Is Aging in Place Delaying Nursing Home Admission?

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 chi 2 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. (C) 2015 AMDA - The Society for Post-Acute and Long-Term Care Medicine.