Nursing Home Admissions Among Medicaid HCBS Enrollees

Evidence of Racial/Ethnic Disparities or Differences

Datos Bibliográficos

ID9101602
AutoresXueya Cai (0000-0001-7922-2703, Computational Physics (United States), autor de correspondencia), Helena Temkin‐greener (0000-0001-6113-2953, University of Rochester), Helena Temkin-Greener
Año2015
Volumen53
Número7
Páginas566-573
Fecha de publicación2015-07-01
Peer ReviewedSí
Open AccessNo
TipoARTICLE
RevistaMedical Care (JOURNAL)
Identificadores de la revistaISSN: 0025-7079 • E-ISSN: 1537-1948
EditorialOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000000379
PMID26067880
OpenAlexW2409585966
IdiomaEN
Citas recibidas10
Referencias citadas24

OBJECTIVES: Rebalancing the long-term care system between institutional care and home-based and community-based services (HCBS) has become an important policy goal of most state Medicaid programs and several provisions of the Affordable Care Act. This study estimated nursing home admission patterns by race and ethnicity in a retrospective cohort of Medicare and Medicaid dually eligible individuals who enrolled in Medicaid HCBS programs. STUDY DESIGN: We analyzed the 2006 Medicaid Analytic eXtract personal summary files from 19 states, and linked these data to nursing home Minimum Data Sets and other files. We used multivariable competing risk proportional hazard models to estimate 2-year risks of short-term and long-term nursing home admissions for black and Hispanic HCBS enrollees, compared with white enrollees. We also compared racial/ethnic differences in physical and cognitive impairments at the time of nursing home admissions. RESULTS: Among 93,508 older (65 y and above) and new HCBS users, the 2-year long-term nursing home admission rates were 10.16% for blacks [n=18,000; hazard ratio (HR)=0.80, P<0.001 in multivariable regression] and 5.59% for Hispanics (n=13,786; HR=0.49, P<0.001), compared with 12.27% for whites. The 2-year short-term nursing home admission rates were 11.99% for blacks (HR=0.84, P<0.001 in multivariable regression) and 9.29% for Hispanics (HR=0.62, P<0.001), compared with 13.40% for whites. Black and Hispanic elders were more impaired than whites in physical and cognitive functions at both short-term and long-term nursing home admissions. CONCLUSIONS: Among dual-eligible older HCBS recipients, blacks and Hispanics tended to stay longer in their communities until a nursing home admission, and upon admission, are more impaired both physically and cognitively. These differences may suggest continued racial/ethnic disparities in access to nursing homes in addition to cultural differences in long-term care preferences

Cohort · Confidence interval · Ethnic group · Family medicine · Hazard ratio · Health care · Long-term care · Medicaid · Nursing homes · Proportional hazards model · Retrospective cohort study · Demography · Emergency Medicine · Frailty in Older Adults · Geriatric Care and Nursing Homes · Intergenerational Family Dynamics and Caregiving · Internal Medicine · Medicine · Nursing · Gerontology