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Transfers between nursing homes are fairly common, but barriers to transfer exist for some patients

The choice of a nursing home for a loved one may not be forever, according to a new study. In fact, nursing home residents often transfer to another nursing home at some point, primarily to receive different services or better care. However, barriers to transfer can prevent patients from moving, even when their health and family situations have changed.

Often, the choice of a nursing home is constrained by financial circumstances or the need to place the individual immediately. Also, even if the initial choice of nursing home is optimal, this may change as the individual's circumstances require more, fewer, or different specialized services. Given the growing specialization of nursing homes, it is becoming increasingly likely that some facilities are better able than others to provide particular services for certain residents.

However, having a less generous payment source (like Medicaid), having health limitations, and not having a spouse (who can advocate for transfers) may pose barriers to residents who want to transfer to another nursing home, according to a recent study of all Maine and New York nursing home residents. The study was supported by the Agency for Healthcare Research and Quality (HS10118).

Richard A. Hirth, Ph.D., and his University of Michigan colleagues examined both the rate of home-to-home transfers and resident characteristics associated with the likelihood of transfer to gain insight into the constraints faced by residents and their families as they search for suitable care. The researchers analyzed a computerized database of nursing home assessments for residents in Maine and New York during 1994 through 1996 and the On-Line Survey Certification and Reporting System (OSCAR) files on nursing facility information for 1994-1996. They identified transfers by locating individuals with assessments in multiple facilities.

After omitting (censoring) data on patients who died or were discharged to the community without a rapid return to nursing home care, Maine's transfer rates were consistently higher than New York's; only 61 percent of Maine's nursing home residents did not transfer within 5 years of admission versus 82 percent in New York. Transfers were most likely to occur during the first 6 months after admission in both States. Transfer rates declined during the first 3 years after admission and remained stable thereafter.

Correlates of transfers were similar across States. For instance, residents who transferred were more likely to be male, married, younger, and have better cognitive and physical health. They also were more apt to have Medicare or private payment sources (versus Medicaid) and to have pressure ulcers (which may have led them to pursue better care elsewhere).

For more information, see "Nursing home-to-nursing home transfers: Prevalence, time pattern, and resident correlates," by Dr. Hirth, Jane C. Banaszak-Holl, Ph.D., and John F. McCarthy, M.P.H., in the June 2000 Medical Care 38, pp. 660-669.

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