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Gerontologist. 2017 Apr 1;57(2):300-308. doi: 10.1093/geront/gnv106.

Transitioning From Community-Based to Institutional Long-term Care: Comparing 1915(c) Waiver and PACE Enrollees.

Author information

1
Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, New York.
2
Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, New York.
3
National PACE Association, Alexandria, Virginia.

Abstract

Purpose of the Study:

To compare the risk of long-term nursing home (NH) admission and the level of functional and cognitive impairment at the time of long-term NH admission in the Program of All-Inclusive Care for the Elderly (PACE) and in 1915(c) aged and aged and disabled waiver programs.

Design and Methods:

Cohorts of new waiver and PACE enrollees in 12 states were identified (in 2005-2007) and followed (through 2009) using the Medicaid Analytic Extract and the Minimum Data Set. Individual-level outcomes of interest were time from waiver or PACE enrollment to long-term (90+ days) NH admission and functional (29-point activities of daily living [ADL]) and cognitive (7-point Cognitive Performance Scale [CPS]) impairment at NH admission. An overall measure of impairment was also created and categorized as low (ADL < 17 and CPS < 3) versus high (ADL ≥ 17 or CPS ≥ 3). The key independent variable was enrollment in PACE versus waiver program. County-level covariates were included. Analyses employed multivariable models including competing risk proportional hazard and linear and logistic regressions.

Results:

Compared with waiver enrollees, PACE enrollees had 31% lower risk of long-term NH admission (p < .001). At NH admission, they were overall significantly (p < .0001) more cognitively impaired (0.34 point), with 55% higher odds of severe (CPS ≥ 4) cognitive impairment (p < .001) and 45% higher odds of having overall high impairment (p = .003).

Implications:

PACE may be more effective than 1915(c) aged and aged and disabled waiver programs in reducing long-term NH use and may be particularly well suited to supporting cognitively impaired individuals, enabling them to remain in the community longer.

KEYWORDS:

Dual eligible beneficiaries; Home- and Community-based Care and Services; Long-term care

PMID:
26286645
DOI:
10.1093/geront/gnv106
[Indexed for MEDLINE]

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