent an email asking them to screen 

clients even if they were seeking services such as basic information and referral, Meals on Wheels, 

or transportation. By loosening eligibility criteria, the team hoped to increase the number of clients 

able to participate in the PES. 

In addition to frequent phone contact by the co-principal investigator and an additional mailing of 

the thank-you postcard, a final effort to increase the number of eligible clients recruited into the 

study was to extend the data collection period by three months from December 31, 2013, to March 

31, 2014. 

3.3.3 Participant Experience Survey 

The research team led by Abt Associates developed the PES to capture consumers’ experiences 

when contacting an ADRC or AAA to inquire about LTSS. The survey received approval from 

Abt’s IRB. The PES can be found in Appendix R. Because respondents in this study are more 

likely than the general population to experience cognitive challenges including limited attention, 

it was preferable to keep the questions brief and easy to answer and the overall survey short so that 

it took no more than 20 minutes to complete. Every effort was taken to make the wording of the 

questions clear and simple and to avoid colloquialisms that might be unique to one culture or even 

25 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

to one part of the country. The survey was designed so that either the recipient of the services or a 

caregiver could answer. As described below, the survey instrument underwent cognitive and pilot 

testing and was revised based on the results of these tests. 

The survey began with a statement of informed consent that was read to the respondent and 

required a verbal agreement to continue. The instrument contained 60 questions prompting yes/no, 

short answer, multiple choice, or Likert scale responses. Skip patterns were built into the survey 

so that questions irrelevant to a specific respondent could be avoided (e.g., “Did you request oneon-one counseling?”). The multiple choice and Likert scale responses were designed to be 

exhaustive, and all included the options “don’t know” and “refused to answer.” The questions 

covered by the survey include the following nine domains: 

 Experience with initial contact 

 Agency efficiency 

 Agency effectiveness 

 Institutional diversion 

 Assistance with services 

 Assistance with Medicaid eligibility determination 

 Assistance with one-on-one counseling 

 Care transition services 

 Services received from the agency 

 Health and demographic information 

3.3.4 Administration of the Participant Experience Survey 

The outcome study used a telephone survey whose development involved three stages: a cognitive 

test to refine the questionnaire design, a pre-test to assess timing and further design issues, and a 

main telephone survey. It was conducted using a fully overlapping dual (landline and cell phone) 

frame sample, with approximately half of the completed surveys originating from the cell phone 

frame and half from the landline frame. As noted earlier, respondents were either clients or client 

proxies of ADRCs and AAAs. Most clients were adults, with the exception of two who were under18 clients; only adults were interviewed. 

26 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.3.5 Response Rates 

The interviewers dialed a total of 1,169 telephone numbers and achieved an interview completion 

rate of 54 percent. Of the 625 telephone interviews completed, 330 were landline respondents and 

295 were cell phone respondents. The completion rate for ADRCs was 88 percent (552 

respondents), while the completion rate for AAAs was 12 percent (73 respondents). For more 

detail about the administration of the PES, please see Appendix S. 

3.3.6 Analytic Approach 

The approach to analyzing the outcome study data that were collected via the PES is described in 

the following sections. 

Sample Weighting. Each responding ADRC and AAA was assigned a sampling weight. This 

weight was used for all population-based estimates and for all statistical analyses. The sampling 

weight combines a base weight and an adjustment for non-response. The determination of weights 

followed the sampling design used for the outcome study. 

For the selection of the sample, the population of ADRCs was stratified by 10 regions, and, within 

each region, the ADRCs were further stratified by rural or urban status, creating 20 strata for 

sample selection. The same design was followed for the selection of AAAs. An equal-probability 

sample of two ADRCs was selected in each stratum. The base sampling weight for each selected 

ADRC is the ratio of the number of ADRCs in the stratum population to the number selected in 

the sample. 

For data collection, one ADRC was selected at random from the two in the stratum, and the other 

was designated as reserve in case the first selected ADRC turned out to be a non-respondent. At 

the end of the survey period, it was found that some strata had no respondents. First, the base 

weight was adjusted for non-response within a stratum. Since there was total non-response in some 

regions, for weighting purposes these regions were merged with adjacent regions to form a 

collapsed stratum, and the weights were based on the total number of ADRCs in the combined or 

collapsed stratum and the number responding in the collapsed stratum. The assumption was that 

ADRCs and AAAs in adjacent regions are likely to be similar with regard to characteristics in the 

survey as compared to other regions. In some cases, the collapsed stratum consisted of regions 

which are not adjacent to the non-responding region. This was done to avoid very large sampling 

weights. Since the samples of ADRCs and AAAs were selected with equal probability in each 

stratum, the base weight adjusted for non-response is essentially the ratio of the number of ADRCs 

in the population to the number responding in the sample. The sum of the sampling weights in 

27 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

each of the four groups—ADRC rural, ADRC urban, AAA rural, and AAA urban—is equal to the 

total population in each of these groups. 

Tabulation. We tabulated the survey questions, and the relevant tables for ADRCs are provided 

in Appendix T (tabulations of questions) and Appendix U (free-text responses). These tables report 

the actual frequencies of the survey responses. However, all the percentages reported are weighted 

using the sample weights generated to account for selection probability and non-response. 

We discuss a selection of these tabulations in the various sections of Chapter 5. We codified and 

summarized the free-text responses. Key findings from the open-ended responses are also 

discussed in this report. 

The corresponding tables for AAAs are available in Appendices V and W. We do not discuss 

findings from the survey respondents who represented AAAs. As mentioned earlier, the fact that 

only 73 AAA clients responded to the outcome study survey limits their usefulness as a viable 

comparison group. 

Bi-Variable Analysis. As in the case of the process study, we implemented bi-variable subgroup 

analyses in addition to tabulating individual survey questions. These analyses identified 

statistically significant differences among subgroups in relation to respondent experience with 

ADRCs. The bi-variable analysis was conducted using cross-tabulations, and statistical 

significance of differences was assessed using chi-square tests. 

The subgroups of interest are categorized into client characteristics and ADRC characteristics. 

The ADRC client characteristics used in the outcome study cross-tabulations include: 

 Gender 

 Education 

 Income 

 Type of client: older adult or adult with a disability 

The ADRC characteristics used in the outcome study cross-tabulations include: 

 Statewide or local ADRC 

 Number of consumers served 

 Number of full-time equivalent (FTE) staff 

 Rural or urban ADRC service areas 

28 
 

 

 

 

 

 

 Level of core service provision categories 

 Extent of site integration categories 

 Status of Medicaid integration categories 

In Exhibit 3.5, we provide the definitions of the various subgroup analysis categories and their 

distributions at the respondent level. The ADRC characteristics are generated from the process 

study survey data, and the client characteristics are from the outcome study survey data. The 

frequencies and percentages presented below are un-weighted. 

Statewide versus local ADRC. A variable that we included to capture the organizational structure 

of ADRCs was whether the ADRC operated statewide or at the local level. Two of the ADRCs 

that participated in the survey, Choices in Living Resource Center in Arkansas and MinnesotaHelp 

NetworkTM: A Network of Aging & Disability Resource Centers in Minnesota, are statewide 

ADRCs with their operations covering the entire states of Arkansas and Minnesota, respectively. 

29 
30 

Exhibit 3.5: Distribution of Survey Respondents by Subgroup Analysis Categories 

Number Percentage

ADRC Characteristics

Organizational Type 

Local 252 46.65 

Statewide 300 54.35 

Number of Consumers

0 – 500 34 6.16 

500 – 2500 265 48.01 

2500 + 253 45.83 

Number of FTEs

0 – 5 60 10.87 

6 – 15 243 44.02 

16 + 249 45.11 

Urbanicity*

Rural 93 16.85 

Urban 159 28.08 

Client Characteristics

Gender

Male 160 29.04 

Female 395 70.96 

Education

Less than High School 109 20.88 

High School Diploma 208 39.85 

More than High School 205 39.27 

Income

≤ $40,000 454 90.26 

> $40,000 49 9.74 

Type**

Older Adult 401 72.64 

Adult with Disability 441 79.89 

*Percentages for rural and urban ADRCs do not add up to 100 as they are generated from the universe of ADRCs, 

which comprised rural, urban, and statewide ADRCs.

**Older adults with a disability are counted in both categories. Therefore, percentages do not add up to 100.
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number of ADRC consumers. To understand how client experience varies with the capacity of 

ADRCs, we used the total number of clients (aged and disabled) served by the ADRC in the most 

recent six months. The same three categories used for the process study subgroup analysis was 

used here: small (0 – 500 consumers), medium (501 – 2,500 consumers), and large (2,500+ 

consumers). 

Number of FTEs at ADRC. Another variable used in the analysis to capture ADRC capacity was 

the total number of FTEs at the agency. The total number of FTEs was split into three categories: 

0 – 5, 6 – 15, and 16+. 

Rural versus urban ADRC service areas. To understand whether respondent experience varies 

with the urbanicity of the service areas of ADRCs, we used the categorical variable rural or urban 

ADRC, defined as in the process study subgroup analysis. Statewide ADRCs were not assigned 

rural or urban status. 

Client gender. Subgroup analysis also explored gender differences in responses. 

Client education. Client education was coded into three categories: less than high school education, 

high school graduate, and more than high school education. 

Client income. Income, a continuous variable from the survey, was recoded as a binary variable 

with the categories income over $40,000 and income less than or equal to $40,000. 

Client type. ADRC clients are categorized into two groups: older adults and adults with a disability. 

Older adults and adults with a disability are not mutually exclusive categories. Older adults are 

individuals who are aged 60 or above, irrespective of disability status. Adults with a disability 

comprise all individuals 18 years of age or older who have a disability. 

The analyses of the three core measures generated for this study are presented together in Section 

5.2.6. The findings from the remaining subgroup analyses are discussed in the corresponding subsections of this report if they were found to be statistically significant. The cross-tabulations are 

provided in Appendices X – HH, with a separate appendix for each major subgroup category. 

Regression Analysis. We used regression analysis as an additional exploratory tool to help 

understand the associations between various client, ADRC, and community characteristics and our 

outcomes of interest after controlling for factors that might influence the outcomes. As mentioned 

earlier, we originally intended to use AAA clients as a comparison group for impact estimation 

under the outcome study. However, the number of AAA respondents to the outcome study survey 

was too low (73 respondents) for them to be used as a comparison group in the regression analysis. 

31 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Since we did not have a viable comparison group, we were unable to conduct an impact estimation 

of ADRCs on respondent experience in order to make causal inferences or focus on the effect of a 

single policy variable such as the receipt of assistance from an ADRC. Therefore, our regression 

findings can only be considered as associations of certain client, ADRC, and community 

characteristics with the outcomes of interest. 

In this section, we first discuss the outcome variables studied in the regression analysis, then the 

covariates, and, finally, the specification of the regression model. 

Outcome variables. We conducted regression analysis on key outcomes of interest including: 

 Efficiency of ADRC staff in service provision 

 Reasons for respondent contact with ADRCs 

 Challenges faced by respondents in resolving their issues 

 Usefulness of ADRC services 

 Respondent satisfaction with ADRCs 

All the above outcomes of interest were coded as binary variables taking a value of 0 or 1 for the 

regression analysis. For example, if the outcome is whether the respondent was able to speak with 

an ADRC representative on his or her first contact with the ADRC, a value of 1 implied that the 

respondent was able to speak with an ADRC representative and a value of 0 implied that he or she 

was unable to speak with an ADRC representative. 

In our list of outcomes of interest, in addition to survey questions with binary response options 

such as “Yes” and “No,” we also had outcomes, such as respondent satisfaction, with ranked 

categories for response options. Some of the response categories for these outcomes had a small 

number of observations, necessitating the recoding of these categorical variables into binary 

variables. For example, the satisfaction-related outcomes had ordered response options such as 

“very satisfied,” “somewhat satisfied,” “somewhat dissatisfied,” and “very dissatisfied.” We 

recoded these categorical variables into binary variables so that “very satisfied” and “somewhat 

satisfied” constituted one category, “satisfied.” Similarly, we combined the response categories of 

“somewhat dissatisfied” and “very dissatisfied” into a single category, “dissatisfied.” With this 

recoding, the satisfaction variables took a value of 1 if the respondent was satisfied with the 

services or interaction that she or he had with the ADRC and a value of 0 if the respondent was 

not satisfied. 

Covariates. We used a variety of client, ADRC, and community characteristics as covariates in 

the regression. Appendix II provides the specifications and sources of data of the covariates 

32 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

included in the regression analysis. Note that all the demographic, health, and economic status 

variables were those of the client who needed LTSS and not of the respondent to the survey. The 

survey respondents are the individuals who contacted ADRCs for services; they may or may not 

have been the clients on whose behalf the ADRC contact was made. Age of the client is the only 

continuous variable at the client level. All the other client-level variables are indicator variables 

such as whether the client was married, lived alone, was more than 60 years old, or had a disability. 

We also included indicators for a White, non-Hispanic client and three education indicators 

capturing whether the client was a high school graduate, had education beyond high school, or had 

less than a high school education. Other client-level explanatory variables included indicators for 

income below $40,000 and self-reported health status at the time of the survey as “poor.” We also 

included variables to indicate whether the client was an older adult (with or without disability) or 

an individual with disability (irrespective of age). 

For some of the outcomes of interest, respondents’ reasons for contacting the ADRC were also 

included in the regression models. In addition, for outcomes measuring satisfaction, we controlled 

for respondent type, that is, whether the client him- or herself contacted the ADRC with a service 

request or someone else called on the client’s behalf. 

To understand whether respondent experience varied with ADRC characteristics, we included two 

variables. The first one was an indicator of whether more than 50 percent of the population in the 

service area of an ADRC resided in urban areas. The second one indicated whether the respondent 

sought assistance from a statewide ADRC or a local ADRC. 

In order to account for community characteristics, we included variables capturing the education, 

race, ethnicity, and poverty status of the population in the service areas of ADRCs. We also 

included the number of older adults and individuals with disabilities in the community, the two 

populations to which ADRCs cater. To capture community-level health infrastructure directly 

relevant for ADRC services, the number of home health agencies per 10,000 older adults (60 years 

and above) and the number of nursing home beds per 1,000 older adults (60 years and above) were 

also included in the regression models. 

Regression model specification. Since all the outcome variables were dichotomous, we used probit 

regression for estimation. All analyses were weighted using sample weights. Standard errors were 

clustered by ADRC to adjust for any correlation across individuals who contacted the same agency. 

33 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The regression coefficients reported are the average marginal effects of the covariates.6 A positive 

average marginal effect coefficient on a covariate means that the variable increases the likelihood 

of the outcome of interest taking a value of 1. The coefficients are reported in percentage points. 

The interpretation of a coefficient depends on whether the variable is continuous or dichotomous. 

For example, in the case of an outcome variable measuring respondent satisfaction, if a continuous 

variable such as age had a coefficient of –0.05 percentage points, it may be interpreted that a oneyear increase in age is associated with a 0.05 percentage point lower probability of respondents 

being satisfied, after controlling for the effect of all other covariates. In the case of a dichotomous 

variable such as the indicator for statewide ADRCs, a coefficient of 5 percentage points means 

that respondents contacting statewide ADRCs for assistance have a 5 percentage point higher 

probability of being satisfied compared to respondents contacting a local ADRC. 

In our discussion of findings from the regression analysis, we report only coefficients that were 

statistically significant at the 95 percent confidence level or higher (p ≤ .05). However, in the 

regression results tables presented in Appendix JJ, we also indicate those coefficients that are 

significant at the 90 percent confidence level (p ≤ .10).7 In addition, when describing the effects in 

the report, we focus on client and ADRC characteristics, though the coefficients on community 

characteristics are also included in the regression output in Appendix JJ. 

We estimated several model specifications—in terms of the covariates included in the regression— 

for each outcome, depending on the nature of the outcome. For example, in some regression 

specifications we included the reasons for contacting ADRCs as covariates, whereas in others we 

did not. However, in this report, we present findings only from the model specification that we 

considered to be the one that best accounted for the variation in the outcome of interest. 

Furthermore, we restricted our analysis to outcomes with sufficient variation.8 

Below is the specification of the probit regression model that we implemented: 

Probability (Yi = 1|ZADRC, X, C) = F (α + ȕZADRC + ȖX + βC + ui) 

The dependent variable in the above model (Y) is the probability of the outcome of interest 

occurring, for example, the client being satisfied with the direct services received. The control 

6 The marginal effect of a covariate is the change in the likelihood of the occurrence of the outcome of interest with 

respect to a small change in that covariate, holding all other covariates in the model at some fixed value. Instead of 

calculating the marginal effect of a covariate at some fixed value of all the other covariates, we calculated the marginal 

effect of the covariate at every observed value of all the covariates and then averaged those values to get the average 

marginal effect of that covariate. 

7 We use asterisks to indicate statistically significant results as *p ≤ .10, **p ≤ .05, or ***p ≤ .01. 8 Binary outcomes variables that had very few (less than 5 percent) 1s or 0s were not analyzed using regression models. 

34 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

variables in the above regression equation include ADRC (ZADRC), client (X) and community 

characteristics (C). The probit function follows a normal (cumulative) distribution. 

ZADRC includes variables that capture the characteristics of ADRCs, such as whether the ADRC is 

a statewide or local ADRC. Inclusion of ADRC characteristic variables help us understand their 

association with the different measures of respondent experience after controlling for client and 

community characteristics. For example, we can analyze the model below to focus on the 

association of the type of ADRC and the outcome of interest, Y. 

Probability (Yi = 1|ZADRC, X, C) = F (α + μRural ADRC + ȕZADRC + ȖX + βC + ui) 

The variable Rural ADRC takes a value of 1 if the ADRC serves a rural area. We show this variable 

separately from ZADRC only as an illustrative example. If Yi is a variable that represents, for 

example, whether difficulty reaching ADRC staff was a challenge in the way of issue resolution, 

this model shows how the service area of ADRCs being rural is associated with the likelihood of 

respondents’ facing difficulty in reaching ADRC staff, after controlling for other ADRC, as well 

as client and community, characteristics. 

Imputation of missing values. Several client characteristics had missing values. The number of 

observations with missing data ranged from one observation for the gender variable to 44 

observations for the income variable. To prevent the loss of observations due to missing data when 

implementing the regression analysis, we imputed the missing values. Since the number of 

observations was small and all the client characteristics were binary, we imputed these values 

based on the proportion of subgroups in the sample. For example, for the income variable, we 

coded all missing values as “income less than $40,000,” since over 85 percent of the clients who 

reported income in the dataset had income less than $40,000. For the education variable, we coded 

all missing values as “high school graduate,” since this was the most frequent education category. 

3.4 Core Integration Dimensions 

Using data from the process study, we developed three core measures to assess the range of 

services provided by ADRCs and their level of integration. The core measures capture the 

following three dimensions of ADRC operations: 

 Level of core service provision 

 Extent of site integration 

 Status of Medicaid integration 

35 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The core measures also contribute to a better understanding of the process and outcome study 

findings. Specifically, they were used in the process study to: 

 Describe the level of core service provision, the extent of site integration, and the status of 

Medicaid integration across local ADRCs 

 Determine if the level of integration was associated with other organizational 

characteristics (e.g., differences between urban and rural service areas) 

 Assess whether key outcomes of interest varied across categories (e.g., by site integration) 

In the outcome study, the core measures were used to: 

 Assess whether key outcomes of interest varied across categories (e.g., differences in the 

challenges faced when receiving services by level of site integration) 

 Assess whether client satisfaction with ADRC services varied by the level of core service 

provision, extent of site integration, or status of Medicaid integration 

3.4.1 Level of Core Service Provision 

The level of core service provision is intended to assess the provision of core services by ADRCs. 

To construct this measure, we counted the number of core services: information and referral (I&R); 

options counseling; eligibility determination, referral, and enrollment; and care transitions. We 

then grouped the ADRCs into three categories according to the comprehensiveness of those 

services. 

ADRCs that provided I&R and either options counseling or eligibility determination, referral, and 

enrollment, but not both, were categorized as low core service providers. Those that offered I&R 

plus both options counseling and eligibility determination, referral, and enrollment were 

categorized as medium core service providers. ADRCs that provided all four services were 

categorized as high core service providers. This grouping allowed us to distinguish ADRCs that 

were providing relatively basic levels of service from those that were offering more comprehensive 

services. 

Information and referral. The process study survey did not include questions that directly collected 

data on whether ADRCs offered I&R or information and assistance (I&A). However, since all 

consumers contact an agency to request some type of information or referral, for the purpose of 

generating the measure of core service provision, we assumed that all ADRCs offer I&R/I&A. 

36 
Options counseling. To construct this measure, we counted the number of “Yes” responses to the 

local-level process study survey Question 33 regarding the provision of options counseling, “Does 

your organization/network provide ‘Options Counseling’?” (See Appendix C for full item.) 

Eligibility determination. Similarly, there was no direct question regarding whether or not an 

ADRC provided eligibility determination services. As a result, we inferred from the eligibility 

determination questions (i.e., Questions 48, 51, 52, and 54; see Appendix C). An ADRC was 

categorized as providing the service if it met any one of the following criteria: 

 Responded “Yes” to Question 48 about administering a screening questionnaire 

 Did not select the response “We do not assist clients with financial eligibility applications” 

for Question 51 

 Did not select the response “We do not assist clients with financial eligibility applications” 

for Question 52 

 Responded “Yes” or “No, but in development” to Question 54 about using a universal, 

comprehensive instrument to determine eligibility 

Care transition services. ADRCs that responded “Yes” to whether or not the organization provided 

transition services were considered as providing transition services to consumers discharged from 

an acute care setting (i.e., Question 24, see Appendix C). 

Degree of Missing Data. ADRCs were categorized as having a low, medium, or high level of core 

service provision only if they answered all applicable questions on all the core services. 

Exhibit 3.6 displays the number of core services on which ADRCs had missing information. The 

level of core service provision measure was generated only for the 436 local ADRCs that had 

information on all four core services. 

37 

Exhibit 3.6: Number of Core Services for Which ADRCs Had Missing Information

Number of Services with Missing Information Number of ADRCs

0 436 

1 19 

2 17 

3 0 

Note: Twenty-six ADRCs had missing information on the options counseling items; 27 had missing 

information on the eligibility determination items.
 

 

 

 

 

 

 

 

 

 

 

Distribution of ADRCs by Level of Core Service Provision. Exhibit 3.7 presents the level of 

core service provision of local ADRCs. One-third of local ADRCs met the requirements to be 

considered a high core service provider. While almost half of the local ADRCs provided a medium 

level of core services, one-fifth of ADRCs provided only a low level of core services. 

3.4.2 Extent of Site Integration 

The measure of site integration was developed to capture the level of comprehensiveness of the 

services and supports offered by a local-level ADRC, as well as the operational processes and 

number of partnerships within and across agencies that facilitate these services. 

Six domains with multiple sub-measures within each domain were scored and aggregated into an 

overall measure of site integration. Local ADRCs were categorized into low, medium, or high 

categories according to the extent of their site integration. 

Domains. Following are the six domains that comprise the site integration measure, with 

respective measurable elements and an explanation of scoring. 

1.	 Populations served assessed the range of older adults, persons with a disability, and 

specific populations, such as those with limited English proficiency, served by the 

ADRC. We counted the consumers in each category listed below based on responses to 

38 
 

 

 

 

 

 

 

 

 

Questions 14a and 14b (i.e., the number of consumers of each type served; see Appendix 

C). 

 Over age 60 

 Under age 60 

 Physical disability 

 Mental disability 

 Intellectual/developmental disability 

 Paid and unpaid caregivers 

 Health and human services professionals 

 Traumatic brain injury 

 Emergency cases 

 Low income 

 Limited English proficiency 

An ADRC received one point for the domain if the ADRC answered question 14a but not 

question 14b. If the ADRC provided any information for question 14b, it received one point; 

if the ADRC served four or fewer types of consumers, including at least one disability group, 

it scored one point; if the ADRC served more than four types of consumers, it scored two 

points. 

2.	 Eligibility determination evaluated the comprehensiveness of the assistance provided by 

ADRCs for financial and functional eligibility determination. 

 Assist with Medicaid and other public LTSS financial eligibility determination 

applications 

 Assist with other public LTSS financial eligibility determination applications 

 Conduct screening eligibility for diverse populations 

 Assist with functional assessment (level of care) for LTSS 

 Conduct functional assessment for diverse populations 

An ADRC received one point if it provided at least one of the following: (a) assist with 

Medicaid and other public LTSS financial eligibility determination applications, (b) assist with 

other public LTSS financial eligibility determination applications, or (c) assist with functional 

assessment (level of care) for LTSS. If an ADRC provided three or more of the above financial 

39 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

and functional eligibility determination services, it received two points. An ADRC was 

excluded from scoring for this domain if it did not answer any one of questions 49a, 51, 52, 

54, and 55d (see Appendix C). 

If an ADRC gave an affirmative answer to response categories 3, 4, 5, 6, or 7 for Question 51, 

we counted it as offering assistance to consumers with their Medicaid LTSS financial 

eligibility determination application. Similarly, based on the response to Question 52, we 

determined whether an ADRC assisted consumers with financial eligibility applications for 

publicly funded LTSS other than Medicaid. If an ADRC administered the eligibility screening 

instrument to consumers aged 65 and older and at least one type of consumer with disability, 

under Question 49a, it was considered as offering eligibility determination services to diverse 

populations. If an ADRC responded “Yes” or “No, but in development” to Question 54, we 

assumed that it assisted with functional assessment for LTSS. Finally, if an ADRC used 

functional assessment for consumers aged 65 and older and consumers with at least one type 

of disability (Question 55d), it was considered as offering functional assessment services to 

diverse populations. 

3.	 Options counseling assessed whether the ADRC provided options counseling to clients 

and the setting(s) where options counseling took place. 

 Options counseling provided 

 Options counseling provided under multiple settings 

Those ADRCs that respond “Yes” to Question 33 regarding the provision of options counseling 

(see Appendix C) were considered as providing options counseling to consumers and received 

one point. ADRCs received a second point if they provided options counseling to clients in 

two or more settings such as the ADRC, a hospital, or residences, per Question 35c (see 

Appendix C). An ADRC was excluded from scoring in this domain if it did not answer 

Question 33. 

4.	 Person-centered transition support measured whether or not the ADRC provided 

transition support from acute care settings and to which population and health insurance 

types. 

 Care transition services provided from acute care setting 

 Care transition services to all ages 

 Care transition services to all insurance types 

40 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Those ADRCs that responded “Yes” to Question 24 regarding the provision of transition services 

(see Appendix C) were considered as providing transition services to consumers discharged from 

an acute care setting and received one point. They got a second point if they offered care transition 

services to all ages per Question 27 or all health insurance types per Question 28 (see Appendix 

C). An ADRC was excluded from scoring in this domain if it did not answer Question 24. 

5.	 Integrated processes assessed the integrated processes in place at the ADRC for the 

coordination of assistance within and across agencies such as data sharing and “warm 

transfers.9

” 

 Shared consumer needs assessment tool common across partners 

 Standardized tool/process for options counseling 

 Comprehensive database/management of information systems (MIS) 

 Staff follow Alliance of Information and Referral Systems (AIRS) standards 

 Data sharing with operational partners 

 Data sharing with service providers 

 Follow up with consumers 

 Follow up with providers 

 Warm transfers 

If an ADRC had between one and four of the above processes, the ADRC received one point. 

Those ADRCs that reported five or more of the processes received two points. An ADRC was 

excluded from scoring for this domain if the respondent did not answer any one of Questions 32, 

36, 39, 40, 41, 42, 42a, 43, and 44 (see Appendix C). 

An ADRC whose representative reported that the ADRC shared common consumer needs 

assessment tools across all or some partners (Question 32) was considered as sharing common 

consumer needs. Whether or not an ADRC had a standardized tool /process for options counseling 

was assessed based on its response to Question 36, and a “Yes” response to Question 39 

determined whether an ADRC’s staff followed AIRS standards. The database/MIS of an ADRC 

was counted as comprehensive if the ADRC selected at least three of the response options for 

Question 40 that queried whether or not the ADRC had a database for specific tracking purposes. 

ADRCs answering “Yes” or “No with plans to develop capacity” to Questions 41 and 42 were 

considered as having the capacity for data sharing with operational partners and service providers, 

9 A warm transfer is a simultaneous transfer of a telephone call and its associated data from one agent to another agent 

or supervisor. 

41 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

respectively. ADRCs answering “Always” or “Sometimes” to Questions 42a and 43 were 

considered to follow up with consumers after their initial contact with the ADRC and with 

providers after consumers are referred to them, respectively. Finally, response to Question 44 told 

whether an ADRC provided warm transfers to consumers referred to other organizations. 

6.	 Partnerships explored whether or not the ADRC had developed strong partnerships with 

organizations representative of aging, disability, and mental health service networks. 

 Strong partnerships with organizations representing the aging population 

 Strong partnerships with organizations representing individuals with disabilities 

 Strong partnerships with government agencies at the federal, state, and local levels 

 Strong partnerships with organizations providing direct services, such as 211 call 

centers and community health clinics 

A partnership was considered strong if the ADRC representative chose the response option “highly 

functional” to Question 63 (see Appendix C). ADRCs that indicated at least one strong partnership 

among the above types received one point. ADRCs mentioning strong partnerships with both 

organizations representing older adults and organizations representing persons with disabilities, as 

well as strong relationships with at least one of the remaining two partnership types, received two 

points. To be considered as having a strong partnership with government agencies, an ADRC had 

to have strong partnerships with at least two levels of government agencies (i.e., federal and state, 

federal and local, or state and local). To be considered as having a strong partnership with 

organizations providing direct services, an ADRC had to have a strong partnership with at least 

two organizations. An ADRC was excluded from scoring for this domain if it did not answer 

Question 63. 

Scoring Mechanism. The measure of site integration was scored on a 12-point scale. An ADRC 

could score up to two points on each of the six domains. We aggregated the scores received under 

each domain to arrive at the total score. It should be noted that all six domains were weighted 

equally, because they are considered of equal importance in offering integrated services. ADRCs 

were categorized into the following groups based on their total number of points: 

 High level of site integration: 10 – 12 points 

 Medium level of site integration: 6 – 9 points 

 Low level of site integration: 0 – 5 points 

42 
 

 

 

Degree of Missing Data. Only ADRCs with scores on all six domains were categorized into the 

low, medium, or high categories of the extent of site integration. As seen in Exhibit 3.8, Domain 

1, Populations Served, was the domain with the largest number of ADRCs without domain scores. 

43 
 

 

 

 

 

In Exhibit 3.9, we present the number of site integration domains for which ADRCs did not have 

scores. The exhibit shows that 377 local ADRCs had scores on all six domains of site integration 

and could be categorized on their extent of site integration. 

Distribution of ADRCs by the Extent of Site Integration. Exhibit 3.10 indicates that more than 

three-quarters of local ADRCs were moderately integrated, whereas around 13 percent had a low 

level of site integration. Only 9 percent of the local ADRCs were found to have a high extent of 

site integration. 

44 

Exhibit 3.2: Number of ADRCs without Scores on the Site Integration Domains

Domain Number of ADRCs without Scores on the 

Domain 

1 – Populations Served 64 

2 – Eligibility Determination 28 

3 – Options Counseling 26 

4 – Person-Centered Transition Support 0 

5 – Integrated Processes 14 

6 – Partnerships 43 

Exhibit 3.3: Number of Site Integration Domains for Which ADRCs Had No Score 

Number of Domains without Score Number of ADRCs

0 377 

1 60 

2 14 
 

 

 

 

 

3.4.3 Status of Medicaid Integration 

Local ADRCs receiving funding during fiscal year 2013 from any of the following six Medicaidrelated sources were considered to be Medicaid integrated: 

 CMS Real Choice Systems Change Grants 

 CMS Person-Centered Hospital Discharge Planning Grant 

 Money Follows the Person Demonstration 

 Program of All-Inclusive Care for the Elderly (PACE) 

 Medicaid for Direct Services (state and federal) 

 Medicaid for Federal Financial Participation 

Degree of Missing Data. For the purpose of this analysis, if a local ADRC did not report a positive 

amount of funding from at least one of the above Medicaid funding sources, it was assumed that 

the ADRC was not Medicaid integrated. Based on this definition of Medicaid integration, we were 

able to identify the Medicaid integration status of all 472 local ADRCs that participated in the 

process study. 

Distribution of ADRCs by Status of Medicaid Integration. Exhibit 3.11 shows that 40 percent 

of local ADRCs were Medicaid integrated. 

45 
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CHAPTER 4. PROCESS STUDY FINDINGS AND IMPLICATIONS
 

In this chapter, we present the results of the process study. Section 4.1 describes the key research 

questions. Section 4.2 presents key process study findings by research domain. It also explores the 

differences among ADRCs across the three dimensions of service provision, site integration, and 

Medicaid integration. Lastly, Section 4.3 presents conclusions and implications based on the 

process study findings. 

4.1 Process Study Purpose, Research Questions, and Research Domains 

4.1.1 Purpose 

The main goals of the process study were to: 

 Explore the motivations of state and local ADRCs for seeking ADRC grants and the effect 

of the grants on local sites’ performance 

 Understand contextual factors (e.g., level of community service capacity) identified from 

a local perspective 

 Learn about the operational characteristics of ADRCs from state and local perspectives 

 Capture aspects of LTSS service delivery that influence participant experience that may 

not be captured in the outcome study 

 Collect and analyze information that will guide improvements of the ADRC program 

4.1.2 Research Questions 

To achieve the above goals, the process study specifically explored the following key research 

questions: 

 What motivated states and local sites to seek ADRC funding? 

 What effects did ADRC funding have on the resources, services, and outcomes of local 

ADRCs? 

 Are there community characteristics or programs that support, facilitate, or create barriers 

to ADRCs? 

 What types of consumers contact ADRCs for services? 

 What types of services do ADRCs provide? 

 What are the organizational structure and operational processes of ADRCs? 

47 
 

 

 

 

 

 

 

 

 

 What types of resources and staffing do ADRCs have? 

 Is there a uniform eligibility determination process, or are there standard operating 

procedures, for ADRCs? 

 To what extent do ADRCs use data for decision-making? 

 How do state and local agencies collaborate to provide access to LTSS at ADRC sites? Are 

there interagency agreements or other collaborative efforts in place? 

4.1.3 Research Domains 

This report groups the above research questions into the following five domains, each of which 

will form a section in the process study findings part of this report below: 

 Motivation and objectives 

 Funding 

 Community and consumer information 

 Organizational information 

 Partnerships 

4.2 Process Study Findings 

4.2.1 Motivation and Objectives 

State ADRCs’ Reasons for Becoming an ADRC. When asked to indicate their goals when first 

applying for an ADRC grant, more than 90 percent of state ADRC respondents cited that they 

intended to better integrate the delivery of LTSS for older adults and persons with disabilities and 

to develop or strengthen agency/organizational partnerships (see Exhibit 4.1). Nearly 63 percent 

cited that they aimed to expand services to additional populations. Approximately three-quarters 

of state ADRCs selected improving data or information technology (IT) infrastructure and 

improving LTSS marketing/awareness efforts as goals. 

48 
 

 

 

 

 

Notes: Response rate was 100%. Percentages do not add up to 100 because ADRC respondents could choose 

multiple options. 

Criteria for Selecting Local Sites for ADRC Funding. State ADRCs indicated the criteria they 

followed in selecting local sites initially for ADRC funding. We see, from Exhibit 4.2, that the 

most common criterion established by state ADRCs was whether the organization already operated 

as an AAA (69%). More than one-third of state ADRCs considered whether the organization was 

currently serving the aging community (35%) or the disability community (35%) when selecting 

local ADRCs for funding. 

49 
 

 

 

 

 

Notes: Response rate was 100%. Percentages do not add up to 100 because ADRC respondents could choose 

multiple options. 

Local ADRCs’ Reasons for Becoming an ADRC. As shown in Exhibit 4.3, descriptive statistics 

indicate that the most frequently selected reason chosen by local ADRC respondents for becoming 

an ADRC was to better integrate the delivery of LTSS for the aging and disability populations. 

Chosen nearly as frequently was the opportunity to develop or strengthen agency /organizational 

partnerships. While state ADRCs could choose multiple response options, local ADRCs could 

choose only one. Therefore, the two sets of findings are not directly comparable. 

50 
 

 

 

 

 

 

 

 

Note: Response rate was 93%. 

The subgroup analyses failed to reveal a statistically significant difference between rural and urban 

local ADRCs among any of the options for becoming an ADRC. In contrast, we did find 

statistically significant differences by organizational structure (p ≤ .01). As presented in Exhibit 

4.4, compared to independent non-profit local ADRCs, government-operated local ADRCs were 

more likely to report that their primary reason for becoming an ADRC was to better integrate 

service provision systems (44% and 27%, respectively). However, independent non-profit 

ADRCs, compared to government local ADRCs, were more likely to report that they became an 

ADRC to develop or strengthen agency/organizational partnerships (42% and 24%, respectively). 

See Appendix M, Exhibit 1 for more detail. 

51 
 

 

 

 

 

 

We also found statistically significant differences by operational structure (p ≤ .01). Centralized 

local ADRCs (31%), compared to decentralized (11%) and mixed (19%) sites, were more likely 

to indicate that their primary reason for becoming an ADRC was to expand services to additional 

populations (see Exhibit 4.5). Decentralized sites (61%), compared to centralized (16%) and mixed 

sites (28%), were more likely to report that they became an ADRC to develop or strengthen 

partnerships. Mixed sites (44%) were more likely than centralized (27%) and decentralized (17%) 

local ADRCs to indicate that they became an ADRC to better integrate service provision systems 

(See Appendix N, Exhibit 1 for more detail). 

52 
 

 

 

 

 

 

 

 

The most common reason for becoming an ADRC was similar for varying sizes of local ADRCs 

and did not demonstrate statistically significant differences. Large, medium, and small local 

ADRCs similarly indicated that their primary reason for becoming an ADRC was to better 

integrate service provision systems. 

Diversion as an Outcome Sought. Respondents from most local ADRCs (91%) indicated that 

diversion from nursing homes or other institutional residential facilities was an outcome that their 

agency sought to achieve. Subgroup analyses failed to show statistically significant differences 

between rural and urban or government and non-governmental agencies on this item. However, 

statistically significant group differences were found based on operational structure and size. As 

presented in Exhibit 4.6, respondents from decentralized and mixed (96%) local ADRCs were 

more likely than those from centralized (82%) local ADRCs to report diversion from institutional 

residential facilities as a desirable outcome (p ≤ .01). 

53 
 

Similarly, large (97%) and medium (95%) ADRCs were more likely than small ADRCs (86%) to 

indicate that diversion was desirable (p ≤ .01) (Exhibit 4.7). (See Appendix N, Exhibit 2, and 

Appendix O, Exhibit 1, for more detail). 

54 
 

 

 

 

 

 

 

 

 

 

4.2.2 Funding 

Sources of Funding 

The local ADRC survey included questions regarding funding sources in fiscal year 2013 as well 

as in prior fiscal years.10 As seen in Exhibit 4.8, local ADRCs reported an average of 3.8 funding 

sources in the prior fiscal years and 4.4 funding sources in fiscal year 2013, with the most common 

funding source being state units on aging in prior fiscal years and in 2013 (see Exhibit 4.9). As 

shown, local ADRCs indicated the same top five sources of funding in prior fiscal years and in 

fiscal year 2013. It is noteworthy that the percentage of local ADRCs receiving funding from 

“other” sources (e.g., Older Americans Act Title III-B, state health funds, and state transportation 

departments) and state general revenue increased in fiscal year 2013 compared to prior fiscal years 

(28% to 34% and 25% to 28%, respectively). 

10 Local and state ADRCs were asked to provide their fiscal year 2013 budget as well as the amount of funding received 

from various sources. Due to high levels of non-response and lack of certainty about the accuracy of the figures (which 

included wide variations and several improbable values), we do not discuss the budget and funding amounts in this 

report. See Appendix F, Question 58, for the local figures and Appendix H, Question 9, for the state figures. 

55 

Exhibit 4.8: Number of Funding Sources for Local ADRCs

Mean Median Mode Range 

Min Max 

Prior years’ funding sources* 3.80 3 1 1 27 

Current (FY13) funding sources** 4.37 4 1 1 18 

*Response rate is uncertain since “not checked” may indicate no response or no prior funding.

**Response rate was 76%.
 

 

 

 

 

 

 

*Percentages do not add up to 100 because ADRC respondents could choose multiple options. 

The state ADRC survey also included questions regarding the sources of funding in both prior 

fiscal years and in fiscal year 2013. Interestingly, state ADRCs relied more heavily on federal 

funds than local ADRCs (see Exhibit 4.10). 

Note that while 54 percent of state ADRCs reported receiving Medicare Improvements for Patients 

and Providers Act (MIPPA) funds prior to fiscal year 2013, only 8 percent reported receiving 

MIPPA funds in fiscal year 2013. Furthermore, “other” sources (e.g., CMS State Health Insurance 

Assistance Program, Older Americans Act Title III-B, and local grants) ranked in the top five most 

common sources in fiscal year 2013 but not in prior years. 

56 
 

 

 

 

 

 

 

 

 

Percentages do not add up to 100 because ADRC respondents could choose multiple options. 

Impact of ADRC Funding 

Impact on Services. Almost all of the local ADRCs (95%) reported that their organization realized 

an improvement in the ability to provide integrated, comprehensive access to LTSS since the start 

of the ADRC grant. For more details on this finding, see Appendix F, Question 1. State ADRCs 

indicated, on a scale from 1 to 5, with 1 being “poor” and 5 being “excellent,” how they rated their 

state’s progress on improving access to services since receiving federal funding for the 

development of ADRCs. Exhibit 4.11 presents the average score on each of four services listed. 

As shown, all services were reported showing greater than average improvement, with 

information, referral, and information showing nearly excellent improvement, on average. 

Appendix H, Question 1, presents these findings in more detail. 

57 
 

 

 

 

 

 

Note: Response rate was 98%. 

Impact on Outcomes. As presented in the following exhibit (see Exhibit 4.12), the most 

frequently selected option among both state and local ADRC respondents for the ways in which 

ADRC grants impacted operational outcomes was enabling them to increase their number of 

partnerships (approximately 82% and 53%, respectively). The second most frequently selected 

option among both state and local ADRC respondents was the ability to increase the skills of 

existing staff (79% and 49%, respectively). 

58 
 

 

 

 

 

 

 

 

Notes: Response rate for local survey was 99%; response rate for state survey was 100%. Percentages do not add up 

to 100 because ADRC respondents could choose multiple options. 

Subgroup analyses indicated statistically significant differences on the following outcomes: 

 Increase or expand populations served 

 Increase the number of consumers served 

 Increase the number of partnerships 

We found statistically significant differences among small, medium, and large local ADRCs on 

the option that the grant enabled them to increase and/or expand populations served (p ≤ .05). As 

shown in Exhibit 4.13, medium and large local ADRCs were significantly more likely than small 

sites to indicate that federal grants enabled them to increase and/or expand populations served. See 

Appendix O, Exhibit 2, for more detail. 

59 
 

 

 

 

 

 

 

 

 

As presented in Exhibit 4.14, the subgroup analyses also indicated statistically significant 

differences among centralized, decentralized, and mixed local ADRC respondents on their 

response to the option that funding helped to increase the number of consumers served (p ≤ .01). 

A quarter of the centralized local ADRCs, compared to approximately one-tenth each of 

decentralized and mixed sites, indicated that grants had very little impact on their ability to increase 

the number of consumers served. See Appendix N, Exhibit 3, for more detail. Further, as illustrated 

in Exhibit 4.15, there were statistically significant differences among small, medium, and large 

local ADRC representatives on their response to the option that federal grants enabled them to 

increase the number of consumers served (p ≤ .05). Nearly 33 percent of small, 46 percent of 

medium, and 51 percent of large local ADRCs indicated that grants enabled them to increase the 

number of consumers served. In contrast, 18 percent of small, 11 percent of medium, and 63 

percent of large sites reported that federal grants did very little to increase the number of consumers 

served. See Appendix O, Exhibit 3, for more detail. 

60 
61 
 

 

 

 

 

 

 

 

 

Lastly, as shown in Exhibit 4.16, there was a trend toward significance in differences among 

ADRCs of different sizes in the impact that federal grants had on the number of partnerships. Small 

(compared to medium and large) local ADRCs were more likely to report that federal grants had 

little impact on their number of partnerships (p ≤ .10). See Appendix O, Exhibit 4, for more detail. 

Impact on Resources. Descriptive analyses were conducted to assess how ADRC grants affected 

resources or resource allocation at the local level. As shown in Exhibit 4.17, representatives of 

local and state ADRCs selected responses in the same order. The most common response was that 

ADRC grants allowed local sites to increase the level of coordination between organizations 

serving older individuals and individuals with disabilities (81% of local ADRCs and 85% of state 

ADRCs). 

When asked to provide additional thoughts about local ADRC resources, local-level respondents 

mentioned two challenges: limited funding and staffing reductions (due to funding cuts). 

Respondents pointed out that the same forces leading to funding and staffing cuts (e.g., the 

economic climate) were also increasing demand for services, leaving remaining staff challenged 

to provide additional support. See Appendix G for details. 

62 
 

 

 

 

 

Notes: Response rate for local survey was 97%; response rate for state survey was 100%. Percentages do not add up 

to 100 because ADRCs could choose multiple options. 

The results showed statistically significant differences in effects among subgroups on improved 

staff training opportunities and contributing to the development of a statewide database of LTSS 

consumers. 

Exhibit 4.18 shows that decentralized local ADRCs (85%) were more likely than centralized (74%) 

and mixed (70%) local sites to report that ADRC grants improved staff training opportunities. This 

difference was statistically significant (p ≤ .05). See Appendix N, Exhibit 4, for more detail. 

63 
 

 

 

 

 

Rural (compared to urban), and large (compared to small and medium) local ADRCs were 

significantly more likely to indicate that ADRC grants had contributed to the development of a 

statewide database of LTSS services and/or consumers. Forty-three percent of rural local ADRCs, 

compared to 33 percent of urban local ADRCs, reported that ADRC grants contributed to the 

development of a statewide database of LTSS services and/or consumers (p ≤ .05, Exhibit 4.19). 

In addition, 39 percent of government local ADRCs, compared to 32 percent of independent sites, 

indicated that grants contributed to the development of a statewide database (p ≤ .10, Exhibit 4.20), 

as did 26 percent of small, 36 percent of medium, and 44 percent of large local ADRCs (p ≤ .05, 

Exhibit 4.21). See Appendix L, Exhibit 1; Appendix M, Exhibit 2; and Appendix O, Exhibit 5, 

respectively, for details. 

64 
65 
 

 

 

 

 

 

 

 

 

 

Impact on LTSS. Most local ADRC respondents reported positive impacts on LTSS and homeand community-based services (HCBS) in their communities since the organizations began serving 

consumers. As shown in Exhibit 4.22, of the 80 percent of local ADRC sites that responded to this 

question, 71 percent reported that there was an increase in the number of LTSS providers since the 

organization started serving consumers. Similarly, 73 percent of responding local ADRCs believed 

that there was an increase in the quality of LTSS services provided in the community since they 

started serving consumers. See Appendix F, Question 68. 

Note: Response rate was 79%. 

Impact on Consumers Served. Descriptive statistics presented in Exhibit 4.23 indicate that twothirds of ADRC respondents indicated that, since the initiation of the ADRC grant, there was an 

increase in consumers served, including the number of adults both over and under 60 years old and 

66 

Exhibit 4.22: Improvements in LTSS and HCBS Since Local ADRCs Started Serving 

Consumers 

Increase in the number of L TSS providers 335 70.97 

Increase in the quality of L TSS services 346 73.31 

Change Frequency Percentage 
 

 

 

 

 

 

 

 

 

 

 

 

the number of consumers with physical disabilities. Among the ADRC respondents, 50 percent 

reported that the number of consumers with mental and emotional disabilities also significantly 

increased. Very few ADRCs (less than 1 percent) showed a significant decrease in the number of 

consumers of the above types. 

Factors Contributing to Positive Outcomes 

Seventy-eight percent of local ADRC respondents stated that developed and/or expanded 

partnerships had the most positive impact on their ability to provide integrated, comprehensive 

access to LTSS. In open-ended responses, respondents reported that strengthening the 

effectiveness of their ADRC, despite the challenges, was possible through creating partnerships 

with state, healthcare, and service organizations. Respondents were asked to select up to two 

options that indicated the factors that had the most impact on their ability to provide LTSS. 

As presented in Exhibit 4.24, almost half (45%) counted their focus on providing person-centered, 

self-directed services as one of the two factors. In addition to the choice responses, some 

respondents noted additional factors that contributed to positive impact on their ability to provide 

integrated, comprehensive access to LTSS including increased staff education and training, 

additional marketing and outreach, increased awareness of LTSS options, infrastructure 

67 
 

 

 

 

 

 

 

 

improvements (e.g., telephone, IT), and enhanced ability to expand the service population 

(Appendix F, Question 2). 

Notes: Response rate was 95%. Percentages do not add up to 100 because ADRC respondents could choose up to 

two options. 

In subgroup analyses, we found statistically significant differences among the following factors: 

 Partnerships developed/expanded; 

 Focus on providing person-centered, self-directed services; 

 Staffing changes; and 

 Shared data. 

Exhibit 4.25 shows a statistically significant difference between urban and rural local ADRCs with 

81 percent of urban versus 71 percent of rural ADRCs indicating that partnerships have had the 

most positive impact on their organization’s ability to provide LTSS (p ≤ .05). As shown in Exhibit 

4.26, 82 percent of independent local ADRCs indicated that partnerships had the most positive 

impact on LTSS provision compared to 75 percent of government-operated local ADRCs (p ≤ .10). 

See Appendix L, Exhibit 2 and Appendix M, Exhibit 3, respectively, for details. 

68 
 

 

 

 

There were also statistically significant differences in the effect of partnerships based on 

operational structure and number of consumers served. Respondents from decentralized local 

ADRCs (89%) were more likely to report that partnerships had the most positive effect on their 

organization’s ability to provide integrated, comprehensive access to LTSS compared to mixed 

69 
 

 

 

 

 

(77%) and centralized (72%) local ADRC respondents (p ≤ .05, Exhibit 4.27). Additionally, large 

local ADRCs (86%) were more likely than medium (77%) and small (71%) sites to report that 

partnerships had the most positive impact on their organization’s ability to provide LTSS (p ≤ .05, 

Exhibit 4.28). For detailed results, see Appendix N, Exhibit 5, and Appendix O, Exhibit 6, 

respectively. 

70 
 

 

 

 

 

 

 

Decentralized local ADRCs (64%), compared to centralized (44%) and mixed (40%) local sites, 

were significantly more likely to report that their focus on providing person-centered, self-directed 

services had the most positive impact on their organization’s ability to provide integrated, 

comprehensive access to LTSS (p ≤ .01, Exhibit 4.29). See Appendix N, Exhibit 6, for detailed 

results. There were no statistically significant differences by geographic location of site, 

organizational type, or size of site. 

Government-operated local ADRCs (28%) were significantly more likely than independently 

operated sites (18%) to report that staffing changes had the most positive impact on their 

organization’s ability to provide integrated, comprehensive access to LTSS (p ≤ .05, Exhibit 4.30). 

See Appendix M, Exhibit 4, for detailed results. There were no statistically significant differences 

by geographic location, operational structure, or size of ADRC. 

71 
 

 

 

 

Lastly, as shown in Exhibit 4.31, rural local ADRCs (26%) were significantly more likely than 

urban sites (15%) to report that shared data had the most positive impact on their organization’s 

ability to provide integrated, comprehensive access to LTSS (p ≤ .01). See Appendix L, Exhibit 3, 

for detailed results. There were no statistically significant differences by organizational structure, 

operational structure, or size of site. 

72 
 

 

 

 

 

 

 

 

 

 

In an attempt to assess the degree of importance of specific factors in improving access to LTSS, 

state ADRC respondents were asked to rank, on a five-point scale where 1 = not important at all 

and 5 = very important, the degree of importance of specific factors in improving access to LTSS 

in their states (for details, see Appendix H, Question 2). Ninety-four percent of the respondents 

indicated that partnerships were important or very important in improving access to LTSS. 

Similarly, 79 percent and 65 percent of the respondents, respectively, rated staffing and shared 

data systems as important or very important in improving access to LTSS. 

4.2.3 Community and Consumer Information 

Community Characteristics 

LTSS Needs Assessment. Exhibit 4.32 shows that approximately 33 percent of local ADRCs 

reported that they had assessed the LTSS needs of their communities within the last 12 months. In 

contrast, only one-fourth of the state ADRCs reported that they had assessed the LTSS needs of 

all of their communities within the last 12 months. One-third of the local ADRCs and almost half 

of the state ADRCs indicated that no LTSS needs assessment had been done in their coverage 

areas in the past three years. 

73 
 

 

 

 

 

Subgroup analyses indicated that nearly 35 percent of urban local ADRCs had not conducted a 

needs assessment in the past three years, while only 26 percent of rural ADRCs had not done so 

(p ≤ .05, Exhibit 4.33). See Appendix L, Exhibit 4, for detailed results. 

There were also statistically significant differences based on the size of the site. As presented in 

Exhibit 4.34, most small sites (42%), compared to medium (29%) and large sites (29%), indicated 

that they had not conducted a needs assessment within the last three years (p ≤ .01). See Appendix 

O, Exhibit 7, for detailed results. 

74 
 

 

 

 

 

 

LTSS Availability in the Community. Local and state ADRC participant responses on the top 

five LTSS services’ current availability are presented in Exhibit 4.35. See Appendix F, Question 

13, and Appendix H, Question 8a, for more information on LTSS service availability at the local 

and state levels. Local ADRC respondents reported ombudsman services as being adequately 

available most often (70%), while 54 percent of state ADRC respondents selected this option, so 

that it ranks third. The second LTSS that was reported by both local and state ADRC respondents 

is nursing home services (77% and 60%, respectively). 

75 

Service Adequate Availability

Frequency Percentage*

Local ADRCs

Ombudsman services 329 69.70 

Opportunities to develop advance 

directives 293 62.08 

Nursing home/residential beds 283 59.96 

Exhibit 4.35: Services Most Frequently Reported as Adequate to Meet Consumer Need at 

Local and State Levels 
In Exhibit 4.36, we show the top five services reported as being inadequately available at the local 

and state levels. It is noteworthy that three services (i.e., transportation, housing, and mental health 

services) were reported by both local and state ADRC respondents. 

76 

Service Adequate Availability

Frequency Percentage*

Education services 242 51.27 

Nutrition programs 237 50.21 

State ADRCs

Nursing home services 37 77.08 

Assisted living services 28 58.33 

Ombudsman services 26 54.17 

Socialization/recreation programs 23 47.92 

Peer support services/groups 22 45.83 

Note: Percentages do not add up to 100 because ADRC respondents could choose 

multiple options.

Exhibit 4.36: Most Inadequately Available LTSS Services at Local and State Levels

Service Inadequate Availability*

Frequency Percentage

Local ADRCs

Transportation services 414 87.71 

Safe and affordable housing options 396 83.90 

Income assistance 380 80.51 

Mental health services 375 79.45 

Energy assistance 348 73.73 

State ADRCs

Safe and affordable housing options 45 93.75 

Transportation services 43 85.98 

Hospital transition programs 41 85.42 

Mental/behavioral health services 41 85.42 

Shared living programs 37 77.08 

*Inadequate availability includes response options “Not available” and “Available but 

inadequate to meet the need.”

Note: Percentages do not add up to 100 because ADRC respondents could choose multiple 

options.
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

There were a few additional notable services that were reported in the open-ended response as 

being inadequately available. Some examples include affordable integrated housing, adult day 

care, homemaking services for clients younger than 60 years old, dental services, weekend 

emergency assistance for the elderly, services for the mentally ill, VA services, and job coaching. 

See Appendix G, Question 13b, for more information. 

There were statistically significant differences between rural and urban local ADRCs on 

transportation and mental health services being inadequately available. A higher proportion of 

rural ADRCs considered transportation services as inadequate (p ≤ .01), whereas a higher 

proportion of urban ADRCs considered mental health services as inadequate (p ≤ .05). See 

Appendix L, Exhibits 5 and 6, for details. 

Barriers to LTSS. Exhibit 4.37 presents the five most common prior and current barriers to 

receiving LTSS reported by local ADRC representatives. No changes were reported in the five 

most common barriers between the period prior to receiving the ADRC grant and the current 

period. Lack of transportation continued to be the most common barrier to consumers seeking 

LTSS services from ADRCs, with 92 percent of local ADRC representatives reporting 

transportation as a barrier in the prior and current periods. More details on the results of the 

analyses of barriers to receiving LTSS are provided in Appendix F, Question 13. In subgroup 

analyses, there was a trend toward statistically significant differences between rural and urban 

local ADRCs on barriers to LTSS. Rural ADRC respondents (25%) were more likely than urban 

ADRC respondents (22%) to report lack of health insurance as a current barrier to LTSS (p ≤ .10, 

Exhibit 4.38). See Appendix L, Exhibit 7, for detailed results. 

77 

Exhibit 4.37: Most Common Barriers to Seeking LTSS Currently and Prior to Receiving 

ADRC Grants: Local ADRCs

Prior Barriers* Freq. % Current Barriers* Freq. % 

Consumers lack transportation 435 92.16 Consumers lack 

transportation 432 91.53 

Lack of health insurance 397 84.11 Lack of health insurance 391 82.84 

Lack of LTSS-needed 

services 395 83.69 Lack of LTSS-needed services 375 79.45 

Lack of available LTSS slots 

(i.e., long waiting lists) 389 82.42 Lack of available LTSS slots (i.e., long waiting lists) 373 79.03 

Providers have high staff 

turnover 365 77.33 Providers have high staff turnover 367 77.75 

*Barrier includes response options “Sometimes a barrier” and “Often a barrier.”

Note: Percentages do not add up to 100 because ADRC respondents could choose multiple options.
 

 

 

 

 

 

 

Organizational structure also affected whether a local ADRC representative reported current 

barriers due to lack of health insurance. As shown in Exhibit 4.39, nearly 27 percent of 

government-operated local ADRC respondents, compared to 17 percent of non-government local 

ADRC respondents, reported that lack of health insurance was often a barrier for individuals 

seeking LTSS (p ≤ .01). See Appendix M, Exhibit 5, for details. Similarly, Exhibit 4.40 illustrates 

that centralized local ADRCs (36%), compared to mixed (23%) and decentralized (12%) sites, 

were more likely to indicate lack of health insurance as a current barrier to LTSS (p ≤ .01). See 

Appendix N, Exhibit 7, for details. 

78 
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In Exhibit 4.41, we explore the five most common prior and current barriers to receiving LTSS 

reported by state ADRCs (see Appendix H, Question 7, for more details). As reported, four of the 

five most common barriers were the same prior to receiving ADRC grants and in the current 

period. These barriers also are similar to the ones reported by local ADRCs. However, the fifth 

most common barrier to receiving LTSS in the prior period, “Providers lack appropriately trained 

staff” was replaced in the current period by “Limits on enrollment in state-only funded LTSS.” 

Seventy-nine percent of state ADRC representatives reported limits on enrollment in state-only 

funded LTSS as one of the most common barriers to seeking LTSS services currently. 

Provider Choice. Exhibit 4.42 shows the five most adequately available provider choices in the 

community as reported by local ADRCs in the years prior to receiving the ADRC grant and 

currently. More information on provider choice is available in Appendix F, Question 13. The only 

service that was reported as one of the top five adequately available provider choices in both the 

prior and current periods was opportunities to develop advance directives. 

Exhibit 4.43 shows the most common provider choices reported as inadequately available in the 

community by local ADRCs. There are not many changes in the list from the years prior to 

receiving ADRC grants to the current period. Transportation service continued to be the most 

commonly reported provider choice. However, transition programs, which were reported as 

inadequately available in the prior period, were not reported as commonly in the current period. 

Emergency services/crisis intervention was reported as inadequate in the current period but not 

prior to receiving the grant. 

80 

Exhibit 4.41: Most Common Barriers to Seeking LTSS Currently and Prior to Receiving 

ADRC Grants: State ADRCs

Prior Barriers* Freq. % Current Barriers* Freq. % 

Non-availability of needed 

services and supports 46 95.83 Consumers lack transportation 46 95.83 

Consumers lack 

transportation 46 95.83 Non-availability of needed services and supports 45 93.75 

Lack of health insurance 43 89.58 Lack of health insurance 42 87.50 

Providers have high staff 

turnover 42 87.50 Providers have high staff turnover 42 87.50 

Providers lack 

appropriately trained staff 42 87.50 Limits on enrollment in stateonly funded LTSS 38 79.17 

*Barrier includes response options “Sometimes a barrier” and “Often a barrier.”

Note: Percentages do not add up to 100 because ADRC respondents could choose multiple options.
 

 

 

 

 

 

In Exhibit 4.44, we explore the five most frequently reported areas with adequate provider choice 

at the state level (see Appendix H, Question 8b, for details). There is only one change in the list of 

five most commonly reported areas with adequate provider choice between the prior and current 

periods. Educational services were added in the current period, replacing socialization/recreation 

programs from the period prior to the ADRC award. 

81 

Exhibit 4.42: Most Common Adequately Available Provider Choices Currently and Prior 

to Receiving ADRC Grants: Local ADRCs

Prior Provider Choice Freq. % Current Provider Choice Freq. % 

Nursing home/residential beds 229 48.52 Opportunities to develop 

advance directives 266 56.36 

Ombudsman services 223 47.25 Nursing home/residential 

beds 259 54.87 

Nutrition programs 179 37.92 Ombudsman services 248 52.54 

Education services 177 37.50 Education services 206 43.64 

Opportunities to develop 

advance directives 170 36.02 Opportunities for socialization/recreation 196 41.53 

Note: Percentages do not add up to 100 because ADRC respondents could choose multiple options.

Exhibit 4.43: Most Common Inadequately Available Provider Choices Currently and Prior 

to Receiving ADRC Grants: Local ADRCs

Prior Provider Choice* Freq. % Current Provider Choice* Freq. % 

Transportation services 402 85.17 Transportation services 405 85.81 

Transition programs 

(from hospitals, nursing 

homes, etc.)

387 81.99 Income assistance 384 81.36 

Safe and affordable 

housing options 386 81.78 Safe and affordable housing options 373 79.03 

Mental health services 375 79.45 Mental health services 372 78.81 

Income assistance 372 78.81 Emergency services/crisis 

intervention 359 76.06 

*Inadequate availability includes response options “Not available” and “Available but inadequate to meet the 

need.” Note: Percentages do not add up to 100 because ADRC respondents could choose multiple options.
 

 

Exhibit 4.45 shows the top five inadequately available provider choices reported by state ADRC 

representatives in prior and current periods. Inadequate provider choice in transportation services 

continued to be the most commonly reported area of concern at the state level. 

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Nursing home services 30 62.50 Nursing home services 31 64.58 

Assisted living services 24 50.00 Assisted living services 28 58.33 

Ombudsman services 22 45.83 Education services 20 41.67 

Socialization/recreation 

programs 

20 41.67 Ombudsman services 20 41.67 

HCBS Medicaid waiver 

programs 

15 31.25 HCBS Medicaid waiver 

programs 

19 39.58 

Note: Percentages do not add up to 100 because ADRC respondents could choose multiple options.

Exhibit 4.44: Most Common Adequately Available Provider Choices Currently and Prior 

to Receiving ADRC Grants: State ADRCs

Prior Provider Choice Freq. % Current Provider Choice Freq. % 

Exhibit 4.45: Most Common Inadequately Available Provider Choices Currently and Prior 

to Receiving ADRC Grants: State ADRCs

Prior Provider Choice* Freq. % Current Provider Choice* Freq. % 

Transportation services 43 89.58 Transportation services 42 87.50 

Hospital transition programs 42 87.50 Mental/behavioral health 

services 39 81.25 

Safe and affordable housing 

options 41 85.42 Safe and affordable housing options 38 79.17 

Nursing home transition 40 83.33 Hospital transition programs 38 79.17 

Independent living 40 83.33 Shared living programs 37 77.08 

*Inadequate availability includes response options “Not available” and “Available but inadequate to meet the

need.”

Note: Percentages do not add up to 100 because ADRC respondents could choose multiple options.
 

 

 

 

 

 

 

 

 

Community Populations 

The local ADRC survey contained questions to collect data on the demographic composition of 

ADRC service areas in terms of race, ethnicity, poverty status, and insurance status. The complete 

tabulations of the demographic survey questions are available in Appendix F, Questions 7 – 10a. 

Racial and Ethnic Composition. Exhibit 4.46 illustrates the average racial composition of local 

ADRC service areas. It should be noted that there was a fairly high non-response rate on some of 

the items (i.e., 10 – 51% non-response) and that Exhibit 4.46 represents only those ADRCs for 

which there was a response to the item. As shown, on average, 79 percent of ADRC service areas 

were Caucasian/White, while 11 percent were Black/African American. Local ADRC respondents 

identified 18 cultural groups, such as Hmong, Middle Eastern, and Amish, as subpopulations (see 

Appendix G, Question 8, for details). Across all local ADRC service areas, an average of 9 percent 

of the population was of Latino/Hispanic ethnicity (see Exhibit 4.47). 

Note: Response rate for sub-categories varied between 49% and 90%. 

83 
 

 

 

 

 

 

 

 

 

 

Note: Response rate was 82%. 

Poverty Status. Fifty-nine percent of the local ADRC respondents responded to the poverty item; 

they reported that, on average, 17 percent of their population was living at or below the poverty 

line. A little over 31 percent indicated that they were not sure about the poverty status of their 

population but believed that a significant proportion of their population lived below the poverty 

line. Only 4 percent of local ADRCs reported that the population living below the poverty line in 

their service areas was small or negligible. 

Medical Insurance Status. The mean uninsured rate was reported to be 15 percent, although only 

25 percent of ADRC representatives responded to this item. Fifty percent of local ADRC 

respondents indicated that, while they were not sure of the exact percentage, they believed that a 

significant portion of the population did not have health insurance coverage. Nineteen percent of 

local ADRC respondents reported that the uninsured population in their service areas was 

negligible. 

We also explored the differences in the demographic composition of ADRC service areas by 

subgroups and did not find any statistically significant differences. 

Consumer Characteristics 

The local ADRC survey also contained questions about the characteristics of ADRC consumers, 

including demographics and most frequently requested services. 

84 
Consumer Demographics. Appendix F, Question 14, displays the number of older adults, persons 

with disabilities, caregivers, and other sub-populations served by local ADRCs during the six 

months preceding the survey (October 2012 to March 2013). They also present the minimum, 

maximum, mean, median, and mode of these categories. As the exhibits indicate, there is wide 

variation in the number of consumers served by ADRCs. Appendix F, Question 14, shows that 

local ADRCs served an average of 3,961 consumers aged 60 or older during the six-month period 

(median = 1,444, maximum = 58,388). 

Exhibit 4.48 shows the number of individuals with disabilities, both under 60 years of age and 60 

years and older, who were served by local ADRCs. The largest numbers of consumers in both age 

groups were adults with physical disabilities. The exhibit also provides caregiver types by 

consumer age group. As shown, informal/family caregivers were the largest group of caregivers 

served by local ADRCs. 

Appendix F, Question 14, presents the number of consumers who belonged to other disability 

groups, such as those with a traumatic brain injury, and those with limited English proficiency. 

Most Frequently Sought Services by Consumers. Items on the local ADRC questionnaire were 

designed to collect data on how frequently consumers inquired about certain types of services (see 

Appendix F, Question 20, for details). As shown in Exhibit 4.49, the most frequently requested 

service was transportation (82%). Medicaid and Medicare eligibility determination and services 

85 

Exhibit 4.48: Number of Consumers with Disabilities and Caregivers Served by Local 

ADRCs

Under 60 60 and over 

Consumers with Disabilities

Physical disabilities 59,071 204,709 

Cognitive impairment 6,904 26,387 

Intellectual disabilities 4,184 4,308 

Developmental disabilities 9,455 7,260 

Mental illness 12,447 14,253 

Multiple disabilities 37,566 78,143 

Caregivers

Informal/family caregiver 25,224 86,871 

Paid caregiver 3,589 14,111 

Health and human services professional 13,877 48,288 
 

 

 

 

 

 

 

 

 

 

 

 

 

were the second and third most frequently sought services at 79 percent and 74 percent, 

respectively. 

Interestingly, in multiple cases the most frequently sought services were also the ones that were 

most frequently cited by local ADRCs as being inadequately available in the communities they 

served. For example, transportation ranked first on services sought and services inadequately 

available. Affordable housing also appeared as a service sought and a service inadequately 

available. There were statistically significant differences between subgroups in the types of 

services that were most frequently sought by consumers, except in the case of transportation, which 

was frequently sought in all subgroups (responses ranged from 87% to 95%). 

Large local ADRCs (97%), compared to medium (89%) and small (77%) sites, were significantly 

more likely to report that consumers frequently asked about Medicaid eligibility and services (p ≤ 

.01, Exhibit 4.50). See Appendix O, Exhibit 8, for details. Further, geographic location, 

organizational structure, and operational structure of an ADRC were linked to frequency of 

consumer inquiry on Medicare eligibility and services. Exhibit 4.51 shows a trend toward 

statistical significance, with more rural than urban local ADRCs reporting that consumers 

frequently asked about Medicare eligibility and services (89% and 81%, respectively, p ≤ .10). 

Similarly, as illustrated in Exhibit 4.52, significantly more government than independent local 

86 
 

 

 

ADRCs reported that they had consumers who frequently asked about Medicare eligibility and 

services (87% and 78%, respectively; p ≤ .05), and more centralized (90%) local ADRCs, 

compared to decentralized (71%) and mixed (85%) sites, reported that consumers frequently asked 

about Medicare eligibility and services (p ≤ .01; see Exhibit 4.53). See Appendix L, Exhibit 8; 

Appendix M, Exhibit 6; and Appendix N, Exhibit 8, respectively, for details. 

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Additional analyses demonstrated a trend toward significance in that more urban (83%) than rural 

(72%) local ADRCs reported that consumers frequently asked about personal care and attendant 

care services (p ≤ .10, Exhibit 4.54). Larger ADRCs (82%) reported inquiries about affordable 

housing significantly more frequently than medium (77%) and small (71%) ADRCs (p ≤ .05; see 

Exhibit 4.55). For detailed results, see Appendix L, Exhibit 9, and Appendix O, Exhibit 9, 

respectively. Similarly, more decentralized local ADRCs (87%) than centralized (64%) and mixed 

(79%) ADRCs and more urban (85%) than rural (57%) local ADRCs reported that consumers were 

significantly more likely to ask about affordable housing options (p ≤ .05 and p ≤ .01, respectively; 

Exhibits 4.56 and 4.57). See Appendix N, Exhibit 9, and Appendix L, Exhibit 10, respectively, for 

details. 

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90 
91 
 

 

 

 

 

 

 

 

 

 

4.2.4 Organizational Information 

Services Provided by ADRCs 

Options Counseling. A majority of local ADRC respondents (76%) indicated that they provided 

options counseling or other one-on-one counseling designed to support consumers’ ability to make 

informed decisions about their long-term care. Additional detail about this finding can be found in 

Appendix F, Question 33. 

Nearly 77 percent of rural and 81 percent of urban local ADRCs provided options counseling, and 

79 percent of government and 81 percent of independent sites provided options counseling. 

However, as shown in Exhibit 4.58, there was a statistically significant difference between 

decentralized local ADRCs (93%) and centralized (78%) or mixed (77%) sites (p ≤ .01). Lastly, 

significant differences between rates of options counseling among small (83%), mid-size (81%), 

and large (80%) local ADRCs were not found. See Appendix N, Exhibit 10, for details. 

Findings from analyses on the number of clients by age, method, and setting who received options 

counseling during the same six-month period from October 2012 to March 2013 can be found in 

Appendix F, Question 35. Note that the response rates to optional categories were relatively low 

(ranging from 16% to 58%). 

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As shown in Exhibit 4.59, respondents reported providing options counseling to a larger number 

of clients aged 60 and older (mean = 1,268) compared to other age groups. During the six-month 

period, local respondents provided counseling to a total of 298,647 older adults age 60 and above, 

compared to 62,819 clients under the age of 60. 

Exhibit 4.60 presents the findings on the analyses of modes of options counseling. Telephone was 

the most common method used to contact local ADRCs (N = 229,653, mean = 1,256). During this 

period, it was reported that staff at local ADRCs provided in-person options counseling to a total 

of 90,648 clients (mean = 438). The least common method for offering options counseling was 

through electronic means, such as email and website chats. 

The most common setting in which local ADRCs provided options counseling was on-site at the 

ADRC facility. A total of 124,030 clients received options counseling in-house at the local ADRC. 

As shown in Exhibit 4.61, staff at local ADRCs provided in-house counseling to an average of 725 

clients. The second most common setting was at the client’s community residence (N = 33,614, 

mean = 242). In addition, 16,930 clients received options counseling at a nursing home or other 

institutional setting over the six-month reporting period (mean = 154), and only 5,488 clients 

received options counseling at a hospital over this same period (mean = 96). 

93 

Exhibit 4.59: Clients Provided Options Counseling at Local Level by Age 

Age Mean Median Mode Range 

Min Max 

Under 60 297 58 2 1 8,234 

60 and older 1,268 170 7 1 74,000 

Unknown age 686 69 1 1 10,192 

Note: Response rates to the sub-questions varied between 45% and 67%. Summary statistics are 

based on ADRCs that served at least one client in that particular age group.

Exhibit 4.60: Clients Provided Options Counseling at Local Level by Method

Method Mean Median Mode Range 

Min Max 

In person 438 85 3 1 12,521 

Phone 1,256 133 12 1 48,935 

Electronic communication 241 19 1,3,5 1 9,650 

Note: Response rates to the sub-questions varied between 32% and 60%. Summary statistics are based on 

ADRCs that provided options counseling to at least one client using that particular method.
Care Transitions. Results of analyses of survey items addressing whether or not local ADRCs 

provided transition services to consumers discharged from an acute care setting and the types of 

care transition services they provided can be found in Appendix F, Questions 24–30. Thirty-seven 

percent of local ADRCs provided transition services to these consumers, as seen in Exhibit 4.62, 

and geographic location, organization structure, and operational structure were each significantly 

related to whether an organization provided transition services to consumers. Exhibit 4.63 shows 

that nearly 44 percent of urban, compared to 29 percent of rural, local ADRCs provided transition 

services (p ≤ .01). Additionally, 47 percent of independent, compared to 33 percent of government, 

local ADRCs provided transition services (p ≤ .01, Exhibit 4.64), and decentralized ADRCs (58%), 

compared to mixed (37%) and centralized (27%) ADRCs, were more likely to provide transition 

services (p ≤ .01, Exhibit 4.65). See Appendix L, Exhibit 11; Appendix M, Exhibit 7; and 

Appendix N, Exhibit 11, respectively, for detailed results. 

Note: Response rate was 94%. 

94 

Exhibit 4.61: Clients Provided Options Counseling at Local Level by Setting 

Setting Mean Median Mode Range 

Min Max 

Local ADRC 725 137 24 1 9,480 

Hospital 96 18 1 1 1,021 

Client’s community residence 242 50 10 1 6,019 

Nursing home/institution 154 19 1 1 2,980 

Note: Response rates to the sub-questions varied between 34% and 50%. Summary statistics are based on 

ADRCs that provided options counseling to at least one client at that particular setting.
95 
 

 

 

 

 

 

 

 

Medicaid Eligibility. Items on the local ADRC survey addressed whether or not ADRC staff 

administered a screening questionnaire to make a preliminary determination of eligibility and the 

need for publicly funded LTSS. Approximately 76 percent of local ADRC respondents reported 

that they conducted an initial screening, and 17 percent reported that they did not (see Appendix 

F, Question 48). 

There was a trend toward significance in the relationship between ADRC size and whether or not 

a site administered a screening questionnaire. Large local ADRCs (87%) were more likely than 

medium (78%) and small (75%) sites to administer a screening questionnaire to make a 

preliminary determination of eligibility and need for publicly funded LTSS (p ≤ .10, Exhibit 4.66). 

For detailed results, see Appendix O, Exhibit 10. 

96 
 

 

 

 

 

Descriptive statistics in Exhibit 4.67 indicate that 71 percent of local ADRCs administered a 

screening instrument to consumers aged 65 and over to make a preliminary determination of 

eligibility for publicly funded LTSS. More than two-thirds of local ADRCs reported screening 

consumers with physical disabilities, and about half reported screening those with intellectual or 

developmental disabilities for a preliminary determination of eligibility for publicly funded LTSS. 

97 
 

 

 

 

 

 

 

 

 

 

 

 

 

Note: Percentages do not add up to 100 because ADRC respondents could choose multiple options 

At the time of the survey, 28 percent of local ADRCs, or their state agencies, permitted 

presumptive financial eligibility in order to expedite the provision of LTSS to clients while their 

financial eligibility applications were being processed. Just over half (56%) reported that neither 

they, nor their state agency, permitted presumptive financial eligibility. Nearly 4 percent were in 

the process of permitting presumptive financial eligibility. 11 

Findings demonstrated that nearly all local ADRCs assisted clients in some capacity with financial 

eligibility applications for Medicaid (93%) and other publicly funded (90%) LTSS programs. 

Exhibit 4.68 presents the top four ways in which local ADRCs assisted with financial eligibility 

applications for Medicaid and other publicly funded LTSS programs (see Appendix F, Question 

51, for more detail). As shown, the most common way in which local ADRC staff assisted with 

Medicaid LTSS program applications was to advise the client where he or she could obtain an 

application (71%). 

11 Response rate was 87 percent. 

98 
Note: Percentages do not add up to 100 because ADRC respondents could choose multiple options 

Provision of ADRC Services 

Organizational Structure. Exhibit 4.69 summarizes the organizational structure of the 82 percent 

of local ADRC participants that responded to the question. As illustrated, a number of local 

ADRCs were independent non-profit organizations (44%). 

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Note: Response rate was 82%. 

Core Operating Organizations. Local ADRC respondents reported that their ADRC was 

composed of an average of four core operating organizations (range = 1 – 15). In Exhibit 4.70, we 

present the top five agencies that were cited as a core operating organization by local ADRCs. The 

most common core operating organization was AAAs, with nearly 81 percent of local ADRCs 

reporting that AAAs served as one of their core operating organizations. Approximately 46 percent 

of local ADRCs reported that their state unit on aging (SUA) was one of their core operating 

organizations, and 43 percent reported a center for independent living (CIL) as a core operating 

organization. More information about core operating organizations is provided in Appendix F, 

Question 61. 

100 
 

 

 

 

 

 

 

 

 

 

 

Notes: Response rates to sub-categories varied between 50% and 88%. Percentages do not add up to 100 

because ADRC respondents could choose multiple options. 

Overall, the local ADRC respondents reported having “positive” and “solid” relationships with 

their core operating organizations. In addition to identifying their core organizations, most of the 

sites provided specific information about the resources that these organizations provided. Many 

organizations provided the ADRCs with resources such as a physical space and connections to 

community resources. In addition, many of the sites signed formal memorandums of understanding 

to officially establish use of resources, staff, information, and coordination. A few local ADRC 

representatives commented about plans to improve the LTSS they offer by working more closely 

with their partners and core operating organizations. Respondents from none of the sites reported 

having a negative relationship with their core operating organizations (see Appendix G, Question 

61a). 

Staffing. Local ADRC respondents reported the number of full-time equivalent staff (FTE) that 

performed various functions at their site. It should be noted that response rates to sub-questions 

varied from 25 percent to 74 percent, thus compromising the accuracy of estimates. Exhibit 4.71 

presents the average number of local ADRC FTEs by function (see Appendix F, Question 64 for 

details). 

101 
Among the 313 responses, local ADRC participants indicated a total of 2,077 front-line staff at 

their organizations with an average of six staff (range = 0.50 – 161; response rate = 66%) 

performing front-line functions at local ADRCs. See Appendix F, Question 65, for details. 

Among the 38 state ADRC responses, participants reported a total of 153 state-level FTEs, with 

an average of four FTEs (range = 0.50 – 21; response rate = 79%) working with local ADRCs at 

each state ADRC. See Appendix H, Question 12, for details. 

Fee-for-Service Activities. As shown in Exhibit 4.72, 18 percent of local ADRCs indicated that 

their organizations were paid on a fee-for-service basis for assessment services, 17 percent 

mentioned options counseling as a fee-for-service activity, and almost 15 percent mentioned that 

they were paid fee-for-service for transition support services. Exhibit 4.73 shows that 18 percent 

of local ADRCs indicated Medicaid waiver as the most common source of fees for services 

provided, followed by state-funded programs other than Medicaid (15%). 

102 

Exhibit 4.71: Full-Time Equivalents at Local Level by Position Type 

Position Mean Median Mode Range 

Min Max 

Independent living services 6.30 2.00 1.00 0.05 171 

Advocacy services 5.39 2.00 1.00 0.10 92 

I&R/I&A 5.07 3.00 1.00 0.14 75 

Benefits counseling/ 

eligibility determination 5.07 2.00 1.00 0.10 150 

Options counseling/ counseling 

to provide in-depth support 4.70 2.00 1.00 0.10 65 

Crisis intervention services 4.46 2.50 1.00 0.05 30 

Administrative support 3.29 2.00 1.00 0.14 91 

Care transition services 3.17 2.00 1.00 0.05 40 

Note: Response rates to the sub-questions varied between 25% and 74%. Summary statistics are based 

on ADRCs that indicated greater than 0 FTE for the position.
 

 

Notes: Response rate was 38%. Percentages do not add up to 100 because ADRC respondents could choose 

multiple options. 

Notes: Response rate was 37%. Percentages do not add up to 100 because ADRC respondents could choose 

multiple options. 

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Exhibit 4.74 shows the findings from the cross-tabulation of the most commonly reported sources 

of funds for fee-based services reported by local ADRCs and the most commonly reported feebased services offered by them. Out of the ADRC representatives who reported Medicare as one 

of the source of funds for fee-based services, 34 percent reported providing fee-based caretransition support services. Among the ADRC representatives reporting Medicaid waiver as one 

of the fee-for-service funding sources, 24 percent provided fee-based assessment services, and 18 

percent provided options counseling services as fee-for-service assistance. 

AIRS Standards. As shown in Exhibit 4.75, nearly 44 percent of local ADRCs indicated using 

Alliance of Information and Referral Systems (AIRS) standards for data collected on consumers. 

In subgroup analyses, decentralized local ADRCs (75%) were more likely than mixed (58%) and 

centralized (57%) sites to require staff to follow AIRS standards with all consumers (p ≤ .05). 

Similarly, large local ADRCs (71%) were significantly more likely than medium (63%) and small 

104 
(45%) sites to require staff to use AIRS standards with all consumers (p ≤ .01). For detailed results, 

see Appendix N, Exhibit 13, and Appendix O, Exhibit 11, respectively. 

Management of Information Systems (MIS)/Databases. As presented in Exhibit 4.76, the most 

common use for databases/MIS at local ADRCs was to maintain records on individual consumers, 

at 78 percent. However, nearly as many local ADRC respondents (76%) indicated that they used 

databases/MIS to track consumer requests for information and referrals. Eleven percent of local 

ADRCs reported that their databases/MIS performed “other” functions, such as linking to their 

state’s Medicaid eligibility system, statewide ADRC database, and 211 system. 

105 

Exhibit 4.75: Use of Alliance of Information and Referral Systems (AIRS) at Local Level 

Common Process Frequency Percentage

AIRS Standards

Yes, with all consumers 208 44.07 

Yes, with specific groups of consumers 0 0.00 

No 129 27.33 

Note: Response rate was 71%.
 

 

 

 

 

 

 

 

 

 

 

 

Note: Percentages do not add up to 100 because ADRC respondents could choose multiple options. 

When asked about additional technical assistance topics they desired, local ADRC representatives 

most commonly identified guidance on improving data and systems (see Appendix G, Question 

47). Some examples included the need for a standardized database and a desire for training on data 

collection. One responded stated: 

“It would be most helpful if the technical assistance provider would be able to assist local 

ADRCs in establishing a data collection system that reflects the information expected to be 

reported on within the SART and/or the local National Study Survey.” 

There also was a concern about cost and resources required for data collection at the local level. 

One local-level ADRC respondent said: 

“We do not track all data the same way it is being asked for in this report. If data needs to 

be collected differently going forward for accurate reporting, data collection should be 

designed using this reporting tool as the basis to pull data when needed and data entry 

should be standardized across the country. The cost borne to make these changes at the 

local level would be astronomical.” 

106 
Standardized Tool for Needs Assessment. Approximately 67 percent of local ADRC 

representatives reported that they always utilized a standard operating procedure to assess 

consumer needs, while 20 percent said that they sometimes did (see Appendix F, Question 31b, 

for details). Similarly, 58 percent of local ADRCs reported having a standardized process or tool 

to provide options counseling (Appendix F, Question 36). As indicated in Exhibit 4.77, almost 23 

percent of local ADRCs reported using the same consumer assessment tools across all partners, 

and one-fourth mentioned using the same consumer assessment tools across some partners. 

Geographic location, organization structure, and operational structure were all significantly linked 

to whether a consumer assessment tool or process was common across partner organizations. 

Exhibit 4.78 shows that there was a trend toward significance based on geographic location, with 

representatives of urban local ADRCs being more likely than representatives of rural sites to report 

that their consumer assessment tool or process was common across all partners (28% and 19%, 

respectively; p ≤ .10). For detailed results, see Appendix L, Exhibit 12. Independent local ADRCs 

(31%), compared to government sites (24%), were significantly more likely to use the same 

consumer assessment tools/processes across all partners (p ≤ .01, Exhibit 4.79), and Exhibit 4.80 

illustrates that centralized local ADRCs (64%) were significantly more likely to report that each 

partner used their own assessment tool/process, compared to mixed (48%) and decentralized (32%) 

sites (p ≤ .01). See Appendix M, Exhibit 8, and Appendix N, Exhibit 12, respectively, for details. 

107 

Exhibit 4.77: Use of Consumer Assessment Tools at Local Level

Common Process Frequency Percentage

Consumer Assessment Tool

Yes, common across all partners 109 23.09 

Yes, common across some partners 118 25.00 

No, each partner organization uses their own 

assessment tool/process 207 43.86 

Note: Response rate was 92%.
108 
 

 

 

 

 

 

 

Care Plan. Of the 54 percent of local ADRC participants who responded to care plan items, 

approximately 23 percent said that their agency worked with consumers to develop a care plan, 

while 31 percent reported that they did not develop care plans with their consumers, as this was 

not part of their service provision (see Appendix F, Question 55c). 

Referrals and Follow Up. Local ADRCs referred a total of 481,797 consumers to public programs 

such as Medicare, Medicaid, Food Stamps, TANF, and Social Security in the six-month period 

prior to survey administration. Over the same period, they referred a total of 236,385 consumers 

to non-public programs and services. Exhibit 4.81 provides the mean, median, mode, and range of 

both referral types. See Appendix F, Exhibit 34 for additional information. Over the six-month 

period, local ADRCs referred more clients to public programs than to non-public ones (response 

rates ranged from 54% to 58%). 

109 
 

 

Almost 90 percent of local ADRC respondents reported that the ADRC followed up with 

consumers (Appendix F, Question 42a). As shown in Exhibit 4.82, 72 percent of them said they 

had their first follow-up with clients within one to two weeks of service. 

Note: Response rate was 87%. 

Fifty-eight percent of local ADRC respondents responded to the survey item regarding receiving 

a “warm transfer”12 when transferred to another agency. Of the 275 responses, it was revealed 37 

percent provided a “warm transfer” on average (range = 0 – 100), and 22 local ADRCs (8%) 

provided “warm transfers” to all clients (see Appendix F, Question 44 for detail). 

12 A warm transfer is a simultaneous transfer of a telephone call and its associated data from one agent to another 

agent or supervisor. 

110 

Exhibit 4.81: Consumers Provided Referrals at Local Level by Referral Type

Referral Type Mean Median Mode Range 

Min Max 

Public program 1,788 719 500 0 30,864 

Non-public program 955 246 10 0 15,968 

Note: Response rates to the sub-questions varied between 54% and 58%.
 

 

 

 

 

Performance Data. More than two-thirds of respondents from local ADRCs (77%) reported that 

they routinely collected performance data about their services and consumers (Appendix F, 

Question 45); they noted several uses for the data. As shown in Exhibit 4.83, respondents most 

frequently indicated that they used performance data to improve consumer services (75%); only 1 

percent reported that they did not use performance data at all. 

Notes: Response rate was 79%. Percentages do not add up to 100 because ADRCs could choose multiple options. 

111 
4.2.5 Partnerships 

Type of Partnerships 

Number of Partnerships. Local and state ADRCs have developed a broad range of partnerships 

including those with federal, state, local, and non-public organizations (for detailed results, see 

Appendix F, Question 63, and Appendix H, Question 10a, respectively). As reported by 

respondents, local ADRCs had an average of 16.3 partners (Exhibit 4.84). In addition to indicating 

the entities with whom they had a partnership, respondents also reported on the functionality of 

these relationships (see Appendix F, Question 63, and Appendix H, Question 10b, respectively, 

for detail). Respondents indicated that local ADRCs had an average of 6.4 highly functional 

partnerships. When comparing this relationship to the mean number of partnerships (16.3), it 

appears that approximately one-third of the local ADRC partnerships can be considered highly 

functional. 

Common Partnerships. Exhibit 4.85 presents the most frequently cited partnerships among local 

and state ADRCs. While local and state ADRC respondents reported common partnerships, state 

ADRC participants reported more partnerships with disability-related organizations, such as state 

developmental disabilities agencies and state mental health agencies, compared to local ADRCs. 

112 

Exhibit 4.84: Number of Partners of Local ADRCs

Mean Median Mode Range 

Min Max 

Partnerships* 16.27 15 10 1 42 

Highly functional partnerships** 6.38 5 3 0 40 

*Response rate is uncertain since “not checked” may indicate no response or no partnership.

**Response rate was 93%.
 

 

 

 

 

 

Note: Percentages do not add up to 100 because ADRC respondents could choose multiple options. 

Quality of Partnerships 

Exhibit 4.86 shows the most common partnerships with high functionality. Response rates for the 

sub-questions on functionality varied between 52 percent and 76 percent for local ADRCs and 

between 54 percent and 96 percent for state ADRCs on the functionality questions. 

In general, the most frequently cited partnerships reported by local and state respondents were also 

the most highly functional. The notable exception was the local Veterans Administration (VA) 

office. Although both groups reported the local VA as a common partnership, only 16 percent of 

local ADRCs and 23 percent of state ADRCs considered the partnership with the VA as highly 

functional. Most local and state sites (28% and 42%, respectively) reported that their relationship 

with the local VA was functioning at a moderate level. 

113 
 

 

 

 

 

 

 

Interestingly, while respondents did not indicate state human services departments as a common 

partnership, this partnership ranked in the top seven high functioning partnerships among local 

and state ADRCs. 

Note: Response rates to the local ADRC sub-questions varied between 52% and 76%. Response rates to the state 

ADRC sub-questions varied between 54% and 96%. 

Partnerships by Type of Core Operating Organizations 

The most common core operating organization types reported by states were AAA, SUA, and CIL 

(see Exhibit 4.70). Additional analyses on partnerships were conducted to examine partnership 

types and quality by these three core operating organization types. Specifically, these additional 

analyses answered three main questions: 

1.	 Do local ADRCs rate partnerships with their core operating agency as strong, highly 

functional partnerships? 

114 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.	 What other organizations do local ADRCs identify as partners outside of their core 

operating agencies? 

3.	 What is the quality of these partnerships? 

To address the first question, Exhibit 4.87 displays the percentage of local sites who rated the 

partnership with their core operating agency as highly functional and the percentage who rated this 

partnership as either moderately functional or weak. Results are mixed. The highest percentage of 

strong partnerships was reported by ADRC sites with SUAs identified as a core operating agency 

(76% rated partnerships with SUAs as highly functional), followed by sites with AAAs as core 

operating organizations (66%). Slightly more than half of sites with CILs as core operating partners 

indicated that this relationship was strong. 

To address the next two questions, we examined non-core operating organizations identified as 

partners by local ADRC sites and the percentage of respondents that rated each partnership as 

highly functional. Exhibit 4.88 presents these results. Overall, a wide range of partnerships was 

reported. Across all core operating organization types, a majority of respondents identified 

partnerships with local VAs, SUAs, state and county Medicaid agencies, AAAs, United Way, 

Alzheimer’s associations, and CILs. Those organizations identified as partners by the fewest 

number of ADRCs included state and county housing offices and county departments on aging. 

County and state housing offices were also the organizations most commonly rated as moderate or 

low functioning partnerships. Few strong partnerships were also reported with state mental health 

agencies, state developmental disability agencies, and vocational or rehabilitation service 

organizations. Results specific to each type of core operating organization are presented next. 

AAA Core Operating Organization Sites. Among ADRCs that identified AAAs as a core 

operating partner, at least half reported partnerships with nearly all the organizations listed in 

Exhibit 4.88. The most commonly identified partners included SUAs (85%), CILs (77%), 

115 

Exhibit 4.87: Percentage of Local ADRCs Reporting Highly Functional Relationships with 

Core Operating Organizations by Core Operating Organization Type 

Strong Relationship with Core 

Operating Organization 

Core Operating Organization Yes No

Area Agency on Aging 65.9% 34.1% 

State Unit on Aging 76.3% 23.7% 

Centers for Independent Living 54.6% 45.6% 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Alzheimer’s associations (68%), hospitals/medical centers (67%), and VAs (65%). With the 

exception of SUA partners, with whom 72 percent of respondents rated partnerships as highly 

functional, the quality of these partnerships was relatively low. For example, only 30 percent rated 

partnerships with Alzheimer’s associations as highly functional, about a quarter identified hospital 

partnerships as strong, and only 14 percent reported strong partnerships with the VA. Partners with 

the lowest percentage of sites rating the partnership as high quality included state departments of 

mental health (9%), state housing departments (10%), and county housing offices (11%). 

SUA Core Operating Organization Sites. The most commonly identified partners for SUA core 

operating organization sites included CILs and VA (each identified by 78% of local ADRCs), 

hospitals/medical centers (67%), and state Medicaid agencies (66%). With respect to the quality 

of these partnerships, less than 40 percent of respondents rated partnerships as highly functional, 

with the most striking result noted with VAs: Only 19 percent of sites rated the partnership as 

strong. Partnerships with AAAs were the most commonly reported strong partnership for this 

group, rated highly functional by 66 percent of local ADRC respondents. Low partnership quality 

ratings were also seen with mental health agencies (9%) and state and local housing offices (11% 

and 12%, respectively). 

CIL Core Operating Organization Sites. Partnerships with SUAs, AAAs, VAs, and Alzheimer’s 

associations were the most frequently identified among ADRCs with a CIL as a core operating 

organization. Over 60% of these sites rated partnerships with SUAs and AAAs as highly 

functional, but far fewer indicated strong partnerships with VAs (15%) and Alzheimer’s 

associations (26%). Of the 50 percent of sites that identified state mental health agencies as a 

partner, only 9 percent rated this partnership as highly functional; partnerships with state and local 

housing agencies were also rated poorly by this group. 

116 
117 

Exhibit 4.88: Percentage of Organizations Identified as ADRC Partners and Percentage of 

Partnerships Rated as “Highly Functional” by Core Operating Organization Type 

Core Operating Organizations Identified by ADRCs

Partners

AAA

N = 381 

SUA

N = 219 

CIL

N = 205 

% 

partner

% strong 

partnership

% 

partner

% strong 

partnership

% 

partner

% strong 

partnership

Federal Agencies

Local Veterans 

Administration 65.1% 14.4% 77.6% 18.7% 67.3% 15.0% 

State Agencies

Health 46.5% 13.9% 53.0% 16.9% 54.2% 16.1% 

Human Services 52.5% 4.5% 61.2% 32.4% 60.5% 30.2% 

State Unit on Aging 85.0% 71.7% 86.8% 76.3% 81.0% 64.9% 

Developmental 

Disabilities 51.4% 13.9% 55.7% 17.3% 57.1% 14.6% 

Mental Health 46.7% 8.7% 50.7% 9.1% 50.2% 8.8% 

Medicaid 61.2% 28.3% 65.8% 34.2% 61.5% 26.8% 

Housing 44.9% 9.7% 49.8% 10.5% 51.2% 11.7% 

Local Government Agencies

Area Agency on Aging 74.0% 65.9% 73.1% 65.8% 74.6% 63.9% 

County Health 

Department 60.6% 18.9% 60.7% 20.1% 56.1% 16.6% 

County Medicaid Office 58.5% 22.6% 61.2% 29.2% 57.1% 19.0% 

County Department on 

Aging 27.6% 21.8% 27.9% 22.4% 29.3% 23.9% 

County Housing Office 37.0% 10.5% 37.0% 11.9% 42.0% 12.7% 

Direct Service Organizations

211 or Other Call Center 54.3% 19.4% 54.8% 19.2% 55.6% 20.4% 

Hospital/Medical Center 66.9% 25.5% 67.1% 26.5% 45.4% 25.4% 

United Way 55.1% 21.5% 58% 21.5% 57.6% 19.5% 

Vocational/Rehabilitation 

Services 45.1% 14.2% 52.1% 16% 54.6% 19.5% 

Advocacy/Referral Organizations

Alzheimer’s Association 67.7% 30.4% 68.0% 32.4% 65.4% 26.3% 

Centers for Independent 

Living 76.6% 39.9% 77.6% 38.4% 90.7% 54.6% 
Data Sharing with Partners 

Exhibit 4.89 depicts local ADRCs’ current plans to share data with their operational partners and 

service providers. Almost 23 percent of local ADRC respondents indicated that they shared data 

with their operational partners, and 24 percent indicated that they shared data with their service 

providers. Twenty-nine percent and 24 percent indicated that they had plans to share data with 

their operational partners and service providers, respectively. 

Local ADRCs shared data with their operational partners for multiple purposes. Most commonly, 

respondents indicated that ADRCs provided access to client tracking and demographic 

information, and some local ADRCs indicated that their service providers had access to consumer 

data for billing purposes. For details on these analyses, see Appendix G, Question 42a. 

4.2.6 Comparison by Core Integration Dimensions 

In each of the three sub-sections below, we explore the distribution of the ADRC core measures 

by subgroups of interest such as location, organizational structure, operational structure, and 

number of consumers served. We then assess whether or not there are statistically significant 

differences in the three measures based on key process study variables of interest. 

118 

Exhibit 4.89: Data Sharing with Partners and Providers at Local Level

Frequency Percentage

Operational Partners*

Yes 107 22.67 

No, but there are plans to develop that capacity 135 28.60 

No, and there are no current plans to do this 182 38.56 

Service Providers**

Yes 114 24.15 

No, but there are plans to develop that capacity 111 23.52 

No, and there are no current plans to do this 214 45.34 

*Response rate was 89%.

**Response rate was 93%.
Level of Core Service Provision 

Exhibit 4.90 indicates the level of core service provision by ADRC characteristics. Urban ADRCs 

were more likely than rural ADRCs to have a high level of core provision (p ≤ .05). Independent 

ADRCs were much more likely to have a high level of core provision when compared to 

governmental ADRCs (p ≤ .01). Further, decentralized ADRCs were significantly more likely than 

centralized or mixed ADRCs to have a high level of core provision (p ≤ .01). There was no 

statistically significant difference among small, medium, and large ADRCs in the level of core 

service provision. 

There were also significant differences in the impact of partnerships based on core service 

provision, shared data, person-centered services, and federal grants. Specifically, ADRCs with a 

high level of core service provision were significantly more likely to have partnerships that had an 

impact on their ability to provide LTSS than ADRCs with low or medium levels of core service 

provision (p ≤ .01, Exhibit 4.91). Exhibit 4.92 shows that ADRCs with a high level of core service 

provision were less likely to indicate that shared data had an impact on their ability to provide 

119 

Exhibit 4.90: Level of Core Service Provision by ADRC Characteristics

 Low Level Medium Level High Level 

Agency Location**

Rural 23.93 52.14 23.93 

Urban 19.81 42.21 37.99 

Total 20.94 44.94 34.12 

Organizational Structure***

Government 21.37 52.56 26.07 

Independent 20.79 36.14 43.07 

Total 21.10 44.95 33.94 

Operational Structure***

Centralized 22.06 52.94 25.00 

Decentralized 12.05 32.53 55.42 

Mixed 23.51 46.67 29.82 

Total 21.10 44.95 33.94 

Number of Consumers*

0 – 500 20.00 55.00 25.00 

500 – 2500 20.00 47.88 32.12 

2500+ 20.98 40.56 38.46 

Total 20.36 46.65 32.99 

Note: Results are reported as percentages. *p ≤ .10, **p ≤ .05, ***p ≤ .01.
LTSS (p ≤ .01), while ADRCs with a low level of core provision were statistically significantly 

less likely to indicate that person-centered services had an impact on their ability to provide LTSS 

when compared to ADRCs with a medium or high level of core service provision (p ≤ .01, Exhibit 

4.93). Finally, as seen in Exhibit 4.94, ADRCs with high and medium levels of core service 

provision were statistically more likely than those with low levels to indicate that federal grants 

had very much or somewhat of an impact on increasing or expanding populations served compared 

to ADRCs with a low level of core service provision (p ≤ .01). 

120 

Exhibit 4.91: Impact of Partnerships on Ability to Provide LTSS by Level of Core Service 

Provision 

Impact of 

Partnerships Low Level Medium Level High Level Total 

No 23.91 26.02 12.16 20.87 

Yes 76.09 73.98 87.84 79.13 

Total 100 100 100 100 

Note: Results are reported as percentages. Results are statistically significant at p ≤ .01.

Exhibit 4.92: Impact of Shared Data on Ability to Provide LTSS by Level of Core Service 

Provision 

Impact of Shared 

Data Low Level Medium Level High Level Total 

No 70.65 81.63 88.51 81.65 

Yes 29.35 18.37 11.49 18.35 

Total 100 100 100 100 

Note: Results are reported as percentages. Results are statistically significant at p ≤ .01.

Exhibit 4.93: Impact of Person-Centered Services on Ability to Provide LTSS by Level of 

Core Service Provision

Impact of Person 

Centered Services Low Level Medium Level High Level Total 

No 72.83 46.43 53.38 54.36 

Yes 27.17 53.57 46.62 45.64 

Total 100 100 100 100 

Note: Results are reported as percentages. Results are significant at p ≤ .01.
Exhibit 4.95 shows that ADRCs with a low level of core service provision were more likely to 

indicate that they had conducted a community LTSS needs assessment within the past year when 

compared to ADRCs with a medium or high level of core service provision (p ≤ .10), and, as seen 

in Exhibit 4.96, ADRCs with a low or medium level of core service provision were more likely 

than ADRCs with a high level to indicate that lack of health insurance was a barrier to accessing 

LTSS (p ≤ .01). 

121 

Exhibit 4.94: Extent to Which Federal Grants Increased/Expanded Populations Served by 

Level of Core Service Provision

Impact on Populations Low Level Medium Level High Level Total 

Very much 33.73 41.88 50.00 43.03 

Somewhat 39.76 46.60 42.96 43.99 

Very little 26.51 11.52 7.04 12.98 

Total 100 100 100 100 

Note: Results are reported as percentages. Results are statistically significant at p ≤ .01.

Exhibit 4.95: Conducted Community LTSS Needs Assessment within the Last 12 Months 

by Level of Core Service Provision

Conducted Community LTSS Needs 

Assessment Low Level Medium Level High Level Total 

No, a community needs assessment was 

not completed within the past three 

years

28.26 40.53 28.47 33.89 

No, but we did complete a community 

needs assessment within the past three 

years

30.43 27.89 35.77 31.03 

Yes 41.30 31.58 35.77 35.08 

Total 100 100 100 100 

Note: Results are reported as percentages. Results are statistically significant at p ≤ .10.
In Exhibit 4.97, we see that ADRCs with a high level of core service provision were more likely 

to indicate that diversion from a nursing home was sought and that ADRCs with a high level of 

core service provision were more likely to provide care transition services when compared to 

ADRCs with a low or medium level (p ≤ .05, p ≤ .01, respectively). Also, representatives of 

ADRCs with medium and high levels of core service provision were significantly more likely to 

indicate that their ADRC provided options counseling when compared to ADRCs with low levels 

of core service provision (p ≤ .01, Exhibit 4.97). 

122 

Exhibit 4.96: Lack of Health Insurance as a Barrier by Level of Core Service Provision

Barrier Level Low Level Medium Level High Level Total 

Often a Barrier 21.43 21.58 22.46 21.84 

Sometimes a Barrier 69.05 72.11 58.70 66.99 

Not a Barrier 9.52 6.32 18.84 11.17 

Total 100 100 100 100 

Note: Results are reported as percentages. Results are statistically significant at p ≤ .01.

Exhibit 4.97: Provision of Diversion, Transition Services, and Options Counseling by Level 

of Core Service Provision

 Low Level Medium Level High Level Total 

Diversion from Nursing Home**

No 6.52 8.85 2.04 6.03 

Yes 93.48 91.15 97.96 93.97 

Total 100.00 100.00 100.00 100.00 

Transition Services***

No 80.90 100.00 0.00 61.18 

Yes 19.10 0.00 100.00 38.82 

Total 100.00 100.00 100.00 100.00 

Options Counseling***

No 93.48 0.00 0.00 19.72 

Yes 6.52 100.00 100.00 80.28 

Total 100.00 100.00 100.00 100.00 

Note: Results are reported as percentages. 

**p ≤ .05, ***p ≤ .01
Extent of Site Integration 

Statistically significant differences were not found for the extent of site integration based on 

geography, organizational type, operational structure, or ADRC size. Exhibit 4.98 provides 

descriptive statistics for each of these domains. 

In contrast, staffing changes, data sharing, and person-centered services were significantly related 

to the extent of site integration. Exhibit 4.99 shows that ADRCs with a low level of site integration 

were statistically more likely to indicate that staffing changes did not have an impact on their 

ability to provide LTSS, as compared to ADRCs with a medium or high level of site integration 

(p ≤ .05). Further, ADRCs with a high level of site integration were statistically less likely to 

answer that shared data had an impact on their ability to provide LTSS (p ≤ .05) than those with a 

low or medium level (Exhibit 4.99), and ADRCs with a low level of site integration were 

123 

Exhibit 4.98: Extent of Site Integration by ADRC Characteristics

 Low Level Medium Level High Level 

Agency Location

Rural 16 76 8 

Urban 11.57 78.36 10.07 

Total 12.77 77.72 9.51 

Organizational Structure

Government 12 79.5 8.5 

Independent 13.56 76.27 10.17 

Total 12.73 77.98 9.28 

Operational Structure

Centralized 12.07 81.03 6.9 

Decentralized 8.7 73.91 17.39 

Mixed 14 78.4 7.6 

Total 12.73 77.98 9.28 

Number of Consumers

0 to 500 20 55 25 

500 to 2500 20 47.88 32.12 

2500+ 20.98 40.56 38.46 

Total 20.36 46.65 32.99 

Note: Results are reported as percentages. No results are statistically significant.
statistically less likely to indicate that person-centered services had an impact (p ≤ .05, Exhibit 

4.99). 

Statistically significant relationships were demonstrated between the effect of federal grants on 

populations served by ADRCs and the extent of site integration. For example, ADRCs with 

medium and high levels of site integration were more likely than those with a low level to indicate 

that federal grants helped to expand the populations served “very much” or “somewhat” (p ≤ .05, 

Exhibit 4.100). Exhibit 4.100 shows that ADRCs with a low level of site integration were much 

less likely to indicate that federal grants had “very much” increased the number of consumers 

when compared to ADRCs with a high or medium level of site integration (p ≤ .05), and ADRCs 

with a high level of site integration demonstrated a trend toward significance in that they were 

more likely to respond that grants “very much” increased the number of partners when compared 

to responses from ADRCs with medium and low levels of site integration (p ≤ .10, Exhibit 4.100). 

124 

Exhibit 4.99: Factors Contributing to Provision of LTSS by Extent of Site Integration 

 Low Level Medium Level High Level Total 

Impact of Staffing Changes**

No 89.58 72.79 74.29 75.07 

Yes 10.42 27.21 25.71 24.93 

Total 100 100 100 100 

Impact of Shared Data**

No 68.75 82.31 91.43 81.43 

Yes 31.25 17.69 8.57 18.57 

Total 100 100 100 100 

Impact of Person-Centered Services**

No 70.83 52.04 40.00 53.32 

Yes 29.17 47.96 60.00 46.68 

Total 100 100 100 100 

Note: Results are reported as percentages. 

**p ≤ .05
 

 

 

 

 

 

 

 

In the final set of site integration analyses, results showed that ADRCs with a low level of site 

integration were less likely to indicate that diversion was sought when compared to ADRCs with 

either a medium or high level (p ≤ .10, Exhibit 4.101), and ADRCs with a high level of site 

integration were more likely to provide care transitions services than those with low and medium 

site integration (p ≤ .01, Exhibit 4.101). Further, ADRCs with medium and high levels of site 

integration were statistically more likely to indicate that they provided options counseling 

compared to ADRCs with low levels of site integration (p ≤ .01, Exhibit 4.101). 

125 

Exhibit 4.100: Impact of Federal Grants by Extent of Site Integration 

 Low Level Medium Level High Level Total 

Impact on Populations**

Very much 31.11 43.11 64.71 43.65 

Somewhat 53.33 43.82 35.29 44.2 

Very little 15.56 13.07 0.00 12.15 

Total 100 100 100 100 

Impact on Number of Consumers**

Very much 27.27 46.32 53.13 44.6 

Somewhat 61.36 41.75 46.88 44.6 

Very little 11.36 11.93 0.00 10.8 

Total 100 100 100 100 

Impact on Number of Partners*

Very much 55.56 55.52 64.71 56.39 

Somewhat 44.44 34.88 35.29 36.11 

Very little 0.00 9.61 0.00 7.5 

Total 100 100 100 100 

Note: Results are reported as percentages.

*p ≤ .10, **p ≤ .05
Status of Medicaid Integration 

In the following exhibit, we present the findings from the analyses of Medicaid integration by the 

key domains of interest. From Exhibit 4.102, we see that the urbanicity of the service areas of 

ADRCs was not significantly associated with their Medicaid integration status. However, 

independent ADRCs were more likely to be Medicaid integrated, compared to government run 

ADRCs, at a statistically significant level (p ≤ .05). Further, decentralized ADRCs were more 

likely to be Medicaid integrated than centralized or mixed ADRCs, with mixed ADRCs being the 

least likely to be Medicaid integrated (p ≤ .01). Exhibit 4.102 shows no statistically significant 

association between Medicaid integration and the number of ADRC consumers. 

126 

Exhibit 4.101: Provision of Diversion, Transition Services, and Options Counseling by 

Extent of Site Integration

Low Level Medium Level High Level Total 

Diversion from Nursing Home*

No 12.77 4.81 2.94 5.65 

Yes 87.23 95.19 97.06 94.35 

Total 100 100 100 100 

Transition Services***

No 95.83 64.69 2.86 62.87 

Yes 4.17 35.31 97.14 37.13 

Total 100 100 100 100 

Options Counseling***

No 66.67 12.93 0 18.57 

Yes 33.33 87.07 100 81.43 

Total 100 100 100 100 

Note: Results are reported as percentages.

*p ≤ .10, ***p ≤ .01

Exhibit 4.102: Status of Medicaid Integration by ADRC Characteristics

 Not Medicaid Integrated Medicaid Integrated

Agency Location

Rural 62.79 37.21 

Urban 58.43 41.57 

Total 59.65 40.35 
Respondents from ADRCs that were Medicaid integrated were less likely to respond that shared 

data had an impact on their ability to provide LTSS (p ≤ .10, Exhibit 4.103), and, as seen in Exhibit 

4.104, respondents from ADRCs that were Medicaid integrated were more likely to indicate that 

person-centered services had an impact on the provision of LTSS than ADRCs that were not 

Medicaid integrated (p ≤ .01). 

127 

 Not Medicaid Integrated Medicaid Integrated

Organizational Structure**

Government 63.77 36.23 

Independent 54.59 45.41 

Total 59.75 40.25 

Operational Structure***

Centralized 54.17 45.83 

Decentralized 45.88 54.12 

Mixed 64.76 35.24 

Total 59.75 40.25 

Number of Consumers

0 – 500 61.9 38.1 

500 – 2500 56.73 43.27 

2500+ 51.7 48.3 

Total 55.97 44.03 

Note: Results are reported as percentages.

**p ≤ .05, ***p ≤ .01

Exhibit 4.103: Impact of Shared Data on Ability to Provide LTSS by Level of Medicaid 

Integration 

Impact of Shared Data Not Medicaid 

Integrated Medicaid Integrated Total 

No 78.01 87.37 81.78 

Yes 21.99 12.63 18.22 

Total 100 100 100 

Note: Results are reported as percentages. Results are statistically significant at p ≤ .01.
Exhibit 4.105 shows that, compared to ADRCs that were not Medicaid integrated, ADRCs that 

were integrated were significantly more likely to indicate that federal grants had “very much” of 

an impact on expanding populations they served (p ≤ .01), and they said that their consumers 

requested services pertaining to Medicare eligibility “sometimes” (p ≤ .10, Exhibit 4.106). 

Respondents from Medicaid integrated ADRCs were slightly more likely to indicate that diversion 

was sought compared to those who were not Medicaid integrated (p ≤ .10, Exhibit 4.107), while 

they were significantly more likely to offer care transition services when compared to ADRCs who 

were not Medicaid integrated (p ≤ .01, Exhibit 4.107). Finally, Exhibit 4.107 shows that 

respondents from integrated ADRCs were also much more likely to indicate that they provided 

options counseling services compared to non-integrated ADRCs (p ≤ .01). 

128 

Exhibit 4.104: Impact of Person-Centered Services on Ability to Provide LTSS by Level of 

Medicaid Integration

Impact of Person 

Centered-Services

Not Medicaid 

Integrated

Medicaid 

Integrated Total 

No 60.64 46.32 54.87 

Yes 39.36 53.68 45.13 

Total 100 100 100 

Note: Results are reported as percentages. Results are statistically significant at p ≤ .01.

Exhibit 4.105: Extent to Which Federal Grants Increased/Expanded Populations Served by 

Level of Medicaid Integration

Impact on Populations Not Medicaid 

Integrated Medicaid Integrated Total 

Very much 36.60 51.09 42.54 

Somewhat 46.04 40.22 43.65 

Very little 17.36 8.70 13.81 

Total 100 100 100 

Note: Results are reported as percentages. Results are statistically significant at p ≤ .01.
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Exhibit 4.106: Frequency of Consumer Requests about Medicare Eligibility by Medicaid 

Integration 

Medicare Eligibility and 

Services

Not Medicaid 

Integrated

Medicaid 

Integrated Total 

Frequently 83.62 82.11 82.94 

Sometimes 12.07 16.84 14.22 

Infrequently 4.31 1.05 2.84 

Never 0.00 0.00 0.00 

Total 100 100 100 

Note: Results are reported as percentages. Results are statistically significant at p ≤ .10.

Exhibit 4.107: Provision of Diversion, Transition Services, and Options Counseling by 

Status of Medicaid Integration 

Not Medicaid Integrated Medicaid Integrated Total 

Diversion from Nursing Home*

No 7.52 3.72 5.95 

Yes 92.48 96.28 94.05 

Total 100 100 100 

Transition Services***

No 66.92 51.61 60.54 

Yes 33.08 48.39 39.46 

Total 100 100 100 

Options Counseling***

No 27.41 9.63 19.96 

Yes 72.59 90.37 80.04 

Total 100 100 100 

Note: Results are reported as percentages.

*p ≤ .10, ***p ≤ .01
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.3 Process Study Discussion and Implications 

This process study examined site-level organizational, community, service, and partnership 

characteristics of ADRCs to gain an understanding of differences and similarities in ADRC 

operations nationally. The study included two types of ADRC respondents: state-level ADRCs and 

local ADRC sites that serve specific geographic areas (e.g., counties) within a state. 

Forty-eight state-level ADRC sites and 472 local ADRC sites participated in this process study by 

providing responses to a web-based survey fielded from April 1, 2013, through August 16, 2013. 

Descriptive and bivariate subgroup analyses were used to interpret the data. 

This section of the report summarizes key findings and discusses implications within the following 

areas: 

 Motivation to become an ADRC 

 Diversion as outcome 

 Funding 

 Community and consumer information 

 Key services provided 

 Partnerships 

 Comparison by core integration dimensions of ADRC operations: service provision, site 

integration, and Medicaid integration 

4.3.1 Motivation to Become an ADRC 

The purpose of an ADRC is to serve as an integrated point of entry (so that there is “no wrong 

door” nor a single point of entry) to long-term services and supports. ADRCs are designed to meet 

the needs of consumers and caregivers for information, services, and supports. According to a 

2006 ADRC Technical Assistance Exchange report, the integration of LTSS by the ADRCs 

“create[s] community-wide service systems that reduce consumer confusion and build consumer 

trust and respect by enhancing individual choice and informed decision-making. This strategy can 

also help to break down barriers to community-based living by giving consumers information 

about the complete spectrum of long-term care options.”13 

13 The Lewin Group (2006). The Aging and Disability Resource Center (ADRC) Demonstration Grant Initiative: 

Interim Outcomes Report. Retrieved from http://www.adrc-tae.acl.gov/documents/InterimReport.pdf. 

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Given the purpose of an ADRC, it is not surprising that over 90 percent of state ADRC respondents 

identified “better integrate the delivery of LTSS for aging and disability populations” and “develop 

or strengthen partnerships with community providers” as rationales for applying for ADRC grant 

funding; from the local-site ADRC perspective, these were also the two most frequently cited 

reasons for becoming an ADRC. Increasing LTSS marketing and awareness, improving data/IT 

infrastructure, and expanding services to different populations were also cited as motivations for 

becoming an ADRC by a majority of state ADRC respondents, but markedly less so for local 

ADRC sites. Expanding to additional geographic locations was identified as a goal by only 37 

percent of state ADRCs and less than 1 percent of local sites. 

When asked to identify criteria used in selecting which local entities would be tapped to receive 

grant funding and become a local ADRC, over 68 percent of state-level respondents selected AAAs 

that were already in existence and 35 percent selected other organizations currently serving older 

adults, while fewer respondents identified other criteria, such as entities that were already serving 

disabled groups or organizations that were already considered “integrated” in providing access to 

LTSS. 

Taken together, these findings suggest that primary drivers for seeking ADRC grant funding and 

establishing ADRC sites were more strongly related to strengthening the LTSS network within the 

state through the aging network, rather than increasing the reach of existing organizations. 

4.3.2 Diversion as an Outcome 

Preventing or delaying Medicaid spend-down and admission into nursing homes and other 

institutional care settings remains an important goal of AoA and ACL programs and activities. 

Improving access to LTSS options throughout the community and within individuals’ preferred 

care setting continues to be an express objective of the ADRC program. This mission is strongly 

reflected in the process study findings, as 91 percent of local-level ADRCs indicated that diversion 

from nursing homes or other institutional residential care facilities was an outcome their agency 

sought to achieve. Closer examination of subgroups of local ADRCs shows that centralized 

ADRCs were significantly less likely to identify diversion as an outcome sought (82%) compared 

to decentralized (96%) or mixed (96%) ADRCs; significantly fewer small ADRCs identified 

diversion as an outcome (86%) compared to large (97%) and medium (95%) ADRCs. 

As centralized ADRCs are often hallmarked by one organization performing all ADRC functions 

and services, with less reliance on partners for assistance beyond referrals, there may be an 

opportunity to effectively target centralized ADRCs to reaffirm the importance of diversion as an 

outcome and provide support on how to achieve this goal. The same may also apply to smaller 

ADRCs, which may have fewer resources (or fewer perceived resources) to allocate to diversion. 

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It is important to note that, while these results are statistically significant, substantially, the vast 

majority of all types of ADRCs still indicate a commitment to diversion. 

4.3.3 Impacts of ADRC Grant Funds and Sources of Funding 

Impact of ADRC Grant Funding on Services. As discussed above, better integration of LTSS 

delivery was cited as a motivation for becoming an ADRC. Findings from this process study 

suggest that this goal is being achieved, as 95 percent of local-level ADRC respondents reported 

that their organization saw an improvement in their ability to provide integrated, comprehensive 

access to LTSS since receiving the ADRC grant. With regard to impact on services at the state 

level, state ADRC respondents rated strong progress in improving information, referral, and 

awareness of LTSS programs and good progress in improving options counseling and personcentered transition support since the receipt of ADRC development grant dollars. More neutral 

ratings of progress were noted, however, in improving streamlined eligibility determination. The 

lower rating of progress in streamlined eligibility determination may be related to the more 

external nature of that particular service, as cooperation with other state agencies is necessary, 

while the other service areas are more endogenous to the ADRC organization. 

Impact of ADRC Grant Funding on Operational Outcomes. When asked to identify ways 

in which the ADRC grant program has had an impact, increasing the number of partnerships and 

increasing staff skills were the two most commonly identified outcomes reported by both state and 

local ADRC respondents. Approximately one-half of state ADRCs identified increases in the 

number of consumers served, populations served, and range of services offered, while 31–42 

percent of local ADRCs identified these impacts. Only 19 percent of state-level and 13 percent of 

local ADRC respondents felt that the grant helped to recruit or attract more experienced staff. It is 

important to note that for this survey item, states were asked to identify the most significant impact, 

whereas local ADRCs were able to choose all that applied. 

Impact on Resources. Seventy-five percent or more of state-level respondents reported increased 

coordination between aging and disability agencies, improved staff training opportunities, 

improved awareness and marketing, and increased service efficiency since the receipt of an ADRC 

grant; a slightly lower percentage (at least 64%) of local-level respondents also identified these 

positive impacts of the ADRC grant program on resources. Leveraging other funding was 

identified as an impact on resources by 60 percent of state ADRCs and 37 percent of local-level 

ADRCs, while contributing to the development of a statewide database of LTSS services or 

consumers was identified as an impact by 54 percent of state-level and 36 percent of local-level 

respondents. 

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With regard to this last issue, development of a statewide LTSS database, results indicated that 

rural, government-run (compared to independent ADRCs), and large local ADRCs (those serving 

2500+ clients) were statistically significantly more likely to have reported database development 

as a function of receiving ADRC grant funds. This is an interesting finding to explore in more 

depth to determine if such databases for these groups were already in place, whether these ADRCs 

received specific funds other than the ADRC grant money earmarked to develop such databases, 

or whether databases have been a low-priority area for these types of ADRCs. Maintaining an upto-date and accurate database of LTSS services is an important facet of service delivery for 

ADRCs. 

Impact on LTSS and HCBS in the Community. Over 70 percent of local-level ADRC agency 

respondents reported positive impacts on LTSS in their communities since becoming an ADRC, 

attributable to increased numbers of LTSS providers and improved quality of LTSS services 

provided. However, after a closer review of the results, these positive impacts differed between 

institutional services and HCBS. Services most often associated with community-based living and 

requested most often by consumers, transportation and housing, were reported to be most often 

inadequately available. This was in contrast to nursing home bed availability, which was reported 

to have increased since the inception of the ADRCs. These findings are mixed; inadequacy of 

services essential to remaining in the community, such as transportation and housing, remains a 

problem for areas served by ADRCs. Yet an increase in the number of nursing home beds may 

indicate success in transitioning people out of such institutional environments and into communitybased settings. 

Impact on Consumers Served. Over 60 percent of local-level ADRC respondents reported that, 

since the beginning of the ADRC grant funding, the number of consumers 60 and older, under 60, 

and with physical disabilities increased; 52 percent reported that the number of persons with 

mental disabilities increased. These results are promising in demonstrating that persons with 

disabilities are becoming more integrated into ADRC services, but more effort is needed to ensure 

ADRCs are breaking down the traditional silos and truly providing access to LTSS for persons of 

all ages, and all disability types. 

When asked to indicate operational factors that most positively impacted their ability to provide 

integrated, comprehensive access to LTSS, 78 percent of local-level ADRC respondents selected 

partnership development/expansion; 45 percent chose having an explicit focus on person-centered, 

self-directed services; 24 percent chose staffing changes; and 18 percent indicated shared data as 

a factor with positive impacts. This finding highlights the importance of partnerships in the ability 

of ADRCs to achieve their mission, beyond factors more related to changes in daily operations 

and mission. 

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Examining this result more closely shows that urban, decentralized, and large local-level ADRCs 

were significantly more likely to report partnerships as a positive impact (81% or higher). In many 

ways this finding is expected, as more partnerships may be available in urban areas compared to 

rural areas, and larger, decentralized models may have more resources to develop and expand these 

partnerships. It is important to note, however, that between 70 and 75 percent of rural, centralized 

or mixed, and small and medium-sized local-level ADRCs also reported partnership 

creation/expansion as an impact, so there may be other unmeasured organizational characteristics 

influencing the positive effects of partnerships on ADRC services. 

State-level respondents were also asked to rate the degree of importance that each operational 

factor had in improving access to LTSS in their states. Ninety-four percent rated partnerships as 

important or very important; this corresponds to the role of partnerships as perceived by locallevel respondents discussed above. However, 79 percent of state-level respondents rated staffing 

as important or very important, and 65 percent rated shared data systems as such, while only 24 

percent of local-level respondents reported staff changes as a positive impact, and only 18 percent 

reported shared data as a positive impact. This discrepancy may have implications in resource 

allocation or prioritization of focus areas as emphasis is placed on staffing and implementing 

shared data systems. More work is needed to understand why so many fewer local ADRCs found 

staffing and shared data important, compared to the value of these factors perceived at the state 

level. 

Funding Sources. Sustainability in funding is a critical aspect to ADRCs’ success. Findings from 

this process study show reliance on multiple funding sources, suggesting that, over the past year, 

local ADRCs expanded their funding networks: The median number of funding sources in 2013 

was four, compared to three sources in prior fiscal years. Nearly half of local ADRCs indicated 

their state unit on aging (SUA) as a funding source, and around one-third of respondents identified 

local county or “other” sources as funders. Approximately 28 percent identified state general funds 

as a source of funding, and a quarter reported receiving AoA Title IV ADRC grants. 

At the state level, state general revenue was the most commonly selected source of funding (67%), 

followed closely by AoA Title IV ADRC grants (65%); SUAs were also important to this group, 

as nearly 48 percent identified SUAs as funding sources. Money Follows the Person demonstration 

funds were identified by 38 percent of state-level respondents as well, but only 8 percent named 

Medicare Improvements for Patients and Providers Act as a source. “Other” sources such as OAA 

Title III-B and local grants were identified by 27 percent. 

The greater reliance on federal funds reported by state ADRCs compared to local-level respondents 

was expected; however, examination of funding sources identified for fiscal year 2013 and those 

identified for prior fiscal years shows a consistent decrease in the percentage of respondents in 

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both groups in identification of federal sources of funding and increases in the percentages of 

respondents identifying state and local funding sources. This suggests that state and local ADRCs 

alike may be becoming less reliant on federal monies to continue operating and providing services. 

From the federal perspective, this may be a promising finding, as the intent of establishing ADRCs 

across the country included achieving financial sustainability. However, in the context of 

constricting state resources, ADRC sites may be feeling negative implications of this possible shift 

in funding. Regardless, these findings highlight the importance of the federal-state-local 

partnerships that the ADRC initiative has encouraged. 

4.3.4 Community Characteristics and Consumer Information 

The national process study measured community service capacity characteristics for both state and 

local ADRCs, including needs assessments, availability of LTSS, and barriers to service, as well 

as community populations and consumer characteristics including demographics, health insurance 

status, poverty, and most frequently sought services. 

LTSS Needs Assessment. State and local ADRCs were both asked to indicate whether an 

assessment for LTSS needs had been conducted within the past year or whether such an assessment 

was planned. Thirty-three percent of local-level respondents and 25 percent of state-level 

respondents indicated that a statewide LTSS needs assessment had been conducted within the past 

12 months, and an additional 7 percent of state ADRCs reported that LTSS needs had been 

assessed in some, but not all, communities within the state. Nearly 30 percent of local-level and 

21 percent of state-level respondents reported that needs assessments had been done within the 

past three years. These findings are encouraging, as they demonstrate that a majority of 

respondents have prioritized assessments and planning. 

However, nearly 44 percent of state ADRC respondents and 32 percent of local ADRCs indicated 

that needs assessments had not been completed. Closer examination of subgroups reveals that 

urban and small ADRCs were less likely to have completed a needs assessment at all. LTSS needs 

assessments can provide ADRC programs with hard data and information about the community 

that are useful not only for planning purposes but also in working with legislatures to secure needed 

funds in prioritized areas; results from this study indicate that many states and communities may 

need additional support to gather such data and complete assessments, particularly urban and 

smaller ADRCs that may have fewer resources. 

LTSS Availability in the Community. Respondents were asked to indicate availability of 

services at the state and local levels. With regard to services that were adequately available, nearly 

70 percent of local-level and 54 percent of state-level respondents indicated that ombudsman 

services were adequate; however, the additional services that state ADRCs and local ADRCs 

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reported as adequate differed between the groups. For example, about 60 percent or fewer of locallevel respondents indicated adequacy in education services, nutrition programs, and opportunities 

to develop advance directives, while state-level respondents identified adequacy in assisted living, 

socialization/recreation programs, and peer support services. This result suggests that there may 

be conflicting perceptions of service adequacy, which could have potential implications in service 

planning and resource allocation. 

There was more agreement between state- and local-level respondents with regard to services that 

were deemed inadequate. Both groups indicated inadequacy in mental health services (85% statelevel, 80% local-level), safe and affordable housing options (93% state-level, 84% local-level), 

and transportation services (86% state-level, 88% local-level). Looking more closely at subgroups, 

we see that rural local ADRCs were significantly more likely to report transportation inadequacy 

compared to urban ADRCs, and urban ADRCs were significantly more likely to consider mental 

health services to be inadequate. These results are not surprising, given the more acute need for 

transportation infrastructure in rural areas and the higher density of population with mental health 

needs in urban centers. 

Barriers to Services. There was again commonality in factors identified to be barriers to service 

between local and state ADRC respondents. At least 79 percent of respondents from both groups 

rated transportation, lack of needed LTSS services, lack of health insurance, and high provider 

staff turnover as barriers to consumers receiving LTSS. Transportation was the most often 

indicated barrier, chosen by 96 percent of state and 92 percent of local ADRCs, with no significant 

difference between rural and urban respondents. At the state level, 79 percent of respondents 

identified providers not accepting Medicaid as a barrier, and 77 percent indicated problems 

associated with persons in need of services not having a permanent address. Taken together, these 

findings suggest that solutions to improving the service environment for individuals in need of 

LTSS must be multi-faceted and must focus not only on infrastructure (such as increasing 

transportation options), but also on working with Medicaid and other health insurance systems and 

on bringing providers on board to acknowledge the importance of their operations (including staff 

turnover) for service delivery. 

Community Populations. When asked to characterize racial and ethnic community composition, 

on average, respondents indicated that their communities included a majority Caucasian/White 

population, with Black/African Americans constituting the next-highest group, followed by much 

smaller segments of Asian, American Indian or Alaska Native, and Native Hawaiian or other 

Pacific Islanders. On average, respondents reported 91 percent non-Hispanic and 9 percent 

Hispanic communities. Respondents were provided the option to identify other significant 

racial/ethnic subpopulations in their areas. Some of the responses provided included cultural 

groups such as Hmong, Amish, and Middle Eastern, as well as LGBT groups. 

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Respondents indicated that an average of 17 percent of their local community members lived in 

poverty; an additional 31 percent reported that they were unsure of the percentage but believed 

that a significant proportion of their communities experienced poverty. Similarly, respondents 

estimated that, on average, 15 percent of the local population was uninsured, and 50 percent 

believed lack of insurance coverage was a significant issue although the exact prevalence of 

uninsured persons was unknown. No differences were found between ADRC subgroups in these 

areas. These data show the importance of local ADRCs understanding the context within which 

they operate and ensuring that outreach, materials, and the like are designed to consider diverse 

groups. 

Consumer Characteristics. In addition to the local communities within which ADRCs operate, 

discussed in the section above, the process study also inquired about the backgrounds of clients 

served by the ADRC, including age and disability status. Data show that the majority of persons 

served were either adults aged 60 years or older or caregivers for persons 60+; this was true for 

persons with all different types of disabilities, with the exception of those with developmental 

disabilities—more younger persons were served within this group. The most frequently reported 

disability group served by local ADRCs was persons with physical disability. 

The study also captured which services were most frequently requested by consumers at the local 

ADRCs. Transportation was the most commonly reported service (identified by 80% of local 

ADRCs) across all subgroups, followed closely by requests for Medicaid and Medicare eligibility 

determination (79% and 74%, respectively). About 70 percent of respondents identified affordable 

housing as a frequently requested service; subgroup analyses show that decentralized and urban 

local ADRCs were more likely than centralized or mixed ADRCs and rural ADRCs to report this 

particular service. Interestingly, transportation and housing were identified by respondents as the 

most inadequately available services. As these are also frequently requested, the study findings 

point to the critical role that transportation and housing play in the LTSS continuum and the 

importance of ensuring adequate supply at the state and federal levels. 

4.3.5 Key Services Provided 

Recognizing that the ADRC initiative attempts to increase awareness of and access to LTSS 

through three key service areas, the study also assessed the provision of options counseling, care 

transitions, and Medicaid eligibility determination, as well as how these services were provided at 

the site level. 

Options Counseling. Over three-quarters of local ADRC respondents reported that they provided 

options counseling services, and decentralized ADRCs were significantly more likely than 

centralized or mixed-model ADRCs to do so. This interesting finding may reflect greater 

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commitment, increased resources, or more efficiently shared resources from multiple core partner 

organizations in decentralized ADRCs. Further investigation is needed to determine why some 

local ADRCs did not provide options counseling and what characteristics of centralized or mixedmodel ADRCs influence the ability to do so. 

Across all groups, respondents reported providing options counseling to significantly older clients 

than to those under age 60. This may reflect different needs of each age group, but it potentially 

also signals a need to more closely examine triggers for options counseling and ensure younger 

consumers are receiving appropriate counseling. 

Care Transitions. Care transition services refer to intensive efforts to reach out to and support 

individuals who are being discharged from acute care settings back into the community. The goal 

is to ensure that patients understand and adhere to discharge and self-care instructions, follow up 

appropriately with care providers, and recognize when immediate attention is needed. The process 

study survey asked local-level respondents whether or not they provide care transition services. 

Only 37 percent of respondents said yes, and subgroup analyses showed that urban, independent 

(versus government), and decentralized ADRCs were more likely to provide care transition 

services. This finding is notable, as ACL promotes the role of ADRCs in care transitions, and 

indicates the need for further efforts to encourage the provision of these critical services. 

Medicaid Eligibility. Assisting consumers with Medicaid eligibility determination through the 

ADRC is also supported by ACL. Approximately 76 percent of local ADRC respondents indicated 

that they administered a screening to make a preliminary determination of Medicaid eligibility and 

need for publicly funded LTSS. Of these, over a quarter reported the ability to make presumptive 

eligibility determinations to expedite service receipt while applications are being processed. This 

is an interesting, innovative approach that may directly benefit persons in need of LTSS while at 

the same time delaying institutionalization, if services can be provided more expeditiously to 

prevent the need for institutional care. More research is needed to fully understand the effects of 

presumptive determination. 

With regard to who received eligibility determination, the most commonly reported groups 

included persons age 65 and older and those with physical disability. Among people who received 

assistance with eligibility determination, the most common forms of assistance were advising 

consumers where applications could be obtained and assisting clients in completing applications. 

Fewer local ADRCs reported checking on the status of applications on behalf of clients or assisting 

clients with the collection of required documentation. These latter two types of assistance may be 

areas to improve, as they reflect oftentimes complicated aspects of applying for Medicaid and other 

public assistance. 

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How Services Were Provided. Approximately 44 percent of local ADRCs identified as 

independent, non-profit entities, while 37 percent identified as part of a local government. On 

average, respondents reported four core operating organizations. Nearly 80 percent of respondents 

identified the AAA as a core operating organization, while 46 percent identified the SUA as such. 

Smaller percentages named disability organizations as core to their operations, reflecting the 

traditional key role that the aging network has played in the development of the ADRC initiative. 

Implementing fee-for-service structures is a relatively underused business practice in aging and 

disability service organizations. Analyses of the process study data reflect this low usage, but also 

show that some organizations are using this type of business model; between 9 and 18 percent of 

respondents reported payment through fee-for-service for assessment, options counseling, 

transition support, screening, application assistance, and other types of services. Payment sources 

for fee-for-service provision varied, with some respondents indicating payment through Medicaid 

waivers, other state funds, Medicare, private health plans, or other sources. This innovative 

approach may be useful to consider in the context of shrinking resources and growing LTSS needs. 

As an intention of the ADRC initiative is to streamline the process by which individuals find and 

access LTSS, assessing consumer needs comprehensively and efficiently is an important aspect of 

ADRC functions. This study attempted to capture the degree to which ADRCs were using common 

assessment tools. Twenty-three percent of local ADRCs reported having a common assessment 

tool shared across all partners, while an additional 25 percent indicated that the tool was common 

across at least some partners but not all. About 43 percent, however, reported that each partner 

organization used its own assessment tool. Urban, independent, and centralized ADRCs were more 

likely to report common assessment tools than other subgroups. This finding suggests that more 

work is needed to encourage the use of shared tools in order to increase the efficiency and 

comprehensiveness of client assessment. 

4.3.6 Partnerships 

As discussed earlier in this section, partnerships are fundamental aspects of ADRC programs. The 

number and quality of partnerships and the extent of data sharing among partners were measured 

as part of this study. The average number of partners reported by local ADRCs was 16, and the 

average number of partnerships rated as highly functional was six, indicating that there may be 

some partnerships that are more valuable than others. 

At the state level, state agencies including mental health agencies, the Medicaid agency, and 

centers for independent living were the most frequently identified partners. However, at the local 

level, local organizations including AAAs, Alzheimer’s associations, and hospitals were the most 

frequently identified. Finally, with respect to data sharing, results were mixed. At the local level, 

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22 percent reported sharing data with operational partners, and an additional 28 percent indicated 

plans to develop data-sharing capacities. About 39 percent reported that no plans currently existed 

to share data with operational partners. On the service partner side (organizations with whom the 

ADRC partners as service providers), 24 percent reported that they currently share data, and 24 

percent reported plans to do so; 45 percent had no plans to share data with service partners. These 

findings underscore the importance of state and local partnerships in the ADRC model but 

highlight the variability across partnerships. 

More detailed analysis was done to examine how partnerships and partnership quality differed 

with respect to the type of organizations named as ‘core operating partners’. Three important 

results were found. First, a higher percentage of strong core operating partnerships were reported 

by ADRCs having an aging organization (e.g., SUA, AAA) as a core partner, compared to those 

that identified a CIL as a core partner. Second, a majority of ADRCs across all core partner types 

identified partnerships with local VAs, SUAs, state and county Medicaid agencies, AAAs, United 

Way, Alzheimer’s Associations, and CILs; the least-often identified partner organizations included 

state and county housing offices, and county departments on aging. Third, county and state 

housing offices were also the organizations most commonly rated as moderate or low functioning. 

Few strong partnerships were also reported with state mental health agencies, state developmental 

disability agencies, and vocational/rehabilitation service organizations. These results suggest that 

more technical assistance may be needed to improve partnerships with disability organizations. 

4.3.7 Comparison by Core Integration Dimensions 

Using data from the process study, we developed three core measures to assess the range of 

services provided by the ADRCs and their level of integration across the following three 

dimensions of ADRC operations: 

 Level of core service provision 

 Extent of site integration 

 Status of Medicaid integration 

Core Service Provision. The degree of core service provision was assessed by determining 

whether sites provided I&R, options counseling, eligibility determination, and care transition 

services. Approximately 34 percent were categorized as “high core service provision” sites, 

providing all four of the aforementioned services. Approximately 45 percent were categorized as 

“medium core service provision” sites, offering I&R, options counseling, and eligibility 

determination but not care transition services. The remaining 21 percent of sites were classified as 

“low core service provision” sites because they did not provide both options counseling and 

eligibility determination. 

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Bivariate analyses showed significant differences related to ADRC characteristics. Urban, 

independent, and decentralized ADRC sites were significantly more likely to be categorized into 

the high core service provision group, compared to rural, government, and centralized or mixedmodel ADRC sites. No effect of ADRC size was observed. In addition, some subgroup differences 

were seen with a number of key process study variables of interest. ADRCs categorized as having 

high core service provision were more likely to: 

 Indicate that lack of health insurance was not a barrier to accessing LTSS 

 Provide care transition services and options counseling 

 Specify nursing home diversion as a sought-after outcome 

 Indicate that grants enabled expansion of populations served 

 Indicate that partnerships positively impacted their ability to provide LTSS 

However, high core service provision ADRCs were less likely to indicate that shared data and 

person-centered services positively impacted their ability to provide LTSS. Medium-level core 

service provision ADRCs were more likely to indicate that grants enabled them to expand service 

populations and to provide care transition services. 

This assessment of core services provided by ADRCs highlights variability among sites that may 

directly impact consumers’ experiences and their ability to understand and access the full range of 

needed LTSS; consumers in areas served by low service provision ADRCs may be at a decided 

disadvantage in this regard. Further, consumers using ADRCs without care transition services may 

experience longer tenures in institutional care, more difficulty transitioning from acute to 

community-based settings, and potential increased risk of re-hospitalization. As about two-thirds 

of respondents were classified as medium or low core service provision sites, a majority of current 

and potential ADRC users are at risk of negative consequences associated with a lack of key 

service provision. 

Site Integration. The measure of the level of site integration was developed to capture the 

comprehensiveness of the services and supports offered by a local ADRC and the operational 

processes and degree of partnerships within and across agencies that facilitated these services. 

Respondents were categorized into three categories (low, medium, or high) according to the extent 

of their site integration. Just over 9 percent of sites were found to have a high level of integration, 

while 78 percent were considered medium level and 13 percent low level. 

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No significant differences in the level of site integration were found among ADRC site 

characteristic subgroups. However, some differences were observed in the relationship of site 

integration and a number of key process study variables. Low-level site integration ADRCs were: 

 Less likely to specify nursing home diversion as a sought-after outcome 

 More likely to report that staffing changes and person-centered services did not impact 

their ability to provide LTSS 

 More likely to report that shared data did impact their ability to provide LTSS 

High-level site integration ADRCs were: 

 More likely to report that federal grants enabled expansion of the populations served, “very 

much” increased the number of consumers served, and increased the number of 

partnerships 

 More likely to provide care transition services and options counseling 

Although only a small percentage of sites can be considered highly integrated in terms of the 

populations they serve, the services they provide, and the nature of their partnerships, the finding 

that an additional 78 percent are considered to have a medium-level of integration is positive. This 

suggests that most ADRCs are making progress in offering comprehensive services to broad 

population groups. However, continued support to encourage and strengthen integration is needed 

to ensure improvement for a large majority of respondents. 

Medicaid Integration. Local ADRCs receiving funding during FY 2013 from any of six 

Medicaid-related sources (e.g., CMS Systems Change Grants, PACE, Money Follows the Person 

Demonstration) were considered to be Medicaid integrated. Interestingly, 60 percent of 

respondents did not receive such funding and were not considered to be Medicaid integrated. This 

seemingly high percentage may reflect a lack of resources to apply for such funding or a low 

prioritization for securing external funds for Medicaid among local or state entities. This finding 

also points to potential disadvantages for older and disabled persons in communities with nonMedicaid integrated ADRCs; these consumers are unable to take advantage of innovative 

programs that have been associated with positive outcomes and increased ability to remain in the 

community. 

Subgroup analyses showed no differences in Medicaid integration by geographic region but did 

indicate that independent and decentralized ADRCs were more likely to be Medicaid integrated; 

mixed-model ADRCs were the least likely. With respect to process study variables of interest, 

Medicaid integrated sites were: 

142 
 

 

 

 

 

 

 

 

 More likely to report that person-centered services positively impacted their ability to 

provide LTSS 

 More likely to report that federal grants enabled expansion of populations served 

 More likely to identify nursing home diversion as a goal 

 More likely to provide care transition services and options counseling 

 Less likely to report that data sharing had a positive impact on ability to provide LTSS 

This last finding is of note, as the hypothesized relationship between data sharing and ability to 

provide services is a positive one. Here, it may be that Medicaid integrated sites have already 

implemented more streamlined practices or MIS that trump the benefit of data sharing as measured 

by this study. Instead, person-centered services and additional federal grants were cited as 

positively impacting service provision, suggesting that more direct service-oriented support to 

Medicaid integrated sites may be more valuable than support around data needs and infrastructure. 

143 
 

 

 

 

 

 

 

 

 

 

 

 

 

CHAPTER 5. OUTCOME STUDY FINDINGS AND IMPLICATIONS
 

This chapter provides an overview of the purpose of the outcome study and presents the study’s 

findings and implications. Section 5.1 describes the key research questions, and Section 5.2 

discusses the outcome study findings by domain. Section 5.3 summarizes the findings and explores 

the implications of the study. 

5.1 Outcome Study Purpose, Research Questions, and Research Domains 

5.1.1 Purpose 

The primary focus of the outcome study was to capture the experiences of clients seeking 

information about or access to LTSS and the challenges they face in receiving this assistance. The 

outcome study assessed: 

 How well ADRCs helped older adults and persons with disabilities access needed LTSS; 

 The factors that led clients to seek information on LTSS from ADRCs; 

 The type and processes of direct and referral services that ADRC provided; 

 The challenges that clients faced in accessing LTSS through ADRC; and 

 Client satisfaction with ADRCs. 

5.1.2 Research Questions 

The following research questions were explored in the outcome study: 

 How responsive and effective are ADRC representatives in addressing the needs of clients, 

overall and by subgroups of interest? 

 How useful is the information provided by the ADRCs? 

 What types of assistance do clients receive from the ADRCs (e.g., information and referral, 

options counseling, and eligibility determination)? 

 What are the factors/needs that lead clients to seek the assistance of ADRCs? 

 How seriously are respondents considering a move to a long-term care setting such as a 

nursing home when they contact ADRCs? 

 What are the challenges faced by clients in seeking information about LTSS? 

 What organizational, geographic, and client-level characteristics are most closely 

associated with positive consumer experiences? 

144 
 

 

 

 

 

 

 

 

 

 

 

 How satisfied are clients with the assistance received at ADRCs? 

5.1.3 Research Domains 

Our analyses of the key research questions listed above are grouped into the following domains: 

 Profile of participants; 

 Responsiveness and effectiveness of ADRCs; 

 Assistance with services; 

 Access to services; and 

 Participant satisfaction. 

We also explore the differences in participant experiences by the three core measures described 

earlier in the report: 

 Level of core service provision; 

 Extent of site integration; and 

 Status of Medicaid integration. 

5.2 Outcome Study Findings 

In this section, we first draw a profile of participating ADRCs and clients. In Section 5.2.1, we 

describe the coverage area of participating ADRCs, including the breadth of the coverage area, 

geographic location, and size of the participating sites. We describe the results of analyses of types 

of clients and their representatives who participated in the survey, and report the demographic 

characteristics of clients who were the subject of the survey, including gender, race, ethnicity, 

education, and household income. We also present findings on clients’ health (including selfreported health status and previous hospital admissions), health insurance coverage, living 

situations, marital status, and long-term care (LTC) facility status (i.e., ever resided in a LTC 

facility). 

Section 5.2.2 presents the findings on agency responsiveness and the ability of agency 

representatives. We describe agency responsiveness by examining the mode of initial ADRC 

contact by respondents, wait time to receive assistance, number of call attempts to the ADRC, and 

frequency with which respondents were required to describe their requests. We examine the ability 

of ADRC representatives in communicating with survey respondents and representatives’ 

145 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

knowledge about LTSS. Lastly, we report regression findings that assess the influence of client, 

ADRC, and community characteristics on the responsiveness and effectiveness of ADRCs. 

In Section 5.2.3, we cover the results of analyses on the services that respondents received from 

the ADRCs. We first examine the reasons why survey respondents contacted the ADRCs, 

including the top five most common reasons. We describe whether the respondent received direct 

access to services from the ADRC or was directed to another agency. We also examine the result 

of their contact and their experience with the referral process. Then, we report respondents’ 

experiences receiving assistance with Medicaid eligibility determination and other types of 

insurance. This section also describes respondents’ assistance with care transition services and 

examines their assistance with diversion from LTSS facilities. Lastly, we present regression 

findings to identify client, ADRC, and community characteristics associated with respondents 

reporting the five most common reasons for contacting the ADRC. 

Section 5.2.4 presents the processes and challenges faced by survey respondents in seeking 

information about LTSS from ADRCs as well as accessing LTSS from other agencies. We begin 

this section by describing how respondents found out about the ADRCs that they contacted for 

assistance, and whether the respondent contacted other agencies before contacting the ADRC. We 

examine whether the ADRCs followed up with consumers on referrals and the usefulness of 

information provided. Next, we describe respondents’ challenges in receiving services from the 

ADRCs, including length of time to receive service and reasons for not receiving the service at the 

ADRC, and respondents’ challenges in resolving issues. We also examine LTSS referrals by 

service type and the results of referrals, and lastly, we present regression analyses that explore the 

client, ADRC, and community characteristics associated with respondent challenges. 

In Section 5.2.5, we explore the level of satisfaction that survey respondents had with the various 

forms of assistance they received from ADRCs. We present respondents’ satisfaction with oneon-one options counseling, and report satisfaction with care transition services. Next, we examine 

satisfaction with the quality of services that respondents’ received at the ADRCs. We also describe 

the overall usefulness of ADRC services by examining whether respondents believed that the 

services or information received improved respondent awareness of LTSS needs, increased 

certainty of LTSS options, and was useful in selecting LTSS. Lastly, we present the value of 

ADRCs to respondents by reporting if respondents would tell a friend or relative to contact the 

ADRC and the likelihood of the respondent contacting the ADRC in the future. 

Section 5.2.6 presents a comparison of key outcomes by the three core measures—level of core 

service provision, extent of site integration, and status of Medicaid integration. 

146 
 

 

 

 

 

 

 

5.2.1 Profile of Participating ADRCs, Clients, and Respondents 

Participating ADRC Characteristics 

In this section, we present the profile of participating ADRCs in terms of their geographic location 

(rural/urban/state-wide) and size (number of consumers, FTEs, and partners). Note that the 

percentages provided are weighted by the sampling weights assigned to each ADRC. Unweighted 

percentages and a comparison with the distribution of all ADRCs participating in the process and 

outcome study surveys may be found in Appendix KK, Exhibits 1 and 2. 

ADRC Coverage Areas. As described in Section 3.3, Outcome Study Methodology, participants 

for the outcome study were recruited from two types of ADRCs in terms of breadth of coverage 

areas: ADRCs whose coverage area is the entire state (i.e., statewide ADRCs, n = 2) and ADRCs 

whose coverage area is limited to a few counties (local ADRCs, n = 19). The local ADRCs were 

further classified into rural and urban. As shown in Exhibit 5.1, two-thirds of participating ADRCs 

served areas that were primarily urban. Nearly one-third of ADRCs had coverage areas that were 

primarily rural, and less than one percent were statewide. 

Note: Percentages are weighted. 

Exhibit 5.2 shows the share of survey respondents by local and statewide ADRCs. Survey 

respondents overwhelmingly represented local ADRCs. 

147 
 

Note: Percentages are weighted. 

Size of ADRCs. As shown in Exhibit 5.3, in the 6-month period from October 2012 through March 

2013, 60 percent of participating ADRCs served between 501 and 2,500 consumers, defined as 

medium sized according to the process study data. Twenty-six percent of ADRCs were large, 

serving more than 2,500 consumers in that period, and 13 percent were small, serving 500 

consumers or less. The mean number of consumers served by these ADRCs was 1,069. 

148 
 

Note: Percentages are weighted. 

Exhibit 5.4 presents the number of FTE staff working at the participating ADRCs. It is noteworthy 

that a considerable number of ADRCs (42%) had more than 15 FTEs. The mean number of FTEs 

of participating ADRCs was 22.3. 

Note: Percentages are weighted. 

149 
 

 

 

 

 

As shown in Exhibit 5.5, participating ADRCs varied in terms of the number of agencies with 

which they partnered. Nearly half of ADRCs (43%) had more than 15 partners. The mean number 

of partners among this group was 11.5. 

Note: Percentages are weighted. 

Participating Client and Respondent Characteristics 

Types of Clients. Only respondents who contacted ADRCs about the LTSS needs of the following 

two categories of clients were eligible to participate in the survey: 

 Older adults (60 years of age and older); 

 Adults with disability (18 years of age and older). 

As shown in Exhibit 5.6, the sample of older adults and adults with disabilities were nearly equal 

with 77 percent of the sample being older adults and 79 percent being individuals with a disability. 

150 
 

 

 

 

Note: Percentages are weighted. 

Types of Respondents. Exhibit 5.7 displays the types of survey respondents. As previously noted, 

not all survey respondents were clients who needed services. Some had contacted the ADRC to 

seek LTSS information and services for their family, friends, patients, or clients. A majority of 

participants (59%) contacted the ADRC on their own behalf. 

151 
 

 

 

 

 

 

 

 

 

Notes: The respondent type indicates the relationship of the respondent to the person on whose 

behalf the contact was made. Therefore, the rows for child and parent have been switched when 

compared to Appendix T, Question PP2, which reports the relationship status of the person on 

whose behalf the contact was made from the perspective of the respondents. While the exhibit 

in the appendix reports the survey options as they appear in the questionnaire, this recoding was 

done based on how other questions in the survey were phrased. 

Percentages are weighted. 

Demographic Characteristics of Clients. Exhibit 5.8 shows the gender distribution of clients 

who needed LTSS services from ADRCs as reported by survey respondents. As indicated, more 

than two-thirds of ADRC clients (70%) were female. 

152 
 

 

 

Note: Percentages are weighted. Percentages do not equal 100 since 0.27 percent of 

respondents refused to answer. 

Client demographic characteristic are presented in Exhibits 5.9 and 5.10. Most of the ADRC clients 

were White (approximately 95%) (Exhibit 5.9), and 4 percent were Black or African American. 

Approximately 4 percent were Hispanic, Latino, or of Spanish origin (Exhibit 5.10). 

153 
Note: Percentages are weighted.
 

*Free text responses accompanying this question are available in Appendix U.
 

Note: Percentages are weighted. 

154 
More than one-third of ADRC clients (38%) reported being high school graduates, while a quarter 

(24%) had less than a high school education (Exhibit 5.11). The majority of ADRC clients reported 

a total household income of less than $40,000 (83%) (Exhibit 5.12). 

155 

Exhibit 5.12: Total Household Income of ADRC Clients 

Total Household Income Frequency Percentage

Less than or equal to $40,000 454 82.91 

More than $40,000 49 9.16 

Don’t know 29 4.90 

Refused 20 4.85 

Total 552 100 

Notes: Frequencies are unweighted; percentages are weighted.
 

 

 

 

 

Health Status of Participating Clients. The survey captured the health status of ADRC clients 

using two measures: 

 Current health status self-rated as excellent, good, fair, or poor 

 Whether admitted to a hospital in the previous 6 months. 

As depicted in Exhibit 5.13, the health status of ADRC clients, as reported by the survey 

respondents, varied considerably. Only 5 percent of respondents self-rated their health as 

“excellent,” while nearly 38 percent reported it was “poor”; moreover, 34 percent of clients had 

been admitted to a hospital in the 6 months prior to the survey administration (Exhibit 5.14). 

Note: Percentages are weighted. 

156 
 

 

 

 

 

Note: Percentages are weighted 

Client Health Insurance Type. Almost three-quarters of ADRC clients were covered by 

Medicare (74%); approximately 7 percent had no health insurance at all (Exhibit 5.15). Although 

the survey did not explicitly ask respondents to report Medicaid status, this information may have 

been provided in an open-ended response if the respondent reported another type of health 

insurance. Although it is likely an underestimate, about 15 percent of clients reported being 

enrolled in Medicaid. Further, 32 percent of ADRC clients who were 65 years old or older did not 

report having Medicare coverage (Exhibit 5.16). 

157 
Notes: Percentages do not add up to 100 because respondents could choose multiple options. Percentages are weighted. 

*Free text responses accompanying this question may be found in Appendix U. 

Marital and Residence Status of Participating Clients. As shown in Exhibit 5.17, 27 percent 

of ADRC clients were married at the time of the survey. One-third each were widowed or 

divorced/separated. Almost half (48%) of respondents lived with a spouse or other family member 

at the time of the survey administration, and 41 percent lived alone (Exhibit 5.18). Eighty percent 

of ADRC clients lived in their own house or apartment, and just less than 1 percent lived in nonmedical custodial housing (Exhibit 5.19). About 4 percent of ADRC clients lived in an assisted 

living setting and 8 percent lived in a nursing home at some point (Exhibit 5.20). Finally, Exhibit 

5.21 illustrates that clients who ever lived in an assisted living setting had a mean length of stay of 

24 months as compared to 9 months for those who ever lived in a nursing home. 

158 

Exhibit 5.16: Client Age by Medicare Enrollment

Age Do Not Have Medicare Have Medicare Total 

Younger than 65 68.08 25.22 36.32 

65 or older 31.92 74.78 63.68 

Total 100 100 100 

Note: Percentages are weighted.
 

 

 

 

Notes: Only those clients who were not reported as “passed away” when asked to rate their current 

health were asked this question. Percentages are weighted. 

Notes: Only those clients who were not reported as “passed away” when asked to rate their current 

health were asked this question. Percentages are weighted. 

159 
160 

Exhibit 5.19: Residence Type of ADRC Clients

Residence Type Frequency Percentage

My own house or apartment (e.g., free-standing, row house, town 

house, apartment, etc.) 437 79.82 

In some other setting, specify* 51 8.66 

In an assisted living setting 31 4.07 

In a nursing home 10 5.26 

Non-medical custodial housing (e.g., group home, congregate house, 

half-way house, safe-house, recovery house, board and care house, 

other residential non-medical adult care facility)

7 0.91 

Refused 4 0.91 

In a continuing care retirement setting 4 0.34 

Don’t know 1 0.02 

Total 545 100 

Notes: Only those clients who were not reported as “passed away” when asked to rate their current health were asked 

this question. Percentages are weighted; frequencies are unweighted.

*Free text responses accompanying this question are available in Appendix U.
Notes: This question was asked of all those who did not respond “In an Assisted Living 

Setting” when asked to describe their current housing situation. Percentages are weighted. 

161 

Exhibit 5.21: Length of Time in Assisted Living Setting or Nursing Home 

Mean* Median Mode Range 

Min Max 

Assisted Living Setting 23.63 9 24 1 144 

Nursing Home 9.32 2 1 1 120 

 *Length of time is given in months.
 

 

 

 

 

 

 

 

 

 

 

 

 

5.2.2 Agency Responsiveness and Effectiveness 

Agency Responsiveness 

Agency responsiveness was measured by assessing the ease with which respondents could directly 

talk with an ADRC representative during their initial contact with the agency. As shown in Exhibit 

5.22, the majority of survey respondents (86%) contacted the ADRC via telephone during their 

initial contact; only 14 percent visited the ADRC in person. Among those whose initial contact 

was through an in-person visit, 57 percent waited less than 5 minutes to speak with someone who 

could assist them with their request for information or services (Exhibit 5.23), while 12 percent 

waited more than 20 minutes. For those whose first contact was by telephone, 74 percent spoke 

with a representative who could assist with their request during their first telephone contact; 18 

percent reported that they did not speak with someone who could help with their request (Exhibit 

5.24). Of those who did not speak with a representative who could help with their request during 

their first telephone contact, 38 percent contacted the ADRC one additional time before speaking 

with a representative, and 11 percent contacted the ADRC four or more times before receiving the 

requested information or services (Exhibit 5.25). Less than 3 percent did not contact the ADRC 

again after their initial contact, although they did not receive the assistance they needed during 

their initial contact. The majority of respondents (70%) reported that they only needed to describe 

or explain their request once (Exhibit 5.26). 

162 
Notes: This question was asked of those where the mode of contact was “In -Person Visit.” Percentages are 

weighted. 

163 
Note: Percentages are weighted. 

Effectiveness of Communication. The effectiveness of ADRC representatives’ communication 

with respondents was assessed using the following survey items: 

 Clear and understandable communication 

 Listen with close attention 

 Probe to correctly assess client needs. 

164 

Exhibit 5.25: Additional Contacts Before Speaking with ADRC Representative Who Could 

Help with Request

Number of Contacts Percentage

None 2.76 

One 38.03 

Two 13.51 

Three 8.15 

Four or more 11.32 

Don’t Know 26.24 

Total 100 

Note: Percentages are weighted.
A majority of respondents (83%) indicated that the information they received from the ADRC 

representative was very clear and understandable (Exhibit 5.27). In contrast, only 3 percent 

reported that it was not at all clear or understandable. Exhibit 5.28 provides a breakdown of 

respondents’ perceptions of the attentiveness of ADRC representatives. As illustrated, a vast 

majority of respondents felt that the ADRC representatives “definitely” paid close attention to 

what they were saying when they contacted the site (84%). Furthermore, a majority of respondents 

(87%) felt that the ADRC representative asked questions that correctly assessed the needs of the 

client (Exhibit 5.29). 

Note: Percentages are weighted. 

165 

Exhibit 5.28: Attentiveness of ADRC Representative

Paid Close Attention Percentage

Yes, definitely 83.52 

Yes, probably 10.20 

No, probably not 1.88 

No, definitely not 3.31 

Don’t know 1.10 

Refused - 

Total 100 

Note: Percentages are weighted.
Knowledge about LTSS Services. Most respondents indicated that the ADRC representative was 

knowledgeable about the reason they contacted the ADRC (Exhibit 5.30). More than three-quarters 

of respondents (78%) reported that the representative was very knowledgeable. In contrast, only 2 

percent reported that the representative was not at all knowledgeable. More than two-thirds (69%) 

of respondents who requested assistance related to long-term care needs reported that the ADRC 

representative worked with them to develop a plan outlining next steps in meeting ongoing LTSS 

needs (Exhibit 5.31); only 16 percent reported that the representative did not work with them. 

166 

Exhibit 5.29: ADRC Representatives’ Assessment of Clients’ Needs

Asked Questions That Correctly Assessed Needs Percentage

Yes 87.17 

No 8.34 

Don’t know 4.49 

Refused - 

Total 100 

Note: Percentages are weighted.

Exhibit 5.30: ADRC Representatives’ Knowledge About Requested Information or 

Services

Level of Knowledge Percentage

Very knowledgeable 78.45 

Somewhat knowledgeable 14.33 

Not very knowledgeable 2.91 

Not at all knowledgeable 2.10 

Don’t know 2.21 

Refused - 

Total 100 

Note: Percentages are weighted.
 

 

 

Note: Percentages are weighted. 

As shown in Exhibit 5.32, subgroup analyses of assistance from ADRC representatives revealed 

that statewide ADRCs were significantly more likely than local sites to assist respondents with 

long-term care planning (22% vs. 16%; p ≤ .05). Detailed results may be found in Appendix FF, 

Exhibit 1. 

167 
Note: Percentages are weighted. 

As shown in Exhibit 5.33, 71 percent of respondents who received assistance with long-term care 

planning reported that the plan definitely reflected the client’s needs and preferences, while less 

than 5 percent reported that it definitely did not. 

168 

Exhibit 5.33: Accuracy of Long-Term Care Plan

Long-Term Care Plan Accurately Reflects Client’s Needs and 

Preferences Percentage

Yes, definitely 70.84 

Yes, probably 18.74 

No, probably not 2.09 

No, definitely not 4.82 

Don’t know 3.51 

Refused - 

Total 100 

Note: This question was asked of all those who responded “Yes” when asked if the representative of the ADRC worked 

with the client to develop a plan for obtaining LTSS. Percentages are weighted.
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Regression Findings – Responsiveness and Effectiveness of ADRCs 

Regression analyses were conducted to investigate the association of client, ADRC, and 

community characteristics with the responsiveness and effectiveness of ADRCs. The following 

two outcomes were explored: 

 ADRC representative paid close attention to the respondent. 

 ADRC representative explained the choices for staying in the community. 

In this section, we discuss only those associations with client, ADRC, and community 

characteristics that are statistically significant at the 95 percent or higher confidence level. Average 

marginal effects and the p-value of the estimates are reported in parentheses. The complete results 

of these regression models are provided in Appendix JJ, Exhibit 1. 

ADRC Representative Paid Close Attention to the Respondent. The first outcome captures 

whether the ADRC representative paid close attention to what the respondent said. The survey 

question offered four ordered options. Small sample sizes for some of the response categories 

precluded the implementation of ordered choice regression models. Therefore, in order to run a 

probit regression model with a binary outcome, “Yes, Definitely” and “Yes, Probably” were 

recoded into a single “Yes” category, and “No, Definitely Not” and “No, Probably Not” into a 

single “No” category. In addition to the ADRC, community, and client characteristics, the reasons 

for contact were also included to capture unobserved ADRC and respondent characteristics. 

Detailed results are shown in Appendix JJ, Exhibit 1, column 1. 

Respondents with disabilities and those who called the ADRC on their behalf were less likely to 

report that the ADRC representative paid close attention to what they said were than older adults 

who did not report disabilities (-4.9 percentage points; p ≤ .05). Married clients were also less 

likely than unmarried clients to report that they received close attention from the ADRC 

representative (-7.9 percentage points; p ≤ .01). However, clients with a high school diploma were 

more likely to find that the representative paid closer attention than did those who did not have a 

high school diploma (7.0 percentage points; p ≤ .05). 

Respondents contacting rural ADRCs were more likely than those contacting urban ADRCs to 

report that they received close attention from the agency representative (11.9 percentage points; p 

≤ .01). Statewide ADRCs were associated with a higher likelihood of respondents receiving close 

attention compared to local ADRCs (11.2 percentage points; p ≤ .01). 

The results of the analysis of the number of home health agencies per 10,000 individuals 60 and 

above in a community and the number of nursing home beds per 1,000 individuals 60 years and 

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above demonstrated opposite directions. The likelihood of respondents’ reporting that they 

received close attention from ADRC representatives increased with the number of home health 

agencies within the ADRC service area (17.7 percentage points; p ≤ .01) whereas the likelihood 

decreased with the number of nursing home beds in the ADRC service area (-54.1 percentage 

points; p ≤ .01). 

ADRC Representative Explained the Choices for Staying in the Community. The second 

outcome that was analyzed was whether the ADRC representative explained to the respondent the 

choices for staying in the community. This model includes all client, ADRC, and community 

characteristics, including reasons for contact. Detailed findings are presented in Appendix JJ, 

Exhibit 1, column 2. 

Clients with a disability or respondents who called on their behalf had a higher likelihood of 

reporting that the ADRC representative explained their choices for staying in the community than 

did those without a disability (19.5 percentage points; p ≤ .01). Clients with self-reported poor 

health status or respondents who called on their behalf were also more likely to report that the 

ADRC representative explained choices for staying in the community than did those with a better 

self-reported health status (19.6 percentage points; p ≤ .01). Finally, we found that respondents 

contacting statewide ADRCs were associated with a lower likelihood of the ADRC representative 

explaining their choices to stay in the community than those contacting non-statewide agencies (-

31.8 percentage points; p ≤ .01). 

5.2.3 Assistance with Services 

Reasons for and Results of Contacting ADRCs 

Reasons for Contact. Exhibit 5.34 presents the five most common reasons why respondents 

contacted ADRCs. Approximately one-fifth of respondents contacted the ADRCs for Medicarerelated questions (21%) and about the same proportion contacted for Medicaid-related questions 

(20%). In Exhibit 5.35, we compare the most common reasons for contact by category of 

respondent. Among older adults without disability, Medicare was the most frequent reason for 

contact (36%) whereas for both older adults with disability (25%) and younger adults with 

disability (26%) the most frequent reason for contact was personal care. While personal care and 

attendant care services are among the most common reasons for contact by older and younger 

individuals with disability, it was not one of the five most common reasons for contact for older 

adults without disability. The reasons for contacting an ADRC differed by respondent type. Clients 

who contacted ADRCs for themselves most commonly contacted for Medicare information (25%), 

170 
whereas individuals who contacted on behalf of a client most commonly requested information 

about personal care services (29%) (Exhibit 5.36). 

Note: Percentages are weighted. 

171 

Exhibit 5.35: Most Common Reasons for Contacting ADRCs by Age and Disability Status

Older Adults 

without 

Disability

Freq. % Older Adults 

with Disability Freq. % 

Younger 

Adults with 

Disability

Freq. % 

Medicare 39 36.11 Personal Care 109 24.55 Personal Care 35 26.72 

Housing 10 9.26 Medicaid 54 12.16 Medicare 15 11.45 

Income 

Assistance 7 6.48 Medicare 42 9.46 Attendant Care Services 14 10.69 

Medicaid 6 5.56 Attendant Care 

Services 36 8.11 Medicaid 9 6.87 

Energy 

Assistance 4 3.70 Housing 32 7.21 Housing 8 6.11 

Notes: Frequencies are unweighted; percentages are weighted. They do not add to 100 because the exhibit shows 

only the five most common reasons for contact.
Several analyses were conducted to identify statistically significant differences between subgroups 

based on reason for contacting the ADRC. Differences in reasons by client education, income, age, 

disability, and health status were examined, as well as whether the respondent contacted an urban 

or rural, statewide or local ADRC. 

As shown in Exhibit 5.37, there were significant between-group differences based on education. 

Respondents with greater than a high school education were significantly more likely than clients 

with a high school diploma or less to contact ADRCs about Medicare and housing (p ≤ .10). Clients 

with a high school diploma were more likely than those with more or with less education to contact 

ADRCs about Medicaid (p ≤ .10). Clients without a high school diploma were more likely than 

others to contact ADRCs about nutrition (p ≤ .10, Exhibit 5.37). See Appendix Z, Exhibit 1, for 

detailed results. Analyses also indicated that clients with a disability were more likely than clients 

without a disability to cite one of the five most common reasons for ADRC contact except for 

Medicare questions (p ≤ .01, Exhibit 5.38). See Appendix CC, Exhibit 1 for detailed results. 

Respondents who self-reported their health as poor were significantly more likely than those who 

reported fair, good, or excellent health to inquire about Medicaid, personal care services, and 

nutrition services (p ≤ .05, Exhibit 5.39). For detailed results, see Appendix BB, Exhibit 1. 

Statistically significant differences were also found between urban and rural ADRCs. Respondents 

contacting rural ADRCs were less likely to cite Medicaid questions and housing services as the 

reason for contact compared to respondents from urban ADRCs (p ≤ .10, Exhibit 5.40). There were 

no significant differences between rural and urban ADRCs in terms of the percentage of 

respondents contacting them for personal care and nutrition services (p ≤ .10). See Appendix DD, 

172 

Exhibit 5.36: Most Common Reasons for Contacting ADRCs by Self versus Representatives

Self Frequency Percentage Representative Frequency Percentage

Medicare 72 24.66 Personal Care 75 28.85 

Personal Care 37 12.67 Medicaid 39 15.00 

Medicaid 21 7.19 Attendant Care 

Services 26 10.00 

Housing 19 6.51 Housing 23 8.85 

Transportation 14 4.79 Caregiver/Respite 

support 

13 5.00 

Note: Frequencies are unweighted; percentages are weighted. They do not add to 100 because the exhibit shows 

only the five most common reasons for contact.
 

 

Exhibit 1 for details. Clients who contacted local ADRCs were significantly more likely than 

clients who contacted statewide ADRCs to inquire about the top five reasons, as seen in Exhibit 

5.41 (p ≤ .01). See Appendix FF, Exhibit 2 for detailed results. 

Note: Percentages are weighted. 

173 
Note: Percentages are weighted. 

Note: Percentages are weighted. 

174 
Note: Percentages are weighted. 

Note: Percentages are weighted. 

175 
 

 

 

 

 

 

 

 

 

Similarly, survey respondents who contacted the agency on their own behalf were significantly 

more likely than respondents who called on behalf of others to cite one or more of the five most 

common reasons for contact (p ≤ .10) (Exhibit 5.42). The only instance where this was not the case 

was for Medicaid questions, where more respondents calling on behalf of a parent asked about 

Medicaid compared to those who called on their own behalf. 

Notes: The respondent type indicates the relationship of the respondent to the person on whose behalf the contact
 

was made. Therefore, the rows for child and parent have switched when compared to Appendix T, Exhibit PP2,
 

which reports the relationship status of the person on whose behalf the contact was made from the perspective of
 

the respondents. While the exhibit in the appendix reports the survey options as they appear in the questionnaire,
 

this recoding was done based on how other questions in the survey were phrased.
 

Percentages are weighted.
 

176 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Regression Findings – Reasons for Contact 

Exhibit 5.34 shows that the three most frequently cited reasons why respondents contacted ADRCs 

were: 

 Medicare questions 

 Medicaid questions 

 Personal care. 

Regression analyses were conducted to explore the relationship between client, ADRC, and 

community characteristics and the most common reasons for contacting ADRCs. Appendix JJ, 

Exhibit 2 shows the detailed regression results. 

Medicare Questions. The estimated average marginal effects from the probit regressions on 

Medicare questions as a reason for contact are presented in Appendix JJ, Exhibit 2, column 1. 

Clients who lived alone or respondents who contacted ADRCs on behalf of such individuals were 

more likely to have questions about Medicare compared to clients who lived with others (10.5 

percentage points; p ≤ .01). In addition, married clients were more likely than unmarried clients to 

contact the ADRCs regarding Medicare (12.8 percentage points; p ≤ .01). Individuals contacting 

statewide ADRCs were more likely than those contacting local ADRCs to have Medicare questions 

(72.5 percentage points; p ≤ .01). 

Medicaid Questions. The association of client, ADRC, and community variables with Medicaid 

questions as the main reason for contacting ADRCs is shown in Appendix JJ, Exhibit 2, column 

2. Those who were single, widowed, or divorced were more likely than married clients to contact 

regarding Medicaid (-14.8 percentage points; p ≤ .05). Moreover, White non-Hispanic clients were 

more likely to contact the ADRCs regarding Medicaid than were non-Whites and Hispanic clients 

(17.6 percentage points; p ≤ .01). Finally, respondents who contacted statewide ADRCs were 

significantly more likely to request Medicaid information than respondents who contacted local 

ADRCs (74.9 percentage points; p ≤ .01). 

Personal Care. The third most common reason for contacting ADRCs was personal care. The 

average marginal effects from the probit regression analysis with personal care as the reason for 

contact are presented in Appendix JJ, Exhibit 2, column 2. Statistically significant findings resulted 

from these analyses. For example, respondents with disabilities were more likely than clients 

without disabilities to contact ADRCs for personal care reasons (10.3 percentage points; p ≤ .01). 

At the ADRC level, respondents were more likely to contact rural ADRCs for personal care reasons 

than respondents from urban ADRCs (42 percentage points; p ≤ .01). Furthermore, the larger the 

number of nursing home beds in the ADRC service area, the greater the likelihood that respondents 

177 
 

 

 

 

 

 

 

 

 

contacted ADRCs for personal care reasons (3.1 percentage points; p ≤ .05). However, the more 

home health agencies in the community, the lower the likelihood of respondents contacting 

ADRCs for personal care reasons (-1.2 percentage points; p ≤ .05). 

Direct Access to Services 

Survey participants were asked whether needed services were received directly from ADRCs or 

indirectly through referrals to another agency, or both. A majority of respondents (59%) reported 

that access to the services was received directly from the ADRC (Exhibit 5.43). Nearly 28 percent 

reported that needed services were received indirectly by a referral to another agency. How 

respondents received access to services was analyzed to identify statistically significant differences 

by several ADRC-level subgroups. The only statistically significant difference was between 

statewide and local ADRCs. Respondents from local ADRCs were more likely than those from 

statewide ADRCs to report that they received access to needed services directly from the site (p ≤ 

.05) (Exhibit 5.44). Detailed results are presented in Appendix FF, Exhibit 3. Finally, of the 

respondents who reported that access to needed services was received indirectly through another 

agency, 62 percent reported that the ADRC representative helped them connect with the services 

they needed. Nearly 36 percent reported that their ADRC representative did not help them connect 

with needed services (Exhibit 5.45). 

Note: Percentages are weighted. 

178 
Note: Percentages are weighted. 

Results of Contact. Exhibit 5.46 presents the results of analyses on respondents’ contact with 

ADRCs. Information assistance and/or referrals were selected most often as the result of the 

contact (86%). More than half of the respondents (52%) reported that their contact resulted in 

benefits counseling or eligibility determination, and over one-quarter (28%) reported that their 

contact resulted in options counseling or peer support/counseling. 

179 

Exhibit 5.45: ADRC Representative Connected Respondent to Needed Services

Helped Connect to Services* Percentage

Yes 61.91 

No 35.65 

Don’t know 2.44 

Refused - 

Total 100 

Note: This question was asked of all respondents who did not respond “Directly” when asked how they received access 

to services. Percentages are weighted.
 

 

 

 

 

 

 

 

 

Notes: Percentages are weighted. Percentages do not add up to 100 because respondents could choose 

multiple options. 

The results of contact with ADRCs were analyzed by client and ADRC characteristics. There were 

statistically significant between-group differences for income, gender, and local versus statewide 

ADRC on receiving I&R/I&A. Specifically, respondents with income of $40,000 or less as 

compared to those with income over $40,000 (p ≤ .01), those who are female as compared to male 

(p ≤ .01), and those who contacted a local ADRC as compared to a statewide ADRC, (p ≤ .01) 

were more likely to receive information assistance or referrals as a result of their contact. In 

addition, there was a trend toward significance for those who contacted an urban ADRC being 

more likely (p ≤ .10) to receive information assistance or referrals compared to those who 

contacted a rural ADRC. The results of these subgroup analyses are shown in Exhibits 5.47–5.50. 

Detailed results may be found in Appendix AA, Exhibit 1; Appendix X, Exhibit 1; Appendix FF, 

Exhibit 4; and Appendix DD, Exhibit 2, respectively. 

180 
Note: Percentages are weighted. 

Note: Percentages are weighted. 

181 
Note: Percentages are weighted. 

Note: Percentages are weighted. 

Significant differences were also revealed in the analyses of options counseling/peer support. 

Respondents who contacted rural ADRCs as compared to urban ADRCs, and those who contacted 

182 
 

 

 

 

 

 

 

 

 

 

statewide ADRCs as compared to local ADRCs, were significantly more likely to receive options 

counseling (p ≤ .01 and p ≤ .01, respectively). Detailed results are presented in Appendix DD, 

Exhibit 3, and Appendix FF, Exhibit 5, respectively. Furthermore, respondents who contacted 

ADRCs that served 500–2,500 consumers in the previous 6 months (compared to those that served 

fewer than 500 or more than 2,500 consumers) and respondents who contacted ADRCs with more 

than 15 FTEs (compared to ADRCs with 0–5 and 5–15 FTEs) were less likely to receive options 

counseling or peer support/counseling as a result of their contact with ADRCs (p ≤ .01 and p ≤ 

.05, respectively). Detailed results are presented in Appendix GG, Exhibit 1 and Appendix HH, 

Exhibit 1, respectively. Age differences approached significance: adults aged 60 or older were 

more likely to receive options counseling or peer support/counseling as a result of their contact 

with an ADRC than adults under 60 years of age (p ≤ .10). These results are presented graphically 

in Exhibits 5.51–5.55. For detailed results, see Appendix Y, Exhibit 1. 

Note: Percentages are weighted. 

183 
Note: Percentages are weighted. 

Note: Percentages are weighted. 

184 
Note: Percentages are weighted. 

Note: Percentages are weighted. 

185 
 

 

 

 

 

 

 

 

 

Several client and ADRC characteristics showed statistically significant differences in the 

likelihood of receiving benefits counseling or eligibility determination. For example, male clients 

were more likely than their female counterparts to receive benefits counseling or eligibility 

determination as a result of their contact with ADRCs (p ≤ .05). For detailed results, see Appendix 

X, Exhibit 2. Respondents contacting urban (compared to rural) or local (compared to statewide) 

ADRCs were also more likely to receive benefits counseling or eligibility determination services 

(p ≤ .01 and p ≤ .01, respectively). For detailed results, see Appendix DD, Exhibit 4 and Appendix 

FF, Exhibit 6, respectively. Respondents contacting medium-sized (compared to small and large) 

ADRCs, and ADRCs reporting fewer than 5 or more than 15 FTEs (compared to ADRCs with 5– 

15 FTEs) were more likely to receive benefits counseling or eligibility determination as a result of 

their contact with the ADRC (p ≤ .01 and p ≤ .05, respectively). For details, see Appendix GG, 

Exhibit 2 and Appendix HH, Exhibit 2, respectively. The results of these cross-tabulations are 

presented in Exhibits 5.56–5.60. 

Note: Percentages are weighted. 

186 
Note: Percentages are weighted. 

Note: Percentages are weighted. 

187 
Note: Percentages are weighted. 

Note: Percentages are weighted. 

188 
 

 

 

 

 

 

Group differences on care transition assistance were also statistically significant. Clients with an 

income of $40,000 or less compared to those with an income over $40,000 (p ≤ .05), those who 

were female compared to male (p ≤ .01), and clients with disability compared to those who did not 

have a disability (p ≤ .01) were more likely to receive care transition assistance as a result of their 

contact with the ADRC. However, as shown, only 3 percent of respondents received care transition 

assistance. For detailed results, see Appendix AA, Exhibit 2; Appendix X, Exhibit 3; and Appendix 

CC, Exhibit 2, respectively. The results of these analyses are displayed below in Exhibits 5.61 -

5.63. 

Note: Percentages are weighted. 

189 
Note: Percentages are weighted. 

Note: Percentages are weighted. 

190 
 

 

 

 

 

Finally, statistically significant group differences were also found for receipt of crisis counseling. 

Clients with a disability were less likely to receive crisis counseling than clients who did not have 

a disability (p ≤ .01, Exhibit 5.64). Clients who reported poor health were more likely to receive 

life skills training or support as a result of their contact with the ADRC compared to those who 

reported better health (p ≤ .10, Exhibit 5.65). Detailed results are presented in Appendix CC, 

Exhibit 3, and Appendix BB, Exhibit 2, respectively. 

Note: Percentages are weighted. 

191 
 

 

 

 

 

 

 

 

 

We also explored whether the results of contact with the ADRC varied based on the reasons for 

contact (Exhibit 5.66). I&A/I&R was a result of contact for the large majority of respondents 

(81%). Respondents whose contact with the ADRC resulted in information assistance and/or 

referrals were not statistically more likely or less likely to have contacted the ADRC for any of the 

most common reasons. 

Respondents who contacted the ADRC for reasons related to personal care or housing were more 

likely to receive options counseling or peer support/peer counseling than those who contacted for 

the other most frequently reported reasons, although this finding only approached statistical 

significance (p ≤ 0.10). Those who contacted ADRCs with questions about Medicare (92%) or 

Medicare (53%), however, were significantly more likely to receive benefit counseling or 

eligibility determination services (p ≤ .01). 

192 
Exhibit 5.67 presents the results of cross-tabulating the results of contact with whether the services 

were received directly or indirectly from ADRCs. Exhibit 5.43, above, showed that 59 percent of 

survey respondents reported that they received the services directly, while 28 percent received 

them indirectly. Exhibit 5.67, Part I illustrates that most services that respondents requested were 

more likely to be provided directly by the ADRCs. The only exception is care transition assistance, 

where 77 percent of respondents reported they received this service indirectly compared to 18 

percent who reported that they received it directly. Almost equal proportions (49% and 43%) of 

respondents who reported receiving options counseling or peer support/counseling were direct and 

indirect recipients of services, respectively. 

Exhibit 5.67 Part II shows that the most frequent result of contact was I&A/I&R, regardless of the 

reported path of service receipt, with more than eighty percent of direct and indirect recipients of 

service(s) reporting that they received the service. The differences between results of contact by 

direct or indirect receipt of data were statistically significant for options counseling (p ≤ .05), and 

life skills training or support (p ≤ .05). 

193 

Life skills training or support 0.14 - - - - 

Notes: Percentages are based on 312 respondents reporting one of the five most common reasons for contact. 

Percentages are weighted.

Exhibit 5.66: Result of Contact, by the Most Common Reasons for Contact 

Results of Contact Medicare 

Questions 

Medicaid 

Questions

Personal 

Care Nutrition Housing

Information Assistance and/or 

Referral(s) (not including options 

counseling) 

81.33 79.45 78.50 94.96 97.45 

Options Counseling or Peer 

Support/Peer Counseling 31.51 20.12 58.05 18.93 46.97 

Benefits Counseling or Eligibility 

Determination 92.29 53.05 22.00 18.42 35.92 

Transition Assistance 4.83 - - 3.70 7.04 

Crisis Intervention - - - - - 
Referral Process. Of the respondents who were referred to another agency and who reported that 

the ADRC representative helped them connect with requested services, only one-quarter (26%) 

reported that the ADRC representative provided a “warm transfer” (i.e., transferred the call to the 

agency to which they were referred) (Exhibit 5.68). Of the respondents who reported that the 

ADRC did not transfer their call, nearly 75 percent reported that the ADRC representative gave 

them contact information, such as a telephone number, address, or web address of the agency or 

organization that provided the services (Exhibit 5.69). Of those who reported that the ADRC did 

not provide the contact information, more than 75 percent reported that the ADRC representative 

did not contact the service provider on the client’s behalf (Exhibit 5.70). Finally, of those who 

reported that the ADRC representative transferred their call, provided contact information, or 

arranged contact between the respondent and the referral agency, 31 percent reported that the 

provider had the correct information about the services the client was seeking (see Exhibit 5.71). 

Over 48 percent reported that the provider did not have the correct information, and the respondent 

had to start the process again. 

194 

Exhibit 5.67: Result of Contact by Path of Service Receipt

Result of Contact Path of Receiving Services

Directly Indirectly Both Total 

Part I -– Row Percentages

Information Assistance and/or Referral(s) 65.88 30.05 4.07 100 

Options Counseling or Peer Support/Counseling 49.13 43.42 7.45 100 

Benefits Counseling or Eligibility Determination 72.56 23.75 3.69 100 

Transition Assistance 17.98 76.97 5.06 100 

Crisis Intervention 100 0 0 100 

Life Skills Training or Support 0 57.14 42.86 100 

Part II – Column Percentages

Information Assistance and/or Referral(s) 87.05 84.93 80.39 N/A

Options Counseling or Peer Support/ Counseling 19.80 37.26 44.92 N/A

Benefits Counseling or Eligibility Determination 58.51 40.96 44.73 N/A

Transition Assistance 0.42 3.81 1.76 N/A

Crisis Intervention 2.76 0 0 N/A

Life Skills Training or Support 0 0.11 0.59 N/A

Notes: Percentages do not add up to 100 because respondents could choose multiple options. Percentages are weighted.
Notes: This question was asked of all those who responded “Yes” when asked if the representative of the 

ADRC helped connect the client to needed services. Percentages are weighted. 

195 

Exhibit 5.69: Provision of Contact Information for Agency to Which Client Was Referred

Gave Contact Information Percentage

Yes 73.25 

No 26.75 

Don’t know - 

Refused - 

Total 100 

Notes: This question was asked of all those who did not respond “Yes” when asked if the representative of the ADRC 

transferred the call to an agency that provided the needed service. Percentages are weighted.
Assistance with Medicaid Eligibility Determination 

Assistance with Medicaid Application. Respondents who were not receiving Medicaid benefits 

at the time of the survey and who spoke to an ADRC representative about Medicaid eligibility 

were included in the following analyses. As shown in Exhibit 5.72, a majority (58%) of 

respondents reported that they did not receive specific information on applying for financial 

assistance for healthcare and residential support services. There were no statistically significant 

differences related to ADRC size or geographic location in whether respondents received 

information on applying for Medicaid services. 

Of those who reported that they received specific information on federally sponsored financial 

assistance for healthcare and residential support services, 47 percent reported that they completed 

an application (Exhibit 5.73). Of respondents who completed an application, 70 percent reported 

196 

Exhibit 5.70: ADRC Representative Contacted Agency for Respondent 

Arranged Contact Between Respondent and Referred to Agency Percentage

Yes 22.73 

No 76.82 

Don’t know 0.45 

Refused - 

Total 100 

Notes: This question was asked of all those who responded “No” when asked if the representative provided contact 

information for an agency that provided the client with needed services. Percentages are weighted.

Exhibit 5.71: Provider’s Knowledge of Referred Client’s Needs

Referred to Agency/Provider Had Information About Needed Services Percentage

Provider had the information 30.84 

Provider had the information but it was not correct or it was incomplete and you 

had to start the process again 6.23 

Provider did not have the information – had to start the process again 48.35 

Don’t know 14.48 

Refused 0.11 

Total 100 

Notes: This question was asked of all those who responded “Yes” when asked if the ADRC representative transferred 

the call to an agency that provided the needed service, if the representative provided contact information for an agency 

that provided the client with needed services, or if the ADRC representative contacted the outside agency on the 

client’s behalf. Percentages are weighted.
 

 

 

 

 

 

 

 

 

 

 

 

 

that they received assistance from the ADRC in completing it (Exhibit 5.74). Of the respondents 

who reported not completing an application, 80 percent (n = 85) provided a reason. The most 

common reason was that respondents believed they or the person on whose behalf they contacted 

the agency was ineligible. The next most common response was that they were “working on 

applying.” 

Some respondents did not complete an application because they did not see a need for Medicaid 

(n = 13), although six of those respondents thought they or their relative might need it in the future. 

Nine respondents mentioned that they already had Medicare, and two reported that they had 

completed an application (despite giving a “no” response). For some respondents (n = 5), they or 

their relatives were too sick to fill out the application. Other respondents (n = 3) described being 

“proud” or “independent of the government” as their reasons for not completing an application. 

Notes: This question was asked of all those who did not indicate they already receive Medicaid benefits 

or who said they did not talk about being eligible for Medicaid benefits when told the next questions 

would focus on Medicaid eligibility. Percentages are weighted. 

197 
Information on Other Types of Insurance. Of those who spoke to an ADRC representative about 

Medicaid eligibility, 20 percent reported that the ADRC provided information on other insurance 

options, including private coverage and other types of government insurance (Exhibit 5.75). 

198 

Exhibit 5.73: Respondent Completed Application for Federally Sponsored Financial 

Assistance for Healthcare and Residential Support Services

Completed Application Percentage

Yes 46.74 

No 49.28 

Don’t know 3.99 

Refused - 

Total 100 

Notes: This question was asked of all those who did not respond “No” when asked if the client received information 

on applying for financial assistance for healthcare or residential support from the government. Percentages are 

weighted. 

Exhibit 5.74: Respondent Received Assistance in Completing Application for Federally

Sponsored Financial Assistance for Healthcare and Residential Support Services

Received Assistance with Application Percentage

Yes 70.14 

No 27.48 

Don’t Know 2.38 

Refused - 

Total 100 

Notes: This question was asked of all those who responded “Yes” when asked if they completed an application for 

financial assistance for healthcare or residential services from the government. Percentages are weighted.
Assistance with One-on-One Options Counseling 

Request and Receipt of One-on-One Options Counseling. As shown in Exhibit 5.76, over threequarters of the respondents (78%) did not request a conversation with an ADRC representative to 

discuss LTSS beyond information and referral, such as home delivered meals, personal care, 

household help, transportation, or similar kinds of services (i.e., options counseling). 

Note: Percentages are weighted. Percentages do not add up to 100 due to rounding. 

199 

Exhibit 5.75: Respondent Was Provided Information About Other Insurance Options

Provided Information About Other Insurance Options Percentage

Yes 20.41 

No 74.23 

Don’t know 5.36 

Refused - 

Total 100 

Notes: This question was asked of all those who did not indicate they already receive Medicaid benefits or who said 

they did not talk about being eligible for Medicaid benefits when told the next questions would focus on Medicaid 

eligibility, and who did not answer “Don’t Know” or “Refused” when asked what other programs they applied for. 

Percentages are weighted.
 

 

 

 

 

The next set of analyses was conducted to determine whether there are statistically significant 

differences in requests for options counseling based on geographic location. The results revealed 

that respondents contacting rural ADRCs were significantly more likely to request options 

counseling compared to those contacting urban ADRCs (31% and 16%, respectively; p ≤ .05) 

(Exhibit 5.77). The complete cross-tabulation results are provided in Appendix DD, Exhibit 5. Of 

the 21 percent of respondents who requested options counseling, only 53 percent reported 

receiving the service by having a conversation with an ADRC representative about understanding 

and selecting LTSS beyond information and referral (Exhibit 5.78). 

Note: Percentages are weighted. 

200 
Notes: This question was asked of all those who responded “Yes” when asked if they requested 

a conversation about understanding and selecting LTSS. Percentages are weighted. 

Process of One-on-One Options Counseling. Of those who received options counseling, 60 

percent reported that the ADRC representative visited the client’s home to discuss his or her 

understanding of LTSS (Exhibit 5.79). Over 69 percent of respondents who received options 

counseling reported that the ADRC representative followed up with them either by phone call or 

additional in-home visits after the first conversation (see Exhibit 5.80). 

201 

Exhibit 5.79: ADRC Representative Provided Options Counseling at Client’s Home 

Options Counseling at Client’s Home Percentage

Yes 60.43 

No 39.35 

Don’t know 0.22 

Refused - 

Total* 100 

Notes: This question was asked of all those who responded “Yes” when asked if the client had a conversation with 

someone about understanding and selecting LTSS. Percentages are weighted.
Results of One-on-One Options Counseling. As shown in Exhibit 5.81, 81 percent of 

respondents who received options counseling reported that the conversation with the representative 

definitely or probably helped them to better understand their LTSS options. Nearly 61 percent 

reported that it helped them to obtain long-term support planning or services that fit within their 

budget; 74 percent reported that it helped them to get in touch with public programs; and 41 percent 

reported that it helped them to make a decision about LTSS. 

202 

Exhibit 5.80: Respondent Received Follow-up after Initial Options Counseling Session

Received Follow-Up Percentage

Yes 69.25 

No 27.03 

Don’t know 3.51 

Refused 0.22 

Total* 100 

Notes: This question was asked of all those who responded “Yes” when asked if the client had a conversation with 

someone about understanding and selecting LTSS. Percentages are weighted.
 

 

 

 

 

 

 

 

 

Notes: This question was asked of all those who responded “Yes” when asked if the client had a conversation with 

someone about understanding and selecting LTSS. Percentages are weighted. 

Assistance with Care Transition Services 

Results of the analyses on care transition services indicated that only 3 percent of respondents 

reported that they received services that helped clients to transition from a hospital or other acute 

care facility into the community (Exhibit 5.82). Of the respondents who received care transition 

services, 77 percent received a contact before discharge to assess the client’s discharge needs; 88 

percent received an explanation of the client’s discharge instructions; and 79 received postdischarge services such as transportation to a doctor, help filling prescriptions, or household help. 

Over 25 percent received a follow-up phone call or visit within 48 hours of discharge (Exhibit 

5.83). 

203 
Note: Percentages are weighted. 

204 

Exhibit 5.83: Specific Care Transition Services Received

Services Received Yes No Don’t 

Know Total 

An explanation of your/your [insert PP2]’s discharge 

instructions 87.64 11.70 0.66 100 

Post discharge services such as transportation to the doctor, 

help filling prescriptions, or household help 78.59 13.69 7.73 100 

A contact before discharge to assess your/your [insert 

PP2]’s discharge needs 77.26 21.41 1.32 100 

Follow-up phone call or visit within 48 hours of discharge 29.14 39.29 31.57 100 

Notes: This question was asked of all those who responded “Yes” when asked if the client received care transitions 

services. Percentages are weighted.
 

 

 

 

 

 

Assistance with Diversion 

Exhibit 5.84 shows that at the time of contact with the ADRC, most respondents (85%) were not 

considering a move to a long-term care facility, either for themselves or for the client on whose 

behalf they called. There were no statistically significant difference in the likelihood of clients 

considering a move to a long-term care facility based on their education, income, gender, or health 

status, or on the geographic location of the agency. As Exhibit 5.85 indicates, only 29 percent of 

respondents believed that they were “very likely” or “somewhat likely” to move into a nursing 

home within 5 years. ADRC representatives helped 31 percent of respondents understand their 

choices for remaining in the community (Exhibit 5.86). 

Note: Percentages are weighted. 

205 
Note: Percentages are weighted. 

5.2.4 Access to Services 

Contacting ADRCs 

Respondents first found out about ADRCs from a wide variety of sources (Exhibit 5.87). Among 

those, two stood out as the most frequent sources of initial information on ADRCs. The most 

common response was that respondents initially heard of ADRCs from a family member, friend, 

or other acquaintance (35%), followed by referral from another agency or organization (27%). 

206 

Exhibit 5.86: Representative Helped Respondent Understand Choices for Staying in the 

Community

Helped Understand Choices Percentage

Yes 31.15 

No 65.09 

Don’t know 3.76 

Refused - 

Total 100 

Note: Percentages are weighted.
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Notes: Percentages are weighted. Free text responses accompanying this question are available in Appendix U. 

Subgroup analyses were conducted to determine whether the method respondents used to find out 

about ADRCs varied according to client income, education, gender, disability status, age, or health 

at the time of the questionnaire. However, no statistically significant differences in the initial 

source of information on ADRCs by client characteristics were observed. 

Differences by ADRC characteristics were also examined, such as the geographic location of the 

ADRC and the size of the agency in terms of number of consumers served and FTEs. Only the 

difference between local and statewide ADRCs was found to be statistically significant. As 

illustrated in Exhibit 5.88, respondents who contacted a local ADRC were more likely to find out 

about the ADRC through a family member, friend, or other acquaintance than respondents 

contacting a statewide ADRC (p ≤ .01). The corresponding cross-tabulations are presented in 

Appendix FF, Exhibit 7. About 79 percent of respondents contacted the ADRC before they 

contacted any other organization (Exhibit 5.89); 18 percent contacted another agency before 

contacting the ADRC. Exhibit 5.90 shows that only 9 percent of respondents contacted a similar 

agency after contacting the ADRC. 

As presented in the supplemental tables in Appendix U, respondents who contacted a similar 

agency after contacting the ADRC were in touch with a range of organizations, from governmental 

organizations to volunteer church-based groups. The most common organizations mentioned were 

207 
 

the VA and nearby AAAs. Of the 83 respondents who contacted a similar agency after contacting 

the ADRC, about one-quarter (27%) found that the other agency was able to provide services that 

the ADRC could not (Exhibit 5.91). Respondents indicated a variety of needs that could not be 

met by the ADRC such as services related to medical care, including in-home care, evaluation for 

assisted living, and supplemental payment for medical care. However, 71 percent of respondents 

indicated that the other agency also was unable to meet their needs. 

Note: Percentages are weighted. 

208 
Note: Percentages are weighted. 

209 

Exhibit 5.90: Respondent Contacted Similar Agencies After Contacting the ADRC

Has Respondent Been in Touch With Any Similar Organizations Since 

Contacting the ADRC? Percentage

Yes 9.08 

No 89.22 

Don’t know 1.7 

Refused - 

Total 100 

Notes: Percentages are weighted. Free text responses accompanying this question are available in Appendix U. 
Follow-up by ADRCs 

The survey asked respondents whether ADRC staff followed up with them on referrals and the 

usefulness of the information provided. As of the time of the survey, only 37 percent of respondents 

indicated that the ADRC had followed up with them regarding either the referral or the usefulness 

of the information provided (Exhibit 5.92). We then examined whether there were significant 

differences in ADRC follow-up according to ADRC characteristics. There was a trend toward 

significance, with rural ADRCs more likely to follow up with respondents than urban ADRCs (p 

≤ .10) (Exhibit 5.93). The corresponding cross-tabulations are presented in Appendix DD, Exhibit 6. 

Note: Percentages are weighted. 

210 

Exhibit 5.91: Other Agency Able to Meet Needs That the ADRC Could Not

Other Agency Met Needs the ADRC Could Not Percentage

Yes 26.50 

No 70.97 

Don’t know 2.53 

Refused - 

Total** 100 

Notes: This question was asked of all those who responded “Yes” when asked if the client had been in touch with 

other agencies regarding the client’s reason for contact after contacting the ADRC. Free text responses accompanying 

this question are available in Appendix U. Percentages are weighted.
 

 

Challenges in Receiving Services from ADRCs 

Length of Time to Service Receipt. The survey included items on the receipt of services and the 

length of time it took to receive the services. A majority of respondents (53%) indicated that they 

did not receive the services they requested (Exhibit 5.94). About 32 percent of respondents 

received services within 1 week of contact, while 11 percent received services after more than a 

week. 

211 
 

 

 

 

 

 

 

Note: Percentages are weighted. 

The question of whether respondents received services was analyzed by subgroups of interest. 

There were statistically significant differences between respondents who contacted local ADRCs 

and statewide ADRCs both in reporting that they received the services sought and in the length of 

time to receive the services. Respondents who contacted a statewide ADRC were more likely to 

report that they did not receive services than those who contacted a local ADRC (p ≤ .10) Exhibit 

5.95). Respondents who contacted a local ADRC reported that they received services within 1 

week of contact more frequently than those who contacted a statewide ADRC, but this finding 

only approached statistical significance (p ≤ .10). The corresponding cross-tabulations are 

presented in Appendix FF, Exhibit 8. 

212 
 

 

 

 

Note: Percentages are weighted. 

Reasons for Non-Receipt of Services. When respondents were asked the reason why they did not 

receive the services they requested, they provided a range of responses. The two most common 

reasons, as shown in Exhibit 5.96, were that the services were not available and that the respondent 

was currently on a waitlist (15% each). Some respondents provided reasons that were not listed as 

a choice on the survey: the most common one was lack of follow-up by the service provider. 

213 
Significant differences based on subgroups of interest were found for several of the reasons that 

respondents provided for not receiving services. For example, respondents who made the contact 

for clients who were in poor health were more likely than respondents who made contact for clients 

who were not in poor health to indicate that the services were not available (p ≤ .10) (Exhibit 5.97). 

For detailed results, see Appendix BB, Exhibit 3. 

214 

Exhibit 5.96: Reason Respondent Believes Services Have Not Been Received

Reason Percentage

You/your [insert PP2] is on a waitlist 14.87 

The services were not available 14.81 

You/your [insert PP2] did not follow-up on the information and/or referral. 11.17 

Difficulties filling out paperwork 10.88 

Some other reason, Unclassified 10.11 

Service provider did not follow-up with me/have not heard back from service 

provider 9.92 

The information/help received from [insert PP1] was not useful 9.91 

You/your [insert PP2] no longer need the services 9.08 

Don’t know 9.08 

Not eligible 6.01 

Not being the right age for these services 5.00 

You/your [insert PP2] could not get to the services (e.g., hours of operation, 

transportation barriers) 5.25 

Too expensive/not affordable 5.05 

Still in the planning/beginning stages 4.55 

Have not applied for services 2.40 

Waiting for evaluation/meeting 2.26 

Refused - 

Notes: This question was asked of all those who responded “No” when asked if the client ever received the requested 

services. Percentages do not add up to 100 because respondents could choose multiple options. Percentages are 

weighted.
 

 

 

 

Note: Percentages are weighted. 

We also explored whether there were statistically significant differences in service availability by 

reason for contact. Respondents who contacted the ADRC for housing-related assistance were 

more likely to indicate that the ADRC did not have the necessary services available than those 

who contacted the ADRC for the other four most common reasons for contact (p ≤ .05) (Exhibit 

5.98). Housing was the only reason for which a majority of respondents indicated that the services 

were unavailable. See Appendix EE, Exhibit 1 for detailed results. 

215 
 

 

Note: Percentages are weighted. 

In addition, we identified a trend toward statistical differences in waitlist status. Clients who were 

in poor health were less likely to be on a waitlist than those in better health (p ≤ .10) (Exhibit 5.99). 

For detailed results, see Appendix BB, Exhibit 4. 

Note: Percentages are weighted. 

216 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

As illustrated in Exhibit 5.100, respondents who contacted a statewide ADRC also were slightly 

less likely to report being on a waitlist (p ≤ .10), although this finding only approached statistical 

significance. See Appendix FF, Exhibit 9, for detailed results. 

Note: Percentages are weighted 

Subgroup analyses between clients with and without a disability revealed significant differences 

in the degree to which clients felt their access to services served as a barrier to the receipt of 

services. Clients with a disability were more likely than clients without a disability to report that 

they could not get to services (p ≤ .05) (Exhibit 5.101). Clients with a disability were also 

significantly more likely to indicate that the information/help they received from the ADRC was 

not useful (p ≤ .01) (Exhibit 5.102). See Appendix CC, Exhibits 4 and 5, respectively, for detailed 

results. In contrast, clients in poor health were less likely than those who were not in poor health 

to indicate that the information they received was not useful (p ≤ .10) (Exhibit 5.103). See 

Appendix BB, Exhibit 5, for detailed results. Finally, respondents contacting rural ADRCs were 

less likely to consider the information/help they received as not useful as compared to those 

contacting urban ADRCs (p ≤ .01) (Exhibit 5.104). Appendix DD, Exhibit 7, presents detailed 

results. 

Another reason for non-receipt of services was difficulty in filling out paperwork. Clients with a 

disability were much more likely than those without a disability to report this as a reason for non217 
receipt of services (p ≤ .01)(Exhibit 5.105). The corresponding cross-tabulations are presented in 

Appendix CC, Exhibit 6. 

Note: Percentages are weighted. 

218 
Note: Percentages are weighted. 

219 
Note: Percentages are weighted. 

Note: Percentages are weighted. 

220 
 

 

 

 

 

 

 

Challenges in Resolving Issues 

Less than one-fifth of respondents reported challenges in dealing with ADRCs that limited their 

ability to resolve issues (Exhibit 5.106). The most common challenge was difficulty reaching 

ADRC staff, with 17 percent of respondents reporting this problem. The second most common 

challenge was a lack of staff follow-through (9%). 

Note: Percentages are weighted. 

We conducted subgroup analysis to assess if the challenges that survey respondents faced varied 

by ADRC characteristics. Findings indicated that there were statistically significant differences 

among subgroups on two of the challenges: ADRCs’ hours of operation and difficulty reaching 

ADRC staff. As shown in Exhibit 5.107, respondents contacting ADRCs with more than 15 FTEs 

were less likely to report hours of operation as a challenge than respondents contacting ADRCs 

with fewer FTEs (p ≤ .05). Exhibit 5.108, below, shows that respondents contacting local ADRCs 

221 
 

 

were more likely to indicate that they had difficulty reaching staff as compared to those contacting 

statewide ADRCs (p ≤ .10). The corresponding cross-tabulations are presented in Appendix HH, 

Exhibit 3 and Appendix FF, Exhibit 10, respectively. 

Note: Percentages are weighted. 

Note: Percentages are weighted. 

222 
 

 

 

 

 

 

 

 

 

 

 

 

 

Regression Findings – Challenges in Resolving Issues 

Regression analyses were used to explore the client, ADRC, and community characteristics 

associated with respondents facing the following challenges in working with ADRCs to resolve 

their issues: difficulty reaching ADRC staff and lack of staff follow–through. 

We could not conduct regression analyses on other challenges such as hours of operation, language 

or communication problems, lack of staff professionalism, and lack of staff knowledge, because 

there were very few observations with a value of “1” (i.e., “Yes, a challenge”). 

Difficulty Reaching ADRC staff. The outcome of interest for these analyses is whether 

respondents faced difficulties in reaching the ADRC staff. The complete results are presented in 

Appendix JJ, Exhibit 3, column 1. Only ADRC characteristics were found to have a significant 

association. Respondents from rural ADRCs were less likely to report difficulties in reaching staff 

compared to their urban counterparts (-14.2 percentage points; p ≤ .05). Similarly, respondents 

contacting statewide ADRCs were less likely to report difficulty in reaching staff compared to 

respondents contacting local ADRCs (-23.1 percentage points; p ≤ .01). 

Lack of Staff Follow-through. The findings from the analysis of the likelihood of respondents 

reporting lack of staff follow-through as a challenge in achieving issue resolution may be found in 

Appendix JJ, Exhibit 3, column 2. None of the covariates were shown to have a statistically 

significant association with this outcome of interest. 

LTSS Referrals by ADRCs 

LTSS Referrals. Data were obtained to explore the types of LTSS to which respondents were 

referred or transferred. As shown in Exhibit 5.109, 22 percent of clients were transferred or referred 

to LTSS. 

223 
 

 

Note: Percentages are weighted. 

Respondents were referred to a variety of LTSS, and no one service was predominant. Exhibit 

5.110 presents the five most common LTSS services, out of a total of 26, reported by survey 

respondents. The complete results may be found in Appendix U, Question E.7. 

224 
 

 

 

 

 

 

Notes: This question was asked of all those who responded “Yes” when asked if the representative of the 

ADRC transferred the call to an agency that provided the needed service, if the representative provided 

contact information for an agency that provided the client with needed services, or if the ADRC 

representative contacted the outside agency on the client’s behalf. Percentages are weighted. 

Results of Referrals. Of the 126 respondents who were referred to LTSS, 43 percent received the 

services for which they were referred. As shown in Exhibit 5.111, only 20 percent of respondents 

indicated they did not receive services, while 34 percent said it was too soon to tell whether 

services were received. 

225 
 

 

 

 

 

Notes: This question was asked of all those who responded “Yes” when asked if the representative of 

the ADRC transferred the call to an agency that provided the needed service, if the representative 

provided contact information for an agency that provided the client with needed services, or if the 

ADRC representative contacted the outside agency on the client’s behalf. Percentages are 

weighted. 

Of the 20 percent of respondents who indicated they did not receive the LTSS to which they were 

transferred or referred, more than one-third stated that the available services were not what they 

wanted or needed (Exhibit 5.112). 

226 
5.2.5 Participant Satisfaction 

Satisfaction with One-on-One Options Counseling 

Almost 93 percent of respondents who received options counseling indicated that they were either 

“very satisfied” or “somewhat satisfied” with the one-on-one options counseling they received. As 

illustrated in Exhibit 5.113, only 5 percent of respondents indicated they were “somewhat 

dissatisfied” or “very dissatisfied.” 

227 

Exhibit 5.112: Respondents’ Reasons for Non-Receipt of Referred LTSS

Respondent’s Reason for Non-Receipt of LTSS Percentage

The services were not what [insert PP2] wanted/needed 37.39 

Don’t know 36.87 

Other, ______________ 8.70 

The service or program is not available at times needed 6.78 

The service/program is not accepting applications/there is a waitlist 6.09 

Have not yet contacted, but plan to 2.09 

[insert PP2] is not eligible 1.57 

It is too expensive 0.52 

There is no transportation - 

I tried to contact the service or program that was referred, but was 

busy/unavailable - 

Line was busy - 

Wait time was too long - 

Have no plans to contact the service or program

Please specify ______________________ - 

Refused - 

Total 100 

Notes: This question was asked of all those who indicated the client did not receive services when asked what the 

result of the referral was. Percentages are weighted. Free text responses are available in Appendix U.
 

 

 

Notes: This question was asked of all those who responded “Yes” when asked if the client had a 

conversation with someone about understanding and selecting LTSS. Percentages are weighted. 

Satisfaction with Care Transition Services 

Of the 3 percent of respondents who indicated that their clients received care transition services 

directly from the ADRC, 92 percent were either “very satisfied” or “somewhat satisfied” with the 

services received. None of the respondents reported dissatisfaction (Exhibit 5.114). 

228 
 

 

 

 

 

 

 

Notes: This question was asked of all those who responded “Yes” when asked if they received 

care transition services. Percentages are weighted. 

Satisfaction with the Quality of All Services 

We examined respondent satisfaction with the quality of services provided by ADRCs on multiple 

dimensions: 

 Direct service receipt 

 Completeness of information 

 Degree to which services met specific needs 

 Accuracy of information 

 Support related to decision-making 

 Professionalism of staff 

 Ease of working with ADRCs to resolve issues 

 Services received at agencies to which referred. 

Direct Service Receipt. Of the 63 percent of respondents who received all or some of the services 

directly, 63 percent indicated that they were “very satisfied” with the services they received 

229 
 

 

 

 

 

 

(Exhibit 5.115). Of the respondents who reported being “very dissatisfied,” the most common 

reason was that they did not receive the services they sought. 

Respondents’ level of satisfaction with the direct services they received was examined for potential 

statistically significant variations by agency location and size as well as by client characteristics. 

The findings showed that respondents who contacted local ADRCs were significantly more likely 

to be satisfied with the services received compared to respondents who contacted statewide 

ADRCs (p ≤ .01) (Exhibit 5.116). Clients with an annual income greater than $40,000 were 

significantly less satisfied with the services they received directly when compared to clients with 

an income of $40,000 or less per year (p ≤ .10) (Exhibit 5.117). The corresponding crosstabulations are presented in Appendix FF, Exhibit 11 and Appendix AA, Exhibit 3, respectively. 

Note: Percentages are weighted. 

230 
Note: Percentages are weighted. 

Note: Percentages are weighted. 

231 
Completeness of Information. We examined respondent satisfaction with the completeness of 

information that they received from the ADRC (Exhibit 5.118). Respondents were generally 

satisfied, with 83 percent indicating they were either “very satisfied” or “somewhat satisfied.” Of 

the respondents who indicated being “very dissatisfied,” the most common reasons were that the 

respondent never received follow-up after the initial contact, and the information received was not 

helpful or was not the information sought. 

According to the subgroup analyses, respondents who contacted a local ADRC were significantly 

more likely to express higher levels of satisfaction compared to those who contacted a statewide 

ADRC about the completeness of information received (p ≤ .01) (Exhibit 5.119). Further, 

respondents calling on behalf of clients in poor health were significantly less likely to report being 

satisfied with the completeness of information they received compared to those calling on behalf 

of clients in good health (p ≤ .05) (Exhibit 5.120). The corresponding cross-tabulations are 

presented in Appendix FF, Exhibit 12, and Appendix BB, Exhibit 9, respectively. 

232 

Exhibit 5.118: Satisfaction with the Completeness of Information 

Satisfaction Percentage

Very satisfied 67.37 

Somewhat satisfied 15.14 

Somewhat dissatisfied 8.39 

Very dissatisfied 4.47 

Not applicable 4.44 

Don’t know 0.20 

Refused - 

Total 100 

Note: Percentages are weighted.
Note: Percentages are weighted. 

Note: Percentages are weighted. 

233 
Degree to which Services Met Needs. Respondents were asked how satisfied they were with the 

degree to which the services received met their needs. Almost 80 percent of respondents reported 

being either “very satisfied” or “somewhat satisfied” with the degree to which the services received 

met their specific needs (Exhibit 5.121). Of the respondents who indicated that they were “very 

dissatisfied” (10%), the most common reason was that the service did not meet their needs. 

Respondent satisfaction appeared to vary by clients’ education level. Respondents with a high 

school education or higher were significantly more likely to be satisfied with the degree to which 

services provided met client needs as compared to those with less than a high school education (p 

≤ .01). Clients with poor health reported lower levels of satisfaction than did those without poor 

health (p ≤ .01). The corresponding cross-tabulations are presented in Appendix Z, Exhibit 2 and 

Appendix BB, Exhibit 10, respectively, and graphical depictions are found below in Exhibits 5.122 

and 5.123. 

234 

Exhibit 5.121: Satisfaction with the Degree to Which Services Met Specific Needs

Satisfaction Percentage

Very satisfied 61.53 

Somewhat satisfied 18.11 

Somewhat dissatisfied 5.50 

Very dissatisfied 10.46 

Not applicable 4.40 

Don’t know - 

Refused - 

Total 100 

Note: Percentages are weighted.
 

 

Note: Percentages are weighted. 

Note: Percentages are weighted. 

Accuracy of Information. Exhibit 5.124 shows the levels of satisfaction with the accuracy of the 

information that ADRCs provided. Over 91 percent of respondents indicated being “very satisfied” 

235 
or “somewhat satisfied” with the accuracy of the information provided, and only 5 percent reported 

feeling “very dissatisfied.” Of the respondents who indicated being “very dissatisfied,” the most 

common reasons were that they were not helped by the agency, they were awaiting follow-up, or 

they did not get any information or sufficient information. 

Support Related to Decision-Making. Respondents were generally satisfied with the support 

they received related to decision-making. As shown in Exhibit 5.125, 71 percent were either “very 

satisfied” or “somewhat satisfied” with the support they received. Similar to the previous 

questions, waiting for follow-up was commonly mentioned as a reason why respondents were 

dissatisfied with the support received. The most common response was that the respondent did not 

receive any support (18 respondents) or did not receive services (11 respondents). 

236 

Exhibit 5.124: Satisfaction with the Accuracy of Information Provided 

Satisfaction Percentage

Very satisfied 70.42 

Somewhat satisfied 20.63 

Somewhat dissatisfied 1.83 

Very dissatisfied 4.80 

Not applicable 2.32 

Don’t know - 

Refused - 

Total 100 

Note: Percentages are weighted.
 

 

 

 

 

 

 

 

Note: Percentages are weighted. 

Subgroup analyses revealed that respondents from local ADRCs were significantly more likely to 

report feeling satisfied with the support they received for decision-making than respondents from 

statewide ADRCs (p ≤ .01, Exhibit 5.126). See Appendix FF, Exhibit 13 for detailed results. More 

educated clients were significantly more likely to be satisfied with the decision-making support 

received than those with less than a high school education (p ≤ .10, Exhibit 5.127). Detailed results 

are presented in Appendix Z, Exhibit 3. 

Clients with a disability were less satisfied with the support they received related to decisionmaking than clients without a disability (p ≤ .05, Exhibit 5.128). Clients who rated their health as 

poor were also significantly less likely to report being satisfied (p ≤ .01, Exhibit 5.129). The 

corresponding cross-tabulations are presented in Appendix CC, Exhibit 9, and Appendix BB, 

Exhibit 9, respectively. 

237 
Note: Percentages are weighted. 

Note: Percentages are weighted. 

238 
Note: Percentages are weighted. 

Note: Percentages are weighted. 

239 
Professionalism of Staff. Respondents rated the professionalism of ADRC staff highly, with 93 

percent of respondents expressing satisfaction. As shown in Exhibit 5.130, only 4 percent of 

respondents reported being either "somewhat dissatisfied” or “very dissatisfied” with the 

professionalism of the ADRC or its staff. Most of the reasons respondents gave for their 

dissatisfaction with staff were related to staff attitude: not helpful; not knowledgeable; rude or 

blunt. Lack of follow-up was also mentioned as a reason for dissatisfaction. 

Respondents who contacted local ADRCs reported higher levels of satisfaction with staff 

professionalism than respondents who contacted statewide ADRCs (p ≤ .05). Similarly, 

respondents with good health compared to those with poor health reported higher levels of 

satisfaction with staff professionalism (p ≤ .05). The corresponding cross-tabulation are presented 

in Appendix FF, Exhibit 14 and Appendix BB, Exhibit 12, respectively, and Exhibits 5.131 and 

5.132 depict this information graphically. 

240 

Exhibit 5.130: Satisfaction with the Professionalism of ADRC Staff 

Satisfaction Percentage

Very satisfied 82.42 

Somewhat satisfied 10.62 

Somewhat dissatisfied 2.44 

Very dissatisfied 2.11 

Not applicable 2.41 

Don’t know - 

Refused - 

Total 100 

Note: Percentages are weighted.
Note: Percentages are weighted. 

Note: Percentages are weighted. 

241 
Ease of Working with ADRCs to Resolve Issues. We also explored the level of satisfaction that 

respondents had with the ease of working with ADRCs to resolve their issues and found that 

respondents were generally satisfied with the ease of working with the ADRC. As highlighted in 

Exhibit 5.133, 84 percent of respondents indicated they were “very satisfied” or “somewhat 

satisfied.” The most commonly mentioned reason for dissatisfaction when working to resolve 

issues was lack of follow up followed by a lack of helpfulness from staff. 

Respondents from local ADRCs were more likely to report feeling “very satisfied” when compared 

to respondents from statewide ADRCs who were slightly more likely to indicate being either 

“somewhat satisfied” or “somewhat dissatisfied” with the ease of working with the ADRC (p ≤ .05) 

(Exhibit 5.134). Older clients were more likely to report being “somewhat satisfied” with the ease 

of working with the ADRC, while younger clients with a disability were more likely to report 

being “very dissatisfied” (p ≤ .01, Exhibit 5.125). Further, respondents who rated their health as 

poor health, compared to those who rated their health as good, were more likely to report that they 

were “very dissatisfied” with ease of resolving issues (p ≤ .05, Exhibit 5.126). The corresponding 

cross-tabulations are presented in Appendix FF, Exhibit 15; Appendix Y, Exhibit 2; and Appendix 

BB, Exhibit 13, respectively. 

242 

Exhibit 5.133: Satisfaction with the Ease of Working with the ADRC to Resolve Issues 

Satisfaction Percentage

Very satisfied 68.10 

Somewhat satisfied 18.59 

Somewhat dissatisfied 3.01 

Very dissatisfied 5.27 

Not applicable 5.03 

Don’t know - 

Refused - 

Total 100 

Note: Percentages are weighted.
Note: Percentages are weighted. 

Note: Percentages are weighted. 

243 
 

 

 

Note: Percentages are weighted. 

Services Received at Referral Agencies. As displayed in Exhibit 5.137, only 59 percent of 

respondents who reported receiving services indirectly, or both directly and indirectly, indicated 

that they were satisfied with the quality of services they received from the agencies to which they 

were referred. Notably, 13 percent of respondents refused to answer the question. The most 

common reasons for dissatisfaction were not receiving help from the contacted agency and not 

receiving the requested service. Some respondents also reported they had not yet contacted a 

referral agency or that when they did contact the agency, the staff seemed uninterested in working 

with them. 

244 
 

 

 

 

 

Note: Percentages are weighted. 

Respondent satisfaction varied across client education levels. Clients with more than a high school 

education expressed significantly higher levels of satisfaction compared to those with a high school 

education or less (p ≤ .05, Exhibit 5.138). Clients who rated their health as poor were significantly 

less likely to be satisfied with the services they received at the referral agencies compared to clients 

who did not report poor health (p ≤ .01, Exhibit 5.139). Detailed results are presented in Appendix 

Z, Exhibit 4 and Appendix BB, Exhibit 14. 

245 
Note: Percentages are weighted. 

Note: Percentages are weighted. 

246 
 

 

 

 

 

 

 

 

 

We explored the variation in respondent satisfaction by the five most common reasons for 

contacting ADRCs on all the dimensions discussed above. We found no statistically significant 

association between the reasons for contact and the degree of satisfaction with the services 

received. 

Usefulness of Services 

To assess the overall usefulness of ADRC services, respondents were asked to report on: 

 Improved awareness of LTSS needs 

 Increased certainty of LTSS options 

 Usefulness of information in selecting LTSS. 

Exhibit 5.140 shows that only 16 percent of respondents reported that after contacting the ADRC, 

they identified an LTSS need of which they were previously unaware. 

Note: Percentages are weighted. 

Respondents felt increased certainty about their long-term care options as a result of contact with 

ADRCs. About 58 percent of respondents reported feeling more certain about their long-term care 

options, while 14 percent of respondents felt more confused. As shown in Exhibit 5.141, 26 percent 

remained at about the same level of certainty. 

247 
Respondents were asked to rank the level of usefulness of the information provided by ADRCs as 

they were selecting long-term care options. Sixty-nine 69 percent of respondents reported that the 

information they received was either “very useful” or “somewhat useful”; only 20 percent reported 

that the information was not useful (Exhibit 5.142). There` were no statistically significant 

differences in reports of level of usefulness by ADRC or client characteristics. 

Value of ADRCs to Respondents 

The survey indirectly assessed the value that ADRCs held for respondents by asking the 

respondents whether they would recommend contacting an ADRC to a friend or relative in need 

and how likely they themselves were to contact ADRCs in the future, if needed. 

248 

Exhibit 5.141: Certainty about Long-Term Care Options as a Result of Contact with 

ADRC

Certainty About Long-Term Care Options Percentage

Much more certain about your/you [insert PP2]’s long-term care options 37.14 

A little more certain 20.59 

About the same 25.80 

A little more confused 9.32 

Much more confused 4.56 

Don’t know 2.53 

Refused 0.06 

Total 100 

Note: Percentages are weighted.

Exhibit 5.142: Usefulness of Information for Selecting Long-Term Care Options

Usefulness Percentage

Very useful 45.43 

Somewhat useful 23.26 

Not too useful 5.46 

Not useful at all 14.18 

Don’t know 10.64 

Refused 1.03 

Total 100 

Note: Percentages are weighted.
Exhibit 5.143 shows an overwhelming majority of respondents (94%) indicated that they would 

tell a friend or relative who needed help to contact the ADRC. 

When asked if they would contact the ADRC again if needed, 92 percent of respondents indicated 

that they were “very likely” or “somewhat likely” to contact. Only eight percent of respondents 

indicated they were either “somewhat unlikely” or “very unlikely” to contact the ADRC again, as 

shown in Exhibit 5.144. 

Note: Percentages are weighted. 

249 

Exhibit 5.143: Respondents who would Tell a Friend/Relative who Needed Help to Contact 

ADRC

Recommend ADRC Percentage

Yes 94.05 

No 5.24 

Don’t know 0.71 

Refused - 

Total 100 

Note: Percentages are weighted.
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Regression Findings – Satisfaction with the Quality of Services 

We explored the satisfaction expressed by survey respondents on the following four dimensions 

of ADRC services: 

 Comprehensiveness of information 

 Personalization of services 

 Accuracy of information 

 Support in decision-making. 

The survey had seven questions that measured satisfaction with different aspects of the ADRC 

service. However, three had very few observations with a value of 0 (i.e., “Not satisfied”), and 

therefore these outcomes were not included in the analysis. 

In all the satisfaction-related regression models, we included client characteristics together with 

the reasons for contact. In addition, we included respondent type (i.e., self vs. other) as a covariate 

in these models to explore whether satisfaction with ADRCs varied by whether the contact was 

made by the clients themselves or by others on their behalf. 

Since satisfaction was a reflection of respondents’ experience interacting with ADRCs, agency 

characteristics also were included. ADRC type (a statewide ADRC versus a local ADRC) was 

used to explore whether respondent satisfaction varied based on contacting a statewide network as 

compared to a local office. In addition, an indicator for whether the ADRC operated in a rural or 

urban coverage area was included. Community characteristics were included in the models as 

proxies for unobserved client and ADRC characteristics that may influence respondent 

satisfaction. 

Comprehensiveness of Information. The likelihood of respondents’ satisfaction with the 

comprehensiveness of information received from ADRCs is presented in Appendix JJ, Exhibit 4, 

column 1. Clients who live alone were less likely to be satisfied with the comprehensiveness of 

information received from ADRCs (-14.1 percentage points; p ≤ .05). Also respondents contacting 

ADRCs for Medicare-related reasons were less likely to be satisfied (-10.5 percentage points; p ≤ 

.05). Respondents contacting rural ADRCs were more likely to be satisfied than respondents 

contacting urban ADRCs (12.25 percentage points; p ≤ .05). Finally, respondents contacting 

ADRCs serving areas with a higher number of home health agencies were also more likely to be 

satisfied with the comprehensiveness of information (0.8 percentage points; p ≤ .05). 

250 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Personalization of Services. Here we analyzed respondent satisfaction with the personalization 

of services (see Appendix JJ, Exhibit 4, column 2). Respondents who contacted ADRCs 

themselves were less likely to be satisfied than those who contacted on behalf of someone else (-

12.4 percentage points; p ≤ .01). Also, clients with a high school degree or respondents calling on 

behalf of clients with a high school degree were more likely to be satisfied with the personalization 

of services compared to clients with less than a high school degree or respondents calling on their 

behalf (15.0 percentage points; p ≤ .01). Respondents contacting ADRCs for Medicare-related 

reasons were more likely to be satisfied with the personalization of the information received from 

ADRCs than those contacting ADRCs for other reasons (7.0 percentage points; p ≤ .05). In 

addition, respondents contacting rural ADRCs were more likely to be satisfied with the 

personalization of services received from their ADRCs compared to respondents contacting urban 

ADRCs (17.1 percentage points; p ≤ .05). The likelihood of respondents expressing satisfaction 

with the personalization of services increased with the number of home health agencies in the 

ADRC service area (1.8 percentage points; p ≤ .01). 

Accuracy of Information. The regression results for respondent satisfaction with the accuracy of 

information received from ADRCs are shown in Appendix JJ, Exhibit 4, column 3. Among the 

client characteristics, clients with a high school degree or respondents contacting ADRCs on their 

own behalf were more likely to be satisfied with the accuracy of information than those with less 

than a high school degree (9.3 percentage points; p ≤ .05). None of the other client characteristics 

were statistically significant. Among ADRC characteristics, respondents contacting statewide 

ADRCs were more likely to be satisfied with the accuracy of information compared to those who 

contacted local ADRCs (12.2 percentage points; p ≤ .01). In addition, the larger the number of 

home health agencies in ADRC service areas, the higher the satisfaction of respondents with the 

accuracy of information received (1.5 percentage points; p ≤ .05). However, respondent 

satisfaction was negatively associated with the number of nursing home beds in the ADRC 

coverage areas (-5.8 percentage points; p ≤ .01). 

Support in Decision-Making. The regression results for satisfaction with the decision-making 

support that respondents received are shown in Appendix JJ, Exhibit 4, column 5. This is the only 

instance where gender was statistically significant. Male clients and respondents contacting 

ADRCs on their behalf were more likely to be satisfied with the support received from ADRCs 

compared to female clients and their respondents (5.9 percentage points; p ≤ .05). However, clients 

who were married were less likely to be satisfied with the decision-making support received (-10.0 

percentage points; p ≤ .05). Also, clients who rated their health as poor were less likely to be 

satisfied with the support they received from the ADRCs (-10.07 percentage points; p ≤ .01) as 

were clients living alone (-12.1 percentage points; p ≤ .05). 

251 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Satisfaction with decision-making support also varied with the reasons for contact. Respondents 

who contacted the ADRC regarding Medicaid (9.3 percentage points; p ≤ .05) or personal care 

services (5.0 percentage points; p ≤ .05) were more likely to be satisfied with the support received 

compared to those who contacted for other reasons. Among ADRC characteristics, respondents 

contacting statewide ADRCs were more likely to be satisfied with the support in decision-making 

compared to those who contacted local ADRCs (16.4 percentage points; p ≤ .01). Also, the number 

of home health agencies in the ADRC service areas was positively associated with respondents’ 

being satisfied with the decision-making support received (3.5 percentage points; p ≤ .01). In 

contrast, the number of nursing home beds in the ADRC services areas was negatively associated 

with satisfaction with decision-making support (-15.9 percentage points; p ≤ .01). 

Usefulness of Information. Respondents were asked to choose one of four ordered categories to 

indicate the degree of usefulness of the information that ADRCs provided to assist in selecting 

LTSS. To assess the factors associated with this item, we converted the ordered response variable 

into a binary variable. “Very Useful” and “Somewhat Useful” were recoded into a single category 

of “Useful,” and “Not too Useful” and “Not at all Useful” into a single category of “Not Useful.” 

The average marginal effects from the probit regression analysis are provided in Appendix JJ, 

Exhibit 5. Client, ADRC, and community characteristics are all included in this regression because 

they are likely to influence whether respondents found the information useful. In addition, we 

included the reasons for contacting the ADRC, because the usefulness of information may vary by 

the reason for contact. 

The likelihood of finding the information useful slightly decreased with clients’ age (-0.7 

percentage points; p ≤ .05). None of the other client characteristics were statistically significant. 

Among ADRC characteristics, respondents who contacted a statewide ADRC were significantly 

less likely to find the information provided by ADRCs useful when compared to respondents who 

contacted local ADRCs (-69.7 percentage points; p ≤ .01). No other ADRC characteristic showed 

a statistically significant association with this outcome. At the community level, ADRCs serving 

communities with a higher number of home health agencies were associated with higher 

respondent satisfaction with the usefulness of the information received (1.4 percentage points; p ≤ 

.01). 

5.2.6 Comparison by Core Integration Dimensions 

In this section, we explore whether there are statistically significant differences on key outcome 

study variables across the three core measures for ADRCs participating in the outcome study: 

level of core service provision, extent of site integration, and Medicaid integration. 

252 
Core Service Provision. Exhibit 5.145 indicates that respondents who contacted ADRCs that had 

a medium or high level of core service provision were much more likely to have had counseling 

or peer support as the result of contact when compared to those who contacted ADRCs that had a 

low level of core provision (p ≤ .10). 

In addition, respondents from ADRCs with a medium level of core service provision were 

significantly more likely than respondents from ADRCs with low or high levels of core service 

provision to report benefits counseling as the result of contact with the ADRC (p ≤ .05, Exhibit 

5.146). 

Respondents from ADRCs with a low level of core service provision were more likely to contact 

the ADRC for nutrition-related services than respondents from ADRCs with medium or high levels 

of core service provision (Exhibit 5.147). Respondents from ADRCs with medium and high levels 

of core service provision were most likely to contact the ADRC regarding Medicare and Medicaid 

assistance requests, respectively. These differences were statistically significant (p ≤ .01). 

253 

Exhibit 5.145: Counseling or Peer Support by Level of Core Service Provision

Counseling or 

Peer Support Low Level Medium Level High Level Total 

No 91.31 79.78 64.80 72.78 

Yes 8.69 20.22 35.20 27.22 

Total 100.00 100.00 100.00 100.00 

Note: Results are reported as weighted percentages. Results are statistically significant at p ≤ .10.

Exhibit 5.146: Benefits Counseling by Level of Core Service Provision

Benefits 

Counseling Low Level Medium Level High Level Total 

No 83.61 38.18 53.60 48.20 

Yes 16.39 61.82 46.40 51.80 

Total 100.00 100.00 100.00 100.00 

Note: Results are reported as weighted percentages. Results are statistically significant at p ≤ .05.
Respondents from ADRCs with a high or medium level of core service provision were 

significantly more likely to hear about the agency from family, friends, or other acquaintances as 

compared to respondents from ADRCs with a low level of core service provision (Exhibit 5.148). 

Respondents from ADRCs with a low level of core service provision were more likely to have 

been referred by another agency. These differences were statistically significant (p ≤ .05). 

254 

Exhibit 5.147: Most Frequent Reasons for Contact by Level of Core Service Provision 

Most Frequent Reasons to 

Contact Low Level Medium Level High Level Total 

Medicare Questions 6.52 46.97 27.22 34.27 

Medicaid Questions 2.17 23.37 33.71 28.56 

Housing 0.00 19.31 4.27 10.03 

Personal Care 2.17 2.48 24.38 15.01 

Nutrition 89.13 7.88 10.42 12.13 

Total 100.00 100.00 100.00 100.00 

Note: Results are reported as weighted percentages. Results are statistically significant at p ≤ .01.

Exhibit 5.148: Where Respondent First Heard About Agency by Level of Core Service 

Provision 

How Respondent First Heard 

About Agency Low Level Medium Level High Level Total 

Family, Friend or other 

Acquaintance 18.94 38.63 41.95 39.38 

Hospital/Clinic/Doctor 0.00 3.23 8.28 5.57 

Nursing Home/Assisted Living 0.00 4.36 0.84 2.41 

Phone Book 15.53 3.25 4.31 4.34 

Brochure/Flyer 1.14 0.00 1.58 0.84 

Referral from Senior Center 2.27 0.38 2.47 1.50 

Referral from another 

Agency/Organization 59.85 26.53 25.30 27.44 

Work 2.27 0.41 5.06 2.80 

Internet/Website 0.00 4.90 6.09 5.27 

Media/Newspaper/TV/Radio 0.00 18.15 1.10 8.87 

Other 0.00 0.15 3.05 1.56 

Total 100.00 100.00 100.00 100.00 

Note: Results are reported as weighted percentages. Results are statistically significant at p ≤ .05.
Respondents from ADRCs with low levels of core service provision were significantly more likely 

to indicate that the ADRC’s hours led to a reduction in the ability to resolve the respondent’s issue 

as compared to respondents from ADRCs with medium and high levels of core service provision 

(p ≤ .01, Exhibit 5.149). 

There was a statistically significant difference between respondents who reported about ADRCs 

with core service provision levels that were categorized as high or medium versus low (Exhibit 

5.150). Respondents from ADRCs with a high or medium level of core service provision were 

more likely to report being “very satisfied” with the professionalism of the staff compared to 

respondents from ADRCs with a low level of core service provision (p ≤ .01). 

In results showing statistical significance or a trend toward significance, as seen in Exhibit 5.151, 

respondents were more likely to indicate being “very satisfied” with the ease of resolving the issue 

faced if the ADRC had a high or medium level of core service provision compared to having a low 

level of core service provision (p ≤ .05). 

255 

Exhibit 5.149: Reduction in Ability to Resolve Issues as Result of Hours of Operation by 

Level of Core Service Provision

Reduction in 

Ability to 

Resolve Issue

Low Level Medium Level High Level Total 

No 53.93 92.63 95.17 92.01 

Yes 46.07 7.37 4.83 7.99 

Total 100.00 100.00 100.00 100.00 

Note: Results are reported as weighted percentages. Results are statistically significant at p ≤ .01.

 

Exhibit 5.150: Satisfaction with Professionalism of the Staff by Level of Core Service 

Provision 

Level of Satisfaction Low Level Medium Level High Level Total 

Very Dissatisfied 0.98 0.67 3.76 2.26 

Somewhat Dissatisfied 0.00 1.34 2.50 1.86 

Somewhat Satisfied 40.33 4.24 14.09 11.05 

Very Satisfied 58.96 93.76 79.65 84.83 

Total 100.00 100.00 100.00 100.00 

Note: Results are reported as weighted percentages. Results are statistically significant at p ≤ .01.
Site Integration. We explored whether the result of respondents’ contact with ADRCs varied by 

the extent of site integration of the ADRCs and found that respondents who contacted an ADRC 

with a low or high level of site integration were significantly more likely to indicate that the result 

of contact was information assistance when compared to those who contacted an ADRC with a 

medium level of site integration (p ≤ .05, Exhibit 5.152). Respondents from ADRCs with a low 

level of site integration were much more likely to have had their contact result in life skills training 

or support than respondents from ADRCs with medium or high levels of site integration (p ≤ .01, 

Exhibit 5.153). 

256 

Exhibit 5.151: Satisfaction with Ease of Resolving Issues by Level of Core Service Provision

Level of 

Satisfaction Low Level Medium Level High Level Total 

Very 

Dissatisfied 0.00 3.79 6.73 5.03 

Somewhat 

Dissatisfied 0.00 0.29 6.16 3.15 

Somewhat 

Satisfied 60.49 20.03 16.02 20.15 

Very Satisfied 39.51 75.89 71.09 71.67 

Total 100.00 100.00 100.00 100.00 

Note: Results are reported as weighted percentages. Results are statistically significant at p ≤ .05.

Exhibit 5.152: Information Assistance by Extent of Site Integration 

Information 

Assistance Low Level Medium Level High Level Total 

No 0.00 18.77 5.75 14.90 

Yes 100.00 81.23 94.25 85.10 

Total 100.00 100.00 100.00 100.00 

Note: Results are reported as weighted percentages. Results are statistically significant at p ≤ .05.
Exhibit 5.154 shows that no respondents from ADRCs with a low level of site integration contacted 

the ADRC for any of the five most frequently given reasons for contacting the agency. 

Respondents who contacted an ADRC with a medium level of site integration did so primarily for 

Medicare questions, while respondents who contacted an ADRC with a high level of site 

integration did so primarily for Medicaid questions. These differences were statistically significant 

(p ≤ .01). 

Respondents from ADRCs with high or medium levels of site integration were more likely to 

indicate that a lack of staff professionalism served as a barrier to resolving their issue (p ≤ .10). 

Interestingly, none of the respondents from ADRCs with a low level of site integration cited lack 

of staff professionalism as a barrier to resolving issues (Exhibit 5.155). 

257 

Exhibit 5.153: Life Skills Training or Support by Extent of Site Integration 

Life Skills 

Training or 

Support

Low Level Medium Level High Level Total 

No 50.00 99.97 100.00 99.70 

Yes 50.00 0.03 0.00 0.30 

Total 100.00 100.00 100.00 100.00 

Note: Results are reported as weighted percentages. Results are statistically significant at p ≤ .01.

Exhibit 5.154: Most Frequent Reasons to Contact the ADRC by Extent of Site Integration 

Most 

Frequent 

Reasons to 

Contact

Low Level Medium Level High Level Total 

Medicare 

Questions 0.00 45.27 10.91 34.27 

Medicaid 

Questions 0.00 26.40 33.15 28.56 

Housing 0.00 12.83 4.09 10.03 

Personal Care 0.00 6.37 33.35 15.01 

Nutrition 0.00 9.12 18.50 12.13 

Total 0.00 100.00 100.00 100.00 

Note: Results are reported as weighted percentages. Results are statistically significant at p ≤ .01.
Exhibit 5.156 shows that respondents of ADRCs that had a medium or high level of site integration 

were statistically more likely to report lack of staff follow-through as leading to a reduced ability 

to resolve issues (p ≤ .05). 

Respondents from ADRCs with a medium level of site integration were significantly more likely 

to report being satisfied with the ease of resolving issues than those from ADRCs with a low or 

high level of site integration (p ≤ .01, Exhibit 5.157). 

258 

Exhibit 5.155: Reduction in Ability to Resolve Issues Due to Lack of Staff Professionalism 

by Extent of Site Integration 

Reduction in Ability to 

Resolve Issue Low Level Medium Level High Level Total 

No 100.00 96.64 89.48 94.60 

Yes 0.00 3.36 10.52 5.40 

Total 100.00 100.00 100.00 100.00 

Note: Results are reported as weighted percentages. Results are statistically significant at p ≤ .10.

Exhibit 5.156: Reduction in Ability to Resolve Issues due to Lack of Staff Follow-through 

by Extent of Site Integration 

Reduction in Ability to 

Resolve Issue Low Level Medium Level High Level Total 

No 100.00 92.81 81.39 89.60 

Yes 0.00 7.19 18.61 10.40 

Total 100.00 100.00 100.00 100.00 

Note: Results are reported as weighted percentages. Results are statistically significant at p ≤ .05.

Exhibit 5.157: Satisfaction with Ease of Resolving Issues by Extent of Site Integration 

Level of Satisfaction Low Level Medium Level High Level Total 

Very Dissatisfied 0.00 3.04 10.39 5.03 

Somewhat Dissatisfied 0.00 0.96 8.97 3.15 

Somewhat Satisfied 50.00 19.93 20.09 20.15 

Very Satisfied 50.00 76.08 60.55 71.67 

Total 100.00 100.00 100.00 100.00 

Note: Results are reported as weighted percentages. Results are statistically significant at p ≤ .01.
Finally, respondents were significantly more likely to report being satisfied with the 

professionalism of the staff if they were reporting on an ADRC with a low level of site integration 

compared to an ADRC with a medium or high level of site integration (p ≤ .05, Exhibit 5.158). 

Medicaid Integration. Regressions were used to determine the presence of associations between 

outcome variables and whether the ADRC was classified as Medicaid integrated. Exhibit 5.159 

shows that respondents who contacted ADRCs that were Medicaid integrated were more likely 

than respondents who contacted those that were not Medicaid integrated to report that information 

assistance was the result of their contact (p ≤ .05). 

Respondents from ADRCs that were not Medicaid integrated were significantly more likely to 

have counseling or peer support as a result of contact than respondents from ADRCs that were 

Medicaid integrated (p ≤ .01, Exhibit 5.160). 

259 

Exhibit 5.158: Satisfaction with Professionalism of the Staff by Extent of Site Integration 

Agency Followed Up Low Level Medium Level High Level Total 

Very Dissatisfied 0.00 1.04 5.19 2.26 

Somewhat Dissatisfied 0.00 1.30 3.24 1.86 

Somewhat Satisfied 0.000 8.27 17.90 11.05 

Very Satisfied 100.00 89.39 73.67 84.83 

Total 100.00 100.00 100.00 100.00 

Note: Results are reported as weighted percentages. Results are statistically significant at p ≤ .05.

Exhibit 5.159: Receipt of Information Assistance by Status of Medicaid Integration 

Information Assistance Not Medicaid 

Integrated

Medicaid 

Integrated Total 

No 25.18 11.54 14.47 

Yes 74.82 88.46 85.53 

Total 100.00 100.00 100.00 

Note: Results are reported as weighted percentages. Results are statistically significant at p ≤ .05.
There were statistically significant differences between Medicaid integrated and non-Medicaidintegrated ADRCs on reasons for contacting the ADRC. Respondents from ADRCs that were 

Medicaid integrated were more likely to contact the ADRC for personal care, housing, or nutrition 

issues, while respondents from ADRCs that were not Medicaid integrated were more likely to 

contact the ADRC for questions regarding Medicaid or Medicare (p ≤ .01, Exhibit 5.161). 

Respondents of Medicaid-integrated ADRCs were slightly more likely to indicate that difficulty 

in reaching ADRC staff led to a reduction in the ability to resolve their issues (p ≤ .10, Exhibit 

5.162). Moreover, respondents who contacted Medicaid-integrated ADRCs were significantly 

more likely to indicate that communication problems (p ≤ .01), and a lack of follow-through by 

ADRC staff (p ≤ .01) led to a reduction in the ability to resolve the respondent’s issue. 

260 

Exhibit 5.160: Receipt of Counseling or Peer Support by Status of Medicaid Integration

Counseling or Peer Support Not Medicaid 

Integrated

Medicaid 

Integrated Total 

No 52.06 77.73 72.78 

Yes 47.94 22.27 27.79 

Total 100.00 100.00 100.00 

Note: Results are reported as weighted percentages. Results are statistically significant at p ≤ .01.

Exhibit 5.161: Most Frequent Reasons to Contact ADRC by Status of Medicaid Integration 

Most Frequent 

Reasons to contact

Not Medicaid 

Integrated Medicaid Integrated Total 

Medicare Questions 44.59 28.70 32.61 

Medicaid Questions 49.71 25.63 31.55 

Housing 4.01 11.67 9.78 

Personal Care 1.55 18.75 14.52 

Nutrition 0.15 15.26 11.54 

Total 100.00 100.00 100.00 

Note: Results are reported as weighted percentages. Results are statistically significant at p ≤ .01.
Finally, respondents were statistically slightly more likely to indicate that they did not receive 

services because of being on a waitlist if they had contacted an ADRC that was not Medicaid 

integrated than if they had contacted a Medicaid-integrated ADRC (p ≤ .10, Exhibit 5.163). 

261 

Exhibit 5.162: Reduction in Ability to Resolve Issues by Status of Medicaid Integration 

Reduction in Ability to 

Resolve Issue Due To:

Not Medicaid 

Integrated

Medicaid 

Integrated Total 

Difficulty Reaching Staff*

No 91.93 80.68 83.12 

Yes 8.07 19.32 16.88 

Total 100.00 100.00 100.00 

Communication Problems***

No 99.57 95.21 96.16 

Yes 0.43 4.79 3.84 

Total 100.00 100.00 100.00 

Lack of Staff Professionalism***

No 99.89 93.41 94.82 

Yes 0.11 6.59 5.18 

Total 100.00 100.00 100.00 

Lack of Staff Follow-Through***

No 96.93 87.84 89.80 

Yes 3.08 12.16 10.20 

Total 100.00 100.00 100.00 

Note: Results are reported as weighted percentages.

*p ≤ .10, ***p ≤ .01

Exhibit 5.163: Clients Did Not Receive Service Because They Were on a Waitlist by 

Medicaid Integration

Did Not Receive Services 

Because of Waitlist

Not Medicaid 

Integrated Medicaid Integrated Total 

No 69.94 88.20 85.11 

Yes 30.06 11.80 14.89 

Total 100.00 100.00 100.00 

Note: Results are reported as weighted percentages. Results are statistically significant at p ≤ .10.
With regard to differences in ability to get to needed services, there was a trend toward statistical 

significance. Respondents from Medicaid-integrated ADRCs were less likely to be unable to get 

to services (p ≤ .10, Exhibit 5.164). 

Statistically significant differences were also found for the usefulness of the information and 

whether the clients still needed the services. Respondents of Medicaid-integrated ADRCs were 

significantly more likely than sites that were not Medicaid integrated to report that the information 

provided by the ADRC was not useful (p ≤ .01, Exhibit 5.165). They were also more likely to 

indicate that they did not receive services from ADRCs because the services were no longer needed 

(p ≤ .01, Exhibit 5.166). Further, respondents were more likely to indicate that services were not 

received due to difficulty in filling out paperwork (p ≤ .05, Exhibit 5.167) or non-eligible age (p ≤ 

.05, Exhibit 5.168) if the ADRC contacted was not Medicaid integrated. 

262 

Exhibit 5.164: Clients Could Not Get to Services by Medicaid Integration

Could Not Get To Services Not Medicaid 

Integrated Medicaid Integrated Total 

No 84.24 96.88 94.74 

Yes 15.76 3.12 5.26 

Total 100.00 100.00 100.00 

Note: Results are reported as weighted percentages. Results are statistically significant at p ≤ .10.

Exhibit 5.165: Information Was Not Useful by Medicaid Integration 

Information Was Not 

Useful

Not Medicaid 

Integrated Medicaid Integrated Total 

No 98.19 88.43 90.08 

Yes 1.81 11.57 9.92 

Total 100.00 100.00 100.00 

Note: Results are reported as weighted percentages. Results are statistically significant at p ≤ .01.

Exhibit 5.166: Clients No Longer in Need of Services by Medicaid Integration

No Longer in Need of 

Services

Not Medicaid 

Integrated Medicaid Integrated Total 

No 98.19 89.43 90.91 

Yes 1.81 10.57 9.09 

Total 100.00 100.00 100.00 

Note: Results are reported as weighted percentages. Results are statistically significant at p ≤ .01.
Respondents were significantly more likely to indicate that the ADRC followed up regarding the 

usefulness of its information if the ADRC contacted was not Medicaid integrated (p ≤ .01, Exhibit 

5.170). 

We also examined the relationship between respondents’ satisfaction with ADRC contact and 

Medicaid integration and found several statistically significant results. For example, as presented 

in Exhibit 5.170, respondents receiving services from ADRCs that were not Medicaid integrated 

were more likely to report being “somewhat satisfied” or “very satisfied” with the services received 

(p ≤ .01) as well as the degree to which the services met their needs (p ≤ .05) compared to 

Medicaid-integrated ADRCs. Similarly, compared to those reporting on Medicaid-integrated 

263 

Exhibit 5.167: Clients Did Not Receive Services Because of Difficulty Filling Out 

Paperwork by Medicaid Integration

Difficulty Filling Out 

Paperwork

Not Medicaid 

Integrated Medicaid Integrated Total 

No 74.07 92.16 89.10 

Yes 25.93 7.84 10.90 

Total 100.00 100.00 100.00 

Note: Results are reported as weighted percentages. Results are statistically significant at p ≤ .05.

Exhibit 5.168: Clients Did Not Receive Services Because of Age by Medicaid Integration

Not the Right Age for 

Services

Not Medicaid 

Integrated Medicaid Integrated Total 

No 83.98 96.98 94.79 

Yes 16.02 3.02 5.22 

Total 100.00 100.00 100.00 

Note: Results are reported as weighted percentages. Results are statistically significant at p ≤ .05.

Exhibit 5.169: Agency Follow-up about Usefulness of Information by Medicaid Integration 

Agency Followed Up Not Medicaid 

Integrated Medicaid Integrated Total 

No 41.66 67.07 61.56 

Yes 58.34 32.93 38.44 

Total 100.00 100.00 100.00 

Note: Results are reported as weighted percentages. Results are statistically significant at p ≤ .01.
ADRCs, respondents reporting on ADRCs that were not Medicaid integrated were more likely to 

state being “very satisfied” with the support received for decision-making (p ≤ .05) and with the 

ease of resolving issues they faced (p ≤ .10). 

264 

Exhibit 5.170: Satisfaction with Services Received by Medicaid Integration

Level of Satisfaction Not Medicaid 

Integrated

Medicaid 

Integrated Total 

Satisfaction with Services Received***

Very Dissatisfied 0.58 2.72 2.27 

Somewhat Dissatisfied 0.58 10.63 8.52 

Somewhat Satisfied 3.31 13.53 11.39 

Very Satisfied 95.53 73.12 77.82 

Total 100.00 100.00 100.00 

Satisfaction with Degree to which Services Met Needs**

Very Dissatisfied 5.05 12.62 10.98 

Somewhat Dissatisfied 1.75 6.89 5.77 

Somewhat Satisfied 11.78 21.00 19.01 

Very Satisfied 81.42 59.49 64.24 

Total 100.00 100.00 100.00 

Satisfaction with Support Received for Decision-Making by Medicaid Integration**

Very Dissatisfied 4.23 8.62 7.55 

Somewhat Dissatisfied 1.31 4.04 3.37 

Somewhat Satisfied 8.11 24.37 20.39 

Very Satisfied 86.36 62.98 68.70 

Total 100.00 100.00 100.00 

Satisfaction with Ease of Resolving the Issue by Medicaid Integration*

Very Dissatisfied 3.64 6.11 5.57 

Somewhat Dissatisfied 1.63 3.61 3.18 

Somewhat Satisfied 8.20 22.84 19.65 

Very Satisfied 86.53 67.44 71.60 

Total 100.00 100.00 100.00 

Note: Results are reported as weighted percentages.

*p ≤ .10, **p ≤ .05, ***p ≤ .01
The final analyses related to Medicaid integration explored differences in whether respondents 

would recommend the ADRC that they contacted to others. There was a trend toward statistical 

significance, with respondents being slightly more likely to recommend the ADRC that they 

contacted if the agency was not Medicaid integrated than it if was Medicaid integrated (p ≤ .10, 

Exhibit 5.171). 

5.3 Outcome Study Discussion and Implications 

This section of the report discusses the main research domains examined by this outcome study. 

The primary focus of the outcome study was to capture the experiences of respondents who sought 

information about or access to LTSS, and the challenges they faced in receiving this assistance. 

The telephone-based survey assessed ADRC users’ experiences accessing needed LTSS, factors 

that led them to seek assistance, information about the services that ADRCs provided to them, 

challenges they faced, and their overall satisfaction with the ADRC. The final sample consisted of 

20 ADRC sites that agreed to participate in the study; from these sites, 552 ADRC respondents 

completed the survey. 

First, a profile of participating ADRCs and consumer respondents is presented. Then, descriptive 

and regression results are provided for the following domains: 

 Responsiveness and effectiveness of ADRCs 

 Assistance with services 

 Access to services 

 Participant satisfaction. 

265 

Exhibit 5.171: Recommend the ADRC to Others in Need by Medicaid Integration

Respondent Would Tell Friends 

or Relatives to Contact Agency

Not Medicaid 

Integrated 

Medicaid 

Integrated Total 

No 2.30 6.12 5.30 

Yes 97.70 93.88 94.71 

Total 100.00 100.00 100.00 

Note: Results are reported as weighted percentages. Results are statistically significant at p ≤ .10.
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.3.1 Profile of Participating ADRCs and Consumers 

Participating ADRC Sites. The majority of the 20 ADRC sites participating in the study were 

local ADRCs (90%) in urban settings (68%), and were medium-sized (60.2%), serving 500–2,500 

consumers; about one-quarter (27%) were larger sites serving more than 2,500 clients. In general, 

these characteristics are similar to the distributions in the national sample of ADRCs that 

participated in the process study. Nearly 43 percent of participating ADRCs identified more than 

15 partnerships; 32 percent reported having between 9 and 15 partners; and the remaining 25 

percent reported 8 or fewer partners. 

Survey Respondents from ADRC Sites. The sample of survey respondents consisted of 552 

ADRC users. Over half of this group came from statewide ADRC sites, indicating an important 

skew in the data because only 2 out of the 20 participating sites were statewide. However, all but 

6 percent of respondents came from medium-sized or large sites; and of the consumers from local 

ADRC sites, more were from sites located in urban areas than in rural areas. These characteristics 

more closely align with the size and geographic regions represented by the participating ADRC 

sites. 

Demographically, survey respondents were most often White (94.%), female (70%), and older 

adults with or without disability (73%). The majority had a high school diploma or less (63%), and 

reported a yearly income of $40,000 or less (82.9%). Over 40 percent of the sample reported living 

alone, and nearly 80 percent of the sample reported living in the community. Approximately 69 

percent self-rated their health as fair or poor , and more than a third had been hospitalized within 

the past 6 months. A small but meaningful percentage had lived in a nursing home (8%) or assisted 

living setting (4%) at least once. This demographic profile identifies many ADRC users with 

backgrounds often associated with negative health outcomes, such as low income, limited 

education, poorer health, and recent hospitalizations. Supporting these clients by helping them to 

understand the full range of available LTSS, thus prolonging their tenure in the community, is a 

key goal of the ADRC program. However, as this profile shows, some ADRC users are healthier 

and younger with more education and a higher income. This suggests that many ADRC sites are 

successfully realizing their mission of providing services not only to older, more at-risk 

populations, but to all persons living in a variety of settings. 

5.3.2 Agency Responsiveness and Effectiveness 

Initial Contact with ADRC. Overall ADRC efficiency was measured by assessing the ease with 

which respondents could directly talk with an ADRC representative during their initial contact, 

including mode of initial contact, wait time, and the number of call attempts needed to speak to an 

ADRC representative. The overwhelming majority of respondents first contacted the ADRC via 

266 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

telephone (86%) compared to visiting in person. The results suggest that some ADRC sites are 

efficient in responding to respondents during initial contact, with 57 percent of respondents 

reporting a wait-time under 5 minutes; however, about 14 percent waited between 5 and 10 

minutes, while an additional 28 percent waited more than 10 minutes, and at times, more than 20 

minutes. This can be a significant barrier for clients calling from work, those who are caring for 

children or other family members, or those who simply do not have the time to wait. 

Over 73 percent of respondents reported speaking with a representative who was able to help them, 

and about 70 percent had to describe their request only once. However, 25 percent of respondents 

had to explain their request two or more times. Of the 18 percent who spoke with an ADRC 

representative who was not able to help them, nearly 71 percent had to make at least one additional 

contact to the ADRC before reaching that representative (nearly 20% of this group reached out 

three or more times). These data may reflect clients who have more difficulty explaining their 

needs or understanding information provided over the phone or in-person, but the outcome also 

highlights the need for continued improvement on the part of ADRC sites to make the initial 

contact and intake process as easy as possible for consumers of all abilities. 

Respondents were asked to identify the primary reasons for contacting the ADRC. The five most 

common reasons were information about Medicare (21%), Medicaid (20%), personal care 

programs (9%), nutrition programs (7%), and housing options (6%). Differences between 

subgroups were identified in regression analyses. Respondents calling from one of the two 

statewide ADRC sites had a greater likelihood of inquiring about Medicare or Medicaid, and 

persons from local ADRCs in rural areas had a greater likelihood of inquiring about personal care 

programs. Clear explanations for these findings could not be determined. Additional analyses that 

control for client income and the availability of services would help to tease out the underlying 

drivers of these findings. 

Effectiveness of ADRC Representatives. Results from this survey suggest that ADRC 

representatives are effective in communicating with clients. Most respondents reported positive 

interactions with ADRC staff. About 87 percent indicated that representatives correctly assessed 

their LTSS needs, and nearly 93 percent rated the representative as very or somewhat 

knowledgeable about the information or services inquired about. In addition, 94 percent of 

respondents indicated that the information they received was “very” or “somewhat” clear and 

understandable, and about the same percentage felt that the representative paid close attention. 

However, two notable findings emerged in the regression analyses. First, persons with disabilities 

and their proxies were less likely to report that the representative paid close attention. This finding 

may be related to the complex needs of this group, which are difficult to understand and solve, but 

it also suggests that ensuring attentiveness to persons with disabilities is a potential area of quality 

improvement for ADRCs. Second, a large effect was observed for those living in areas with more 

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nursing home beds; this group had a significantly lower likelihood of feeling that the representative 

paid close attention (-54.1 percentage points; p ≤ .01). While the connection between nursing home 

bed supply and representative attentiveness is not immediately clear, ADRCs located in such areas 

may be operating in an environment with an increased demand and limited supply of HCBS, which 

may detract from representatives’ ability to identify and convey information about available 

services. 

With regard to whether LTSS planning was provided by ADRC representatives, in general, the 

findings are positive. Among those who requested it, 69 percent of respondents indicated that they 

received assistance with long-term planning (significantly more respondents from local ADRCs 

received planning assistance compared to those using statewide ADRCs). Of this group, about 90 

percent felt that the plan reflected their specific LTSS needs and preferences. Examining 

specifically whether respondents were given an explanation of choices for remaining in the 

community, regression analyses showed that persons with disabilities and those who self-rated 

their health as poor were more likely to have received such an explanation; however, respondents 

from statewide ADRC sites were less likely to have community options explained. In many 

respects these results are positive, indicating that persons with potentially higher risk of 

institutionalization are appropriately targeted and made aware of community-based options. 

Results of Contacting ADRC. Survey participants were asked a number of questions to determine 

the nature of services received as a result of contacting the ADRC. About 59 percent of respondents 

accessed needed services directly from the ADRC, while 28 percent were referred elsewhere. 

Respondents from local ADRCs were more likely than statewide ADRC users to have accessed 

services directly. Not surprisingly, the most common services provided directly by the ADRC were 

I&R, options counseling, and eligibility determination—core services encouraged throughout the 

Federal ADRC program. The exception to this was care transition services, which were more 

commonly reported to be delivered indirectly, through a referral to an external organization. This 

is notable, because increasing the ability of ADRCs to either directly deliver care transition 

services or partner with other organizations to provide those services has been promoted through 

grant programs at the Federal level. 

Of those respondents who were referred elsewhere to receive services, 62 percent reported that an 

ADRC representative helped them connect to services through the referred providers, suggesting 

that even when referrals are made, many ADRCs continue to assist clients as they engage with the 

external providers. However, only 26 percent of this group reported receiving a “warm transfer,” 

whereby an ADRC representative remained on the line to assist in transferring the caller to the 

provider organization. Of the 71 percent who did not receive warm transfers, 73 percent reported 

being given contact information for the referred organization, and 22.7 percent indicated that the 

ADRC helped arrange contact in some other way. 

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Warm transfers help ensure that complete and accurate information, including the client’s needs, 

preferences, and eligibility, is relayed to the provider; the low proportion of warm transfers flags 

a potential area for quality improvement, since some respondents in this sample were left to contact 

providers and arrange services on their own. The practice of not providing a warm transfer or not 

continuing to be involved as callers are referred elsewhere may result in clients not following 

through with the referral, needing to provide key information again, going through additional 

assessments, becoming confused about their options, or experiencing delays in the receipt of 

services. The survey explored such negative consequences, and found that of respondents referred 

to outside agencies, 48 percent reported that the provider did not have any information and the 

process had to be started over again; an additional 6 percent indicated that providers had some 

information, but it was not correct. This finding points to another aspect of service provision that 

might be considered for future ADRC quality improvement initiatives. 

Assistance with Medicaid Eligibility. The survey examined the Medicaid eligibility 

determination experiences of ADRC users who were not current beneficiaries, but who spoke to a 

representative about the Medicaid program. A majority of this group (58%) reported not receiving 

specific information on applying for federally sponsored healthcare financial assistance and 

residential support services, while just over one-third did receive such information. About 74 

percent of this group also did not receive information about other insurance options. This finding 

points to a potential service gap experienced by a majority of ADRC users interested in Medicaid 

and other public programs, because applying for this program is often considered a timeconsuming and complicated task, which may be a barrier to receiving services as quickly as 

possible. 

Of those respondents who did receive information on applying, nearly half (47%) reported that 

they completed an application; most of those who completed the application reported receiving 

assistance from the ADRC (70%). Respondents who did not complete an application (49%) cited 

several reasons: they believed they or their family members to be ineligible for Medicaid, or that 

they were currently in the process of gathering information, making a decision to apply, or hadn’t 

yet received an application. Taken together, these reasons indicate a continued need for education 

on eligibility as well as hands-on assistance in completing applications to ensure enrollment as 

quickly as possible. 

Assistance with One-on-One Options Counseling. Options counseling refers to an interactive 

process through which appropriate and desired LTSS needs are determined and planned according 

to an individual’s particular circumstances. Often considered a “value-added” benefit that sets 

ADRCs apart from other organizations, one-on-one options counseling may encourage proactive 

planning for current and future needs in a comprehensive manner. The outcome study measured 

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aspects of options counseling services and the results of receiving such counseling. While a large 

majority of survey participants did not request options counseling (78%), about one-fifth did. 

Of those who requested options counseling, 53 percent reported that they received the service, 

while, surprisingly, 44 percent indicated that they did not receive it. It may be worthwhile to more 

closely examine the reasons for this discrepancy by matching respondents who did not receive 

requested options counseling to their home ADRC sites to determine the reasons why the service 

was not provided. 

Of those that requested and received options counseling, 60 percent received such counseling in 

their own homes, and nearly 70 percent received a follow-up call after completion of the options 

counseling. As a result of receiving the counseling, 81 percent of respondents felt that they better 

understood their LTSS options, 74 percent intended to get in touch with public programs, and 61 

percent reported that they obtained LTSS planning or services that fit within their budget. These 

data suggest that options counseling was fairly successful in delivering clear, tailored options that 

included public programs. However, only 41 percent of respondents reported that they were able 

to make a decision about LTSS, and only 36 percent intended to get in touch with private-pay 

services. These data point to a need to bolster the decision-making aspects of options counseling, 

as well as private-pay components, which may include helping lower-income clients more 

thoroughly understand how to budget non-publicly funded services. 

Care Transition Service. The vast majority of respondents reported that they did not receive care 

transition services (96%). This finding is important because although the process study and 

subgroup analyses revealed the characteristics of sites more likely to offer care transition services 

(e.g., local vs. statewide, decentralized, and Medicaid-integrated sites), the provision of such 

services is still quite low in this sample. Given the growing interest in care transitions and the key 

role such services play in individuals’ ability to remain in the community, it may be of interest to 

explore why care transition services are frequently not provided even though they may be offered. 

Of the 3 percent of respondents who indicated that they did receive care transitions services, most 

received some combination of the following: a needs assessment prior to discharge from the acute 

care setting, an explanation of discharge instructions, and post-discharge services such as 

transportation, help filling prescriptions, or household help. However, less than one-third of this 

group received a follow-up phone call or in-person visit within 48 hours of discharge. Since 

“having eyes on” newly discharged clients is often considered an essential aspect of care transition 

management, such a low number of respondents receiving follow-up points to another area where 

improvement is needed. 

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Diversion from Nursing Homes. At the time of contact with the ADRC, most respondents (85%) 

were not considering a move to a long-term care facility, either for themselves or for the person 

on whose behalf they called. Further, only 29 percent of respondents believed that they were “very 

likely” or “somewhat likely” to move to a nursing home within 5 years. 

The study explored whether ADRC representatives helped respondents understand their options 

for staying in the community and thereby avoid or delay a move to a nursing home or another 

long-term care facility. Only 31 percent of respondents indicated that ADRC representatives 

helped them in this regard. When considered together with the finding that most ADRC users in 

this sample were not thinking about entering a nursing home, it would seem to follow that ADRC 

representatives did not have reason to provide this assistance. However, in the process study, 

approximately 91 percent of local ADRCs indicated that diversion from nursing homes or other 

institutional residential care facilities is an outcome their agency seeks to achieve. There is a 

mismatch, then, in that less than one-third of respondents received services in line with this goal. 

5.3.3 Access to Services 

This section summarizes the results related to the processes and challenges faced by respondents 

in seeking information about LTSS from ADRCs and accessing LTSS from other agencies. This 

information is useful in identifying areas for improvement in ADRCs’ performance and for 

facilitating access to LTSS. 

ADRC Contact and Follow-up. Over 35 percent of respondents initially heard about the ADRC 

from a family member, friend, or other acquaintance; 27 percent were referred to the ADRC from 

another agency or organization. The remaining respondents said they learned about the ADRC 

through media, hospitals, or doctors; by browsing the Internet or telephone book, or through their 

workplaces. These data highlight the importance and impact of word-of-mouth in outreach efforts. 

Just over 79 percent of respondents contacted the ADRC before they contacted any other 

organization, while 18 percent contacted another agency first. However, relatively few (9%) 

respondents were in touch with a similar agency after contacting the ADRC, and of those who did, 

about 71 percent felt that the other organization was unable to meet their needs. 

After contact with the ADRC was initiated, only 37 percent of respondents indicated that the 

ADRC made a follow-up call regarding either the referrals that were made or the usefulness of the 

information received. Interestingly, rural ADRCs were more likely to have made follow-up calls 

compared to urban sites. More work should be done to examine the utility and benefit of followup contact related to referrals and information quality, to determine if specific protocols for followup should be put in place. 

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Challenges in Receiving Services from ADRCs. Respondents were asked whether they received 

the services they needed and desired and, if so, the length of time it took to begin receiving the 

service. Approximately 32 percent received services within 1 week’s time, while 11 percent waited 

more than 1 week to receive services. 

However, a majority of respondents (53%) reported that they did not receive services that they had 

requested. These survey participants were asked to provide the reasons that they did not receive 

the requested services. Responses included placement on a waitlist, lack of available services, and 

difficult paperwork. Respondents with lower self-rated health were more likely to identify lack of 

available services, waitlists, and information that was not useful compared to respondents with 

higher self-rated health. Persons with disabilities were more likely to identify inconvenient hours, 

transportation issues, and difficulty filling out paperwork as challenges. Identifying surmountable 

challenges to these two subgroups of clients, who may be at higher risk for hospitalizations or 

institutional placement, is an important finding of this research. Focusing efforts to reduce these 

barriers, to the extent possible, may help these individuals more easily access the services they 

need to help them remain healthier and in the community. 

Challenges in Resolving Issues. When asked about challenges experienced while working with 

ADRCs, less than one-fifth of respondents reported experiencing challenges that limited their 

ability to resolve issues. However, among those that did report challenges, the most common issue 

was difficulty reaching ADRC staff (17%), followed by lack of staff follow-through, lack of staff 

knowledge, and hours of operation. Regression analyses showed that respondents from rural 

ADRCs and those contacting statewide sites were less likely to report challenges in reaching 

ADRC staff. An examination of policies and procedures surrounding operational aspects such as 

methods of contacting staff members, follow-up protocols, and more convenient hours of operation 

may reveal solutions to reduce these challenges; however, relatively few respondents reported 

having experienced these challenges. 

LTSS Referrals by ADRCs. Types and results of referrals made by ADRCs were also explored 

in the study. A small number of respondents (126) reported being referred to a variety of LTSS; 

no single service category stood out. The five most common referred services, as reported by 

respondents, were the following: 

 Non-medical in-home assistance (9%) 

 Health insurance other than Medicaid or Medicare (8%) 

 Medicare (6%) 

 Food stamps/pantry/assistance services (6%) 

 Departments of Health/Human Services (5%). 

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Of this group, only 43 percent received the services for which they were referred, while 20 percent 

did not. Those who did not receive the services cited reasons such as the service was not wanted 

or needed, or the service was not available at needed times (some respondents were consequently 

placed on waitlists). 

5.3.4 Participant Satisfaction 

A major goal of the study was to understand respondent satisfaction with a number of ADRC 

services and the overall quality of information and support provided. This section summarizes and 

discusses results related to these aspects of satisfaction and suggests potential areas for 

improvement. 

Satisfaction with Services. Among those who received key services from ADRC sites, there was 

relatively high satisfaction reported by respondents. About 93 percent of respondents reported 

being “very” or “somewhat” satisfied with one-on-one options counseling, and 92 percent were 

satisfied with the care transition services received. 

However, when considering overall direct services received, a slightly smaller proportion of 

respondents indicated satisfaction (63% were “very satisfied,” 9% were “somewhat satisfied”). 

Subgroup analyses showed that respondents from local ADRCs were more likely to be, whereas 

those who reported lower incomes were more likely to be satisfied with overall direct services 

received. The most common reason cited for dissatisfaction was respondents’ belief that they did 

not receive the services they sought from the ADRC. 

Completeness of Information. Respondents were generally satisfied with the completeness of 

information received (83%). However, regression analyses show that respondents who lived alone 

and those who contacted the ADRC for Medicare-related questions were less likely to report 

satisfaction. It may be that respondents living alone lacked support in helping them use the 

information they received, resulting in a misperception by the ADRC that they had provided 

complete, adequate information. This may indicate an opportunity for the ADRC to more closely 

support those without a co-resident. A lesser likelihood of satisfaction regarding Medicare-related 

questions may reflect the complexity inherent in the program, or misunderstanding of what 

Medicare does and does not cover; again, ADRCs may have an opportunity to improve services to 

those calling about Medicare inquiries by bolstering the amount of information that staff have and 

their ability to comprehensively and efficiently convey it in a way that is easy to understand. 

Degree to Which Services Met Needs. Approximately 80 percent of respondents reported being 

“very” or “somewhat” satisfied with the degree to which services that were offered met their 

specific needs. Factors identified in regression analyses as associated with higher satisfaction 

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include having more education, accessing rural ADRC sites, and calling about Medicare-related 

questions. Respondents contacting the ADRC on their own behalf (versus as a proxy for someone 

else), however, were less likely to be satisfied with the degree to which services met their needs. 

This may not indicate actual dissatisfaction, but, rather, may suggest that proxies are differently 

assessing how well services meet the needs of their care recipients. Regardless, there may be 

opportunities to support users who contact the ADRC on their own behalf to ensure that they have 

enough information, support, and service levels to meet their LTSS needs and preferences. 

Accuracy of Information. Over 91 percent of respondents indicated being “very” or “somewhat” 

satisfied with the accuracy of the information they received. Bivariate analyses showed that 

respondents contacting local ADRCs reported higher satisfaction. However, when controlling for 

other factors, regression analyses showed higher likelihoods of satisfaction from those respondents 

having a high school degree and contacting a statewide ADRC. Interestingly, regressions also 

demonstrated that persons calling from areas with higher availability of nursing home beds were 

significantly more likely to report dissatisfaction, albeit with a relatively low effect size. 

Decision-Making Support. About 71 percent of respondents were either “very satisfied” or 

“somewhat satisfied” with the support they received for decision-making. Regressions showed 

that factors associated with higher satisfaction likelihood included respondents from statewide 

ADRC sites, and respondents with Medicaid-related inquiries. A number of factors associated with 

lower likelihoods of satisfaction were also identified: married respondents, respondents who selfrate their health as poor, respondents who live alone, and respondents from areas with a higher 

number of nursing home beds available. In many respects, these findings are logical; persons living 

alone, those in poor health, and those living in regions where HCBS may be constrained might 

require more support in making decisions than others. However, the finding that married 

respondents had lower likelihood of satisfaction with decision-making support was unexpected 

and is difficult to explain. 

Staff Professionalism. Respondents rated the professionalism of ADRC staff highly, with 93 

percent of respondents expressing satisfaction. Subgroup analyses revealed that respondents who 

contacted local ADRCs and who had better self-reported health reported higher levels of 

satisfaction with staff professionalism, compared to those who contacted statewide ADRCs and 

those with poorer self-rated health. No other subgroup effects were observed, suggesting that, 

overall, ADRC sites have hired and appropriately trained staff. 

Ease of Working with ADRCs to Resolve Issues. Respondents were generally satisfied with the 

ease of working with the ADRCs; more than 86 percent of respondents indicated they were “very 

satisfied” or “somewhat satisfied.” Older respondents were more likely to report being 

“somewhat” satisfied, while younger participants were more likely to report being “very 

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dissatisfied.” Since all younger adults in the sample have a disability, this finding supports our 

earlier assumption that problems experienced by adults with disabilities are more complicated or 

difficult to resolve, resulting in less satisfaction with ADRC services. No other significant 

subgroup effects were found. 

Satisfaction with Services Received at Agencies to Which Respondents Were Referred. Only 

59 percent of respondents who reported receiving services indirectly, or both directly and 

indirectly, indicated that they were satisfied with the services they received from the agencies to 

which they were referred. The results of the subgroup analyses show that those with more 

education reported higher satisfaction, while respondents who rate their health as poor were less 

likely to be satisfied. Those reporting dissatisfaction identified reasons such as not receiving 

services, or their perception that the agency seemed to be uninterested in working with them. These 

results underscore the reality that clients are referred to external agencies that may or may not be 

partner organizations to the ADRC, which alters the degree of control of how and when services 

are provided. The results also highlight the importance and value of ADRC staff remaining 

involved as clients set up services with referred providers, and of following up to ensure clients’ 

needs are being met. 

5.3.5 Usefulness of Services 

To assess the overall usefulness of ADRC services, the outcome study survey asked respondents 

to report on awareness of LTSS needs, certainty of LTSS options, and usefulness of information 

in selecting LTSS. Only 15.5 percent of respondents indicated improved awareness of LTSS needs, 

suggesting either that most respondents who contact ADRCs already have a comprehensive 

understanding of their needs, or that ADRC staff are not sufficiently assessing additional, 

previously unknown needs during contact. 

Respondents were asked to rank the level of usefulness of the information provided by ADRCs as 

they were selecting LTSS options. About 69 percent reported that the information they received 

was either “very useful” or “somewhat useful.” Only 20 percent indicated that the information was 

not useful. Regression analyses showed a large effect on perceived usefulness of services among 

respondents who contacted statewide ADRCs (vs. local ADRCs): this group was much less likely 

to rate the information as useful. 

5.3.6 Value of ADRCs to Respondents 

Finally, the study assessed the value that ADRCs held for respondents by asking respondents 

whether they would recommend contacting an ADRC to a friend or relative in need and how likely 

they themselves were to contact ADRCs in the future, if needed. An overwhelming majority (94%) 

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indicated that they would recommend the ADRC to others, and 92 percent said that they were 

“very likely” or “somewhat likely” to contact the ADRC again if needed. Only 8 percent indicated 

they were either “somewhat unlikely” or “very unlikely” to do so. This suggests that despite 

dissatisfaction with specific aspects of ADRC services, respondents had an overall positive 

experience and sense of value, and felt that others would experience the same value. 

5.3.7 Comparison by Core Integration Dimensions 

Bivariate exploratory analyses were conducted on key variables for each of the three core measures 

developed for this project: level of core service provision, extent of site integration, and status of 

Medicaid integration. 

Core Service Provision. The results of the bivariate analyses showed some evidence of effects 

associated with the level of core services provided by the ADRC, with regard to specific issues in 

assistance with services, access to services, and participant satisfaction. As discussed in earlier 

sections, high-level core service providers were those that provide information and referral, 

options counseling, eligibility determination, and care transition services; medium-level core 

service provision sites offer all of the above but not care transition services; and low-level sites do 

not offer options counseling or eligibility determination. 

First, an association between level of core service provision and reason for ADRC contact was 

observed; respondents from low-level core service provision ADRCs were significantly more 

likely to cite nutrition services as a reason for contact (89%), those from medium-level sites were 

more likely to cite Medicare questions (47%), and those from high-level sites were more likely to 

inquire about Medicaid questions (34%). Differences in reason for contact were not expected to 

vary between levels of core service provision, but the results may point to such sites operating in 

environments where nutrition services are more needed or more available, or where other agencies 

are known to provide information on Medicare and Medicaid. In addition, respondents from lowlevel core service provision sites were also significantly less likely to have received benefits 

counseling as a result of contacting the ADRC, with a lower likelihood of receiving counseling or 

peer support that approached significance. These results are in line with sites that, by definition, 

do not provide either options counseling or Medicaid eligibility determination. 

Next, two significant differences were seen between ADRC core service provision levels and 

accessing ADRC services. First, respondents from low-level core service provision sites were 

significantly more likely to have first heard about the ADRC via referral from another agency or 

organization (nearly 60%), compared to respondents from medium-level (27%) and high-level 

(25%) core service provision sites. On the other hand, a significantly higher percentage of 

respondents from medium-level (39%) and high-level (42%) core service provision sites learned 

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about the ADRC via friends, family, or other acquaintances compared to those from low-level sites 

(19%). It may be that medium- and high-level sites have more resources for outreach and 

marketing, thus increasing general awareness and higher usage of their ADRCs than low-level 

sites, which is translated by work-of-mouth to others in need. It may also be the case, however, 

that low-level sites have stronger referral networks to compensate for a lack of resources that 

prevents them from offering options counseling or eligibility determination services. Second, 

significantly more respondents from low-core service provision sites reported hours of operation 

to be a barrier in resolving their issues (46% versus only 7% for medium-level and 5% for highlevel sites). ADRCs that offer fewer services may have more limited hours of operation. No other 

significant differences were observed. 

Finally, two measures of participant satisfaction were shown to vary by core service level. As a 

whole, most respondents reported satisfaction with the professionalism of ADRC staff. However, 

a higher percentage of those from high-level core service provision sites reported being either very 

or somewhat dissatisfied with staff professionalism (6%) than respondents from low-level (1%) 

and medium-level (2%) core service sites. A similar result was observed for satisfaction with ease 

of resolving issues; about 13 percent of respondents from high-core service level sites reported 

dissatisfaction, compared to about 4 percent of medium-level and 0 percent of low-level sites. 

Perhaps this is related to a greater opportunity to experience dissatisfaction in sites that provide 

more services; respondents from high-level sites received more services from potentially more 

staff members, thereby increasing the chance to observe a lack of professionalism. Alternately, it 

may be that staff from high-level sites are busier or stretched more thinly. Still, the vast majority 

of respondents from all core service provision levels reported satisfaction with these two outcomes, 

and no other outcomes demonstrated significant between-group differences. 

Overall, the results from these analyses show some differences between outcomes from 

respondents of low-level core service provision ADRCs compared to high- and medium-level sites. 

These differences suggest that low-level sites may depend more heavily on referrals and provide 

a narrower scope of services, while high-level sites may have operational practices that are 

associated with a slightly higher degree of dissatisfaction. However, most of the significant 

differences observed are marginal or have relatively low practical significance, indicating that 

level of core service provision is not a major determinant of participant experience. 

Site Integration. Extent of site integration was captured by determining the comprehensiveness 

of services and supports offered by an ADRC, and the operational processes and degrees of 

partnerships that facilitate these services. This included assessing populations served, specific 

services offered, extent of integration and sharing of data, and the breadth of partnerships and 

stakeholder involvement. Bivariate analyses revealed a number of differences between 

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respondents from low-, medium-, and high-level site integration ADRCs in the domains of 

assistance with services, access to services, and participant satisfaction. 

Only three aspects of assistance with services were found to significantly differ by level of site 

integration. A lower percentage of respondents from medium-level sites reported receiving 

information and referral services as a result of contacting the agency, while a much larger 

proportion of respondents from low-level sites reported receiving life skills training. Further, no 

respondents from low-level sites indicated any of the five most common reasons for contact 

(Medicare, Medicaid, housing, personal care, and nutrition), whereas about one-third of 

respondents from high-level sites mentioned Medicaid questions and the same proportion reported 

personal care inquiries. The relationship between the extent of site integration and access to 

services is not clear; these results show unexpected differences related both to respondent 

motivation in seeking out an ADRC and the services received as a result. 

Regarding access to services, only two significant differences in site integration were observed. 

First, more respondents from high-level site integration ADRCs identified a lack of staff followthrough as a challenge in getting their issues resolved. Two additional results approached but did 

not meet statistical significance: respondents from low-level sites were more likely to identify 

hours of operation as a challenge, while a greater percentage of respondents from high-level sites 

reported lack of staff professionalism as a challenge. Second, a higher percentage of respondents 

from high-level sites indicated that the organization did not follow up about referrals/information 

provided (76%) compared to those from medium-level sites (57%) and low-level sites (50%). 

Taken together, these results contradict what was anticipated: ADRCs with more comprehensive 

services and broad partnership networks were expected to be able to provide consistent follow-up. 

That respondents from this group were less likely to report receiving follow-up and more likely to 

indicate lack of follow-up as a barrier to addressing their unique issues suggests that follow-up 

policies and procedures may need to be examined and strengthened. 

Two aspects of participant satisfaction demonstrated significant differences related to site 

integration. First, a greater percentage of respondents from high-level sites reported dissatisfaction 

with staff professionalism (8%, vs. 2% of medium-level sites and 0% of low-level sites). Similarly, 

a higher percentage of this group also reported dissatisfaction with the ease of resolving issues 

(19%) compared to medium-level (4%) and low-level (0%) sites. Because high-level sites were 

classified based on the depth and breadth of partnerships, number of consumers served, and 

services offered, these results may reflect that staff have less time to spend with each client, or 

have an increased workload compared to less integrated sites. Fine-tuning these aspects of 

customer service may be particularly important to more integrated ADRCs. However, it is 

important to note that a majority of respondents across all groups reported satisfaction with staff 

professionalism and the ease of resolving issues. 

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Evidence from the outcome study suggests that some aspects of service provision—offering 

follow-up and ensuring client satisfaction—are related to the extent of integration an ADRC strives 

to achieve. Yet most outcomes of interest to this project did not vary between site integration 

subgroups. Teasing apart the aspects of site integration that account for the largest variance in the 

few differences that were observed may shed more light on potential strategies to improve services 

and satisfaction. 

Medicaid Integration. A dichotomous variable was computed to categorize ADRC sites on 

Medicaid integration, based on whether they had received funding from any of six Medicaidrelated sources during FY 2013: CMS Real Choice Systems Change Grants, CMS PersonCentered Hospital Discharge Planning Grants, Money Follows the Person Demonstration, 

Program of All-inclusive Care for the Elderly (PACE), Medicaid for Direct Services, and Medicaid 

for Federal Financial Participation. Significant differences were detected through bivariate 

analyses that examined Medicaid integration and assistance with services, access to services, and 

participant satisfaction. 

First, a slightly higher percentage of respondents from Medicaid-integrated ADRCs reported 

receipt of information and referral services (89%) versus those from sites that were not Medicaid 

integrated sites (75%). In contrast, a larger proportion of respondents from sites that were not 

Medicaid integrated (48%) reported receiving counseling or peer support (compared to just 22% 

of those from Medicaid-integrated ADRCs). No significant differences were found with regard to 

receipt of eligibility determination, which was unexpected. Interestingly, with regard to reasons 

for contacting an ADRC, a higher percentage of respondents from sites that were not Medicaid 

integrated cited Medicaid questions (50%) compared to just over one-quarter of respondents from 

Medicaid-integrated sites, underscoring the importance of all ADRCs having accurate and easily 

understood information about the Medicaid program to convey to clients, regardless of whether 

they engage with Medicaid-related funding sources. 

Significant differences by Medicaid integration were observed for three outcomes related to access 

to services. A larger proportion of respondents from Medicaid-integrated sites identified 

communication problems (5%), lack of staff professionalism (7%), and lack of staff followthrough (12%) as barriers to resolving their issues. These findings suggest that ADRCs with a 

focus on Medicaid programming have staff who may be less attuned to client preferences; 

however, the percentages of respondents who identified these issues in the first place are quite 

small. 

Respondents were asked whether they received requested services, and those who indicated that 

they had not received requested services were asked the reasons for this. Differences between 

respondents from Medicaid-integrated and non-Medicaid-integrated ADRCs were observed. 

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Compared to respondents from sites that were not Medicaid integrated, 12 percent of respondents 

from Medicaid-integrated sites said that the “information was not useful,” compared to 2 percent 

from non-Medicaid-integrated sites; and 11 percent indicated they were no longer in need of the 

service, compared to 2 percent from non-Medicaid-integrated sites. However, larger percentages 

of respondents from sites that were not Medicaid integrated reported not receiving services due to 

difficulty filling out paperwork (26% vs. 8% from Medicaid-integrated sites), or not being the right 

age for the services (16% vs. 3% from Medicaid-integrated sites). Yet when asked if staff followed 

up about the usefulness of information or referrals, a larger percentage of respondents from sites 

that were not Medicaid integrated said yes (58% vs. 33% from Medicaid-integrated sites). These 

results demonstrate the value of Medicaid-integrated sites in assisting with paperwork that may be 

confusing to clients, and appropriately assessing age-based eligibility for programs. The findings 

also highlight a potential need to improve the quality of information given and institute more 

standardized follow-up procedures. Again, it should be noted that the majority of respondents from 

both groups did not report these problems. 

Finally, subgroup differences were observed in three measures of participant satisfaction. A larger 

percentage of respondents from Medicaid-integrated sites indicated dissatisfaction with the 

services received, the degree to which services met their needs, and the support received for 

decision-making. On all of these measures, 12–20 percent of respondents from Medicaidintegrated sites expressed dissatisfaction, compared to just 7% percent or less from sites that were 

not Medicaid integrated. These data may reflect a greater complexity in the services and 

information delivered by integrated ADRCs, or the more complicated needs of clients who are 

likely to be linked to the Medicaid program. Although a majority of all respondents indicated 

satisfaction on these measures, these findings point to a need to examine the quality of information 

and services, as well as the manner in which they are delivered, in organizations that are engaged 

in Medicaid-related activities. 

Overall, these findings suggest that Medicaid integration is associated slightly negatively with the 

services clients receive and with the quality of interactions between clients and staff with regard 

to communication, clarity, and meeting client needs. Given the relative importance of integrating 

ADRC services with Medicaid and public program eligibility determination, improving these 

aspects of participant experiences—and ensuring that declines do not occur as more ADRCs move 

toward integration—may be a priority area for the near term. 

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CHAPTER 6. CONCLUSIONS FROM THE PROCESS AND OUTCOME 

STUDIES
 

The first national process and outcome study of ADRCs was designed to understand how ADRCs 

are facilitating access to LTSS as needed and desired by older persons, individuals with 

disabilities, and their caregivers and to understand clients’ experiences when contacting an ADRC 

for assistance in obtaining LTSS. 

Process study data were collected from 48 state-level and 472 local-level ADRC sites via a webbased survey fielded in conjunction with required ADRC program reporting through the SART. 

Survey items considered motivation and objectives in becoming an ADRC, funding, community 

and consumer information, organizational information, and partnerships. The outcome study 

gathered data through a telephone-based PES, completed by 552 clients from a sample of 20 

ADRCs. The PES captured the characteristics of participants and assessed the responsiveness and 

effectiveness of ADRCs, assistance with services, access to services, and participant satisfaction. 

6.1 Progress in Achieving the Goals and Vision of the ADRC Program 

The ADRC program was designed around a vision of providing integrated access to LTSS to 

persons of all ages, disabilities, and incomes. To assess the ADRCs' progress in achieving this 

vision, relevant domains were identified and evaluated in the process and outcome studies. This 

chapter highlights a number of meaningful findings from the process and outcome studies and 

situates the results in the context of the status of the ADRC program at the time of the study. 

Limitations of the research and considerations for the future evolution of ADRCs are also 

discussed. 

6.1.1 Providing Access to LTSS through Key Services 

Overall, many positive findings in both studies demonstrate that ADRCs are making strides to 

meet their mission as evidenced by the services they provide, the improvements they have 

instituted since receiving ADRC funding, and their increasingly diversified sources of funding. 

For example, over three-quarters of ADRC respondents indicated that they provide one-on-one 

options counseling and conduct initial screenings for Medicaid eligibility—two services deemed 

key to the original vision of the ADRC program. About 25 percent of sites that provide eligibility 

determination also reported the ability to make presumptive eligibility determination to expedite 

service receipt while applications are processed. This may help consumers get needed services 

more quickly and thus lengthen their tenure in the community by delaying institutionalization. 

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However, a vast majority of PES respondents reported that they did not receive care transition 

services, and only 37% of ADRCs reported offering care transition services. This finding is 

important: Despite specific funding efforts to encourage care transition services, provision was 

quite low. Of the 3 percent of respondents who indicated that they did receive care transitions 

services, most received some combination of: 

 A needs assessment prior to discharge from the acute care setting 

 An explanation of discharge instructions 

 Post-discharge services such as transportation, help filling prescriptions, or household help 

While these low numbers may be, in part, a result of the eligibility requirement for study 

participation that excluded health care professionals and professional caregivers, who are typically 

the people who initiate care transition services, this is an area for more research. Further, less than 

one-third of this group received a follow-up phone call or an in-person visit within 48 hours of 

discharge. As “having eyes on” newly discharged clients is often considered an essential aspect of 

care transition management, the low number of respondents receiving follow-up contact points to 

another area where improvement is needed. Going forward, given the growing interest in care 

transition and the key role such services play in individuals’ abilities to remain in the community, 

it may be of interest to explore this apparent disconnect. 

More than half of PES respondents said that they had not received the services they had requested 

by the time of the survey, which was approximately three to four weeks after contact with the 

ADRC. However, it is important to note that most of the services requested by clients— 

transportation, housing, and the like—are not provided directly by the ADRC. The ADRC serves 

to provide integrated access, including referral to appropriate services. This finding may reflect a 

lack of availability of needed services in the community, or it may suggest that a longer duration 

of time may be needed to determine whether the services were indeed eventually received. 

Notwithstanding, this is an area for further review in order to determine what technical assistance 

or future funding initiatives might be developed to understand the etiology of the problem and to 

ensure that ADRC consumers are receiving needed and wanted LTSS to the extent possible. 

Delaying or preventing individuals from having to spend-down to meet Medicaid eligibility 

requirements or to rely on more expensive LTSS options by helping them learn about low-cost 

options and make better use of their own resources has been a focus of ADRC grants since their 

inception in 2003. Results of the process study show that 91 percent of ADRC sites indicated that 

diversion from nursing homes or other institutional residential facilities was an outcome their 

agency sought to achieve. However, only 31 percent of PES respondents reported that ADRC 

representatives helped them understand their options for staying in the community and, thereby, 

avoid or delay a move into a nursing home or another long-term care facility. It may be that clients 

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did not request assistance with diversion services, but further work is needed to determine if a 

mismatch exists between citing diversion as a goal and providing information and assessments 

accordingly. 

6.1.2 Effects of Funding on Achieving Mission and Goals 

Sites were generally positive about the effects of ADRC funding on their program goals. Nearly 

all local ADRC representatives reported improvement in the ADRC’s ability to provide integrated, 

comprehensive access to LTSS since the inception of the ADRC program. Information, referral, 

and awareness of LTSS programs; options counseling; and person-centered transition support were 

cited as services provided since the receipt of ADRC grant dollars. Furthermore, most state 

ADRCs reported that ADRC program funding enabled them to increase the number of partnerships 

and improve the skills of staff members, while local-level sites reported that funding increased 

their level of coordination with aging and disability network organizations and improved staff 

training opportunities. Some evidence, however, suggests that large and medium-sized ADRCs 

that served more clients realized larger benefits of funding. More work is needed to understand 

why differences exist and to develop strategies to reduce this disparity in the future. 

6.2 Partnerships 

State and local partnerships have been recognized as a central component of the ADRC program 

since its inception. The importance of partnerships has been reflected in the evolution of the ADRC 

program at the federal level as well, as formal agreements with AoA/ACL, CMS, and VHA over 

the past decade have encouraged changes to the ADRC model, emphasizing inclusion of 

populations served by each agency. 

The process and outcome studies were designed to understand the structure and quality of 

partnerships at the state and local levels and to elucidate specific aspects of partnerships such as 

data sharing and assessing client needs. Importantly, local ADRC sites indicated that partnership 

development and expansion fostered through receiving grant funding had the most positive impact 

on providing access to LTSS, suggesting that sites share in the recognition that partnerships are 

vital to realizing their mission. 

With respect to organizational structure, ADRC respondents identified an average of four core 

operating organizations and 16 organizational partners. The most frequently identified 

partnerships were between ADRCs and state units on aging, centers for independent living, area 

agencies on aging, state Medicaid agencies, and local Veterans Administration (VA) offices, 

demonstrating the importance of aging, disability, and other organizations in providing integrated 

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and streamlined access to LTSS. In general, a majority of respondents indicated that these 

partnerships were highly functional. A notable exception, however, was found in partnerships with 

the local VA. While nearly half of local ADRC sites reported having formal partnerships with their 

local VA, few of them considered this partnership as highly functional. This was seen at the state 

level as well, as less than one-quarter of state-level respondents reported a highly functional 

relationship. Given the partnership building between the VHA and the federal ADRC program, 

understanding reasons for this discrepancy and determining strategies for improving partnership 

relations may be vital to ensuring success of these recent initiatives. 

The ACL might also promote collaboration and coordination between the ADRCs and their 

partners by encouraging the sharing of client resources and information. For instance, less than 

half of ADRC respondents indicated that a consumer assessment tool was used and shared across 

partners, and fewer said that data were shared between the organization and service provider 

partners. The current vision of ADRCs to serve as a “No Wrong Door” site for accessing LTSS is 

dependent on coordination with a full range of aging, disability, and other organizations to provide 

integrated and seamless services to individuals. It is clear that support and resources are needed to 

help the ADRCs foster partnerships and encourage the sharing of consumer information and data. 

6.3 ADRC Client Satisfaction 

Overall, ADRC clients were quite positive about their interactions with the ADRC. For example, 

a large majority of respondents indicated that ADRC representatives correctly assessed their LTSS 

needs, and nearly all reported that representatives were knowledgeable, paid close attention, and 

provided information that was clear and understandable. A majority of respondents were satisfied 

with completeness of information received, the degree to which services offered met their specific 

needs, the accuracy of the information they received, and staff professionalism. Finally, most 

indicated that they would recommend the ADRC to friends or family in need and that they were 

likely to contact the ADRC again. 

Interestingly, however, satisfaction was not uniform across all groups. For example, respondents 

contacting urban ADRCs and ADRCs with less than 15 full-time equivalent staff reported 

difficulty reaching the ADRC staff. Also, differences for persons with disabilities and those who 

rated their health as poor were found. Individuals with disabilities were less likely to perceive that 

ADRC staff paid close attention to what they said, to receive information that was helpful, and to 

perceive that accessible services were unavailable. Further, they were more likely to express that 

they had difficulty completing paperwork. On the positive side, this group was more likely to 

report that that ADRC staff talked to them about their options for staying in the community. 

Similarly, individuals with poor health were more likely to say that ADRC staff talked with them 

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about options for staying in the community and were less likely to report that the services they 

requested were not available. 

These subgroup results are mixed in nature. On one hand, it is a positive finding that persons with 

disabilities and poor health were more likely to report that ADRC staff discussed community 

options, as these groups may be at increased risk for institutionalization. Providing appropriate and 

adequate home- and community-based options to persons at risk may help to keep them in the 

community longer and delay institutionalization. However, the findings also point to the fact that 

quality improvement initiatives should be considered to encourage ADRC staff to be more 

attentive to the needs of these at-risk populations. Importantly, service availability is likely to be 

dependent not on what the ADRC can provide, but on what is adequately available in the 

community; while ADRCs may not have direct control over solutions to this problem, it is still in 

the interest of ADRCs at the local, state, and federal level to advocate for increased LTSS to help 

persons with disabilities and poorer health remain in the community as long as possible. 

6.4 LTSS Supply and Availability 

This study examined aspects of the community and LTSS service environment within which 

ADRCs operate. When asked to identify LTSS considered adequately available, ADRCs 

respondents most commonly reported ombudsman services, opportunities to develop advance 

directives, nursing homes, education services, and nutrition programs. Those most frequently 

deemed inadequate included transportation, housing options, income assistance, mental health 

services, and energy assistance. Interestingly, transportation, Medicaid and Medicare eligibility 

determination, and affordable housing were among the most frequently requested services, as 

reported by local ADRCs. These results pinpoint areas in which LTSS are needed in communities 

and underscore the limitations faced by ADRCs in providing streamlined access to needed services 

in environments where they may be inadequately available. 

6.5 Consumer Characteristics 

The overarching vision of the ADRC program is to provide access to LTSS for persons of all ages, 

all disability groups, and all income levels. In the process study, local ADRCs reported service 

areas comprising a majority of consumers who were adults age 60 and older, who were White and 

non-Hispanic, and who had no health insurance coverage. Further, ADRCs reported serving more 

persons with physical disabilities and their caregivers than any other disability type, across all 

ages. This underscores the importance of improving the ability of ADRCs to reach and 

appropriately serve ethnic, cultural, age, and disability-diverse communities; the finding suggests 

that there may be a disparity in access to or understanding of the value of ADRC services. 

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6.6 Limitations 

A number of limitations in the research design should be noted, including a non-representative 

sample of ADRC sites as well as ADRC consumers and the lack of a comparison group that would 

enable us to make statements regarding between-group differences in the execution of the ADRCs’ 

goals and vision for seamless access to LTSS. 

The primary limitation of the analyses conducted with the process study responses concerns the 

issue of item non-response. While item non-response is not a serious problem for many questions, 

such as those that required ADRCs to select responses from a range of options, it is an issue of 

concern for questions that sought a numerical response. For example, non-response ranged from 

45 to 95 percent on questions asking local ADRCs to provide the number of disabled consumers 

by type. Similarly, on questions where local ADRC representatives were asked to report funding 

amounts by type, non-response ranged from 51 percent to 97 percent. We did not consider 

imputation of missing values as an appropriate method to address item non-response. This is an 

issue that should be further examined for possible technical assistance if the issue is found to be a 

result of a lack of reliable data or of data collection or storage methods. 

Although the outcome study was intended to be a nationally representative, comparative study of 

ADRC and AAA consumer experiences, we were unable to recruit a representative sample of 

ADRCs across the AAA regions, states, and rural/urban coverage areas as planned. We addressed 

this limitation by using sample weights that adjusted for selection probability and non-response. 

However, even with these adjustments, these data should be taken as suggestive rather than 

definitive. 

The number of eligible clients that the recruited ADRCs and AAAs referred for participation in 

the PES was much less than anticipated. In spite of intensive respondent recruitment efforts by our 

team, we ended up with a final sample of 552 PES respondents from ADRCs and 72 PES 

respondents from AAAs. In addition, because of the low response rate, all eligible clients were 

invited to participate in the study, resulting in a non-randomly selected, skewed population of 

ADRC clients primarily from two large, statewide ADRCs. This small sample size limited the 

types of data analysis we could conduct and the number of covariates we could include in our 

regression models. Furthermore, the number of AAA respondents who participated in the PES was 

so few that we were unable to implement our original plan of using them as a comparison group 

to conduct a quasi-experimental impact study of ADRCs on client experiences. Therefore, this 

study is limited to an account of a limited group of ADRC client experiences and does not 

demonstrate the value of ADRCs compared to AAAs. 

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6.7 Conclusions and Considerations for the Future 

Broadly, evidence from this work suggests that ADRCs have made progress towards the goals 

and vision of the ADRC program, but challenges in connecting persons to LTSS are still present. 

Further, improvements are needed in some key areas such as expanding geographic service 

areas, increasing diversity in ADRC clientele, and strengthening key partnerships. Results from 

the outcome study confirm these challenges but also show that, despite the challenges, 

respondents are largely satisfied with their experiences in accessing ADRCs. 

A number of specific areas that may be appropriate to improve through targeted technical 

assistance or through future funding initiatives include: 

 Expanding service areas and/or outreach to ensure inclusion of diverse populations 

 Improving the quality of partnerships with local VAs 

 Providing adequate and appropriate person-centered approaches to meet the needs of 

clients with disabilities and poor health 

 Increasing the delivery of diversion and care transition services 

 Supporting the collection of high quality data about consumers and their interactions with 

the ADRCs 

In conclusion, findings from the national ADRC process and outcome studies suggest that local 

and state ADRC programs are, at their foundation, true systems change initiatives, as there is 

evidence that ADRCs are increasing partnerships, standardizing and sharing information and 

assessment tools across stakeholders, and providing highly satisfactory access even in the 

environment of inadequate LTSS. PES respondents indicated that they felt listened to and that their 

care plans reflected their needs and desires; a majority of ADRCs reported providing core aspects 

of integrated access to LTSS, including options counseling and Medicaid eligibility determination. 

However, there is still room for progress in many areas, including increasing care transition service 

provision, improving aspects of participant satisfaction for specific groups of people, expanding 

the reach of ADRCs to underserved populations, and solidifying partnerships with key 

stakeholders such as local VAs. 

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