Activities of Daily Living and Costs in Nursing Homes

Functionality, as measured by activities of daily living (ADL), is the most important predictor of the cost of nursing home care. Data from a field-test version of the federally mandated Minimum Data Set (MDS) were examined using analysis of variance (ANOVA) and recursive partitioning methods to determine the relationships between ADL limitations and nursing cost (wage-weighted nursing time) among nursing home residents (n = 6,663). From this analysis, an index based on limitations in four ADLs was created. The developed ADL index is a readily determined measure of functional status useful in allocating nursing staff within nursing homes and in comparing the functional status of groups of residents, explaining 30 percent of variance in nursing costs among nursing home residents.

[1]  B. Fries.  Comparing case-mix systems for nursing home payment , 1990, Health care financing review.

[2]  E. Cornelius,et al.  Refining a Case‐Mix Measure for Nursing Homes: Resource Utilization Groups (RUG‐III) , 1994, Medical care.

[3]  J. M. Cameron.  Case-mix and Resource Use in Long-term Care , 1985, Medical care.

[4]  B. Fries,et al.  Case-Mix Classification of Medicare Residents in Skilled Nursing Facilities: Resource Utilization Groups (RUG-T18) , 1989, Medical care.

[5]  G. Arling,et al.  Nursing Home Case Mix: Patient Classification by Nursing Resource Use , 1987, Medical care.

[6]  S. Katz,et al.  STUDIES OF ILLNESS IN THE AGED. THE INDEX OF ADL: A STANDARDIZED MEASURE OF BIOLOGICAL AND PSYCHOSOCIAL FUNCTION. , 1963, JAMA.

[7]  J. Morgan,et al.  Problems in the Analysis of Survey Data, and a Proposal , 1963 .

[8]  P Giovannetti,et al.  A New Generation Patient Classification System , 1990, The Journal of nursing administration.

[9]  S. Katz,et al.  Designing the national resident assessment instrument for nursing homes. , 1990, The Gerontologist.

[10]  S. Travis,et al.  Simple counts of the number of basic ADL dependencies for long-term care research and practice. , 1990, Health services research.

[11]  B. Fries,et al.  Case mix for nursing home payment: Resource utilization groups, version II , 1988, Health care financing review.

[12]  V. Mor,et al.  MDS data should be used for research. , 1992, The gerontologist.

[13]  J. P. Young,et al.  An integrated system for patient assessment and classification and nurse staff allocation for long term care facilities. , 1980, Health services research.

[14]  T. Suurmeijer,et al.  The development of a hierarchical polychotomous ADL-IADL scale for noninstitutionalized elders. , 1990, The Gerontologist.

[15]  F. Mahoney,et al.  FUNCTIONAL EVALUATION: THE BARTHEL INDEX. , 2018, Maryland state medical journal.

[16]  S. Katz,et al.  Progress in development of the index of ADL. , 1970, The Gerontologist.

[17]  W. Spector,et al.  The hierarchical relationship between activities of daily living and instrumental activities of daily living. , 1987, Journal of chronic diseases.

[18]  J. Morris,et al.  FRED: an innovative approach to nursing home level-of-care assignments. , 1987, Health services research.