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Comparison of resource utilization for Medicaid dementia patients using nursing homes versus home and community based waivers for long-term care.
Med Care. 2008 Apr; 46(4):449-53.MC

Abstract

BACKGROUND

Medicaid waiver home and community-based long-term care services (HCBS) may provide a partial solution to the escalating costs of long-term care. Persons with dementia can have complex caregiving needs; it is unknown whether their expenditures and resource utilization differ between community-based versus institutional settings.

OBJECTIVE

To compare expenditures and resource utilization for Medicaid recipients with dementia who received long-term care through a nursing home versus HCBS waivers.

DESIGN

Twelve-month cohort study.

SETTING

Indiana Medicaid administrative data from 2001 through 2004.

PARTICIPANTS

Medicaid recipients with dementia who lived in the community 6 months before receiving long-term care through nursing homes (N = 1534) or HCBS waivers (N = 174).

MEASUREMENTS

Monthly inpatient and emergency department rates and total expenditures adjusted for prior use, demographics, insurance status, and comorbidities.

RESULTS

Adjusted rates of inpatient use were stable for nursing home patients (0.06) but significantly increased over 12 months for HCBS recipients (0.07-0.12; P = 0.048). Adjusted total expenditures increased over 12 months from $1419 to $2002 for HCBS recipients (P < 0.001), but remained stable for those in nursing homes ($3413-$3336). Long-term care expenditures were on average $1688 per month higher for those in nursing homes.

CONCLUSIONS

The escalation in inpatient use for HCBS waiver recipients suggests that future development of HCBS programs should consider the unique needs of persons with dementia so as to optimize their health outcomes. Despite increasing inpatient use among HCBS recipients, their overall expenditures remained significantly lower than those of nursing home patients.

Authors+Show Affiliations

School of Nursing, Purdue University, West Lafayette, Indiana 47907-2069, USA. lsands@purdue.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18362827

Citation

Sands, Laura P., et al. "Comparison of Resource Utilization for Medicaid Dementia Patients Using Nursing Homes Versus Home and Community Based Waivers for Long-term Care." Medical Care, vol. 46, no. 4, 2008, pp. 449-53.
Sands LP, Xu H, Weiner M, et al. Comparison of resource utilization for Medicaid dementia patients using nursing homes versus home and community based waivers for long-term care. Med Care. 2008;46(4):449-53.
Sands, L. P., Xu, H., Weiner, M., Rosenman, M. B., Craig, B. A., & Thomas, J. (2008). Comparison of resource utilization for Medicaid dementia patients using nursing homes versus home and community based waivers for long-term care. Medical Care, 46(4), 449-53. https://doi.org/10.1097/MLR.0b013e3181621eae
Sands LP, et al. Comparison of Resource Utilization for Medicaid Dementia Patients Using Nursing Homes Versus Home and Community Based Waivers for Long-term Care. Med Care. 2008;46(4):449-53. PubMed PMID: 18362827.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of resource utilization for Medicaid dementia patients using nursing homes versus home and community based waivers for long-term care. AU - Sands,Laura P, AU - Xu,Huiping, AU - Weiner,Michael, AU - Rosenman,Marc B, AU - Craig,Bruce A, AU - Thomas,Joseph,3rd PY - 2008/3/26/pubmed PY - 2008/5/21/medline PY - 2008/3/26/entrez SP - 449 EP - 53 JF - Medical care JO - Med Care VL - 46 IS - 4 N2 - BACKGROUND: Medicaid waiver home and community-based long-term care services (HCBS) may provide a partial solution to the escalating costs of long-term care. Persons with dementia can have complex caregiving needs; it is unknown whether their expenditures and resource utilization differ between community-based versus institutional settings. OBJECTIVE: To compare expenditures and resource utilization for Medicaid recipients with dementia who received long-term care through a nursing home versus HCBS waivers. DESIGN: Twelve-month cohort study. SETTING: Indiana Medicaid administrative data from 2001 through 2004. PARTICIPANTS: Medicaid recipients with dementia who lived in the community 6 months before receiving long-term care through nursing homes (N = 1534) or HCBS waivers (N = 174). MEASUREMENTS: Monthly inpatient and emergency department rates and total expenditures adjusted for prior use, demographics, insurance status, and comorbidities. RESULTS: Adjusted rates of inpatient use were stable for nursing home patients (0.06) but significantly increased over 12 months for HCBS recipients (0.07-0.12; P = 0.048). Adjusted total expenditures increased over 12 months from $1419 to $2002 for HCBS recipients (P < 0.001), but remained stable for those in nursing homes ($3413-$3336). Long-term care expenditures were on average $1688 per month higher for those in nursing homes. CONCLUSIONS: The escalation in inpatient use for HCBS waiver recipients suggests that future development of HCBS programs should consider the unique needs of persons with dementia so as to optimize their health outcomes. Despite increasing inpatient use among HCBS recipients, their overall expenditures remained significantly lower than those of nursing home patients. SN - 0025-7079 UR - https://www.unboundmedicine.com/medline/citation/18362827/Comparison_of_resource_utilization_for_Medicaid_dementia_patients_using_nursing_homes_versus_home_and_community_based_waivers_for_long_term_care_ DB - PRIME DP - Unbound Medicine ER -