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Demographics and Payment Characteristics of Nursing Home Residents in the United States: A 23-Year Trend

¹ Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Health Care, Iowa City.
² Division of Gerontology and Geriatric Medicine, Department of Medicine, Schools of Medicine, and Department of Epidemiology and International Health, School of Public Health, Center for Aging, Center for Outcomes and Effectiveness Research and Education, and Geriatric Heart Failure Clinic, University of Alabama at Birmingham, Section of Geriatrics and Geriatric Heart Failure Clinic, Birmingham VA Medical Center, and Heart Failure Project, Alabama Quality Assurance Foundation, Birmingham.
³ Sections of Cardiology and Geriatrics, Department of Medicine, New York Medical College, Valhalla, and Mount Sinai School of Medicine, New York, New York.

Background. With the aging of our population, an increased number of older Americans are expected to reside in nursing homes. Our objective is to determine the national trend in nursing home residence for older Americans.

Methods. Using the Beyond 20/20 software, we analyzed publicly available data from National Nursing Home Surveys 1977–1999 to determine the trend in the demographics, marital status, and source of payments for older Americans residing in nursing homes.

Results. The absolute number of persons aged 65 years and older residing in nursing homes increased from 1,126,000 to 1,469,500 during the 23-year study period, with those aged 85 years and older, women, and African Americans being at a higher risk for nursing home placement. The rate of residence per 1000 civilian population actually declined from 58 to 43. Decline was most notable for persons aged 85 years and older, female, and white residents. The proportion of widowed persons among residents declined during the study period as well. Overall, Medicaid and private sources were the most common sources of payment. In 1999, Medicaid use was particularly prevalent among residents who were aged 65–74 years old, women, and/or African Americans.

Conclusions. Older Americans at high risk for placement in nursing home facilities are aged 85 years and older, women, and African Americans, who are also more likely to rely on Medicaid as their primary source of payment. Preventive programs to keep older adults in the community should focus on this group of high-risk older adults.