The following is a summary of “Natural History of Disability and Caregiving Before and After Long-Term Care Entry,” published in the November 2023 issue of Primary Care by Lam, et al.

Disability and limited home care force many older adults into long-term care facilities (LTCFs). The degree of impairment and caring upon entrance is unclear. Compare nursing home (NH), assisted living (AL), and independent living (IL) entrants’ disability and caring before and after LTCF enrollment. A longitudinal cohort research employing prospectively gathered yearly National Health and Aging Trends research data from 2011 to 2020 with continental US participants. They enrolled 932 community-dwelling Medicare patients joining LTCF from 2011 to 2019. 

They utilized participant interviews from 4 years before and 2 years after LTCF entry (t = 0). Severe disability prevalence, caregiver prevalence, and median weekly caregiving hours per entry were analyzed using weighted mixed-effects regression versus time as a linear spline. At admission, the mean (SD) age was 84 (8.4) years, 609 (64%, all percentages survey-weighted) were women, 143 (6%) were Black, 29 (3%) were Hispanic, 30 (4%) were other, and 497 (49%) had dementia. 349 (34%), 426 (45%), and 157 (21%) entered NH, AL, and IL. Months of severe handicap and rising caring preceded NH and AL admission. 

Before admission, 49% (95% CI, 29%-68%) of NH and 10% (95%, 3%-24%) of AL participants had severe impairment. Most (>97%) had a caregiver, but just one-third (NH, 33%; 95% CI, 20%-50%; AL, 33%; 24%-44%) had a paid caregiver. Median weekly care was 27 hours in NH newcomers and 18 in AL entrants (95% CI, 18-40 and 14-24). Severe disability grew to 89% (95% CI, 82%-94%) and 28% (95%, 16%-44%) on NH and AL admission and 66% (2 years later) among AL residents. Some IL participants (<2%) had severe disabilities and received fewer than 7 hours of weekly care before and after entrance. This research indicated that people join NHs and ALs after months of severe impairment and significant home support, mainly from unpaid caretakers. Assisted living residents relocate when less handicapped but reach NH disability standards within 2 years. Clinicians may use data to determine when home supports fail.

Source: jamanetwork.com/journals/jamainternalmedicine/article-abstract/2811180