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Explaining Transfers from Home and Community Based Waiver Program to Nursing Home: Can Patients Stay at Home?
Midwest Nursing Research Society (2011)
  • Sandra Spoelstra, Grand Valley State University
Purpose Among6,836 medically and economically vulnerable older persons enrolled in a Home and Community Based Waiver (HCBW) program between 2003 and 2007 we compare those who remain at home with those who transfer to a nursing home (NH).
Background NHs is costly, averaging over $70,000 per year. Beyond escalating financial concerns, there are a constellation of potentially negative outcomes associated with NH admission, and most older adults prefer to remain in their homes but are forced to transfer to NHs because community supports are inadequate to meet their needs.
Methods Those who remained at home (4343) and NH transfers (2493) were compared according to: socio-demographics, physical function, cognitive status, caregiver support, living arrangement, and service utilization. Data were obtained from the Minimum Data Set-Home Care and claims. Multiple linear logistic regression models were used.
Results Mean age of the sample was 76.4 years; with 62% being 76 years of age or older, (75%) were White (70%) female, (35%) widowed and 97% reported having a primary caregiver at the first assessment. Sex and race/ethnicity did not influence NH transfer, however Caucasians had a higher rate of NH transfer. The most impact factors predicating transfers to NH were age, patient or caregiver expressing preference for another living arrangement, ADL deterioration and whether or not persons received increases in home services. The highest risk group  for NH transfer are aged 76+, who deteriorated in ADL’s, preferred another  living arrangement, and experienced  no increase  in their home  services; 43 out of 54 (80%) of this group, albeit small, transferred to a NH.
Implications for Gerontological Nursing Awareness of important thresholds for NH transfer may inform older adults, their caregivers, and, most importantly, service providers prior to a potential admission event. Earlier intervention as these important thresholds arise may also prompt the mobilization of community-based resources or clinical services to forestall NH transfer.
Publication Date
Spring 2011
Citation Information
Sandra Spoelstra. "Explaining Transfers from Home and Community Based Waiver Program to Nursing Home: Can Patients Stay at Home?" Midwest Nursing Research Society (2011)
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