225470 Barriers to Nursing Home Discharge: The Effect of Race and Geographic Factors

Wednesday, November 10, 2010 : 9:30 AM - 9:45 AM

Annette E. Snyder, PhD, MSN, CFNP , The Hilltop Institute at the University of Maryland, Baltimore County, Baltimore, MD
Nancy A. Miller, PhD , Public Policy, University of Maryland Baltimore County, Baltimore, MD
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.

Learning Areas:
Provision of health care to the public
Public health or related research
Social and behavioral sciences

Learning Objectives:
1. Describe strategies that are currently used to identify individuals who will be targeted for discharge. 2. Describe the differential incidence of an array of factors associated with discharge for Black nursing home residents 3. Describe geographical influences on nursing home discharge (rurality, affordable housing, nursing home bed availability, etc.).

Keywords: Nursing Homes, Long-Term Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have conducted the research on which I am presenting and am thoroughly aware of the recent, relevant literature on the issue.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.