An Analysis of the Heterogeneity of U.S. Nursing Home Patients

Abstract

Research has shown that the nursing home patient population is quite heterogeneous in terms of both individual patient characteristics and service needs. Furthermore, existing administrative classifications do a poor job of representing this heterogeneity. As a consequence we have conducted an analysis of the individual and service characteristics of two types of patients represented in the National Nursing Home Survey of 1977 (i.e., patients whose primary source of payment was Medicare and patients whose primary payment source was not Medicare). In this analysis we identified patterns of individual characteristics within the two patient groups and showed how these patterns related to their service needs. The logic of the model permitted us both to establish patterns of characteristics within the two payment types and to examine the implications of individual heterogeneity remaining in the classification. This makes the methodology useful both as a research tool for understanding the nature of the nursing home population and as a tool for studying the consequences of various classification schemes for questions of identifying service patterns and needs as well as the evaluation of policy options.

Protein‐Calorie Undernutrition in the Nursing Home

“…Within any nursing home, the patients differ substantially with regard to: 1. the reason for chronic institutionalization (eg, neurodegenerative or vascular dementia; status post cerebrovascular accident; status post hip fracture; advanced arthritis; psychosis; or a lesser degree of impairment or very old age in a person who lacks a social support system); 2. mode of feeding (self‐fed, fed with assistance, or tube‐fed); 3. functional caparities (ability to walk, transfer and toilet oneself); 4. degree of cognitive impairment 51,52 . The “case mix” shown in category C of Table 2 varies between nursing homes 53–57 .…”

Conceptual and measurement issues in assessing disability cross-nationally: Analysis of a WHO-sponsored survey of the disablement process in Indonesia

“…The GOM model was designed to describe chronic disease processes where there was considerable variation in the way individuals expressed the disease process through time (Clive et al 1983;Manton, Liu, and Cornelius 1985;Manton and Soldo 1985;Manton and Vertrees 1984;Woodbury et al 1978;Woodbury and Manton 1982). GOM described this variation by using continuous scores to relate each patient to a small set of discrete disease types or profiles.…”

Morbidity and disability patterns in four developing nations: Their implications for social and economic integration of the elderly

“…The procedure has been applied successfully in a series of analyses of functionally disabled elderly persons where those functional limitations interact with other health characteristics (Clive, Woodbury and Siegler 1983;Manton, Liu and Cornelius 1985;Manton et aL 1986a, b). The special feature of the GOM analysis that makes it appropriate for analysis of the interaction of morbidity and disability is that the groups it defines are not exclusive, i.e., a person may be a partial member of more than one group in the sense that one's observed characteristics represent a mixture of the characteristics from two or more of the analytically defined groups.…”