| Summary: | <h4>Background</h4>Previous research has focussed on individual-level determinants of nursing home admission (NHA), although substantial variation in the prevalence of NHA between European countries suggests a substantial impact of country of residence. The aim of this analysis was to assess individual-level determinants and the role of country of residence and specifically a country`s public institutional long-term care infrastructure on proxy-reported NHA in the last year of life.<h4>Methods</h4>We analysed data from 7,018 deceased respondents (65+) of the Survey of Health, Ageing and Retirement in Europe (2004-2015, 16 countries) using Bayesian hierarchical logistic regression analysis in order to model proxy-reported NHA.<h4>Results</h4>In total, 14% of the general older population utilised nursing home care in the last year of life but there was substantial variation across countries (range = 2-30%). On the individual-level, need factors such as functional and cognitive impairment were the strongest predictors of NHA. In total, 18% of the variance of NHA was located at the country-level; public expenditure on institutional care strongly affected the chance of NHA in the last year of life.<h4>Conclusion</h4>On the individual-level, the strong impact of need factors indicated equitable access to NHA, whereas differences in public spending for institutional care indicated inequitable access across European countries.
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