Medicaid in Residential Care. APPENDIX A. Resident Health and Functional Characteristics by Medicaid Status and Age

09/01/2013

Because of significant differences in the age distribution of Medicaid and non-Medicaid residents, we examined health and functional characteristics by age within each Medicaid status and by Medicaid status within each age group. Table A-1 presents the data on resident characteristics by age group and Medicaid status. The first two columns of statistical significance indicators show whether the difference between the proportions of residents in each age group within each Medicaid status category is significant. The last two columns of statistical significance indicators for this table show whether the difference between the proportions of residents in each Medicaid status category within each age group is statistically significant.

Differences exist between the under-65 and 65+ age groups on all but one health condition, diabetes, which had a higher incidence for non-Medicaid residents under age 65 than those aged 65 and older. For residents aged 65 and older, Medicaid residents had a higher incidence of diabetes than non-Medicaid residents. Also, a greater proportion of both Medicaid and non-Medicaid residents under age 65 have intellectual disabilities and serious mental illness, and a greater proportion of both Medicaid and non-Medicaid residents aged 65 and older have Alzheimer's disease or other dementia. A significant difference is observed for residents aged 65 and older with serious mental illness: 10.1 percent of Medicaid residents aged 65 and older have this condition compared to 2.8 percent of non-Medicaid residents aged 65 and older. For residents aged 65 and older, Medicaid residents had a higher incidence of both intellectual disabilities and serious mental illness than non-Medicaid residents. All of the aforementioned differences are statistically significant.

When examining ADL and IADL limitations, we found that age is a significant factor accounting for differences in severity. On average, older residents, regardless of Medicaid status, have more impairments. For both Medicaid and non-Medicaid residents, a significantly greater proportion of residents under age 65 have no limitations and a significantly greater proportion of residents aged 65+ have three or four ADL limitations. The same pattern is found for IADL limitations. A higher proportion of the older residents have IADL impairments--and more IADL impairments--regardless of Medicaid status. On average, for all residents, regardless of age, Medicaid residents had more ADL and IADL limitations than non-Medicaid residents.

TABLE A-1. Resident Demographic and Health Functional Status Characteristics, by Medicaid Status and Age
Resident Characteristics Total RCFPopulation Non-Medicaid ResidentsUnder Age 65 Non-Medicaid ResidentsAge 65 & Over Medicaid ResidentsUnder Age 65 Medicaid ResidentsAge 65 & Over Significance Testp-value for Test ofDifference Between <65 & 65+Non-Medicaid Significance Testp-value for Test ofDifference Between <65 & 65+Medicaid Significance Testp-value for Test ofDifference Between Medicaid &Non-MedicaidUnder age 65 Significance Testp-value for Test ofDifference Between Medicaid &Non-MedicaidAge 65 & Over

SOURCE: RTI analysis of the 2010 NSRCF data.

NOTES:

  1. IADLs include housework, taking medications, managing money, shopping for personal items and use of telephone or other form of communication.
  2. ADLs include eating, dressing, bathing or showering, using the bathroom, and transferring.

# : Sample size is too small (n<=30) to report by National Center for Health Statistics standards.

†† : Estimate cannot be assumed to be reliable; sample size is between 30 and 59 and/or the sample size is greater than 59 but has a relative standard error of 30 percent or more.

* p<0.1, ** p<0.05, *** p<0.001, ns: not significant p>0.1

Unweighted n=8,094 — (A) (B) (C) (D) (A vs B) (C vs D) (A vs C) (B vs D)
Weighted n=733,309 n=8,094 n=552 n=5,570 n=666 n=1,238 --- --- --- ---
Resident characteristics % % % % % --- --- --- ---
Gender
   Male 30.4 58.8 27.7 54.6 25.9 *** *** ns ns
   Female 69.6 41.2 72.3 45.4 74.1 *** *** ns ns
Race/Ethnicity
   Hispanic/Latino 2.9 # 2.8 # 3.4†† ns ns ns ns
   White non-Hispanic 91.1 82.1 93.9 72.3 86.3 *** *** ** ***
   Black non-Hispanic 4.3 12.9 2.0 20.9 7.7 *** *** ** ***
   Asian 1.1 # 1.0 # # ns ns ns ns
   Other 0.7 # 0.4† # # ns ns ** ns
Marital status
   Married 13.1 # 14.9 # 9.3 *** *** ns ***
   Divorced/Legally separated 10.1 30.5 6.3 28.4 16.8 *** *** ns ***
   Widowed 63.2 5.6† 72.0 5.3† 58.0 *** *** ns ***
   Never married 13.7 57.7 6.8 62.7 15.9 *** *** ns ***
Education
   High school or less 59.4 68.9 53.7 84.7 76.5 *** ** *** ***
   Some college or more 40.6 31.1 46.3 15.3 23.5 *** ** *** ***
Resident LOS in a facility
   0-3 months 9.2 10.7 9.5 9.6 6.7 ns * ns **
   More than 3 month less than 6 months 9.2 6.0† 9.9 6.8† 7.8 ** ns ns ns
   More than 6 months and less than 1 year 14.2 12.5 15.3 9.0† 10.6 ns ns ns ***
   More than 1 year and less than 3 years 36.2 27.7 37.3 30.2 35.6 *** * ns ns
   More than 3 years and less than 5 years 16.0 14.1 15.8 13.8 19.1 ns ** ns **
   5 years or more 15.2 29.0 12.1 30.6 20.3 *** *** ns ***
Health conditions
   Arthritis 27.2 10.3 28.9 13.3 30.3 *** *** ns ns
   Stroke 11.0 8.6† 11.0 10.1† 12.6 ns ns ns ns
   Congestive heart failure 13.3 # 13.9 5.1† 17.2 *** *** ns ns
   Diabetes 17.3 22.9 14.6 25.8 26.9 ** ns ns ***
Mental and cognitive health
   Alzheimer's disease/ other dementia 42.1 11.3† 45.9 12.0 45.1 *** *** *** ns
   Intellectual and developmental disabilities 3.4 16.9 0.6† 23.8 5.2 *** *** ns ***
   Serious mental illness such as schizophrenia or psychosis 7.6 40.5 2.8 38.4 10.1 *** *** ns ***
IADL limitations1
   Any IADL limitations 95.2 95.7 94.3 98.7 99.2 ns ns * ***
   Number of IADL limitations --- --- --- --- --- --- --- ns ***
      0 IADLs 4.8 # 5.7 # # ns ns ** ***
      1-2 IADL 18.5 31.1 17.4 32.3 14.0 *** *** ns **
      3-4 IADLs 46.0 48.1 45.6 43.0 50.1 ns ** ns **
      5 IADLS 30.6 16.5 31.3 23.4 35.1 *** *** ** *
Mean  IADL score (0-5) 3.5 3.0 3.5 3.2 3.8 *** *** ** ***
ADL assistance2
   Any ADL limitations 74.3 48.7 75.7 58.7 82.5 *** *** ns **
      0 ADLs 25.4 51.3 24.3 41.3 17.5 *** *** ** ***
      1-2 ADL 37.0 34.0 36.7 35.4 39.6 ns ns ns ns
      3-4 ADLs 31.8 13.1 32.8 21.7 35.8 *** *** ** ns
      5 ADLS 5.9 # 6.2 # 7.1 *** *** ns ns
   Mean ADL score (0-5) 1.9 1.0 2.0 1.4 2.2 *** *** ** **

 

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