Joshua M. Wiener

Potentially Avoidable Hospitalizations of Dually Eligible Medicare and Medicaid Beneficiaries from Nursing Facility and Home- and Community-Based Services Waiver Programs

Beneficiaries dually eligible for Medicare and Medicaid are of increasing interest because of their clinical complexity and high costs. The objective of this study was to examine the incidence, costs, and factors associated with potentially avoidable hospitalizations (PAH) in this population.

Why Do They Stay? Job Tenure Among Certified Nursing Assistants in Nursing Homes

PURPOSE This study identifies factors related to job tenure among certified nursing assistants (CNAs) working in nursing homes. DESIGN AND METHODS The study uses 2004 data from the National Nursing Home Survey, the National Nursing Assistant Survey, and the Area Resource File. Ordinary least squares regression analyses were conducted with length of job tenure as the dependent variable. Tenure of CNAs was hypothesized to be motivated by the extrinsic rewards of their job, initial training and mentoring, reasons for being a CNA, organizational culture, and personal, facility, and market characteristics. Separate analyses were conducted for the overall sample and for CNAs who worked for the facility for more than 1 year. RESULTS Among policy-relevant domains, extrinsic rewards had the largest number of significant variables (4). Only 1 training and 1 organizational culture variable significantly affected CNA job tenure. Significant variables in domains not readily influenced by policy (e.g., personal characteristics and characteristics of the facility and surrounding market area) were often significant in both regressions. IMPLICATIONS This study underscores the importance of the basic economics of job choice by low-income workers. Wages, fringe benefits, job security, and alternative choices of employment are important determinants of job tenure that should be addressed, in addition to training and organizational culture.

Estimates of state-level health-care expenditures associated with disability.

Objectives. We estimated state-level disability-associated health-care expenditures (DAHE) for the U.S. adult population. Methods. We used a two-part model to estimate DAHE for the noninstitutionalized U.S. civilian adult population using data from the 2002–2003 Medical Expenditure Panel Survey and state-level data from the Behavioral Risk Factor Surveillance System. Administrative data for people in institutions were added to generate estimates for the total adult noninstitutionalized population. Individual-level data on total health-care expenditures along with demographic, socioeconomic, geographic, and payer characteristics were used in the models. Results. The DAHE for all U.S. adults totaled

Hospital And ED Use Among Medicare Beneficiaries With Dementia Varies By Setting And Proximity To Death

397.8 billion in 2006, with state expenditures ranging from

Estimates of National Health Care Expenditures Associated With Disability

598 million in Wyoming to

Immigrant and non-immigrant certified nursing assistants in nursing homes: how do they differ?

40.1 billion in New York. Of the national total, the DAHE were

Patient-centered, Person-centered, and Person-directed Care They are Not the Same

118.9 billion for the Medicare population,

The Impact of Assistive Technologies on Formal and Informal Home Care

161.1 billion for Medicaid recipients, and

After CLASS: The Long-Term Care Commission’s Search For A Solution

117.8 billion for the privately insured and uninsured populations. For the total U.S. adult population, 26.7% of health-care expenditures were associated with disability, with proportions by state ranging from 16.9% in Hawaii to 32.8% in New York. This proportion varied greatly by payer, with 38.1% for Medicare expenditures, 68.7% for Medicaid expenditures, and 12.5% for nonpublic health-care expenditures associated with disability. Conclusions. DAHE vary greatly by state and are borne largely by the public sector, and particularly by Medicaid. Policy makers need to consider initiatives that will help reduce the prevalence of disabilities and disability-related health disparities, as well as improve the lives of people with disabilities.

The CLASS Act: Is It Dead or Just Sleeping?

Hospitalizations and emergency department (ED) visits for people with Alzheimers disease and related disorders are of particular concern because many of these patients are physically and mentally frail, and the care delivered in these settings is costly. Using data from the Health and Retirement Study linked with Medicare claims from the period 2000-08, we found that among community-dwelling elderly fee-for-service Medicare beneficiaries, those who had dementia were significantly more likely than those who did not to have a hospitalization (26.7 percent versus 18.7 percent) and an ED visit (34.5 percent versus 25.4 percent) in each year. Comparing nursing home residents who had dementia with those who did not, we found only small differences in hospitalizations (45.8 percent versus 41.9 percent, respectively) and ED use (55.3 percent versus 52.7 percent). As death neared, however, utilization rose sharply across settings and by whether or not beneficiaries had dementia: Nearly 80 percent of community-dwelling decedents were hospitalized, and an equal proportion had at least one ED visit during the last year of life, regardless of dementia. Our research suggests that substantial portions of hospitalizations and ED visits both before and during the last year of life were potentially avoidable.