• Sheryl Zimmerman, Ann L Gruber-Baldini, J Richard Hebel, Lynda Burton, Kenneth Boockvar, George Taler, Charlene C Quinn, and Jay Magaziner.
• Program on Aging, Disability and Long-Term Care, Cecil G. Sheps Center for Health Services Research and the School of Social Work, University of North Carolina at Chapel Hill, North Carolina 27514, USA. Sheryl_Zimmerman@unc.edu
• Am J Alzheimers Dis Other Demen. 2008 Feb 1;23(1):57-65.

ObjectivesTo evaluate the relationship of nursing home characteristics to Medicare costs overall and by dementia status.DesignNew admissions followed for 2 years. Setting. Random stratified sample of 55 Maryland nursing homes.ParticipantsSample of 1257 residents.MeasuresRecords, interview, and observation.ResultsMedicare costs were lower in facilities that have a better environmental quality, hospice beds, and more food service workers; costs were higher in hospital-based facilities and those that have a higher Medicaid case mix, X-ray, and some specified types of staff. Across all characteristics, costs for residents with dementia were consistently two-thirds the cost of other residents.DiscussionIn terms of dementia status, resident characteristics drive Medicare costs, as opposed to facility characteristics. Using alternative residential settings for individuals with dementia may increase Medicare costs of nursing home residents and Medicare costs of residents with dementia who are cared for in settings less able to attend to medical needs.

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