THE DETERMINANTS OF NURSING HOME ADMISSION AND THE EFFECT OF COMMUNITY CARE ON ADMISSIONS AMONG IMPAIRED LOW INCOME ELDERS IN SOUTH CAROLINA.

The purposes of this dissertation were to discover the risk factors of nursing home admission among low income impaired elders and to examine the ways in which the provision of case management and in-home services affected risk of admission. Using secondary clinical assessment data collected during the South Carolina Community Long-Term Care Project (a longitudinal study using an experimental design) information on 1648 elders who were all eligible for a Medicaid-covered nursing home stay at the time of admission into the Project was analysed using multivariate logistic regression. It was found that the risk factors of nursing home admission among control group members were age, sex, prior nursing home admission, case manager judgement of elder and caregiver preference for care (respectively), mental status, atherosclerosis, assessment location, and Medicaid status. Application of the admission model to treatment group members revealed that the intervention effected risk of admission in three ways: having no effect, increasing the risk, or decreasing the risk depending upon the characteristics of treatment group participants. The research and policy implications of the findings are discussed.