Outcomes After Community Discharge From Skilled Nursing Facilities: The Role of Medicaid Home and Community-Based Services

Abstract

This study investigated the association between Medicaid Home and Community-Based Services (HCBS) generosity and post-discharge outcomes among dual-eligible beneficiaries discharged from skilled nursing facilities (SNFs). We linked multiple national datasets for duals discharged from SNFs between 2010 and 2013. Accounting for SNF fixed effects, we estimated the effect of HCBS generosity, measured by its breadth and intensity, on the likelihood of remaining in the community, risks of death, nursing home (NH) admission, and hospitalizations within 30 and 180 days after SNF discharge. We found that higher HCBS generosity was associated with an increased likelihood of remaining in the community. HCBS breadth and intensity were both significantly associated with reduced risks of NH admission, while higher HCBS intensity was related to a reduced risk of acute hospitalizations within 30 days after discharge. Our findings suggest that more generous HCBS programs may facilitate smoother transitions and sustainable community living following SNF discharge.

Keywords

home and community-based care and services long-term services and supports health outcomes Medicaid

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References

Abt Associates Inc . (2019). Nursing home compare ClaimsBased quality measure technical specifications. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/Nursing-Home-Compare-Claims-based-Measures-Technical-Specifications.pdf#:∼:text=This-claims-based-quality-measure-was-first-reported-by,the-specifications-and-risk-adjustment-methodology-for-this-measure

Acumen . (2016). Discharge to community claims-based measure for home health: Risk adjustment methodology. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Downloads/DTC_Risk_Adjustment_Methodology_07DEC2016-3-v3.pdf

Allen

S. M.

Piette

E. R.

Mor

(2014). The adverse consequences of unmet need among older persons living in the community: Dual-eligible versus Medicare-only beneficiaries. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 69(Suppl 1), S51–S58. https://doi.org/10.1093/geronb/gbu124

American Council on Aging . (2022). 2021 nursing home costs by state and region. Accessed Jan 8th. https://www.medicaidplanningassistance.org/nursing-home-costs/

Carnahan

J. L.

Slaven

J. E.

Callahan

C. M.

Torke

A. M.

(2017). Transitions from skilled nursing facility to home: The relationship of early outpatient care to hospital readmission. Journal of the American Medical Directors Association, 18(10), 853–859. https://doi.org/10.1016/j.jamda.2017.05.007

Caswell

K. J.

Waidmann

T. A.

Wei

(2021). Measuring Medicaid service utilization among dual MedicareMedicaid enrollees using fee-forService and encounter claims. Urban Institute. Accessed Jan 18th. https://www.urban.org/sites/default/files/publication/104788/measuring-medicaid-service-utilization-among-dual-medicare-medicaid-enrollees-using-fee-for-service-and-encounter-claims-t-msis-analytic-files-data-quality_0.pdf

Coughlin

T. A.

McBride

T. D.

Perozek

Liu

(1992). Home care for the disabled elderly: Predictors and expected costs. Health Services Research, 27(4), 453. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1069889/

DHHS . (2019). Long-term care providers and services users in the United States, 2015–2016. Accessed Jan 8th. https://stacks.cdc.gov/view/cdc/76253

Gaugler

J. E.

Duval

Anderson

K. A.

Kane

R. L.

(2007). Predicting nursing home admission in the US: A meta-analysis. BMC geriatrics, 7, 1–14. https://doi.org/10.1186/1471-2318-7-13

10.

Gonçalves

Weaver

Konetzka

R. T.

(2020). Measuring state Medicaid home care participation and intensity using latent variables. Journal of Applied Gerontology, 39(7), 731–744. https://doi.org/10.1177/0733464818786396

11.

Guo

Temkin-Greener

(2021). Community discharge among post-acute nursing home residents: An association with patient safety culture? Journal of the American Medical Directors Association, 22(11), 2384–2388.e1. https://doi.org/10.1016/j.jamda.2021.04.022

12.

Hesselink

Flink

Olsson

Barach

Dudzik-Urbaniak

Orrego

Toccafondi

Kalkman

Johnson

J. K.

Schoonhoven

Vernooij-Dassen

European HANDOVER Research Collaborative . (2012). Are patients discharged with care? A qualitative study of perceptions and experiences of patients, family members and care providers. BMJ Quality & Safety, 21(Suppl 1), i39–i49. https://doi.org/10.1136/bmjqs-2012-001165

13.

HRSA . (2013). Area health resources files. https://data.hrsa.gov/data/download?data=AHRF#AHRF

14.

Irvin

C. V.

Denny-Brown

Bohl

Schurrer

Lim

SweetlLester

Peebles

(2015). ‘Money follows the person 2013 annual evaluation report executive summary’. Mathematica Policy Research. https://www.mathematica.org/-/media/publications/pdfs/health/mfp_2013_annualrpt.pdf

15.

KFF . (2022). ‘Medicaid home & community-based services: People served and spending during COVID-19’. Accessed Spet 2nd. https://www.kff.org/report-section/medicaid-home-community-based-services-people-served-and-spending-during-covid-19-issue-brief/

16.

KFF . (2023). How many people use Medicaid long-term services and supports and how much does Medicaid spend on those people? Accessed Jan 8th. https://www.kff.org/medicaid/issue-brief/how-many-people-use-medicaid-long-term-services-and-supports-and-how-much-does-medicaid-spend-on-those-people/

17.

Konetzka

R. T.

Karon

S. L.

Potter

D. E. B.

(2012). Users of Medicaid home and community-based services are especially vulnerable to costly avoidable hospital admissions. Health Affairs, 31(6), 1167–1175. https://doi.org/10.1377/hlthaff.2011.0902

18.

LaPlante

M. P.

Kaye

H. S.

Kang

Harrington

(2004). Unmet need for personal assistance services: Estimating the shortfall in hours of help and adverse consequences. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 59(2), S98–S108. https://doi.org/10.1093/geronb/59.2.s98

19.

Lefaivre

K. A.

Macadam

S. A.

Davidson

D. J.

Gandhi

Chan

Broekhuyse

H. M.

(2009). Length of stay, mortality, morbidity and delay to surgery in hip fractures. The Journal of Bone & Joint Surgery British Volume, 91(7), 922–927. https://doi.org/10.1302/0301-620X.91B7.22446

20.

MedPAC . (2018). Report to the Congress: Medicare payment policy. https://www.medpac.gov/wp-content/uploads/import_data/scrape_files/docs/default-source/reports/mar18_medpac_entirereport_sec_rev_0518.pdf

21.

MedPAC . (2021). Report to the Congress: Medicare payment policy. Accessed Sept 2nd. https://www.medpac.gov/wp-content/uploads/2021/10/mar21_medpac_report_ch7_sec.pdf

22.

Mistiaen

Duijnhouwer

Wijkel

de Bont

Veeger

(1997). The problems of elderly people at home one week after discharge from an acute care setting. Journal of Advanced Nursing, 25(6), 1233–1240. https://doi.org/10.1046/j.1365-2648.1997.19970251233.x

23.

Newcomer

Kang

LaPlante

Kaye

(2005). Living quarters and unmet need for personal care assistance among adults with disabilities. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 60(4), S205–S213. https://doi.org/10.1093/geronb/60.4.s205

24.

Puhani

(2000). The Heckman correction for sample selection and its critique. Journal of Economic Surveys, 14(1), 53–68. https://doi.org/10.1111/1467-6419.00104

25.

Reistetter

Bokov

Schmidt

Prochaska

Haas

Lin

M.-L.

Dean

Kuo

Y.-F.

Eschbach

(2022). Association of social determinants of health measures and successful community discharge across rehabilitation service areas. Archives of Physical Medicine and Rehabilitation, 103(12), e186–e187. https://doi.org/10.1016/j.apmr.2022.08.942

26.

Wang

Temkin-Greener

Simning

Konetzka

R. T.

Cai

(2021). Medicaid home-and community-based services and discharge from skilled nursing facilities. Health Services Research, 56(6), 1156–1167. https://doi.org/10.1111/1475-6773.13690

27.

Wang

Yan

Temkin-Greener

Cai

(2021). Nursing home admissions for persons with dementia: Role of home-and community-based services. Health Services Research, 56(6), 1168–1178. https://doi.org/10.1111/1475-6773.13715

28.

Wolff

J. L.

Nicholas

L. H.

Willink

Mulcahy

Davis

Kasper

J. D.

(2019). Medicare spending and the adequacy of support with daily activities in community-living older adults with disability: An observational study. Annals of Internal Medicine, 170(12), 837–844. https://doi.org/10.7326/M18-2467

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