Medicaid in Residential Care. Services: Provided and Used

09/01/2013

A major policy question is whether RCFs that serve Medicaid residents offer the same type and level of services as RCFs that do not serve Medicaid beneficiaries and whether Medicaid residents use the same services as non-Medicaid residents. Table 4a and Table 4b present services offered by all RCFs and by Medicaid status. The table is divided into two sections. Table 4a presents the data at the facility level and Table 4b includes the same data, but is for facilities in which the residents live (i.e., the resident level). Data show that almost all RCFs--between 93.4 percent and 99.4 percent--provide basic health monitoring, incontinence care, and assistance with ADLs. In contrast, fewer than half of RCFs provide skilled professional services (nursing, occupational and physical therapy, and counseling), and only 57.2 percent provide case management. Fewer facilities provide transportation to educational programs (26.7 percent); transportation to a sheltered workshop, work training program, or supported employment (19.4 percent); or social services counseling (34.6 percent).

TABLE 4a. Services Offered by Facility, by Medicaid Status
Services Offered by Facility1 Total RCF FacilitiesN=2,302 (%) Non-Medicaid FacilitiesN=1.292 (%) Facilities Serving Any Residents on MedicaidN=998 (%) Significance Test p-value

SOURCE: RTI analysis of the 2010 NSRCF.

NOTES:

  1. The list of services offered by facilities and the list of services used by residents are slightly different because of differences between the two surveys.

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

Special diets 92.6 92.9 92.2 ns
Skilled nursing 38.8 31.0 49.1 ***
Basic health monitoring 96.2 94.9 97.8 **
Assistance with ADLs 99.4 99.5 99.2 ns
Incontinence care 93.4 94.3 92.2 *
Social/recreational activities in the facility 98.8 98.5 99.2 ns
Social/recreational activities outside the facility 78.8 76.8 81.3 **
Transportation to medical appointments 80.7 81.4 79.8 ns
Transportation to stores/elsewhere 75.0 74.5 75.6 ns
Transportation to educational programs 26.7 23.7 30.7 **
Transportation to a sheltered workshop/work training program/supported employment   19.4 15.4 24.7 ***

Services offered by facilities are generally the same by Medicaid status and when differences exist, a higher proportion of Medicaid RCFs provide the service. Of note, 49.1 percent of Medicaid RCFs provide skilled nursing services compared to only 31.0 percent of non-Medicaid RCFs, a statistically significant difference.

More statistically significant differences exist at the resident level. A statistically significantly higher proportion of Medicaid residents than non-Medicaid residents use each of the services listed, with the exception of ADL assistance and social and recreational activities inside and outside the facility. The survey did not collect data at the resident level for several services: transportation to educational programs or a sheltered workshop, work training program, or supported employment; case management services; and occupational and physical therapies.

TABLE 4b. Services Used by Resident, by Medicaid Status
Services Used by Residents1 All ResidentsN=8,094 (%) Non-Medicaid ResidentsN=6,122 (%) Medicaid ResidentN=1,904 (%) Significance Test p-value

SOURCE: RTI analysis of the 2010 NSRCF.

NOTES:

  1. The list of services offered by facilities and the list of services used by residents are slightly different because of differences between the two surveys.

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

Social services counseling 34.6 28.6 42.5 ***
Case management services 57.2 54.2 61.0 **
Occupational therapy 40.0 41.1 39.1 ns
Physical therapy 43.9 43.0 45.0 ns
Personal laundry 99.3 99.2 99.5 ns
Linen laundry services 97.1 97.2 97.0 ns
Special diets 30.7 28.8 38.5 ***
Skilled nursing 12.6 11.1 18.7 ***
Basic health monitoring 75.1 74.0 80.8 ***
Assistance with ADLs 69.2 69.1 70.6 ns
Incontinence care 37.6 37.2 40.4 *
Transportation to medical appointments 58.9 55.6 72.4 ***
Transportation to stores/elsewhere 39.3 37.8 45.3 ***
Social service counseling 15.8 12.5 29.9 ***
Personal laundry 86.6 84.9 94.4 ***
Linen laundry services 84.4 83.5 88.6 **
Social/recreational activities in the facility 80.3 80.9 78.5 ns
Social/recreational activities outside the facility   44.7 44.3 46.8 ns

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