Family structure and the risk of nursing home admission.

Given the high costs associated with institutionalization, understanding factors related to nursing home admissions is of considerable interest. The family is particularly relevant to a discussion of nursing home admission, given its critical role in providing care to older disabled persons. Using data from the New Haven EPESE, we examine the relationship between family structure and the risk of first nursing home admission. Family structure is defined more broadly than in most previous studies and includes not only the spouse, but also sons, daughters, and siblings. Because of the relatively lengthy follow-up period of the EPESE, we are able to depart from previous methodological conventions, adopting a continuous time survival model with age at admission as the outcome and time-varying measures of family structure and health. Results show that married older persons have about half the risk of nursing home admission of unmarried persons, and that having at least one daughter or sibling reduces an older person's chance of admission by about one-fourth.