Can your house keep you out of a nursing home?

Association of Indoor Environment with the Intention to Enter Nursing Homes among Older Adults with Functional Limitations in Japan

OBJECTIVES

The indoor environment refers to the conditions within a building, including thermal comfort, air quality, lighting, and noise levels. However, the association between the indoor environment and the intention to enter nursing homes among older adults with functional limitations remains unclear. Therefore, this study examined the association of indoor environmental factors with intention to enter nursing homes within this population.

DESIGN

Cross-sectional data from the Japan Gerontological Evaluation Study-Home Care 2022.

SETTING AND PARTICIPANTS

This study included 3202 adults aged ≥65 years, certified under the Japanese long-term care insurance system, and living at home.

METHODS

Intention to enter nursing homes was assessed by asking the participants if they were considering entering a nursing home. The indoor environment was assessed using the Comprehensive Assessment System for Built Environment Efficiency Housing Health Checklist, which includes 5 items: cooling, heating, acoustic, odor, and lighting environments. Logistic regression was used to examine the association between these 5 items and consideration of nursing home admissions.

RESULTS

Approximately 43.0% of participants had considered nursing home admission. After adjusting for sociodemographic factors, economic status, health, and long-term care-related factors, the overall indoor environment score, which includes 5 items, was negatively related to nursing home admission.

CONCLUSIONS AND IMPLICATIONS

The results of this study revealed that better indoor environments in terms of cooling, heating, acoustics, odor, and lighting could potentially delay nursing home admission. Integrating the assessments of these indoor environmental factors into policy frameworks may enhance the effectiveness of long-term care strategies and promote aging.

The effect of parental health shocks on living arrangements and employment

This study investigates the impacts of health shocks among older individuals on the dynamics of their living arrangements in Europe and the United States. Exploiting unpredicted health shocks, we use an event-study difference-in-differences approach to demonstrate that health shocks increase difficulties with activities of daily living and instrumental activities of daily living, thereby increasing the need for care. Our findings indicate that health shocks raise the probability of nursing home residency and co-residence with adult children by 0.7 and 1.4 percentage points in Europe, and by 2.1 and 1.8 percentage points in the U.S., respectively. Further analyses reveal that more generous long-term care public policies correlate with a higher probability of nursing home residency and a lower probability of co-residing with adult children, highlighting the significant role of public policies in household responses to health shocks. Additionally, we find that health shocks negatively impact adult children's labor supply, particularly in the U.S.

Does informal care delay nursing home entry? Evidence from Dutch linked survey and administrative data

We assess whether informal care receipt affects the probability of transitioning to a nursing home. Available evidence derives from the US, where nursing home stays are often temporary. Exploiting linked survey and administrative data from the Netherlands, we use the gender mix of children to retrieve exogenous variation in informal care receipt. We find that informal care increases the chance of an admission within a three-year period for individuals with severe functional limitations, and increases the costs incurred on formal home care. For individuals with mild limitations, informal care substantially decreases total care costs, whereas its effect on nursing home admission is unclear. Further, informal care results in lower post-acute care use and hospital care costs, and does not increase mortality. Promoting informal care cannot be expected to systematically result in lower institutionalization rate and care costs, but it may nonetheless induce health benefits for its recipients.

Do subsidized nursing homes and home care teams reduce hospital bed-blocking? Evidence from Portugal

Excessive length of hospital stay is among the leading sources of inefficiency in healthcare. When a patient is clinically fit to be discharged but requires support outside the hospital, which is not readily available, they remain hospitalized until a safe discharge is possible -a phenomenon called bed-blocking. I study whether the availability of subsidized nursing homes and home care teams reduces hospital bed-blocking. Using individual data on the universe of inpatient admissions at Portuguese hospitals during 2000-2015, I find that the entry of home care teams in a region reduces bed-blocking by 4 days per episode, on average. Nursing home entry only reduces bed-blocking among patients with high care needs or when the intensity of entry is high. Reductions in bed-blocking do not harm patients' health. The beds freed up by reducing bed-blocking are used to admit additional elective patients.

Does independent needs assessment limit use of publicly financed long-term care?

In health care the assessment of patients' needs is typically entrusted to health care providers. By contrast, in publicly financed long-term care (LTC) needs assessment is often delegated to an independent assessor. One rationale offered for independent needs assessment in LTC is to limit the scope for moral hazard and supplier-induced demand, which may be particularly strong in case of public LTC insurance. We study whether independent needs assessment restricts use of publicly financed LTC at the intensive margin (i.e. after people are being assessed to be eligible for receiving care). Therefore, we link nationwide Dutch administrative datasets about individual LTC use and eligibility decisions by the independent assessment agency in 2012. We find for virtually all types of care, all population subgroups, and all regions that LTC use by patients was substantially less than the maximum amount of care allowed by the independent assessor. This suggests that in the Netherlands independent needs assessment in LTC does not impose a binding constraint on use once a person is considered eligible for care. Still, independent needs assessment may have reduced LTC use at the extensive margin. A significant proportion of the applications for care (16 %) was rejected. In addition, the independent assessment may deter some people from applying.