Changes in Long-Term Care Markets: Assisted Living Supply and the Prevalence of Low-Care Residents in Nursing Homes

被引:19
作者
Cornell, Portia Y. [1 ,2 ]
Zhang, Wenhan [1 ]
Thomas, Kali S. [1 ,2 ]
机构
[1] Providence VA Med Ctr, Bldg 32, Providence, RI 02908 USA
[2] Brown Univ, Sch Publ Hlth, Providence, RI USA
基金
美国国家卫生研究院;
关键词
Assisted living; long-term care; nursing home residents; FACILITIES; QUALITY;
D O I
10.1016/j.jamda.2020.01.006
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
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. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
引用
收藏
页码:1161 / +
页数:9
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