Abstract
Objectives
To assess the effect of changes in assisted living (AL) capacity within a market on
prevalence of residents with low care needs in nursing homes.
Design
Retrospective, longitudinal analysis of nursing home markets.
Setting and participants
Twelve thousand two hundred fifity-one nursing homes in operation during 2007 and 2014.
Measurements
We analyzed the percentage of residents in a nursing home who qualified as low-care.
For each nursing home, we constructed a market consisting of AL communities, Medicare
beneficiaries, and competing nursing homes within a 15-mile radius. We estimated the
effect of change in AL beds on prevalence of low-care residents using multivariate
linear models with year and nursing home fixed effects.
Results
The supply of AL beds increased by an average 258 beds per nursing home market (standard
deviation = 591) during the study period. The prevalence of low-care residents decreased
from an average of 13.0% (median 10.5%) to 12.2% (median 9.5%). In adjusted models,
a 100-bed increase in AL supply was associated with a decrease in low-care residents
of 0.041 percentage points (P = .026), controlling for changes in market and nursing home characteristics, county
demographics, and year and nursing home fixed effects. In markets with a high percentage
of its Medicare beneficiaries (≥14%) dual eligible for Medicaid, the effect of AL
is stronger, with a 0.066–percentage point decrease per 100 AL beds (P = .026) vs a 0.016–percentage point decrease in low-duals markets (P = .48).
Conclusions and implications
Our analysis suggests that some of the growth in AL capacity serves as a substitute
for nursing homes for patients with low care needs. Furthermore, the effects are concentrated
in markets with an above-average proportion of beneficiaries with dual Medicaid eligibility.
Keywords
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Article info
Publication history
Published online: February 27, 2020
Footnotes
This work was supported by the National Institutes of Health (Grant R21 AG047303 to KST), the National Institute on Aging (1 R21 AG059120 01 to KST), and the U.S. Department of Veterans Affairs Health Services Research and Development Service (CDA 14-422 to KST).
The authors declare no conflicts of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, the National Insitutes of Health, or the United States government.
Identification
Copyright
Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
