Barriers to Nursing Home Discharge: The Effect of Race and Geographic Factors

Background: Implementation findings from the Money Follows the Person demonstration indicate that virtually all state grantees have experienced significant difficulties in transitioning eligible individuals from nursing homes to the community. State efforts typically focus on older adults in nursing homes, yet, working-age adults appear to be at increasing risk for nursing home use. Miller found rates of use to decline for adults age 65+ in two-thirds of states and the District of Columbia, while increasing among working-age adults age 31-64 in all but two states for the period 2000-2007. Methods: This study uses Cox Proportional Hazard models to examine factors associated with discharge to the community for working-age adults admitted to Maryland nursing homes over a 5-year period. Minimum Data Set data were used to conduct the analyses. Findings: The strongest factors related to discharge to the community were an individual's expressed preference for discharge and perceived support for community discharge. Black working-age adults, who are overrepresented in nursing homes in Maryland, as well as nationally, were less likely to be discharged, as were individuals with a prior residential stay, covered by Medicaid, or admitted with a diagnosis of depressive symptoms or schizophrenia. Significant county-level effects were also observed. Implications: Policy efforts to transition working-age adults will need to focus on community support and psychiatric issues, to facilitate successful community discharge. The role of race and geographic factors, and the comparative effectiveness of strategies to promote discharge, warrant additional investigation, given working-age Blacks' significant over-representation in nursing homes.