scholarly journals Social Isolation and Medicare Spending: Among Older Adults, Objective Isolation Increases Expenditures While Loneliness Does Not

2017 ◽  
Vol 29 (7) ◽  
pp. 1119-1143 ◽  
Author(s):  
Jonathan G. Shaw ◽  
Monica Farid ◽  
Claire Noel-Miller ◽  
Neesha Joseph ◽  
Ari Houser ◽  
...  

Objective: The purpose of this study was to evaluate the impact of objective isolation and loneliness on Medicare spending and outcomes. Method: We linked Health and Retirement Study data to Medicare claims to analyze objective isolation (scaled composite of social contacts and network) and loneliness (positive response to three-item loneliness scale) as predictors of subsequent Medicare spending. In multivariable regression adjusting for health and demographics, we determined marginal differences in Medicare expenditures. Secondary outcomes included spending by setting, and mortality. Results: Objective isolation predicts greater spending, US$1,644 ( p < .001) per beneficiary annually, whereas loneliness predicts reduced spending, −US$768 ( p < .001). Increased spending concentrated in inpatient and nursing home (skilled nursing facilities [SNFs]) care; despite more health care, objectively isolated beneficiaries had 31% ( p < .001) greater risk of death. Loneliness did not predict SNF use or mortality, but predicted slightly less inpatient and outpatient care. Discussion: Objectively isolated seniors have higher Medicare spending, driven by increased hospitalization and institutionalization, and face greater mortality. Policies supporting social connectedness could reap significant savings.

2021 ◽  
pp. 089826432110131
Author(s):  
Leah R. Abrams ◽  
Geoffrey J. Hoffman

Objectives: Despite detrimental effects of depressive symptoms on self-care and health, hospital discharge practices and the benefits of different discharge settings are poorly understood in the context of depression. Methods: This retrospective cohort study comprised 23,485 hospitalizations from Medicare claims linked to the Health and Retirement Study (2000–2014). Results: Respondents with depressive symptoms were no more likely to be referred to home health, whereas the probability of discharge to skilled nursing facilities (SNFs) went up a half percentage point with each increasing symptom, even after adjusting for family support and health. Rehabilitation in SNFs, compared to routine discharges home, reduced the positive association between depressive symptoms and 30-day hospital readmissions (OR = 0.95, p = 0.029) but did not prevent 30-day falls, 1-year falls, or 1-year mortality associated with depressive symptoms. Discussion: Depressive symptoms were associated with discharges to SNFs, but SNFs do not appear to address depressive symptoms to enhance functioning and survival.


2002 ◽  
Vol 32 (2) ◽  
pp. 315-325 ◽  
Author(s):  
Charlene Harrington ◽  
Steffie Woolhandler ◽  
Joseph Mullan ◽  
Helen Carrillo ◽  
David U. Himmelstein

Quality problems have long plagued the nursing home industry. While two-thirds of U.S. nursing homes are investor-owned, few studies have examined the impact of investor-ownership on the quality of care. The authors analyzed 1998 data from inspections of 13,693 nursing facilities representing virtually all U.S. nursing homes. They grouped deficiency citations issued by inspectors into three categories (“quality of care,” “quality of life,” and “other”) and compared deficiency rates in investor-owned, nonprofit, and public nursing homes. A multivariate model was used to control for case mix, percentage of residents covered by Medicaid, whether the facility was hospital-based, whether it was a skilled nursing facility for Medicare only, chain ownership, and location by state. The study also assessed nurse staffing. The authors found that investor-owned nursing homes provide worse care and less nursing care than nonprofit or public homes. Investor-owned facilities averaged 5.89 deficiencies per home, 46.5 percent higher than nonprofit and 43.0 percent higher than public facilities, and also had more of each category of deficiency. In the multivariate analysis, investor-ownership predicted 0.679 additional deficiencies per home; chain-ownership predicted an additional 0.633 deficiencies per home. Nurse staffing ratios were markedly lower at investor-owned homes.


2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 231-232
Author(s):  
Amanda Sonnega ◽  
Gwen Fisher ◽  
Brooke Helppie-McFall

Abstract Mismatch between demands of work and workers’ ability to meet those demands may play an important role in retirement decisions. This presentation extends earlier work using Health and Retirement Study data linked to O*NET to develop measures of discrepancy between individual’s own reports of physical and mental abilities and 1) their perceptions of the physical and mental demands of their jobs and 2) O*NET ratings of the physical and mental demands of their jobs. In particular, we utilize newly available linked information using 2010 Census codes and 2019 O*NET ratings that reflect more current jobs. We then examine the impact of each type of mismatch (subjective and objective) on retirement timing. Overall, we find a stronger connection between subjective mismatch relative to objective mismatch. We discuss implications of this finding in terms of the value of the O*NET linkage and potential interventions aimed at extending working lives for positive aging.


Stroke ◽  
2021 ◽  
Author(s):  
Michael E. Reznik ◽  
Seth A. Margolis ◽  
Ali Mahta ◽  
Linda C. Wendell ◽  
Bradford B. Thompson ◽  
...  

Background and Purpose: Delirium portends worse outcomes after intracerebral hemorrhage (ICH), but it is unclear if symptom resolution or postacute care intensity may mitigate its impact. We aimed to explore differences in outcome associated with delirium resolution before hospital discharge, as well as the potential mediating role of postacute discharge site. Methods: We performed a single-center cohort study on consecutive ICH patients over 2 years. Delirium was diagnosed according to DSM-5 criteria and further classified as persistent or resolved based on delirium status at hospital discharge. We determined the impact of delirium on unfavorable 3-month outcome (modified Rankin Scale score, 4–6) using logistic regression models adjusted for established ICH predictors, then used mediation analysis to examine the indirect effect of delirium via postacute discharge site. Results: Of 590 patients (mean age 70.5±15.5 years, 52% male, 83% White), 59% (n=348) developed delirium during hospitalization. Older age and higher ICH severity were delirium risk factors, but only younger age predicted delirium resolution, which occurred in 75% (161/215) of ICH survivors who had delirium. Delirium was strongly associated with unfavorable outcome, but patients with persistent delirium fared worse (adjusted odds ratio [OR], 7.3 [95% CI, 3.3–16.3]) than those whose delirium resolved (adjusted OR, 3.1 [95% CI, 1.8–5.5]). Patients with delirium were less likely to be discharged to inpatient rehabilitation than skilled nursing facilities (adjusted OR, 0.31 [95% CI, 0.17–0.59]), and postacute care site partially mediated the relationship between delirium and functional outcome in ICH survivors, leading to a 25% reduction in the effect of delirium (without mediator: adjusted OR, 3.0 [95% CI, 1.7–5.6]; with mediator: adjusted OR, 2.3 [95% CI, 1.2–4.3]). Conclusions: Acute delirium resolves in most patients with ICH by hospital discharge, which was associated with better outcomes than in patients with persistent delirium. The impact of delirium on outcomes may be further mitigated by postacute rehabilitation.


Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sheila M Manemann ◽  
Alanna M Chamberlain ◽  
Jennifer St. Sauver ◽  
Susan A Weston ◽  
Ruoxiang Jiang ◽  
...  

Background: Referral to a skilled nursing facility (SNF) should contribute to reducing hospital readmissions; however, a “revolving door” phenomenon after admission to SNF has been hypothesized to drive readmissions. The urgent need to study the impact of SNF on readmissions in heart failure (HF) was recently emphasized, yet this has never been studied in the community. Objectives: To evaluate the association between discharge to SNF and 30-day readmissions in a community cohort of hospitalized incident HF patients. Methods: Olmsted County, MN residents hospitalized with first ever (incident) HF (International Classification of Diseases-9 th Revision code 428) from 1995 through 2010 were identified. HF was validated by Framingham criteria. Patients residing in a SNF prior to hospitalization were excluded from the analysis. Logistic regression was used to examine the association between discharge to SNF and 30-day readmissions. Results: Among 1360 HF patients (mean age 74±14, 47% male), 241(18%) were referred to a SNF. Overall, 296 (22%) patients were readmitted within 30-days after index hospitalization. The proportion of 30-day readmissions was greater among patients discharged to a SNF compared to patients discharged home (27% vs 21%, p=0.031). After adjustment for age and sex, patients discharged to a SNF had a 40% increase in the odds of having a hospital readmission within 30 days post HF compared to those discharged home (OR: 1.42, 95% CI 1.01-1.99). Further adjustment for year of HF diagnosis, ejection fraction, anemia, renal function, dementia and cancer did not alter the strength of the association (OR: 1.43, 95% CI: 0.99-2.09). Conclusion: Among community patients with HF, 30-day readmissions remain frequent and are more likely to occur among patients discharged to a SNF compared to those discharged home. These data provide new insight into the drivers of HF readmissions and suggest that interventions targeted to HF patients in SNFs may be warranted.


2020 ◽  
Vol 35 (7) ◽  
pp. 324-330
Author(s):  
Casondra Kleven ◽  
Joshua Postolski ◽  
Brad Hein ◽  
Bethanne Brown

BACKGROUND: Use of skilled nursing facilities (SNFs) has grown as an intermediary step for patients unready to discharge to lower acuity care settings. Discharge planning from SNFs has become a critical component of the care continuum and may impact patient outcomes and facility payment status. Currently, the discharge process does not include a pharmacist-led comprehensive medication review.<br/> OBJECTIVES: To determine the impact of a pharmacistdriven discharge consultation service on 30-day allcause rehospitalization. Secondary outcomes included hospital readmission diagnosis, discharge consultation times, number of pharmacist interventions, and patient satisfaction.<br/> METHODS: The institutional review board approved this prospective cohort with a historical control pilot study to evaluate patients discharging from SNFs. Patients who provided informed consent were enrolled to participate in a video consultation service at the time of discharge. The primary outcome measured was 30-day hospital readmission rate postdischarge compared with one year prior.<br/> RESULTS: One hundred ninety-six counseling sessions were performed at three facilities. The average time per discharge was 15.4 ± 3.3 minutes, average number of medications was 15.5 ± 6.2, and average Charlson Comorbidity Index was 5.6 ± 2.2. Patient readmission data were tracked by diagnosis and reported by facility.<br/> CONCLUSION: A positive correlation between reduced readmission rates and participation in consultation service were observed. Second, positive patient satisfaction surveys indicated patients value medication education. The use of a pharmacist-led telehealth service like the one described in this study may lead to a reduction in facility readmission penalties and improve patient access to pharmacist services in remote locations.


ILR Review ◽  
2019 ◽  
Vol 74 (1) ◽  
pp. 199-223 ◽  
Author(s):  
John R. Bowblis ◽  
Austin C. Smith

Occupational licensing has grown dramatically in recent years, with more than 25% of the US workforce having a license as of 2008, up from 5% in 1950. Has licensing improved quality or is it simply rent-seeking behavior by incumbent workers? To estimate the impact of increased licensure of social workers in skilled nursing facilities (SNFs) on service quality, the authors exploit a federal staffing provision that requires SNFs of a certain size to employ licensed social workers. Using a regression discontinuity design, the authors find that qualified social worker staffing increases by approximately 10%. However, the overall increase in social services staffing is negligible because SNFs primarily meet this requirement in the lowest cost way—substituting qualified social workers for unlicensed social services staff. The authors find no evidence that the increase in licensure improves patient care quality, patient quality of life, or quality of social services provided.


Healthcare ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 114 ◽  
Author(s):  
Michael Mileski ◽  
Upwinder Pannu ◽  
Bobbi Payne ◽  
Erica Sterling ◽  
Rebecca McClay

The objective of this study was to increase the understanding of the role a nurse practitioner (NP) has in reducing the risk of hospitalizations and improving quality outcomes among nursing facility residents. This was explored by the research team conducting a systematic literature review via Cumulative Index of Nursing and Allied Health Literature, PubMed (MEDLINE), and Academic Search Ultimate. This is of concern because of the increased rate of hospital readmissions from skilled nursing facilities. The study found that utilization of NPs as primary care providers resulted in decreased unnecessary hospitalizations, increased access to healthcare, and improved health outcomes. NPs are fundamental in building relationships with residents and families and providing them information for decision making. The utilization of NPs in a long-term care setting should be encouraged to improve access to care, decrease hospitalizations, and enhance quality of care. States with reduced or restrictive scope of practice for NPs should revisit the regulations to provide unrestricted scope of practice for NPs.


2011 ◽  
Vol 14 (3) ◽  
Author(s):  
Bernice Pescosolido

This part of the mid-term review of the Health and Retirement Study (HRS) provides an overall assessment of the utility of HRS data for research targeting the nature and influence of social connectedness. As one of the major dimensions of the social aspects of psychosocial influences, social connectedness is among the most complicated in terms of definition, conceptualization, and measurement. However, the century-long body of theory and findings couple with a recent resurgence of research on the critical impact of these ties for health, illness, and health care to call for an examination of the richness in and limitations of current HRS data. This assessment is comprised of three broad steps: 1) an overview of the nature of social connectedness, and of the dimensions and methodological approaches that can and have been used in studying health, health care, and aging; 2) the range, strengths and limitations of the HRS data on each approach; and 3) suggestions for potential directions to increase the utility of data collected and further research contributions from the HRS. While no tabular listing of items relevant to social connectedness is presented, the sets of items that tap this notion are referenced throughout. Overall, the HRS represents one of, if not the most impressive data sets regarding the ability to examine the influence of social connectedness on health, illness and health care. Given different theoretical and methodological traditions of social connectedness (e.g., the local or ego-centered perspective; social support perspective; social capital perspective; Pescosolido 2006a), the HRS either currently offers a way to tap into various views of social connectedness or holds the potential to do so. Specifically, the HRS includes four kinds of social connectedness data: socio-demographic proxies that represent a tie (e.g., marital status) with detailed data on the nature of the bond; social support batteries which offer respondent perceptions of the overall positive and negative aspects of sets of relationships; eco-centric tie data, which provide a list of names or roles that can provide support (i.e. latent ties); and networks of event response in which respondents list individuals who were called upon (e.g., activated ties) under certain conditions. Given the individually-based and national scope of the HRS, the collection of full or complete network data is not feasible at present. Four strategies could improve the collection and use of social connectedness data in the HRS. First, data collection sections that are explicit or implicit ego-centric name generators or activated ties lists could be expanded and refined to provide more complete data. Under the “looping” structure of the HRS, both the ego-centric and event response batteries can serve as a foundation for expanded network batteries. Second, given the increasing role of social media in contemporary American lives, the HRS section on the use of technology should be reviewed and expanded to tap into virtual ties. Third, locator data designed to improve follow-up of the HRS samples can form the basis of a network roster and for analyses of the dynamics of ties and its influence on health and health care. Fourth, while it is not possible to “go back” and recapture data about social connectedness, a sub study which targets the named “social convoy” over a person’s life (defined only as time in the HRS) would provide invaluable data that could not be collected from any other existing study. That is, while subject to a variety of criticism (e.g., telescoping effects), the ability to collect data on extent of turnover and the reasons for shifts in social connectedness would allow an analysis of the impact of social network dynamics in later life, potentially reveal key turning points in social network support, and offer targeted points of interventions for fostering the social connectedness that has, to date, been shown (in the HRS and other studies) to be so essential to health and well-being.


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