The extended impact of the COVID-19 pandemic on long-term care residents in Medicare with frailty or dual Medicaid enrollment

被引:0
作者
Lin, Sunny C. [1 ,2 ]
Zheng, Jie [3 ]
Epstein, Arnold [3 ]
Orav, E. John [4 ]
Barnett, Michael [3 ]
Grabowski, David C. [5 ]
Maddox, Karen E. Joynt [2 ,6 ]
机构
[1] Washington Univ, Sch Med, Dept Med, Div Gen Med Sci, St Louis, MO USA
[2] Washington Univ, Ctr Adv Hlth Serv Policy & Econ Res, Inst Publ Hlth, St Louis, MO USA
[3] Harvard T H Chan Sch Publ Hlth, Dept Hlth Policy & Management, Boston, MA USA
[4] Brigham & Womens Hosp, Dept Med, Div Gen Internal Med & Primary Care, Boston, MA USA
[5] Harvard Med Sch, Dept Hlth Care Policy, Boston, MA USA
[6] Washington Univ, Dept Med, Cardiovasc Div, Sch Med, St Louis, MO USA
关键词
COVID-19; dual-Medicaid Medicare eligibility; frail elderly; long-term care; pandemics;
D O I
10.1111/jgs.19131
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Background: Although many healthcare settings have since returned to pre-pandemic levels of operation, long-term care (LTC) facilities have experienced extended and significant changes to operations, including unprecedented levels of short staffing and facility closures, that may have a detrimental effect on resident outcomes. This study assessed the pandemic's extended effect on outcomes for LTC residents, comparing outcomes 1 and 2 years after the start of the pandemic to pre-pandemic times, with special focus on residents with frailty and dually enrolled in Medicare and Medicaid. Methods: Using Medicare claims data from January 1, 2018, through December 31, 2022, we ran over-dispersed Poisson models to compare the monthly adjusted rates of emergency department use, hospitalization, and mortality among LTC residents, comparing residents with and without frailty and dually enrolled and non-dually enrolled residents. Results: Two years after the start of the pandemic, adjusted emergency department (ED) and hospitalization rates were lower and adjusted mortality rates were higher compared with pre-pandemic years for all examined subgroups. For example, compared with 2018-2019, 2022 ED visit rates for dually enrolled residents were 0.89 times lower, hospitalization rates were 0.87 times lower, and mortality rates were 1.17 higher; 2022 ED visit rates for frail residents were 0.85 times lower, hospitalization rates were 0.83 times lower, and mortality rates were 1.21 higher. Conclusions: In 2022, emergency department and hospital utilization rates among long-term residents were lower than pre-pandemic levels and mortality rates were higher than pre-pandemic levels. These findings suggest that the pandemic has had an extended impact on outcomes for LTC residents.
引用
收藏
页码:3457 / 3466
页数:10
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