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OBJECTIVES: To examine the incremental effect of dementia‐related problem behaviors (DRPBs) on the risk of and time to nursing home placement (NHP) in poor, frail, demented older people.

DESIGN: Client assessments were reviewed retrospectively for clinical, functional, and cognitive information, particularly the presence of DRPBs and the time during enrollment at which they occurred.

SETTING: The Georgia Community Care Services Program (CCSP), a Medicaid 1915‐C home and community‐based services program (HCBS).

PARTICIPANTS: A random sample of demented clients (n = 204) discharged during fiscal year 1996 from four CCSP regions.

MEASUREMENTS: The risk of and time to nursing home placement. Cox proportional hazards models and an extended Cox model with a time‐varying covariate for the presence of DRPBs were used to evaluate the risk factors associated with NHP in …