Kinosian Bruce, Stallard Eric, Wieland Darryl
Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA 19104, USA.
Gerontologist. 2007 Jun;47(3):356-64. doi: 10.1093/geront/47.3.356.
The purpose of this article is to describe the projected use for long-term-care services through 2012.
We constructed a static-component projection model using age, function, and other covariates. We obtained enrollee projections from the Veterans Health Administration (VHA) and combined these with nursing home and community long-term-care service use rates from the 1999 National Long-Term Care Survey and the 2000 National Health Interview Survey.
Over the next decade, the number of oldest veterans (aged 85+) will double, and VHA-enrolled veterans aged 85 and older will increase sevenfold. This will result in a 20-25% increase in use for both nursing home and home- and community-based services. VHA currently concentrates 90% of its long-term-care resources on nursing home care. However, among those who receive long-term care from all formal sources, 56% receive care in the community. Age and marital status are significant predictors of use of either type of formal long-term-care service for any given level of disability. VHA's experience with the mandatory nursing home benefit suggests that even when the cost to the veteran is near zero, only 60-65% of eligibles will choose VHA-provided care. Assisted living represents nearly 15% of care provided during the past decade to individuals in nursing homes, and approximately 19% of veterans using nursing homes have disability levels comparable to those of men supported in assisted living.
As most of the increased projected use for long-term care will be for home- and community-based services, VHA will need to expand those resources. Use of VHA resources to leverage community services may offer new opportunities to enhance community-based long-term care.
本文旨在描述到2012年长期护理服务的预计使用情况。
我们构建了一个静态成分预测模型，使用年龄、功能和其他协变量。我们从退伍军人健康管理局（VHA）获得了参保人数预测，并将其与1999年全国长期护理调查和2000年全国健康访谈调查中的养老院和社区长期护理服务使用率相结合。
在接下来的十年中，最年长的退伍军人（85岁及以上）数量将翻倍，VHA登记的85岁及以上退伍军人将增加七倍。这将导致养老院以及家庭和社区服务的使用量增加20%至25%。VHA目前将其90%的长期护理资源集中在养老院护理上。然而，在所有正规来源接受长期护理的人中，56%在社区接受护理。对于任何给定的残疾水平，年龄和婚姻状况是使用任何一种正规长期护理服务的重要预测因素。VHA在强制性养老院福利方面的经验表明，即使退伍军人的成本几乎为零，只有60%至65%的符合条件者会选择VHA提供的护理。在过去十年中，辅助生活占养老院中个人所接受护理的近15%，使用养老院的退伍军人中约19%的残疾水平与辅助生活中得到支持的男性相当。
由于预计长期护理使用量的增加大部分将用于家庭和社区服务，VHA将需要扩大这些资源。利用VHA资源来利用社区服务可能会为加强社区长期护理提供新机会。
