Where Are The Missing Elders? The Decline In Nursing Home Use, 1985 And 1995

Bishop, Christine E.

doi:10.1377/hlthaff.18.4.146

Cited by 156 publications

(96 citation statements)

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“…Over time, residents and/or their families may learn that the initial home is not providing the desired levels or types of services as well as an alternative home could. Even if the initial choice was optimal when it was made, health and functional status can change (Bishop 1988;Gillen et al 1996).…”

Section: Does Quality Influence Consumer Choice Of Nursing Homes? Evimentioning

confidence: 99%

“…The nature of nursing home care has changed over the last decade as the medical acuity and the frailty of nursing home residents have risen, while the length of stay for nursing home residents has decreased (Bishop 1999). Subsequently, more, fewer, or different specialized services (e.g., rehabilitative therapies, Alzheimer's units) may be appropriate for residents, and their needs may change dramatically as health status changes.…”

Section: Does Quality Influence Consumer Choice Of Nursing Homes? Evimentioning

confidence: 99%

“…As in other health policy arenas, the effects of competition in long-term care markets on outcomes such as access, quality, and cost are debated often (e.g., Grabowski and Hirth 2003;Hirth 1999;Nyman 1988aNyman , 1988bBishop 1988). Long-term care is provided primarily by private firms, both for-profit and nonprofit.…”

Section: Does Quality Influence Consumer Choice Of Nursing Homes? Evimentioning

confidence: 99%

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Does Quality Influence Consumer Choice of Nursing Homes? Evidence from Nursing Home to Nursing Home Transfers

Hirth

Banaszak-Holl²,

Fries³

et al. 2003

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We estimated Cox proportional hazards models using assessment data from the Minimum Data Set to test whether nursing home residents and their proxies respond to quality of care by changing providers. Various indicators of poor quality increased the likelihood of transfer. Residents of for-profit homes or homes with excess capacity also were more likely to transfer. Inability to participate in care decisions and factors indicating frailty limited residents' ability to transfer. The apparent responsiveness to quality is encouraging. Nonetheless, because the absolute transfer rate is low, significant barriers to movement among nursing homes still may exist.

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Section: Does Quality Influence Consumer Choice Of Nursing Homes? Evimentioning

confidence: 99%

Section: Does Quality Influence Consumer Choice Of Nursing Homes? Evimentioning

confidence: 99%

Section: Does Quality Influence Consumer Choice Of Nursing Homes? Evimentioning

confidence: 99%

See 1 more Smart Citation

Does Quality Influence Consumer Choice of Nursing Homes? Evidence from Nursing Home to Nursing Home Transfers

Hirth

Banaszak-Holl²,

Fries³

et al. 2003

INQUIRY

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show abstract

“…But the past two decades have seen a radical shift in the composition of long-term care spending. Nursing home usage has fallen substantially; between 1985 and 1995, there was an 8.2% decline in the share of elderly who reported staying overnight in a nursing facility on a given day (Bishop 1999). And there has been a parallel substantial rise in long-term care delivered in the home setting, "home health care", over the same period, with an 82% increase in the share of Medicare beneficiaries who used home care and a 208% increase in the number of home care visits per user (U.S. Congress 2000).…”

Section: Introductionmentioning

confidence: 99%

Home Care Reimbursement, Long-term Care Utilization, and Health Outcomes

McKnight

2004

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Long-term care currently comprises almost 10% of national health expenditures and is projected to rise rapidly over coming decades. A key, and relatively poorly understood, element of long-term care is home health care. I use a substantial change in Medicare reimbursement policy, which took the form of tightly binding average per-patient reimbursement caps, to address several questions about the market for home care. I find that the reimbursement change was associated with a large drop in the provision of home care. This drop was concentrated among unhealthy beneficiaries, which is consistent with the incentives for patient selection inherent in the per-patient caps. I find that the decline in home health utilization was not offset by increases in institutional long-term care or other medical care and that there were no associated adverse health consequences. However, approximately one-quarter of the decline in Medicare spending was offset by increases in out-of-pocket expenditures for home health care, with the offset concentrated in higher income populations. Despite the value of home health care implied by the out-of-pocket expenditures, I find that the welfare implications of the reimbursement change were ambiguous. *

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“…It has been shown that in the US an increase of time spent living as a couple due to relatively increased male life expectancy could lead to a greater supply of informal care and a decrease of health and long-term care expenditure due to a decreased number of individuals living in nursing homes. 22,23 Changes in healthy life expectancy differ between the young old (< age 85) and the oldest old (age 85+). As for the former, the evidence is again mixed.…”

mentioning

confidence: 99%

Is there a Wealth Dividend of Aging Societies?

2010

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Apocalyptic views on the social, economic and health consequences of aging abound. This review examines the potential upside of aging, in particular from a public health perspective. First, we review the evidence on whether there is healthy aging in the sense of a compression of morbidity: people spending fewer of the life years gained in poor health. The evidence turns out to be decidedly mixed, depending on the country, the data and perhaps most critically on the definition of "health" considered. Second, we explore the potential and actual labour market impact a healthy elderly population could make. We find considerable support for the notion that if only effective retirement age was raised to reflect past and future increases in life expectancy, then the result could be a significant increase in elderly labour force participation rates. Moreover, a significant share of the already retired elderly population is in good health, indicating a potential unused capacity for the labour market. Third, we turn to the impact of improved health (especially among the elderly) on healthcare expenditures. In general, evidence does not support the optimistic expectation that improved health will mitigate or even reverse the trend of increasing health expenditures. Even if better health may, in some circumstances, lead to lower healthcare spending, other cost drivers, in particular technological advances, will more than outweigh any such expenditure-reducing effect. On the other hand, there is not much support for the hypothesis that better health by itself is a major cost driver. Policy can make a difference in facilitating the realisation of the potential benefits of a healthy aging scenario. This does, however, require a coordinated approach between social, economic and health policy and will enter into policy arenas in which the political costs of reform, despite their expected societal benefits, may become a bottleneck that is hard to overcome.

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Where Are The Missing Elders? The Decline In Nursing Home Use, 1985 And 1995

Cited by 156 publications

References 1 publication

Does Quality Influence Consumer Choice of Nursing Homes? Evidence from Nursing Home to Nursing Home Transfers

Does Quality Influence Consumer Choice of Nursing Homes? Evidence from Nursing Home to Nursing Home Transfers

Home Care Reimbursement, Long-term Care Utilization, and Health Outcomes

Is there a Wealth Dividend of Aging Societies?

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