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The Cost of Institutional Care in Alzheimer's Disease: Nursing Home and Hospital Use in a Prospective Cohort
Author(s) -
Welch H. Gilbert,
Walsh John S.,
Larson Eric B.
Publication year - 1992
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1992.tb02072.x
Subject(s) - medicine , cohort , dementia , reimbursement , nursing homes , prospective cohort study , cohort study , disease , minimum data set , long term care , family medicine , emergency medicine , gerontology , nursing , health care , surgery , economics , economic growth
Objective To assess the nursing home and hospital use of patients with Alzheimer's Type Dementia. Design A prospective cohort study of 126 patients entered into an Alzheimer's disease registry after diagnosis at a university hospital clinic between 1980 and 1982. Only four patients were in nursing homes at enrollment. Measurements and Main Results Data regarding nursing home use came from the registry and the individual nursing homes themselves. Hospital‐use data were obtained using Medicare claims files. Follow‐up was obtained on 123 patients (98%). Eighty‐five (69%) had died by July 1, 1989. Three‐quarters of the cohort (92) eventually resided in nursing homes. The median nursing home length of stay was 2.75 years (mean 2.95, 95% CI = 2.5, 3.4), over 10 times the national median length of stay for all diagnoses. Based on prevailing rates in the region, nursing home charges for the cohort were estimated to be between $4.3 and $6.4 million ($35,000–$52,000 per patient). During the 5‐year period 1983–1988, 69 patients filed Part A (hospital) claims to Medicare for 76 admissions and 616 inpatient days. Part A Medicare reimbursement for the cohort totaled $460,000 over 5 years ($3,700 per patient), an expenditure comparable to what a random Medicare cohort might incur. Conclusions The combination of a high rate of nursing home entry and lengthy stays makes long‐term care the largest determinant of the cost of care in Alzheimer's disease. While Alzheimer's Type Dementia undoubtedly has profound indirect costs, this study demonstrates that the direct institutional costs alone are considerable.