Effects of the Medicare Alzheimer's Disease Demonstration on nursing home entry

Health Serv Res. 1999 Aug;34(3):691-714.


Study question: Did the Medicare Alzheimer's Disease Demonstration, with its goal of improving caregiver outcomes through case management and subsidized community services, affect the nursing home entry rate of treatments with dementia compared to controls?

Data sources: Interviews conducted at baseline and six months thereafter. Measures include date of nursing home entry, client and caregiver health, and income.

Study design: The demonstration randomly assigned voluntary applicants into treatment and control groups. Treatment group cases were eligible for case management and for an 80 percent discount on community care benefits, up to about $600 per month.

Data collection: All cases received baseline and semi-annual assessment interviews for up to three years after enrollment. Analyses are among cases that remained in the demonstration for more than 30 days after enrollment (n = 8,095).

Principal findings: The intervention of case management and subsidized community service had no effect on nursing home entry rates for treatments overall, compared to those of controls, and few effects on treatment subgroups, with the exception of one site where it may have increased nursing home entry rates.

Conclusions: Providing case management and subsidized community services with the goal of improving caregiver outcomes may have little effect on nursing home entry rates for people with dementia.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Alzheimer Disease / nursing*
  • Caregivers / statistics & numerical data
  • Case Management / statistics & numerical data
  • Community Health Services / statistics & numerical data*
  • Demography
  • Female
  • Homes for the Aged / statistics & numerical data*
  • Humans
  • Male
  • Medicare / organization & administration*
  • Middle Aged
  • Nursing Homes / statistics & numerical data*
  • Pilot Projects
  • Proportional Hazards Models
  • Random Allocation
  • United States