Skip to main content

Advertisement

SpringerLink
Log in

The effects of state-level expenditures for home- and community-based services on the risk of becoming a long-stay nursing home resident after hip fracture

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

This study measures the effect of spending policies for long-term care services on the risk of becoming a long-stay nursing home resident after a hip fracture. Relative spending on community-based services may reduce the risk of long-term nursing home residence. Policies favoring alternative sources of care may provide opportunities for older adults to remain community-bound.

Introduction

This study aims to understand how long-term care policies affect outcomes by investigating the effect of state-level spending for home- and community-based services (HCBSs) on the likelihood of an individual’s nursing home placement following hip fracture.

Methods

This study uses data from the 5 % sample of Medicare beneficiaries from 2005 to 2010 to identify incident hip fractures among dual-eligibility, community-dwelling adults aged at least 65 years. A multilevel generalized estimating equation (GEE) model estimated the association between an individual’s risk of nursing home residence within 1 year and the percent of states’ Medicaid long-term support service (LTSS) budget allocated to HCBS. Other covariates included expenditures for Title III services and individual demographic and health status characteristics.

Results

States vary considerably in HCBS spending, ranging from 17.7 to 83.8 % of the Medicaid LTSS budget in 2009. Hip fractures were observed from claims among 7778 beneficiaries; 34 % were admitted to a nursing home and 25 % died within 1 year. HCBS spending was associated with a decreased risk of nursing home residence by 0.17 percentage points (p 0.056).

Conclusions

Consistent with other studies, our findings suggest that state policies favoring an emphasis on HCBS may reduce nursing home residence among low-income older adults with hip fracture who are at high risk for institutionalization.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. National Hospital Discharge Survey (NHDS), National Center for Health Statistics (2014) Hospital discharges by first- and any-listed listed diagnosis: US, 1990–2010. Retrieved from: http://205.207.175.93/HDI/TableViewer/tableView.aspx. Accessed 13 October 2014

  2. Leibson CL, Tosteson AN, Gabriel SE, Ransom JE, Melton LJ (2002) Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriatr Soc 50:1644–1650. doi:10.1046/j.1532-5415.2002.50455.x

    Article  PubMed  Google Scholar 

  3. Bentler SE, Liu L, Obrizan M, Cook EA, Wright KB, Geweke JF, Chrischilles EA, Wallace RB, Ohsfeldt RL, Jones MP, Rosenthal GE, Wolinsky FD (2009) The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol 170(10):1290–1299. doi:10.1093/aje/kwp266

    Article  PubMed  PubMed Central  Google Scholar 

  4. Braithwaite RS, Col NF, Wong JB (2003) Estimating hip fracture morbidity and costs. J Am Geriatr Soc 51:364–370. doi:10.1046/j.1532-5415.2003.51110.x

    Article  PubMed  Google Scholar 

  5. Dolan MM, Hawkes WG, Zimmerman SI, Morrison RS, Gruber-Baldini AL, Hebel JR, Magaziner J (2000) Delirium on hospital admission in aged hip fracture patients: prediction of mortality and 2-year functional outcomes. J Gerontol A Biol Sci Med Sci 55(9):M527–M534. doi:10.1093/gerona/55.9.M527

    Article  CAS  PubMed  Google Scholar 

  6. Farahmand BY, Michaelsson K, Ahlbom A, Ljunghall S, Baron JA, Swedish Hip Fracture Study Group (2005) Survival after hip fracture. Osteoporo Int 16(12):1583–1590. doi:10.1007/s00198-005-2024-z

    Article  Google Scholar 

  7. Haentjens P, Magaziner J, Colon-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, Boonen S (2010) Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 152(6):380–390. doi:10.7326/0003-4819-152-6-201003160-00008

    Article  PubMed  PubMed Central  Google Scholar 

  8. Handoll HH, Cameron ID, Mak JC, Finnegan TP (2009) Multidisciplinary rehabilitation for older people with hip fractures. Cochrane Database Syst Rev 7(4):CD007125. doi:10.1002/14651858.CD007125.pub2

  9. de Luise C, Brimacombe M, Pedersen L, Sorensen HT (2008) Comorbidity and mortality following hip fracture: a population-based cohort study. Aging Clin Exp Res 20(5):412–418. doi:10.1007/BF03325146

    Article  PubMed  Google Scholar 

  10. Tajeu GS, Delzell E, Smith W, Arora T, Curtis JR, Saag KG, Morrisey MA, Yun H, Kilgore ML (2014) Death, debility, and destitution following hip fracture. J Gerontol A Biol Sci Med Sci 69(3):346–353. doi:10.1093/gerona/glt105

    Article  PubMed  Google Scholar 

  11. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22(3):465–475. doi:10.1359/jbmr.061113

    Article  PubMed  Google Scholar 

  12. Centers for Medicare & Medicaid Services (2014, November 3) 1915(c) Home & Community-Based Waivers. Retrieved from http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Home-and-Community-Based-1915-c-Waivers.html Accessed on 14 October 2014

  13. Kitchener M, Ng T, Miller N, Harrington C (2005) Medicaid home and community-based services: national program trends. Health Aff (Millwood) 24(1):206–212. doi:10.1377/hlthaff.24.1.206

    Article  Google Scholar 

  14. Miller NA (2011) Relations among home- and community-based services investment and nursing home rates of use for working-age and older adults: a state-level analysis. Am J Public Health 101(9):1735–1741. doi:10.2105/AJPH.2011.300163

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ng T, Stone J, Harrington C (2014) Medicaid home and community-based services: how consumer access is restricted by state policies. J Aging Soc Policy. doi:10.1080/08959420.2015.969078

    Google Scholar 

  16. Lester RS, Irvin CV, Lim W (2013) Recent developments in state efforts to rebalance long-term services and supports. Mathematica policy research reports from the field. Retrieved from http://www.mathematica-mpr.com/~/media/publications/pdfs/health/mfpfieldrpt13.pdf Accessed 13 October 2014

  17. Thomas KS, Mor V (2013) Providing more home-delivered meals is one way to keep older adults with low care needs out of nursing homes. Health Aff (Millwood) 32(10):1796–1802. doi:10.1377/hlthaff.2013.0390

    Article  Google Scholar 

  18. Thomas KS, Mor V (2013) The relationship between Older Americans Act Title III state expenditures and prevalence of low-care nursing home residents. Health Serv Res 48(3):1215–1226. doi:10.1111/1475-6773.12015

    Article  PubMed  Google Scholar 

  19. Thomas KS (2014) The relationship between Older Americans Act in-home services and low-care residents in nursing homes. J Aging Health 26(2):250–260. doi:10.1177/0898264313513611

    Article  PubMed  Google Scholar 

  20. Rahman M, Tyler D, Thomas KS, Grabowski DC, Mor V (2014) Higher Medicare SNF care utilization by dual-eligible beneficiaries: can Medicaid long-term care polices be the answer? Health Serv Res. doi:10.1111/1475-6773.12204

    PubMed Central  Google Scholar 

  21. Kilgore ML, Morrisey MA, Becker DJ, Gary LC, Curtis JR, Saag KG, Yun H, Matthews R, Smith W, Taylor A, Arora T, Delzell E (2009) Health care expenditures associated with skeletal fractures among Medicare beneficiaries, 1999–2005. J Bone Miner Res 24(12):2050–2055. doi:10.1359/jbmr.090523

    Article  PubMed  Google Scholar 

  22. Taylor AJ, Gary LC, Arora T, Becker DJ, Curtis JR, Kilgore ML, Morrisey MA, Saag KG, Matthews R, Yun H, Smith W, Delzell E (2011) Clinical and demographic factors associated with fractures among older Americans. Osteoporo Int 22(4):1263–1274. doi:10.1007/s00198-010-1300-8

    Article  CAS  Google Scholar 

  23. Yun H, Kilgore ML, Curtis JR, Delzell E, Gary LC, Saag KG, Morrisey MA, Becker D, Matthews R, Smith W, Locher JL (2010) Identifying types of nursing facility stays using Medicare claims data: an algorithm and validation. Health Service Outcome Res Methodol 10(1):100–110. doi:10.1007/s10742-010-0060-4

    Article  Google Scholar 

  24. Eiken S, Sredl K, Gold L, Kasten J, Burwell B, Saucier P (2013) Medicaid expenditures for long term services and supports in 2011. Truven Health Analytics. Retrieved from: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Supports/Downloads/LTSS-Expenditure-Narr-2011.pdf. Accessed October 29, 2014

  25. Eiken S, Sredl K, Gold L, Kasten J, Burwell B, Saucier P (2014) Medicaid expenditures for long-term services and supports in FFY 2012. Truven Health Analytics. Retrieved from: http://www.nasuad.org/sites/nasuad/files/LTSS_Expenditures_2012.pdf. Accessed October 29, 2014

  26. Schneeweiss S, Wang PS, Avorn J, Glynn RJ (2003) Improved comorbidity adjustment for predicting mortality in Medicare populations. Health Serv Res 38:1103–1120

    Article  PubMed  PubMed Central  Google Scholar 

  27. Muramatsu N, Yin H, Campbell RT, Hoyem RL, Jacob MA, Ross CO (2007) Risk of nursing home admission among older Americans: does states’ spending on home- and community-based services matter? J Gerontol B Psychol Sci Soc Sci 62(3):S169–S178

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kemper P, Weaver F, Short PF, Shea D, Kang H (2008) Meeting the need for personal care among the elderly: does Medicaid home care spending matter? Health Serv Res 43:344–362. doi:10.1111/j.1475-6773.2007.00762.x

    Article  PubMed  PubMed Central  Google Scholar 

  29. Muramatsu N, Yin H, Hedeker D (2010) Functional declines, social support, and mental health in the elderly: does living in a state supportive of home and community-based services make a difference? Soc Sci Med 70:1050–1058. doi:10.1016/j.socscimed.2009.12.005

    Article  PubMed  PubMed Central  Google Scholar 

  30. Muramatsu N, Hoyem RL, Yin H, Campbell RT (2008) Place of death among older Americans: does state spending on home- and community-based services promote home death? Med Care 46(8):829–838. doi:10.1097/MLR.0b013e3181791a79

    Article  PubMed  PubMed Central  Google Scholar 

  31. Thomas KS, Keohane L, Mor V (2014) Local Medicaid home- and community-based services spending and nursing home admissions of younger adults. Am J Public Health 104:e15–e17. doi:10.2105/AJPH.2014.302144

    Article  PubMed  PubMed Central  Google Scholar 

  32. Locher JL, Wellman NS (2011) Never the twain shall meet: dual systems exacerbate malnutrition in older adults recently discharged from hospitals. J Nutr Gerontol Geriatr 30(1):24–28. doi:10.1080/01639366.2011.545039

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Source or support

Data used in this research were obtained through funding provided by Amgen, Inc. The authors maintained complete control of the data, analytical results, and the drafting and revision of this manuscript. The authors have no other disclosures.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, RPHB 330K, 1720 2nd Ave S, Birmingham, AL, 35294-0022, USA

    J. Blackburn, D. J. Becker & M. L. Kilgore

  2. Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham School of Medicine, 933 19th Street South, CH19 218, Birmingham, AL, 35294-2041, USA

    J. L. Locher

  3. Department of Health Policy and Management, School of Public Health, 306 SPH Administration Building, Texas A&M University, College Station, TX, 77843-1266, USA

    M. A. Morrisey

Authors
  1. J. Blackburn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. L. Locher
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. A. Morrisey
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. J. Becker
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. L. Kilgore
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Blackburn.

Appendix A

Appendix A

Table 4 Description of the changes in per capita expenditures for Medicaid long-term support services (LTSSs) and per population aged 60 Title III expenditures by state between 2006 and 2009
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Blackburn, J., Locher, J.L., Morrisey, M.A. et al. The effects of state-level expenditures for home- and community-based services on the risk of becoming a long-stay nursing home resident after hip fracture. Osteoporos Int 27, 953–961 (2016). https://doi.org/10.1007/s00198-015-3327-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-015-3327-3

Keywords

Search

Navigation