Development of a Risk Index to Predict Transfers from Home and Community-Based Waiver Programs to Nursing Homes: Can Care Managers Assist Older Adults to delay Nursing Home Placement?Midwest Nursing Research Society (2013)
Purpose: This research examines the risk of nursing home placement (NHP) among an inception cohort of 6525 older adults entering a statewide home and community-based waiver program between 2002—2007.
Background: With adults aged 65 and older currently comprising 15% of the population and growing exponentially, concern is mounting as to how to care for this group. It will be important to deliver high-quality care tailored to the needs of clients in order to allow these individuals to remain living in the community. Most older adults prefer to remain in their homes but are forced to transfer to NHs because community supports are inadequate to meet their needs.
Methods: This longitudinal study was based on information obtained from the Minimum Data Set-Home Care, linked with Medicaid claim files and death certificate data. All persons had two assessments and survived through 2007 or had NHP. We examined age, gender, race, physical/cognitive function, falls, caregiver information, and hospitalization to develop a risk index to identify who would transfer to a nursing home (NH).
Results: Using the risk index, the probability of transferring to a NH is approximately 50%; and the sensitivity is 0.4 and the specificity is 0.9; correctly identifying 40% of those clients who will actually go to a NH.
Implications for Gerontological Nursing: The data are presented to provide waiver agency personnel with a NHP risk index so that they could be informed as to when to intervene and modify the plan of care. The utility of this risk index comes from the fact that this model can be easily produced from information that is already being collected. Nurses have an overall indicator of the risk of NHP and change of risk at each subsequent observation, and can review the mix of indicators and the strength of the contribution of each to the overall risk.
Publication DateSpring 2013
Citation InformationSandra Spoelstra. "Development of a Risk Index to Predict Transfers from Home and Community-Based Waiver Programs to Nursing Homes: Can Care Managers Assist Older Adults to delay Nursing Home Placement?" Midwest Nursing Research Society (2013)
Available at: http://works.bepress.com/sandra-spoelstra/33/