Predicting the risk of "permanent" nursing home residence: the role of community help as indicated by family helpers and prior living arrangements.

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OBJECTIVE. This study examines the difference between permanent and transitory residence in a nursing home with special emphasis on the extent to which the risk of a long nursing home stay is reduced by the availability of informal help in the community. DATA SOURCE. Secondary data were used, taken from the National Long-Term Care Surveys of 1982 and 1984. The 1982 NLTCS samples disabled elderly living in the community. For these community dwellers, the 1984 NLTCS provides information on continued residence in the community and on their nursing home episodes between 1982 and 1984. METHOD OF ANALYSIS. The analysis is based on estimates from a multinomial logit regression with three explicit categories: persons with at least one long nursing home stay (n = 292), persons with only short stays (n = 227), and persons who died without ever having had a nursing home stay (n = 945). The implicit category: persons living in the community in 1984 without having had any nursing home stay (n = 3,368). PRINCIPAL FINDINGS. This study demonstrates the systematic differences in the personal characteristics that predict the risk of long stays from those that predict short stays in a nursing home. Controlling for limitations in physical and cognitive functioning, the regression analysis shows that indicators of informal help in the community have a statistically significant and relatively large effect on the risk of long stays; but the effects of these indicators on the risk of short stays is numerically smaller and not statistically significant. Specifically, when the burden of caregiving is shared by a spouse and children, the risk of a long stay in a nursing home is reduced by 9.3 percentage points; in contrast, the risk is increased by 18 percentage points for childless elders who are living alone and by 45.8 percentage points for elders living with adults other than a spouse or children. CONCLUSION. The relatively strong effects of family helpers and living arrangements on the risk of long nursing home stays confirm the hypothesis that, after controlling for the effects of physical and cognitive functioning, adequate help in the community reduces the risk of permanent nursing home residence. But help in the community has no effect on the risk of short nursing home episodes because these episodes are likely to be extensions of acute hospital care. The findings provide essential information for designing a long-term care program because they suggest the magnitudes of the effects that such a program can have on reducing the risk of permanent nursing home residence.

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