Original study
Nursing Home Involuntary Relocation: Clinical Outcomes and Perceptions of Residents and Families

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Objectives

To examine the physical and mental health characteristics of 120 residents 3 months following their discharge from 1 transferring nursing home to 23 facilities, to compare these characteristics to their pre-transfer status, and to describe resident and family perceptions of the transfer.

Design

Secondary analysis of a longitudinal, prospective quasi-experimental intervention and a qualitative description of resident and family views.

Setting

The setting was 23 nursing homes in the Philadelphia metropolitan area.

Participants

Participants included 120 nursing home residents and 56 family members.

Measurements

Minimum Data Set (MDS) and data from the Centers for Medicare and Medicaid Services (CMS) Nursing Home Compare Web site

Results

There was a statistically significant increase in the number of residents who fell during the post-transfer (76.9%) compared to the pre-transfer (51.2%) period (P = .0001): 76.3% of those with a history of falling prior to transfer fell during the post-transfer period while 77.4% of those without a history of falling prior to transfer fell. Residents were 3.78 times more likely to fall if they required more than supervision while walking (95% confidence interval [CI] 1.57–9.06) and 2.65 times more likely if they required more than supervision while transferring (95% CI 1.09–6.44). Logistic regression demonstrated that the mobility was also associated with falls (odds ratio 1.15, 95% CI 1.05–1.26). Residents did not demonstrate any other significant physical or mental health changes during the 3 months following the involuntary transfer when compared with their pre-transfer status. Residents and family members clearly voiced their dismay over the process of involuntary relocation.

Conclusion

Relocation is a stressful event; however, a move to a higher quality care environment does not result in any significant physical or mental health changes. The high incidence of falls post-transfer in both those with and without a fall history points to the need for extra fall precautions in newly admitted residents. In particular, frequent reorientation reminders for the cognitively intact and a high level of staff surveillance for all new residents is indicated during the first few weeks of admission.

Section snippets

Methods

This is a secondary analysis of a longitudinal, prospective quasi-experimental intervention study. The primary study tested the effect of an advanced practice nurse intervention on physical and mental health outcomes of involuntarily relocated nursing home residents.

Results

Receiving facility characteristics are described in Table 1. All facilities were located in the Philadelphia metropolitan area, compared to 60% of nursing homes nationally that are in urban locations. The average bed size of the receiving facilities was 170.1 beds (SD = 87.4), more than twice the national average. The percentage of proprietary ownership (60.9%) and chain affiliation (56.5%) approximated national comparison data.

Resident demographic characteristics are presented in Table 2. The

Discussion

Although the study facility and residents’ demographic characteristics do not reflect a typical American nursing home and its residents, they do mirror the population of nursing homes that are generally likely to close. Facilities that depend primarily on Medicaid funding are at greatest risk of closure since they do not have the financial resources to respond to negative government surveys.28, 29 African Americans are 4 times more likely than whites to reside in facilities at risk of closure.30

Conclusion

Nursing homes will continue to close because of financial problems resulting from civil litigation and government sanctions, or, as in this case, as a result of the inability of a hospital system to adequately provide nursing home care.29, 49 In 2002, the Public Policy Institute of the American Association of Retired Persons released an issue paper regarding nursing home closure. It encouraged a uniform protocol for tracking residents after relocation as well as a central point of coordination

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  • Cited by (0)

    This study was supported by a grant authorized through a settlement agreement between the United States Department of Justice (United States Attorney’s Office for the Eastern District of Pennsylvania) and a large hospital health system.

    Disclaimer: The opinions set worth in this manuscript express the views of the authors, not the views of the United States Attorney’s Office for the Eastern District of Pennsylvania or any other entity or person associated with the United States Department of Justice.

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