Conversion Diversion: Participation in a Social HMO Reduces the Likelihood of Converting From Short-Stay to Long-Stay Nursing Facility Placement

doi:10.1016/j.jamda.2009.10.009

Journal of the American Medical Directors Association

Volume 11, Issue 5, June 2010, Pages 333-337

https://doi.org/10.1016/j.jamda.2009.10.009 Get rights and content

Objectives

To determine the effect of a Social Health Maintenance Organization (S/HMO) on diverting older adults admitted into a nursing facility from converting to long-stay placement.

Design

Members of the SCAN S/HMO and those in Medicare Fee-For-Service were compared on successful discharge to the community after being admitted to nursing facilities between January 1, 2001, and December 31, 2003.

Setting

Skilled nursing facilities in 4 counties in Southern California (Los Angeles, Orange, San Bernardino, Riverside).

Participants

Data (N = 4635) were extracted from Minimum Data Set (MDS) 2.0 records for nursing facility residents in the S/HMO or the Medicare Fee-for-Service 5% sample who were aged 65 and older with an episode of care greater than 14 days.

Measurements

Predisposing, enabling, and need measures were used to predict successful discharge to the community within 90 days.

Results

After controlling for selected sociodemographics, comorbidities, behavioral issues, mental health conditions, and other risk factors, being enrolled in the S/HMO increased the likelihood of successful discharge by 26%.

Conclusion

With systemic increases in short-stay patients, research on diversion must look past the avoidance of unnecessary entry to nursing facilities, to the successful transition of short-stay residents to the community. As described in this study, the S/HMO model is an important but largely unaddressed method of avoiding the conversion to long-stay.

Section snippets

Methods

We compared older adults in nursing facilities in 4 counties in Southern California according to whether they were insured under Medicare Fee-For-Service (FFS) or SCAN Health Plan, the S/HMO that served these communities. SCAN, located in Southern California, was one of the original sites of the S/HMO demonstration. As an S/HMO, SCAN provided the full range of Medicare benefits offered by standard Medicare HMOs plus additional services such as care coordination, prescription drug coverage,

Results

As shown in Table 2, the average age of the sample was 83 years. The sample was 67% female, 29% married, and 74% White; 75% had at least a high school education. Compared with those in the Medicare FFS sample, SCAN members were significantly older, more likely to be male, be married, be white, have higher education, live alone, and not have Medicaid. Although there were fewer differences in need variables, SCAN members were less likely to be depressed and have fewer comorbidities and were more

Discussion

After controlling for a number of factors associated with long-stay placement, enrollment in the SCAN S/HMO increased the likelihood of community transition within 90 days by 26%. These results suggest that the S/HMO model may help avoid long-stay placement by supporting residents' transition from the nursing facility before converting to long stay.

Studies examining the extent to which the S/HMO model affected placement in nursing facilities have had conflicting results (see Fischer et al. for

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Cited by (11)

Profile of Nursing Home Residents Admitted Directly From Home
2017, Journal of the American Medical Directors Association
Citation Excerpt :
The unit of analysis for the study was an individual episode of care. Unlike stays, which tend to overinflate discharge rates,14,15 episodes of care represent a NH stay without an intervening discharge of more than 30 days and were used as the unit of analysis in this study.16 An episode began when the resident was admitted to the NH as identified on the MDS full admission assessment.16
Advance knowledge about the characteristics of nursing home residents admitted directly from home.
The Minimum Data Set (MDS) for all free-standing, certified nursing homes in the United States from July 2007 to July 2008 was used to construct episodes of care. Descriptive and bivariate analyses were performed to examine admission profiles for all older adults aged 65 years and older who were newly admitted to the nursing home from home as indicated on their initial admission assessment. Admission characteristics were examined by discharge disposition at 90 days to illicit similarities and differences between the groups.
An average of 5.3% of all newly admitted nursing home residents were admitted directly from home with substantial state variations (2.8% in Florida to 17% in Iowa). Overall, 52.68% of these residents had limited to extensive activities of daily living dependency and moderate cognitive impairment. The most common diagnoses included dementia and diabetes. While 65% of residents admitted from home converted to long stay, 20% were discharged to the community, 9% died, and 6% were discharged to the hospital within 90 days of admission, but there was a large variability of these percentages among states.
Findings suggest that the percentage of residents admitted directly from home and their discharge disposition had substantial variations at the state level. Better understanding of the reasons for admission to the nursing home and long-term outcomes is needed to anticipate and plan for care to address unmet care needs and promote aging-in-place.
Gender Differences in Institutional Long-Term Care Transitions
2015, Women's Health Issues
Citation Excerpt :
Thus, in the context of transitional care, it is particularly important to explore whether various sociodemographic (i.e., predisposing) factors, socioeconomic and family (i.e., enabling) factors, and health and functioning (i.e., need) factors operate differently for women and men in shaping their likelihood of discharge and post-discharge living patterns, taking into account the duration of their institutional stay. Previous research shows that nursing home discharge is largely a function of health needs (Mehr, Williams, & Fries, 1997; Murtaugh, 1994; Thomas et al., 2010), and women tend to have greater health needs than men (Case & Paxson, 2005). In addition to need factors, however, several predisposing and enabling characteristics of nursing home residents are also found to be importantly related to discharge and post-discharge living arrangements.
This study investigates the relationship between gender, the likelihood of discharge from institutional long-term care (LTC) facilities, and post-discharge living arrangements, highlighting sociodemographic, health, socioeconomic, and family characteristics.
We use the Health and Retirement Study to examine individuals age 65 and older admitted to LTC facilities between 2000 and 2010 (n = 3,351). We examine discharge patterns using survival analyses that account for the competing risk of death and estimate the probabilities of post-discharge living arrangements using multinomial logistic regression models.
Women are more likely than men to be discharged from LTC facilities during the first year of stay. Women are more likely to live alone or with kin after discharge, whereas men are more likely to live with a spouse or transfer to another institution. Gender differences in the availability and use of family support may partly account for the gender disparity of LTC discharge and post-discharge living arrangements.
Our findings suggest that women and men follow distinct pathways after LTC discharge. As local and federal efforts begin to place more emphasis on the transition from LTC facilities to prior communities (e.g., transitional care initiatives under the Patient Protection and Affordable Care Act), policymakers should take these gender differences into account in the design of community transition programs.
Aging in Place
2012, Journal of the American Medical Directors Association
Reducing the likelihood of long-stay nursing facility placement through health plan-linked community services
2010, Journal of the American Medical Directors Association
Treatment of depression in nursing home residents without significant cognitive impairment: A systematic review
2017, International Psychogeriatrics
Who is in the revolving door? Policy and practice implications of recurrent reports to adult protective services
2020, Journal of Elder Abuse and Neglect

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: This research was supported in part by the National Institute on Aging T32 AG000037 and the data were made available through funding from SCAN Health Plan.

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Original StudyConversion Diversion: Participation in a Social HMO Reduces the Likelihood of Converting From Short-Stay to Long-Stay Nursing Facility Placement

Objectives

Design

Setting

Participants

Measurements

Results

Conclusion

Section snippets

Methods

Results

Discussion

J Chronic Dis

Predicting elderly people's risk for nursing home placement, hospitalization, functional impairment and mortality: A comparative review and analysis

Med Care Res Rev

Do non-institutional long-term care services reduce Medicaid spending?

Health Aff

Fixing to Stay: A National Survey of Housing and Home Modification Issues

Physical rehabilitation following Medicare prospective payment for skilled nursing facilities

Health Serv Res

Going home: Community reentry of light care nursing facility residents age 65 and over

J Health Care Finance

Nursing Home Transition Programs: Perspectives of State Medicaid Officials

Long-term care after Olmsted v. L.C.: Will the potential of the ADA's integration mandate be achieved?

J Contemp Health Law Policy

Original Study
Conversion Diversion: Participation in a Social HMO Reduces the Likelihood of Converting From Short-Stay to Long-Stay Nursing Facility Placement