Characteristics of elderly home health care users: data from the 1996 National Home and Hospice Care Survey

OBJECTIVE: This report presents demographic characteristics, service utilization, and primary admission diagnoses of elderly users of home health care services. Included are home health care services used by both current and discharged clients (called patients). These services are provided by home health care agencies and hospices. The focus of the report is on services used by both current patients and discharges aged 65 years and over. METHODS: The data used for this report are from the National Center for Health Statistics 1996 National Home and Hospice Care Survey's (NHHCS) sample of current patients and discharges. The 1996 NHHCS is the fourth survey of home health care agencies and hospices and their current patients and discharges. RESULTS: The overall results of the survey indicate that, as in previous years, the elderly current patients and discharges were predominantly women, 75-84 years old, white, non-Hispanic, widowed, and most often lived in a private residence with members of their family. For elderly men and women, the most commonly used home health care service was skilled nursing services and the primary admission diagnosis was diseases of the circulatory system, including heart disease.     

Characteristics of patients receiving hospice care at home versus in nursing homes: results from the National Home and Hospice Care Survey and the National Nursing Home Survey

This study examined 1170 deceased home hospice patients from the 1998 National Home and Hospice Care Survey and 617 deceased nursing home hospice patients from the 1997 and 1999 National Nursing Home Surveys. T tests and Bonferroni adjustments for multiple comparisons were performed to assess differences in characteristics of patients receiving hospice care at home versus in nursing homes. We found that the nursing home hospice population differs significantly from the home hospice population in the United States. Nursing home hospice patients were more likely to be older, have Medicaid as their primary payment source, have dementia and other noncancer primary diagnosis, and receive dietary/nutrition service, medication management, and physician services than home hospice patients.     

Characteristics of elderly nursing home residents: data from the 1995 National Nursing Home Survey

OBJECTIVE: This report presents the sociodemographic characteristics, functional dependencies in the activities of daily living (ADL) and instrumental activities of daily living (IADL), dental status, primary admission diagnosis, types of services used, and source of payment of elderly nursing home residents. METHODS: The data used for this report are from the National Center for Health Statistics' 1995 National Nursing Home Survey's (NNHS) sample of current residents age 65 years and above. The 1995 NNHS is the fourth annual survey of nursing homes. The first survey was conducted from August 1973 through April 1974, the second was conducted from May through December 1977, and the third was conducted from August 1985 through January 1986. The 1995 NNHS was conducted from July 1995 through December 1995. RESULTS: The overall results of the survey indicate that elderly nursing home residents were predominantly women, 75 years old and over, white, non-Hispanic, and widowed. A large portion of residents needed assistance in their ADL's and IADL's. A shifting of the primary source of payment to Medicaid occurred among residents who used Medicare as their source of payment at the time of admission.     

Differences across payors in charges for agency-based home health services: evidence from the National Home and Hospice Care Survey.

OBJECTIVE: To investigate charge and payment differentials for home health services across different payors. DATA SOURCES: The 1992 National Home and Hospice Care Survey, a nationally representative survey of home and hospice care agencies and their patients, collected by the National Center for Health Statistics. STUDY DESIGN: We compare the average charge for a Medicare home health visit to the average charge for patients with other sources of payment. In making such comparisons, we control for differences across payors in service mix and agency characteristics. PRINCIPAL FINDINGS: Agencies charge various payors different amounts for similar services, and Medicare is consistently charged more than other payors. CONCLUSIONS: Findings imply the potential existence of payment differentials across payors for home health services, with Medicare and privately insured patients likely to be paying more than others for similar services. Such conclusions raise the possibility that, as in other segments of the healthcare market, cost-shifting and price discrimination might exist within the home health industry. Future research should explore these issues, along with the question of whether Medicare is paying too much for home health services.     

Predictors of live hospice discharge: data from the National Home and Hospice Care Survey (NHHCS)

In the context of the current regulatory environment, patients may be discharged from hospice if their condition stabilizes or improves over time and the certifying physician is unable to provide a conscientious recertification of the six-month prognosis. Little is known about the characteristics or outcomes of patients who are determined by physicians to no longer be eligible for hospice care. This retrospective study was designed to characterize the rates and predictors of live hospice discharge using data from the 1996 and 1998. National Home and Hospice Care Survey (NHHCS). We compare records of live hospice discharge with hospice discharges due to death from the discharge patient files of the 1996 and the 1998 NHHCS. Of the 807,733 patients in the combined 1996 and 1998 NHHCS discharge patient file who met study inclusion criteria, 761,858 (94 percent) were deceased and 45,875 (6 percent) were discharged alive. Those who were discharged alive were more likely to be female, have received hospice care for more than 60 days, and to have had a noncancer diagnosis, particularly advanced cardiopulmonary or neurologic disease. Mean age and total number of assistive medical devices used did not differ significantly between patients who were discharged alive and those who died in hospice care. Factors most associated with live hospice discharge, using bivariate analyses, were length of service greater than 60 days (OR, 6.60; 95 percent CI, 6.47-6.73), cardiopulmonary diagnosis (OR, 3.24; 95 percent CI, 3.19-3.30), and neurologic diagnosis (OR, 2.73; 95 percent CI, 2.67-2.79). Multivariate logistic regression identified length of service greater than 60 days, cardiopulmonary diagnosis, neurologic diagnosis, female gender, worse functional status, and living in an institutional setting as being independently associated with live hospice discharge. We found that patients who were discharged alive from hospice care were more likely to have longer lengths of service, noncancer diagnoses, and better functional status than those who died while receiving hospice care. Age was not associated with discharge disposition. Given the demonstrated differences between these patients and those who died while receiving hospice care, these data provide further impetus for careful study of the appropriateness of current hospice eligibility criteria, the determinants of hospice discharge and, most important, the outcomes of patients who are discharged alive from hospice and the impact of hospice discharge on patients and their families.     

An overview of nursing home facilities: data from the 1997 National Nursing Home Survey

OBJECTIVE: This report presents estimates on the number and distribution of nursing home facilities, their services, current residents, and discharges in the United States during 1997. METHODS: Data presented in this report are estimates based on a sample of nursing home facilities, residents, and discharges from the 1997 National Nursing Home Survey (NHHS). The survey collects information about providers and recipients of care from nursing home facilities. NHHS has been periodically conducted by the National Center for Health Statistics since 1973. RESULTS: In 1997 there were an estimated 1.6 million current residents and 2.4 million discharges from 17,000 nursing homes nationwide. These facilities were predominantly proprietary and certified by both Medicare and Medicaid. There was an average of 107 beds per nursing home with an occupancy rate of 88 percent and a discharge rate of 130 patients per 100 beds. The majority of nursing home residents and discharges were elderly, white, and female.     

Measuring the health of the Indian elderly: evidence from National Sample Survey data

Background  

Comparable health measures across different sets of populations are essential for describing the distribution of health outcomes and assessing the impact of interventions on these outcomes. Self-reported health (SRH) is a commonly used indicator of health in household surveys and has been shown to be predictive of future mortality. However, the susceptibility of SRH to influence by individuals' expectations complicates its interpretation and undermines its usefulness.     

Use of home health services: some findings from the National Medical Care Expenditure Survey.

Data from the National Medical Care Expenditure Survey (NMCES) are used to produce national estimates of the use and sources of payment for home health care services for various demographic groups. The findings indicate that age and health status are strongly associated with home health care use and the vast majority of home health care services are delivered to this population. Nevertheless, there are a large number of younger, relatively healthy people who also use home health care services. Such use is generally non-intensive, often involving only a single visit. In addition it was found that private insurance is only rarely mentioned as a source of payment for home health care.     

Socioeconomic circumstances and health among the brazilian elderly: a study using data from a National Household Survey

The influence of socioeconomic circumstances on senior citizens' health is still controversial. We used data from the 1998 Brazilian National Household Survey (PNAD 1998) to examine this influence. A representative sample of the Brazilian population aged > or = 65 years (n = 19,068) were included in the study. The characteristics of those in the lower quintile of per capita household income were compared with those with higher income (< 0.67 vs > or = 0.67 the Brazilian minimum wage). The lower income group presented worse health conditions (self-rated health, inability to perform routine activities due to a health problem, bedridden conditions, and a report of any disease), and worse physical functioning (level of difficulty in performing selected physical activities), and less frequent use of medical and dental services. These results do not confirm observations, in some developed countries, of a lack of association between socioeconomic status and health among the elderly. On the contrary, according to our results, in Brazil even small differences in income are sufficiently sensitive to identify older adults with worse health conditions and limited access to health services.