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2009 HSR&D National Meeting Abstract

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National Meeting 2009

1032 — VA Long-Term Care Planning Model: Validation and Update of Nursing Home Use

Kinosian B (CHERP/ Philadelphia-Pittsburgh), Stallard E (Duke University), Fields S (CHERP), Manton K (Duke University), Bergofsky L (ADUSH, VA), Canamucio A (CHERP), Chen W (CHERP)

Objectives:
Project the demand for total and mandated nursing home (NH) care by enrolled veterans.

Methods:
We developed a static projection model, using the 2002 enrolled veteran projections stratified by age/gender/priority/VISN. We imputed marital status from the National Long-Term Care survey (NLTCS), after matching with the VA enrollment file. We imputed disability from the NLTCS for those age 65+, and the National Health Interview Survey for those < 65. We constructed rates of NH use for each age/gender/marital status/priority/disability group, within VISNs. For validation, we matched the 2001-2004 MDS files with the VA enrollment file. We constructed the actual enrolled veteran NH population using the Extended Care, Fee, DSS (State veteran home extract), and MDS files for 2002-2004. We re-estimated the NH projection, using age/gender/marital status/priority-specific NH use rates, independent of disability level. Projections are expressed in Average Daily Census (ADC: total bed days / 365).

Results:
For 2004, the model projected a total NH population of 124,000, and a 65+ population of 103,000. The observed 65+ NH population was 94,000, similar to the 96,000 NH population found in the 2004 round of the NLTCS, with a total population of 111,000. Adjustment for missing MDS records in a MDS/Extended care file joint sample raises the estimate to 121,000. Despite close total, priority-specific estimates were poor (P1A observed:projected were 11,800:14,900). The update, using priority-specific NH rates, is similar to the original projection assuming a disability decline (138,000 v. 141,000). Using the observed lack of disability decline among enrolled veterans, the NH population rises to 148,000 in 2018 (138,000 w/disability decline); the P1A population rises 94% to 23,000 (20,800 w/disability decline). Growth in NH use up to 2012 is driven by veterans age 85+. After 2012 it is driven by veterans age 65-74.

Implications:
Available data sources allow direct validation of the VA LTC planning model for nursing home use. There will be an additional 30,000 veterans daily using NH care, with nearly 11,000 being mandatory veterans.

Impacts:
VA will face a substantial increase in demand for NH-level care. Development of non-institutional settings to provide nursing home level long-term living services may substantially alter this demand.


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