What age will disability force you into a nursing home? Study finds it’s 84

AURORA, Colo. — What’s the average age of a person entering long-term care? Researchers from the University of Colorado Anschutz Medical Campus now have an answer to this difficult question — as well as how long older adults will likely live with a disability before opting for a nursing home. It turns out the number is now 84 years-old, usually preceded by months of both severe disability and escalating caretaking by the person’s loved ones at home.

As a geriatrician, or physician specially trained to treat older adults, Kenneth Lam, MD, MAS, has spent years working with families to determine when it’s time for older relatives to move into a nursing home or assisted living facility, as well as what kind of specific services they’ll need.

“They might be deteriorating and becoming less able to care for themselves, and the family members would ask us, ‘Where do you think this person should go? What services should they get? Should they move into an assisted living facility, or should they move into a nursing home?,’” says Lam, assistant professor of geriatric medicine in the University of Colorado School of Medicine, in a media release. “In my clinical practice, I had honed a sense of where people belong, but as I started to move into research, it kept bothering me: This is a really big decision, and I had never seen any data around it.”

So, Dr. Lam set out to finally provide some relevant data in a new study. More specifically, the research focuses on the ages at which people enter care facilities, as well as their disability levels prior to entry.

“I learned about a dataset called the National Health and Aging Trends Study, which follows older people every year and asks questions like, ‘Can you get dressed on your own? Can you get around in your home on your own?,’” Prof. Lam explains. “It also asks questions like, ‘How many people help you? How many hours of help are they giving you?’ Those were exactly the questions I was asking — how independent are people before they go into a facility, and how much help do they tend to get? What does the process leading up to that point look like?”

Scroll down to see the step-by-step process of entering a nursing home

Dr. Lam also calculated that the average person moving into a nursing home is already severely disabled, and typically receiving about 27 hours a week of care for at least one month. Severe disability refers to major difficulties performing daily tasks or if someone is already assisting them with three activities of daily living (getting dressed, bathing, and moving around inside their home). Older adults moving into assisted living were less likely to be severely disabled but still received 18 hours a week of care.

“Clearly, many people are providing a lot of care at home, and also dealing with severe disability at home, for months or years before these people move into nursing homes,” the researcher comments. “It’s less of an issue for people moving into assisted living facilities, and that might reflect the sociodemographic advantages of people who tend to move into assisted living facilities.”

Dr. Lam notes one of his more interesting discoveries was that among those moving into assisted living facilities, levels of severe disability approached those of nursing home residents within one to two years.

“There’s been a lot of discussion of late saying, ‘What is the interrelationship between assisted living and nursing homes?’,” he says. “The data show that after a few years, people who moved into assisted living start to look much more like people who moved into nursing homes. This leads to more questions: Should people stay at assisted living facilities forever, or do we need to have upfront conversations about what care might look like in those places a couple of years down the line?”

Dr. Lam adds that the data indicates nursing home entry tends to happen late in the course of disability. “Everyone wants to know why,” he continues, “but that’s a much harder question to answer.”

It may be because of stigma. Many people are afraid of what will happen to their relatives once they enter these facilities. Affordability is another major factor.

“You have to have a low enough income and low enough assets to qualify for nursing home coverage; otherwise you have to pay out of pocket. Most people can’t afford that,” he says. “These data give a picture of the moment when people and society has decided to make this trade off — when they say, on average, ‘I can’t do this anymore, now you get help.’”

Dr. Lam plans to follow up on the quantitative study with some qualitative research by interviewing people who have recently moved into nursing homes or assisted living. He hopes this will lead to greater insights regarding the circumstances of their entry, how it changed their social lives, and what advice they may want to give to other people in the same situation. He is also considering the role of dementia in such decisions.

“I knew this was a really big decision that was really important to people,” he says. “I felt it deserved more robust research, rather than just my advice and opinion.”

Now that his report has been published, Dr. Lam hopes it can serve as a starting point for clinicians, patients, and families as they weigh options around long-term care for older individuals. “Too early” and “too late” are terms relative to each person’s individual situation, he stresses, but this research helps set a general timeframe for when one can start having conversations.

“Now we know at what age people move in, on average, and from there you can start to define what it means to move in early or move in late,” he concludes. “The next step is to figure out if moving in early or moving in late makes a difference, and if so, a difference in what? That is an important and different question. It’s a tricky problem, and this paper is trying to open up the discussion around it.”

Steps to Entering a Nursing Facility

The process of entering a nursing home can vary depending on the state in which you live, but there are some general steps that are typically the same across the country.

1. Determine your need for nursing home care. Before you can be admitted to a nursing home, you must first meet the state’s criteria for nursing home care. This means that you must have a medical condition that requires 24-hour skilled care and that cannot be adequately met at home. You can talk to your doctor or a social worker to determine if you meet the criteria.
2. Research nursing homes. Once you have determined that you need nursing home care, you should start researching different nursing homes in your area. You can use online resources, such as Medicare.gov or A Place for Mom, to compare nursing homes and read reviews from other residents and families.
3. Schedule tours. Once you have narrowed down your choices, you should schedule tours of the nursing homes that you are interested in. This will give you a chance to see the facility for yourself and meet the staff.
4. Apply for admission. Once you have found a nursing home that you are comfortable with, you will need to apply for admission. The application process will vary from nursing home to nursing home, but will typically require you to provide information about your medical history, financial situation, and insurance coverage.
5. Complete a preadmission assessment. Once your application has been approved, you will need to complete a preadmission assessment. This assessment will be conducted by a nurse or other healthcare professional and will help to determine your level of care needs and develop a care plan.
6. Move in. Once the preadmission assessment is complete and you have signed the admission agreement, you are ready to move into the nursing home.

The study is published in JAMA Internal Medicine.

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