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April 2, 1997

An Intervention to Delay Nursing Home Placement-Reply

Author Affiliations

University of California, Los Angeles

JAMA. 1997;277(13):1035. doi:10.1001/jama.1997.03540370025021

In Reply.  —Our Editorial was not directed toward minimizing the significance of the findings in the article by Dr Mittelman and colleagues.1 The specific comments to which Dr Butler refers were from our perspective to emphasize the importance of considering the differences between efficacy of an intervention trial vs effectiveness of replications in the community. The last paragraph of the editorial addresses this issue in greater detail.The financial and other barriers to nursing home admission (for example, spousal or family choice or medical necessity) are difficult to generalize from state to state. I personally find the "spend-down" regulation onerous. However, in frail elderly individuals with dementia, there is little or no evidence of a greater obstacle to nursing home admission than with nondemented persons, although anecdotal reports have occurred (oral communication, Katie Maslow, Alzheimer's Association of America, and oral communication, Lori Smetanka, The National Citizens Coalition for Nursing Home Reform,