How Housing Influences Nursing Home Utilization in the United States: An Integrative Review.
Marissa Bergh, Abraham A Brody, Tina R Sadarangani and 2 others
PMID 41547541WHAT IT FOUND
Housing cost, ownership, and accessibility were associated with long-term nursing home use in U.S. studies.
Renters were more likely to enter nursing homes than homeowners. Affordable housing and home modifications were associated with community transitions.
Key findings
01Across three studies, renters were more likely to use long-term nursing homes than homeowners.
02One quasi-experimental study found housing vouchers improved rates of transition back to the community, and one mixed-methods study found lack of affordable housing and burdensome subsidized housing applications prolonged nursing home stays.
03Four studies on home accessibility and quality gave mixed results, including lower nursing home admission when home modification and repair services were used and no relationship for basic kitchen and plumbing quality.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for RNs
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What it does not show
This is a review of existing observational studies, not a trial, so it cannot show that changing housing alone prevents nursing home placement. Only 16 studies were included, and 14 were secondary quantitative analyses of existing data, with very little primary or qualitative work. Definitions of long-term nursing home use varied across studies, including different length-of-stay thresholds and discharge criteria. A single reviewer screened and appraised the articles, which could introduce bias. Study quality ranged from low to high, and weaker studies had poor variable selection, inadequate descriptions, and poor reporting. Many studies did not measure caregiver support, which may explain weak, null, or conflicting housing associations. The review focused on nursing homes, not assisted living, and did not comprehensively examine who people live with or near.
Declared interests
The supplied metadata lists NIH and non-U.S. government research support, but the text gives no author conflict-of-interest statement.
The easy way to misread this
Do not conclude that housing affordability or home modifications alone prevent nursing home placement. The review found associations and mixed results, and many studies did not measure caregiver support, which may be decisive.