Transitions to Nursing Homes Among Residents of Assisted Living and Community-Dwelling Home Care Recipients

Derek R Manis; David Kirkwood; Stacey Fisher; Wenshan Li; Colleen Webber; Peter Tanuseputro; Nathan M Stall; Jennifer A Watt; Amy T Hsu; Rachel D Savage; Susan E Bronskill; Andrew P Costa

doi:10.1016/j.jamda.2024.105429

Transitions to Nursing Homes Among Residents of Assisted Living and Community-Dwelling Home Care Recipients

J Am Med Dir Assoc. 2024 Dec 18:105429. doi: 10.1016/j.jamda.2024.105429. Online ahead of print.

Authors

Affiliations

¹ Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA; ICES, Toronto, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada. Electronic address: Derek.Manis@asu.edu.
² ICES, Toronto, Ontario, Canada.
³ ICES, Toronto, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
⁴ Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
⁵ ICES, Toronto, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada.
⁶ Division of General Internal Medicine and Geriatrics, Sinai Health and the University Health Network, Toronto, Canada; Women's Age Lab, Women's College Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁷ ICES, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
⁸ Bruyère Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁹ ICES, Toronto, Ontario, Canada; Women's Age Lab, Women's College Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
¹⁰ ICES, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
¹¹ ICES, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Schlegel Research Institute for Aging, Waterloo, Ontario, Canada; Centre for Integrated Care, St. Joseph's Health System, Hamilton, Ontario, Canada.

PMID: 39709180
DOI: 10.1016/j.jamda.2024.105429

Abstract

Objectives: To examine transitions to a nursing home among residents of assisted living relative to community-dwelling home care recipients.

Design: Population-based retrospective cohort study emulating a target trial.

Setting and participants: Linked, individual-level health system data were obtained from older adults (≥65 years of age) who made an incident application for a bed in a nursing home in Ontario, Canada, between April 1, 2014, and March 31, 2019, and were followed until December 31, 2019.

Methods: Residency in assisted living was compared with only community-dwelling home care. Any long-stay (≥90 days) and short-stay (<90 days) transitions to a nursing home were examined. Inverse probability weighted pooled logistic regression models were used to generate marginal cumulative incidence curves under each exposure status that were standardized by the covariates.

Results: This study included 10,012 residents of assisted living (mean [SD] age 88.7 [6.26] years, 75% female) and 131,679 home care recipients (mean [SD] age 84.8 [7.43] years, 63% female) who applied for a bed in a nursing home (N = 141,691; 95,744.6 person-years). There were 6049 transitions among applicants from assisted living and 85,190 transitions among applicants who were home care recipients to a nursing home. The 5-year absolute risk reduction was 110 transitions to a nursing home per 1000 older adult applicants if all applicants resided in assisted living (95% CI, 71-148). Residency in assisted living resulted in a 12.7% relative decrease in the 5-year risk of any transition to a nursing home had all applicants resided in assisted living (95% CI, 8.3%-17.1%).

Conclusions and implications: Residents of assisted living were less likely to transition to a nursing home, despite equivalent clinical complexity and health care needs. The integration of assisted living into the continuum of care from the community to institutionalized nursing homes would better inform health system capacity and planning.

Keywords: Assisted living facilities; home care; long-term care; nursing homes; target trial emulation.