Medicaid in Residential Care. Resident Behavior Problems


Given the high proportion of RCF residents with cognitive impairment, Alzheimer's disease, intellectual and developmental disabilities, and serious mental illness, behavior issues are common in RCFs. The NSRCF asked whether, in the past 30 days, residents exhibited any of the following behaviors: refusing to take prescribed medicines; creating disturbances or being excessively noisy; wandering; refusing to bathe or clean him or herself; rummaging through or taking other people's belongings; damaging or destroying property; verbally threatening staff or other residents; being physically aggressive toward others; removing clothing in public; or making unwanted sexual advances toward staff or other residents.

As shown in Figure 9, there are significant differences in the proportion of Medicaid and non-Medicaid residents who exhibit specific behavior problems. A significantly higher proportion of Medicaid residents exhibit each of the behaviors asked about in the survey except refusing to take prescribed medicines and removing clothing in public. Approximately half of the Medicaid residents (49.5 percent) exhibited at least one of the problem behaviors in the 30 days prior to the survey compared to just over a third of the non-Medicaid residents (34.8 percent), which is a statistically significant difference. Among persons with behavior issues, a significantly higher proportion of Medicaid than non-Medicaid residents were prescribed medication to control the behavior or to reduce agitation--62.6 percent of Medicaid residents compared to 55.5 percent of non-Medicaid residents.

FIGURE 9. RCF Residents: Resident Behaviors, by Medicaid Status

FIGURE 9 shows the proportion of residents exhibiting certain behaviors by Medicaid status.  It also includes the proportion of residents prescribed medications to control behavior and to reduce agitation, by Medicaid status. BAR CHART: Physician prescribed meds to help control behavior to reduce agitation*--Medicaid Residents (63), Non-Medicaid Residents (56); In the past 30 days resident has exhibited any behavior problems--Medicaid (50), Non-Medicaid (35); Making unwanted sexual advances toward staff/other residents--Medicaid (5), Non-Medicaid (2); Physically aggressive towards staff/other residents--Medicaid (12), Non-Medicaid (7); Verbally threatening staff/other residents--Medicaid (15), Non-Medicaid (9); Removed clothing in public--Medicaid (4), Non-Medicaid (3); Damaging/destroying property--Medicaid (5), Non-Medicaid (2); Rummaging through/took other people's belongings--Medicaid (9), Non-Medicaid (7); Refused to take prescribed meds at right time/prescribed dosage--Medicaid (15), Non-Medicaid (14); Refusing to bathe--Medicaid (23), Non-Medicaid (17); Wandering--Medicaid (20), Non-Medicaid (16); Creating disturbances/being excessively noisy--Medicaid (25), Non-Medicaid (14).

SOURCE: RTI International analysis of the NSRCF.

NOTES: Differences shown are statistically significant at p<0.001 or less, with the exception of wandering, rummaging through others belongings and physician has prescribed medication to control behaviors, which are statistically significant at p<0.05 or less. Differences shown for refusing to take prescribed medication at the appropriate time or in the prescribed dose and removing clothing in public are not statistically significant.*Only for residents who had at least one of the behaviors show in the figure.


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