Modeling lifetime nursing home use under assumptions of better health.

OBJECTIVES There is evidence of notable improvement in active life expectancy among older Americans. Little is known, however, about the effect of better health on lifetime nursing home use. The purpose of this study was to address this gap in our knowledge. METHODS Discrete-time hazard models of nursing home admission and discharge were developed using data from the 1982, 1984, and 1989 National Long Term Care Surveys and the 1984-1990 Longitudinal Study of Aging. Microsimulation techniques were used to incorporate monthly functional status information into the models that predict nursing home use and to generate lifetime nursing home histories for a cohort of older men and women under various assumptions of improved morbidity. RESULTS Improved health increased total life expectancy and the absolute amount of time spent in both the community and in nursing homes. Better health did not change the proportion of life older persons spent in nursing homes or the percentage of the cohort who entered nursing homes. DISCUSSION If morbidity improves there will be an increase in the use of nursing homes. However, for the majority of older persons, better health will be associated with more independent living throughout the life span.