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The Gerontologist Advance Access originally published online on March 18, 2009
The Gerontologist 2009 49(1):46-56; doi:10.1093/geront/gnp009
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© The Author 2009. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Residential Outcomes for Nursing Facility Applicants Who Have Been Diverted: Where Are They 5 Years Later?

Rosemary Chapin, PhD1,2, Beth Baca, LMSW2, Kelley Macmillan, PhD, ACSW3, Roxanne Rachlin, MHSA2 and Mary Zimmerman, PhD4,5

2 Office of Aging and Long Term Care, School of Social Welfare, University of Kansas, Lawrence
3 School of Social Work, University of Maryland, Baltimore
4 Department of Sociology, University of Kansas, Lawrence
5 Department of Health Policy and Management, University of Kansas, Lawrence

1 Address correspondence to Rosemary Chapin, PhD, Office of Aging and Long Term Care, School of Social Welfare, University of Kansas, 1545 Lilac Lane, Lawrence, KS 66044. E-mail: rchapin{at}ku.edu


  Abstract

Purpose: The purpose of this longitudinal study was to determine the length of community tenure for adults aged 60 and older after application for nursing facility (NF) admission and to examine the proportion of older adults who lost community tenure due to either (a) death while a community resident or (b) permanent NF admission. Design and Methods: In this 5-year prospective study, we tracked older adults who had applied for NF admission and were diverted (residing in the community 30 days later). Four waves of NF applicants (N = 2,882) were identified, and those diverted (n = 599) were tracked for 60 months at 3-month intervals. Results: Sixty months after diversion, 18.0% of older adults (n = 108) were residing in the community, 39.2% died as community residents (n = 235), and 42.7% (n = 256) became permanent NF residents. In all, 414 diverted older adults (69.1%) died during the 5 years following NF application, with the majority of deaths occurring while older adults were community residents.Implications: This longitudinal study documents the capacity of NF applicants aged 60 and older to remain in the community long term, which was previously unknown. Policymakers now have data indicating that for many NF applicants, diversion does not simply delay NF admission; rather, diversion helps older adults avoid permanent NF placement until death.

Keywords: Home- and community-based services, Long-term care, Medicaid HCBS Waiver, Community tenure, Public policy

Received December 7, 2007; Accepted February 5, 2008

Decision Editor: William J. McAuley, PhD


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