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Assessed effect of changes in minimum number of activities of daily living (ALD) and instrumental activities of daily living (IADL) limitations, types of help, and duration of disability required on size of population potentially eligible for home care benefits. Only 411,000 elders met restrictive disability criteria; over 4 million would qualify under expansive criteria. (Author/NB)

The underwriting of private long-term care insurance is studied based on data from the National Mortality Followback Survey. Results show that if the population applied for private long-term care insurance at age 65, about 12% to 23% of applicants will be rejected due to poor health. The number will increase to 20% to 31% for applicants aged 75. Long-term care insurance underwriting criteria also vary depending on the risks perceived by the insurers.

This paper describes the methodology used in selecting and reweighting discharge level data from the 1985 National Nursing Home Survey so that it represents a sample of decedents who used nursing homes sometime during their lives. Such a strategy allows for the analysis of lifetime nursing home use and financing with a level of information that previously was not available. Adjustments to the existing weight included those for unit nonresponse, multiple probabilities of selection, and differential follow-up periods, as well as a ratio adjustment to bring the distribution of nursing home users with and without use in the last year of life in line with an external distribution from the 1986 National Mortality Followback Survey. A comparison of weighted estimates is made between the reweighted Nursing Home Survey data and the Mortality Followback data.

A study was conducted to identify the most important variables affecting the probability that a nursing home resident will be hospitalized over the course of one year. The Institutional Population Component of the 1987 National Medical Expenditure Survey was used as the main data source. Results showed that the rate of payment to the nursing home, for-profit status of the nursing home, being a Medicaid patient and health status of residents are among the variables that have significant positive or negative effects on the probability of hospitalization.

In this paper data from the National Mortality Followback Survey and the National Nursing Home Survey are used to estimate the lifetime cost of nursing home care. The expected discounted cost for persons turning 65 in 1990 is $27,600. However, variation around this average is high. The 9% of persons expected to use at least 5 years of nursing home care will account for 64% of aggregate cost for the cohort; the 68% using less than 3 months of care will account for only about 1% of cost. The percentage of costs covered under alternative financing strategies also varies widely. An entitlement covering the first 3 months of care subject to 30% coinsurance would cover 5% of aggregate cost; an entitlement with a 2-year deductible and the same coinsurance would cover 41% of cost.

BACKGROUND/OBJECTIVES New or worsened disabilities in functional, cognitive, or mental health following an intensive care unit (ICU) stay are referred to as post‐intensive care syndrome (PICS). PICS has not been described in older adults receiving home care. Our aim was to examine the relationship between length of ICU stay and PICS among older adults receiving home care. We expected that patients in the ICU for 3 days or longer would demonstrate significantly more disability in all three domains on follow‐up than those not in the ICU. A secondary aim was to identify patient characteristics increasing the odds of disability. DESIGN Retrospective cohort study. SETTING Hospitalization for sepsis in the United States. PARTICIPANTS A total of 21 520 Medicare patients receiving home care and reassessed a median of 1 day (interquartile range 1‐2 d) after hospital discharge. MEASUREMENTS PICS was defined as a decline or worsening in one or more of 16 indicators tested before and after hospitalization using OASIS (Home Health Outcome and Assessment Information Set) and Medicare claims data. RESULTS: The sample was predominantly female and white. All had sepsis, and most (81.8%) had severe sepsis. In adjusted models, an ICU stay of 3 days or longer, compared with no ICU stay, increased the odds of physical disability. Overall, the declines were modest and found in specific activities of daily living (16% for feeding and lower body dressing to 26% for oral medicine management). No changes were identified in cognition or mental health. Significant determinants of new or worsened physical disabilities were sepsis severity, older age, depression, frailty, and dementia. CONCLUSION: Older adults receiving home care who develop sepsis and are in an ICU for 3 days or longer are likely to develop new or worsened physical disabilities. Whether these disabilities remain after the early postdischarge phase requires further study. J Am Geriatr Soc 67:520–526, 2019. [ABSTRACT FROM AUTHOR]

Heart failure is difficult to manage and increasingly common with many individuals experiencing frequent hospitalizations. Little is known about patient factors consistently associated with hospital readmission. A literature review was conducted to identify heart failure patient characteristics, measured before discharge, that contribute to variation in hospital readmission rates. Database searches yielded 950 potential articles, of which 34 studies met inclusion criteria. Patient characteristics generally have a very modest effect on all-cause or heart failure-related readmission within 7 to 180 days of index hospital discharge. A range of cardiac diseases and other comorbidities only minimally increase readmission rates. No single patient characteristic stands out as a key contributor across multiple studies underscoring the challenge of developing successful interventions to reduce readmissions. Interventions may need to be general in design with the specific intervention depending on each patient's unique clinical profile. [ABSTRACT FROM AUTHOR]

To test the effectiveness of two interventions designed to improve the adoption of evidence-based practices by home health nurses caring for heart failure (HF) patients.Information on nurse practices was abstracted from the clinical records of patients admitted between June 2000 and November 2001 to the care of 354 study nurses at a large, urban, nonprofit home care agency.The study employed a randomized design with nurses assigned to usual care or one of two intervention groups upon identification of an eligible patient. Thebasicintervention was a one-time e-mail reminder highlighting six HF-specific clinical recommendations. Theaugmentedintervention consisted of the initial e-mail reminder supplemented by provider prompts, patient education material, and clinical nurse specialist outreach.At each home health visit provided by a study nurse to an eligible HF patient during the 45-day follow-up period, a structured chart abstraction tool was used to collect information on whether the nurse provided the care practices highlighted in the e-mail reminder.Both the basic and the augmented interventions greatly increased the practice of evidence-based care, according to patient records, in the areas of patient assessment and instructions about HF disease management. While not all results were statistically significant at conventional levels, intervention effects were positive in virtually all cases and effect magnitudes frequently were large.The results of this randomized trial strongly support the efficacy of just-in-time evidence-based reminders as a means of changing clinical practice among home health nurses who are geographically dispersed and spend much of their time in the field. [ABSTRACT FROM AUTHOR]

To assess the impact and cost-effectiveness of two information-based provider reminder interventions designed to improve self-care management and outcomes of heart failure (HF) patients.Interview and agency administrative data on 628 home care patients with a primary diagnosis of HF.Patients were treated by nurses randomly assigned to usual care or one of two intervention groups. Thebasicintervention was an e-mail to the patient's nurse highlighting six HF-specific clinical recommendations. Theaugmentedintervention supplemented the initial nurse reminder with additional clinician and patient resources.Patient interviews were conducted 45 days post admission to measure self-management behaviors, HF-specific outcomes (Kansas City Cardiomyopathy Questionnaire-KCCQ), health-related quality of life (EuroQoL), and service use.Both interventions improved the mean KCCQ summary score (15.3 and 12.9 percent, respectively) relative to usual care (p≤.05). The basic intervention also yielded a higher EuroQoL score relative to usual care (p≤.05). In addition, the interventions had a positive impact on medication knowledge, diet, and weight monitoring. The basic intervention was more cost-effective than the augmented intervention in improving clinical outcomes.This study demonstrates the positive impact of targeting evidence-based computer reminders to home health nurses to improve patient self-care behaviors, knowledge, and clinical outcomes. It also advances the field's limited understanding of the cost-effectiveness of selected strategies for translating research into practice. [ABSTRACT FROM AUTHOR]