Hospitalization of Elderly Medicaid Long-Term Care Users Who Transition from Nursing Homes
Article first published online: 2 JAN 2014
© 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society
Journal of the American Geriatrics Society
Volume 62, Issue 1, pages 71–78, January 2014
How to Cite
J Am Geriatr Soc 62:71–78, 2014.
- Issue published online: 17 JAN 2014
- Article first published online: 2 JAN 2014
- home- and community-based services;
- nursing home;
- dually eligible
To compare hospitalizations of dually eligible older adults who had an extended Medicaid nursing home (NH) stay and transitioned out to receive Medicaid home- and community-based services (HCBS) with hospitalizations of those who remained in the NH.
Retrospective matched cohort study using Medicaid and Medicare claims and NH assessment data.
Community (receiving Medicaid HCBS) or NH.
Dually eligible fee-for-service beneficiaries aged 65 and older in Arkansas, Florida, Minnesota, New Mexico, Texas, Vermont, and Washington from 2003 to 2005. Individuals who had a Medicaid NH stay of at least 90 days and transitioned to Medicaid HCBS (N = 1,169) were matched to individuals who had a Medicaid NH stay of at least 90 days and remained in the NH (N = 1,169).
Potentially preventable hospitalizations (defined according to ambulatory-care-sensitive conditions) and all hospitalizations were examined.
Cox proportional hazards models were used to compare the risk of hospitalization between the groups, accounting for the differing time at risk and censoring. Being a NH transitioner increased the hazard of experiencing a potentially preventable hospitalization by 40% (95% confidence interval (CI) = 1.01–1.93) over remaining in the NH. NH transitioners had a 58% (95% CI = 1.32–1.91) greater risk of experiencing any type of hospitalization than NH stayers.
Individuals who transitioned from the NH to HCBS had a greater risk of hospitalization. Most of the attention in long-term care transition programs has been focused on NH readmission, but programs encouraging NH transition should recognize that individuals may be at greater risk for hospitalization after returning to the community. Planning for the medical needs of individuals who transition from an extended NH stay may improve their posttransition outcomes.