title: Comparison of Long-term Care in Nursing Homes Versus Home Health: Costs and Outcomes in Alabama.
abstract: OBJECTIVE
  To compare acute care outcomes and costs among nursing home residents with community-dwelling home health recipients.
  
  
  METHODS
  A matched retrospective cohort study of Alabamians aged more than or equal to 65 years admitted to a nursing home or home health between March 31, 2007 and December 31, 2008 (N = 1,291 pairs). Medicare claims were compared up to one year after admission into either setting. Death, emergency department and inpatient visits, inpatient length of stay, and acute care costs were compared using t tests. Medicaid long-term care costs were compared for a subset of matched beneficiaries.
  
  
  RESULTS
  After one year, 77.7% of home health beneficiaries were alive compared with 76.2% of nursing home beneficiaries (p < .001). Home health beneficiaries averaged 0.2 hospital visits and 0.1 emergency department visits more than nursing home beneficiaries, differences that were statistically significant. Overall acute care costs were not statistically different; home health beneficiaries' costs averaged $31,423, nursing home beneficiaries' $32,239 (p = .5032). Among 426 dual-eligible pairs, Medicaid long-term care costs averaged $4,582 greater for nursing home residents (p < .001).
  
  
  CONCLUSIONS
  Using data from Medicare claims, beneficiaries with similar functional status, medical diagnosis history, and demographics had similar acute care costs regardless of whether they were admitted to a nursing home or home health care. Additional research controlling for exogenous factors relating to long-term care decisions is needed.
authors.affiliation: Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health. jblackburn@uab.edu.
authors.forename: Justin
authors.initials: J
authors.lastname: Blackburn
authors.affiliation: Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham School of Medicine.
authors.forename: Julie L
authors.initials: JL
authors.lastname: Locher
authors.affiliation: Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health.
authors.forename: Meredith L
authors.initials: ML
authors.lastname: Kilgore
mesh_terms: D000368:Aged; D000407:Alabama; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006699:Home Care Services / Q000191:economics*; D006707:Homes for the Aged / Q000191:economics; D006801:Humans; D008134:Long-Term Care / Q000191:economics*; D008297:Male; D006278:Medicare; D012189:Retrospective Studies; D014481:United States
keywords: Home- and community-based services (HCBS); Medicaid; Medicare; Nursing home