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- Title
Transitioning From Community-Based to Institutional Long-term Care: Comparing 1915(c) Waiver and PACE Enrollees.
- Authors
Segelman, Micah; Xueya Cai; van Reenen, Christine; Temkin-Greener, Helena
- Abstract
Purpose of the Study: To compare the risk of long-term nursing home (NH) admission and the level of functional and cognitive impairment at the time of long-term NH admission in the Program of All-Inclusive Care for the Elderly (PACE) and in 1915(c) aged and aged and disabled waiver programs. Design and Methods: Cohorts of new waiver and PACE enrollees in 12 states were identified (in 2005-2007) and followed (through 2009) using the Medicaid Analytic Extract and the Minimum Data Set. Individual-level outcomes of interest were time from waiver or PACE enrollment to long-term (90+ days) NH admission and functional (29-point activities of daily living [ADL]) and cognitive (7-point Cognitive Performance Scale [CPS]) impairment at NH admission. An overall measure of impairment was also created and categorized as low (ADL < 17 and CPS < 3) versus high (ADL ≥ 17 or CPS ≥ 3). The key independent variable was enrollment in PACE versus waiver program. County-level covariates were included. Analyses employed multivariable models including competing risk proportional hazard and linear and logistic regressions. Results: Compared with waiver enrollees, PACE enrollees had 31% lower risk of long-term NH admission (p < .001). At NH admission, they were overall significantly (p < .0001) more cognitively impaired (0.34 point), with 55% higher odds of severe (CPS ≥ 4) cognitive impairment (p < .001) and 45% higher odds of having overall high impairment (p = .003). Implications: PACE may be more effective than 1915(c) aged and aged and disabled waiver programs in reducing long-term NH use and may be particularly well suited to supporting cognitively impaired individuals, enabling them to remain in the community longer.
- Subjects
UNITED States; ACTIVITIES of daily living; MEDICAL care for older people; COGNITIVE testing; COMMUNITY health services; COMPARATIVE studies; CONFIDENCE intervals; DATABASE management; HOSPITAL care; LONG-term health care; RESEARCH methodology; MEDICAID; NURSING care facilities; PEOPLE with disabilities; REGRESSION analysis; RESEARCH funding; LOGISTIC regression analysis; RELOCATION; DESCRIPTIVE statistics; ODDS ratio
- Publication
Gerontologist, 2017, Vol 57, Issue 2, p300
- ISSN
0016-9013
- Publication type
Article
- DOI
10.1093/geront/gnv106