Predicting long-term nursing home transfer from MI choice waiver program.

Area of Science:

• Gerontology
• Health Services Research
• Public Health

Background:

• Home and Community-Based Waiver Programs aim to support elderly individuals living at home.
• Identifying risk factors for long-term nursing home placement is crucial for resource allocation and care planning.
• The Michigan Home and Community-Based Waiver Program serves a significant elderly population.

Purpose of the Study:

• To identify demographic and clinical characteristics associated with a high risk of long-term nursing home placement among elderly waiver program participants.
• To inform policy decisions aimed at reducing nursing home admissions for this population.

Main Methods:

• Analysis of data from 8172 waiver clients aged 65 and older between October 1, 2010, and September 30, 2014.
• Utilized a proportional cause-specific hazards regression model to assess risk factors.
• Examined variables including race, history of long-term care use, mental disorders, and dependencies in daily activities.

Main Results:

• White race (HR: 2.76 vs. black, 1.77 vs. other races) was associated with increased risk of long-term nursing home placement.
• History of long-term care use (HR: 1.42), mental disorders (HR: 1.51), bathing dependency (HR: 1.43), and finance management dependency (HR: 1.73) significantly increased the hazard of placement.
• These factors indicate specific vulnerabilities within the waiver program population.

Conclusions:

• Specific characteristics, including race and functional dependencies, are significant predictors of long-term nursing home placement among elderly waiver participants.
• Findings can guide targeted interventions and support services to promote aging in place.
• Policy interventions should consider these risk factors to optimize waiver program effectiveness and reduce nursing home reliance.