A social systems model of nursing home use

Causal modeling (path analysis) was applied to data from the 39 mental health catchment areas of Massachusetts to analyze the effects of sociocultural and health-resource variables on long-term-care utilization. The variables chosen explained 53 percent of the variance of long-term-care use by persons 60 and older: 41 percent was explained by the sociocultural variables and 12 percent by the health-resource variables. With data adjusted for age, the major determinant of long-term-care use was ethnicity: less long-term care was used in areas with more persons who were foreign-born or had a foreign-born parent. The effects of other health resources (supply of primary care physicians and use of mental and general (short-term) hospitals) were small and negative.