A community-based long-term care model for the United States elderly

Introduction. Because aging baby boomers have expressed a preference for living in communities, providing community-based long-term care (CBLTC) will be required. It is therefore crucial to better understand the effects of CBLTC on elders who remain in communities.;Purpose. To provide empirical evidence for CBLTC development and policymaking.;Methodology. This dissertation used Andersen's Health Behavioral Model to guide the model development and data analysis. Three studies were used to explore and investigate issues related to CBLTC services use and elders' remaining in communities. These included: a comparative descriptive design study, and a hierarchical multiple regression design study, and a modeling test study. National representative data, from the Second Longitudinal Study of Aging (LSOAII), was used to answer these questions.;Results. A total of 6,052 elders were included for data analysis. The elderly who remained in communities throughout the six years of follow-up were largely younger and had fewer IADL disabilities. The elderly who were older and had more IADL disabilities tended to move into institutions, at least temporarily. If these temporarily-institutionalized elderly used more types of non-discretionary services, but not too frequently, they might have been able to move back into community. When elders had developed more IADL disabilities and need for house modification, using more types of non-discretionary services frequently, and purchasing more ADL assistance from a personal care attendant might enable them to stay in community longer. They nonetheless might still eventually have to move into an institution.;Model testing shows that the only CBLTC service that helped/supported elders in remaining in communities was paid IADL personal care services. The unmet need factors and disability factors positively predicted the use of paid IADL personal care services, while enabling support was a negative predictor for such service use.;Implications. The most important implications of this study are the need to base CBLTC development on the community's goals and the benefit to nurses in communities who can use the scientific knowledge generated from this study in order to provide constructive suggestions for assisting those elders and families involved in decision-making with respect to services use or residential placement.