A COST AND VALUE ANALYSIS OF 2 INTERVENTIONS WITH INCONTINENT NURSING-HOME RESIDENTS

OBJECTIVE: More than half of nursing home residents suffer from urinar y incontinence. These residents typically have long stays and, because of comorbid cognitive and physical impairments, have little hope of l iving again in a noninstitutional environment The value of interventio ns to change functional status of this chronically institutionalized p opulation is often questioned. This paper explores this value issue in the context of two incontinence management interventions that have be en shown to improve functional status: (1) Functional Incidental Train ing (FIT), and (2) Prompted Voiding (PV). The relative value of the di fferent interventions for the nursing home population was estimated us ing paired preferences. DESIGN: The cost of two interventions (FIT and PV) that target incontinent nursing home residents was related to the value of these interventions as perceived by consumers of nursing hom e services. Both interventions decrease incontinence frequency, and on e intervention also improves mobility endurance. PARTICIPANTS: Ninety incontinent nursing home residents received the intervention; 37 older nondemented board and care residents and 31 family members of the nur sing home residents provided estimates of the intervention's value. ME ASUREMENT: The staff-time allocations involved in implementing both in terventions were documented in more than 85 resident care episodes. Th ese time data were converted to labor cost based on the cost of nursin g aides who would actually implement the intervention. The value of ea ch intervention was assessed by asking consumers to make choices betwe en the intervention and its associated outcomes (such as increased dry ness) and other nursing home services of known cost (e.g., moving to a private room). RESULTS: Both interventions had labor costs that were greater than ''usual care'' costs. The additional cost was estimated t o be $4.31 per resident per day for PV and $6.42 per resident per day for FIT if these programs were implemented from 7 AM to 7 AM. Consumer preference data indicated that consumers preferred the FIT and PV out comes to more expensive alternative services, calculated to cost $10.0 0 per day, often marketed to consumers, CONCLUSION: Consumers may pref er the FIT and PV interventions relative to the typical services often marketed to the nursing home consumer. The analysis completed in this paper suggests that both interventions have value for frail residents likely to live out their lives in a nursing home.