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The Effect of Older People's Economic Resources on Care Home Entry Under the United Kingdom's Long-Term Care Financing System

^a Nuffield Community Care Studies Unit, University of Leicester, United Kingdom
^b Department of Epidemiology and Public Health, University of Leicester, United Kingdom
^c School of Nursing, Faculty of Medicine and Health Sciences, University of Nottingham, United Kingdom

Ruth Hancock, Nuffield Community Care Studies Unit, Department of Epidemiology and Public Health, University of Leicester, 22-28 Princess Road West, Leicester, LE1 6TP, United Kingdom E-mail: rmh5{at}le.ac.uk.

Decision Editor: Fredric D. Wolinksy, PhD

Objective. To determine how older people's economic resources affect their likelihood of care home entry in the United Kingdom.

Methods. In 1988, income, home ownership, and health data were collected for 1,425 people aged 75+. Participants received up to five subsequent health assessments before the study endpoint (1999), in which care home entry was also recorded. Care home entry was identified from death certificates for those who died. Using proportional hazards regression, the effect of home ownership and income on the risk of care home entry was estimated, controlling for predisposing, enabling, and need factors, and health service utilization.

Results. Age, living alone, activities of daily living restriction, cognitive impairment, poor/fair self-perceived health, and contact with services increased the risk of care home entry. Home ownership decreased it. Gender was not a significant predictor of care home entry once other factors were controlled for, and no significant effect was found for income.

Discussion. UK public authorities can require older home owners to use the value of their homes to pay for institutional but not community-based care, thus producing a financial incentive to place home owners in institutional settings. However, we find that home ownership reduces the likelihood of care home entry, suggesting that other factors dominate the decision process.