Dual eligibles in nursing homes have fewer hospitalizations than those in home- and community-based care, researchers find

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Hospitals slap the government with lawsuits over 'two-midnight' policy to reduce observation stays
Hospitals slap the government with lawsuits over 'two-midnight' policy to reduce observation stays

Elderly, frail people are more likely to be hospitalized if they are receiving home- or community-based services than if they live in a nursing home, according to newly published research.

Recent Medicaid reforms have aimed to increase use of HCBS because it is believed to be less costly than institutional long-term care, investigators noted. They said their findings suggest that more frequent hospitalizations are a “hidden cost” of home- and community-based care.

The analysis looked at seniors dually eligible for Medicare and Medicaid, who were receiving home health or personal care or residing in a nursing home during the 2003 to 2005 period. Investigators calculated how many hospitalizations these people experienced per quarter by analyzing data from the Centers for Medicare & Medicaid Services, the Health Resources and Services Administration, and the Medicaid offices of Arkansas, Florida, Minnesota, New Mexico, Texas, Vermont and Washington.

Receiving HCBS rather than nursing home care increased the likelihood of experiencing a potentially preventable hospitalization within three months by 1.1 percentage points, the researchers found. This risk increased even more (2.3 percentage points) for non-preventable hospitalizations.

The study did not allow the researchers to “directly ascertain” why nursing homes had fewer hospitalizations. The skilled care and round-the-clock monitoring in nursing homes might help explain the results, they wrote. However, there also are reasons to believe nursing homes would be more likely than home health providers to hospitalize dual eligibles, they noted. For example, some nursing homes are paid to hold beds for hospitalized Medicaid beneficiaries, then are reimbursed at higher Medicare levels when these residents return.

The most common reasons for a potentially preventable hospitalization were the same for HCBS and nursing homes, the investigators found: congestive heart failure, pneumonia, chronic obstructive pulmonary disease, urinary tract infection and dehydration.

The findings will be published in Health Services Research.

Lead author Andrea Wysocki, Ph.D., also was involved in research showing increased hospitalization risks for dual eligibles who move from a long-term care facility to HCBS.

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