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Utilization Across the Continuum of Long-Term Care Services

^a Department of Psychology, Colorado State University, Fort Collins
^b Florida Policy Exchange Center on Aging, University of South Florida, Tampa
^c The Center on Aging, Florida International University, North Miami

Correspondence: Evelinn A. Borrayo, PhD, Department of Psychology, Colorado State University, Fort Collins, CO 80523. E-mail: borrayo{at}lamar.colostate.edu.

Decision Editor: Laurence G. Branch, PhD

Purpose: This study presents an analysis of the influence of consumers' predisposing, enabling, and need characteristics on the utilization of long-term care (LTC) services in nursing facilities (NFs), assisted living facilities, or home- and community-based services (HCBS). Design and Methods: Data were gathered through a record review of a cross-sectional sample of 1,968 consumers aged 60 years or older receiving formal LTC services. Results: Need contributes the most to differential LTC use. Those with the most need are more likely to be in a NF or HCBS. Enabling characteristics such as Medicaid eligibility and geopolitical region of the state were associated with higher use of NFs. Predisposing and enabling characteristics had a moderating influence on need. Implications:Although high need predicts care in NFs, some of the most impaired elders are also being cared for at home. Because Medicaid increases the likelihood of NF placement, public financing of LTC should reflect the capacity of the system to serve elders at home.

Key Words: Public policy • Nursing facilities • Assisted living facilities • Home care • Public financing • Long-term care utilization

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