THE EFFECTS OF THE MEDICAID SPEND DOWN PROCESS UPON THE SUBJECTIVE WELL-BEING OF NURSING HOME RESIDENTS (WELFARE, SELF-ESTEEM, LIFE SATISFACTION, DEPRESSION).
Contributors: University of Maryland at Baltimore.
Published: 1985
Number of pages: 244
Subjects: Social Work.
Description: This study investigates how the Medicaid spend down process adversely affects the subjective well-being of nursing home residents. A nonequivalent control group designed is used to compare residents who experience spend down financial losses to residents who do not. Six research hypotheses are tested which predict differences and changes on three indicators of subjective well-being: self-esteem, life satisfaction, and depression. Qualitative data are also presented which explore the meaning of the spend down experience.

Fifty-three mentally alert individuals were followed for a six months period after their admissions to nursing homes in Maryland. Each subject was interviewed shortly after admission and again at the six months interval. The twenty subjects who reported spend down losses during the study period are compared to the remaining subjects who did not.

Three of the research hypotheses are accepted. Significant differences between the groups are observed for changes in life satisfaction and depression. The spend down group reported a decrease in life satisfaction and an increase in depression, while the non-spend down group experienced a reverse pattern on each variable. The difference between the groups on change in self-esteem is in the direction predicted, but not significant. None of the control variables are found to help explain the observed differences between the groups. Spend down subjects, as a group, are found to experience a significant change in only life satisfaction. A loss in self-esteem and an increase in depression is observed; however, the magnitudes of these changes are not significant. Significant declines in self-esteem are noted for numerous specific conditions. Under no conditions do the spend down subjects experience significant increases in depression.

Qualitative data show the subjects to have mixed feelings about the experience. Ambivalence and resignation characterize the subjects' feelings. Many find it difficult and regrettable, while at the same time finding meaning in being able to pay for their care.

Theoretical implications are discussed for self-esteem theory, attribution theory, the effects of institutionalization, and the effects of welfare. Implications for social work practice within long-term care settings are identified, as are some limited implications for welfare policy.
Notes: Source: Dissertation Abstracts International, Volume: 47-01, Section: A, page: 0314.

Thesis (PH.D.)--UNIVERSITY OF MARYLAND AT BALTIMORE, 1985.

School code: 0373.