Robert J. Newcomer

Caregiver characteristics are associated with neuropsychiatric symptoms of dementia

OBJECTIVES: To determine whether caregiver characteristics are independently associated with neuropsychiatric symptoms of dementia (NPS) after accounting for patient characteristics.

Mortality Risk and Prospective Medicare Expenditures for Persons with Dementia

Objectives: To determine whether an index that stratifies dementia patients into high‐ and low‐mortality‐risk groups can be effective in prospectively identifying persons with high and low expenditures.

Health and long-term care for people with Alzheimer's disease and related dementias: Policy research issues

Policy research into the service needs of persons with dementia had its origin looking at challenges confronting caregivers—extended hours of instrumental task assistance, social isolation, fatigue, depression—and how public policy might support informal care-giving while saving public expenditures from nursing home care. This paper, drawing on the experience of the Medicare Alzheimers Disease Demonstration and other work, provides suggestions for extending care and financing considerations to include health care use and the medical management of chronic health conditions. Basic research is needed to document current use and risk factors, as is experimentation with clinical and other interventions designed to achieve desired quality of care and cost outcomes. This section of the paper will be of direct interest to both US and international readers. The second half of the paper reviews the US state role in regulating and financing nursing homes, home and community-based care, and residential care. All these sectors have high rates of staff turnover, staff shortages, and concerns with quality of care. The international community and US states provide naturally occurring opportunities for delivery system experimentation and innovation. Research taking advantage of these opportunities could greatly inform public policy.

Long term care of the elderly : public policy issues

Social, Political, and Economic Background of Long Term Care Policy - Carroll L Estes and Philip R Lee Health Care Needs of the Elderly - Dorothy P Rice State Policies on Long Term Care - Charlene Harrington et al Equity and Incentives in Medicaid Program Eligibility - Robert J Newcomer, A E Benjamin Jr, and Carol E Sattler Medicaid Cost Containment Trials and Innovations - Robert J Newcomer and Marjorie P Bogaert-Tullis Medicaid Nursing Home Reimbursement Policies - James H Swan and Charlene Harrington Institutional Long Term Care Services - Charlene Harrington and James H Swan The State Role in Board and Care Housing - Robyn Stone and Robert J Newcomer Community-Based Long Term Care - A E Benjamin Jr Private Nonprofit Organizations and Community-Based Long Term Care - Juanita B Wood and Carroll L Estes Medicaid Policy Changes in Long Term Care - Lynn Paringer A Framework for Impact Assessment Future Directions in Long Term Care - Carroll L Estes and Charlene Harrington

Assisted-Living and Nursing Unit Use among Continuing Care Retirement Community Residents

Using the lifetime experience of residents in seven continuing care retirement communities, we examine the probability of moving from independent living to assisted-living and nursing unit beds, and calculate the length of stay within each level of care. Between 50% to 70% of entering residents can be expected to use either (or both) assisted-living or nursing units during their tenure. Length of stay in independent living is increased and the length of stay in assisted living is reduced within high-rise facilities. There is a minor substitution effect between assisted-living and nursing unit use, especially among women. The nursing unit results are not affected by high rise or garden apartment design of the facility, or the percentage of nursing beds to total beds.

Board and care housing. An analysis of state differences.

Interest in board and care arrangements designed to provide food, shelter, and protective and personal care for chronically impaired adults has increased in recent years. Most of the authority for licensing and regulating such supportive housing arrangements resides with the states. The results of a regression analysis of state board and care supply for 1983 suggest that Supplemental Security Income Program (SSI) policy, specific board and care regulations, Medicaid nursing home rates, and the percentage of elderly are particularly important in explaining about two-thirds of the variance in state bed supply.

Relationships between Acute Care and Nursing Unit Use in Two Continuing Care Retirement Communities

The likelihood of nursing home use among Continuing Care Retirement Community (CCRC) residents is substantially affected by temporary placements. CCRC residents are more likely to use a nursing unit after a hospital stay or outpatient surgery than are community residents. On the other hand, CCRC residents have a lower rate of hospital admissions and a higher rate of outpatient surgery. There is an apparent substitution between the use of on-site personal care and nursing services among the CCRCs studied. The interrelationships between acute care and nursing unit use suggest implications for managed care, insurance coverage, and the measurement of outcomes of care in assisted living facilities.

Health Care Expenditures After Initiating Long-term Services and Supports in the Community Versus in a Nursing Facility.

Background:Individuals who receive long-term services and supports (LTSS) are among the most costly participants in the Medicare and Medicaid programs. Objectives:To compare health care expenditures among users of Medicaid home and community-based services (HCBS) versus those using extended nursing facility care. Research Design:Retrospective cohort analysis of California dually eligible adult Medicaid and Medicare beneficiaries who initiated Medicaid LTSS, identified as HCBS or extended nursing facility care, in 2006 or 2007. Subjects:Propensity score matching for demographic, health, and functional characteristics resulted in a subsample of 34,660 users who initiated Medicaid HCBS versus extended nursing facility use. Those with developmental disabilities or in managed care plans were excluded. Measures:Average monthly adjusted acute, postacute, long-term, and total Medicare and Medicaid expenditures for the 12 months following initiation of either HCBS or extended nursing facility care. Results:Those initiating extended nursing facility care had, on average,

Integrated Care: Incentives, Approaches, and Future Considerations

2919 higher adjusted total health care expenditures per month compared with those who initiated HCBS. The difference was primarily attributable to spending on LTSS

Predictors of Nursing Facility Entry by Medicaid-Only Older Adults and Persons With Disabilities in California:

2855. On average, the monthly LTSS expenditures were higher for Medicare