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HSR&D 2004 National Meeting Abstracts

1060. Disease, Not Age, Is the Critical Variable Influencing Nursing-Home Use
Wei Yu, PhD, VA Health Economics Resource Center, TH Wagner, VA Health Economics Resource Center, PG Barnett, VA Health Economics Resource Center

Objectives: Nursing-home cost near the end of life increase with increasing age. We examined this pattern in detail and evaluated whether diseases explained the phenomenon.

Methods: We conducted bivariate and multivariate analyses of final stays of patients who died in 124 Veterans Affairs nursing homes in fiscal year 2000 (n=5973). We analyzed cost, length of stay (LOS), and intensity of care by primary disease, age, race, gender, benefit-eligibility type.

Results: The average LOS of the final stays was 171 days and its mean cost was $42,800. Our multivariate regression analysis showed that disease, rather than age, was the dominant factor in the cost of final nursing-home stays. The marginal effect of age on cost was not statistically significant among the elderly (age 65+ years). Patients who had a living spouse and nonwhites had lower cost than did other patients.

Conclusions: The costs of nursing-home final stays increase with patient age, not because older patients are on average more acutely ill, but rather because they have higher prevalence of diseases that required a longer average LOS. The future demand for nursing-home care at the end of life will depend on disease prevalence, rather than on age.

Impact: Although veterans population is aging rapidly, disease prevalence is more important in predicting demand for long-term care than age.