Road to the nursing home: costs and disease progression among medicare beneficiaries with ADRD.

OBJECTIVES: To estimate long-term care costs and disease progression among Medicare beneficiaries aged 65+ with ADRD. METHODS: Retrospective analysis of Medicare Part A claims and nursing home (NH) Minimum Data Set (MDS) records among beneficiaries 1999-2007. Expenditures were grouped into 3 periods; PRE, events occurring between date of ADRD diagnosis, before first NH admission; PERI, from first NH admission to at least 100 days; and, PERM, after 120 days. Utilization and reimbursements were computed for each period. RESULTS: Demographics of the3,681,702 ADRD beneficiaries showed average age of 83 (+/-7), female (67.7%) and white (87.4%). Medicare reimbursements per person increased by 58% from the PRE ($47,912) to PERM period ($75,654). Age, ethnicity, gender (male), and comorbidities were significantly related to total reimbursements in each phase. CONCLUSIONS: Applying a taxonomy of NH phases, Medicare expenditures per person year are higher among patients in their terminal phase and higher still with comorbidities.