Strokes and hip fractures are major causes of long-term disability, institutionalization and mortality among elderly persons. These health conditions generate significant acute, post-acute, and long-term care (LTC) costs for Medicare, state Medicaid programs, and for the affected individuals and families. This application is a four year continuation study which builds on the investigators' current research examining the effects of public subsidies on families' long-term care decisions. They propose to evaluate the costs of these diseases and the cost-effectiveness/benefit of various interventions and public subsidies by collecting data from hospital charts for 1,162 National Long-Term Care Survey respondents who experienced a stroke or hip fracture between 1987 and 1994 to supplement data from prior NLTCS interviews and Medicare service data. The analyses will examine: 1) long-term effects of Medicare-subsidized rehabilitation services on mortality, health, functional, and cognitive status of stroke and hip-fracture patients; 2) assess the determinants of the amount of Medicare-subsidized services stroke/hip fracture patients receive following hospitalization; 3) determine social value of rehabilitative services relative to their costs; and 4) examine the effects of public subsidies of supportive care on living arrangements, and use of formal and informal care received by these patients. The models and strategies developed for stroke and hip fracture may be applicable for other types of diseases affecting the elderly.
