AHRQ Focus on Research

Long-Term Care

Describes AHRQ research into the factors that affect the delivery and quality of a variety of long-term care services.

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Scope of the Problem / Background / Impact of AHRQ Research / Examples of Current Projects / For More Information

Scope of the Problem

The need for long-term care services is expected to increase dramatically in this country as the population ages. Changing demographics, along with other factors may reduce the ability of family members to take care of elderly relatives placing additional demands on public and private programs.

• In 2011, 77 million people will turn 65, and by 2025, the number of Medicare beneficiaries is expected to reach 69.3 million, representing 20.6 percent of the U.S. population.
• Over the same period, those over age 80 will comprise the fastest growing segment of the population.
• Four out of every 10 people turning age 65 will use a nursing home at some point in their lives, and many will need home care and other related services as well.
• Expenditures for elderly living in the community were more than three times those of the nonelderly in 1996—$5,644 vs. $1,865—and are projected to increase to $7,674 (in 1996 dollars) by 2005.
• Medicare and Medicaid long-term care expenditures are projected to double by 2005.

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Background

The Agency for Healthcare Research and Quality (AHRQ) supports research on improving the quality of health care, reducing cost, enhancing patient safety, and broadening access to and use of essential services. The research supported and conducted by AHRQ aims to improve the quality of long-term care for elderly Americans, enhance their access to appropriate services, and ensure that the services provide value for the money spent.

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Impact of AHRQ Research

• Reducing transfers of nursing home residents to hospitals. AHRQ-sponsored researchers in Missouri have designed a new tool that helps identify nursing home residents at relatively low risk for death from lower respiratory infection (LRI), which means patients may be treated safely without transferring them to a hospital. LRIs, primarily pneumonia, are among the leading causes of hospitalization and death among nursing home residents.
• Describing the "sandwich generation." Research sponsored by AHRQ indicates that adults in their 50s, members of the so-called "sandwich generation," often have elderly parents prone to frailty and disability.
  • Nearly three out of four people in the age range of 50 to 54 have at least one living parent and one living child.
  • One-fifth of middle-aged households include at least one elderly parent who cannot be left alone and needs help with activities of daily living (e.g., eating, dressing, using the toilet). These are mostly multigenerational households that also include children and even grandchildren.
  • In 29 percent of these households, adult children provide caregiving time (hours of caregiving), give money for needed care and assistance, and/or share living space with their disabled elderly parents.
• Reducing the use of non-steroidal anti-inflammatory drugs (NSAIDs) in nursing homes. Elderly nursing home patients with osteoarthritis who were treated with NSAIDs are at greater risk for drug-induced complications and even death. AHRQ researchers developed an educational program for nursing home doctors and staff to treat chronic pain. As a result of AHRQ's research:
  • NSAID use was reduced by 70 percent over a 3-month period. This reduced the cost of NSAID treatment by 53 percent.
  • Implementation of the educational program could be expected to reduce the risk of gastrointestinal bleeding, other complications, and associated costs from hospitalizations.
  • Journal articles published as a result of this research provide guidance to physicians in treating elderly osteoarthritis patients.
  • These results have been shared with Tennessee's Medicaid program to improve care for all patients with osteoarthritis.
• Providing information on the nursing home quality. Nursing Home Compare, http://www.medicare.gov/NHCompare/home.asp, the most popular Web site operated by the Centers for Medicare and Medicaid Services, grew out of an AHRQ-funded project to develop a consumer information system to help people find data on nursing homes. The site was launched in 1999, and has an average of 400,000 page views per month. The primary purpose of this tool is to provide detailed information about the performance of every Medicare and Medicaid certified nursing home in the country.

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Examples of Current Projects

• Assisted living and health system use. Researchers at Texas A & M Health Sciences Center are examining how the characteristics of assisted living facilities (ALFs) affect the ways in which ALF residents interact with the health and long-term care systems, specifically their use of Medicare-covered health services and transitions to other care settings.
• Quality factors in nursing home choice. Researchers at the University of Colorado Health Science Centers are developing and evaluating information strategies to assist consumers in using quality-related factors in choosing a nursing home.
• Nursing home care at the end of life: cost and quality. Researchers at Brown University are studying the cost and quality of care of terminally ill nursing home residents, both in hospice care and regular nursing home care settings.
• Evidence-based "reminders" in home health care. Researchers at the VisitingNurse Service of New York are promoting the use of evidence-based practice strategies among home health care nurses. Researchers will detail provider's use of evidence-based information in the treatment of two highly prevalent, chronic diseases: congestive heart failure and cancer and the impact use of this information the quality and cost of care.
• Translating Research Into Practice. AHRQ researchers have developed a model of care to examine the effectiveness of implementing previous AHRQ research findings on methods to reduce urinary incontinence (UI). The model will be tested in 10 nursing homes in New York State. The goal is to significantly reduce the incidence of UI and to improve the quality of life of nursing home residents and their families.

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For More Information

For more information on AHRQ research on long-term care, contact:

Irene Fraser, Ph.D., Director
Center for Organization and Delivery Studies
Agency for Healthcare Research and Quality
540 Gaither Road, 5th Floor
Rockville, MD 20850
Phone: (301) 427-1410
E-mail address: IFraser@ahrq.gov

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AHRQ Publication No. 02-M028
Current as of March 2002

Internet Citation:

Long-Term Care. AHRQ Focus on Research. AHRQ Publication No. 02-M028, March 2002. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/focus/focltcare.htm

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