Abstract
Background: Short-term residential stay (STRC) is an intermediate care model in the Netherlands designed to support older adults in returning home and maintaining independent living in the community. Yet, 33% transition to long-term care (LTC), and 30% die within the same year of admission. Analysing average population trajectories is insufficient for informing (clinical) policy. This study identifies underlying latent groups of STRC patients with similar cost trajectories from one before to five months after admission.
Approach: We analysed administrative claims data for STRC patients admitted between February 1 and July 31, 2022, from Statistics Netherlands. Costs included STRC, hospitalisation and emergency department admissions, outpatients visits, district care, LTC, and geriatric rehabilitation (GR). Variations in trajectory cost patterns were explored using group-based trajectory modelling. Descriptive statistics and logistic regression were applied to investigate differences between the latent groups.
Results: Among 16,278 patients, total costs were €27,994 (SD = 19,012) over the six-month trajectory. Two latent groups with cubic growth terms were identified. Costs were unevenly distributed, with 28% of patients accounting for 50% of total trajectory costs, driven by nursing home admissions, long STRC stays, hospital and GR admissions, and outpatient visits. Patient characteristics explained membership only to a limited extent.
Implications: STRC trajectory costs are unevenly distributed, driven by nursing home admissions, long STRC stays, hospital admissions and outpatient visits. Future research should examine cost trends over time and focus on improving care for older adults with cognitive impairment in both home and intermediate care settings. Policymakers should assess whether spillover effects in intermediate care are a desirable outcome of efforts to reduce or discourage nursing home use.