Untapped Potential: Using the HRS-Medicare-Linked Files to Study the Changing Nursing Home Population

Nursing home (NH) care in the United States now includes many short-term admissions to skilled nursing facilities (SNFs) for postacute care.

To demonstrate the potential of the Health and Retirement Study (HRS) linked to administrative data to study this group.

Descriptive retrospective panel study.

HRS respondents between 2002 and 2010 linked to administrative data from the Centers for Medicare and Medicaid Services (CMS).

NH use was defined in 3 ways: by survey responses, Medicare SNF claims, and mandatory NH assessments.

In total, 8.5% of observation periods (ie, time between 2 consecutive survey dates or 2 years before initial survey) reported by the survey and 26.0% reported by administrative data indicated some NH use. There was 98% agreement between survey responses and administrative data when there was no indication of a NH observation in the administrative data. However, there was only 33% agreement between survey responses and administrative data when a NH stay was indicated in the administrative data. NH stays associated with SNF care were responsible for the discrepancy-they were not consistently captured by the HRS survey. Rates of agreement were highest when a proxy respondent was used, and lowest among respondents who rated themselves in excellent overall health. Rates of agreement were higher later in the decade than earlier.

The HRS-Medicare-linked files enhance the ability of the HRS to examine the growing use of NH for postacute care as well as offer a more comprehensive view of who uses NHs.