Discrete-time hazard functions were estimated to determine factors associated with the probability of admission to a nursing home from the community, and the probability of discharge to the community from nursing home care, for 3,332 individuals enrolled in The National Long Term Care Channelling Demonstration. This was a relatively frail elderly population assessed to be at high risk for nursing home use. In predicting admissions, major factors were found to be ethnicity (Blacks and Hispanics were at much lower risk), homeownership, advancing age, living alone, exhibiting higher cognitive and functional impairment levels, physician use, and living in an area with a larger nursing home bed supply. The probability of being discharged alive was predicted by several factors, including ethnicity (Blacks being less likely to be discharged), homeownership, being of younger age, better (self-rated) health, functional and cognitive capacities, and medical acuity.

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An eight-week professionally guided caregiver support group program was found to produce statistically significant reductions in anxiety, depression, and sense of burden among family caregivers to frail elderly persons living in the community. Effects were weaker four months after the intervention ended than immediately after, but reductions in anxiety and depression were still evident.

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Can community services be made more effective in reducing nursing home use through better management of their mix and allocation? To test this idea, we used data from the National Long-Term Care Channeling Demonstration to estimate logistic regression models relating the use of various types of community services to nursing home use. We then used these estimates to form an objective function for a mathematical optimization procedure which minimizes total expected population nursing home use as a function of community service use, subject to a total expenditure constraint. We find through this simulated reallocation that, in theory, significant reductions in nursing home use can be produced without increasing total community expenditures.