Health Services/Policy
Reduced transitions to a nursing home among residents of assisted living facilities: a target trial Derek R. Manis* Derek Manis David Kirkwood Stacey Fisher Wenshan Li Peter Tanuseputro Zain Pasat Colleen Webber Andrew P. Costa
Background: The rapid expansion of assisted living suggests an increasing share of clinically frail older adults use it as a substitute for a nursing home. We examined transitions to a nursing home among residents of assisted living facilities relative to community-dwelling home care recipients.
Methods: We conducted a retrospective cohort study using the target trial framework in Ontario, Canada. We obtained linked, individual-level health system administrative data from residents of assisted living and home care recipients who applied for a bed in a nursing home from 04/01/14 to 03/31/19; these individuals were followed until 03/31/22. We examined any transition, long-stay transitions, and short-stay transitions to a nursing home among those in assisted living who resided there for at least one year before their application to a nursing home. We used inverse probability weighted marginal structural Cox models to control for time-varying and time-invariant confounding.
Results: There were 10,012 residents of assisted living (Mean [SD] age 87.9 [6.56] years, 72% female) and 131,679 home care recipients (Mean [SD] age 84.5 [7.47] years, 61% female) who applied for a bed in a nursing home (N = 141,691; 95,744.6 person-years). Residents of assisted living facilities had 11.6 fewer (76.4 v. 88.0) transitions to a nursing home per 100 person-years; 13.2% of the transitions among those in assisted living were prevented. Residents of assisted living had a decreased hazard of any transition (HR 0.46, 95% CI 0.45-0.47), a long-stay transition (HR 0.47, 95% CI 0.46-0.48), and a short-stay transition (HR 0.16, 95% CI 0.13-0.21) to a nursing home at any point during the follow-up period.
Conclusions: Residents of assisted living facilities mostly age in place, despite their clinical complexity and needs for ongoing health care. The integration of assisted living into the continuum from home to institutionalized nursing home care informs health system capacity and planning.
