title: Activities of daily living in nursing home and home care settings: a retrospective 1-year cohort study.
abstract: OBJECTIVE
  Korea introduced universal long-term care insurance (LTCI) for physically dependent older adults in 2008. Older adults, their family members, and policy makers in Korea want to know patient outcomes in different care modalities because older adults who have a similar functional status and LTC needs can choose either nursing home care or home care. The aim of this study was to compare activities of daily living (ADLs) in nursing home care and home care settings for physically dependent older adults in Korea.
  
  
  METHODS
  A retrospective 1-year cohort study using national LTCI data.
  
  
  METHODS
  This study used the LTCI dataset from the National Health Insurance Service in Korea.
  
  
  METHODS
  Participants were identified from among those in the LTCI dataset who enrolled from July 2008 to June 2010. We extracted a sample consisting of 22,557 older adults who consistently received either nursing home care (n = 11,678) or home care (n = 10,879) for 1 year.
  
  
  METHODS
  The outcome variable was change in ADLs after 1 year. Covariates were an older adult's home geographical region, LTC level, age, sex, primary caregiver, Medicaid beneficiary status, bedridden status, medical diagnosis, baseline ADLs, cognitive function, behavioral problems, nursing and special treatment, and rehabilitation needs. Multiple regression analysis of all participants unmatched and a paired t-test with a propensity-score-matched cohort were performed to explain the association of changes in ADLs with the types of LTC.
  
  
  RESULTS
  Multiple regression analysis with all participants (n = 22,557) unmatched showed that compared with older adults who received home care, those who received nursing home care had deteriorated further in terms of ADLs after 1 year (β = 0.44108, P < .0001). After propensity-score matching, paired t-test analysis also found that the ADLs of older adults had deteriorated less in the home care group compared with the nursing home group after 1 year (P < .0001).
  
  
  CONCLUSIONS
  The ADLs of older adults who received home care showed significantly less deterioration than those of the older adults in nursing home care after 1 year. The ADLs of older adults could differ according to the type of LTC they receive, and home care could result in better maintenance of ADLs than nursing home care.
authors.affiliation: Nursing Policy Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea.
authors.forename: Tae Wha
authors.initials: TW
authors.lastname: Lee
authors.affiliation: Nursing Policy Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea. Electronic address: ehcho@yuhs.ac.
authors.forename: Eunhee
authors.initials: E
authors.lastname: Cho
authors.affiliation: Department of Nursing, Daegu Health College, Daegu, Republic of Korea.
authors.forename: Eun Shil
authors.initials: ES
authors.lastname: Yim
authors.affiliation: Department of Biostatistics, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hye Sun
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Department of Nursing Science, Wonkwang University, Iksan, Jeonbuk, Republic of Korea.
authors.forename: Yu Kyung
authors.initials: YK
authors.lastname: Ko
authors.affiliation: Department of Nursing, Daegu Health College, Daegu, Republic of Korea.
authors.forename: Bok Nam
authors.initials: BN
authors.lastname: Kim
authors.affiliation: Nursing Policy Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea.
authors.forename: Sinhye
authors.initials: S
authors.lastname: Kim
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D015331:Cohort Studies; D016208:Databases, Factual; D004185:Disability Evaluation; D005260:Female; D015577:Geriatric Assessment; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D007353:Insurance, Long-Term Care / Q000191:economics*; D008134:Long-Term Care / Q000191:economics / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000458:organization & administration*; D011788:Quality of Life; D056910:Republic of Korea; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Activities of daily living; Korea; home care services; long-term care; nursing homes; older adults; outcomes