Dynamics of functional status and nursing home use

Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Public Administration


Douglas A. Wolf


elderly, Public administration, Demographics, Health, Nursing homes, Life expectancy

Subject Categories

Public Administration


Do various subgroups of older Americans, as distinguished by gender, education, and race, exhibit different trends in the amount of time they can expect to live free from significant disability (Active Life Expectancy, ALE) and their use of nursing homes? How do functional status and other factors influence how older Americans use nursing homes over their lifetimes? How does lifetime use of nursing homes change under assumptions of better health? To address these questions, I develop a Markov model to estimate monthly functional status transition probabilities from the 1984-1990 Longitudinal Study of Aging. Discrete-time hazard models of nursing home admission and discharge are developed from the 1982, 1984, and 1989 National Long-Term Care Survey. Microsimulation techniques examine the life-cycle implications of the Markov and hazard models.

Major findings are: First, estimates of ALE and nursing home use vary substantially among various subgroups of older persons. While women live longer than men, women spend a lower percentage of life free from significant disability. Women also use nursing homes notably more than men. Persons who have more education live longer, and spend larger percentages of their lives free from severe disability compared with individuals with less education. Nonwhite males and females live smaller percentages of their lives free from significant disability compared with white males and females; nonwhite males use nursing homes substantially less than white males. Second, women who live in states having generous Medicaid payment policies use nursing homes notably more than women living in states without these policies. Third, better health is associated with increased longevity, and more absolute years spent in the community and nursing homes; there are no remarkable differences in the proportion of life spent in nursing homes due to better health.

Important policy implications are: Policies that states implement are significantly associated with the use of nursing homes. Further, the use of nursing homes by the growing number of older Americans will depend on both the absolute number of older persons and their health status.


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