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Can Your House Keep You Out Of a Nursing Home?
Keeping long term care accessible and affordable is a challenge for countries worldwide. One way to contain costs is by stimulating elderly to live at home as long as possible, and substituting relatively expensive nursing home care by less expensive home care. The house may play an important, but still under investigated, role in the decision of older people to move to a nursing home. Elderly who live in a house that is accessible, or easily adaptable to their health-related limitations, might live longer at home than elderly with the same health problems, who live in a poorly accessible home. The house might also have a direct impact on the health of the elderly (e.g. a house without stairs causes less falls). In this study, we consider the combined effect of both mechanisms and investigate whether elderly living in more accessible houses are less likely to use nursing home care than elderly living in poorly accessible houses.
To test whether the suitability of a house causes less nursing home care use, we gathered unique data on the accessibility of a house for all houses in the Netherlands. We combine these data with individual level data from different administrative sources on health and health care use, the living environment, and personal characteristics. We focus on elderly (75+) and consider the period 2012-2014. We control for two potential endogeneity problems. First, healthier people might live in better neighborhoods and therefore our housing variable may pick up a health effect. To solve this issue, we include neighborhood fixed effects. Second, there might be selective moving when elderly with health problems move to more suitable houses. We use the house an individual lived in 15 years ago as an instrument for the suitability of their current house to control for this issue.
We find that living in a more accessible house reduces the probability to use nursing home care. This effect is age dependent: living in an accessible house lowers the probability to use nursing home care most for elderly who are 90 or older. We find that the type of house matters only for elderly with physical problems. The house does not affect the probability to use nursing home care for elderly with cognitive problems. We find some evidence that elderly living in more accessible houses are more likely to use home care.
Our results suggest that improving the housing conditions of elderly can play a role in promoting substitution between nursing home care and home care. Policy makers could stimulate or finance housing improvements, such as stair lifts, to make houses suitable for elderly with mobility problems. Besides, local policy makers could try to stimulate older people to move to more suitable houses in time.
