Correlates of open- and locked-facility placement in a population of decisionally impaired adults.

OBJECTIVES This study compares characteristics of public conservatees placed in locked facilities with those in less restrictive settings. Given the principle of the least restrictive alternative, the study seeks to identify factors, including the role of aging and advanced age, associated with restrictive placement within conservatorship. METHODS Management Information Systems data on 1,534 adult conservatees in Los Angeles County in July, 1993, are examined in cross-section. Models exploring individual and environmental characteristics of conservatees and linear, curvilinear, and multiplicative aging effects are tested on the probability that adults are placed in locked facilities versus all other placement types. RESULTS Locked facility placement is associated with being female, receiving SSI, a diagnosis of dementia, and being identified as a danger to oneself and to others. Locked-facility placement is associated with increasing age until age 60, when the effect becomes inversely related; the multiplicative effect of older age and impaired functioning is also inversely related. DISCUSSION The curvilinear nature of age and the interaction effect of Age x Functioning implies that increasing frailty in older adults makes locked facility-placement less likely. Further research is needed on whether alternative placement types, such as special care units with secured perimeters, can further reduce the need for locked facilities.