Trajectories Over the First Year of Long-Term Care Nursing Home Residence

Shuang Li, Addie Middleton, Kenneth Ottenbacher, James Goodwin

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objectives: To describe the trajectories in the first year after individuals are admitted to long-term care nursing homes. Design: Retrospective cohort study. Setting: US long-term care facilities. Participants: Medicare fee-for-service beneficiaries newly admitted to long-term care nursing homes from July 1, 2012, to December 31, 2013 (N=535,202). Measurements: Demographic characteristics were from Medicare data. Individual trajectories were conducted using the Minimum Data Set for determining long-term care stays and community discharge, and Medicare Provider and Analysis Reviews claims data for determining hospitalizations, skilled nursing facility stays, inpatient rehabilitation, long-term acute hospital and psychiatric hospital stays. Results: The median length of stay in a long-term care nursing home over the 1 year following admission was 127 [interquartile range (IQR): 24, 356] days. The median length of stay in any institution was 158 (IQR: 38, 365). Residents experienced a mean of 2.1 ± 2.8 (standard deviation) transitions over the first year. The community discharge rate was 36.5% over the 1-year follow-up, with 20.8% discharged within 30 days and 31.2% discharged within 100 days. The mortality rate over the first year of nursing home residence was 35.0%, with 16.3% deaths within 100 days. At 12 months post long-term care admission, 36.9% of the cohort were in long-term care, 23.4% were in community, 4.7% were in acute care hospitals or other institutions, and 35.0% had died. Conclusion: After a high initial community discharge rate, the majority of patients newly admitted to long-term care experienced multiple transitions while remaining institutionalized until death or the end of 1-year follow-up.

Original languageEnglish (US)
JournalJournal of the American Medical Directors Association
DOIs
StateAccepted/In press - Jan 1 2017

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Long-Term Care
Nursing Homes
Medicare
Insurance Claim Review
Length of Stay
Skilled Nursing Facilities
Fee-for-Service Plans
Psychiatric Hospitals
Inpatients
Hospitalization
Cohort Studies
Rehabilitation
Retrospective Studies
Demography
Mortality

Keywords

  • Community discharge
  • Long-term care nursing home
  • Medicare
  • Residential history files
  • Trajectory

ASJC Scopus subject areas

  • Nursing(all)
  • Health Policy

Cite this

@article{d7e0a801a6f5462c8fe66f5c0fd914df,
title = "Trajectories Over the First Year of Long-Term Care Nursing Home Residence",
abstract = "Objectives: To describe the trajectories in the first year after individuals are admitted to long-term care nursing homes. Design: Retrospective cohort study. Setting: US long-term care facilities. Participants: Medicare fee-for-service beneficiaries newly admitted to long-term care nursing homes from July 1, 2012, to December 31, 2013 (N=535,202). Measurements: Demographic characteristics were from Medicare data. Individual trajectories were conducted using the Minimum Data Set for determining long-term care stays and community discharge, and Medicare Provider and Analysis Reviews claims data for determining hospitalizations, skilled nursing facility stays, inpatient rehabilitation, long-term acute hospital and psychiatric hospital stays. Results: The median length of stay in a long-term care nursing home over the 1 year following admission was 127 [interquartile range (IQR): 24, 356] days. The median length of stay in any institution was 158 (IQR: 38, 365). Residents experienced a mean of 2.1 ± 2.8 (standard deviation) transitions over the first year. The community discharge rate was 36.5{\%} over the 1-year follow-up, with 20.8{\%} discharged within 30 days and 31.2{\%} discharged within 100 days. The mortality rate over the first year of nursing home residence was 35.0{\%}, with 16.3{\%} deaths within 100 days. At 12 months post long-term care admission, 36.9{\%} of the cohort were in long-term care, 23.4{\%} were in community, 4.7{\%} were in acute care hospitals or other institutions, and 35.0{\%} had died. Conclusion: After a high initial community discharge rate, the majority of patients newly admitted to long-term care experienced multiple transitions while remaining institutionalized until death or the end of 1-year follow-up.",
keywords = "Community discharge, Long-term care nursing home, Medicare, Residential history files, Trajectory",
author = "Shuang Li and Addie Middleton and Kenneth Ottenbacher and James Goodwin",
year = "2017",
month = "1",
day = "1",
doi = "10.1016/j.jamda.2017.09.021",
language = "English (US)",
journal = "Journal of the American Medical Directors Association",
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T1 - Trajectories Over the First Year of Long-Term Care Nursing Home Residence

AU - Li, Shuang

AU - Middleton, Addie

AU - Ottenbacher, Kenneth

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N2 - Objectives: To describe the trajectories in the first year after individuals are admitted to long-term care nursing homes. Design: Retrospective cohort study. Setting: US long-term care facilities. Participants: Medicare fee-for-service beneficiaries newly admitted to long-term care nursing homes from July 1, 2012, to December 31, 2013 (N=535,202). Measurements: Demographic characteristics were from Medicare data. Individual trajectories were conducted using the Minimum Data Set for determining long-term care stays and community discharge, and Medicare Provider and Analysis Reviews claims data for determining hospitalizations, skilled nursing facility stays, inpatient rehabilitation, long-term acute hospital and psychiatric hospital stays. Results: The median length of stay in a long-term care nursing home over the 1 year following admission was 127 [interquartile range (IQR): 24, 356] days. The median length of stay in any institution was 158 (IQR: 38, 365). Residents experienced a mean of 2.1 ± 2.8 (standard deviation) transitions over the first year. The community discharge rate was 36.5% over the 1-year follow-up, with 20.8% discharged within 30 days and 31.2% discharged within 100 days. The mortality rate over the first year of nursing home residence was 35.0%, with 16.3% deaths within 100 days. At 12 months post long-term care admission, 36.9% of the cohort were in long-term care, 23.4% were in community, 4.7% were in acute care hospitals or other institutions, and 35.0% had died. Conclusion: After a high initial community discharge rate, the majority of patients newly admitted to long-term care experienced multiple transitions while remaining institutionalized until death or the end of 1-year follow-up.

AB - Objectives: To describe the trajectories in the first year after individuals are admitted to long-term care nursing homes. Design: Retrospective cohort study. Setting: US long-term care facilities. Participants: Medicare fee-for-service beneficiaries newly admitted to long-term care nursing homes from July 1, 2012, to December 31, 2013 (N=535,202). Measurements: Demographic characteristics were from Medicare data. Individual trajectories were conducted using the Minimum Data Set for determining long-term care stays and community discharge, and Medicare Provider and Analysis Reviews claims data for determining hospitalizations, skilled nursing facility stays, inpatient rehabilitation, long-term acute hospital and psychiatric hospital stays. Results: The median length of stay in a long-term care nursing home over the 1 year following admission was 127 [interquartile range (IQR): 24, 356] days. The median length of stay in any institution was 158 (IQR: 38, 365). Residents experienced a mean of 2.1 ± 2.8 (standard deviation) transitions over the first year. The community discharge rate was 36.5% over the 1-year follow-up, with 20.8% discharged within 30 days and 31.2% discharged within 100 days. The mortality rate over the first year of nursing home residence was 35.0%, with 16.3% deaths within 100 days. At 12 months post long-term care admission, 36.9% of the cohort were in long-term care, 23.4% were in community, 4.7% were in acute care hospitals or other institutions, and 35.0% had died. Conclusion: After a high initial community discharge rate, the majority of patients newly admitted to long-term care experienced multiple transitions while remaining institutionalized until death or the end of 1-year follow-up.

KW - Community discharge

KW - Long-term care nursing home

KW - Medicare

KW - Residential history files

KW - Trajectory

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