How does formal and informal community care affect nursing home use?

We examined the effects of informal and formal community care on the 6-year risk of nursing home use in a representative sample of disabled elders. Increased risk was associated with receiving formal community services and with caregiver burnout. There was a modest reduction in risk of using a nursing home among those receiving greater amounts of informal care. Elders with male caregivers were at over twice the risk of using a nursing home than those with female caregivers, while those who lived with their primary caregiver were at reduced risk. Increasing amount of formal services was associated with reduced risk of nursing home use for cognitively impaired older persons. Formal community services did not buffer the effects of severity of disability on nursing home use. Supplementing informal services with formal care was associated with greater risk of using a nursing home. Future research should move beyond testing global hypotheses regarding the protective effects of informal and formal community care and examine the impact of specific types of community care for specific subgroups of older persons on subsequent nursing home use.