The accelerated growth in the number of very old Americans has increased the number of individuals needing continued help over a long period. Most of the long-term disabled elderly are maintained in the community, but some will spend their remaining years in nursing homes. Since minimizing the time spent in an institution improves the quality of life, there have been many studies focusing on whether nursing home placement can be prevented or delayed by expanding publicly financed community services. Thus far, almost all studies have analyzed nursing home placement as a dichotomous decision, that is, a person lives either in the community or in an institution, as if all nursing home stays are homogeneous. However, there is evidence that differences in length of stay indicate qualitative differences in the characteristics of the patients and the types of stays. Our study will focus on long stays because long nursing home episodes reduce considerably the chance of returning to live in the community, account for a very large number of nursing home days, and increase the risk of """"""""spending down"""""""" to poverty. We plan to investigate the circumstances that lead older Americans to leave the community for a long nursing home stay and to examine how these circumstances differ from those that are conducive to remaining in the community. The study will be based on the 1982 and 1984 Long-Term Care Surveys and the linked Medicare (Part A) file. The proportional hazard model will estimate the risk factors of a long stay in a nursing home. Further, a multinomial logit model will estimate the determinants of community residence and nursing home residence to bring into sharp relief the difference between them. The regression coefficients are used to compute indices that measure the relative strength of different policy-sensitive variables in their effects on the probabilities of community residence and nursing home residence. These indices are used to develop a quantitative criterion for policies designed to encourage staying in the community.
| Boaz, R F; Muller, C F (1994) Predicting the risk of ""permanent"" nursing home residence: the role of community help as indicated by family helpers and prior living arrangements. Health Serv Res 29:391-414 |
