Prevalence, Geographic Variation, and Trends in Hospital Services Relevant to the Care of Older Adults

Abstract

Background The availability of hospital services for older adults nationwide is not well understood. Objective Present the development of the Senior Care Services Scale (SCSS) through: (1) identification of hospital services relevant to the care of older adults; (2) development of a taxonomy classifying these services; and (3) description of prevalence, geographic variation, and trends in service provision in US hospitals over time. Design, Setting, and Participants Retrospective cohort study of US hospitals in 1999 and 2006 rounds of American Hospital Association Annual Survey of Hospitals, (n= 4,998 and 4,831 hospitals, respectively). Exploratory factor analysis was used to create the SCSS, and confirmatory factor analysis was used to examine services over time. The paper reports prevalence of services nationwide. Results The SCSS consisted of two service groups: (1) Inpatient Specialty Care (IP): geriatrics, palliative care, psychiatric geriatrics, pain management, social work, case management, rehabilitation, and hospice; and (2) Post-acute Community Care (PA): skilled nursing, intermediate care, other long-term care, assisted living, retirement housing, adult day care, and home health services. Over time, hospitals offered more IP services and fewer PA services. The distribution of services did not mirror the distribution of where older adults reside in the US. Conclusions The development of the SCSS provides important information about senior care services prior to the passage of the Affordable Care Act. The apparent mismatch of hospital services and demographic trends suggests that many US hospitals may not provide a seamless continuum of care for an increasing population of older adults.

Senior Services in US Hospitals and Readmission Risk or Mortality Among Medicare Beneficiaries Since the Affordable Care Act

“…An SCSS score was calculated for each hospital based on how many services the hospital or the health system provided relevant to the care of older adults. The SCSS was developed in a multi-step process, (Arbaje et al, 2015) using the 2006 round of the ASH. The SCSS was found to be related to readmission risk in a prior study.…”

“…(Wadhera et al, 2018) We found no studies specifically using the SCSS other than the initial instrument development. (Arbaje et al, 2015(Arbaje et al, , 2017…”

The Clarity and Contribution of the Hospital Social Work Role: Observations on its Professional Identity

“…Professional identity is often seen as reflecting its legitimated exercise of authority or power. The professional identity of social workers in hospitals remains largely unchanged in these respects in that they make decisions and judgements, provide recommendations, and assess risk (Arbaje et al 2015). However, little research has examined if or how hospital social workers exert their authority, have recourse to the law, act as advocates, or influence multidisciplinary fora.…”