Estimating the extent of Medicaid spend-down in nursing homes

Although it is commonly thought that a very high proportion of private-pay nursing home patients become eligible for Medicaid during their stay, few national studies have been conducted to determine the extent of Medicaid "spend-down." The discharged resident survey of the 1985 National Nursing Home Survey was analyzed to determine the extent of spend-down among elderly nursing home patients during a single nursing home episode, the proportion of patients who remained Medicaid or private payers throughout their stay, and how the measures varied by patient characteristics. Overall, during a single nursing home episode only 10 percent of nursing home patients who entered as private payers received Medicaid at discharge. Roughly one-third of nursing home patients remained on Medicaid throughout their stay, and another third remained private payers throughout their stay.     

A testable theory of problem solving courts: Avoiding past empirical and legal failures

Recent years have seen a proliferation of problem solving courts designed to rehabilitate certain classes of offenders and thereby resolve the underlying problems that led to their court involvement in the first place. Some commentators have reacted positively to these courts, considering them an extension of the philosophy and logic of Therapeutic Jurisprudence, but others show concern that the discourse surrounding these specialty courts has not examined their process or outcomes critically enough. This paper examines that criticism from historical and social scientific perspectives. The analysis culminates in a model that describes how offenders are likely to respond to the process as they engage in problem solving court programs and the ways in which those courts might impact subsequent offender conduct. This Therapeutic Jurisprudence model of problem solving courts draws heavily on social cognitive psychology and more specifically on theories of procedural justice, motivation, and anticipated emotion to offer an explanation of how offenders respond to these programs. We offer this model as a lens through which social scientists can begin to address the concern that there is not enough critical analysis of the process and outcome of these courts. Applying this model to specialty courts constitutes an important step in critically examining the contribution of problem solving courts.     

Research opportunities in search of federal flood policy

Continuing increases in flood losses raise a variety of issues, and suggest numerous important research opportunities, from: (1) evidence of persistently incorrect economic analysis of structural flood control; (2) lack of understanding of how subsidies (for navigation, structural versus non-structural mitigation, and parts of agriculture) have defeated or subverted flood policies; and (3) lack of understanding of the distortions of urban form resulting from manipulation of hazard mitigation, induced development and inappropriate incentives for municipalities. Without adequate understanding of these topics, policy will fail to reduce flood losses and improve location of investments, and flood policy will continue to be effectively a legitimating rationale for other purposes. But policy-supportive research in re-analysis, historical analysis, and empirical work awaits only recognition of its value. Failure to do the useful work, however, bodes ill for responses to global change and other threats; the research proposed here would help establish methods badly needed for human dimensions research.     

Point and Counterpoint: Forensic Use of the Millon Inventories

Law and Human Behavior -