Caregiver attitudes and hospitalization risk in michigan residents receiving home- and community-based care.
OBJECTIVE
To study a cohort of participants in home- and community-based services (HCBS) in Michigan to evaluate the relationship between (1) caregiver attitudes and participant characteristics and (2) the risk of hospitalization.


METHODS
HCBS programs funded by Medicaid or state/local funds in Michigan.


METHODS
Five hundred twenty-seven individuals eligible for HCBS in Michigan were studied. These HCBS participants were randomly selected clients of all agencies providing publicly funded HCBS in Michigan from November 1996 to October 1997.


METHODS
Data for this study were collected using the Minimum Data Set for Home Care. Assessments were collected longitudinally, and the baseline (initial admission assessment) and 90-day follow-up assessments were used. Key measures were caregiver attitudes (distress, dissatisfaction, and decreased caregiving ability) and HCBS participant characteristics (cognition, functioning, diseases, symptoms, nutritional status, medications, and disease stability). Multinomial logistic regression was used to evaluate how these characteristics were associated with the competing risks of hospitalization and death within 90 days of admission to HCBS.


RESULTS
We found a strong association between caregiver dissatisfaction (caregiver dissatisfied with the level of care the home care participant was currently receiving) and an increased likelihood of hospitalization. HCBS participant cancer, chronic obstructive pulmonary disease, pain, and flare-up of a chronic condition were also associated with increased hospitalization. Poor food intake and prior hospitalization were associated with hospitalization and death.


CONCLUSIONS
We conclude that, within a cohort of people receiving HCBS who are chronically ill, highly disabled, and at high risk for hospitalization and death, interventions addressing caregiver dissatisfaction, pain control, and medical monitoring should be evaluated for their potential to decrease hospitalization.
RAND Corporation, 1700 Main Street, PO Box 2138, Santa Monica, CA 90407, USA. lisa_shugarman@rand.org
Lisa R
LR
Shugarman
Amna
A
Buttar
Brant E
BE
Fries
Tisha
T
Moore
Caroline S
CS
Blaum
D000368:Aged; D001294:Attitude to Health; D017028:Caregivers / Q000523:psychology*; D003153:Community Health Services; D005260:Female; D015577:Geriatric Assessment; D006701:Home Nursing; D006760:Hospitalization; D006801:Humans; D008297:Male; D008824:Michigan; D012307:Risk Factors; D013315:Stress, Psychological