Constructing a Measure of Private-pay Nursing Home Days

What Do Clinicians Caring for Aging Patients Need to Know About Private Long-Term Care Insurance?

Preparing for future long-term care (LTC) needs is a critical component of successful aging. Clinicians with aging patient panels may be a valuable source of information about the importance of LTC planning and the mechanisms available to do so, including private LTC insurance (LTCi). This article provides an overview, from a clinician's perspective, of current LTC financing and the key questions patients should consider when assessing LTCi. Although actual purchasing decisions likely require support from impartial financial experts, clinicians may be well positioned to help initiate difficult conversations about LTC planning and point patients to unbiased resources concerning LTCi. J Am Geriatr Soc 67:2167-2173, 2019.

Increasing Prevalence of Assisted Living as a Substitute for Private-Pay Long-Term Nursing Care

OBJECTIVE

Given the tremendous growth in assisted living (AL) over the past 20 years, it is important to understand how expansion has affected the demand for long-term care (LTC) provided in nursing homes (NHs). We estimated the effect of a change in county-level AL beds on the prevalence of private-pay residents and private-pay resident days at the NH-level.

DATA SOURCES

National census of large AL providers (25+ beds), and Minimum Data Set combined with Medicare enrollment records and claims from 2007 and 2014.

STUDY DESIGN

Retrospective longitudinal analysis of LTC markets.

PRINCIPAL FINDINGS

Mean AL beds per county increased from 285 to 324, while NHs exhibited a decrease in private-pay residents (20.1 to 17.7 percent) and resident days (21.3 to 17.5 percent). An increase of 1,000 AL beds at the county level is associated with a reduction of 0.44 percentage points in private-pay resident days but is not significantly associated with percent of private-pay residents.

CONCLUSIONS

These results suggest that increases in AL capacity have potentially allowed NH residents to delay or decrease their privately financed lengths of stay. As demand for AL continues to grow, it will be important to assess the effects on other LTC sectors.

Increasing Prevalence of Assisted Living as a Substitute for Private-Pay Long-Term Nursing Care

OBJECTIVE

Given the tremendous growth in assisted living (AL) over the past 20 years, it is important to understand how expansion has affected the demand for long-term care (LTC) provided in nursing homes (NHs). We estimated the effect of a change in county-level AL beds on the prevalence of private-pay residents and private-pay resident days at the NH-level.

DATA SOURCES

National census of large AL providers (25+ beds), and Minimum Data Set combined with Medicare enrollment records and claims from 2007 and 2014.

STUDY DESIGN

Retrospective longitudinal analysis of LTC markets.

PRINCIPAL FINDINGS

Mean AL beds per county increased from 285 to 324, while NHs exhibited a decrease in private-pay residents (20.1 to 17.7 percent) and resident days (21.3 to 17.5 percent). An increase of 1,000 AL beds at the county level is associated with a reduction of 0.44 percentage points in private-pay resident days but is not significantly associated with percent of private-pay residents.

CONCLUSIONS

These results suggest that increases in AL capacity have potentially allowed NH residents to delay or decrease their privately financed lengths of stay. As demand for AL continues to grow, it will be important to assess the effects on other LTC sectors.