Substance Use Disorders and Health Care Costs Among Veterans Affairs Nursing Home Residents

Background: Research on the relationship between substance use disorders (SUDs) and older adults' health care costs is equivocal. A large-scale study comparing health care costs among older adults with and without SUDs has never been conducted. Objective: To determine the relation of SUDs to health care costs in a large sample of adults following entry into a Veterans Affairs (VA) nursing home. Methods: We performed a retrospective analysis of 29,997 adults aged 45+ who entered a VA nursing home in 2000. Total costs were tallied over fiscal years 1997 to 2000 by setting (outpatient, nursing home, other inpatient, and total) and included all care paid by VA. Results: Relative to non-SUD patients, those with SUDs aged 75 to 84 years had significantly higher total costs of care (+$ 10,020), as did those aged 85 and above (+$ 16,052). Yet, SUD diagnosis was not a significant predictor of total cost or nursing home cost among persons 65 and above after controlling for demographic, clinical, and financial factors. Conclusions: SUDs do not directly increase health care costs among older adults entering nursing homes, although they may affect cost of care indirectly through factors such as income and marital dissolution. The generational increase in SUD rates occurring in the United States may not lead to substantially greater health care expenses if appropriate assistance can be provided before nursing home entry.