Medicaid in Residential Care. Resident Demographic, Health, and Functional Characteristics

09/01/2013

FIGURE 3. Resident Characteristics, by Medicaid Status

FIGURE 3a shows the proportion of residents with certain demographic characteristics, by Medicaid status. STACKED BARS #1: Medicaid residents--65 and over (69.1), Under 65 years (31.0); Non-Medicaid residents--65 and over (94.3), Under 65 years (5.7). STACKED BARS #2: Medicaid residents--Female (65.2), Male (34.8); Non-Medicaid residents--Female (70.6), Male (29.4). STACKED BARS #3: Medicaid residents--Other (6.3), Black non-Hispanic (11.8), White non-Hispanic (81.9); Non-Medicaid residents--Other (4.2), Black non-Hispanic (2.6), White non-Hispanic (93.2).

FIGURE 3b shows the proportion of residents with certain demographic characteristics, by Medicaid status. STACKED BARS #1: Medicaid residents--Never married (30.4), Widowed (41.7), Divorced/Legally separated (20.4), Married (7.5); Non-Medicaid residents--Never married (9.7), Widowed (68.2), Divorced/Legally separated (7.7), Married (14.5). STACKED BARS #2: Medicaid residents--Some college or more (20.9), High school or less (79.1); Some college or more (45.4), High school or less (54.6).

SOURCE: RTI International analysis of the NSRCF.

NOTE: Differences shown are statistically significant at p<0.05.

Of the estimated 727,125 RCF current residents in 2010, 137,655 residents (19 percent) had their LTC services paid by Medicaid in the 30-day period preceding the survey. Figure 3 compares Medicaid and non-Medicaid residents on five demographic characteristics. Non-Medicaid residents are older than Medicaid residents--94.3 percent are 65 years or older compared to 69.1 percent of Medicaid residents; only 5.7 percent of non-Medicaid residents are under age 65, whereas 31.0 percent of Medicaid residents are non-elderly. A larger proportion of Medicaid residents than non-Medicaid residents are male, minority, and unmarried. Medicaid residents are less well-educated than non-Medicaid residents. Almost four-fifths (79.1 percent) of Medicaid residents had a high school education or less compared to about half (54.6 percent) of non-Medicaid residents. All of these differences are statistically significant.

Medicaid residents generally have longer length of stay (LOS) than do non-Medicaid residents, especially among people with very long LOS (Figure 4). About a quarter (23.7 percent) of Medicaid residents have stays in excess of five years compared to 13.1 percent of non-Medicaid residents, a statistically significant difference.

FIGURE 5. Resident Health Conditions, by Medicaid Status

FIGURE 5 shows the proportion of residents with arthritis, stroke, congestive heart failure and diabetes by Medicaid status. BAR CHART: Arthritis--Medicaid Residents (25.0), Non-Medicaid Residents (27.8); Stroke--Medicaid Residents (11.8), Non-Medicaid Residents (10.8); Congestive heart failure--Medicaid Residents (13.5), Non-Medicaid Residents (13.3); Diabetes--Medicaid Residents (26.5), Non-Medicaid Residents (15.1).

SOURCE: RTI International analysis of the NSRCF.

NOTE: Differences for comparisons for residents with diabetes, by Medicaid status are statistically significant at p<0.001. Other comparisons are not statistically significant at p<0.05 or less.

Figure 5 presents data showing whether a doctor or other health professional ever told residents whether they had four common chronic health conditions: arthritis, stroke, congestive heart failure, and diabetes. Medicaid and non-Medicaid residents differ very little with respect to these health conditions, with the exception of diabetes. A higher proportion of Medicaid than non-Medicaid residents have diabetes (26.5 percent compared to 15.1 percent), a statistically significant difference. The reasons for this difference are unclear, but one possible explanation is that Medicaid residents are more likely to be minorities who have a higher prevalence of type 2 diabetes (Centers for Disease Control & Prevention, 2011).

FIGURE 6. Residential Care Facility Residents' Cognitive and Mental Health, by Medicaid Status

FIGURE 6 shows hte proportion of  residential care facility residents with cognitive and mental health conditions, by Medicaid status. It includes data on Alzheimer's disease and other dementia as well as intellectual and developmental disabilities. BAR CHART: Alzheimer's disease/other dementia--Medicaid Residents (34.8), Non-Medicaid Residents (43.9); Intellectual/developmental disabilities--Medicaid Residents (11.0), Non-Medicaid Residents (1.6); Serious mental illness--Medicaid Residents (18.9), Non-Medicaid Residents (4.9).

SOURCE: RTI International analysis of the NSRCF.

NOTE: Differences shown are statistically significant at p<0.001.

 

The NSRCF excluded facilities that exclusively serve individuals with intellectual disabilities or serious mental illness, but a small proportion of the sampled residents have these conditions. As shown in Figure 6, a significantly higher proportion of Medicaid than non-Medicaid residents have intellectual disabilities or serious mental illness. On the other hand, a significantly higher proportion of non-Medicaid than Medicaid residents have Alzheimer's disease or other dementias, reflecting the greater proportion of individuals aged 75 and older among non-Medicaid residents. These differences are statistically significant.

FIGURE 7. Residential Care Facility Residents: ADL Limitations, by Medicaid Status

FIGURE 7 shows the proportion of residents with no ADL limitations, 1-2 ADL impairments, and 3-5 ADL limitations, by Medicaid status. STACKED BAR CHART: Medicaid residents--0 ADLs (24.9), 1-2 ADLs (38.3), 3-5 ADLs (36.8); Non-Medicaid residents--0 ADLs (25.8), 1-2 ADLs (36.0), 3-5 ADLs (37.7); Total--0 ADLs (25.7), 1-2 ADLs (36.9), 3-5 ADLs (37.4).

SOURCE: RTI International analysis of the NSRCF.

NOTE: Differences are not statistically significant at p<0.05 or less.


FIGURE 8. Residential Care Facility Residents: IADL Limitations, by Medicaid Status

FIGURE 8 shows the proportion of residents with no IADL limitations, 1-2 ADL impairments, and 3-4 ADL limitations and 5 IADL limitations, by Medicaid status. STACKED BAR CHART: Medicaid residents--1-2 ADLs (19.7), 3-5 ADLs (47.9), 5 IADLs (31.5); Non-Medicaid residents--0 ADLs (5.6), 1-2 ADLs (18.2), 3-5 ADLs (45.8), 5 IADLs (30.5); Total--0 ADLs (4.8), 1-2 ADLs (18.5), 3-5 ADLs (46.0), 5 IADLs (30.6).

SOURCE: RTI International analysis of the NSRCF.

NOTES: The proportion of Medicaid residents with no IADL limitations is not displayed because the sample size is too small (n<30) to report by National Center for Health Statistics Standards. Differences shown are not statistically significant at p<0.05 or less.

Three-quarters of all residents have limitations in ADLs, with 37.4 percent having three or more. The mean number of ADL limitations for all residents is 1.9 and the mean number of instrumental activity of daily living (IADL) limitations is 3.5 (not shown). Figure 7 and Figure 8 show that virtually no differences by Medicaid status exist in the distribution of the number of ADL and IADL limitations.9 On these two measures, Medicaid and non-Medicaid residents appear to be about equally disabled.

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