The Impact of Consolidating AAA on the Delivery of HCBS: Evidence From Iowa

Abstract

In this study, the authors evaluate the 2013 consolidation of Iowa’s Area Agencies on Aging (AAA) on the delivery of home and community-based services (HCBS) to older adults in the state. A mixed-methods approach combined a quasi-experimental design using longitudinal service delivery data with qualitative analyses of surveys and interviews with AAA staff and clients. Overall, consolidation had no detectable effect on the proportion of older adults served by the AAAs. Subgroup analysis showed that consolidation increased the average proportion of older adults served in nonmetropolitan counties and the proportion served through congregate meals. AAA staff and clients described both positive and negative aspects of consolidation: better collaboration across agencies, improved consistency in services, significant challenges with completing consolidation processes, and serving expanded geographic areas. As the American population ages and budgetary allocations tighten, findings from this evaluation can inform other states considering similar restructuring efforts.

Promises and Pitfalls of Health Information Technology for Home- and Community-Based Services

“…Moreover, BIP provided no ongoing resources to support the sustainment of HIT tools. Consolidation of local or regional HCBS agencies as seen in some states (Arora et al, 2020) may facilitate economics of scale in terms of information technology and support ongoing investments to sustain the use of HIT. It will be informative to examine the extent to which BIP-related HIT interventions are sustained into the future and what resources states need to sustain HIT.…”

Independent Evaluation of the New York State 1115 Waiver Amendment: The Children's Design: Interim Findings

“…One that has is a study in Iowa that assessed the impact of consolidating service agencies and found that, while there was no statistically significant impact on the proportion of the population served, the consolidation did lead to an increase in quality of services (Arora et al, 2020). While the object of the study differs from the Children's Design in that it was consolidating agencies and not waivers, the study does demonstrate the potential benefit of simplified access and streamlined services.…”

Self-Reported Dental Visits Among Older Adults Receiving Home- and Community-Based Services

“…A national survey of OAA program recipients found that more than 85% of individuals receiving HCBS were able to remain at home, and without the relatively basic and inexpensive assistance from the HCBS to meet their needs, many would have been institutionalized (Arora et al, 2019). Remaining at home and aging-in-place significantly reduce nursing home, hospital admissions, and health care expenditures (Ferris et al, 2016).…”