Post‐acute care transitions and outcomes among medicare beneficiaries in assisted living communities

Abstract

Background Despite the rapid growth of assisted living (AL) and frequent hospitalizations among AL residents, little is known about their patterns of post‐acute care transitions and outcomes. This study examined the post‐acute care transitions among AL residents and their association with outcomes in the first 30 and 60 days after hospital discharge. Methods This study used data from 2018 national Medicare enrollment and claims datasets, the Minimum Data Set (MDS), and Medicare Provider Analysis and Review (MedPAR) of 104,497 unique Medicare beneficiaries residing in ALs in the U.S. Post‐acute care referrals, based on hospital discharge status, to skilled nursing facilities (SNF), home with home health care (HHC), home without HHC, and other settings. Outcomes included 30‐day and 60‐day hospital readmissions, emergency department (ED) visits, long‐stay care nursing home placement, and mortality. Multinomial logistic regression analysis and logistic regression analysis were conducted. Results The most common post‐acute care referral was to SNF (40%), followed by home without HHC (28%), home with HHC (17%), and others (15%). Compared to discharge home without HHC, discharge to SNF was associated with a lower likelihood of ED visits (Odds Ratio = 0.597, p < 0.01) and hospital readmissions (OR = 0.856, p < 0.001), and higher likelihood of long‐stay nursing home placement (OR = 11.224, p < 0.01) and mortality (OR = 2.025, p < 0.01). Discharge home with HHC was associated with a higher likelihood of hospital readmissions (OR = 1.148, p < 0.01) and a lower likelihood of long‐stay nursing home placement (OR = 0.737, p < 0.05) than discharge home without HHC. The results were similar within the first 30 days as well as 60 days after hospital discharge. Conclusions AL residents who are discharged to different post‐acute care settings tend to differ in 30‐day and 60‐day outcomes. At hospital discharge, clinicians and discharge planners should be provided information about the exact type and availability of services at AL to make the most appropriate discharge referrals for AL residents.

The Relative Importance of Hospital Discharge and Patient Composition in Changing Post-Acute Care Utilization and Outcomes Among Medicare Beneficiaries

“… 17 , 18 , 24 , 25 , 36 For some patients and families, professional supports were critical when caregiving at home was not an option. 11 , 26 , 29 Recently developed telemonitoring service might be a solution to the geographic disparities in access to home-based services. 18 , 27 , 28 , 30 Regardless, a patient-centered customized roadmap on possible discharge options and expected outcomes will help the interest parties to make complicated medical decisions.…”

“…and service-specific outcomes (eg, functionality improvement, etc.) will provide additional perspectives in the field, 11 , 26 , 28 , 40 , 41 especially given the fact that post-acute care and hospital readmissions are the 2 major drivers for cost variations overall. 16 , 40 , 42 - 44 Fifth, as with many studies that used administrative data, this study lacks information from patient perspectives.…”

“…Short-term responses in health outcomes may include changes in mortality and hospital readmissions. 7 , 21 , 26 Long-term health outcomes could include physical and cognitive functional deterioration in the remainder of the life span due to missed or delayed detection or treatment in the corresponding post-acute care settings. 27 – 29 These short- and long-term health outcomes will further lead to the projected changes in care costs, with significant social and economic implications for the patients, families, caregivers, 30 and the whole care sector and subsectors.…”

Post‐acute care transitions and outcomes among Medicare beneficiaries with dementia: Associations with race/ethnicity and dual status

“…For the general Medicare population, Werner and colleagues have shown that discharge to HHC was associated with higher rates of readmissions, but no impact on mortality 5 . Another national study of Medicare beneficiaries residing in assisted living communities, showed a similar pattern of increased 30‐day readmissions for those receiving HHC, but a lower likelihood of 30‐day mortality 6 …”

“…5 Another national study of Medicare beneficiaries residing in assisted living communities, showed a similar pattern of increased 30-day readmissions for those receiving HHC, but a lower likelihood of 30-day mortality. 6 Medicare beneficiaries diagnosed with Alzheimer's disease or related dementia (ADRD) are known to be at an increased risk of hospitalizations and subsequent transitions across care settings. [7][8][9] To date, little is known about PAC transitions among community-dwelling Medicare ADRD population, and even less about how different PAC settings may impact their outcomes.…”