Portia Y Cornell1, Wenhan Zhang2, Kali S Thomas3. 1. Providence VA Medical Center, Providence, RI; Brown University School of Public Health, Providence, RI. Electronic address: portia_cornell@brown.edu. 2. Providence VA Medical Center, Providence, RI. 3. Providence VA Medical Center, Providence, RI; Brown University School of Public Health, Providence, RI.
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. Published by Elsevier Inc.
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. Published by Elsevier Inc.
Entities:
Keywords:
Assisted living; long-term care; nursing home residents
Authors: Benjamin C Silver; David C Grabowski; Pedro L Gozalo; David Dosa; Kali S Thomas Journal: Health Serv Res Date: 2018-07-31 Impact factor: 3.402
Authors: Denise A Tyler; Zhanlian Feng; Natalie E Leland; Pedro Gozalo; Orna Intrator; Vincent Mor Journal: J Am Med Dir Assoc Date: 2013-06-28 Impact factor: 4.669
Authors: Kali S Thomas; David Dosa; Pedro L Gozalo; David C Grabowski; Jennifer Nazareno; Rajesh Makineni; Vincent Mor Journal: Med Care Date: 2018-02 Impact factor: 2.983
Authors: Cassandra L Hua; Kali S Thomas; Lindsay J Peterson; Kathryn Hyer; David M Dosa Journal: J Am Med Dir Assoc Date: 2020-11-15 Impact factor: 4.669
Authors: Cassandra L Hua; Portia Y Cornell; Sheryl Zimmerman; Jaclyn Winfree; Kali S Thomas Journal: Am J Geriatr Psychiatry Date: 2020-09-19 Impact factor: 4.105
Authors: Lindsey Smith; Paula Carder; Taylor Bucy; Jaclyn Winfree; Joan F Brazier; Brian Kaskie; Kali S Thomas Journal: Health Serv Res Date: 2021-01-10 Impact factor: 3.734
Authors: Derek R Manis; Jeffrey W Poss; Aaron Jones; Paula A Rochon; Susan E Bronskill; Michael A Campitelli; Richard Perez; Nathan M Stall; Ahmad Rahim; Glenda Babe; Jean-Éric Tarride; Julia Abelson; Andrew P Costa Journal: CMAJ Date: 2022-05-30 Impact factor: 16.859