Predictors of Nursing Facility Entry by Medicaid-Only Older Adults and Persons With Disabilities in California

• Published in: Inquiry (Chicago) Vol. 55; pp. 1 - 8
• Main Authors: Ko, Michelle, Newcomer, Robert J., Harrington, Charlene, Hulett, Denis, Kang, Taewoon, Bindman, Andrew B.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA Sage Publications Inc 01-01-2018; SAGE Publications; SAGE PUBLICATIONS, INC; SAGE Publishing
• Subjects: Activities of daily living; Adult; Adults; Aged; Alternative approaches; Beneficiaries; California; Case management; Chronic illnesses; Cognition; Cognitive Dysfunction; Disability; Disabled Persons - statistics & numerical data; Disorders; Drug use; Eligibility Determination - methods; Ethnicity; Female; Health services; Homeless people; Housing; Humans; Long-Term Care - economics; Male; Medicaid; Medicaid - statistics & numerical data; Medicare; Mental disorders; Mental health care; Middle Aged; Minority & ethnic groups; Nervous system; Nurses; Nursing; Nursing homes; Nursing Homes - economics; Nursing Homes - organization & administration; Older people; Original Research; People with disabilities; Personal grooming; Policy making; Population; Poverty; Rehabilitation; Residential care; Retrospective Studies; Substance abuse; Substance use disorder; Trust; United States; Waivers; United States > US; California; long-term services and supports; home and community-based services; Medicaid; skilled nursing facilities
• ISSN: 0046-9580; 1945-7243
• DOI: 10.1177/0046958018768316

Nearly one-third of adult Medicaid beneficiaries who receive long-term services and supports (LTSS) consist of older adults and persons with disabilities who are not eligible for Medicare. Beneficiaries, advocates, and policymakers have all sought to shift LTSS to home and community settings as an alternative to institutional care. We conducted a retrospective cohort study of Medicaid-only adults in California with new use of LTSS in 2006-2007 (N = 31 849) to identify unique predictors of entering nursing facilities versus receiving Medicaid home and community-based services (HCBS). Among new users, 18.3% entered into nursing facilities, whereas 81.7% initiated HCBS. In addition to chronic conditions, functional and cognitive limitations, substance abuse disorders (odds ratio [OR] 1.35; 95% confidence interval [CI]: 1.23, 1.48), and homelessness (OR: 4.35, 9% CI: 3.72, 5.08) were associated with higher odds of nursing facility entry. For older adults and persons with disabilities covered by Medicaid only, integration with housing and behavioral health services may be key to enabling beneficiaries to receive LTSS in noninstitutional settings.