The influence of community context on the decision to enter a nursing home

The purpose of this research was to examine the association between community context (rural versus urban residence) and the reasons older adults (65+) decide to enter a nursing home. Personal interviews were conducted using open-ended questions with a sample of new admissions, or their proxies, in nine rural and nine urban nursing homes (N = 113). Responses were subjected to content analysis, which identified five categories of reasons that we labeled as: (1) Experiencing Sudden Events: some elders described a sudden unexpected event (such as a fall or serious illness) that caused them to be unable to continue to live in a community setting; (2) Changing Family Circumstances: some elders described family changes that reduced family members' capacity to meet their needs; (3) Needing Skilled Care; some elders reported an increased need for skilled health care providers, like nurses and rehabilitative therapists; (4) Receiving Pressure from Others: some elders reported being "told to" enter a nursing home by a "significant other;" and (5) Living in Fear: some elders expressed apprehension about continuing to live in their community. Residential differences emerged in the frequency with which specific reasons were cited for nursing home admissions. These findings improve our understanding of the reasons for entering a nursing home described by older adults, highlighting the influence of residence.