Table 2.
Use and Expenditures Associated With Medicare Services Among Nursing Home Residents With Advanced Dementiaa
| Service | All Residents (N=323)
|
Residents Who Died Before End of Study (n=177)
|
||||||
|---|---|---|---|---|---|---|---|---|
| Total | Mean (SD)b | Per 90 Daysc | Proportion of Total, % | Total | Mean (SD)b | Per 90 Daysc | Proportion of Total, % | |
| Inpatient | ||||||||
| No. of admissions | 74 | 0.2 (0.6) | … | … | 41 | 0.2 (0.6) | … | … |
| No. of days | 425 | 1.3 (4.4) | … | … | 256 | 1.4 (4.8) | … | … |
| Expenditures, $ | 830 105 | 2570 (7512) | 625 | 30.2 | 412 752 | 2332 (6832) | 928 | 33.2 |
| Emergency department | ||||||||
| No. of visits | 60 | 0.2 (1.3 | … | … | 15 | 0.1 (0.3) | … | … |
| Expenditures, $ | 29 059 | 90 (549) | 22 | 1.1 | 7656 | 43 (167) | 17 | 0.6 |
| Skilled nursing facility | ||||||||
| No. of admissions | 31 | 0.1 (0.4) | … | … | 17 | 0.1 (0.4) | … | … |
| No. of days | 905 | 2.8 (12.7) | … | … | 389 | 2.2 (10.6) | … | … |
| Expenditures, $ | 310 999 | 963 (4355) | 234 | 11.3 | 133 832 | 756 (3485) | 301 | 10.8 |
| Primary care provider | ||||||||
| No. of visits | 4826 | 14.9 (11.4) | … | … | 1797 | 10.2 (9.6) | … | … |
| Expenditures, $ | 327 593 | 1014 (823) | 247 | 11.9 | 120 729 | 682 (697) | 272 | 9.7 |
| Hospice | ||||||||
| No. of admissionsd | 78 | 0.2 (0.5) | … | … | 56 | 0.3 (0.5) | … | … |
| No. of days | 9516 | 29.5 (90.4) | … | … | 4291 | 24.2 (65.6) | … | … |
| Expenditures, $ | 1 254 799 | 3885 (11 859) | 1050 | 45.6 | 568 544 | 3212 (8617) | 1279 | 45.7 |
| Total, $ | 2 752 555 | 8522 (15 705) | 2073 | 100.0 | 1 243 513 | 7026 (12 919) | 2797 | 100.0 |
a
Expenditures are based on a 18-month observation period. All expenditures are based on nationally representative 2007 Medicare payment rates.
b
The mean is the average expenditure per resident over the entire 18-month observation period, independent of survival time.
c
The rate per 90 days is calculated as (total expenditure/total number of person-days) × 90 days.
d
There were a total of 78 hospice admissions; 71 of 323 residents (22%) had at least 1 admission (65 residents had only 1 admission; 5 residents had 2 admissions; and 1 resident had 3 admissions).