Changes in Long-Term Care Markets: Assisted Living Supply and the Prevalence of Low-Care Residents in Nursing Homes |
| |
| Institution: | 1. Providence VA Medical Center, Providence, RI;2. Brown University School of Public Health, Providence, RI;1. University of Milan, Milan, Italy;2. ASP IMMeS Pio Albergo Trivulzio, Milan, Italy;3. Fondazione IRCCS Ca'' Granda Ospedale Maggiore Policlinico, Milano, Italy;4. Department of Clinical and Biomedical Sciences L. Sacco Hospital, Milano, Italy;5. Department of Medical Sciences and Community Health, University of Milan, Milan, Italy;1. Division of General Medicine & Geriatrics, Emory University School of Medicine, Atlanta, GA, USA;2. Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center (GRECC), Atlanta, GA, USA;1. Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, FL;2. College of Engineering, University of South Florida, Tampa, FL;3. Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI;4. Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI;5. School of Public Health, Brown University, Providence, RI;6. Warren Alpert School of Medicine, Brown University, Providence, RI;1. Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY;2. Geriatrics & Extended Care Data & Analysis Center (GEC DAC), Canandaigua VA Medical Center, Canandaigua, NY;1. Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA;2. Department of Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA;3. Department of Biostatistics and Computational Biology, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA;4. School of Social Work, University of North Carolina, Chapel Hill, NC, USA |
| |
| Abstract: | ObjectivesTo assess the effect of changes in assisted living (AL) capacity within a market on prevalence of residents with low care needs in nursing homes.DesignRetrospective, longitudinal analysis of nursing home markets.Setting and participantsTwelve thousand two hundred fifity-one nursing homes in operation during 2007 and 2014.MeasurementsWe 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.ResultsThe 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 implicationsOur 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: | Assisted living long-term care nursing home residents |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
