Delivering services to the rural elderly: a study of policy implementation.
This article presents an analysis of two demonstration projects designed to improve delivery of services to elderly residents of rural Nebraska. One project employs a statewide system of care management focused on individual clients. In the other, local agencies in four communities coordinate services by using the local senior center as a focal point. This article uses established theory of policy implementation to illustrate problems encountered in starting new social programs that require state-local cooperation. Four guidelines are suggested for policymakers: (a) if local agencies are responsible for implementation, local managers must be involved in all the planning activities for new programs; (b) clear guidelines are needed to be sure that there is consensus concerning the details of implementation; (c) all health care providers should be involved in implementation when health care services are being coordinated; and (d) community coordinating councils can be effective.
Foster
B
B
Susman
J
J
Mueller
K
K
Bowman
A
A
Lunt
K
K
D000368:Aged; D003695:Delivery of Health Care / Q000458:organization & administration*; D006284:Health Plan Implementation; D006291:Health Policy; D006302:Health Services Research; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration*; D009329:Nebraska; D012423:Rural Health