Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Currently, informal caregivers provide 80% of long-term care services to older and functionally impaired adults in the United States (National Alliance for Caregiving & AARP, 1997), providing an estimated $257 billion worth of care each year (Arno, 2002). Without public support to promote the well-being of vulnerable older adults and their informal caregivers, the home and community-based long-term care service delivery system cannot be a reliable resource for those who need care. This paper examines potential predictors of successful implementation of caregiver support policy in 50 states. Using the communications model of intergovernmental policy implementation (Goggin et al., 1990) as a theoretical framework, this study examined the implementation of the National Family Caregiver Support Program (NFCSP) in 50 states. The NFCSP, enacted as part of the Older Americans Act reauthorization of 2000, allocates federal dollars through the Administration on Aging to state and local programs that support informal caregivers of older adults, and older adults caring for children. Since 2000 the NFCSP has been implemented in all states, funding five types of caregiver support: information about services; assistance with accessing services; counseling/support groups/training; respite; and supplemental services. Data sources included: (a) survey data from 150 program administrators in all 50 states who oversee public caregiver support programs (collected by the National Center on Caregiving at Family Caregiver Alliance); (b) service utilization data from the U.S. Administration on Aging; (c) state-level demographic data from the U.S. census; and (d) historical/political data. Both quantitative and qualitative analyses were used to examine potential predictors of successful implementation of caregiver support programs (operationalized as respite utilization) in each state across four dimensions: demographic, historical, political, and organizational. Preliminary findings show that states with single points of entry for caregiver programs have significantly lower levels of respite utilization (t = 2.55, p<.05) compared with other states. This raises the question of whether a single point of entry should be promoted as the best practice model it claims to be. Multiple regression analysis was used to identify variables most likely to predict respite utilization in each state. Qualitative analysis found that collaboration among programs may lead to more effective and innovative implementation of policies and programs. Understanding from a theoretical perspective how policies and programs are successfully implemented builds on current knowledge in the area of social policy and implementation theory. In addition, further understanding of the organizational context within which informal caregiving is publicly supported is necessary to ensure that caregivers continue to provide their valuable services as the demand for informal care grows.