The Lifetime Risk of Nursing Home Use

This chapter estimates the lifetime risk and distribution of stays in nursing homes using 10 waves of data from the Health and Retirement Study covering the population over the age of 50. Using both non-parametric and parametric approaches which account for censoring, we estimate that a 50 year old has a 53 percent to 59 percent chance of ever entering a nursing home before he dies and that, conditional on any stay, the average duration is just over a year. We show that stays at the end of life which are typically not captured in core interviews are very important for assessing lifetime exposure. The HRS performs exit interviews with proxies for those who died. Excluding exit interviews yields lifetime risk under 40 percent. Being female, white and a nonsmoker are associated with higher lifetime risk due to lower (competing) mortality risk and higher nursing home risk at older ages.