Larry J. Hackman Research Residency Sample Application

This is a sample successful general application (with the personal "Applicant Information" section removed) to help guide other applicants as they prepare their applications.

Project Title

Systems of Long-Term Care for the Aged and Chronically Ill in New York State, 1940-1970 

Description of Proposed Project

While the care of people with long-term, chronic illness has always been part of health care, the magnitude of need has increased substantially in the United States in this century, particularly since the late 1930s. Innovations in prevention, care, and treatment have resulted in a shift in the major causes of morbidity and mortality from acute and communicable diseases to chronic illness. The challenge has become how to care for this ever increasing population in a caring and cost-effective manner, both in New York State and nationally.

Contemporary inquiry addressing the history of long-term and chronic illness care has been limited. Historical research on health care has emphasized acute hospital care, particularly from the point of view of hospital organization, physicians, and treatment, rather than long-term illness. Research on long-term care has failed to recognize and sufficiently examine the historical determinants of current chronic care problems. Two excellent studies of nursing homes build insight into obstacles impeding chronic illness care, but both are now thirty years old (One of these studies is: Thomas, W. C. (1969). Nursing homes and public policy: Drift and decision in New York State. Ithaca, NY: Cornell University Press). As the historical context of long-term care is poorly described and poorly understood, contemporary policy and planning will depend on additional historical research.

Previous research by this investigator on the evolution of care for the chronically ill in Philadelphia between 1945 and 1965, found a localized array of services for chronic illness care that emerged as neither orderly nor systematic. Care for the chronically ill gained minimal acceptance when it supported the preservation of over-crowded and understaffed hospitals, but accompanying increases in funding were not forthcoming. In fact, in order to stabilize and protect acute care, policymakers were willing to take actions to the detriment of home care, long-term care, and community-based services. Quality of care in boarding homes and nursing homes before 1965 was officially sacrificed to the need to house the dependent, chronically ill at minimal cost. Thus financing determined the availability of long-term services for the chronically ill, as well as program survival and the size of the service population.

The proposed project will contribute to understanding how public policy has affected and continues to affect the organization of long-term care for the chronically ill and aged. As many of the roots of the current health care system are located in the social, political, and economic choices of the research period, 1940 to 1970, this research may contribute to public policy discussions about long-term care in New York State and elsewhere.

The proposed research project will use materials available at the New York State Archives to trace the development of New York's system of long-term care services for the chronically ill and elderly from 1940 to 1970. This system of care may reflect services in nursing homes, boarding homes, through home care (such as visiting nurses or homemakers), or may be part of the larger picture of health services in acute care, rehabilitation, and psychiatric hospitals.

Records/Methodology to be Used

(1) Records To Be Used

(2) Information Expected To Be Derived From Records

(3a) Proposed Methodologies and Context For Interpreting the Data
An historical approach will be used to guide identification, review, and analysis of primary source materials at the New York State Archives. Agencies, organizations, and institutions that contributed to the system of care for the chronically ill in New York during the study period will be identified and their contribution described. I expect that some documents will directly relate to the care of the chronically ill, while other documents may contribute indirectly to the historical analysis, for example, public policy about hospitals or hospital records that suggest the differential management and discharge of the chronically ill, compared to those acutely ill.

The methodology for research using case materials from state mental hospitals (should permission be granted to access these records) will be to sample records of patients, aged 60 and over admitted between 1940 to 1970, to suggest source and rationale for admission, and reason and destination at discharge. I anticipate examining 20-30 records for each year. I expect to employ a sampling approach to the case records, which I will pilot at the Archives using a one year period. As I am unsure of the total number of available case records, let me suggest a possible method of sampling. I would target the first of every 50 case records. If this first record was not for a individual aged 60 or over, I would continue one by one in the case series and select the next record that met the selection criteria for age.

(3b) Linkage Between Information from New York State Archives and Other Sources

The focus of my research program is the history of long-term care for the aged and chronically ill in the United States. In this context, I am particularly interested in linking the proposed research at the New York State Archives with work I have previously done, and work that I will do, as part of a book-length manuscript on the development of systems of long-term care for the aged and chronically ill in the United States between 1940 and 1970. As part of my dissertation, "Caring for the Chronically Ill: Philadelphia, 1945-1965," and my currently funded research, "Pilot Study on the Care for the Chronically Ill in North Carolina, 1930-1970," I have analyzed local and national archival and published materials that speak to the organization of care and public policy for the chronically ill during the middle decades of the twentieth century. I am very interested to determine if the New York State approach to the care of the chronically ill reflects a regional perspective, in comparison with Pennsylvania. I seek to continue historical research in additional states and at the federal level to extend scholarly understanding of this period which underpins contemporary policy for long-term care. As New York State has been a leader in care of the aged and chronically ill, particularly during the study period, I find it very important to incorporate the proposed research at the New York State Archives into the proposed manuscript. 

Previous Use of Archives

I have discussed this research topic and available records with Dr. James D. Folts of the Archives. We reviewed the records I had identified for use, and he made additional suggestions from other series.

I have not previously used the New York State Archives. I am familiar with the type and organization of materials at similar state archives in Pennsylvania, North Carolina, and Virginia, and have conducted detailed research in both Pennsylvania and North Carolina.

Publication or Other Dissemination Plans

As my previous research has led to 15 oral presentations and 3 poster presentations, I would look forward to submitting abstracts based on research at the New York State Archives. I understand that those receiving awards may be asked to make a public presentation in New York about their work. I would anticipate a scholarly paper would be submitted on this research topic. Building on my first book, on care of the chronically ill in Philadelphia, my long-term goal is preparation of a book-length manuscript on the development of systems of long-term care for the aged and chronically ill in the United States between 1940 and 1970, and related public policy.

Statement of Estimated Expenses

• Inclusive dates for requested project support: 05/15/01 to 05/31/02
• Anticipated research schedule (describe the number of visits to the Archives you think will be necessary, general calendar involved, and number of days):
  • Two visits of one week each are planned, providing 10 full research days at the Archives. Each week I would arrive in Albany on a Sunday in order to begin work early Monday, and complete work late Friday, requiring an additional overnight stay before returning home on Saturday. I would prefer to visit the Archives during late May-early August 2001.
• Estimated budget for research expenses:
  

  BUDGET ITEM	RATE/DETAILS	TOTAL
  Mileage	2528 miles @ 25¢ Two round trips, 632 miles one-way	$ 632.00
  Tolls	(Estimate)Two round trips	$ 20.00
  Airfare		0
  Train fare		0
  Local transportation	Use own car from lodging to archives. Estimate 6 miles each way, for: $.25 X 120 miles	$ 30.00
  Parking	$7.00/day X 10 research days	$ 70.00
  Lodging/Meals *	$75/day X 12 days (Sunday through Friday nights).	$ 900.00
  Photocopying and other research expenses	$.25 X 1000 copies	$ 250.00
  	TOTAL AMOUNT REQUESTED:	$1902.00

  * rate based on what is generally available in the region

Please identify other financial resources that support this project: This would be the only source of support for this research at the New York State Archives.

SIGNATURE:________________________________ DATE: _______________

Note: Recipients of this award may be requested to make a public presentation concerning their research.