emerging profiles of michigan long-term care users mary l. james, m.a. brant e. fries, ph.d....

Emerging Profiles of Michigan Long-Term Care Users

Mary L. James, M.A.Brant E. Fries, Ph.D.

University of Michigan

March 23, 2006

Agenda

Compare people who use nursing homes with people using home- and community-based services (HCBS)

Temporal trends Selected sub-populations Next steps

Notes

1999-2005 data from MDCH data warehouse

MDS (NH) and MDS-HC (HC) All people, not only Medicaid eligibles 2005 data from Jan-June Admission = all admissions in year Prevalence = assessment closest to

July 1st of that year

Number of Annual NH Admissions is Growing

0

10,000

20,000

30,000

40,000

50,000

60,000

NH HCBS

Number of NH Admissions is Growing – From Hospitals

0

10000

20000

30000

40000

50000

60000

NH HCBS

From Hospital

NH Admissions Increasingly Physically Dependent

0%

25%

50%

75%

100%

Dependent

Limited

Independ

NH HCBS

ADL Hierarchy

HC Admissions Increasingly Cognitively Dependent

0%

25%

50%

75%

100%

DependentLimitedIndepend

NH HCBS

CPS Scale

RUG-III Categories at Admission

0%

25%

50%

75%

100%

RehabExtensSpecialClinCompImpairCogBehaviorPhysical

NH HCBS

Q1A/Q1B – NH Prevalence

0% 25% 50% 75% 100%

Prefer communitySupport positive

Identifying LTC Sub-populations

SMI (any of 4)• verbally abusive, physically abusive, socially inappropriate• hallucinations, delusions• bipolar disease, schizophrenia• symptoms of depression

Short stay• Admission from hospital (NH)• Medicare (NH)• LOS < 90 days (both NH and HCBS)

Long stay: >1 year Age <45 years Note: subpopulations overlap somewhat

Selected Sub-Population Notes

Used 2004 (last year with full data, as some pops had low prevalence)

Some differences in NH and HC definitions (long- and short-stay)

SMI not really SMI

National Study: Some Diagnoses Decline with Age

0%

10%

20%

30%

40%

50%

60%

0-4 5-14 15-24

25-34

35-44

45-54

55-64

65+

Age Decade

ID/Seizures

ID/Seizures&Quad

Hemi- or Quadriplegia

National Study: Some Diagnoses Increase in Middle Age

0%

10%

20%

30%

40%

50%

60%

0-4 5-14 15-24

25-34

35-44

45-54

55-64

65+

Age Decade

ID/Seizures

ID/Seizures&Quad

Hemi- or Quadriplegia

Multiple Sclerosis

National Study: Some Diagnoses Increase in Old Age

0%

10%

20%

30%

40%

50%

60%

0-4 5-14 15-24

25-34

35-44

45-54

55-64

65+

Age Decade

ID/Seizures

ID/Seizures&Quad

Hemi- or Quadriplegia

Multiple Sclerosis

CVA with Hemiplegia

Alzheimer’s Disease

Cancer

Cardiac Conditions

Prevalence of Selected Subpopulations

0%

10%

20%

30%

40%

50%

60%

NH HCBS

ADL Special Pops

0%

25%

50%

75%

100%

DependentLimitedIndepend

NH HCBS

Cognition Special Pops

0%

25%

50%

75%

100%

DependentLimitedIndepend

NH HCBS

WHERE THEY CAME FROM - NH

0%

25%

50%

75%

100%

OtherHomeOther NHHospital

Q1a/Q2a by NH Subpopulations

0%

25%

50%

75%

100%

Q1aQ2a

NH HCBS

Prevalence of Conditions in HC Subpopulations

0%

25%

50%Head Trauma

Multiple Sclerosis

Alzheimer's

Dementia other thanAlzheimer's

Hemiplegia/Hemiparesis

Cancer (not including skincancer)

Falls

Prevalence of Conditions in HC Subpopulations

0%

25%

50%Head Trauma

Multiple Sclerosis

Alzheimer's

Dementia other thanAlzheimer's

Hemiplegia/Hemiparesis

Cancer (not including skincancer)

Falls

Prevalence of Conditions in HC Subpopulations

0%

25%

50%Head Trauma

Multiple Sclerosis

Alzheimer's

Dementia other thanAlzheimer's

Hemiplegia/Hemiparesis

Cancer (not including skincancer)

Falls

Prevalence of Conditions in HC Subpopulations

0%

25%

50%

Head Trauma

Multiple Sclerosis

Alzheimer's

Other Dementia

Hemiplegia/Hemiparesis

Cancer (not skin)

Falls

Results

Following slide shows output from preliminary analysis

Groups (boxes) with lighter color

more like Passages individuals Groups with darker colors

less like Passages individuals

A B CD

E

X

Results – “Focused Approach”

Groups “most like” Passages individuals:• < 65, in facility 60d-2yr, at most mildly

cognitively impaired (A, B, D)• < 65, in facility >2yr, with hemiplegia,

quadriplegia, or paraplegia (C)• 65+ age, in facility 60d-2yr, in lowest RUG-III

case-mix groups, cognitively intact (E)• Focused target is 1.5% of entire NF population

– 62.2% sensitivity– 98.5 specificity

Next Steps

Link new data with:• Medicaid identifiers• Death records• Length of stay information

Examine longitudinal outcomes Identify “boutique” populations

• What are your ideas to define these? Make data available to UoM LTC researchers Could we forge a common research agenda?

Contact Us

mljames@umich.edu bfries@umich.edu www.interrai.org