Estimates of the Risk of Long-Term Care: Assisted Living and Nursing Home Facilities

The goal of this report is to identify the individual-level factors associated with nursing home and assisted living entry and determine whether and how they differ. While it is possible to estimate a simple model of entry into these facilities at some point in the observation period, a more useful model would make use of data on elapsed time until such a transition. Such a model makes better use of the data and differentiates delayed entry from early entry into a facility. Survival analysis is a natural candidate that allows us to build into our models several key features including right censoring and competing risks. The report addresses the question of whether persons entering assisted living facilities were similar enough to those entering nursing homes to consider the two types of facilities substitutable in function, or are the populations entering these facilities substantially different, indicating that assisted living facilities serve a different purpose. While we can reject the hypothesis that the determinants of the two types of transition are equivalent, the results lend some support the notion that assisted living may substitute for nursing homes for some segment of the elderly population. There is some evidence that nursing homes are more likely to serve lower income and older populations and those experiencing the most severe disabilities. However, the health-related factors associated with the two types of transitions show as many similarities as differences. [28 PDF pages]