state policy initiative.
Nebraska Legislative Planning Committee 2012 Report Policy Briefs
The purpose of the Policy Briefs is to identify and explore in greater depth issues identified by the evidence presented. The Policy Briefs do not recommend specific policies but rather describe options and considerations that relate to the issues. Summaries of the Policy Briefs are below or you can download the entire report.
These briefs identify some of the issues that were identified when reviewing the indicators presented in the Legislative Planning Database 2012-2013, a joint initiative with the Nebraska Legislature's Planning Committee and the University of Nebraska at Omaha College of Public Affairs and Community Services. The database is presented in a series of reports that consist of data and summaries of data for each of the nine categories of benchmarks established by the Planning Committee. Download the 2012-2013 Database report.
Addressing the Long-Term Care Needs of Nebraska’s Aging Population through Expanded Assistance to Caregivers
In this brief, Jerry Deichert and Karl Kosloski emphasize the fact that the number of persons aged 65 or older in Nebraska will increase greatly during the next 20 years. One immediate concern to Nebraska’s policymakers is the financial impact of the long-term care needs of this growing population on Medicaid. The authors suggest that the most efficient way to save costs in the Nebraska Medicaid program is to delay or eliminate the need for nursing home placement. They indicate that the most effective way to do so is to develop alternatives to nursing home placement with home and community-based services. They identify three policy options that could result in fewer nursing home placements, improve the quality of care and help in local economic development. These options are: (1) broaden the definition of client to allow compensation for services that informal caregivers provide; (2) modify the assessment and referral process to provide personalized recommendations for support services; and (3) assist individuals in becoming microenterprises to supplement the pool of caregivers for older adults. Allowing compensation for services provided by informal caregivers addresses the financial hardship that families face today. Since this is a significant determinant in nursing home placement, the authors propose that financial compensation to family member caregivers for the service they provide may significantly reduce placement.
Secondly, by modifying the current assessment and referral process, case managers and support service providers could assess the type of stress being experienced by a caregiver. That information can be used to make personalized referrals to specific support services aimed at reducing specific types of caregiver stress.
Finally, they suggest a policy change to increase the home care work force by the creation of microenterprises. These will be small companies (as small as a single provider) intended to relieve the shortage of trained personnel available to provide caregiving services such as respite care to caregivers and custodial care to the elderly.
Cost Savings in Medical Care for the Elderly through Expanded Case Management
Deichert and Kosloski also review the living arrangements of Nebraska’s older adults. They point out that most older adults do not live in a nursing home. Instead, they live in a household. However, a sizeable percentage of older adults live alone. They suggest that efforts to provide a support system for persons living alone that prevents them from becoming institutionalized could have considerable cost advantages. They identify two options to confront this issue: (1) telephone reassurance, and (2) culture change in discharge planning.
Telephone reassurance can provide individuals with a means of contact with others and could greatly allay fears associated with living alone. Culture change in discharge planning would team the hospital discharge planner with a state-sponsored case manager. This could lessen the use of nursing homes as the hospital discharge planner could identify patients who are nursing home-eligible and appropriate for community-based services and refer them to the state-sponsored case manager.
City-County Consolidation: Implications for Nebraska
John R. Bartle and Sikarn Issarachaiyos review several studies on city-county consolidation. They look at both the political factors affecting the adoption of consolidation proposals and the economic consequences of consolidation where it has been accomplished. The critical political factors explaining the outcome of referendum campaigns are: (1) appropriate proposed charter provisions, and (2) strong consolidation campaigns that emphasize economic development. Charter provisions need to address issues such as how debt obligations of the separate entities will be shared, treatment of employees, and how the county sheriff and the city police will be woven together. The potential for efficiencies that reduce costs is not an important influence on the adoption of consolidation referenda; rather, the promise of more effective economic development is the most significant factor where consolidation has been most successful.
The most important consequence of city-county consolidation is the improved coordination of economic development policy. While this did not happen in all cases, in some cases it is important. There are efficiency improvements due to city-county consolidations, but they are also relatively small. In some cases, functional mergers between the city and county appear to have realized most of the efficiency gains, in so much that few savings are achieved by legal consolidation.
County Mergers: Evidence for Nebraska
County mergers are rare and none have been attempted in Nebraska. However, they are often discussed. John Bartle and Sikarn Issarachaiyos find that there are some savings that could be achieved, especially by spreading administrative costs over a broader population. However, in 2 other cases, mergers of counties would increase the costs for one or more counties. Also, public safety costs increase as the scale of service increases, and a merged county would incur new expenses. Other concerns include reduced local control, reduced access to services and potential reduced service quality.
Rather than merge counties, John Bartle and Sikarn Issarachaiyos suggest policy alternatives such as greater use of inter-local agreements, service sharing, special districts and state assumption of services. Careful efficiency analyses would likely identify alternatives to a merger that would achieve many of the benefits of a merger without the disadvantages.
Early Childhood Education for Children with All Parents in the Labor Force
Jerry Deichert calls attention to the fact that historically Nebraska has had one of the highest labor force participation rates in the nation. As a result, a large portion of Nebraska’s children have working parents and this trend is on the rise. Given this fact he suggests that the number and percentage of children with working parents should be utilized as a factor when considering the development of an early childhood program.
This site last updated 9/26/2013 by Melanie Kiper