Factors Contributing to Long-Term Care Institutionalization upon Hospital Discharge: A Binary Logistic Regression Analysis of the 2008 National Hospital Discharge Survey

Objective: Nursing home residents increasingly are being admitted from hospitals, with rates of use increasing for the working-age population. We examined various factors associated with discharge to a nursing facility and how these vary by age. Methodology: We compared working age patients (age 18 to 64, n=81,283) and older patients (age 65 and older, n=59,029) from the 2008 National Hospital Discharge Survey. A binary logistic regression analysis was used to examine the risk factors for institutionalization. Findings: Among the patients discharged to LTC institutions, almost twice as many working-age adults discharged to an institution were Black (30.38%) relative to older adults (15.3%). Being Black was significantly associated with greater odds of institutionalization in both groups. While 92.97% of the institutionalized elderly were insured by Medicare, 42.49% of working-age were insured by Medicare and 25.19% were insured by Medicaid. Medicare coverage for the inpatient stay was associated with greater odds of institutionalization in both groups, and the effect was greater in the working-age group (OR 3.97, 95%CI[3.96,3.98] and OR 1.43, 95%CI[1.26,1.63]). Medicaid coverage was significantly associated with institutional use only among the working-age. Admission through the ER and discharged with lower-limb fractures substantially increased the odds of institutional use for both groups. Being discharged with a stroke was significant for working-age but not older adults. Implications: Blacks face significantly greater odds of being discharged to an institution in both age groups after adjusting for factors such as diagnosis. Research is needed to further explore the basis of this disparity.