Abstract
Purpose of the Study: To compare the risk of long-term nursing home (NH) admission and the level of functional and cognitive impairment at the time of long-term NH admission in the Program of All-Inclusive Care for the Elderly (PACE) and in 1915(c) aged and aged and disabled waiver programs. Design and Methods: Cohorts of new waiver and PACE enrollees in 12 states were identified (in 2005-2007) and followed (through 2009) using the Medicaid Analytic Extract and the Minimum Data Set. Individual-level outcomes of interest were time from waiver or PACE enrollment to long-term (90+ days) NH admission and functional (29-point activities of daily living [ADL]) and cognitive (7-point Cognitive Performance Scale [CPS]) impairment at NH admission. An overall measure of impairment was also created and categorized as low (ADL < 17 and CPS < 3) versus high (ADL ≥ 17 or CPS ≥ 3). The key independent variable was enrollment in PACE versus waiver program. County-level covariates were included. Analyses employed multivariable models including competing risk proportional hazard and linear and logistic regressions. Results: Compared with waiver enrollees, PACE enrollees had 31% lower risk of long-term NH admission (p < .001). At NH admission, they were overall significantly (p < .0001) more cognitively impaired (0.34 point), with 55% higher odds of severe (CPS ≥ 4) cognitive impairment (p < .001) and 45% higher odds of having overall high impairment (p = .003). Implications: PACE may be more effective than 1915(c) aged and aged and disabled waiver programs in reducing long-term NH use and may be particularly well suited to supporting cognitively impaired individuals, enabling them to remain in the community longer.
Original language | English (US) |
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Pages (from-to) | 300-308 |
Number of pages | 9 |
Journal | Gerontologist |
Volume | 57 |
Issue number | 2 |
DOIs | |
State | Published - Apr 1 2017 |
All Science Journal Classification (ASJC) codes
- Gerontology
- Geriatrics and Gerontology
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New Jersey Institute for Successful Aging (NJISA)
Chopra, A. (Manager), Perweiler, E. (Other), Pruchno, R. (Other) & Nagele, R. (Other)
Geriatric - NJISAEquipment/facility: Facility