Caregiver Attitudes and Hospitalization Risk in Michigan Residents Receiving Home- and Community-Based Care

To study a cohort of participants in home- and community-based services (HCBS) in Michigan to evaluate the relationship between (1) caregiver attitudes and participant characteristics and (2) the risk of hospitalization. SETTING: HCBS programs funded by Medicaid or state/local funds in Michigan. PARTICIPANTS: Five hundred twenty-seven individuals eligible for HCBS in Michigan were studied. These HCBS participants were randomly selected clients of all agencies providing publicly funded HCBS in Michigan from November 1996 to October 1997. MEASUREMENTS: Data for this study were collected using the Minimum Data Set for Home Care. Assessments were collected longitudinally, and the baseline (initial admission assessment) and 90-day follow-up assessments were used. Key measures were caregiver attitudes (distress, dissatisfaction, and decreased caregiving ability) and HCBS participant characteristics (cognition, functioning, diseases, symptoms, nutritional status, medications, and disease stability). Multinomial logistic regression was used to evaluate how these characteristics were associated with the competing risks of hospitalization and death within 90 days of admission to HCBS. RESULTS: We found a strong association between caregiver dissatisfaction (caregiver dissatisfied with the level of care the home care participant was currently receiving) and an increased likelihood of hospitalization. HCBS participant cancer, chronic obstructive pulmonary disease, pain, and flare-up of a chronic condition were also associated with increased hospitalization. Poor food intake and prior hospitalization were associated with hospitalization and death. CONCLUSIONS: We conclude that, within a cohort of people receiving HCBS who are chronically ill, highly disabled, and at high risk for hospitalization and death, interventions addressing caregiver dissatisfaction, pain control, and medical monitoring should be evaluated for their potential to decrease hospitalization.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65947/1/j.1532-5415.2002.50264.x.pd

A national study showed that diagnoses varied by age group in nursing home residents under age 65

Objective: It is commonly held that those aged <65 in nursing homes (NHs) are substantially different from elderly residents. This study uses data gathered using the Resident Assessment Instrument’s Minimum Data Set (MDS) to describe these relatively rare residents. STUDY DESIGN AND SETTING, RESULTS, CONCLUSION Data: The study uses MDS assessments of close to three-quarter million residents in nine states from 1994-6. An algorithm resolved potentially incorrect ages caused by confusion between residents age < 15 from those 100-115. Methods: Residents are described within chronological age group (0-4, 5-14, etc.). Functional status, prevalence of chronic conditions and treatments are described for each group. Co-morbidity is examined using factor analyses and cross-tabulations. Results: Overall, pediatric residents appear substantially more physically and cognitively impaired than young adult residents. The youngest population primarily has diagnoses related to mental retardation and developmental disabilities, young adults have the highest prevalence of hemi- and quadriplegia, while older residents are typified by increasing prevalence of neurological diagnoses and more co-morbid conditions. Thirteen diagnostic factors describe nearly 85% of all NH residents and highlights differences between age groups. Conclusions: This study offers a first description of nearly all NH residents <65. The classification demonstrates significant differences within this population and between these residents and those 65+