2028. VA Utilization and Costs for Long Term Care (LTC) Patients with Alzheimer’s Disease (AD)
L Wolfsfeld, Center for Health Quality, Outcomes and Economic Research, S  Zhu, Center for Health Quality, Outcomes and Economic Research, A Hendricks, Center for Health Quality, Outcomes and Economic Research

Objectives: To compare utilization and costs for VA LTC patients with a diagnosis of AD with utilization and costs of VA LTC patients as a whole, by VISN, age and LTC program.

Methods: Using VA nationwide utilization files (PTF, OPC, Census) for FY1998 to FY2000, we identified all LTC patients with an AD diagnosis (ICD-9 code 331.0). Results are stratified by inpatient and outpatient long term care program, age and VISN, by year.

Results:  In FY2000, 4,247 LTC inpatients and 6315 LTC outpatients had an AD diagnosis.  The largest number (3,839) of LTC inpatients with an AD diagnosis received care in VA nursing homes, but respite programs had the largest percentage of patients  (13.7%).  The largest number of LTC outpatients with an AD diagnosis received care at geriatric clinics (3,842) while the Alzheimer’s/dementia and the adult day health programs had the greatest proportionate number of AD patients (49% and 21.5% respectively). AD diagnoses increase with age.  For example, among LTC inpatients, 6.3% of 65-74 year olds, 14.2% of 75-84 year olds and 16.5% of 85+ year olds had an AD diagnosis. Across VISNs, the percentage of LTC patients with AD varied from 2% to 12% for LTC inpatients and from 2% to 27% for LTC outpatients.  Mean number of nursing home days for VA nursing home patients with a diagnosis of AD was 132 compared to 111 days for all VA nursing home patients.  Nursing home costs for nursing home patients with a diagnosis of AD were $38,385 per year compared to $32,256 per year for all nursing home patients.

Conclusions: Approximately 7% of VA LTC patients had a diagnosis of AD in FY2000. Almost 90% of LTC inpatients with an AD diagnosis received VA nursing home care compared to 60% of LTC inpatients overall.  AD patients comprised 9.7% of all nursing home patients and accounted for 11% of total nursing home costs.

Impact: This study begins to systematically identify utilization, costs and place of service of veterans with an AD diagnosis.  This is a first step in understanding the cost to the VA of patients with Alzheimer’s disease.