Residential outcomes for nursing facility applicants who have been diverted: where are they 5 years later?

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.