Peri Rosenfeld

Over the past several decades, home- and community-based services (HCBS) have played an increasingly important role in providing care to patients with complex health problems and functional impairments, and in enabling patients to remain independent in their own homes. This article identifies developments in U.S. health care policy during the past three decades that have led to increases in demand for and utilization of home- and community-based health care. We discuss the implications of these policy developments, societal trends, and the unique opportunities they present for the nursing workforce. Descriptive analyses of data from the 2008 National Sample Survey of Registered Nurses ( N = 28,402) reveal significant differences between nurses employed in HCBS and hospital settings, and provide little evidence that the nursing workforce has responded to the shifting needs for nursing resources in HCBS.

In an era that demands accountability and cost-effectiveness, health care and social service professionals are increasingly expected to demonstrate the effectiveness of their interventions and treatments. Social workers, specifically those serving the elderly, have been markedly slow in embracing the need to measure outcomes and produce evidence of their practices, which stymies efforts at advocacy and policy development for the profession. Using a modified systematic review method, the New York Academy of Medicine's (NYAM's) Center for Aging Policy created an evidence database comprising peer-reviewed journal articles on social work interventions and outcomes research on cost-effectiveness and other measures of effectiveness. The evidence database, though focused on care of the elderly, draws on research studies involving age groups across the lifespan. A key product of this initiative is a series of white papers on cost-effective interventions in areas such as care management. A work group of social work professionals and a team of NYAM staff with diverse expertise reviewed articles based on their content, key topics, and outcomes. This article describes the steps taken, from the conceptualization of the review process to the development and implementation of the Web-based interface for user access to the evidence database. Though originally conceived as a tool for supporting a policy agenda for the Center for Aging Policy, the evidence database is also a useful reference tool for social workers, policy makers, and others interested in quality of care for elderly.