"Alice Through the Looking Glass," or Trying New Evaluation Techniques

This article appeared in the GAO Review, Vol. 15, Issue 3, Summer 1980. In its study of the well-being of older people in Cleveland, Ohio, GAO measured the well-being of older people, observed changes in their well-being over a period of time, quantified the effect of services on their well-being, and estimated the changes in their well-being 20 years into the future. The study was immense and highly complex. The state of the art of evaluation techniques in sociology, gerontology, and medicine were used. The questionnaire used contained questions about an older person's well-being status in five areas of functioning: social, economic, mental, physical, and activities of daily life. Services to older people were defined, measured, and quantified. The personal conditions of people are measurable and are important in determining the effect of existing and proposed services. Applying the same rate of change that was observed in the first year, a 20-year estimate of anticipated problems and conditions of the elderly was derived. Costs of medical care and compensatory help were projected for the next 20 years. This showed that if medical treatment were expanded to all in need, total medical costs over the 20 years would decrease slightly; and the cost of compensatory help would be reduced significantly. Eight reports were issued and three hearings were held on the study. Legislation based on the study is pending before Congress to provide additional health care and home services for older people. The Federal Council on Aging has proposed policy changes concerning the provision of services to the frail elderly. GAO recommended to Congress that a national information system be developed. GAO methodology is being used by other health planning and social services organizations. A long-term care center and a center for gerontology have been established in the Cleveland area, using the results of the study.