Factors That Influence Medicare Part A Beneficiaries' Length of Stay in the Nursing Home, After a Hospitalization

Abstract

The purpose of this study was to begin testing of a downward cross-level model for studying the ability of older adults to transition from a nursing home after a Medicare Part A reimbursed stay. Transitions are known to be a weak point in the provision of healthcare to older adults and thus far, research has not identified those factors that influence older adult's transitions i.e., from the nursing home after a post acute stay. The theoretical background for this study was supported by Resource Dependency Theory which is a theory that contends that organizations are externally controlled by activities outside the organization such as the "free-market" economic model that predominates the nursing home industry. It was thought that nursing homes may prioritize their need for resident census above the resident's need for discharge. The hypothesis was that both individual resident characteristics and organizational characteristics might influence the ability of older adults to transfer from the nursing home after a Medicare Part A stay. The method of analysis in this study was contextual regression. Individual and facility characteristics were the independent variables and length of stay was the dependent variable. For this project, emphasis was placed on the development of a methodology for using the MDS in this and future research studies. Selection of variables and methods for variable computation were highlighted. Individual and facility characteristics and discharge disposition (level of care) were reported descriptively. Although facility characteristics did not contribute significantly to the model, individual characteristics explained 28% of the variance in the length of stay. Fifteen percent of individuals in the sample died during their Medicare Part A stay and 18% were readmitted to the hospital. The most prevalent diagnoses of the sample were hypertension (35%), falls (34%) and arthritis (32%). Findings suggest that individual characteristics account for only a portion of the length of stay for post acute nursing home residents. Further model testing is needed and should include a larger facility sample size and market characteristics to determine if those factors significantly influence the ability of older adults to transfer after the Medicare Part A stay ends.