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Predictors of Low-Care Prevalence in Florida Nursing Homes: The Role of Medicaid Waiver Programs

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Title: Predictors of Low-Care Prevalence in Florida Nursing Homes: The Role of Medicaid Waiver Programs
Language: English
Authors: Hahn, Elizabeth A., Thomas, Kali S., Hyer, Kathryn, Andel, Ross, Meng, Hongdao
Source: Gerontologist. Aug 2011 51(4):495-503.
Availability: Oxford University Press. Great Clarendon Street, Oxford, OX2 6DP, UK. Tel: +44-1865-353907; Fax: +44-1865-353485; e-mail: jnls.cust.serv@oxfordjournals.org; Web site: http://gerontologist.oxfordjournals.org
Peer Reviewed: Y
Page Count: 9
Publication Date: 2011
Document Type: Journal Articles
Reports - Research
Descriptors: Incidence, Nursing Homes, Expenditures, Counties, Predictor Variables, Role, Health Insurance, Community Services, Case Studies, Daily Living Skills, Classification, Health Services
Geographic Terms: Florida
DOI: 10.1093/geront/gnr020
ISSN: 0016-9013
Abstract: Purpose of the study: To examine the relationship between county-level Medicaid home- and community-based service (HCBS) waiver expenditures and the prevalence of low-care residents in Florida nursing homes (NHs). Design and Methods: The present study used a cross-sectional design. We combined two data sources: NH facility-level data (including characteristics of the facility and its residents) and county-level market characteristics (including HCBS waiver expenditures) for 653 Florida NHs in 2007. Low-care was defined as residents who require no physical assistance in any of the 4 late-loss activities of daily living (bed mobility, toileting, transferring, and eating). We estimated a 2-level hierarchical linear model (HLM) to examine the relationship between Medicaid HCBS waiver expenditures and the prevalence of low-care residents while accounting for resident assessment, facility-, and county-level covariates. Results: All Florida counties offered 2 statewide waivers, and 33 counties offered one or more of the 4 regional Medicaid HCBS waivers in 2007. Per-month beneficiary expenditures ranged from $755 to $1,778. The average Florida NH had 120 beds, and 8.0% of its residents were classified as low-care. Results from the HLM model showed that a $10,000 increase in per-enrollee HCBS waiver expenditures was associated with a 3.5 percentage point reduction in low-care resident prevalence (p = 0.03). Implications: The findings suggest that Medicaid HCBS waiver programs may reduce the prevalence of low-care residents in NHs. Future studies should evaluate whether Medicaid HCBS waiver programs are effective in promoting community-living among low-care residents and mitigating the growth in long-term care expenditures.
Abstractor: As Provided
Entry Date: 2011
Accession Number: EJ934519
Database: ERIC
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  Data: Predictors of Low-Care Prevalence in Florida Nursing Homes: The Role of Medicaid Waiver Programs
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  Data: <searchLink fieldCode="AR" term="%22Hahn%2C+Elizabeth+A%2E%22">Hahn, Elizabeth A.</searchLink><br /><searchLink fieldCode="AR" term="%22Thomas%2C+Kali+S%2E%22">Thomas, Kali S.</searchLink><br /><searchLink fieldCode="AR" term="%22Hyer%2C+Kathryn%22">Hyer, Kathryn</searchLink><br /><searchLink fieldCode="AR" term="%22Andel%2C+Ross%22">Andel, Ross</searchLink><br /><searchLink fieldCode="AR" term="%22Meng%2C+Hongdao%22">Meng, Hongdao</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Gerontologist%22"><i>Gerontologist</i></searchLink>. Aug 2011 51(4):495-503.
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  Data: Oxford University Press. Great Clarendon Street, Oxford, OX2 6DP, UK. Tel: +44-1865-353907; Fax: +44-1865-353485; e-mail: jnls.cust.serv@oxfordjournals.org; Web site: http://gerontologist.oxfordjournals.org
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  Data: 9
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  Data: Journal Articles<br />Reports - Research
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  Data: <searchLink fieldCode="DE" term="%22Incidence%22">Incidence</searchLink><br /><searchLink fieldCode="DE" term="%22Nursing+Homes%22">Nursing Homes</searchLink><br /><searchLink fieldCode="DE" term="%22Expenditures%22">Expenditures</searchLink><br /><searchLink fieldCode="DE" term="%22Counties%22">Counties</searchLink><br /><searchLink fieldCode="DE" term="%22Predictor+Variables%22">Predictor Variables</searchLink><br /><searchLink fieldCode="DE" term="%22Role%22">Role</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Insurance%22">Health Insurance</searchLink><br /><searchLink fieldCode="DE" term="%22Community+Services%22">Community Services</searchLink><br /><searchLink fieldCode="DE" term="%22Case+Studies%22">Case Studies</searchLink><br /><searchLink fieldCode="DE" term="%22Daily+Living+Skills%22">Daily Living Skills</searchLink><br /><searchLink fieldCode="DE" term="%22Classification%22">Classification</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Services%22">Health Services</searchLink>
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  Label: Geographic Terms
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  Data: <searchLink fieldCode="DE" term="%22Florida%22">Florida</searchLink>
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  Data: 10.1093/geront/gnr020
– Name: ISSN
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  Data: 0016-9013
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Purpose of the study: To examine the relationship between county-level Medicaid home- and community-based service (HCBS) waiver expenditures and the prevalence of low-care residents in Florida nursing homes (NHs). Design and Methods: The present study used a cross-sectional design. We combined two data sources: NH facility-level data (including characteristics of the facility and its residents) and county-level market characteristics (including HCBS waiver expenditures) for 653 Florida NHs in 2007. Low-care was defined as residents who require no physical assistance in any of the 4 late-loss activities of daily living (bed mobility, toileting, transferring, and eating). We estimated a 2-level hierarchical linear model (HLM) to examine the relationship between Medicaid HCBS waiver expenditures and the prevalence of low-care residents while accounting for resident assessment, facility-, and county-level covariates. Results: All Florida counties offered 2 statewide waivers, and 33 counties offered one or more of the 4 regional Medicaid HCBS waivers in 2007. Per-month beneficiary expenditures ranged from $755 to $1,778. The average Florida NH had 120 beds, and 8.0% of its residents were classified as low-care. Results from the HLM model showed that a $10,000 increase in per-enrollee HCBS waiver expenditures was associated with a 3.5 percentage point reduction in low-care resident prevalence (p = 0.03). Implications: The findings suggest that Medicaid HCBS waiver programs may reduce the prevalence of low-care residents in NHs. Future studies should evaluate whether Medicaid HCBS waiver programs are effective in promoting community-living among low-care residents and mitigating the growth in long-term care expenditures.
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        Value: 10.1093/geront/gnr020
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      – Text: English
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        PageCount: 9
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      – SubjectFull: Nursing Homes
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      – SubjectFull: Expenditures
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      – SubjectFull: Counties
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      – SubjectFull: Florida
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      – TitleFull: Predictors of Low-Care Prevalence in Florida Nursing Homes: The Role of Medicaid Waiver Programs
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