Exploring the Association Between the Quality of HIV Care in Nursing Homes and Hospitalization

Abstract

Persons living with HIV/AIDS (PLWH) are living long enough to need age-related and HIV-related nursing home (NH) care. Nursing home quality of care has been associated with risk for hospitalization, but it is unknown if quality of HIV care in NHs affects hospitalization in this population. We assessed HIV care quality with four national measures adapted for the NH setting. We applied the measures to 2011–2013 Medicare claims linked to Minimum Data Set assessments of resident health, prescription dispensing data, and national reports of NH characteristics. Cox proportional hazards models calculated the risk of all-cause and HIV/AIDS-related hospitalization by HIV care compliance. We identified 1,246 PLWH in 201 NHs with 382 all-cause and 63 HIV/AIDS-related hospitalizations. Nursing home HIV care compliance varied from 24.9% to 64.7%. After regression adjustment, we could detect no difference in all-cause or HIV/AIDS-related hospitalizations by NH HIV care compliance. We postulate that the lack of association may be due to inappropriate HIV care quality measures that do not accurately represent NHs ability to care for PLWH. There is urgent need to create valid NH HIV care quality measures.

Management of HIV in the older adults: Clinical and public health challenge

“…Despite the surge in older PLWH, little data has thus far been collected regarding long‐term care options for these patients. A recent study by Olivieri‐Mui et al., 2021 found that of the 1246 PLWH studied who were admitted to nursing homes, nearly 74% were male, relatively young (mean age of 59.9, SD = 12.02), and were mostly entitled to Medicare due to disability (69.9%). A 2017 study by Naudet examined some of the challenges and obstacles that older PLWH faced when seeking admission to nursing or long‐term care facilities.…”

“…As the number of new PLWH enter long‐term care facilities and nursing homes increases, steps should be taken to ensure that the staff caring for these patients are competent in meeting the unique needs of older (or even younger) PLWH (Justice & Akgün, 2019; Olivieri‐Mui, 2021). Multidisciplinary health care teams are vital to deal with the complex clinical and psychosocial issues facing this population.…”

“…professionals advocate for continued funding of Medicare/Medicaid and full implementation of the ACA. Ready availability of health insurance navigators is also vital since they can help guide older PLWH through the complexities of obtaining affordable health insurance and help make certain they have the correct coverage for their specific medical needs.As the number of new PLWH enter long-term care facilities and nursing homes increases, steps should be taken to ensure that the staff caring for these patients are competent in meeting the unique needs of older (or even younger) PLWH(Justice & Akgün, 2019;Olivieri-Mui, 2021). Multidisciplinary health care teams are vital to deal with the complex clinical and psychosocial issues facing thispopulation.…”