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Managed care reduces hospitalizations in nursing home residents with advanced dementia
Date:9/26/2013

BOSTON Nursing home residents with advanced dementia commonly experience burdensome, costly interventions that do not improve their quality of life or extend their survival. Now a new study suggests that providing intensive primary care services may result in less burdensome and less costly care for these terminally ill residents.

Led by researchers at the Harvard Medical School-affiliated Institute for Aging Research at Hebrew SeniorLife, New York University School of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, the study appears in the Sept. 23 online issue of JAMA Internal Medicine.

The researchers analyzed data from 291 nursing home residents with advanced dementia, comparing those who were covered by managed care insurance to those enrolled in traditional fee-for-service Medicare insurance.

Most of these residents are dually eligible for traditional Medicare, which pays for hospital care and physician services on a fee-for-service basis, and Medicaid, which pays nursing homes for daily room, board and nursing care. Since nursing homes do not receive higher reimbursement to manage acutely ill long-term-care residents on-site, they have an incentive to transfer these residents to the hospital, temporarily shifting the cost of care from Medicaid to Medicare. In contrast, managed care programs combine Medicare and Medicaid costs for dual-eligible nursing home residents.

"Under managed care, the fiscal incentive for hospitalizing acutely ill nursing home residents with end-stage dementia goes away," explained co-author Susan L. Mitchell, M.D., M.P.H., a senior scientist at the Institute for Aging Research whose grants in part supported the research."We'd like policymakers to understand that this is an example of how a change in the system can lead to less burdensome, more affordable care."

Patients with advanced dementia no longer recognize their families, depend on others fo
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Contact: Jennifer Davis
jdavis@hsl.harvard.edu
617-363-8282
Hebrew SeniorLife Institute for Aging Research
Source:Eurekalert

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