Predictors of Mortality Following Involuntary Interinstitutional Relocation

Turkish validity and reliability study of the nursing home adjustment scale

BACKGROUND

Adapting to a nursing home has a significant effect on facilitating the transition to a nursing home. However, a tailored nursing home adjustment scale for Turkish nursing home residents is not yet available. The purpose of this study was to translate the nursing home adjustment scale from English to Turkish and assess its reliability and validity in a sample of nursing home residents in Turkey.

METHODS

A total of 202 older adults from four nursing homes were included in this study. The reliability of the Turkish nursing home adjustment scale was tested using Cronbach's alpha values for internal consistency. Exploratory and confirmatory factor analyses were used to examine the factor structure, whereas correlation analysis was conducted for convergent validity.

RESULTS

The Turkish version displayed satisfying internal consistency (Cronbach's alpha = 0.88) and perfect convergent validity for life satisfaction (r = 0.482). The Turkish scale included five factors: difficulty fitting in, acceptance of new residence, emotional distress, depressed mood, and relationship development.

CONCLUSION

The findings indicate that the Turkish version of the scale is a valid and reliable tool for measuring the level of nursing home adjustment among older adults in Turkey.

Residential Environments for Older Persons: A Comprehensive Literature Review (2005-2022)

BACKGROUND

Independent noninstitutional and institutional residential long-term care environments for older persons have been the subject of significant empirical and qualitative research in the 2005-2022 period. A comprehensive review of this literature is reported, summarizing recent advancements in this rapidly expanding body of knowledge.

PURPOSE AND AIM

This comprehensive review conceptually structures the recent literature on environment and aging to provide conceptual clarity and identify current and future trends.

METHOD AND RESULT

Each source reviewed was classified as one of the five types-opinion piece/essay, cross-sectional empirical investigation, nonrandomized comparative investigation, randomized study, and policy review essay-within eight content categories: community-based aging in place; residentialism; nature, landscape, and biophilia; dementia special care units; voluntary/involuntary relocation; infection control/COVID-19, safety/environmental stress; ecological and cost-effective best practices; and recent design trends and prognostications.

CONCLUSIONS

Among the findings embodied in the 204 literature sources reviewed, all-private room long-term care residential units are generally safer and provide greater privacy and personal autonomy to residents, the deleterious impacts of involuntary relocation continue, family engagement in policy making and daily routines has increased, multigenerational independent living alternatives are increasing, the therapeutic role of nature and landscape is increasingly well-documented, ecological sustainability has increased in priority, and infection control measures are of high priority in the wake of the coronavirus pandemic. Discussion of the results of this comprehensive review sets the stage for further research and design advancements on this subject in light of the rapid aging of societies around the globe.

Household Composition Under Strain: Regional Unemployment Rates and the Older American Housing Decision

This research explored the relationship between regional unemployment rates and the community-based housing configuration of older Americans. The analysis used the American Community Survey from 2006 to 2016 to examine regions experiencing high unemployment for differences in the likelihood of older adults to live alone, with a spouse or partner, or in a multigenerational household. Findings demonstrated that under the strain of higher regional unemployment, older adults were less likely to live alone and more likely to live in a multigenerational household. Additionally, older adults with a difficulty that could signify a need for support were less likely to live with a spouse or partner, while those without a difficulty were more likely to live with a spouse or partner. Recession-related safety-net policy should target supports to community-dwelling older adults, particularly those living alone, those with more support needs, with lower income, and older renters, because their housing arrangements may become vulnerable during regional economic contraction. Implications during COVID-19 are discussed.

Depression within the First Year of Relocation to Residential Care/Assisted Living: Where You Come From Matters

Depression is common within the first year of relocation to residential care/assisted living (RC/AL). Yet, few studies investigate the relationship between depression and relocation factors that might help identify at-risk residents, such as previous location. This study analyzed cross-sectional resident data (n = 2651) from the National Survey of Residential Care Facilities to test: (1) group differences between residents relocating from acute/post-acute facilities (e.g., hospital, rehabilitation facility) and community-based residences, and (2) the relationship between previous location and depression within the first year of relocation. The 921 (35%) residents relocating directly from acute/post-acute facilities were more likely to have depression (p < .001) and poorer outcomes on select health and psychosocial variables. After controlling for covariates, relocating directly from an acute/post-acute facility significantly related to depression (OR = 1.22). Findings highlight opportunities to improve routine screening and transitional care for this subpopulation of RC/AL residents at heightened risk for depression.

Adapting a whole health model to home-based primary care: Bridging person-driven priorities with veteran and family-centered geriatric care

Through the integration of Whole Health for Life into the Department of Veterans Affairs (VA) health care system, the VA aims to transform health care delivery from a disease management approach to one that embraces person-centered care. The home-based primary care (HBPC) program is a care model that, within the VA, provides holistic primary care services to homebound veterans with multiple chronic medical conditions, mental health issues, and functional declines. These veterans may have limited access to VA programs delivered in a traditional outpatient format. This article describes adaptations to the whole health model of care that could improve its accessibility and applicability to HBPC veterans, caregivers, and the interdisciplinary teams that serve this population. These modifications are informed by whole-person geriatric and gerontological and family-systems theories and address population-based differences in the focus and approach to care. The focus on care is expanded to (a) reflect the importance of attending to caregiver needs and well-being and (b) shift from a preventative model to one that prioritizes resilience and maintenance. The approach to care emphasizes alternative modes of delivery, adaptations to interventions, and integration of geriatric-specific medical considerations into the self-care domains and more directly centers the collaboration between family, the VA, and community partners. This adapted model also addresses the unique needs of health care teams providing in-home services to medically complex veterans and offers suggestions for enhancing self-care and preventing burnout. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A Scoping Review: Characteristics and Outcomes of Residents Who Experience Involuntary Relocation

BACKGROUND AND OBJECTIVES

Relocation to a residential care facility has been described as the most significant relocation affecting older adults, yet subsequent relocations, like in the case of a facility closure, have received minimal attention in the scholarly research literature. This paper reviews the published literature on involuntary relocation, focusing on the experiences of residents, families, and staff and the effects of involuntary relocation on nursing home residents' health.

RESEARCH DESIGN AND METHODS

We conducted a scoping review to identify peer-reviewed studies reporting on involuntary relocation of nursing home residents. A total of 28 quantitative, qualitative, and mixed-method articles met inclusion criteria.

RESULTS

Researchers mostly relied on longitudinal designs and quantitative indicators of functional health, cognitive status, psychological and emotional well-being, environment, and relocation context to examine residents' mortality risk and health outcomes associated with involuntary relocation. Inclusion of qualitative and mixed-method approaches was infrequent, as were indicators of social engagement and perceptions of relocation. Residents' awareness of and preparation for involuntary relocation positively influenced their health and well-being. Family involvement was frequently hindered by communication challenges with facilities. Staff expressed concern about residents, experienced increased workload demands, and acknowledged challenges with planning and communication.

DISCUSSION AND IMPLICATIONS

Based on the collective findings, we propose a conceptual model of critical factors at play during relocation for consideration for guiding future research and developing provisions to current policies guiding relocation processes. Facilities and policymakers need to consider procedures that enhance planning efforts and decision-making among this vulnerable population and their families.

The impact of relocation stress on cognitively impaired and cognitively unimpaired long-term care residents

Objectives: The current aims were to explore the effects of relocation stress on depression and anxiety in long-term care residents and to investigate the moderating effect of cognitive status.Methods: The study used existing data from nursing home and congregate apartment residents. Self-reported measures of relocation stress, cognitive status, depression, and anxiety were examined. Exploratory analyses examined group differences in depression and anxiety within the full sample (n = 568) and the sample of first-year residents (n = 347). Main analyses were conducted in a subsample of 107 first-year residents who completed the measure of relocation stress.Results: Residents who had moved in the past year reported more anxiety but not depression than longer-term residents. Relocation stress significantly predicted depression but not anxiety in the subsample of first-year residents. There was no significant effect of cognitive status or the interaction of cognitive status and relocation stress on depression and anxiety.Conclusion: Findings suggest that cognitively impaired older adults are no more vulnerable to the negative effects of relocation stress than cognitively unimpaired older adults. Relocation stress should be regarded as a risk factor for depression in long-term care residents, regardless of cognitive status, in the first year after relocation.

Psychosocial reactions to relocation to a nursing home among Chinese older adults

OBJECTIVES

This study aimed to describe the psychosocial reactions to relocation to a nursing home from the perspective of older adults.

METHOD

This study applied a qualitative interview design. Narratives from 23 Chinese nursing home residents in a life review program in Fuzhou, China were recorded, transcribed into sentences, and analyzed using qualitative content analysis.

RESULTS

The following psychosocial reactions to relocation to a nursing home emerged: fear, struggle, compromise, acceptance, and contribution. The fear resulted from negative labels attached to nursing homes, fear of disconnection to society, fear of difficulties in establishing new relationships, and fear of being abandoned by their families. The behaviors of 'struggle' were complaining about family members, thinking of returning home, praying for change, and taking action to leave. The keys to compromise were a choice between maintaining harmony in family relations and the companionship of relatives, a choice between professional care and family care, and a choice between the cost and effectiveness of family care and nursing home care. The process of acceptance included accepting life yet with worries, affirming the benefits of living in a nursing home, and embracing nursing home life. Contribution was mainly reflected in two aspects, a sense of ownership and bring into full play their self-worth.

DISCUSSIONS

This study generates new insights into knowledge on the psychosocial reactions to relocation to a nursing home. It provides both family members and nursing home staff with direction on how to ensure a smoother relocation process.

Nursing Home Facility-Initiated Involuntary Discharge

Involuntary discharge of nursing home (NH) residents is a prominent reason for NH complaints in the United States, but little is known about facility-initiated involuntary discharge (FID). A literature review was conducted to improve understanding of FID. The findings distinguish between six types of FID, identify populations at risk of FID, and differentiate between legal and unlawful FID practices and processes. The findings also characterize common FID destinations; show how policy, regulatory, and financial factors impact FID; and indicate that FID outcomes are commonly detrimental to the health and well-being of NH residents. Findings highlight challenges with understanding FID, including differentiating legal from unlawful FID. Although more research about NH FID is needed, the current study indicates that FID outcomes are regularly adverse, protections against unlawful FID are needed for Medicaid beneficiaries and NH residents with dementia, and stronger enforcement of existing policies and regulations regarding NH FID-including NH bed-hold requirements-are needed. [Journal of Gerontological Nursing, 45(8), 23-31.].

Nursing home Facebook reviews: who has them, and how do they relate to other measures of quality and experience?

BACKGROUND

The growing use of social media creates opportunities for patients and families to provide feedback and rate individual healthcare providers. Whereas previous studies have examined this emerging trend in hospital and physician settings, little is known about user ratings of nursing homes (NHs) and how these ratings relate to other measures of quality.

OBJECTIVE

To examine the relationship between Facebook user-generated NH ratings and other measures of NH satisfaction/experience and quality.

METHODS

This study compared Facebook user ratings of NHs in Maryland (n=225) and Minnesota (n=335) to resident/family satisfaction/experience survey ratings and the Centers for Medicare and Medicaid (CMS) 5-star NH report card ratings.

RESULTS

Overall, 55 NHs in Maryland had an official Facebook page, of which 35 provided the opportunity for users to rate care in the facility. In Minnesota, 126 NHs had a Facebook page, of which 78 allowed for user ratings. NHs with higher aid staffing levels, not affiliated with a chain and located in higher income counties were more likely to have a Facebook page. Facebook ratings were not significantly correlated with the CMS 5-star rating or survey-based resident/family satisfaction ratings.

CONCLUSIONS

Given the disconnect between Facebook ratings and other, more scientifically grounded measures of quality, concerns about the validity and use of social media ratings are warranted. However, it is likely consumers will increasingly turn to social media ratings of NHs, given the lack of consumer perspective on most state and federal report card sites. Thus, social media ratings may present a unique opportunity for healthcare report cards to capture real-time consumer voice.

Management of Relocation in Cognitively Intact Older Adults

Relocation, a major life transition that can affect health positively and negatively, is moving from one permanent home to another. Many older adults will relocate at some time during their life. Relocation is also a complex process that requires careful consideration and planning before the move (i.e., pre-location) and adjustment to the new home after the move (i.e., post-relocation). The current article is a summary of content based on a comprehensive evidence-based practice guideline focused on management of relocation in cognitively intact older adults. The guideline was designed to be used across diverse settings by nurses and other providers. Pre-relocation guidelines include assessment for the need for relocation, interventions prior to moving, and outcomes for evaluation of the pre-relocation process. For post-relocation, content focuses on assessment of risks for not adjusting after the move as well as intervention guidelines to promote adjustment and outcomes for evaluation. Implications include advocacy for older adults by using the guideline, disseminating it, and conducting future research. [Journal of Gerontological Nursing, 42(11), 14-23.].

Discharge Criteria and Follow-Up Support for Dementia Care Units

Specialized dementia care units (DCUs) house individuals whose behaviors cannot be managed in other settings. To ensure environmental fit, admission/discharge criteria are recommended for DCUs; however, there is no consensus about what criteria should be used. This study aimed to describe, in a random sample of DCUs, the current admission criteria, current/recommended discharge criteria, and services to support discharge. Usable surveys were returned by 23 of 30 facilities. Residents were most frequently admitted because they had a diagnosis of dementia and exhibited cognitive/behavioral problems. The four most common discharge criteria in place/recommended were resident ability to manage in a non-specialized long-term care environment, lack of socially inappropriate behaviors, dependency in activities of daily living, and inability to participate in dementia care activities. These findings suggest that discharge from DCUs is relatively ad hoc. The study lays the groundwork for future research to evaluate the use/appropriateness of these criteria.

Involuntary relocation and safe transfer of care home residents: a model of risks and opportunities in residents' experiences

Few studies explore the application of literature on care home closures in practice or how it can influence residents' experiences. The aim of this study was to investigate from multiple perspectives how a protocol, designed by a local council for the involuntary relocation and safe transfer of older adult residents, was adhered to and the influence that the protocol had on the experiences of residents who relocated from two care homes. Interviews were conducted with 34 stakeholders, including relocated residents (N=11), relatives (N=2), care home staff (N=13), managers (N=6) and advocates (N=2), and analysed using framework analysis. The protocol covered key aspects of guidelines extracted from research evidence grouped into four themes:involvement; staff approaches; preparation; andconsistency and familiarity, with the majority of the guidelines being followed in practice. Two further themes that centred on theprocesses of transitional adjustmentandimpact of relocationwere influenced by the protocol but were also mediated by factors relating to the environment and the resident. Involvement of residents, relatives and advocates, extensive planning and a person-centred approach were of particular importance in improving residents' experiences of relocation. A model that places residents' experiences at the centre of relocations is proposed, which draws on and applies the themes identified in this study and applies them within the context of opportunities and risks.

Cognitive function, behavioral problems, and physical function in long-term care insurance beneficiaries with dementia in South Korea: comparison of home care and institutional care services

OBJECTIVES

To examine, in beneficiaries with long-term care (LTC) insurance (LTCI) with dementia in Korea, changes in cognitive function, behavioral symptoms, and physical function over time in relation to LTCI service type and to determine the 2-year effects of service type on those health outcomes.

DESIGN

Secondary analyses of the existing LTCI data set from 2008 to 2010.

SETTING

South Korea.

PARTICIPANTS

LTCI beneficiaries with dementia aged 65 and older (N=31,319). Participants were divided according to the service type that they were receiving home care (HC), institutional care (IC), and combined care (CC).

MEASUREMENTS

A LTC approval checklist was used to determine the level of LTCI coverage of each participant and to assess cognitive function, behavioral symptoms, and physical function. Linear mixed models and multiple regression models were used.

RESULTS

There were significant differences in cognitive function, behavioral symptoms, and physical function at baseline between individuals receiving the three service types (P<.001) and overall improvements in those outcomes over 2 years in the three groups (P<.001). After limiting the sample to those who had received LTCI services for the full 2 years (2008-2010) and adjusting for baseline characteristics, individuals receiving HC were more likely to have better cognitive and physical function than those receiving IC or CC but were likely to have more behavioral symptoms 2 years after the LTCI enrollment (P<.001).

CONCLUSION

LTCI service type (HC, IC, CC) predicted cognitive function, behavioral symptoms, and physical function at 2-year follow-up in beneficiaries with dementia. Further research is necessary to examine the effect of LTC services on health outcomes in a longer observational cohort.

Relocation decisions and constructing the meaning of home: a phenomenological study of the transition into a nursing home

The transition from community dwelling to a nursing home is a common, though idiosyncratic, experience in the United States. This study employed an interpretive phenomenological approach to uncover how eight older adults in nursing homes in the Midwestern U.S. constructed the meaning of home shortly following the relocation and again approximately two months later. The degree to which the individual had been involved in the decision making process was also explored as it related to the meaning of home within the nursing home setting. The majority of individuals did not consider the facility to be "home," but actively changed their attitudes toward the facility and themselves to better adjust to the setting. The findings demonstrate the importance of autonomy in older adults' definitions of home.

Individual characteristics and relocation factors affecting adjustment among relocated American and Egyptian older adults

Worldwide, the population of elders is increasing significantly. Relocation can be a positive or a negative experience, depending on many factors, including culture. The purpose of this study is to compare individual characteristics (age, gender, marital status, education, perceived health status, activities of daily living), relocation factors (movement preparation, time passed since relocation, closeness of prior home to the present, and whether relocation was from home or another facility), and adjustment in relocated American and Egyptian elders. This secondary analysis study merged data from two cross-sectional descriptive studies of a 104 elders relocated to retirement communities in Northeast Ohio and 94 elders relocated to retirement communities in Alexandria, Egypt. Our findings indicated that American elders have greater independence in daily activities (t (161.23) = -3.03, p = .003); better perceived health (χ(2)[3, N = 198] = 53.21, p < .001), better education (χ(2)[1, N = 198] = 47.28, p < .001), better preparation before the move (χ(2)[1, N = 198] = 40.58, p < .001), and better relocation adjustment (t (196) = 9.42, p < .001) than relocated Egyptian elders. Our results indicate that culture should be taken into account when caring for older adults who relocate to retirement communities. Additionally, interventions, such as counseling, and preparation before relocation are needed to help elders adjust to relocation.

Forced relocation between nursing homes: residents' health outcomes and potential moderators

That transfer of older people from one institution to another is detrimental to well-being, health and survival has been reported for 50 years. This has led to fear, anger and legal challenges when closures occur. Previous reviews identified accounts of relocation followed by adverse outcomes and others where problems were avoided or benefits claimed. This paper reviews the last twelve years of literature on health outcomes following involuntary relocation between nursing homes. Reports of post-move mortality, physical or psychological health suggest and confirm that relocation without preparation carries higher risk of poor outcomes than moves that are orderly and include preparation. The literature on the care home closure process, admissions and individual transfers offers insights into practices that might help minimize adverse outcomes. A number of agencies have produced helpful guidelines. How these are implemented needs to be monitored and linked to in-depth studies of sample closures.

Resourcefulness, positive cognitions, relocation controllability and relocation adjustment among older people: a cross-sectional study of cultural differences

BACKGROUND

The population of older people in both the United States and Egypt is expected to double by the year 2030. With ageing, chronic illnesses increase and many older people need to relocate to retirement communities. Research has shown that positive cognitions and resourcefulness are positively correlated with adaptive functioning and better adjustment.

AIMS AND OBJECTIVES

The purpose of this study was to examine and compare relocation controllability, positive cognitions, resourcefulness and relocation adjustment between American and Egyptian older people living in retirement communities. The purpose of this cultural comparison is to gain insight into influencing factors in each culture that might lead to interventions to help relocated older adults in both cultures adjust to their new surroundings.

DESIGN AND METHOD

A cross-sectional, descriptive design was used to compare relocation controllability, positive cognitions, resourcefulness and relocation adjustment of a convenience sample of American older people (n = 104) and a convenience sample of Egyptian older people (n = 94). The study was a secondary analysis of two studies of older people residing in six retirement communities in Northeast Ohio and in five retirement communities in Alexandria, Egypt.

RESULTS

Examination of mean scores and standard deviations on the measure of positive cognitions using independent sample t-tests indicated that on average, the American older people reported more positive cognitions (t (131.16) = 11.29, P < 0.001), more relocation controllability (t (196) = -6.78, P < 0.001) and more relocation adjustment (t (196) = 9.42, P < 0.001) than the Egyptian older people. However, there was no significant difference between Egyptians and Americans in resourcefulness (t (174.16) = -0.97, P > 0.05).

CONCLUSION

The results provide direction for the development of positive cognition interventions and engaging older people in the decision-making process to help them to adjust to relocation. Implications for practice.  Positive thinking and resourcefulness training interventions can be used by nurses to help relocated older people to adjust to the stress of relocation to retirement communities. These interventions can be used on primary, secondary, and tertiary levels. Primary interventions can help to prevent the stress of relocation before happening by helping older people to use their positive thinking and their resources and work with them before relocating to retirement communities. Secondary prevention can be used by nurses to help older people who have already relocated to retirement communities and have already experienced stress of relocation to help them out by decreasing the stress that they are suffering. Tertiary prevention can be used to prevent further stress and deterioration for those who have suffered physical and psychological symptoms as a result of relocation.

Psychometric properties of the pressure to move scale in relocated american older adults: further evaluation

The number of elders who relocate to retirement communities is increasing exponentially, and their ability to exercise free choice, personal control, and autonomy has been associated with relocation adjustment and positive outcomes in regard to physical, emotional, and social well-being. Although a measure of relocation controllability (the degree of personal control associated with the move) exists, there is limited evidence of its psychometric adequacy. This study tested the reliability and validity of the Pressure to Move Scale (PTMS). A convenience sample of 104 American elders who relocated to six Northeast Ohio retirement communities was recruited. Study participants completed the nine-item PTMS and two validation measures during structured interviews. Cronbach's alpha was .71. Homogeneity was supported by item-to-total correlations between .30 and .70, except for two items. Deletion of the item asking about the elder's first impression of relocation improved the alpha to .74. The PTMS was correlated in the expected direction with positive cognitions (r = -.37, p < .01) and relocation adjustment (r = -.62, p < .01), indicating convergent validity. Factor extraction generated three factors, the first reflecting "internal" control factors and the second reflecting "external" control factors; a third factor, containing two items with low item-to-total correlations, reflected another level of "external" control. With preliminary evidence of its reliability and validity, this scale can be a useful tool for screening for pressure to move or involuntary relocation among older adults so that negative outcomes associated with relocation can be prevented through tailored interventions.

The Role of Positive Cognitions in Egyptian Elders’ Relocation Adjustment

Relocation is a major life event for elders and it has been found to adversely affect their adjustment. Resilience theory suggests that adverse effects can be minimized if elders have positive cognitions. In addition, research has shown that positive cognitions are related to independence and healthy, productive lifestyles in older adults. Yet no studies have determined whether the relationship between relocation and adjustment is mediated or moderated by positive cognitions. This study examined these relationships in a sample of 94 cognitively intact elders (aged 60+ years) who had relocated to retirement communities in Alexandria, Egypt. Results showed that relocation controllability had direct effects on positive cognitions and on relocation adjustment. Positive cognitions had a moderating and a partial mediating effect on the relationship between relocation controllability and relocation adjustment. These findings suggest that it is imperative to develop interventions to enhance positive thinking for elders facing the need to relocate.

Predictors of adjustment to nursing home life of elderly residents: a cross-sectional survey

BACKGROUND

Adjustment to a nursing home by elderly residents is an issue in transitional care in nursing homes. Although research on relocation adjustment has been conducted in many countries, adjustment has generally been measured with life satisfaction scales, assuming equivalence between life satisfaction and successful adjustment. Research has not been reported on adjustment to relocation using an adjustment scale.

OBJECTIVES

To identify predictors of nursing home life adjustment.

DESIGN

Descriptive study with cross-sectional surveys.

PARTICIPANTS AND SETTING

One hundred fifty-six residents from seven nursing homes completely subsidized by the South Korea government.

METHODS

A structured questionnaire about resident characteristics, relocation characteristics, social support and general facility satisfaction was administered. The facility characteristics were obtained from the facility records. A scale of nursing home adjustment was also used during one-on-one interviews. Multiple regression was used to identify predictors of adjustment to the nursing home life for elderly residents.

RESULTS

The predictors of nursing home adjustment were self-efficacy, self-reported health, preconception about nursing homes, emotional support from staff and other residents, family satisfaction and general satisfaction with the facility. The total explained variance for this model was 60.6%.

CONCLUSIONS

Nursing home staff should consider the following four factors in assisting the elderly achieve successful adjustment to a nursing home: residents, relocation, social support and facilities. Social support inside the facility should be fostered to improve nursing home adjustment. Further studies are needed to explore adjustment using a nursing home adjustment scale.

Reasons for Relocation to Retirement Communities

The purpose of this qualitative study is to understand the reasons why elders move to retirement communities and what living in retirement communities is like from the perspective of relocated elders. Several themes emerged following qualitative analysis. The themes reflect three categories, labeled as “pushing” factors, “pulling” factors, and “overlapping” factors. Pushing factors included own or spouse's failing health, getting rid of responsibilities, not helped, facility closed out, and loneliness. Pulling factors were location, familiarity and reputation of the facility, security, and joining friends. The third category reflected both pushing and pulling factors, which overlapped and constituted their reason for moving. The findings help to inform the planning of tailored interventions to address elders' special needs or concerns associated with relocation.

Maintaining continuity of care for nursing home residents: effect of states' Medicaid bed-hold policies and reimbursement rates

OBJECTIVE

Recent public concern in response to states' intended repeal of Medicaid bed-hold policies and report of their association with higher hospitalization rates prompts examination of these policies in ensuring continuity of care within the broader context of Medicaid policies.

DATA SOURCES/STUDY DESIGN

Minimum Data Set assessments of long-stay nursing home residents in April-June 2000 linked to Medicare claims enabled tracking residents' hospitalizations during the ensuing 5 months and determining hospital discharge destination. Multinomial multilevel models estimated the effect of state policies on discharge destination controlling for resident, hospitalization, nursing home, and market characteristics.

RESULTS

Among 77,955 hospitalizations, 5,797 (7.4 percent) were not discharged back to the baseline nursing home. Bed-hold policies were associated with lower odds of transfer to another nursing home (AOR=0.55, 95 percent CI 0.52-0.58) and higher odds of hospitalization (AOR=1.36), translating to 9.5 fewer nursing home transfers and 77.9 more hospitalizations per 1,000 residents annually, and costing Medicaid programs about $201,311. Higher Medicaid reimbursement rates were associated with lower odds of transfer.

CONCLUSIONS

Bed-hold policies were associated with greater continuity of NH care; however, their high cost compared with their small impact on transfer but large impact on increased hospitalizations suggests that they may not be effective.

Maintaining continuity of care for nursing home residents: effect of states' Medicaid bed-hold policies and reimbursement rates

OBJECTIVE

Recent public concern in response to states' intended repeal of Medicaid bed-hold policies and report of their association with higher hospitalization rates prompts examination of these policies in ensuring continuity of care within the broader context of Medicaid policies.

DATA SOURCES/STUDY DESIGN

Minimum Data Set assessments of long-stay nursing home residents in April-June 2000 linked to Medicare claims enabled tracking residents' hospitalizations during the ensuing 5 months and determining hospital discharge destination. Multinomial multilevel models estimated the effect of state policies on discharge destination controlling for resident, hospitalization, nursing home, and market characteristics.

RESULTS

Among 77,955 hospitalizations, 5,797 (7.4 percent) were not discharged back to the baseline nursing home. Bed-hold policies were associated with lower odds of transfer to another nursing home (AOR=0.55, 95 percent CI 0.52-0.58) and higher odds of hospitalization (AOR=1.36), translating to 9.5 fewer nursing home transfers and 77.9 more hospitalizations per 1,000 residents annually, and costing Medicaid programs about $201,311. Higher Medicaid reimbursement rates were associated with lower odds of transfer.

CONCLUSIONS

Bed-hold policies were associated with greater continuity of NH care; however, their high cost compared with their small impact on transfer but large impact on increased hospitalizations suggests that they may not be effective.