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activities of daily adult day analysis assessment average basic model CCODA Community-Based Long-Term community-based services control group copayment cost savings cost-effectiveness differences disabled discharged elderly persons eligible Evaluation expanded expenditures financial control model financial model formal community services formal services frail elderly functional status funding geriatric day hospital Gerontologist Health Care Financing Health Care Services health maintenance organizations Health Services Research Highland Heights Hip Fractures home care services home health impact impaired included increased individuals informal caregivers institutional Johns Hopkins Hospital length of stay ln addition long-term care services Medicaid Medicare MSSP National Long Term nursing home admission nursing home placement nursing home utilization overall participants patients percent Policy population preadmission screening Research 23:1 April residents respite risk of institutionalization sample Services Research 23:1 South Carolina study found substitution effect targeting Term Care Demonstration tion treatment group unmet needs waiver