1. How Long Did Enrollees Live in Nursing Homes?
Three-quarters of enrollees with new spells of nursing home care had either very short stays or long-term stays (Figure II.1), with 34 percent of all elderly and disabled enrollees discharged within three months of the beginning of the spell and 41 percent having spells of one year or more.11 As suggested above, the shorter stays could be a combination of enrollees receiving some post-acute care, those who died shortly after admission, and those who were not able to be placed in other LTC services.
|FIGURE II.1. Length of First New Nursing Home Spells Among Aged or Disabled Medicaid Enrollees with New Medicaid-Financed Nursing Home Spells Between July 2006 and December 2006|
|SOURCE: Mathematica analysis of 2006-2007 MAX data for 44 states and the District of Columbia with representative FFS nursing home and ICF/IID data (excludes data from Arizona, Indiana, Maine, Minnesota, New Hampshire, and Utah).
NOTES: New spells in this figure are spells beginning between July 1, 2006, and December 31, 2006, inclusive; spells are censored at December 31, 2007. 243,912 enrollees had new nursing home spells beginning between July and December 2006. The median length of first new spells was 211 days for nursing facilities. State-level detail is provided in Appendix Table D.1.
2. Did Enrollees Receiving Nursing Home Care Also Use HCBS?
Although HCBS were introduced as an alternative to nursing home care, HCBS and institutional services could also be complementary services in an integrated system of care, with each type of service meeting a specific level of need. To understand the extent to which these services are used together, we examined patterns of HCBS use prior to and after a nursing home stay. Of all enrollees with new spells in 2007, more than one in five (22.6 percent) used HCBS prior to their stay. Among those with shorter spells of nursing home care -- beginning and ending during the first half of 2007 -- an even greater fraction (27.2 percent) had previously used HCBS. Similarly, 30 percent of enrollees with spells beginning and ending in the second half of 2006 used HCBS in the following year.
|TABLE II.7. HCBS Use Among Aged or Disabled Enrollees with New Nursing Home Spells Between July 2006 and December 2007|
|HCBS Use Category||Percentage|
|First new spells beginning in 2007 preceded by HCBS use in 2006||22.6|
|First new spells beginning in 2007 and ending on or before June 30, 2007, preceded by HCBS use in 2006||30.3|
|First new spells ending in 2006 followed by HCBS use in 2007||27.2|
|SOURCE: Mathematica analysis of 2006-2007 MAX data for 37 states and the District of Columbia with representative FFS nursing home and ICF/IID data and valid HCBS data (excludes data from Arizona, Indiana, Maine, Massachusetts, Michigan, Minnesota, Montana, New Hampshire, Oregon, Pennsylvania, Rhode Island, Texas, and Utah).
NOTES: New spells are spells beginning on or after July 1, 2006. HCBS includes 1915(c) waiver services, personal care services, residential care services, home health, adult day services, and private duty nursing services. Spells are censored at December 31, 2007. New spells beginning in 2007 preceded by HCBS use in 2006 refers to all spells beginning and ending at any time in 2007 (including spells censored as of December 31, 2007) that were associated with an enrollee who used HCBS at any time in 2006; the percentage is taken with respect to all first new spells beginning and ending (possibly censored) in 2007. The percentage of first new spells beginning in 2007 and ending on or before June 30, 2007 preceded by HCBS use in 2006 and the percentage of first new spells ending in 2006 followed by HCBS use in 2007 are defined analogously. State-level detail is provided in Appendix Table D.2.
In many states, enrollees living in nursing homes used HCBS at a substantially higher rate than the overall average.12 At least 35 percent of nursing home residents in six states (Connecticut, Idaho, Iowa, Missouri, New York, and Washington) used HCBS either before or after their nursing home stays.13