Abstract
Aims: Nursing home placement (NHP) is costly, and the majority of older adults prefer to remain living in the community. The purpose of this research was to examine NHP among a cohort of participants in a home and community-based waiver program during 2002 to 2007 to develop a risk model for predicting who may transition to a nursing home. Methods: This longitudinal study was conducted on data from the minimum data set-home for care linked with medicaid claim files and death certificates. The sample included 6525 participants who had two assessments and survived through 2007 or had NHP. A risk index was developed to identify participants who had NHP. Results: Using the risk index, the probability of NHP was 50%, with sensitivity of 0.4 and specificity of 0.9. Forty percent of participants who had NHP were correctly identified. Conclusion: This NHP risk index may inform waiver agency personnel as to when participants may need more intense interventions, and consequently provide additional care to delay or prevent NHP when possible.
Highlights
With adults aged 65 and older currently comprising 15% of the population and growing exponentially, concern is mounting as to how to care for this growing demographic group [1]
Those participants at high risk of Nursing home placement (NHP) were over 75 years of age, of Caucasian race, had prior nursing home stays, wished to reside in another setting, were more likely to have been hospitalized in the last 90 days, and reported behavioral problems at the last assessment
For those participants with a score of less than 5 we will correctly identify 90% of those participants who are not going to transfer to a nursing home. The utility of this risk index for Home and Community Based Waiver (HCBW) clinicians comes from the fact that this model can be be produced from information that is already being collected in the MDSHC assessments
Summary
With adults aged 65 and older currently comprising 15% of the population and growing exponentially, concern is mounting as to how to care for this growing demographic group [1]. It will be important to find ways to deliver high-quality care tailored to the needs of these individuals in order to allow them to remain living in the community These concerns are relevant to State Medicaid programs serving the elderly who are medically indigent and dually-eligible for coverage under both Medicare and Medicaid. The majority of older adults prefer to remain living at home in the community, but are forced to transfer to a nursing home because community-based supports are inadequate to meet their needs [4] This necessitates more research to identify factors that predict NHP in these duallyeligible Medicare and Medicaid beneficiaries, and for the development of strategies to support and retain the Edorium Journal of Aging Research, Vol 1; 2015
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