Abstract
Objectives
To describe the trajectories in the first year after individuals are admitted to long-term
care nursing homes.
Design
Retrospective cohort study.
Setting
US long-term care facilities.
Participants
Medicare fee-for-service beneficiaries newly admitted to long-term care nursing homes
from July 1, 2012, to December 31, 2013 (N=535,202).
Measurements
Demographic characteristics were from Medicare data. Individual trajectories were
conducted using the Minimum Data Set for determining long-term care stays and community
discharge, and Medicare Provider and Analysis Reviews claims data for determining
hospitalizations, skilled nursing facility stays, inpatient rehabilitation, long-term
acute hospital and psychiatric hospital stays.
Results
The median length of stay in a long-term care nursing home over the 1 year following
admission was 127 [interquartile range (IQR): 24, 356] days. The median length of
stay in any institution was 158 (IQR: 38, 365). Residents experienced a mean of 2.1
± 2.8 (standard deviation) transitions over the first year. The community discharge
rate was 36.5% over the 1-year follow-up, with 20.8% discharged within 30 days and
31.2% discharged within 100 days. The mortality rate over the first year of nursing
home residence was 35.0%, with 16.3% deaths within 100 days. At 12 months post long-term
care admission, 36.9% of the cohort were in long-term care, 23.4% were in community,
4.7% were in acute care hospitals or other institutions, and 35.0% had died.
Conclusion
After a high initial community discharge rate, the majority of patients newly admitted
to long-term care experienced multiple transitions while remaining institutionalized
until death or the end of 1-year follow-up.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Hospitalization and mortality rates in long-term care facilities: Does for-profit status matter?.J Am Med Dir Assoc. 2015; 16: 874-883
- Risk of continued institutionalization after hospitalization in older adults.J Gerontol A Biol Sci Med Sci. 2011; 66: 1321-1327
- Who transitions to the community from nursing homes? Comparing patterns and predictors for short-stay and long-stay residents.Home Health Care Serv Q. 2013; 32: 75-91
- Obesity and pressure ulcers among nursing home residents.Med Care. 2013; 51: 478-486
- Predictors of nursing home residents' time to hospitalization.Health Serv Res. 2011; 46: 82-104
- Prevalence and patterns of potentially avoidable hospitalizations in the US long-term care setting.Int J Qual Health Care. 2016; 28: 104-109
- Use of postacute care by nursing home residents hospitalized for stroke or hip fracture: How prevalent and to what end?.J Am Geriatr Soc. 2008; 56: 1490-1496
- Skilled nursing facility admissions of nursing home residents with advanced dementia.J Am Geriatr Soc. 2013; 61: 1645-1650
- Mortality-related factors and 1-year survival in nursing home residents.J Am Geriatr Soc. 2003; 51: 213-221
- Community discharge of nursing home residents: The role of facility characteristics.Health Serv Res. 2016; 51: 645-666
- The residential history file: Studying nursing home residents' long-term care histories(*).Health Serv Res. 2011; 46: 120-137
- Center for Medicare and Medicaid Services, Office of the Actuary. Brief summaries of Medicare & Medicaid.(Available at:)
- Comorbidity measures for use with administrative data.Med Care. 1998; 36: 8-27
- Effect of forced transitions on the most functionally impaired nursing home residents.J Am Geriatr Soc. 2012; 60: 1895-1900
- Polychoric and polyserial correlations.in: Encyclopedia of Statistical Sciences. 7. John Wiley, New York1988: 69-74
- Hospital variation in rates of new institutionalizations within 6 months of discharge.J Am Geriatr Soc. 2017; 65: 1206-1213
- Comparison of methods to identify long term care nursing home residence with administrative data.BMC Health Serv Res. 2017; 17: 376
- Medicare expenditures among nursing home residents with advanced dementia.Arch Intern Med. 2011; 171: 824-830
Department of Health and Human Services. Nursing Home Data Compendium 2015 Edition. Available at: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/nursinghomedatacompendium_508-2015.pdf Accessed September 14, 2016.
- Medicare and Medicaid: Conflicting incentives for long-term care.Milbank Q. 2007; 85: 579-610
Medicare Payment Advisory Commission. A data book: Health care spending and the Medicare program. Available at: . http://medpac.gov/documents/data-book/june-2016-data-book-health-care-spending-and-the-medicare-program.pdf?sfvrsn=0. Accessed July 20, 2016.
- End-of-life transitions among nursing home residents with cognitive issues.N Engl J Med. 2011; 365: 1212-1221
- Nursing home adverse events: Further insight into highest risk periods.J Am Med Dir Assoc. 2011; 12: 467-474
- Medicare’s bundled payment pilot for acute and postacute care: Analysis and recommendations on where to begin.Health Aff. 2011; 30: 1708-1717
- Opportunities and challenges for episode-based payment.N Engl J Med. 2011; 365: 777-779
- Measure specifications for measures adopted in the FY 2017 SNF QRP final rule.(Available at:)
- Nursing home placement: Perspectives of community-dwelling older persons.J Clin Nurs. 2007; 16: 911-917
- Giving voice to elderly people: Community-based long-term care.Public Health Nurs. 1997; 14: 217-226
- Attitudes about entering a nursing home: Comparisons of older rural and urban African-American women.J Aging Stud. 1997; 11: 27-47
- Clarity Final Report: Aging in Place in America.Prince Market Research, Nashville, TN2007
- Medicaid expenditure for long-term services and supports (LTSS) in FY 2014: Managed LTSS reached 15 percent of LTSS spending.(Available at:)
- Prospects for transferring nursing home residents to the community.Health Aff (Millwood). 2007; 26: 1762-1771
Article info
Publication history
Published online: November 03, 2017
Footnotes
This work was supported by the National Institutes of Health (grants number R01AG33134, K05CA134923, R01HD069443, K12HD055929, P2CHD065702, and P30AG024832) and the Agency for Healthcare Research and Quality (grant number R24HS22134). The funding organizations had no role in the design of the study; the collection, management, analysis, and interpretation of the data; or the preparation of the manuscript.
The authors have no conflicts of interest to declare.
Identification
Copyright
© 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
