title: The cost of institutional care in Alzheimer's disease: nursing home and hospital use in a prospective cohort.
abstract: OBJECTIVE
  To assess the nursing home and hospital use of patients with Alzheimer's Type Dementia.
  
  
  METHODS
  A prospective cohort study of 126 patients entered into an Alzheimer's disease registry after diagnosis at a university hospital clinic between 1980 and 1982. Only four patients were in nursing homes at enrollment.
  
  
  RESULTS
  Data regarding nursing home use came from the registry and the individual nursing homes themselves. Hospital-use data were obtained using Medicare claims files. Follow-up was obtained on 123 patients (98%). Eighty-five (69%) had died by July 1, 1989. Three-quarters of the cohort (92) eventually resided in nursing homes. The median nursing home length of stay was 2.75 years (mean 2.95, 95% CI = 2.5, 3.4), over 10 times the national median length of stay for all diagnoses. Based on prevailing rates in the region, nursing home charges for the cohort were estimated to be between $4.3 and $6.4 million ($35,000-$52,000 per patient). During the 5-year period 1983-1988, 69 patients filed Part A (hospital) claims to Medicare for 76 admissions and 616 inpatient days. Part A Medicare reimbursement for the cohort totaled $460,000 over 5 years ($3,700 per patient), an expenditure comparable to what a random Medicare cohort might incur.
  
  
  CONCLUSIONS
  The combination of a high rate of nursing home entry and lengthy stays makes long-term care the largest determinant of the cost of care in Alzheimer's disease. While Alzheimer's Type Dementia undoubtedly has profound indirect costs, this study demonstrates that the direct institutional costs alone are considerable.
authors.affiliation: Department of Veterans Affairs Medical Center, White River Junction, Vermont 05001.
authors.forename: H G
authors.initials: HG
authors.lastname: Welch
authors.forename: J S
authors.initials: JS
authors.lastname: Walsh
authors.forename: E B
authors.initials: EB
authors.lastname: Larson
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000191:economics* / Q000453:epidemiology / Q000503:physiopathology; D003953:Diagnosis-Related Groups; D004469:Economics, Hospital; D005249:Fees and Charges; D005260:Female; D005500:Follow-Up Studies; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D016344:Medicare Part A / Q000706:statistics & numerical data; D009735:Nursing Homes / Q000191:economics / Q000706:statistics & numerical data*; D010044:Outpatient Clinics, Hospital; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries; D015996:Survival Rate; D014481:United States