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Member Research & Reports

Member Research & Reports

UAB Measures Risk of Becoming Long-stay Nursing Home Resident after Hip Fracture

Dr. Justin L. Blackburn, assistant professor in the department of health care organization and policy at the University of Alabama at Birmingham, recently measured how spending policies for home- and community-based services (HCBSs) affect a patient’s risk of becoming a long-term nursing home resident after experiencing a hip fracture. Department co-investigators are Dr. Julie L. Locher, professor; Dr. Michael A. Morrisey, professor emeritus; Dr. David J. Becker, associate professor; and Dr. Meredith Kilgore, professor and chair.

[Photo: Dr. Justin L. Blackburn]

Data from 7,778 community-dwelling Medicare beneficiaries 65 years or older who were identified with incident hip fractures between 2005 and 2010 were analyzed. The study was limited to those who were also enrolled in Medicaid or enrolled subsequent to their hip fracture. The team used a multilevel generalized estimating equation (GEE) model to examine the link between the likelihood of becoming a resident in a nursing home within one year of injury and the percentage of the states’ Medicaid long-term support service (LTSS) budget being earmarked for HCBS. Additional covariates include “expenditures for Title III services and individual demographic and health status characteristics.”

Study results determined that states vary significantly in HCBS spending, ranging from 17.7 to 83.8 percent of the Medicaid LTSS budget during 2009. Among those patients with hip fractures, 34 percent were admitted to nursing homes and 25 percent died within a year. A higher proportion of long-term care spending on HCBS was related to a decreased risk of nursing home residence.

Dr. Blackburn notes, “Consistent with other studies, our findings suggest that state policies favoring an emphasis on HCBS may reduce nursing home residence among low-income older adults with hip fracture who are at high risk for institutionalization.”

“The Effects of State-Level Expenditures for Home- and Community-based Services on the Risk of Becoming Long-Stay Nursing Home Resident after Hip Fracture” was published online in September in the journal Osteoporosis International.

Journal article: