Setting of care modifies risk of nursing home placement for older adults with dementia.
OBJECTIVE
The purpose of this study was to examine risk of nursing home (NH) placement among older adults receiving publicly funded home and community-based services (HCBS) or assisted living (AL) and to explore whether these settings of care modify the relationship between dementia and risk of NH placement.


METHODS
The sample consisted of dually eligible Medicare and Medicaid beneficiaries age 65 and older who received HCBS (n = 1630) or resided in AL (n = 836) in Florida between July 1999 and June 2000. Cox proportional hazards regression was used to estimate risk of NH placement over a 5-year study period and to test the interaction of setting of care by dementia status.


RESULTS
In all, 15% of HCBS participants were placed in a NH compared to 26% of AL participants. As indicated by a significant interaction term in the regression model, setting of care modified the relationship between dementia and NH placement (HR = 0.45, CI = 0.31-0.66). In post hoc analyses stratified by setting of care, dementia was associated with a 50% increased risk of NH placement from HCBS (HR = 1.50, CI = 1.12-2.02) but was not associated with placement from AL (HR = 0.86, CI = 0.63-1.16).


CONCLUSIONS
The findings suggest that differences in care provided in HCBS and AL may influence subsequent NH placement for older adults with dementia.
Temple
April
A
Health Services Administration Program, Department of Health Sciences, James Madison University, 800 South Main Street, Harrisonburg VA, USA. templ2al@jmu.edu
Andel
Ross
R
Dobbs
Debra
D
D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities / Q000706:statistics & numerical data; D003704:Dementia / Q000451:nursing*; D005260:Female; D005431:Florida; D006699:Home Care Services / Q000706:statistics & numerical data; D006707:Homes for the Aged; D006801:Humans; D007326:Institutionalization; D008297:Male; D009735:Nursing Homes; D010343:Patient Admission / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012307:Risk Factors