MEDICARE EXPENDITURES FOR RESIDENTS IN ASSISTED LIVING: DATA FROM A NATIONAL STUDY

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MEDICARE EXPENDITURES FOR RESIDENTS IN ASSISTED
LIVING DATA FROM A NATIONAL STUDY

• Phillips C1, Holan S2, Sherman M2, Spector W3,
  Hawes C1.
• Texas AM University System Health Science
  Center1
• Texas AM University2
• Agency for Healthcare Research and Quality3

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ACKNOWLEDGEMENTS

• Grant RO1-HS-10606 (C. Phillips, PI) from the
  Agency for Healthcare Research and Quality
  supported this research.
• Collection of the resident and facility data was
  supported by contracts HHS-100-94-0024 and
  HHS-100-98-0013 from the Office of Disability,
  Aging, and Long-Term Care Policy, Office of the
  Assistant Secretary for Planning and Evaluation
  (ASPE), U.S. Department of Health and Human
  Services.
• Claims data were provided by the Centers for
  Medicare and Medicaid Services.

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RESEARCH OBJECTIVES

• To investigate Medicare expenditures for assisted
  living facility (ALF) residents and
• To investigate whether ALF characteristics were
  related to Medicare expenditures for ALF
  residents.

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ASSISTED LIVING IN UNITED STATES, 1998
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DEFINING ASSISTED LIVING

• A congregate residential setting that provides
  or coordinates personal services, 24-hour
  supervision, and assistance (scheduled and
  unscheduled), activities, and health related
  services.... (ALQC, 1998)

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ALF PHILOSOPHY

• to minimize the need to move . to accommodate
  residents changing needs and preferences . to
  maximize residents dignity, autonomy, privacy,
  independence, and safety and . to encourage
  family and community involvement. (ALQC, 1998)

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Hypothesized Relationship Between Assisted
Living and Other Types of Residential Long-Term
Care ACUITY High Low
low AVERAGE MONTHLY
CHARGE High

Nursing Homes
BC Homes
Assisted Living
Congregate Living
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AL INDUSTRY IN USA 1998

• CALLED ALFs, OR PROVIDE PERSONAL CARE, 24 HR.
  SUPERVISION, MORE THAN 10 BEDS
• 11,459 ALFs operated nationwide
• 611, 000 beds
• 521,000 residents.
• 1,600 most common monthly charge
• Almost exclusively private-pay
• 77 in metropolitan areas
• Avg. number of units is 53
• lt50 of total units are apartments
• 1/3 of ALF offer minimal service or privacy
• Estimates based on national sample of 1,500
  facilities

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ALF RESIDENTS AND CLAIMS DATA

• On-site data collection in facilities with either
  high services or high privacy --, those
  consistent with ALF philosophy (40 of 1,500
  sample of 300 facilities 1,500 residents)
• Analyzed Medicare claims data for six months
  after baseline ( paid)
• Only for residents still in ALF at 7 month
  follow-up (n 1,202)
• Only 545 (46) supplied HIC number that could be
  matched with claims data
• Compared 545 with 1202 on 17 characteristics with
  only one significant difference ( w/
  hospitalization in 12 months prior to baseline)

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ALF RESIDENT CHARACTERISTICS AT BASELINE (N66,092 n545) ALF RESIDENT CHARACTERISTICS AT BASELINE (N66,092 n545)
Age 84
Female 76
Married 13
Some ADL assistance 18
Intact or Mild Cognitive Impairment 82
Never Incontinent of urine 67
Length of stay in facility 2-3
ER visit in last year 25
Hospital stay in last year 38
Multi-level campus 64
Full-time nurse on staff 71
High privacy 66
Average Price 1,757
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MEDICARE EXPENDITURES FOR INDIVIDUALS RESIDING IN
ALFs
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MEDICARE EXPENDITURES FOR ALF RESIDENTS, 1998 (N66,092 n545) MEDICARE EXPENDITURES FOR ALF RESIDENTS, 1998 (N66,092 n545) MEDICARE EXPENDITURES FOR ALF RESIDENTS, 1998 (N66,092 n545) MEDICARE EXPENDITURES FOR ALF RESIDENTS, 1998 (N66,092 n545)
Acute/post-acute Outpatient Total
Six Month Mean (Std. Error) 1,507 (237) 883 (99) 2,391 (286)
Annualized Mean 3,014 1,764 4,782
Residents With Claims 22.12 84.42 84.62
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MEDICARE EXPENDITURES

• On an annualized basis, average Medicare
  expenditures for an ALF resident were 4,782.
• 1996 average Medicare expenditures for
  community-dwelling beneficiaries adjusted for two
  years of inflation are 4,465.

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MEDICARE EXPENDITURES

• In 1997, the 15 of beneficiaries
• incurred annual Medicare costs of 10,000 or
  greater,
• received over 75 of total Medicare expenditures
• Among AL residents, in six months of data, 14.8
  of the residents
• had Medicare claims that totaled 5,000 or more.
  
• represented 78 of Medicare expenditures for the
  sample.

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MEDICARE EXPENDITURES

• For those beneficiaries using services, the
  annual average is approximately 5,800.
• The average Medicare program payment for aged
  beneficiaries served in calendar year 1999 was
  5,635

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FACTORS ASSOCIATED WITH MEDICARE EXPENDITURESFOR
ALF RESIDENTS
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TWO-PART UTILIZATION MODEL

• Logistic regression
• Inpatient , outpatient , total
• Individual characteristics
• Facility characteristics
• OLS regression
• Inpatient , outpatient , total (logged)
• Individual characteristics
• Facility characteristics

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RESULTS FOR LOGISTIC REGRESSION FOR ALL RESIDENTS

• INDIVIDUAL CHARACTERISTICS
• Variables with significant effects (plt.05) --
  age, ADL status, incontinence
• Variables without significant effects (pgt.05)
  gender, cognitive function, marital status,
  length of stay, hospitalization in prior year, ER
  visit in prior year

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RESULTS FOR LOGISTIC REGRESSION FOR ALL RESIDENTS

• FACILITY CHARACTERISTICS
• Variables with significant effects (plt.05)
  none
• Variables without significant effects (pgt.05)
  ownership, size, occupancy, multi-level campus,
  privacy level, service level, price, and location

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OLS RESULTS FOR RESIDENTS UTILIZING SERVICES

• INDIVIDUAL CHARACTERISTICS
• Variables with significant effects (plt.05)
  cognitive status, ADL status, length of stay
• Variables without significant effects (pgt.05)
  gender, age, marital status, incontinence,
  hospitalization in prior year, ER visit in prior
  year

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OLS RESULTS FOR RESIDENTS UTILIZING SERVICES

• FACILITY CHARACTERISTICS
• Variables with significant effects (plt.05)
  size, occupancy
• Variables without significant effects (pgt.05)
  ownership, multi-level campus, privacy level,
  service level, price, and location

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CONCLUSIONS
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• Medicare expenditures for individuals in assisted
  living are very similar to those of other
  community-dwelling elderly
• Medicare expenditures for ALF residents are
  largely driven by individuals characteristics
• Facility size may affect the level of Medicare
  expenditures for those using services -- lower
  expenditures for residents in smaller facilities