Objectives: This study identified specific personal factors and home- and community-based services (HCBS) that predict older adults’ residential transitions between community and institutional settings. Method: Logistic regression of interview data from 5294 participants in the Second Longitudinal Study of Aging identified predictors of three residential transition patterns and of frequency and duration of institutional services use. Results: Different HCBS services differently affected residential transitions. Informal support and paid personal care services (PCS) were the main factors affecting older adults’ ability to reside in community settings or to remain in community longer. Frequency of HCBS use and quantity of paid PCS used indicated direction of transitions: from communities into institutions or vice versa. Discussion: Integration of informal and formal care systems and attention to community-dwelling older adults’ HCBS use and paid PCS use, as a guide for possible future transitions, are tasks for community care professionals.
R. J. Hanley, et al., “Predicting Elderly Nursing Home Admissions. Results from the 1982-1984 National Long- Term Care Survey,” Research on Aging, Vol. 12, No. 2, 1990, pp. 199-228. doi:10.1177/0164027590122004
V. Mor, et al., “Prospects for Transferring Nursing Home Residents to the Community,” Health Affairs, Vol. 26, No. 6, 2007, pp. 1762-1771. doi:10.1377/hlthaff.26.6.1762
J. E. Gaugler, et al., Predicting Nursing Home Admission in the US: A Meta-Analysis,” BMC Geriatrics, Vol. 7, 2007, p. 13. doi:10.1186/1471-2318-7-13
A. B. Akamigbo and F. D. Wolinsky, “Reported Expectations for Nursing Home Placement among Older Adults and Their Role as Risk Factors for Nursing Home Admissions,” The Gerontologist, Vol. 46, No. 4, 2006, pp. 464- 473. doi:10.1093/geront/46.4.464
V. L. Greene, et al., “Reducing Nursing Home Use through Community Long-Term Care: An Optimization Analysis,” The Journal of Gerontology: Series B, 1995, Vol. 50, No. 4, pp. S259-S268. doi:10.1093/geronb/50B.4.S259
A. M. Jette, S. Tennstedt and S. Crawford, “How does Formal and Informal Community Care Affect Nursing Home Use?” The Journals of Gerontology: Series B, Vol. 50, No. 1, 1995, pp. S4-S12. doi:10.1093/geronb/50B.1.S4
L. R. Fischer, et al., “Community-Based Care and Risk of Nursing Home Placement,” Medical Care, Vol. 41, No. 12, 2003, pp. 1407-1416. doi:10.1097/01.MLR.0000100587.51573.7A
S. McFall and B. H. Miller, “Caregiver Burden and Nursing Home Admission of Frail Elderly Persons,” The Journals of Gerontology, Vol. 47, No. 2, 1992, pp. S73-S79.
C. Eng, et al., “Program of All-Inclusive Care for the Elderly (PACE): An Innovative Model of Integrated Geriatric Care and Financing,” Journal of the American Geriatrics Society, Vol. 45, No. 2, 1997, pp. 223-232.
G. Mitchell 2nd, et al., “The Relative Benefits and Cost of Medicaid Home- and Community-Based Services in Florida,” The Gerontologist, Vol. 46, No. 4, 2006, pp. 483-494. doi:10.1093/geront/46.4.483
K. F. Ferraro and J. A. Kelley-Moore, “A Half Century of longitudinal Methods in Social Gerontology: Evidence of Change in the Journal,” The Journals of Gerontology: Series B, Vol. 58, No. 5, 2003, pp. S264-S270. doi:10.1093/geronb/58.5.S264
R. Andersen and J. F. Newman, “Societal and Individual Determinants of Medical Care Utilization in the United States,” The Milbank Memorial Fund Quarterly, Health and Society, Vol. 51, No. 1, 1973, pp. 95-124. doi:10.2307/3349613
R. M. Andersen, “A Behavioral Model of Families’ Use of Health Services,” Research Series, University of Chicago, Center for Health administration Studies, Chicago, 1968.
R. M. Andersen, “Revisiting the Behavioral Model and Access to Medical Care: Does It Matter?” Journal of Health and Social Behavior, Vol. 36, No. 1, 1995, pp. 1-10. doi:10.2307/2137284
J. A. Krout, J. Oggins and H. H. Holmes, “Patterns of Service Use in a Continuing Care Retirement Community,” The Gerontologist, Vol. 40, No. 6, 2000, pp. 698-705. doi:10.1093/geront/40.6.698
J. Mitchell and J. A. Krout, “Discretion and Service Use among Older Adults: The Behavioral Model Revisited,” The Gerontologist, Vol. 38, No. 2, 1998, pp. 159-168. doi:10.1093/geront/38.2.159
R. Andersen, et al., “Application of the Behavioral Model to Health Studies of Asian and Pacific Islander Americans,” Asian American and Pacific Islander Journal of Health, Vol. 3, No. 2, 1995, pp. 128-141.
E. A. Miller and W. G. Weissert, “Predicting Elderly People’s Risk for Nursing Home Placement, Hospitalization, Functional Impairment, and Mortality: A Synthesis,” Medical Care Research and Review, Vol. 57, No. 3, 2000, pp. 259-297. doi:10.1177/107755870005700301
C. Mustard, et al., “What Determines the Need for Nursing Home Admission in a Universally Insured Population?” Journal of Health Services Research & Policy, Vol. 4, No. 4, 1999, pp. 197-203.
M. Tomiak, et al., “Factors Associated with Nursing-Home Entry for Elders in Manitoba, Canada,” The Journals of Gerontology: Series A, Vol. 55, No. 5, 2000, pp. M279-M287. doi:10.1093/gerona/55.5.M279
D. Lekan-Rutledge, “Functional Assessment,” In: M. A. Matteson, E. S. McConnel and A. D. Linton, Ed., Gerontological Nursing: Concepts and Practice, Sounders Company, Philadelphia, 1998.
R. J. Johnson and F. D. Wolinsky, “Use of Community- Based Long-Term Care Services by Older Adults,” Journal of Aging and Health, Vol. 8, No. 4, 1996, pp. 512-537. doi:10.1177/089826439600800403
S. C. Miller, et al., “Time to Nursing Home Admission for Persons with Alzheimer’s Disease: The Effect of Health Care System Characteristics,” The Journals of Gerontology: Series B, Vol. 53, No. 6, 1998, pp. S341-S353. doi:10.1093/geronb/53B.6.S341
S. J. Newman, et al., “Overwhelming Odds: Caregiving and the Risk of Institutionalization,” The Journals of Gerontology, Vol. 45, No. 5, 1990, pp. S173-S183.
The Second Longitudinal Study of Aging, The Second Supplement on Aging: 1994 (Version 2, No. 1, September 1998); Wave 2 Survivor Data File (Version SF1.2, June 2002); Wave 2 Decedent Data File (Version DF1.1, August 2002); Wave 3 Survivor Data File (Version SF2.1, October 2002); Wave 3 Decedent Data File (Version DF2.1, December 2002) 2002 [cited 2002; Data files]. http://www.cdc.gov/nchs/about/otheract/ aging/lsoa2.htm.
K. G. J?reskog and D. S?rbom, “LISREL8: Structural Equation Modeling with the SIMPLIS Cammand Language,” Lawrence Erlbaum Associates, Hillsdale, 1993.
P. Kemper, “The Use of Formal and Informal Home Care by the Disabled Elderly,” Health Services Research, Vol. 27, No. 4, 1992, pp. 421-451.
V. L. Greene, M. E. Lovely and J. I. Ondrich, “The Cost-Effectiveness of Community Services in a Frail Elderly Population,” The Gerontologist, Vol. 33, No. 2, 1993, pp. 177-189. doi:10.1093/geront/33.2.177
The Second Longitudinal Study of Aging, The Second Supplement on Aging: Wave 3 Survivor Questionnaire (Version SF2.1, October 2002) 2002 [cited 2002; Coding Book files]. http://www.cdc.gov/nchs/ about/otheract/aging/lsoa2.htm.
Q. Cai, J. W. Salmon and M. E. Rodgers, “Factors Associated with Long-Stay Nursing Home Admissions among the US Elderly Population: Comparison of Logistic Regression and the Cox Proportional Hazards Model with Policy Implications for Social Work,” Social Work in Health Care, Vol. 48, No. 2, 2009, pp. 154-168. doi:10.1080/00981380802580588
R. F. Boaz and C. F. Muller, “Predicting the Risk of ‘Permanent’ Nursing Home Residence: The Role of Community Help as Indicated by Family Helpers and Prior Living Arrangements,” Health Services Research, Vol. 29, No. 4, 1994, pp. 391-414.
Y. M. Chen, “A Community-Based Long-Term Care Model for the US Elderly,” Doctoral Dissertation, University of Washington, Seattle, 2004, p. 258.
N. Muramatsu, et al., “Risk of Nursing Home Admission among Older Americans: Does States’ Spending on Home- and Community-Based Services Matter?” The Journals of Gerontology: Series B, Vol. 62, No. 3, 2007, pp. S169-S178.
D. J. Rabiner, S. C. Stearns and E. Mutran, “The Effect of Channeling on in-Home Utilization and Subsequent Nursing Home Care: A Simultaneous Equation Perspective,” Health Services Research, Vol. 29, No. 5, 1994, pp. 605- 622.
M. Kitchener, et al., “Institutional and Community-Based Long-Term Care: A Comparative Estimate of Public Costs,” Journal of Health & Social Policy, Vol. 22, No. 2, 2006, pp. 31-50. doi:10.1300/J045v22n02_03