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Setting of care modifies risk of nursing home placement for older adults with dementia
Author(s) -
Temple April,
Andel Ross,
Dobbs Debra
Publication year - 2010
Publication title -
international journal of geriatric psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.28
H-Index - 129
eISSN - 1099-1166
pISSN - 0885-6230
DOI - 10.1002/gps.2333
Subject(s) - dementia , medicaid , medicine , proportional hazards model , nursing homes , gerontology , long term care , health care , nursing , disease , economics , economic growth
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). Conclusion The findings suggest that differences in care provided in HCBS and AL may influence subsequent NH placement for older adults with dementia. Copyright © 2009 John Wiley & Sons, Ltd.