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Original Study
Is Aging in Place Delaying Nursing Home Admission?

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Abstract

Objectives

This study examines whether aging in place (community-based living before admission to a nursing home) delays nursing home admission among New York State home health care recipients.

Design

Retrospective cohort study (January 2007–December 2012).

Setting

New York State.

Participants

Adults age 65+ who received home health services for at least 2 months before permanent nursing home admission.

Measurement and Analysis

Permanent transition is defined as home care patients who are discharged to and stay at a nursing home for more than 3 months. Data were abstracted from the Minimum Data Set (MDS) and Outcome and Assessment Information Set (OASIS). Descriptive and bivariate Kruskal-Wallis and χ2 tests were performed.

Results

The average age of nursing home residents at admission remained steady at 83 years between 2007 and 2012. The proportion of minority populations (Asian, black, Hispanic/Latino) increased, whereas the white population declined (P < .0001). The average length of stay at home increased 8 months, from 17 months in 2007 to 25 months in 2012 (P < .0001). Chronic conditions with significant increases in prevalence during the study period were hypertension (P < .0009), dementia (P < .0001), heart failure (P = .05), urinary incontinence (P < .0001), and bowel incontinence (P < .0001). Increases in functional disabilities requiring extensive human assistance included toileting, dressing, personal hygiene, and transferring (all P < .001).

Conclusion

Home health services enabled recipients to remain at home 8 months longer, thus delaying nursing home entry. Given the increase in prevalence of comorbidities and disability, we anticipate a concomitant increase in support services at the nursing home. These results may inform policy and staffing decisions regarding adjustments in required caregivers' credentials and nurse-patient ratios.

Section snippets

Study Design

This was a retrospective cohort study from January 2007 to December 2012 in NYS. Inclusion criteria for the study population were as follows: older adults (65+) who received care from a home health care agency for more than 2 months at baseline, followed by a permanent transition to an NH. Individuals were excluded if gender or date of birth changed within their record, indicating irregularities in data collection.

Data Source

Outcome and Assessment Information Set (OASIS) and the Minimum Data Set (MDS)

Results

Table 1 shows selected sociodemographic characteristics of the study population. The mean age at admission to a NH was 83 years and approximately 70% were women, both characteristics remained constant during the study period. The diversity of residents at admission increased substantially; however, the proportion of Asian, black, and Hispanic residents increased by 4.0%, 4.4%, and 5.2%, respectively (P < .0001), while the proportion of white residents decreased by approximately 10%.

With respect

Discussion

Our study found that support for aging in place for the home care population can measurably delay NH admission by 8 months. This study adds to the body of knowledge about home health services, which support aging in place, and their impact on patient health and functional change, all of which inform staffing decisions for both home health agencies and NHs.

The sociodemographics of NH residents in NYS are similar to those elsewhere in the United States. At admission, NH residents are mostly

Conclusion

This study further substantiates the measurable impact of community-based home health services that facilitate aging in place that delay permanent NH entry. The health finance and policy implications are clear: aging in place is good for the patient, but CHHAs and NH directors will need to plan staffing appropriately to care for the patients' more complex needs when admission to the NH is delayed. Further research on aging-in-place initiatives should be designed with the planning needs of home

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  • Cited by (0)

    The authors declare no conflicts of interest.

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