The Influence of Long-Term Care Insurance on the Likelihood of Nursing Home Admission

OBJECTIVES To determine the effect of long-term care (LTC) insurance on nursing home use. DESIGN Longitudinal analysis, 1998 to 2006 waves of the Health Retirement Study. SETTING Community-dwelling nationally representative sample. PARTICIPANTS Nineteen thousand one hundred seventy adults aged 50 and older, 1998 wave. METHODS Two groups of respondents were created at baseline: those with and without an LTC insurance policy. Respondents admitted to the nursing home from 1998 to 2006 were identified. Propensity scores were used to control for known predictors of LTC insurance possession. A Cox proportional hazards model was used to compare the probability of nursing home admission over 8 years of follow-up for respondents possessing LTC insurance and those without a policy. RESULTS Of the 19,170 respondents aged 50 and older in 1998, 1,767 (9.2%) possessed LTC insurance. A total of 1,778 (8.5%) were admitted to a nursing home during the 8-year period: 149 (8.7%) of those with LTC insurance and 1,629 (8.4%) of those without LTC insurance. The hazard ratio, adjusted for propensity score, for those with LTC insurance entering a nursing home compared with those without was 1.07 (95% confidence interval=0.83-1.38). Likelihood of nursing home admission was relatively low because the low-risk population included in the study, limiting the power to detect small differences in risk of nursing home utilization between groups. CONCLUSION There was no difference in nursing home utilization between low-risk older adults who did and did not possess an LTC insurance policy.