Determinants of Remaining in the Community After Discharge: Results From New Jersey's Nursing Home Transition Program

Abstract

Purpose: To inform states with nursing home transition programs, we determine what risk factors are associated with participants' long-term readmission to nursing homes within 1 year after discharge. Design and Methods: We obtained administrative data for all 1,354 nursing home residents who were discharged, and we interviewed 628 transitioning through New Jersey's nursing home transition program in 2000. We used the Andersen behavioral model to select predictors of long-term nursing home readmission, and we used Cox proportional hazards regressions to examine the relative risk of experiencing such readmissions. Results: Overall, 72.6% of the 1,354 individuals remained in the community, with 8.6% readmitted to a nursing home for long stays (.90 days) and 18.8% dying during the study year. Cox proportional hazards regression analysis showed that being male, single, and dissatisfied with one's living situation; living with others; and falling within 8 to 10 weeks after discharge were significant predictors of long-term nursing home readmission during the first year after discharge. Implications: Most of the factors predicting long-term readmission were predisposing, not need, factors. This fact points to the limits of formulaic approaches to assessing candidates for discharge and the importance of working with clients to understand and address their particular vulnerabilities. Consumers, state policy makers, nursing home transition staff, discharge planners, and caregivers can use these findings to understand and help clients understand their particular risks and options, and to identify those individuals needing the greatest attention during the transition period as well as risk-specific services such as fall-prevention programs that should be made available to them.

Risk Factors for Inpatient Psychiatric Readmission: Are There Gender Differences?

“…In this model, predisposing factors, such as age, may externally influence readmission, while enabling factors, such as insurance or Community Ment Health J financial status make it possible for readmission to occur. Further, factors of need, such as having severe symptoms, may be necessary for readmission (Chan et al 2008;Howell et al 2007). While the variables in the present study were selected based on previous psychiatric readmission literature, Andersen's model may be useful in understanding why factors such as payer and employment status can be influential to patient readmission, while others, such as age, may be associated with readmission in this population.…”

Successful Strategies for Discharging Medicaid Nursing Home Residents With Mental Health Diagnoses to the Community

“…In terms of risk factors for readmission into NHs within one year of discharge, a study of New Jersey's nursing home transition program identified that 72.6% of participants remained in the community (Howell, Silberberg, Quinn, & Lucas, 2007). This study identified that (1) being male, single, and dissatisfied with one's living situation; (2) living with others; and (3) falling within 8 to 10 weeks after discharge were significant predictors of NH readmission.…”

Home- and Community-Based Services Utilization and Aging in Place

“…Recent development of nursing home transition programs demonstrates that nursing home residents can return to community settings. Through the linkage to HCBS, the nursing home transition program in New Jersey provides information about the full range of long-term care options, and has helped about three quarters of the participants remain in the community during the first year after leaving a nursing home (Howell et al, 2007).…”

“…One such solution is to expand homeand community-based services (HCBS; Golant, 2009). Increasing numbers of older adults-especially the oldest-old (those aged 85 and older) and those aging with disabilities-have created an increasing demand for a broad array of HCBS (Borrayo, Salmon, Polivka, & Dunlop, 2002;Howell, Silberberg, Quinn, & Lucas, 2007). The traditional long-term care that entailed longterm placement in a nursing home institution has given way to transient post-acute and rehabilitation placement, assisted living facilities, and HCBS programs (adult day care, meals-on-wheels, home health care, etc.)…”

“…The traditional long-term care that entailed longterm placement in a nursing home institution has given way to transient post-acute and rehabilitation placement, assisted living facilities, and HCBS programs (adult day care, meals-on-wheels, home health care, etc.) that have become more prevalent and available (Howell et al, 2007). As Baby Boomers age and longevity continues to rise, expansion of HCBS will be needed to meet the increasing service needs among vulnerable older adults for aging in place.…”