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marketing,106,1","“aging,83,1","“assessing,24,7","“big,24,3","“ds”,24,3","“excellent,24,8","“excellent” ga,24,8","“find”,86,1","“positive,24,4","“reachable,24,3","“shared,24,4","“staffing,24,1","“support”,24,1","“the,106,1","a1,46,1","a28,46,2","aa,7,58,97,1",",97,5","aaa,3,1,7,36,55,2,61,4,62,5,63,6,87,34,83,4,86,4,89,2,92,4,97,2,212,1,210,4",",97,5",",97,3","aaa’s,24,4",",97,2",",97,1","aaas,5,1,7,9,24,5,55,1,61,4,87,22,83,9,86,1,89,3,92,7,97,7,212,1",",97,1","aammvv,37,1","aamse,62,1,63,1","aapi,92,2","aar,92,1","aaron,23,1","aarp,5,5,7,4,23,5,24,4,46,3,48,1,56,1,92,2,93,2,109,2","aba,23,1","abanet,23,1","abaya,84,2","abbreviations,7,1","abc,63,1","abcs,117,1,118,1","abdomen,26,1","abilities,7,1,95,1","ability,2,4,7,7,14,16,24,3,26,1,56,1,61,1,63,2,86,1,88,4,92,3,95,1,97,5,106,2,110,1,122,1","able,2,2,7,3,14,5,41,1,42,1,43,4,45,8,92,2,95,5,97,20,109,1,110,3,113,2,116,1,117,1,118,1,213,5","abruptly,26,1","absence,4,1,7,1,46,3,211,1,213,1","absent,84,1,85,1,109,1","absenteeism,2,1,4,1","absolute,109,1","absolutely,97,1","absolving,111,1","abstract,2,1","abuse,23,3,61,1,87,1,84,1,85,1,88,7,93,1,97,8","abused,113,1","academic,61,1,95,1,111,1","academy,2,1,7,2,61,1,62,1,87,3","acc,21,11","accelerate,61,1","accelerating,3,1","accentuated,46,1","accept,14,1,23,1,27,1,87,1,88,1,92,1,97,2","acceptability,95,3","acceptable,43,2,45,1,87,1,92,2,95,3","acceptance,24,1,92,1,95,1,97,3","accepted,84,1,85,1","accepting,14,1","accepts,97,1","access,2,19,3,1,7,137,14,1,23,1,24,6,43,1,54,1,62,1,87,3,83,11,86,2,88,19,92,9,93,1,95,2,97,11,106,1,105,2,109,1,118,1,211,1,213,1","accessibility,110,1","accessible,60,1,87,1,83,1,88,3,92,2,110,2,117,1","accessing,14,1,87,1,92,4","accident,45,1,111,1","accidents,111,1","accommodate,87,1","accompanies,23,1","accomplish,7,2,14,1,92,1,97,1","accomplished,92,3","accomplishing,87,1","accomplishment,211,2,213,3","accomplishments,14,1,122,1","according,2,1,4,2,7,5,14,2,21,1,46,3,87,2,88,1,92,1,97,18,213,2","accordingly,14,1","account,7,3,46,1,87,1,95,2,111,1,113,1","accountability,3,1,7,1,21,1","accounted,7,1","accounting,7,3,97,1,116,1","accounts,84,1,109,1","accrue,95,1","accrued,7,1","accsv,92,1","accumulating,109,1","accuracy,7,1","accurate,7,1,27,1,87,1,89,1,97,2,109,1","accurately,25,1,26,1","ace,92,3","achieve,7,1,21,1,95,1,97,1","achieved,14,1,92,1,97,1","achievements,2,1","achieves,92,1","achieving,7,4","acknowledge,7,1,43,1,45,1,97,1,117,1","acknowledged,14,2,46,1","acknowledgement,92,1","acknowledgements,7,1,43,1,97,1","acknowledges,14,2","acknowledgments,14,1","acquisition,3,1","across,6,1,7,77,14,5,21,1,23,2,24,1,46,1,56,1,62,1,87,5,85,1,86,1,88,4,92,4,97,15,116,1,117,1,118,1","act,2,3,7,23,14,2,43,1,56,1,83,4,84,1,85,1,88,8,92,2,97,22,109,1,122,1","acta,95,1","acted,92,1,106,1","acting,46,1,60,1,113,1","action,7,2,14,1,43,24,61,2,87,1,88,1,92,3,97,2,110,3","actions,7,1,88,1,92,1,97,1,110,1,113,2","active,21,1,60,1,63,2,87,1,92,1,106,1","actively,14,1,43,1,63,1,92,1,97,2,105,1","activities,3,1,7,38,14,2,20,1,21,5,23,1,24,4,41,1,42,1,54,2,55,6,87,4,83,3,88,5,92,9,95,7,97,12,110,5,113,1,117,5,211,3,213,3","activities—time,24,3","activity,7,2,24,10,46,1,60,1,95,1,97,1,110,1,116,1","acts,7,1,88,1","actual,7,2,14,3,43,3,88,1,95,2,97,1","actually,14,1,95,2,97,4,212,1,113,1","acupuncture,118,1","acute,95,1,111,2","adams,6,2,92,1","adapt,92,1","adaptation,14,1","adaptations,92,1","adapted,14,1,21,1,45,1,87,1,93,1","adapting,14,1,86,1,92,2","adaptive,92,1","adc,97,1","adcrc,7,8","add,43,1,63,1,97,3,110,2,113,2,116,1","added,7,3,14,1,97,3,110,1","addgs,94,1","adding,2,1,14,1,87,1,85,1,97,1","addition,2,4,4,1,5,2,7,5,14,1,23,1,42,1,43,2,87,1,89,1,92,1,95,2,97,17,110,3,111,3,116,1,117,1,210,1,211,2,213,1","additional,1,1,2,3,7,6,14,2,21,3,24,7,27,1,41,1,42,5,43,7,45,1,60,1,63,1,87,4,83,1,88,3,89,1,92,4,97,8,105,1,110,1,212,1,113,1,117,1,210,1,211,2,213,5","additionally,97,1,118,1","address,6,1,7,8,14,5,21,2,27,1,29,2,37,1,41,2,42,4,43,6,56,1,61,1,87,1,83,1,86,1,88,6,89,1,92,1,95,1,97,17,105,2,109,4,110,1,212,1,117,2,210,1,211,1","addressed,2,1,7,38,14,3,24,8,43,1,87,3,83,1,92,2,95,3,97,3,110,2","addresses,7,33,14,1,43,3,87,1,88,1,92,1,95,1,97,8","addressing,5,2,7,1,14,2,21,1,87,1,92,3,95,1,97,5,118,1","adds,92,1,110,1","adelaide,14,1","adelphia,37,1","adequacy,14,2,110,1","adequate,2,1,7,1,45,2,61,1,95,2,97,5,110,1,111,1,113,1","adequately,7,1,113,1","adern,62,1,92,1","adhc,7,9","adhere,210,1","adi,7,8","adjunct,95,1","adjust,14,2,97,1","adjusting,95,1","adjustment,92,1,97,1","adjustments,45,1","adl,7,7,14,2,95,3,97,1","adle,84,1","adler,95,2","adls,7,37,14,8,24,4,95,5","admin,7,2","administer,3,1,4,1,7,6,14,1,97,1,212,1","administered,15,1,7,11,14,4,29,1,43,1,83,2,92,1,93,1,97,6,212,1,210,1","administering,7,87,14,2,42,1,92,2,210,3,211,1","administers,7,2","administra,97,1","administrating,87,1,213,1","administration,7,24,14,7,21,4,23,1,41,1,43,9,45,2,53,1,61,2,63,2,87,6,83,4,88,1,89,1,92,51,93,5,97,13,212,1,213,1,214,1","administrative,7,78,87,1,88,5,97,5","administrator,7,3,43,2,45,1,88,1","administrators,5,2,7,58,24,4,28,1,62,1,88,2,92,2,95,1,97,21","admission,45,3,88,1","admissions,3,2","admit,46,1,97,1","admitted,45,1,97,2","adolfsson,95,1","adopt,5,1,83,1,88,1","adopted,14,1","adopting,14,1,97,1","adoption,7,4,92,1","adored,111,1","adrienne,61,2,62,2,63,1,92,1","ads,4,1,92,9,95,73,106,1,118,1","adsp,7,8","adult,2,1,5,2,7,65,14,4,21,1,23,2,42,3,46,3,55,1,62,2,63,2,71,1,87,8,92,19,95,28,97,5,106,5,109,1,110,1,111,1,117,2,211,4,213,4","adultonset,7,1","adults,2,18,5,3,18,1,7,82,14,7,21,1,23,10,41,2,43,2,54,1,87,1,88,2,92,12,95,1,93,1,97,14","advance,7,4,14,3,24,4,89,1,109,2","advanced,24,4,42,1,86,2,88,1,211,1,213,1","advancing,97,1","advantage,43,14,87,1,95,1,97,2,110,1,118,1","advantages,95,1,105,1","advent,7,2","adventure,46,1","adverse,5,1","adversely,7,1","advertise,84,1,85,1,109,1","advertised,87,1,92,1","advertisement,4,1,84,3,85,3,109,2","advertisements,4,1","advertising,7,1,60,2","advice,4,2,42,1,45,1,87,3,97,3,109,1,111,2,118,1,211,1","advise,87,1,88,2,92,1,113,2","adviser,46,1,109,1","advises,7,1,88,2","advisor,97,2","advisory,3,3,7,6,14,2,21,1,46,1,87,1,83,1,88,8,92,4,95,2,97,1","advmec,23,1","advocacy,2,1,7,2,14,1,87,11,88,1,92,1,93,1,97,25,110,1","advocate,2,1,45,1,56,1,87,2,88,1,92,1,97,1,111,1","advocated,7,1","advocates,3,1,62,1,87,3,88,6,92,2,97,3,110,3,118,1","advocating,87,1,92,2,97,1","advoctes,87,1","afar,4,1","afcsp,38,1","afettinger,37,1","affairs,2,1,7,13,92,4,213,1","affect,2,1,3,1,7,1,42,1,43,2,89,1,92,1,95,4,97,3,110,3,211,2","affected,14,1,42,1,95,1,211,1,213,1","affecting,14,2,87,1,93,1,97,3,213,2","affects,4,1,88,1,95,1,211,2,213,1","affiliated,23,1,92,1","affiliation,87,12","affirmatively,7,1","affirming,23,1","afford,2,2,4,1,43,1","affordability,2,1,3,1,110,2","affordable,2,1,4,1,21,2,43,1,88,1,95,2,93,1,97,1","afraid,45,2,97,2,111,1","african,7,33,24,4,42,1,92,2,211,1,213,1","afternoon,46,1,117,2","afterward,110,1","against,2,1,7,1,23,1,24,4,45,1,84,1,97,1","age,2,23,3,1,4,7,5,1,7,148,14,4,23,1,24,8,41,1,42,3,43,1,46,1,49,1,56,2,61,1,87,3,83,1,84,2,88,9,92,15,95,3,97,16,111,2,112,1,117,2,211,2,213,10","aged,3,1,4,1,7,65,43,1,45,1,46,1,49,1,83,1,92,3,97,3,122,1,213,1","ageing,95,2","ageism,97,1","ageist,24,8","agencies,5,2,6,1,7,33,14,1,23,2,42,1,43,3,45,5,50,1,56,2,61,2,62,2,63,2,87,6,83,3,86,1,88,16,92,22,95,5,93,3,97,68,106,2,110,1,212,1,116,3,117,1,118,1,210,1,211,4,213,1","agency,2,4,3,1,7,130,14,8,20,1,21,1,24,3,31,2,41,1,42,4,43,16,45,1,61,1,62,3,63,4,71,4,87,6,83,1,88,7,89,1,92,5,95,3,97,76,110,1,212,1,111,1,117,1,118,1,122,1,210,2,211,5,213,1","agenda,3,1,6,1,8,5,24,1,52,1,63,1,88,1,97,4,105,1,110,2,113,1,117,1","agenda1,8,4","agendas,87,1,97,1,106,1","agent,84,1,85,1,88,1,97,2,109,1","agents,7,1","ages,2,18,3,1,87,1,88,2,93,1,97,1,213,1","aggregate,7,1","aggregated,7,1","aggressive,111,1","aging,3,2,4,1,5,5,6,5,7,59,8,1,9,2,14,13,21,6,72,1,23,24,24,18,31,2,36,1,37,2,38,1,41,5,43,17,45,5,46,2,48,1,52,1,53,3,54,1,56,4,59,1,61,6,63,5,66,1,71,3,87,47,83,12,84,2,85,3,86,2,89,17,92,144,95,14,93,7,97,157,109,6,212,3,111,1,112,1,116,5,117,10,118,7,122,3,210,2,213,11","agings,214,1","agingresources,38,1","agingwithdignity,109,1","agitate,111,1","agitation,95,1","ago,97,2,111,1","agree,7,9,14,2,88,1,92,1","agreed,61,2,97,1","agreeing,116,1,117,1,118,1","agreement,3,1,7,57,89,1,92,1,97,3","agreements,87,1,97,1,116,1","agrees,111,1","ahead,5,6,8,1,25,1,26,1,48,1,56,1,85,1,97,2,110,1","aid,14,1,57,1,117,2","aide,4,1,24,8,97,1,116,1,117,1,118,1,211,1,213,2","aides,7,33,45,2,92,1,95,1,97,1,111,1,117,5,213,1","aiding,7,1","aids,97,2,110,1","ailing,2,2,4,1,46,2","ailments,111,2","aim,7,1,110,1","aimed,7,1,23,1,87,1","aims,111,1","air,84,1,85,1","airman,109,1","airport,6,1","airs,117,1","aisle,97,1","alabama,5,3,7,19,97,1","alarm,7,1,84,1,85,2","alaska,7,46,42,1,211,1","albany,6,3,37,1,41,1,43,8,48,1,54,1,56,1,89,1,92,6,106,9,105,2,112,2,122,1","albany 135,106,1","albany”,106,1","albanycounty,37,1","albert,7,2","album,46,1","alcohol,14,1,61,1","alcoholic,46,1","alcoholics,93,1","aldershot,95,1","aldine,7,1","alecxih,7,3","alert,110,1","alerts,2,1,84,1,85,1,109,1","alice,2,2","alison,46,1","alive,62,1","allegany,37,1","alleganyco,37,1","alleviate,7,1,97,1,213,2","alleviated,213,1","alleviates,21,1","alleviating,95,1","alliance,18,1,7,16,12,1,13,2,14,20,20,1,23,2,45,7,46,4,50,1,54,1,57,1,61,1,62,1,87,1,92,7,95,1,97,1","alliances,31,1","allison,31,1","allocated,7,2,97,1","allocation,7,1,87,1","allocations,7,4","allotted,110,1","allow,4,1,5,1,7,11,14,1,41,1,43,1,62,1,63,1,87,4,88,1,92,4,97,14,105,1,109,1,110,1,113,4,213,2","allowable,7,1","allowance,7,1,32,1","allowances,87,1","allowed,7,3,14,1,43,2,45,1,97,8,113,1,213,1","allowing,2,1,7,3,87,1,97,8,113,1,213,1","allows,2,1,42,1,43,1,60,2,87,3,83,1,88,2,97,6,213,2","almost,7,6,23,1,87,1,85,2,95,1,97,6","alone,5,1,7,36,13,1,14,2,23,1,42,2,43,3,45,2,46,1,95,1,106,2,110,1,211,2","along,7,1,23,1,24,1,27,1,43,1,92,2,95,1,97,2,110,1,111,1,122,1","alpha,14,1,23,1","alphabetically,7,2","already,7,2,23,1,43,9,45,2,62,1,87,1,95,2,97,6,110,1,111,1,211,1","alsberry,92,1","altcs,7,7","alternate,105,1","alternative,7,11,14,2,43,2,45,1,92,1,95,2,97,1","alternatively,95,1","alternatives,87,1,88,1,92,2,97,1,109,1","alterra,23,1","although,2,1,7,15,14,5,43,4,46,1,60,2,87,3,95,7,97,2,109,1,110,1,111,1,117,1,213,1","alumna,2,1","always,14,2,43,1,45,3,46,3,60,1,61,3,62,1,97,8,111,2,113,1,118,1,211,4,213,5","alz,95,1","alzconf2005,9,4","alzheime,87,1","alzheimer,7,22,9,3,14,9,20,4,21,1,23,24,41,3,45,1,46,3,87,3,83,1,88,4,92,1,94,1,95,23,97,11,111,1,112,1,116,1,117,5,118,2,213,1","alzheimer,23,1","alzheimer’s,24,5,83,1","alzheimers,23,1,95,1","ama,15,1,14,1,61,5,62,4,63,1","amazing,97,1","ambiguity,95,1","ambinder,14,1,95,2","ambition,46,1","ambivalence,113,2","ambulance,26,1","ambulances,111,1","ambulating,97,1","ambulation,97,1","amending,97,1","amendments,7,2,14,1","amenities,46,1","amenta,14,1","america,3,1,4,1,7,1,13,1,14,1,23,1,95,1,111,1","american,2,1,7,69,13,1,14,5,23,2,24,4,31,3,42,2,62,8,71,1,87,1,83,2,92,13,95,4,97,2,211,2","americans,2,1,7,9,14,1,21,1,54,1,56,1,83,6,84,1,92,2,97,16,122,1,213,2","americas,97,1","americus,92,1","amilies,7,46","amily,7,64","among,2,5,4,1,5,4,7,31,14,5,21,3,46,4,54,1,63,1,87,2,83,1,86,1,88,5,92,7,95,13,97,10,109,1,110,1,111,2","amount,5,1,7,8,14,3,27,2,43,7,60,1,61,1,87,4,88,2,95,7,97,7,110,2,213,1","amounts,5,1,7,2,42,1,43,2,87,1,95,14,211,2,213,1","amp,18,1,12,1,24,1,28,4,32,1,35,1,38,1,48,2,53,1,54,1,57,1,64,1,69,1,86,1,91,1,94,2,106,2,98,1,103,1,112,1","amplifies,97,1","amplify,97,2","ana,92,1","analyses,7,1,95,3","analysis,2,4,7,11,14,2,24,11,32,1,45,2,89,1,92,2,95,5,97,8,106,1","analyst,2,2","analytic,2,1,95,1","analytical,2,1","analyze,7,4,14,1,89,1","analyzed,7,5,95,1,97,1","analyzing,95,2","anchor,46,1","andrea,8,2,37,1","andrew,85,5,92,2","andrus,92,2","anecdotal,14,2,95,1,97,1,213,1","anecdotally,95,1","aneshensel,95,4","angela,7,1,23,1,61,1,63,1","angeles,2,1,46,1,92,1","anger,14,1,95,2,113,2","angie,37,1","angleses,23,1","angry,60,1,113,2","ann,23,2,31,3,37,1,92,2","anna,37,1","anne,97,1","announce,20,1,50,1,122,1","announced,97,1","announcement,110,2,116,1","announcements,20,1,116,1","annual,2,2,7,4,9,1,21,1,24,8,42,1,43,4,62,1,97,1","annually,5,2,7,2,92,2","annuity,109,1","anonymity,97,1","another,2,1,7,5,14,2,23,1,42,3,43,6,45,6,46,2,60,1,71,1,87,2,85,1,88,1,95,5,97,53,109,2,110,2,111,1,118,1,211,1","answer,13,1,42,2,43,1,85,1,97,1,110,1,210,2,211,1","answered,13,2,27,1,97,6,210,1","answering,46,1,97,1,210,1,211,1","answers,7,1,14,1,87,1,97,1,109,1,210,3","anthony,23,1","anticipated,7,2,86,1,95,1,97,1","anticipating,7,1,46,1","anticipation,24,4","antidrug,4,1","antiwar,84,1,85,1","anxieties,85,1","anxiety,2,1,14,1,24,3,95,1","anxious,111,1","anyone,23,3,43,4,46,1,97,1","anything,7,1,26,1,43,2,45,1,46,1,113,1,117,1","anywhere,23,1,105,1,116,1","aoa,2,2,7,3,13,1,14,2,21,4,23,2,24,4,28,1,45,1,50,1,53,1,54,1,56,1,57,1,61,1,62,6,87,5,83,4,86,1,89,2,91,1,92,6,93,5,97,2,106,1,105,1,212,2","aoainfo,21,1,92,1,93,1","aoaprog,2,2,53,1","aol,92,1,109,1","aota,92,1","apa,95,3","apart,213,1","apartment,4,1,111,2","apparent,4,1","apparently,46,1","appeal,45,4,97,1","appeals,45,1","appear,2,1,7,1,14,1,43,1,87,1,113,1","appeared,7,1,62,1,95,1","appears,7,6,95,4,97,3,210,1","appended,46,1","appendices,7,1,88,2,97,3","appendix,7,5,43,14,88,2,97,8","appetite,111,1","applebaum,7,2","appliance,97,1","appliances,97,3","applicable,7,2,14,1,29,1,45,1,87,1,212,1,113,1","applicant,88,1","applicants,87,1,88,5","application,3,1,7,2,14,2,43,4,83,1,88,7,92,2,97,7","applications,7,11,14,6,20,1,87,6,88,6,97,3,213,1","applied,7,2,87,1,95,3,97,2,106,1,212,1","apply,14,2,20,2,42,1,43,16,46,1,62,1,97,18,109,1,110,2,211,7","applying,89,1,92,1,97,5","appoint,88,1","appointed,97,8","appointing,87,1","appointment,2,1,25,1,45,2,116,1","appointments,21,1,87,2,92,1,113,2,116,1","appoints,3,1","appraisal,14,3","appraisals,7,1,95,2","appreciate,4,1,14,2,42,1,71,1","appreciated,97,1,113,1,211,1,213,2","appreciates,43,1,211,1","appreciation,1,1,7,1,97,1","appreciative,113,1","apprehension,97,1","apprized,105,1","approach,3,1,7,15,14,3,21,5,23,3,43,1,87,12,83,1,89,1,92,5,95,8,97,11,110,1","approached,97,1","approaches,5,1,7,14,14,4,23,1,28,1,87,32,83,1,92,7,95,4,97,2","approaching,97,1","appropriate,3,3,7,6,14,8,24,4,29,1,31,1,45,3,60,1,87,3,83,3,88,1,92,5,95,8,97,10,110,2,117,1,118,1,122,1,211,1","appropriated,7,8,88,1","appropriately,92,2","appropriations,7,1,92,1","approval,7,2,23,1,87,1,88,3,97,4,109,1","approved,5,1,43,6,87,2,97,4","approves,60,1","approving,7,1","approx,6,1,106,1","approximate,87,1,97,2","approximately,2,2,7,2,43,1,87,1,83,2,92,1,97,5,110,2","apr,88,1","april,3,1,6,1,7,1,14,1,21,1,41,1,42,12,63,1,88,1,97,1,212,1,211,11,213,1","apriljuly,7,1","apriljune,7,1","aproper,37,1","apt,87,3","aquarius,23,2","arbor,92,1","arc,38,1,88,1,92,4","arcane,4,1","arch,93,1","archetypal,46,1","archive,46,5","archived,112,10","archives,44,4","archrespite,93,1","archstone,14,2","are more,24,7","area,5,2,6,1,7,9,14,2,21,1,23,2,41,1,42,2,43,18,45,2,56,2,61,3,63,3,71,4,87,7,83,2,86,1,92,22,88,2,89,1,95,2,97,4,105,1,110,2,212,1,116,1,117,2,118,1,122,1,210,2,211,2,213,1","areas,5,1,7,55,14,7,24,4,48,1,87,1,83,2,92,8,88,1,95,5,97,15,212,1","aregiver,7,113","aren,26,1,97,4,109,1,113,2","arena,7,1,87,1","arenas,14,3","argue,95,1,97,1","argued,97,5","argument,95,1","arguments,95,1","arise,92,1","arises,7,2,45,1","arish,7,1","arizona,7,12,92,2,97,1","arkansas,7,16,87,1,97,1","arlie,46,1","armed,92,1","arms,111,1","army,117,1","arno,7,2,213,1","arnold,92,1","aromatherapy,116,1","arose,26,1,55,1","around,1,1,7,1,14,1,23,3,24,5,43,5,46,1,87,2,88,1,95,5,106,1,105,1,110,2,113,2,118,1","arqrhyhrqvphvqxhvrpr,97,1","arqrhyhrqvphvqyhyrhq,97,1","arrange,14,1,45,1,92,1,97,1,113,1","arranged,95,1,97,1","arrangement,5,1,14,2,21,1,45,1,97,2,109,1,213,1","arrangements,14,2,24,4,45,1,71,1,110,1,211,1","arranging,4,1,7,1,45,1,92,1,97,1","array,7,10,46,1,87,1,83,3,88,2,97,4,111,1","arrest,84,1,85,1","arrive,97,1","arrived,26,1","arrives,110,1","art,11,1,14,7,87,2,117,1","arthr,2,1","arthritis,2,3,14,1,61,1,213,1","arthur,23,1","article,4,1,29,2,46,12,49,1,55,1,56,1,62,1,63,1,116,1,117,1,118,1,122,3","articles,2,2,4,2,11,1,12,1,14,2,28,1,31,3,38,1,39,1,45,1,48,1,49,1,57,1,64,1,65,1,87,2,88,1,91,1,94,1,97,4,106,1,98,1,99,1,111,1,112,1,113,8,117,1","articulate,88,1,95,1","artists,4,1","arts,21,1,24,3","asa,92,2,97,1","asaging,20,1,92,1","asaps,83,1","ash,7,13","ashburn,92,1","asian,7,33,21,6,24,4,42,1,83,1,92,6,97,1,211,1","asians,21,1","aside,7,1,116,1,122,1","asin,23,1","asino,7,1","ask,14,2,24,3,25,3,27,1,42,4,43,16,45,7,62,2,63,1,97,4,110,6,113,3,210,2,211,12","asked,2,5,7,23,14,3,43,3,46,4,55,1,61,1,87,1,97,37,210,1,213,6","asking,7,1,14,1,43,3,61,1,62,1,84,1,97,2,113,1,118,1,210,1","asks,7,1,27,1,43,1,46,2,97,1,210,1","asp,2,1,53,2,59,1","aspect,14,2,55,1,97,1,211,1,213,2","aspects,14,7,23,1,24,12,92,3,95,5,97,3,110,1,117,1","aspen,14,1","aspirations,122,1","asplund,95,1","assemble,3,1,63,1","assembly,55,1,88,2","assertive,27,1,97,1,113,1","assess,7,24,14,20,87,1,83,1,86,2,92,12,95,2,97,4","assess1,10,8,119,2,126,8","assessed,7,3,14,3,95,2","assesses,7,32,212,1","assesshead,127,8","assessing,3,1,5,2,18,1,7,4,14,20,24,1,92,3,88,1,89,2,97,1","assessmenr,11,4","assessment,1,1,3,5,5,8,15,5,16,4,17,4,18,6,19,4,7,272,11,1,12,9,13,1,14,173,45,2,54,1,62,3,63,2,87,4,83,1,86,6,92,5,89,1,95,1,97,2,212,2,119,2","assessmentcaregivertooleng,13,8","assessments,3,1,5,1,7,4,14,21,92,1,97,3","assessor,14,9","assessors,14,7","assets,7,3,43,4,92,1,109,4","assign,7,1,92,1,97,1,110,1","assigned,7,1,92,2,95,4,110,1","assigning,95,1","assignment,95,1","assignments,105,1","assist,7,6,14,3,43,6,56,1,87,1,83,2,92,18,88,3,95,2,111,1,113,1,213,2","assistance,2,3,3,2,4,1,5,2,7,114,12,1,14,8,21,1,74,8,23,2,24,4,42,12,43,12,45,4,54,1,58,1,62,1,63,6,87,9,83,4,86,1,92,18,88,8,95,6,93,1,97,14,110,3,111,1,113,1,116,1,210,2,211,4,213,7","assistant,2,1,87,1,92,3,95,2","assistants,24,8,97,3,110,1","assisted,4,3,7,1,23,2,24,1,42,4,55,1,87,1,95,1,106,2,111,7,117,1,118,1,211,1","assisting,7,2,41,1,61,1,87,3,88,1,95,2","assistive,5,1,7,5,92,3,97,1","assists,7,1,43,1,92,1","assoc,7,2","associate,2,5,14,1,42,1,87,1,95,1,97,2,211,1","associated,5,1,14,3,55,1,61,2,87,1,92,1,88,1,89,1,95,10,105,1,111,1,213,1","associates,2,1,23,1,95,2,97,4","association,2,2,5,1,7,6,9,1,11,1,13,2,14,4,23,5,24,1,25,1,26,2,27,2,45,2,53,1,56,1,57,1,61,2,62,3,63,2,87,1,83,1,92,12,88,2,95,7,93,3,97,4,116,2,117,4,118,2","associations,14,1,92,2","assuages,21,1","assume,3,1,27,1,45,1,87,1,110,1,113,2","assumed,2,1,87,1,97,2","assuming,45,1,111,1","assumption,46,1,97,1","assumptions,45,1","assurance,3,1,14,1,92,1,88,1,97,10","assure,3,1,7,1,14,1,83,2,92,1,88,1,95,2,97,2","assured,43,1,97,1","assures,83,1","assuring,21,1,87,1,92,1","atlanta,72,1,24,4,46,2,92,1","atria,118,1","attached,97,1","attachment,60,2,105,2","attachments,60,2","attack,2,4","attempt,7,1,113,1,210,5","attempting,7,1","attempts,210,3","attend,1,1,6,1,7,1,21,1,24,3,41,2,43,2,87,1,92,2,97,1,106,1,110,2","attendance,105,1,110,3","attendant,7,4,97,4","attendants,45,1,97,2","attended,55,1,110,1","attendees,110,3,116,2,117,1","attending,25,1,87,1,95,1,97,1,118,1","attention,5,1,7,3,14,8,21,2,46,2,56,1,87,2,83,1,86,1,92,1,97,2,106,1,110,1,113,1,118,1","attentive,97,1","attitudes,14,1,23,1,24,6,92,2,97,4","attorney,14,1,24,4,109,1,118,1","attorneys,87,1","attract,62,1,63,2,87,2,110,1","attracting,61,1","attractive,71,1","attribute,95,1","attributed,45,1,97,1","attrition,95,2","attuned,113,1","audience,23,1,29,1,62,2,63,1,86,1,92,81,95,1,110,3","audio,71,1,87,3,85,1","audiotapes,14,1","audit,97,1","aug,88,1","augment,7,1","augmenting,21,1","august,2,3,7,3,14,1,62,1","aunt,42,2","australia,14,2","author,7,4,14,2,23,1,29,3,95,5,109,1","authoring,97,1","authoritative,87,1","authority,7,3,24,4,87,1,97,2","authorization,7,1,87,1,92,1","authorize,45,1,97,2","authorized,7,3,43,1,87,1,97,1","authorizing,97,1","authors,2,2,7,1,14,1,45,1","auto,43,1,46,1","automated,5,1,27,1","automatically,43,8,87,2","autonomy,87,1,86,1,92,1,97,1","ava,23,1","availability,7,12,72,1,24,6,45,1,87,1,95,2,97,2,106,2,110,5","available,2,2,3,2,5,1,7,32,13,1,14,5,21,3,20,1,23,11,24,3,31,1,42,3,43,9,45,5,54,1,60,2,71,2,87,16,92,15,88,9,89,1,95,13,93,1,97,16,106,1,110,3,113,1,116,1,117,2,118,1,211,2","avenue,45,1,71,1,92,11,110,1,112,1","avenues,106,1","average,4,1,7,104,43,13,95,1,111,1,117,1,211,1,213,4","averaging,7,1,14,1,95,1","avoid,43,1,45,1,46,2,95,1,113,1","avoided,97,1","avoiding,7,1,97,1","avon,23,1","aw,7,1","award,2,1,20,2,23,4,95,1","awarded,7,1,86,1,97,1","awarding,20,1,23,1","awards,3,1,20,7,23,1,46,1,50,1","aware,87,1,92,1,97,15,113,1,213,1","awareness,7,13,14,1,41,1,45,1,56,1,61,2,62,4,63,2,92,11,88,5,97,18,110,3","away,4,1,14,1,21,1,26,1,27,1,45,1,46,4,56,1,110,1,113,1,117,1,211,5,213,3","awbs,87,5","az,7,12,92,2","b1,53,1","baby,4,9,56,1,84,4,85,3,97,2,111,1,113,1","babysitting,21,2","bachelor,2,1,42,1,211,1,213,1","backbone,5,1,7,3","backgr,14,1","background,2,1,7,40,14,1,21,1,97,6,128,8,211,1","backseat,46,1","backup,4,2,97,3","backups,110,1","backwards,97,1","bad,84,1,85,1,109,2,210,1","bag,25,1","baghdad,4,1","bags,110,1","baked,21,1","baker,37,1","balance,1,1,7,1,14,1,45,1,87,1,97,2,118,1","balancing,23,1,87,1,92,1","baldwinsville,6,1","ballard,14,3","ballinger,95,2","balsamic,46,1","baltimore,7,1,13,1,14,1,23,3,61,1","ban,60,1","bandages,14,1,24,4,61,1,211,1,213,1","bangor,92,1","bank,84,1,97,1,109,3","banked,87,1","banks,87,1","bannersaanys,146,8","bannertile,147,8","bannes,92,2","banquet,112,1","banville,92,2","bar,2,1,23,2","barbara,7,1,23,2,61,1,92,2","barber,46,1,213,1","barbershop,46,1","baritone,46,1","baroody,8,1,37,1","barrier,7,3,13,1,97,17","barriers,2,1,7,6,14,3,87,2,86,1,92,2,95,7,97,42,105,1,106,3","bars,7,2","barylak,14,2","base,2,7,7,1,87,1,88,1,95,1,110,1","based,2,2,3,3,5,1,7,142,14,8,21,1,20,2,23,1,24,1,28,1,31,1,43,11,45,3,46,1,54,1,56,1,71,4,87,10,83,2,86,1,92,19,88,12,89,2,94,2,95,11,97,40,212,1,111,1,117,1,213,3","baseline,14,2,43,1,92,1","basement,6,1,8,1,117,1","bashaw,37,1","basic,5,1,7,4,14,4,43,9,60,1,71,1,86,2,92,2,105,1,106,1","basics,45,1,110,1","basis,4,1,7,3,14,2,23,2,43,1,92,1,95,2,116,1,210,1","basket,1,1,55,1","baskets,116,1","bass,14,10,23,1,95,2","bath,46,1,213,2","bathe,14,1,211,1","bathed,97,1","bathing,7,3,14,2,42,1,95,1,97,2,211,1","bathroom,111,1,113,1,211,1,213,1","batteries,116,1","battery,7,1","battle,111,1","baxter,7,2,14,3","bay,92,1","bayville,4,1","beach,61,1","bear,46,1","bearing,62,1,63,1","beat,23,1,113,1","beauty,97,1,109,1","became,7,1,86,1,95,1,97,3","because,2,11,5,1,7,10,13,1,14,5,21,1,23,2,24,4,43,3,45,5,46,6,60,1,61,1,62,1,87,5,92,3,95,9,97,44,105,1,109,2,110,3,111,4,211,1,213,4","beckwith,37,1","become,2,2,4,1,23,1,24,4,43,1,45,1,87,3,92,5,95,4,97,4,109,1,113,5,117,1,213,1","becomes,3,1,14,1,24,1,45,3,46,2,95,1,97,2","becoming,2,5,7,1,87,1,213,1","bed,45,3,46,1,97,2,111,1","bedlin,97,1","bedridden,111,1,213,1","bedroom,46,1","bedrooms,46,1","beds,7,32","bedto,45,1","beerman,23,1","began,7,3,21,1,24,3,87,1,97,3,111,1","begging,46,1","begin,14,1,43,3,45,5,62,1,63,1,88,3,97,1,110,1,113,1,211,1","beginning,3,1,7,5,14,4,41,1,43,3,46,1,97,3,110,1,116,1","begins,4,1,43,1,88,3,95,1","begun,97,2","behalf,21,1,45,1,92,2,109,2","behave,97,1","behavior,7,1,14,10,21,1,23,1,95,5","behavioral,7,2,14,1,87,1,88,3,95,4","behaviors,14,1,92,4","belief,7,1,97,1","beliefs,14,1,92,1","believe,7,2,45,1,46,1,56,1,87,1,95,1,97,3","believes,97,1","bell,23,1,87,1","belle,14,1","belong,43,1","beloved,23,1","beneath,43,2","beneficial,43,1,97,13","beneficiaries,7,9,43,1","beneficiary,2,1,7,5,43,3","benefit,4,2,7,13,43,15,87,3,92,2,88,1,95,11,93,1,97,6","benefited,87,1,95,3","benefits,2,1,4,9,7,3,21,1,24,5,27,1,42,2,43,13,45,1,46,1,62,1,63,1,87,2,92,2,95,61,97,7,106,1,110,1,211,2,213,2","benefitscheckup,23,2,93,2","bengston,85,2","benign,95,1","benjamin,7,3,14,1,31,1,92,1","ber,2,1","berkeley,46,1","berman,23,3","bernard,23,1","bernice,4,1","berry,95,3","berson,31,1","bert,23,1","besides,92,1,95,1","best,1,5,6,2,15,1,7,11,8,1,12,1,14,7,20,1,23,6,24,4,28,1,29,1,32,1,38,1,42,1,43,15,45,2,48,1,50,2,52,1,57,1,58,1,63,1,64,1,66,1,87,2,84,2,85,4,92,3,88,1,91,1,94,1,97,4,105,1,98,1,100,1,109,2,110,2,111,1,113,1,118,2","bestpracticesrespitecoop,21,4","bet,110,1","beth,6,3,8,1,23,1,122,1","bethesda,45,1","bette,92,1","better,2,3,7,13,14,6,23,1,42,2,43,6,45,1,46,1,84,1,92,5,88,1,95,10,97,8,109,1,111,3,116,1,118,1,210,1,211,2,213,6","between,2,1,4,1,5,5,7,7,13,1,14,1,23,1,24,12,26,1,32,1,43,4,46,3,54,1,60,2,63,2,87,3,83,2,84,1,85,1,92,5,88,1,95,5,97,14,111,1,113,1,117,1,118,2,211,3,213,7","beumer,92,1","beverages,24,3","beween,97,1","beyer,88,1","beyond,7,7,14,5,45,2,87,2,92,1,89,1,95,1,97,4,110,1","bg,22,8","bhull,37,1","bi,97,4,117,1","bibliography,23,10,48,1,51,1,117,1","bicultural,21,1","biennial,2,7","big,7,1,23,1,43,2,45,1,46,2,97,5,110,1","bigger,46,1,86,1,97,3","biggest,7,1,211,1,213,2","bile,111,1","bilingual,21,1","bility,7,36","bill,2,15,7,5,27,4,55,1,84,1,85,2,88,8,97,3","billboards,92,1","billing,27,1,62,1,63,1","billion,7,3,54,1","bills,2,13,43,2,87,2,211,1,213,1","bind,93,1","bing,113,4","biomedical,92,1,95,1","bios,110,1","birkel,95,2","birth,27,1,83,1,88,1","bit,97,1","bjl25,37,1","bl,7,1","black,2,1,23,1,42,1,211,1","blandford,95,1","blank,43,2,97,4,109,1","blaser,7,2","bleeding,26,2","blender,97,3","blending,86,1","blessing,213,1","blind,7,7,43,1,83,4,111,1,116,1","blindness,92,1,111,2","block,7,2,97,2","blocked,60,1","blocks,6,1","blog,84,1,85,1,109,1","blogs,84,2,85,2,109,2","blood,26,1","bloomberg,2,1","blows,46,1","blue,7,3","blueprint,45,2","bluetooth,85,1","bmilton,37,1","board,7,1,21,1,23,1,60,2,92,4,95,3,97,2,117,1","boards,24,4,87,1,95,1","bob,23,1","bobbi,37,1","bobby,37,1","bochniak,31,1","body,23,1,61,1,92,2,88,1","bogged,97,1","bold,111,1","bolster,5,1,7,1","bolstered,21,1","bond,95,1","bonding,110,1","bones,4,1,26,1","bonni,23,1","bonnie,7,1,37,1","bono,110,1,117,1","book,14,1,105,2,111,1,122,1","booker,37,1","bookkeeping,97,1","booklet,45,4,92,2,88,2,117,1","booklets,92,4,97,1","bookmarks,62,1","bookpartners,23,1","books,2,2,16,1,12,1,23,13,28,1,29,1,33,1,38,1,45,1,48,1,51,1,57,1,64,1,67,1,87,1,91,1,94,1,95,1,98,1,101,1,109,2,111,1,117,2","bookstores,117,1","boom,97,2","boomer,85,1","boomerang,97,2","boomers,4,9,54,1,56,1,84,6,85,3,97,1,111,1","boothe,92,1","borgatta,15,1,7,2,12,1,14,1,24,19,95,4","borgatta 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activities,24,3","care athens,24,3","care benefits,24,13","care building,24,6","care common,24,3","care how,24,1","care problems,24,3","care reflections,24,6","care staffing,24,1","care staffing comm,24,3","care success,24,3","cared,14,2,71,1,95,1,113,1,211,2,213,2","career,2,1,46,13,49,2,95,1,112,1,113,2,122,2","careers,23,1,46,4,111,1","careframe,53,1","careful,45,1,95,6,113,1","carefully,26,1,43,1","caregiv,92,1,97,1","caregive,113,1","caregiver,1,6,2,19,3,2,5,20,6,5,15,3,16,1,17,1,18,4,19,1,7,1031,8,2,11,3,12,5,13,3,14,257,21,14,20,4,72,1,23,11,24,122,28,1,29,1,31,2,32,1,33,1,34,1,35,1,36,1,37,1,38,2,39,1,40,1,41,1,42,39,44,1,45,13,48,3,49,1,50,3,51,2,52,3,53,8,54,9,55,8,56,12,57,5,58,1,59,1,61,10,62,9,63,5,64,1,65,1,66,2,67,1,68,1,69,1,70,1,71,8,87,82,83,18,86,18,92,123,88,10,89,3,90,1,91,2,94,3,93,2,95,34,97,13,105,3,106,1,98,2,99,1,100,1,101,1,102,1,103,1,104,2,107,1,108,1,110,7,115,1,212,19,112,2,113,22,116,14,117,10,118,11,119,32,122,14,210,15,211,31,213,18,214,2","caregiver support,83,2","caregiver’s,83,1,86,1","caregivercooperative,21,4","caregivernj,86,2","caregiverpa,95,1","caregivers,1,2,2,86,3,2,5,18,18,1,7,442,13,3,14,74,21,24,20,4,23,24,24,120,25,1,26,2,27,2,42,3,45,17,46,4,48,2,50,1,53,5,54,5,55,13,56,8,57,1,58,1,60,1,61,30,62,10,63,11,71,22,87,150,82,8,83,20,86,12,92,179,88,27,94,1,93,3,95,187,97,26,105,2,106,10,110,26,111,1,112,2,113,9,116,10,117,11,118,4,122,2,210,11,211,3,213,66","caregivers of,83,1","caregivers’,83,2","caregiving,2,21,5,7,18,1,7,250,13,3,14,79,21,1,20,2,23,18,24,25,31,1,37,1,42,1,45,19,46,4,48,1,50,3,53,2,54,2,55,1,56,2,60,1,61,9,62,6,63,2,71,2,87,8,83,1,92,97,90,5,95,20,97,2,105,3,106,1,107,1,110,10,115,1,212,2,113,28,116,2,117,6,118,2,210,3,211,10,213,20","caregiving”,24,4","caremanager,45,1","carenet,14,1","carenetwork,14,2,87,4","careplanner,45,1,53,1","careprof,2,1","carer,14,2,95,1","careradio,23,1","carereceiver,92,1","carergiver,92,1","carers,14,2,23,1,95,1","cares,7,7,14,2,92,5,113,1","caress,92,3","caretaker,7,1","caretakers,2,1,85,1,111,1","caretrust,23,1","caring,2,10,4,1,7,21,13,2,14,5,23,13,26,1,42,2,46,2,61,4,62,5,63,3,71,3,87,1,83,1,84,2,85,2,92,16,88,3,95,4,97,1,106,1,111,1,113,2,116,1,117,2,118,1,211,11,213,2","carl,23,1","carol,7,1,14,2,37,2,45,1,46,1,61,1,62,1,87,1,84,1","carole,23,1","carolina,5,2,7,7,24,4,61,1,87,10,97,2","caroline,23,1","carols,46,1","carolyn,61,3","caron,7,2","carpenter,7,1","carried,14,2,110,1","carries,7,1","carry,7,3,14,3,88,1,95,1","carrying,14,4","carryover,7,2","carter,24,4,61,1,92,2","carved,97,1","casa,116,2","cascade,95,1,111,1","case,3,1,4,3,7,6,14,8,24,15,29,1,42,1,43,3,45,4,46,1,92,5,89,2,95,19,97,40,110,2,111,4,117,1,211,1,213,10,214,1","caseload,7,42","caseloads,7,4","caserta,95,2","cases,4,1,7,2,23,1,43,2,45,2,87,2,95,3,97,9,116,1","caseworker,92,2","cash,7,6,20,1,28,1,31,1,32,2,43,9,87,5,97,35,109,3","casino,7,1","cason,23,1","cassilly,113,1","cassily,113,1","cast,111,1","castillo,88,1","castleman,23,1","catalog,117,1","catalyst,46,1,97,1","catapulted,111,1","catch,6,1","catches,46,1","categorical,7,1,97,1","categories,7,3,14,2,20,1,23,2,43,5,88,4,95,1,97,2","categorized,97,1","categorizing,87,1","category,7,6,23,1,29,1,42,1,97,2","catered,118,1","catheter,97,1,111,1","catheters,61,1","catholic,92,5,116,1,118,2","cathy,46,1","cattaraugus,37,1","cattco,37,2","caucasian,24,4,92,1,211,1","caught,84,3,110,1","cause,7,1,14,1,26,2,110,1","caused,26,1,97,5","causes,23,1,84,1,85,2,95,1","causing,97,2","caution,43,1,45,1,97,2","cautious,110,1","cayuga,1,1,37,1","cbaker,37,1","ccc,92,1","ccci,92,5","cce,7,8","ccp,7,7","ccped,7,8","ccsp,7,7","cd,7,5,92,1,97,44","cdc,83,1","cdf,93,1","ce,7,2,97,2","ceiling,7,1","celebrate,56,1","celebrated,56,1","celebrations,14,2","census,2,2,3,1,7,2,23,4,24,1","center,1,1,4,1,6,7,18,1,7,10,8,2,9,2,13,1,14,20,21,2,23,4,24,16,41,1,42,1,43,6,45,1,56,6,87,4,83,1,85,1,92,31,89,2,93,3,95,3,106,1,110,1,111,4,113,1,116,2,117,2,118,1,122,3,211,1","center”,83,1","centered,5,1,7,5,62,1,92,1,97,2","centers,7,10,14,2,23,1,24,9,43,2,87,2,92,6,95,2,97,3,106,1,110,1,111,3,116,2,117,1,118,1","central,3,1,7,8,14,1,42,1,87,1,88,2,97,1,109,1,117,1,211,1","centralize,7,1","centre,95,1","century,14,1,46,2","cereal,46,1","cerebral,92,2,88,1","ceremony,117,1","certain,2,1,7,5,14,2,27,1,45,3,61,1,87,1,97,7,110,1,117,1,210,1,213,1","certainly,45,1,97,2","certificate,62,1,63,1","certificates,62,1,63,1","certification,97,5","certified,7,64,97,2,117,1","certifies,7,1","ces,14,1","cfcrochester,92,1","cfischer,92,1","cfm,54,1,56,2,57,1,93,1","cg,7,4,14,17,24,16,83,1,211,2","cg3,210,8","cg3survey,211,8","chain,84,1,85,1,109,1","chair,7,1,24,3,45,1,46,1,95,2,97,1","chairing,24,1","chairman,2,1","challenge,3,3,7,10,87,1,83,1,86,2,97,6,213,1","challenged,2,1,97,1","challenges,3,1,6,1,7,16,14,4,21,1,23,3,46,1,56,1,61,2,62,1,87,7,92,1,93,1,95,1,97,4,106,2","challenging,7,2,14,3,88,1","chamberlain,14,2","chambers,88,1","championing,7,1,14,1","champions,110,2","chance,21,2,43,1,46,1,87,1,111,1","chances,13,1","change,2,3,3,4,4,1,5,1,7,12,14,2,43,4,45,1,54,1,71,1,87,3,83,1,92,2,95,3,97,17,106,1,110,1,111,1,113,1,116,1","changed,7,1,13,1,61,1,97,4,211,1,213,1","changes,2,1,4,1,5,1,7,6,14,4,23,1,24,3,42,1,45,2,60,1,92,2,95,7,97,5,106,1,113,1,117,1,118,1,211,1,213,1","changing,2,1,7,1,14,1,23,1,24,4,87,1,83,1,85,1,86,2,97,3,113,1,211,1,213,1","chaos,60,1,106,1","chapin,14,2","chapko,95,1","chaplain,45,1","chappell,95,1","chapter,14,1,23,1,24,1,87,4,88,1,95,1","chapters,23,2,95,2","characteristic,97,1","characteristics,2,2,7,40,14,5,24,1,42,2,87,1,92,1,97,11","characterize,7,2","characterized,87,1,83,1,97,1","characterizes,7,1","charge,6,1,20,1,45,1,87,1,111,2","charged,3,1,88,1","charities,84,1,85,1,116,1,118,2","charles,4,1","charlotte,85,1","charset,119,2","chart,43,1,46,3","charter,92,1","charts,97,1","chassler,14,2","chat,60,4,87,4,92,1","chats,92,1","chatzky,109,7","chautauqu,116,1","chautauqua,1,1,37,2,56,1,89,1,90,1,115,1,116,6","check,13,1,23,3,25,3,29,1,42,8,43,8,45,1,48,1,60,1,88,1,97,21,106,1,109,3,211,11","checkbook,1,1","checked,43,23,97,3","checking,84,1,85,1,113,1","checklist,14,2,25,2,110,2","checklistforhealthcareencounters,25,4","checklists,25,4,57,2","checkmark,211,1","checks,97,4,118,1,211,1,213,2","chemical,23,1","chemung,1,1,37,2","chenango,37,2","cheryl,37,1","chest,26,1","chha,3,1","chi,92,1","chicago,7,1,13,1,14,1,23,32,71,1,92,5","chicken,61,1,62,1","chief,63,1","child,2,2,4,3,7,3,14,1,45,1,84,1,85,1,92,1,93,3,95,1,106,1,117,1","childhood,46,2","childless,46,1","childre,109,1","children,2,12,4,3,7,4,13,1,21,2,23,9,42,1,45,1,46,3,54,1,87,1,83,1,84,3,85,2,92,19,88,6,93,7,95,2,97,2,105,2,106,2,111,1,113,3,117,2,211,2","childrens,14,1","childrensdefense,93,1","chimera,95,1","chinese,21,1,92,1","chippewa,87,1","chock,109,1","choice,3,1,7,77,14,2,23,1,32,1,43,5,45,1,46,1,60,1,87,10,92,2,97,14,110,1,111,1","choiceonemail,37,1","choices,3,1,7,13,14,2,23,1,31,1,43,5,45,2,48,1,61,1,87,4,95,2,97,5,117,1","choose,1,1,5,1,7,37,14,1,23,1,24,8,43,11,46,2,87,6,84,1,85,1,97,8,110,1,113,1,116,1","choosing,23,1,54,1,111,1","chore,5,1,7,79,42,1,87,1,97,1,211,1,213,1","chose,7,3,97,3","chosen,14,1,43,1,87,1,92,1,88,1,111,1,116,1","chris,4,1,23,1,37,1,87,4","christensen,95,1","christina,37,1","christine,37,1","christmas,46,1","chronic,2,9,18,1,61,1,71,1,92,1,88,3,111,2","chronically,7,6,14,1,45,2,61,1,62,1,95,1","chronicles,23,1,122,1","church,7,2,97,1,110,1,113,3,117,3,118,1","churches,92,1,110,1,117,1","cincinnati,92,1","cindy,37,1","circle,23,1,41,1,92,2,211,1","circles,23,1","circulate,117,2","circumstance,43,6,95,1","circumstances,2,1,92,1,88,1,95,1","citations,7,1","cite,4,1,7,3,97,1","cited,7,2,46,1,61,1","cites,46,1","cities,7,32","citizen,88,2","citizens,1,1,88,3,110,3","city,2,1,24,3,37,1,42,2,45,1,46,2,53,1,61,1,92,3,109,1,117,1,211,1","civic,1,1,6,7,8,2,45,1,92,1,88,3","ckather,92,1","claim,97,1","claims,27,3,97,3","claire,23,2","clarification,7,1,14,1,210,1","clarified,7,1,27,1","clarifies,213,1","clarify,7,1,14,1,43,1,95,1,97,2","clarifying,7,1","clarity,97,1","class,1,1,14,1,46,1,71,7,92,3,105,4,117,2","classes,7,1,14,1,71,1,92,1,105,1","classic,23,1","classification,43,1","classified,7,1","classify,7,1","claudia,31,1","claus,97,1","clay,95,1","clean,110,1","cleaned,7,1,213,1","cleaner,97,1","cleaning,211,1,213,1","clear,7,1,14,1,27,1,87,1,83,1,84,1,85,1,95,4,97,23,109,1,110,1,118,1,119,4,129,8","clearer,42,1,45,2","clearinghouse,93,1","clearly,7,1,26,1,27,1,87,1,95,2,97,11,112,1","cleveland,14,1,92,1","clewis,37,1","clicking,46,1","client,7,72,14,5,23,2,61,1,87,1,89,1,95,3,212,1,117,1,211,43,213,3","clients,4,1,5,1,7,7,14,2,23,2,24,4,42,1,87,1,89,1,95,9,97,1,211,1,213,1","cliff,72,1,24,12,87,1,92,1","cliffs,14,1","climbing,46,1","clinic,2,3,53,1","clinical,14,2,23,1,95,2,97,1","clinically,61,1","clinician,95,1","clinics,14,1,43,1,62,1,63,1","clinton,37,2,92,1","clip,48,1","clipping,87,1","clock,23,1,46,1,95,1","close,42,1,43,1,62,1,63,1,92,1,97,1,210,1,213,1","closed,7,1,95,1","closely,7,1,97,1,117,1","closer,97,1,109,1","closets,113,1","closing,24,2,88,1","club,105,1","clubs,88,1","clude,7,1","cms,7,6,97,13","cmwf,2,2","cna,23,1,116,1","cny,117,4","co,7,5,21,20,23,2,37,26,43,9,63,1,87,2,92,3,94,1,95,1,97,1,113,2,116,1,213,1","coach,97,1,109,1,117,1","coaching,63,1","coaf,93,1","coala,92,1","coalition,7,4,24,10,45,1,48,1,92,1,88,3,93,1,110,5,117,2","coalitions,24,3,92,8,110,1","coast,46,1,109,1","coaster,113,1","coauthor,95,1","cobbling,111,1","code,7,1,27,1,42,1,105,2,110,1,211,1","codebook,7,3","coded,7,3","coder,7,1","codes,7,4","coding,7,3","coffers,7,1","cognitive,5,1,7,8,14,6,24,3,87,1,92,1,95,9,97,1,117,1","cognitively,14,1,31,1,95,2","cohen,14,1,23,2,84,1,95,2","cohesive,7,1","cohorts,95,1","coincide,105,1","coincides,95,1","coinsurance,43,1","cold,13,1","cole,14,1","coleman,7,1","collaborate,7,2,63,1,92,2,97,1,110,1,116,1","collaborates,87,1,106,1","collaborating,92,3,111,1","collaboration,3,2,7,6,9,1,24,8,43,1,83,1,92,5,117,1","collaborations,5,3,7,1,58,1,62,1,95,1","collaborative,7,1,92,2,89,6,97,1","collaboratively,21,1,97,1","collaborators,95,1","collage,130,8","collage1,131,8","collage2,132,8","collage3,133,8","collage4,134,8","collagetile,135,8","collapse,213,1","collapsed,97,1","colleagues,7,1,14,2,46,2,95,14,97,1","collect,7,2,14,2,43,2,92,1,89,3,97,1","collected,5,1,7,8,14,6,32,1,86,1,92,1,89,2,97,1","collecting,14,2,83,1,89,3","collection,2,3,7,15,14,1,63,2,92,1,88,1,89,1,117,1","collections,109,1","collector,109,1","college,1,1,42,1,61,1,62,1,84,3,92,1,95,1,211,1,213,3","colleges,110,1","collins,2,4","colo,4,1","colonie,41,3,43,2","colonno,43,1","color,71,1,92,1","colorado,7,13,97,1","columbia,7,46,37,2,92,1,88,1,97,1","columbus,87,1,92,1","column,43,1,97,14,109,1","columnist,109,1","columns,109,2","colvin,23,1","com,4,14,23,2,37,13,45,2,46,9,53,2,60,1,71,3,87,1,84,23,85,19,92,4,97,2,105,4,106,1,104,1,109,29,115,1,111,7,112,1,113,9,118,2,119,2","combination,7,6,14,1,92,2,88,1,95,1,97,6","combine,97,2,106,1,118,1","combined,7,2,43,2,95,1,97,3,211,1","combines,97,1","combining,45,1,97,6","come,2,1,6,1,7,1,21,2,26,1,45,1,46,2,62,1,63,1,85,1,88,1,95,1,97,5,105,2,116,1,117,1,118,2","comes,4,1,7,1,23,1,45,1,60,1,95,3,113,2,213,1","comfort,14,1,23,1,46,1,106,1,115,1,113,1","comfortable,45,1,60,1,97,5,105,1,211,1","comforting,113,1","comfortofhome,115,1,119,2","comforts,116,2","coming,7,2,23,1,46,1,84,1,97,3","comm,24,1,84,1,85,1,109,1","commeff,25,4,26,4,27,4","commence,3,1","comment,7,1,13,1,56,1,95,2,97,1,109,1,110,1","commentaries,23,1","commentary,23,1,29,1","commented,7,1,95,1,105,1,213,1","comments,7,1,13,1,14,1,21,1,23,1,42,1,43,1,60,1,63,1,95,1,97,8,105,1,109,3,213,2","commercial,92,1","commercials,92,1","commission,7,40,97,1","commissioner,3,1,8,1,117,1,118,1","commissioners,43,1","commissions,7,5,93,1","commit,87,1,106,1,110,3","commitment,7,1,63,1,92,1,88,1,97,2,110,1","committed,14,1,92,1,97,2,110,1","committee,7,7,14,3,83,1,88,9,95,1,110,14,117,1","committees,97,1,110,1","common,2,1,4,1,7,10,13,1,14,6,21,1,23,1,46,1,87,2,83,1,85,1,95,1,97,7,110,1,111,1,113,1,117,1","commonalities,14,2","commonly,4,1,7,8,14,1,87,1","commonwealth,2,16,56,1","communicate,26,1,27,1,57,2,87,7,92,1","communicating,1,1,23,3,25,1,26,2,27,3,87,1,92,3,97,2","communicatinginacrisis,26,4","communicatinginsurance,27,4","communication,3,2,7,1,14,5,23,2,24,8,27,1,71,1,87,6,92,3,97,1,110,2,117,2","communications,87,1,92,1,97,1","communism,95,1","communities,7,1,21,2,20,1,24,9,41,2,62,1,87,2,83,1,92,10,88,10,97,2,110,1,111,1","community,1,2,3,3,5,3,7,155,13,2,14,11,21,7,20,2,23,1,24,45,28,1,31,1,41,2,43,2,45,5,54,2,55,2,56,1,57,4,61,2,63,2,71,1,87,12,83,5,92,52,88,55,94,2,95,10,97,36,106,3,110,23,116,3,117,11,118,2,213,4","communitybased,7,17,88,1","commuter,85,1","companies,2,1,4,5,92,1,105,1","companion,45,1,92,2,111,1,113,1,118,2","companions,97,1","companionship,95,1,211,2,213,3","company,4,5,14,1,27,3,43,5,46,2,97,4,212,1,111,1,119,2,136,8","comparability,95,1","comparable,7,2,89,1,95,2","comparatively,97,2","compare,7,1,14,3,43,5,84,3,85,3,97,1","compared,2,11,4,1,7,9,13,1,24,20,43,1,92,1,95,15,97,2","comparing,24,4,31,1,43,10,92,2,95,1","comparison,2,1,54,2,92,1,95,7,97,1","comparisons,7,1,95,1","compassion,7,8","compat,97,2","compatibility,97,6","compatible,97,5","compensation,24,4,97,13","compete,97,2,113,1","competence,7,2,14,5,92,2,106,1","competencies,86,1,95,1","competency,24,1,95,1","competent,14,1,83,2,92,2,97,2","competing,7,1","competition,43,1","competitive,7,1,92,1","compiled,7,1","compiling,88,1,97,1","complain,97,1","complained,46,1","complaining,118,1","complaints,23,1,26,1,97,1","complement,7,2","complementary,5,1,92,1","complete,4,1,7,12,14,1,23,8,29,1,43,4,63,2,84,1,85,1,92,4,88,2,97,6,211,1","completed,7,4,14,2,27,1,43,4,92,1,97,9,210,3","completely,13,1,43,1,210,1","completes,92,1,97,1","completing,3,1,43,1,89,1,97,2","completion,7,1","complex,7,2,14,3,61,1,62,1,95,2,97,2,111,1","complexes,118,1","complexities,14,3,24,4","complexity,7,5,14,1","compliance,7,1","compliant,3,1","complicated,97,3","complications,111,1","compliment,92,1,113,1","comply,88,1","component,18,1,7,53,14,1,97,4","components,3,1,7,4,14,3,92,7,88,3,95,3","compose,210,1","composed,88,2","composer,4,1","composing,2,1","composition,14,2","compounding,95,2","comprehens,87,1","comprehensive,3,3,18,1,7,2,14,10,23,3,54,2,86,2,92,6,95,4","comprised,43,1,92,1,95,1","comprises,87,1","comprising,61,1","compromise,7,3","computer,2,1,7,1,14,1,43,1,87,1,84,1,97,3,109,2","computers,92,1","comrades,113,1","con,92,1","concedes,111,1","concentrate,92,1,213,1","concept,5,1,7,3,14,3,63,1,87,1,92,1,88,3,97,3","concepts,14,2,87,2,95,1","conceptualize,7,1,87,1","concern,1,2,27,1,45,2,95,1,97,16,110,1","concerned,13,1,97,43","concerning,2,1,7,1,87,1,95,1,113,1","concerns,2,10,3,1,7,2,14,2,21,1,23,1,27,1,45,2,56,1,87,2,92,5,88,1,95,1,97,16,109,1,110,4","concert,97,1,109,1","concise,27,1","conclude,95,1,106,1","concluded,117,1","conclusion,2,1,5,1,92,1,95,1,97,4,105,2,213,1","conclusions,7,6,83,1","concordant,88,1","concurrence,61,1","condition,2,6,5,1,7,1,14,2,23,1,42,2,45,6,46,1,84,1,85,1,92,1,95,6,97,2,109,1,211,3,213,3","conditions,2,4,18,1,7,1,46,1,88,4,95,3,111,2","condominium,111,1","conducive,97,1","conduct,3,2,7,7,14,2,45,1,87,1,92,4,95,1,97,2,106,1,110,1","conducted,2,3,7,7,14,5,21,1,24,7,61,1,87,1,92,2,95,6,97,8,212,1,117,2,213,2,214,2","conducting,14,4,24,1,42,1,87,1,88,1,97,1,106,1,211,1","conducts,2,1,87,1,83,1","conference,7,8,9,5,14,1,24,1,41,7,62,3,63,3,87,2,92,2,88,3,97,5,105,1,106,8,112,2,117,1,118,1","conferences,6,1,7,1,24,4,41,3,48,1,87,2,92,1,97,2,117,1","confianza,92,1","confidence,2,3,7,2,14,5,21,1,23,1,71,1,92,2,97,1","confidences,113,1","confident,2,6,14,1,97,11","confidential,42,1,43,4","confidentiality,97,1","configure,87,1","configured,7,1","confirm,25,1,42,1,95,1","confirmation,105,2","conflict,46,1,113,1,213,2","conflicts,61,1,106,2,211,2,213,1","conforming,7,1","confounded,95,1","confronted,111,1","confronting,23,1","confused,21,1,23,1,26,1","confusing,3,1,7,2,213,1","confusion,95,1,97,3","congregate,89,2,97,2","congregations,87,1","congress,7,1,43,1,92,1","congressionally,7,1","congruence,7,2,14,1","conjunction,95,1,97,1","conn,14,1","connect,4,1,42,1,62,3,63,3,87,1,88,1","connected,3,1,87,1,83,1,112,1","connecticut,4,1,7,17,14,1,92,1,97,1,110,1,112,1","connecting,1,1,42,1,63,1,83,1,92,1,88,1","connection,54,1,61,1,62,1,63,1,97,2,113,1","connections,2,1,23,1,87,1,83,2,110,1","connie,23,1","connis,95,1","cons,106,1","consecutive,7,1","consensus,3,1,18,1,7,6,12,1,14,3,87,2,97,2","consent,45,1","consequence,7,1","consequences,2,1,7,1,14,2,43,1,92,1,95,3,110,2","consequently,7,1","conservative,87,1,97,2","conservatorships,14,2","conserve,95,2","consider,2,1,7,8,13,3,14,5,43,20,45,1,60,1,87,3,88,1,95,1,97,3,109,3,110,2,111,2,113,1,116,1","considerable,5,1,7,2,88,1,95,1,97,3","considerably,7,3,14,1","considerate,27,1","consideration,7,1,14,2,27,1,43,1,95,8","considerations,3,2,24,4,43,3,97,2,110,2","considered,7,4,14,4,83,2,95,2,97,2,111,1","considering,43,1,55,1,95,2,97,2","considers,14,1","consisted,2,1,7,3,92,1,95,1","consistent,2,1,3,1,7,6,14,6,21,1,88,1,95,1,97,3","consistently,7,1,14,1,45,1,95,1,97,2","consisting,3,1,105,1,212,1","consists,2,1,23,1,92,2,105,1,116,1","consolidation,84,2,85,2","consortium,7,1,92,3","constant,2,3,88,1,113,2","constantly,213,1","constituency,7,2","constituents,7,1,92,2","constitute,87,1","constitutes,87,1,97,1","constrained,7,2","constraining,7,1","constraints,14,3,97,1","construct,92,1","constructive,118,1","consult,7,34,45,1","consultant,2,1,14,1,46,1,63,1,97,3","consultants,3,1,87,1,97,3,117,1","consultation,7,37,14,1,87,1,92,3,95,3,97,1,111,1","consultations,7,3,87,1,92,1","consulting,97,1,212,1","consum,7,1","consumable,7,4","consumer,1,1,3,2,5,6,7,147,14,4,23,1,24,4,28,5,31,18,32,5,33,4,34,4,35,4,36,5,43,4,45,1,48,1,87,62,83,1,92,2,89,1,95,3,97,635,119,2","consumer1,119,2,137,8","consumer2,97,1","consumerdirected,7,4,87,5,97,23","consumerdirection,36,1,97,4","consumerform,29,4","consumerhead,30,8,138,8","consumers,3,3,7,4,14,1,21,1,23,1,31,1,32,1,36,1,54,1,87,16,83,4,92,2,88,2,93,1,97,152,111,1","consuming,4,1,27,1","cont,7,94,97,2","contact,2,1,4,1,6,1,7,1,14,1,21,2,23,1,29,1,31,1,37,1,41,1,43,25,45,1,56,1,61,1,62,3,63,5,87,13,83,1,84,1,85,1,92,41,88,6,89,1,93,4,95,1,97,4,106,3,109,1,110,4,113,1,118,1,210,13","contact1,119,2,139,8","contacted,2,3,61,1,97,3,210,2","contacthead,140,8","contacting,92,1","contacts,6,1,7,5,13,1,14,2,37,8,87,2,110,3,119,2","contain,7,1,46,1,88,1,116,1","contained,23,1,87,1,97,1","containing,14,1","containment,2,7,7,1","contains,23,2,48,1,92,1,95,1,97,1,210,1","contd,7,41","contemplating,23,1","contemporary,23,2","content,14,4,56,1,97,1,119,1","contention,24,3","contents,43,1,55,1,83,1,88,1,95,1,97,1","context,7,4,14,3,87,1,95,1,110,1","continental,2,2","continuation,46,1,87,1","continue,3,3,5,1,6,1,7,5,14,8,42,1,43,1,45,1,87,1,92,3,88,1,89,1,97,2,106,1,110,2,111,1,213,5","continued,3,1,7,1,14,2,43,3,87,2,97,5,110,1","continues,2,6,7,1,46,1,84,1,85,1,92,1,97,1,109,1,113,1","continuing,45,3,86,1,97,3,210,1","continuity,54,1,83,2,92,2,117,1","continuously,2,1,97,1","continuum,7,2,14,1,92,1,97,3","contra,92,3","contract,3,5,7,1,87,1,88,2,97,2,111,2,117,4,118,6","contracted,1,2,87,2,212,1","contracting,97,1","contractor,3,2,97,1","contractors,3,1,7,1,24,4,97,1","contracts,3,1,88,1,97,2,111,1,117,1","contractually,3,1","contradiction,97,1","contrary,7,1,87,1,95,1","contrast,7,2,14,3,87,1,111,2","contribute,7,2,14,1,21,1","contributed,7,1,46,1,97,2,213,2","contributes,2,1,117,1","contributing,97,1","contribution,7,19","contributions,7,4,14,1,20,1,43,2,45,1,83,1,97,1","contributor,4,1","control,2,1,7,6,14,2,21,1,24,4,45,1,87,5,83,1,92,3,95,28,97,25,106,1,113,1","controlled,7,1,95,3","controls,60,1,61,1,95,3,97,1","convened,92,1","convenience,27,1,43,1","convenient,43,1,87,1,110,1","convening,87,1,83,1,97,1","convention,9,1","conventional,14,1","convergence,61,1","conversation,3,2,14,1,24,3,27,1,45,1,46,1,97,1,109,1,111,1","conversations,23,1,27,1,97,1,109,1","converse,213,1","convert,109,1","converted,97,1","conveyed,97,1","convince,97,2","convincing,97,2","cook,97,2,213,3","cookbooks,109,1","cooking,24,3,92,1,213,3","coombs,97,1","cooper,37,1","cooperation,3,1,7,1,42,1,54,1,97,1","cooperative,21,6,92,1,89,1","cooperatively,97,1","cooperatives,21,1","coord,55,4","coordinate,7,7,14,2,87,1,83,1,92,1,88,3,95,1,97,2,110,1,117,2","coordinated,7,3,41,1,83,2,86,1,92,1,88,5,97,3","coordinates,83,1,88,1","coordinating,3,1,5,1,7,6,14,2,83,1,86,1,92,1,88,6,97,1,110,1","coordination,3,2,7,7,83,8,86,6,92,7,88,6,95,2,110,2,118,1","coordinator,1,1,6,2,8,1,24,8,37,1,52,1,56,2,87,3,86,1,97,4,105,1,110,8,118,1,210,4","coordinators,14,1,55,1,116,1,117,1,118,1,122,1","copayment,87,1","copayments,2,1","copays,43,1","cope,4,7,23,1,56,1,87,1,213,1","coped,14,2","copied,45,1","copies,2,1,31,1,62,2,63,2,97,2,118,1","coping,2,3,7,1,14,4,23,4,54,1,71,1,92,2,88,1,95,2,106,2,117,1","copy,15,1,16,1,17,1,18,1,19,1,7,3,11,1,12,1,20,2,26,1,28,1,29,1,31,1,32,1,33,1,34,1,35,1,36,1,37,1,38,1,39,1,40,1,41,1,43,1,44,1,48,1,49,1,50,1,51,1,52,1,53,1,54,1,56,1,57,1,58,1,59,1,62,1,63,1,64,1,65,1,66,1,67,1,68,1,69,1,70,1,90,1,91,1,94,1,97,2,106,1,98,1,99,1,100,1,101,1,102,1,103,1,104,1,107,1,108,1,109,1,115,1,118,1,210,1,214,1","copyright,4,1,15,1,16,1,17,1,18,1,19,1,11,1,12,1,20,1,28,1,29,1,31,1,32,1,33,1,34,1,35,1,36,1,37,1,38,1,39,1,40,1,41,1,44,1,46,1,48,1,49,1,50,1,51,1,52,1,53,1,54,1,56,1,57,1,58,1,59,1,64,1,65,1,66,1,67,1,68,1,69,1,70,1,90,1,91,1,94,1,98,1,99,1,100,1,101,1,102,1,103,1,104,1,107,1,108,1,111,1,113,2,115,1,214,1","corbeil,95,1","cordially,41,1","core,7,1,83,1,86,1,95,1,110,1","coreside,213,1","coretta,84,2,85,2,109,1","cornell,37,1","corner,6,6,23,1","corners,4,1","cornerstone,7,1","cornerstones,21,1","corporate,4,2,46,1,87,2,92,1,110,1","corporation,2,1,92,4","corporations,46,1","correction,46,2","corrections,4,1,46,1,111,1","correctly,97,1","correspondent,84,2,85,2","cortland,37,2","cost,2,16,3,1,4,1,7,41,14,3,23,1,29,1,42,1,43,25,46,1,87,6,84,1,85,5,92,4,88,1,95,27,97,26,105,1,106,2,111,1,213,1","costa,92,3,109,1","costalandsales,109,1","costantini,46,2","costly,3,1,4,1,7,2,14,1","costrelated,2,1","costs,2,5,7,6,14,2,21,1,24,7,43,15,55,2,87,9,88,5,89,1,93,1,95,13,97,21,105,1,110,4,117,1,213,2","costsavings,95,2","could,2,4,7,7,14,4,21,1,24,6,26,1,43,2,46,3,87,3,84,1,85,1,86,1,92,1,95,9,97,14,105,3,109,1,212,1,111,2,113,2,118,2,213,2","couldn,13,1,14,1,97,2,213,1","council,3,2,7,3,21,5,87,2,23,1,24,3,92,9,88,17,93,2,95,2,97,4","councils,7,2,87,1,92,2","counsel,97,2","counseling,1,1,2,1,7,12,87,7,24,8,28,1,31,1,32,2,42,3,43,1,83,1,92,7,95,3,97,31,113,1,211,2,213,2","counselors,87,4,45,1,92,1","counsels,87,1","count,7,2,46,1,210,1","counted,13,2","counterparts,7,1","counties,3,1,87,4,24,6,43,2,54,1,86,2,92,1,88,10,97,1,106,1","counting,113,1,211,1","countries,31,1,95,2,111,1","country,7,3,14,1,21,1,87,1,43,1,56,1,85,1,92,1,106,1,110,1","county,1,17,3,3,6,5,15,1,7,11,8,3,12,1,87,7,29,1,37,2,41,1,43,19,48,1,52,1,53,1,55,1,56,2,61,2,64,1,66,1,83,2,86,5,92,7,88,8,89,7,90,4,91,2,97,7,106,1,107,2,110,2,212,2,115,4,116,10,117,9,118,11,213,3,214,2","countyofschenectady,37,1","coup,46,1","couple,1,1,43,4,95,1,97,3,111,2,117,1,213,1","coupled,95,1","couples,43,2","course,14,3,87,1,45,2,71,1,92,8,95,4,97,1,105,3,110,3,113,1","courses,105,1","court,4,1,7,2,83,1","courts,92,1","coveny,92,1","cover,2,1,7,4,14,4,21,1,87,2,43,6,55,1,63,1,84,1,85,1,97,1,109,2,110,2","coverage,2,15,7,2,43,159,45,2,48,1,54,1,97,4,110,2","covered,7,9,23,1,43,16,45,2,97,1","coverge,43,1","covering,7,1,42,1,43,1,55,1,92,1,88,1","covers,23,5,43,2,97,1","covhomemaker,7,1","cox,23,1,92,2,95,2","cr,7,1,14,5","cracks,87,1,110,1","crafting,87,1","crafts,21,1,24,3","crane,37,2","cray,23,1","crc,14,1,87,2","crcs,7,9,14,4,87,3","create,5,1,87,5,24,4,62,2,63,1,84,1,92,5,88,2,97,3,110,1,113,1,116,1,211,3","created,2,1,7,7,87,3,43,1,45,1,92,1,97,2,117,1,211,1","creates,7,1,85,1,92,1,95,1,211,1,213,1","creating,3,1,7,2,21,2,87,2,62,1,88,1,97,2,110,1","creation,43,1,83,1,92,2,93,1,110,1","creative,6,1,21,1,87,1,23,1,92,1,95,1","credentials,87,2","credibility,24,6","credit,84,2,85,2,97,1,109,7","creditable,43,9","credited,43,1","credits,2,1,7,1,87,1,110,1","creeping,97,1","crei,92,1","cried,210,1","criminal,88,1,97,4","crises,7,1","crisis,4,2,14,3,25,1,26,9,53,1,57,1,92,4,88,1,93,1,111,2,113,1,118,1","crisisclinic,53,1","cristina,85,3","criteria,5,1,7,24,14,7,45,1,92,1,88,4,97,10","critical,2,2,5,1,7,2,14,5,21,1,87,4,25,1,83,1,86,1,92,2,88,1,95,4,97,5,110,2,113,1","criticism,46,1,111,1","critics,111,1","critique,122,1","cross,1,1,7,4,92,2,97,1,117,1,118,1","crosscutting,7,1","crossing,7,1","crossings,14,1,45,1","crowd,110,1","crowded,45,1","crowther,14,1","crucial,7,2,87,1","crunching,46,1","crush,97,1","crying,13,1,46,1","csitterly,37,1","css,119,2","cstevenson,6,1,117,1","csw,23,1","ct,7,7,92,1,97,4,112,1","ctaddei,37,1","cuellar,31,1","cuidando,92,1","cuing,14,1","culled,111,1","cultural,7,1,14,3,21,1,23,2,45,1,46,1,83,1,86,1,92,1,97,4","culturally,7,4,14,2,31,1,83,4,86,1,92,10,97,1","culture,3,1,23,1,46,1,88,1,97,1","cultures,23,1,86,1","cumulative,97,3","cur,2,1","curing,61,3,62,1","curl,109,1","curran,95,2","current,7,4,13,2,14,6,87,1,25,1,42,2,43,26,84,1,85,1,92,4,95,7,97,15,109,1,211,1","currently,2,6,7,2,14,2,87,1,43,6,83,2,92,1,95,1,97,14,105,1,117,1,118,1,211,2","curricula,3,1","curriculum,71,1,83,1,92,3","curve,5,6,48,1,56,1,97,1","customer,3,2,27,1,88,1,91,4,97,1","customers,109,1","customized,92,1","cut,46,1,85,1,97,2,113,1","cutbacks,4,1","cuts,23,1,213,1","cutting,92,1,97,1","cybulski,43,1,118,1","cynthia,6,1,37,3,92,2,90,1,107,1,115,1,117,11,119,2","cynthiastevenson,37,1","cyoung,37,1","czerniak,7,1","d1,42,1,53,1","d10,42,1","d11,42,2","d12,42,1","d13,42,1","d14,42,1","d15,42,1","d2,42,1","d3,42,1","d4,42,1","d5,42,1","d6,42,1","d7,42,1","d8,42,1","d9,42,2","da,7,1","dad,46,2,85,2","dadeland,92,1","daily,7,7,14,5,84,2,85,2,92,1,95,4,97,1,117,2,213,2","dakota,7,23,97,2","dallas,23,1","dalsberr,92,1","dancing,92,1","dangers,45,1","daniel,92,1","dark,4,1","darlene,87,1","daryl,37,1","dassen,95,3","dsso,97,1","data,2,5,3,1,5,2,7,85,14,10,23,3,24,4,32,2,63,2,92,4,88,2,89,12,95,3,97,12,106,1,210,1","database,7,2,23,1,83,1,92,1,93,1,97,1,118,1","databases,7,2,87,1,53,1","date,9,5,14,2,27,2,29,4,42,1,43,8,88,1,89,1,95,4,110,5,122,1,210,2,211,2","dateline,84,2,85,2,109,2","dating,97,1","daughter,4,2,7,1,14,1,87,1,23,3,42,4,46,8,85,1,92,2,116,1,211,2,213,2","daughters,2,2,7,1,14,1,21,1,24,7,46,1,84,1,92,1,95,1,111,1,213,1","daunted,111,1","daunting,14,1","david,23,2,37,1","davis,2,3,92,2","davison,23,1","day,2,1,5,1,6,1,7,171,14,6,21,4,20,1,72,9,87,8,23,2,24,92,42,2,45,2,46,5,55,1,60,1,62,1,71,2,84,1,85,1,86,1,92,11,88,1,94,1,95,43,97,3,106,2,109,4,110,6,111,2,116,2,117,8,211,7,213,10","daycare,42,3,211,3,213,2","daydream,113,1","days,1,1,2,15,4,1,7,5,14,1,72,1,23,1,24,16,43,1,45,1,46,2,85,2,95,7,109,1,111,1,116,1,117,2,118,2,210,1,211,1","daytime,97,1,213,1","dayto,87,1","dbutts,92,1","dc,5,1,7,14,21,1,87,1,92,2,93,2","dead,97,1,113,1","deadline,97,3","deaf,92,10","deafened,92,3","deal,14,1,23,3,41,1,43,1,62,1,63,1,92,1,93,1,97,6,109,2","dealing,23,2,42,1,92,1,97,11,106,1,110,1,111,1,112,1,117,2,211,1,213,1","deals,84,2,97,1","deana,37,1,90,1,115,1,118,11,119,2","dear,43,1","death,14,1,23,3,61,1,106,1","debaggio,23,1","debate,7,3,14,1,97,1","debbie,88,2","deborah,23,2","debt,2,9,109,3","debt3,2,1","dec,109,1","decade,7,1,97,2,111,1","decades,14,1","deceased,42,1","december,3,3,4,1,7,2,14,1,43,1,46,1","decent,46,1","decide,87,1,43,6,45,2,97,11,110,1,117,1","decided,7,1,43,2,86,1,97,1","decides,7,3,117,1","deciding,7,1,43,5,97,1","decision,3,2,5,1,7,7,14,6,87,8,23,2,43,24,45,6,83,1,92,1,88,1,95,2,97,9,110,3,111,4","decisionmaking,14,1,110,1","decisions,4,1,7,3,13,1,14,3,87,4,23,6,42,1,43,3,45,2,46,1,92,2,97,7,109,2,110,4,111,1,113,2","declared,88,1","declaring,88,1","decline,3,1,61,1,95,1","declined,46,1,111,1","declining,95,2","decrease,24,4,43,1,92,3,95,3","decreased,95,2,113,1","decreases,95,1","decreasing,3,1,88,1","dedicate,106,1","dedicated,7,1,13,1,23,1,45,1,110,1,111,1,210,1","dedication,43,2","deductible,43,17","deductibles,43,4","deem,24,5","deemed,43,5","deep,213,1","deer,23,1","def,85,1","defeated,97,1","defects,83,1","defense,93,1","define,7,2,24,1,45,1,92,1","defined,2,6,3,2,7,4,92,3,88,1,95,1,97,3","defines,7,1,45,1,63,1","defining,7,1,97,1","definite,7,1","definitely,97,1,211,2,213,3","definition,2,1,7,2,45,1,88,1,95,1,97,6","definitions,7,6,14,1,88,1,97,1","definitive,23,1,95,1","defintion,42,1","degenholtz,14,1","degree,2,3,7,3,13,1,14,7,42,3,97,10,211,3,213,3","degrees,7,1,87,2","dehydration,111,1","dei,4,1","deimling,14,1,95,2","deinstitutionalizing,97,1","dejohnson,37,1","delaware,1,1,7,22,37,1,92,1,97,1","delay,5,1,7,2,26,1,95,7","delayed,95,1,97,2","delaying,95,9","delays,3,1,95,4,97,1","delegate,7,1","delegation,97,4","deli,84,1","deliberate,87,1,83,1,111,1","deliberations,83,1","deliberative,92,1","delineate,14,1","deliver,7,3,56,1,83,1,95,1,97,1,111,1,122,1","delivered,7,4,87,4,42,1,62,1,92,2,88,1,89,2,95,1,97,5,210,1,211,1,213,5","delivering,5,2,7,5,87,1,92,4,97,1,213,1","delivers,71,1","delivery,4,1,7,13,14,7,87,5,24,16,92,5,88,1,95,5,97,15","delmar,92,1","demand,7,1,24,7,97,12,118,1","demanding,24,1,46,1,211,1,213,1","demands,2,1,7,2,14,1,61,1,62,1,84,1,92,2,88,3,95,4,97,1,110,1,113,1","demented,14,1,95,1","dementia,1,1,18,1,7,17,14,13,20,1,87,1,23,4,41,4,46,3,92,4,95,56,97,4,111,2,112,1,117,2","dementias,7,3,14,1,21,1,23,1,24,4,41,1,95,1","dementiaspecific,117,1","dementing,7,1,14,1,95,1","demo,24,4","demographic,2,1,7,22,14,4,87,1,42,2,92,1,212,1","demographics,3,2,5,1,7,35,14,1,87,1","demonstrate,3,1,14,1,92,9,89,2","demonstrated,95,1,97,1,213,1","demonstrates,213,1","demonstration,7,1,31,1,41,1,92,5,89,6,94,1,95,3,97,11","demonstrations,92,1,95,3,116,1","dems,84,1,85,1,109,1","denavas,2,1","denial,83,1","denise,60,4,105,14","dennis,37,1","denote,95,1","densie,60,4","dent,97,1","dental,87,1","denver,7,1,92,3","depart,43,1","department,2,3,3,1,6,3,15,1,7,88,9,1,14,8,21,1,87,9,41,1,43,13,45,2,52,1,53,1,61,1,83,1,86,2,92,15,88,23,89,2,93,1,95,1,97,9,212,1,116,1,117,3,118,3,213,1,214,1","departmental,88,1","departments,7,4,24,5,97,3,111,2","depend,7,1,43,1,45,1,97,1","dependence,3,1,92,1,113,1","dependency,23,1,113,1","dependent,2,1,14,1,23,1,24,3,92,1,95,4,97,1,113,12,213,2","depending,2,1,7,2,14,2,72,1,24,2,95,1,110,1,116,1","depends,14,1,97,2","deposit,109,1","depressed,23,1,61,1,92,1","depressing,23,1","depression,7,27,14,3,23,2,24,6,61,1,85,1,92,3,88,1,95,11,117,1,213,1","depressive,95,3","dept,6,1,7,11,8,1,21,1,93,1","depth,5,1,7,1,23,1,92,1,95,1,97,1","deputy,2,1,3,1,63,1,97,1,109,1","der,23,1","derek,23,1","derived,7,1,71,1","dern,61,2,62,2,63,1,92,1","derxw,97,3","descent,21,1,111,1","describe,6,1,7,2,14,3,25,1,43,1,97,4,211,3","described,14,1,88,2,95,2,97,31","describes,7,1,42,1,43,5,94,1,97,1,211,1","describing,14,1,117,1","description,7,1,14,1,87,1,24,1,42,1,92,1,88,4,95,2,97,2,110,1","descriptions,87,1,48,1","descriptive,7,2,97,4","deserve,7,1,14,1,110,1","design,7,7,14,2,87,2,83,1,92,8,88,2,89,1,95,4,97,1","designate,7,2,88,1","designated,7,35,88,2,95,1","designating,7,1","designation,7,5,88,1","designed,7,4,14,7,87,4,23,2,43,1,56,1,57,1,62,1,71,1,83,2,92,12,88,2,95,2,97,2,111,1,117,1,122,1","designee,88,1","designees,97,2","designing,14,4,87,3,83,1,88,1","designs,87,2,95,1","desire,3,1,87,1,83,1,97,1,113,1","desired,14,2,24,4,92,1,212,1","desires,24,1,92,1","desk,46,1","desktop,109,1","desperate,92,1","desperately,7,1,14,1","despite,7,4,87,1,46,1,95,4,97,4,111,2","detail,7,1,97,1","detailed,23,1,95,1,97,3,110,1,212,1","detailing,88,1","details,2,1,6,1,20,1,43,2,45,1,97,3,110,2,117,1","deter,7,1","deteriorate,95,1,118,1","deteriorating,23,1","deterioration,111,1","determinate,3,1","determination,3,1,87,5,43,2,97,4","determine,7,6,13,1,14,6,87,2,23,1,24,5,43,9,45,2,83,1,92,5,95,1,97,2,110,3","determined,7,1,21,1,43,1,45,1,83,1,88,1,95,1","determines,43,1","determining,7,3,14,2,43,3,95,1,97,3,110,2","detroit,87,2,46,2","dev,24,4","devastating,85,1","develop,3,4,5,1,7,12,14,5,21,2,20,1,87,1,23,1,24,8,41,1,45,1,63,2,83,1,86,1,92,20,88,11,89,4,95,2,97,13,106,1,110,1,116,1","developed,1,1,3,1,15,1,7,8,14,13,21,2,87,6,23,1,24,5,43,1,50,1,54,2,55,1,56,1,60,1,62,1,83,2,86,3,92,13,88,1,89,5,95,2,97,18,212,2,111,1,117,1,122,2","develophead,141,8","developing,3,1,7,3,14,4,87,4,83,2,92,7,88,5,89,3,95,1,97,21,112,1","development,2,2,5,1,7,28,14,10,87,4,23,1,24,4,31,1,38,4,39,4,40,4,41,4,43,3,48,1,54,3,61,1,62,1,83,15,86,8,92,19,88,7,89,1,94,2,95,5,97,41,109,1,119,2","developmental,7,5,14,1,87,4,41,1,83,1,92,16,88,11,97,8,112,2,117,2","developmentally,7,1,87,1,38,4,41,4,92,1,97,1,117,2","developments,7,1,87,1,46,1","develops,23,1,24,4,97,1","devices,5,1,7,1,92,2","devil,110,1","devlin,88,1","devote,110,1","devoted,111,1,118,1","devoting,46,1","devotion,46,1","dfa,37,1","dffruglqj,97,4","dfurvv,97,2","dgglwlrq,97,1","dgxow,97,2","dgylfh,97,1","dhhs,87,1","dhqrhrprhqphps,97,1","dhr,72,1,87,1,24,6,92,1","dhs,88,8","di,7,1","diabetes,2,4,61,1","diabetic,213,1","diagnosed,7,1,14,1,92,1","diagnosis,7,3,14,2,23,1,26,1,27,1,92,2,95,1","diagnostic,7,1,14,1","dial,106,3","dialogue,3,1,7,1,55,1,97,1,110,1","dialogues,110,1","dialysis,61,1","diamonds,84,1","diane,7,1,31,1,37,1,92,1","diapers,113,1","dicaid,97,1","dictate,95,1","did,1,2,2,8,4,1,7,11,14,2,21,3,24,1,26,5,43,3,46,4,86,1,95,6,97,17,113,2,116,1,117,1,118,1,211,1,213,2","didn,23,1,46,1,97,14,110,1,213,7","die,84,1,85,2,92,1,109,1","died,4,2,42,1,46,1,111,3,113,1","diego,95,1","diehr,95,1","dies,84,1,85,1,97,1,109,1,213,1","dieticians,111,1","differ,5,1,7,6,14,2,95,3","differed,95,1","difference,46,1,60,1,84,1,85,1,95,6,97,3,110,1,118,1","differences,2,2,7,7,14,3,23,1,60,1,83,1,86,1,95,3,106,2","different,1,2,4,2,7,18,14,5,72,1,87,7,23,1,24,12,43,1,45,2,60,1,92,2,95,11,97,17,111,1,116,1,210,2","differentially,95,1","differentiate,95,1,97,3","differently,97,1","differing,7,5,87,1,86,1,95,1,97,1","differs,87,1,95,1","difficult,2,3,7,5,14,4,87,2,23,2,26,1,45,3,46,1,60,1,62,1,88,2,95,4,97,15,110,1,113,3,210,1","difficulties,7,1,14,1,95,6,97,3,106,1","difficulty,2,1,7,33,13,1,87,1,92,1,95,4,97,10,211,1,213,2","diffuse,92,1,95,1","digeronimo,23,1","digest,60,1","digital,4,1,84,1","dignified,23,1","dignity,14,2,87,1,23,1,24,4","dilemma,24,4","dimension,14,1","dimensions,7,1,14,1,95,1","diminished,97,1","dinner,46,1,55,1,85,2,118,2","diploma,42,2,211,2","direct,5,1,7,12,14,2,87,12,23,1,24,4,36,1,45,1,63,1,92,1,95,2,97,18,106,1,109,1,110,1","directed,1,1,5,4,7,84,87,33,24,100,28,1,31,9,32,2,83,1,92,7,97,174","directing,97,1","direction,5,2,7,48,14,1,87,22,31,5,36,1,71,1,95,2,97,396,106,1,110,1","directions,6,1,14,3,97,2","directive,106,1","directives,14,2","directly,7,5,87,4,43,2,92,1,88,1,95,2,97,11","director,2,1,3,1,7,1,87,3,24,5,45,2,46,2,55,1,61,4,63,2,71,2,92,1,88,3,89,1,95,2,97,10,116,1,117,2","directors,2,1,7,2,95,1,97,30,117,1","directory,13,1,87,1,86,1","directs,88,1","disabilities,3,2,5,3,7,101,13,1,14,4,87,5,41,1,83,1,92,19,88,14,93,1,95,1,97,13,112,2,117,1","disability,2,7,3,2,7,111,14,3,42,1,92,2,88,3,97,13,111,1,211,3,213,2","disabled,2,19,7,108,14,1,87,2,38,4,41,4,43,1,45,2,92,1,95,1,97,14,117,2,213,3","disabled1,119,2,142,8","disablilties,117,1","disabling,18,1,7,1,46,1","disadvantages,95,1","disagree,7,1,14,2,45,1","disagreed,7,2","disagreements,45,1","disappear,95,1","disappointing,95,1","discharge,1,1,24,4,45,53,57,1,97,1,111,1,117,1,118,2","discharges,3,1","discomfort,106,2","discontinuing,95,1","discord,113,1","discount,62,1,84,2,85,2","discourage,87,1,95,1","discouraged,97,1","discouraging,45,1","discover,45,1","discovered,46,1,97,2","discovergreene,37,1","discovery,7,1,118,1","discrete,97,2","discretionary,92,1","discuss,6,1,13,1,87,1,23,1,25,2,45,1,88,1,211,1","discussed,7,1,43,2,45,1,95,1,97,2,110,2","discusses,14,2","discussing,97,2","discussion,6,1,7,1,8,1,21,2,87,4,23,3,45,1,52,2,55,1,56,1,60,1,63,1,95,2,97,1,110,3,117,2","discussions,7,3,14,2,87,3,23,1,97,1,118,1","disease,2,4,4,2,7,18,9,1,14,13,21,1,20,2,87,4,23,14,45,1,46,2,61,3,62,1,92,1,88,3,94,1,95,17,97,1,111,3,112,1","diseases,87,2","diseasespecific,14,1","disinterest,106,1","dismiss,97,6","dismissal,97,2","disorder,7,14,14,3,95,1","disorders,87,2,23,1,88,5,95,3","disoriented,26,1","disparity,97,1","dispel,113,1","display,7,1,55,1","disproportionate,46,1","disproportionately,2,2","disputed,97,1","disputes,92,1","disruption,87,1,24,1","disruptions,24,3","dissatisfied,97,1,211,2,213,2","disseminate,7,1,92,5,89,1,106,1","disseminated,87,1,24,4,92,1","disseminating,24,2","dissemination,41,3,92,1,95,1","dissenting,88,2","distance,3,1,7,9,87,2,23,2,26,1,56,1,92,2,95,1,105,1,106,2,110,1,111,1,213,3","distances,97,1","distinct,5,2,7,11,14,5,92,2","distinctions,4,1","distinguish,87,1","distinguished,2,2,110,1","distinguishes,46,1","distractions,4,1","distress,13,1,14,1,26,1,95,2","distribute,7,1,88,1,116,1,117,1","distributed,97,1","distribution,2,2,45,1,92,1","distributions,7,1","district,7,47,14,1,41,1,92,2,97,1,118,1","disturbed,13,1","diverge,95,1","diverse,7,5,14,3,23,1,61,1,83,2,86,1,92,5,88,7","diversion,3,1","diversity,14,1,87,1,23,1,54,1,97,2","divide,7,1","divided,7,1,23,1","dividing,111,1","division,2,2,7,2,72,1,87,7,24,6,71,1,92,8,88,3,95,2","divisions,97,1","divorced,42,1,211,1,213,1","divvy,21,1","dize,7,1,31,1,92,1,97,1","djh,97,5","djhedvhg,97,1","djhqflhv,97,4","djlqj,97,2","dk,211,4","dkuhn,92,1","dl,7,4","dleblanc,92,1","dly,92,1","dmb1,37,1","dmeissel,37,1","dmhhq,87,1","dmv,1,2","doable,46,1","doc,1,4,6,4,8,4,87,4,23,4,42,4,89,4,93,4,116,4,117,4,118,4,213,4","doctor,2,4,7,1,13,2,14,1,24,4,25,2,26,1,43,3,45,4,59,1,84,1,85,1,109,1,111,1,113,1,116,1,211,1,213,2","doctoral,2,1","doctors,85,1,111,2,116,1","document,14,2,45,1,92,1,88,4,210,2","documentary,23,2","documentation,7,3","documented,2,1,21,1,92,1","documents,7,4,23,1,109,1,212,1,122,1","dodd,92,1","doers,24,3","doesn,97,3,111,2,116,1,117,1,118,1,213,1","doh,3,11,92,1","doing,5,1,6,1,13,1,14,2,26,1,45,3,46,2,62,1,83,2,85,1,97,9,105,1,113,3,116,1,211,1,213,1","dol,2,1","dolan,37,1","dollar,7,2,97,1","dollars,7,1,87,2,43,1,83,1,88,1,97,4,111,1,117,1","dolores,23,1","dolton,92,1","domains,7,1,14,8","domainspecific,14,1","domestic,42,3","don’t,106,1","donated,1,1,55,2,110,1,116,2","donations,7,1,21,1,109,1","donelan,2,1","donna,7,1,23,1,92,3,97,3","donor,24,4","donors,24,3","doo,97,7","dooin,46,1","door,24,3,61,1,62,1,63,1,97,2,110,1","doorz,97,4","doreen,37,2","dormered,46,1","dorothy,86,1","dosage,43,3,95,2","dosages,43,1,45,1","doty,2,3,7,3,31,1","double,2,1,46,1","doubts,45,1","doucette,23,1","dougherty,92,1","dovetailing,97,1","dovr,97,5","down,4,1,7,2,23,1,27,1,43,1,45,1,46,2,85,1,97,4,109,1,112,1,213,2","downey,92,1","download,52,2,54,1","downloadable,23,1","downloaded,23,3","downsizing,46,1","downstairs,46,1","downtown,110,1","downturn,7,2","dowse,43,1","dozen,46,1","dozens,92,1","dplqlqj,97,1","dprest,37,1,118,1","dprqj,97,1","dprxqw,97,1","dpsoh,97,1","dq,97,4","dqw,97,1","dqdjhphqw,97,1","dqg,97,23","dqgru,97,1","dr,2,1,8,1,24,11,41,1,61,1,63,1,95,2,97,2,111,16,117,1,118,1","dracz,87,1","draft,7,1,42,20,52,1,88,1,97,1","drafting,3,1","draining,71,1,109,1","dramatic,3,4,97,1","dramatically,7,1","draw,1,1,87,1,56,1,97,1,110,1,116,1","drawbacks,95,6","drawing,21,1,95,1,116,1","drawn,87,2,46,1","draws,87,1","dress,211,1,213,1","dressing,7,1,14,2,42,1,95,1,97,2,211,1","dressings,61,1","drew,95,1,113,1,116,1,117,1","drinking,111,2","drive,7,2,87,1,24,4,92,3,111,1","driven,4,1,7,1,14,2,31,1,88,5,95,2","driver,97,1,111,1,118,1","drivers,1,1","driving,14,1,46,1,97,2,213,2","drop,21,6,43,4,94,1,95,1,109,1,113,1","dropped,95,2","drops,84,1,85,1,109,1","drug,4,3,14,1,23,1,43,191,48,1,54,1,62,1,95,1,109,1","drugcoverage,43,1","drugs,43,30,61,1","drugstore,87,1","ds,7,3,97,2","dshs,87,1","dss,7,1,116,1","dsso,97,1","dssur,97,3","dstoyell,37,1","du,92,1,97,1","dual,7,1,43,2,95,1","duc,7,62","duct,111,1","dudman,23,1","due,7,6,14,1,21,1,20,1,92,1,95,7,97,7,110,1","duh,97,24","dujhu,97,1","dult,7,88","dunah,95,1","dunphy,37,1","dunya,31,1","duplicate,14,1","duplicated,7,1","duplication,88,2,97,1","duplicative,3,1","durable,45,1,97,1,109,1","duration,7,23,14,1,213,1","durham,14,1","during,2,3,4,1,7,6,13,1,14,3,21,1,87,4,25,1,26,2,43,1,46,1,55,3,60,1,92,5,95,5,97,9,110,2,212,1,111,4,210,2,211,2,213,4","dutch,95,1","dutchess,37,2","duties,21,1,24,4,88,1","dutiful,23,1","duty,3,1,46,1,111,1","duulhuv,97,1","dv,97,5","dvd,109,1","dvds,117,1","dvh,97,2","dvhv,97,1","dvk,97,1","dvnhg,97,1","dw,97,2","dwlrqv,97,1","dwyer,31,1","dyad,7,1,92,2","dyadic,92,3,95,2","dyads,92,3","dydlodeoh,97,1","dyhudjh,97,3","dying,23,1,46,1","dynamic,14,2,116,1","dynamics,14,1,113,1",",97,59","eaaa,92,1","eal,7,3","ealth,2,5","eap,117,1","earlier,5,1,7,1,14,1,95,5,97,3","early,3,1,7,1,14,6,23,1,31,1,45,1,46,4,92,6,95,11,97,9,109,1,110,4,111,1,211,3,213,2","earmarking,87,1","earned,87,1","earning,46,1","earns,21,1","ears,113,1","easier,14,1,42,1,43,2,45,1,86,1,97,3,109,1,110,1,213,10","easiest,113,1","easily,87,1,46,1,71,1,83,1","easing,23,1","east,6,1,92,8","easter,92,4","eastern,92,2","easy,4,1,14,1,87,1,23,3,46,1,63,1,83,3,86,1,97,8,109,1,213,1","eat,62,1,211,1,213,3","eating,45,1,111,1,213,5","eatment,92,1","eaton,95,1","eats,213,1","ebbing,46,1","ebeckwith,37,1","eboni,7,1","ec,95,1,97,1","ecdsrs,212,1,213,3,214,2","echo,92,2","eco,7,9","ecology,95,1","economic,2,1,7,39,23,1,213,1","economically,92,1","economics,2,6","economist,2,2","ecosystem,111,1","ecox,92,1","ecs,92,2","eddi,92,1","eden,92,2","ederal,7,3","edge,109,1","edgy,13,1","edicaid,7,31","edina,92,1","edited,97,1,111,1","edith,4,1","edition,109,1","editor,2,1,84,1,94,1,95,1,109,7,110,1","editorial,7,1,55,1,95,1","editorials,97,1","edowney,92,1","eds,7,1,95,1","edu,87,1,37,1,92,4,95,1,106,1","educ,7,1","educate,7,2,87,3,56,1,86,1,92,1,95,1,97,2","educated,24,4,46,1","educating,43,1,88,1,97,1,110,1","education,2,1,3,2,7,16,14,4,20,1,87,5,23,3,24,12,42,3,45,1,54,1,61,1,71,1,84,1,86,1,92,11,88,1,89,1,95,2,106,1,97,2,110,1,211,1,213,4","educational,1,1,17,1,12,1,14,2,28,1,29,1,34,1,38,1,45,1,48,1,52,1,57,1,64,1,68,1,71,2,91,1,94,1,97,8,98,1,102,1,211,1","educator,95,1","educators,111,1","eduulhuv,97,4","edvhg,97,1","edward,43,1","edwards,23,1","eekend,7,55","effect,2,5,7,1,14,3,43,1,92,2,88,1,95,13,97,1","effective,5,1,7,3,14,5,87,5,24,4,42,1,43,6,71,2,83,1,92,6,88,2,95,4,97,57,118,2","effectively,1,1,7,4,14,1,25,1,26,2,27,3,92,5,97,2","effectiveness,7,1,14,2,43,1,92,4,89,3,94,1,95,21,106,2,97,9","effects,2,2,5,1,7,4,14,1,87,1,42,1,45,1,92,2,95,20,212,2,111,1,211,2,213,1","efficacy,92,5,95,3","efficiencies,92,1","efficiency,3,1,7,1,97,5","efficient,87,1,92,1,88,3,97,3","efficiently,87,1","effort,7,2,87,4,92,1,88,4,95,1,97,6,210,1","efforts,7,10,20,1,87,7,61,1,92,4,88,1,89,1,95,2,106,1,97,5,213,3","eg,97,1","egal,7,29","egan,92,1","eggs,4,1","egiv,92,1","ehealth,7,10","ehfrph,97,1","ehhq,97,2","ehiruh,97,1","ehreth,95,1","ehsd,92,1","ehwzhhq,97,1","ehzhhq,97,1","eight,5,1,7,7,14,2,87,1,23,1,88,1,97,4,118,1","eight22,7,1","eighteen,7,2,14,1,97,1","eisdorder,23,1","eisep,3,1,117,1,118,1","either,2,3,7,15,13,1,14,1,87,4,23,1,42,1,43,1,46,3,83,1,92,3,95,1,97,8,109,1,110,1,211,1,213,3","ejones,87,1","ek,84,1,85,1,109,1","elaborate,97,1","elaborated,87,1,97,1","elaine,87,1","elder,3,1,4,7,5,1,7,20,87,2,23,5,43,1,46,1,84,1,92,5,95,2,97,1,117,1","elderaffairs,92,1","eldercare,4,1,13,1,23,5,45,3,53,2,54,1,92,6,93,2,117,1","eldercaring,23,1","elderchoices,7,6","elderly,1,1,2,1,4,7,7,117,14,4,21,3,23,3,24,4,42,1,43,3,45,2,46,2,49,1,84,3,85,1,92,9,88,1,95,3,97,39,111,4,112,1,113,1,116,1,213,3","elderlycarefinders,4,1","elderpage,13,1","elders,3,3,18,1,7,17,14,2,21,1,87,2,23,4,83,3,92,9,95,3,97,8,213,1","eleanor,23,1","elect,87,1","elected,97,9","electric,87,1","electricity,43,1","electronic,7,1,83,1,97,1,122,1","electronically,7,2,14,1,97,1","electronics,109,1","element,7,1","elements,3,1,14,2,45,1,86,2,88,2,110,1","elephants,21,1","elersch,37,1","elevated,61,1","elevators,45,1","eleven,24,8,92,1,97,1","elicit,14,1","eligibility,3,2,5,2,7,72,14,2,87,2,24,4,43,4,45,1,92,1,88,1,106,1,97,7","eligible,2,1,7,46,87,2,43,13,45,1,95,7,106,1,97,9,210,1","eligibles,3,1,43,2","eligilibility,7,1","eliminate,2,1,14,1,97,1","eliminated,106,1,97,2","eliminating,88,1","elinor,7,1","elizabeth,9,1,37,2","elkan,37,1","elkans,37,1","ellano,14,2,31,1,95,2","ellen,23,1,46,6","ellie,37,1","ellis,84,2","ellison,87,1","eltzeroth,92,1","elwood,23,1","email,6,1,7,1,21,1,72,1,87,6,24,4,37,1,41,1,60,1,71,2,84,1,85,1,93,1,109,1,122,1","emanating,7,1","embedded,97,1","ember,9,1","embrace,97,2","embraces,97,1","embracing,46,1","emc,111,7","emerg,7,1","emerge,7,2,95,1,97,1","emerged,14,1,87,1,55,1,95,1,97,2","emergence,5,1,14,1","emergencies,4,1","emergency,4,2,7,5,14,1,87,1,24,8,25,3,45,1,84,1,92,1,88,2,97,7,111,1,117,1","emerging,5,9,7,12,14,2,48,1,56,1,97,1,122,1","emotion,14,1,23,1","emotional,2,1,5,1,7,2,14,7,87,1,23,3,24,4,45,2,61,1,84,2,85,6,92,5,88,6,89,2,95,6,113,4,117,2,210,2,211,1,213,3","emotionally,71,1,85,1,95,2,111,1","emotions,23,1,24,3,71,1,95,1,105,1,117,1","empathic,14,1","empathy,87,1","emphasis,83,1,92,1,95,1,97,1,109,1","emphasize,7,1,14,1,87,2,92,1","emphasized,87,1,92,1","emphasizes,87,2,71,1,84,1,92,1","emphasizing,14,1,92,1","empire,89,1","empirical,23,1,95,1","employ,4,1,87,2,97,2","employed,2,7,4,1,7,1,14,1,24,7,61,1,92,4,95,1,97,1","employee,4,1,7,1,45,1,92,1,97,3","employeefunded,7,1","employees,2,1,4,3,7,1,92,3,111,2","employer,4,2,24,4,43,6,45,1,97,4","employers,2,1,4,1,7,1,46,1,92,1,97,1,117,1","employing,87,1","employment,2,3,5,1,14,9,21,1,24,4,92,2,97,3,211,2,213,6","employs,87,1,105,1,97,1","empower,87,1,71,1,97,1","empowered,87,1","empowering,21,1,23,1,53,1,60,1,97,1","empowerment,87,1,56,2,71,1,92,2,117,2","empowers,24,4,92,1,97,2","enable,7,4,87,2,92,1,97,1,116,1,117,1,213,6","enabled,41,1,42,1,211,1,213,3","enables,7,1,24,12,92,2,213,1","enabling,7,1,24,4,213,1","enacted,7,70,14,1,88,1","enacting,7,3","enactment,7,1,14,1","enclosed,41,1","encompass,88,1","encompassing,5,1,14,1","encounter,87,1,95,1","encountered,24,3,95,1,97,1,122,1","encounters,25,1,57,1","encourage,7,1,14,1,87,2,41,1,83,1,92,3,88,3,95,2,97,4,110,3","encouraged,7,1,83,1,97,2","encouragement,7,1,23,1","encourages,24,3,60,1,93,1","encouraging,95,1,97,2","encr,43,4","encumber,21,1","end,7,2,14,2,87,2,23,4,42,3,43,1,46,1,92,12,95,3,97,4,110,1,111,1,117,2,211,1","endeavor,64,1","ended,7,4,14,1,105,1,97,3,211,1","ends,1,1,43,5,85,1","endured,111,1","energy,21,1,43,1,95,1,110,2","enews,44,4,120,8","enewshead,121,8","enforcement,1,1,118,1","enforces,60,1","engage,14,1,92,2,88,1,97,1,110,1","engaged,7,1,105,1","engagement,84,1,92,1","engaging,71,1","engenders,21,1","engine,96,4","england,23,1","englewood,14,1","english,2,1,14,1,83,1,109,1,210,1","enhance,7,5,14,2,87,3,61,2,63,1,83,1,92,10,95,1,105,1,97,1","enhanced,7,4,23,1,92,1,95,2","enhancements,7,1,97,1","enhances,88,1","enhancing,7,1,14,2,92,2","enid,92,1","enjoy,21,1,87,1,45,1,110,1","enjoyable,95,1","enjoyed,116,1","enjoying,21,1,87,1","enjoys,113,1,213,1","enlarge,4,2,55,1","enlist,25,1","enormity,95,1","enormous,2,1,7,2,97,3","enormously,213,1","enough,7,1,21,1,87,1,43,1,45,1,83,1,85,1,92,1,95,1,97,9,109,2,110,2,111,1,210,1,211,5,213,4","enroll,21,1,43,8,97,2","enrolled,43,11,92,1,88,1,97,3","enrollees,43,3","enrolling,43,4,92,1,95,1,97,1","enrollment,43,20,92,1,97,2,109,1","enron,84,1,85,1,109,1","ensure,7,10,14,3,87,4,43,1,83,4,92,1,88,5,95,1,97,10,110,4,116,1","ensures,3,2,83,1","ensuring,7,1,87,1,88,1,97,2,110,1","ente,109,1","enter,3,1,43,2,111,1","entered,7,2,23,1,89,1","enters,14,1,45,1","entertain,63,1","entertainment,84,1,85,1,109,1","enthusiasm,7,1,95,1,97,1","entire,3,1,7,1,87,1,43,3,84,1,85,1,105,1,97,1,210,1","entirely,2,1,87,1,46,1,118,1","entities,3,2,7,2,87,1,43,1,92,1,95,1,97,1","entitled,4,1,23,1,117,2","entitlement,7,1","entity,7,34","entrance,6,3","entrenched,95,1","entrusted,92,1","entry,3,4,6,1,7,70,8,1,52,1,83,3,86,2,92,4,210,1","environment,14,1,21,1,97,4,113,1,118,1","environmental,14,1,41,2,92,2,95,1","environments,87,1","envision,3,1,87,1,109,2","envisioned,3,1","envy,46,1","eodqn,97,4","epic,43,80","epidemic,23,1","epidemiological,14,1","epiphany,111,1","ept,7,1","equal,87,1","equality,113,1","equally,85,1,110,1","equate,118,1","equipment,2,1,14,2,87,3,45,5,61,1,92,1,110,1","equitably,7,1","equity,97,1","equiv,119,1","equivalent,21,1,20,1","erie,15,1,12,1,37,2,56,1,89,2,91,1,212,2,213,3,214,2","eriksson,95,1","ering,7,1","erk,92,1","err,97,1","errands,21,2,87,1,97,2,116,1","error,97,1","ersonal,7,35","erxw,97,1","esa,2,1","escheat,7,12","escheat17,7,1","esem,92,1","especially,7,5,87,1,45,4,92,1,95,5,105,1,97,8,110,1,111,2,113,1,118,1","espite,7,125","esponsibility,3,1","essays,46,1","essential,3,1,18,1,7,3,14,1,87,1,43,1,45,2,58,1,61,2,71,1,88,2,110,1","essentially,97,3,109,2","essex,37,2,92,1","establish,3,1,7,5,14,1,87,4,24,7,92,6,88,6,89,1,105,1,118,1","established,3,1,7,12,14,5,21,2,87,3,45,2,86,1,92,2,88,10,95,2,97,6,118,1","establishes,3,1,88,1","establishing,3,2,7,1,14,1,87,2,92,2,88,3,105,1,97,4","establishment,7,2,92,2,88,3,110,2","estate,43,1,84,1,85,1,109,2,111,1,113,1,117,2,118,1","esteem,23,1,92,1,95,1","estimate,97,1,213,1","estimated,2,5,7,3,43,1,61,1,71,1,95,1,97,1,213,2","estimates,2,1,213,1","eta1,111,7","ethical,7,1","ethics,23,1,112,1,117,1","ethnic,14,1,83,3,92,6,97,1","ethnically,7,4,14,1,23,1,92,1","ethnicity,2,2,14,3,21,1,42,1,88,2,95,1,97,1,213,2","ethno,21,1","eurdg,97,1","european,95,1","eustis,31,1","evaluate,3,1,14,1,24,4,45,1,92,5,88,1,95,2,106,1","evaluated,87,2,92,2,95,1,111,1","evaluates,14,1,92,1","evaluating,87,1,92,1,95,5","evaluation,3,3,7,4,13,2,87,3,24,8,31,1,63,5,71,1,83,1,92,10,88,4,91,4,95,12,97,7","evaluations,87,2,92,1,95,3,97,2","evans,31,1","evanston,71,3,92,1","evelyn,43,1","even,4,1,7,7,14,3,43,8,45,11,46,1,60,1,95,7,97,15,109,1,110,3,111,2,113,1","evening,14,1,55,1,97,1,113,1,117,1","evenings,110,1","evenly,7,1","event,29,2,45,1,62,1,63,1,110,6,116,1,117,1,118,1,122,1","events,6,1,17,1,12,1,24,7,28,1,29,1,34,1,38,1,40,1,41,1,43,2,48,1,52,1,57,1,64,1,68,1,88,1,91,1,94,1,95,1,97,1,98,1,102,1,110,2,112,9,116,1,117,3","eventual,111,1","eventually,23,1,111,1","everyday,7,7,14,6,42,1,213,1","everyone,21,2,23,2,43,2,55,1,60,2,84,1,85,4,105,1,97,6,110,1,113,4","everything,27,1,45,1,46,2,84,1,97,1,110,1,113,1","evidence,61,1,95,21,97,4","evidenced,7,2","evident,95,1","evolution,23,1","evolved,87,2,55,1,97,2","evolving,87,1,31,1","ews1,92,1","ex,4,10,87,1,106,1","exact,2,1,7,1,85,1","exactly,95,1,210,1","exam,92,1","examination,5,1,7,2,14,1,94,1,95,2,97,3","examinations,14,1","examine,2,1,7,37,14,3,43,1,95,4,97,2","examined,2,1,7,4,14,1,43,1,95,6,97,1","examines,2,1,7,1,95,1,97,1","examining,2,1,7,1,95,4","example,5,1,7,9,13,1,14,8,87,6,43,2,45,3,55,1,95,3,97,28,212,1,111,1,210,1","examples,7,1,14,3,87,8,95,1,97,4","exceed,7,1,24,4,97,1","exceeding,7,1","excel,7,1","excellence,43,3","excellent,2,2,23,4,42,1,45,1,71,1,93,1,213,2","except,87,1,95,1,210,1,211,4","exception,97,1","exceptional,2,1,92,1,117,1","excerpted,25,1,26,2,27,2","excess,2,1,43,2","excessive,61,1","exchange,5,1,6,1,21,3,87,2,83,1,88,2,110,1","exchanged,7,1","exchanges,60,1","exchanging,21,1,97,1","excited,117,1","exclude,2,1,7,1","excluded,7,2","excludes,2,1,7,1","excluding,7,1,210,1","exclusion,7,1","exclusively,7,1,14,2","excuse,46,1","executive,3,1,7,11,87,1,45,1,46,1,61,1,63,1,71,3,83,1,92,3,95,2,97,2,110,2,118,1","executives,62,3","exempting,97,1","exercise,14,2,21,1,87,1,43,2,61,2,97,1,113,1,116,1","exercises,24,6,92,1","exgjhwv,97,1","exhausted,97,1,113,4","exhaustion,113,3","exhibit,87,22,95,5,97,4,116,1","exisitng,110,1","exist,14,3,43,1,88,2,93,1","existed,7,2,111,1","existence,7,1,88,1,97,4","existing,3,2,5,1,7,1,14,8,21,1,87,2,60,1,61,2,62,1,86,5,92,5,88,4,97,8,110,2,118,1","exists,5,1,7,3,87,2,88,1","exit,6,5","exp,23,1","expand,2,1,7,9,21,1,87,2,24,4,92,5,106,1,97,14,116,1","expanded,7,4,32,1,46,1,92,2,89,1,97,4","expanding,2,1,7,14,88,1,97,5","expands,7,1","expansion,7,2,24,4,93,1,97,4","expect,7,2,27,2,45,3,95,1,105,1,106,2,97,6,117,1","expectancy,46,1","expectation,83,1,97,1","expectations,3,1,21,1,45,1,97,1,113,1","expected,3,1,7,1,14,1,87,1,84,1,85,1,92,3,95,6,105,1,97,3,109,1,110,1,212,1","expects,109,1","expended,7,1","expenditure,7,7","expenditures,7,109,95,3,97,1","expense,88,1,95,1,111,1","expenses,2,2,87,1,43,3,88,1,106,1,97,1","expensive,4,1,95,1,97,2,118,1","exper,2,2","experience,2,1,5,1,7,4,14,3,21,3,87,3,24,3,41,1,60,1,83,3,92,2,88,4,95,8,105,1,97,16,110,1,111,4,113,2,210,1,211,1","experienced,2,1,7,1,14,1,23,1,31,1,45,1,71,1,95,4,97,3","experiences,14,1,21,1,87,1,46,1,60,1,71,1,83,1,92,1,88,2,97,16,113,2,117,1,211,2","experiencing,2,1,13,1,41,2,95,1","experiential,71,1","experiment,97,1","experimental,92,4,95,2,111,1","experimentation,97,1","expert,7,1,87,1,41,1,43,1,83,2,97,1,113,1","expertise,7,1,87,1,49,1,92,1,110,1,111,1","experts,4,3,7,1,14,1,87,2,31,1,41,1,46,1,49,2,83,1,84,2,92,4,105,1,111,10,112,2,117,2,122,2","expires,97,1","explain,45,1,46,1,62,1,63,1,97,2,210,1","explained,46,1","explaining,97,2","explains,7,2,87,1,45,1,84,1","explanation,27,1","explicit,7,16","explicitly,7,3,95,1","exploitation,23,1,97,4","exploration,23,1","explore,2,1,7,1,14,1,87,1,45,1,92,1,95,1,106,1,97,2,112,1,117,1,118,1","explored,7,1,95,1,97,4","explores,14,2,23,5","exploring,24,1,45,1,92,1,97,3","expos,116,1","exposes,84,1,85,1,95,1","exposure,2,1,97,2","express,7,1,14,1,87,2,83,1,97,3","expressed,2,1,14,1,46,1,95,1,97,4","expressing,97,1","expression,14,1","expressions,23,1","ext,92,5","extend,2,1,83,1,116,1,117,1,118,1,213,1","extended,7,1,21,1,43,1,97,1","extending,2,1","extension,87,1,27,1","extensive,97,4","extensively,46,1","extent,2,1,7,2,14,3,24,4,92,1,95,1,97,1,110,1,113,1,117,1,211,1","external,97,4","extra,43,41,45,2,97,2","extraordinary,88,1","extras,110,1","extremely,13,1,87,2,23,1,97,10,210,2","extremes,97,1","exw,97,3","eye,83,1,95,2","eyes,46,1,92,1,97,1","f1e46d21f,4,6","f50a17f,46,4","f50a17f63d550c778edda8099,46,5","faan,87,1","fabrizio,46,2","fac,85,1","face,4,1,7,6,14,1,87,1,23,1,43,1,61,1,62,1,92,3,88,1,95,1,106,2,97,2","faced,43,1,95,1,97,1,211,1","facet,92,1","faceted,83,1,92,1","facets,43,1","facial,23,1","facilitate,87,5,60,1,83,1,92,1,95,2,97,2,117,1","facilitated,43,2,116,1,117,1","facilitates,88,1","facilitating,7,1,60,1,71,1,213,1","facilitation,88,1","facilitator,105,1","facilitators,63,1","facilities,7,64,23,1,42,1,45,2,55,1,62,1,63,1,118,1,211,1","facility,5,1,7,35,23,2,24,4,42,3,45,2,71,1,92,2,95,1,110,2,112,1,211,1","facing,7,4,23,4,56,1,85,1,89,1,95,1,97,2","fact,2,2,14,1,21,2,23,1,46,2,57,1,93,7,95,4,97,6,110,1,113,1,116,1","facto,92,1","factor,7,1,61,1,95,6,97,4","factors,2,2,7,2,14,1,43,2,45,1,83,1,95,4,97,22","faculty,117,2","fades,46,1","fading,46,1","fail,87,1,61,1,95,2","failed,2,1,84,1,95,2","failing,111,1","failure,4,1,14,1,61,1,83,1,95,2,111,1","faint,213,1","fair,2,5,42,1,93,2,211,1","fairfax,61,1","fairly,7,4,97,2","fairview,23,4","faith,87,1,24,4,71,1,92,3,88,6,97,1","faithful,45,1","fall,3,1,4,2,87,1,31,1,97,1,110,1,111,1,113,1,117,1,118,1","fallen,26,1","falls,7,2,88,1,113,1","false,113,1","falsevti,119,3","famil,85,1","familiar,87,1,43,1,45,1,95,2,97,1,110,2","familiarity,7,1","families,2,3,3,1,5,3,18,1,7,100,14,12,21,2,20,2,87,5,23,7,24,3,45,4,46,2,53,1,61,1,62,2,84,1,92,10,88,50,93,2,95,21,97,7,111,2,113,1,117,1,118,1","family,1,3,2,44,3,1,5,25,18,2,7,894,11,1,12,1,13,4,14,125,21,8,20,5,87,37,23,17,24,17,25,1,26,2,27,2,31,1,32,1,38,1,42,3,43,2,45,31,46,10,48,1,50,1,53,1,54,6,55,2,56,10,57,4,60,1,61,4,62,4,63,3,71,9,83,9,84,1,85,4,86,2,92,95,88,35,93,3,95,36,106,2,97,56,98,1,109,2,110,29,111,4,113,26,116,2,117,9,118,4,211,13,213,13","familycaregiveralliance,53,1","familycaregiversguidetodischargeplanning,45,4","familycentered,62,1","familystates,7,1","famlies,92,1","fancey,14,9","fanlight,23,3","fantasia,112,1","far,2,1,3,1,4,1,7,1,87,1,43,1,45,1,56,1,88,3,95,1,97,4,111,1,211,1","fare,2,1","fashion,95,1,109,1","fast,14,2,46,2,84,2,85,2,109,3","fastestgrowing,4,1","fatalistic,111,1","father,4,3,14,1,23,2,42,2,46,16,85,1,111,3,211,2,213,2","fault,43,2","faults,84,1,85,1,109,1","faulty,45,1","favorability,97,1","favorable,97,17","favorite,46,1","favorites,109,1","fax,6,3,7,1,21,1,92,1,93,1,110,2","faxed,97,2","fay,23,1","fayetteville,6,1","fc,7,227","fca,7,12,14,4","fcaregr,87,1","fcjobs,87,1","fcs,7,1",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95,2,97,3,110,2,111,2,112,1,116,1","formal,5,1,7,2,14,4,21,2,87,3,60,1,86,1,92,1,94,1,97,8,110,1,213,2","formalized,7,2,97,1","format,7,2,14,2,60,1,88,1,97,1,110,5","formation,92,1","formative,95,1","formats,14,1,87,1","formed,5,1,7,1,21,1,88,1,97,1,111,1","former,2,1,13,1,42,1,61,1,71,1,95,2","formidable,87,1","forming,92,2","forms,2,1,7,1,14,5,23,2,24,4,95,1,97,2,111,1","formula,7,1,83,1,97,1","formulary,43,1","formulate,7,2","formulates,7,33","forth,7,1,46,1,117,1","fortunate,43,1,117,1","forty,2,1,14,1,87,1,97,5","forum,7,4","forums,6,1,87,4,97,2","forward,4,1,5,1,24,1,95,1,105,1,97,4,110,1,113,1,116,1","forwarded,7,1,87,1,88,1","foster,7,2,87,1,83,1,92,3,88,1,93,1","fosters,106,1","fotf,23,1","foun,85,1","found,2,4,4,1,7,10,13,1,14,4,87,1,43,2,61,1,84,1,95,20,97,14,113,1,118,1","foundation,2,1,7,1,9,1,14,3,20,5,87,2,23,2,36,1,45,2,50,1,53,1,61,1,83,1,85,1,92,3,93,2,95,1,106,1,97,5,213,2","founded,7,1,14,1,71,1,111,1","founder,21,1,61,2","four,2,4,4,1,7,16,14,4,23,6,24,9,43,1,45,2,46,1,61,1,85,1,92,8,89,4,95,4,97,14,109,2,110,3,117,2","fourteen,23,1","fourth,7,3,87,1,92,1,95,1,97,1","fourths,21,1","fowl,111,1","fox,5,1,7,4,95,4","foxvwhuv,97,1","fp,7,1","fpl,2,6","fqus,119,1","fragile,111,1","fragility,88,2","fragmentation,7,7,24,4","fragmented,3,1,7,3,14,1,88,1,95,1","frail,2,1,3,2,4,1,5,1,18,1,7,16,14,2,21,1,92,2,88,1,95,2,97,4,111,3,213,4","frailty,3,1,61,1","frame,92,2","framework,3,2,14,2,95,4","francis,117,1","francisco,7,5,14,5,87,1,23,1,31,1,46,3,92,2","frank,4,1,87,1","franklin,37,2","fraud,43,3,97,7,109,2","fraught,97,1","free,4,1,7,6,13,1,14,1,20,1,87,1,23,1,24,3,43,5,45,2,54,1,60,2,61,1,84,3,85,3,86,1,92,2,93,1,105,2,109,3,110,1","freeconfernce,105,1","freed,213,2","freedom,7,4,95,1","freedoms,87,1","freehold,61,1","freely,7,1,83,1","frena,23,1","frenzel,95,3","frequencies,7,1","frequency,7,34,14,5","frequent,7,1,92,1,97,5,211,2","frequently,7,8,14,1,87,1,95,1,105,1,97,4,211,2,213,2","fresh,55,1,97,1","fria,23,1","friday,6,1,21,3,211,1","friend,2,1,7,1,14,1,87,2,23,1,25,1,42,3,45,3,84,1,85,1,92,1,113,3,211,2","friendly,4,1,7,1,14,1,23,1,24,4,92,1,95,3,106,1,97,1,113,1,116,1,213,2","friends,5,1,7,9,14,6,21,1,87,3,23,2,24,12,43,1,45,1,46,1,92,1,97,6,111,1,113,1,117,1,211,3,213,3","friendship,85,1","friendships,113,1","fringe,97,1,211,1,213,1","friss,5,1,7,2,14,4,31,1,92,1","front,23,2,43,1,46,2,84,2,85,2,97,2,109,2","frpelqdwlrq,97,1","frpprq,97,1","frqfhuqhg,97,3","frqvxphu,97,8","frqvxphugluhfwhg,97,3","frqvxphuv,97,1","frustrated,97,1","frustrating,27,1","frustration,88,1,113,3","frustrations,88,1,97,1,113,3","frvwv,97,2","frxqvholqj,97,6","fs,21,4","fsus,119,13","fu,7,1,97,1","fuel,7,1,43,1","fueling,7,3","fulfilling,85,1","fulfillment,14,1","full,2,3,5,1,7,2,14,1,21,1,20,1,87,1,23,2,24,14,43,12,45,1,46,1,54,1,83,1,95,1,97,3,109,1,111,1,113,1,117,2,211,2,213,3","fuller,92,2","fulltime,85,1","fully,3,1,7,1,43,5,45,1,97,3,113,2,116,1","fulton,37,2","fulwhuld,97,12","fulwhulrq,97,1","function,2,1,14,1,23,1,26,1,92,1,95,1,97,2,118,1","functional,7,62,14,7,61,1,95,2","functionally,14,2","functioning,3,1,87,1,89,4,95,4","functions,3,3,7,3,14,2,87,1,97,1","fund,2,28,7,71,9,1,14,6,45,7,46,1,56,1,61,1,62,1,88,2,93,1,97,1,110,1,117,2","fundamental,5,1,87,1","fundamentally,4,1","fundamentals,95,1","funded,5,1,7,135,14,7,87,3,24,4,36,1,41,1,45,2,50,1,56,1,83,3,92,4,88,1,95,1,105,1,97,14","funder,97,1","funders,89,1,97,1","fundi,87,1","funding,3,1,5,2,7,144,87,13,23,1,24,4,56,1,61,1,62,1,71,1,86,1,92,4,88,8,95,4,106,1,97,60,116,1,117,1,118,1,122,1","fundraising,110,2","funds,7,49,21,4,87,7,83,3,92,2,88,8,95,1,106,1,97,46,109,1,110,1","funeral,24,4,84,1,85,1,109,1,113,1","funerals,84,1,85,1,109,1","furniture,113,1","further,7,3,87,1,26,1,43,1,92,2,95,5,97,5,113,1,210,1","furthermore,87,1,43,1","fuse,110,1","fused,97,1","future,1,1,2,2,6,1,7,13,14,1,24,4,43,8,45,3,46,1,84,1,92,6,88,1,89,1,95,3,106,1,97,7,109,5,110,3","futures,46,1,92,1","fw,97,3","fwixqghg,97,2","fxvwrphuv,97,1","fy,7,164,97,7","gadgets,85,2,109,1","gail,7,1,45,1,61,1","gained,95,1,113,1","gainesville,87,1","gaining,5,1,7,1,21,1,23,1,95,1,97,1","gallagher,61,1","gallaher,23,1","galvanize,111,1","game,23,1","games,24,3","gao,7,2","gap,97,1","gaps,7,7,43,3,88,3,97,15","garden,109,1,111,7","gardening,24,3","garrison,4,1","gas,87,1,43,1","gather,14,1,23,1,25,1,27,1,84,1,85,1,92,1,97,2,110,1,111,1","gathered,7,1,92,1,97,1","gathering,88,1,97,1","gathers,46,1","gatti,4,2","gauge,25,1","gaugler,7,2,14,5,95,2","gave,7,3,21,1,45,1,105,1,97,4,213,1","gay,83,1","gcburt,72,1,87,1,24,4,92,1","geared,23,1,92,1","geico,84,3,85,3","geist,46,34","gency,7,1","gender,2,5,14,2,24,4,42,2,211,2,213,1","geneduethics11,47,8","general1,143,8","generalhead,144,8","generalizing,89,1","generate,83,1,84,1,92,1,88,1,97,1","generated,1,1,97,2,110,1","generates,110,1","generating,92,1","generation,4,1,84,13,85,10,92,1,97,2","generation2,85,4","generational,14,1","generations,7,3,14,3,23,1,31,1,92,3,93,2,95,2,111,1","generic,14,3,43,6,117,1","generics,43,1","generous,4,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9,1,110,9,212,3,111,1,115,1,116,7,117,2,118,1,210,1,211,9,213,5","informational,1,1,43,9,92,1,93,1","informationfrom,92,1","informative,87,1","informed,14,1,87,4,27,1,43,11,45,1,61,1,92,1,97,1","informs,14,1","infrastructure,7,1,97,10","infringement,24,1","infuse,97,1","infusion,7,1","inhome,7,1,95,5,97,1,118,1","initail,92,1","initial,7,5,14,6,21,1,87,1,24,1,43,5,45,1,62,1,63,1,92,1,88,1,94,1,106,1,97,4,110,1,118,1","initially,7,1,97,3","initiate,92,1,97,1,118,2","initiated,86,1,95,1,97,1","initiates,88,1","initiative,7,5,14,1,21,1,87,4,36,1,41,1,88,3,95,1,97,1","initiatives,3,1,7,13,24,1,31,1,45,1,92,1,95,2,97,10","injections,14,2","injuries,7,1,14,1,92,1","injury,7,1,14,1,87,1,26,1,92,1","innovation,7,8,87,1,83,1,106,1,97,1","innovations,7,1,92,1","innovative,5,1,7,10,21,2,87,1,23,1,50,1,62,1,83,2,92,3,95,2","inpatient,95,1","input,7,1,8,1,87,1,24,4,92,3,95,1,97,4,110,1","inquiry,84,1,85,1,109,1","insecurity,7,1","insert,42,1,110,1","inserting,110,1","inside,4,1,23,1","insight,7,1,92,1","insights,7,4","insist,43,1","insisted,111,1","inspirational,110,1","inspired,111,1","installation,87,1","instance,4,1,111,1","instances,87,2,95,3","instant,84,1,85,1,109,1","instead,7,1,97,5,118,2,213,2","institute,1,1,5,2,7,1,14,3,87,3,24,15,48,1,54,2,56,2,59,1,61,1,71,1,83,1,92,7,95,2,106,3,117,2","institutes,23,1","institution,92,1,95,1","institutional,3,1,7,2,41,1,61,1,92,1,94,1,95,1,97,2,111,1,118,1","institutionalization,5,1,7,3,87,1,95,13,106,1","institutionalize,92,1","institutionally,3,1","institutions,7,3,97,1,213,1","instruct,45,1","instructing,97,1","instruction,14,2,87,1,116,1","instructions,14,1,25,1,45,2,212,4,210,11,214,1","instructor,23,1","instrument,7,4,14,4,24,4,97,1,212,3,214,1","instrumental,7,1,14,1,95,1","instruments,7,3,14,5,92,2,89,1,97,8","insufficient,95,1","insulting,110,1","insurance,2,29,4,2,7,1,14,1,23,1,24,4,27,14,43,17,45,10,46,1,57,1,84,3,85,3,93,1,109,1,117,2","insuranceplansdirect,4,1","insure,7,1","insured,2,2","insurers,43,1","insurmountable,97,2","intact,84,1,95,2","intake,3,1,7,3,14,5,87,2,83,2,86,1","integral,7,1,87,1,23,1","integrate,7,5,92,2,89,1","integrated,3,4,7,13,83,2,86,1,92,1,95,1","integrates,95,1","integrating,7,7,83,2,92,1,88,1","integration,7,10,83,1,86,1,88,1,95,2","intellectual,92,2","intended,7,1,14,1,83,1,92,1,88,1,95,1,110,1","intends,14,1,92,2","intense,87,1,45,1,46,2,97,1","intensity,14,1","intensive,45,1,71,1,92,2,88,1,95,2,111,1","intensivepresentation,61,4","intent,7,1,109,1,110,1","interact,57,4,60,1,92,1,118,1,119,2","interact1,119,2,152,8","interact2,58,4","interact6,59,4","interacthead,153,8","interacting,23,1,57,4","interaction,14,2,21,1,87,1,24,3,106,2,97,1","interactions,23,1,95,1","interactive,7,1,87,1,71,2,83,1,84,1,85,1,92,1,104,1","interagency,97,1","interchangeably,7,1","interdependence,87,1","interdisciplinary,3,1","interest,5,1,7,1,87,4,23,1,48,2,71,1,83,1,92,1,89,2,95,1,97,7,98,1,110,1,111,1,117,1,122,1","interested,7,2,87,6,42,1,46,1,62,1,92,4,88,4,106,1,97,8,211,2","interesting,46,1,95,1,97,1,113,1","interestingly,7,1,95,1","interests,61,1,95,1,113,1","interfaith,87,4","interfere,211,2,213,1","interferes,45,1,211,2,213,2","interfering,213,2","intergenerational,14,1,23,2,92,1","intermediaries,31,1,97,2","intermediary,97,24","intermediate,97,1","intern,1,1","internal,62,1,97,4","international,2,1,14,1,23,2,62,1,95,4","internet,15,1,16,1,17,1,18,1,19,1,7,33,11,1,12,1,14,4,87,4,23,2,28,1,29,1,31,1,32,1,33,1,34,1,35,1,36,1,37,1,38,1,39,1,40,1,41,1,44,1,45,1,48,1,49,1,50,1,51,1,52,1,53,1,54,1,56,1,57,1,60,6,64,1,65,1,66,1,67,1,68,1,69,1,70,1,92,1,91,1,94,1,97,3,98,1,99,1,100,1,101,1,102,1,103,1,104,1,108,1","internetsupportdensiebrown,60,4","interpret,13,1,45,1","interpretation,14,1","interpretations,45,1,97,1","interpreted,95,1,97,1","interrelated,111,1","interrupt,46,1","interrupting,105,1","interruption,2,1","interval,95,1","intervals,14,1,87,1","intervene,92,1","intervening,95,1","intervention,3,1,7,3,14,7,23,1,24,3,86,1,92,11,95,12,106,1","interventions,14,3,24,1,54,1,61,1,92,3,95,10","interview,5,1,7,12,14,10,42,4,92,4,97,17,115,1,116,9,117,9,118,9,119,6,210,3,211,4","interviewed,7,1,92,1,97,5,210,1","interviewee,210,1","interviewer,42,2,211,3","interviewing,14,1","interviews,2,1,5,1,7,13,14,1,21,1,23,2,24,4,63,1,92,1,97,46,116,1,117,1,118,2,119,3","intimacy,23,1,113,1","intimate,23,1,113,1","intimidation,87,1","intra,97,1","intrastate,7,1","intrinsic,95,1","introduce,25,1,210,1","introduced,87,1,97,1","introducing,97,1","introduction,5,1,7,3,21,1,24,3,92,1,97,3","introductory,62,1,63,1,210,1","intruding,105,1","inui,95,1","invalids,113,1","invaluable,7,2,116,1","inventory,14,1","invest,7,2,97,1,109,1","invested,97,1","investigate,28,1,45,1","investigation,95,1","investigative,84,1,85,1","investigators,14,1","investment,7,1,87,1,71,1,88,1,97,2","investments,7,1,43,1","invisible,62,2,63,2","invitation,97,1,110,3","invitations,110,2","invite,87,2,55,1,92,1,113,1,117,2","invited,20,1,41,1,55,1","invitee,110,1","inviting,97,1,116,1","invoices,110,1","involve,45,1,63,1,92,3,88,2,95,4,97,1","involved,14,1,7,2,21,1,87,2,23,1,24,5,42,1,45,7,46,2,61,2,63,1,85,1,93,1,95,2,97,13,109,1,110,1,111,2,113,2,116,1,117,1,211,1,213,1","involvement,7,2,87,2,61,2,92,1,88,2,95,1,97,2,110,1","involves,87,2,92,1,89,1,95,3,97,5","involving,14,1,7,1,87,2,92,1,95,1,97,2","inward,46,1","io,7,2,97,1","iod,2,1","ion,13,1","ior,2,2","iowa,7,18,97,1","iraqi,84,1,85,1","ire,97,1","irect,7,17","irene,92,1","iroorzlqj,97,3","irritable,13,1","iru,97,14","irvine,23,1","irxu,97,1","is…,86,1","isam,14,2","isiting,7,4","island,7,11,97,1,111,2","islander,42,1,92,2,211,1","islanders,7,33","islands,92,1","isn,60,1,61,3,62,1,97,3,113,1,117,1","iso,119,1","isolated,56,1,83,1,92,1,106,2","isolation,14,1,21,1,88,1","issue,2,6,3,3,5,2,14,1,7,11,87,7,23,2,27,1,31,2,41,1,48,1,56,1,63,1,92,1,95,37,97,10,110,3,112,1,118,1,122,1","issuebriefs,14,1,87,4","issued,3,1,20,1,45,1","issues,1,1,2,4,14,14,6,2,7,113,12,1,21,2,87,12,23,12,24,20,27,1,31,3,45,3,46,1,54,1,56,1,83,2,86,1,92,7,88,2,89,1,93,1,95,9,97,20,110,9,212,1,117,1","italian,23,2","item,14,1,97,5","items,14,8,43,1,45,1,55,1,97,7,110,2","itis,2,1","itle,7,5","its,2,1,4,1,14,4,7,12,21,2,87,1,41,2,43,5,45,2,61,1,62,1,86,1,92,5,88,2,89,1,95,7,106,1,97,20,110,2,111,1,117,1,118,1","itself,14,1,21,1,95,1","iuhtxhqwo,97,1","iulhqgv,97,2","iurp,97,3","iv,7,2,97,3","ivan,4,1","ive,87,1","ivision,7,1","ix,87,41,97,1","ixqghg,97,2","ixqglqj,97,14","ixqgv,97,1","ja,9,1","jacc,7,8","jackson,95,1","jacob,9,1","jacqueline,23,1,92,1","jail,111,1","james,92,1,95,1","jan,61,1,84,2,85,2,88,2","jane,4,1,31,1,46,1,49,2,92,1,111,1,113,2","janet,37,2,85,3","january,2,1,3,1,4,1,14,5,7,1,43,4","januaryfebruary,7,1","januarymarch,7,1","japanese,21,1","jarrott,95,4","jaw,4,1","jazz,46,1","jcsmith,87,1","jdodd,92,1","jdougher,92,1","jealous,113,1","jealousy,113,1","jean,23,1,31,1,37,1,92,2,109,8","jeanchatzky,109,1","jefferson,1,1,37,2","jeffrey,23,1","jelinski,95,1","jennifer,23,1","jenson,88,1","jerry,84,1","jersey,14,4,7,21,87,3,50,2,83,1,86,2,92,4,95,3","jersey’s,86,1","jewelry,109,1","jh,97,1","jhqhudo,97,1","jill,87,1","jim,97,1","jklein,92,1","jlatane,92,1","jlmokos,87,1","jlundgren,37,1","jlyh,97,1","jn,87,1","jo,5,1,37,1","joan,23,1,92,2,111,2","job,2,1,4,1,5,1,14,2,7,6,87,1,24,1,27,1,45,3,46,3,85,1,88,1,97,1,109,1,113,3,118,1,211,1,213,1","jobs,4,1,5,1,27,1,46,1,49,1,84,1,85,1,109,1,113,2,211,1,213,1","joe,113,1,118,1","john,23,5,92,3,94,1,95,1","johns,2,1,7,1,23,1","johnson,14,1,87,2,36,1,37,1,54,1,61,3,95,8,97,6","johnston,88,1","join,87,1,41,1,43,41,60,2,95,1","joined,87,2","joining,2,2,4,1,13,1,43,11","joins,60,2,88,1","joint,3,2,7,2,97,2,117,1","jointly,3,1,24,3,97,2,117,1","jokes,46,1","jolynn,87,1","jon,71,1,118,1","jones,87,1,71,1,95,2","jnkping,95,1","josefina,87,1,92,1","joseph,23,2,43,1","joshua,31,1","jossey,23,1","journal,14,7,7,4,31,1,95,16,111,1","journals,95,1,111,1","journey,23,1,105,1","joy,23,1","jpg,128,8,130,8,131,8,132,8,133,8,134,8,147,8,148,8,207,8","jpmarosy,92,1","jr,23,1,95,2","jsp,53,2","judge,43,1,95,1","judgements,14,1","judges,20,1","judging,106,1","judgment,87,1","judith,23,1","judy,87,2,37,1,95,1","juggle,46,1","juggling,113,1","juhdwhu,97,2","juhdwo,97,1","julie,92,1","july,2,1,3,1,7,1,21,1,20,1,61,4,62,2,63,1,88,8,90,1,95,1,115,1","july2006,116,4,119,2","jump,97,1","june,3,1,7,1,42,12,43,3,88,3,97,1,212,2,213,1,214,1","juno,37,1","jurisdictions,97,1","jurxs,97,1","justice,1,1","justified,92,1,95,1","justify,45,1","jusuf,7,1","jwhiteman,37,1","kaiser,7,1,213,2","kane,14,25,7,4,23,1,95,1,111,28","kanes,111,4","kankakee,71,1","kansans,92,1","kansas,7,9,97,1","kaplan,46,1","kapp,31,1","kare,2,1","karen,2,1,7,2,87,1,37,3,92,1","kari,5,1","kasner,7,1","kassner,7,2","kather,92,1","kathleen,7,1","kathryn,37,1,92,1","kathy,3,1,7,1,24,4,31,1,92,1","kathyegan,92,1","katrina,84,3,85,3,109,2","katz,95,1","kay,116,1","kaye,37,1","kbraun,92,1","kdata,53,1","kdv,97,3","kdyh,97,9","keats,23,1","keefe,14,9","keeffe,2,1,7,1","keeping,4,1,14,2,7,2,13,1,45,1,84,1,92,1,97,4,110,1","keeps,21,1,105,1,118,1","keillor,4,1","kelly,7,1,37,1,95,1","kellyc,37,1","kendall,23,1","kendig,95,1","kennedy,7,1","kensington,92,1,110,1","kent,4,2","kentucky,7,10,87,2,97,1","kept,4,1,42,1,213,3","kerstin,23,1","kevin,31,2","key,5,3,14,1,7,35,87,5,43,2,54,3,61,1,83,1,84,1,85,1,92,8,88,4,97,4,110,4,111,1","keynote,41,2","keywords,87,1","kh,97,2","kharriell,37,1","khdowk,97,2","khfn,97,2","khosixo,97,1","khq,97,2","khuh,97,1","kicking,97,1","kid,85,1","kidding,46,1","kidney,4,1,111,1","kids,23,1,84,2,118,1","kilner,14,2","kim,37,3","kincare,117,1","kind,4,1,7,2,26,2,42,1,43,1,85,1,88,1,111,1,116,1,117,1,118,1,211,3,213,1","kindly,27,1","kinds,1,1,42,3,45,3,97,2,212,1,211,4,213,2","king,37,1,53,1,84,2,85,2,109,1","kinks,97,1","kinney,14,2","kinship,7,1,83,1,92,5,93,2","kintner,43,1","kisthardt,14,1","kit,62,2,63,2","kitchen,85,1,109,1,113,1","kitchener,7,1","kits,63,1","kitzhaber,88,1","klamath,88,6","kleban,14,1","klein,92,1","klfk,97,2","kloh,97,1","klv,97,1","km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,1,117,1","morris,7,1,23,1","morrison,46,1","mortality,61,2,95,2","mortgage,43,1,84,6,85,5,97,3,109,2","mortgages,97,19","mortimer,95,1","moscinski,105,1,106,1","moss,14,1","mostly,4,1,7,2,97,2,118,1","mother,4,4,23,5,42,2,46,10,111,9,113,2,211,2,213,9","mothers,21,1,46,1","motion,97,1","motivated,97,2","motivating,97,1","motivation,95,1","motives,113,1","mount,14,1","mountain,109,1","mounting,7,1","mouth,118,1","move,7,2,87,1,24,1,27,1,31,1,45,1,46,2,97,13,109,1,111,1","moved,4,1,85,1,97,2,210,1","movement,87,1","moves,88,1,95,1,97,1,113,1","movie,118,1","moving,7,6,14,2,23,1,26,1,97,7,109,1,110,2,211,1","mpa,72,1,24,4","mpaladino,116,1","mphasize,3,1","mppc,92,3","mr,4,1,46,5,111,2","mrconference,105,1","mrs,46,6,111,4","ms,2,1,4,7,7,4,46,26,111,8","msn,84,10,85,11,109,11","msnbc,84,22,85,18,109,24","msp,43,2","mssp,7,8","msw,14,2,92,1","mt,7,4","mtg,7,1,55,4","muddled,111,1","muhammad,4,1","muir,95,1","mullan,14,1,95,2","multi,7,3,83,1,92,9,95,1,109,1","multicomponent,95,6","multicultural,54,1,88,1","multidimensional,14,3,95,2","multidisciplinary,92,2,106,1,111,1","multifaceted,7,2,92,1","multimedia,92,1","multiple,7,7,14,9,87,3,55,1,86,1,92,1,95,1,97,1,118,1","multiply,43,2","multipurpose,7,1","multisite,14,1,95,1","multiweek,105,1","munbodh,95,2","municipal,97,4","murphy,23,1","museum,4,1","music,23,1,46,1,110,1","musson,23,1","musthaves,109,1","mutual,14,1,97,1,117,1","myfai,109,1","myself,95,1,113,1,213,5","mysteries,4,1","myths,87,1,113,1","n4a,73,8,74,8,75,8,23,1,54,1,57,3,61,4,62,6,63,6,76,8,77,8,78,8,79,8,80,8,81,8,82,8,83,8,92,4","na,2,8,97,1","naccrra,93,2","nahmaish,14,1","nahmiash,14,1","name,7,256,6,1,27,4,29,2,42,37,43,13,46,2,86,1,88,2,95,1,106,1,97,4,109,3,110,2,117,1,210,4,211,54","names,1,1,7,1,42,1,45,1,88,1,97,1,110,1,116,2,210,1,211,1","nancy,4,3,23,1,31,1,37,3","nannies,111,1","nanny,117,1","napis,7,2","naps,62,1","narrated,23,1","narrative,97,4","narrow,43,1","narrowed,7,1","nascent,111,1","nassau,37,1","nasua,7,1,28,1,48,1,54,2,83,14,92,3,97,16","nasua’s,83,1","nasw,92,1","nation,7,7,87,1,23,1,37,1,62,1","national,1,1,2,6,4,11,5,3,7,149,14,24,18,2,8,1,12,1,13,4,21,2,20,2,87,6,23,11,25,1,26,2,27,2,36,1,43,2,45,9,46,5,50,2,53,2,54,2,55,4,56,4,57,1,59,1,61,5,62,10,63,6,71,1,83,11,86,3,92,33,89,1,93,11,95,3,106,1,97,14,110,2,116,1,117,1,122,1","nationally,2,2,48,1,56,1,62,1,92,2","nationalranking85,7,1","nations,23,1","nationwide,4,2,7,3,92,1","native,2,1,7,66,42,2,83,2,92,1,211,2","natural,60,1,113,1","naturally,95,1","nature,7,1,14,4,87,1,95,2,97,2,110,1,113,1","nav,151,8","navigate,14,1,60,1,88,1","navigating,14,1,87,1,27,1,49,1,92,1,111,1","naythons,23,1","nb,84,1","nbc,84,5,85,6,109,5","nbcnews,84,4,85,4","nc,87,1","ncc,7,4","ncmail,87,2","ncoa,28,1,93,1,97,13","ncsha,93,1","ncsl,7,18","ndependent,7,2","ndigent,7,1","ndividual,7,1","neal,3,1","nean,97,1","near,46,2,92,1,111,1","nearby,111,1","nearest,43,2","nearly,2,4,4,2,7,10,14,1,95,1,97,9,211,4","nearon,14,1","nebraska,7,9,97,1","necessarily,2,1,7,1,14,1,83,1,95,2,97,4,111,1","necessary,7,2,14,5,87,2,43,1,45,1,92,1,88,4,95,2,97,6,110,2,117,1","necessitated,7,1","needed,2,9,3,1,7,14,14,5,13,1,87,9,42,4,43,2,45,3,46,2,60,2,61,2,83,1,92,7,88,2,95,5,97,14,110,2,113,2,116,1,117,1,211,2,213,5","needing,14,2,87,1,92,2,88,1,97,2","needs,1,1,2,2,3,7,4,2,5,5,7,83,14,41,18,1,13,1,21,5,87,17,23,3,24,22,41,1,42,2,43,14,45,8,46,3,54,1,60,1,61,3,83,11,86,6,92,31,88,31,93,1,95,9,106,1,97,32,109,1,110,3,111,1,113,1,116,1,211,3,213,4","negative,7,1,14,3,23,1,43,1,95,2,97,4,211,2,213,3","neglect,14,1,61,2,88,7","neglected,14,1","negotiate,23,1,97,4","negotiated,95,1,97,1,111,1","negotiating,97,1","negotiations,87,1","neighbor,7,1,14,1,6,1,87,2,42,1,43,1,97,1,211,2","neighborhood,3,1,21,1,92,1","neighborhoods,87,1,92,1","neighbors,7,1,14,1,24,4,97,5,213,2","neill,7,1","neither,7,2,23,1,95,1,97,2,111,1","nekvapil,37,1","nelson,7,2","nelvig,95,1","nerney,31,1","nervous,97,1","nervousness,24,3","nes,2,1","net,6,1,87,2,37,5,92,5,93,1,117,1","nets,92,3","network,1,2,5,3,7,15,21,1,87,16,23,1,43,2,54,1,61,1,62,1,83,3,92,33,88,6,89,3,93,1,95,5,97,5,110,2,212,1,117,2,213,5","networks,83,2,92,3,88,18,89,2,97,1","neurodegenerative,95,1","neuroscience,2,1","neutral,97,7","neutrality,3,1","nevada,7,19,97,1","never,14,1,42,1,43,1,46,3,106,2,97,3,110,1,111,1,113,3,211,3,213,3","nevertheless,7,1,14,2,97,1","new,2,5,3,5,4,13,5,3,7,82,14,23,9,1,21,2,20,3,87,4,23,35,24,8,37,1,41,5,42,14,43,20,45,7,46,12,49,2,50,3,53,1,54,1,56,4,58,1,62,2,83,3,84,2,85,2,86,3,92,15,88,3,89,9,94,1,95,6,106,2,97,42,109,4,110,1,118,4,111,4,113,6,116,1,117,5,122,4,211,2,213,6","newcomer,95,7","newest,97,1","newly,4,1,87,1,97,1","newman,7,9","newmarket,23,1","newnation,157,8","newny,158,8","news,2,1,4,1,8,1,87,1,44,4,46,3,61,1,84,21,85,21,92,1,97,2,109,10,110,1,116,1,122,6","newsletter,55,1,71,1,113,2,116,1,122,1","newsletters,55,1,84,2,85,2,92,1,109,2","newspaper,1,1,87,2,55,1,97,1,110,1,118,1","newspapers,55,2,110,1,116,2,117,2","newsweek,84,1,85,1,97,1,109,1","newton,92,1,95,1","next,3,2,4,2,7,3,6,5,13,1,42,2,43,8,45,2,46,1,84,2,92,1,95,1,97,5,118,1,111,1,117,1,211,3","nextstudent,109,1","nfc,56,2","nfca,110,8","nfcacares,13,1,25,1,26,2,27,2,45,1,110,1","nfcmonth,56,2","nfcsp,7,149,14,1,87,35,24,4,28,1,61,4,62,2,63,1,83,11,92,10,95,25,106,1","nfcsps,7,41,87,1,83,1","nfo,7,69","nformed,48,1","nfpa,93,1","nfpainc,93,1","nfscp,7,1,63,1","nh,7,4","nhhs,119,1","nholkrrg,97,1","nhtd,3,1","nhww,7,8","ni,97,1","nia,2,1","niagara,37,1","niagaracounty,37,1","niapublications,59,1","nice,109,1,110,1,117,1","nichcy,13,1","niche,87,1","niece,97,1","night,14,1,46,1,55,1,60,1,97,3,118,1","nightingale,23,1","nightly,46,1,84,12,85,12,109,2","nih,53,1","nine,7,4,14,2,87,3,23,2,97,3","nittany,92,1","nj,7,9,54,1,61,2,83,1,86,17,92,4","nlihc,93,1","nllefeber,37,1","nlm,53,1","nm,7,4","no1,7,1","nobody,46,2","noelker,95,2","nolo,23,1","nomadic,111,1","nominate,55,1","nominated,116,1","nomination,55,1","nominations,55,1","non,2,16,3,1,7,10,87,3,23,1,24,4,28,1,41,1,42,1,61,2,83,2,92,1,95,2,106,1,97,10,110,2,118,1,213,1","noncaregiver,2,3","noncaregivers,2,2,14,1","noncaregiving,14,1","noncategorical,88,3","noncontracted,87,1","noncoverage,45,1","nondementia,95,2","none,2,1,7,101,43,4,97,5,111,1,211,5,213,2","nonenglish,14,2","nonfiction,109,1","noninstitutionalized,14,1","nonmedicaid,3,1","nonmembers,88,1","nonpartisan,54,1","nonpharmacologic,95,1","nonprofit,7,2,87,4,45,1,46,1,88,10,117,1","nonprofits,46,1","nonrespite,95,1","nontraditional,87,24,97,1","nontraditionalapproachestocaregiving,87,4","nonusers,95,1","nonvalidated,14,2","noon,117,1","nor,7,2,23,1,95,1,97,1,111,1,113,1","norlander,23,1","normal,24,4,61,1,111,1","normalcy,21,1","normandale,92,3","normative,24,4","normluth,92,1","north,5,2,7,15,14,1,6,3,13,1,87,11,24,4,55,1,61,1,71,1,92,2,97,2,112,1,116,3","northeastern,71,1,92,1,95,1","northern,116,1","norton,23,1","notable,110,1","notably,95,1","notation,97,1","note,2,2,7,17,23,1,42,1,43,2,45,1,54,1,60,1,109,3,110,3,210,2","notebook,27,1,45,2","noted,14,2,43,1,46,1,60,7,95,7,105,1,97,13","notes,2,1,7,2,14,2,87,1,25,1,27,2,52,1,56,1,60,1,92,2,105,1,97,1","nothing,3,1,4,1,111,1","notice,3,1,43,2,45,2,88,1,95,1,110,1","noticeably,97,1","noticed,26,1","notification,97,2","notify,43,1,88,1","noting,97,1,111,1","notion,4,1,7,1,14,3,21,1,87,1,97,1","notresuscitate,14,1","nott,43,2","nourishing,213,1","nov,88,1","nov15,43,4","nova,14,1,23,30","november,3,1,7,2,14,1,8,1,43,7,46,1,49,2,56,3,86,1,110,1,118,1,111,1,112,2,117,2,122,1","now,1,1","nsn,37,1","number,2,2,3,1,4,1,5,2,7,22,13,1,72,3,87,5,23,3,24,10,26,1,27,1,37,1,42,7,43,6,45,3,46,1,54,2,61,1,71,1,86,1,92,4,88,6,95,1,105,1,97,53,109,1,110,5,111,1,210,2,211,6","numbers,7,1,23,1,43,1,45,1,46,1,88,1,106,2,97,2,109,2","numerous,87,1,45,1,95,1,97,3,213,1","nurse,4,1,25,1,45,3,92,5,95,2,97,5","nurses,7,3,87,1,45,1,62,2,63,1,92,2,94,1,97,1,110,1,111,1","nursing,2,1,3,4,7,121,14,4,87,2,23,12,24,9,42,4,45,6,46,2,55,1,60,1,92,4,88,1,95,11,97,13,110,1,111,6,116,2,117,2,211,2,213,2","nutrition,89,1,93,1,97,1,113,1,117,1,213,2","nutritional,213,1","nv,7,6","nw,5,1,72,1,24,4,92,2","nyc,9,1,37,2,61,1","nyccaregiver,53,1","nys,1,1,3,5,6,3,23,1,52,2,55,1,56,1,89,1,117,1","nysaaaa,6,7,28,4,46,1,56,1,116,1,122,12","nysofa,3,9,6,3,8,2,23,1,55,3,89,3","nyt,46,2","nytimes,4,11,46,10,111,7","oaa,7,25,89,1,97,7","oaala,87,3","oahu,92,1","oak,71,1","oakley,88,1","oard,7,1","obacco,7,8","objections,111,1","objective,7,2,14,1,24,7,62,7,63,9,95,4","objectively,12,1","objectives,7,2,63,14,92,40,95,1","obligate,3,1","obligation,4,1,46,1,84,1,85,1,97,1","obligations,2,1,21,1,45,1","observation,14,1,92,1","observations,14,2","observe,7,1,26,1,117,1","observed,2,1,14,1,56,1","observers,95,1","observes,14,1","obstacle,97,1","obstacles,95,2,97,1","obstructed,111,1","obtain,2,2,7,5,20,1,87,4,31,1,42,1,43,2,92,1,95,2,106,1,97,4,110,1,122,1","obtained,7,11,14,1,92,1,213,1","obtaining,95,5,97,2","obvious,2,1,4,1,42,2,95,2,211,3","obviously,95,1,97,1,110,1","ocal,7,3","occasional,88,2","occasionally,97,1,113,1","occupational,1,1,45,1,61,1,62,1,92,3,97,1,111,1","occupied,21,1","occur,45,1,83,1,92,2,97,1","occurred,45,1,71,1","occurrence,14,1","occurring,7,1","occurs,14,2,87,1,25,1","ocean,109,1","ocgov,37,1","ocial,7,2","oct,88,2","october,2,2,7,7,14,3,87,1","od,97,1","odds,2,6","odujhu,97,1","odujhvw,97,3","odysseys,14,1,45,1","odzv,97,1","ofa,1,1,6,2,37,1,41,1,89,1,117,1","off,2,5,4,2,7,1,14,1,6,1,43,1,45,1,46,3,61,1,95,2,97,2,118,1,111,1,113,1,117,1,211,7,213,4","offer,4,1,5,1,7,23,87,7,43,9,45,1,46,2,55,1,62,1,92,3,88,2,93,2,95,1,106,1,97,34,110,3,118,3,113,1,116,2,117,4","offered,4,2,5,1,7,46,87,4,43,2,61,1,71,1,92,3,88,1,95,1,97,14,118,1,111,1,116,1,213,1","offering,5,2,7,5,14,1,87,1,43,4,95,1,97,14,116,1,117,1","offerings,7,1","offers,4,2,7,2,87,2,23,3,43,3,50,1,84,2,85,2,88,1,93,2,105,1,97,3,109,1","offers critical,83,4","office,2,1,3,1,4,1,7,15,14,1,6,2,20,1,87,4,23,1,25,1,26,1,27,1,41,1,43,3,55,1,56,2,61,2,62,5,63,5,66,1,83,1,92,2,89,7,97,2,110,1,118,3,116,4,117,3,122,1,210,1,211,12,213,2","officer,2,2,63,1","officers,2,1","offices,5,1,7,2,87,1,24,4,43,1,48,1,61,2,62,1,93,1,97,2,116,1","official,7,1,45,1,83,1,109,1,211,1,213,1","officials,4,1,7,16,97,14","offset,7,1,43,1,110,1","offsetting,95,1","oflife,14,1","oftentimes,14,1","oh,87,1,92,4","ohdvw,97,2","ohio,7,5,14,1,61,1,83,2,92,6,95,1,97,1","ohiw,97,4","ohvv,97,2","ohyho,97,1","ok,109,1,118,1","okay,84,1,85,1,97,1","okdhs,87,1","oklahoma,2,1,7,11,87,9,97,1","ol,97,1","old,23,4,24,4,46,6,49,1,71,1,85,1,95,1,97,3,111,4,113,1","older,1,2,2,5,5,2,7,58,14,20,21,2,87,5,23,15,31,1,36,1,42,1,43,7,54,2,55,1,56,1,59,1,62,2,63,2,71,1,83,7,92,33,93,3,95,9,97,108,109,1,117,3,122,2,213,5","oldest,60,1,97,2","olearczyk,7,1","oljlelolw,97,4","oljleoh,97,1","olmstead,3,2,7,16,54,1,83,2,97,16","olnho,97,11","olyhlq,97,1","olympic,87,4","omb,7,1","ombudsman,92,1,97,3","ombudsmen,24,4","omebound,7,1","omemaker,7,73","once,7,2,14,1,13,1,21,4,23,1,43,4,45,1,46,2,84,1,95,3,105,2,97,3,110,1,118,1,117,2,213,1","oncologist,111,1","ondents,97,1","onefourth,7,1","onehalf,2,1","oneida,37,1","ones,2,1,7,1,14,3,21,2,23,1,45,1,92,1,97,2,110,2,213,5","onetime,97,1","ongoing,7,3,87,2,92,3,88,8,95,2,110,1","ongov,6,1,37,1,117,1","online,2,1,4,1,7,3,87,4,29,1,43,2,45,6,84,1,85,1,92,2,97,5,109,1","onondaga,1,1,6,4,8,2,37,1,52,1,90,1,107,1,115,1,117,4","onset,7,3,14,1,87,2,113,1","onsite,110,1","onsum,7,34","onsumer,7,10,97,1","ont,95,1","ontario,37,2","onto,7,1,60,1,211,1","ontracted,7,1","onyahsa,116,1","oo,97,1","ooa,87,1","ooduv,97,1","op,4,1,21,19,94,1","opal,92,1","open,7,3,14,3,6,1,8,1,21,1,24,19,43,1,105,1,106,1,97,3,110,1","opened,97,1,109,1,116,1","openended,7,1","openers,24,3","opening,95,1,97,1,109,1","openly,14,1","openness,71,1","operate,7,7,88,2,97,11,117,1","operated,7,1,24,3,41,1,83,1,88,1,97,2","operates,7,2,14,1,21,2,92,1,106,1,97,1","operating,7,3,61,1,62,1,97,18,110,1","operation,43,4,92,1,88,2,97,2","operational,87,11,92,1,97,3","operationalize,92,1","operations,7,3,21,1","operative,21,1","operator,106,3","opinion,2,1,7,2,97,29","opinions,7,3,14,1,87,1,83,1,97,3,110,1","opportunities,7,2,87,10,36,1,43,1,63,1,88,4,95,1,97,2,116,1,213,1","opportunity,14,1,21,1,87,6,23,2,46,1,61,1,93,1,95,1,97,2,109,1,110,6,118,1,113,1","oppose,97,1","opposed,7,1,14,1,23,1,95,2,97,1","opposite,95,2,97,1","oprah,109,1","optimal,7,1","optimism,97,2","optimistic,84,1","optimize,61,1","optimum,87,1","option,2,1,5,1,7,43,21,1,87,3,43,6,45,1,92,2,97,15,109,1","optional,14,1,83,1,110,1,211,2","options,1,2,2,1,3,2,4,2,5,4,7,56,14,4,12,1,87,7,23,2,41,1,43,10,45,4,83,1,92,3,88,6,95,1,106,1,97,14,118,1,111,3,117,2","opus,4,1","oral,97,1","orange,37,3","order,2,3,7,2,14,4,87,1,43,3,62,1,63,2,92,2,89,1,106,1,97,2,109,1,210,1","ordered,110,1","ordering,117,1","orders,14,1","oregon,7,9,71,1,23,1,83,1,88,68,94,1","org,2,2,3,1,5,2,7,1,6,5,13,4,20,3,87,3,23,9,25,1,26,2,27,2,36,1,37,7,38,1,45,13,53,7,54,1,56,3,57,1,59,1,62,1,92,20,93,14,95,3,109,1,110,1,122,3","organization,7,2,14,1,71,1,87,1,23,2,27,1,43,2,45,3,92,2,88,1,89,1,93,1,95,1,106,1,97,3,110,1,111,2","organizational,7,39,71,1,87,1,92,2","organizations,7,6,14,2,20,1,71,1,87,4,23,1,24,4,43,1,45,1,62,1,83,2,92,10,88,7,93,1,95,1,97,7,110,6,117,1,210,1","organize,43,2,45,1,92,1","organized,7,2,87,1,23,2,92,1,95,1,105,1,97,5,110,1","organizing,87,1,43,1,88,1,110,1","orient,21,1","orientation,88,2","oriented,92,2,95,1,97,1","origami,92,1","origin,211,1","original,7,1,43,1,86,1,97,3,110,1","originally,87,1,97,2,118,1,122,1","originated,14,1","origins,14,1","orlando,7,1","orleans,4,1,37,1,89,1","orleansny,37,1","orr,14,1","orrington,71,1,92,1","orrnlqj,97,1","ors,88,2","ory,95,2","ospitals,7,2","osteoporosis,61,1","ostwald,7,2","oswego,37,1","otherwise,2,1,4,1,7,1,21,1,43,1,60,1,97,2,110,2,213,1","otsego,37,1","otsegocounty,37,1","ott,95,1","ottawa,111,1","oundation,7,2","ounseling,7,52","ounty,7,6","ourselves,113,1,117,3","outcome,3,1,7,5,14,3,87,1,45,2,52,1,63,2,83,1,92,3,88,2,89,14,95,1,97,1,213,2","outcomes,3,2,5,1,7,3,14,5,6,1,8,1,71,1,24,3,86,1,92,3,88,7,89,5,91,1,95,9,106,2,97,8,212,1,213,1,214,1","outgrowth,87,1","outing,46,1,116,1","outlets,110,1","outlines,7,1,83,1","outlining,116,1","outlying,97,1","outof,7,1","outpace,87,1","outputs,97,6","outreach,7,12,87,5,61,3,62,7,63,1,83,6,86,1,92,7,88,1,95,2,97,2,110,1,118,2,116,1,117,1","outset,45,3,95,1","outside,7,35,14,1,45,1,92,1,212,1,111,1,213,1","outstanding,2,2","overall,2,1,7,11,14,6,24,1,42,3,43,1,92,2,89,1,95,2,106,1,97,14,212,1,211,2,213,2","overarching,92,1","overcame,97,1","overcome,14,1,92,1,95,1,97,6","overcoming,14,1,87,1,95,1,97,1,113,1","overcompensation,83,1","overhaul,111,1","overhead,97,4,110,1","overhear,210,1","overlap,97,1","overload,14,1,95,9","overlooked,113,1","overly,24,1,95,1","overnight,1,1,5,1,7,2,87,1,60,1,95,25,109,1,116,2","overpower,46,1","overproduction,61,1","overriding,95,1","oversee,21,1,213,1","overseeing,7,1","oversees,7,2","oversight,21,1,97,2","overtake,111,1","overton,92,1","overview,2,1,14,2,52,1,63,7,83,1,92,1,89,5,95,1,212,9,214,1","overview aoa,83,1","overview key,83,1","overview older,83,3","overview 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97,2,117,3,211,2,213,9","perceive,7,1,87,1,95,2,97,2","perceived,14,1,7,1,24,1,92,1,95,3,97,8","perceives,24,1","percent,2,17,4,5,7,22,46,5,84,1,88,2,95,1,97,42,109,1,111,1","percentage,7,1,87,5,46,1,97,4","percentages,7,7","perception,4,1,14,3,7,3,97,2","perceptions,7,5,95,1,97,4","perfect,71,1,109,1","perfectmatch,84,1,85,1,109,1","perform,14,3,46,1,61,1,92,1,95,1,97,1","performance,3,4,6,1,8,1,52,1,92,1,88,1,89,8,91,1,95,1,212,1,213,1,214,1","performed,5,1,14,4,7,2,97,4,213,1","performing,95,1","performs,97,1","perhaps,43,1,45,1,97,1,110,1,111,1","perigee,23,1","period,2,1,7,1,43,3,45,1,92,3,95,13,105,2,97,1,118,1,113,1","periodic,62,1","periodically,60,1","periodontal,61,1","periods,7,1,43,1,92,1,113,1","perkins,14,3","permanent,97,1","permanently,46,1","permission,4,1,5,1,45,1","permit,7,5,87,1,97,2","permits,2,1","perry,23,1","persistent,27,1,45,3,95,1,113,1","person,14,14,7,54,71,1,87,3,23,1,24,3,26,3,27,2,42,2,43,1,45,2,60,2,85,1,92,2,88,1,95,7,106,1,97,20,110,6,111,4,113,15,117,1,210,4,211,3,213,3","personal,2,3,3,4,14,12,7,83,13,1,71,1,87,4,24,4,42,3,43,1,45,2,61,1,62,1,92,3,95,1,106,1,97,23,109,2,110,1,111,1,117,1,211,2,213,2","personalities,97,1,116,1","personally,43,1","personals,84,1,85,1,109,1","personhood,113,2","personnel,5,1,27,3,57,1,88,1,94,1,97,7,210,2","persons,5,2,14,23,7,56,21,1,87,5,23,3,24,3,41,2,42,1,43,2,45,1,83,1,92,12,93,2,95,2,97,24,113,1,117,2,211,4,213,1","persoon,95,2","perspective,2,1,5,1,14,15,87,1,95,4,97,1","perspectives,7,4,23,1,31,1,97,2","persuasive,95,1","persuasively,92,1","pertain,97,1,110,1","pertaining,92,1","peter,23,1,41,2","peters,92,1","peterson,92,1","pettinger,105,1,106,1","petty,7,2","pew,87,1,84,1","pg,46,3","ph,2,6,87,1,23,1,41,1,95,2,97,1","pharmaceutical,43,4","pharmacies,43,4","pharmacist,43,8","pharmacy,43,8,55,1","phase,3,8,14,1,88,3,97,1","phases,97,1","phd,14,2","phdq,97,1","phenomenon,3,1,46,1","philadelphia,92,3","philanthropic,45,1","philanthropy,45,1","philip,43,1","phillips,37,1,97,1","philosophical,7,1","philosophy,7,7,71,1,92,1,88,1,97,5","phommel,92,1","phone,6,2,21,1,71,1,72,1,24,4,27,4,41,1,42,2,43,2,45,6,61,1,86,1,92,1,88,1,93,13,105,3,97,3,109,1,110,3,122,1,210,4,211,1","phoned,46,1","phones,85,1","phoning,105,1","photo,46,1","photographs,46,2,111,1","photos,46,1","phqw,97,13","phrase,14,1","phrases,97,2","phulfdqv,97,5","phwkrg,97,7","phwkrgv,97,2","phyllis,37,2,46,1","physical,2,1,14,7,7,74,21,1,87,1,23,4,45,4,61,2,62,1,92,6,88,4,89,2,95,1,97,1,111,1,113,4,211,1,213,3","physically,7,7,21,1,71,1,87,1,97,1,213,1","physician,5,1,14,1,24,4,25,1,45,3,61,4,62,16,63,14,92,1,111,1","physicians,14,3,13,1,58,1,61,10,62,9,63,16,92,5","pi,97,1","piano,46,1","pick,1,1,27,1,43,3,46,1,95,1,105,1,97,1","pickamortgage,84,1,85,1","picks,1,1,46,1,84,1","picnic,117,1","picot,14,2","picture,4,1,7,1,45,1,86,1,97,2,110,1","pictures,110,1","pie,84,1,85,1,109,1","piece,111,1","pieces,97,1,110,1","piercy,88,1","pilisuk,14,1,7,5","pilot,7,8,24,4,83,1,86,2,92,3,97,10","piloting,1,1,86,1,92,1","pima,92,2","pine,93,1","pinpoints,7,1","pinsky,8,1,117,1","pioneer,14,1,7,1","pioneering,95,1","piquing,87,1","pit,113,2","pitching,23,1","pivotal,83,1,113,1","pizza,118,1","pkon,37,1","place,3,1,14,3,7,5,9,1,71,1,87,2,24,11,25,1,41,1,42,1,43,3,45,2,46,1,60,1,61,1,62,1,84,1,85,1,92,5,95,3,97,5,110,2,118,1,111,1,116,1,211,2","placed,2,1,3,2,7,3,43,1,92,1,95,4,97,1","placement,3,1,14,1,7,1,23,1,61,1,88,1,95,42","placements,97,1","places,4,1,7,1,95,1,97,1,211,1","placing,87,1,95,1","plagued,97,1","plain,109,1","plan,3,1,4,1,14,13,7,8,21,1,23,1,41,1,43,142,45,14,46,2,54,1,61,1,63,1,92,12,88,4,106,2,97,17,109,2,110,5,113,1,116,1,117,2","planned,43,1,45,2,46,1,85,1,97,1,110,1,113,1","planner,87,1,23,1,45,11,53,1,84,1","planners,1,1,87,1,24,8,45,2,110,1,118,2,111,1,117,1","planning,2,1,3,1,14,4,7,13,8,1,87,10,23,1,24,4,41,1,45,17,54,1,55,1,57,1,86,1,92,13,88,3,95,2,97,5,109,1,110,11,118,1,212,1,117,6","plans,4,1,5,1,14,1,7,2,87,1,43,38,45,1,46,1,83,1,84,1,92,2,106,1,97,11","plasma,85,1","plates,110,1","platform,3,2","play,2,1,5,2,14,1,7,3,87,3,41,1,83,1,84,2,85,2,92,1,95,1,97,1,109,2,110,1","playground,84,1,85,1","playing,87,1","plays,46,1,97,1","plaza,89,1","pleased,20,1,50,1,63,1,88,1,95,1","pleasure,21,1,92,1","plenary,24,6","plenty,43,1,46,1,97,2","plgho,97,1","plications,87,1","ploolrq,97,8","plots,43,1","plugged,122,1","plus,6,1,92,6,97,8","plvvlqj,97,2","pm,1,1,6,3,7,1,8,1,41,1,52,1,60,2,117,2,211,3","pocket,1,1,14,2,43,1,45,1,46,1,84,1","pockets,45,1,97,1","podcasts,84,1,85,1,109,1","poe,3,17,23,2","poeregionalspowerpointdec05,3,8","point,3,3,14,1,6,1,7,72,8,1,87,1,24,3,45,2,52,1,83,3,84,1,92,4,88,3,95,1,106,1,97,20,109,1,110,1,118,2,210,1,213,1","pointed,97,3","pointing,97,2","points,14,3,7,7,24,3,43,1,83,4,92,1,95,2,111,1","police,84,1,85,1,118,1","polices,2,1","policies,4,1,14,1,7,9,23,1,43,2,86,2,92,3,88,1,95,1,97,5","policy,2,14,3,1,4,1,5,2,14,11,7,34,27,1,31,2,43,13,45,1,46,1,48,1,56,2,83,1,86,3,92,1,88,2,95,3,106,1,97,30,110,2,111,2","policymakers,2,1,5,1,14,1,7,2,92,3,88,3,95,1,97,4","policymaking,7,1","polite,113,1","political,4,1,7,1,87,1,97,3,110,3","politically,97,2","politicians,110,1","polizza,118,1","polls,84,1,85,1,109,1","pomp,24,39,52,1,56,1,89,7,91,1,212,8,213,4,214,5","pompoverview,89,4","pool,7,1,88,1,97,2","pooling,7,1,88,1","poor,2,7,3,2,14,2,21,1,42,1,95,2,97,6,109,1,113,1,211,1","poorly,95,2","pop,7,328","popejoy,23,1","poppins,111,1","popular,7,1,46,1,84,2,85,2,109,2,118,1","population,2,9,3,2,4,1,14,9,7,78,87,21,23,1,38,4,66,1,83,2,92,2,95,1,97,5,117,1,210,1","populations,2,1,14,3,7,7,64,4,83,5,92,2,88,2,97,4,117,1","portable,84,1","portfolio,109,1","portion,7,1,88,1,95,1,110,1","portions,14,1","portland,23,1","portrait,23,2","portrays,23,1","pose,7,2,87,1","posed,7,1","poses,7,1,84,1,85,1","position,14,1,61,1,62,1,88,1,97,1,118,3,113,1,116,2,117,1","positions,87,2,24,5,46,1,97,1,110,1","positive,14,9,71,1,23,1,24,12,45,1,92,1,95,12,106,1,97,9,110,2,118,1,113,1,211,2,213,6","possessions,43,1","possibilities,45,1","possibility,23,1,95,1,97,3","possible,5,1,14,1,6,3,7,2,21,1,42,1,43,6,45,7,60,1,92,3,88,1,95,11,105,2,106,1,97,5,110,8,111,1,117,1,211,1,213,1","possibly,110,3","post,87,1,25,1,42,1,60,1,92,4,95,1,211,1","postage,63,1,110,1","postal,7,1,84,2,85,2,109,2","postcards,57,1","posted,56,1,116,1","posters,57,1,61,1,62,1","postfeminist,46,1","potential,5,1,14,6,71,1,87,1,23,1,45,1,88,1,92,1,95,3,106,2,97,14","potentially,2,1,61,1,62,1,97,2","poverty,2,7,7,32","poweful,50,1","power,87,1,24,4,109,3,110,1,117,2","powered,46,1","powerful,71,12,23,1,92,1","powerlessness,92,1","powerpoint,3,4,32,1,61,4,62,4,63,4,83,1,98,1","powers,14,1","pp,7,6,24,1,95,1,97,1","ppi,5,3","ppo,43,6","pproved,7,1","pprrq,97,2","ppt,72,4,24,4,61,4,62,4,63,4,83,4,86,4,106,4","pr,2,2,7,1,97,1,110,1","practical,14,8,7,5,71,1,23,1,45,2,92,1,95,3,110,1","practically,14,2","practice,2,1,14,44,7,12,11,1,87,1,45,2,62,3,63,7,92,4,95,8,106,2,97,11","practices,1,9,5,7,14,2,15,1,6,2,7,8,8,1,12,1,87,1,23,1,28,1,29,1,32,1,38,1,48,2,50,3,52,1,56,1,57,1,58,1,64,1,66,1,88,1,91,1,94,1,92,54,97,59,98,1,100,1","practioner,92,1","practitioner,14,3,92,1","practitioners,5,3,14,7,71,1,92,1","practitionersguide,14,1","pre,7,1,23,1,92,2,97,2,109,2","precarious,95,1","precipitated,95,1","precise,46,1","precluded,95,1","precursor,24,4","predated,7,1","predict,4,1,24,6,45,1","predictable,4,1","predominantly,97,1","preface,7,1","prefer,14,1,43,1,95,1,97,1,117,1","preferably,24,4","preference,7,1,87,1,95,2","preferences,14,15,7,5,87,9,45,1,83,2,92,5,95,1,97,7","preferred,43,2,110,2","prefers,14,1","prejudices,24,3","preliminary,3,1,14,1,52,1,86,1,95,2,106,2","premature,61,1","premier,4,1","premise,87,1","premium,43,26","premiums,2,1,43,5","prentice,14,1","preparation,3,2,21,1,61,1,92,1,97,1","prepare,3,1,63,1,92,2,106,1,97,1,110,2,213,3","prepared,14,1,6,1,7,1,71,1,87,4,23,2,25,1,27,2,28,1,45,2,51,1,92,1,110,1,111,2,210,1,213,1","preparedness,14,1","prepares,87,1","preparing,7,1,24,1,45,1,97,1,211,1,213,2","prescottfinancial,109,1","prescribed,7,1","prescription,2,4,23,1,43,180,48,1,54,1,61,1,97,1","prescriptions,87,1,25,1,43,13","presence,7,1,211,1","present,3,1,14,1,7,1,87,1,24,1,42,1,45,1,62,1,92,2,95,2,97,2,110,3,113,1,117,4","presentation,14,1,15,2,6,3,8,2,32,1,54,3,61,1,62,1,63,1,66,1,97,1,98,1,110,1,116,1","presentation february,83,1","presentations,2,1,62,2,63,2,83,1,88,1,92,1,97,1,110,2,117,3","presented,2,2,14,1,87,3,23,1,62,1,63,1,95,4,97,6,118,2,116,1","presentedby,6,1","presenter,60,1,105,1","presenting,24,1,118,1,116,1,117,1","presently,14,1","presents,7,1,87,6,23,2,46,1,97,2,212,1,210,1,213,1,214,1","preservation,88,2","preserve,92,1","preserved,95,1","president,2,1,4,1,46,1,61,1,95,2","press,14,8,7,7,23,12,61,1,62,3,63,4,84,2,85,2,95,4,97,4,109,2,110,1,111,1","pressing,6,1,7,1,46,1,92,1,95,1,106,1,97,1","pressure,7,2,26,2,45,1,89,1,95,1,213,3","pressures,7,1,95,1,97,1","pressuring,111,1","prest,37,1,90,1,118,7,115,1,119,2","prest2,118,4","prestigious,46,1","presumably,111,1","presumption,87,1","pretest,210,1","pretested,7,1","pretty,46,1,97,4","prev,84,1,85,1","prevalence,7,1,23,1,95,1","prevalent,97,1","prevent,7,3,87,1,45,1,95,1,97,2","prevented,97,3","preventing,7,1,88,1,92,1,95,1,97,1","prevention,4,1,23,1","preventive,7,1,92,1","previe,23,1","previous,2,2,7,2,87,1,26,1,43,1,60,1,92,1,97,4,118,1","previously,2,2,14,1,7,2,43,1,97,4","prhyy,97,1","price,2,1,21,1,43,8,97,1","prices,109,1","pricing,71,1","primarily,14,7,7,8,87,2,92,2,95,1,97,4,117,1","primary,2,1,5,1,14,4,7,7,87,3,23,1,24,4,45,3,62,2,88,1,92,52,95,14,97,4,111,2,113,2,117,1,211,2,213,2","prime,3,1","primer,7,1","princeton,2,1","principles,71,1,87,5,45,1,88,4,92,1","pringle,95,1","print,23,1,84,1,85,1,109,1,111,3,113,8","printed,7,1,23,1,92,1","printer,4,1","printing,24,2,110,2","printout,43,1","prior,14,1,7,6,87,1,45,2,88,1,95,1,97,4,110,3","priorities,7,6,84,1,97,2","prioritize,14,1,86,1","prioritized,24,4","priority,7,26,87,1,97,15","privacy,4,1,14,5,13,1,46,2,84,1,85,1,109,1,111,2,113,2,211,2,213,2","private,2,2,3,1,14,2,7,5,43,4,88,8,89,1,110,1,111,2,113,1","privately,5,1,14,1","privileged,113,1","prizes,110,1","pro,7,1,43,1,45,3,92,1,110,1,117,1","proactively,5,1","probably,43,2,45,1,95,4","probation,118,1","probe,14,2","probing,97,1","problem,1,1,2,9,14,4,87,1,26,7,43,1,46,2,88,1,92,2,95,4,105,1,106,5,97,14,111,2,117,1,211,1","problem4,2,1","problematic,97,2","problems,1,2,2,40,4,1,5,1,14,9,7,5,13,1,87,2,23,3,42,1,45,2,61,1,62,1,88,1,94,1,92,3,95,15,106,1,97,37,110,2,118,1,111,1,113,1,211,2,213,1","problems2,2,1","procedural,41,1","procedure,88,1","procedures,14,1,45,1,61,1,88,2,95,3,97,5,210,1","proceed,43,1,92,1,211,1","proceedings,61,1","process,3,3,5,1,14,14,7,15,87,5,23,4,27,1,43,3,45,7,54,1,83,2,84,1,85,1,88,2,92,7,95,13,105,1,106,1,97,44,110,3,111,2,117,1,210,1","processes,3,1,45,1,97,9","processing,84,1,85,1,97,3,210,1","proclaim,110,1","proclaims,88,1","proclamation,55,1","proclamations,55,1","proctor,2,1","produce,89,1,92,5,95,1,213,1","produced,23,3,43,1,48,1,57,1,92,3,95,1,97,1","produces,71,1","producing,92,1,95,1","product,92,1,97,1,117,1","production,7,1","productions,23,4","productive,92,2","productivity,2,3","products,7,1,24,4,62,1,92,4","prof,2,2,53,1","profession,46,1","professional,1,1,14,1,15,1,16,1,17,1,18,1,19,1,11,1,12,1,20,1,87,5,23,2,28,1,29,1,31,1,32,1,33,1,34,1,35,1,36,1,37,1,38,1,39,1,40,1,41,1,44,1,45,3,48,1,49,1,50,1,51,1,52,1,53,1,54,1,56,1,57,1,58,1,59,1,64,1,65,1,66,1,67,1,68,1,69,1,70,1,90,1,91,1,92,4,94,1,97,5,98,1,99,1,100,1,101,1,102,1,103,1,104,1,107,1,108,1,110,1,113,1,115,1,117,3,122,5,213,1,214,1","professionals,1,1,3,1,21,2,71,1,87,2,23,10,24,4,45,7,61,1,93,3,92,23,106,1,97,4,110,2,111,3,117,3","professions,14,2,23,1,92,1","professor,2,1,46,2,95,2,97,1","professors,111,1","profigure,7,1","profile,2,1,7,140,109,1","profiled,7,1","profiles,7,87,23,2,37,1,49,1,56,1,83,3,90,5,92,1,95,1,107,1,118,1,112,1,115,1,116,1,117,1,122,1","profit,3,1,7,8,20,1,71,1,88,6,106,1,116,1,117,1","progguidance,2,1","progra,14,1","program,1,2,2,10,3,4,5,5,14,19,6,1,7,983,21,15,20,4,71,13,72,1,87,50,23,2,24,50,29,2,31,2,32,2,37,1,42,15,43,33,45,2,48,1,50,2,54,3,56,1,57,2,61,2,62,1,63,4,83,15,86,11,88,60,89,2,91,8,93,5,92,38,94,3,95,16,97,220,110,6,118,5,116,5,117,11,119,2,122,2","program overview,83,1","program1,119,2,159,8","programhead,160,8","programmatic,7,6,97,1","programme,23,1","programming,21,2,97,1","programs,3,2,4,1,5,9,14,19,15,2,16,1,17,1,18,1,19,1,6,1,7,519,11,1,12,2,21,2,20,5,87,20,23,5,24,17,28,2,29,2,31,3,32,2,33,1,34,1,35,1,36,1,37,2,38,2,39,1,40,1,41,1,43,4,44,1,45,2,48,4,49,1,50,3,51,1,52,1,53,1,54,2,56,2,57,2,58,1,59,1,61,3,62,2,63,5,64,2,65,1,66,2,67,1,68,1,69,1,70,1,83,13,86,3,88,15,89,3,90,2,91,2,93,9,92,22,94,4,95,24,97,264,98,2,99,1,100,2,101,1,102,1,103,1,104,1,107,2,108,1,110,3,118,2,115,2,117,7,122,3,213,1,214,1","programs nasua’s,83,1","programs21,7,1","programs23,7,1","programs24,7,1","programs28,7,1","progress,7,2,45,2,60,1,61,1,88,1,92,1,97,1","progressed,26,1","progressive,23,1","prohibit,97,1","prohibits,60,1","project,5,1,14,1,6,1,7,16,8,1,87,6,24,12,31,1,38,1,41,8,43,1,45,2,46,1,52,1,61,5,62,10,63,41,83,12,86,3,88,3,89,11,91,1,92,56,95,4,97,11,106,6,110,7,212,1,213,1,214,2","project activities,83,1","project goals,83,1","project outcomes,83,2","project products,83,1","project state,83,1","projected,3,1,62,1,88,2,110,1","projects,5,2,14,1,7,1,24,8,50,1,62,1,83,3,86,1,88,1,92,6,95,2,97,2,106,1","proliferate,95,2","prolong,87,1","prometheus,23,1","prominent,25,1,97,2","promise,5,1,7,1,111,1","promises,95,1","promising,14,2,7,2,50,1,92,49,95,4","promisingpractices,92,8","promote,2,6,3,2,5,1,7,5,87,1,63,1,88,3,92,3,97,2,118,1","promoted,87,1,113,1","promotes,3,1,21,1,87,1,88,2,93,1","promoting,14,1,7,5,87,1,23,1,31,1,45,1,83,2,92,2,95,1,97,7","promotion,87,1,62,2,63,1,83,1,97,1,211,1","promotional,213,1","prompted,89,1","prompting,62,1,63,1","promptly,210,1","pronounced,2,1","proofing,92,1","proper,37,1,61,1,92,1,109,1,213,2","properly,87,1,92,1,95,1","property,43,1,109,1","proportion,7,2,24,7,95,2,97,2,110,1,211,1","proportionate,7,1","proposals,20,2,88,1","proposed,14,1,21,2,28,4","proposes,92,1","pros,106,1","prosecute,97,1","prospect,23,1","protect,56,1,113,1","protection,2,1,87,1,97,2","protectionism,97,1","protective,111,1,117,1","protocol,7,1,97,2","protocols,7,1,86,3,92,1,110,1","proud,97,1","prove,87,1,46,1","proved,46,1,118,1","proven,71,2,97,1","provide,1,1,2,4,3,1,5,4,14,11,7,204,12,1,13,1,21,2,71,1,87,28,23,1,24,7,41,2,42,3,43,4,45,7,61,1,83,2,86,2,88,13,93,2,92,34,95,6,105,1,97,35,110,5,118,9,113,3,116,4,117,8,210,1,211,13,213,16","provided,2,2,3,1,5,1,14,9,6,1,7,68,8,1,21,1,71,1,87,4,23,1,24,7,42,5,43,1,60,1,83,2,92,7,95,8,97,31,110,1,118,4,212,1,116,1,117,2,210,2,211,1,213,14","provider,7,4,87,11,43,4,45,1,83,1,88,3,89,1,92,6,97,52,106,1","providers,1,1,3,1,5,3,14,2,7,58,87,13,24,4,25,1,26,2,27,2,43,2,45,2,60,1,61,1,83,3,88,24,89,1,92,11,97,81,106,1,110,1,213,1","provides,2,3,3,2,4,1,14,3,7,11,21,4,87,9,24,1,32,1,43,4,45,1,60,1,88,4,93,8,92,7,95,4,105,1,97,9,110,2,118,2,212,1,113,1,116,1,211,1","providing,2,4,5,1,14,12,7,49,21,1,87,14,43,1,83,1,88,6,92,14,95,5,105,1,97,26,110,1,113,2,117,1,211,7,213,6","provision,14,2,7,2,87,1,83,1,86,1,88,3,92,2,95,1,97,1,213,1","provisionally,7,1","provisions,7,2,92,1","proxy,109,2,210,1","prqj,97,1","prqvrprqc87t2,97,1","pruh,97,4","prvw,97,11","psa,55,1,62,4,63,2","psu,92,1,95,1","psychiatrica,95,1","psychiatry,7,1,95,3","psychoeducational,7,1","psychogeriatrics,95,2","psychological,14,1,7,3,23,1,61,1,62,1,95,1","psychologist,117,1","psychology,14,2,61,1,95,1","psychometrics,14,1","psychosocial,95,2","psychotherapist,117,1","pt,24,1","pta,93,1","ptc,71,4","ptla,93,1","pub,2,1","public,1,1,2,6,3,1,5,2,14,1,7,33,87,3,23,1,24,3,45,1,48,1,56,2,61,1,62,2,63,2,88,11,89,1,92,6,95,6,97,16,110,4,111,1,116,1,211,1","publication,7,1,28,1,45,1,54,1,92,1,109,1,115,1,116,1","publications,2,3,23,2,93,1,95,2,97,1","publicity,110,2","publicize,88,3,116,1","publicized,97,1","publicly,3,1,5,1,14,3,7,11,97,7","publish,23,1,55,1,117,2","published,2,1,4,1,14,2,24,4,46,1,54,1,61,1,94,1,97,2,109,2,118,1,116,1,122,2","publisher,29,3,45,1","publishers,23,2,45,1","publishes,118,1,112,1","publishing,14,1,23,1","pubs,59,1","pull,46,2,110,1,111,1","pulse,26,1","purhryhyrrtyhv,97,1","purchase,7,21,87,4,23,36,24,3,32,1,97,8","purchased,97,1","purchases,87,1,23,1","purchasing,24,4,117,1","purpose,5,1,14,4,7,4,86,1,88,1,89,2,92,2,97,1","purposes,14,4,7,3,88,2,95,1,97,1","pursuant,88,1","pursue,5,1,7,1,97,13","pursued,3,2,97,2","pursuing,2,1,5,1,7,1,97,1","pursuit,23,1","push,2,1,87,1,46,1,97,2","pushed,97,2","pushing,24,4,97,2","putnam,37,1","putnamcountyny,37,1","puts,7,2,21,1,60,1,118,1,113,1","putting,84,1","puzzles,24,3","pxfk,97,1","pxowlsoh,97,1","qa,86,1","qg,97,3","qglylgxdo,97,1","qhljkeruv,97,1","qhr,97,1","qi,43,1","qmb,43,1","qo,97,1","qrprhtr,97,1","qrprhtrsth,97,1","qrqh,97,1","qrw,97,7","qualifications,97,2","qualified,3,2,7,1,24,4,43,2,92,1,95,1,97,3,110,1,111,1","qualifies,43,2,84,1,85,1","qualify,7,3,23,1,43,30,116,1","qualifying,3,1,7,1,97,1","qualitative,7,1,95,2,97,1","qualities,3,1","quality,2,5,3,2,5,1,14,6,7,10,20,1,87,1,23,3,24,1,31,1,56,1,84,1,85,1,88,4,93,1,92,13,95,7,97,55,110,1,212,1,111,1,113,2,122,1,211,1,213,1","quantifies,97,1","quantify,89,1","quantifying,97,3","quantity,95,1","quarter,2,2,92,1,97,3","quarterly,14,1,7,2,21,1,43,1,92,1,94,1,95,1,97,1","quarters,7,1,92,1,97,4","quasi,95,1","quayhagen,95,4","quebec,14,2","query,7,1","question,14,3,7,6,13,2,24,8,27,1,42,1,43,27,56,1,62,1,84,1,85,1,95,2,97,13,109,3,110,1,113,1,210,7","questioned,14,1","questioning,27,1","questionnaire,1,1,14,1,13,1,42,1,61,1,62,1,63,1,97,1,210,5,211,1","questionnaires,14,2,97,1,210,2","questions,5,1,14,17,7,19,13,4,87,4,23,1,24,8,25,3,27,2,42,2,43,6,45,3,46,1,56,1,62,1,63,3,83,5,84,2,85,1,92,2,95,3,105,1,97,15,106,1,109,3,110,2,210,4,211,5,213,1","quick,84,1,85,1,97,1,111,1","quicker,97,1","quickly,45,1,88,1,97,1","quinn,37,2","quinones,7,1","quit,45,1,46,2,213,1","quite,7,2,26,1,43,1,97,6,113,1,116,1,211,2,213,2","quitting,14,1,46,2","quote,84,2,85,2,97,1","quotes,84,1,85,1,97,1,109,1","qutub,88,1","qvhivyvpvrvhyihtrpvrvh4,97,1","qwhuphgldu,97,4","qxd,43,4","rabatin,95,2","rabins,14,1,23,1","race,2,2,21,1,23,1,42,1,88,3,97,1,211,1","racial,14,1,83,1","racially,92,1","racz,87,1","radar,97,1","radio,87,1,23,3,46,2,62,1,63,1,92,1,110,2,116,1","raeann,23,1","rage,23,1","raise,7,2,21,1,23,1,41,1,56,1,85,1,92,3,110,1,113,1","raised,4,1,95,1","raisers,88,1","raises,95,1","raisin,84,1","raising,1,3,7,1,21,1,23,11,54,1,83,1,84,2,85,1,93,3,92,8,94,1,110,2,118,1,116,1","ramifications,83,1,113,2","ramp,6,2","ramps,7,1","ran,92,1,117,1","random,2,1,7,2,23,1,63,1,95,1","randomization,106,1","randomized,7,3,95,1","randomly,92,4,95,2,213,1","range,14,3,7,30,87,12,23,5,24,4,43,1,83,1,92,1,95,3,105,1,97,25,213,1","ranged,24,8,97,1","ranges,97,1,213,2","ranging,7,2,87,1,23,2,43,1,97,2","rank,97,4","ranked,7,1,97,3,213,2","ranking,7,97,97,1","ransportation,7,48","rantz,23,1","rapid,26,1,31,1","rapp,14,3,93,1","rappaport,23,1","rare,4,1,7,1,213,2","rarely,14,2,97,1,113,1,211,2","rarity,111,1","rate,2,3,3,1,7,3,13,2,87,1,42,1,43,1,84,4,85,4,88,1,92,1,97,29,109,1,211,1,213,1","rated,2,1,23,1,24,8,84,2,85,2,109,2","rates,2,2,3,2,14,1,61,2,84,3,85,3,95,11,97,3,109,2","rather,5,1,14,10,7,9,87,4,60,1,95,5,97,6,109,1,111,3","rating,24,12,84,1,85,1,97,15,109,1,211,1","ratings,14,2,97,3,212,2","ratio,2,3,24,3","rationale,95,1","ratios,2,1","rci,92,1","rcs,87,2","rd,112,1","reach,5,1,14,2,7,2,87,3,43,2,56,1,61,1,62,1,63,2,83,1,92,4,95,1,97,14,106,2,110,1,118,1,116,1,117,1,210,3","reachable,24,3","reached,42,2,211,1","reaches,56,1","reaching,87,3,43,1,58,1,61,2,66,1,83,1,95,1,97,15","react,14,1,7,1","reaction,14,2,23,1,24,3,95,1,97,10,111,1","reactions,14,1,25,1,97,4","read,7,2,26,1,42,9,43,2,56,1,60,2,61,4,62,4,63,5,84,1,85,1,97,2,122,1,210,2,211,10","readers,113,1","readily,21,1,93,1,95,1","readiness,97,1","reading,43,1,97,3,109,1","ready,25,1,43,3,45,2,95,4","real,87,6,43,1,84,1,85,1,97,7,109,2,110,2,111,1","realistic,45,4,110,1","realities,45,1","reality,14,2,7,1,97,1,111,1","realize,21,1,97,1,116,1","realized,84,1,113,1","realizing,95,1","reallocate,97,1","really,23,1,43,1,60,1,85,1,97,9,110,2,118,3,113,3,116,3","realtime,87,1","reanalysis,95,1","reanalyzed,7,1","reason,46,1,95,2,97,5","reasonable,14,1,95,2,110,1","reasonably,14,1","reasons,14,3,95,2,97,2,113,1","reassessed,5,1","reassessment,5,1,14,11,7,1","reassessments,14,2","reassurance,24,4,116,1,213,1","rebalance,3,1,7,1","rebuilding,84,1,85,1","recall,23,1","receipt,7,1,87,1,97,1","receipts,7,2","receive,2,3,5,1,14,1,7,38,87,21,23,1,24,4,42,2,43,16,45,1,57,1,83,1,88,3,92,7,95,2,97,10,106,1,109,1,211,2,213,1","received,2,4,14,2,7,6,24,12,42,6,43,10,55,1,61,1,62,1,95,8,97,13,212,3,117,1,211,2,213,1","receiver,7,291,42,28,92,3,95,2,105,1","receivers,1,1,7,39,92,5,95,1","receives,7,2,88,1,211,3,213,1","receiving,5,1,14,2,7,3,87,5,24,8,42,3,43,8,62,1,88,3,92,4,95,4,97,11,211,4","recent,14,2,7,6,87,1,24,1,46,3,84,1,92,1,95,2,97,2,111,1,213,1","recently,14,2,7,1,23,1,46,2,97,5","reception,110,3","receptionist,62,1,63,1","receptive,92,1","receptivity,21,1","recharge,116,1","rechlin,95,2","recieve,87,1","recipient,5,3,14,51,7,1,21,1,87,13,24,7,26,2,27,3,92,9,95,11,97,1,212,2,116,1,210,3,213,4","recipients,2,1,87,19,61,1,83,3,92,10,95,5,97,4,110,2,212,1,213,22","reciprocal,7,1","reciprocity,21,1","recital,46,1","reciver,42,1","reclaim,46,1","reclassified,7,1","recognition,5,1,14,1,7,11,45,1,46,1,116,1","recognize,5,1,14,3,7,1,87,4,25,1,43,1,55,3,63,1,83,1,97,2","recognized,2,2,14,3,7,2,21,1,48,1,56,1,61,1,83,2,105,1,97,4","recognizes,7,1,21,1,93,1","recognizing,14,1,18,1,7,10,20,1,87,2,23,2,46,1,86,1","recommend,7,4,42,1,109,1","recommendation,88,1","recommendations,3,1,7,6,24,8,25,1,83,1,92,2,95,1,106,3","recommended,2,3,92,2,95,1","recommending,92,1","recommends,7,2,43,1","record,14,1,25,1,42,2,84,1,85,1,86,1,97,3,109,1,210,11,211,2","recorded,46,1,210,2","recording,14,1,97,1","records,7,1,42,1,45,1,88,1,97,1","recover,45,1,213,1","recovered,45,1","recovering,46,1","recreation,21,1,24,3","recruit,87,4,88,5,92,2,97,2","recruited,21,1,92,1,95,1,97,2","recruiting,21,1,87,2,60,1,88,2,97,1","recruitment,87,3,88,5,92,1,97,1,106,3","recruits,88,1","rectify,97,1","rectum,26,1","recurring,7,2,116,1","red,1,1,92,1,95,1,97,1,117,1","redburn,95,1","redefining,87,1","redesigned,97,1","redirecting,89,1","redistribute,97,1","reduc,211,1","reduce,2,1,7,5,71,1,87,2,24,4,88,1,92,8,95,4,97,3,213,2","reduced,95,5,106,1,213,1","reduces,21,1,88,2,92,1,95,4,213,2","reducing,7,3,31,1,45,1,55,1,88,1,95,4,97,3","reduction,2,1,7,1,87,1,92,1,95,9,97,5,106,1","reductions,95,1","reester,7,3","reev,92,1","reevaluated,87,1","reever,92,1","ref,2,7","refer,2,1,5,1,7,2,87,1,45,1,63,1,117,1,213,1","reference,14,1,7,1,26,1,92,1,97,1","referenced,14,1,115,1","references,7,2,23,1,95,2","referral,4,2,23,1,86,1,88,4,93,2,92,3,95,1,116,1,117,2","referrals,24,3,45,4,61,1,62,2,83,1,92,2,106,3,118,2,116,1,117,2","referred,87,2,45,1,60,1,92,3,97,2","referring,87,1,63,2,92,1","refers,7,2,97,1","refinance,84,2,85,2,109,1","refine,92,2,106,1","refined,92,2","refinement,14,1,87,1","refining,89,1","reflect,14,2,87,1,88,1,97,4","reflected,7,1,97,3","reflects,14,1,95,1","reform,3,3,97,1","reforming,7,4","reforms,7,1,86,1","refreshments,110,1","refusal,3,1,210,1","refused,7,1,42,3,95,1","refuses,23,1,95,1","regain,95,1","regard,21,1,88,1","regarded,95,1","regarding,14,2,87,3,24,8,41,1,43,4,83,1,88,1,92,2,97,1,113,2,117,1","regardless,3,2,14,1,7,3,21,1,87,2,46,1,88,6,110,1","regards,92,1","region,2,1,7,32,87,7,41,1,43,1,54,1,92,1,95,1,106,2","regional,3,2,7,1,87,2,24,4,41,1,43,2,97,1","regionalresources,104,1","regions,7,1,41,1,88,1,92,1","regis,37,1","register,2,1","registered,92,1","registration,6,1,29,1,41,1,105,2,112,1","registry,43,2,92,4,97,2","regression,2,3","regret,111,1","regular,14,1,7,1,87,1,23,2,25,1,45,1,88,1,95,3,97,3","regularly,95,1,110,1","regulations,7,3,43,1,97,24","regulatory,7,2,97,8","rehabilitation,14,2,45,2,97,4,118,1,111,1","rehabilitative,83,1","rehearsal,46,1","rehearse,46,1","rehema,84,2","reimburse,7,1,97,1","reimbursed,95,1,97,2,111,1","reimbursement,7,1,87,4,24,4,92,1,97,4","reimbursements,7,1","reimburses,87,1,97,6","reinforced,71,1","reinforces,21,1","reinhard,14,1,7,2","reinvent,62,1","reiterated,97,1","rejection,88,1","relate,7,2,23,1,92,1,105,1,97,3","related,2,4,4,2,14,4,7,28,87,4,23,2,24,7,43,4,45,1,61,1,84,2,88,15,92,5,95,15,97,15,106,1,109,1,113,1,210,1","relates,87,1","relating,14,1,88,1,97,2,115,1","relation,95,1","relations,14,1,87,3,23,1,95,1,97,1,110,3","relationship,14,1,7,2,87,4,24,3,27,1,42,1,45,1,61,2,62,2,63,2,105,1,97,2,118,1,113,1,117,1,211,1,213,1","relationships,14,4,7,1,87,1,23,1,62,1,97,1,109,1,116,1,211,2,212,1,213,3","relative,2,1,14,3,7,6,13,5,87,2,23,1,24,3,42,2,45,42,83,1,92,3,95,14,97,2,116,1,211,2,213,1","relatively,4,1,14,1,7,10,92,1,95,3,97,2","relatives,14,2,7,5,23,1,24,4,42,2,45,1,46,1,54,1,83,1,93,3,92,7,95,3,97,6,111,3,117,1","relax,21,1,110,1","relaxation,87,1,55,2,105,1,116,2","relaxed,111,1","relay,25,1","release,3,2,62,1,63,1,110,1","releases,97,1","relevant,14,1,7,1,87,1,83,2,92,1,97,1,106,1,117,1,212,1","reliability,14,1,7,1","reliable,3,1,14,3,87,1,23,1,88,1,89,1,95,2,110,1,111,1","reliance,7,2","relief,7,10,13,1,88,4,95,8,113,4,211,3,213,2","relies,18,1,7,1","relieve,4,1,7,1,87,1,95,2,213,1","relieved,213,3","relieves,84,1,213,1","relieving,2,1,95,2","religion,14,1","religious,87,1,110,1","relocations,111,1","reluctance,21,1,97,1","reluctant,46,1,95,2,97,1,118,1,210,1","rely,14,1,7,5,97,1","relying,97,1,111,1","remain,7,6,87,2,41,1,92,1,95,1,97,1,111,1,213,4","remainder,105,1,97,1","remained,7,1,111,1","remaining,88,2,92,1,97,3","remains,14,1,23,1,43,1,95,1","remarked,7,1","remarks,63,2,110,1","remedy,111,1","remember,26,2,43,16,45,2,46,2,110,1","remembering,87,1","remembers,46,1","reminder,23,1,42,1","reminders,87,1","reminding,46,1","reminds,46,2","reminiscing,24,3","remnant,46,1","removal,92,1","remove,23,1,60,1,92,1,118,1","removed,7,1","removing,97,4","renewal,21,1,23,1,97,1","rensco,37,1,118,1","rensselaer,1,1,37,1,43,6,54,1,90,1,118,4,115,1","rent,2,1,105,1","rental,23,35,45,1,110,1","reorganization,97,2","repair,2,1","repairs,7,55,43,1","repay,109,1","repayment,88,1","repeated,14,1,210,1","repeatedly,95,1,97,3","repeating,14,1","repine,88,1","replace,97,1,118,1","replaced,84,1,111,1,213,2","replacement,7,1,31,1","replicable,24,4,92,1","replicate,92,1","replicated,92,2","replication,87,1,24,4,92,3","repor,85,1","report,2,3,4,1,5,2,14,5,18,2,6,1,7,66,12,1,23,1,24,6,26,1,29,1,43,3,54,3,56,1,61,1,62,1,63,2,83,1,88,1,89,1,91,1,92,2,95,4,97,33,110,2,212,3,213,12,214,2","reported,2,16,14,1,7,9,24,4,95,22,97,54,213,16","reporters,110,2","reporting,7,13,25,1,89,2,97,5,210,1,213,6","reports,2,1,14,2,18,1,7,1,12,1,87,2,24,2,28,1,29,1,35,1,38,1,48,1,54,1,57,1,64,1,69,1,83,1,84,1,88,2,91,1,92,1,94,1,95,5,97,2,98,1,103,1","represent,7,2,87,3,83,1,88,2,95,1,97,4,210,1","representative,2,2,27,2,43,4,88,1,110,2","representatives,87,2,27,1,43,1,88,4,110,2","represented,7,1,92,1,97,1","representing,7,4,88,3,97,3,213,1","represents,4,1,87,1,97,4","reprinting,5,1","reprints,4,1","republished,45,1","request,20,1,87,1,43,2,88,3,97,4","requested,7,1,21,1,29,1,88,2","requesting,14,1,97,2,116,1","requests,92,2,97,1,116,1","require,5,2,14,1,7,4,87,2,43,3,88,3,92,1,97,7,110,1,213,1","required,14,3,7,6,29,1,43,2,45,1,83,1,88,2,92,1,97,12,109,1,110,3,111,2,113,1","requirement,14,1,7,107,45,1,97,4","requirements,3,3,5,1,14,2,7,20,83,3,88,1,97,6","requires,3,1,4,1,14,4,7,13,87,1,43,1,60,1,105,1,97,2,110,1","requiring,87,1,42,1,88,1,97,2,211,1","res,46,9","rescue,213,1","research,2,8,14,24,7,7,9,1,71,2,23,2,24,12,45,3,46,1,48,1,54,3,61,1,83,3,84,1,89,1,92,8,95,25,97,8,106,8,212,1","researched,86,1","researcher,97,1","researchers,14,3,7,2,21,1,54,1,93,1,92,1,95,1,97,1,122,1","resentment,23,1,83,1","reserve,6,1,7,1","reserved,15,1,16,1,17,1,18,1,19,1,7,1,11,1,12,1,20,1,28,1,29,1,31,1,32,1,33,1,34,1,35,1,36,1,37,1,38,1,39,1,40,1,41,1,44,1,48,1,49,1,50,1,51,1,52,1,53,1,54,1,56,1,57,1,58,1,59,1,64,1,65,1,66,1,67,1,68,1,69,1,70,1,90,1,91,1,94,1,98,1,99,1,100,1,101,1,102,1,103,1,104,1,107,1,108,1,113,1,115,1,214,1","reside,213,1","residence,42,2,118,1,117,1","residences,55,1,117,2","residency,14,1,7,1","resident,23,1","residential,97,1,117,1","residents,43,1,97,1,111,1","residing,43,1,97,1","resist,97,1,111,1","resistance,95,1,97,43","resolution,88,1,105,1","resolutions,109,1","resolve,7,1","resolved,27,1,113,1","resonate,87,1","resouce,122,1","resource,3,3,4,3,14,4,7,16,87,23,23,6,43,2,56,6,58,1,61,2,62,3,63,4,83,1,84,1,85,1,86,1,93,3,92,13,94,1,95,1,109,1,118,2,116,1,117,2,122,2","resourceguideforgpraisinggc,93,4","resources,3,2,4,1,14,11,15,1,16,1,17,1,18,2,7,22,11,1,12,2,13,3,21,2,19,1,20,1,87,16,23,6,24,8,28,3,29,1,31,1,32,1,33,1,34,1,35,2,36,1,37,1,38,2,39,1,40,1,41,1,42,2,43,7,44,1,45,5,48,2,49,1,50,1,51,1,52,1,53,1,54,2,57,2,58,1,59,1,60,2,64,2,65,1,66,1,67,1,68,1,69,2,70,1,86,1,88,25,89,1,90,1,91,2,93,12,92,24,94,2,95,8,97,14,98,2,99,1,100,1,101,1,102,1,103,2,104,1,107,1,108,1,110,6,118,1,112,1,115,1,117,3,214,1","resp,97,1","respect,14,3,24,4,27,1,88,1,110,3","respected,113,1,122,1","respecting,14,1,23,1","respective,7,1,117,1","respectively,7,1","respite,1,2,2,1,5,2,14,5,7,547,21,25,20,3,87,36,23,1,24,21,42,3,45,1,54,1,55,1,60,1,83,6,86,1,88,190,93,3,92,8,94,15,95,255,97,8,110,4,118,7,113,1,116,6,117,5,119,2,211,4,213,3","respite1,119,2,161,8","respiteanalysiszarit,95,4","respitehead,162,8","respiteprogram,20,2","respond,14,1,7,8,87,2,83,2,92,2,97,1,110,1,113,1","responded,7,5,61,1,97,4,213,2","respondent,7,24,42,4,97,17,210,1,211,2","respondents,2,4,7,80,46,1,62,1,95,1,97,74,210,2,213,13","responders,3,1,7,1","responding,3,3,4,1,7,4,23,1,60,1,97,3,210,1","responds,83,1,92,1,105,1","response,2,1,14,3,7,67,13,2,87,2,23,1,26,1,31,1,42,1,63,1,84,1,85,1,86,1,88,1,92,4,95,3,97,25,109,1,110,1,211,6,213,2","responses,3,2,14,1,7,27,13,1,71,1,87,1,23,1,24,8,42,1,83,1,92,2,95,1,97,20,211,1,213,1","responsibilities,2,4,14,3,7,5,13,1,21,1,71,1,87,1,24,2,45,3,46,1,60,1,84,1,88,5,92,2,97,3,113,1,117,1,213,3","responsibility,2,3,3,2,14,1,7,41,21,1,87,1,24,1,85,2,97,3,111,1,113,2,211,1","responsible,2,1,7,5,21,1,87,1,43,1,45,1,83,1,88,1,92,1,105,1,97,2,111,1,210,1","responsive,7,4,83,1,88,1,92,1","responsiveness,92,1","rest,23,1,43,1,97,1,109,1,211,2","restore,43,4","restraints,111,1","restrict,7,1","restricted,46,9","restrictions,14,2,97,1","restrictive,3,2,7,1,97,1,110,1","restructure,3,1","restructuring,3,2","rests,71,1","result,7,9,42,1,45,2,83,1,88,1,92,3,95,7,97,14,118,1,210,2,213,1","resulted,97,7","resulting,14,3,7,2,92,3","results,2,2,3,1,4,1,14,2,7,4,71,2,87,1,24,4,25,1,43,1,86,1,89,1,92,3,95,11,97,6,106,1,210,1,212,2,213,2,214,1","resume,95,1","resumed,46,1","retailers,97,1","retain,3,1,24,4","retains,87,1","retardation,7,2,92,2","retention,92,1","retire,46,1","retired,87,1,46,1,92,1,111,2,211,2,213,2","retirement,7,1,23,2,43,3,46,4,84,4,85,1,109,4,110,1,117,1,211,1","retrain,97,1","retraining,97,1","return,43,2,92,1,95,1,97,1,117,1,213,3","returned,7,1,23,1,46,2,95,2,97,1","returning,46,1,109,1","reunited,84,1,85,1","rev,23,1","reveal,14,1,7,2,61,1,95,1","revealed,7,1","revene,37,1","revenue,7,3,97,3","revenues,7,8,97,1","reversal,85,5","reverse,13,1,84,1,97,22,109,1","revert,7,1","review,3,1,5,1,14,5,7,6,25,2,31,1,43,4,45,4,60,1,63,6,88,4,94,1,95,12,97,9,110,1,122,1,210,1","reviewed,3,1,14,2,7,1,55,1,92,1,97,1","reviewing,88,1,95,1,97,1","reviews,92,1,95,1,97,3","revised,14,3","revisions,7,1","revoke,88,1","rewarding,14,1,88,1","rewards,14,2,23,1,85,1,116,1,211,1,212,1,213,2","rfa,3,4","rfenley,37,1","rfi,3,5","rfp,3,7,20,2","rget,92,39","rheumatoid,213,1","rhode,7,11,97,1","rhodes,23,1","rhonda,24,4,94,1","rhyvppr2,97,1","ri,97,23","rica,13,1,109,1","rice,2,1","rich,95,1,97,1","richard,7,1,54,1,92,1","richardson,92,1,97,1","richmond,92,1","rick,7,1","rides,92,1","right,3,1,4,4,6,3,7,1,23,1,27,1,43,3,45,1,95,1,97,12,109,1,110,1,118,1,213,1","rights,14,1,15,1,16,1,17,1,18,1,7,3,11,1,12,1,19,1,20,1,23,1,25,1,28,1,29,1,31,1,32,1,33,1,34,1,35,1,36,1,37,1,38,1,39,1,40,1,41,1,44,1,45,2,48,1,49,1,50,1,51,1,52,1,53,1,54,1,55,1,56,1,57,1,58,1,59,1,64,1,65,1,66,1,67,1,68,1,69,1,70,1,90,1,91,1,94,1,98,1,99,1,100,1,101,1,102,1,103,1,104,1,107,1,108,1,113,1,115,1,214,1","rigor,14,1","riihu,97,4","riihulqj,97,1","rikki,46,1","rin,7,1","ring,84,1","rise,4,1,7,1,21,1","risk,2,6,5,1,14,2,7,2,23,1,43,7,61,3,62,1,88,6,89,1,95,1,97,1,111,1,112,1","risks,7,1,61,1,92,1,95,1,111,2","rita,23,1","rite,111,1","ritual,46,1","ritva,37,2","rivate,7,5","rivers,23,1","riwhq,97,2","rjudpv,97,1","rm,7,1,97,1","rn,7,1,87,1,24,4,97,1,113,1,213,1","rns,7,1","road,23,1,84,1,85,1,92,3,95,1,97,1,109,1","roadways,110,1","rob,23,1","robert,14,1,7,1,87,2,23,3,36,1,37,1,97,7,111,2","roberta,92,1","robin,37,1,84,3","robinson,2,2,87,1","rochester,6,1,41,1,92,4","rock,85,2","rocking,84,1","rockland,37,2","roghu,97,2","role,2,11,5,2,14,13,7,17,71,1,87,5,23,3,31,1,41,1,42,1,46,1,54,1,60,1,61,3,62,2,63,1,83,2,85,4,92,7,95,2,105,1,97,5,110,1,113,7","roles,2,5,5,1,7,1,71,1,87,2,23,1,56,1,88,3,97,2,110,1,113,1","rolina,87,1","roll,3,1,4,1,97,1","rolla,46,1","roller,113,1","rollercoaste,113,8","rollercoaster,84,1,113,4","ron,8,1","ronda,61,1","ronnback,95,1","rood,15,1","room,4,1,25,2,60,1,92,1,97,4,110,1","rooms,4,1,14,1,60,2,97,1,111,1","rooted,14,1,113,1","roots,97,1","rope,117,1","rosalie,111,3","rosalynn,24,4,61,1,92,2","rose,14,1,7,1,87,4,23,1,37,1,92,1","rosello,87,1","rosemary,46,1","rosenbaum,7,2","ross,23,1,88,1","rotates,24,1","roth,7,2,109,1","rothbart,31,1","rothman,61,1,95,1","rough,14,1,45,1","round,24,3,52,1,111,1","roundtable,1,9","route,6,2","routine,61,1,62,1,85,1,92,1,95,1,117,1,213,1","routinely,87,1,45,1,97,1,113,3","routines,45,1,95,3","rovine,14,1","row,43,4,211,2","rowland,23,1","roxbury,4,1","royal,14,1","royalton,23,1","rp,7,1","rpelqdwlrq,97,1","rph,97,1","rpt,3,1","rq,97,1","rqh,97,4","rqhwklug,97,1","rqo,97,1","rr,37,1","rshudwlqj,97,1","rshudwlrq,97,1","rss,84,2,85,2,109,2","rst,7,1","rsvp,87,9,110,1","rswlrqv,97,1","rtainm,109,1","rtyhv2,97,2","ru,97,11","ruberson,23,1","ruh,97,1","rujdql,97,1","rule,88,1","ruled,7,1","rules,7,4,23,1,24,4,43,1,60,3,88,4,95,4,97,24","run,21,3,45,1,97,4,116,1,213,2","running,87,1,23,2,92,1,122,1","runs,23,1,92,1,116,1","rural,5,1,7,5,24,9,42,1,46,2,83,1,92,7,97,19,106,1,211,1","rushed,111,1","rusinowitz,31,2","russo,14,1","rutan,61,1","rutgers,7,1","ruth,31,2,111,1","ruthie,23,2","ruw,97,1","rv,7,3,97,3","rvw,97,1","rvwv,97,1","rwj,87,1,97,5","rwkhu,97,3","rx,43,2,62,2,97,1","rxfkhu,97,1","rxqvholqj,97,1","rxu,97,1","ryhu,97,1","rzhyhu,97,2","s00dace,43,1","s112s115,14,1","s121,95,1","s124,95,1","s131,95,1","s137,95,1","s267,7,1,95,1","s277,7,1,95,1","s84,95,1","s98,95,1","sacramento,21,3,92,5","sacrifice,46,1","sad,113,1","saddam,84,1,85,1,109,1","safe,14,2,43,2,45,2,46,1,118,1,111,1,213,1","safely,109,1,113,1","safety,14,1,23,2,88,1,92,3,97,1,111,2,117,1","sage,95,1","said,2,3,4,8,7,2,45,2,46,14,95,1,97,22,111,16","sails,97,1","sainsbury,14,3","salaries,106,1","salary,46,3","sale,21,1,46,1","saleebey,14,1","salem,88,1","sally,23,1","salvation,117,1","sam,95,1","samaritan,84,1,85,1,109,1,118,1","same,3,1,4,2,14,3,7,45,21,1,87,2,27,1,43,2,45,2,84,1,92,4,95,2,97,11,118,1,111,1,113,1,117,1,211,1","samoa,97,1","sample,2,2,14,1,7,5,24,4,62,2,63,2,92,1,95,9,97,9,210,1,213,1","sampled,213,1","samples,14,1,95,1,97,1","sampling,63,2","san,14,5,7,5,87,1,23,1,31,1,46,3,92,2,95,1","sand,84,1","sanderson,23,1","sandra,7,2","sandwich,23,1,84,12,85,14,92,1","sandwiched,46,1,84,1","sandy,63,3","sangl,2,1","sanity,213,1","santa,97,1","saperstein,95,3","sqth,97,1","sara,2,3","saraage1,37,1","saratoga,37,2,48,1","satisfaction,14,2,7,1,24,8,46,1,56,1,88,1,89,3,91,5,92,3,94,1,95,8,97,18,113,1,210,3,211,12,212,13,213,5,214,1","satisfied,13,1,24,4,43,1,89,1,95,2,97,2,211,3,213,3","saturday,211,1","saturdays,110,1","savanaugh,210,1","save,4,1,9,5,43,6,46,2,84,3,85,3,97,5","saved,46,2,97,2","savedate,9,4","saves,4,1,84,1,85,1,97,3,109,1,213,1","saving,26,1,43,3,97,4","savings,87,1,43,16,95,9,97,4,109,1","savvy,110,1","saw,97,2","say,4,4,7,26,26,1,42,3,45,4,46,1,84,2,95,1,97,11,109,1,110,2,113,1,211,9","saying,43,2,46,1,113,3","says,4,1,7,1,43,4,46,1,84,4,85,7,109,1,110,1","sb,7,12","sboot1,92,1","sc,7,229,97,1","scala,31,1","scale,14,2,15,1,12,1,13,2,87,1,24,23,97,22,110,1","scale finding,24,3","scaled,97,1","scales,14,2","scams,97,1","scandinavia,95,1","scandinavian,95,1","scanlan,4,1","scenario,95,1","scenarios,23,1","scene,95,1,111,1","scenes,84,1,85,1","schaffer,43,1","schaner,54,1","scharlach,95,3","schedule,87,2,45,1,46,1,95,1,105,1,97,1,106,2,110,2,113,2,116,2","scheduled,24,4,60,1,105,1,97,1,110,1,113,2","schedules,4,1","scheme,7,1","schenectady,1,1,37,1,43,7,48,1,54,1","schofa,37,1","schoharie,1,1,37,1","scholarly,111,1","scholarships,118,1","school,1,1,2,2,4,1,14,2,87,2,23,1,42,2,92,2,97,2,111,1,113,1,211,2,213,3","schooler,14,1","schools,88,1,110,1,118,1,111,1","schoolteacher,111,1","schultz,14,1,61,1","schulz,14,2,95,4","schuyler,37,1","schwartzberg,14,1","sciegaj,87,1","science,2,1,4,1,84,2,85,2,109,2","sciences,2,1,7,3,61,1,95,4","scientific,14,1,95,1","scooper,37,1","scope,14,4,7,16,87,1,88,1,92,1,97,8,110,4","score,13,6,97,12","scored,97,2","scorekeeping,113,1","scores,14,1,24,4,95,2,97,5,111,1","scoring,14,1,86,1","scotia,14,1","scott,24,4,31,1,37,1,84,2,85,2,109,1","scottl,37,1","scramble,97,1","scrambles,4,1","screaming,113,1","screen,86,1,88,1,97,1","screened,92,1","screening,3,1,14,5,7,1,87,2,62,1,63,1,86,5,88,2,92,2,97,2","screens,88,1","scripps,87,1,92,1","script,210,1","scripted,71,1","scripts,210,1","sd,97,15","sdlg,97,9","sdqvlrq,97,1","sduhqwv,97,1","sduwlflsdqwv,97,10","sdvw,97,1","sdwwhuq,97,1","seals,92,4","seamless,83,1","seams,84,1,85,1","search,4,1,15,1,16,1,17,1,18,1,11,1,12,1,19,1,20,1,28,1,29,1,31,1,32,1,33,1,34,1,35,1,36,1,37,1,38,1,39,1,40,1,41,2,43,1,44,1,45,1,46,10,48,1,49,1,50,1,51,1,52,1,53,1,54,1,57,1,58,1,59,1,64,1,65,1,66,1,67,1,68,1,69,1,70,1,84,1,85,1,90,1,91,1,94,1,96,12,98,1,99,1,100,1,101,1,102,1,103,1,104,1,107,1,108,1,109,1,111,1,115,1,214,1","searchable,7,1,23,1","searches,4,1","season,109,1","seasonal,57,1","seats,85,1","secluded,4,1","second,7,3,87,1,23,1,45,1,46,1,62,1,92,2,95,5,97,10,118,1","secondary,7,1,43,1,95,6,97,1,213,1","secretary,2,1,87,2,92,3,97,2","secrets,111,1,122,1","section,14,6,7,8,87,4,23,2,46,2,84,2,85,2,88,13,95,3,97,9,109,2,118,1,116,2,117,1","sections,14,2,7,1,23,2,43,1,48,1,88,2,97,1,110,1","secunda,23,1","secures,117,1","security,2,1,7,3,43,11,109,3,113,1,211,1","sedation,111,1","see,2,3,5,1,7,29,43,20,45,2,46,2,60,6,84,2,85,1,95,6,105,3,97,18,110,3,113,2,117,1","seed,20,1,87,1","seeing,4,1,13,1,46,2,86,1,97,1","seek,2,1,3,1,5,1,14,2,7,4,87,1,43,1,88,1,92,1,106,1,111,2","seeking,1,1,2,1,3,1,14,1,7,2,88,2,95,1,97,2,106,1","seeks,23,1","seem,26,1,45,1,95,1,97,5,110,1,113,1","seemed,97,6","seems,45,1,46,1,60,1,97,4,113,1,213,1","seen,14,1,23,1,95,1,97,19","sees,60,1","segment,4,1","segments,2,1,87,1,92,1,109,2","segregation,92,1","seizure,26,1","select,7,1,20,1,87,3,42,1,46,9,63,1,88,1,97,3,110,1,211,1,212,1,213,1","selected,5,1,14,1,7,44,87,3,63,2,83,2,88,5,92,1,95,26,97,1,110,1,117,1,213,1","selecting,23,1,97,3,110,1","selection,14,1,7,1,8,1,23,1,55,1,88,3,97,4","selects,88,1","selfassessments,61,1","selfcare,71,1","selfdetermination,87,1","selfdirected,92,1","selfdirecting,97,1","selfhelp,21,1","selfidentify,7,1,87,1","selfish,46,1","sell,97,1,111,1","sellers,109,2","selling,21,1,111,1","sells,97,1","semi,7,3,63,1,92,1","semiannual,88,1","seminal,14,1","seminar,92,1,95,1","seminars,1,1,87,1,24,4,48,1,95,2,117,1","semple,14,1,95,1","senate,55,1","senator,95,1","senators,88,1","send,87,1,27,1,42,1,45,2,55,1,60,1,62,1,97,1,110,2,118,1,122,1,211,1","sending,42,1,45,1,60,1,95,1,110,1,211,1","sends,87,1,60,2,105,1","seneca,37,2","senior,2,5,14,4,15,1,7,29,21,1,87,3,23,1,24,21,41,1,43,2,85,1,86,3,88,2,89,2,92,13,95,1,105,1,97,6,106,5,110,1,118,4,116,2,117,3,212,1,213,2,214,1","seniors,24,3,42,1,43,5,45,1,83,1,88,4,92,2,97,13,106,1,118,1,116,1,211,1","seniorservicesofalbany,92,1,105,1,106,1","sense,14,1,21,2,87,2,23,1,43,1,45,1,85,1,92,2,95,1,97,3,110,2,111,1,113,1,211,2,213,6","sensitive,14,2,83,1,88,2,92,1,111,1","sensitivity,14,1,86,1","sensory,7,33","sent,7,4,27,1,92,1,97,5,109,1","sep,7,18","separate,5,1,14,1,7,8,23,1,86,1,105,1,97,4,106,1","separated,23,1,42,2,211,1,213,1","separately,14,1,7,2,111,1,213,1","seps,7,5","sept,60,4,88,2,105,4","september,2,2,14,4,7,2,20,1,60,1,62,2,63,2,86,2,105,1","septemberdecember,7,1","septemberoctober,7,1","sequel,14,1","series,1,1,2,1,23,4,85,1,92,1,97,1,109,1,118,2,111,1,116,1,117,2","serious,2,1,7,3,46,1,97,9,113,1","seriously,14,1,7,2,43,4,45,1","serv,60,1","serve,5,1,14,1,7,12,87,10,23,2,27,1,43,1,45,1,63,1,83,2,88,8,92,6,95,1,97,10,106,1,110,1,117,1","served,2,2,14,2,7,38,87,4,24,4,42,1,89,1,92,2,95,1,97,8,113,1,211,1","serves,14,1,7,3,87,1,88,2,92,2,97,4,109,1,117,1","service,2,2,3,6,4,2,5,2,14,17,7,84,20,1,71,2,87,37,23,1,24,28,31,1,42,5,43,1,60,1,83,14,86,5,88,4,89,4,93,1,92,35,95,34,97,54,106,7,109,1,110,1,118,3,116,5,117,3,210,1,211,14,212,1,213,10","services,1,1,2,4,3,9,4,3,5,12,14,21,15,1,7,667,13,1,21,10,72,1,87,86,23,3,24,93,28,1,31,3,32,2,36,1,41,2,42,35,43,16,45,12,46,1,50,1,54,3,55,1,56,1,61,3,62,1,63,4,83,16,86,8,88,55,89,12,93,9,92,84,94,3,95,127,105,1,97,267,106,6,110,4,118,5,111,1,113,1,116,5,117,11,122,1,211,18,212,5,213,38,214,1","services1,7,1","servicing,92,1","serving,5,1,14,1,7,11,87,7,43,1,83,2,88,1,95,1,97,2,106,1","ses,95,1","session,1,1,7,1,87,1,55,1,88,1,92,1,105,4,117,1","sessions,1,1,3,1,24,5,92,2,105,1,97,1,117,4","set,3,1,14,2,7,7,21,1,71,3,87,1,23,2,43,1,45,1,46,1,60,2,61,1,92,2,95,2,105,1,97,2,110,3,113,1,116,1,117,1,213,1","sets,7,1,92,1,95,1","setting,3,3,14,1,71,1,24,4,43,4,92,3,95,3,97,4,106,2,113,1,117,1","settings,3,3,5,1,14,25,7,1,11,1,87,1,23,2,84,1,92,2,111,1","settle,14,1,45,2","settled,46,1","settlement,7,2,87,1","settles,46,1","settling,111,1","seven,14,2,7,8,87,2,23,2,63,1,97,4,118,1,111,1,210,1","seventeen,87,1","seventh,95,1","several,14,4,7,5,21,1,87,9,23,1,24,4,43,2,45,1,49,1,60,1,89,1,95,4,105,1,97,43,118,2,116,1,117,2,122,1,210,1,211,1","severe,14,2,7,1,26,2,97,1","severely,26,1,97,1","sex,2,1,42,1,46,1,109,1","sexual,23,1","sexuality,23,1","sfy,7,1","shaffer,37,1","shah,84,2","shall,3,1,88,26","shambhala,23,1","shamlian,85,3","shanas,14,2","shangrila,4,1","shape,7,1,45,1","shaped,87,1,88,1","shapes,7,1","shapiro,23,2","share,14,2,7,5,87,3,23,1,88,2,97,1,106,1,110,2,111,1,117,1,122,1","shared,2,1,87,1,23,1,24,3,46,2,60,1,88,2,97,1,113,1","shares,7,2,109,1","sharing,87,2,43,1,60,1,105,1,97,1","sharon,92,1","sharp,3,1,4,1","shashin,84,1","she,2,15,4,5,87,1,23,1,42,1,43,1,45,10,46,31,60,26,84,1,95,1,105,4,97,5,109,3,111,11,113,4,213,13","shea,95,2","sheet,21,2,43,9,62,3,63,2,93,6","sheets,14,1,23,1,45,1,57,1,93,1,110,1","shelby,92,1","shelter,46,1","shelves,117,1","shenk,23,1","sheridan,7,1","sheriff,1,1,118,1","sheryl,87,1,37,1","shflilfdoo,97,1","shield,7,2","shields,88,1","shift,4,1,14,1,7,4,46,1,97,1","shifted,14,1,97,1","shifting,92,1,118,1","shifts,7,1,87,2,97,1","ships,88,1","shocked,45,1","shooby,46,1","shoot,84,1","shooting,84,2,85,2,109,2,117,1","shoots,109,1","shop,43,1,97,1,109,1,213,2","shopping,87,1,24,4,42,1,84,3,85,3,92,1,97,2,109,1,113,1,116,2,211,2,213,5","shore,87,1","short,14,1,7,2,45,6,46,1,62,1,63,1,88,3,95,2,97,1,109,1,110,2,113,2,116,1,117,2,211,1","shortage,14,1,7,5,84,1,85,2,97,8,110,2","shortages,7,3,87,1,97,11","shortchange,97,1","shorter,2,6,14,1,7,1","shot,23,1","shots,57,1","should,14,13,7,9,13,2,21,1,20,1,71,1,87,15,23,3,24,4,26,1,27,1,43,43,45,20,54,1,60,1,61,1,84,1,85,1,88,1,92,1,95,12,105,1,97,12,106,2,109,1,110,11,111,1,113,6,116,1,210,7","shouldn,97,1,111,1","show,2,2,14,1,7,1,42,1,61,1,84,2,85,2,92,4,95,6,97,5,109,7,112,1","showcase,117,1","showcased,92,1","showcases,87,1","showed,95,6","showing,23,1,95,1,97,1","shown,2,3,7,15,71,1,87,1,95,1,97,4","shows,7,12,87,1,23,1,92,2,97,3,118,1","shrsoh,97,2","shufhqw,97,7","shulman,14,1,7,2,23,1,95,2","shuplw,97,1","si,97,1","sibley,92,1","siblings,97,2,109,1,111,1,213,1","sick,2,35,7,2,61,1","sicker,2,2","sickness,2,1,23,1","side,87,1,23,1,42,1,45,1,97,2,111,1,211,1","sides,97,1","sigford,92,1","sight,13,1","sign,46,1,84,2,85,2,97,1,109,2,110,1,111,1","signal,210,1","signals,97,1,210,1","signature,63,1","signed,97,1","significance,7,1,62,1,83,3,92,1,97,5,106,1,213,1","significance powerpoint,83,1","significant,2,3,5,1,18,1,7,7,87,1,88,1,92,1,97,15,106,2","significantly,2,2,7,1,43,1,95,2,97,12","signifies,7,1","signposts,63,1","signs,23,2,45,1","signup,21,1","silen,7,1","silo,7,1","silos,7,1","silver,23,1","similar,14,1,7,4,87,3,45,1,95,5,97,2,106,1","similarly,14,3,7,1,92,1,95,1,97,2","simon,31,2","simone,31,1,54,1","simple,14,1,45,1,85,1","simplify,7,1,97,1","simply,23,1,45,1,46,1,83,1,97,6,117,1","simpson,95,1","simultaneous,3,1","simultaneously,7,1,94,1,109,1","since,4,2,14,4,7,10,87,1,43,2,45,2,46,2,62,2,95,7,97,16,111,1,116,1,213,1","sincere,7,1,118,1,116,1,117,1","sincerely,7,1","sinclair,95,1","sing,46,1","singalong,46,1","singing,21,1","single,2,4,4,1,5,1,14,2,6,1,7,77,8,1,87,2,23,1,37,1,43,4,45,1,83,1,86,2,88,1,89,1,92,3,95,1,97,6,109,1,110,1,122,1","singles,43,2","sister,42,2,46,1,111,4,113,1,211,2,213,4","sisters,46,4","sit,7,1,213,2","site,2,1,4,1,15,2,16,2,17,2,18,2,6,1,7,1,11,2,12,2,19,2,20,1,72,1,87,5,23,17,24,3,28,6,29,2,31,2,32,3,33,2,34,2,35,2,36,4,37,2,38,2,39,2,40,2,41,2,44,2,45,1,46,1,48,2,49,2,50,2,51,2,52,2,53,3,54,2,56,3,57,2,58,1,59,1,64,2,65,2,66,2,67,2,68,2,69,2,70,2,83,1,84,1,90,1,91,2,94,2,95,4,96,4,97,3,98,2,99,2,100,2,101,2,102,2,103,2,104,2,107,1,108,2,109,3,110,6,115,1,116,1,117,1,122,2,214,1","site’s,24,1","sites,7,33,72,2,87,9,23,3,24,33,41,1,48,1,56,1,83,1,92,4,95,1,97,1,109,1,110,1","sitterly,37,1","sitting,97,1,113,1","situation,5,1,14,22,7,11,13,1,87,2,42,1,43,8,45,4,46,1,85,1,88,4,92,1,95,2,97,2,106,1,113,1,118,1,111,2,117,1,211,1","situations,14,3,87,3,23,2,88,4,113,1,118,1","six,2,2,14,3,7,14,71,2,87,2,24,5,61,1,88,1,89,2,92,5,95,2,97,7,110,2,118,1","sixfigure,46,1","sixteen,14,1","sixth,2,1,84,2,85,2,95,1,109,2","sixty,2,1,14,1,7,1,92,1","sizable,95,1,110,1","size,2,1,14,2,7,68,87,1,24,4,85,1,95,1,97,2,110,3","sizeable,7,2","sizes,97,7","sjr,7,1","sk,97,2","skaff,14,1,95,1","skawinski,43,1","skill,95,1","skilled,7,2,23,1,92,1,95,1,97,1,117,1","skilling,84,1,85,1,109,1","skills,14,20,7,1,12,4,21,1,71,3,87,1,24,4,46,1,88,1,89,1,92,11,97,4,106,3,117,1","skip,14,1,42,1,43,1,97,4,211,6","skipped,2,3","skrzv,97,1","skyrocketing,109,1","slash,109,1","slated,7,1","sleep,13,1,95,1,97,1,113,1","sleeping,45,1","sleeps,46,1","slide,27,1","slides,52,1","sliding,87,1","slight,7,1,95,2","slightly,2,1,7,2","slimb,43,1","slitting,4,1","slow,111,1","slurred,26,1","sm,7,1","small,14,1,21,2,20,1,92,2,95,12,97,11,110,1,213,1","smallest,97,1","smart,46,1","smegelsky,37,2","smith,2,2,14,3,7,2,87,1,85,1,106,1","smith institute,106,1","smitka,37,1","smolkin,111,7","smolkins,111,2","smooth,45,2","smoothly,45,1","snapshot,87,1","sni,37,1","snyder,95,1","soaring,4,1,7,1","social,2,3,3,2,14,23,7,35,13,1,20,2,71,1,87,5,23,2,43,17,45,8,88,2,89,2,92,18,95,10,97,3,109,2,118,2,111,2,117,2,211,3,213,2","socialization,21,2,113,1,117,2","societies,62,1,63,1","society,2,1,4,3,7,4,87,1,23,1,24,1,31,2,45,2,61,2,62,6,63,1,92,3,95,4,97,1,117,2","socio,7,32","sociological,14,1","sociologist,46,1,85,1","sociologists,14,1,46,1","sodlqhg,97,1","soft,46,1","softened,46,1","software,87,2,97,2","soldiers,111,1","solely,14,1,7,2,87,1,95,1","solicit,21,1,87,1,24,3,88,1,110,1","solicitous,111,1","solid,7,1,71,1","solo,46,1","solution,21,2,92,1,106,1","solutions,2,1,6,1,24,1,92,5,94,1,105,1,106,1","solutions”,24,1","solve,42,1,97,1","solver,46,1","solves,46,1","solving,7,1,87,1,24,3,88,1,92,1,106,3,117,1","somehow,118,1","someone,5,1,6,1,7,1,71,2,23,4,24,4,26,1,42,3,43,11,45,5,46,1,60,8,92,1,95,1,105,2,97,12,110,3,113,4,116,1,210,1,211,6,213,5","someplace,42,1,213,2","something,23,1,26,1,27,1,45,1,46,2,84,1,97,3,118,1,111,1","sometimes,14,1,7,3,23,1,45,6,46,2,88,1,95,2,105,2,97,3,113,4,118,1,111,1,211,2,213,4","somewhat,2,1,7,2,95,1,97,1,211,2,213,2","somewhere,97,1","son,87,1,42,4,116,1,211,2,213,2","song,110,1","sons,213,1","soon,45,4,85,1,110,2","sooner,5,1,87,1,43,1,46,1","sophisticated,95,1,97,2","sophistication,95,1","sore,111,1","sorrow,46,1","sort,46,1,97,3,109,1","sorting,43,1","sought,14,1,87,2","sound,71,1,213,1","sounding,21,1","soundtrack,46,1","soup,61,1,62,1","source,2,4,3,3,7,26,87,3,23,1,24,7,45,1,86,1,88,1,97,13,117,1","sourcebook,23,2","sources,14,1,7,55,71,1,87,3,43,1,45,1,46,2,62,1,88,2,95,1,97,15,110,1,211,1","sources7,97,1","south,14,1,6,2,7,15,87,1,23,1,55,1,92,5,97,2,116,2","southeast,83,1","southern,92,4","southwestern,87,1,92,4","sowle,37,1","sp,7,1,97,1","space,14,1,6,1,24,9,43,1,85,1,97,2,113,1,117,1","spacer,163,8","spaces,97,1,117,1","spain,87,1","spanish,2,1,23,1,42,1,83,1,97,1","spans,97,1","spares,46,1","spark,110,1","speak,14,1,27,3,42,1,43,7,45,3,62,1,63,1,95,1,110,1,118,1,210,1","speaker,8,5,118,1","speakers,1,1,41,1,110,2,117,1","speaking,14,4,24,1,43,1,83,1","speaks,23,1","special,6,1,7,2,8,1,21,1,23,2,45,3,64,4,83,2,86,1,88,28,89,1,92,3,95,2,97,2,110,3,116,2,117,4","specialist,2,3,72,1,87,8,24,4,62,1,63,1,92,1,106,1,111,1,117,1","specialists,5,1,6,1,7,1,87,7,92,2","specialize,21,1","specialized,14,1,87,3,92,2","specific,14,19,7,20,20,1,87,11,41,1,43,1,45,2,60,1,62,1,83,1,88,3,89,2,92,2,95,3,97,19,106,1,110,1,117,2,212,2,213,2","specifically,1,1,5,1,14,1,7,105,87,4,24,4,45,1,92,2,95,4,97,7","specified,7,2,43,3,88,1,97,2,110,1","specify,14,1,42,6,97,1,211,9","spectrum,7,1,87,2","speech,26,1,97,1","speeding,7,3","spell,13,1","spelled,45,1","spend,21,1,87,3,24,1,27,1,43,1,95,1,97,3,213,4","spenddown,43,3","spending,7,6,45,1,97,6","spends,14,1","spent,14,3,7,2,46,1,95,1,97,1,111,3,213,1","spillover,95,1","spin,118,1","spinster,46,1","spirit,87,1","spiritual,23,2","spirituality,14,1","spite,97,4","split,7,1,92,1,118,1","spoiling,23,1","spoke,45,1,60,1","spoken,118,1","spokesman,4,1","spokesperson,87,1","sponsor,7,2,29,1,62,1,63,1,117,1","sponsored,9,1,23,1,43,1,84,1,85,1,88,2,109,2,118,1,117,1","sponsors,87,2,84,1,85,1","sponsorship,7,1,87,1,83,1","spoon,46,1","spore,95,3","sports,84,2,85,2,109,2","spot,85,1","spots,55,2","spousal,61,2,92,2","spouse,2,2,14,1,7,1,87,1,23,1,42,1,43,1,45,1,61,2,92,2,95,3,97,1,106,2,211,1,213,1","spousecaregivers,95,1","spouses,2,2,7,1,21,2,23,1,24,3,46,1,92,1,95,2,105,2,97,6,106,1,117,1","sprawling,111,1","spread,7,1,24,4","spring,3,2,117,1","springer,14,2,23,2,95,1","springfield,92,1","spss,7,2","square,92,1","squeeze,23,1,84,3","sr,24,3,119,1","src,2,1","srcp,7,8","srmt,37,1","srr,97,1","srvhprshvrqhqryrprq,97,1","srvhprsvqrhtrpvr,97,1","srvhprvuv,97,1","sryhvruyvrvuphrtvr,97,1","ss,7,1,95,2,97,1","ss103,95,1","ss94,95,1","ssa,43,5","ssi,7,2,43,5","ssistant,87,1","ssistive,7,42","ssoci,13,1","sstone,37,1","ssvpvhy2,97,1","sswlhc,45,1","stability,2,1,88,2,92,1","stabilize,88,1","stabilized,95,1","stable,7,1,31,1,45,1,95,2,109,1","stacey,92,1","stachow,37,1","staff,2,1,3,1,14,8,6,1,7,22,21,3,72,1,87,14,24,36,25,2,41,1,43,4,45,1,55,1,61,1,62,3,63,5,83,1,86,6,88,2,92,11,95,3,97,38,106,1,110,3,111,1,117,4,212,2,213,2","staff”,24,4","staffed,1,1,24,4,92,1,97,1","staffing,4,1,72,1,24,6,97,1","stage,7,1,92,4,95,5,97,2,110,1","stages,87,1,23,2,46,1,89,1,92,3,95,1,97,3","stake,110,1,111,1","stakeholder,3,6,92,1","stakeholders,7,2,92,1","stamps,43,1,97,1","stand,14,1,7,1,43,1","standard,43,4,96,4","standardization,14,1","standardize,14,1","standardized,5,1,14,2","standards,2,1,3,3,86,1,92,3,97,1","standing,87,1","standr,92,1","starbucks,46,1","start,3,1,6,1,7,4,20,2,23,1,24,3,26,1,27,1,43,2,45,2,60,1,62,1,63,1,88,1,97,2,110,1,117,1","started,7,1,26,3,43,3,45,2,84,1,97,15,211,2,213,1","starting,7,3,92,2,97,4,109,1,117,1","starts,7,1,43,1,46,1","startup,97,1","state,1,1,2,1,3,9,5,1,14,18,6,7,7,1148,11,1,13,1,72,1,87,18,23,4,24,19,27,1,28,1,31,1,37,1,41,5,42,1,43,17,45,1,48,1,54,2,55,5,56,3,61,1,63,1,83,16,84,1,85,1,86,3,88,19,89,9,93,2,92,42,95,6,97,319,109,2,110,4,113,3,118,2,116,1,117,1,122,1,213,1","state’s,83,2","stateadministered,7,2","statecdsurveydec2004bynasuaandncoa,97,4","stated,213,1","statefunded,7,17","statefunded,7,1","statement,3,1,7,1,45,2,113,2","statements,97,2,213,3","states,2,7,3,3,5,16,14,11,7,394,87,6,23,1,24,4,45,2,46,1,54,2,62,1,83,3,93,1,92,14,94,2,95,7,105,1,97,226,104,1","states10,7,1","states11,7,1","states12,7,1","states13,7,1","states16,7,1","states18,7,1","states19,7,1","states20,7,1","states25,7,1","states26,7,1","states29,7,1","states30,7,1","states31,7,1","states32,7,1","states7,7,1","states8,7,1","states9,7,1","statewide,3,2,14,8,7,114,87,2,24,4,83,2,86,1,88,10,89,1,92,3,95,2,97,6","stating,43,1,210,1","station,46,3","stations,62,1","statistically,2,2,92,1,97,2","statistics,7,1,97,2","status,2,17,3,1,5,1,14,16,7,52,87,13,42,1,43,1,61,1,88,1,92,1,106,1,211,2,213,2","statute,88,1","statutes,7,1","statutorily,3,1","statutory,7,3","stauffacher,23,2","stay,5,1,6,3,23,1,25,1,27,1,43,6,45,6,88,2,95,1,97,4,109,2,118,1,211,1,116,2","stayed,60,1,111,1","staying,43,1,95,1,97,1,213,1","stays,2,6,5,1,14,1,7,1,45,2,46,1","steenberg,14,1,7,3","steerforth,23,1","steering,3,1,14,1,88,2","steinberg,14,1,7,2,95,2","stems,5,1","step,2,1,87,1,23,4,42,12,43,1,83,2,95,2,97,1,110,16","stepby,23,1","stephens,14,3,7,2,95,4","stepping,60,1","steps,2,1,3,2,7,3,13,1,27,1,45,1,61,1,83,2,88,1,89,1,105,1,97,4,106,1","sterling,23,1","steuben,1,1,6,1,8,1,37,2","steve,7,1,61,1","steven,14,1,92,1,95,2","stevenson,6,1,37,1,90,1,107,1,115,1,117,11,119,2","stick,84,1,109,1","stigma,118,1","still,4,1,5,1,14,2,7,4,42,1,43,6,45,2,84,1,95,2,97,14,110,1,111,1,117,1,210,1","stimulate,7,1,21,1,92,3","stimulation,21,1,95,3","stimulus,97,1","sting,109,1","stingy,95,1","stipend,42,1,211,1","stny,37,1","stockpiled,109,1","stomach,13,1","stone,2,1,14,2,87,1,37,1","stop,23,1,45,1,86,1,95,2,109,1,113,1,213,1","stopped,95,3,211,1,213,1","stoppers,95,1","stopping,95,1,113,1","storage,210,1","store,97,2,117,1","stored,210,1","stores,4,1","stories,23,5,24,6,84,3,85,1,97,4,109,3,117,1,122,1","storming,106,1","story,14,1,6,3,23,1,46,1,84,2,85,2,97,1,109,2,110,1","storyteller,1,1","storytelling,1,1","stove,213,1","stoyell,37,1","straight,4,1","strain,2,1,5,1,14,3,7,41,87,1,46,1,92,1,95,17,106,1","strained,7,2,13,1","straining,84,1,85,1","strains,213,1","strangeness,95,1","strangers,23,1","strategic,2,1,7,2,88,3,97,2","strategies,2,6,5,1,14,6,7,3,87,12,24,3,41,1,55,1,63,12,83,1,86,1,88,1,92,9,95,2,97,2,117,2","strategy,7,3,87,1,62,1,63,2,95,1,97,1,117,1","stratified,63,1","strauss,7,2","stream,7,1","streamline,24,4","streamlines,83,1","streams,86,1,92,1,95,1,97,2","street,5,1,14,1,13,1,72,1,23,2,24,4,42,2,88,1,92,15","streetcars,4,1","streib,14,1","streiner,95,1","strength,117,1","strengthen,3,1,14,1,7,12,63,1,92,2","strengthening,5,1,92,1,97,1","strengthens,88,3","strengths,14,18,88,4,92,1","stress,2,1,5,1,14,8,7,6,13,1,87,1,24,13,42,2,45,2,55,1,61,2,88,3,92,6,95,23,97,1,118,1,211,2,117,1,213,9","stressed,23,1,88,1,210,1","stresses,45,1,92,1,95,1","stressful,14,1,13,2,85,1,95,1,213,2","stressors,14,2,7,1,95,13","stressrelated,4,1","stretched,97,1","strict,43,1","strictly,87,1","stringent,95,1","strive,87,1","stroke,14,1,87,1,45,2,85,1,111,3","strong,2,1,5,1,71,1,23,2,88,3,95,1,97,10,118,1","stronger,56,1,95,1,97,3,116,1","strongest,118,1,116,1","strongly,14,2,7,1","structure,2,5,5,1,14,4,7,38,88,1,105,1","structured,7,3,63,1,83,1,92,2,95,1,111,1","structures,7,1","structuring,105,1","struggle,4,7,14,2,7,1,23,1,46,1,56,1,84,1,122,1","struggling,85,1,210,1","stuck,105,1","student,1,1,84,1,85,1,109,1","students,21,1,84,1,93,1","studied,14,2,7,1,95,2,111,1","studies,2,2,14,4,7,4,46,1,54,3,61,1,95,40","studio,23,1","studios,110,1","study,2,3,14,6,7,183,87,1,46,3,54,2,61,1,84,1,92,3,95,38,97,6,111,1,212,2,213,3","stuff,46,1","stump,105,1","sua,7,21,87,7,83,1,92,2,97,3","suas,7,4,87,6,83,2,97,4","sub1,11,4,31,4,39,4,49,4,65,4,99,4","sub2,15,4,32,4,50,4,66,4,100,4","sub3,16,4,33,4,40,4,51,4,67,4,101,4","sub4,17,4,34,4,41,4,52,4,68,4,102,4","sub5,18,4,35,4,53,4,69,4,103,4","sub6,19,4,36,4,54,4,70,4,104,4","subcommittee,88,4","subcommittees,88,1","subcontract,7,1","subcontracted,7,1","subcontracting,87,1","subject,7,1,92,1,97,4,118,1,116,1,117,1","subjected,109,1","subjective,14,2,24,14,92,1,95,5","subjects,7,1,95,1,97,1","submission,29,1,108,1","submissions,55,1","submit,1,1,12,1,28,1,29,4,38,1,48,1,57,1,63,1,64,1,88,2,91,1,94,1,95,1,97,2,98,1,108,4,116,1,117,1","submitted,21,1,29,1,88,1,93,1","submitting,97,3","subscribe,4,1,113,2","subscribers,87,1,46,1","subscription,1,1,71,1","subscriptions,63,1","subsequent,7,1,91,1,95,1","subsequently,118,1","subset,14,1,24,4,97,1","subsidies,95,2","subsidized,4,2,87,1,95,1","subsidy,7,9,42,1,95,1,211,1","subsisting,109,1","substance,93,1","substantial,7,2,97,2,109,1,213,2","substantially,14,1,7,4","subtherapeutic,95,1","suburban,71,1,42,1,110,1,211,1,117,1","succeed,116,1","success,7,1,21,2,46,2,61,1,63,2,88,1,92,1,95,2,97,21,110,2","successes,6,1,7,2,97,2","successful,1,1,5,1,14,1,7,3,87,1,54,1,64,1,66,1,92,2,95,1,97,7,106,1,110,1,116,1,122,1","successfully,71,1,23,1,92,1,97,1","sudden,45,1","suddenly,113,2","sue,37,2","suffer,85,1,113,1","suffered,14,1,85,1","suffering,95,2","sufficient,14,1,95,6","sufficiently,95,1","suffolk,37,1","suffolkcountyny,37,1","sugar,213,1","suggest,14,4,7,3,61,1,95,7,97,1","suggested,14,1,43,23,60,1,111,1","suggesting,95,1","suggestion,55,1,111,1","suggestions,7,1,87,1,45,1,55,1,83,1,105,1,106,1,110,2,113,1,213,1","suggests,14,3,95,2,111,2","suicide,14,1,23,2","suit,4,1","suitability,14,1","suitcase,46,1","suite,14,1,71,1,72,1,23,2,24,4,43,1,92,15,110,1","sullivan,14,1,37,1","sulpdu,97,1","sum,97,6,109,1","sumissions,122,1","summaries,87,1,83,1,92,1","summarize,7,1,43,1","summarized,97,2","summarizes,5,1,14,2,97,1","summarizes state,83,1","summarizing,105,1","summary,14,2,7,3,21,1,87,1,24,1,54,1,60,1,95,5,105,1,97,2","summed,97,1","summer,3,1,7,2,88,1","summit,1,1,6,4,8,1,52,1,55,1,56,2,62,5,88,2","sums,97,1","suncoast,92,2","sunday,211,1","suny,106,1","supergroup,4,1","superior,4,1","supermarket,111,1","supervise,14,2,7,1,45,1,111,1","supervised,24,3","supervising,4,1,14,1,97,3","supervision,14,1,7,13,87,1,24,4,45,1,88,2,95,1,97,3,117,1","supervisor,4,1,87,1,23,1,42,1,211,1","supervisors,97,4","supp,95,2","supplement,2,1,4,1,14,2,43,1,60,1,95,1,97,1,213,1","supplemental,2,1,5,1,7,41,42,2,43,3,83,1,92,4,97,1","supplemented,97,2,109,1","supplementing,60,1","supplies,7,40,87,1,24,8,43,1,93,1,92,1,97,1","supply,97,5","supplying,7,1","support,1,6,2,20,3,1,5,15,14,39,15,4,16,4,17,4,18,5,7,564,11,4,13,2,21,4,19,4,20,5,71,1,87,49,23,6,24,31,31,6,32,4,33,4,34,4,35,4,36,4,38,1,39,4,40,4,41,4,42,20,43,1,45,11,46,1,48,1,49,4,50,4,51,4,52,4,53,4,54,8,56,6,58,4,59,4,60,13,61,3,62,3,65,4,66,4,67,4,68,4,69,4,70,4,83,13,86,2,88,19,89,3,90,4,91,1,93,4,92,84,95,9,105,15,97,53,98,10,99,8,100,8,101,8,102,8,103,8,104,9,106,2,107,4,109,1,110,2,113,3,118,8,211,14,115,4,116,9,117,5,119,2,212,11,213,7,214,5","support1,119,2,164,8","supported,7,1,21,1,24,4,45,1,61,2,62,1,63,2,83,3,88,1,92,1,97,8","supporthead,165,8","supporting,2,1,7,6,20,1,87,5,23,1,54,2,83,2,88,2,92,1,97,4","supportive,7,5,87,1,31,1,32,1,92,5,95,1,105,1,97,3","supports,3,2,14,4,7,10,87,1,45,1,54,1,63,1,83,8,86,1,88,5,92,2,97,2,116,1","supposed,95,1","supreme,7,1,83,1","sur0udpv,97,1","sure,7,1,26,1,42,4,43,3,45,4,60,1,97,8,109,5,110,8,113,1,210,1","surfaced,110,1","surgery,45,2,117,1","surjudp,97,17","surjudpv,97,53","surklelw,97,1","surprised,97,1,116,1","surprises,105,1","surprising,7,2,95,1,97,1","surprisingly,7,4,21,1,95,2","surprwlqj,97,1","surrender,43,1","surrogate,5,1,97,2","surrounded,23,1","surrounding,23,1","surry,23,1","survey,2,16,5,1,14,2,7,55,24,16,28,1,31,1,42,22,52,1,56,1,61,3,62,1,63,1,89,1,91,1,92,6,97,81,110,1,211,14,210,12,212,19,213,24,214,6","surveyed,14,1,7,7,92,1,97,3,213,2","surveys,4,1,7,9,63,1,88,1,97,23","survival,14,1,23,1","survive,23,3","survived,113,1","survives,46,1","surylgh,97,2","surylghuv,97,10","surylghv,97,1","susan,23,1,31,1,97,1","suspect,26,1","suspicion,97,1","suspicious,43,3","sustain,5,2,7,8,45,1,118,1,116,1,117,1","sustainable,92,1","sustained,92,1,95,1","sustaining,1,2,92,1","suvey,213,2","svcs,7,89","sw,88,1","swap,21,1","swapping,21,1","sweden,95,3","swedish,95,2","sweet,46,1,62,1,63,1","switch,7,1,43,1,97,2","switching,43,4","switzer,14,2","sylvie,23,1","symposium,7,1","symptom,26,1","symptoms,14,1,25,2,26,4,45,2,57,1,83,1,95,5","synagogue,117,1","synagogues,110,1","sync,97,1","syndrome,112,1","synopsis,29,3,50,1","synthesising,83,1","synthesize,54,1","synthesized,92,1","syracuse,1,1,6,4,8,1,55,1","syracuse1,55,4","system,2,7,3,7,5,2,14,11,7,105,87,13,23,1,24,16,27,1,45,2,49,1,83,6,84,1,85,1,86,1,88,12,92,13,95,3,97,32,110,1,113,1,111,2,117,3,213,1","systematic,5,1,14,7,7,5,92,1,95,4","systematically,14,3,89,1,92,1","systemic,7,1,87,1,83,4,92,3","systems,5,3,14,3,7,38,87,4,54,1,83,3,86,2,88,2,89,2,92,9,97,24","ta,7,2,63,4,92,29,97,3","tab,1,1","table,2,12,14,6,7,9,24,3,43,1,46,1,52,1,83,1,85,2,95,1,97,43,110,1,116,1","tables,7,5,97,3","tablet,84,1","tabling,106,1","tabulations,7,1","tackle,97,1","tackles,23,1","taddei,37,1","tags,110,1","tai,92,1","tailor,5,1","tailored,92,4","tailoring,111,1","take,2,3,14,4,7,8,13,1,21,2,71,1,87,1,23,3,25,1,27,3,42,1,43,14,45,5,46,6,54,1,60,1,61,1,62,1,84,1,88,3,92,2,95,3,97,16,106,1,109,2,110,2,113,9,118,3,211,1,111,4,116,3,213,3","taken,14,1,7,1,45,1,83,2,95,1,97,2,110,1,113,1,118,1,211,3,213,1","takes,14,1,7,1,71,1,87,2,23,2,42,1,43,1,45,2,46,1,84,1,85,1,88,1,95,1,109,1,110,1,113,1,211,2","taking,5,1,14,1,7,3,23,1,24,4,43,3,45,1,46,1,84,2,88,1,92,1,95,1,97,5,106,2,109,1,113,2,211,2,111,1,117,2,213,1","talents,87,1","talk,3,1,7,1,87,2,23,3,27,1,42,1,43,5,45,2,84,3,85,1,105,1,97,1,109,2,211,1,117,1,210,2,213,1","talked,97,1,109,1","talking,7,1,21,1,43,1,45,1,46,1,59,2,97,3,109,1,112,1","talley,61,1","tamara,106,2","tammy,37,1","tammyz,37,1","tanf,7,1","tangible,24,1","tap,14,1,6,1","tape,71,1,46,1,95,1","tapes,87,1","tapping,7,1,97,1","tarbell,37,2","target,14,2,7,4,87,11,29,1,56,1,83,1,86,1,92,6,97,1,110,1,122,1","targeted,2,1,7,5,45,1,88,1,92,3,97,1","targeting,7,1,87,1,92,1","targets,7,1,87,1,92,1,95,1","task,3,1,14,1,7,71,87,1,45,1,46,2,88,1,97,2","taskforce,7,1","tasking,109,1","tasks,4,1,14,23,7,1,87,2,24,1,42,1,45,3,92,1,95,3,97,7,211,1,210,1,212,1","tasting,46,1","tastrom,37,2","tate,7,48","taught,71,1,92,1,97,1,110,1","tax,2,3,7,1,23,1,42,1,97,9,211,1","taxable,97,1","taxes,43,1,97,5","taxi,110,1","taxing,111,1","taxonomy,31,1","taylor,4,1,37,2","tbi,3,1","tcsg,92,1","tea,55,2,116,2","teach,7,1,71,1,45,1,92,5,97,1","teacher,93,1","teaches,23,2","teaching,23,1,45,1,97,1","team,3,1,14,1,7,3,71,1,87,1,61,2,62,1,88,1,89,1,92,10,97,2,111,1","teams,7,1,97,2","teamwork,92,1","tear,42,1","tech,84,2,85,3,109,2","technical,7,15,21,1,58,1,61,1,62,1,63,6,88,6,92,9,97,5,106,1","technically,111,1,117,1","technician,4,1","technique,63,1,97,1,110,1","techniques,7,1,45,3,92,2,117,1","technological,87,1","technologies,7,1,92,1","technology,3,1,7,49,20,1,87,9,60,2,92,4,95,1,105,1,97,2,106,4","tee,110,3","teens,23,1","tel,2,1","telecare,87,1","teleclass,105,3","teleclasses,105,8","teleclassleader,105,1","telecommunications,4,1","teleconference,60,6,105,5","teleconferences,92,1","teleconferencing,92,1","telecourses,105,1","telemedicine,7,1","telenet,37,1","telephone,2,2,14,4,7,18,87,1,24,8,27,2,37,1,42,1,43,6,56,1,62,1,63,1,86,1,88,4,92,7,105,12,97,12,98,1,106,5,211,2,116,1,117,1,212,1","telephonesupportdenisebrown,105,4","telephonesupportgroup,106,8","telesupport,105,2","television,87,1,45,1,62,2,63,1,92,2,97,1,110,2","televisions,85,1","tell,14,1,7,1,43,1,46,1,97,1,211,3,210,3","telling,43,2","tells,7,1,45,1,46,1,109,1,210,1","temper,95,1","temperamental,111,1","tempered,46,1","template,62,1,63,1,97,1,107,4","temporarily,7,1,46,1,113,1","temporary,7,1,42,1,88,1,95,5","tempted,43,1","tend,21,1,55,1,97,4","tending,111,1","tends,97,1,118,2,111,1","tennenbaum,14,1","tennessee,7,6,97,1","tennstedt,95,2","tension,7,1,87,1,24,3,213,1","tentative,3,2","tenuous,2,1","tepper,94,1","teri,14,1","term,3,3,5,4,14,16,18,1,7,100,21,3,87,10,23,9,24,1,31,5,43,2,45,7,49,1,83,2,88,4,92,4,94,1,95,6,97,33,211,2,111,5,116,1,117,3","terminal,23,1","terminally,23,1","terminate,42,1,97,2,211,2","terminology,7,1","terms,2,2,7,4,87,1,23,1,60,1,84,1,85,1,97,9,109,1,210,1,213,1","terra,23,30","terrace,43,1","terrible,113,2","terrific,110,1","territorial,97,7","territories,97,2","terry,7,1","test,2,3,14,1,25,1,41,1,92,6,95,1,97,1","tested,14,4,7,1,71,1,87,1,89,8,92,1,97,3","testify,88,1","testimony,23,1,110,2","testing,14,1,7,1,89,1,92,3,97,1","tew,95,1","texas,7,7,62,1","text,87,2,97,2,119,1","textoriented,87,1","thank,7,1,27,1,42,1,43,4,55,1,56,1,97,3,108,1,110,2,211,2,210,1,213,1","thankfully,109,1","thanks,3,1,7,1,108,4,118,1,116,1,117,1","thear,92,1","thearc,38,1","theater,85,1","theclock,111,1","thefamilycaregiver,56,2","thehospice,92,1","theme,14,1,7,1,95,1,97,1","themes,7,5,21,1,24,8,97,1","themselves,2,3,5,1,14,3,7,2,21,2,71,2,87,5,23,2,61,1,62,1,84,1,85,1,88,3,92,2,95,3,105,1,97,10,109,1,113,5,118,1,116,3","theoretical,23,1","theory,7,2,45,1,95,4,111,1","therapeutic,14,2,95,3","therapeutically,95,1","therapies,55,1","therapist,1,1","therapists,92,1,111,1","therapy,45,3,92,2,97,4,117,1","thereby,88,1,92,1,95,1","therefore,14,1,7,3,41,1,60,2,83,1,95,1,97,2,110,1,113,2,213,1","theresa,23,1","therese,92,1","thing,4,1,46,1,97,8,113,1,213,1","things,1,1,7,1,23,3,26,1,27,1,45,1,97,17,113,4,211,1,111,1,213,3","think,7,4,42,1,43,3,45,2,60,1,105,1,97,13,106,1,110,2,113,1,118,1,211,2,116,3,213,2","thinking,7,1,42,1,45,3,97,2,110,1,113,1,211,1","thinks,60,2,97,1","third,2,5,7,13,45,2,46,1,92,2,95,4,97,13,116,1,213,2","thirds,2,1,7,4,97,1","thirteen,97,1","thirty,14,3,95,1,97,2","thomas,23,1","thompson,14,1,7,2,23,1","thorny,84,1,85,1","thorough,7,1","thoroughly,87,1","those,1,1,2,7,3,1,4,2,5,1,14,4,7,24,20,1,87,2,23,3,24,9,41,1,43,7,45,2,46,4,60,1,61,1,85,1,88,2,92,6,95,8,105,1,97,40,109,1,113,2,118,1,211,1,111,2,213,2","though,14,1,7,1,21,2,43,1,45,4,95,5,97,1,111,1","thought,2,1,23,1,97,4,118,1,213,1","thoughts,43,3,113,1","thousand,23,1,117,1","thousands,7,131,84,1,85,1,97,2","thrhrqvphvqyhyrhq,97,1","thread,60,1","threads,24,3","threat,87,1","threatened,97,1","threatening,26,1,97,1","three,1,1,2,4,5,3,14,4,7,64,21,1,20,1,87,2,23,3,24,6,41,2,43,1,45,1,61,1,62,1,63,1,83,1,86,1,92,12,95,14,105,1,97,20,109,3,111,2,117,1,213,1","threefifths,2,1","threshold,97,1","thrills,84,1","throat,4,1","through,2,4,4,1,5,1,14,3,6,2,7,32,71,2,87,12,23,2,24,24,27,2,43,17,45,3,46,1,54,2,55,1,60,3,61,1,62,2,63,1,83,2,86,1,88,7,89,1,92,33,95,3,105,1,97,24,106,1,110,2,113,2,118,2,211,1,116,1,117,3,213,3","throughout,3,1,7,8,87,2,43,1,45,2,55,2,88,1,92,2,95,1,97,1,113,1,116,1,117,2","thrust,92,2","thruway,6,2","thursday,20,1,46,2","thursdays,117,1","thus,7,4,87,1,60,1,92,1,95,1,111,2,212,1","tianna,105,1,106,1","tice,14,3","tide,24,4","tied,97,1","ties,93,1","tight,23,1","tile,151,8","till,109,2","tilly,7,2,31,1","timbury,95,2","time,1,1,2,11,4,2,14,13,7,14,13,2,21,8,87,14,23,5,24,25,25,1,26,5,27,2,29,1,42,8,43,15,45,13,46,11,54,1,56,1,60,7,62,1,84,2,85,1,86,1,88,6,92,5,95,22,105,1,97,19,106,1,109,3,110,11,113,4,118,4,211,20,111,2,116,4,117,7,210,4,213,29","timeline,3,4","timely,27,1,43,1,89,1,95,3,97,1","times,2,3,4,10,7,2,87,1,46,10,49,2,56,1,61,1,62,1,95,2,110,1,113,1,211,1,111,4,112,1,116,1,117,1,122,2,210,3","timesselect,46,1","timing,14,1,97,1","tin,97,1","tiny,46,2,97,1","tio,7,1,95,1,97,3","tioga,37,1","tiogaopp,37,1","tip,43,4,45,3,46,1,62,2,63,2","tips,23,1,27,2,43,5,53,1,60,1,62,2,92,1,109,1,113,4,212,1","tired,46,1","tiring,14,1","tis,109,1","title,6,1,7,37,29,4,45,1,56,1,61,4,62,4,63,5,87,12,92,5,97,14,122,1","titled,54,1","titles,23,1","tiv,95,1,97,1","tjcog,87,1","tly,7,1","tmoscinski,105,1,106,1","tnekvapil,37,1","to10,117,1","tobacco,7,2,87,1","today,14,3,7,2,71,1,43,1,53,1,61,1,62,1,63,2,84,4,85,4,109,21,112,1,117,1,122,1","toddler,4,1","toes,97,1","together,3,2,6,1,7,3,23,1,43,3,45,1,60,1,87,2,88,2,92,1,95,1,97,2,110,5,113,1,111,3,117,2,213,1","toileting,42,1,211,1","told,46,1,97,2","toledo,23,1","tolerate,113,2","toll,7,6,71,1,45,1,61,1,85,1,86,1,93,1,92,1,95,1","tom,31,1","tomorrows,23,1","tompkins,37,2,89,1","tone,97,1","toner,94,1","toni,37,1","tonusc,92,1","too,2,2,4,1,14,1,18,1,7,6,23,1,26,1,46,2,60,2,95,2,97,3,111,2,116,2,213,1","took,4,1,46,2,105,1,97,5,118,2,211,1,213,5","tool,5,1,14,33,15,1,7,83,71,1,24,4,43,2,45,2,83,1,86,5,92,5,95,2,97,1","toolbox,62,2,63,2","toole,23,1","toolkit,57,2,92,3","tools,5,1,14,34,7,3,71,13,46,1,50,1,62,1,63,2,84,1,85,1,86,3,87,1,88,1,89,1,92,8,97,1,109,2,116,1","tools4caregivers,71,3","toone,14,1","top,4,1,7,38,46,1,54,4,60,1,84,2,85,2,97,3,109,4,210,1","topconsolidator,84,1,85,1","topic,7,1,87,4,105,2,97,1,110,7,211,1","topics,7,8,23,2,24,4,83,1,87,3,92,2,95,2,105,1,97,6,110,2,118,1,117,2","tops,7,1,54,1","tors,97,1","total,2,10,14,1,7,81,13,2,23,1,24,4,27,1,42,1,43,4,46,1,61,1,92,2,97,11,109,1,211,3,213,4","totaling,87,1","totally,97,2,113,1,111,1","totals,87,1","touch,27,1,62,1,110,1,122,1","touchstone,23,1,46,1","tough,27,1,84,1","toughest,86,1","tour,4,1","toward,2,1,3,1,14,1,7,3,23,1,31,2,43,2,84,2,95,5,97,5","towards,7,2,24,3,92,1","town,1,1,43,1,48,1,62,1,63,1,97,1,110,26","townhallguide,110,8","townsend,6,5,7,2,95,4","tr,97,1","track,4,2,7,4,24,1,46,5,88,1,97,1,211,1,213,1","tracked,7,1,46,1","tracking,14,1,7,2,110,1","trade,111,1","tradition,21,1","traditional,7,3,21,1,24,24,28,1,46,1,83,1,87,3,92,3,97,13","traditionally,5,1,88,1,92,1","traffic,6,2,26,1","trail,97,1","train,71,1,50,1,61,1,87,7,88,1,92,10,97,4,117,1","trained,14,1,7,1,21,1,71,1,43,7,86,1,88,2,92,4,95,2,97,2","trainer,71,1,50,1,92,4","trainers,71,1,92,2,117,1","training,2,1,3,7,14,12,7,112,21,1,20,1,71,5,23,4,24,17,41,1,42,2,45,3,54,1,61,1,76,8,83,3,86,7,87,19,88,12,92,37,105,2,97,30,110,2,118,1,211,1,117,1,213,1","trainings,88,2,92,1,117,1","trains,87,2,88,1","transactions,97,1","transcribed,97,1","transcript,84,1","transfer,14,1,97,1,111,2","transferred,7,1,97,1","transferring,97,2","transfers,45,1,92,2","transition,3,1,7,2,23,1,92,6,95,1,97,2","transitioned,7,4","transitions,3,1","transitory,95,2","translate,7,1","translated,14,2,83,1,97,1","translation,14,1","translator,210,1","transparencies,71,1","transpired,24,1","transportation,7,1,24,18,42,3,45,2,89,2,92,9,95,1,97,3,106,3,110,3,211,3,117,1,213,2","transporting,92,2","trap,23,1","trapped,14,1,95,1","trauma,84,1,85,1","traumatic,14,1,7,2,87,1,111,1","travel,24,10,43,1,84,1,85,1,97,2,109,1","traveling,46,1","tre,95,2","treat,111,1","treatable,111,1","treated,24,4,27,1,92,1,97,1","treating,23,1,84,1,85,1","treatment,2,1,7,1,23,1,26,1,43,1,45,2,92,5,95,20,118,1","treatments,23,1,95,5,97,1","tree,93,1","tremendous,97,3,113,2,213,1","tremendously,213,1","trenches,23,1","trend,6,1,7,2,92,1,122,1","trends,5,10,14,2,7,3,48,1,56,1,87,1,95,2,97,1,118,1","trenton,14,1,92,1","triad,118,4","trial,14,1,7,2,84,1,85,1,95,5,97,1,109,1","trials,95,1","tribal,7,1,97,3","tricks,109,1","tricky,111,1","tried,4,1,95,1,97,4,213,1","tries,46,1","trigger,23,2","trip,4,2,24,3","triplicate,97,1","triumph,4,1","trooper,1,1","trophies,46,1","trouble,1,1,14,1,13,1,26,1,95,1,97,3","troubled,85,1","troubling,23,1","trow,88,1","troweprice,109,1","troxel,23,1","troy,43,2","truax,14,1","true,4,1,95,1,97,6,110,1","truevti,119,1","truly,7,1,97,1","trust,1,1,7,3,8,1,21,1,24,8,43,4,95,1,97,1,118,2","trusted,3,1,45,1,62,1,92,1,109,1,113,1,111,1","trustees,24,4","trying,7,1,27,1,45,1,86,1,97,5,110,1,113,1,111,1","tsg,106,20","tsmith,106,1","tt,7,1","tty,88,1","tubes,61,1","tuck,26,1","tucke,14,4","tucson,92,2","tudor,111,1","tues,113,1","tumlinson,7,2","tumultuous,111,1","tuned,97,1","turn,4,1,5,1,6,2,7,2,13,1,45,1,85,1,92,2,95,1,109,1,113,2","turned,97,2","turning,95,1,97,1","turnover,7,1,97,1","turns,45,1","tuscon,92,3","tusubira,4,1","tv,62,1,84,3,85,4,97,1,109,3,113,2","tvs,84,1,85,2","tweak,97,1","twelve,118,2","twenty,14,5,92,1,97,8","twice,2,3,14,1,7,3,60,1,92,1,95,1,97,1,116,1","twist,46,1","two,1,1,2,5,5,3,14,6,18,1,7,27,20,1,71,4,72,1,23,1,24,19,41,2,43,11,46,2,61,1,83,2,84,1,85,2,87,1,92,17,95,13,105,2,97,34,110,1,118,1,211,1,111,5,116,3,117,5,122,1","twofifths,7,1","twofold,87,1","twothirds,97,1","twoyear,7,1","tx,23,1","ty,92,1","tyndale,23,1","type,14,5,7,56,29,1,42,1,60,1,61,1,87,4,88,1,95,33,97,7,106,1,118,1,211,2,119,1,213,1","typed,97,1","types,14,2,7,79,23,2,45,1,55,1,84,1,85,1,87,5,88,1,92,1,94,1,95,6,97,11,106,1,110,1,212,1","typical,95,1,97,1,110,1,211,2,111,1","typically,14,7,7,12,42,1,87,2,95,2,97,2,211,1,116,2,117,1","ua,7,5","ublic,7,1","ucpsa,92,1","ucsf,7,1","udqjh,97,4","udqjhg,97,1","uhdfk,97,1","uhfhlyh,97,1","uhfhqw,97,1","uhfnyc,45,2","uhjxodwlrqv,97,2","uhodwhg,97,2","uhodwlyhv,97,5","u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arrFiles=new Array();arrFiles[0]=new Array(1,"050306Best_Practices_Roundtable-final.pdf","2006-06-01","Microsoft Word - Best Practices Roundtable-final.doc","","","2006 NYS Caregiver Coordinator Summit Wednesday May 3, 2006 Onondaga County Civic Center 421 Montgomery St. Syracuse, NY 10:00 am 3:00 pm Best Practices Roundtable Steuben County Choose 2 Trust in the Lives of Older Women Program Have built on this in their county now do two of these groups at different ends of the county. They are very different in focus, make-up Older drivers a concern. Partner with sheriff, law enforcement, DMV, VA, Town Justice, State Trooper: HELP Network meetings On website, link to DMV form for letter of concern for health care providers and citizens Grandparents raising grandchildren: student intern developed questionnaire to identify needs. What kinds of things are they seeking? * Legal * Mental Health *School Issues had an info session Schoharie County: Had a volunteer appreciation luncheon Schenectady County: Having trouble sustaining support groups Genessee County: Specifically having problems with dementia in care receivers Ulster County: Held a workshop on communicating effectively with health professionals Also did Understanding Memory Loss 101 at local Community College (35 people) Broome County: Held a class, How to Balance a Checkbook ; had to institute a waiting list Now working with discharge planners at three hospitals Wyoming County: Respite cap 1K; caregivers will often pick up a couple of additional days out of pocket; Also respite for grandparents raising grandchildren at overnight camp at YMCA Yates County: Educational seminars; hard to find a draw Local Public Health partnership: professional and family caregivers Provide a magazine subscription to those unable to attend support groups Assessment visit by occupational therapist (up to 4 visits for identifiable need) Cayuga County: Local Hospital, Speakers Bureau contracted storyteller, Connecting with Your Elderly Parents Via Storytelling This program generated a support network. Future informational sessions to include LTC options Delaware County: Support hotline at particular time of week staffed by a volunteer Rensselaer County: Having options for the caregiver builds buy-in Chemung County: Piloting a consumer-directed model; Caregiver workshop series contracted with Red Cross; Haven \'t been as successful with Grandparents raising grandchildren Jefferson County: Having problems sustaining support groups Chautauqua County: Family Services Counseling; if low income, OFA picks up the tab. For National Family Caregiver Support Month, did a newspaper campaign to have community submit names to honor caregiver; winner gets a (donated) basket. This gets around the problem of Caregiver self-identification. ",107);arrFiles[1]=new Array(2,"2005AugustCommonwealthFundworkingcaregiversreport.pdf","2006-06-02","A Look at Working-Age Caregivers \\' Roles, Health Concerns, and Need for Support - Issue Brief","The role of informal caregivers is becoming increasingly important as the U.S. population continues to age and cost-containment strategies promote shorter hospital stays.","","AUGUST 2005 Issue Brief A Look at Working-Age Caregivers \' Roles, Health Concerns, and Need for Support Alice Ho, Sara R. Collins, Kare n Davis, and Michelle M. Doty For more information about this study, please contact: Sara R. Collins, Ph.D. Senior Program Officer The Commonwealth Fund Tel 212.606.3838 E-mail src@cmwf.org ABSTRACT: The role of infor mal caregivers is becoming increasingly important as the U.S. population continues to age and cost-containment strategies promote shorter hospital stays. There are currently 16 million working-age adults caring for a sick or disabled family member, according to data from the Commonwealth Fund Biennial Health Insurance Survey. Caregivers are less likely to be working, more likely to miss days of work when they are employed, and more likely to lack health insurance coverage. This may leave them financially vulnerable and unable to obtain needed health care. Indeed, one-half of caregivers reported not getting care because of cost issues, and three of five caregivers experienced problems with medical bills. Polices to expand Medicaid and Medicare would improve caregivers \' ability to access health care for themselves and their families, as well as help eliminate the financial strain of going without health insurance. * * * * * Additional copies of this and other Commonwealth Fund publications are available online at www.cmwf.org. To learn about new Fund publications when they appear, visit the Fund \'s Web site and register to receive e-mail alerts. Commonwealth Fund pub. #854 Overview Infor mal caregiving has become increasingly important as the U.S. population continues to age and cost-containment strategies promote shorter hospital stays. By providing care for sick or disabled family members, infor mal caregivers play a critical support role in the U.S. health care system. Based on data from the Commonwealth Fund Biennial Health Insurance Survey, nearly one of 10 working-age adults ages 19 to 64 is caring for a sick or disabled family member, for a total of 16 million caregivers in 2003.1 Adding to their burden, more than 9 million of these caregivers have health problems of their own. This study finds that caregivers are less likely than non-caregivers to be working, more likely to miss days of work when they are employed, and more likely to lack health insurance coverage. Such vulnerabilities can leave 2 Th e C om monwealth Fund caregivers financially at risk and may make it difficult for them to obtain needed health care. Onehalf of all caregivers reported not getting needed care because of cost, compared with 35 percent of non-caregivers. Sixty percent of caregivers reported problems with their medical bills, compared with 39 percent of non-caregivers. This issue brief examines the implications of caregiving in terms of caregivers \' personal health, work, insurance coverage, and ability to afford health care. It also provides targeted policy steps that could help lend greater assistance to caregivers and their families. Who Are the Caregivers? There are approximately 16 million caregivers ages 19 to 64 in the United States (Table 1) and more than 2 million over the age of 65 (data not shown). This analysis is limited to working-age caregivers in order to explore the implications of caregiving on employment, insurance coverage, and access to the health care system. Women are more likely than men to be caregivers, with women composing approximately two-thirds of the total group (Table 1). About 12 percent of women, compared with 6 percent of men, said they were caring for a sick or disabled family member (Figure 1). Among women and men of all ages, women ages 50 to 64 are the group most likely to be caring for sick or disabled family members. Nearly one of five (18%) of these women reported being a caregiver--a rate two and a half times higher than reported by women ages 19 to 29. Previous studies have observed that daughters in mid-life provide the bulk of care to both their parents and in-laws.2 In addition, women ages 50 to 64 may also take on caregiving responsibilities for their sick or disabled spouses. Caregivers disproportionately come from lower-income households.3 Forty-four percent live in households under twice the federal poverty level, compared with one-third (33%) of non-caregivers (Table 1). Double Burden: Caregiving and Health Problems In addition to the burden of car ing for sick or disabled family members, caregivers are also more likely than non-caregivers to have health problems of their own. Three-fifths of caregivers reported fair or poor health status, one or more chronic conditions, or a disability, compared with one-third of non-caregivers (Figure 2).4 Caregivers reported chronic conditions at nearly twice the rate of noncaregivers (45% vs. 24%). Large segments of the U.S. population are either coping with their own health problems, a A Look at Working-Age Caregivers \' Role s , H ealth Concerns, and Need for Support 3 family member \'s poor health, or both. More than two of five (43%) women are either coping with personal health problems or caring for a sick or disabled family member (data not shown). Men fare only slightly better: more than one-third (35%) reported health problems of their own or a caregiving responsibility. Impact of Caregiving on Employment Status, Sick Leave The responsibility of car ing for a sick or disabled family member may make it difficult to hold a full-time job. One-half (51%) of caregivers reported working full-time, compared with threefifths of non-caregivers (Table 2).5 Working caregivers who have health problems of their own may experience increased needs for time off from work. The Fund \'s survey asked respondents how many days of work they missed because they or a family member was sick. Over one-third (35%) of employed caregivers reported missing more than one week of work during the year, compared with one-sixth (18%) of non-caregivers (Figure 3). Caregiving has a strong, independent effect on whether workers miss days of work. For caregivers, the odds of missing six or more days of work because they or a family mem- ber was sick is nearly twice that of non-caregivers, holding constant for gender, family structure, insurance coverage, health problems, income, and paid sick leave (Table 3).6 Previous studies have found a reduction in caregivers \' productivity at work because of factors including absenteeism, unscheduled time off, and lateness.7,8 Caregivers at Risk for Lacking Insurance Coverage Many caregivers have low income and only tenuous connections to the workforce, leaving them at risk of lacking health insurance. One-third (34%) of caregivers are uninsured for at least some per iod during the year, compared with one-quarter (26%) of people without such responsibilities (Table 2). Lack of coverage may affect both the ability of caregivers to seek care for themselves and to provide adequate care for their ailing family members. Health Care Affordability Problems Lack of insurance coverage, low income, and the financial burden of providing care can make it difficult for caregivers to afford health care. The survey asked respondents if, in the past year, they: had not filled a prescription; had failed to see a specialist when they or a doctor thought it was needed; had skipped a recommended medical test, treatment, or follow-up visit; or had a medical problem but did not visit a doctor or clinic. Caregivers were more likely than non-caregivers to report each of these four access problems. In fact, one-half of all caregivers reported experiencing at least one costrelated access problem, compared with 35 percent of non-caregivers (Figure 4). Although the analysis did not show an independent effect of caregiving on access problems, individuals with characteristics more common among caregivers than non-caregivers--being female, lacking coverage, having health problems, and being of lower-income status--were found to be at higher risk of exper iencing access problems. 4 Th e C om monwealth Fund structure, insurance, health, and income (Table 3). In addition, each of these variables also has an independent effect. Adults who were female, had dependent children, lacked coverage, had health problems, and were of lower-income status were at higher risk of exper iencing medical bill problems or medical debt. Caring for a sick or disabled family member can potentially increase the caregiver \'s exposure to medical bills. Health care costs of sick or disabled family members, such as insurance copayments and premiums, uncovered prescription medication costs, and medical equipment expenses, may be shared or assumed entirely by the caregiver.9 Respondents were asked whether in the past year they had difficulty paying or were unable to pay their bills, had been contacted by a collection agency concerning outstanding medical bills, or had to change their lives significantly in order to meet their obligations. People who reported none of these medical bill problems were asked if they were currently paying off medical debt incurred in the past three years. Medical bill problems or medical debt could include those incurred by another family member. The survey found that caregivers reported disproportionately high rates of medical bill problems. Three of five (60%) caregivers reported medical bill problems or medical debt, compared with two of five (39%) non-caregivers (Figure 5). In fact, caregiving has an independent effect on medical bill problems or medical debt. The odds of medical bill problems or medical debt for caregivers is one-and-a-half times that of non-caregivers, holding constant for gender, family Lack of Confidence in the Health Care System Caregivers, coping with their own personal health problems and the needs of the people they care for, expressed heightened anxiety about the U.S. health care system. More than two of five (43%) adults caring for a sick or disabled family member, compared with one-quarter (27%) of non-caregivers, said they were not too confident or not at all confident they would receive high-quality care when needed in the future (Figure 6). This level of wor ry is particularly pronounced for female caregivers: 45 percent of female caregivers, versus 38 percent of male caregivers, reported not being confident they would receive quality care. Conclusion and Policy Implications Sickness and disability exact enormous costs on the health care system each year, but the burden A Look at Working-Age Caregivers \' Role s , H ealth Concerns, and Need for Support 5 placed on the families of those in poor health is less well documented. This study finds that an estimated 16 million working-age adults are currently car ing for a sick or disabled family member. Caregivers are less likely to be working and, if they do work, are far more likely to take time off from work than are those without caregiving responsibilities. Because employment is the primary source of health insurance in the United States, this leaves caregivers at risk of lacking coverage. Caregivers report higher rates of health problems than noncaregivers, and they are also more likely to have cost-related access problems and problems paying medical bills. While caregivers provide a critical, vital function in society, they pay a price in terms of their financial security and overall well-being. Caregivers have received some forms of policy support, such as the Family and Medical Leave Act of 1993 and the Family Caregiver Support Program under the Older Americans Act of 2001.10,11 Advocacy groups are currently seeking legislation in more than 20 states to guarantee workers are paid sick days or family leave to care for themselves and ill family members.12 Policymakers might consider additional ways to ease their financial burden. Extending health insurance coverage to low-income people is an obvious first step toward relieving cost burdens and improving access to health care. Medicaid and Medicare cover disabled individuals, but often exclude their caregivers.13 Policy options to extend coverage include expanding Medicaid and the State Children \'s Health Insurance Program to lowincome caregivers of sick or disabled children and adults, as well as allowing a Medicare buy-in for individuals caring for a Medicare beneficiary. In addition, employers may find that providing better support for working caregivers, through health insurance or paid sick leave, could reduce emotional and physical stress and increase productivity among working caregivers. Better protection against the financial hardships created by disability and caregiving could also be addressed through tax policy (e.g., tax credits for expenses in excess of 5 percent of income, or 10 percent in higher tax brackets). These are modest changes that would provide caregivers meaningful and affordable access to a health care system they help to support through their care of ailing or disabled loved ones. NOTES 1 The Commonwealth Fund Biennial Health Insurance Survey asked respondents, ages 19 and older, whether they were currently caring for a sick or disabled relative, including a child, spouse or partner, parent, or other family member. Other estimates of number of caregivers in the U.S. vary depending on the base population of both caretakers and care recipients, as well as the definition of caregiving. A 1998 national survey, Long-Ter m Care from the Caregiver \'s Perspective, found that 16 percent of adults, ages 18 and older, were providing care to a family member or friend at the time of the survey, and 23 percent said they had provided care in the pr ior year. See K. Donelan et al., Challenged to Care: Infor mal Caregivers in a Changing Health System, Health Affairs 21 (July/August 2002): 22231. 6 Th e C om monwealth Fund 2 K. M. Robinson, Family Caregiving: Who Provides the Care, and at What Cost? Nursing Economics 15 (September/October 1997): 24347. Low-income households defined as those under 200 percent of poverty, or 37,600 for a family of four in 2003. C. DeNavas-Walt, B. D. Proctor, and R. J. Mills, Income, Poverty and Health Insurance Coverage in the United States: 2003 (Washington, D.C.: Cur rent Population Reports, U.S. Census Bureau, August 2004). Chronic conditions included heart attack/heart disease, cancer, diabetes, and arthritis. 11 3 The National Family Caregiver Support Program provides information about services, assistance with access to services, individual counseling, support groups and caregiver training, respite care, supplemental services such as adults day care, homemaker assistance, and home repair. See National Family Caregiver Support Program, http://www.aoa.gov/ prof/aoaprog/caregiver/caregiver.asp. S. Greenhouse, As Demands on Workers Grow, Groups Push for Paid Family and Sick Leave, New York Times (March 6, 2005): 23. Federal Medicaid law permits family members to become paid caregivers, but excludes those family members who are legally responsible for the care of an individual (e.g., spouses and parents/guardians of minor children). However, states have the option to pay these family members under certain exceptional circumstances. G. Smith, P. Doty, and J. O \'Keeffe, Supporting Informal Caregiving (under Medicaid), National Family Caregiver Support Program, February 2004. Available at http://www.aoa.gov/ prof/aoaprog/caregiver/careprof/progguidance/ background/program_issues/Fin-Smith.pdf. 12 4 13 5 This analysis indicates an association between caregiving and work status only. Health problems defined as fair or poor health, one or more chronic condition (heart attack/disease, cancer, diabetes, arthr itis), or disability. R. Stone, G. L. Cafferata, and J. Sangl, Caregivers of the Frail Elderly: A National Profile, Gerontologist 27 (October 1987): 61626. C. L. Bar nes, B. A. Given, and C. W. Given, Parent Caregivers: A Comparison of Employed and Not Employed Daughters, Social Work 40 (May 1995): 37581. K. M. Robinson, Family Caregiving, 1997. The Family Medical Leave Act of 1993 allows eligible workers employed by private companies with 50 or more employees to take a total of 12 workweeks of unpaid leave during any 12-month period in order to care for an immediate family member (spouse, child, or parent) with a serious health condition. Refer to the U.S. Department of Labor for additional details: http://www.dol.gov/esa/whd/fmla/. 6 7 8 9 10 A Look at Working-Age Caregivers \' Role s , H ealth Concerns, and Need for Support 7 Table 1. Demographic Characteristics Base: Adults ages 1964 Total Total in millions (estimated) Percent distribution Age*** 1929 3049 5064 Gender*** Male Female Self-rated health status*** Excellent Very good Good Fair or poor Chronic condition*** Yes No Sicker*** Yes No Race/Ethnicity** White Black Hispanic Other Family structure*** Mar r ied, no children Mar r ied, with children Single, no children Single, with children Annual income*** Less than 20,000 20,000 34,999 35,000 59,999 60,000 or more Less than 35,000 35,000 or more Poverty status*** Below 100% FPL 100%199% FPL Below 200% FPL 200% or more FPL 172.0 100% 24 50 27 48 52 23 32 28 17 26 74 36 64 68 11 14 6 25 35 28 12 26 16 24 24 43 50 15 20 35 57 Caregiver 15.8 9% 16 50 34 33 67 15 28 31 26 45 55 60 40 63 15 15 5 26 30 24 20 32 19 22 18 52 41 18 27 44 47 Non-Caregiver 155.6 90% 24 50 26 50 50 23 32 28 16 24 76 33 67 69 11 13 6 25 35 28 12 25 15 24 25 42 51 15 19 33 59 Differences by caregiver status statistically significant at: *** p < .001; ** p < .01. Note: Chronic conditions include heart attack/disease, cancer, diabetes, or arthritis; Sicker defined as fair/poor health, chronic condition, or disability. Source: The Commonwealth Fund Biennial Health Insurance Survey (2003). 8 Table 2. Access and Medical Bill Problems, Confidence in Future Care, Insurance, and Work by Caregiving Responsibility Base: Adults ages 1964 All Adults Ages 1964 Total 172.0 100% 15.8 9% 155.6 90% 82.9 100% 5.3 6% 77.4 93% 89.1 100% 10.5 12% Caregiver NonCaregiver Total Caregiver Total Caregiver NonCaregiver Men Women NonCaregiver 78.2 88% Total in millions (estimated) Percent distribution Access problems in past year Went without needed care in past year because of costs: Did not fill prescription Did not get needed specialist care Skipped recommended test or follow-up Had a medical problem, did not visit doctor or clinic At least one of four access problems because of inability to pay 23 13 19 22 37 23 21 15 32 9 41 29 40 28 26 74 59 12 28 122.5 38% 42 19 9.9 25%*** 39 35 51*** 11 38 60 12 28 112.2 40% 42 18 34** 66 26 74 20*** 34 43 30 41 27 32 40 25 27 73 70 7 22 64.2 47% 38 15 27 30 38 34 66 69 12 19 NA NA NA NA 43*** 33*** 29*** 52*** 7 60*** 21 19 14 30 9 39 17 15 11 25 7 32 39*** 25* 29*** 45*** NA 47** 16 14 10 24 7 31 32 41 24 26 74 70 7 22 59.8 48% 38 13 28 26 18 39 11 50 26 40 31 26 74 49 16 34 58.2 29% 47 24 38*** 19*** 29*** 32*** 50*** 21 12 18 21 35 17 11 14 18 31 35*** 19* 27*** 29* 44** 15 10 13 17 30 29 15 23 25 42 40*** 20*** 31*** 34*** 53*** 45*** 37*** 28*** 56*** 9 66*** 17** 36 45 34** 66 43** 10 47 5.6 21%*** 43 34 27 14 22 24 41 26 24 17 37 11 48 27 41 30 25 75 50 17 33 52.4 30% 47 22 Medical bill problems in past year Problems paying or not able to pay medical bills Contacted by a collection agency for medical bills Had to change way of life to pay bills Any medical bill problem Medical bills/debt being paid off over time Any medical bill problem or outstanding debt Confidence in ability to get high-quality care when needed Very confident Somewhat confident Not too/not at all confident Insurance stability Any time uninsured Insured continuously Adult work status Full-time Part-time Not working Worker productivity (Base: Employed adults, ages 1964, total in millions [estimated]) Missed work because self or family member sick 0 days 15 days 6 or more days Differences by caregiver status statistically significant at: *** p < .001; ** p < .01; * p < .05. Th e C om monwealth Fund Source: The Commonwealth Fund Biennial Health Insurance Survey (2003). A Look at Working-Age Caregivers \' Role s , H ealth Concerns, and Need for Support 9 Table 3. Effects of Caregiving and Other Factors on Sick Loss Days, Access Problems, and Medical Bill Problems Based on Logistic Regression Models Six or more sick loss days from work1 (Base: working adults ages 1964) Var iables Caregiving status (ref = not caring for sick or disabled family member) Car ing for sick or disabled family member Gender (ref=male) Female Family structure (ref = married, no children) Single, with children Mar r ied, with children Single, no children Insurance status (ref = insured all year) Any time uninsured Health status (ref = No health problem4) Health problem Poverty status (ref = 200% FPL or more) Less than 200% FPL Paid sick leave (ref = yes, paid sick leave) No paid sick leave *** p < .001; ** p < .01; * p < .05. Note: Models control for all variables unless otherwise indicated (NA). 1 2 Any cost-related access problems2 (Base: all adults ages 1964) Odds ratio Any medical bill problems or medical debt3 (Base: all adults ages 1964) Odds ratio Odds ratio 1.91** 1.29 1.53** 1.82*** 1.64*** 2.07*** 1.93** 1.79** 1.33 1.61** 1.27 1.10 2.07*** 1.98*** 1.05 0.89 3.28*** 2.62*** 2.06*** 2.31*** 2.65*** 1.14 1.48*** 1.66*** 0.74* NA NA Sick loss days defined as reported days of missed work because self or family member was sick. Cost-related access problems include did not fill prescription, did not get needed specialist care, skipped recommended test or follow-up, or had medical problem but did not visit doctor or clinic because of cost within the last 12 months. Bill problems include not able to pay medical bills, contacted by a collection agency for medical bills, or had to change way of life significantly to pay bills within the last 12 months. No health problem defined as excellent/very good/good health status, no chronic condition (heart attack/disease, cancer, diabetes, or arthritis), and no disability; health problem defined as fair/poor health status, chronic condition, or disability. Source: The Commonwealth Fund Biennial Health Insurance Survey (2003). 3 4 10 Th e C om monwealth Fund METHODOLOGY The Commonwealth Fund Biennial Health Insurance Survey was conducted by Princeton Survey Research Associates International from September 3, 2003, through January 4, 2004. The survey consisted of 25-minute telephone interviews in either English or Spanish and was conducted among a random, nationally representative sample of 4,052 adults ages 19 and older living in the continental United States. To make the results representative of all adults ages 19 and older living in the continental United States, the data are weighted by age, sex, race/ethnicity, education, household size, geographic region, and telephone service interruption using the U.S. Census Bureau \'s 2003 Annual Social and Economic Supplement. The analytic sample consists of 3,261 adults ages 19 to 64. The 50 percent survey response rate was calculated consistent with standards of the American Association for Public Opinion Research. A series of logistic regression models were estimated to examine the independent effects of caregiving, gender, family structure, insurance, health status, and poverty on sick-loss days, cost-related access problems, and medical bill problems or medical debt. The logistic regression model for sick-loss days also examined the independent effect of paid sick leave. Results presented in Table 3 show odds ratios for each variable holding all other variables shown in the table constant. A Look at Working-Age Caregivers \' Role s , H ealth Concerns, and Need for Support 11 ABOUT THE AUTHORS Alice Ho is a former research associate at The Commonwealth Fund, for whom she provided analytical and writing support for Fund publications and presentations. Previously she was an associate consultant in the Global Health Solutions division of Computer Sciences Corporation, where she conducted strategic planning for hospitals. She received her bachelor \'s degree in neuroscience from Brown University and is currently pursuing a law degree from New York University School of Law. Sara R. Collins, Ph.D., is a senior program officer at The Commonwealth Fund. She is an economist whose responsibilities include survey development, research, and policy analysis, as well as program development and management of the Fund \'s Health Care Coverage and Access Program. Pr ior to joining the Fund, Dr. Collins was associate director/senior research associate at the New York Academy of Medicine, Division of Health and Science Policy. Previously, she was an associate editor at U.S. News & World Report, where she wrote articles on economics and health care. She was also a senior health policy analyst in the New York City Office of the Public Advocate. She holds an A.B. in economics from Washington University and a Ph.D. in economics from George Washington University. Karen Davis, Ph.D., president of The Commonwealth Fund, is a nationally recognized economist with a distinguished career in public policy and research. Before joining the Fund, she served as chairman of the Department of Health Policy and Management at The Johns Hopkins Bloomberg School of Public Health, where she also held an appointment as professor of economics. She served as deputy assistant secretary for health policy in the Department of Health and Human Services from 1977 to 1980 and was the first woman to head a U.S. Public Health Service agency. A native of Oklahoma, she received her doctoral degree in economics from Rice University, which recognized her achievements with a Distinguished Alumna Award in 1991. Ms. Davis has published a number of significant books, monographs, and articles on health and social policy issues, including the landmark books Health Care Cost Containment; Medicare Policy; National Health Insurance: Benefits, Costs, and Consequences; and Health and the War on Poverty. Michelle McEvoy Doty, Ph.D., is a senior analyst at The Commonwealth Fund, where she conducts research examining health care access and quality among vulnerable populations, as well as the extent to which lack of health insurance contributes to barriers to health care and inequities in quality of care. She received her M.P.H. and Ph.D. in public health from the University of Califor nia, Los Angeles. The Commonwealth Fund is a private foundation that undertakes independent research on health care issues and makes grants to improve health care practice and policy. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund or its directors, officers, or staff. ",370);arrFiles[2]=new Array(3,"2005Dec_POEregionalsPowerPointDec05_3slidesperPage.pdf","2006-05-15","Microsoft PowerPoint - POEregionalsPowerPointDec05","","","POINT OF ENTRY IN NYS A CONVERSATION Neal Lane, Director of NYSOFA Kathy Kuhmerker, Deputy Commissioner for Medicaid, DOH December 2005 The Conversation Why POE: demographics, other considerations Responding to the Challenge POE System Defined & Collaboration (Lessons Learned) Framework for POE Mega Waiver Next Steps Q&A 2 The Graying of America: 65+ Population 19502030 70 60 Number in Millions 50 40 30 20 10 0 1950 65 years+ 85 years+ 85 1960 1970 1980 1990 2000 2010 2020 20 30 Year Source:Health, United States, 1999, U.S. Bureau of the Census 3 1 NYS - Projected Population Growth 30.0% 25. 0% 20. 0% 15. 0% 10. 0% 5.0% 0.0% 2000 8.9% 1.2% 2.4% 20.2% 28.2% 19.3% Aged 85+ 6.6% 7.0% ed Ag 65 + 16.6% Impaired 2005 2010 2015 4 Dramatic increases in 85+ (1990-2000) rate of growth was 26% - same for only a few more years *Accelerating phenomenon* - Frail - Poor Dramatic decline in # of workers & caregivers per elder Dramatic increase in 65+ beginning in 7-8 years In-migration to NYS of frail, poor elders Dramatic increase in minority elders - Lower Incomes - Higher rates of frailty If we do nothing within 10 years the system as we know it becomes unaffordable 5 OTHER CONSIDERATIONS Olmstead Decision requires States to administer their services, programs, and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities. Challenges States to review intake and admissions processes to assure service is provided in the most integrated setting appropriate. 6 2 Most Integrated Setting Coordinating Council A statutorily established group charged with implementing the Olmstead Decision in New York State Ensures that New York: Establishes a process for assessing individuals placed in institutional settings Identifies appropriate less restrictive settings for services Transitions institutionally-placed individuals to such less restrictive settings based on State resources and the needs of others with disabilities 7 GOVERNOR PATAKI \'S AGENDA Implement Nursing Home Transition and Diversion Waiver Joint agency cooperation in establishing POE and creating LTC Restructuring Waiver 8 70 60 Responding to the Challenge LTC Reform Restructure & Rebalance Aging & Family Policy 40 - Retain - Support & Partner 30 20 50 Upstream Identification & Intervention Build Community/Neighborhood Capacity & 10 esponsibility R 0 mphasize Independence / Not Dependence E 1 9 50 19 6 0 1 97 0 1 9 80 1 99 0 2 00 0 20 10 20 2 0 9 2 03 0 3 70 60 Responding to the Challenge 50 Affect Rates of Disability for All Ages 40 Continue to Build/Strengthen Caregiver Based Services 3 Capitalize on Elders as a Resource 0 20 10 0 1 9 50 19 6 0 1 97 0 1 9 80 1 99 0 2 00 0 20 10 20 2 0 0 21030 11 Results of A Non-System Costly Prime determinate of service where you enter Duplicative Assessment & Case Management Lack of Responsibility Customer outcomes System performance Fragmented & Confusing Unsustainable Demographics - & Hands Increasing # of eligibles & decreasing workforce 12 4 NEW YORK STATE OFFICE FOR THE AGING NEW YORK STATE DEPARTMENT OF HEALTH VISION FOR LONG TERM CARE We envision a system that: Supports Self-Determination and Promotes Personal Responsibility Provides Services that Meet Consumer Needs Provides High Quality Care Ensures Efficiency and Affordability POE Process Timeline 2001: NYSOFA & DOH Partner Vision Statement DOH Consultants conduct Stakeholder Meetings Gov. Appoints HCR Task Force 1st Rpt. Focus on LTC NYSOFA/DOH Issue RFI Providers & Advocates State Listening Sessions (9) Families, Consumers Monitor State & Fed. Initiatives 14 POE Elements Defined 15 5 Goal Implement a Point of Entry System within each county of New York State Incorporate all the functions envisioned by the Governor \'s Health Care Reform Workgroup 16 Comprehensive and unbiased information and assistance in all services and supports Screening - social and medical needs; financial status; available service options, regardless of payer source Comprehensive needs assessment 17 Service/care coordination Public education Promote planning, promote personal choice Prepare financially Interdisciplinary team approach 18 6 How? A Partnership! NYSOFA/DoH desire Present a consensus set of recommendations on POE Functions and Implementation..... 19 Lessons Learned about Collaboration Agreement Lessons on the influence of Org. culture & on communication Not a lack of willingness NYSOFA lead in POE working together with DOH DOH lead in Mega Waiver working together with NYSOFA 20 Qualities of NYS POE All Age or disability Trusted resource Connected with their community Place (within the community) Consumers, caregivers, professionals Reliable, impartial information 21 7 Accountability Consistent and unbiased program throughout the entire state Contractually obligate local POE Statewide contractor for IT platform Statewide contractor or contractors will provide program monitoring and training of Point of Entry entities 22 POE Contract Local government right of first refusal Not-for-profit ? (Other model) 23 IT Contract Information Technology Central Web based system HIPAA compliant Customer access (local & long distance) Data entry Communication Information acquisition, personal education Work toward integrated care 24 8 MONITORING AND TRAINING CONTRACT Monitor performance of qualified responders Develop training curricula essential components 25 No Change, But Change No change: 2 existing assessment requirements will continue: Those qualifying for publicly financed long term care services; Consumers seeking nursing home placement, regardless of payer source; Change: POE, in Phase II, will assume the assessment functions 26 FRAMEWORK 27 9 Phase I Statewide Roll Out Information and Assistance Screening (consisting of a preliminary evaluation of the consumer and their caregiver \'s general social, medical and financial needs to identify available service options and choices) 28 NYSOFA & DOH Jointly work on: Standards Requirements Program outcomes Performance measures RFA for POE Entities RFP for IT RFP for Staff Training RFP for Monitoring, Evaluation, Quality Assurance 29 In preparation for: Tentative Timeline Phase I NYSOFA/DOH develop standards, performance measures for Phase I POE and IT Contracts (winter/spring 2006) Issue RFA/RFP (spring \'06) RFA to Counties IT Contract Develop Training RFP 30 10 Tentative Timeline Phase I (Summer 2006) RFA \'s reviewed If needed, RFP issued in any county passing Notice of county awards Issue training contract 31 PHASE I (Fall/Early Winter 2006) Implement POE \'s Build IT platform Monitoring & evaluation RFP developed 32 Phase II Bring on-line fully functioning POE Comprehensive Needs Assessment Service Coordination Simultaneous with Phase I implementation NYSOFA & DOH develop standards, requirements, expected outcome measures 33 11 STAKEHOLDER CONCERNS ABOUT POE Delays: Completing assessments Establishing eligibility Hospital discharges Nursing home admissions Start of home care services Funding and Resources 34 THE PROCESS: Developing the Mega Waiver 35 Restructuring Long Term Care in NYS: What we know so far... An 1115 Waiver will be pursued Waiver will fold in existing DOH waiver programs, e.g. CAH, TBI, LTHHC, and NHTD, with Medicaid LTC State Plan services (Personal Care, CHHA, and Private Duty Nursing) Waiver will be a Medicaid program, and will seek FFP for nonMedicaid services (EISEP, Meals on Wheels, etc.) for a higher income group Medicaid eligibility reform will be pursued The Waiver must demonstrate and maintain cost neutrality 36 12 Timeline November/December 2005 January March 2006 April June 2006 July - December 2006 Establish Stakeholder Advisory Council Finalize preparation of RFI Release RFI Assemble and evaluate RFI responses Release RFI responses Continue regional stakeholder meetings Executive, Steering and Stakeholder Advisory meetings Commence drafting of 1115 waiver application Conduct regional stakeholder meetings 37 NEXT STEPS Continued Dialogue Joint AAA/LDSS training Resource Expectations (F-SHARP) Advisory Workgroup 38 Shall we talk... 39 13 And Thanks for Listening 40 14 ",810);arrFiles[3]=new Array(4,"2006March25NYTAsParentsAge.pdf","2006-06-02","http://www.nytimes.com/2006/03/25/national/25care.html?ex=11493","","","As Parents Age, Baby Boomers and Business Struggle to Cope - New York Times Page 2 of 7 As Parents Age, Baby Boomers and Business Struggle to Cope By JANE GROSS Published: March 25, 2006 E-Mail This Printer-Friendly Single-Page Nancy Goodman \'s Reprints employer, a Save Article telecommunications company in Boston, offers benefits to help employees care for elderly parents. But she found them nearly useless during four years of caring for her mother, who has Parkinson \'s disease, and her father, who died of kidney failure last year. Advertisement Past 24 Hours | Past 7 Days 1. Drug for Bones Is Newly Linked to Jaw Disease 2. Glass Artists Face Off in Court 3. At Home With Garrison Keillor: Where All the Rooms Are Above Average 4. Op-Ed Contributor: Opus Dei \'s Box-Office Triumph 5. A Guide to Guilt-Free Fish Go to Complete List Enlarge This Image C.J. Gunther for The New York Times Edith Tusubira, right, a nurse, helped Bernice Goodman at the home of Ms. Goodman \'s daughter Nancy in West Roxbury, Mass. Nancy Goodman \'s company offers care benefits, but she says they are nearly useless. They say they want to do the right thing, Ms. Goodman, 58, said of her employer, which she would not identify for fear of losing her job. But when it comes down to it, they \'re not seeing the true picture. Ms. Goodman \'s ADVERTISEMENTS Political news. 50% off Times delivery. Drug Prevention Find Advice & Resources Online www.antidrug.com http://www.nytimes.com/2006/03/25/national/25care.html?ex=1149393600&en=f1e46d21f... 6/2/2006 As Parents Age, Baby Boomers and Business Struggle to Cope - New York Times Page 3 of 7 When Life Affects Work Enlarge This Image Ozier Muhammad/The New York Times Companies are responding, but experts say they often use child care benefits as a model when they do not suit the different and unpredictable needs of the elderly. In addition, at a time of cutbacks in expensive health insurance and pensions, the most commonly offered benefits are those that cost a company little or nothing, like referral services and unpaid leaves. Ms. Goodman, for instance, tried her company \'s referral service to supplement inadequate staffing when her parents lived at an assisted living center in Connecticut. It was like going to the yellow pages, she said, since it did not relieve her of the time- Kent Burtis, right, a technician for Verizon in Bayville, N.J., gets lunch for his father, Ivan Burtis, each workday, but an aide does the morning shift. It \'s kept me from slitting my throat, Kent Burtis said of that benefit. lament is common, as corporate America scrambles to help the soaring number of baby boomers, mostly working women, whose obligation to frail, elderly parents results in absenteeism, workday distractions or stressrelated health problems. http://www.nytimes.com/2006/03/25/national/25care.html?ex=1149393600&en=f1e46d21f... 6/2/2006 As Parents Age, Baby Boomers and Business Struggle to Cope - New York Times Page 4 of 7 consuming tasks of arranging for and supervising the services from afar. Ms. Goodman was also entitled to a year \'s leave of absence, a benefit a new mother might appreciate. But if she took a leave now, what happened if her mother lingered? Employees with ailing parents, more than 20 million nationwide, cite other benefits that would allow them to focus more on their jobs, like geriatric case managers to guide them through the mysteries of Medicaid and Medicare, or backup care for emergencies like a last-minute business trip. Companies that offer this kind of hands-on assistance generally pay for at least part of the service. But they are rare. According to the Society for Human Resource Management, which represents more than 200,000 human resource and other corporate officials, 39 percent of its members said in 2003 that elder care benefits were too costly to be feasible. Only 1 percent of their companies subsidized any elder care benefits last year. And only 3 percent offered the emergency backup care -- subsidized or otherwise -- that experts say saves money by keeping workers at work. The perception among companies is that they can \'t afford elder care benefits, said Frank Scanlan, a spokesman for the society. It is the largest companies that are the most generous, but even those often subscribe to the mistaken notion that the Mommy Track and the Daughter Track are the same, said Chris Gatti, president of the Work Options Group in Superior, Colo. Work Options, whose clients employ 400,000 people nationwide, provides in-home care for Copyright 2006The New York Times Company Home Privacy http://www.nytimes.com/2006/03/25/national/25care.html?ex=1149393600&en=f1e46d21f... 6/2/2006 As Parents Age, Baby Boomers and Business Struggle to Cope - New York Times Page 5 of 7 children and the elderly. These benefits fall under the same umbrella but are fundamentally different, Mr. Gatti said. Child care programs are relatively straight-forward and easy to administer compared to elder care, which is a maze with lots of sharp corners and dark secluded places. An individual supervisor can ease an employee \'s burden but still leave them vulnerable to management changes. Just 6 percent of employers have written policies about elder care, according to surveys by the Society for Human Resource Management, while 76 percent say they help employees on a case-by-case basis. For Ms. Goodman, the one godsend since her father died and her mother moved into her Boston apartment has been permission to work at home. But that is likely to change with a new boss. I \'m walking on eggs right now, Ms. Goodman said. The distinctions between child care and elder care have become apparent as the first of the 77 million baby boomers turn 60 and their parents live past 85, joining the fastestgrowing segment of the population. The most obvious is that children \'s schedules are predictable -- a school holiday next Monday -- while elderly parents \' needs -- a trip to the emergency room -- are crisis-driven. Also, children are raised at home; an elderly parent often lives far away. Guiding the decisions of an elderly parent also requires mastery of arcane legal, financial and medical matters. Policy Search Corrections XML Help Contact Us Work http://www.nytimes.com/2006/03/25/national/25care.html?ex=1149393600&en=f1e46d21f... 6/2/2006 As Parents Age, Baby Boomers and Business Struggle to Cope - New York Times Page 6 of 7 1 2 NEXT PAGE > for Us Site Map Back to Top More Articles in National > Ads by Google PA Health Insurance what \'s this? Affordable Major Medical Health Plans for the PA Self Employed InsurancePlansDirect.com Elder Care Our experts connect you with local eldercare services, advice & more! www.elderlycarefinders.com ShangriLa Assisted Living Maryland \'s Premier Assisted Living Call 443-801-6304 for a tour! RELATED ARTICLES Report Foresees No Crisis Over Aging Generation \'s Health (March 10, 2006) CASES; Impressive Science Meets Unimpressed Patient (Hi, Mom!) (February 21, 2006) As New Drug Plan Begins, Stores Predict Bumps (January 1, 2006) The Streetcars Roll Again in New Orleans (December 19, 2005) RELATED SEARCHES Aged Medicine and Health INSIDE NYTIMES.COM http://www.nytimes.com/2006/03/25/national/25care.html?ex=1149393600&en=f1e46d21f... 6/2/2006 As Parents Age, Baby Boomers and Business Struggle to Cope - New York Times Page 7 of 7 Charles Taylor \'s Rise and Fall The Ghost in the Baghdad Museum Making of a Toddler Supergroup Digital Composer When a Car Is a Home http://www.nytimes.com/2006/03/25/national/25care.html?ex=1149393600&en=f1e46d21f... 6/2/2006 ",240);arrFiles[4]=new Array(5,"2006MarchAARPIssuePaperTrendsInCaregiverSupport.pdf","2006-06-02","Ahead of the Curve: Emerging Trends and Practices in Family Caregiver Support","","","Ahead of the Curve: Emerging Trends and Practices in Family Caregiver Support Introduction and Purpose This In Brief summarizes the findings of the AARP Public Policy Institute Issue Paper, Ahead of the Curve: Emerging Trends and Practices in Family Caregiver Support, by Lynn Friss Feinberg, Kari Wolkwitz, and Cara Goldstein.1 Some states incorporate caregiver support services into their programs that serve older people or adults with disabilities; in other states, caregiver support is a separate program with distinct eligibility criteria. Because many states have been increasing funding of home and community-based services (HCBS), there is strong interest among policymakers and program administrators in learning more about emerging trends and forward-looking practices in caregiver support that have the potential to bolster caregiving families and improve the quality of care for adults who receive long-term care at home. This report highlights three emerging trends that have important implications for addressing the needs of family caregivers: caregiver assessment; consumer direction in family caregiver support services; and collaborations between the aging network and the health care system, for example, in identifying family caregivers who may be at risk for their own health problems and emotional strain associated with the caregiving role. These trends were identified from data collected for an earlier 50state survey of 150 publicly funded programs. Eight states--Alabama, California, Georgia, Massachusetts, Minnesota, North Carolina, Pennsylvania, and Washington--were then selected for in-depth examination, including interviews with key program personnel. In addition, a literature review identified two model programs that have formed partnerships on caregiving between health care providers and area agencies on aging (AAAs). IN BRIEF Key Findings Caregiver Assessment 1. One key to good outcomes in community settings is not just assessing the frail elder or adult with disabilities (i.e., the care recipient), but the family caregiver as well. The value of systematic assessment of family caregivers \' needs stems, in part, from recognition of the fundamental need to sustain caregiving families and help them stay on the job. The concept of a single, universal assessment tool for long-term care clients, including family caregivers, is gaining attention in a number of states. 2. Caregiver assessments in California, Massachusetts, Minnesota, Pennsylvania, and Washington are being used to tailor care plans and support services to meet the needs of family caregivers. These states also have been successful in using information from caregiver assessment and reassessment data to modify existing programs or develop new programs and services. While the assessment tools vary, all include some standardized questions about basic demographics (e.g., age, employment situation), caregiver stress, burden, and health status. The structure of the assessment also may differ by state, but all programs require an in-home interview with the caregiver 1 For the full report, see PPI Issue Paper #2006-09. March 2006. In Brief written by Wendy Fox-Grage and Mary Jo Gibson, March 2006 2006, AARP. Reprinting with permission only. AARP Public Policy Institute, 601 E Street NW, Washington, DC 20049 http://www.aarp.org/ppi 202-434-3860 ppi@aarp.org INB Number 120 that generally lasts between 90 minutes and three hours. Family caregivers are reassessed annually or sooner if there is a significant change in the condition or living arrangement of the care recipient. Most states have automated their assessment systems or are in the process of doing so. Consumer Direction 3. The emergence of consumer-directed service options specifically for family caregivers is taking hold in states. These options can be particularly effective in addressing the needs of families in rural areas where fewer formal services may be available. In addition, family members often play critical roles within broader consumer-directed HCBS programs for older persons and adults with disabilities--from being paid to provide direct services to coordinating services to serving as surrogate decision-makers for persons with cognitive impairment. 4. While most states offer at least one consumer-directed service option to family caregivers, considerable variation exists among states and among programs within states in the amount of assistance provided and eligibility requirements. Most states offering consumer-directed options for caregivers include respite care (such as in-home care, adult day care, or weekend or overnight stays in a long-term care facility) and supplemental services (encompassing home modifications, yard work, chore services, and assistive devices). Amounts offered annually for respite vary, from 500 1,500 in Alabama up to 3,500 in Minnesota and 3,600 in California. Some states, such as Alabama and North Carolina, provide a list of approved providers and goods from which caregivers may choose; other states, such as Minnesota and Pennsylvania, allow caregivers to hire someone privately; still others, such as California and Georgia, provide both options. Collaborations on Caregiving between the Aging Network and the Health Care System 5. Two projects--one in Maine and the other, a national project with the National Association of Area Agencies on Aging--are offering innovative ways to create partnerships on caregiving between two distinct but complementary systems: the aging network and health care providers. With federal funding from the National Family Caregiver Support Program, these projects are pursuing systems development strategies through partnerships and collaborations with health care practitioners. Many people who are providing assistance and care to family and friends do not recognize themselves as caregivers; health care practitioners can help these individuals self-identify as family caregivers and refer them to caregiver specialists in the community. 6. By proactively identifying family caregivers in primary care physician offices, rather than waiting for caregivers to seek help or continue to provide care alone, family caregiver support programs can reach caregivers before they experience any adverse effects from caregiving. This support, in turn, may delay institutionalization of those receiving care for as long as possible. Conclusion States play a large and growing role in financing and delivering services to support and sustain family and informal caregivers, the backbone of long-term care. These three emerging trends require changes in the way many program administrators and practitioners have traditionally performed their jobs, such as the need to adopt a more family-centered perspective in assessing needs and delivering services. These new approaches can help to promote an exchange of new ideas among states as they pursue the goal of strengthening HCBS and hold promise for increasing the well-being of both individual care recipient and family caregivers. ",460);arrFiles[5]=new Array(6,"2006SummitBrochure2.pdf","2006-04-10","Microsoft Word - 2006SummitBrochure.doc","","","Location & Directions From NYS Thruway or Airport Thruway to Exit 36 (Syracuse Route 81) South on 81 Exit 18 (Harrison St/Adams St)- stay on RIGHT ramp Immediately get into the LEFT lane on one-way Harrison St Go through the next traffic light (Townsend St) pay parking lot entrance is on LEFT (Park in this lot, if possible) Walk out of the parking lot, go to STATE ST (corner of Harrison) and walk north on State past the War Memorial. The Civic Center is on the next corner (Madison St) a 16-story brick building. The Department for Aging and Youth is on the 13th floor AGENDA Wednesday May 3, 2006 Onondaga County Civic Center 421 Montgomery St. Syracuse, NY 10:00 am 3:00 pm 2006 NYS Caregiver Coordinator Summit Presentedby: From 690 West (Fayetteville and Albany) Exit at Townsend St turn left on Townsend Continue on Townsend to HARRISON ST (approx 4-5 blocks) Turn right on one-way Harrison St and immediately get into the LEFT lane pay parking lot entrance is on the left (Park in this lot if possible) Walk out of the parking lot, go to STATE ST (corner of Harrison) and walk north on State past the War Memorial. The Civic Center is on the next corner (Madison St) a 16-story brick building. The Department for Aging and Youth is on the 13th floor Performance Outcomes Measurement Project NYSOFA presentation with Q & A Best Practices A special presentation from Steuben County Lunch Lunch will NOT be provided, however there is a cafeteria in the basement of the Civic Center Update on Single Point of Entry NYSOFA presentation with Q & A Open Discussion What \'s On Your Mind? Onondaga County Dept. for Aging & Youth ~and~ From 690 East (Baldwinsville/Rochester) Exit to Route 81 SOUTH Get off at Exit #18 (Harrison St/Adams St) stay on right ramp Immediately get into the LEFT lane on one-way Harrison St Go through the next traffic light (Townsend St) pay parking lot entrance is on LEFT (Park in this lot, if possible) Walk out of the parking lot, go to STATE ST (corner of Harrison) and walk north on State past the War Memorial. The Civic Center is on the next corner (Madison St) a 16-story brick building. The Department for Aging and Youth is on the 13th floor Wednesday May 3, 2006 Onondaga County Civic Center 421 Montgomery St. Syracuse, NY 10:00 am 3:00 pm 272 Broadway Albany, NY 12204 Phone 518-449-7080 Fax 518-449-7055 www.nysaaaa.org office@nysaaaa.org Registration Please mail this form to NYSAAAA, 272 Broadway, Albany, NY 12204 or fax to (518) 449-7055 by Friday, April 28, 2006 YES! Please reserve a space for: Name:_______________________________________________________________ OFA:_______________________________________________________________ Title:_________________________________________________________________ Phone:______________________________ Fax:___________________________ Details 2006 NYS Caregiver Coordinator Summit Wednesday May 3, 2006 Onondaga County Civic Center 421 Montgomery St. Syracuse, NY 10:00 am 3:00 pm Be a part of the Information Exchange We will be bringing together OFA staff from across the state, plus specialists from NYSOFA to discuss the most pressing issues of the day. Come prepared to bring your challenges to light...and help your neighbor tap into your office \'s successes and creative solutions! For more information contact: Beth Mahar at (518) 449-7080 beth@nysaaaa.org or Email ________________________________________________________________ Describe/list issues you \'d like to address at this Summit, or future Forums: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Cynthia Stevenson at (315) 435-2362 cstevenson@ongov.net Want to stay in the loop? Can \'t attend? There is no charge for this summit Catch someone doing good...Report the best practices/conferences/events in your program to beth@nysaaaa.org...You might start a trend! Visit the NYSAAAA caregiver web site at www.nysaaaa.org/caregiver for the latest information on caregiver programs and contacts for all 59 Area Agencies on Aging ",171);arrFiles[6]=new Array(7,"50_state_report_complete.pdf","2005-10-04","50_state_report_complete","","","The State of the States in Family Caregiver Support: A 50-State Study November 2004 About Family Caregiver Alliance Founded in 1977, Family Caregiver Alliance serves as a public voice for caregivers, illuminating the daily challenges they face, offering them the assistance they so desperately need and deserve, and championing their cause through education, services, research and advocacy. Long recognized as a pioneer among caregiver organizations, FCA operates programs at local, state and national levels. FCA is the lead agency and model for California \'s statewide system of Caregiver Resource Centers. In 2001, FCA established the National Center on Caregiving to advance the development of high-quality, cost-effective policies and programs for caregivers in every state in the country. The Forum for State Health Policy Leadership National Conference of State Legislatures The Forum for State Health Policy Leadership (the Forum) is a unit within the National Conference of State Legislatures whose mission is to provide objective information on critical and emerging issues and leadership development to legislators and staff. Established in 1995, the Forum carries out a variety of initiatives that serve targeted constituents within NCSL and respond to emerging issues and complex problems facing state legislatures. NCSL operates from offices in Denver, Colorado and Washington, D.C. Website: www.ncsl.org The State of the States in Family Caregiver Support: A 50-State Study November 2004 By: Lynn Friss Feinberg, M.S.W. Sandra L. Newman, M.P.H. Leslie Gray, M.P.H Karen N. Kolb, M.S. National Center on Caregiving Family Caregiver Alliance In Collaboration With: Wendy Fox-Grage, M.P.A., M.S.G. National Conference of State Legislatures 2004 Family Caregiver Alliance. All Rights Reserved. Funding for this project was provided in part by a grant, number 90-CG-2631 from the Administration on Aging, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration on Aging policy. OMB approval number 0985-0016. PREFACE T his report focuses attention on a growing issue facing the nation: how to support and sustain those who are the cornerstone of our long-term care system--the dedicated families and informal caregivers of older people and adults with disabilities. This 50-state study is the first to examine publicly funded caregiver support programs throughout the country. It focuses on caregiver support provided through the Older Americans Act \'s National Family Caregiver Support Program (NFCSP), Aged/Disabled Medicaid waiver programs, and state-funded programs. The report identifies key findings, describes state approaches to providing caregiver support services, offers state-by-state profiles, pinpoints needs and challenges, and expands recognition of family caregiver needs as distinct from the needs of care receivers (i.e., older people and adults with disabilities). The report also identifies emerging themes and the relationship of caregiver support to other home and community-based programs. Through this first nationwide study of caregiver support services in the U.S., we hope to: w w inform policy discussions among federal and state leaders in caregiving and long-term care throughout the nation; and advance the public debate about the explicit provision of family support within the context of long-term care systems development. This report builds on in-depth case studies of ten states \' caregiver support programs undertaken by FCA \'s National Center on Caregiving in 2002 with funding from the U.S. Administration on Aging. As such, it is designed to serve as a reference point for examining future progress and anticipating emerging issues that are likely to shape the future. Lynn Friss Feinberg Sandra L. Newman Leslie Gray Karen N. Kolb National Center on Caregiving Family Caregiver Alliance Wendy Fox-Grage National Conference of State Legislatures i The State of the States in Family Caregiver Support: A 50-State Study ACKNOWLEDGEMENTS T he authors thank the U.S. Administration on Aging (AoA) for its funding of this two-year project and Rick Greene, in particular, whose support and enthusiasm were invaluable throughout the study. This report is the result of a collaborative process involving many individuals and organizations. Our national advisory committee provided invaluable assistance in defining the issues to be covered in the 50-state survey and offered important guidance and support throughout the twoyear project: Diane Braunstein, National Governors Association; Richard Browdie, Benjamin Rose; Elinor Ginzler; AARP; Gail Hunt, National Alliance for Caregiving; Kathy Kotula, National Association of State Medicaid Directors; Robert Mollica, National Academy for State Health Policy; and Lynda Terry, California Department of Aging. We sincerely acknowledge the many staff at Family Caregiver Alliance (FCA) who contributed to the research and production components of this project: Steve Czerniak, Angela Hernandez, Melania Jusuf, Bonnie Lawrence, Lana Sheridan and Heather Whitmore. Kathleen Kelly, FCA \'s executive director, provided vital support and encouragement throughout the project. We are also grateful to our colleagues at the National Conference of State Legislatures (NCSL) who made important contributions to this study: Barbara Coleman, Donna Folkemer and Eboni Morris. Sincere appreciation also goes to Virginia Dize, National Association of State Units on Aging (NASUA), for her assistance in sample selection and her support of this 50-state study. This project could not have been completed without the expert work of Brad Silen and his team at Quality Process, particularly Paul Quinones, in developing the web-based survey and online display mechanism. Special thanks are extended to Carol Van Steenberg for her skilled editorial assistance and ongoing support. We especially are grateful to the 150 state program administrators in all 50 states and the District of Columbia who provided the information for this study, responded to follow-up questions and reviewed their respective state profiles. These state officials gave generously of their time and expertise to provide us with their perspectives and the information that allowed us to conduct this 50-state study. This report could not have been prepared without their cooperation and support. ii LIST OF FIGURES AND TABLES Figures 1. 2. 3. 4. 5. 6. 7. 8. 9. Eighteen States are Relatively New to Providing Support Services for Family Caregivers....................................................................... 12 NFCSP Programs in the States Have Transitioned from Program Development to Delivering More Services........................................... 15 State are Beginning to Utilize Single Entry Points (SEP) for all HCBS Programs and Include Access to Caregiver Support Services................. 16 Major Sources of Program Funding, FY 2003....................................... 18 Who is Considered the Client?........................................................... 21 State Programs with Age Eligibility Criteria......................................... 22 Who is Assessed?............................................................................ 24 Assessment in Programs with Family Caregiver as Main Client............... 25 Assessment in Programs in Both Family Caregiver and Care Receiver as Clients....................................................................................... 25 10. Caregiver Assessment: Top Five Areas Addressed................................ 25 11. Type of Caregiver Support Services Provided by State Programs............ 27 12. Selected Services Provided to Caregivers, by Program Type.................. 27 13. States Offer a Variety of Types of Respite Care.................................... 29 14. Use and Amount of Respite Cost Caps by State Programs..................... 30 15. Caregivers Can Access State Programs in a Variety of Ways.................. 31 16. State Programs Offer a Range of Consumer-Directed Options................ 33 17. Perception of Level of Integration of States \' HCBS Systems Varies by Program Type................................................................................. 36 18. States Have Mixed Views on the Importance of Olmstead to Caregiver Support......................................................................................... 38 19. Barriers that Limit/Prevent Coordination with Other HCBS Programs...... 38 20. Top Three Long-Term Care Priorities in States by Program Type............. 39 21. Top Five Unmet Needs of Caregivers in the States............................... 41 22. Top Five Identified Technical Assistance & Training Areas for Staff Who work with Family Caregivers............................................................. 42 23. Top Five Challenges to Implementing Family Caregiver Support Programs in the States.................................................................... 42 24. Major Lessons Learned by State Programs in Providing Family Caregiver Support Services............................................................................ 43 25. Top Five Recommendations to Other States........................................ 44 26. 23 States have Enacted Caregiver Legislation..................................... 45 Tables 1. 2. 3. 4. 5. 6. Program Client Designation.............................................................. 267 Program Eligibility Criteria: Age and Functional Status......................... 273 Uniform Caregiver Assessment and Areas Assessed............................. 278 Caregiver Support Services.............................................................. 283 Respite Care.................................................................................. 291 Training on Caregiving..................................................................... 298 iii The State of the States in Family Caregiver Support: A 50-State Study EXECUTIVE SUMMARY Background The need to strengthen families in their caregiving role, and to sustain them as the backbone of our long-term care system, is a central issue in our aging society. As more long-term care is provided at home and in the community, rather than through institutions, reliance on family and informal caregivers grows. The federal government \'s increased role in financing services to caregivers of older people is evidenced by the National Family Caregiver Support Program (NFCSP) enacted under the Older Americans Act Amendments of 2000. Before passage of the NFCSP, state general revenues financed explicit caregiver services in relatively few states. Some states have also covered respite care, an important benefit for family caregivers, under their Medicaid home and community-based services (HCBS) waiver programs. Today, the NFCSP, Medicaid waivers and state-funded programs provide the bulk of public financing to support family caregiving. States approach the design of home and community-based programs, including those to support caregivers, in different ways. Some states view caregiver support as a component of programs that serve frail elders or adults with disabilities. Others see caregiver support as a separate program with distinct eligibility criteria; they seek to ensure the explicit recognition of family and informal caregivers as individuals with rights to their own services and supports. Despite the importance of state-administered programs in the everyday lives of families, we know relatively little about how these programs operate in the 50 states or the differences in their philosophy or structure. Purpose of Study This report profiles the experience of all 50 states and the District of Columbia since the passage of the NFCSP in providing publicly funded support services to family and informal caregivers of older people and adults with disabilities. The report arises from a two-year project to provide an understanding of the range and scope of federal and state-funded caregiver support programs in each of the 50 states and across states. The study was designed to take a broad focus; it examines policy choices and approaches to caregiver support through state agencies responsible for the administration of the NFCSP, Aged/Disabled Medicaid HCBS waiver programs, and state-funded programs that have either a caregiver-specific focus or include a family caregiving component in their service package. Through this first 50-state study of caregiver support services in the U.S., we hope to inform policy discussions among federal and state leaders in caregiving and long-term care throughout the nation. Method This study used the survey method, with written surveys and telephone interviews, to profile federal and state caregiver support programs in the 50 states and the District of Columbia. We obtained supplemental information from public documents, public agency and research databases, state websites and a literature review. We collected programmatic data iv Executive Summary from state program administrators for fiscal year 2003 and collected or obtained fiscal and legislative data for fiscal years 2001-2003. We chose a three-part approach to data collection because of the range of information to be obtained and the national scope of the study. Family Caregiver Alliance \'s (FCA) National Center on Caregiving staff fielded Part 1 (written survey) and Part 2 (follow-up semi-structured telephone interviews) of the survey. Part 3 consisted of a fiscal and legislative analysis. The National Conference of State Legislatures, under a subcontract with FCA, conducted that part of the study. Responses to the Part 1 survey were received from 150 out of 154 identified state programs from all 50 states and the District of Columbia, representing a 97% response rate overall. We received responses from 69 state agencies and the District of Columbia, including all 51 administrators of the NFCSP (100% response); 49 Aged/Disabled Medicaid waiver programs (94% response); and 50 state-funded programs (98% response). A total of 148 of the 150 (99%) initial state respondents participated in the Part 2 follow-up telephone interview. NFCSP program administrators in 43 states and the District of Columbia responded to the Part 3 fiscal survey. These administrators also completed Part 3 surveys for an additional 16 state-funded family caregiver programs. Key Findings Program Administration w More than one in three (36%) states began providing support to caregivers of older people for the first time as a result of the federal funds through the NFCSP. Most caregiver support and home and community-based services (HCBS) programs are administered at the state level by State Units on Aging and are available statewide. Area Agencies on Aging (AAAs) are the most common agency to have administrative responsibility for local programs providing caregiver support. In 15 states all respondents agree that the state has a single entry point (SEP) for consumers, providing better access to all HCBS programs. In 11 of these states, the SEP includes access to caregiver support. w w w Funding w State program administrators use a range of definitions and data collection methods to track expenditures and caregiver service delivery, resulting in much variability across the states. Most state programs report multiple sources of funding, with the majority of funding coming from four main sources: State general funds, NFCSP, Aged/Disabled Medicaid HCBS waivers, and client contributions. Aged/Disabled Medicaid HCBS waiver programs are a significant source of funds for services helping family caregivers of beneficiaries, typically for respite care. w w Eligibility and Assessment w Client designation varies by funding source, with half the programs in this survey recognizing either the family or informal caregiver as the primary client (30%), or both the person with disability and the care- v The State of the States in Family Caregiver Support: A 50-State Study giver as the client population (21%). w Programs use a range of criteria, including age, functional state and/or income to determine eligible populations, with most state-administered programs focused on care-receiver characteristics. Less than half of the programs in this study uniformly assess caregiver needs. w Services w w Programs offer an array of services to support family and informal caregivers. Respite is the service strategy most commonly offered to caregivers and is available in all 50 states and the District of Columbia, although the amount of respite to family members varies substantially from state to state and program to program within states. The NFCSP is emerging both as a key program to enhance the scope of services available to caregivers and as fuel for innovation. Access to program information or services varies by program type; even within the same state, caregivers typically do not find the same package of services to be available. w w Consumer Direction w States and programs within states differ in the extent to which they offer consumer-directed options to family members. The NFCSP appears to be speeding the adoption of consumer direction in family caregiving programs. Most states (all but six) pay families to provide care in at least one of their programs. w Systems Development w About one-fourth of the states use a uniform assessment tool for all HCBS programs for the elderly and adults with disabilities; family caregiving is a component in just five states \' uniform assessments. The top barriers to coordinating caregiver support programs with other HCBS programs in the states are differing eligibility requirements and service complexity and fragmentation. Expanding Medicaid HCBS waivers, integrating long-term care services and implementing or expanding consumer-directed care are the top long-term care issues identified by the states. States are beginning to establish task forces or commissions to examine family caregiving. w w w Other Issues w State program administrators see the lack of resources to meet caregiver needs in general and limited respite care options in particular as the top unmet needs of family caregivers in the states. About half the state programs offer training for staff who work with family caregivers. Three of the five current training topics match those training and technical assistance areas almost all respondents say would benefit staff: best practices in service delivery, outreach/public awareness and caregiver assessment. w w vi Executive Summary w w States identify inadequate funding as the main challenge to implementing caregiver support services. The major lesson learned by the states in providing family caregiver support is one size does not fit all so programs should increase the choices that families have. To strengthen caregiving programs, state officials recommend more innovation in program design to provide a broader array of services, better coordination and integration of caregiver support into HCBS, and more local collaboration. State legislatures, recognizing family caregivers \' role, are enacting laws to fund caregiver support services, expand family and medical leave, and include family caregiving in state long-term care efforts. w w Conclusions States play a large role in supporting family caregivers. This 50-state study of caregiver support services in the U.S. leads to the following main conclusions: w There is both an increasing availability of publicly funded caregiver support services, as well as a great unevenness of services and service options for family caregivers across the states and within states. All states now provide some explicit caregiver support services as a result of the passage of the NFCSP in 2000. Yet, similar to HCBS, in general the availability of caregiver support services varies greatly across the U.S. due to differences in philosophy, program eligibility criteria, funding, and approaches to design and administration of the services. At a practical level, such service gaps and variations can pose challenges for caregivers by limiting choices for needed support services that may not be available where they live. Service inequities may also place more pressure on already strained caregiving families and compromise the caregivers \' abilities to care for their loved one. The NFCSP is emerging as a key program to enhance the scope of caregiver support services and is fueling innovation in the states, but is inadequately funded. The modest level of NFCSP funding to the states ( 138.7 million in 2003) leaves gaps in caregiver support services that vary substantially from state to state. As a result, most states in this study continue to rely on their own general revenues to provide caregiver support services, and utilize Aged/Disabled Medicaid waivers, a significant source of funds, to finance respite care for family caregivers of Medicaid waiver beneficiaries. While there is great variation among states and programs within states in their approach to caregiver assessment, there is broad recognition of the value of uniformly assessing caregiver needs and the importance of training and technical assistance in this area. Only five states that use a uniform assessment tool for all HCBS programs for older people and adults with disabilities were found to include a family caregiving component as part of systematic assessment practice. Yet, systematic assessment of the caregiver \'s needs as distinct from, but related to the needs of the care receiver, is central to systems change and to improving policy and practice in HCBS. States have mixed views on approaches to systems development, the importance of caregiver support services within home and communitybased care, and integrating family caregiving programs into HCBS. It is not surprising that in a time of major organizational and systems w w w vii The State of the States in Family Caregiver Support: A 50-State Study change efforts, there may be different levels of understanding and perspectives of how states can and should accomplish the policy goal of reforming long-term care by expanding HCBS. Issues for the Future From this study, we can identify important issues for the future. Following are five initial steps towards achieving a better caregiver support system across the nation: 1. 2. 3. 4. 5. Raise the funding level of the NFCSP to reduce gaps in caregiver support services and provide meaningful support to caregiving families. Improve data collection and reporting under the NFCSP and other state programs that provide caregiver support services. Strengthen and expand uniform assessment of caregiver needs in all HCBS programs that provide some component of caregiver support. Conduct a national public awareness campaign on family caregiving. Invest in innovation, promising practices and technical assistance. This first 50-state study on caregiving provides new insights into the ways states provide caregiver support services and their approaches to family caregiving issues in the context of HCBS. As such, it provides a starting point to further examine the policy choices and state approaches to caregiver support, as well as changes over time. viii INTRODUCTION I n our aging society, the challenges of family care are an increasing reality of daily life for America \'s families. An estimated 44.4 million Americans provide care for adult family members and friends who, because of disabling illnesses or conditions, cannot carry out basic activities of daily living, such as bathing, preparing meals or managing medications (National Alliance for Caregiving & AARP, 2004). In 2000, informal caregiving had an estimated national economic value of 257 billion per year, greatly exceeding the combined costs of nursing home care ( 92 billion) and home health care ( 32 billion) (Arno, 2002). Contrary to popular belief, most people who need long-term care depend on help from family and friends, not on paid service providers or institutions. The vast majority (78%) of adults in the U.S. who receive long-term care at home get all their care exclusively from unpaid family and friends, mostly wives and adult daughters. Another 14 percent receive some combination of family care and paid assistance; only eight percent rely on formal care alone (Thompson, 2004). The need to strengthen families in their caregiving role, and to sustain them as the backbone of our long-term care system, is a central issue in our aging society. At both federal and state levels, debate is mounting about policy choices to support family and informal care and increase the capacity of families and friends to provide such care. The need to strengthen families in their caregiving role, and to sustain them as the backbone of our long-term care system, is a central issue in our aging society. Families often undertake caregiving willingly and as a source of great personal satisfaction. However, caregiving can exact a high cost. Families commonly face health risks, financial burdens, emotional strain, mental health problems, workplace issues, retirement insecurity and lost opportunities. Research shows that support services effectively reduce the burden, strain and depression of caregiving responsibilities (Mittleman, Roth, Haley, & Zarit, 2004; Montgomery & Borgatta, 1989; Ostwald, Hepburn, Caron, Burns, & Mantell, 1999; Zarit, Stephens, Townsend, & Greene, 1998), allow family caregivers to remain in the workforce (Wagner, 2001), and can even delay the institutionalization of a loved one (Mittleman, Ferris, Shulman, Steinberg, & Levin, 1996). Keeping family caregivers healthy and able to provide care helps families remain together with their loved ones, thus avoiding more costly nursing homes. That is what most Americans value and want. In recent years, changes in our health care delivery system--including shorter hospital stays--have transferred cost and responsibility for ongoing care onto families. As more and more long-term care is provided through home and community-based service programs rather than institutions, reliance on family and informal caregivers grows. Health care worker shortages, a highly fragmented and confusing array of programs, and soaring health and long-term care costs all limit families \' access to helpful formal services such as in-home care or adult day services. We can expect the psychological and other costs of caregiving to rise as everyday care continues to shift to families. 1 The State of the States in Family Caregiver Support: A 50-State Study The federal government \'s increased role in financing caregiver support services to older people is evidenced by the National Family Caregiver Support Program (NFCSP) passed under the Older Americans Act (OAA) Amendments of 2000. States, however, still lead the effort to increase recognition of the caregiving role, and its demands, in order to strengthen and support families. Despite the importance of state-administered programs in the everyday lives of families, we know relatively little about how these programs operate in each of the 50 states, or how the programs differ in philosophy or structure. Background States approach the design of home and community-based programs, including those to support caregivers, in different ways. Some states view caregiver support as part of their programs that serve frail elders or adults with disabilities. Others see caregiver support as a separate program with distinct eligibility criteria; they seek to ensure the explicit recognition of family and informal caregivers as individuals with rights to their own services and supports. The availability, range and scope of publicly funded home and communitybased programs vary greatly across the U.S. Family caregiver support in general, and respite care in particular, first appeared in the statutes of several states in the 1970s, primarily focusing on family support for the developmentally disabled (Petty, 1990). Most state-funded programs, particularly those targeting caregivers of persons with Alzheimer \'s disease or other dementing illnesses, began in the mid-to-late 1980s (Feinberg & Pilisuk, 1999). Until recently, just a few states had created distinct caregiver support programs or included some degree of caregiver support services in their strategies for frail elders or adults with disabilities. The availability, range and scope of publicly funded home and communitybased programs vary greatly across the U.S. (Kassner & Williams, 1997; Weiner, Tilly, & Alecxih, 2002). These programs have multiple funding sources and each source has its own terminology, eligibility criteria and services, often constraining systems development. States, therefore, face a challenge to administer and coordinate programs, develop integrated systems of care and improve access to services for older people or adults with disabilities, as well as their family caregivers (Feinberg & Pilisuk, 1999; Mollica, 2003; Weiner et al., 2002). Before passage of the NFCSP in 2000, state general revenues paid for most publicly funded caregiver support services. However, some states have covered respite care, an important benefit for family caregivers, under their Medicaid home and community-based services (HCBS) waiver programs. Today the NFCSP, Medicaid waivers and state-funded programs provide the bulk of public financing for family caregiving. National Family Caregiver Support Program (NFCSP) The NFCSP signifies national recognition of and commitment to providing direct support services to caregivers. It is the first major nationwide program initiative under the Older Americans Act since the 1970s (Lewin Group, 2002). Under broad federal guidelines, the NFCSP calls for the states, working in partnership with area agencies on aging (AAAs) and local 2 Introduction service providers, to develop multifaceted systems of support for family and informal caregivers within five basic service categories: w w w w w information to caregivers about available services; assistance to caregivers in gaining access to supportive services; individual counseling, support groups and caregiver training to assist caregivers in making decisions and solving problems related to their roles; respite care to temporarily relieve caregivers from their responsibilities; supplemental services (e.g., emergency response systems, home modifications), on a limited basis, to complement the care provided by caregivers. Congress appropriated 125 million for the NFCSP in fiscal year 2001, 141.5 million for 2002 and 155.2 million for 2003. State Units on Aging (SUAs) receive over 90 percent of these funds, allocated through a congressionally mandated formula based on a proportionate share of the state \'s over-70 population.1 Funds also support a National Innovations Program,2 the goal of which is to conduct activities of national significance. Grants, awarded on a competitive basis, foster the development and testing of new approaches to supporting caregivers (Administration on Aging [AoA], 2004). Under the NFCSP, the states use federal funds to offer direct support services to family caregivers of persons age 60 and older.3 All income groups are eligible for services, but states must give priority to those providing care to older individuals in the greatest social or economic need with particular attention to low-income individuals.4 Functional eligibility criteria vary by type of service: individuals 60 years and older must have two or more limitations in activities of daily living (ADLs) (e.g., bathing, dressing) or a cognitive impairment for the caregiver to be eligible for respite or supplemental services. Other service categories (e.g., counseling, support groups) are available to family caregivers regardless of the care receiver \'s functional status. Medicaid Home and Community-Based Services (HCBS) Waiver Programs Medicaid, mainly through its waiver programs, supplies the majority of public funding for home and community-based care. Financed by the federal government and the states, Medicaid, as an entitlement program, has an enormous impact on state budgets, with substantial implications for state policy overall and for state policy concerning family caregivers in particular (Feinberg, Newman, & Van Steenberg, 2002). Within broad federal guidelines, states have considerable flexibility in determining who is eligible and what services to cover in their Medicaid program (U.S. General Accounting Office [GAO], 2002). While federal Medicaid services must address the beneficiary \'s needs, Medicaid HCBS waiver programs permit states to provide a wide variety of services Another portion, approximately 5 million in fiscal year 2001, 5.5 million in fiscal year 2002, and 6.2 million in fiscal year 2003, supported grants to Indian Tribal Organizations. 1 6.2 million in fiscal year 2001, 6.8 million in fiscal year 2002, and 7.5 million in fiscal year 2003. 2 States also have the flexibility to reserve up to a maximum of 10% of their funding to provide support services to grandparents and relative caregivers of children age 18 and younger. 3 Priority consideration for services is also given to older individuals providing care and support to persons 18 and under with mental retardation and related developmental disabilities. 4 3 The State of the States in Family Caregiver Support: A 50-State Study not otherwise covered under Medicaid, including respite care and other caregiver support services such as education and training. Although Medicaid services focus directly on the beneficiary, they indirectly sustain families in their caregiving role (Feinberg & Newman, in press). The federal government does not require states to maintain records on or report whether or not a waiver beneficiary also receives help from a family member. To qualify for a waiver program, beneficiaries must be at risk of institutional care and meet state residency and financial requirements. Each state sets its own guidelines and defines the particular level of care required for a person to be nursing-home eligible, such as medical diagnosis or number of ADL limitations (Smith et al., 2000). Although Medicaid financial eligibility criteria are quite restrictive (Kassner & Williams, 1997), Medicaid HCBS waiver programs allow beneficiaries to have somewhat higher incomes, generally incomes at or below 300 percent of the federal Supplemental Security Income (SSI) level. HCBS waiver programs do not have to provide the same services to similar beneficiaries across the state. Thus, states may target specific geographic areas or population groups (e.g., people with traumatic brain injuries, frail elders, people with developmental disabilities). A common waiver type, known as the aged or aged/disabled waiver program, provides services to aged or aged and disabled Medicaid beneficiaries. Medicaid waiver expenditures have grown dramatically over the last decade as a share of Medicaid \'s community-based service benefits, increasing from 37 percent in 1992 to 66 percent in 2001 (Reester, Missmar, & Tumlinson, 2004). In 2001, waiver programs for the aged and disabled population served over half of all waiver participants, but accounted for only 21 percent of waiver program spending. In contrast, HCBS waivers for persons with mental retardation or developmental disabilities served 38 percent of total waiver participants and used almost three-quarters of total waiver funds in 2001 (Reester et al., 2004). State-Funded Programs State funds generally pay for the home and community-based service programs having the most flexible eligibility criteria.5 These programs usually offer services that Medicaid will not cover or are more liberal and expand eligibility to people who do not qualify for Medicaid HCBS waivers, OAA services, or other programs (Summer, 2003). State-funded programs need not be bound by federal Medicaid and OAA regulations and can provide specific services (e.g., respite care) to distinct populations (e.g., family caregivers). One example is Connecticut \'s state-funded Alzheimer \'s Respite Care Program. Its eligibility requirements focus on the income and assets of the care receiver, who can be of any age; income cannot exceed 30,000 per year and assets cannot total more than 80,000. Impact of Recent Federal Initiatives on States States \' efforts to support family caregivers, particularly with the added resources from the NFCSP, take place in the context of the federal government \'s New Freedom Initiative. Established by executive order in 2001, the initiative outlines a plan to assist states and local communities Note that in this report home and community-based services (or HCBS) refers to the aggregate of programs that may be delivered in the home or community to support persons in need of long-term care and their caregivers. These programs include, but are not limited to, the programs funded through Medicaid HCBS waivers. 5 4 Introduction in responding to the U.S. Supreme Court \'s decision in Olmstead v. L.C. In this landmark decision, the Court ruled that states must provide services in community, rather than institutional, settings for certain persons with disabilities who receive assistance in publicly funded programs (Rosenbaum, 2001). The New Freedom Initiative identifies lack of family support as a major barrier to community living for persons with disabilities, underscoring the need for greater assistance to families and informal caregivers (U.S. Department of Health and Human Services, 2002). Support of caregiving families will be crucial in assisting frail elders and persons with disabilities to remain in or transition back to the community. Despite the NFCSP and Olmstead major policy developments, viewing family caregivers as a consumer or client population is a relatively new concept for many state program administrators. Recent case studies of 10 states (since passage of the NFCSP) found that providing explicit support for family caregivers under the NFCSP represented a sometimes challenging paradigm shift in philosophy and program operations. Some state administrators of the NFCSP, Aged/Disabled Medicaid waivers and state-funded programs identified the tension between serving the older person (i.e., care receiver), who is the traditional client in the long-term care system, and the new mandate of the NFCSP to address the family caregivers \' needs as distinct from but related to the needs of the care receiver (Feinberg et al., 2002). These 10 case studies also reveal that state administrators (directors of state units on aging and Medicaid waiver programs) believe that caregiver support can reduce the strain on Medicaid and other state-funded programs by keeping individuals in the home or community longer. A greater understanding of federal and state-funded caregiver support programs in and across the 50 states will help federal and state leaders react more effectively to emerging issues in implementing the NFCSP and state-funded programs, expanding Medicaid waivers and providing coordinated and quality services for people with disabilities and their family caregivers. Purpose of Study This report profiles the experience of all 50 states and the District of Columbia since the passage of the NFCSP in providing support services to family and informal caregivers to older people and adults with disabilities. It arises from a comprehensive two-year study designed to: 1) provide an understanding of the range and scope of federal and statefunded caregiver support programs in each of the 50 states and across states; and 2) assist the aging network and other program administrators in areas of program development and best practice, facilitating the implementation of the NFCSP and its coordination with other caregiver policy initiatives in the states. We collected information from state agencies responsible for the administration of the NFCSP; Aged/Disabled Medicaid waiver programs; and state-funded programs that either have a caregiver-specific focus or include a family caregiving component (e.g., respite care) in their home and community-based service offerings. The information obtained will be used to establish a searchable online database of caregiver support policies, programs and services in the 50 states and the District of Columbia. 5 The State of the States in Family Caregiver Support: A 50-State Study Organization of Report Following a description of the study methodology, we summarize the key findings, identify crosscutting themes, address issues for the future and present individual profiles for each of the 50 states and the District of Columbia. To identify the study \'s major findings: the key findings section presents findings for these topics: w w w w w w w program administration funding eligibility/Assessment services consumer direction systems development other issues. To find data on a particular state: Review the state profiles, organized alphabetically by state. Each profile includes: w w w selected background characteristics (e.g., census data, caregiving and long-term care data) for the state and the U.S. data about the state \'s home and community-based services as they relate to family caregiving key program-level information about programs and services to support caregivers (i.e., administrative structure, funding and caseload, eligibility, assessment and consumer direction). Sources of data for the state profiles, in addition to the survey responses, appear in the Data Documentation section on page 264 of this report. To compare how programs within a state respond to key survey questions: Review the data tables. These tables follow the state profiles section and highlight key descriptive information about programs within states. The appendices follow the data tables and include the survey instruments used in this study as well as a list of state programs participating in this 50-state study. Throughout the report, the terms respondents state program administrators and state officials are used interchangeably to refer to the individuals interviewed for this study. The term care receiver is used to describe the frail elder or adult with disabilities. 6 METHODS T his study used the survey method, with written surveys and telephone interviews, to profile federal and state caregiver support programs in the 50 states and the District of Columbia. A national Advisory Committee of selected experts in the field and stakeholders guided our efforts. We obtained supplemental information from public documents, public agency and research databases, state websites and a literature review. We collected programmatic data for fiscal year 2003 and collected or obtained fiscal and legislative data for fiscal years 2001-2003. For purposes of the study, the term family caregiver includes care provided by relatives, friends or neighbors to persons 60 years or older or adults aged 18-59 with physical and/or adult-onset cognitive disabilities (e.g., Huntington \'s disease, traumatic brain injury). The persons giving care could be primary or secondary caregivers, provide full or part-time help, and live with or separately from the person receiving care. To be included in the 50-state study, a program had to be administered by the state and provide support services to family caregivers under: (1) the Older Americans Act \'s National Family Caregiver Support Program (NFCSP);(2) the Aged/Disabled Medicaid home and community-based services (HCBS) waivers; or (3) state general funds. State-funded programs could be caregiver-specific or have a family caregiver component (e.g., respite care) as part of a home and community-based program aimed at care receivers. State general fund programs with a caregiver-specific focus had these characteristics: w w primarily state funded and administered according to state rules provide one or more services (e.g., respite care, family counseling) explicitly to families or friends who care for older people or younger adults with disabilities in need of long-term care. State-funded HCBS programs with a family caregiver component had these characteristics: w w w primarily state funded and administered according to state rules target older people or younger adults with disabilities with long-term care needs, and provide one or more services (e.g., respite care, family counseling) to support family caregivers of the eligible population. We did not attempt to detail all the publicly funded programs that states administer through which family caregivers may receive some support. Within the array of caregiver support services across the lifespan, we focused on programs for caregivers of the elderly and younger adults with physical and/or adult-onset cognitive disabilities. Consequently, this study did not look at some programs known to be important to family caregivers and people with disabilities, but beyond the study \'s scope. We did not: w survey programs serving the target populations of family caregivers of persons with developmental disabilities or grandparents raising grandchildren, or 7 The State of the States in Family Caregiver Support: A 50-State Study w examine programs in states funded by the federal Alzheimer \'s Disease Demonstration Grants to States that were considered stand alone rather than integrated into a larger caregiver support program. Identification of Programs and State Contacts We identified programs and state contacts to include in the study using the following process: w based on a literature review, examination of state agency websites and discussions with the project \'s Advisory Committee, created an initial list of state programs within the 50 states and the District of Columbia (January-March 2003). compiled a list of key state contacts with knowledge and insights about their state \'s program operations and practice, and an understanding of family caregiving issues (JanuaryMarch 2003). made calls to agency officials responsible for administering the NFCSP, Aged/Disabled Medicaid waivers and state-funded programs to inform them of the study, seek their participation, obtain their contact information and query the existence of any additional state-funded programs that met the study inclusion criteria (AprilJuly 2003). w w In all, we identified 154 programs in 71 state agencies in the 50 states and the District of Columbia, an average of three programs per state. We classified each program based on its major source of funding and provisionally assigned it a code: w w w NFCSP (FC) Aged/Disabled Medicaid waivers (MC) state-funded programs with either a caregiver-specific focus, or HCBS programs with a caregiver component (SC). Several state programs were reclassified later, based on survey responses. Survey Development The study \'s national Advisory Committee and previous state studies conducted by Family Caregiver Alliance \'s National Center on Caregiving (NCC) guided survey development. We chose a three-part approach because of the range of information to be collected and the national scope of the study. FCA \'s NCC staff fielded the first two parts of the survey, focusing on programmatic information. Parts 1 and 2 of the 50-state survey were pre-tested with state officials in Alabama and Hawaii. For the third part, FCA \'s NCC subcontracted with the National Conference of State Legislatures (NCSL). Part 3 was pretested in New Jersey and Pennsylvania. w Part 1 was a written survey, developed so it could be completed in printed form or electronically, then returned by mail, fax or electronically. We mailed the written survey and cover letter to program officials and also sent them the same material via email with hyperlink access to the Web-based survey instrument. Respondents were asked to complete the survey for each identified program that met the study inclusion criteria. The survey included 30 questions: 29 fixed-choice and one open-ended. The questions addressed program background, program eligibility/assessment process, program administration, services, consumer direction, systems development and other issues. (See Appendix A for a copy of the survey instrument). Part 2 was a semi-structured telephone interview with state w 8 Methods respondents, conducted after receipt of their Part 1 written surveys. The Part 2 interview guide included 17 questions: three fixedchoice and 14 open-ended. Our aim in the Part 2 interview was to allow respondents as much freedom as possible in their responses. The interview guide had two sections, the first (8 questions) asked specifically about the program; the second (9 questions) gathered impressions about family caregivers within the state, and about the state \'s system of HCBS generally. Within the first section, two questions applied only to NFCSP respondents. (See Appendix B for a copy of the interview guide). w Part 3 consisted of a fiscal and legislative analysis for the 50 states and the District of Columbia to identify and analyze new and expanded policies, programs and appropriations since the NFCSP \'s passage in 2000. FCA \'s NCC selected the NCSL to collect and analyze these data because of NCSL \'s relationships with the states and familiarity with their data. The NCSL developed the Part 3 instrument in consultation with project staff. It included eight questions addressing caseloads; federal, state, local, private, in-kind and other funding levels; funds used to meet the federally mandated match requirements under the NFCSP; state legislation related to family caregiving; and anticipated funding in future years for family caregiver programs. (See Appendix C for the Part 3 instrument). Data Collection We collected data using the following steps: w sent written survey (Part 1) and cover letter to each identified program to obtain background information on the program and services and identify emerging issues; and assisted, by telephone or e-mail, respondents who reported difficulties with the Web-based format to complete survey on-line (July 2003) made up to two follow-up contacts with states by mail, e-mail and telephone to encourage participation (August-October 2003) entered Part 1 data received via paper into the Web-based application (October-December 2003) sent all Part 1 respondents the Part 2 interview guide (SeptemberOctober 2003) conducted semi-structured telephone interviews (Part 2) to explore more fully the program \'s successes and challenges, and the relationship to other HCBS programs in the state (SeptemberDecember 2003) provided NCSL with list of Part 1 program contacts (September 2003) fielded the fiscal and legislative survey (Part 3) by e-mail and postal mail (October-December 2003, by NCSL) sent second copy of Part 3 survey to non-responders (JanuaryFebruary 2004, by NCSL) developed codebook and cleaned data (FebruaryApril 2004) made follow-up calls to state respondents, when necessary, to clarify data or responses for all three parts of the data collection (AprilJune 2004) provided each respondent with a draft of their state \'s profile to verify the accuracy of the data included in this report (August 2004). w w w w w w w w w w 9 The State of the States in Family Caregiver Support: A 50-State Study Part 1: Written Survey Response Of the 154 identified state programs, 150 responded to the written survey in all 50 states and the District of Columbia, representing a 97% response rate overall (See Appendix D). We received responses from 69 state agencies and the District of Columbia, including all 51 administrators of the NFCSP (100% response); 49 Aged/Disabled Medicaid waiver programs (94% response); and 50 state-funded programs (98% response). Over half (57%) of the respondents used the electronic format. Part 2: Follow-Up Telephone Interview Response The telephone interviews lasted, on average, 34 minutes. When a respondent was responsible for more than one state program meeting the study criteria, one interview covered all qualifying programs. In some telephone interviews, multiple respondents representing a single program participated. Of the 150 respondents to the Part 1 survey, 148 (99%) participated in the Part 2 follow-up telephone interview. This response included all 51 administrators of the NFCSP (100%); 48 of the 49 responding waiver programs (98%); and 49 of the 50 state-funded programs (98%). Part 3: Fiscal and Legislative Trend Analysis Response NCSL decided to exclude Aged/Disabled Medicaid waiver programs from the Part 3 survey. While Medicaid HCBS waivers are important funding sources for older people, persons with disabilities and their family caregivers, states deliver and pay for services based on the eligibility of the client. The federal government does not require states to track whether a waiver client is also served by a family caregiver. Given the size and scope of many of the HCBS waivers, NCSL determined that asking state officials to separate waiver clients according to the availability of a family caregiver would be very challenging for states and would likely result in inconsistent or incomplete data. In many cases, state program administrators for the NFCSP forwarded the surveys to fiscal counterparts within their agencies. NCSL researchers conducted follow-up telephone interviews when clarification was needed. To augment survey data, NCSL also used its Health Policy Legislative Tracking Service, the National Association of State Units on Aging \'s Promoting Systemic Development of State Family Caregiver Support Programs: State Profiles from 2002, as well as various online state resource documents. Program administrators in 43 states and the District of Columbia responded to the Part 3 survey. Responses were received from 436 NFCSP program administrators (84%), and administrators also completed Part 3 surveys for an additional 16 state-funded family caregiver programs (32%). Data Analysis We used SPSS for Windows, version 11.0, to analyze the data. Part 1 and Part 2 data were analyzed by the total sample and separately by the three program types (i.e., NFCSP, Medicaid waivers and state general fund programs). We used descriptive statistics, including frequency distributions and cross-tabulations of selected questions, to characterize closed-ended questions. For selected questions that addressed state (rather than program) issues, we examined the responses from each of the respondents within a state for congruence. Congruence is defined as the level of The 7 states that did not respond to the Part 3 survey were Alaska, Missouri, Ohio, Rhode Island, South Carolina, South Dakota and Wisconsin. 6 10 Methods agreement among the state respondents within a state in their perceptions or assessment of certain state-level questions in this study. For those questions in which respondents within a state disagreed, we report a lack of agreement on the state profile. Any other reported state-level finding indicates all respondents within the state gave the same response. The project team developed a set of codes to analyze questions with openended responses. All questions with an other response were coded so that the other category included less than 15 percent of all responses for that question. These data were then re-entered into the Web-based application prior to data analysis by SPSS. For the Part 2 telephone interviews, the project team developed an initial codebook by question based on past surveys conducted by FCA. A qualitative, grounded theory (Glaser & Strauss, 1967) approach was used throughout analysis. The 148 interviews were divided into groups of 10 interviews, and coded two times daily in two-hour periods for nine weeks. Coding teams consisted of two project staff, who each coded the same interview simultaneously, then had a short discussion of the interview and coding scheme to ensure coder reliability. To determine if any additional codes were necessary, 20 surveys were initially selected at random and analyzed. During this process, we clarified, expanded or narrowed the codes. For data verification, we reanalyzed the first 30 interviews to insure that the data and codes reflected any changes in the codebook. Upon completion of coding, we chose 15 surveys at random and analyzed them by question to ensure no themes were missed. We then calculated frequencies by program type and for the entire sample. We also incorporated data taken from other sources (e.g., legislative and bill information from the NCSL Health Policy Tracking Service) into the database used for the Part 1 and Part 2 data analyses. For Part 3, NCSL analyzed data using Microsoft Excel. Certain Part 3 data, specifically NFCSP expenditures and NFCSP caseloads, have not been analyzed and are not included in this report. We excluded caseload data from the analysis because of the wide variance of state data reported and the lack of comparable data. For example, some states reported caseloads using a duplicated count, others an unduplicated count. We excluded the NFCSP fiscal data collected based on variance in state fiscal years, carryover of funds from one year to the next, and different reporting and accounting systems. Fiscal information used in this report is based on data obtained from the following sources: w w for all years cited, we obtained federal allocations to the states for the NFCSP from the U.S. Administration on Aging we obtained expenditures for state-funded programs from either NCSL \'s Part 3 survey or from the state program respondent during the data verification process, where available for fiscal years 2001 and 2002, we obtained Medicaid waiver data from CMS Form 372 for respite participants and expenditures, and total participants and expenditures. For fiscal year 2003, we obtained waiver data from CMS 64 quarterly reports of total expenditures for Aged/ Disabled waivers. (For full citations, please see page 264.) w 11 The State of the States in Family Caregiver Support: A 50-State Study KEY FINDINGS Program Administration T o understand what is taking place in the states in administering caregiver programs, we posed a number of questions for analysis: Did the infusion of federal funds through the National Family Caregiver Support Program (NFCSP) enable any states to serve family caregivers for the first time? How are states administering their caregiver support programs? Are local agencies involved in program administration? Is promoting a statewide identity for caregiver programs a priority in the states? Are intrastate collaborations, including pooling of funds, occurring among agencies or programs? How have caregiver programs changed since 2001, when the NFCSP implementation started? We explored the impact of the NFCSP on caregiver program growth by looking at the programs funded primarily through state general funds and identifying states that had no state-funded programs serving caregivers before the passage of NFCSP in 2000. More than one in three (36%) states began providing support to caregivers of older people for the first time as a result of the federal funds through the National Family Caregiver Support Program. w Before the NFCSP, 18 states and the District of Columbia had no state program primarily funded through state general funds that served family or informal caregivers--neither a caregiver-specific statewide program nor a caregiver component within a broader HCBS program (see Figure 1). w In 32 states, 50 state-funded proFigure 1. Eighteen States are Relatively New to Providing Support Services for Family Caregivers grams serving family and informal caregivers had predated the NFCSP. Usually these programs were part of state-funded home and communitybased services, where one or more components, e.g., respite, helped family caregivers of older people or adults with physical and/or adultonset cognitive disabilities such as Alzheimer \'s disease. A few states had state-funded programs with a caregiver-specific focus. w Just seven state-funded programs, operating in six states (California, Nevada, Oklahoma, Oregon, Virginia and Washington), had recognized family caregivers as the explicit client population before the NFCSP. Another 16 programs identified both the care receiver and the family caregiver as the client population in the HCBS program (see Table 1). States with some caregiver support services or program prior to NFCSP No caregiver support program prior to NFCSP 12 Key Findings Most caregiver support and home and community-based services programs are administered at the state level by State Units on Aging and are available statewide. States administer their caregiver support and HCBS programs in a variety of ways. w About two-thirds of the states7 (34) centralize administrative responsibilities for caregiver support and HCBS programs in one state agency serving the elderly and their family caregivers, typically the SUA. The District of Columbia and 14 states8 administer caregiver support programs through two agencies: typically the SUA, which oversees the NFCSP and some state-funded programs, and the Medicaid agency, which oversees services within the Aged/Disabled HCBS waiver program. Two states (California and Virginia) spread administrative responsibility for caregiver support and HCBS programs among three or more state agencies. w w Many SUAs also have responsibility for other state HCBS programs which often have a caregiving component as well. w In 31 states9, the SUA has lead responsibility for managing the Aged or the Aged/Disabled Medicaid waiver program. In 26 states10 the SUA administers state-funded HCBS programs for older people and/or younger adults with disabilities. Three states (California, Maryland and Virginia) administer some statefunded caregiver support programs outside either the SUA or the state Medicaid agency. Virtually all (96%) the programs in this study operate statewide, providing access to caregivers in all regions of their state. Only six programs (2 Medicaid waivers, 4 state-funded) did not provide services statewide by 2003. w w Overseeing caregiver programs merits special focus in most states and for most programs. According to more than three out of four (77%) program respondents, an organizational unit or a person specifically designated for caregiver programs or activities exists within their state agency. w All but three (94%) of the SUAs that administer the NFSCP designate a lead unit or staff for caregiver programs. (Michigan, New Jersey and Texas do not.) Alaska, Arkansas, Connecticut, Delaware, Florida, Georgia, Indiana, Kansas, Kentucky, Maine, Massachusetts, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New York, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Utah, Vermont, Washington, West Virginia, Wisconsin, Wyoming. 7 Alabama (shares administrative responsibility with the SUA), Arizona, Colorado, District of Columbia, Hawaii, Iowa, Idaho, Illinois, Louisiana, Maryland, Michigan, Mississippi, New Mexico, North Carolina, Texas. 8 Arkansas, California, Delaware, Florida, Georgia, Illinois, Indiana, Kansas, Maine, Maryland, Massachusetts, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Jersey, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Utah, Vermont, Washington, West Virginia, Wisconsin, Wyoming. 9 Arizona, California, Connecticut, Florida, Hawaii, Idaho, Indiana, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New York, North Carolina, North Dakota, Oklahoma, Pennsylvania, Tennessee, Utah, Virginia, Washington, Wyoming. 10 13 The State of the States in Family Caregiver Support: A 50-State Study w The great majority (80%) of the state-funded programs and over half (57%) of the Aged/Disabled Medicaid waiver programs have an organizational unit or person for caregiving programs within their agency as well. Most of the waiver programs with caregiver specialists (23 of 28) are administered by the SUA. Among the 34 programs in 22 states that do not have a designated unit or person for caregiving, most are linked to the Aged/Disabled Medicaid waivers, a program targeted to the older person or adult with disabilities. Area Agencies on Aging (AAAs) are the most common agency to have administrative responsibility for local programs providing caregiver support. w w AAAs have administrative responsibility for three-fifths of the programs (92 of the 150, or 61%). Other local entities most frequently involved in administering the programs are nonprofit agencies (16%), other government agencies (13%), county health departments (5%), county human/social services departments (3%), and private for-profit agencies (2%). About one in six of the 150 programs (7 NFCSP, 12 Medicaid waivers and 7 state-funded programs), in 16 states, use the SUA as the administrative entity. Nine states11 and the District of Columbia operate as single state planning and service areas without AAAs where the SUA administers all programs under the OAA, including the NFCSP. In 18 states the single state agency for Medicaid has local administrative responsibility for some programs, covering five state-funded and 19 Medicaid waiver programs. w w As to the priority placed on promoting a statewide identity for their caregiver support program, state program administrators divide fairly evenly in their responses. About one-third (35%) see statewide identity as a high priority, slightly fewer (32%) rate it as a medium priority, and one-third (33%) assign it a low priority. This variation is consistent across program type. w All program respondents from seven states (Alabama, Delaware, Massachusetts, Pennsylvania, Rhode Island, South Dakota, and Vermont) report that their state agencies place a high priority on promoting a statewide identity for caregiver support programs. All seven states also designate a specific unit or person for caregiving programs, allowing for a focused and consistent effort in promoting caregiver support services. About one-third (34%) of all state programs report collaboration initiatives and pool funding for joint activities. The top three joint efforts are outreach/advertising/marketing (74%), education and training (44%), and toll-free telephone numbers (40%) to improve access to the program. State NFCSP programs have transitioned from program development to delivering more services to caregivers. As shown in Figure 2, NFCSPs report that in 2003, as compared to 2001, they were offering more services to caregivers (57%) and serving more caregivers (22%), having transitioned from start-up and program Alaska, Delaware, District of Columbia, Nevada, New Hampshire, North Dakota, Rhode Island, South Dakota, Wyoming. 11 14 Key Findings Figure 2. NFCSP Programs in the States Have Transitioned from Program Development to Delivering More Services (n = 51) 70% 60% 50% 61% 57% Percent 40% 30% 20% 10% 0% 33% 29% 22% 20% 16% 12% 10% HC BS n st af f ra m er s s ce ta tio ce tly en iv se rv i se rv i ca re g ro g y fic i em en ds b to fp m or e rm in es so ee sm or e ra m m or e im pl fo aw ar en rin ve in ro g g nd ffe ds rp tt gi in en re rv fu ee ve O ca Se pm d ln ic gi en of ca lo bl Sp ng ve lo pu t/ de er di an en at m rst m re fro de G ss se n un io sit d an se ea Tr development in 2001 to implementation of more programs and services in 2003 (the year of this survey). One-third (33%) of the NFCSPs say their staff has an increased awareness of caregiver needs, and one in five (20%) report greater public awareness of the NFCSP. Eight states (16%) report spending their funds more effectively and six states (12%) say they are integrating the caregiver program into their state \'s system of HCBS. In 15 states all respondents agree that the state has a single entry point (SEP) for consumers, providing better access to all HCBS programs. In 11 of these states, the SEP includes access to caregiver support. Some states have created SEP systems to help individuals and their families find and simplify access to the most appropriate long-term care and supportive services for their needs. Broadly, these organizations carry out a range of functions that include, but are not limited to, information and assistance, screening, assessment, care planning, service authorization, monitoring and reassessment using one or more funding sources. These functions may be combined in a single agency or split among agencies (Mollica & Gillespie, 2003). We asked all program respondents (i.e., NFCSP, Medicaid waivers and state-funded programs) whether or not their state has a SEP for all HCBS programs. The presence of SEPs varies across the states, as do the perceptions of program administrators, in some states, as to whether their state has a SEP and, if so, whether it provides access to all HCBS programs and includes access to caregiver support. w w In 19 states and the District of Columbia all respondents agree that they do not operate SEPs. Respondents from 68 programs (45%) in 31 states report SEPs, including 57 respondents from 27 states who say the SEP includes access to In cr N ee ds as In te gr at in g ca re Im pr ov ed o g da ta rn co ef g in lle ct io n s 15 The State of the States in Family Caregiver Support: A 50-State Study w w the state \'s caregiver support program. However, in more than half of these states (16) respondents within the state disagree. In just 15 states do all respondents within that state say that the state has a SEP for all HCBS programs. In these 15 states, respondents from all but four agree that the SEP for all HCBS includes access to caregiver programs. Only administrators in Arkansas, Colorado, Maine and Nevada vary in their opinions as to whether their state \'s SEP provides access to caregiver support. Figure 3 shows the states that reported SEPs for all HCBS programs. It also indicates which state \'s SEPs provide access to caregiver support. Figure 3. States are Beginning to Utilize Single Entry Points (SEP) for all HCBS Programs and Include Access to Caregiver Support Programs The organization that most frequently functions as the SEP is the AAA (56%). The other SEP options are state agency field offices (e.g., Medicaid agency, SUA) (22%), county health or human service departments (13%), communitybased nonprofit agencies (10%), other government agencies (e.g., social services) (10%), other organizations (e.g., home health agency (7%) and private for-profit agencies (4%). = States whose SEP includes access to caregiver support = States whose SEP does not include access to caregiver support = States don \'t operate SEP 16 Key Findings FUNDING C aregiver support services are financed through a variety of public and private funding sources. In this study, we wanted to gain an understanding of the sources and amount of federal and state funding for caregiver support in the 50 states since the enactment of the NFCSP. We also wanted to identify general trends and issues in spending by the stateadministered programs. We expected these trends would provide insight into broader spending patterns for caregiver support. In all programs included in this study (i.e., NFCSP, Medicaid waivers, statefunded), states have enormous flexibility in determining what services are provided to best meet locally identified needs, how they are delivered, and how services and expenditures are reported. However, this flexibility at the state level poses challenges: without comparable data, cross-state comparisons cannot be made and we cannot obtain a clear picture of spending, across all the states, for caregiver support services. During the study period, the NFCSP, in particular, was in a developmental stage: states have been identifying needs, building programs and services, and creating reporting systems to meet the new client mandate under the OAA. Data are available on the federal allocations to the states, but variance in fiscal years among the states and in treatment of carryover funds results in inconsistent reporting of actual state program expenditures. Beginning in FY 2005, states will use a new version of the National Aging Program Information System (NAPIS). As part of NAPIS, SUAs will complete utilization and expenditure profiles for the NFCSP to provide more consistent programmatic and expenditure data across the states. State program administrators use a range of definitions and data collection methods to track expenditures and caregiver service delivery, resulting in much variability across the states. Due to data limitations, we could not obtain consistent and accurate information on expenditures (and persons served) for programs providing caregiver support services. Indeed, many states have no uniform system in use across their own state \'s HCBS programs. Thus it was not possible to consistently identify total funding (or the total number of families served) for programs in this study. On the other hand, study respondents give us insights into the sources of funding, how these vary across states and how the sources and funding levels are changing over time, especially with the advent of the NFCSP. In addition, data reported for the Medicaid waiver programs allow us to see expenditure trends for one service of significant help to caregivers, respite. Most states continue to rely primarily on their own general revenues to provide caregiver support services. We asked state program administrators to identify the major sources of public funding that their program receives for fiscal year 2003. Most state programs report multiple sources of funding, with the majority of funding 17 The State of the States in Family Caregiver Support: A 50-State Study Figure 4. Major Sources of Program Funding, FY 2003 State general fund NFCSP Medicaid HCBS waiver Client contribution Tobacco settlement fund Local/county fund AD** grants to states Social Services Block Grant (Title XX) Lottery fund Private foundation Other sources # of programs receiving funding from this source* 86 55 49 36 11 10 7 5 3 2 20 % of programs receiving funding from this source 57% 37% 33% 24% 7% 7% 5% 3% 2% 1% 13% coming from four main sources: State general funds; NFCSP; Aged/Disabled Medicaid HCBS waivers; and client contributions. Figure 4 shows the range of funding sources. State general revenues are a source of funding for the majority (57%) of programs in this study. State general funds allow states to develop programs that are generally not constrained by federal rules and regulations. States also use their general revenues to match federal funds (NFCSP or Medicaid waiver programs). Some over-match by supplying more state money than Note. Many programs identified more than one source of funding. *N = 150. **AD = Alzheimer \'s disease. required for federal funding. w Among respondents for Medicaid waiver programs, more than twofifths (43%) identify state general funds as a major source of funding for their program. About one-third (39%) of respondents for the state NFCSPs say state general funds are a major funding source. In California, Florida, New Jersey and Pennsylvania state coffers have significantly funded caregiver support programs. w w In this study, some state-funded programs provided expenditure data for fiscal years 2001-2003. In all, 22 of the 50 state-funded programs in 14 states12 (44% of programs of this type in these states) provided expenditure data, with the most complete data for fiscal years 2002 and 2003. These identified expenditures represent less than half of the statefunded programs in this study. Based on previous research (Feinberg & Pilisuk, 1999; Feinberg et al., 2002), as well as data limitations and reporting variances, these expenditures clearly under-report the amount of state funding for caregiver support across all states. (See State Profiles for expenditure data). w These 22 state-funded programs (a combination of explicit caregiver support programs and HCBS programs with a caregiver component) expended approximately 132.4 million in state general funds in fiscal year 2002 and 128.5 million in fiscal year 2003. In fiscal year 2003, state funding varied from a high of 42.3 million in Florida \'s HCBS program, Community Care for the Elderly, and 11.7 million in California \'s Caregiver Resource Centers, to a low of 250,971 in Minnesota \'s Alternative Care Program and 238,407 in Nevada \'s Community-Based Caregiving Training Program. w The NFCSP (Title III-E) is the funding source that state officials cite second most frequently (by 37% of study respondents). Through this relatively new funding source, explicit family caregiver support services now operate in all 50 states and the District of Columbia. Where caregiver California, Connecticut, Florida, Maine, Michigan, Minnesota, Nevada, New Jersey, North Carolina, North Dakota, Pennsylvania, Texas, Washington, Wisconsin. 12 18 Key Findings support programs existed before the NFCSP, these funds expand the range and scope of services to families. In the other states, the NFCSP serves as the major funding source for a range of caregiver support services not available previously. w Federal data on the NFCSP show the AoA provided the 50 states and the District of Columbia with about 110.9 million in fiscal year 2001, 126.6 million in 2002 and 138.7 million in 2003. In fiscal year 2003, federal funding varied from 13.9 million in California and 11.1 in Florida to a low of 705,756 in 11 states13 and the District of Columbia. Between fiscal years 2001 and 2003, the NFCSP federal allocations to the states increased 25 percent. (See State Profiles for allocation data). w w Aged/Disabled Medicaid HCBS waiver programs are a significant source of funds for services that help family caregivers of beneficiaries, typically for respite care. w According to data reported to the Centers for Medicare and Medicaid Services (CMS), the Aged/Disabled 1915(c) waivers14 provided an estimated 84.5 million for respite care alone in FY 2001. Respite care expenditures under these waivers grew to 101.4 million (a 20% increase) in fiscal year 2002, the most recent year for which these data are available. (See State Profiles for expenditure data).15 w Client contributions are a funding source for about one-fourth (24%) of program respondents. These funds are more likely to contribute some support to state-funded programs (36%) or the NFCSPs (28%) rather than those offered through Medicaid waivers (8%). Tobacco settlement funds, study respondents report, support 11 programs in seven states16 including four Medicaid waivers, six statefunded programs and one state NFCSP. These monies have typically been used to expand services to more older people or adults with disabilities or to support specific services, such as respite care for family caregivers. State officials report several other funding sources: w w Revenue from state lotteries supports two Pennsylvania programs (OPTIONS and NFCSP) and West Virginia \'s Aged/Disabled Medicaid waiver. Casino revenue contribute to New Jersey \'s state-funded Adult Day Services Program for Persons with Alzheimer \'s Disease or Related Dementias. Escheat17 monies benefit Michigan \'s State/Escheat Respite program. w Alaska, Delaware, District of Columbia, Hawaii, Idaho, Montana, New Hampshire, North Dakota, South Dakota, Rhode Island, Vermont, Wyoming. 13 Source: CMS Form 372 (Annual Report on HCBS Waivers), with data analysis performed by Kitchener, M., Ng., T. & Harrington, C., UCSF Department of Social and Behavioral Sciences, 2004. 14 Source: CMS Form 372 (Annual Report on HCBS Waivers), with data analysis performed by CMS Center for Medicaid and State Operations, 2004. 15 Medicaid waivers in Georgia, Iowa, Nevada and Pennsylvania; state-funded programs in Florida (RELIEF and Community Care for the Elderly), Nevada (Independent Living Grant), Michigan (Caregiver Respite Program), Nebraska (Respite Subsidy Across the Lifespan), Pennsylvania (BRIDGE program); and the Pennsylvania NFCSP. 16 17 Escheat refers to unclaimed reimbursements or payments made by Blue Cross/Blue Shield for insurance in Michigan. The unclaimed payments revert back to the state and the funds are then set aside for designated health-related programs. 19 The State of the States in Family Caregiver Support: A 50-State Study w Arizona and Wyoming use federal OAA Title III-B social services funds for state-funded programs (Non-Medical Home and Community Based Services Program in Arizona and Community Based In-Home Services Program in Wyoming). Alaska \'s Innovative Respite Program uses Mental Health Trust Authority authorized receipts. w Although most states experienced severe budget crises between 2001 and 2003, funding levels for family caregiver programs generally held their own--either increased or remained about the same. Program administrators in Alabama, Arizona, Connecticut, Delaware, the District of Columbia and Florida (for the NFCSP), and Iowa, Massachusetts, Montana, New Mexico, Oklahoma, Pennsylvania, Utah, Virginia, Washington, West Virginia and Wyoming (for the state-funded program in general or the state respite program in particular) report either stable funding or slight increases between fiscal years 2002 and 2003 and project increases for fiscal year 2004. For many, modest increases in federal NFCSP allocations account for the growth. Program respondents also expect to see an increase in demand for services from family and informal caregivers due to budget pressures on other aging and disability supportive services. 20 Key Findings ELIGIBILITY AND ASSESSMENT The aging network now recognizes the family caregiver as a valued consumer in need of support services in their own right. Other HCBS programs don \'t yet share this philosophy. --Medicaid waiver respondent E ligibility criteria determine who will have access to caregiver support, further define service priorities, and vary by source of program funding. Most HCBS programs focus solely on the functional limitations of frail elders or persons with disabilities. The programs usually do not address the family unit together as the client system, the range of informal caregivers \' needs or the complexity of caregiving responsibilities (Feinberg et al., 2002; Levine, C., Reinhard, S., Feinberg, L. F., Albert, S., & Hart, A., 2004). State officials generally define family caregiving programs as those that specifically serve families who are providing care to a relative. Although states vary, they typically do not consider programs targeted to serve an older person or younger adult with disabilities as caregiver support programs, even if they provide important and often significant benefits to families. Who is the Program Client? Client designation varies by funding source, with half of the programs in this survey recognizing either the family or informal caregiver as the primary client (30%), or both the person with both disability and the caregiver as the client population (21%). A program \'s client designation impacts eligibility and shapes how program services are configured and delivered. As shown in Table 1 and Figure 5 the three types of programs examined in this study (i.e., NFCSP, Medicaid waiver and state-funded) differ considerably in whom they see to be program clients. w Across all three types of programs, half the respondents (74 or 50%) say they consider the person with disease/disability (i.e., the care receiver) the client. All but one of the Medicaid HCBS waiver programs (48 out of 49) identified the individual with disability as the client, as did more than half of state-funded programs (52%) and one state NFCSP (Virginia). Among programs focused on the care receiver, a sizeable proportion (44%) cannot say whether or not their clients have a family caregiver because they do not collect these data. We found that the family or informal caregiver is the primary client in nearly one-third (30%) of the programs studied Figure 5. Who is Considered the Client? (N = 149) 100% 80% Percent 60% 40% 20% 0% 2% 26% NFCSP (n = 50) w 14% 73% 98% 52% Caregiver Care Receiver 34% 2% Medicaid Waiver (n = 48) State-funded Program (n = 51) Both 21 The State of the States in Family Caregiver Support: A 50-State Study (44 programs in 38 states and the District of Columbia). I think we `get \' it now, says one state NFCSP administrator, but that was one of the biggest challenges and one of the lessons learned. The focus [of the program] is the caregiver, the client is the caregiver, and the recipient is the caregiver too. That is quite a switch from how we think, especially in the HCBS world. w NFCSPs make up the great majority of programs (37 out of 44; 84%) designating the caregiver as primary client. They have an explicit requirement under the OAA to serve caregivers of older people. Nevertheless, a sizeable number of NFCSPs (those in 13 states18) view both the family caregiver and the person with disease/disability as the primary client group. Only a few state-funded programs (seven in six states19) identify the family caregiver as their primary client. These programs typically have explicit state mandates to serve family and informal caregivers. w Overall, 31 programs in 23 states (21%) including New Hampshire \'s Medicaid waiver program and 17 of the 50 state-funded programs in this study, take a more family centered approach to service eligibility and consider both the person with a disability (i.e., the care receiver) and the caregiver to be clients. Eligibility Criteria The programs in this study serve a range of disease/disability groups. Eligible populations most commonly include persons 60 years and older with physical disabilities (79%) and/or persons 60+ with Alzheimer \'s Figure 6. State Programs with Age Eligibility Criteria (N = 150) disease or a related cognitive impairment 60% (73%). Younger adults (i.e., age 18-64) with 50% 48% physical disabilities are 45% eligible for more than one-third (38%) of the 40% 36% programs, generally Medicaid HCBS waiver 30% (52%) or state-funded 24% (49%) programs. State-funded programs Caregiver 20% in only nine states20 15% focus solely on persons Care Receiver 9% 10% with dementia. 4% 0% 18 + 60 + 65 + Age criteria None Other 5% 5% Percent 18 Arizona, Connecticut, Florida, Hawaii, Idaho, Missouri, Montana, New Mexico, Nevada, New York, Pennsylvania, Rhode Island, Texas. 19 California (Caregiver Resource Centers); Nevada (Community-Based Caregiving Training); Oklahoma (Respite Resource Network); Oregon (Lifespan Respite Care); Virginia (Caregiver Grant Program); and Washington (Family Caregiver Support Program; Respite Care Services). 20 Alaska, California, Florida, Kentucky, Maine, New Jersey, Ohio, Pennsylvania, Texas. 22 Key Findings Programs use a range of criteria, including age, functional status and/or income to determine eligible populations, with most stateadministered programs focused on care-receiver characteristics. Age: As shown in Figure 6 the vast majority of programs have age eligibility criteria for care receivers (85%) and fewer have age criteria for the caregiver (52%). Not surprisingly, given the OAA mandate, NFCSPs were the most likely of all program types to serve caregivers of persons age 60 and older. w w The most common age requirement for care receivers are age 60+ (68 programs; 45%) and age 18+ (36 programs; 24%). The most common age requirement for caregivers is 18+ (53 programs; 36%); just a few programs require the caregiver to be age 60 or older (6 programs, 4%). Functional Status: Most programs use some type of criteria related to the functional status or diagnostic category of the care receiver to determine program eligibility. As shown in Table 2, functional eligibility requirements vary by source of funding and type of service. w w w w w The most common functional requirements for eligibility are based on the status of the care receiver: Nursing home eligible (50 programs21, 33%); Limitations in two ADLs (33 programs, 22%); Diagnosed with Alzheimer \'s disease or a related cognitive impairment (28 programs, 19%). A few programs (16, 11%) report no functional status requirements. Income: Like functional status and age, states vary widely in financial eligibility requirements depending on funding source and type of service provided. Most publicly funded programs restrict the income eligibility of the care receiver to target those most in need. w A total of 61 of 146 (42%) programs responding report no income requirements for their program. These are the NFCSPs (79%) and state-funded programs (21%). Programs with financial requirements typically look at the care receiver \'s income and/or assets. Although amounts allowed vary widely, SSI-eligilibility is the most common. w Assessment Less than half of the programs in this study uniformly assess caregiver needs. Caregiver assessments may establish eligibility for explicit caregiver programs or for support services from broader HCBS programs. Although understanding the role, multiple stressors and particular situation of the family caregiver is viewed as essential to any care plan developed for the care receiver (Baxter, 2000; Feinberg, 2004; Gaugler, Kane, & Langlois, 21 90% of the Aged/Disabled Medicaid waiver programs. 23 The State of the States in Family Caregiver Support: A 50-State Study 2000), few state programs uniformly assess the family caregiver \'s wellbeing and his or her own service needs. Caregivers need a formalized assessment system, advocated one Medicaid waiver respondent. They need a tool that asks them what they need, that is unified and formalized they and can be used across the health care continuum. As shown in Table 3, about half of the state administrators (49%, 74 programs) say they assess needs, in some way, of both the older adult or person with disabilities and the family caregiver. This approach to dual assessment is much more common among the NFCSPs (82%), compared to Medicaid waiver (22%) or state-funded programs (42%). Figure 7. Who is Assessed? (N = 150) 100% 75% Percent 78% 50% 82% 42% 22% 0% NFCSP (n = 50) Medicaid Waiver (n = 49) State-funded Program (n = 51) 10% 8% 6% 52% Caregiver Care Receiver Both Medicaid waver and state-funded programs most commonly assess only the person with disease or disability (in 78% of waiver and 52% of state-funded programs). In all, 68 programs (45%), including four NFCSPs (Iowa, Louisiana, New Hampshire and Virginia), report they assess only the person with disease or disability. Eight22 programs (5%) in seven states and the District of Columbia assess only the family caregiver \'s needs. 25% Despite the variation among programs in their assessment targets, there is broad recognition of the value of uniformity in program assessment instruments. The more established the program, the more likely it is to use a uniform tool. Among all 150 programs surveyed, the majority (69%; 104 programs) use a statewide, uniform assessment tool in their program, rather than instruments that differ from one locality to another. Moreover, programs with a uniform assessment process often include the family caregiver \'s situation in their assessment. w w Almost all Medicaid waivers (94%) report using a uniform tool, as compared to state-funded programs (64%) and the NFCSPs (51%). More than two-thirds (68%; 71 programs) of programs with a uniform assessment tool say they assess the family caregiver \'s needs and situation, too. Still, fewer than half (47%) of all state administrators in this survey say their state program uniformly assesses the family caregiver \'s needs and situation in addition to the care receiver. The programs that most typically utilize a uniform assessment process for the care receiver but do not conduct a caregiver assessment are the Medicaid HCBS waivers (44%). We don \'t have caregiver issues built into the assessment process, comments one Medicaid waiver respondent. This would be a whole new way of thinking about support and services. As shown in Figures 8 and 9, client designation appears to influence 22 NFCSPs in Alaska, District of Columbia, Maine, Minnesota, and North Dakota; state-funded programs in California (Caregiver Resource Centers); Nevada (Community-Based Caregiving Training); and Oklahoma (Oklahoma Respite Resource Network). 24 Key Findings Figure 8. Assessment in Programs with Family Caregiver as Main Client (n = 44) assessment policies. Programs that are caregiver-specific or view both the care receiver and the family caregiver as their clients, generally assess both members of the dyad to better understand the care situation. w Among the 44 programs (37 NFCSPs and 7 state-funded) that consider the family caregiver the client (Figure 8), eight programs (18%) assess the family or informal caregiver only and 32 (73%) assess both the caregiver and the care receiver. Of the 31 programs that consider both the care receiver and the family caregiver as clients (Figure 9), the great majority (81%, 25 programs) assess both family members. 9% 18% Assess family caregiver only Assess caregiver & care receiver Assess care receiver only 73% w Figure 9. Assessment in Programs with Both Family Caregiver and Care Receiver as Main Client (n = 31) 19% Table 3, shows how the domains used to assess a family caregiver \'s needs and situation vary greatly among states and programs. Figure 10 illustrates the top five areas found in uniform assessment tools used by programs to assess caregivers. w For the NFCSPs, the top five areas of caregiver assessment are: ability to provide care (76%); basic demographics (71%); caregiver strain (67%); care frequency ; and caregiver physical health and caregiver depression (57% each). For the Medicaid waiver programs, the top five areas of caregiver assessment are: willingness to provide care (92%); ability to provide care (88%); care frequency (84%); caregiver strain (72%); and care duration and physical health (56% each). For the state-funded programs, the top five areas of caregiver assessment are: ability to provide care (80%); caregiver strain (76%); basic demographics (64%); and caregiver physical health , care frequency and caregiver depression (56% each). Assess care receiver only Assess caregiver & care receiver 81% w Figure 10. Caregiver Assessment: Top 5 Areas Addressed (n = 71) Ability to provide care 82% 72% 66% 65% 58% 0% 25% 50% Percent Note. CG = caregiver 75% 100% CG strain Care frequency Willingness to provide care w CG demographics In their responses, state officials frequently observe that the Medicaid waiver assessment of caregivers focuses on whether or not the family caregiver is willing and available to provide care to the individual, not on the caregiver \'s own particular needs and support. 25 The State of the States in Family Caregiver Support: A 50-State Study Services There is a growing recognition within the policy arena of the importance of caregiver support services as a preventive service. The more you provide in terms of services and infrastructure for caregiver support, the better off the state will be in future expenditures. --Medicaid waiver respondent Respite is frequently identified as the number one need, but once the family caregiver starts having regular respite, there is usually the recognition that they need information, support and links to other services and supports. --State-funded program respondent F amily members and friends may have different needs and preferences at different times during their caregiving experience. A variety of services can bolster them in providing care to a loved one. We asked state program administrators to identify each service that their program provides specifically to family caregivers. The programs in this survey offer a broad array of services that either directly or indirectly assist caregivers. Table 4 shows which of 18 services each program in this survey provides to caregivers. Definitions for services vary across programs and across states. Because service categories, names and availability fluctuate, they challenge efforts to track and classify them. At a practical level, these variations make it more difficult for a caregiver to access needed help. For example, under the NFCSP, states can provide the service category of supplemental services , as defined by the state, to complement the care provided by caregivers. By definition, supplemental services are intended to benefit caregivers and be flexible enhancements to the caregiver support programs (Lewin Group, 2002). Services can include home modifications, assistive technology, emergency alarm response systems, consumable supplies, or any service or service option as defined by the state. Neither the Medicaid waiver nor the state-funded programs have such a broad service category. Similarly, definitions of the term respite vary widely from program to program. As one state-funded program respondent said, Respite means different things to different people. Some program administrators view respite as a specific service; others view it as an outcome of providing other out-of-home or in-home services, such as personal care or homemaker/chore services. Some state-funded and Medicaid waiver programs consider in-home services such as homemaker/chore and personal care to be respite for the family caregiver, even though it is often not tracked as such and this care directly benefits the older person or adult with disabilities. Caregiver Support Services Figure 11 illustrates the types of services provided by programs in this study to support family and informal caregivers. Figure 12 shows the percentage of state programs surveyed by program type providing selected caregiver support services. 26 Key Findings State-administered programs offer an array of services to support family and informal caregivers; respite care tops the list. w At least half of all programs in this survey (76 out of 150 programs) provide one or more of the following eight services: respite care (95%), information and assistance (69%), education and training (62%), care management/family consultation (58%), homemaker/chore/personal care (58%), assistive technology/emergency response systems (54%), individual and/or family counseling (52%), and home modifications (51%). Most, but not all, programs in this survey offer multiple services to caregivers, generally respite care and one or more other services. In 14 programs23 in ten states (six statefunded programs; eight Medicaid waivers) respite care is the only service identified specifically for family caregivers. Figure 11. Types of Caregiver Support Services Provided by State Programs Respite Care Information & Assistance Education & Training Care Management/Family Consultations Homemaker/Chore/Personal Care Assistive Technology/Emergency Response Counseling (individual and/or family) Home Modifications Support Groups Transportation Consumable Supplies Legal/Financial Consultations Family Meetings Other Services Cash Grant eHealth Applications (excluding read-only websites) Note. *N=150. **Percentages are based on total number of responses. Program responses* n %** 143 102 93 87 86 80 77 76 71 66 51 48 39 22 20 10 95% 69% 62% 58% 58% 54% 52% 51% 48% 44% 34% 32% 26% 15% 13% 7% w The NFCSP is emerging both as a key program to enhance the scope of services available to caregivers and fueling innovation. Many services now available to support caregivers come mainly through the NFCSPs, as shown below. w Caregiver education and training is offered by nearly two out of Respite Care three (62%) programs surveyed. Information & Assistance Education and training can inEducation & Training clude conferences or classes covHomemaker/Chore/Personal Care ering a broad range of topics of interest to family caregivers, or Counseling can teach caregivers hands-on Home Modifications skills and knowledge to improve Support Groups confidence and competence in Family Meetings Cash Grant Figure 12. Selected Services Provided to Caregivers, by Program Type NFCSP (n = 51) Medicaid Waiver (n = 49) State-funded Program (n = 50) 0% 25% 50% Percent 75% 100% State-funded programs (California \'s Adult Day Health Care, Michigan \'s State/Escheat Respite, Nebraska \'s Respite Subsidy Across the Lifespan, Oklahoma \'s Respite Resource Network, Washington \'s Respite Care Services and Wyoming \'s Community-Based In-Home Services Program). Medicaid waivers in Arkansas, California, Illinois, Nebraska, Oklahoma, Texas, Vermont and Wyoming. 23 27 The State of the States in Family Caregiver Support: A 50-State Study w the caregiving role (e.g., training for lifting or bathing a person, techniques for managing behavioral problems, methods of coping with stress). Caregiver education and training is much more commonly offered by the NFCSPs (94%) than the state-funded (56%) or Medicaid waiver programs (35%). Care Care management or family consultations are covered by well over half (58%) the programs in this study, and are considerably more common among the NFCSPs (84%), as compared to the Medicaid waiver (47%) or state-funded programs (42%). These services assist families in making a care plan, identifying and arranging needed services, locating other resources, and assisting caregivers with both everyday and longterm choices and decisions. Individual and/or family counseling to address specific caregiving needs and psychological well-being are offered by over half (52%) of the programs surveyed. Counseling is twice as likely to be a covered service under the NFCSP as compared to the other programs in the study (NFCSP, 80%; state-funded, 38%; and Medicaid waiver programs, 35%). Caregiver support groups are available through fewer than half (48%) of the programs. Support groups are provided by almost all the NFCSPs (90%). Support groups are especially uncommon among Medicaid waivers (15%) and offered by a little over one-third of the state-funded programs (36%). w w In several emerging, or innovative, service areas the NFCSP is leading the way: w Family meetings, offered by only 26 percent of programs in this study, help resolve caregiving issues and improve communication among family members about difficult subjects. NFCSPs are twice as likely to offer this service (43%) as compared to the state-funded (18%) or Medicaid waiver programs (17%). Cash grants to purchase goods (e.g., incontinence products, ramps, grab bars) and/or services (e.g., respite care) help offset the often high costs of providing care and, for some, may enable the family to continue to provide care. Cash grants are available through only 20 of the programs surveyed (13%) in 18 states and the District of Columbia, mostly through the supplemental services category of the NFCSPs. The NFCSPs are at least twice as likely to offer this option as are the other programs in this study (24% NFCSP, versus 12% of state-funded programs and just 4% of waiver programs, i.e., those in Alabama and Minnesota). eHealth applications (e.g., telemedicine, interactive websites) include information and services delivered or enhanced through the Internet and related technologies. Although this offering for family caregivers is still rare (by just 10 programs24 in eight states overall), NFCSPs account for more than half. w w NFCSPs (Arkansas, Idaho, Maine, Missouri, New York and Oregon); state-funded programs (California Caregiver Resource Centers, Minnesota Alternative Care Program) and Medicaid waivers (Minnesota, Oregon). 24 28 Key Findings Respite Care responses* Respite care addresses one of the most pressing Types of Respite Care n %** needs identified by caregiving families. Although some programs consider respite to be a broad In-home 136 91% concept that includes almost anything if it improves Adult Day Services 131 87% the caregiver \'s quality of life (Feinberg & Pilisuk, Overnight in Facility 113 75% 1999), respite care is generally defined as temporary, Weekend/Camp 86 57% short-term help provided to the care receiver that Other 17 11% enables caregivers to take a break. Note. *N=150. **Percentages are based on total number In this survey, we found that respite is offered of responses. in varying degrees, by all types of programs and in all 50 states. It is provided under the NFCSP; as a statefunded, single purpose program; as part of state-funded HCBS multi-component programs; and also as a specific benefit under Medicaid HCBS waiver programs. In the NFCSP, respite is a specific part of the core package of services to caregivers. In Medicaid waiver and state-funded HCBS programs, however, respite may not be an explicitly covered benefit or service. Administrators of these programs often see respite as a byproduct of other in-home (e.g., homemaker/chore/personal care) or outof-home services (e.g., adult day services). Some say that cash grants to care receivers to purchase in-home services or home modifications, for example, provide respite and relief for the family caregiver, although their purpose is to benefit the care receiver. Figure 13. States Offer a Variety of Program Respite is the service strategy most commonly offered to support caregivers and is available in all 50 states, although the amount of respite to family members varies substantially from state to state and program to program within states. w w w w Nearly all (95%) of the programs in this survey (143 out of 150) report providing respite care, regardless of funding source. All states and the District of Columbia (100%) offer respite care to caregivers under the NFCSP. All but four states25 report including respite as an explicit service under their Aged/Disabled Medicaid HCBS waiver. In two states, Tennessee and Nevada, a state-funded HCBS program does not offer respite or other in-home services. As shown in Table 5, respite care takes many forms. The most common types of respite offered in the state programs surveyed are in-home respite, adult day services and overnight respite in a facility. Figure 13 shows the prevalence of various types of respite service options available in the states. w The great majority (71%) of the programs offering respite assistance do not require that the caregiver live with the care receiver, enabling adult children or other relatives to qualify for respite services even if they live in separate households. This broader eligibility criteria exists more often in the NFCSPs (80%) and the state-funded programs (75%), than in the Medicaid waiver programs (58%) (see Table 5). w The Aged/Disabled Medicaid HCBS waiver programs in Alaska, Kentucky and New York did not respond to this survey. The waiver programs that do not report including respite as an explicit service are located in Louisiana, Rhode Island, Washington and West Virginia, although the waiver in Louisiana includes homemaker/chore/personal care that can provide some respite to family caregivers. 25 29 The State of the States in Family Caregiver Support: A 50-State Study To control costs and distribute services equitably, given limited program budgets, programs cap cost or service utilization. We were particularly interested in better understanding how caps are used for respite care in the states and who decides how to Figure 14. Use and Amount of Respite Cost Number of formulate the caps. Caps by State Programs Programs None 100 - 200/mo 501 - 600/mo 1,000/mo < 500/yr 501 - 1,000/yr 1,001 - 2,000/yr 2,000 - 3,000/yr 3,001 - 4,000/yr > 4,000/yr 73 1 3 1 3 7 5 1 6 1 w Sixty-six programs (46%) in 38 states and the District of Columbia that offer respite assistance utilize a respite cap of some type to contain costs. Considerable variation exists within the limits imposed. In a majority of these programs (49 out of 66; 74%), the respite cap is applied uniformly across each program site, with Medicaid waiver (96%) and state-funded programs (88%) most likely and the NFCSPs least likely (48%) to do so. w In nearly two-thirds (62%) of these 66 programs, the administering state agency decides how to formulate the cap. Medicaid waivers (91%) and state-funded programs (71%) are much more likely than the NFCSPs (33%) to set policy through the state agency. Less than one-third (30%) of the respite caps overall are set by local administering agencies. However, where the NFCSP has a cap for respite, the majority (59%) rely on their AAAs to set it. In contrast, a minority of state-funded (18%) and Medicaid waiver programs (5%) let the local agency do this. Half (50%) of the programs with a respite cap utilize a cost cap. Nearly as many (47%) use a utilization cap, typically a ceiling on the number of allowable hours of respite per year. w w w Caps vary widely. Some use monthly limits, while others calculate caps on an annual basis. In the NFCSPs, most capped programs (19, 70%) refer to dollars, not utilization. The caps range from 250- 500 per year (Colorado) to 4,000 per year (District of Columbia) and average 1,300 per year. Medicaid waiver programs more often use a utilization cap, with these ranging from 168 hours per year (Maryland) to 6,480 hours per year (South Dakota) and averaging 937 hours annually. w State-funded programs are slightly more likely to use cost (59%) than utilization (41%) caps. These caps range from 1,500 per year (Nebraska \'s Lifespan Respite) to 7,200 per year (New Jersey \'s Assistance for Community Caregiving) and average 3,844 annually. The average utilization cap across state-funded pro grams was 300 hours per year. Among the programs reporting dollar amounts for their respite caps, Colorado \'s Family Caregiver Support Program has the lowest 30 Key Findings ( 250- 500 per year) and New Jersey \'s Enhanced Community Options (ECO) Medicaid waiver program the highest ( 1,000 per month). The variation in the 29 programs reporting the amount of their respite caps is shown in Figure 14. Figure 15. Caregivers Can Access State Programs in a Variety of Ways (N = 148) AAA* Toll-free Number Other Local Admin. Agency Web State Admin. Agency 0% Note. *Area Agency of Aging. 10% 13% 20% 30% Percent 40% 50% 60% 23% 53% 49% 46% Access to Information and Services Access to program information or services varies by program type; even within the same state, caregivers typically do not find the same package of services to be available. Fragmented services, confusing service delivery systems, and inaccessible information about community resources can compromise the family member \'s ability to care for their relative and adversely affect the caregiver \'s own health and quality of life. We asked state program administrators to describe the best way for a caregiver to access their program either for information or for services. As shown in Figure 15, over half (53%) of the program respondents, regardless of type of program, point to the local AAA. Nearly half (49%) indicate the state \'s toll-free telephone number. Programs in this survey suggest various ways for caregivers to access information or services: w w w w for the NFCSP, officials cite first the local AAA (69%), then the state \'s toll-free telephone number (55%) for the Medicaid waivers, respondents see the top method to be the local administrative toll-free number (40% each) for state-funded programs, respondents say to call the toll-free number or the local AAA (51%) relatively few program administrators mention the Web as a way to access programs (31%, state-funded; 25%, NFCSP; 13%, Medicaid waiver). We asked respondents whether or not family caregivers in their state have access to the same package of services within their program. In about half (49%) the programs, respondents said No. The NFCSPs were the least likely of all three program types to respond affirmatively; more than three out of four (77%) report that caregivers in their state don \'t have access to the same program services, followed by state-funded programs (44%) and the Medicaid waivers (18%). w Under the NFCSP, only 21 states26 (42%) report that all of their state \'s AAAs offer each of the five specified service components (information, assistance, counseling/support groups/education and training, respite and supplemental services). Alabama, Connecticut, Florida, Georgia, Hawaii, Kentucky, Louisiana, Massachusetts, Maryland, Maine, Michigan, New Hampshire, New York, Ohio, Pennsylvania, South Dakota, Tennessee, Texas, Utah, Washington, Wyoming. Note: 4 states (Alaska, Delaware, Rhode Island, Wisconsin) and the District of Columbia responded not applicable. All but Wisconsin do not have AAAs; the state or district acts as the single planning and service area. 26 31 The State of the States in Family Caregiver Support: A 50-State Study CONSUMER DIRECTION he philosophy and practice of consumer direction is an emerging trend in HCBS programs. Consumer direction is not a single method; rather it is a philosophical approach to paying for services or supports. It shifts the locus of decision-making and control from service providers and payers to consumers and families (Benjamin, 2001; Doty, 2004). At one end of the spectrum the consumer has total control over how the care dollar is spent, from hiring a relative to paying for goods. At the other is traditional service delivery, where the provider or payer decides what is needed and will be covered. In between is a familyStates are grappling with ways to improve centered approach, such as the NFCSP \'s quality of care, address the shortage of direct supplemental services category: giving family caregivers a menu of services from care workers and increase consumer choice. which to choose and taking a flexible One method of achieving these goals is to pay approach to approving services. For family members who provide vital care to their example, NFCSP funds can pay for a car battery needed for a family member to elderly or disabled relatives. drive a relative to the doctor \'s office. States are grappling with ways to improve quality of care, address the shortage of direct care workers and increase consumer choice. One method of achieving these goals is to pay family members who provide vital care to their elderly or disabled relatives. However, the practice of paying relatives is subject to debate in the U.S. (Blaser, 1998; Kunkel, Applebaum, & Nelson, 2004). In states that enable consumers to direct their own services, the freedom to hire a family member, friend or neighbor is viewed as a meaningful feature of choice and control (Feinberg & Newman, in press). The NFCSP, Medicaid HCBS waivers and some state-funded programs permit consumer-directed approaches depending upon each state \'s rules and regulations. For example, under the NFCSP, states may make direct payments to family caregivers or provide a voucher or budget for goods and services (e.g., grab bars, respite care) to meet their needs and those of the care receiver. Thus, a state \'s NFCSP may give families maximum control as to how, when and to whom respite is provided, or the goods or services to buy directly (Feinberg & Newman, in press). States may also let each individual AAA (the local administering agency) set policy for this option. States and programs within states differ in the extent to which they offer consumer-directed options to family members. The NFCSP appears to be speeding the adoption of consumer direction in family caregiving programs. All but two states (Delaware and New York27) report at least one program with a consumer-directed option for family caregivers; 106 programs T 27 New York \'s Aged/Disabled Medicaid waiver program did not respond to this survey. 32 Key Findings nationwide (71% of sample) say they offer consumer direction of some kind. But consumer direction is far from universally available. w w In 43 programs28 (29% of the sample) in 29 states and the District of Columbia, family caregivers have no consumer-directed options. The NFCSPs are more likely than the Medicaid waiver or state-funded programs to say they have a consumer-directed option for family caregivers. Just seven NFCSPs (14%) report no Figure 16. State Programs Offer a Range of Consumer-Directed Options (N = 149) consumer directed option in their service package compared to 17 Medicaid Choice of respite provider 49% waiver (35%) and 19 statefunded (38%) programs. Menu of services 33% Voucher/budget for respite & supplemental services 25% We asked state program Direct payment to FCs for purchase of goods/services 17% administrators to identify the Voucher/budget for respite only 12% types of consumer-directed options, if any, their program CD attendant care 7% provides for family caregivers. Other 3% Direct payments to families to No CD options 29% hire, supervise or fire workers, including other family members, 0% 10% 20% 35% 40% 50% 60% or vouchers/budgets for respite Percent and supplemental services give Note. CD = consumer-directed; FC = family caregiver families the most choice and control to select the options that work best for them and their relative. As shown in Figure 16, programs in this survey offer a range of choices. w Most commonly, programs give the family a choice of respite providers, (e.g., between contract agencies such as home care agencies or independent providers), effectively allowing families to hire their own worker. Overall, 73 programs (49%) in 43 states have this option, including two-thirds of the NFCSPs (67%) but less than half of statefunded (42%) or Medicaid waiver (38%) programs. One-third of all programs (49 in 35 states, 33%) provide caregivers a menu of services from which to choose those that best fit their needs. Nearly half the NFCSPs (49%) do so, compared to about onefourth of state-funded and Medicaid-waiver programs (26% and 23% respectively). w Fewer programs (37 in 29 states, 25%) offer a voucher or budget for respite care and supplemental services (e.g., consumable supplies, assistive devices, yard maintenance). Again, NFCSPs lead the way, with more than half (51%) offering supplemental services, one of the five statutory service components under the NFCSP. Relatively few statefunded (16%) or Medicaid-waiver (6%) programs provide this option. Direct payments to family members to buy goods or services also are more likely from the NFCSPs (31%) than the state-funded (16%) or Medicaid waiver (4%) programs. Overall, 26 programs (17%) in 20 states and the District of Columbia permit such payments to families. A respite-only voucher or budget appears as an option in 17 programs w w w 28 The South Dakota Medicaid waiver program did not respond to this question. 33 The State of the States in Family Caregiver Support: A 50-State Study (12%) in 14 states, more often in state-funded programs (18%) and less frequently in NFCSPs (12%) or Medicaid-waiver (4%) programs. Most states (all but six) pay families to provide care in at least one of their state-administered programs. We asked state program administrators: Can family members be paid to provide care in your program? w Over half (57%), or 86 out of 150, in 44 states and the District of Columbia) say they do. Only Alaska, Delaware, Mississippi, Nevada, Pennsylvania and Tennessee do not allow payments to family members. A higher proportion of Medicaid waiver programs (36, 74%) than NFCSPs (59%) or state-funded programs (40%) report they allow payment to family members (other than spouses or parents/guardians of minors). w The practice of paying families to provide care may be perceived by some state administrators as a consumer-directed option for the individual beneficiary or consumer (i.e., the care receiver) without directly aiding the family caregiver. Nine of the Medicaid waivers and five of the state-funded programs reporting no consumer-directed option for family caregivers say they do permit beneficiaries to pay family members to provide care. 34 Key Findings SYSTEMS DEVELOPMENT I think that this is the most important program that the aging network has done in the last 20 years in terms of crossing boundaries and starting to think of older people in terms of their families and those who support them. We are moving toward supporting families as opposed to making people fit into categorical age criteria, and recognizing that older people are part of larger family systems. If we are successful... it will change the way that we deliver social services. This is working to break down some of the silos that we talk about. We are becoming more responsive as a result of supporting caregivers. --NFCSP respondent State System of Home and Community-Based Services (HCBS) I n the absence of a national, cohesive long-term care system, states have developed their own systems, primarily funded by Medicaid and state general revenues. Currently, a key policy goal in most states is reforming long-term care by expanding HCBS (Weiner et al., 2002). States face growing needs for long-term care services and supports due to an aging population, consumer preference for HCBS and constrained federal and state resources. Many states seek to develop more responsive community systems of long-term care, including family caregiver supports. State approaches to systems development in HCBS and family care vary greatly due to differing administrative structures, funding sources and levels, program eligibility requirements, service definitions and distinct services, and other factors. For example, a respondent in this study (an administrator of a state-funded program) notes a major challenge: Differences in the definition of ADLs and IADLs from one funding stream to the next [NFCSP and Medicaid waiver, primarily]. This creates an organizational barrier because it leads to staff inconsistencies and not being able to translate the same assessment information from two different tools. States also differ in the degree to which they integrate their family caregiver support programs into other HCBS programs, and state officials \' views about this issue vary, too (Feinberg & Newman, in press). The NFCSP may be helping states to advance their system development efforts. One study respondent, for example, tells of collaboration between the Medicaid waiver administration and the family caregiver support program to educate waiver service staff about the needs of the state \'s family caregivers. Program administrators within a state often have differing views about the level of integration of their states \' HCBS system for the elderly and adults with physical disabilities. In this study, we asked state program administrators to choose one statement that best characterizes the level of integration of their state \'s HCBS system for the elderly and adults with physical disabilities. We gave them three choices: w w integrated through intake, assessment, care planning and data collection part of a larger program, but separate assessment and data collection 35 The State of the States in Family Caregiver Support: A 50-State Study w not integrated into the state \'s home and community-based service system. In only 21 states do all program administrators within the state agree on this issue. w More than four in 10 (43%) or 62 programs (in 33 states and the District of Columbia) report that their state \'s HCBS system is integrated through intake, assessment, care planning and data collection. In 14 states29 all program respondents within the state agree on the level of integration. Nearly one-third (31%) of state administrators for 45 programs (in 21 states) say they are part of a larger program, but have separate assessment and data collection. In three states (Florida, New Jersey and Pennsylvania) all respondents within the these states are in agreement on this issue. About one in four (26%) respondents for 37 programs (in 23 states) characterize their program as not integrated into the state \'s HCBS system. In four states (Kentucky, Massachusetts, New York and Rhode Island) the program respondents within these states are in agreement on this issue. w w As shown in Figure 17, the perception of level of integration varies by type of program. w Medicaid waiver respondents are the most likely to view their state \'s HCBS system as integrated (60% Medicaid waivers, 40% NFCSPs, 30% state-funded programs). State-funded program respondents are the most likely to view their w Figure 17. Perception of Level of Integration of States \' HCBS Systems Varies by Program Type NFCSP (n = 50) A/D Medicaid Waivers (n = 47) 23% 40% 45% State-funded Programs (n = 47) 26% 30% 17% 34% Integrated into HCBS Not Integrated into HCBS 60% 25% Separate assessment & data collection Arizona, Delaware, Iowa, Indiana, Kansas, Maine, Minnesota, Mississippi, North Dakota, New Hampshire, South Dakota, Washington, West Virginia, Wisconsin. 29 36 Key Findings programs as part of a larger program, but with separate assessment tools and data collection requirements (45% state-funded, 26% NFCSPs, 23% Medicaid waivers). w The NFCSPs are the most likely of the three program types to view their program as not integrated into their state \'s HCBS system (34% NFCSPs, 25% state-funded, 17% Medicaid waiver programs). About one-fourth of the states use a uniform assessment tool for all HCBS programs for the elderly and adults with disabilities; family caregiving is a component in just five states \' uniform assessments. A uniform assessment tool and protocol for all HCBS programs is one method that states utilize to develop support systems that are more responsive to consumer needs and preferences and to coordinate eligibility and care across various state programs that serve frail elders, adults with physical disabilities and their family caregivers. As discussed in earlier findings (see Eligibility and Assessment section), we asked state program administrators if their specific program uses a uniform assessment tool. We also asked administrators whether their state has a uniform assessment tool for all its HCBS programs for the elderly and adults with physical disabilities, and if the state does, whether this tool includes a family caregiving component. w w A total of 60 programs (41%) in 30 states and the District of Columbia report a uniform assessment tool for all HCBS programs in their state. Of these, only half (31 of 60 programs) in 17 states indicate their state \'s tool includes a caregiving component. Not surprisingly, given that administrators in the majority of states have differing perceptions about the level of integration they see in their state \'s HCBS system, there is also a general lack of agreement among state program administrators about the adoption of a uniform HCBS assessment tool in their state. w In just 12 states30 do all program administrators within the state agree that a uniform assessment tool is used for all HCBS programs for the elderly and adults with disabilities. Of those 12 states, respondents in only five (Delaware, Louisiana, Minnesota, South Dakota and Washington) report their state \'s tool includes a caregiving component. w Several Medicaid waiver respondents from states that have uniform assessment protocols but do not assess the needs and situation of the caregiver, commented that their state does not have caregiver issues built into the assessment process. One Medicaid waiver respondent remarked: Sometimes we don \'t know who is the significant other in a client \'s life. A major barrier to looking at program outcomes is trying to assess how well the program is meeting the family caregiver \'s needs too. Colorado, Delaware, Indiana, Louisiana, Maine, Minnesota, Mississippi, North Dakota, Oregon, South Dakota, Washington, West Virginia. 30 37 The State of the States in Family Caregiver Support: A 50-State Study Figure 18. States Have Mixed Views on the Importance of Olmstead to Caregiver Support (N = 148) Not at all important A little important Fairly important Very important Don \'t know/refused 0% 3% 5% 10% 22% 16% 30% States have mixed views on the importance of Olmstead to caregiver support. As required by the Olmstead decision, each state has worked to develop an Olmstead plan and is engaged in ongoing activities to expand community services 30% for individuals with disabilities and promote community integration. A recent analysis of state Olmstead plans found that some states developed specific 15% 20% 25% 30% 35% strategies slated for implementation over Percent a number of years; some identified key priorities for more immediate actions; some set forth broad policy recommendations to guide future action; and others anticipated frequent plan updates and revisions in what they consider to be working documents (Fox-Grage, Folkemer, & Lewis, 2003). Family and informal support are essential to the successful transition of those with disabilities back into the community. We asked state program administrators how important the Olmstead decision is in influencing the development of caregiver support services in their state. As shown in Figure 18, states have mixed views on this issue, although over half (52%) of program respondents say that Olmstead is fairly or very important in influencing the development of caregiver support in their state. Medicaid waiver respondents are somewhat more likely (59%) than those representing state-funded programs (53%) and the NFCSPs (46%) to report that Olmstead is either fairly or very important to caregiver support. We also asked each state respondent to indicate what priority is placed on implementing an Olmstead plan, among all long-term care issues in their state. Nearly half (48%) report a high priority, one-third (33%) say medium, a few (6%) report low and two programs believe that Olmstead Olmstead is not a priority at all. Some (12%) say they don \'t know. Figure 19. Barriers That Limit/Prevent Coordination with Other State HCBS Programs* Different eligibility requirements Complexity and fragmentation of services Different client population than in other programs Different reporting requirements/ capabilities Organizational cultural differences Federal regulatory or statutory requirements Staff have too many responsibilities State regulatory or statutory requirements Lack of access to adequate computer technology and support Lack of knowledge of opportunities for coordination Low priority given to caregiver support services Other Program responses** n 70 60 55 37 31 30 29 23 16 16 14 9 %*** 50% 43% 39% 26% 22% 21% 21% 16% 11% 11% 10% 6% The top barriers to coordinating caregiver support programs with other HCBS programs in the states are differing eligibility requirements and service complexity and fragmentation. We asked program administrators to identify the three most important organizational, programmatic, geographic or political barriers (other than funding) that limit or prevent coordination of the caregiver support program with other HCBS programs in their state. Eligibility issues (50%) take the lead as shown in Figure 19. One Medicaid waiver respondent identified the need to change eligibility and the service package to better support family caregivers: We must move beyond the care receiver as the focus of care, a waiver Note. *Excludes funding. **N=140. ***Percentages are based on total number of responses. 38 Key Findings respondent explains. No one looks at the caregiver when we look at eligibility or when they are seeking to deter institutionalization. Overall, it is the stress of the family caregiver as well as the care receiver status that puts someone in a nursing home. If we were able to look at factors outside the care receiver \'s status that would be helpful, and we would do a better job of truly assessing risk of institutionalization. The next two most important barriers are complexity and fragmentation of services (43%), and different client population (i.e., informal caregivers) than in other programs (39%). No major differences were found among the three groups in this study (i.e., NFCSP, Medicaid waivers, state-funded programs). Top Long-Term Care Issues; Caregiver Support Priority Expanding Medicaid HCBS waivers, integrating long-term care services and implementing or expanding consumer-directed care are the top long-term care issues identified in the states. We asked state program administrators their opinion about the state \'s priority (high, medium, low) for 11 long-term care issues. The top priorities among respondents, include: w w w expanding Medicaid HCBS waivers for the elderly and people with disabilities (61%) integrating long-term care services (60%) implementing or expanding consumer-directed options (56%). Figure 20. Top Three Long-Term Care Priorities in States by Program Type Expanding Medicaid HCBS Waivers Integrating LTC services Implementing or expanding CD options 0% 20% 51% Figure 20 shows the top longterm care priorities in the states by program type. Not surprisingly, given the economic downturn in most states at the time of this survey, lowest priority is given to expanding programs and services or creating other financial supports at the state level. Issues most frequently ranked as a low priority are: w w expansion of state-funded caregiver support programs (33%) expansion of state-funded 67% 65% 73% NFCSP (n = 51) Medicaid A/D Waivers (n = 48) State-funded Programs (n = 46) 46% 61% 41% 54% 40% 60% 73% 80% 100% Percent Note. HCBS = home and community-based services; LTC = long-term care; CD = consumer-directed. home and community-based services for the elderly and adults with disabilities (32%) w establishment of tax credits for caregiving (29%). 39 The State of the States in Family Caregiver Support: A 50-State Study State program administrators have mixed views about the importance of caregiver support within home and communitybased care; the majority perceive caregiver services as a medium priority. We asked respondents to indicate what priority (high, medium, low) their state places on family caregiver support services within all of the state \'s home and community-based care programs. No differences emerge among program groups. Overall, program administrators view the importance of caregiver support in HCBS as follows: w w w high priority (26%) medium priority (56%) low priority (18%) As with other opinion questions in this survey, respondents within a state often have different views of the priority placed in their state on caregiver support. In 27 states there was no consensus. In the 23 states with consensus, we see: w w w high priority given to caregiver support within six states (Illinois, Louisiana, Massachusetts, Montana, North Dakota and Pennsylvania) medium priority in 13 states31 low priority in four states (Alabama, Colorado, Kansas and West Virginia). States are beginning to establish task forces or commissions to examine family caregiver issues. In response to the NFCSP, some states have formed task forces or commissions on family caregiving issues. Other states have established task forces or commissions to highlight the central role that family caregivers play in long-term care as states move toward more responsive and coordinated systems of care. In still other states, informal caregiving issues are being addressed as part of broader state task forces on longterm care in general or HCBS in particular. In this study, 15 states32 report either a task force or commission on family caregiving. These entities range in scope and objective. Examples include: w The Connecticut LifeSpan Respite Coalition, a grassroots coalition of individuals, is seeking to identify gaps in respite services and to coordinate existing services available to families across the lifespan. Hawaii \'s Hawaii \'s Family Caregiver Network is bringing together family caregivers by providing a coordinated system to disseminate information to family caregivers on a range of issues, serving as a vehicle for families to comment on and respond to caregiving needs and policies, and serving as a resource for researchers. The Maryland Caregivers Support Coordinating Council, operated through the Maryland Department of Human Resources, is working to improve support services for unpaid family caregivers in the states, including the need for additional resources for respite care. w w Arkansas, Arizona, Delaware, Florida, Iowa, Maryland, Minnesota, New Hampshire, Oregon, Rhode Island, South Carolina, Vermont, Wyoming. 32 Alabama, Colorado, Connecticut, Hawaii, Illinois, Indiana, Louisiana, Maryland, Michigan, North Carolina, New York, Oklahoma, Oregon, Utah, Virginia. 31 40 Key Findings OTHER ISSUES Supporting family caregivers is family-friendly state policy. --Medicaid waiver respondent A s state administrators work to strengthen and enhance services in the home and community, they face complex issues. We asked respondents for their opinions about key policy and programmatic issues for caregiver support and long-term care in their state. What do they see as unmet needs for caregivers? What are their views about training and technical assistance to better meet the needs of family and informal caregivers? What are their major challenges, what have they learned about providing caregiver support services and what would they recommend to other states pursuing similar goals? What new legislation has been enacted in the states to support caregiving families? Top Unmet Needs of Caregivers State program administrators see the lack of resources to meet caregiver needs in general and limited respite care options as the top unmet needs of family caregivers in the states. When we asked respondents this open-ended Figure 21. Top Five Unmet Needs of question, What would you say is the major Caregivers in the States unmet need of family caregivers in your state? we received many different answers, Lack of resources to provide a range of services but definite themes emerge. As Figure 21 Limited respite care/options shows, about half of all respondents in the Lack of public awareness about caregiver states identify as unmet needs the overall lack issues/programs of resources for a range of caregiver services Shortage of providers (workforce) (e.g., services for working caregivers, culturally Limited access to services in rural areas appropriate services, family counseling) and Note. *N=139. **Percentages are based on total number the limitation in respite options. Although a of responses. minority of respondents identify other unmet needs in the top five, their concerns reveal the challenges officials are facing in the states as they implement caregiver support programs: lack of public awareness about caregiver issues and programs, shortage of workers to provide help to caregivers, and access to services in rural areas. Program responses* n %** 69 66 38 23 13 50% 47% 27% 17% 9% Program Support Needs: Training and Technical Assistance About half the state programs offer training for staff who work with family caregivers. Well-trained staff can reduce the stress of the family caregiver (Levine, 2004). As shown in Table 6, 69 programs or about half (47%) of programs surveyed provide training for staff who work with family caregivers. Another six programs (4%) say they are developing training on caregiving topics. w The top five training areas are: caregiver assessment (60%) best practices in service delivery (54%) data collection and reporting (50%) 41 The State of the States in Family Caregiver Support: A 50-State Study w outreach and public awareness (47%) caregiver intake issues (47%) NFCSP respondents (61%) are, not surprisingly, more likely than state-funded (40%) or Medicaid waiver programs (39%) to provide caregiver-related training to program staff. Three of the top five current training topics match those training and technical assistance areas almost all respondents say would benefit staff: best practices in service delivery, outreach/public awareness and caregiver assessment. Figure 22. Top Five Identified Technical Assistance & Training Areas for Staff Who Work with Family Caregivers* Best practices in service delivery Culturally/ethnically appropriate services Program evaluation/outcome measures Outreach/public awareness Caregiver assessment issues % Responding Strongly Agree or Agree ** 99% 97% 96% 92% 91% Note. *N = 139. **Percentages are based on total number of responses. We asked respondents to share their views about the benefit to their staff of technical assistance and training on 11 specified topics. Figure 22 shows the five areas where state program administrators see the most likely benefit. Interestingly, two of the top three areas for technical assistance are not among the topics that actual training programs most often address: culturally/ethnically appropriate services and program evaluation/outcome measures. Top Challenges, Lessons Learned and Recommendations States identify inadequate funding as the main challenge to implementing caregiver support services. In telephone follow-up interviews we asked program respondents this question, What are the three main challenges to implementing family caregiver support services in your state? The majority of program respondents (64%) report inadequate funding. As Figure 23 shows, many of the other recurring themes match the officials \' views on unmet caregiver needs: Figure 23. Top 5 Challenges to Implementing Family Caregiver Support Program in the States (N = 145) 70% 60% 50% 40% 30% 20% 10% 0% Inadequate funding Lack of information and outreach to the public Workforce shortages Caregivers don \'t selfidentify Working with diverse populations 46% 36% 26% 26% 64% w Lack of information and outreach to the public. Nearly half (46%) feel that many families who might benefit from their services do not know where to go for help. More outreach is needed to educate families about caregiving needs and available services. Workforce shortages. More than one in three (36%) respondents face a shortage of qualified service providers (e.g., social workers) or direct care workers (e.g., nurses aides). Low wages and turnover are often cited as a big part of this challenge. w 42 Key Findings w Caregivers don \'t self-identify. One in four (26%) respondents say it is often difficult to provide services when many caregivers don \'t identify with the term family caregiver. Rather, family members view themselves as the husband, wife or daughter and may not recognize their own support needs or that programs could assist them in the care of their loved one. Increased public awareness campaigns can help alleviate this challenge. Working with diverse populations. One in four (26%) cite the challenge of providing targeted services to support ethnically diverse caregivers and meeting the needs of working, long-distance and other caregivers with particular care concerns. w Among just the NFCSP respondents specifically, one in four (25%) note the challenge of the paradigm shift in serving a new constituency, family members and friends, along with supporting the older person, the traditional client in the long-term care system. The major lesson learned by the states in providing family caregiver support is `one size does not fit all \'--so increase the choices that families have. We asked in our follow-up interviews with state program administrators, What is the major lesson you \'ve learned in providing family caregiver support services? (see Figure 24). Among the many lessons that they share, the one that comes up most often is maximizing flexibility and choice for families. Support is different for each family there \'s there \'s no one size fits all for families, one Medicaid waiver respondent puts it. Sometimes the support is more for the caregiver themselves than for the care receiver. Figure 24. Major Lessons Learned by State Programs in Providing Family Caregiver Support Services Maximize flexibility and choice for families Allow caregivers to tell you what they need Provide a range of support services to meet caregiver needs Focus on consumer education and outreach to general public Caregivers don \'t self-identify Note. *N=141. **Percentages are based on total number of responses. Program responses* n 47 37 25 22 14 %** 33% 26% 18% 16% 10% Other lessons that multiple respondents report are that it is important to focus on consumer education and outreach to the general public and that caregivers often need help to self-identify with the term caregiver. One NFCSP respondent explains, No one knows the stress and need (emotional, mental, and physical) of caregivers. Once you start talking about it people understand, but until you start that dialogue they can \'t conceptualize the need. To strengthen caregiving programs, state officials recommend more innovation in program design to provide a broader array of services, better coordination and integration of caregiver support into HCBS, and more local collaboration. When asked what recommendations they would make to other states that are implementing caregiver programs, respondents have many suggestions. As Figure 25 shows, the top recommendations are these: 43 The State of the States in Family Caregiver Support: A 50-State Study w Ensure innovative programs and a flexible array of caregiver support services to meet the diverse needs of families and the individuals for whom they care. Respondents emphasize the importance of finding new ways for delivering services (e.g., through enhanced use of technology and on-line support groups, or providing mobile respite in rural areas) as well as the importance to caregivers of flexibility, especially for those who may be hard to reach (e.g., rural, working and long-distance caregivers). Coordinate and integrate caregiver support into HCBS. Respondents call attention to the fragmented nature of long-term care services and stress the need to integrate caregiver support into the HCBS system, making the delivery of caregiver services an everyday practice in family-centered home and community-based care. Don \'t look at caregiver programs in a silo, recommends one NFCSP respondent. Integrate caregiver support into other HCBS programs. Collaborate with local stakeholders. Respondents suggest collaboration with local consumer groups to build consensus, develop programs and deliver services. One state-funded respondent notes, Tapping into community resources is a key element to a successful program. w Program responses* n 57 42 32 28 27 26 w w Figure 25. Top Five Recommendations to Other States Ensure innovative programs and a flexible array of caregiver support to meet the diverse needs of families Coordinate and integrate caregiver support into HCBS Collaborate with local consumer groups/ agencies to build consensus, develop programs, and provide services Maximize family and consumer involvement in service planning and delivery Conduct strategic planning/needs assessment prior to program implementation Promote consumer-directed models of care Note. *N=144. **Percentages are based on total number of responses. %** 40% 29% 22% 19% 19% 18% Maximize family and consumer involvement in service planning and delivery. Respondents underscore the importance of recognizing families and care receivers as partners in long-term care. Delegate flexibility all the way down to the consumer level. It is not enough just to give it to the AAA, or to the provider, recommends one NFCSP respondent. Instead: Listen to, assess, and take into account the caregiver \'s individual needs and situation. Develop a vocal constituency base and have families participate in advocacy efforts to build partnerships at the community and state levels. Conduct strategic planning. Respondents recommend advance planning and a thorough needs assessments prior to program implementation. We did four public hearings around the state [prior to the start of the NFCSP] to hear from individuals and families to see what they needed, shares one NFCSP state administrator. This was great for us, and helped us get the input from people providing care. w Promote consumer direction. Respondents say that consumerdirected models of care allow for a more family-centered approach to support and services, including payment to families to provide care. One Medicaid waiver respondent advises, Make caregiver support an integral part of any type of personal care program, also allowing the families to be paid providers. Making sure families can be paid will help with funding issues, because it \'s built-in support for families. w 44 Key Findings New Legislation in the States State legislatures, recognizing family caregivers \' important role, are enacting laws to fund caregiver support services, expand family and medical leave, and include family caregiving in state long-term care efforts. From 2001 through 2003, 23 states enacted legislation that was relevant to family caregiving (see Figure 26 and State Profiles). w w In 1133 states, legislation funded family caregiver support programs, many enacting these changes as a direct result of the NFCSP. California, Hawaii and Washington enacted legislation that expanded the minimum requirements of the federally prescribed Family and Medical Leave Act (FMLA). California enacted the most comprehensive paid family leave bill in the nation in 2002. It provides up to six weeks of partial wage replacement (100% employee-funded) for workers caring for a new child or seriously ill family member. Maryland, New Hampshire and Washington established work groups, councils or commissions to study and coordinate family caregiver support services. Connecticut, Hawaii and Iowa enacted legislation to ensure that family caregivers are central to long-term care programs and policies. In 2001, the Connecticut legislature required state agencies to include provisions that support family caregivers in any program that assists or supports people with long-term care needs. In 2001, the Hawaii legislature established support for family caregivers of adults with disabilities as a long-term goal of the state. The 2003 session of the Iowa legislature added support for caregivers to the state \'s objectives for serving older individuals. w Figure 26. 23 States Have Enacted Caregiver Legislation (2001 - 2003) w States that have enacted caregiver legislation (2001 - 2003) No caregiver legistlation enacted (2001 - 2003) California, Colorado, Florida, Idaho, Illinois, Indiana, Maine, Massachusetts, New Jersey, North Dakota, Pennsylvania. 33 45 The State of the States in Family Caregiver Support: A 50-State Study CONCLUSIONS AND ISSUES FOR THE FUTURE T his study illuminates the large role states play in the nation \'s support of family caregivers. The study profiled the experience of all 50 states and the District of Columbia in providing publicly funded support services to caregivers of older people and younger adults with disabilities since the passage of the NFCSP. Designed to take a broad focus, the study examined policy choices and state approaches to caregiver support through state agencies responsible for the administration of the NFCSP, Aged/Disabled Medicaid waiver programs, and state-funded programs that have either a caregiver-specific focus or include a family caregiving component in their service package. This wide-ranging report of caregiver support services in the U.S. revealed the following: While there is increasing availability of publicly funded caregiver support services, there is also great unevenness in services and service options for family caregivers across the states and within states. All states now provide some explicit caregiver support services as a result of the passage of the NFCSP in 2000. Yet, similar to HCBS in general, the availability of caregiver support services varies greatly across the U.S. due to differences in philosophy, program eligibility criteria, funding and approaches to program design and administration of services. In this study, state program administrators identified the For example, although respite care is the service strategy lack of resources to meet the range of caregiver needs in most commonly offered general, and limited respite care options in particular, as to help caregivers, and is the top unmet needs of caregivers in the states. available in all 50 states, our findings suggest that the goal of respite (i.e., whether it is targeted toward the care receiver or viewed as a service to sustain the family caregiver), its definitions, and the amount of respite assistance available to family members varies substantially from state to state and programs within states. In this study, state program administrators identified the lack of resources to meet the range of caregiver needs in general, and limited respite care options in particular, as the top unmet needs of caregivers in the states. At a practical level, such service gaps and variations pose challenges for caregivers by limiting choices for needed support services that may not be available where they live. Service inequities may also place more pressure on already strained caregiving families and compromise the ability to care for a loved one. The NFCSP is emerging as a key program to enhance the scope of caregiver support services and is fueling innovation in the states, but is inadequately funded. In this study, the NFCSP was found to expand the range and scope of services to caregivers of older people in states where caregiver support services existed before the establishment of the NFCSP. In other states, the NFCSP now serves as an important resource for the provision of 46 Conclusions and Issues for the Future services not available previously. Caregiver education and training, care management and family consultation, individual and/or family counseling, and support groups are offered by the majority of the states to some degree under the NFCSP, in addition to respite care. The NFCSP also appears to be speeding the adoption of consumer direction in explicit family caregiving programs. However, the modest level of NFCSP funding leaves gaps in caregiver support services and also results in substantial variation in service availability across the states. As a consequence, most states in this study continue to rely on their own general revenues to provide caregiver support services, and utilize Aged/ Disabled Medicaid waivers, a significant source of funds, to finance respite care for family caregivers of Medicaid waiver beneficiaries. When compared to spending for Medicaid waiver funds spent on respite care alone, the NFCSP funding appears even more limited. While there is great variation among states and programs within states in their approach to caregiver assessment, there is broad recognition of the value of uniformly assessing caregiver needs and the importance of training and technical assistance in this area. Only five states that use a uniform as distinct from, but related to the needs of the assessment tool for all HCBS programs for care receiver, is central to systems change and older people and adults with disabilities to improving policy and practice in HCBS. were found to include a family caregiving component as part of systematic assessment practice. The majority of state-funded and Medicaid waiver programs in this study assess only the person with disabilities, not the needs and situation of the family caregiver. Yet, systematic assessment of the caregiver \'s needs as distinct from, but related to the needs of the care receiver, is central to systems change and to improving policy and practice in HCBS. Indeed, identifying and meeting the specific needs of family caregivers is often a deciding factor in determining whether an individual can remain at home or must turn to more costly nursing home care. Without uniform, aggregated assessment information on the caregiver, it is difficult to measure the impact of services on family caregivers and to assure quality of care for frail elders and adults with disabilities. States have mixed views on approaches to systems development, the importance of caregiver support services within home and community-based care, and integrating family caregiving programs into HCBS. On the one hand, state program administrators in this study often had different perspectives on these issues and, more frequently than not, respondents within a state lacked agreement. On the other hand, during the time of this survey, states were facing an economic downturn while they were attempting to develop plans to rebalance long-term care by expanding HCBS options. In addition, the advent of the NFCSP created a paradigm shift with its new mandate to explicitly provide services to family caregivers of older people. Recognizing the legitimate needs of family caregivers as a consumer or client population has been found to be a relatively new concept for many states (Feinberg et al., 2002). Therefore, Systematic assessment of the caregiver \'s needs 47 The State of the States in Family Caregiver Support: A 50-State Study it is not surprising that in a time of major organizational and systems change, there may be different levels of understanding and perspectives of how states can and should accomplish the policy goal of reforming longterm care by expanding HCBS. Our current HCBS system relies heavily on family and informal caregivers. Families need help more than ever as they struggle to balance competing demands of work, family and caregiving. Caregiver support services can help ease the burden on families, increasing confidence and competence in everyday care tasks and providing needed respite care to sustain them in their caregiving role. Without recognition of the legitimate needs of family and informal caregivers and additional investments in caregiver support services, the reforms underway in HCBS may not be as effective and meaningful to American families. If we are serious about reducing fragmentation in home and communitybased care and recognizing the legitimate needs of informal caregivers, then If we are serious about reducing fragmentation assessment of caregiver needs and in home and community-based care and caregiver support services should be integrated into HCBS. A family-centered recognizing the legitimate needs of informal approach to HCBS should be considered caregivers, then assessment of caregiver needs as states continue to pursue the goal of and caregiver support services should be reforming the long-term care system to strengthen integrated systems of home integrated into HCBS. and community-based care. Issues for the Future From this study, we can identify important issues for the future. The following are five initial steps towards achieving a better caregiver support system across the nation: 1. Raise the funding level of the NFCSP to reduce gaps in caregiver support services and provide meaningful support to caregiving families. The level of NFCSP funding is too low to meet the multifaceted needs of family caregivers. Increasing funds for the NFCSP will help promote systems change and ease the burdens on family caregivers, in turn preventing much higher expenditures in Medicaid and HCBS programs that might be necessitated if the informal caregivers became incapacitated or unavailable (Vladack, 2004). 2. Improve data collection and reporting under the NFCSP and other state programs that provide caregiver support services. As part of the development process for the NFCSP, the Administration on Aging should partner and work closely with states on the uniform reporting requirements that will take effect in fiscal year 2005. Accountability is critical to the success of the NFCSP and other caregiver support programs. However, because many states do not have uniform reporting systems in use across their own HCBS programs, including those providing caregiver services, it is impossible to report on caseloads and funding across all programs providing some component of family caregiver support services at this time. Federal, state and local policymakers and program administrators must make decisions based on outcomes. Uniform data collection is essential for programs to achieve a more consistent understanding of the scope of services across the country and to ensure that federal and state funding remain viable. 48 Conclusions and Issues for the Future 3. Strengthen and expand uniform assessment of caregiver needs in all HCBS programs that provide some component of caregiver support. Currently, there is no consensus about how to assess family care or what should be included in a uniform caregiver assessment tool. Developing such a consensus should be a high priority (Gould, 2004). Establishing guidelines for caregiver assessment, based on an outcome-driven knowledge management system, would be a worthwhile investment to develop better data to support and drive decision making. Ultimately, consistent approaches to caregiver assessment will enable family caregivers to obtain needed support, strengthen their ability to ensure optimal outcomes and quality of care for the care receiver, remain in their caregiving role as long as appropriate, and provide solid information to policymakers and program administrators intent on improving the effectiveness and efficiency of HCBS. 4. Conduct a national public awareness campaign on family caregiving. Outreach to informal caregivers specifically, and to the public in general, is crucial to ensuring that families and friends access information and services early in the caregiving process, and have the supports they need to adequately sustain them in the caregiving role. In this study, lack of public awareness about caregiver issues and programs--including the notion that caregivers don \'t self-identify with the term caregiver --was a recurring theme, as a top unmet need of caregivers, as a topic for training and technical assistance, and as a challenge to implementing caregiver support services in the states. 5. Invest in innovation, promising practices and technical assistance. States want to know about and learn from the successes and challenges of other states \' efforts to support and strengthen family and informal caregivers. State administrators of the NFCSP, Medicaid waiver and state-funded programs were particularly interested in program design to provide a broader array of services, develop consumer direction to maximize flexibility and choice for families, and to use technology with those caregivers who may be difficult to reach (e.g., rural, working and long-distance caregivers). Over 90 percent of respondents in this study viewed five topics as the top training and technical assistance areas most likely to benefit their staff: best practices in service delivery; culturally/ethnically appropriate services; program evaluation/outcome measures; outreach/public awareness; and caregiver assessment. This first 50-state study on caregiving offers new insights into the ways states provide caregiver support services and approach family caregiving issues in the context of HCBS. As such, it provides a starting point for further examination of the policy choices and state approaches to caregiver support, as well as changes over time. We hope that this report, and subsequent papers and issue briefs emanating from this study, will help to stimulate continued development of policies and programs to support family and informal caregivers of older people and adults with disabilities. 49 The State of the States in Family Caregiver Support: A 50-State Study REFERENCES Administration on Aging. (2004, June). The Older Americans Act National Family Caregiver Support Program: Compassion in action. Washington, DC: U.S. Department of Health and Human Services. Arno, P. S. (2002, February). Well being of caregivers: The economic issues of caregivers. In T. McRae (Chair), New Caregiver Research. Symposium conducted at the annual meeting of the American Association of Geriatric Psychiatry, Orlando, FL. Baxter, E. C. (2000). Caregiver assessment: Learn about the caregiver, distinct from the person with dementia. Alzheimer \'s Care Quarterly, 1, 62-70. Benjamin, A. E. (2001). Consumer-directed services at home: A new model for persons with disabilities. Health Affairs, 20, 80-85. Blaser, C. J. (1998). The case against paying family caregivers: Ethical and practical issues. Generations, 22, 65-69. Doty, P. (2004, October). Consumer-directed home care: Effects on family caregivers. San Francisco, CA: Family Caregiver Alliance. Feinberg, L. F. (2004). Recognizing the work of family and informal caregivers: The case for caregiver assessment. In C. Levine (Ed.), Family caregivers on the job: Moving beyond ADLs and IADLs (pp. 67-98). New York: United Hospital Fund. Feinberg, L. F., & Newman, S. L. (in press). A study of 10 states since passage of the National Family Caregiver Support Program: Policies, perceptions, and program development. The Gerontologist. Feinberg, L. F., Newman, S. L., & Van Steenberg, C. (2002). Family caregiver support: Policies, perceptions and practices in 10 states since passage of the National Family Caregiver Support Program. San Francisco, CA: Family Caregiver Alliance. Feinberg, L. F., & Pilisuk, T. L. (1999, October). Survey of fifteen states \' caregiver support programs. San Francisco, CA: Family Caregiver Alliance. Fox-Grage, W., Folkemer, D., & Lewis, J. (2003). The states \' response to the Olmstead decision: A work in progress. Washington, DC: National Conference of State Legislatures. Gaugler, J. E., Kane, R. A., & Langlois, J. (2000). Assessment of family caregivers of older adults. In R. L. Kane & R. A. Kane (Eds.), Assessing older persons: Measures, meaning and practical applications (pp. 320-359). New York: Oxford University Press. Glaser, B., & Strauss, A. (1967). Discovery of Grounded Theory. Chicago: Aldine. Gould, D. A. (2004). Measuring what matters: Levers for change. In C. Levine (Ed.), Family caregivers on the job: Moving beyond ADLs and IADLs (pp. 139-149). New York: United Hospital Fund. Kasner, E., & Williams, L. (1997). Taking care of their own: State-funded home and community-based programs for older persons. Washington, DC: AARP Public Policy Institute. Kunkel, R., Applebaum, R. A., & Nelson, I. M. (2004). For love or money: Paying family caregivers. Generations, 27, 74-80. Levine, C. (2004). Family caregiving: Current challenges for a time-honored practice. Generations, 27, 5-8. 50 References Levine, C., Reinhard, S., Feinberg, L. F., Albert, S., & Hart, A. (2004). Family caregivers on the job: Moving beyond ADLs and IADLs [Appendix]. In C. Levine (Ed.), Family caregivers on the job: Moving beyond ADLs and IADLs (pp. 152-165). New York: United Hospital Fund. Lewin Group. (March, 2002). The National Family Caregiver Support Program: Resource guide. Falls Church, VA: Author. Mittleman, M. S., Roth, D. L., Haley, W. E., & Zarit, S. H. (2004). Effects of caregiver intervention on negative caregiver appraisals of behavior problems in patients with Alzheimer \'s disease: Results of a randomized trial. Journal of Gerontology: Psychological Sciences, 59B, P27-P34. Mittleman, S. H., Ferris, S. H., Shulman, E., Steinberg, G., & Levin, B. (1996). A family intervention to delay nursing home placement of patients with Alzheimer \'s disease: A randomized controlled trial. Journal of the American Medical Association, 276, 1725-1731. Mollica, R. (2003). Coordinating services across the continuum of health, housing, and supportive services. Journal of Aging and Health, 15, 165-188. Mollica, R., & Gillespie, J. (2003, August). Single entry point systems: State survey results. New Brunswick, NJ: National Academy for State Health Policy & Rutgers Center for State Health Policy. Montgomery, R. J., & Borgatta, E. (1989). The effects of alternative support strategies on family caregiving. The Gerontologist, 29, 457-464. National Alliance for Caregiving, & AARP. (2004). Caregiving in the U.S. Washington, DC: Author. Ostwald, S. K., Hepburn, K. W., Caron, W., Burns, T., & Mantell, R. (1999). Reducing caregiver burden: A randomized psychoeducational intervention for caregivers of persons with dementia. The Gerontologist, 39, 299-309. Petty, D. (1990). Respite care: A flexible response to service fragmentation. In N. Mace (Ed.), Dementia care: Patient, family, and community (pp. 243-269). Baltimore, MD: Johns Hopkins University Press. Reester, H., Missmar, R., & Tumlinson, A. (2004, April). Recent growth in Medicaid Home and Communitybased Service Waivers. Washington, DC: The Kaiser Commission on Medicaid and the Uninsured. Rosenbaum, S. (2001). Olmstead v. L.C.: Implications for family caregivers. San Francisco, CA: Family Caregiver Alliance. Smith, G., O \'Keeffe, J., Carpenter, L., Doty, P., Kennedy, G., Burwell, B., Mollica, R., & Williams, L. (2000, October). Understanding Medicaid home and community services: A primer. Washington, DC: U.S. Department of Health and Human Services. Summer, L. (2003, May). Choices and consequences: The availability of community-based long-term care services to the low-income population. Washington, DC: Georgetown University, Long-Term Care Financing Project. Thompson, L. (2004, March). Long-term care: Support for family caregivers (Issue Brief). Washington, DC: Georgetown University, Long-Term Care Financing Project. U.S. Department of Health and Human Services. (2002). Delivering on the promise: Self-evaluation to promote community living for people with disabilities. Washington, DC: Author. U.S. General Accounting Office (2002, September). Long-term care: Availability of Medicaid home and community services for elderly individuals varies considerably (GAO Publication No. 02-1121). Washington, DC: Author. 51 The State of the States in Family Caregiver Support: A 50-State Study Vladeck, B. C. (2004). You can \'t get there from here: Dimensions of caregiving and dementias of policymaking. In C. Levine (Ed.), Family caregivers on the job: Moving beyond ADLs and IADLs (pp. 123137). New York: United Hospital Fund. Wagner, D. L. (2001). Enhancing state initiatives for working caregivers (Policy Brief No. 5). San Francisco, CA: Family Caregiver Alliance. Weiner, J. M., Tilly, J., & Alecxih, L. M. B. (2002). Home and community-based services in seven states. Health Care Financing Review, 23, 89-114. Zarit, S. H., Stephens, M. A. P., Townsend, A., & Greene, R. (1998). Stress reduction for family caregivers: Effects of adult day care use. Journal of Gerontology: Social Sciences, 53B, S267-S277. 52 HOW TO READ THE STATE PROFILES T he state profiles in this report are organized alphabetically by state. Each profile includes: w w w Selected state background characteristics (e.g., census data, caregiving and long-term care data) for the state and the U.S. Data about the state \'s home and community-based services as they relate to family caregiving, derived from this study Key program-level information from the study respondents and other sources about programs and services to support caregivers (i.e., administrative structure, funding and caseload, eligibility, assessment, services and consumer direction) To determine the original data source for Selected State Background Characteristics , go to the Data Documentation section that follows the state profiles on page 264. In the State System of Home and Community-Based Services section of the profiles, level of agreement among program respondents within a state was examined for responses to questions on single point of entry and the availability of a uniform assessment tool for all home and communitybased programs in a state. All program respondents within a state had to be in agreement for data to be reported as either yes or no. For those data points in which program respondents within a state disagreed, we report that there was a lack of agreement. To identify sources for fiscal and caseload data used in State Program Information , go to the Data Documentation section that follows the state profiles on on page 264. In certain cases, data were not applicable (N/A), not available (n/a) from the data sources utilized, or no response was provided by the survey respondent. Abbreviations Used in State Profiles FC=National Family Caregiver Support Program MC=Aged or Aged/Disabled Medicaid HCBS waiver SC=State-funded program AAA=Area Agency on Aging AD=Alzheimer \'s Disease ADL=Activity of Daily Living Adult day svcs.=Adult day services 53 The State of the States in Family Caregiver Support: A 50-State Study Care mgt.=Care management Consum. supplies=Consumable supplies Dept.=Department Educ. & training=Education & training Emerg. response=Emergency response Family Consult.=Family consultation Gov \'t=Government HCBS=Home and Community-Based Services IADL=Instrumental Activity of Daily Living Info. & assistance=Information & Assistance OAA=Older Americans Act OAA guidelines=the care receiver must have two or more ADL limitations or a cognitive impairment for the caregiver to be eligible for respite or supplemental services1 SUA=State Unit on Aging Title XX=Social Services Block Grant funds Alecxih, L., Zeruld, S., Linkins, K., Bush, S., Olearczyk, B. & Neill, C. (2002). The National Family Caregiver Support Program Resource Guide. Falls Church, Virginia: The Lewin Group. 1 54 State Profiles State Profile: Alabama Selected State Background Characteristics AL Population Total Pop. Pop. 60+ % 60+ National Ranking 60+ % White (60+) % African American (60+) % Hispanic (60+) % Asian (60+) % Native Hawaiian/ Pacific Islanders (60+) % American Indian/ Alaska Native (60+) Pop. 65+ (thousands) (millions) US Informal Caregivers 281.4 45,797.2 16.3 N/A 82.3 8.4 5.4 2.5 0.1 0.4 34,991.8 12.4 N/A 4,239.6 1.5 N/A Care Receivers % Pop. 21-64 Years w/Disability % Pop. 65+ w/Disability % 65+ by Type of Disability Sensory Physical Self-care Mental Difficulty Going Outside Home # of Caregivers (millions) (millions) AL 0.4 465.2 4,099.0 4.5 US 27.2 29,182.0 257,096.0 4.4 4.4 769.9 17.3 14 79.6 18.7 0.6 0.3 0.0 0.2 579.8 13.0 21 67.3 1.5 26 (thousands) Caregiving Hours (millions) Value of Caregiving % Grandchildren living w/grandparents age 65+ 23.2 49.5 17.0 35.5 13.0 14.6 25.1 19.2 41.9 14.2 28.6 9.5 10.8 20.4 % Pop. 65+ National Ranking 65+ Pop. 85+ (thousands) % Pop. 85+ National Ranking 85+ Economic Indicators Per Capita Income Median Household Income % of Pop. 65+ Below Poverty 26,338 37,603 15.7 31,632 42,409 10.4 Long-Term Care Certified Nursing Facilities Certified Nursing Facility Beds (thousands) Average Cost Per Day in a Nursing Home Licensed Adult Day Facilities Home Health Aides 0.4 33.1 23.5 2.5 3.0 37.6 24.7 30.1 40.1 2.6 3.1 50.1 218 24.9 128 40 6,490 15,162 1,574.0 158 3,407 N/A Socio-Demographics Households with Individuals 65+ (millions) % Persons Age 65+ Living Alone % Pop. 65+ in Major Cities Average Household Size Average Family Size % Households with Internet Access 55 The State of the States in Family Caregiver Support: A 50-State Study State Profile: Alabama (cont \'d) State System of Home and Community-Based Services (HCBS) Legislation Enacted Within the Last Three Years (2001-2003) that Addresses Family Caregiving Issues Task Force or Commission Specifically to Examine Family Caregiver Issues Name of Task Force: Single Point of Entry for State System of HCBS Single Point of Entry Includes Access to State \'s Caregiver Support Program Uniform Assessment Tool for All HCBS Programs for the Elderly and Adults with Disabilities Assessment Includes Caregiver Component At Least One State Program with Consumer-Directed Option for Family Caregivers None Yes Department of Senior Services Support for Caregivers No N/A Lack of agreement N/A Yes State Program Information Administrative Structure Alabama CARES (FC) AL Department of Senior Services Yes Program Name Administering State Agency Organizational Unit or Person Specifically Designated for Caregiving Programs or Activities Geographic Region Served Local Program Administrative Responsibility Elderly & Disabled Waiver (MC) AL Medicaid Agency Yes Statewide AA A Statewide AA A ept. of Public Health & Dept. of D Senior Services are operating agencies Program Name Funding & Caseload Major Sources of Program Funding FY 2001 Expenditures FY 2002 Expenditures FY 2003 Expenditures FY 2001 A/D Waiver Respite Participants FY 2002 A/D Waiver Respite Participants Alabama CARES (FC) AA, Title III-E O tate general fund S Medicaid HCBS waiver Elderly & Disabled Waiver (MC) 1,739,242 1,996,374 2,187,095 N/A N/A 5,148,710 (respite only) 5,676,620 (respite only) 52,919,759 (total waiver) 1,704 1,776 56 State Profiles State Profile: Alabama (cont \'d) Eligibility Program Name Caregiver Age Requirement Care Receiver Age Requirement Care Receiver Functional Status Requirement Client Population Alabama CARES (FC) None 60+ 2 IADLs Family Caregiver Elderly & Disabled Waiver (MC) None None Nursing home level of care Care Receiver Assessment Program Name Program Assesses Uniform Assessment Tool Includes Caregiver Assessment Areas Addressed by Caregiver Assessment Alabama CARES (FC) Both family caregiver and care receiver Yes Yes bility of caregiver to provide A care are duration C are frequency C aregiver demographic C information aregiver mental health/ C depression aregiver social support network C inancial situation F Elderly & Disabled Waiver (MC) Care Receiver Yes N/A N/A Services Alabama CARES (FC) No Program Name All Caregivers Eligible for Program Have Access to Same Package of Services Services Provided Specifically to Family Caregivers Elderly & Disabled Waiver (MC) No Types of Respite Care Offered ssistive technology A are mgt. C onsum. supplies C ounseling C duc. & training E merg. Response E ome modification/repairs H omemaker/chore/personal care H nfo. & assistance I espite care R upport groups S ransportation T ther O dult day svcs. A n-home I vernight O eekend/camp W ssistive technology A are mgt. C ash grant C ounseling C ome modification/repairs H n-home I 57 The State of the States in Family Caregiver Support: A 50-State Study State Profile: Alabama (cont \'d) Services (cont \'d) Program Name Caregiver Must Live with Care Receiver to Receive Respite Respite Cap Uniform Respite Cap Across Program Sites Entity that Formulates the Respite Cap Alabama CARES (FC) No 500 - 1200/year No Administering local agency Elderly & Disabled Waiver (MC) No 720 hours/year Yes Operating agencies Consumer Direction Alabama CARES (FC) menu of services from which A Program Name Consumer-Directed Options Elderly & Disabled Waiver (MC) None caregivers can choose voucher or budget for respite A and/or supplemental services amilies have a choice of respite F Family Members Can Be Paid to Provide Care Types of Services Families Can Be Paid to Provide providers No N/A Yes omemaker/chore H ersonal care P 58 State Profiles State Profile: Alaska Selected State Background Characteristics AK Population Total Pop. Pop. 60+ % 60+ National Ranking 60+ % White (60+) % African American (60+) % Hispanic (60+) % Asian (60+) % Native Hawaiian/ Pacific Islanders (60+) % American Indian/ Alaska Native (60+) Pop. 65+ (thousands) (millions) US Informal Caregivers 281.4 45,797.2 16.3 N/A 82.3 8.4 5.4 2.5 0.1 0.4 34,991.8 12.4 N/A 4,239.6 1.5 N/A Care Receivers % Pop. 21-64 Years w/Disability % Pop. 65+ w/Disability % 65+ by Type of Disability Sensory Physical Self-care Mental Difficulty Going Outside Home # of Caregivers (millions) (millions) AK 0.1 60.6 533.8 8.8 US 27.2 29,182.0 257,096.0 4.4 0.6 53.0 8.5 51 73.4 2.1 1.8 4.7 0.2 15.3 35.7 5.7 51 2.6 0.4 51 (thousands) Caregiving Hours (millions) Value of Caregiving % Grandchildren living w/grandparents age 65+ 15.6 46.2 20.7 32.1 10.4 12.3 20.2 19.2 41.9 14.2 28.6 9.5 10.8 20.4 % Pop. 65+ National Ranking 65+ Pop. 85+ (thousands) % Pop. 85+ National Ranking 85+ Economic Indicators Per Capita Income Median Household Income % of Pop. 65+ Below Poverty 33,568 52,774 N/A 31,632 42,409 10.4 Long-Term Care Certified Nursing Facilities 12 Certified Nursing Facility Beds (thousands) Average Cost Per Day in a Nursing Home 0.6 457 11 1,180 15,162 1,574.0 158 3,407 N/A Socio-Demographics Households with Individuals 65+ (millions) % Persons Age 65+ Living Alone % Pop. 65+ in Major Cities Average Household Size Average Family Size % Households with Internet Access 0.0 26.0 39.9 2.7 3.3 64.1 24.7 30.1 40.1 2.6 3.1 50.1 Licensed Adult Day Facilities Home Health Aides 59 The State of the States in Family Caregiver Support: A 50-State Study State Profile: Alaska (contd) State System of Home and Community-Based Services (HCBS) Legislation Enacted Within the Last Three Years (2001-2003) that Addresses Family Caregiving Issues Task Force or Commission Specifically to Examine Family Caregiver Issues Name of Task Force: Single Point of Entry for State System of HCBS Single Point of Entry Inc