Medicare Expenditures Among Nursing Home Residents With Advanced Dementia | Dementia and Cognitive Impairment | JAMA Internal Medicine | JAMA Network
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Original Investigation
May 9, 2011

Medicare Expenditures Among Nursing Home Residents With Advanced Dementia

Author Affiliations

Author Affiliations: Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York (Mr Goldfeld); and Department of Health Care Policy, Harvard Medical School (Dr Stevenson), Department of Medicine, Beth Israel Deaconess Medical Center (Drs Hamel and Mitchell), and Hebrew SeniorLife Institute for Aging Research (Dr Mitchell), Boston, Massachusetts.

Arch Intern Med. 2011;171(9):824-830. doi:10.1001/archinternmed.2010.478

Dementia is a leading cause of death among older Americans.1 In 2000, 5 million adults in the United States had dementia, and projections predict 13 million by 2050.2 Health care expenditures for dementia are estimated to total $172 billion in 2010.2 These costs will rise as the number of persons living to experience the end stage of this disease increases.

Although 70% of persons with dementia die in nursing homes (NHs),3 most research describing health care spending for these individuals has been conducted in the community setting, and almost none has focused on end-stage disease. For Americans older than 65 years, Medicare covers the costs of acute care, subacute care, physician and other provider services, hospice, prescription drugs, and diagnostic tests. Medicare does not cover NH care, which is generally paid for by Medicaid after individuals exhaust their own resources. The total Medicare and Medicaid payments for patients with dementia are roughly 3 times higher than for age-matched controls.2,4 Total direct costs increase substantially over the course of the disease, with much of the increase in the later stages attributable to spending for NH care.5 Although per diem Medicaid payments account for most public spending within the NH setting, limited data suggest that Medicare expenditures explain most of the spending variation among dying residents with dementia.6 How this spending breaks down across the various Medicare services has not been well described.