title: New estimates of lifetime nursing home use: have patterns of use changed?
abstract: OBJECTIVE
  The elderly population at risk for costly nursing home care is increasing. It is important to understand patterns of lifetime nursing home use and their implications for public and private payers. We provide new lifetime nursing home use estimates, project future use, and discuss cost implications.
  
  
  METHODS
  Data are next-of-kin reports of nursing home use for representative samples of decedents from the 1986 and 1993 National Mortality Followback Surveys. Future use is based on projected mortality from the Social Security Administration.
  
  
  RESULTS
  The proportion of elderly decedents who ever used a nursing home rose modestly between 1986 and 1993, with increased use before the last year of life. Rising longevity after age 65 and older the next 20 years will increase the risk for a 65 year old ever entering a nursing home to 46%. With increased survival to age 65, the number of 65 year olds ultimately using nursing homes will double by 2020.
  
  
  CONCLUSIONS
  Disability declines and changes in Medicare policy between 1986 and 1993 had little impact on overall patterns of nursing home use. Barring dramatic changes in health status or other factors, population aging will make nursing home costs a growing share of national health spending. More needs to be known about relationships between nursing home use and alternative care settings and the cost and quality implications of shifts from one setting to the other. A key issue is how constraints on Medicare SNF and home health benefits will affect use and the distribution of costs.
authors.affiliation: The Urban Institute, Washington DC 20037, USA. bspillma@ui.urban.org
authors.forename: Brenda C
authors.initials: BC
authors.lastname: Spillman
authors.forename: James
authors.initials: J
authors.lastname: Lubitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003710:Demography; D005260:Female; D005544:Forecasting; D019538:Health Care Surveys; D005102:Health Expenditures / Q000639:trends*; D006301:Health Services Needs and Demand / Q000191:economics / Q000639:trends*; D006707:Homes for the Aged / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008017:Life Expectancy; D008136:Longevity; D008297:Male; D008484:Medicaid; D006278:Medicare; D009735:Nursing Homes / Q000191:economics / Q000706:statistics & numerical data*; D014600:Utilization Review