December 6, 2002
A new study points out several differences between people with MS who are admitted to nursing homes and nursing home residents without MS, and suggests that nursing homes should provide services and programs that address the specific needs of people with MS.
A new study points out several differences between people with MS who are admitted to nursing homes and nursing home residents without MS, and suggests that nursing homes should provide services and programs that address the specific needs of people with MS. Robert J. Buchanan, PhD (Texas A&M University System Health Science Center) and colleagues report the study in the October issue of Multiple Sclerosis (2002;8:512-522). This project is part of an ongoing study supported by a contract from the Health Care Delivery and Policy Research program of the National MS Society.
Some individuals with progressive forms of MS eventually develop symptoms and disabilities that require skilled care and special equipment. When the needs of the patient go beyond the ability of home-based caregiving, admission to a long-term care facility may be necessary to ensure adequate care. Long-term care and skilled nursing facilities, which are often geared to geriatric patients, may not provide services and care appropriate for the typically younger individuals with MS.
Dr. Buchanan is analyzing the specific needs of individuals with MS in such facilities using the “Minimum Data Set” (MDS), a comprehensive federal dataset developed by the U.S. Health Care Financing Administration (now called the Centers for Medicare and Medicaid Services.) Beginning in June 1998, all nursing homes in the U.S. that are Medicare and Medicaid certified have been required to complete the MDS on all residents regardless of payment source. This dataset includes assessments made at the time of admission and periodically thereafter and provides detailed information about medical conditions and demographics (e.g., age, gender, and race), as well as comprehensive information about the care and services received.
Dr. Buchanan and colleagues analyzed 14,009 assessments of people with MS admitted to nursing homes between June 22, 1998 and December 21, 2000, as well as 440,642 assessments of all nursing home residents without MS admitted during the year 2000. They found many significant differences between the two groups.
This study reveals that upon admission to nursing homes, people with MS are younger, more physically disabled, and have better cognitive function than residents without MS. They are also more likely to experience depression and urinary tract infections. “Nursing homes caring for residents with MS must provide services and programs, including mental health care, that address the needs of these younger, physically disabled and more cognitively intact residents,” write the authors.
As a possible alternative to nursing home care, Dr. Buchanan’s team suggests Medicaid home- and community-based care waiver programs, which are available in a number of states. Covered services may include attendant care, respite care and home-delivered meals. More information about such services is available on the Medicaid Web site at: http://cms.hhs.gov/medicaid/waivers/default.asp. Dr. Buchanan is exploring other home- and community-based alternatives to nursing homes as this study proceeds.
The National MS Society has long been concerned about the needs of people
with multiple sclerosis for quality, accessible, affordable, and comprehensive
long-term care services. Society chapters may work with local skilled nursing
facilities to educate staff on caring for people with MS, or to help the
facility establish a separate section to care for younger people with disabilities
who have different programmatic needs. Chapters also are involved in planning
and implementing initiatives to increase access to community-based, in-home
and integrated services. Reports on the latest of these chapter activities
are available in the following articles on our Web site: “2002 Advocacy
Successes: Long-Term Care” and “The Challenge Of Long-Term Care”.
© 2002 The National Multiple Sclerosis Society