Patterns of nursing home use in a prepaid managed care system: the continuing care retirement community.

The use of nursing home services among 3,316 residents of six continuing care retirement communities (CCRCs) was compared with that of the general elderly population. CCRC residents have a greater lifetime risk of nursing home entry and repeat entries. CCRC resident's length of stay per admission, however, is shorter. Findings from this comparative analysis provided insight into nursing home use in an insured and managed long term care program for a closed population.

Epithelial markers in synovial sarcoma. An immunohistochemical study on paraffin embedded tissues.

Immunohistochemical studies on synovial sarcomas have proved the potentiality of these neoplasm for epithelial and mesenchymal differentiation and antibodies detecting epithelial cells have been found to be helpful in determining the histological types. In this study different epithelial markers directed against various cytokeratins, HMFG-2 and EMA were investigated on paraffin embedded tissues of 13 cases of synovial sarcomas, with regard to their reliability in unmasking the epithelial components demonstrable in this type of neoplasm. The results lead to three conclusions: firstly, synovial sarcomas possess the capacity for generating different epithelial cell types with uncommon compositions of intermediate filaments as well as of membrane proteins, secondly, these features may be expressed in a heterogenous pattern even within the same tumour and finally, the use of wide range anti-cytokeratin antibodies covering the spectrum of basic as well as acidic type proteins seems to be necessary for the detection of all epithelial components demonstrable in synovial sarcomas.

The risk factors of nursing home entry among residents of six continuing care retirement communities.

We identified client characteristics related to nursing home entry for 3,316 residents of six continuing care retirement communities with a longitudinal dataset that follows an initially healthy entry cohort for up to 15 years. The Cox Proportional Hazards Model was used for the analysis of survival data that includes censored data. We calculated hazard indices for residents with different characteristics to show the independent effect of these variables on the probability of nursing home entry. Seven variables emerged as statistically significant covariates: sex, marital status, roommate status, entry year into the community, entry age into the community, number of hospitalizations, and community of residence. The community of residence, which in large part reflects system effects on nursing home entry, was found to be the single most important variable explaining variance in the data. Tobit analysis was used to examine the factors associated with multiple nursing home entries and total days per year spent in a nursing home. With a few exceptions, most of the variables listed above were also significant correlates of multiple entries and total days per year spent in a nursing home.

Life Care at Home: a new model for financing and delivering long-term care.

In this paper we describe the Life Care at Home (LCAH) concept, a new long-term care insurance and service delivery model that combines the financial and health security of a continuing care retirement community (CCRC) with the freedom and independence of living at home. LCAH retains risk pooling for long-term care and provides other benefits and guarantees of CCRCs, including unlimited nursing home care. Because subscribers live in their own homes as long as they can, LCAH costs are substantially lower than those of CCRCs and more individuals can participate. Our market research indicates that LCAH has strong appeal among the elderly. We suggest that LCAH has a market potential of 10% to 25% of all elderly.

New directions in life care: an industry in transition.

Current approaches to financing long-term care are inadequate; they are even less likely to meet future needs of increasing numbers of disabled and chronically ill elderly persons. While insurers, providers, and policy makers are developing models of risk-pooling that cover long-term care, the industry that first put these concepts into practice is moving in other directions. Despite the success of many continuing-care retirement communities in offering full and affordable long-term care coverage, a new trend emphasizes amenities over comprehensiveness. Sponsorship and consumer demand are contrasted with insurability of risks as key issues for the industry and for policy makers.

The lifetime risks and costs of nursing home use among the elderly.

In this paper, we estimate the risk of an individual of entering a nursing home throughout the aging process. We then estimate the expected lifetime costs of nursing home use both for an individual and for society as a whole. The model is based on double-decrement life-table analysis. Data are taken from a 1977 survey of 4,400 Medicare beneficiaries. At age 65, the upper bound for the lifetime risk of entering a nursing home is 43.1%. The risk of entering a nursing home increases with age until around age 80. At about age 85, the risk begins to decline significantly. At almost all ages, the lifetime risk of entry for females is twice that of males. The expected lifetime costs of nursing home care across all ages are between $10,500 and $13,600. These costs are distributed very unequally. Only 13% of the elderly account for 90% of all nursing home expenditures. Given current life expectancy, the expected annual cost per person over age 65 is between $532 and $760. In the year 2000, the expected annual average costs of nursing home care per elderly person will range from $450 to $650. The decline in the average annual cost per person reflects shifts in the age structure and increased life expectancy. These figures need not represent an unmanageable burden on society's resources. Figures presented here help establish the feasibility and desirability of long-term care risk-sharing arrangements among the elderly, like long-term care insurance, life care communities, and other models.

Client-related risk factors of nursing home entry among elderly adults.

We estimated the relative importance of various client characteristics related to nursing home entry for a national probability sample of Medicare recipients and developed predictive models of nursing home entry that account for the interactive effects among variables. In contrast with previous research, we focused on the characteristics of nursing home entrants, not residents. By using a national sample we ensured that the influence of regional variations in the configuration of long-term care services would not confound estimates of the relative effect of client-related factors. Nine variables emerged as statistically significant predictors: age, being confined to a bed, requiring help to get around, requiring aid getting around, being widowed, never married, welfare as a payment source, insurance as a payment source, and perceived health status. When these factors were controlled for, sex, geographic region, and educational status were not statistically significant.

A dialysis need-forecasting model. A retrospective evaluation.

A model to forecast the need for dialysis beds, currently used by the Massachusetts Department of Public Health (DPH), is evaluated after ten years of availability and two years of formal use. The model was originally developed in 1972 to accommodate some informal planning needs of dialysis providers in Massachusetts. In 1978 the model was formally adopted by the DPH for its end stage renal disease planning. The model was designed to be and proved to be flexible in accommodating parameters and inputs specific to a given region, changes due to medical and technological innovations, and the acquisition of new data. This paper evaluates the model in terms of its accuracy, its financial impact, and the impact it has had on the allocation of dialysis resources in Massachusetts. The usefulness of the model as a planning tool is evaluated along several criteria. Two case studies are presented to illustrate how the model has been used to evaluate requests for dialysis facility development or expansion.