TY - JOUR
T1 - Trajectories Over the First Year of Long-Term Care Nursing Home Residence
AU - Li, Shuang
AU - Middleton, Addie
AU - Ottenbacher, Kenneth J.
AU - Goodwin, James S.
N1 - Funding Information:
This work was supported by the National Institutes of Health (grants number R01AG33134, K05CA134923, R01HD069443, K12HD055929, P2CHD065702, and P30AG024832) and the Agency for Healthcare Research and Quality (grant number R24HS22134). The funding organizations had no role in the design of the study; the collection, management, analysis, and interpretation of the data; or the preparation of the manuscript.
Publisher Copyright:
© 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine
PY - 2018/4
Y1 - 2018/4
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 - Medicare
KW - community discharge
KW - long-term care nursing home
KW - residential history files
KW - trajectory
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U2 - 10.1016/j.jamda.2017.09.021
DO - 10.1016/j.jamda.2017.09.021
M3 - Article
C2 - 29108886
AN - SCOPUS:85032919052
SN - 1525-8610
VL - 19
SP - 333
EP - 341
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 4
ER -