South Carolina [SC], like many states, has developed community alternatives to more expensive nursing homes [NHs] for Medicaid LTC recipients. It also operates a multi-dimensional gatekeeping assessment program to qualify applicants for long-term care [LTC]. We explore demographic, health-related, and assessment predictors of direct NH placement, as opposed to entry into the home- and community-based [HCB] waiver program, in order to generate questions concerning the relationship of need to other factors influencing placement in SC.
A 100% sample of a community inception cohort qualifying for CLTC between 1/1/94 and 1/1/98 was taken (n=13,332) from SC Medicaid records. Gatekeeping assessments provided baseline data on demographics, communication and sensory impairments, cognitive impairments, behavioral disorders, diseases, skilled treatments, and disabilities. The first admission to either HCB or NH within 6 months subsequent to baseline qualifying assessment was taken as the placement outcome. After data screening, bivariate analyses and multivariate logistic regression are used to determine factors predicting NH placement and their interrelations. Highly significant bivariate odds ratios in excess of 3.0 were found for all ADLs, multiple measures of cognitive and communication impairment, and several diagnoses including dementia and psychiatric conditions. Demographic and assessment predictors included being single (1.82; 95% c.i.: 1.61, 2.05), White (1.77: 1.64, 1.9), male (1.44; 1.33, 1.56), with some college or more (2.0; 1.7, 2.36) and having "skilled" needs (4.09; 3.68, 4.53). Multivariate analyses will determine whether these latter factors are independently predictive of placement more than the net of health factors.
Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to: 1.List 5 strong predictors of nursing home placement. 2.compare and contrast the differential selection of patients by nursing homes vs. community-based care. 3.ientify the possible interventions for reducing nursing home admission
Keywords: Nursing Homes, Risk Factors
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.