Nursing Home Use by Dual-Eligible Beneficiaries in the Last Year of Life

Much of the research on health care at the end of life has focused on Medicare-financed acute care services. Only a few studies have examined the patterns of services used by Medicare beneficiaries who are dually eligible for Medicaid —a very high-cost subgroup of the Medicare population. The researchers in this study used data from the Multi-State Dual Eligible Data Files to examine nursing home admissions in the last year of life, the odds of dying in a nursing home versus a hospital or community, and variations in Medicare and Medicaid service use and costs by place of death. The data files contained enrollment and claims data for Medicare and Medicaid dual-eligible beneficiaries in 12 states from 1994 to 1996.

The study revealed that among dual-eligible people, 75 percent used nursing home care in the last year of life. The prevalence of Medicaid nursing home use in the last year ranged from 23 percent for those aged 74 and younger to 60 percent for those aged 85 and older. Medicare was used by about 35 percent of each age group. Of the total sample of 136,205 dual-eligible people, 30 percent died in hospitals, 38 percent died in nursing homes and 32 percent died in the community. Increasing age was associated with a greater likelihood of dying in a hospital. In addition, dual-eligible people who died in hospitals had higher health care costs, which may be attributable to higher Medicare hospital costs in the last month of life.