Since the late 1980s, policymakers have attempted to reduce the institutional bias of their long-term services and supports by investing in more accessible home and community-based services for older adults with long-term care needs and adults with disabilities. To further advance rebalancing discussions, this study examined the resident, facility, and state characteristics associated with the admission of community-dwelling older adults to the nursing home and the subsequent discharge of this population back to community settings. Data from the Minimum Data Set (MDS) 2.0 were used to construct episodes of care for all newly-admitted residents aged 65 and older to any free-standing U.S. nursing home. Several secondary datasets including the Online Survey, Certification, and Reporting Database (OSCAR), LTCFocus.org website, Nursing Home Compare, Nursing Home Data Compendium, and U.S. census estimates were used in the study analyses. On average, approximately 5.3% of all newly admitted nursing home residents were admitted directly from home with substantial variations across states. Most residents admitted directly from home had limited to extensive dependency in activities of daily living and moderate cognitive impairment. The most common diagnoses on admission included dementia and diabetes. While 31% of residents admitted from home remained in the facility at least 365 days after admission, 32% were discharged to the community, 15% were discharged to the hospital, and 21% died. Most residents admitted from assisted living communities, either remained in the facility or died by the end of the study. Findings from multivariate analyses suggest that resident-level factors, including demographics and health status, influenced the community transition of nursing home residents. Facility characteristics, including ownership, deficiency scores, the ratio of Medicare and Medicaid residents, and urban location were associated with discharge to the community but the effect of these factors differed according to length of stay. The commitment of a state to home and community-based services was also predictive of community discharge. Collectively, findings suggest that resident, facility, and state characteristics influence the community discharge of residents admitted from home or assisted living communities. By understanding the reasons for admission to the nursing home and the factors influencing discharge from the facility, policymakers and administrators can better anticipate and care for community-dwelling older adults with long-term care needs.

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身心障礙者如同一般人，擁有獨立自主的人權，但因其障礙使然，如要達到自立生活，時常需要藉助外界的協助。障礙者自立生活已逐漸成為障礙者社會促進的制度典範，在如此的前提下，支援障礙者的自立生活的自立支援措施，應為如何的設計，應為障礙者社會促進措施的研究要點所在。本文旨在從日本與台灣的學界及實定法中，探尋障礙者福利措施的典範移轉，以及從「自立」於社會保障法上及障礙者社會促進中的意義，剖析障礙者自立支援措施的應有樣貌，並進而藉此檢視及分析日本與台灣身心障礙者法制中具體的障礙者自立支援措施，提出本文的比較結論，期待能對我國的身心障礙者社會促進法制未來的改革，提供比較法上的參考。本文研究架構如下： 第一章為緒論，介紹本論文的研究動機與目的、研究範圍、用詞定義、研究方法及研究架構。 第二章探討身心障礙法政策的典範移轉。本章將先針對身心障礙者社會福利法制的典範移轉進行論述，再介紹身心障礙者的自立生活運動的國際脈絡，其理念、內容、發源及於亞洲的擴散。 第三章探討「自立」及「自立支援」於日本社會保障法脈絡中的意義。本章將從日本學說及實定法進行剖析，目的為將對於「自立」概念論述較深入的日本狀況，引為參考標的。 第四章為探討日本障礙者自立支援法及障礙者總合支援法之法制。從其發展脈絡，到具體的法制內容介紹，使讀者一窺日本對於障礙者支援法制之中心─障礙者總合支援法之樣貌，並對本文後續章節之我國與日本制度的比較進行鋪陳。 第五章為將先針對我國身心障礙者權益保障法中與障礙者自立生活較有相關的個人支持服務進行介紹，再進行台日制度的比較分析。 第六章為本文結論，本文將於本章呼應本文研究動機及目的，提出結語。