Does Home- and Community-Based Care Affect Nursing Home Use?
Does Home- and Community-Based Care Affect Nursing Home Use?
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DOI：
10.1080/08959420.2013.766069
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发表时间：
2013-04-01
影响因子：
5.1
通讯作者：
Wysocki, Andrea
中科院分区：
文献类型：
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作者：
Kane, Robert L.;Lum, Terry Y.;Wysocki, Andrea
一项研究评估了随着医疗补助计划在家庭和社区服务（HCBS） 1915(c)豁免中的投资在七个州的增加，养老院居民的数量、支出和病例组合的变化。这七个州提供了2001年至2005年的医疗补助支出和使用数据，包括豁免和州计划使用数据。最小数据集用于养老院居民。有三个州还使用了社区评估数据。在六个州，养老院的客户数量随着HCBS客户数量的增加而减少。然而，在大多数州，额外豁免客户的数量往往大大超过疗养院居民的减少。养老院的支付略有下降，但这种下降被HCBS豁免和国家计划支出的增加所抵消，导致2001年至2005年长期支持服务（LTSS）支出的净增长。豁免支出的增长超过了豁免客户的增长，表明在客户扩大的基础上，服务的扩大。显示HCBS大幅增加的州显示疗养院病例组合仅略有增加。疗养院居民的病例组合比HCBS用户的病例组合更严重。更多的HCBS使用将吸走不太严重的LTSS用户，从而导致养老院的病例组合增加，这一预期部分得到了满足。疗养院中更严重的病例组合表明，HCBS服务的是一些以前在疗养院得到照顾的人，但许多人没有得到照顾。促进以卫生保健服务替代机构护理的努力将需要更积极主动的战略，例如转移。
A study was conducted to assess change in numbers, expenditures, and case mix of nursing home residents as Medicaid investment in home- and community-based services (HCBS) 1915(c) waivers increased in seven states. The seven states provided Medicaid expenditure and utilization data from 2001 to 2005, including waiver and state plan utilization. The Minimum Data Set was used for nursing home residents. For three states, community assessment data were also used. In six states, the number of nursing home clients decreased as the numbers of HCBS clients grew. However, in most states, the number of additional waiver clients often greatly exceeded reductions in nursing home residents. Nursing home payments decreased moderately, but this decrease was offset by increases in HCBS waiver and state plan expenditures, leading to a net increase in long-term support services (LTSS) expenditures from 2001 to 2005. Increases in waiver expenditures outpaced increases in waiver clients, indicating expansion of services on top of expansion in clients. States that showed substantial increases in HCBS showed only modest increases in nursing home case mix. The case mix for nursing home residents was more acute than that for HCBS users. The expectation that greater HCBS use would siphon off less severe LTSS users and hence lead to a higher case mix in nursing homes was partially met. The more acute case mix in nursing homes suggests that HCBS serves some individuals who were previously cared for in nursing homes but many who were not. Efforts to promote substitution of HCBS for institutional care will require more proactive strategies such as diversion.