Association for Public Policy Analysis & Management

A majority of formal care services for the elderly in the U.S. are provided through government-sponsored programs. In recent years, budgetary challenges have led states to restructure existing mechanisms for delivering formal home care in order to achieve efficiencies and generate cost savings. Despite this growing trend, there exists little evidence on the effect of such cost-containment strategies on overall service provision. This study examines the outcome of one such restructuring effort in the state of Iowa – the consolidation of 13 Area Agencies on Aging into six – on various dimensions of formal home care service provision within the state. The 2013 restructuring of the AAAs represented the single largest transformation of Iowa’s aging network since its inception in 1966. According to Iowa Department on Aging (IDA), this restructuring is expected to maximize cost efficiencies of programs, staff, physical plants, and other unit costs while ensuring the continuity of services across the state. However, the IDA also acknowledges two challenges resulting from the process: First, four of the six newly designated AAAs significantly expanded their geographical service area. For example, one agency expanded to service 29 counties or almost one-third of the state. Second, no resources were appropriated by Iowa’s General Assembly to assist the AAAs in the transition of service areas. From this perspective, the effect of AAA reorganization on service provision remains unclear. The objective of this study is to evaluate the extent to which consolidation influenced the availability, accessibility, efficiency and quality of services delivered by Area Agencies on Aging in Iowa. A mixed-methods approach will be applied consisting of two distinct components – a quantitative analysis (quasi-experimental design) of agency data that focuses on examining the overall effect of consolidation on the availability and accessibility of services – and, a provider and beneficiary-level component that uses surveys and in-depth interviews to describe the subjective experience of consolidation with regard to the efficiency and quality of services. With regards to the quantitative aspect, a difference-in-differences methodology will be used to examine the effect of consolidation on the number of unduplicated clients served by AAAs in a given county. Of the 13 original AAAs, two AAAs did not consolidate, providing us with treatment and control counties. The data for this will come from the Iowa Aging Program Reporting System (IAPRS). Area agencies use the IAPRS system to report activities to the Iowa Department on Aging. The results of this study are expected to contribute to our understanding of how fiscal pressures impact the delivery of publicly-supported long-term care services to older adults in rural communities.