Los(t) in Long‐term Care: Empirical Evidence From German Data 2000–2009

Abstract

Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Terms of use: Documents in AbstractUsing microdata, i.e. representative samples of 114,403 German long-term care dependants (LTCDs) observed from 2000 to 2009 we give a comprehensive insight into the length of stay (LOS) in long-term care (LTC). Furthermore, this paper evaluates the effects of longevity on the LOS thus revisiting the debate on the validity of the competing theories of compression or expansion of morbidity in LTC. The analysis finds significant effects on the LOS when age is controlled for thus rejecting the time-to-death hypothesis. However, controlling for assessment level suggests an improved health status of LTCDs over time thus supporting the time-to-death hypothesis. An analysis of the mortality rates of LTCDs is to give insight into the opposing results. But the regression of mortality shows a divergence in the development of mortality rates for different disability levels. This is evidence to suggest that the "improved" health status in LTC is not only due to actual changes in the health status, but also a consequence of political meddling.

Impact of long term care and mortality risk in community care and nursing homes populations

“…From the several aspects mentioned in the literature, which may influence the status at discharge, we selected as explanatory variables the socio-demographic characteristics, medical conditions, cognitive/physical dependence levels at admission and settings of care. Even though the direct association of other factors like the referral entity and length of care is not yet well proven [2,16,18,31], they were used as control variables. In this last analysis, only individuals alive at discharge were included.…”

“…As concluded by several studies, individuals with fewer chronic diseases are more likely to achieve better outcomes [2,4,31]. Finally, whereas global limitations in motor functions at admission combined with cognitive impairment can influence the overall levels of disability at discharge [2][3][4]16,26,29,31,32], limitations in the ability to perform at admission single ADL like the use of a wheelchair [33], walking [34] or transfers (to the toilet and/or to the bed/chair) [35], can also be seen as important outcome predictors.…”

“…After assessing the mortality rate, some authors found no differences between NH and HCBS, either after adjusting for baseline variables (age, gender, race, education, race, education, marital status, length of stay, cognition, and comorbidity) [12] or when comparing patients receiving care at NH, HCBS or combined care [13]. Others found a higher mortality among those at NH [6,[14][15][16].…”

“…Besides the overall differences in outcomes between these two populations, several findings can be highlighted concerning the influence of different variables as predictors of physical and cognitive changes. Older age seems to be related to a higher cognitive impairment [24,25]; moreover, some studies concluded that younger age positively influences the physical improvement [2,4,16,18,26] but others found no significant effect [27][28][29][30]. In most health facilities with similar rehabilitation programmes, men and women are expected to achieve similar progress and outcomes.…”

“…Others concluded that women were twice as likely to show physical improvements compared to men [2]. Within HCBS individuals, one study concluded that women were more likely to achieve functional recovery [4], while others concluded the opposite [16,28].…”