Factors related to non-elderly nursing home residents' preferences and opportunities for de-institutionalization in Maryland

Unnecessary institutionalization, especially against the will of an individual, has been found to be unconstitutional and a violation of civil rights. There are many efforts underway to enforce national and state-level laws, and to implement programs addressing the needs of people with disabilities and the aged, who prefer and are able to live in the community. These efforts suffer, however, from the lack of science to prospectively identify the candidates for de-institutionalization. To identify measures that might help accomplish this, the Long-Term Care Minimum Data Set (MDS) was used to conduct survival analysis, using Kaplan-Meier estimates to construct life tables and survival curves, as well as Cox Proportional Hazard regression. The variables found to have the greatest impact on predicting discharge were support for returning to the community and preference for returning to the community. Large negative effects included, feeding tubes urinary incontinence/indwelling catheter, and some other nursing home or a prior stay either in a mental health/psychiatric facility.