Strategic Patient Discharge: The Case of Long-Term Care Hospitals

Medicare’s prospective payment system for long-term acute-care hospitals (LTCHs) provides modest reimbursements at the beginning of a patient’s stay before jumping discontinuously to a large lump-sum payment after a prespecified number of days. We show that LTCHs respond to the financial incentives of this system by disproportionately discharging patients after they cross the large-payment threshold. We find this occurs more often at for-profit facilities, facilities acquired by leading LTCH chains, and facilities colocated with other hospitals. Using a dynamic structural model, we evaluate counterfactual payment policies that would provide substantial savings for Medicare. (JEL H51, I11, I13, I18)

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Long-Term Care Insurance and Carers' Labor Supply: A Structural Model

SSRN Electronic Journal ◽

10.2139/ssrn.2512199 ◽

2014 ◽

Author(s):

Johannes Geyer ◽

Thorben Korfhage

Keyword(s):

Labor Supply ◽

Long Term Care ◽

Structural Model ◽

Term Care ◽

Long Term Care Insurance

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Long-Term Care Spending Relevant to U.S. Medicaid Expansion

Sustainable Health and Long-Term Care Solutions for an Aging Population - Advances in Medical Diagnosis, Treatment, and Care ◽

10.4018/978-1-5225-2633-9.ch003 ◽

2018 ◽

pp. 46-70

Author(s):

Mary Schmeida ◽

Ramona Sue McNeal

Keyword(s):

Financial Incentives ◽

Long Term Care ◽

Financial Incentive ◽

State Level ◽

Care Program ◽

Nursing Facility ◽

Term Care ◽

Care Services ◽

The U.S

The U.S. population is living longer, placing a demand on long-term care services. In the U.S., Medicaid is the primary player in funding costly long-term care for the aged poor. As a major health reform law, the 2010 Patient Protection and Affordable Care Act, Public Law 111-148, gives financial incentive for states to expand Medicaid, transitioning long-term care services from facilities toward community care. Facing other funding obligations and recent recessions, not all states expanded their Medicaid long-term care program using the financial incentives. Some states continue to spend more dollars on traditional nursing facility care despite legislation. This chapter explores why some states spend more revenue on nursing facility long-term care despite enhanced federal funding to reform, while others are spending more on home and community-based services. Regression analysis and 50 state-level data is used.

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Incapacitated and Alone: Prevalence of Unbefriended Residents in Alberta Long-Term Care Homes

SAGE Open ◽

10.1177/2158244019885127 ◽

2019 ◽

Vol 9 (4) ◽

pp. 215824401988512 ◽

Cited By ~ 2

Author(s):

Stephanie A. Chamberlain ◽

Wendy Duggleby ◽

Janet Fast ◽

Pamela B. Teaster ◽

Carole A. Estabrooks

Keyword(s):

Online Survey ◽

Long Term Care ◽

Survey Methods ◽

Population Level ◽

Urban Centers ◽

Cross Sectional ◽

Term Care ◽

For Profit ◽

Not For Profit

The objective of this study was to assess the prevalence of residents who are incapacitated and have no surrogate decision maker, known as the “unbefriended” in Alberta long-term care (LTC) homes. Using cross-sectional online survey methods, data were collected from 123 staff (i.e., directors of care/nursing, administrators) from Alberta LTC homes. Information was collected on survey respondents’ demographic characteristics, number of unbefriended residents, and on organizational characteristics. The overall prevalence of unbefriended residents in LTC homes was 4.14% in Alberta ( SD = 6.28%, range: 0%-34.6%). Homes with the highest prevalence (nearly 15%) of unbefriended residents had >135 beds and were public not-for-profit and located in large urban centers. Fifty-three percent of unbefriended residents were male. The highest prevalence of unbefriended residents lived in homes located in large urban centers and public not-for-profit operators. Population level and LTC home level prevalence data are needed to assess the scope of unmet needs.

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Helping Yourself or Others? Motivation Dynamics for High-Performing Volunteers in GLAM Crowdsourcing

Australasian Journal of Information Systems ◽

10.3127/ajis.v24i0.2599 ◽

2020 ◽

Vol 24 ◽

Author(s):

Sultana Lubna Alam ◽

Ruonan Sun ◽

John Campbell

Keyword(s):

Financial Incentives ◽

Incentive Structure ◽

Open Communication ◽

Non Profit ◽

High Performing ◽

For Profit ◽

Not For Profit ◽

Over Time

While most crowdsourcing (CS) cases in the literature focus on commercial organisations, little is known about volunteers’ motivation of initial and continued participation in not-for-profit CS projects and importantly, about how the motivations may change over time. It is vital to understand motivation and motivational dynamics in a not-for-profit context because a fundamental challenge for not-for-profit CS initiations is to recruit and keep volunteers motivated without any formal contract or financial incentives. To tackle this challenge, we explore high performing volunteers’ initial motivation for joining and sustaining with a GLAM (galleries, libraries, archives and museums) CS project. We situated our interpretive exploration in a case study of the Australian Newspapers CS project initiated by the National Library of Australia. Based on the case study, we found that high-performing volunteers were motivated by a combination of personal, collective, and external factors classified into intrinsic, extrinsic, and internalised extrinsic motivations. Further, we found that these motivations changed over time. Specifically, many volunteers presented substantial personal (i.e., personal interest and fun) and community-centric motivations (i.e. altruism and non-profit cause) when they initially joined the project, whereas external motivations (i.e., recognition and rewards) had a greater impact on long-term participation. Our findings offer implications for CS system design (e.g., user profiles, tagging and commenting), incentive structure (e.g., reputation-based ranking, leader boards), and relational mechanisms (e.g., open communication channels) to stimulate sustainable contributions for not-for-profit CS initiatives.

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Depressive symptoms in long term care facilities in Western Canada: a cross sectional study

BMC Geriatrics ◽

10.1186/s12877-019-1298-5 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Matthias Hoben ◽

Abigail Heninger ◽

Jayna Holroyd-Leduc ◽

Jennifer Knopp-Sihota ◽

Carole Estabrooks ◽

...

Keyword(s):

Cognitive Impairment ◽

Depressive Symptoms ◽

Long Term Care ◽

Assessment Instrument ◽

Western Canada ◽

Cross Sectional ◽

Term Care ◽

Data Set ◽

For Profit

Abstract Background The main objective is to better understand the prevalence of depressive symptoms, in long-term care (LTC) residents with or without cognitive impairment across Western Canada. Secondary objectives are to examine comorbidities and other factors associated with of depressive symptoms, and treatments used in LTC. Methods 11,445 residents across a random sample of 91 LTC facilities, from 09/2014 to 05/2015, were stratified by owner-operator model (private for-profit, public or voluntary not-for-profit), size (small: < 80 beds, medium: 80–120 beds, large > 120 beds), location (Calgary and Edmonton Health Zones, Alberta; Fraser and Interior Health Regions, British Columbia; Winnipeg Health Region, Manitoba). Random intercept generalized linear mixed models with depressive symptoms as the dependent variable, cognitive impairment as primary independent variable, and resident, care unit and facility characteristics as covariates were used. Resident variables came from the Resident Assessment Instrument – Minimum Data Set (RAI-MDS) 2.0 records (the RAI-MDS version routinely collected in Western Canadian LTC). Care unit and facility variables came from surveys completed with care unit or facility managers. Results Depressive symptoms affects 27.1% of all LTC residents and 23.3% of LTC resident have both, depressive symptoms and cognitive impairment. Hypertension, urinary and fecal incontinence were the most common comorbidities. Cognitive impairment increases the risk for depressive symptoms (adjusted odds ratio 1.65 [95% confidence interval 1.43; 1.90]). Pain, anxiety and pulmonary disorders were also significantly associated with depressive symptoms. Pharmacologic therapies were commonly used in those with depressive symptoms, however there was minimal use of non-pharmacologic management. Conclusions Depressive symptoms are common in LTC residents –particularly in those with cognitive impairment. Depressive symptoms are an important target for clinical intervention and further research to reduce the burden of these illnesses.

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