Patterns and Predictors of Transitions Across Residential Care Settings and Nursing Homes Among Community-Dwelling Older Adults in the United States

Abstract

Background and objectives: Older adults prefer to age in place, but sociodemographic, health, and socioeconomic factors may influence their decision to remain in the community. Guided by Andersen's behavioral model, we characterize incident transitions out of the community into residential care settings or nursing homes and identify predictors of these transitions.

Research design and methods: Study participants include 2,725 (weighted n = 13,704,390) community-dwelling U.S. older adults of the National Health and Aging Trends Study from 2011 to 2018. We examined the associations between sociodemographic, socioeconomic, and health factors and the probability of transition using a multinomial logit model.

Results: Over the study period, 86.2% of older adults remained in the community, whereas 9.0% and 4.9% transitioned to residential care settings and nursing homes, respectively. Older age, living alone, having functional and cognitive limitations, and hospitalization were associated with increased risk of transitioning to residential care settings or nursing homes from the community. Blacks and Hispanics were less likely to transition to residential care settings or nursing homes. Adults with lower income had a greater risk of transitioning to nursing homes. Medicaid enrollment did not affect the likelihood of transition.

Discussion and implications: Majority of older adults remained in the community, and incident transition to residential care settings was more common than to nursing homes. Policy should target sociodemographic, health, and socioeconomic factors that enable older adults to age in place. Future work should examine whether these new residential care settings enhance the quality of life or result in subsequent transitions back into the community.

Keywords: Aging; Assisted living; Care transitions; Medicaid.