Alternative paths to long-term care: nursing home, geriatric day hospital, senior center, and domiciliary care options.

This paper examines certain quality of life outcomes, as well as comparative costs of care, for selected types of persons entering three very distinct types of alternative service programs that address the long-term care needs of vulnerable elderly persons: nursing homes (NH), geriatric day hospitals (GDH), and senior center (SC) programs. For selected outcomes, based on secondary analysis of the data gathered in another study, it was possible to add to the comparison samples of similar types of persons entering small foster-type domiciliary care homes (DC). From pools of persons entering these programs, six separate sets of comparison samples who were similar at baseline were constructed (GDH-SC, NH-SC, NH-GDH, NH-DC, SC-DC, GDH-DC). Only analyses pertaining to institutionalization and costs were conducted for the last three sets of comparison groups. Except for the issue of institutionalization, quality of life impact analysis showed only a few more post-test differences than would be expected by chance (although the few post-test differences that were observed in each case favored less restrictive settings). This more general similarity of outcome is indeed provocative, suggesting that in many ways the applicants adapted similarly to these quite distinct programs. Cost analyses found that nursing home and geriatric day hospital care, the two most restrictive settings, were also the two most expensive interventions.