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Emerging Profiles of Michigan Long-Term Care Users

Mary L. James, M.A. Brant E. Fries, Ph.D. University of Michigan March 23, 2006. Emerging Profiles of Michigan Long-Term Care Users. Agenda. Compare people who use nursing homes with people using home- and community-based services (HCBS) Temporal trends Selected sub-populations

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Emerging Profiles of Michigan Long-Term Care Users

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  1. Mary L. James, M.A. Brant E. Fries, Ph.D. University of Michigan March 23, 2006 Emerging Profiles of Michigan Long-Term Care Users

  2. Agenda • Compare people who use nursing homes with people using home- and community-based services (HCBS) • Temporal trends • Selected sub-populations • Next steps

  3. Notes • 1999-2005 data from MDCH data warehouse • MDS (NH) and MDS-HC (HC) • All people, not only Medicaid eligibles • 2005 data from Jan-June • Admission = all admissions in year • Prevalence = assessment closest to July 1st of that year

  4. Number of Annual NH Admissions is Growing HCBS NH

  5. Number of NH Admissions is Growing – From Hospitals From Hospital HCBS NH

  6. NH Admissions Increasingly Physically Dependent ADL Hierarchy NH HCBS

  7. HC Admissions Increasingly Cognitively Dependent CPS Scale NH HCBS

  8. RUG-III Categories at Admission NH HCBS

  9. Q1A/Q1B – NH Prevalence

  10. Identifying LTC Sub-populations • SMI (any of 4) • verbally abusive, physically abusive, socially inappropriate • hallucinations, delusions • bipolar disease, schizophrenia • symptoms of depression • Short stay • Admission from hospital (NH) • Medicare (NH) • LOS < 90 days (both NH and HCBS) • Long stay: >1 year • Age <45 years • Note: subpopulations overlap somewhat

  11. Selected Sub-Population Notes • Used 2004 (last year with full data, as some pops had low prevalence) • Some differences in NH and HC definitions (long- and short-stay) • SMI not really SMI

  12. National Study: Some Diagnoses Decline with Age

  13. National Study: Some Diagnoses Increase in Middle Age

  14. National Study: Some Diagnoses Increase in Old Age

  15. Prevalence of Selected Subpopulations NH HCBS

  16. ADL Special Pops NH HCBS

  17. Cognition Special Pops NH HCBS

  18. WHERE THEY CAME FROM - NH

  19. Q1a/Q2a by NH Subpopulations NH HCBS

  20. Prevalence of Conditions in HC Subpopulations

  21. Prevalence of Conditions in HC Subpopulations

  22. Prevalence of Conditions in HC Subpopulations

  23. Prevalence of Conditions in HC Subpopulations

  24. Results • Following slide shows output from preliminary analysis • Groups (boxes) with lighter color  more like Passages individuals • Groups with darker colors  less like Passages individuals

  25. X C A B D E

  26. Results – “Focused Approach” • Groups “most like” Passages individuals: • < 65, in facility 60d-2yr, at most mildly cognitively impaired (A, B, D) • < 65, in facility >2yr, with hemiplegia, quadriplegia, or paraplegia (C) • 65+ age, in facility 60d-2yr, in lowest RUG-III case-mix groups, cognitively intact (E) • Focused target is 1.5% of entire NF population • 62.2% sensitivity • 98.5 specificity

  27. Next Steps • Link new data with: • Medicaid identifiers • Death records • Length of stay information • Examine longitudinal outcomes • Identify “boutique” populations • What are your ideas to define these? • Make data available to UoM LTC researchers • Could we forge a common research agenda?

  28. Contact Us • mljames@umich.edu • bfries@umich.edu • www.interrai.org

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