Evidence Summary

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The evidence is unclear about whether it is better for older adults to receive long-term care through home and community-based services or in a nursing home

Wysocki A, Butler M, Kane RL et al. Long-term care for older adults: A review of home and community-based services versus institutional care Agency for Healthcare and Quality (US). 2012;Report no 12 (3):EHC134-EF.


Review question

What are the benefits and harms of long-term care provided through home and community-based services compared to institutions such as nursing homes, for adults age 60 and older who need long-term care?



Long-term care refers to a range of services designed to provide assistance over longer periods of time to help those suffering from chronic illness or physical or mental disability.


The type, frequency and intensity of long-term care services varies, with some people needing assistance for a few hours each week and others needing full-time support.


Long-term care includes institutional settings such as nursing homes as well as care provided outside of institutions, which are generally referred to as home and community-based services.


How the review was done

The review aimed to identify studies conducted from 1995-2012 that compared home and community-based care to nursing homes, for those aged 60 and over.


42 eligible articles were identified that presented results from 32 studies.


The review was funded by the Agency for Healthcare Research and Quality.


What the researchers found

There is low-strength evidence that changes in physical function, cognition and mental health do not differ significantly between home and community-based services and nursing home residents.


There is low-strength evidence that mortality does not differ between residents receiving long-term care through home and community-based services and nursing home residents.


Low-strength evidence suggests that those who receive care in a nursing home are less likely to experience episodes of pain, shortness of breath, and use anti-anxiety medication, but are more likely to require a feeding tube or oxygen therapy, and more likely to develop pneumonia, or a pressure ulcer.



There is no strong evidence to suggest that health outcomes differ among older adults receiving long-term care in a nursing home compared to those who receive long-term care through home and community-based services.


The results are also mixed with respect to different rates of harms associated with long-term care provided through home and community-based services compared to nursing homes.


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