ALL Adults in Household are Age 55+ 8%* 3%* 1%* 14%** 48%** 60%** 63%** 45%** 39%** 17%** 26%** 29%**

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1 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 Household Survey, Barnstable County Dept. of Human Services. Senior/Elder Household Health Insurance Status COVERAGE: One or more adult in household is NOT health insured ALL Adults in Household are Ages ALL Adults in Household are Age 55+ ALL Adults in Household are Age 65+ 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.) Health insurance obtained through an employer s insurance plan Health insurance purchased privately from insurance company 14%** 48%** 60%** 63%** 45%** 39%** 17%** 26%** 29%** * Percentage of the group of households reporting one or more adult was without health insurance at the time of survey. ** Percentage of that particular group of households. SNAPSHOT Rev. B 4-1 July 11, 2003

2 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.) SNAPSHOT Rev. B 4-2 July 11, 2003

3 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 COVERAGE: One or more adult in household is NOT health insured Some household insurance programs INCLUDE dental care coverage INSURANCE SOURCE: Health insurance obtained through a State/Federal program (Medicare, Medicaid, VA, etc.) Health insurance obtained through an employer s insurance plan Health insurance purchased privately from insurance company SOME Adults in Household are Ages SOME Adults in Household are Age 55+ SOME Adults in Household are Age %* 12%* 8%* 57%** 42%** 34%** 29%** 47%** 60%** 66%** 52%** 46%** 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. SNAPSHOT Rev. B 4-3 July 11, 2003

4 SNAPSHOT Rev. B 4-4 July 11, 2003

5 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 of two parts: Hospital Insurance (Part A) and Medical Insurance (Part B). 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: and at May 22, SNAPSHOT Rev. B 4-5 July 11, 2003

6 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, ,651 Part A Enrollees ( HI ) 51, ,260 Part B Enrollees ( SMI ) 49, ,996 DISABLED: (March 2002 update) Part A and/or Part B Enrollees ( HI &/or SMI ) 4, ,758 Part A Enrollees ( HI ) 4, ,747 Part B Enrollees ( SMI ) 4, ,247 TOTAL: (Aged + Disabled) Part A and/or Part B Enrollees ( HI &/or SMI ) 56, ,409 Part A Enrollees ( HI ) 56, ,007 Part B Enrollees ( SMI ) 54, ,243 * Number of enrollees as of July 1, Disabled enrollment data updated to March 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, ,496 Part A Enrollees ( HI ) 51, ,461 Part B Enrollees ( SMI ) 49, ,257 DISABLED: (March 2001 update) Part A and/or Part B Enrollees ( HI &/or SMI ) 4, ,226 Part A Enrollees ( HI ) 4, ,213 Part B Enrollees ( SMI ) 4, ,303 TOTAL: (Aged + Disabled) Part A and/or Part B Enrollees ( HI &/or SMI ) 56, ,722 Part A Enrollees ( HI ) 56, ,674 Part B Enrollees ( SMI ) 53, ,560 ** Number of enrollees as of July 1, Disabled enrollment data updated to March SNAPSHOT Rev. B 4-6 July 11, 2003

7 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: (for Year 2000 enrollment data) and (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: and at 5/22/03. Enrollment in Medicaid Program At the present time, no Medicaid enrollment data is officially available for Barnstable County enrollees. SNAPSHOT Rev. B 4-7 July 11, 2003

8 SNAPSHOT Rev. B 4-8 July 11, 2003

9 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, Hospital Number of Beds Annual Patient Days* Cape Cod Hospital, Hyannis, MA ,570 Jordan Hospital, Plymouth, MA ,750 Toby Hospital, Wareham, MA 85 31,023 Falmouth Hospital, Falmouth, MA 83 30,295 Totals ,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 SNAPSHOT Rev. B 4-9 July 11, 2003

10 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, SNAPSHOT Rev. B 4-10 July 11, 2003

11 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, 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 Cape Cod Extd Care Comm P Hyannis, MA Cape Cod Nursing & Rehabilat Buzzards Bay, MA Cape End Manor Provincetown, MA Cape Heritage Nursing & Rehab Sandwich, MA Cape Regency Nursing & Rehab Centerville, MA Cranberry Pointe Rehab & Skld Harwich, MA Eagle Pond Rehab & Living Ctr South Dennis, MA Epoch Senior Hlthcare-Brewster Brewster, MA Harborside Healthcare-Falmouth Falmouth, MA Harborside-Mashpee Mashpee, MA Hyannis Skilled Care Center Hyannis, MA JML Care Center Inc. Falmouth, MA Liberty Commons N. Chatham, MA Mayflower Place Nursing Center W. Yarmouth, MA Pleasant Bay Nursing & Rehab Brewster, MA Royal Megansett Nursing and Re N. Falmouth, MA Royal Nursing Center, LLC Falmouth, MA Windsor Nursing & Retirement H S. Yarmouth, MA CAPE COD TOTALS - 2,224 1,931 - Massachusetts (Ave.) All Nurs. Homes residents 3.90 Unites States (Ave.) All Nurs. Homes residents 3.90 * Most Barnstable County nursing homes were last inspected during the year Two facilities (Bourne Manor Extended Care FAC, JML Care Center, Inc.) have been inspected in the year SNAPSHOT Rev. B 4-11 July 11, 2003

12 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, Home Health Agency Name (per Medicare web site) Corporate Office Location Nursing Care Services? Medicare-Covered Services Offered Physical Medical Therapy Social Services? 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 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 Morton Home Care Taunton, MA Yes Yes Yes Yes SNAPSHOT Rev. B 4-12 July 11, 2003

13 Table 4.7 Continued. Home Health Agency Name (per Medicare web site) Corporate Office Location Nursing Care Services? Medicare-Covered Services Offered Physical Medical Therapy Social Services? 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 * Listed in alphabetical order as per the Medicare web site SNAPSHOT Rev. B 4-13 July 11, 2003

14 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, Dialysis Facility Cape Cod Artificial Kidney Center (BMA Cape Cod) FMC Dialysis Services of Falmouth Location Number of Dialysis Stations In-Center Hemodialysis Facilities? Peritoneal Dialysis Facilities? Home Hemodialysis Training? Yarmouth 24 Yes Yes Yes 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. SNAPSHOT Rev. B 4-14 July 11, 2003

15 Table 4.9 Disability Among Older Adults in Barnstable County: Persons Age 65 and Older With A Disability, Year 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. Disability Status of Older Adult Population Persons Age 65 Years and Over With a Disability * Persons Age 65 Years and Over Count Percent* TOWNS: Barnstable [including Hyannis] 3, % Hyannis [separate] 1, % Bourne % Brewster % Chatham % Dennis 1, % Eastham % Falmouth 2, % Harwich 1, % Mashpee % Orleans % Provincetown % Sandwich % Truro % Wellfleet % Yarmouth 2, % REGIONS: Upper-Cape 4, % Mid-Cape 7, % Lower/Outer-Cape 3, % COUNTY: Barnstable County 15, % STATE: Massachusetts 305, % NATION: United States 13,978, % * Percentage of the civilian, non-institutionalized Older Adult population (age 65 and older) with a disability per the US Census Bureau, Census See also, Glossary, U.S. Census 2000 Terminology. SNAPSHOT Rev. B 4-15 July 11, 2003

16 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 Rates are tabulated for each senior/elder age group. Note that while hospitalization rates for residents age 75 and older increased during the 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 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.) SNAPSHOT Rev. B 4-16 July 11, 2003

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18 Table 4.10: Average Hospitalization Rates For Barnstable County Senior/Elders: Patients Ages 55 and Older, For Five-Years Data Source: Mass. Dept. of Public Health, MassCHIP Web Site Senior/Elder Hospitalizations Barnstable County Barnstable County Barnstable County Barnstable County Barnstable County Seniors and Elders Ages Ages Ages 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.) ,574 * Number of hospitalizations for the particular illness per 100,000 Barnstable County residents in the specified age group. ** Average of rates for the five years; 1996, 1997, 1998, 1999, and SNAPSHOT Rev. B 4-18 July 11, 2003

19 Table 4.11: Hospitalization Rates For Barnstable County Senior/Elders: Patients Ages 55 and Older, Year Data Source: Mass. Dept. of Public Health, MassCHIP Web Site Senior/Elder Hospitalizations Barnstable County Barnstable County Barnstable County Barnstable County Barnstable County Seniors and Elders Ages Ages Ages 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.) ,163 2,090 * Number of hospitalizations for the particular illness per 100,000 Barnstable County residents in the specified age group. ** Latest year for which data is available. SNAPSHOT Rev. B 4-19 July 11, 2003

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24 Massachusetts Hospitalizations: Figure 4.6 shows senior/elder Hospitalization Rates of Massachusetts residents due to ALL illnesses/conditions for the years Rates are tabulated for each senior/elder age group. Note that while hospitalization rates for residents age 85 and older increased somewhat during the 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 (osteoarthritis, etc.). SNAPSHOT Rev. B 4-24 July 11, 2003

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26 Table 4.12 Average Hospitalization Rates For Massachusetts Senior/Elders: Patients Ages 55 and Older, For Five-Years Data Source: Mass. Dept. of Public Health, MassCHIP Web Site Senior/Elder Hospitalizations Massachusetts Massachusetts Massachusetts Massachusetts * Massachusetts Seniors and Elders Ages Ages Ages 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.) ,619 2,614 * Number of hospitalizations for the particular illness per 100,000 Massachusetts residents in the specified age group. ** Average of rates for the five years; 1996, 1997, 1998, 1999, and SNAPSHOT Rev. B 4-26 July 11, 2003

27 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 Massachusetts Massachusetts Massachusetts Massachusetts * Massachusetts Seniors and Elders Ages Ages Ages 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.) ,569 2,660 * Number of hospitalizations for the particular illness per 100,000 Massachusetts residents in the specified age group. ** Latest year for which data is available. SNAPSHOT Rev. B 4-27 July 11, 2003

28 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 Massachusetts United States Pre-Retirement & Younger-Age Seniors - Ages Ages Ages (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.) ,802 2,017 2,751 - Diseases of Respiratory System, ALL (Pneumonia, Chronic Bronchitis, etc.) ,018 - Diseases of Digestive System, ALL (Diverticula of Intestine, Cholelithiasis, etc.) ,176 1,225 1,424 - Injury And Poisoning, ALL (Fractures, etc.) Malignant Neoplasms [Cancer], ALL (Malignant Neoplasms) *** *** - Diseases of Musculoskeletal System, ALL (Osteoarthritis, Intervertebral Disc Disorders, etc.) Endocrine, Nutritional, Metabolic, Immunity, ALL (Diabetes Mellitus, etc.) * Number of hospitalizations for the particular illness per 100,000 residents in age age group. ** Latest year for which data is available. *** United States cancer related data includes ICD-9 Codes State and County cancer data do not include ICD-9 Codes (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, SNAPSHOT Rev. B 4-28 July 11, 2003

29 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 Massachu- Setts United States 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.) ,140 10,052 11,379 - Diseases of Respiratory System, ALL (Pneumonia, Chronic Bronchitis, etc.) ,432 4,839 4,764 - Diseases of Digestive System, ALL (Diverticula of Intestine, Cholelithiasis, etc.) ,026 3,422 3,761 - Injury And Poisoning, ALL (Fractures, etc.) ,767 2,895 2,932 - Malignant Neoplasms [Cancer], ALL (Malignant Neoplasms) *** 1,953 2,062 1,851*** - Diseases of Musculoskeletal System, ALL (Osteoarthritis, Intervertebral Disc Disorders, etc.) ,130 1,835 2,047 - Endocrine, Nutritional, Metabolic, Immunity, ALL (Diabetes Mellitus, etc.) ,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 State and County cancer data do not include ICD-9 Codes (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 SNAPSHOT Rev. B 4-29 July 11, 2003

30 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 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 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 hospitalized for diseases of the musculoskeletal system (osteoarthritis, etc.). Average Length of Hospital Stay for patients ages 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 hospitalized due to ALL illnesses/conditions by gender [sex]. U.S. males ages tend to be hospitalized for a longer average period (5.2 days) than do U.S. females ages (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). SNAPSHOT Rev. B 4-30 July 11, 2003

31 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 Average Length of Hospital Stay: (In Days) - ALL Reasons For Hospitalization Condition Codes [ICD-9] Barnstable County Ave. Stay Length* Massachu- Setts Ave. Stay Length* United States Ave. Stay Length* - Ages Ages Ages (Year 2000**) (Year 2000**) (Year 2001) - N/A N/A Diseases of Circulatory System, ALL (Heart Disease, Stroke, etc.) N/A N/A Diseases of Respiratory System, ALL (Pneumonia, Chronic Bronchitis, etc.) N/A N/A Diseases of Digestive System, ALL (Diverticula of Intestine, Cholelithiasis, etc.) N/A N/A Injury And Poisoning, ALL (Fractures, etc.) N/A N/A Malignant Neoplasms [Cancer], ALL (Malignant Neoplasms) ** N/A N/A 6.8** - Diseases of Musculoskeletal System, ALL (Osteoarthritis, Intervertebral Disc Disorders, etc.) N/A N/A Endocrine, Nutritional, Metabolic, Immunity, ALL (Diabetes Mellitus, etc.) N/A N/A 4.2 * Average number of days spent in hospital by persons in the age group in the year N/A: Not Available. ** United States cancer related data includes ICD-9 Codes State and County cancer data do not include ICD-9 Codes (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. Massachusetts and Barnstable County length of hospital stay data is not available. SNAPSHOT Rev. B 4-31 July 11, 2003

32 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 Data Source: See below. Middle Age Adult and Pre-Retirement-Age Senior Patient Hospital Stays Barnstable County Average Stay Length* Massachusetts Average Stay Length* United States Average Stay Length* (2001) (2001) (2001) Average Length of Hospital Stay: ALL Reasons For Hospitalization - Females, Ages N/A N/A Males, Ages N/A N/A 5.2 * Average number of days spent in hospital by persons in the age group in year 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. SNAPSHOT Rev. B 4-32 July 11, 2003

33 Table 4.18 Average Length of Hospital Stay For Older Adult Patients, Age 65 and Older, Year Data Source: See below. Older Adult Hospital Stays Average Length of Hospital Stay: (In Days) - ALL Reasons For Hospitalization Condition Codes [ICD-9] - Barnstable County Ave. Stay Length* Age 65+ Massachusetts Ave. Stay Length* Ages 65+ United States Ave. Stay Length Ages 65+* (2001) (2001) (2001) N/A N/A Diseases of Circulatory System, ALL (Heart Disease, Stroke, etc.) N/A N/A Diseases of Respiratory System, ALL (Pneumonia, Chronic Bronchitis, etc.) N/A N/A Diseases of Digestive System, ALL (Diverticula of Intestine, Cholelithiasis, etc.) N/A N/A Injury And Poisoning, ALL (Fractures, etc.) N/A N/A Malignant Neoplasms [Cancer], ALL (Malignant Neoplasms) ** N/A N/A 7.3** - Diseases of Musculoskeletal System, ALL (Osteoarthritis, Intervertebral Disc Disorders, etc.) N/A N/A Endocrine, Nutritional, Metabolic, Immunity, ALL (Diabetes Mellitus, etc.) N/A N/A 4.9 * Average number of days spent in hospital for persons in the 65+ age group in year N/A Not Available. ** United States cancer related data includes ICD-9 Codes State and County cancer data do not include ICD-9 Codes (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. Massachusetts and Barnstable County length of hospital stay data is not available. SNAPSHOT Rev. B 4-33 July 11, 2003

34 Table 4.19 Average Length of Hospital Stay For Older Adult Patients, Age 65 and Older, By Patient Gender [Sex], Year 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 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 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, 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 Data Sources: The Human Condition 2001 Household Survey, Quality of Life Module, Barnstable County Dept. of Human Services, Caregiving Activities CAREGIVING: One or more household member is PRIMARY caregiver for a disabled or chronically ill person ALL Adults in Household are Ages ALL Adults in Household are Age 55+ ALL Adults in Household are Age % 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% * Note: The sample size is too small to yield a meaningful percentage. N/A Not Available SNAPSHOT Rev. B 4-34 July 11, 2003