scholarly journals Regional Variation in Healthcare Use Among Medicare Beneficiaries With Alzheimer’s Disease and Related Dementias

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 21-22
Author(s):  
Elizabeth White ◽  
Momotazur Rahman
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Nursing Home ◽  
Nursing Homes ◽  
Regional Variation ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Term Care ◽  
Regional Patterns ◽  
Hospital Referral

Abstract In this national prospective study we describe regional variation in healthcare utilization among Medicare beneficiaries with Alzheimer’s disease and related dementias (ADRD) in the six years after diagnosis. We use 2008-2015 Medicare claims and other administrative data to map nursing home, home health, hospital, and hospice use across hospital referral regions; and examine the relationship of state and county supply-side factors to time beneficiaries spend in different settings. The sample includes 1,158,655 Medicare fee-for-service beneficiaries diagnosed with ADRD in 2008 and 2009. Nationally, beneficiaries spent a mean of 70.6% of survived days in the community, 23.9% of days in nursing home, and 5.4% of days in hospital. 37.2% of beneficiaries who died within six years had received hospice. Distinct regional patterns emerged. Adjusting for beneficiary and local characteristics, beneficiaries in Midwestern states spent the most time in nursing homes, while beneficiaries in Western states spent the most time in community. The probability of receiving hospice was generally highest in Western and Southern states, and lowest in the Midwest and Northeast. Controlling for beneficiary, local, and state characteristics, we found the following factors to be associated with beneficiaries spending less time in nursing homes: fewer nursing home beds in the county, higher state Medicaid long-term care spending for home and community-based services (HCBS), and state use of Certificate of Need laws. These findings illustrate that state investment in HCBS, and state and local regulation of provider supply are important factors influencing where individuals with ADRD receive care.

scholarly journals Disparities in Nursing Home Use and Quality Among African American, Hispanic, and White Medicare Residents With Alzheimer’s Disease and Related Dementias

2018 ◽  
Vol 31 (7) ◽  
pp. 1259-1277 ◽  
Author(s):  
Maricruz Rivera-Hernandez ◽  
Amit Kumar ◽  
Gary Epstein-Lubow ◽  
Kali S. Thomas
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
African American ◽  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Population Based ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Health Care Equity

Objective: This article examines differences in nursing home use and quality among Medicare beneficiaries, in both Medicare Advantage and fee-for-service, newly admitted to nursing homes with Alzheimer’s disease and related dementias (ADRD). Method: Retrospective, national, population-based study of Medicare residents newly admitted to nursing homes with ADRD by race and ethnic group. Our analytic sample included 1,302,099 nursing home residents—268,181 with a diagnosis of ADRD—in 13,532 nursing homes from 2014. Results: We found that a larger share of Hispanic Medicare residents that are admitted to nursing homes have ADRD compared with African American and White beneficiaries. Both Hispanics and African Americans with ADRD received care in segregated nursing homes with fewer resources and lower quality of care compared with White residents. Discussion: These results have implications for targeted efforts to achieve health care equity and quality improvement efforts among nursing homes that serve minority patients.

scholarly journals Overlap of Pain and Depression Among Nursing Home Residents With Advanced Alzheimer’s Disease and Related Dementia

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 42-43
Author(s):  
Emmanuelle Belanger ◽  
Richard Jones ◽  
Gary Epstein-Lubow ◽  
Kate Lapane
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Nursing Home ◽  
Depressive Symptoms ◽  
Hospice Care ◽  
Care Delivery ◽  
Nursing Home Residents ◽  
National Sample ◽  
Fee For Service ◽  
Minimum Dataset

Abstract Physical and psychological suffering are interrelated and should be assessed together as part of palliative care delivery. We aimed to describe the overlap of pain and depressive symptoms among long-stay nursing home (NH) residents with advanced Alzheimer’s disease and related dementia (ADRD), and to determine the incidence of pain and depressive symptoms. We conducted a retrospective study of a US national sample of fee-for-Service Medicare beneficiaries who became long-stay NH residents in 2014-2015, had two consecutive quarterly Minimum Dataset assessments (90 and 180 days +/- 30 days), and had a diagnosis of ADRD in the Chronic Condition Warehouse and moderate to severe cognitive impairment (N= 92,682). We used descriptive statistics and Poisson regression models to examine the incidence of each symptom controlling for age, sex, and concurrent hospice care. Sub-groups with self-reported and observer-rated symptoms (pain/PHQ-9) were modelled separately, as were those switching between the two. The prevalence of depressive symptoms was low (5.7%), while pain was more common (18.2%). Across various subgroups, 2% to 4% had both pain and depression, but between 20% and 25% were treated with both antidepressants and scheduled analgesia. Depressed residents at baseline had an incidence rate ratio (IRR) of pain of 1.2 at the second assessment, while the residents with pain at baseline had an IRR of depressive symptoms of 1.3 at the second assessment. Our results support the expected relationship between pain and depressive symptoms in a national sample of long-stay NH residents with advanced ADRD, suggesting the need for simultaneous clinical management.

Families, Alzheimer's Disease, and Nursing Homes

1988 ◽  
Vol 7 (3) ◽  
pp. 331-349 ◽  
Author(s):  
Nathan L. Linsk ◽  
Baila Miller ◽  
Roberta Pflaum ◽  
Anna Ortigara-Vicik
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Nursing Home ◽  
Nursing Homes ◽  
Care Center ◽  
Family Members ◽  
Nursing Home Care ◽  
Demonstration Program ◽  
Home Setting

The Alzheimer's Disease Family Care Center program was established within an intermediate care teaching nursing home as a demonstration program to investigate ways to involve families in care of their relatives. In total, 45 family members participated in a program including an orientation session; a preliminary family involvement interview; contracts with family members, in which they chose specific tasks to engage in during visits; a five-session course on Alzheimer's disease and how families may be partners in care within the facility; and an ongoing family support group. Evaluation data sources include a baseline and 9-month follow-up questionnaire completed by families, preliminary and follow-up family interviews conducted by project codirectors, records of family visits, and family choices on contracts. Findings from the 23 family members who contracted for tasks during their visits and from the follow-up questionnaire completed by 25 family members showed that most sought social and emotional interactions with relatives, some maintained direct personal care activities, and only a few identified interest in extensive involvement with staff and facility. At follow-up, family members involved in the program reported they continued to feel close to their relatives. Many felt that their relatives were generally stable or improved with regard to cognitive function, but over a third noted difficulties in communicating. Participating family members reported that the program of staff supports helped them to feel more integral to the unit. They expressed a need for more education and support for their involvement in the nursing home setting. Project findings confirm previous studies recommending that programming at nursing homes needs to include specific institutional and staff supports to maintain and enhance family contributions to the long-term nursing home care of their relatives.

Regional variation in treatment costs and survival for elderly patients with myelodysplastic syndromes.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6628-6628
Author(s):  
Xiaomei Ma ◽  
Rong Wang ◽  
Jessica B. Long ◽  
Heather Taffet Gold ◽  
Stephanie Halene ◽  
...  
Keyword(s):  
Myelodysplastic Syndromes ◽  
Regional Variation ◽  
The Elderly ◽  
Cost Of Care ◽  
Care Hospital ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Hospital Referral ◽  
The Difference ◽  
Cost Efficient

6628 Background: Myelodysplastic syndromes (MDS) occur primarily in the elderly (≥65 years). The expected 5-year cost for an elderly MDS patient tops $63,200 in 2009 US$. This study assessed regional variation in the cost of care and survival for elderly MDS patients. Methods: Using the Surveillance Epidemiology and End Results–Medicare data, we identified primary MDS patients aged 66-99 years diagnosed from 2001-2007, had continuous fee-for-service coverage for Parts A and B, and had no history of other cancer. We assigned patients to Dartmouth Atlas of Health Care Hospital Referral Regions (HRRs) based on their residence at time of diagnosis. We also selected controls from a 5% sample of Medicare beneficiaries without cancer and matched controls 1:1 to patients by HRR, age, sex, pre-diagnosis cost and comorbidity. All Medicare claims through 2009 were tallied, and MDS-related costs were defined as the difference between the payments for a patient and a matched control. Results: With 6244 patients in 73 HRRs, the average 3-year MDS-related cost varied across HRRs, ranging from $12,900 to $83,600 (2009 US$). Patients in high-spending regions had more comorbidities and higher Medicare costs before diagnosis and were more likely to be racial minorities and live in lower-income areas. Three-year survival ranged from 13.0% to 62.1%. However, there was no significant correlation between 3-year costs and 3-year survival (ρ=-0.06, p=0.61). The hazard ratios (HR) for higher spending regions compared to the lowest-expenditure region were near 1, after controlling for covariates including MDS subtype (2nd quartile: HR=1.03, 95% CI: 0.94-1.12; 2nd quartile: HR=1.04, 95% CI: 0.95-1.14; 4th quartile: HR=0.98, 95% CI: 0.90-1.08). Conclusions: We observed considerable regional variation in Medicare expenditure on elderly MDS patients during the first 3 years post-diagnosis. However, patients in higher cost regions had similar 3-year survival to patients in lower cost regions. Given the substantial economic burden of MDS and Medicare’s current fiscal challenges, it is important to further assess the factors associated with higher regional costs and to improve the care of MDS patients in a cost-efficient way.

Alzheimer's Disease and Other Dementia in Nursing Homes: Levels of Management and Cost

2001 ◽  
Vol 13 (3) ◽  
pp. 347-358 ◽  
Author(s):  
Judith A. O'Brien ◽  
J. Jaime Caro
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Resident ◽  
Annual Cost ◽  
Nursing Home Residents ◽  
Care Needs ◽  
Diagnosis Of Dementia ◽  
Care Costs

Objective: To estimate comparative mangement levels and the annual cost of caring for a nursing home resident with and without dementia. Method: Data from the 1995 Massachusetts Medicaid nursing home database were used to examine residents with Alzheimer's disease, other types of dementia, and no dementia to determine care and dependency levels. Massachusetts Medicaid 1997 per-diem rates for each of 10 designated management levels were applied accordingly to residents in each level to estimate annual care costs. Costs from this analysis are reported in 1997 U.S. dollars. Results: Of the 49,724 nursing home residents identified, 26.4% had a documented diagnosis of dementia. On average, a resident with dementia requires 229 more hours of care annually than one without dementia, resulting in a mean additional cost of $3,865 per patient with dementia per year. Conclusions: Dementia increases the care needs and cost of caring for a nursing home resident.

Treated Behavioral Symptoms and Mortality in Medicare Beneficiaries in Nursing Homes with Alzheimer's Disease and Related Dementias

2015 ◽  
Vol 63 (9) ◽  
pp. 1757-1765 ◽  
Author(s):  
Ting-Ying Huang ◽  
Yu-Jung Wei ◽  
Patience Moyo ◽  
Ilene Harris ◽  
Judith A. Lucas ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Nursing Homes ◽  
Behavioral Symptoms ◽  
Medicare Beneficiaries

scholarly journals Group Activity Participation in Relation to Contextual Isolation of United States Nursing Home Residents Living with Alzheimer’s Disease and Related Dementias

2021 ◽  
pp. 1-9
Author(s):  
B.M. Jesdale ◽  
C.A. Bova ◽  
A.K. Mbrah ◽  
K.L. Lapane
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Group Activity ◽  
Activity Participation ◽  
Data Set ◽  
Group Activities ◽  
Multiple Characteristics

Background: Residents of nursing homes frequently report loneliness and isolation, despite being in an environment shared with other residents and staff. Objective: To describe, among long-stay US nursing home residents living with Alzheimer’s disease and/or related dementias (ADRD), group activity participation in relation to contextual isolation: living in a nursing home where fewer than 20% of residents share socially salient characteristic(s). Design: A cross-sectional evaluation of group activity participation in relation to contextual isolation across 20 characteristics based on demographic characteristics, habits and interests, and clinical and care dimensions. Setting: US nursing homes. Participants: We included 335,421 residents with ADRD aged ≥50 years with a Minimum Data Set 3.0 annual assessment in 2016 reporting their preference for group activity participation, and 94,735 with participation observed by staff. Measurements: We identified 827,823 annual (any anniversary) assessments performed on nursing home residents in 2016, selecting one at random for each resident, after prioritizing the assessment with the least missing data (n=795,038). MDS 3.0 item F0500e assesses resident interest in group activities. Results: When considering all potential sources of contextual isolation considered, 30.7% were contextually isolated on the basis of a single characteristic and 13.7% were contextually isolated on the basis of two or more characteristics. Among residents reporting importance of group activity, 81% of those not contextually isolated reported that group activity participation was important, as did 78% of those isolated on one characteristic, and 75% of those isolated on multiple characteristics. Among residents with staff-observed group activity participation, 64% of those not contextually isolated reported were observed participating in group activities, as were 59% of those isolated on one characteristic, and 52% of those isolated on multiple characteristics. Conclusion: Residents with ADRD facing contextual isolation placed less importance on group activity than residents who were not contextually isolated.

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