Everyone wants to live out their days in comfort. But the logistics of aging are complicated. What residential and long-term care options are available? How are they paid for? What influences the quality of care throughout a resident’s stay and at the end of life? How is the quality of care affected by government and other policies? As the first wave of baby boomers approaches retirement age, these and other aging-related issues loom large to an increasing number of people.

The Department of Health Care Policy is continually building on its understanding of these issues, with several HCP faculty members conducting research on various aspects of aging. Here’s a sampling of our ongoing projects in several major areas of concern in aging.

Nursing homes/long-term care

Disparities by race and payer status. HCP faculty members David C. Grabowski, PhD, and Thomas McGuire, PhD, are investigating disparities in nursing home care by race, ethnicity, and payer status, particularly service variations within a facility. The results of this project will allow providers, advocates, clinicians, consumers, and policymakers to better evaluate and address these disparities.

Impact of growth in the assisted living market on nursing home care. The growth in assisted living has coincided with a decrease in occupancy rates in nursing homes. With this decrease has come an increase in the share of Medicaid residents. Grabowski and David G. Stevenson, SM, PhD, are examining the possible link between these changes and the expansion in assisted living, and the role of public policy in addressing this changing market.

Psychiatric drugs and nursing homes. Stevenson, Grabowski, and Haiden A. Huskamp, PhD, are studying the use of antipsychotic and tranquilizer drugs in nursing homes. The researchers are looking at which patients are most likely to receive these medications inappropriately and at which type of facility. Results of this study show that these drugs are often prescribed without indication, and that inappropriate prescribing increases with the percentage of Medicaid residents.

Hospitalizations and nursing home residents. Nursing home residents often return to the nursing home after hospitalization more impaired than when they left. How might hospitalizations be prevented through treatment within the nursing home setting? What financial savings might be realized by avoiding unnecessary hospitalizations? Grabowski and A. James O'Malley, PhD, are examining these issues.

Nursing home hospice referrals. Huskamp is leading a project to better understand which nursing home residents with a terminal illness are referred for early hospice care. Although earlier referral may maximize the benefits of hospice for patients and their families, many patients receive hospice care only in their final days. This study will provide insight into factors that influence the timing of referral to hospice care for nursing home residents in New England and shed light on ways to ensure earlier access to hospice care where appropriate.

Medicare and Medicaid

Impact of Medicare Part D on hospitalizations. HCP faculty members Chris Afendulis, PhD; Michael Chernew, PhD; and Yulei He, PhD, are investigating whether expanded drug coverage provided by Medicare’s Part D program has resulted in reduced hospitalizations. The researchers are assessing whether geographic areas most affected by Part D have experienced greater changes in admissions than other areas. 

Leveraging Medicare policies to improve nursing home quality. Recent policy changes have expanded the share of post-acute nursing home residents whose stay is covered by Medicare. The Centers for Medicare & Medicaid also introduced a national report card for nursing homes to improve quality. Grabowski, McGuire, O’Malley, and Afendulis are investigating the impact of these changes and Medicare’s expanded involvement in this market on the quality of care.

Studies such as these on the multiple facets of aging are increasingly important. "As our population ages," says Stevenson, "we can’t afford to ignore these issues or to proceed without effective policies. Developing solutions will become more difficult the longer we wait, which makes it critical for the new administration to provide leadership for sustainable reform."

Research on these issues by the Department of Health Care Policy can serve to inform these discussions in the years ahead. For more information about HCP’s work on aging, please visit the Aging section of the Research part of our website.