The impact of stroke on the cost and level of care in nursing homes: A retrospective population-based study

Objective: To estimate the impact of incident stroke on nursing home (NH) c osts and level of care. Subjects and Methods: This retrospective population-based cohort study is p art of a larger study that identified all Rochester, Minn, residents with a confirmed first stroke occurring between January 1, 1988, and December 31, 1989. One Rochester resident who had not had a stroke was matched to each person with stroke. Persons with and without stroke were followed up in pro vider-linked medical records and NH files from baseline (ie, date of stroke ) through December 31, 1994, for evidence of NH use. This study characteriz ed the NH activity of those individuals with any NH activity after baseline (58 persons with major stroke, 36 persons with minor stroke, and 63 person s without stroke) as to NH case mix at first assessment, number of NH days, and per diem Medicaid reimbursement. Results: Characteristics at first NH assessment after baseline revealed tha t NH residents with major stroke were younger and more disabled and require d more services than residents without stroke. Over the full period of foll ow-up, the mean number of NH days was similar for NH residents with major s troke and those without stroke, yet per diem Medicaid reimbursement was 11% higher for residents with major stroke compared with residents without str oke. Nursing home residents with minor stroke appeared similar to those wit hout stroke with respect to time to admission, characteristics at first ass essment, number of NH days, and per diem Medicaid reimbursement. Conclusion: Lower incidence and severity of stroke may contribute to lower care needs and per diem cost, but no fewer NH days.