Setting of care modifies risk of nursing home placement for older adults with dementia

Objective: The purpose of this study was to examine risk of nursing home (NH) placement among older adults receiving publicly funded borne 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 (C) 2009 John Wiley & Sons, Ltd.