The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #71811

Greg Arling, PhD, Cookingham Institute, University of Missouri at Kansas City, Bloch School, Room 308, 5110 Cherry Street, Kansas City, MO 64110, 816-235-5431, arlingg@umkc.edu

Although Alzheimer’s special care units (SCUs) have become commonplace in the nursing home industry, relatively little is known about the nursing costs for residents on SCUs compared to costs for cognitively impaired residents on conventional nursing home units. Information on cost of care is important because there is growing pressure on Medicaid programs to reimburse SCUs at a higher rate than conventional units. This study examined care costs on SCUs and conventional units while taking into account types of residents served on the units and differences in care practices such as use of physical or chemical restraints. The sample consisted of 3,125 residents in 29 Alzheimer’s SCUs and 67 conventional units in three states (CO, IN, and MS). Resident-specific resource use was measured through a time and motion study with cost weights assigned to minutes of care per day. Data on resident health and functional conditions and service use were obtained from the Minimum Data Set assessment instrument. The findings showed that residents on SCUs were more stable medically and less ADL dependent but they were much more likely to display behavioral problems. SCU residents received significantly more nursing resources than cognitively impaired residents on conventional units when controlling statistically for comorbidities, unit type, and care practices. Resource use differences were primarily in the amount of unlicensed staff time. There was no evidence on either unit type that physical or chemical restraints were being substituted for staff time. The implications of the findings for state Medicaid policies will be discussed.

Learning Objectives:

At the conclusion of the session, the participant (learner) in this session will be able to:
• Describe differences in types of residents and services provided on Alzheimer's SCUs and conventional nursing home units.
• Identify factors that affect nursing resource use on the two types of units.
• Understand issues concerning Medicaid reimbursement for Alzheimer's SCUs.

Keywords: Dementia, Nursing Homes

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.