Ian M. Nelson

Fall Risk Factors in Community-Dwelling Elderly Who Receive Medicaid-Supported Home- and Community-Based Care Services

Objective: This study identifies fall risk factors in an understudied population of older people who receive community-based care services. Method: Data were collected from enrollees of Ohio’s Medicaid home- and community-based waiver program (preadmission screening system providing options and resources today [PASSPORT]). A total of 23,182 participants receiving PASSPORT services in 2005/2006 was classified as fallers and nonfallers, and a variety of risk factors for falling was analyzed using logistic regressions. Results: The following factors were identified as risk factors for falling: previous fall history, older age, White race, incontinence, higher number of medications, fewer numbers of activity of daily living limitations, unsteady gait, tremor, grasping strength, and absence of supervision. Discussion: Identifying risk factors for the participants of a Medicaid home- and community-based waiver program are useful for a fall risk assessment, but it would be most helpful if the community-based care service programs incorporate measurements of known fall risk factors into their regular data collection, if not already included.

Here's to Your Health: Will They Stay or Will They Go? Predicting disenrollment from home care services to nursing homes using classification trees

According to the U.S. Department of Health and Human Services, there are 36 million adults over age 65 living in the United States, representing 12% of the population. This segment of the population is expected to increase to more than 70 million by 2030. The number of individuals age 85 and older—who are more likely to be disabled and in need of services for chronic disability than members of the general population—is predicted to increase by 44% between 2005 and 2020. Although the majority of daily custodial care (referred to as long-term care) is paid privately, Medicaid plays a major role. Long-term care services are provided in a variety of settings, including homes, residential care, and nursing facilities. A high proportion of people who disenroll from homecare services leave for nursing homes, and nursing homes are the most expensive option. Policymakers naturally would like to know if any policy interventions would make it possible for the elderly to stay at home longer. A related important question that can be assessed with available data is: Among those individuals who have been enrolled in a homecare services program, who is most likely to disenroll and enter a nursing home? Something Other Than Logistic Regression?