Do community-based, long-term - care services reduce nursing home use? : a transition probability analysis

elderly population poses special challenges to the health-care system. Rising demand for nursing home facilities and commensurate growth in long-term-care expenditures stimulates the search for cost-effective alternatives to institutional care for the frail elderly. Community-based care is one alternative that showed early promise as a substitute for nursing home care. A community-based care system provides a variety of services, including skilled medical care to elderly residing in the community. Despite the promise of this approach, however, government-sponsored demonstration programs and other research indicates that community services have little effect on nursing home utilization and suggests that these services cannot reduce total long-term-care expenditures. This study presents new evidence which casts doubt on the conclusion that community-based care does not reduce nursing- home use. With data from the National Long Term Care (Channeling) Demonstration, the study estimates the effect of personal and environmental characteristics on transitions between the community and institutional care. It finds that the community-based services of nurses, home-health aides, and social support workers significantly reduce entry into nursing homes and promote transitions from nursing homes back to the community. Of the services considered, it finds that nursing services have the most powerful effect in promoting community residence. The study argues for a reconsideration of the role that community-based services can play in the long-term health care system. (Author abstract)