Socioeconomic Inequalities in the Transition to Nursing Home Care: Longitudinal Evidence from a Population Based Study in Switzerland

Lower socioeconomic status (SES) is linked to earlier nursing home admission, but it is unclear if this remains true after accounting for health needs. This study examines SES-related inequalities in nursing home admission, controlling for health needs in an area of Switzerland with universal home-based care for older adults. Data were from the Lausanne Cohort 65+ study, including 3650 participants. SES was measured by education level, occupational class, and receiving means-tested benefits (a proxy for low income). Health needs were assessed with a set of physical and mental health variables. Cox proportional hazard models are controlled for demographics and health needs. Over 6 years, 115 (3.2%) participants were admitted to a nursing home. Lower education and receiving means-tested benefits were linked to earlier nursing home admission. However, after adjusting for all SES variables and health needs, associations between socioeconomic inequalities and nursing home admission did not remain significant. Lower SES is initially associated with earlier nursing home admission, but this is substantially explained by functional and cognitive impairment. The study suggests that access to long-term care in Switzerland is horizontally equitable but emphasizes the importance of preventing functional and cognitive decline in lower SES groups.