Averting nursing home care: The role of family structure

For years researchers have speculated that family members can avert--sometimes indefinitely--the need for institutional care for older relatives. Yet few studies have explicitly examined the relationship between family structure and the length of time older persons spend in nursing homes. The main objective of this dissertation is to quantify the extent to which family members avert the use of nursing home care by older relatives. Using data from the New Haven EPESE, a community-based sample of older persons living in New Haven, Connecticut in 1982, we examine the relationship between family structure and (1) age at nursing home entry, (2) time from entry until community return and (3) time from entry until death. Results from multivariate hazard models are then used to calculate the number of days of care averted due to the presence of family members.;Controlling for the confounding effects of health and demographic characteristics using proportional hazards techniques, we find that older persons with a living spouse, daughter or siblings have a reduced risk of entering nursing homes compared to persons without such family members. In addition, we find for persons with relatively high vitality who enter institutions for a recuperative stay, the presence of a daughter triples the risk of live exit and the presence of a spouse is associated with 26 times the risk of live exit. Furthermore, for persons with relatively low vitality at the time of entry, the presence of daughters has a weak inverse relationship with the risk of dying in a nursing home.;As a result of these relationships, family structure has a sizable effect on the total number of days older persons spend in a nursing home. This analysis demonstrates that approximately 34 percent of person days of nursing home care are averted due to the presence of spouses, children, and siblings for older persons living in New Haven in 1982. The majority of days are averted because older persons with kin are much less likely than those without family members to enter a nursing home. Implications of findings for future research and the formulation of long term care projections are discussed.