Saturday, 15 January 2005 - 8:00 AM

This presentation is part of: Health-Related Services for Older Adults

Length of Community Tenure Following Application for Nursing Facility Placement: A Prospective Study

Purpose: This study tracked a cohort (N=124) of low-income diverted older adults over a 24 month period following their application and assessment for nursing facility (NF) admission. The purpose was to identify the factors or conditions that accounted for length of community tenure. Older adults were considered diverted if they were residing in the community when a follow-up was conducted 30 days after their initial NF admission assessment. Older adults were considered low-income if potential use of Medicaid to pay for support services at home was indicated at the time of NF assessment.

Methods: The Cox proportional hazards regression model was used to analyze the probability that low-income diverted older adults would permanently enter a NF (NF stay of at least 100 days out of 120 days) up to 24 months later. The length of community tenure was measured in the number of days the diverted low-income older adults (N=124) lived in the community until their death or permanent NF admission.

Results: Twenty-four months after their initial diversion, 54 applicants were still in the community, 23 had died and 47 had entered the NF permanently . Statistically significant risk factors for permanent NF admission were age (p £ 0.10), rurality (p £ 0.01), living alone (p £ 0.05) and NF assessments conducted in the hospital (p £ 0.01). The rurality finding indicates that the more rural the low-income diverted older adult′s residence, the less likely the older adult was to permanently enter a NF. Low-income diverted older adults who lived alone were more than twice as likely to permanently enter a NF as low-income diverted older adults who lived with someone.

Low-income diverted older adults who were assessed in the hospital were less likely to enter a NF permanently. It is noteworthy that the LTC threshold score (a composite measure of functional disability based on ADL, IADL, and cognitive factors) was not related to permanent NF admission. These two findings suggest that functional or cognitive impairments have less to do with NF admission than other factors such as living alone or urban/rual residence of the older adult. In summary, the analysis of risk factors for permanent NF admission of low-income diverted older adults suggests low-income diverted older adults who live alone in urban areas are at an increased risk of a permanent NF admission.

Implications for Policy and Practice: Specific in-home community based services and case management interventions targeted to low-income frail older adults that could likely reduce the impact of the identified risk factors have been identified. Additionally, social policy makers can work collaboratively with community agencies serving low-income urban dwelling older adults to identify and develop community based services that support isolated low-income older adults′ efforts to remain in their own homes.

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