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The Relationship Between Psychiatric Disorders and the Ability to Age in Place in Assisted Living

From the School of Aging Studies, University of South Florida, Tampa, Florida (DD); Rehabilitation Outcomes Research Center, Gainesville, Florida (JH); Kansas City Veteran’s Administration Medical Center, Department of Health Policy and Management, University of Kansas, Lawrence, Kansas (JH); School of Social Welfare, University of Kansas, Lawrence, Kansas (RC); and the Policy Research Institute, University of Kansas, Lawrence, Kansas (PO).

Objective: Residential care/assisted living (RC/AL) has become a popular long-term care option in the past decade, in part because these settings offer residents a more home-like environment than nursing homes (NHs) while still offering supervision and assistance to meet individuals’ personal and healthcare needs. One of the goals of RC/AL is to facilitate residents’ ability to age in place by providing access to needed services and thereby delaying NH admission. This article explores individual and facility-level characteristics associated with discharge from RC/AL to NH with particular attention to persons with a psychiatric disorder.

Methods: A Cox proportional hazards model was used to examine the risk factors associated with discharge from RC/AL to NH for a nonrandom sample of 366 residents in 37 RC/AL facilities in one state.

Results: Thirty-two percent of residents sampled had a psychiatric disorder. Residents with a psychiatric disorder were 1.78 times more likely to discharge to a NH. Other factors significantly associated with discharge from a RC/AL to NH included age (older), being married, more hospitalizations, for-profit ownership status, and part of a NH or continuing care retirement community.

Conclusion: This article identifies both facility and individual characteristics that increase the likelihood of RC/AL residents discharging to NHs. Given that one of the main findings is that persons with a psychiatric disorder are at increased risk of discharge to NH, there is a need for improved provision of services for this population in RC/ALs to reduce premature discharge to NHs and to support aging in place in RC/ALs.

Key Words: Assisted living • depression • Cox Proportional Hazards Model