Placement: Brown University School of Public Health
Mentors: Elizabeth (Betsy) White, APRN, Ph.D., Assistant Professor of Health Services, Policy, and Practice, Brown University School of Public Health
Vincent Mor, Ph.D., Professor of Health Services, Policy, and Practice, Florence Pirce Grant University Professor, Brown University School of Public Health
Project: Disparities in Dementia: The Effects of Nursing Home Quality on the Short- and Long-Term Outcomes of People with Dementia
Hanne Marie Rostad, Ph.D., M.S.N., is a 2022–23 Norwegian Harkness/Research Council of Norway Fellow in Health Care Policy and Practice. She currently works as a researcher at the Center for Care Research at the Norwegian University of Science and Technology, where she started as a postdoctoral researcher in 2018. She is passionate about creating a society where it is good to grow old and has a particular interest in evidence-based measures of health care performance and quality, and complex interventions in long-term care. Rostad is a coinvestigator on several research projects funded by the Norwegian Research Council and the Norwegian Directorate of Health. She has served as an assistant editor for the Norwegian Journal of Clinical Nursing and is currently an editorial member for the Journal of Care Research. Rostad received her Ph.D. in health sciences from the Oslo Metropolitan University, where she conducted an embedded pragmatic clinical trial that aimed to improve pain assessment and management for older nursing home residents with advanced dementia.
Project Overview: The World Health Organization estimates that worldwide, around 55 million people have Alzheimer’s disease and related dementias. As the size of the world’s population age 65 and older continues to grow, so too will the number and proportion of people with dementia. Nursing homes are a critical site of care for people with Alzheimer’s disease and related dementias — both for postacute and long-term care. However, nursing homes face disincentives to admit people with dementia as they are costly to care for, generate less revenue than other patients, require longer lengths of stay, and are less likely to be successfully discharged from the nursing home. These financial disincentives are exacerbated by current trends in segmentation of the nursing home market into two distinct tiers: high-resource nursing homes specializing in higher-margin, higher quality of care and nursing homes which are low-resourced, low-quality which serve long-term Medicaid residents reimbursed at or below cost.
Nursing home market segmentations has been exacerbated by the rise of alternative payment models including growth in Medicare Advantage, the emergence of accountable care organizations, and the introduction of bundled payments. The project will empirically determine whether a diagnosis of Alzheimer’s disease and related dementias constitutes an unrecognized disparity — that is, does it reduce access to high-resource, higher-quality nursing home care; and whether alternative payment models mitigate this effect. This will be addressed using more than a decade of data on Medicare beneficiaries merged with Minimum Data Set assessment for nursing home entrance.