Successful Discharge to Community Gap of FFS Medicare Beneficiaries With and Without ADRD Narrowed.

Bardenheier BH, Rahman M, Kosar C, Werner RM, Mor V. Successful Discharge to Community Gap of FFS Medicare Beneficiaries With and Without ADRD Narrowed. Journal of the American Geriatrics Society. 2021 Apr 1; 69(4):972-978.

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Abstract:

BACKGROUND/OBJECTIVES: We sought to compare the post-acute and long-term care experience of Medicare beneficiaries with and without Alzheimer Disease and Related Dementias (ADRD), and whether differences changed from January 1, 2007 to September 30, 2015. DESIGN: Retrospective cross-sectional trend study using Medicare claims linked to the Centers for Medicare and Medicaid Services'' (CMS) Minimum Data Set. SETTING: CMS-certified skilled nursing facilities (skilled nursing facility (SNF), n = 17,043). PARTICIPANTS: Fee-for-service Medicare beneficiaries aged = 66?years (n = 6,614,939) discharged from a hospital to a SNF who had not lived in a nursing home during the year before hospitalization. MEASUREMENTS: ADRD was defined by the Chronic Condition Data Warehouse. Outcome measures included: (1) successful discharge defined as being in SNF less than 90?days, then discharged back to the community, alive without subsequent inpatient health care for 30 continuous days; (2) became long-stay resident in SNF; (3) death in SNF within 90?days; (4) hospital readmission within 30?days of entering SNF; and (5) transferred to another nursing home within 30?days of entering SNF. RESULTS: Successful discharge of beneficiaries with ADRD increased from 43.4% in 2007 to 53.9% in 2015 (average annual percent change (AAPC) = 2.1 (95% CI = 2.0-2.2)); those without ADRD also increased (from 59.1% to 63.6%, AAPC = 0.9 (95% CI = 0.7-1.1)) but not as fast as those with ADRD (P? < .01). The proportion of all beneficiaries who became long-stay or were readmitted to the hospital decreased (P? < .05). The proportion with ADRD who became long-stay was nearly three times higher than those without throughout the study (15.0% vs 5.5% in 2007; 11.3% vs 4.3% in 2015). CONCLUSION: Though disparity in ADRD in becoming long-stay residents remains, the increase in successful discharges among those with ADRD also stresses the increasing importance of community as a care setting for adults with ADRD.