PREDICTORS OF SKILLED NURSING PLACEMENT IN A MULTILEVEL LONG-TERM-CARE FACILITY

OBJECTIVE: To determine if cognitive and functional data gathered befo re admission to residential care (i.e., board and care) placement can predict nursing home placement. DESIGN: Retrospective study using Cox proportional hazards analysis and pairwise assessment of adjusted rela tive risk factors to determine which independent variables predicted s killed nursing placement. Subjects were followed for an average of 23. 7 months (SD = 18.6 months). SETTING: Multilevel 735-bed long-term car e facility, Jewish Home for the Aging, Reseda, California. PARTICIPANT S: Of the 248 consecutive residential care admissions studied, 80% wer e women. Subject's mean age was 84.8 years (SD = 5.0); 67% had no sign ificant cognitive impairment. INDEPENDENT VARIABLES: Categorical varia bles were classifications with respect to dementia status, incontinenc e, hearing, and ambulation. Interval variables were number of medicati ons, Katz ADL, and five neuropsychological tests. Demographic variable s were gender, age, language of origin, and education. OUTCOME VARIABL E: Time between preadmission testing and the move up to skilled nursin g placement. RESULTS: Pairwise assessment of adjusted potential risk f actors indicated that cognitive dysfunction, less than perfect Katz AD L performance, and hearing loss were the most important independent ri sk factors for nursing placement. CONCLUSIONS: The findings remind us to pay careful attention to residents exhibiting even relatively mild cognitive deficits upon admission because these residents are likely t o need increased environmental support.