Predicting Nursing Home Utilization Among the High-Risk Elderly

This paper explores the influence of various characteristics on nursing home utilization. It examines a targeted population of elderly individuals whose poor health and lack of social supports were expected to lead to heavy use of long-term care. We develop an empirical framework based on a transition probability model to describe the frequency and duration of nursing home admissions. Using longitudinal data on the high-risk elderly enrollees of the National Long-Term Care Demonstration ("Channeling" demonstration), we. find that a small set of characteristics distinguish individuals who are likely to be heavy utilizers of nursing homes from low utilizers. The factors associated with a high likelihood of institutionalization are not identical to the health characteristics associated with high mortality; for example, the likelihood of death increases with age, but nursing home utilization does not, when functional status and other characteristics are held constant. A somewhat healthier population might have used nursing homes more heavily than the Channeling participants, whose nursing home utilization was limited by high mortality.