The Four Percent Fallacy: Some Further Evidence and Policy Implications

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Abstract
As a part of a larger study of black and white nursing home patients in Alabama, it is learned that as many as 44% of the deaths occur within a month after admission. Short-lived patients are necessarily under-represented in cross-sectional studies, giving rise to the myth that only a small proportion of the elderly end their lives in nursing homes. In fact, cross-sectional enumerations are heavily biased against those whose lives in institutions are short or who are moved to hospitals for their final medical crisis. The evidence suggests that some, if not many, families may institutionalize their older members only under great duress.

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