Activities of daily living in nursing home and home care settings: A retrospective 1-year cohort study

Taewha Lee, Eunhee Cho, Eun Shil Yim, Hye Sun Lee, Yu Kyung Ko, Bok Nam Kim, Sinhye Kim

Research output: Contribution to journalArticle

10 Citations (Scopus)


Objective: Korea introduced universal long-term care insurance (LTCI) for physically dependent older adults in 2008. Older adults, their family members, and policy makers in Korea want to know patient outcomes indifferent care modalities because older adults who have a similar functional status and LTC needs canchoose either nursing home care or home care. The aim of this study was to compare activities of daily living (ADLs) in nursing home care and home care settings for physically dependent older adults in Korea. Design: A retrospective 1-year cohort study using national LTCI data. Settings: This study used the LTCI dataset from the National Health Insurance Service in Korea. Participants: Participants were identified from among those in the LTCI dataset who enrolled from July 2008 to June 2010. We extracted a sample consisting of 22,557 older adults who consistently received either nursing home care (n=11,678) or home care (n=10,879) for 1year. Measurements: The outcome variable was change in ADLs after 1year. Covariates were an older adult's home geographical region, LTC level, age, sex, primary caregiver, Medicaid beneficiary status, bedridden status, medical diagnosis, baseline ADLs, cognitive function, behavioral problems, nursing and special treatment, and rehabilitation needs. Multiple regression analysis of all participants unmatched and a paired t-test with a propensity-score-matched cohort were performed to explain the association of changes in ADLs with the types of LTC. Results: Multiple regression analysis with all participants (n=22,557) unmatched showed that compared with older adults who received home care, those who received nursing home care had deteriorated further in terms of ADLs after 1year (β=0.44108, P<.0001). After propensity-score matching, paired t-test analysis also found that the ADLs of older adults had deteriorated less in the home care group compared with the nursing home group after 1year (P<.0001). Conclusions: The ADLs of older adults who received home care showed significantly less deterioration than those of the older adults in nursing home care after 1year. The ADLs of older adults could differ according to the type of LTC they receive, and home care could result in better maintenance of ADLs than nursing home care.

Original languageEnglish
Pages (from-to)114-119
Number of pages6
JournalJournal of the American Medical Directors Association
Issue number2
Publication statusPublished - 2015 Feb 1


All Science Journal Classification (ASJC) codes

  • Nursing(all)
  • Health Policy
  • Geriatrics and Gerontology

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