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Survey: shorter stays: residents spending less time in nursing homes.

Nursing homes aren't quite the long-term stays they used to be for many residents. In fact, people are leaving facilities almost twice as fast as they did two decades earlier, according to a new study by the National Center for Health Statistics.

The discharge rate for residents with short-term stays--those of 90 days or less--rose from 46.1 per 100 beds in 1977 to 91.7 in 1999, according to the study, "Nursing Homes, 1977-99: What Has Changed, What Has Not?" released in early summer by the Hyattsville, Md., research facility.


The shorter tenure came despite an overall growth in population of those needing nursing homes: 1.63 million people received care at the facilities in 1999, a 27 percent increase from the 1.28 million total in 1977, according to the study. During that period the number of beds per facility also rose, from 79 in 1977 to 105 in 1999.

"It has long been recognized that the nursing home was a place providing care to residents with needs requiring short stays and to those with more chronic conditions requiring longer, if not permanent care," said NCHS researcher Frederic Decker, the study's author. "(But)in recent years, there has been a rise in assisted living and other long term care settings as possible alternatives to nursing homes for individuals requiring long term care."

The NCHS study noted that the shorter resident stays coincide with Medicare's increasing role as primary payer. In 1985, when the average length of stay for resident was 398 days, Medicare was primary payer for 11 percent of all discharges. Fourteen years later, when Medicare's responsibility had risen to 39 percent, the average length of stay had dropped to 272 days.

The shorter stays are also due to an increasing tendency by hospitals to discharge moderately injured persons sooner and transfer them into long term care facilities for rehabilitative care if needed, industry officials note.

"It has to do with healthcare controls and expense controls, and the fact that everybody is on some sort of government plan or company plan that only pays for so many days, period," said Theresa Bourdon, managing director at Aon Risk Consultants in Columbia, Md. "If they're not getting paid, they don't want the patient there."

David Abraham, administrator at Sentara Nursing Center in Norfolk, Va., agreed. "Hospitals are certainly under pressure with reimbursements and margins, much like nursing homes, to put these people out quicker--as well as insurance companies," he said. "It's a lot easier to contract with a nursing home at a lower rate than with a hospital at a much higher one."

But while the short-term residents are going through the turnstiles faster, the population of long term folks--those staying more than three months at a facility--rose slightly, according to the study. From 1977 to 1999 discharges among persons staying three months to a year rose from 19.3 to 20 per 100 beds; discharges among those staying one to three years rose from 12 to 12.5; and discharges among those staying three years or more rose from 8.7 to 10.

The distribution of residents by length of stay hasn't changed much, either. According to the study, those staying fewer than three months in a facility made up 14.4 percent of the population in 1977, compared to 17.8 percent in 1999; persons staying three months to one year accounted for 22.1 percent in 1977 and 25 percent in 1999; those staying one to three years accounted for 32.8 percent in 1977 and 30.1 percent in 1999; and persons staying three years or longer accounted for 30.7 percent in 1977 and 27.1 percent in 1999.

Residents are getting older, too. In 1977, 34.8 percent of residents were age 85 or older, compared to 46.5 percent in 1999. In contrast, 31.8 percent of residents were age 75 to 84 in 1999, down from 36 percent in 1977, and 12 percent of residents were age 65 to 74 years in 1999, down from 16.2 percent 22 years earlier.
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Title Annotation:INDUSTRY FOCUS
Author:Naditz, Alan
Publication:Contemporary Long Term Care
Date:Jul 1, 2005
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