1. Emerging Profiles of Michigan Long-Term Care Users Mary L. James, M.A. Brant E. Fries, Ph.D. University of Michigan March 23, 2006

2. Agenda l Compare people who use nursing homes with people using home- and community-based services (HCBS) l Temporal trends l Selected sub-populations l Next steps

3. Notes l 1999-2005 data from MDCH data warehouse l MDS (NH) and MDS-HC (HC) l All people, not only Medicaid eligibles l 2005 data from Jan-June l Admission = all admissions in year l Prevalence = assessment closest to July 1 st of that year

4. Number of Annual NH Admissions is Growing NH HCBS

5. Number of NH Admissions is Growing – From Hospitals NH HCBS From Hospital

6. NH Admissions Increasingly Physically Dependent NHHCBS ADL Hierarchy

7. HC Admissions Increasingly Cognitively Dependent NHHCBS CPS Scale

8. RUG-III Categories at Admission NHHCBS

9. Q1A/Q1B – NH Prevalence

10. Identifying LTC Sub-populations l SMI (any of 4) verbally abusive, physically abusive, socially inappropriate hallucinations, delusions bipolar disease, schizophrenia symptoms of depression l Short stay Admission from hospital (NH) Medicare (NH) LOS < 90 days (both NH and HCBS) l Long stay: >1 year l Age <45 years l Note: subpopulations overlap somewhat

11. Selected Sub-Population Notes l Used 2004 (last year with full data, as some pops had low prevalence) l Some differences in NH and HC definitions (long- and short-stay) l SMI not really SMI

12. National Study: Some Diagnoses Decline with Age

13. National Study: Some Diagnoses Increase in Middle Age

14. National Study: Some Diagnoses Increase in Old Age

15. Prevalence of Selected Subpopulations NHHCBS

16. ADL Special Pops NHHCBS

17. Cognition Special Pops NHHCBS

18. WHERE THEY CAME FROM - NH

19. Q1a/Q2a by NH Subpopulations NHHCBS

20. Prevalence of Conditions in HC Subpopulations

24. Results l Following slide shows output from preliminary analysis l Groups (boxes) with lighter color  more like Passages individuals l Groups with darker colors  less like Passages individuals

25. AB C D E X

26. Results – “Focused Approach” l Groups “most like” Passages individuals: < 65, in facility 60d-2yr, at most mildly cognitively impaired (A, B, D) 2yr, with hemiplegia, quadriplegia, or paraplegia (C) 65+ age, in facility 60d-2yr, in lowest RUG-III case-mix groups, cognitively intact (E) Focused target is 1.5% of entire NF population –62.2% sensitivity –98.5 specificity

27. Next Steps l Link new data with: Medicaid identifiers Death records Length of stay information l Examine longitudinal outcomes l Identify “boutique” populations What are your ideas to define these? l Make data available to UoM LTC researchers l Could we forge a common research agenda?

28. Contact Us l mljames@umich.edu mljames@umich.edu l bfries@umich.edu bfries@umich.edu l www.interrai.org