Rf. Boaz et Cf. Muller, PREDICTING THE RISK OF PERMANENT NURSING-HOME RESIDENCE - THE ROLE OFCOMMUNITY HELP AS INDICATED BY FAMILY HELPERS AND PRIOR LIVING ARRANGEMENTS, Health services research, 29(4), 1994, pp. 391-414
Objective. This study examines the difference between permanent and tr
ansitory residence in a nursing home with special emphasis on the exte
nt to which the risk of a long nursing home stay is reduced by the ava
ilability of informal help in the community. Data Source. Secondary da
ta were used, taken from the National Long-Term Care Surveys of 1982 a
nd 1984. The 1982 NLTCS samples disabled elderly living in the communi
ty. For these community dwellers, the 1984 NLTCS provides information
on continued residence in the community and on their nursing home epis
odes between 1982 and 1984. Method of Analysis. The analysis is based
on estimates from a multinomial logit regression with three explicit c
ategories: 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 nursin
g home stay (n = 3,368). Principlal Findings. This study demonstrates
the systematic differences in the personal characteristics that predic
t the risk of long stays from those that predict short stays in a nurs
ing home. Controlling for limitations in physical and cognitive functi
oning, 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 statistical
ly 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 percentages points for elders living with adults other than a
spouse or children. Conclusion. The relatively strong effects of famil
y helpers and living arrangements on the risk of long nursing home sta
ys confirm the hypothesis that, after controlling for the effects of p
hysical and cognitive functioning, adequate help in the community redu
ces the risk of permanent nursing home residence. But help in the comm
unity has no effect on the risk of short nursing home episodes because
these episodes are likely to be extensions of acute hospital care. Th
e findings provide essential information for designing a long-term car
e program because they suggest the magnitudes of the effects that such
a program can have on reducing the risk of permanent nursing home res
idence.