Predictors of nursing home placement in community-based long-term care.

Objective: To identify predictors for nursing home placement among a group of frail older patients receiving formal home care services.

Design: Retrospective chart review.

Setting: A geographically defined catchment area of southeast Baltimore, Maryland.

Patients: A total of 334 homebound patients who started using the Elder Housecall Program (EHP), a multidisciplinary team providing in-home care and housed at the Johns Hopkins Geriatrics Center, between 1986 and 1989.

Measurements: Independent variables, based on the chart review, were age, sex, diagnosis, functional status, and caregiver conditions at entry into EHP. Dependent variable was nursing home placement until December 31, 1991.

Main Results: Cox proportional hazards analysis indicated that significant predictors were diabetes mellitus, bowel incontinence, and three caregiver characteristics: living separate from the patient, having time conflicts because of a job, and being stressed by caregiving.

Conclusion: Among this group of frail older people, caregiver problems were significant predictors of nursing home placement, but functional disabilities generally were not. These results suggest the need for geriatricians to be alert to the psychosocial aspects of patients and their caregivers.