The cost of institutional care in Alzheimer's disease: nursing home and hospital use in a prospective cohort

J Am Geriatr Soc. 1992 Mar;40(3):221-4. doi: 10.1111/j.1532-5415.1992.tb02072.x.


Objective: To assess the nursing home and hospital use of patients with Alzheimer's Type Dementia.

Design: A prospective cohort study of 126 patients entered into an Alzheimer's disease registry after diagnosis at a university hospital clinic between 1980 and 1982. Only four patients were in nursing homes at enrollment.

Measurements and main results: Data regarding nursing home use came from the registry and the individual nursing homes themselves. Hospital-use data were obtained using Medicare claims files. Follow-up was obtained on 123 patients (98%). Eighty-five (69%) had died by July 1, 1989. Three-quarters of the cohort (92) eventually resided in nursing homes. The median nursing home length of stay was 2.75 years (mean 2.95, 95% CI = 2.5, 3.4), over 10 times the national median length of stay for all diagnoses. Based on prevailing rates in the region, nursing home charges for the cohort were estimated to be between $4.3 and $6.4 million ($35,000-$52,000 per patient). During the 5-year period 1983-1988, 69 patients filed Part A (hospital) claims to Medicare for 76 admissions and 616 inpatient days. Part A Medicare reimbursement for the cohort totaled $460,000 over 5 years ($3,700 per patient), an expenditure comparable to what a random Medicare cohort might incur.

Conclusions: The combination of a high rate of nursing home entry and lengthy stays makes long-term care the largest determinant of the cost of care in Alzheimer's disease. While Alzheimer's Type Dementia undoubtedly has profound indirect costs, this study demonstrates that the direct institutional costs alone are considerable.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Alzheimer Disease / economics*
  • Alzheimer Disease / epidemiology
  • Alzheimer Disease / physiopathology
  • Diagnosis-Related Groups
  • Economics, Hospital
  • Fees and Charges
  • Female
  • Follow-Up Studies
  • Health Expenditures / statistics & numerical data*
  • Hospitals / statistics & numerical data*
  • Hospitals, University
  • Humans
  • Length of Stay / economics
  • Length of Stay / statistics & numerical data
  • Male
  • Medicare Part A / statistics & numerical data
  • Nursing Homes / economics
  • Nursing Homes / statistics & numerical data*
  • Outpatient Clinics, Hospital
  • Prevalence
  • Prospective Studies
  • Registries
  • Survival Rate
  • United States