Timothy D. McBride

Predicting Nursing-Home Admission and Length of Stay: A Duration Analysis

Information on who enters nursing homes and how much nursing-home care people use continues to be important for the consideration of various long-term care policies. Research on how characteristics of noninstitutionalized disabled elderly persons are related to both risk of admission and length of stay is presented here. Hazard models were developed using data from the 1982-84 National Long-Term Care Survey. Personal characteristics of elderly persons and state policy variables had varying effects on nursing-home use in a 2-year period.

Determinants of Transitory and Permanent Nursing Home Admissions

This article describes an analysis of data from the 1982-84 National Long-Term Care Demonstration Project to estimate the risks of any nursing home admission, a temporary or transitory admission, and a permanent admission. Using a multinomial logit model, the relative predictive power of several individual characteristics on nursing home use and admission type were evaluated. It was found that the cognitively impaired subgroup was at the greatest risk of entering a nursing home, especially on a permanent basis. The results also demonstrated that the combination of cognitive impairment and functional impairment further increased the risk of a nursing home admission, particularly a permanent one. Other subgroups that had high probabilities of experiencing a nursing home admission were whites, nonhomeowners, those living alone, and those with prior nursing home stays. The findings identified several aged subgroups that were at no greater risk of nursing home admission regardless of admission type: older persons who were unmarried, had a low income, had no assets, and those on Medicaid.

Risk of entering nursing homes for long versus short stays.

Research on the risk of nursing home use has generally not distinguished between risk for long versus short stays. This paper presents an analysis of data from the 1982–84 National Long-Term Care Surveys to identify characteristics of disabled persons that predicted one or the other type of stay. Measures that are recognized to be strong predictors of nursing home use in general, such as dependencies in activities of daily living and cognitive impairment, were not significantly associated with admission for short stays. Results from the multivariate analysis were also used to make projections of lifetime risk of long and short stays. Approximately one-third of lifetime nursing home risk applies to stays of 90 days or less.

Wives Who Outearn Their Husbands: A Transitory or Persistent Phenomenon for Couples?

In what percentage of married couples do wives outearn their husbands, and, moreover, how persistent are these patterns? This study systematically examined variation in point-in-time estimates across alternative measures of earnings, definitions of types of couples, and data sources and gauged the persistence of these patterns for a period of three calendar years using data from the 2000 Current Population Survey and the 1996–2000 Survey of Income and Program Participation. Among the findings are that in 19% to 30% of all married couples, wives have higher earnings than their husbands. In 60% of such couples, this arrangement persists over the three-year period; for the rest, this arrangement is transitory.

The Changing Profile of the Elderly: Effects on Future Long-Term Care Needs and Financing

Simulation techniques are used to analyze the changing profile of the elderly from 1990 to 2030. The results show that the future demand for long-term care services is likely to be greater than many realize. Increases in the number of elderly who are 85 years of age and older, who have health limitations, or who live alone are likely to outpace the general increase in the elderly population. Although there will be a very large group of elderly at risk, their economic status will be better than that of todays elderly population. The percentage of elderly who can afford insurance premiums for broad long-term care coverage will increase in the future, but most older Americans probably will not be able to afford insurance. Although policies that reduce the cost and encourage the purchase of long-term care insurance could help to expand coverage, a large long-term care financing gap is likely to remain for the future elderly population.

Patterns of health insurance coverage among rural and urban children.

Despite the potential for the State Children’s Health Insurance Program to improve the health care coverage of rural children, the expansion of public health insurance to children in rural areas may be hampered by a lack of understanding about the patterns of insurance coverage they experience. This study uses the Census Bureau’s 1993-1996 panel of the Survey of Income and Program Participation to evaluate differences in the duration of, and in their entry into and exit from, uninsured spells. While the average duration of newspells was shorter for rural children and most regained coverage quickly, rural children were also more likely than urban children to experience protracted spells of uninsurance. Moreover, rural children were more likely than urban children to move between public and private coverage. These findings have important implications for designing insurance expansion programs and outreach strategies to effectively enroll and retain rural children.

Knowledge of Health Insurance Terminology and Details Among the Uninsured

By 2014, uninsured adults will be eligible for health insurance through exchanges with multiple plan options. Choosing health insurance is challenging even for those who have engaged in the process previously. We examined 51 uninsured adults’ health insurance knowledge and preferences through semistructured qualitative interviews. Our sample was predominantly low-income and African American. Most had little or no experience with health insurance terminology. Those with limited health literacy skills understood less than those with higher health literacy. Many confused related insurance concepts. Non-health contexts (e.g., car insurance) aided understanding. Premiums, fixed costs, and specific coverage were rated very important to insurance decisions. Our study was one of the first to examine uninsured individuals’ health insurance knowledge and preferences. Uninsured individuals may have different information needs and preferences than those studied in previous research. Clear information and familiar non-health contexts can be important strategies when communicating about the exchanges.

The March to Accountable Care Organizations--How Will Rural Fare?.

PURPOSE This article describes a strategy for rural providers, communities, and policy makers to support or establish accountable care organizations (ACOs). METHODS ACOs represent a new health care delivery and provider payment system designed to improve clinical quality and control costs. The Patient Protection and Affordable Care Act (ACA) makes contracts with ACOs a permanent option under Medicare. This article explores ACA implications, using the literature to describe successful integrated health care organizations that will likely become the first ACOs. Previous research studying rural managed care organizations found rural success stories that can inform the ACO discussion. FINDINGS Preconditions for success as ACOs include enrolling a minimum number of patients to manage financial risk and implementing medical care policies and programs to improve quality. Rural managed care organizations succeeded because of care management experience, nonprofit status, and strong local leadership focused on improving the health of the population served. CONCLUSIONS Rural provider participation in ACOs will require collaboration among rural providers and with larger, often urban, health care systems. Rural providers should strengthen their negotiation capacities by developing rural provider networks, understanding large health system motivations, and adopting best practices in clinical management. Rural communities should generate programs that motivate their populations to achieve and maintain optimum health status. Policy makers should develop rural-relevant ACO-performance measures and provide necessary technical assistance to rural providers and organizations.

What can health communication science offer for ACA implementation? Five evidence-informed strategies for expanding Medicaid enrollment.

CONTEXT Implementing the Affordable Care Act (ACA) in 2014 will require effective enrollment and outreach efforts to previously uninsured individuals now eligible for coverage. METHODS From 1996 to 2013, the Health Communication Research Laboratory conducted more than 40 original studies with more than 30,000 participants to learn how to improve the reach to and effectiveness of health information for low-income and racial/ethnic minority populations. We synthesized the findings from this body of research and used them to inform current challenges in implementing the ACA. FINDINGS We found empirical support for 5 recommendations regarding partnerships, outreach, messages and messengers, life priorities of low-income individuals and families, and the information environment. We translated these into 12 action steps. CONCLUSIONS Health communication science can inform the development and execution of strategies to increase the publics understanding of the ACA and to support the enrollment of eligible individuals into Medicaid or the Health Insurance Marketplace.

Duration of homeless spells among severely mentally ill individuals: A survival analysis

The major objective of this study was to identify predictors of the duration of homeless spells among persons with severe mental illness (SMI). This was the first study to incorporate time-varying covariates into the survival analysis model predicting the length of homeless spells. The sample consisted of 215 individuals who had participated in two experiments evaluating the effectiveness of various treatment programs for homeless individuals. Persons who received assertive community treatment exited homelessness sooner than individuals who received brokered case management, outpatient treatment, or services from a drop-in center. More assistance in finding and maintaining housing were especially predictive of shorter homeless spells. Inclusion of variables which varied over time in the model (e.g., income and frequency of service contacts) reduced the impact of many of the demographic variables in the model. This survival analysis demonstrated that the efforts of human service agencies to assist homeless mentally ill individuals do make a difference. In general, persons who received more services exited homelessness sooner.