Care Trajectories for a Cohort of First-Time Nursing Home Admissions: A 5-Year Longitudinal Study in Minnesota

Abstract

Objectives

This study modeled 5-year care trajectories of first-time, dual-eligible older adults admitted to Minnesota nursing homes (NHs), capturing discharges to the community, NH readmissions, hospitalizations, and mortality. A secondary aim was to examine associations between care trajectories and dementia, baseline cognitive function, and demographic, clinical, and functional profiles.

Design

Retrospective cohort study.

Setting and Participants

We analyzed 9853 older adults first admitted to Minnesota NHs in 2015 and followed them for up to 60 months. Minimum Data Set were linked to Medicaid claims from the Minnesota Medicaid Management Information System.

Methods

Latent class growth analysis identified trajectories based on monthly NH stay, hospitalization, and community stay, with mortality treated as a discrete time survival outcome. Dementia was included as a binary covariate. Resident characteristics across trajectories were compared using bivariate analyses and multinomial logistic regression.

Results

The following 4 distinct trajectories were identified: (1) trajectory 1 (early mortality with continued NH use, 38%) experienced shortest survival, highest NH utilization, and peak hospitalizations in year 1; (2) trajectory 2 (steady return to long-term NH care, 11%) had longer survival and frequent hospitalizations in years 2 and 3, ultimately spending 90% of time alive in NHs by year 5; (3) trajectory 3 (transitional care with multiple moves, 22%) had better survival and longer community stays but the most transitions, with increased NH use over time; and (4) trajectory 4 (short stay then return to community, 29%) experienced best outcomes with longest survival, minimal NH readmissions, and few hospitalizations. Trajectories were significantly associated with baseline differences in cognitive function, physical dependency, and sociodemographic characteristics.

Conclusions and Implications

Care trajectories among dual-eligible NH residents are highly heterogeneous. Although 38% remained in NHs until death, 29% sustained community living, and 33% experienced frequent transitions. These patterns underscore the need for individualized care planning and system-level strategies to meet complex, evolving needs.