Use of long-term services and supports among dual-eligible beneficiaries with Alzheimer's disease and related dementias.
Use of long-term services and supports among dual-eligible beneficiaries with Alzheimer's disease and related dementias.
复制标题
患有阿尔茨海默病和相关痴呆症的双重资格受益人使用长期服务和支持。
DOI：
10.1111/jgs.18115
复制
发表时间：
2023
影响因子：
6.3
通讯作者：
McConnell,KJohn
中科院分区：
文献类型：
--
作者：
Kim,Hyunjee;Senders,Angela;Simeon,Erika;Juarez,Cesar;Huang,Sean;Dodge,Hiroko;McConnell,KJohn
背景为了尊重人们对就地养老的偏好并控制成本，许多州的医疗补助计划制定了扩大家庭和社区服务作为护理机构护理的替代方案的政策。然而，人们对医疗补助长期服务和支持 (LTSS) 在国家层面的使用情况知之甚少，特别是在患有阿尔茨海默病和相关痴呆症 (ADRD) 的双重资格受益人中。方法使用 2016 年以来 30 个州的医疗保险和医疗补助索赔，我们重点关注 65 岁或以上患有 ADRD 的双重资格受益人，并描述了他们对任何形式的 LTSS 的使用结果我们发现，80.5% 的 ADRD 双重资格受益人在 2016 年接受了某种形式的医疗补助 LTSS。最常见的 LTSS 环境是护理机构 (46.7%)，其次是家庭 (31.5%) 和社区 (12.2%)。使用任何形式的 LTSS 的 ADRD 双重资格受益人的百分比存在相当大的州差异（从缅因州的 61% 到蒙大拿州的 96%）。各州使用的 LTSS 类型也有很大差异。例如，家庭服务的使用率从缅因州、亚利桑那州和南达科他州的 9% 到俄勒冈州的 62%。在大多数州，护理设施服务是最常见的 LTSS 类型。然而，俄勒冈州、阿拉斯加州和加利福尼亚州的家庭服务使用量超过了护理机构的使用量。结论我们的研究结果表明，患有 ADRD 的双重资格受益人在各州对 LTSS 的使用存在显着差异。鉴于 LTSS 对于这一人群及其家庭的重要性，为了改善各州获得 LTSS 的机会，有必要更深入地了解各州 LTSS 政策以及导致各州 LTSS 使用存在较大差异的其他因素。
BackgroundTo respect people's preference for aging in place and control costs, many state Medicaid programs have enacted policies to expand home and community‐based services as an alternative to nursing facility care. However, little is known about the use of Medicaid long‐term services and supports (LTSS) at a national level, particularly among dual‐eligible beneficiaries with Alzheimer's disease and related dementias (ADRD).MethodsUsing Medicare and Medicaid claims of 30 states from 2016, we focused on dual‐eligible beneficiaries 65 years or older with ADRD and described their use of any form of LTSS and sub‐types of LTSS (home‐based, community‐based, and nursing facility services) across states.ResultsWe found that 80.5% of dual‐eligible beneficiaries with ADRD received some form of Medicaid LTSS in 2016. The most common LTSS setting was nursing facility (46.7%), followed by home (31.5%) and community (12.2%). There was sizeable state variation in the percentage of dual‐eligible beneficiaries with ADRD who used any form of LTSS (ranging from 61% in Maine to 96% in Montana). The type of LTSS used also varied widely across states. For example, home‐based service use ranged from 9% in Maine, Arizona, and South Dakota to 62% in Oregon. Nursing facility services were the most common type of LTSS in most states. However, home‐based service use exceeded nursing facility use in Oregon, Alaska, and California.ConclusionsOur findings suggest substantially different use of LTSS across states among dual‐eligible beneficiaries with ADRD. Given the importance of LTSS for this population and their families, a deeper understanding of state LTSS policies and other factors that contribute to wide state variation in LTSS use will be necessary to improve access to LTSS across states.