The comparative evaluation of California's multipurpose senior services project.

The Multipurpose Senior Services Project implemented a case management model of service coordination for aged Medicaid recipients at eight sites throughout California. The answers to the evaluation questions--"What works?", "For whom?", and "At what cost?" provide policy direction for long-term care programs. The research and demonstration Project ended in June 1983 and an on-going Program began in July 1983. Dynamic modeling of the outcomes of MSSP and of a comparison group served by the existing service system showed that MSSP increased longevity, decreased nursing home days, and decreased hospital days (in 1982); these results were most efficient for the frailest clients. This group had the greatest savings on public service dollars, with the Federal government the beneficiary through lower than expected Medicare expenditures. In-home supportive services proved to be the most productive non-medical service in both systems, but was more productive through MSSP. The evaluation methodology provides a multivariate frailty measure based on expected nursing home entry that can be used to identify those individuals for whom case management is most likely to have efficient outcomes.