hey are not] get getting the assistance. It’s just another barrier for them.
– Victim services panelist
The challenges created by the pandemic for providers of victim services required signifi- cant innovation and adaptation.1 Such groups and agencie


ecca Pfeffer, Impact of COVID-19 on North Carolina’s Victim Service Providers, Washington, D.C.: RTI International, 2020.
232 The U.S. Criminal Justice System in the Pandemic Era and Beyond
 I think it’s creating unprecedented times for us to adapt o


the transition to virtual operations was much easier for organizations that had made previous technology investments and were not starting from limited capability when the pandemic hit. The smoothest transition required an organi- zation to already h


emic Era and Beyond
area where a phone conversation could be held without being overhead.5 However, even ubiq- uitous methods, such as texting, have cybersecurity vulnerabilities; abusers could use various types of spyware or tracking software “to co


o services, giving victims more control over how they participate, who they have with them when they participate, when they talk to people [and] for how long, [and] that’s been an incredibly positive thing that’s come out of it.
– Victim services pan


ound over time.
 Most of the providers that we work with have tried to move to remote services, but had to restrict intakes. . . . I think they’re focusing their responses on folks who are coming back into contact, and those cases that they have with


stributing solar chargers so that individuals without stable housing still had access to their mobile devices and could stay in touch with outreach teams and caseworkers.”10 Such efforts are needed because if the populations that services are intende


hing is done remotely. So the technology gap has been really spotlighted on the fact that many people do not have access to the internet. They don’t have computers at home. They don’t know how to navigate through setting up a Blue Jeans call or [othe


tion with both parents and siblings can be arranged and moni- tored by the person in charge of supervision so that the visit can be controlled and recorded if required (this is particularly easy with software such as Zoom). Conferencing can also be u


he “potential for permanent psycho- logical harm if children are unable to see their parents and siblings, especially during a time of crisis, and call for continued in-person visits in lower risk cases, based on guidance from public health officials


v- ernment]—reaching those in the community to let them know that the police were still responding, that shelters were still open, the hotline was still available 24/7, that you could still, even though the courts shut down, you could still petition


to be tested, providing an alternative opportunity to reach victims who might be sheltering with their abusers.
 Some places worked really hard to let people know that “shelters were still open, that they would put you up in a hotel if they would nee


ustrophobic behind the mask. Mask-wearing also was cited as a cause of serious stress for some people of color because of concerns about interacting with police and others with their faces covered and about how it would be perceived.
Constraints arou


from two hotel brands and, with a service provider on the ground, we’re able to coordinate and provide hotel stays for people kind of as a stop- gap between accessing some sort of more stable housing situation. Pre-pandemic, a lot of what we saw was


heir cars to get away from the abusers.
– Victim services panelist
 We also have a lot of sites where there’s not a lot of redundancy in victim service pro- grams, so there’s only maybe two victims service providers for an entire agency. And we’ve ha


have the time and resources to develop safety plans. One panelist said that it would be “untenable” for them to go back to in-person options. Given the demands on their time in attempting to serve their backlog of clients, there is simply not time av


s impact. Working from home increases the difficulty in separating work life from home life, potentially magnifying stress. Because many provider staff members also are members of minority groups, the national protests focused on social justice and e


e terrified at the idea of residents being able to kind of come and go on their own and potentially bring the virus back in. So we’re still trying to figure out when we reopen . . . what that means now that the [state-imposed] restrictions are a litt


hire skilled staff who were laid off by financially struggling hospitals. Finding staff who are already trained is valuable; panelists cited similar challenges to other justice agencies in onboarding and hiring new employees. In this case, the chall


icipation during COVID, [with] most of them citing a risk level that they weren’t willing to take on for nonemployed personnel. . . . And that of course affects service [delivery].
– Victim services panelist
There are some programs that eliminated se


rsus a patrol response unit, many of the investigators were [reassigned to] frontline positions. They were taken off inves- tigative details. . . . And [the victim service personnel] weren’t reassigned along with the investigator or sworn personnel t


rimes that were deprioritized were “less serious,” that did not mean that they did not have victims and, as a result, the decision to take broad categorical action to limit case flow by offense type missed key individual differences that might exist


m notification, or making the victim aware that the accused, who might have been arrested only hours before, was already being released as a result of pandemic limitations on jail custody. In addition to citing examples where this did not happen, pan


conomy, we’re anticipating—it hasn’t happened yet, knock on wood— that we’re going to see hits to our budget. It’s going to impact staffing and also [funds available for client assistance]. . . . So as the need goes up, sadly, the funding will poten-


nks so that people can wash their hands and not have to go into the bathroom” . . . or “We need to get rid of carpeting and put down like laminate flooring to be able to just kinda hose it down with Lysol.” Normally you would work with a local plumbi


that hadn’t worked with [Housing and Urban Development] funding before, it’s hard.
– Victim services panelist
Sites have been reporting to us that a lot of people doing the work aren’t necessarily specialized in understanding grant processes, procure


he pandemic that appeared valuable to carry forward than members of our other panels. However, the pan- elists did note the importance of partnerships and collaborations in accessing resources and facilitating service delivery in ways that would not


e who might not otherwise have been identified, and therefore would not have been served previously. One of our panelists pointed out that the only crime—and, therefore, the only victims—the criminal justice system is aware of are the ones that get r


parts of the justice system, the pressures of the COVID-19 pandemic were seen by panelists as pushing changes that have been considered in the broader context of crimi- nal justice reform. This was less the case for victim services, which is not surp


r that—of the three perspectives on change in the justice system: justice agencies, justice-involved individuals and their communities, and victims of crime—the needs of the latter might have been the least considered or reflected in the strategies f


essed in research and evaluation studies?
• Given concerns about the digital divide significantly affecting the ability of victims from locations with low broadband or little communications infrastructure accessing services and participating in the j


rly on you, on your department, on the system as a whole, [and so] it’s a very, very risk-averse system.
– Community organization panelist
Our parole board, they were slapping GPS on every single person they parole . . . [because they] were fearful o


tter response to such concerns as domestic violence going forward. The nature of the pandemic created needs within the justice system, causing stress among incarcerated indi- viduals and practitioners across justice organizations that built on simila


ned that—particularly for counseling and service delivery—the effectiveness of virtual modes might not be suf- ficient. And although there are clearly some types of virtual interactions and processes that are entirely unproblematic (e.g., providing i


 agencies (National Commission on COVID-19 and Criminal Justice, 2020b, p. 33).
 266 The U.S. Criminal Justice System in the Pandemic Era and Beyond
part of the system affected others and, although those choices might have been unavoid- able in the f


do, including the choice to not arrest many people and not require many individuals to complete their original sentences or periods of detention for some crimes and violations. Lessons can be learned from
3 One of the final recommendations of the Nat


ightened the touch of the justice system on society for an extended period. As more than one of our panelists observed, those changes were in line with reforms that some organizations and communities have argued should be made for some time. Their im


concerns about to better understand of the pandemic on and ethnic groups on different racial the burden of dis- • What have been the populations and cor- and disparities in rectional staff, and both incarcerated how long do such ease across demo- in


 their abil-
ity to contribute to
Have more-trusted
play in public health
police is appropriate
tions and categories
departments been
sensitive data or other
could productively
resources to enable
plan for future pan-
conflicts and impreci-
sion in p


e distin- tural or other retro- on the capacity of carceral facilities’ • How has the reduc- • Are there architec- tional institutions of the changes made effects of other ini- already underway in tion affected crime tion in detention, fitting option


effective are virtual assessment of the impact with providers using per- low broadband or little communications infra- vices remotely? Similar models for delivering better mapped to inform comes (including virtual services to victims, and the justic


 technologies
dispatchers to work
among different
provision of virtual
alternative models
differ from those of
trained in person?
• Did digital divides
Were alternatives
officers who were
remotely)?
resources?
Assessing virtual justice services deliv


in the lives of the poorest people in the community. But there’s also tremendous resistance. . . . I think it’s going to be up to researchers to be able to really evaluate the impact of COVID and bail reform and these arguments around police legitim


community organizations panelist in the introduction to this report noted, there are at least the following three fundamental perspectives from which such changes need to be examined:
• the justice system itself and how changes affect its functioning


ing. As a result, in considering the path forward, how major changes affect different populations served by the justice system will be important.
However, even with the difficulty in finding changes that meet the needs of all three of these groups si


This is an opportunity to the extent that it allows us to thin [the] prison population, have people put onto supervision, and then also give supervision a chance to thin those people that they cannot manage because of the numbers that are being relea


t of the system that will mean that the justice system’s recovery will be a long- term process. That recovery will be complicated by the scars that the pandemic almost cer- tainly will leave on municipal budgets, on the philanthropic funding streams


ustice in the hope that any future infectious disease outbreak will find a system that is better positioned to weather the storm.
Many of the responses by justice agencies to the COVID-19 pandemic came out of policy experiments and innovations that e


lic safety and fairer to those who become justice-involved. In our discussions, panelists talked about the inherent tensions that exist within the system between the desire to craft justice interventions that are effective at the individual level and


ciation
San Diego County Sheriff’s Department (California)
New York City Department of Probation
Maryland Parole Commission and International Association of Paroling Authorities
Bowling Green State University
University of Florida
The Safe Sisters Ci


Community Supervision
Michigan Supreme Court
Nicoletti-Flater Associates
Fayetteville Police Department (North Carolina)
Alameda County District Attorney’s Office and California District Attorney Association
Fortune Society
Georgia Southern Universit


ber 8, 2020: https://www.americanbar.org/advocacy/the-aba-task-force-on-legal-needs-arising-out-of-the-2020-pandem/
American Correctional Association, “The Wall of Honor,” webpage, undated. As of December 7, 2020: http://www.aca.org/ACA_Prod_IMIS/ACA


ries 616, 2020.
Bella, Timothy, “A GOP Sheriff Vowed Not to Enforce Arizona’s Coronavirus Restrictions. Now He’s Tested Positive,” Washington Post, June 18, 2020.
Bender, Adam, “COVID-19 Could Change Views Toward Remote 911 Operators,” Communications


 “Court Adaptations During COVID-19 in the World’s Two Largest Democracies,” SSRN, May 24, 2020.
Carter, TaLisa J., “COVID-19 in the Common Area: The Pandemic Is Reinforcing the Interconnected Nature of Corrections,” Urban Wire blog, June 16, 2020. A


sponse to COVID-19,” MacArthur Foundation Safety and Justice Challenge blog, April 8, 2020. As of December 8, 2020: https://www.safetyandjusticechallenge.org/2020/04/how-interagency-trust-can-foster-an-optimal-jail-respon se-to-covid-19/
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Gonzalez, Jennifer M. Reingle, Rebecca Molsberry, Jonathan Mas


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The Marshall Projec


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PERF—See Police Executive Research Forum.
Phi


t - 3 9 5 6 6 5
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s://www.rand.org/pubs/research_reports/RR3213.html
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 Face One-Two Punch: Defund Protests and Coronavirus,” NBC News, June 28, 2020. As of December 8, 2020:
https://www.nbcnews.com/politics/politics-news/ police-departments-face-one-two-punch-defund-protests-coronavirus-n1232182
Smith, Carl, “All Rise:


, and Grace Kao, “The Anxiety of Being Asian American: Hate Crimes and Negative Biases During the COVID-19 Pandemic,” American Journal of Criminal Justice, Vol. 45, 2020, pp. 636–646.
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United States Comm


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Welsh-Huggins, Andrew, “In Cities Across U.S., Voters Support More Police Overs


ericans focused attention on equity and fairness in the justice system, resulting in significant pressure for reform.
The conditions faced by organizations across the justice system differed widely, and responses to address the risk of infection vari


 Societal Impact of
Research Funding for
Women’s Health
IN ALZHEIMER’S DISEASE AND ALZHEIMER’S DISEASE–RELATED DEMENTIAS
Matthew D. Baird Melanie A. Zaber Andrew W. Dick Chloe E. Bird Annie Chen
Molly Waymouth Grace Gahlon Denise D. Quigley Hamad Al-


thewhamreport.org/report/brain to learn more about using these data and citing this report.
 WHAM’s LEAD PARTNERS
WHAM’s sponsorship of this research project was enabled through the generous financial support from the following partners.
American Hea


M BOARD
Carolee Lee, Founder and Chair
Founder, AccessCircles, Founder and Former CEO of CAROLEE
Meryl Comer, Vice Chair and Global Chair Co-Founder, UsAgainstAlzheimers/ WomenAgainstAlzheimers
Chair, Global Alliance on Women’s Brain Health
Anula Jay


omen’s Hospital Paula A. Johnson Associate Professor of Psychiatry in the Field of Women’s Health, Brigham and Women’s Hospital
Dr. Wendy Klein, MD, MACP, Former Medical Director, Health Brigade
Dr. JoAnn Manson, DrPH, MD, Michael and
Lee Bell Profes


th Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington
Hadine Joffe, MD
Vice Chair for Research, Department of Psychiatry, Executive Director, Mary Horrigan Connors Center for Women’s Health and Gender Bio


h research.
The results establish the potential for investment in women’s health research on AD/ADRD to realize gains beyond additional gen- eral research investment and point the way to a concrete, actionable research and funding agenda. Large socie


n invest- ment. Leaders across multiple other business sectors need to understand the consequences of underinvestment for workforce productivity and the health care burden associated with AD/ADRD. These communities are key to informing future researc


ress the gap in knowledge about investment in women’s health research (see, for example, Grant and Buxton, 2018). Women’s health research as used in this report refers both to analyses that address sex and/or gender within general sample or populatio


 in health research gener- ally and women’s health research in particular. The results using NIH funding levels can be considered a lower bound on the possibilities for research investment.
The goal of the analyses is to serve as a foundation for dev


CH FUNDING FOR WOMEN’S HEALTH IN ALZHEIMER’S DISEASE AND ALZHEIMER’S DISEASE–RELATED DEMENTIAS
Expenditures were estimated as a function of age, gender, care status, and disease severity. For example, severe AD/ADRD is asso- ciated with higher nursin


acts, first separately and then assum- ing that all three impacts occur together:
1. decreased age incidence of disease (probability of onset at a given age)
2. delay in progression to more-severe levels of disease, with the assumption that innovatio


billion dollars, and 12 percent of that amount was invested in women-focused projects in 2019, according to the method described in this section (NIH, 2020a; Sekar, 2020). Models examined a doubling of the 12 percent. All costs are presented in 2017


545
–1,431
 –894
 A 0.01 percent health improvement results in more than 5,500 fewer life years with AD/ADRD for women and nearly 900 fewer life years with AD/ADRD for men.
  FIGURE 3
Health and Economic Improvements for U.S. Population Age 35-Plus:


over 30 years, in 2017 dollars. Approximately 40 percent of that cost reduction is a result of fewer nursing home stays. Noncare health care costs demonstrate a very small increase as a result of fewer years of formal institutional care. The costs of


der-neutral or gender-inclusive research yields results that are less applicable to women than to men. Assuming that women benefit from women-focused research investment at a rate of three to one com- pared with men may underestimate the actual benef


erm outlook for treatments. Disease modification that yields a differ-
ent severity profile—for example, longer time in moderate-to-severe
22 SOCIETAL IMPACT OF RESEARCH FUNDING FOR WOMEN’S HEALTH IN ALZHEIMER’S DISEASE AND ALZHEIMER’S DISEASE–RELATE


h. A key focus of this evaluation must be on the ways in which women’s research careers are disadvantaged relative to men’s because of family factors, such as a differential caregiving burden for women, and because of systemic factors, such as an imp


ocial and Behavioral Policy Program
RAND Social and Economic Well-Being is a division of the RAND Corporation that seeks to actively improve the health and social and economic well-being of populations and communities throughout
the world. This resea


 to Medical Research Funding,” BMJ Open, Vol. 8, No. 9, 2018.
Hansen, Johan, Natasha Azzopardi Muscat, Ilmo Keskimäki, Anne Karin Lindahl, Holger Pfaff, Matthias Wismar,
Kieran Walshe, and Peter Groenewegen, “Measuring and Improving the Societal Imp


shington, D.C.: Congressional Research Service, R43341, updated May 12, 2020. As of November 20, 2020:
https://fas.org/sgp/crs/misc/R43341.pdf
Yang, Zhou, and Allan Levey, “Gender Differences: A Lifetime Analysis of the Economic Burden of Alzheimer’s


Provisional Caseload Standards for the Indigent Defense of Adult Criminal and Juvenile Delinquency Cases in Utah
Report for the Utah Indigent Defense Commission
NICHOLAS M. PACE, DULANI WOODS, ROBERTO GUEVARA, CHAU PHAM, SHAMENA ANWAR
 Sponsored by U


l spend on criminal and delinquency matters within various case type categories.
• The second effort was a survey of attorneys who had previously been identified as indigent defenders practicing in Utah. In the survey, the results of the first effort


 63
vii
Summary Background
In 2019, the Utah Indigent Defense Commission (IDC) asked the RAND Corporation for assistance in developing a provisional set of maximum caseload standards for providers of indigent legal representation in the courts of the


gs, or other legal matters; the adjective indigent as used here simply refers to a person’s overall eligibility for appointed counsel, and not necessarily to their financial status.
  viii
Texas, and Virginia, have conducted rigorous studies intended


to appear with the defendant when the defendant is informed of the filed charges at the initial court appearance, or to address collateral consequences, such as suspension of driving privileges. The recommended average of 11 hours of attorney time ac


ories.
The second effort was a survey of attorneys who had previously been identified as indigent defenders practicing in Utah. In the survey, the results of the first effort’s time analysis were presented to participants as evidence of current time


ose who participate in assigned counsel programs are listed on a roster of available defenders, and, if appointed by the court to represent an indigent defendant, they might be paid by the hour, by the case, or by each event in a case. Defenders who


ase types and the final set of categories ultimately utilized by the expert panel, along with detailed descriptions of the relevant defining statutes, are set forth in Table S.1. It should also be noted that the categories exclude criminal cases invo


ction for which probation was originally ordered only involved misdemeanor charges.
Table S.1. Case Type Classifications Used in This Study
    Interim Case Type Category (Time Analysis and Attorney Survey)
   Final Case Type Category (Expert Panel a


that at least some attorney time was recorded) at some point during the five-month period from June 2019 through October 2019 (the “study period”). A total of 11,703 adult criminal cases active during the study period and involving one of the client


hearings can be thought of as the functional equivalent of trials and subsequent sentencings in District and Justice Courts. Such adjudications result in a finding by the court as to whether a petition’s allegations that a juvenile committed acts co


able S.2 reflect the experiences of a specific segment of the Utah indigent defense bar: attorneys working for the two public defender offices in the state’s most populous and densely populated county. As such, the nature of their practices, the size


survey were sent to all 355 attorneys who had been identified by the IDC as accepting indigent defense appointments. A total of 183 respondents began the survey and 141 completed the questionnaire to the end, yielding a response and completion rate o


inquency
Juvenile Delinquency
Juvenile Delinquency
Time Analysis
Interim Case Type (N; % Agreed/Less/More) Results Non-Capital Murder 206.0
(N = 53; 62%/4%/34%)
Felony DUIs 8.5 (N = 88; 67%/3%/30%)
Other Felonies 8.4 (N = 95; 52%/8%/40%)
Misdemeanor


efense.
The inquiry only addressed the issue of attorney time. Although support staff resources ultimately play a major role in delivering an adequate defense, our interest for the instant work was solely focused on attorney time expenditures. The pa


no further discussion would be useful. CoVs exceeding 0.8 would indicate a poor degree of consensus, and, unless the range of results could be tightened, the case type would need to be dropped from the standards-setting process. The RAND facilitator


nors
                                                Provisional Caseload Standards and Case Weights
Annual Case-Related Duty Hours
To develop caseload standards, we first need to decide on a value that represents the amount of time an indigent defen


this type might consume most of an attorney’s working hours over the course of a year. But if the consensus estimates of average attorney hours yielded by the expert panel are taken at face value, an indigent defense system must, at least for planni


of their time compared with the activities of
xxiv
attorneys in other offices and law firms across the state (and thus the dramatic increases over time expenditures arising from the experts’ recommendations would be greatly reduced if we had better t


tantial part of their practices despite possibly receiving fewer appointments over the course of a year. Even in the smallest or least populated jurisdictions in the state, plans must be in place for alternative counsel to quickly and seamlessly abso


of shepherding this project from conception to realization, and we are thankful for her thoughtful guidance and support at every step of the process. Commission staff members Leslie Howitt, Gregory Bates, Katriina Adair, Jojo Liu, and Darien Hickey


by an attorney over the course of a specific time period (such as “no more than 150 felonies in a year”), are a useful tool that administrators of indigent defense programs, the courts that appoint indigent defense counsel, and policymakers who decid


address issues that, left unresolved, would increase the likelihood of recidivism. Without a reliable metric available to flag (and subsequently remedy) instances where workloads for an individual attorney, a law firm, or the indigent defense system


ven months after that recommendation was published, the Utah Legislature established the IDC with the goal of ensuring that the state meet its “obligations for the provision of indigent criminal defense services, consistent with the United States Con


al Council Study Committee, 2015, p. 2. 12 Utah Senate Bill 155, 2016, Section 6.
13 Utah Code § 78B-22-404.
 3
For purposes of this standard, the term case means a single charge or set of charges concerning a defendant (or other client) in one court


seload standards should in no event be exceeded,” citing the numbers in NAC Standard 13.12); Washington State Office of Public Defense, Washington State Supreme Court Standards for Indigent Defense, 2012, Standard 3.4; and American Council of Chief D


ourt Innovation, October 2014.
24 Nicholas M. Pace, Dulani Woods, Shamena Anwar, Roberto Guevara, Chau Pham, and Karin Liu, Caseload Standards for Indigent Defenders in Michigan: Final Project Report for the Michigan Indigent Defense Commission, Sant


rk that simply measures current mean time expenditures is in the use of expert opinion to develop recommended averages that account for all effort needed to deliver effective assistance of counsel conducted pursuant to prevailing professional norms.


ve assistance conducted pursuant to prevailing professional norms. The average increase of one hour might, for example, allow for increased time working with the client to review the prosecution’s evidence, to appear with the defendant when the defen


and marshal resources appropriate for meeting the demand. That said, a maximum caseload standard should not be viewed as an inflexible target for defenders to strive for when accepting new clients. As always, attorneys have an ethical responsibility


case, or by each event in a case (the manner of compensation depends on the program’s rules and the nature of the appointment). Assigned counsel can be solo practitioners or members of private law firms. Defenders who participate in contract defende


unties and could, for example, function as assigned counsel in one location and as contract defenders in another. And there are indigent defenders who are not staff of a public defender office, are not on an assigned counsel roster, or have not enter


ssues with support staff availability. This statewide body regulating indigent defense in Utah might, for example, decide to phase in the implementation of the standards over time as a result of budgetary considerations, or modify them on the basis o


cific period of time, whereas other studies were able to analyze existing timekeeping information already collected by defenders as a routine business practice (see “Time Analysis” in Table 1.1). When special time studies were employed, participation


ologically is in the nature of the information provided to the panel for its deliberations. One approach ensures that the panel is familiar with the results of the time analysis regarding current average time expenditures and with the findings of the


 adult criminal, 1 juvenile,
2 family
Time Analysis
Mandatory time study over
16 weeks
Voluntary time study over
12 weeks
None
Mandatory time study over
6 months
Approach
Yes, using 26 task types
Yes, using 13 task types
Yes, using 11–13 task types d


groups specified both the amount of additional time needed per case and the percentage of cases in which this additional time was required.
Amount of time required, on average, to accomplish each task within each case type
Average amount of time that


 weeks
Mandatory time study over
7 weeks
Used existing timekeeping data covering 6 months
No, task data only informed expert decisions
Yes, using 35 task types
Yes, using 12 task types
15
        Jurisdiction and Primary Researchers or Sponsors (Cita


tion would be voluntary (the voluntary nature of the data collection meant that the duration of the study would have to be limited, perhaps as short as eight weeks, to avoid participant fatigue and subsequent dropout). We would not utilize a task-bas


55 attorneys, though we were well aware that some of the names on the list identified individuals who were no longer practicing law at all or only doing so in areas outside of interest to this study, were now deceased, or who had new (and unknown) co


ntained as part of their normal business practices, and spend a nontrivial amount of time at the end of each work day thinking about what they did for their clients and recording such activities in an organized manner. Such a task would be made much


activity would eliminate the not-inconsiderable timekeeping burden that would have been placed on the defenders who volunteered for the proposed time study. Factoring into the decision was our understanding that the IDC was in the process of launchi


 the influence of alcohol, drugs, or a combination of both or with specified or unsafe blood alcohol concentration (§ 41-6a-503(1)).
Jail sentence of up to 1 year. Examples: Manufacturing or delivering drug paraphernalia (§ 58-37a-5(2)(b)); Assault o


ile a highly granulated breakout of the two offices’ caseloads would certainly be useful for a research perspective when developing maximum caseload standards, recording the information necessary for such an analysis (typically a listing of the relev


cy Juvenile Delinquency
Case Type Category
Non-Capital Murder
Felony DUIs
Other Felonies
Misdemeanor DUIs
Other Misdemeanors
Probation Violations—Felonies Probation Violations—Misdemeanors
Felonies
Misdemeanors
Status Offenses
Orders to Show Cause
Pr


xamples include aggravated arson of a habitable structure or vehicle (§ 76-6-103(2)), burglary of a dwelling (§ 76-6-202(2)), and odometer violation with intent to defraud (§41-1a-1319).
Third-degree felony charges for violations of Utah Code § 41-6a


and Class C misdemeanor charges would be assigned to the “Class A Misdemeanors” case type because that category precedes “Class B and C Misdemeanors” in the list. Indigent defense appointments that fall outside the categories described in the table


June 2019 for those cases with a start date prior to the beginning of the study period and for imputing attorney time for cases that were still pending at the time of the analysis.48 To do so, we used a relatively simple imputation technique for est


 within 161 days, and 95 percent within 637 days, and 1 percent were open longer than 1,147 days.
We used this special closed case dataset to calculate median days from opening to closure for those matters that remained open beyond different time thr


d total number of days open based on the number of known
open days.
For all of these scenarios, imputed total hours were calculated as follows:50
Imputed total hours = actual hours recorded  ́ (total open days / recording days).
It should be remember


t case number for each newly filed criminal complaint or information. For an indigent defender, the representation of a client as a result of an appointment is likely to begin about the same time as the court case, and it is likely to end about the s


nt juvenile defense bar is made up of multiple private law firms or solo practitioners, it is possible that Juvenile Court will appoint one attorney to handle a juvenile’s first representation and appoint a different one for a subsequent involvement


 facing charges arising from all events allegedly occurring within a span of a few weeks or
52 Utah Sentencing Commission, 2015 Juvenile Disposition Guidelines, January 2015, p. 9. 29
 months of each other. As such, all of the offenses that are addre


Case Type
Mean hours for attorney time expenditures in the cases included in the time analysis are set forth in Table 2.1. As would be true with any mathematical analysis, as the size of a sample grows, its mean gets closer to the average of the whol


ool, better opportunities will exist in
31
subsequent years for assessing the changing nature of defender time expenditures, particularly in regard to private attorneys, to attorneys outside Salt Lake County, and to attorneys in small and medium-size


oele, Utah, Wasatch, and Weber. Office of Management and Budget, Revised Delineations of Metropolitan Statistical Areas, Micropolitan Statistical Areas, and Combined Statistical Areas, and Guidance on Uses of the Delineations of These Areas, OMB Bull


and the 90th percentile (the value in which 90 percent of the respondents were below and 10 percent were above) was 60 hours. Public defenders reported slightly greater weekly hours than attorneys in other types of practices (Table 3.3).
Table 3.3. A


d about office size and support. Single-person offices were common (44 percent) among attorneys who received appointments through contracts, assigned counsel programs, or other means (Table 3.6). About 18 percent of non-public defenders reported that


s shortcoming. We can, however, use the 90th and 95th percentiles in Table 3.7 to identify instances where active attorneys are shouldering a particularly large caseload in one of our interim study types. For example, 10 percent of all respondents re


more “Other Felonies” each year, and 10 percent (likely a different 10 percent) had more than 600 adult criminal cases.
Table 3.8. Reported Annual Caseloads for Attorneys with Adult Criminal Focus and Half or More of Workweek Devoted to Criminal or J


the results for the specialist respondents in Table 3.8 and Table 3.9 by adjusting their caseloads by both the number of average weekly work hours they reported and the percentage of weekly work hours devoted to their primary practice areas. Using 40


ve been repeatedly criticized as allowing far too many cases annually given the current professional and ethical demands on indigent defense attorneys today, limited felonies to just 150 per year. It should be kept in mind that those respondents repo


 hours to be used for planning purposes. Specifically, we requested that the attorneys consider
the amount of time, on average, that [they] believe an attorney should plan on spending for a particular type of case in order to provide an adequate and


tever your determination, please base your entries on your personal experience and upon what you believe to be the average amount of lawyer time that would be required to afford a client adequate and effective aid in the defense of a case of that typ


he average hours necessary to deliver effective representation. Their deliberations were informed by the results of the earlier data collections, as well as by current guidance on the ethical and professional standards for criminal and juvenile defen


t Lake City
Utah County Public Defender Association, Provo
    Though the information we sought to elicit from the expert panel paralleled that of the attorney survey (panel members were also asked to provide an opinion as to the average amount of ti


was provided to help the panelists think about the question of the amount of time is needed, on average, to represent clients in different types of cases in Utah and render, as described in Strickland v. Washington, “reasonably effective assistance”


 way, any recommended average time expenditure should be the same for all attorneys representing clients in the case type categories of interest.
Detailed information about the two data collection efforts was also provided, covering such topics as pr


sensus, making further discussion about the case type in question unnecessary. CoVs exceeding 0.5 but less than or equal to 0.8 would be considered less satisfactory, and additional discussion would be recommended for the purpose of enhancing consens


for sex-related crimes due to the complexities of the defense and the potential for an outcome in the case that would trigger offender registration and associated consequences. The changes instituted by the expert panel will address some of those co


 so the choice of statistic to use to report a typical result need not be limited to the mean.
49
                                            Table 4.2. Expert Panel Session Recommended Hours Compared with Time Analysis and Survey
        Subject Are


s. We use the results of the attorney survey in which participants reported spending an average of 11.8 percent of their workweek in the practice of law but not working on specific cases (Table 3.4). When these assumptions are plugged into the formul


e 5.2. Provisional Caseload Standards Expert Panel Recommended
Maximum Annual Caseload Standards
6 12
        48
        71
        89
        71
       149
       298
       357
        25
        71
        89
       298
       357
    Subject Area


 paying clients or court appointments.
Case Weights
There are essentially two types of time-based case weights: absolute (the weight reflects the average time measured for a particular type of case) and relative (the weight reflects how the average t


eloads when a mix of client matters is being handled. Assume that a solo practitioner who works only on adult criminal indigent appointments receives a contract to take on 60 Class A misdemeanors over the course of a year. For planning purposes, it m


plated by those weights. As indicated previously, the case types chosen for this work represent adult criminal and juvenile delinquency client matters that are believed to consume most of a defender’s workday, but there were some exceptions. For exam


ly adhere to the NAC caseload standards that have essentially functioned as the default guidance for indigent defender workload limits throughout the nearly five decades since their publication.59
For the sake of comparability, we made several decisi


ut parole) Felony—life without parole
Murder
Murder
Mandatory sex and kidnap registration felonies First-degree murder (includes capital)
Class 2 felony
Murder/manslaughter
Homicide (average)
Murder/homicide
Nonmurder with possible life sentence Supe


 weight (25 hrs.) Standard
Case weight (24.13 hrs.) Standard
Standard
Case weight (22 hrs.) Case weight (21.99 hrs.) Case weight (19.12 hrs.) Standard
Standard
Standard
Case weight (838 min.) Case weight (766 min.) Standard
Standard
Standard
Standard


ion revocation
Modifications/sentence reviews, circuit (average)
Violations of probation, circuit
Modifications/sentence reviews, district (average)
Extradition
Probation violation, misdemeanor Violations of probation, district Preliminary hearings,


200 Case weight (7.4 hrs.) 241 Standard 250 Case weight (397 min.) 270 Standard 298 Case weight (348 min.) 308 Case weight (317 min.) 338 Standard 351 Standard 357 Case weight (4.6 hrs.) 388 Case weight (2.3 hrs.) 776
             offender
(average)


t majority of indigent defenders in Utah), adoption of the provisional standards, if accompanied by a surge in attorney availability, will certainly cause a major sea change in the delivery of services to indigent defendants.
We do have some evidence


bmitted by many of the attorneys who participated in the survey evidence deep frustration over a lack of resources and inadequate time to do the job that they believe is necessary for effectively fulfilling their professional responsibilities to thei


 over on a moment’s notice, courts will have little choice but to continue to appoint those who are at risk of excessive workloads.
IDC must also regularly revisit the issue of caseload standards in the future, in part to make sure that caseload maxi


individually identifiable information.
1. A metric worth exploring may not be time on task, but a time frame in which to complete the task. For example, counsel may have a “eureka” moment for a case after having sat with it for several weeks; but mea


e. Most clients are in need of treatment. Support staff and additional attorneys are essential.
 67
6. Having the assistance of investigators that can work with IDC funds would be helpful in all cases. I would love to be able to get an investigator t


fense is that if you are choosing which cases to give more of your time, it undoubtedly comes at the expense of another (perhaps less serious) case. That practice seems to undercut the quality of representation. More qualified bodies to handle cases


ven the caseload. Right now, it is an inconvenient truth that indigent defenders do not have sufficient time to provide an adequate defense to indigent clients. Everyone knows this. Hopefully, this will change but I am skeptical.
17. If the data refl


t defense is funded by each county, something needs to be done in order to offer juvenile defenders, especially those who solely do juvenile defense, a livable salary.
20. In the State of Utah, the public defenders are compensated by counties instead


 because there’s too many clients and too little time.
26. More resources need to be spent on treatment, housing and early intervention to avoid the cycle of clients.
27. Most counties pay the lowest bidder. Further, all counties don’t pay based on e


stigate and pursue defenses, even if it doesn’t go to trial. DUIs are not that much different from run of the mill felonies, but they are the only special category separated out in this survey. The study should also look at types of cases by content


t is not appropriate for attorneys balancing those caseloads to continue to balance the rest of their full caseload, which is probably too big to start with.
36. Re: misdemeanor appeals. I wasn’t clear if this contemplated an appeal de novo from just


 events will add an average of at least 100 hours to the time the appeal would take from beginning to end.
39. The current going rate for indigent appeals is shockingly low. Rough math suggests that, for example, Salt Lake County Legal Defenders Asso


to adequately represent my clients. Third, establish a group of expert witnesses that we can go to in order to obtain assistance to adequately represent our clients. A group of experts in all the typical fields involved in the criminal justice system


 and mental health clients. And with the indigent population, that’s about 90% of the clients.
47. Utah’s indigent defense funding is 49th in the US. Washington County is the least funded county in Utah. Enough said.
48. We have been tracking our tim


lated to Excessive Workloads, August 2009. As of October 3, 2020: https://www.americanbar.org/content/dam/aba/administrative/legal_aid_indigent_defendants/ ls_sclaid_def_train_eight_guidelines.authcheckdam.pdf
American Bar Association, Criminal Justi


hrough Public Defense Delivery Systems, 2nd ed., Washington, D.C., 2008.
New York State Office of Indigent Legal Services, A Determination of Caseload Standards Pursuant to § IV of the Hurrell-Harring v. The State of New York Settlement, December 8,


, Boston, Mass., October 2015.
Utah Indigent Defense Commission, Core Principles for Appointed Attorneys Representing Youth in Delinquency Proceedings, 2018. As of December 15, 2020: https://idc.utah.gov/wp- content/uploads/2018/06/DelinquencyCorePri


COVID-19 and the Experiences of Populations at Greater Risk
Description and Top-Line Summary Data—Wave 3, Winter 2021
KATHERINE GRACE CARMAN, ANITA CHANDRA, DELIA BUGLIARI, CHRISTOPHER NELSON, CAROLYN MILLER
 Sponsored by the Robert Wood Johnson Foun


op-line report will update these findings after the final survey.
Researchers from RAND and RWJF jointly conducted the research reported here; the report is intended for individuals and organizations interested in learning more about public attitudes


in a community during a major stressful event like a natural disaster, economic challenge like a
plant closure, major incident of community violence?.................................................................21
COVID Impacts: COVID Experience..


g., the governor
or state legislature) is doing enough in dealing with the impact of coronavirus (COVID-19)
to look out for the interests of all people, regardless of a person’s race, how much money
someone makes, where people live, or other factors.


......................................................................35 Q35a [w2_positivechg] (if w2_positivech = strongly agree or somewhat agree) What is the
most important positive change that you would like to see change?........................


final survey.
The questions in this COVID-19 survey focused specifically on experiences related to the pandemic (e.g., financial, physical, emotional), how respondents viewed the disproportionate impacts of the pandemic, whether and how respondents’


These oversamples will allow for research that compares subgroups based on income or race and ethnicity.1 We created weights to align the distribution of characteristics in our sample as closely as possible to the distribution of characteristics of


eriences, views, and perceptions of a nationally representative sample of groups living in the United States and historically at greater risk as they face the COVID-19 pandemic, economic recession, and social injustice. The objectives of this survey


rld. Our survey content was reviewed by a group of researchers conducting surveys about COVID-19 impacts. The survey design process balanced the urgency of capturing real-time experiences with COVID-19 with finding survey items that at least had reas


Katherine Grace Carman, Anita Chandra, Sarah Weilant, Carolyn Miller, and Margaret Tait, 2018 National Survey of Health Attitudes: Description and Top-Line Summary Data, Santa Monica, Calif.: RAND Corporation, RR-2876- RWJF, 2019. As of October 9, 20


een measured in other surveys, and there were few existing survey questions to draw from, so many survey questions were developed de novo.
We conducted a series of meetings with a group of researchers implementing surveys about the impacts of COVID-1


xtent to which respondents’ ability to engage in well-being activities has been affected by COVID-19.
One question was modified. In wave 1, more than 70 percent of respondents reported that the pandemic could be an opportunity for positive change (w1


ispanic, or Asian respondents. We were most interested in understanding the experiences of historically underserved individuals in U.S. society. The income limits allow us to focus on individuals in households that were likely eligible to receive the


with incomes between $75,000 and $125,000, non-Hispanic White panelists were randomly selected to participate and all panelists of other races or ethnicities were invited to participate.3 This resulted in a sample of 1,331 panel members being invite


h wave and each panel.
Table 1.3. Summary of Field Dates and Sample Sizes
ALP KnowledgePanel Total
Sample Participation Sample Participation Sample Participation
          Wave Field Dates
1 June 29–July 22, 2020
2 October 9–November 2, 2020
3 Februa


gender and age, as well as household income interacted with household size. To calculate the weights, we combined the two samples and matched the distribution of characteristics of the pooled sample to the distribution of the CPS. In other words, our


nown as the margin of error [MOE]) based on the 95-percent confidence interval. If a study were repeated 100 times, the 95-percent
11
confidence interval would contain the true value 95 percent of the time. The MOE is a function of the sample size an


reater Risk Survey. For each question in the survey, we present the text as it was presented to survey respondents, as well as a variable name for those who use the data. All responses were listed in the order presented in the top line unless otherwi


ral, would you say your health is excellent, very good, good, fair, or poor?
Select only one answer.
       Sample
Excellent Very good Good
Fair Poor
Missing
       7.0 32.2 40.1 6.4 33.2 39.1 6.3 31.4 41.4
Q4. [w3_wellbeing1-w3_wellbeing6] Below are


                                17
Q6. [w3_chronic] Do you personally currently have one or more chronic health conditions (e.g., diabetes, asthma, depression, heart disease, high blood pressure, substance use disorder)?
Select only one answer.
Sampl


ut do not have to take leave
Wave 1
Wave 2
Wave 3
SOURCE: Developed by RWJF and RAND.
I am receiving
unemployment No, I receive
insurance no pay
Sample
Yes, I use paid leave
Yes, I receive partial pay
1.1 1.4 1.5
Missing
       1.1 1.1 0.6
2.6 1.2 1.


 for coronavirus (COVID-19) (through a nasal swab or blood test)?
    Sample Yes
No Missing
    Wave 1
Wave 2
Wave 3
SOURCE: Modified from COVID Impact Survey.
11.7 88.0 0.3 26.2 73.4 0.4 44.9 54.7 0.3
    21
Q14a. [w1_covidexp1- w1_covidexp14] Are y


n wave 1, and if w3_exp11, w3_exp4 or w3_exp5 selected in wave 3) [w3_finhard] How long do you think you will have trouble affording your basic expenses?
Select only one answer.
Note: The question wording was modified slightly from wave 1, which read


tance from this program before coronavirus (COVID- 19) started
Yes, my household started receiving assistance from this program since coronavirus (COVID-19) started
My household applied or asked for but has not received assistance from this program s


- 19) started
Missing
      Wave 1 Wave 2 Wave 3
94.8 0.8 94.9 0.6 94.4 0.7
 26
 H. Programs related to caring for my children (including school-based programs, meals)
      Yes, my household was already receiving assistance from this program before


    Wave 1
Wave 2
Wave 3
SOURCE: Developed by RWJF and RAND.
30.9 27.6 30.1 27.9 29.1 28.4
               Sample
Somewhat Strongly agree agree
Neither agree Somewhat Strongly
nor disagree disagree disagree Missing
32.2 6.5 8.7 0.2 32.0 7.3 7.7 0.4 31


f coronavirus (COVID-19)
                   Sample
Wave 1 Wave 2 Wave 3
Most of the time
36.4 43.2 46.8
Some of the
time Rarely Never
Missing
      48.3 12.0 3.2 0.2 45.0 8.9 2.7 0.3 42.4 8.0 2.4 0.4
  B. The people in my community are taking action


Missing
Wave 1 2.6 3.1 22.2 24.7 47.3 0.1 Wave2 XXXXXX Wave3 XXXXXX
B. The place they live (e.g., community conditions, housing)
Very strong No effect effect
Sample 1 2 3 4 5 Missing
Wave 1 3.9 5.8 30.8 30.4 28.8 0.3 Wave2 XXXXXX Wave3 XXXXXX


r agree Somewhat Strongly agree nor disagree disagree disagree
Missing
       Wave 1
Wave 2
Wave 3
SOURCE: Stanford Mind & Body Lab Mindset Measures for COVID-19 study.
35.4 33.2 35.8
37.2 18.1 4.4 4.5 0.4 37.5 20.8 3.5 4.5 0.6 34.9 20.8 3.5 4.6 0.3


nly one answer.
Note: This is a new question added in wave 3.
Somewhat Neither agree Somewhat Strongly Sample Strongly agree agree nor disagree disagree disagree
31.0 30.0 29.7
19.4 19.1 9.5 20.5 0.4 21.0 19.2 10.0 19.2 0.6 21.5 20.0 9.1 19.1 0.5


s about who gets the vaccine first. Please indicate the level of priority that should be given for each of the listed groups.
Note: This question was not asked in wave 1 or wave 3.
       A. Front-line medical care staff working with coronavirus pati


dents only (n = 4,031)
Respondents by Age Group, in Years
     Sample
Wave 1 Wave 2 Wave 3
18 to 24
4.0 2.8 2.2
25 to 44
29.1 27.2 26.5
45 to 64 65+
37.5 29.4 38.0 32.0 37.6 33.7
          NOTES: Our sample from the ALP is not representative of indiv


, Katherine Grace, Anita Chandra, Sarah Weilant, Carolyn Miller, and Margaret Tait, 2018 National Survey of Health Attitudes: Description and Top-Line Summary Data, Santa Monica, Calif.: RAND Corporation, RR-2876-RWJF, 2019. As of August 24, 2020: ht


Values Survey,” webpage, undated. As of October 9, 2020:
https://www.pewresearch.org/politics/values/
———, “Explore the Data,” webpage, 2020. As of October 9, 2020: https://www.pewresearch.org/pathways-2020/covid_econopen/total_us_adults/us_adults/
P


  CORPORATION
SIERRA SMUCKER, ESTHER M. FRIEDMAN, MEAGAN CAHILL, JIRKA TAYLOR, JOHN DALY, REGINA A. SHIH
An Initial Evaluation of the Weinberg Center for Elder Justice’s Shelter Model for Elder Abuse and Mistreatment
 For more information on this pub


uals experiencing EM, public payers, and society.
Social and Behavioral Policy Program
RAND Social and Economic Well-Being is a division of the RAND Corporation that seeks to actively improve the health and social and economic well-being of populatio


een the First and Second Assessments. . . . .
4.3. Share of Clients by Reported Cognition over Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.4. Change in Clients’ Cognitive Impairment Between the First and Second Assessments.


ults of Ciara’s Vignette: Population-Level Analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6.7. Results of Dmitry’s Vignette: Individual Analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6.8. Results of Dmi


on of the nation’s first elder-specific shelter—the Harry and Jeanette Weinberg Center for Elder Justice, which is part of the Hebrew Home at Riverdale. Located in the Bronx, New York, the Hebrew Home is a nonprofit residential health care facility (


portant to note that this is an initial evaluation with a scope limited to describ- ing the model and providing illustrative examples of ways the model could lead to cost savings. A full evaluation would employ a rigorous experimental design, includi


enter, with more patients improving than declining. Although statistical tests of the trajectories of Weinberg Center were not incorporated into the present analysis, the relatively low frequency of deterioration among the client group is noteworthy


berg Center clients have stable health and functioning throughout the duration of their stays in the Hebrew Home. Our analysis of medical data for select health indicators suggests that the health status of Weinberg clients is relatively stable—and,


they entered the Weinberg Center. These data would help establish the uniqueness of the Wein- berg Center interventions over and above services available to Weinberg Center clients elsewhere. These data would also provide insights into the nature of


ical and sexual abuse; neglect; and financial exploitation. Globally, an estimated 16 percent of community-dwelling adults aged 60 and older reported experiencing some form of EM in the prior year, with 12 percent psychological abuse, 7 percent finan


service provider, work together to resolve difficult cases, and provide opportunities for learning about different strategies and resources (Morris, 2010; Schecter and Dougherty, 2009; Teaster and Wangmo, 2010).
Although multisystem team approaches h


RiNG Alliance advocate for shelter, offer peer-to-peer support, and gather annually to share best practices.
The distinctive features of the Weinberg Center compared with family violence and homeless shelters are that it combines a shelter model of p


when EM is suspected. The Weinberg Center also works to help replicate the shelter model in other communities and to advocate for policies and laws that seek to address and prevent EM. Expected impacts of the Weinberg Cen- ter’s direct services to cl


also conducted a cost-benefit analysis involving vignettes to identify the cost saving of the Weinberg Center to key stakeholders: public payers, private insurance, and the public.
Interviews with Weinberg Center Staff
To learn more about the Weinber


2019 (n = 100); this date range was chosen to ensure that at least 100 clients were represented in the data for our analysis. The first assessment takes place at intake, with subsequent assessments done on a quarterly basis until the client leaves th


o using ERs or hospitals. Efficient care could also play a role in creating savings when treating previously unmet needs (the first pathway). Thus, these two pathways are not mutually exclusive, but viewing them separately provides a useful framework


e with the benefits achieved through the Center’s intervention (“benefits”). These benefits, ideally determined through an outcome evaluation (i.e., an evaluation that measures program effects by assessing the attainment of outcome that the program h


eeds and Weinberg Center interventions for exemplar indi- viduals allows us to provide an initial assessment of whether these elements could be expected to create cost savings and benefits, using data from existing literature instead of needing data


curring attributable to Weinberg
Center intervention
• Pi = population of Weinberg Center clients receiving the intervention
• Ci = costs of delivering the Weinberg Center intervention.
Parameters
To populate this equation with parameters appropriate


er interventions are dependent on what support its clients would be able to access else- where. In our discussion of the vignettes, presented later in this report, we make a series of informed assumptions about the counterfactual, but there are uncer


York City shelters are not equipped to support the health and cognitive needs of older adults experienc- ing EM. Many clients spend time in the hospital as a social admit until they feel home is safe, but hospital stays are not a long-term option and


assistance with financial awareness (e.g., the Center runs credit reports and helps
provide sense of financial standing)
• legal services, including representation in court, prepping clients for court dates,
testimonies, facilitating clients’ meeting


on of the abuser was a specific cost mentioned in one interview as something staff would like to address but are currently unable to do.
18
Initial Evaluation of Weinberg Center’s Shelter Model for Elder Abuse and Mistreatment
•
• • •
The Center face


k at other outcomes, such as housing, social func- tioning, or resolution of legal issues, because data on those outcomes are not available for Weinberg Center clients.
In this chapter, we evaluate four indicators of Weinberg Center client health and


he Center with moderate depression, 21 percent with mild depression, and 59 percent with mini- mal depression. Over the course of four assessments, there was little change in the composition of the cohort in terms of depression severity.
This stabili


. By the fourth assessment, nine months after entering the Hebrew Home, 62 percent of clients report- edly had some degree of cognitive impairment, while 39 percent were cognitively intact.
Figure 4.4 shows changes in clients’ cognition between the f


clients who received their first and second assessment (96 clients).
45%
Severely impaired Moderately impaired Cognitively intact
 Cognitively intact Increase in cognition Unchanged cognition Decrease in cognition
24 Initial Evaluation of Weinberg Ce


ssessment one and two.
Mobility
To assess Weinberg Center clients’ mobility, we examined clients’ reported mobility “on unit” (i.e., in his or her room or adjacent corridor) during their stays. The results are presented in Figure 4.9. Our analysis of


results suggest that between 2013 and 2019, most clients served by the Weinberg Center faced significant and persistent mobility issues.
Next, we investigated whether client mobility changed between the first and second assessment. Figure 4.10 presen


use of any specific treatment from the Weinberg Center. This point
Improved self-locomotion on unit
No change in self-locomotion on unit Decline in self-locomotion on unit
 Changes in Health Conditions Among Weinberg Center Clients 29
cognitive issue


thout incurring additional operating costs to the Center. Historically, 80 percent of Weinberg clients are eligible for Medicare and/or Medicaid, which offsets the costs incurred by the Hebrew Home. For the remaining 20 percent of clients, the Hebrew


the number of patient-days recorded over the same period.
Figure 5.3 provides a breakdown of Weinberg Center operating costs by type. It shows that most Weinberg Center operating costs were incurred through the provision of legal services and mental


er month and other)
Indirect overhead costs
Furniture and household setup
Mental health services Total legal services
  Percentage
100
 90
 80
 70
 60
 50
 40
 30
 20
 10
  0
     2013 2014
2015 2016
2017 2018 2019
Figure 5.4
Composition of Weinberg


me of potential savings, but we return to the discussion of the distribution of costs and benefits later in this chapter.
Vignette 1: Armando’s Untreated Condition
 Box 6.1
Vignette 1: Armando’s Untreated Condition
• Armando is a 65-year-old man who


arameter, the reduction in risk attributable to Wein- berg Center intervention, Armando’s case assumes that the provision of hyperten- sion treatment at the Weinberg Center prevented Armando from requiring ER care and subsequent hospitalization in th


respect to the reduction in the risk, a recent systematic review and meta- analysis based on 123 studies (Ettehad et al., 2016) found that treatment for hyperten- sion, which results in a 10mm Hg decrease in systolic blood pressure, reduces risks of


f the savings, presented above, assumes that none of the Weinberg Center cohort were previously treated for hypertension. However, any clients already receiving treatment should be removed from the population count. Second, the parameters for risk re


. To estimate the cost of a hospital, stay for older patients with dementia, we turn to the literature. Zhu et al. (2015) under- took a longitudinal study of Medicare beneficiaries residing in Northern Manhattan admitted to a hospital between 1999 an


rg Center services) or by the Weinberg Center (for individuals supported by the Center).
Table 6.3
Results of Belinda’s Vignette: Individual Analysis
Parameter
Costs of an adverse event that the Weinberg Center intervention aims to avoid
Reduction in


 to the remaining vignettes.
In sum, the vignette indicates that, if the situation described in Belinda’s case, approximates the situation experienced by Weinberg Center clients, there is a potential for sizable savings to payers and governments. How


rs pertaining to the costs of adverse events can be retained and
7 We thank one reviewer for pointing out that Adult Protective Services may only keep track of significant losses and not include smaller losses which could bias our estimates. However,


m his physician, Dmitry visited the ER three times a year.
• After being referred to the Weinberg Center, its legal team helped Dmitry enroll in Medicaid,
which he can use to pay his co-payments for his medical care.
• By providing this service, the


Center intervention aims to avoid
Reduction in the risk of the adverse event occurring attributable to Weinberg Center intervention
Population of Weinberg Center clients receiving the intervention Savings stemming from the Weinberg Center interventio


ation for all patients hospitalized during the study period. In this hospital’s database, data are recorded for each patient, and a profile of resources consumed and billed to a patient can be generated to estimate the cost of his or her hospital sta


cause of support or encouragement from Weinberg Center staff. It is critical to understand whether clients would have requested and created advance directives without the sup- port of Weinberg Center staff or not. We do not currently have this type o


Osteoporosis 17
Heart failure 15
Thyroid 15
Stroke (cerebrovascular accident, 15 transient ischemic attack, or stroke)
Chronic obstructive pulmonary disease 14
Cataracts, glaucoma, or macular 14 degeneration
Anxiety disorder 13 Benign prostatic hyper


, 2019). This method is frequently used to compare the effectiveness of various therapies and inform clinical decisions. QALY gains associated with the type of interventions provided by the Weinberg Center provide an indication of the scope of potent


ngs, the same caveats about transferability of lessons from existing literature to the context of the Weinberg Center and the absence of clear counterfactual data apply.
10 To illustrate the debate about appropriate cost-effectiveness cutoffs, the th


he scenario might result in savings. Table 6.13 provides an illustrative indication of the distribution of savings across individual classes of stakeholders involved in the vignettes. Green text represents possible gains, and red represents possible


f life
Improved quality • of life
Costs associ- ated with provi- sion of health services
Some reduction in future health care costs
Costs associated with provision of legal services
Costs associated with provision of legal services
Costs associated w


d Mistreatment
plausibly lead to savings that exceed multiple times the amount it normally costs to run the Center.
However, substantial uncertainties remain on both sides of the equation. On the savings side, estimates of savings depend on the exten


eintegration. In addition to helping achieve positive reintegration outcomes, the bridge is an opportunity to collect some follow-up data during the program, although this effort does not address the question of a longer follow-up. The bridge program


rred to Adult Protective Services, where they receive case management, with a greater likelihood of outpatient care provision.
Conclusions and Recommendations 57
APPENDIX A
Additional Details on Changes in Selected Health Indicators Among the Weinber


ain
In our analysis, pain severity is classified using a scale of 0 to 10 found in the MDS. Trained staff at the Weinberg Center as patients to consider the intensity of their worst pain during the previous five days, where 0 is no pain and 10 is the


Evaluation of Weinberg Center’s Shelter Model for Elder Abuse and Mistreatment
Transfer
The MDS defines transfer as “How resident moves between surfaces including to or from a bed, chair, wheelchair, or standing position (excludes to or from the bath


can draw on already existing infrastruc- ture and accompanying resources.
Accounting for these additional costs is difficult because of the deeply inter- twined nature of the Weinberg Center and the Hebrew Home. However, when assess- ing the overall


ained relatively constant during this period, ranging from $276 in 2015 to $311 in 2013. Bed charge figures for 2019 are notably lower, although this is likely attribut- able to billing delays. This means that services provided in late 2019 might hav


Reduction
(RR; relative to no treatment)
Relative CV risk reduction 10–44%
Relative CV risk reduction 17–34%
Total mortality (RR 0.57,
CI 0.39–0.78), coronary mortality (RR 0.53, CI 0.29– 0.74), coronary morbidity (RR 0.46, CI 0.25–0.71)
RR of CV mor


    Train social workers and staff to screen for EM on newly admitted patients and residents at the Hebrew Home
 Design and implement educational and marketing material: brochures, website, press releases, newsletters, and other forms
 Partner and tr


r abuse and neglect
Professionals trained on EM and referral process in cases of suspected abuse
Organizations and older adults provided with resources on
EM prevention and intervention strategies
Resources, strategies, and information shared to comb


rnal of Medicine, Vol. 371, 2014, pp. 1793–1802.
Broeders, Mireille, Sue Moss, Lennarth Nystrom, Sisse Njor, Hôkan Jonsson, Ellen Paap, Nathalie Massat, Stephen Duffy, Elsebeth Lynge, Eugenio Paci, and EUROSCREEN Working Group, “The Impact of Mammog


w and Implications for Practice,” Journal of the American Geriatrics Society, Vol. 63, 2015, pp. 1214–1238.
Dong, XinQi, and Melissa Simon, “Association Between Elder Self-Neglect and Hospice Utilization in a Community Population,” Archives of Geront


ect Hope), Vol. 24, No. 1, 2005, pp. 263–270.
FJC—See NYC Family Justice Centers.
Folstein, M. F., S. E. Folstein, and P. R. McHugh, “Mini-Mental State: A Practical Method for Grading the Cognitive State of Patients for the Clinician,” Journal of Psy


yle Modification Programmes for Patients with Coronary Heart Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials,” European Journal of Preventive Cardiology, Vol. 20, No. 4, 2013, pp. 620–640.
Jongenelis, K., A. M. Pot, A.


e Bet Tzedek Legal Services Model: How a Legal Services Model Addresses Elder Abuse and Neglect,” Journal of Elder Abuse and Neglect, Vol. 22, Nos. 3–4, 2010, pp. 275–280.
Musich, S., S. S. Wang, J. Ruiz, K. Hawkins, and E. Wicker, “The Impact of Mob


 “Management of Chronic Pain in Older Adults,” BMJ,
February 13, 2015.
Richards, S. H., L. Anderson, C. E. Jenkinson, B. Whalley, K. Rees, P. Davies, P. Bennett, Z. Liu, R. West, D. R. Thompson, and R. S. Taylor, “Psychological Interventions for Coro


ulse Pressure and Risk of Cardiovascular Events in the Systolic Hypertension in the Elderly Program,” American Journal of Cardiology, Vol. 88, No. 9, 2001, pp. 980–986.
Villanti, A. C., Y. Jiang, D. B. Abrams, and B. S. Pyenson, “A Cost-Utility Analy


 Online Dispute Resolution
Perspectives to Support Successful Implementation and Outcomes in Court Proceedings
Amanda R. Witwer, Lynn Langton, Duren Banks, Dulani Woods, Michael J. D. Vermeer, and Brian A. Jackson
Court-based online dispute resolutio


 needs.
Increasing access to justice
• Potential strategies and partners, such as local com- munity centers and libraries, should be identified for addressing the digital divide and providing access to ODR, including via telephone assistance.
• Featu


ODR program engagement.
Broadly, workshop participants noted that the use of ODR could remove barriers to access to justice, but the potential barriers to engagement in ODR also need to be better under- stood and addressed. Courts need guidance to un


ernization Initiative, Pew Charitable Trusts
Alex Sanchez
Dispute resolution department, Franklin County Municipal Court (Ohio)
Doug Van Epps
Director, Office of Dispute Resolution, Michigan Courts
Linda Warren Seely
Director, Section of Dispute Reso


 court systems across the United States have found themselves grappling with growing numbers of disputes and have looked to technology for solutions. Moreover, an increasing empha-
sis on procedural justice (i.e., processes that promote fair and tran


0; also see Jackson et al., 2021). In response to the ongoing public health crisis, court systems across the country have shifted away from in-person proceed- ings and toward virtual forums. Against this backdrop, judicial interest in online dispute


t system, and providing feedback to the courts
• increased court efficiency by streamlining the resolution of disputes outside the courtroom and, in doing so, reduc- ing case backlogs and delays in case adjudication
• improved case outcomes, such as


iency. The rate of voluntary dismissal of court cases also is significantly higher among participants in Franklin County’s small claims ODR program, particularly for defen- dants from low- and middle-income neighborhoods (Sanchez and Embley, 2020). A


 variation in virtual platform origin, functionality, and integration within existing processes. In accordance with these findings, the scope of the workshop was structured to encompass the following topics:
 1. ODR
2. other existing court applicatio


 of needs on two dimensions: their importance and their feasibility. For a more detailed description of the methodology employed in this virtual meeting, see the technical appendix.
RESULTS
The primary output of the workshop was a prioritized list of


actors. To address this opportunity, participants voiced the need for guidance from objective sources about why, when, and how to reimagine court processes with ODR in mind. Addi- tionally, courts need to be provided with approaches to better underst


the access needs of their user bases and build- ing these considerations into the design of ODR platforms, including where these platforms could complement—rather than replace—face-to-face interactions. Courts need to develop strategies and partnersh


of digital media as a tool for ensuring that potential ODR users understand their rights and available options.
Evaluating ODR Programs
The final category of top-tier needs related to the evaluation of ODR programs. In this category, workshop partici


ce to help courts identify the technological requirements to discuss with vendors and providers.
• Provide guidance for courts on how to effectively communicate the require- ments for due process and other legal protections in the technological platf


ms that emphasize user-centered design and features, including mobile-accessible ODR systems that do not require users to have an email address.
  • Promote the development of self-help resources, vignettes, and other infor- mational materials as a b


ions from individual interviews with workshop participants. Presented with this
list at the start of the discussion, participants first determined whether the list encompassed the full scope of problems and
opportunities and then considered the propo


could lead to more-just processes, but only if other important factors, such as fairness and transparency, are maintained.
When ODR is viewed as a means to replicate in-person processes, it is key for courts to understand the appropriate processes an


the technology often think about only the existing processes, and the people who think about changing the processes do not necessarily understand the technology. There must be a way
to merge the two perspectives; one way to start is for courts to thi


work to rectify by exploring differ- ent strategies for making potential users aware of their options and the benefits and drawbacks of those options. Participants noted that digital media is one tool for helping the public better understand ODR and


onduct evalua-
Courts should be given opportunities to partner with researchers and should be granted the freedom to experiment with ODR approaches.
tions, and do not have the capacity to conduct rigorous studies of the impact of ODR. Courts should b


 programs. These high-priority needs relate to the design and implementation of ODR programs and platforms, strategies
to improve access to justice, opportunities to engage potential ODR users, and the rigorous research and evaluation of ODR programs


mall group of experts. To limit the effect of that reality on the representativeness of the results, we strove to make the group as representative as possible of different disciplines, perspectives, and geographic regions. However, the final output o


scussed and refined problems related to each category and identified potential solu- tions (or needs) that could address each problem. In addition, needs could be framed in response to opportunities to improve performance by adopting or adapting a ne


l Sessions
Once each participant had been interviewed and the needs had been consolidated, we held four two-hour virtual meetings using Zoom, a virtual meeting platform. These meetings were config- ured such that the participants could see each other


ail contained a column with two dimensions: importance and probability of success. We asked each participant to score each need and associated strategies to address those needs in the document using a 1–9 scale and return it to us by email. Fig- ure


the priorities that should be the primary policymaking focus, the middle-tier needs should be examined closely, and the bottom- tier needs are probably not worth much attention in the short term (unless, for example, they can be addressed with exist-


mation and best practices.
• Develop guidance for incorporating security and privacy consid- erations into the adoption and administration of an ODR system.
• Develop protocols for screening approaches that are specific to relevant case types, such a


nding, chatbots, connections to legal assistance por- resolving a dispute, navigating the court system, tals, and embedded features within ODR platforms; educate users; and providing feedback to the courts. and document that the user understands thei


to serve account the differences in urban, suburban, and the needs of rural jurisdictions.
rural jurisdictions.a • Identify and develop communication channels through which suc-
cessful ODR models can be shared with and adopted by jurisdic- tions tha


at which users are more likely to disengage (e.g., serving a process.a notice in person).
Digital media can help engage the public in the • Develop approaches to identify and connect ODR users with court system through strategies for helping users av


al intelligence or other emerging technologies in ODR systems to support user engagement.
• Conduct rigorous longitudinal studies examining the impact of ODR systems on a broad variety of outcomes for ODR providers and ODR users.
• Provide funding fo


y and Other Needs for Improving Court Operations and Outcomes, Santa Monica, Calif.: RAND Corporation, RR-1255-NIJ, 2016. As of March 31, 2021: https://www.rand.org/pubs/research_reports/RR1255.html
Jackson, Brian A., Joe Russo, John S. Hollywood, Du


h-Pajama-Court-and-Resolving-Cases-Online.html
RAND Corporation, “Delphi Method,” webpage, undated. As of April 5, 2021:
https://www.rand.org/topics/delphi-method.html
Sanchez, Alex, and Paul Embley, Access Empowers: How ODR Increased Participation a


d victim responses to crime, violence against women, victim services, police-community relations, and survey methodology. Prior to joining RTI, she was chief of the Victimization Statistics Unit at the Bureau of Justice Statistics. She holds a Ph.D.


n and virtual platforms for case navigation and resolution. This report presents the proceedings of that workshop, topics considered, needs that the panel participants developed, and overarching themes that emerged from the panel discussions. This re


ions of its research clients and sponsors. R® is a registered trademark.
 This publication was made possible by Award Number 2018-75-CX-K006, awarded by the National Institute of Justice, Office of Justice Programs, U.S. Department of Justice. The op


 CORPORATION
LLOYD DIXON, JAMIE MORIKAWA
Improving the Availability and Affordability of Pandemic Risk Insurance
Projected Performance of Proposed Programs
                  For more information on this publication, visit www.rand.org/t/RRA1223-1.
Ab


es the distinguishing features of the most-visible proposals and develops a quantitative model that shows their potential consequences. Proposed programs are evaluated in terms of the proportion of revenue decline replaced (efficacy), efficiency, aff


D improved the flow and clarity of the exposition, and Rebecca Fowler skillfully edited the document.
Contents
 AboutThisReport................................................................................... iii Figures and Tables. . . . . . . . .


 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
v
vi Improving the Availability and Affordability of Pandemic Risk Insurance
Expected Annual Government Outlays . . . . . . . . . . . . . . . . . . .


. 30
3.6. MajorContagiousDiseaseIncidentsSince1918.....................................37
4.1. ProgramPerformanceatBase-CaseParameterValues............................. 44
4.2. Ranking of Modeled Programs by Program Metric at Base-Case Parameter Valu


ss Interruption Reinsurance program (Pandemic Re), which is open to firms with more than 500 employees.
• TheZurichPreliminaryPandemicProposalproposesaflexibleprogramthat allows insurers to choose how much risk to bear.
• ThePandemicRiskInsuranceActo


s were evaluated in terms of efficacy, efficiency, affordability, risk borne by commercial insurers, expected annual government net outlays, and policyholder subsidy.
Results
The relative performance of the modeled programs under the base-case parame


 3 2 1
00 Small and medium-sized firms Large firms
to purchase coverage at these rates, remembering the large government-funded Pay- check Protection Program (PPP) in the current pandemic.
The premiums for large firms are comparable to those for smal


arametric insurance policy is triggered by a metric or index that is easy to determine rather than property damage or other loss suffered by the insured. In the context of pandemic risk insurance, payment would be triggered following a government dec


 the amount of risk borne by commercial insurers is likely a better indicator of overall net government out- lays than direct government outlays through the pandemic insurance program.
Projected outcomes are sensitive to several underlying model para


sured property
• whether parametric policies would result in some firms receiving more compensa- tion than they need and others less (basis risk).
In this analysis, we have in effect assumed that gaps are filled, thereby resulting in the right amount


ance can create incentives to reduce risk by providing premium reductions to poli-
cyholders that adopt risk mitigation measures. It is not obvious, however, whether insurance can create similar incentives to mitigate pandemic risk. As an example, co


s based on a number of underlying parameters, and we reviewed economic and insurance literature and data to develop reasonable values for these parameters. We also consulted with experts in the field about what values would be reasonable.4 For each p


osal 1: Business Continuity Protection Program
The Business Continuity Protection Program (BCPP)—proposed by the American Property Casualty Insurance Association, the National Association of Mutual Insur- ance Companies, and the Independent Insurance


w the firm to maintain payroll and survive until the policy limit is reached. For a policy limit equal to three months of preshutdown payroll, benefits, and ongoing operating expenses, the coverage would last for three months under a complete shutdow


 be affected? It might be more expensive for an insurer to set up coverage with a new policyholder than to add pandemic coverage on to an existing policy
Proposal 2: Chubb Pandemic Business Interruption Program
Chubb’s Pandemic Business Interruption


ays of payroll and fixed costs for benefits, and
benefits, and
benefits, and
benefits, and
BI policy
parametric BI policy, ongoing expenses
ongoing expenses
ongoing expenses
expenses, capped at
capped at $50M per
$20M per month for
same as underlying


e for 500 employees
Varies by
industry (90% for accommodations and food services, 30% for utilities); 65% economy-wide
Pandemic Risk Business Continuity Insurance Act (PRIA) Coalition (BCC) Program
Included in premium
Not discussed
 Government will


00 businesses with more than 500 employees is voluntary, with no strong opt-out or requirement that insurers offer cov- erage to large firms.
Policy Features
The policy again looks similar to those offered by the BCPP and Chubb’s BEIP: Payroll and ex


le experience.7
Like the BCPP and Chubb proposals, insurers participating in the ZPPP must offer coverage to their customers with fixed property coverage. In contrast to the BCPP and Chubb proposals, insurers are required to participate in the ZPPP.


c
8 The federal subsidy in the federal crop insurance program amounts to approximately two-thirds of the premium.
9 Rate on line is premium as a percentage of the amount of coverage provided.
10 Zurichwouldimplementasubsidybyallowingthegovernmenttous


al applies to all P&C policies, including workers’ compensation, commercial general liability, directors and
14 BusinessContinuityCoalition,homepage,undated.
15 Business Continuity Coalition, “Pandemic Risk Insurance Act Business Continuity Coalition


adjust the risk they retain over time by modifying the distribution of policies across pools.
To reduce the costs of simultaneously adjusting a large number of claims, all but one of the proposals rely at least in part on a parametric trigger. The Ch


BCC programs. The ZPPP can perform quite similarly to the BCPP if insurers decide to retain only a very small portion of the risk or perform more like the Chubb program if insurers retain more risk. Zurich projects that 99 percent of risk will be tr


the risk, program and policy features, take-up rate for the BCPP, and the price elas- ticity of demand. It then predicts outputs, such as insured loss, the premium, program expenses, and the allocation of cost and risk between the private and public


.1 Model Inputs
Input
Firms affected
Required revenue replacement
Return period
Losses covered
Policyholder waiting period Policyholder co-pay
Coverage duration Policy limit
Firms eligible
Program cap Insurer deductible
Insurer co-pay
G&SE
LAE ratio


iscussed later is this chapter, we take a different approach because the premium does not reflect the full costs of the program in some cases. To calcu- late costs of adjusting and paying claims, an LAE ratio is applied to insured loss. The ratio dep


te
Description
Number of firms purchasing coverage; projected separately for small and medium-sized firms (<500 employees) and large firms (500 employees)
Shortfall in revenue needed to sustain payroll, benefits, and ongoing operating expenses regar


 proportion of insured losses (using the LAE ratio) and differ depending on whether a traditional indemnity policy or parametric policy is used.
Annual G&SE: These expenses are the brokerage, commission, and other selling costs associated with placin


about the return period used by insur- ers and the government in setting prices. In some cases, the insured loss relevant to pricing is only the part of overall insured loss that is the responsibility of private insur- ers. In others, it is the tota


or firms that participate in the program
Ratio of claim payments to overall program costs
Annual premium per firm and per $1,000 payroll
Premium per $1,000 coverage
Insurer incurred loss and LAE should an event occur
Capital required by commercial in


ovide for uninsured losses. For example, if the government covered all uninsured losses, the government would ultimately cover all losses less the amount of claim payments funded by commercial insurers. Direct government outlays through the program a


We do not include these firms in our analysis. Even though the $1.29 trillion in receipts for nonemployee firms is small relative to the $37.4 trillion in receipts for firms with employees, providing revenue replacement assistance for nonemployee fi


able firms to keep payroll and benefits at prepandemic levels and cover ongoing expenses.10 However, the economy will not completely shut down. Many businesses will continue to operate, perhaps at reduced levels.
One measure of the economic impact of


ll, benefits, and ongoing expenses
6.00M
$12B
5% of losses above insurer deductible
$750B
     Revenue Replacement Needed to Sustain Prepandemic Payroll, Benefits, and Ongoing Expenses for 12 Months
Table 3.5—Continued
Parameter
G&SE per policy for s


bb proposal (see Table 2.1). To facilitate compari- son of the different proposals, we assume a 20 percent co-pay for each program. As discussed in Chapter Two, the coverage provided under PRIA would be the same as the underlying BI policy, and a num


of G&SE to the premium. The ratio was 0.176 for the P&C industry overall over the last five years (Table D.1 in Appendix D).18 Using a G&SE ratio to calculate G&SE in this study presents chal- lenges because we do not have a full premium to which to


Resources Agency, August 2018). Dividing $2.11 billion by 9.5 million policies results in $222 per policy.
Modeling Approach and Base-Case Parameters 33
 34 Improving the Availability and Affordability of Pandemic Risk Insurance
National Association


igation, generating substantial LAE. Data on the LAE for BI indemnity policies are not available, but it stands to reason that the LAE ratio for BI policies is higher than the 0.11 for the commercial multiple peril, nonliability line, as a whole. On


tal for Insurance Companies,” Geneva Papers on Risk and Insurance, Vol. 25, No. 1, January 2000, p. 16. Kielholz’s analysis focused on the use and cost of equity. He pointed out that although insurers do use debt financing, it is typically a small po


on debt to support the risk. In addition, a short return period may be necessary to convince investors to provide capital at rates that have typically been paid by the industry (see the preceding discussion of the cost of capital). Some of those with


Control and Prevention, National Center for Emerging and Zoonotic Infectious Disease, Division of High-Consequence Pathogens and Pathology, Viral Special Pathogens Branch, “2014–2016 Ebola Outbreak in West Africa,” webpage, last reviewed March 8, 20


ms with fewer than 100 employees, and according to the Census data, there are about 5.88 million firms with fewer than 100 employees.28 This sug- gests a substantial take-up rate BI coverage, but, as discussed in Appendix A, there are
25 SeeDixonetal


he cost of terrorism coverage for certified events in the United States. In cases when the policy covers both terrorism and other perils (“embedded policies”), the Federal Insur- ance Office found that insurers provide terrorism coverage at no additi


he percentage change in the number of firms that purchase coverage to the percentage change in premiums. Their analysis also excluded smaller firms.
Price elasticities in other settings are potentially also relevant. The price elasticity of demand fo


he BCPP program, expectations of the program proposers, and review of take-up in other settings, we assume that take-up in the BCPP would be 65 percent. The take-up rates for the other programs are then adjusted from the 65 percent baseline based on


remium is $0.98 per $1,000 payroll (see Table 4.1). In contrast, workers’ compensation coverage averaged $12.10 per $1,000 in the United States in 2018.1 The Federal Insurance Office puts the cost of terrorism coverage when embedded with other covera


$105,000
Table 4.1—Continued
Performance Metric
Government outlays and revenue
Government-incurred loss and LAE should an event occur
Per participating firm
Total program
Annual government premium revenue
Small and Medium- Sized Firms
BCPP Approach
L


th fewer than 500 employees comes to $4,800 per firm.
Considerable uncertainty remains on the average cost of property and liability insurance for firms with fewer than 500 employees. But if the average property and liability insurance cost for busin


centage is lowest for the combined Chubb approach, but it is not high for any of the approaches.
Efficiency
There is considerable LAE variation across the approaches, driven by the different loss adjustment approaches (see the “Efficiency” section of


ause indemnity policies are used for large firms in the Chubb proposal and for all firms in the PRIA proposal.
Although a full assessment of the administrative and loan processing costs of the PPP has not been completed, initial information from the


the diversifiability index is set to 0.5 in the base case, which means that insurers need to hold half as much capital as would be the case if they treated the pan- demic coverage as entirely separate from insurance for other hazards. For comparison,


ons of net government outlays for large firms in BCPP and PRIA follow patterns similar to those for small and medium-sized firms. Because Pan-
Figure 4.3
Expected Annual Government Net Outlays per Participating Firm for Small and Medium- Sized Firms


e-Case Parameter Values
250
200
150
($ billions) 100
50
0
–50
0 10 20 30 40 50 60 70 80 90 100 Actual return period (years)
Figure 4.8
Policyholder Subsidy for Small Firms
100
Percentage of program costs subsidized Expected annual government net outl


annual government net outlays and policyholder subsidy.
The greater efficiency of the BCPP and the ability of the government to price cov- erage using a much longer return period than the private sector results in the BCPP’s lower premium. Although t


ecting the difficulty of insuring pandemic risk, is not particularly high in any of the programs. Chubb proposes that the insurer risk share double over time—but even so, it will remain modest. One advantage of the insurer deductible in the PRIA appr


se. If insurers use a 30-year return period, the pre- miums in all three programs are quite close for small and medium-sized firms.
1 State insurance regulators could potentially resist the use of such longer return periods, fearing that these longer


and large firms) Chubb (large firms)
    0 10 20 30 40 50 60 70 80 90 100
Return period used by insurers in setting premium (years)
Sensitivity of Projections to Changes in Parameter Values 63
Figure 5.4
Capital Help by Insurers as Return Period Used


 Chubb and PRIA approaches, and the diversifiability index has considerable impact on the amount of capital held by insurers in the Chubb and PRIA approaches.
The results of this sensitivity analysis suggest areas in which further work to narrow unce


insurers, the approach to paying claims, the extent to which the U.S. government receives a premium for the risk it bears, and the extent of policyholder subsidies.
The programs all leverage the deep capability of the commercial insurance indus- try


re order
• whetherpoliciesbackedbyPRIAwillprovidecoverageforpandemiclosseswhen the underlying BI policies require physical damage to the insured property
• whether parametric policies will result in some firms receiving more compensa- tion than they


e BI coverage included in the standard BOP. Others said that small businesses in the United States typically opt out of ordinary payroll coverage.
Continuing normal operating expenses are not explicitly defined in the standard policy, which is one of


pport postshutdown level of pro- duction.
The firm makes zero profit in this situation.
Subtracting the amount of income needed from the amount of income received
postshutdown results in the amount of the insurance payment that is returned or reserve


mit  pholder _ deductible ) * (1 pholder _ copay ), program _ cap).
The amount of insured loss incurred by insurers should an event occur is
insurer _ claims =
insured _ loss if insured _ loss  insurer _ deductible
(C.3)
(C.4)
(C.5) (C.6)
( C . 7


The premium becomes
premiumPanRe =
e v e n t _ p r o b * i n s u r e d _ l o s s * (1 + L A E _ r a t i o ) +  r o r  * p l o s s
G&SE +
1+ror *copay_industry

   .
(C.12)
 premiumretained byinsurersPanRe =industry_copay*premium+ (1ind


missioners data via S&P Global Intelligence, provided to RAND by the American Property Casualty Insurance Association.
References
 American Property Casualty Insurance Association, “Property Casualty Insurance Industry Suffered Largest-Ever Drop in S


:
https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html
Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, “Highly Pathogenic Asian Avian Influenza A(H5N1) Virus,” webpage, last review