To examine factors associated with expenditures, variables were selected a priori from the CASCADE data set based on the literature.4,6- 8,19,20 Baseline resident characteristics obtained from the chart included demographics (sex, race [white vs other], and age); whether or not the resident lived in a special care dementia unit; NH length of stay (<2 years, 2-5 years, and >5 years); and comorbidities (eg, congestive heart failure, active cancer, chronic obstructive lung disease); and presence of a percutaneous endoscopic gastrostomy tube. Additional resident variables were collected at baseline and at each follow-up assessment. Cognitive status was measured by direct examination using the Test for Severe Impairment (TSI) score (range, 0-24; higher scores indicate better cognitive function).21 The TSI was categorized as either 0 or greater than 0 in these analyses. Functional status was quantified by the residents' nurses using the Bedford Alzheimer Nursing Severity Scale (range 7-28; higher scores signify greater disability).22 The presence of a do-not-hospitalize (DNH) order was recorded. Finally, the determination was made as to whether the resident experienced at least 1 acute major illness (febrile episode, pneumonia, or other [eg, hip fracture, stroke, myocardial infarction]) in the interval between assessments.