PREDICTORS OF NURSING-HOME PLACEMENT IN COMMUNITY-BASED LONG-TERM-CARE

OBJECTIVE: To identify predictors for nursing home placement among a g roup of frail older patients receiving formal home care services. DESI GN: Retrospective chart review. SETTING: A geographically defined catc hment area of southeast Baltimore, Maryland. PATIENTS: A total of 334 homebound patients who started using the Elder Housecall Program (EHP) , a multidisciplinary team providing in-home care and housed at the Jo hns Hopkins Geriatrics Center, between 1986 and 1989. MEASUREMENTS: In dependent variables, based on the chart review, were age, sex, diagnos is, functional status, and caregiver conditions at entry into EHP. Dep endent variable was nursing home placement until December 31, 1991. MA IN RESULTS: Cox proportional hazards analysis indicated that significa nt predictors were diabetes mellitus, bowel incontinence, and three ca regiver characteristics: living separate from the patient, having time conflicts because of a job, and being stressed by caregiving. CONCLUS ION: Among this group of frail older people, caregiver problems were s ignificant predictors of nursing home placement, but functional disabi lities generally were not. These results suggest the need for geriatri cians to be alert to the psychosocial aspects of patients and their ca regivers.