Journal of Cross-Cultural Gerontology 15: 99–118, 2000.
© 2000 Kluwer Academic Publishers. Printed in the Netherlands.
99
Nursing home entry in Germany and the United States
CHRISTINE L. HIMES
1
, GERT G. WAGNER
2
, DOUGLAS A. WOLF
1
,
HAKAN AYKAN
1
& DEBORAH D. DOUGHERTY
1
1
Center for Policy Research, Syracuse University, Syracuse, New York, USA;
2
German
Institute for Economic Research and European University, Viadrina, Frankfurt (Oder),
Germany
Abstract. This paper investigates the transition into a nursing home in old age, using recent
panel survey data from Germany and the United States. Among the questions addressed are:
what is the incidence of nursing home entry, and how does it vary by age and sex; and to what
extent are differentials in nursing home entry attributable to variations in family composition?
Although the percentage of older persons living in nursing homes is similar in these two
countries, the age-specific rates of movement into them appear to be much lower in Germany
than in the USA, possibly due to the effects of public policies. The correlates of nursing home
entry appear to be similar across countries as well, although data limitations limit our ability
to make definitive comparisons.
Keywords: Comparative studies, Germany, Health care, Nursing home entry, Population
aging
Introduction
As is well known, many countries in Europe, North America and Asia are
presently experiencing growth in the absolute and relative numbers of older
persons in their populations. Many of these countries are faced with future
growth in their older population to unprecedented levels as postwar ‘baby
boomers’ move through old age, accompanied by intense pressures on public
budgets resulting from growing claims for age-based entitlement and service
programs. Against this background of similar demographic phenomena and
public policy issues, there is potential value to international comparative
research and analysis. This paper addresses one such issue, the transition into
a nursing home in old age.
We use recent data from Germany and the United States to address a series
of related questions, such as: what is the incidence of nursing home entry,
and how does it vary by age and sex; and, to what extent are differentials
in nursing home entry attributable to variations in family composition? We
emphasize similarities and contrasts between the two countries studied. Our