Use of the Medicare Posthospitalization Skilled Nursing Benefit in the Last 6 Months of Life

TitleUse of the Medicare Posthospitalization Skilled Nursing Benefit in the Last 6 Months of Life
Publication TypeJournal Article
Year of Publication2012
AuthorsAragon, K, Covinsky, KE, Miao, Y, Boscardin, WJ, Flint, L
JournalArchives of Internal Medicine
Volume172
Issue20
Pagination1573
KeywordsHealthcare, Medicare/Medicaid/Health Insurance
Abstract

In the last 6 months of life, many older adults will experience a hospitalization, followed by a transfer to a skilled nursing facility (SNF) for additional care. We sought to examine patterns of Medicare posthospitalization SNF use in the last 6 months of life. We used data from the Health and Retirement Study, a longitudinal survey of older adults, linked to Medicare claims (January 1994 through December 2007). We determined the number of individuals 65 years or older at death who had used the SNF benefit in the last 6 months of life. We report demographic, social, and clinical correlates of SNF use. We examined the relationship between place of death and hospice use for those residing in nursing homes and the community before the last 6 months of life. The mean age at death among 5163 individuals was 82.8 years; 54.5 of the cohort were female, and 23.2 had resided in a nursing home. In total, 30.5 had used the SNF benefit in the last 6 months of life, and 9.2 had died while enrolled in the SNF benefit. The use of the SNF benefit was greater among patients who were 85 years or older, had at least a high school education, did not have cancer, resided in a nursing home, used home health services, and were expected to die soon (P .01 for all). Of community dwellers who had used the SNF benefit, 42.5 died in a nursing home, 10.7 died at home, 38.8 died in the hospital, and 8.0 died elsewhere. In contrast, of community dwellers who did not use the SNF benefit, 5.3 died in a nursing home, 40.6 died at home, 44.3 died in the hospital, and 9.8 died elsewhere. Almost one-third of older adults receive care in a SNF in the last 6 months of life under the Medicare posthospitalization benefit, and 1 in 11 elders will die while enrolled in the SNF benefit. Palliative care services should be incorporated into SNF-level care.

Notes

Copyright - Copyright American Medical Association Nov 12, 2012 Language of summary - English ProQuest ID - 1152162690 Last updated - 2012-11-16 Place of publication - Chicago Corporate institution author - Aragon, Katherine; Covinsky, Kenneth; Miao, Yinghui; Boscardin, W John, PhD; Flint, Lynn; Smith, Alexander K, MD, MS, MPH DOI - 2817091601; 73733012; 29256; AINM; INODAINM0000634121

URLhttp://search.proquest.com.proxy.lib.umich.edu/docview/1152162690?accountid=14667
Endnote Keywords

Medical Sciences/Medicare claims/Skilled Nursing Facilities/ economics/Skilled Nursing Facilities/ economics/HOSPITALIZATION/Palliative care/posthospitalization benefit

Endnote ID

69784

Citation Key7782