Medicare Compliance & Reimbursement

Study reveals factors common to discharges.

The Kaiser Commission on Medicaid and the Uninsured issued a report in August showing that nursing homes tended to discharge residents back into the community who had shorter lengths of stay, were younger and had spouses. The prevalence of a major chronic disease was high in both short-stay and long-stay residents, but long-stay residents were more than two times as likely to have a cognitive disorder.

The study notes that states with federal funding and support have focused on returning nursing home residents to community settings. The high cost of nursing home care and the strong preference of disabled individuals and their families for non-institutional care is driving interest in reducing nursing home placement for persons with long-term care needs.

The initiation of formal programs to move people out of institutional care settings began with the Centers for Medicare and Medicaid Services' Nursing Home Transition Grants to 12 states from 1998 to 2000.

The Kaiser study analyzed data from the 1999 National Nursing Home Survey, examining two populations: individuals age 65 or older who were current residents and had a length of stay of 90 days or longer; and individuals age 65 or older who were discharged over a one-year period because they were stable or had recovered, regardless of length of stay.

The most common reasons for nursing home discharge among individuals age 65 or older were death (35 percent) and discharge to a hospital (29 percent). Discharges to the community (stable or recovered) represented 23 percent of all discharges.

The proportion of persons under age 65 in nursing homes is small, representing only 9 percent of persons with stays longer than 3 months. These individuals are often the first group that nursing homes target for a transition. The largest segment of the long-stay resident nursing home population, therefore--and potentially among the most difficult to transition back to the community--are those over age 65.

Most Resident Discharges Follow Brief Stays

The study found that discharges to the community were concentrated among persons with stays of less than 30 days. Among all older individuals discharged from nursing homes back to the community, 73 percent had a stay less than 30 days and another 20 percent stayed less than 90 days. Seven percent of discharges were among individuals with stays of longer than 90 days, but less than 1 percent of discharges were persons who resided at the nursing home for one year or longer.

Discharges to the community were younger than long-stay nursing home residents--older individuals stayed for 90 days or longer, the study found. Among individuals returning to a community setting, 23 percent were 65 to 74 years of age and 31 percent were 85 and older. By contrast, 13 percent of long-stay residents were ages 65 to 74 and 53 percent were 85 and older.

Among those returning to the community within 30 days, 38 percent were men--but men made up only 25 percent of the long-stay population. Married individuals had a higher percentage of discharges, representing 38 percent of persons discharged in under 30 days versus 17 percent of long-stay residents.

Only 7 percent of all discharges occurred after a 90-day nursing home stay or longer, but persons returning to the community following a stay of this length were twice as likely to be married as long-stay residents.

Individuals admitted to nursing homes were most commonly admitted from hospitals, but individuals who transferred from a hospital comprised 72 percent of those subsequently discharged from the nursing home--in contrast to 44 percent of long-stay residents.

Nursing homes admitted approximately one-third of long-stay residents from a private residence and 12 percent from another nursing home. Prevalence of major chronic diseases associated with disability was high in both the discharged and long-stay populations. Almost 30 percent of each group had heart disease.