Long-term care case managers' out-of-home placement decisions - An application of hierarchical logistic regression

Hierarchical logistic regression was used with the results of a factorial v ignette survey of a national sample of case managers for the disabled elder ly in Medicaid home- and community-based services waiver programs. The effe cts of client,client, case manager, and agency factors on case managers' ou t-of-home placement decisions in response to hypothetical case studies were estimated. Results show that client preferences, workload, and division of labor affect the probability that a case manager will recommend an out-of- home placement, controlling for client's physical and cognitive disability and the available resources. Significant variation among individuals was fo und. Implications of the findings are discussed.