Reducing nursing home use through community long-term care: an optimization analysis.

Can community services be made more effective in reducing nursing home use through better management of their mix and allocation? To test this idea, we used data from the National Long-Term Care Channeling Demonstration to estimate logistic regression models relating the use of various types of community services to nursing home use. We then used these estimates to form an objective function for a mathematical optimization procedure which minimizes total expected population nursing home use as a function of community service use, subject to a total expenditure constraint. We find through this simulated reallocation that, in theory, significant reductions in nursing home use can be produced without increasing total community expenditures.