Predictors of nursing home placement and home nursing services utilization by elderly patients after hospital discharge in Taiwan

Background. Providing appropriate follow-up health/long-term care services after hospital discharge for elderly persons is important to enhance health and quality of life. Therefore, identifying factors that affect follow-up service utilization has become an important concern. Most studies of predictors of follow-up service utilization for elderly persons after discharge were conducted in the United States of America (USA). Taiwan differs substantially from the USA in health care system, clinical practice, case-mix, culture, and social organization; thus the findings from the USA need to be validated in Taiwan to ensure appropriate discharge referrals. Aim. To investigate pre-discharge predictors of follow-up care including home nursing services and nursing home placement for elderly patients, discharged from hospitals in Taiwan. Methods. A prospective study with a case-control design was used. Findings. The strongest predictors of institutionalization in a nursing home at 1, 3 and 6 months after discharge were the elderly person's pre-admission institutionalization (0·33 to 0·48) and the caregiver's preference for institutional displacement (0·23 to 0·85). The strongest predictors of use of home nursing services were the elder's self-care ability (0·69 to 0·76), conscious level (0·51 to 0·73), and tubes remaining before discharge (0·58 to 0·79). These predictors were stable at 1, 3 and 6 months after discharge and could correctly classify 60-89% of sample. Conclusions. When taking nursing home and home nursing utilization into considerations at the same time, the elderly person's pre-admission institutionalization and the caregiver's preference for institutional displacement strongly predicted nursing home utilization after hospital discharge. The elder's self-care ability, conscious level, and tubes remaining before discharge strongly predicted the use of home nursing services after discharge.