4. HEATH AND HEALTHCARE
Senior/Elder Health Insurance Coverage
Recent research among Cape Cod residents (The Human Condition 2001 Household Survey) has revealed important insights into health insurance coverage patterns of seniors/elders. Survey responses tell us that the younger the age of household members, the greater the likelihood that adult household members will NOT be covered by health insurances. Conversely, insurance coverage for dental care appears to decrease as the age of household members increase. Tables 4.1 and 4.2 provide summaries of health insurance status for households with various combinations of senior/elder age groups. (Note: These are
HOUSEHOLD-level insurance coverage rates and not health insurance coverage rates for individual household members).
An inspection of data contained in Table 4.1 shows that, while only one-percent (1%) of households with ALL adults age 65 or older have uninsured adults, those households with adults age 55 or older report triple that rate--a three percent (3%) uninsured rate. Table 4.1 also shows that eight percent (8%) of households with all Pre-Retirement-Age Seniors (ALL adults ages 55-64) report at least one uninsured adult member.
Table 4.1 Household-Level Health Insurance Status Among Barnstable County
Seniors/Elders: All Adults Ages 55 and Older, Year 2001
Data Source:The Human Condition 2001 HouseholdSurvey, Barnstable County Dept. of Human Services. Senior/Elder Household Health Insurance Status ALL Adults in Household are Ages 55-64 ALL Adults in Household are Age 55+ ALL Adults in Household are Age 65+ COVERAGE:
One or more adult in household is NOT health
insured 8%* 3%* 1%*
Some household insurance programs INCLUDE
dental care coverage 55%** 34%** 27%**
INSURANCE SOURCE:
Health insurance obtained through a State/Federal program (Medicare, Medicaid, VA, etc.)
14%** 48%** 60%**
Health insurance obtained through an employer’s
insurance plan 63%** 45%** 39%**
Health insurance purchased privately
from insurance company 17%** 26%** 29%**
* Percentage of the group of households reporting one or more adult was without health insurance at the time of survey.
Table 4.2 shows health insurance status for households with only SOME senior/elder adults. These data indicate a very similar pattern of health insurance coverage, but at considerably higher rates of un-insurance.
Sources of Health Insurance Coverage
The Human Condition 2001 Project survey research queried Cape Codders as to the source(s) of their health insurance coverage. Three broad categories of health insurance coverage were reported as follows, health insurance obtained through; 1) a state/federal program such as Medicare/Medicaid or the VA, 2) through an employment-related health insurance plan, and 3) through health insurance privately purchased directly from an insurance company. Both Tables 4.1 and 4.2 show that the percentage of households with members obtaining health insurance through a state/federal program increases with the age of adult household members. This phenomenon is also true for households in which members privately purchase health insurance. Further, reliance upon an employment-related health insurance plan diminishes with the increasing age of household members. (Data Analyst’s Note: No surprises here! All of these phenomena would be expected as household members retire, and as older adult members become Medicare-eligible and begin to purchase “MediGap” extended coverage policies.)
Table 4.2
Household-Level Health Insurance Status Among Barnstable County
Seniors/Elders: Some Adults Age 55 or Older, Year 2001
Data Source:The Human Condition 2001 Household Survey, Barnstable County Dept. of Human Services. Health Insurance Status SOME Adults in Household are Ages 55-64 SOME Adults in Household are Age 55+ SOME Adults in Household are Age 65+ COVERAGE:
One or more adult in household is NOT health insured 19%* 12%* 8%* Some household insurance programs INCLUDE dental care coverage 57%** 42%** 34%** INSURANCE SOURCE: Health insurance obtained through a State/Federal program (Medicare, Medicaid, VA, etc.) 29%** 47%** 60%** Health insurance obtained through an employer’s insurance plan 66%** 52%** 46%** Health insurance purchased privately from insurance company 18%** 24%** 27%**
* Percentage of the group of households reporting one or more adult being without health insurance at the time of survey.
** Percentage of that particular group of households.
Medicare Enrollment
Medicare
“The federal health insurance program for: people 65 years of age or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure with dialysis or a transplant, sometimes called ESRD). Made up
f two parts: Hospital Insurance (Part A) and Medical Insurance (Part B).” o
Part A: Hospital Insurance
“Part A is the hospital insurance portion of Medicare. It was established by §1811 of Title XVIII of the Social Security Act of 1965, as amended, and covers inpatient hospital care, skilled nursing facility care, some home health agency services, and hospice care. The Medicare program that covers specified inpatient hospital services, posthospital skilled nursing care, home health services, and hospice care for aged and disabled individuals who meet the eligibility requirements. The part of Medicare that pays for inpatient hospital stays, care in a skilled nursing facility, hospice care and some home health care. Medicare Hospital Insurance also referred to as ‘HI’.“
“Part A Premium: A monthly premium paid by or on behalf of individuals who wish for and are entitled to voluntary enrollment in the Medicare HI program. These individuals are those who are aged 65 and older, are uninsured for social security or railroad retirement, and do not otherwise meet the requirements for entitlement to Part A. Disabled individuals who have exhausted other entitlement are also qualified. These individuals are those not now entitled but who have been entitled under section 226(b) of the Act, who continue to have the disabling impairment upon which their entitlement was based, and whose entitlement ended solely because the individuals had earnings that exceeded the substantial gainful activity amount (as defined in section 223(d)(4) of the Act).”
Part B: Medical Insurance
“Part B is the supplementary or ‘physicians’ insurance portion of Medicare. It was established by 1831 of the Title XVIII of the Social Security Act of 1965 as amended, and covers services of physicians/other suppliers, outpatient care, medical equipment and supplies, and other medical services not covered by the hospital insurance part of Medicare. It also covers other medical services that Part A does not cover, like physical and occupational therapy. . . . also referred to as ‘SMI’.”
Source: Centers for Medicare & Medicaid Services, U.S. Dept. of Health and Human Services, web sites: http://cms.hhs.gov/glossary and http://cms.hhs.gov/acronym at May 22, 2003.
Enrollment in Medicare Programs: Part A and Part B Enrollees
Well over 55,000 Cape Codders are enrolled in the various Medicare programs. Tables 4.3 and 4.4 provide details of Medicare enrollment in Barnstable County and Massachusetts for the two most recent years for which county-level Medicare enrollment data is available (years 2000/2001). See Medicare Enrollment Terminology below.
Table 4.3 Medicare Aged and Disabled Enrollment: Barnstable County and
Massachusetts, as of July 1, 2001
(latest data year
)* Data Sources: See below.Number of Medicare Enrollees Barnstable County Massachusetts Count Count AGED:
Part A and/or Part B Enrollees (“HI &/or SMI”) 51,807 826,651
Part A Enrollees (“HI”) 51,703 824,260
Part B Enrollees (“SMI”) 49,812 773,996
DISABLED: (March 2002 update)
Part A and/or Part B Enrollees (“HI &/or SMI”) 4,818 134,758
Part A Enrollees (“HI”) 4,817 134,747
Part B Enrollees (“SMI”) 4,245 116,247
TOTAL: (Aged + Disabled)
Part A and/or Part B Enrollees (“HI &/or SMI”) 56,625 961,409
Part A Enrollees (“HI”) 56,520 959,007
Part B Enrollees (“SMI”) 54,057 890,243
* Number of enrollees as of July 1, 2001. Disabled enrollment data updated to March 2002.
Table 4.4
Medicare Aged and Disabled Enrollment: Barnstable County and
Massachusetts, as of July 1, 2000
(prior year)**
Data Sources: See below.Number of Medicare Enrollees Barnstable County Massachusetts Count Count AGED:
Part A and/or Part B Enrollees (“HI &/or SMI”) 51,488 829,496
Part A Enrollees (“HI”) 51,335 826,461
Part B Enrollees (“SMI”) 49,538 779,257
DISABLED: (March 2001 update)
Part A and/or Part B Enrollees (“HI &/or SMI”) 4,680 131,226
Part A Enrollees (“HI”) 4,680 131,213
Part B Enrollees (“SMI”) 4,119 113,303
TOTAL: (Aged + Disabled)
Part A and/or Part B Enrollees (“HI &/or SMI”) 56,128 960,722
Part A Enrollees (“HI”) 56,015 957,674
Part B Enrollees (“SMI”) 53,657 892,560
Medicare Enrollment Terminology:
“HI” Hospital Insurance (also called Medicare Part A)
“SMI” Supplemental Medical Insurance (also called Medicare Part B)
“&/or” Unduplicated count of persons enrolled in either or both parts of program.
Data Sources: Centers for Medicare & Medicaid Services, U.S. Dept. of Health and Human Services, web sites: http://cms.hhs.gov/statistics/enrollment/county/2000/stma00.asp (for Year 2000 enroll-ment data) and http://cms.hhs.gov/statistics/enrollenroll-ment/county/2001/stma01.asp (for year 2001 enrollment data).
Medicaid Enrollment
Medicaid
“A joint federal and state program that helps with medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid.”
Data Source: Centers for Medicare & Medicaid Services, U.S. Dept. of Health and Human Services, web sites: http://cms.hhs.gov/glossary and http://cms.hhs.gov/acronym at 5/22/03.
Enrollment in Medicaid Program
SENIOR/ELDER HEALTHCARE INFRASTRUCTURE
Hospital Facilities
Among the four community hospitals in the greater Cape Cod area, there are a total of 536 licensed beds. That is, at maximum capacity these four hospitals combined can accommodate a total of 536 inpatients for 365 days each year. This equates to a total combined capacity of over 195,000 patient days per year. Table 4.5 provides a summary of local hospital faculty capacities.
Table 4.5 Local Community Hospital Facilities, Barnstable County and Southeastern Massachusetts, Year 2003 Data Sources: Web sites operated by Cape Cod Healthcare, Inc, Jordan Hospital, and Southcoast Health System, May 6, 2003.
Hospital
Number of Beds
Annual Patient Days*
Cape Cod Hospital, Hyannis, MA 218 79,570
Jordan Hospital, Plymouth, MA 150 54,750
Toby Hospital, Wareham, MA 85 31,023
Falmouth Hospital, Falmouth, MA 83 30,295
Totals 536 195,640
* Annual Patient Days: The number of licensed beds multiplied by 365 days.
Inpatient Statistics
Cape Cod Healthcare, Inc. reports that in the year 2002 Cape Cod Hospital and Falmouth
Hospital recorded combined inpatient stays (patient days) totaling about eighty-eight percent (88%) of maximum capacity. Hospital discharges for these two hospitals combined totaled over 23,000 in that same year. Data Source: Web sites operated by Cape Cod Healthcare, Inc., May 6, 2003
Emergency Room Facilities
In addition to inpatient beds, each of the four local community hospitals has Emergency Room facilities. In 2002, Cape Cod Hospital and Falmouth Hospital recorded a combined total of nearly 114,000 emergency room visits. “Urgent care” facilities located in Sandwich operated by Cape Cod Healthcare, Inc. recorded an additional 7,000 emergency visits in that year. Data Source: Web sites operated by Cape Cod Healthcare, Inc., May 6, 2003
Nursing Home Facilities
In Barnstable County, there are a total of nineteen (19) licensed nursing home facilities that participate in Medicare and Medicaid--with a combined total of 2,224 certified beds. That is, at maximum capacity these nineteen nursing home facilities combined can accommodate a total of 2,224 residents for 365 days each year. This number of beds equates to a total combined capacity of nearly 812,000 resident days per year. At the time of their last Medicare inspection (years 2002/2003), nursing homes on Cape Cod were filled to about eighty-seven percent (87%) of their combined maximum resident capacity. Table 4.6 provides a summary of local nursing home faculty capacities.
Nursing Staff
Medicare collects nursing home staffing data and publishes several statistics on the number of staff hours (by professional nursing skill area) worked for each nursing home. Professional nursing skill areas include; Registered Nurse (RN), Licensed Practical Nurse (LPN)/Licensed Vocational Nurse (LVN), and certified Nursing Assistant (CNA). The total numbers of hours worked per resident by this combined professional nursing staff are aggregated into the Total Number of Nursing Staff Hours Per Resident per Day statistic (“Hours per resident per day is the average daily work [in hours] given by the entire group of nurses or nursing assistants divided by total number of residents. The amount of care given to each resident varies.”). Nationally, and in Massachusetts, the average Total Number of Nursing Staff Hours Per Resident per Day is 3.9 hours. At the time of their last Medicare inspection (years 2003/2003) seven (7) nursing homes on Cape Cod reported a higher number of total nursing hours per resident than this state and national average. However, twelve (12) Cape Cod nursing homes reported a lower number of total nursing hours per resident than the state and national average.
Table 4.6 also shows the average number of residents per nursing home and average number of nursing staff per resident per day for Massachusetts and the United States as of May 6, 2003.
Table 4.6
Local Medicare/Medicaid Participating Nursing Home Facilities,
Barnstable County, Year 2002*
(Listed in alphabetical order). Data Sources:Medicare.gov web site, Centers For Medicare and Medicaid Services (CMS), Nursing Home Compare, at May 6, 2003, http://www.medicare.gov/
Nursing Home Name
(per Medicare web site) Location
Number of Certified Beds Number of Occupied Certified beds Total Number of Nursing Staff Hours Per Resident Per Day
Bourne Manor
Extended Care FAC Bourne, MA 142 139 3.23
Cape Cod Extd Care
Comm P Hyannis, MA 82 76 4.32
Cape Cod Nursing &
Rehabilat Buzzards Bay, MA 99 92 3.61
Cape End Manor Provincetown, MA 60 45 4.27
Cape Heritage
Nursing & Rehab Sandwich, MA 123 107 3.45
Cape Regency
Nursing & Rehab Centerville, MA 120 111 3.05
Cranberry Pointe
Rehab & Skld Harwich, MA 135 123 3.61
Eagle Pond Rehab &
Living Ctr South Dennis, MA 142 132 3.43
Epoch Senior
Hlthcare-Brewster Brewster, MA 173 162 3.31
Harborside
Healthcare-Falmouth Falmouth, MA 120 102 4.25
Harborside-Mashpee Mashpee, MA 98 89 3.30
Hyannis Skilled Care
Center Hyannis, MA 142 132 3.97
JML Care Center Inc. Falmouth, MA 132 121 7.27
Liberty Commons N. Chatham, MA 132 125 3.56
Mayflower Place
Nursing Center W. Yarmouth, MA 72 67 4.15
Pleasant Bay Nursing
& Rehab Brewster, MA 133 117 3.91
Royal Megansett
Nursing and Re N. Falmouth, MA 78 73 3.75
Royal Nursing Center,
LLC Falmouth, MA 121 100 3.11
Windsor Nursing &
Retirement H S. Yarmouth, MA 120 107 3.50
CAPE COD TOTALS - 2,224 1,931 -
Massachusetts (Ave.) All Nurs. Homes - 97.3 residents 3.90
Unites States (Ave.) All Nurs. Homes - 88.6 residents 3.90
* Most Barnstable County nursing homes were last inspected during the year 2002. Two facilities (Bourne Manor Extended Care FAC, JML Care Center, Inc.) have been inspected in the year 2003.
Home Health Agencies
There are a total of thirty-nine (39) Medicare-certified home health agencies that have provided services to Barnstable County residents in the past (but not necessarily at the present time). Table 4.7 provides a list of Medicare-certified home health agencies that report having provided services at some point to Barnstable County residents. (Data Analyst’s Note: This is without a doubt, not an exhaustive or timely list of such agencies). Only five (5) of these thirty-nine agencies report an on-Cape business address. Note: In addition, Medicare collects and publishes a series of eleven quality measures about the outcome of work of these and other Home Health Agencies (The Home Health Outcomes and Assessment Information Set [OASIS] database). Those outcome measures are publicly available on the Medicare web site noted below.
Table 4.7 Massachusetts-Based Home Health Agencies That Have In The Past Provided Services To Barnstable County Residents* Data Sources: Medicare.gov web site, Centers For Medicare and Medicaid Services (CMS), Home Health Compare, at 5/5/03, http://www.medicare.gov/
Medicare-Covered Services Offered Home Health Agency
Name (per Medicare web site)
Corporate Office Location Nursing Care Services? Physical Therapy Services? Medical Social Services? Home Health Aide Services?
All Care VNA of Gtr
Lynn, Inc Lynn, MA Yes Yes Yes Yes
Bayada Nurses Hyannis, MA Yes Yes Yes Yes
Capital Home Health,
Inc. Fall River, MA Yes Yes Yes Yes
Caregroup Home Care Belmont, MA Yes Yes Yes Yes
Caretenders of Boston Waltham, MA Yes Yes Yes Yes
Caritas Home Care
Neponset Norwood, MA Yes Yes Yes Yes
Centrus Premier Home
Care, Inc. N. Plymouth, MA Yes Yes Yes Yes
Community Nurse &
Hospice Care Fairhaven, MA Yes Yes Yes Yes
Cura Visiting Nurse
Assoc. Inc. Plymouth, MA Yes Yes Yes Yes
Emerson Hosp.
Homecare W. Concord, MA Yes Yes Yes Yes
Gentiva Health Services Watertown, MA Yes Yes Yes Yes
Gentiva Health Services N. Andover, MA Yes Yes Yes Yes
Gentiva Health Services Worcester, MA Yes Yes Yes Yes
Gentiva Health Services S. Yarmouth, MA Yes Yes Yes Yes
Interim HC of Boston
Hyannis Hyannis, MA Yes Yes No Yes
Jewish Family &
Children’s Srv. Boston, MA Yes Yes Yes Yes
Managed Health Care
Systems Hingham, MA Yes Yes Yes Yes
Table 4.7 Continued.
Medicare-Covered Services Offered Home Health Agency
Name (per Medicare web site)
Corporate Office Location Nursing Care Services? Physical Therapy Services? Medical Social Services? Home Health Aide Services?
Norwell VNA, Inc. Norwell, MA Yes Yes Yes Yes
Overlook Home Health
Falmouth E. Falmouth, MA Yes Yes Yes Yes
Partners Home Care,
Inc. Rockland, MA Yes Yes Yes Yes
Personal Touch Home
Aides Boston, MA Yes Yes Yes Yes
Physicians’ Homecare New Bedford, MA Yes Yes Yes Yes
PSA Home Healthcare Brockton, MA Yes Yes Yes Yes
South Shore Visiting
Nurse Assn. Braintree, MA Yes Yes Yes Yes
Southcoast Home Care Fairhaven, MA Yes Yes Yes Yes
UMass Memorial Home
Health Worcester, MA Yes Yes Yes Yes
Visiting Nurse Comm.
Health, Inc. Arlington, MA Yes Yes Yes Yes
VNA of Boston Brighton, MA Yes Yes Yes Yes
VNA of Cape Cod Hyannis, MA Yes Yes Yes Yes
VNA of Greater Salem,
Inc. Beverly, MA Yes Yes Yes Yes
VNA of Gtr
Milford/Northbridge Milford, MA Yes Yes Yes Yes
VNA of Middlesex East Wakefield, MA Yes Yes Yes Yes
VNA of Southeastern,
MA, Inc. Fall River, MA Yes Yes Yes Yes
Winchester Home Care Winchester, MA Yes Yes Yes Yes
Dialysis Facilities
On Cape Cod there are two (2) licensed Medicare participating dialysis facilities—one in Yarmouth and the other in Falmouth. Together they have a total combined capacity of 39 dialysis stations. Table 4.8 provides a brief summary of these two local Medicare participating dialysis faculties.
Table 4.8 Local Medicare Participating Dialysis Facilities, Barnstable County, Year 2003 Data Sources: Medicare.gov web site, Centers For Medicare and Medicaid Services (CMS), Dialysis Facility Compare, at May 6, 2003, http://www.medicare.gov/
Dialysis Facility Location Number of Dialysis Stations In-Center Hemodialysis Facilities? Peritoneal Dialysis Facilities? Home Hemodialysis Training?
Cape Cod Artificial Kidney Center
(BMA Cape Cod) Yarmouth 24 Yes Yes Yes
FMC Dialysis Services of
Falmouth Falmouth 15 Yes Yes No
Disability
According to Census 2000 reports, “People . . . are considered to have a disability if they have one or more of the following; (a) blindness, deafness, or a severe vision or hearing problem; (b) a substantial limitation in the ability to perform basic physical activities, such as walking, climbing stairs, reaching, lifting, or carrying; (c) difficulty learning, remembering, or concentrating; or (d) difficulty dressing, bathing, or getting around inside the home. . . .[or] have difficulty going outside the home alone to shop or visit a doctor’s office, . . .[or] difficulty working at a job or business.”
Table 4.9 provides detail on the more than 15,000 Older Adult Cape Codders (age 65 and older) who, in the year 2000 reported a “disability” to a Census taker. Percentages greater than the Barnstable County average are highlighted. Older Adult residents in eight Cape Cod towns report a greater-than-County average percentage of disabilities. These towns include: Barnstable/Hyannis, Wellfleet, Truro, Sandwich, and Yarmouth. Regionally, Older Adult residents in the Upper-Cape and Mid-Cape regions reported a greater-than-County average proportion of “disability.”
Table 4.9
Disability Among Older Adults in Barnstable County: Persons
Age 65 and Older With A “Disability,” Year 2000.
Source: U.S. Census Bureau, Census 2000, Tables DP-2. See Glossary, U.S. Census 2000 Terminology for a more complete Census 2000 definition of “disability.”With a “Disability”* Disability Status of
Older Adult Population
Persons Age 65 Years and Over Persons Age 65 Years and Over Count Percent* TOWNS:
Barnstable [including Hyannis] 3,133 32.9%
Hyannis [separate] 1,206 45.2% Bourne 898 29.2% Brewster 552 24.3% Chatham 550 25.5% Dennis 1,441 31.4% Eastham 371 26.1% Falmouth 2,177 30.5% Harwich 1,055 30.9% Mashpee 737 31.8% Orleans 551 25.3% Provincetown 153 30.3% Sandwich 897 34.0% Truro 126 34.2% Wellfleet 217 37.4% Yarmouth 2,444 33.4% REGIONS: Upper-Cape 4,709 31.0% Mid-Cape 7,018 32.8% Lower/Outer-Cape 3,575 27.7% COUNTY: Barnstable County 15,302 30.9% STATE: Massachusetts 305,241 37.8% NATION: United States 13,978,118 41.9%
* Percentage of the civilian, non-institutionalized Older Adult population (age 65 and older) with a “disability” per the US Census Bureau, Census 2000. See also, Glossary, U.S. Census 2000 Terminology.
Hospitalizations
Hospitals keep careful records of the disease or illness for which each patient is treated. These records are tabulated and made available in aggregate form by the Massachusetts Dept. of Public Health. Recent hospitalization rates based upon these records reveal key medical conditions for which senior/elder Cape Cod residents have been hospitalized.
Barnstable County Hospitalizations:
Figure 4.1 shows senior/elder Hospitalization Rates of Barnstable County residents due to ALL
illnesses/conditions for the years 1996 – 2000. Rates are tabulated for each senior/elder age group. Note that while hospitalization rates for residents age 75 and older increased during the 1996-2000 period, the rates for residents under age 75 declined. (Note: The reader may wish to compare these Barnstable County rates with Massachusetts rates shown in Figure 4.6.)
Table 4.10 provides detailed five-year average Hospitalization Rates for these same Barnstable County senior/elder age groups by illness/condition. The highest hospitalization rates are highlighted. Table 4.11 shows similar information to that of Table 4.10 except ONLY for the year 2000 (the latest year for which data is available). Note that in several instances, the year 2000 hospitalization rates are considerably higher than the five-year average rates—possibly indicating an upward trend in the rate of hospitalizations for these illnesses/conditions.
Figures 4.2 through 4.5 show Hospitalization Rates for the top six illnesses/conditions tabulated for each of the four senior/elder age groups individually. Note again, that while hospitalization rates for residents’ age 75 and older generally all increased during the 1996-2000 period, the rates for residents younger than age 75 tended to decline. (Data Analyst’s Note: The reasons for this decline in hospitalizations of residents younger than age 75 are unclear.)
Table 4.10: Average Hospitalization Rates For Barnstable County Senior/Elders:
Patients Ages 55 and Older, For Five-Years 1996-2000.
Data Source: Mass.Dept. of Public Health, MassCHIP Web Site
Senior/Elder Hospitalizations Barnstable County Hosp. Rate* Barnstable County Hosp. Rate* Barnstable County Hosp. Rate* Barnstable County Hosp. Rate* Barnstable County Seniors and Elders Ages 55-64 Ages 65-74 Ages 75-84 Age 85+
(5-Year Ave.**) (5-Year Ave.**) (5-Year Ave.**) (5-Year Ave.**)
Rate of Hospitalizations:
(Per 100,000 persons in age group)
- ALL Reasons For Hospitalization 12,502 21,871 29,927 37,088
- Diseases of Circulatory System, ALL
(Heart Disease, Stroke, etc.) 3,238 6,750 9,878 11,195
- Diseases of Respiratory System, ALL
(Pneumonia, Chronic Bronchitis, etc.) 1,022 2,118 3,416 5,161
- Diseases of Digestive System, ALL
(Diverticula of Intestine, Cholelithiasis, etc.) 1,564 2,408 3,068 3,769
- Injury And Poisoning, ALL
(Fractures, etc.) 987 1,630 2,752 5,168
- Malignant Neoplasms [Cancer], ALL
(Malignant Neoplasms) 1,354 2,148 2,285 1,792
- Diseases of Musculoskeletal System, ALL (Osteoarthritis, Intervertebral Disc
Disorders, etc.) 1,176 1,918 1,892 1,521
- Endocrine, Nutritional, Metabolic,
Immunity, ALL (Diabetes Mellitus, etc.) 376 604 994 1,574
* Number of hospitalizations for the particular illness per 100,000 Barnstable County residents in the specified age group.
Table 4.11: Hospitalization Rates For Barnstable County Senior/Elders:
Patients Ages 55 and Older, Year 2000.
Data Source: Mass. Dept. of PublicHealth, MassCHIP Web Site
Senior/Elder Hospitalizations Barnstable County Hosp. Rate* Barnstable County Hosp. Rate* Barnstable County Hosp. Rate* Barnstable County Hosp. Rate* Barnstable County Seniors and Elders Ages 55-64 Ages 65-74 Ages 75-84 Age 85+
(Year 2000**) (Year 2000**) (Year 2000**) (Year 2000**)
Rate of Hospitalizations
:(Per 100,000 persons in age group)
- ALL Reasons For Hospitalization 10,867 20,250 34,410 49,670
- Diseases of Circulatory System, ALL
(Heart Disease, Stroke, etc.) 2,656 6,203 11,519 14,338
- Diseases of Respiratory System, ALL
(Pneumonia, Chronic Bronchitis, etc.) 973 2,118 4,055 7,023
- Diseases of Digestive System, ALL
(Diverticula of Intestine, Cholelithiasis, etc.) 1,371 2,095 3,677 4,969
- Injury And Poisoning, ALL
(Fractures, etc.) 885 1,496 3,213 6,685
- Malignant Neoplasms [Cancer], ALL
(Malignant Neoplasms) 1,114 1,761 2,235 1,931
- Diseases of Musculoskeletal System, ALL (Osteoarthritis, Intervertebral Disc
Disorders, etc.) 1,157 1,991 2,245 2,370
- Endocrine, Nutritional, Metabolic,
Immunity, ALL (Diabetes Mellitus, etc.) 296 527 1,163 2,090
* Number of hospitalizations for the particular illness per 100,000 Barnstable County residents in the specified age group.
Massachusetts Hospitalizations:
Figure 4.6 shows senior/elder Hospitalization Rates of Massachusetts residents due to ALL
illnesses/conditions for the years 1996 – 2000. Rates are tabulated for each senior/elder age group. Note that while hospitalization rates for residents age 85 and older increased somewhat during the 1996-2000 period, the rates for residents younger than age 85 held almost steady.
Table 4.12 provides detailed five-year average Hospitalization Rates for these same Massachusetts
senior/elder age groups by illness/condition. The highest hospitalization rates are highlighted. Table 4.13 shows similar information to that of Table 3.3 except ONLY for the year 2000 (the latest year for which data is available). Note that for the younger seniors/elders the year 2000 hospitalization rates are
approximately the same as the five-year average rates but that year 2000 hospitalization rates for older Massachusetts residents tended to increase somewhat—especially hospitalization rates for residents age 85 and older.
Table 4.14 provides the latest (years 2000/2001) detailed Hospitalization Rates for Barnstable County, Massachusetts, and United States for the Middle Age and Pre-Retirement-Age Senior (ages 45-64) group by illness/condition. The highest hospitalization rates are highlighted. For this age group, Barnstable County Hospitalization Rates are generally lower than Massachusetts rates with the exception of cancer and diseases of the musculoskeletal system (osteoarthritis, etc.).
Table 4.15 provides the latest (years 2000/2001) detailed Hospitalization Rates for Barnstable County, Massachusetts, and United States for the Older Adult (age 65+) group by illness/condition. The highest hospitalization rates are highlighted. For this age group, Barnstable County Hospitalization Rates are all lower than Massachusetts rates with the exception of diseases of the musculoskeletal system
Table 4.12 Average Hospitalization Rates For Massachusetts Senior/Elders:
Patients Ages 55 and Older, For Five-Years 1996-
2000
Data Source: Mass. Dept. of Public Health, MassCHIP Web SiteSenior/Elder Hospitalizations Massa- chusetts Hosp. Rate* Massa- chusetts Hosp. Rate* Massa- chusetts Hosp. Rate* Massa- chusetts Hosp. Rate**
Massachusetts Seniors and Elders Ages 55-64 Ages 65-74 Ages 75-84 Age 85+
(5-Year Ave.**) (5-Year Ave.**) (5-Year Ave.**) (5-Year Ave.**)
Rate of Hospitalizations
:(Per 100,000 persons in age group)
- ALL Reasons For Hospitalization 13,603 24,410 40,719 53,737
- Diseases of Circulatory System, ALL
(Heart Disease, Stroke, etc.) 3,503 7,319 12,450 15,353
- Diseases of Respiratory System, ALL
(Pneumonia, Chronic Bronchitis, etc.) 1,486 3,090 5,679 8,584
- Diseases of Digestive System, ALL
(Diverticula of Intestine, Cholelithiasis, etc.) 1,494 2,413 3,954 5,191
- Injury And Poisoning, ALL
(Fractures, etc.) 979 1,681 3,364 6,115
- Malignant Neoplasms [Cancer], ALL
(Malignant Neoplasms) 1,215 2,008 2,453 2,000
- Diseases of Musculoskeletal System, ALL (Osteoarthritis, Intervertebral Disc
Disorders, etc.) 879 1,537 2,032 1,713
- Endocrine, Nutritional, Metabolic,
Immunity, ALL (Diabetes Mellitus, etc.) 503 872 1,619 2,614
* Number of hospitalizations for the particular illness per 100,000 Massachusetts residents in the specified age group.
Table 4.13 Hospitalization Rates For Massachusetts Senior/Elders: Patients
Ages 55 and Older, Year 2000
Data Source: Mass. Dept. of Public Health,MassCHIP Web Site
Senior/Elder Hospitalizations Massa- chusetts Hosp. Rate* Massa- chusetts Hosp. Rate* Massa- chusetts Hosp. Rate* Massa- chusetts Hosp. Rate**
Massachusetts Seniors and Elders Ages 55-64 Ages 65-74 Ages 75-84 Age 85+
(Year 2000**) (Year 2000**) (Year 2000**) (Year 2000**)
Rate of Hospitalizations
:(Per 100,000 persons in age group)
- ALL Reasons For Hospitalization 13,284 24,330 39,912 57,264
- Diseases of Circulatory System, ALL
(Heart Disease, Stroke, etc.) 3,245 7,011 11,929 16,120
- Diseases of Respiratory System, ALL
(Pneumonia, Chronic Bronchitis, etc.) 1,498 3,170 5,589 8,931
- Diseases of Digestive System, ALL
(Diverticula of Intestine, Cholelithiasis, etc.) 1,475 2,421 3,940 5,688
- Injury And Poisoning, ALL
(Fractures, etc.) 972 1,680 3,269 6,339
- Malignant Neoplasms [Cancer], ALL
(Malignant Neoplasms) 1,155 1,926 2,270 1,996
- Diseases of Musculoskeletal System, ALL (Osteoarthritis, Intervertebral Disc
Disorders, etc.) 915 1,651 2,054 1,916
- Endocrine, Nutritional, Metabolic,
Immunity, ALL (Diabetes Mellitus, etc.) 494 859 1,569 2,660
* Number of hospitalizations for the particular illness per 100,000 Massachusetts residents in the specified age group.
Table 4.14 Hospitalization Rates For Middle Age and Pre-Retirement-Age Seniors:
Patients Ages 45-64, Years 2000 and 2001
Data Source: See below.Middle Age and Pre-Retirement-Age Senior Hospitalizations Condition Codes [ICD-9] Barnstable County Hosp. Rate* Massachu- setts Hosp. Rate* United States Hosp. Rate*
Pre-Retirement & Younger-Age Seniors - Ages 45-64 Ages 45-64 Ages 45-64
(Year 2000**) (Year 2000**) (Year 2001)
Rate of Hospitalizations
:(Per 100,000 persons in age group)
- ALL Reasons For Hospitalization - 8,776 10,086 11,207
- Diseases of Circulatory System, ALL
(Heart Disease, Stroke, etc.) 390-459 1,802 2,017 2,751
- Diseases of Respiratory System, ALL
(Pneumonia, Chronic Bronchitis, etc.) 460-519 651 984 1,018
- Diseases of Digestive System, ALL
(Diverticula of Intestine, Cholelithiasis, etc.) 520-579 1,176 1,225 1,424
- Injury And Poisoning, ALL
(Fractures, etc.) 800-999 836 791 911
- Malignant Neoplasms [Cancer], ALL
(Malignant Neoplasms) 140-208*** 768 748 641***
- Diseases of Musculoskeletal System, ALL (Osteoarthritis, Intervertebral Disc
Disorders, etc.) 710-739 949 674 813
- Endocrine, Nutritional, Metabolic,
Immunity, ALL (Diabetes Mellitus, etc.) 240-279 256 378 648
* Number of hospitalizations for the particular illness per 100,000 residents in age 45-64 age group. ** Latest year for which data is available.
*** United States cancer related data includes ICD-9 Codes 230-234. State and County cancer data do not include ICD-9 Codes 230-234 (Data Analyst’s Note: This is a relatively minor difference).
Tables 4.14 Data Sources: United States data from 2001 National Hospital Discharge Survey, Advance Data From Vital and
Health Statistics, Number 332, April 9, 2003, National Center For Health Statistics, Centers For Disease Control and Prevention, U.S. Department of Health and Human Services, Tables 1, 3, and 4, Discharges of inpatients from non-federal hospitals only. “First-listed diagnosis” adjusted per 100,000 persons. ICD-9 coded conditions.
Massachusetts and Barnstable County data from Massachusetts Department of Public Health, MassCHIP v3.0 r303.0, Custom
Reports by Barnstable County Department of Human Services, Hospital Discharges (UHDDS), May 8, 2003.
Table 4.15 Hospitalization Rates For Older Adults: Patients Age 65 and Older,
Years 2000 and 2001
Data Source: See below.Older Adult Hospitalizations Condition Codes [ICD-9] Barnstable County Hosp. Rate* Massachu- Setts Hosp. Rate* United States Hosp. Rate*
Elders - Age 65+ Age 65+ Age 65+
(Year 2000**) (Year 2000**) (Year 2001)
Rate of Hospitalizations
:(Per 100,000 persons in age group)
- ALL Reasons For Hospitalization - 29,049 34,516 35,492
- Diseases of Circulatory System, ALL
(Heart Disease, Stroke, etc.) 390-459 9,140 10,052 11,379
- Diseases of Respiratory System, ALL
(Pneumonia, Chronic Bronchitis, etc.) 460-519 3,432 4,839 4,764
- Diseases of Digestive System, ALL
(Diverticula of Intestine, Cholelithiasis, etc.) 520-579 3,026 3,422 3,761
- Injury And Poisoning, ALL
(Fractures, etc.) 800-999 2,767 2,895 2,932
- Malignant Neoplasms [Cancer], ALL
(Malignant Neoplasms) 140-208*** 1,953 2,062 1,851***
- Diseases of Musculoskeletal System, ALL (Osteoarthritis, Intervertebral Disc
Disorders, etc.) 710-739 2,130 1,835 2,047
- Endocrine, Nutritional, Metabolic,
Immunity, ALL (Diabetes Mellitus, etc.) 240-279 952 1,364 1,909
* Number of hospitalizations for the particular illness per 100,000 residents in 65+ age group. ** Latest year for which data is available.
*** United States cancer related data includes ICD-9 Codes 230-234. State and County cancer data do not include ICD-9 Codes 230-234 (Data Analyst’s Note: This is a relatively minor difference).
Tables 4.15 Data Sources: United States data from 2001 National Hospital Discharge Survey, Advance Data From Vital and
Health Statistics, Number 332, April 9, 2003, National Center For Health Statistics, Centers For Disease Control and Prevention, U.S. Department of Health and Human Services, Tables 1, 3, and 4, Discharges of inpatients from non-federal hospitals only. “First-listed diagnosis” adjusted per 100,000 persons. ICD-9 coded conditions.
Massachusetts and Barnstable County data from Massachusetts Department of Public Health, MassCHIP v3.0 r303.0, Custom Reports by Barnstable County Department of Human Services, Hospital Discharges (UHDDS), May 8, 2003
Average Length of Senior/Elder Hospital Stay
Nationally, the average length of hospital stay has recently been studied.(2001 National Hospital Discharge Survey). These data help us to assess the future need for hospital bed capacity.
Patients Ages 45-64 Years:
Table 4.16 provides the latest (year 2001) Average Length of Hospital Stay information for United
States Middle Age adult and Pre-Retirement-Age Senior patients (ages 45-64) by illness/condition. (Note: Barnstable County and Massachusetts Average Length of Hospital Stay information is not available at the time of this writing.) The overall U.S. Average Length of Hospital Stay for ages 45-64 patients is 5.0 days. Average hospital stay time is the longest (6.8 days) for U.S. cancer patients ages 45-64, and the shortest (3.7 days) for U.S. patients ages 45-64 hospitalized for diseases of the musculoskeletal system (osteoarthritis, etc.).
Average Length of Hospital Stay for patients ages 45-64 varies slightly by patient gender [sex]. Table 4.17 provides the latest (year 2001) Average Length of Hospital Stay information for United States patients ages 45-64 hospitalized due to ALL illnesses/conditions by gender [sex]. U.S. males ages 45-64 tend to be hospitalized for a longer average period (5.2 days) than do U.S. females ages 45-64 (average of 4.9 days).
Older Adult Patient Hospital Stays (Age 65 and Older)
Table 4.18 provides the latest (year 2001) Average Length of Hospital Stay information for United States Older Adult patients (age 65+) by illness/condition. The overall U.S. Average Length of Hospital Stay for patients age 65+ is 5.8 days. Average hospital stay time is the longest (7.3 days) for U.S. cancer patients age 65+, and the shortest (4.8 days) days for U.S. patients age 65+ hospitalized for diseases of the musculoskeletal system (osteoarthritis, etc.).
Average Length of Hospital Stay (in year 2001) for U.S. Older Adult patients (age 65+) does not vary by gender [sex] of the patient. Table 4.19 provides the latest (year 2001) Average Length of Hospital Stay information for United States patients ages 65+ hospitalized due to ALL illnesses/conditions by gender [sex]. Table 4.19 shows that U.S. males age 65+ and U.S. females age 65+ tend to be hospitalized for the same average length of time (5.8 days).
Table 4.16 Average Length of Hospital Stay For Middle Age Adult and Pre-
Retirement-Age Senior Patients, Ages 45-64, Years 2000 and 2001
Data Source: See below.
Middle Age Adult and Pre-Retirement-Age Senior
Patient Hospital Stays
Condition Codes [ICD-9] Barnstable County Ave. Stay Length* Massachu- Setts Ave. Stay Length* United States Ave. Stay Length*
- Ages 45-64 Ages 45-64 Ages 45-64
(Year 2000**) (Year 2000**) (Year 2001)
Average Length of Hospital Stay:
(In Days)
- ALL Reasons For Hospitalization - N/A N/A 5.0
- Diseases of Circulatory System, ALL
(Heart Disease, Stroke, etc.) 390-459 N/A N/A 4.3
- Diseases of Respiratory System, ALL
(Pneumonia, Chronic Bronchitis, etc.) 460-519 N/A N/A 5.4
- Diseases of Digestive System, ALL
(Diverticula of Intestine, Cholelithiasis, etc.) 520-579 N/A N/A 4.8
- Injury And Poisoning, ALL
(Fractures, etc.) 800-999 N/A N/A 5.3
- Malignant Neoplasms [Cancer], ALL
(Malignant Neoplasms) 140-208** N/A N/A 6.8**
- Diseases of Musculoskeletal System, ALL (Osteoarthritis, Intervertebral Disc Disorders, etc.)
710-739 N/A N/A 3.7
- Endocrine, Nutritional, Metabolic,
Immunity, ALL (Diabetes Mellitus, etc.) 240-279 N/A N/A 4.2
* Average number of days spent in hospital by persons in the 45-64 age group in the year 2001. N/A: Not Available.
** United States cancer related data includes ICD-9 Codes 230-234. State and County cancer data do not include ICD-9 Codes 230-234 (Data Analyst’s Note: This is a relatively minor difference).
Tables 4.16 Data Sources: United States data from 2001 National Hospital Discharge Survey, Advance Data From Vital and
Health Statistics, Number 332, April 9, 2003, National Center For Health Statistics, Centers For Disease Control and Prevention, U.S. Department of Health and Human Services, Tables 1, 3, and 4, Discharges of inpatients from non-federal hospitals only. “First-listed diagnosis” adjusted per 100,000 persons. ICD-9 coded conditions.
Table 4.17 Average Length of Hospital Stay For Middle Age Adult and Pre-
Retirement-Age Senior Patients, Ages 45-64, By Patient Gender
[Sex], Year 2001.
Data Source: See below.Middle Age Adult and Pre-Retirement-Age Senior
Patient Hospital Stays
Barnstable County Average Stay Length* Massachu- setts Average Stay Length* United States Average Stay Length* (2001) (2001) (2001)
Average Length of Hospital Stay
:ALL Reasons For Hospitalization
- Females, Ages 45-64 N/A N/A 4.9
- Males, Ages 45-64 N/A N/A 5.2
* Average number of days spent in hospital by persons in the 45-64 age group in year 2001. N/A: Not Available.
Tables 4.17 Data Sources: United States data from 2001 National Hospital Discharge Survey, Advance Data From Vital and Health Statistics, Number 332, April 9, 2003, National Center For Health Statistics, Centers For Disease Control and
Prevention, U.S. Department of Health and Human Services, Tables 1, 3, and 4, Discharges of inpatients from non-federal hospitals only. “First-listed diagnosis” adjusted per 100,000 persons. ICD-9 coded conditions.
Table 4.18 Average Length of Hospital Stay For Older Adult Patients, Age 65
and Older, Year 2001.
Data Source: See below.
Older Adult Hospital Stays Condition Codes [ICD-9] Barnstable County Ave. Stay Length* Age 65+ Massachu- setts Ave. Stay Length* Ages 65+ United States Ave. Stay Length Ages 65+* (2001) (2001) (2001)
Average Length of Hospital Stay:
(In Days)
- ALL Reasons For Hospitalization - N/A N/A 5.8
- Diseases of Circulatory System, ALL
(Heart Disease, Stroke, etc.) 390-459 N/A N/A 5.0
- Diseases of Respiratory System, ALL
(Pneumonia, Chronic Bronchitis, etc.) 460-519 N/A N/A 6.3
- Diseases of Digestive System, ALL
(Diverticula of Intestine, Cholelithiasis, etc.) 520-579 N/A N/A 5.5
- Injury And Poisoning, ALL
(Fractures, etc.) 800-999 N/A N/A 6.4
- Malignant Neoplasms [Cancer], ALL
(Malignant Neoplasms) 140-208** N/A N/A 7.3**
- Diseases of Musculoskeletal System, ALL (Osteoarthritis, Intervertebral Disc Disorders, etc.)
710-739 N/A N/A 4.8
- Endocrine, Nutritional, Metabolic,
Immunity, ALL (Diabetes Mellitus, etc.) 240-279 N/A N/A 4.9
* Average number of days spent in hospital for persons in the 65+ age group in year 2001. N/A Not Available.
** United States cancer related data includes ICD-9 Codes 230-234. State and County cancer data do not include ICD-9 Codes 230-234 (Data Analyst’s Note: This is a relatively minor difference).
Tables 4.18 Data Sources: United States data from 2001 National Hospital Discharge Survey, Advance Data From Vital and
Health Statistics, Number 332, April 9, 2003, National Center For Health Statistics, Centers For Disease Control and Prevention, U.S. Department of Health and Human Services, Tables 1, 3, and 4, Discharges of inpatients from non-federal hospitals only. “First-listed diagnosis” adjusted per 100,000 persons. ICD-9 coded conditions.
Table 4.19 Average Length of Hospital Stay For Older Adult Patients, Age 65 and
Older, By Patient Gender [Sex], Year 2001. Data Source: See below.Older Adult Hospital Stays Barnstable County Average Stay Length* Massachu- Setts Average Stay Length* United States Average Stay Length* (2001) (2001) (2001)
Average Length of Hospital Stay: ALL REASONS For Hospitalization
- Females, Age 65+ N/A N/A 5.8
- Males, Age 65+ N/A N/A 5.8
* Average number of days spent in hospital for persons in the age 65+ age group in year 2001.
N/A Not Available.
Tables 4.19 Data Sources: United States data from 2001 National Hospital Discharge Survey, Advance Data From Vital and
Health Statistics, Number 332, April 9, 2003, National Center For Health Statistics, Centers For Disease Control and Prevention, U.S. Department of Health and Human Services, Tables 1, 3, and 4, Discharges of inpatients from non-federal hospitals only. “First-listed diagnosis” adjusted per 100,000 persons. ICD-9 coded conditions.
Massachusetts and Barnstable County data from Massachusetts Department of Public Health, MassCHIP v3.0 r303.0, Custom Reports by Barnstable County Department of Human Services, Hospital Discharges (UHDDS), May 8, 2003.
Caregiving Among Seniors/Elders
Recent research among Cape Cod residents (The Human Condition 2001 Household Survey and the Cape Cod & Islands Senior/Elder Survey) provides insight into the caregiving activities of our
senior/elder residents. The Human Condition 2001 Household Survey responses show that the highest levels of caregiving occur among the Pre-Retirement-Age Seniors (ages 55-64). Further, the mental/-emotional stress produced by caregiving is reported to be the greatest problem faced by senior/elder caregivers. Table 4.20 provides details of survey responses (from The Human Condition 2001 Household Survey) relating to caregiving in households which include senior/elder members.
Table 4.20 Caregiving Activities Among Barnstable County Seniors/Elders, Year 2001.
Data Sources: The Human Condition 2001 Household Survey, Quality of Life Module,
Barnstable County Dept. of Human Services, 2001.Caregiving Activities ALL Adults in Household are Ages 55-64 ALL Adults in Household are Age 55+ ALL Adults in Household are Age 65+ CAREGIVING:
One or more household member is PRIMARY caregiver for a disabled
or chronically ill person 14% 12% 11%
Caregiver him/herself has a
disability or long-term illness N/A* 39% 26%
PROBLEMS:
The mental/emotional stress of caregiving is the most severe
problem encountered in caregiving 12% 15% 16%