Graber D, Liao J, Buchanan RJ; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2002; 19: 13.
Medical Univesity of South Carolina, 19 Hagood Avenue; Suite 408, Charleston, SC 29425; Tel: (843) 792-9218; Fax: (843) 792-3327; E-mail: graberd@musc.edu
RESEARCH OBJECTIVE: 1. Determine which health system factors contribute to nursing home admissions of more disabled individuals; 2. Determine if prior home health care of an individual allows more disabled individuals to remain longer in the community; 3. Identify if the availability of day care, home health agencies, and residential care are associated with disability upon admission; 4. Determine if racial/ethnic group membership is related to health status upon nursing home admission. STUDY DESIGN: Individual level factors, nursing home characteristics, and state health system factors were posited to be related to an individual's physical functioning upon nursing home admission. Individual level variables were included such as age, race, sex, diagnosis, and payment source. Other variables represented various nursing home characteristics. State health system characteristics were considered to be potentially related to disability upon admission. This included variables such as the proportion of residential care beds to the elderly population, average Medicaid nursing home reimbursement rate, and proportion of elderly population served by community long-term care programs. The analyzed dependent variable was the RUG-III ADL Index score. Hierarchical linear analyses were used due to the nested nature of the data. POPULATION STUDIED: All nursing home admissions in 6 southeastern states (using the Minimum Data Set) over 6 months in 2000. Data on all nursing homes in the 6 states (National On-Line Survey and Certification Database). Health system data procured through surveys of state agencies. PRINCIPAL FINDINGS: ADL functioning was significantly and negatively associated with age, all races other than white race, and being admitted to the facility from home when home health services were received. Functioning was negatively associated with admission to a for-profit facility, the census of the facility, LVN staffing levels, a high proportion of elderly on Medicaid in the state, and high levels of home health agencies in the state. ADL functioning was positively associated with being male, having daily contact with relatives and close friends, being admitted to a hospital-based nursing home, the presence of an Alzheimer's unit in the facility, high proportions of private residents in the facility, a recent moratorium on nursing home bed construction in the state, and the average Medicaid reimbursement rate in the state. CONCLUSIONS: A key finding was that individuals admitted from home without receiving home health services showed poorer cognitive and ADL functioning than individuals admitted from home who received home health services prior to admission. This indicates that home health care may delay admission to nursing homes. A finding of concern is that all races compared to whites were admitted to nursing homes with greater dependency in physical functioning. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Factors other than health condition clearly influence the level of disability at which elderly individuals enter nursing homes. Programs targeted to community-dwelling elderly and closer monitoring of nursing home admission practices may be beneficial for individuals seeking admission to nursing homes. PRIMARY FUNDING SOURCE: South Carolina Research Initiative Grant
Publication Types:
Keywords:
- Activities of Daily Living
- Aged
- Certification
- Data Collection
- Demography
- Ethnic Groups
- European Continental Ancestry Group
- Frail Elderly
- Health Services
- Health Services Accessibility
- Home Care Services
- Homes for the Aged
- Long-Term Care
- Male
- Medicaid
- Nursing Homes
- Residence Characteristics
- South Carolina
- economics
- rehabilitation
- hsrmtgs
Other ID:
UI: 102274067
From Meeting Abstracts