Journals of Gerontology Series B: Psychological Sciences and Social Sciences
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Journals of Gerontology Series B: Psychological Sciences and Social Sciences, Vol 53, Issue 6 S341-S353, Copyright © 1998 by The Gerontological Society of America

ARTICLES

Time to nursing home admission for persons with Alzheimer's disease: the effect of health care system characteristics

SC Miller, TR Prohaska, SE Furner, S Freels, JA Brody and PS Levy
Center for Gerontology and Health Care Research, Brown University, Providence, Rhode Island, USA. [email protected]

OBJECTIVE: To study the influence of state health care system characteristics on time to nursing home admission (NHA) for persons with Alzheimer's disease (AD). METHOD: Up to nine years of Consortium to Establish a Registry for Alzheimer's Disease (CERAD) data on 639 non- Latino White individuals were merged with longitudinal data from the 28 states in which the CERAD participants resided. The state variables reflected characteristics of each state's long-term care (LTC) system, including Medicaid LTC spending practices and the supply of LTC providers. Cox Proportional Hazards Models with time-varying covariates were used to evaluate the risk factors associated with time to NHA. RESULTS: There was differential influence of state variables by marital status. For unmarried non-Latino White persons with AD, a higher percentage of Medicaid LTC spending on home and community-based services (HCBS) was significantly associated with a longer time to NHA. For married persons, a greater number of home health agencies was associated with a longer time to NHA. Other associations also varied by marital status. CONCLUSION: Study findings support the utility of targeted continued expanded provision of HCBS by states and provide a basis for future research regarding the impact of changing state health care systems on LTC utilization for persons with AD.


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