Decision making by high functional status elders regarding nursing home placement

An analysis of the Minimum Data Set Plus (MDS+) from one midwestern state revealed a group of "high functional elders" entering nursing homes, who potentially could be served in the community at a lower cost. The purpose of this qualitative study was to identify and better understand the reasons why these apparently high functioning elder adults entered nursing homes. Data from the 1995 MDS+ were used to identify "high functional" elders recently admitted to the nursing home from two urban and seven rural counties. Data were collected through in-depth, face-to-face, semi-structured interviews and analyzed using qualitative content analysis. Of the 33 persons judged to be high functional, only 36% remained in the nursing home 3 to 6 months later. Most elders were using a wide array of community-based services and extensive informal support networks prior to entering the nursing home. Most described specific events that forced them into the nursing home environment. Health needs, specifically the need for 24-hour care or supervision, emerged as the dominant factor for remaining in the nursing home. Of the 12 elders interviewed, all demonstrated some evidence of cognitive impairment. This study suggests that there are persons in nursing facilities today for whom community-based services, such as affordable assisted-living, would be reasonable and appropriate. Case managers may be the most qualified not only to assess for and coordinate services, but also to advocate for affordable services that preserve elders' functional status.