Outcomes for Long-Stay Nursing Facility Residents Following On-Site Acute Care under a CMS Initiative

OBJECTIVES

The goal of this study was to describe outcomes of long-term nursing facility (NF) residents treated for one of 6 conditions on-site in the NF and to compare outcomes to those treated for the same conditions in the hospital.

DESIGN

Cross-sectional retrospective study.

SETTINGS AND PARTICIPANTS

The Centers for Medicare & Medicaid Services (CMS) Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents-Payment Reform enabled participating NFs to bill Medicare for providing on-site care to eligible long-stay residents meeting specified severity criteria due to any of 6 medical conditions, as an alternative to hospitalization. For billing purposes, residents were required to meet clinical criteria severe enough to warrant hospitalization.

METHODS

We used the Minimum Data Set assessments to identify eligible long-stay NF residents. We used Medicare data to identify residents who were treated, either on-site or in the hospital, for the 6 conditions and measure outcomes including subsequent hospitalization and death. To compare residents treated in the 2 modes, we used logistic regression models and adjusted for demographics, functional and cognitive status, and comorbidities.

RESULTS

Among residents treated on-site for the 6 conditions, 13.6% were subsequently hospitalized and 7.8% died, within 30 days, compared to 26.5% and 17.0%, respectively, among those treated in the hospital. Based on multivariate analysis, those treated in the hospital were more likely to be readmitted (OR = 1.666, P < .001) or to die (OR = 2.251, P < .001).

CONCLUSIONS AND IMPLICATIONS

Although unable to fully account for differences in unobserved severity of illness between residents treated on-site vs in the hospital, our results do not indicate any harm, but rather a possible benefit, to being treated on-site.

What Drove Program Participants to Initially Attend Congregate Meals? Socialization, Health, and Other Reasons

The Congregate Nutrition Services support efforts to keep older Americans independent and engaged in their communities. We examined participants' self-reported reasons for initially attending the congregate meals program and whether reasons differed by participant characteristics. Descriptive statistics and tests of differences were used to compare participants (n = 1,072). Individuals attended congregate meals for several reasons, with the top two being socialization (36.3%) and age- or health-related reasons (18.7%). Those attending for socialization were less likely to be lower income, have food insecurity, or live with 3+ ADL limitations while participants who first attended due to age or health-related reasons were more likely to be low income, food insecure, and from historically marginalized populations. Health and social service professionals and community organizations could expand data collection on older adults in their communities and partner with congregate meal providers to encourage participation for individuals with unmet nutritional, health, and socialization needs.

Trends in the Use of Residential Settings among Older Adults

OBJECTIVES

As the U.S. population ages, the prevalence of disability and functional limitations, and demand for long-term services and supports (LTSS), will increase. This study identified the distribution of older adults across different residential settings, and how their health characteristics have changed over time.

METHODS

A cross-sectional analysis of older adults residing in traditional housing, community-based residential facilities (CBRF), and nursing facilities using three data sources: The Medicare Current Beneficiary, 2008 and 2013; the Health and Retirement Study, 2008 and 2014; and the National Health and Aging Trends Study, 2011 and 2015. We calculated age-standardized prevalence of older adults by setting, functional limitations, and comorbidities, and tested for health characteristics changes relative to the baseline year (2002).

RESULTS

The proportion of older adults in traditional housing increased over time, relative to baseline (p < 0.05), while the proportion of older adults in CBRF was unchanged. The proportion of nursing facility residents declined from 2002 to 2013 in the MCBS (p < 0.05). The prevalence of dementia and functional limitations among traditional housing residents increased, relative to the baseline year in the HRS and MCBS (p < 0.05).

DISCUSSION

The proportion of older adults residing in traditional housing is increasing, while the nursing facility population is decreasing. This change may not be due to better health; rather, older adults may be relying on non-institutional LTSS.

Treating in Place: Acute Care for Long-Stay Residents in Nursing Facilities Under a CMS Initiative

BACKGROUND/OBJECTIVES

Nursing facility (NF) residents are commonly hospitalized, and many of these hospitalizations may be avoidable. A Centers for Medicare & Medicaid Services (CMS) initiative enables participating NFs to bill Medicare for providing on-site acute care to long-stay residents diagnosed with one of six ambulatory care sensitive conditions (pneumonia, congestive heart failure, chronic obstructive pulmonary disease, dehydration, skin infection, and urinary tract infection) that account for many avoidable hospitalizations. This study describes the frequency of initiative-related treatment for the six conditions, both on site and in the hospital, and the health status of residents who were treated.

DESIGN

We used the Minimum Data Set V3.0 and Medicare data to identify eligible residents, detect on-site treatment under the initiative as well as in-hospital treatment both before and during the initiative, and measure health status.

SETTING

Participating NFs during fiscal years 2017 to 2018.

PARTICIPANTS

There were 47,202 long-stay NF residents from 260 facilities in seven states.

INTERVENTION

CMS initiative to reduce avoidable hospitalizations among NF residents-payment reform.

MEASUREMENTS

Percentage per year who received on-site treatment (2017-2018), and who received in-hospital treatment (2014-2018), for the six conditions.

RESULTS

Each year, approximately 20% of residents received treatment on site during 2017 to 2018, and under 10% received treatment in the hospital during 2014 to 2018, with little change over these years. Residents treated on site had less chronic illness than those treated in the hospital.

CONCLUSION

Although the initiative sought to reduce hospitalizations, in-hospital treatment for the six conditions did not substantially change after initiative implementation, despite substantial new billing for on-site treatment for those conditions. These findings suggest that many residents treated on site would likely not have been hospitalized even absent the initiative. The residents treated on site tended to have fewer chronic conditions than those treated in the hospital.

Long-term care: nursing home quality and safety--2005. End of Year Issue Brief

In 2002, the Government Accountability Office reported that more than 1.7 million senior citizens resided in over 17,000 nursing homes across the United States. A 2003 Administration on Aging report predicted that number would increase dramatically as the "baby-boom" generation ages. Accordingly, legislators and nursing home administrators have striven to develop facilities that provide safe, high-quality eldercare to the nations' growing senior population. The Health Policy Tracking Service (HPTS) published a study in January--2005 Health Care Priorities Report--that depicts state lawmakers' concern for nursing home quality and safety. To policymakers, nursing home quality and safety is a very high priority, second only to Medicaid. The HPTS survey also indicated that 38 states planned to address senior facility safety in 2005 by adopting more stringent employee background checks, higher staffing standards and strict licensure requirements

Long-term care: long-term care insurance--2005. End of Year Issue Brief

As the "Baby Boom" generation approaches retirement, state and federal lawmakers are struggling to ensure that the nation's long-term care system will provide adequate services for the growing number of senior citizens. A 2003 Administration on Aging report predicted that the elderly population will double by 2030. Accordingly, policymakers must prepare for the impending squeeze on public health and Medicaid resources. Many consumers are exploring private long-term care insurance options as a means of preparing for the cost of eldercare. Yet, a lack of market uniformity has rendered the long-term care insurance industry somewhat difficult for consumers to decipher. In addition, senior care insurance is often costly, particularly for those over age 50.

Long-term care: end of life issues--2005. End of Year Issue Brief

While end-of-life care encompasses many issues, assisted suicide, chronic pain management and advance health care directives have been key aspects of recent legislation. Assisted suicide poses many ethical issues, while advance care directives gained tremendous attention in the wake of the Terri Schiavo case. In addition, states have worked throughout 2005 to evaluate the best means of promoting policies that assist persons who suffer from chronic pain.