Institutional Special Needs Plans and Hospice Enrollment in Nursing Homes

A National Analysis

Lara Dhingra, Karen Lipson, Nathan Dieckmann, Jack Chen, Marilyn Bookbinder, Russell Portenoy

    Research output: Contribution to journalArticle

    Abstract

    BACKGROUND: Institutional Special Needs Plans (I-SNPs) in nursing homes could impact hospice use by residents with advanced illness. Little is known about their relationship. OBJECTIVE: To determine whether I-SNP availability has been associated with changes in hospice utilization. DESIGN: Federal data from 2011 and 2013 were extracted from the Minimum Data Set (MDS) and other sources. Multilevel models evaluated I-SNP–, resident-, and facility-related variables as predictors of hospice utilization. SETTING: All US nursing homes in 2011 (N = 15 750) and 2013 (N = 15 732). PARTICIPANTS: Nursing home residents enrolled in Medicare or in both Medicare and Medicaid. MEASUREMENTS: Nursing home and resident data were obtained from Centers for Medicare and Medicaid Services sources: the MDS 3.0, Master Summary Beneficiary File, and Special Needs Plan Comprehensive Report. RESULTS: The mean number of residents per nursing home was 210.9 (SD = 167.1) in 2011 and 217.2 (SD = 171.5) in 2013. The prevalence of I-SNP contracts in nursing homes increased between 2011 and 2013, from 55.2% (N = 8691) to 61.1% (N = 9605), respectively (P <.001). In multivariate analyses, greater hospice enrollment in nursing homes was associated with having at least one I-SNP enrollee per month; year (2013 higher than 2011); smaller facility size; urban (vs rural) setting; location in the Northeast (vs Midwest); lower average resident mental status; higher average resident mobility; younger residents, on average; and facilities with higher proportions of residents with specific diagnoses (cancer, cirrhosis, and dementia). After adjusting for resident and nursing home characteristics, the association between monthly I-SNP presence and hospice enrollment was found only in nursing homes with 50 or greater beds and there was a positive relationship with increasing size. CONCLUSIONS: Growth of I-SNPs has been associated with changes in hospice utilization, and the relationship varies by facility size. Studies are needed to clarify the nature of this association and determine whether care may be improved through coordination of these programs.

    Original languageEnglish (US)
    JournalJournal of the American Geriatrics Society
    DOIs
    StateAccepted/In press - Jan 1 2019

    Fingerprint

    Hospices
    Nursing Homes
    Medicare
    Centers for Medicare and Medicaid Services (U.S.)
    Medicaid
    Contracts
    Dementia
    Fibrosis
    Multivariate Analysis

    Keywords

    • aging
    • hospice enrollment
    • Institutional Special Needs Plans
    • Medicare
    • nursing homes

    ASJC Scopus subject areas

    • Geriatrics and Gerontology

    Cite this

    Institutional Special Needs Plans and Hospice Enrollment in Nursing Homes : A National Analysis. / Dhingra, Lara; Lipson, Karen; Dieckmann, Nathan; Chen, Jack; Bookbinder, Marilyn; Portenoy, Russell.

    In: Journal of the American Geriatrics Society, 01.01.2019.

    Research output: Contribution to journalArticle

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    abstract = "BACKGROUND: Institutional Special Needs Plans (I-SNPs) in nursing homes could impact hospice use by residents with advanced illness. Little is known about their relationship. OBJECTIVE: To determine whether I-SNP availability has been associated with changes in hospice utilization. DESIGN: Federal data from 2011 and 2013 were extracted from the Minimum Data Set (MDS) and other sources. Multilevel models evaluated I-SNP–, resident-, and facility-related variables as predictors of hospice utilization. SETTING: All US nursing homes in 2011 (N = 15 750) and 2013 (N = 15 732). PARTICIPANTS: Nursing home residents enrolled in Medicare or in both Medicare and Medicaid. MEASUREMENTS: Nursing home and resident data were obtained from Centers for Medicare and Medicaid Services sources: the MDS 3.0, Master Summary Beneficiary File, and Special Needs Plan Comprehensive Report. RESULTS: The mean number of residents per nursing home was 210.9 (SD = 167.1) in 2011 and 217.2 (SD = 171.5) in 2013. The prevalence of I-SNP contracts in nursing homes increased between 2011 and 2013, from 55.2{\%} (N = 8691) to 61.1{\%} (N = 9605), respectively (P <.001). In multivariate analyses, greater hospice enrollment in nursing homes was associated with having at least one I-SNP enrollee per month; year (2013 higher than 2011); smaller facility size; urban (vs rural) setting; location in the Northeast (vs Midwest); lower average resident mental status; higher average resident mobility; younger residents, on average; and facilities with higher proportions of residents with specific diagnoses (cancer, cirrhosis, and dementia). After adjusting for resident and nursing home characteristics, the association between monthly I-SNP presence and hospice enrollment was found only in nursing homes with 50 or greater beds and there was a positive relationship with increasing size. CONCLUSIONS: Growth of I-SNPs has been associated with changes in hospice utilization, and the relationship varies by facility size. Studies are needed to clarify the nature of this association and determine whether care may be improved through coordination of these programs.",
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    AU - Chen, Jack

    AU - Bookbinder, Marilyn

    AU - Portenoy, Russell

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    N2 - BACKGROUND: Institutional Special Needs Plans (I-SNPs) in nursing homes could impact hospice use by residents with advanced illness. Little is known about their relationship. OBJECTIVE: To determine whether I-SNP availability has been associated with changes in hospice utilization. DESIGN: Federal data from 2011 and 2013 were extracted from the Minimum Data Set (MDS) and other sources. Multilevel models evaluated I-SNP–, resident-, and facility-related variables as predictors of hospice utilization. SETTING: All US nursing homes in 2011 (N = 15 750) and 2013 (N = 15 732). PARTICIPANTS: Nursing home residents enrolled in Medicare or in both Medicare and Medicaid. MEASUREMENTS: Nursing home and resident data were obtained from Centers for Medicare and Medicaid Services sources: the MDS 3.0, Master Summary Beneficiary File, and Special Needs Plan Comprehensive Report. RESULTS: The mean number of residents per nursing home was 210.9 (SD = 167.1) in 2011 and 217.2 (SD = 171.5) in 2013. The prevalence of I-SNP contracts in nursing homes increased between 2011 and 2013, from 55.2% (N = 8691) to 61.1% (N = 9605), respectively (P <.001). In multivariate analyses, greater hospice enrollment in nursing homes was associated with having at least one I-SNP enrollee per month; year (2013 higher than 2011); smaller facility size; urban (vs rural) setting; location in the Northeast (vs Midwest); lower average resident mental status; higher average resident mobility; younger residents, on average; and facilities with higher proportions of residents with specific diagnoses (cancer, cirrhosis, and dementia). After adjusting for resident and nursing home characteristics, the association between monthly I-SNP presence and hospice enrollment was found only in nursing homes with 50 or greater beds and there was a positive relationship with increasing size. CONCLUSIONS: Growth of I-SNPs has been associated with changes in hospice utilization, and the relationship varies by facility size. Studies are needed to clarify the nature of this association and determine whether care may be improved through coordination of these programs.

    AB - BACKGROUND: Institutional Special Needs Plans (I-SNPs) in nursing homes could impact hospice use by residents with advanced illness. Little is known about their relationship. OBJECTIVE: To determine whether I-SNP availability has been associated with changes in hospice utilization. DESIGN: Federal data from 2011 and 2013 were extracted from the Minimum Data Set (MDS) and other sources. Multilevel models evaluated I-SNP–, resident-, and facility-related variables as predictors of hospice utilization. SETTING: All US nursing homes in 2011 (N = 15 750) and 2013 (N = 15 732). PARTICIPANTS: Nursing home residents enrolled in Medicare or in both Medicare and Medicaid. MEASUREMENTS: Nursing home and resident data were obtained from Centers for Medicare and Medicaid Services sources: the MDS 3.0, Master Summary Beneficiary File, and Special Needs Plan Comprehensive Report. RESULTS: The mean number of residents per nursing home was 210.9 (SD = 167.1) in 2011 and 217.2 (SD = 171.5) in 2013. The prevalence of I-SNP contracts in nursing homes increased between 2011 and 2013, from 55.2% (N = 8691) to 61.1% (N = 9605), respectively (P <.001). In multivariate analyses, greater hospice enrollment in nursing homes was associated with having at least one I-SNP enrollee per month; year (2013 higher than 2011); smaller facility size; urban (vs rural) setting; location in the Northeast (vs Midwest); lower average resident mental status; higher average resident mobility; younger residents, on average; and facilities with higher proportions of residents with specific diagnoses (cancer, cirrhosis, and dementia). After adjusting for resident and nursing home characteristics, the association between monthly I-SNP presence and hospice enrollment was found only in nursing homes with 50 or greater beds and there was a positive relationship with increasing size. CONCLUSIONS: Growth of I-SNPs has been associated with changes in hospice utilization, and the relationship varies by facility size. Studies are needed to clarify the nature of this association and determine whether care may be improved through coordination of these programs.

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