Predictors of nursing home admission and shared housing arrangements as alternative residences for people in need of nursing care. An exploration based on health and long-term care insurance claims data and international empirical evidence

By the end of 2019, around 4.1 million people in Germany were in need of nursing care as defined in § 14 of the German Social Code Book XI. A further increase in the number of people in need of nursing care is expected in the upcoming years. Many older people wish to remain in their own homes for a long time. However, it is not always possible to fulfil this wish, especially when nursing care is needed. For many older people a move to a nursing home is often the only alternative, although there are now a number of other options, such as shared housing arrangements. There is still a lack of research on the question of which factors play a central role in the decision on where to live. The objectives of this cumulative dissertation are to determine predictors for nursing home admission on the basis of routine data from health insurance and long-term care insurance and to explore shared housing arrangements as an alternative form of housing compared to nursing homes. For this, three papers were published that 1. present predictors for nursing home admission by conducting a systematic review, 2. describe predictors for nursing home admission that were determined by means of event time analyses on the basis of health insurance routine data and care assessment data, and 3. compare health-related outcomes of residents of shared housing arrangements and nursing homes in a rapid review. Further, the results are reflected against the underlying assumptions of the theory of ecological gerontology. The results show that predictors such as older age or chronic diseases can be considered as given constants. Therefore, new forms of housing such as shared housing arrangements play an important role in the choice of residence. However, the results of the rapid review did not show any clear evidence for the advantages of one of the two residential settings above the other, even though there are indications that quality of life is increased in shared housing arrangements. The results of this study therefore underline the relevance of counselling people in need of care in decisions about the place of residence, taking into account individual preferences related to the current and future environment. At the political level, the further development of existing social environment-oriented concepts or measures to improve the living environment are recommended. Since – according to the results of this dissertation – individuality, independence and limitations of people in need of care as well as their care situation must be given greater attention when choosing a place of residence, future research should increasingly focus on predictors that do justice to the diversity of people in need of care. This includes comparisons of health-related outcomes in different settings with methodically high-quality study designs which pose an important decision-making basis for the organisation and management of transitions from one's own home to another residential setting. Overall, this dissertation was able to show that, in the sense of ecological gerontology, housing and the choice of place of residence play a crucial role for the objective and subjective suitability of the person-environment relationship