Here - American Geriatrics Society

P OSTER
A BSTRACTS
Table 1. Effect of co-morbidities and medications on 1-year rate of
hypoglycemia in elderly patients
§ Comparison of hypoglycemia rates with vs. without factor
C113
Baby Boomers Caring for Aging Parents: Pilot Data from a
Validated Survey Measuring Caregiving Effect on Attitudes,
Expectations and Healthcare Practices of Caregivers.
D. Kaplan, 1 L. Kaplowitz, 2 M. Reid, 1 E. Finkelstein. 1 1.
Medicine/Geriatrics, Weill Cornell Medical College, New York, NY; 2.
State University of New York, Buffalo, NY.
Purpose: Over 45 million adult children provide informal care
to aging parents. The effect of caregiving on caregiver’s health and
well-being has been well documented. However, little information exists
regarding how providing care for an aging parent affects caregivers’
attitudes, expectations and behaviors toward their own aging.
This study uses a novel, validated survey instrument that aims to expand
our knowledge of caregiving and its effects in those particular
domains. Pilot data are reported here.
Methods: The Caregiver’s Aging Trajectory Survey (CATS) is a
41-item instrument that measures respondents’ attitudes of and expectations
for aging, plans for aging and healthcare practices of caregivers
providing or who have provided care to aging parents. CATS
also captures relevant data about caregivers and the quality and extent
of the caregiving experience. Participants are being recruited at
an urban academic geriatric practice, as well as at local caregiver support
groups. Our target “n” is 100 caregivers and 100 non-caregiver
controls.
Results: As of 12/5/11, we have collected data from 58 adult
child caregivers. Mean age is 56 (SD +/- 5), 82% female, 58% married,
77% Caucasian. Time spent caregiving ranges from 40 hrs/wk.
Participants are well-educated (64% college graduates), 58% rate
their own health as excellent or very good; 40% report feeling depressed.
Caregiver strain was reported as severe in 55% of participants
using the Caregiver Strain Index (> or = 7 on a scale of 1-13).
Caregiver’s expectations regarding aging (as per Expectations Regarding
Aging Survey-12, which is on a scale of 0-100, 0=lowest) are
low overall – mean of 34 for physical health and 36 for cognitive function.
Though 78% reported having a routine check-up in the past
year, only 10% reported having advanced directives, 24% a living
will, and 29% a health care proxy. 24% of participants indicated that
they had long-term care insurance, and of those who had not, only 18
indicated that they may plan to in the future.
Conclusions: The purpose of the present study is to gain a better
understanding of the nuanced effects of caregiving on the aging
child caregiver. This can in turn help the health care system provide
better care to the growing number of baby boomers who are informal
caregivers.
C114
How similar are Medicaid’s PACE payments to its outlays on
alternative long-term care for comparable patients?
G. D. Wieland, 1 B. Kinosian, 2 E. Stallard. 3 1. U South Carolina,
Columbia, SC; 2. Department of Medicine, University of Pennsylvania
School of Medicine, Philadelphia, PA; 3. Center for Population Health
and Aging, Duke University, Durham, NC.
Supported By: None to declare.
Background. In rebalancing from nursing homes [NH], states
are increasing access of NH-certified dual eligibles to aged/disabled
waiver programs, and—in 29 states—PACE. Evaluations using community
controls suggest Medicaid’s [MA] PACE capitation exceeds
its spending for alternative fee-for-service [FFS] care. By design, these
studies did not compare PACE payments to outlays for patients with
equivalent health deficits/needs in both waiver and NH. Here, we develop
a multiattribute model of PACE-eligible admissions to waiver,
NHs and PACE to test whether MA PACE payments are lower than
FFS outlays for equivalent controls. Methods. Using grade-of-membership
methods, we model health deficits for duals >= 55 admitted
from 1997 to 2005 (n=3,988) using SC data. Pure patient types, membership
vectors, and program type prevalences are described. We calculate
a PACE blend-—fitting PACE between waiver & NH entrants.
FFS utilization was measured to 1-year from admission and converted
to attrition-adjusted FY05$ outlays. The PACE blend locates
FFS estimates for PACE entrants between mean waiver and NH payments,
adding the waiver base cost. PACE’s capitation is then compared
to the expenditure prediction. Results. Four clinical types describe
population health deficits/service needs. The waiver cohort is
most represented among the least impaired type (1: 47.1%), NH entrants
in the most disabled (4: 38.5%). PACE’s highest prevalences
were in Types 3 (32.7%) & 2 (32.3%). PACE’s blend probabilities are:
Waiver—0.5602; 95% c.i., 0.5472, 0.5732, and NH—0.4398; 0.4268,
0.4528. MA attrition-adjusted 1-year per capita payments for waiver
& NH were $4,177 & $77,945. The PACE blend is 43.98% of the difference
atop the waiver base, i.e., $36,620 (95% c.i.: $35,662, $37,580).
PACE’s MA capitation was $27,648—28% below the lower limit of
predicted FFS payments for the PACE cohort. Discussion. PACE entrants
in SC comprise a 56/44% blend of the health deficits/service
needs of waiver & NH patients. PACE’s capitation was well below
outlays for equivalent patients in alternative placement—a substantial
savings for the MA program. Further, our methods provide an element
of PACE rate setting which states presently lack.
C115
Hospitalizations and Emergency Room Visits in Older Adults
Receiving Care Transition: a Cohort Study.
H. Syed, K. Swanson, A. Rahman, J. Naessens, N. Shah, G. Hanson,
P. Takahashi . Mayo Clinic, Rochester, MN.
Background: Management of care transitions from the hospital
to home is an important area of need for older adults. It has been
widely recognized that older adults are readmitted to the hospital at
high rates which can potentially be reduced. Our clinical practice has
initiated a nurse practitioner (NP) care transitions program (CTP) to
help address the immediate needs of the patient after hospital stay.
The aim of this study was to determine the change in number of hospitalizations
from the 60 days prior to enrollment in CTP to 60 days
after enrollment in CTP.
Methods: This was retrospective cohort study of patients within
CTP from March 2011-September 2011. Patients discharged from the
hospital were selected for CTP based on risk stratification using the
elder risk assessment index. The intervention included a home visit by
the NP after discharge (within 7 days as goal). Primary outcomes included
a within group comparison of average hospitalizations, number
of hospital days and average emergency room visits for all subjects.
McNemars test or paired t tests were used for analysis.
Results: 95 subjects were enrolled in the cohort. The average
number of hospitalizations prior to CTP enrollment was 1.03 (SD
0.7) compared to 0.38 (SD 0.6) after enrollment (p value