Everyone’s Talking About It, But Does It Work? Nursing Home Diversion and Transition

Abstract

In response to increasing Medicaid expenditures and consumer preferences, states are reforming their long-term care systems to provide more community-based services. One popular reform is renewed efforts to prevent unnecessary long-term nursing home placement (diversion) and to provide nursing home residents an opportunity to return to the community (transition). Nearly 3,800 individuals, 60 years old and older, participated in Ohio's statewide nursing home diversion and transition initiative between March 2010 and May 2011. This research tracked outcomes for consumers and evaluated the implementation of the new program. Nearly 80% of diversion and transition participants who were still living at the time of their 6-month follow-up were residing in the community. An agency-level process analysis revealed innovative intervention strategies, promising practices, and barriers. Process results found that Area Agencies on Aging (AAAs) have become more proactive in working with high-risk individuals, with agencies identifying new at-risk consumers through hospital and nursing home interventions.

Factors affecting residents transition from long term care facilities to the community: a scoping review

“…The study designs employed predominantly quantitative techniques [ 26 , 28 – 30 , 32 – 38 , 40 , 42 – 57 , 60 ]. Research in this area represents a new and emerging field where over half of the included articles (22/36) were published in the last 5 years [ 26 , 28 , 29 , 31 , 35 – 38 , 41 – 45 , 47 – 50 , 52 , 54 – 56 , 60 ] (Fig. 2 ).…”

“…Authors’ background and type of institution varied across studies. Single academic institutional authorship was most prevalent (21/36) [ 26 – 28 , 30 – 34 , 36 , 41 , 44 , 48 , 51 – 55 , 57 , 58 , 60 , 61 ], of which five also included author partners from community locations such as hospitals and LTCFs [ 33 , 34 , 51 , 56 , 60 ] and five included research institutes, centres for aging, and non-profit partners [ 28 , 30 , 31 , 36 , 52 ]. Just over one-third of articles (14/36) were inter-institutional collaboration [ 29 , 35 , 37 , 38 , 40 , 42 , 43 , 45 – 47 , 50 , 51 , 56 , 59 ] of which six included additional community and research institutional partners [ 29 , 37 , 46 , 49 , 50 , 56 ] and four were multi-national collaborations [ 35 , 40 , 43 , 46 ].…”

Disability and Care Needs Among Older Americans

“…Past research also has established that unmet need leads to other negative outcomes, such as falls, hospitalizations, and emergency room use . In light of the focus on shifting public benefits from nursing homes to community settings, further investigation is needed to better understand how care networks and settings affect unmet need and what policies might be proposed to address such risks.…”

Assessing the impact of Minnesota's return to community initiative for newly admitted nursing home residents

“…The research literature although diverse is insufficiently robust to answer the most pressing research questions . A primary focus of prior research has been the effectiveness of the program in keeping individuals in the community after nursing home discharge, and in examining outcomes such as hospitalization, readmission, and mortality . Less attention has been given to the question further upstream that influences the interpretation of postdischarge outcomes.…”

“…in examining outcomes such as hospitalization, readmission, and mortality. [10][11][12][13][14] Less attention has been given to the question further upstream that influences the interpretation of postdischarge outcomes. Would transitioned residents have left the nursing home without the program?…”