Transitions from home to nursing home in a capitated long-term care program: the role of individual support systems.

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OBJECTIVE. This study calculated the risk of nursing home admission for clients receiving home- and community-based (HCB) care in a capitated long-term care system. DATA SOURCES. Program administrative data for non-institutionalized elderly and physically disabled (EPD) clients who had an HCB long-term care placement in the Arizona Long-Term Care System (ALTCS) during the period from January 1989 through December 1991. STUDY DESIGN. The program experience of clients who were initially placed in HCB care (N = 2,923) was tracked from the date on which they entered the program until the end of December 1992. DATA EXTRACTION METHODS. Program administrative data were used to create spans of program experience for each client. Cox proportional hazards regression models were then used to assess the individual factors associated with the risk of nursing home entry during the study period. PRINCIPAL FINDINGS. The greatest risk of nursing home entry was observed for those who were older or white, and for those clients with Alzheimer's disease. Little significant effect was observed for support system variables. CONCLUSIONS. Study results suggest that efforts to prevent nursing home entry may be most productive if they focus on the point at which clients are first assessed for placement into the ALTCS program. Once in HCB care, subsequent risk of nursing home placement may be more related to the client's health and frailty than to support system factors.

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