Nursing home involuntary relocation: clinical outcomes and perceptions of residents and families.

摘要

OBJECTIVES: To examine the physical and mental health characteristics of 120 residents 3 months following their discharge from 1 transferring nursing home to 23 facilities, to compare these characteristics to their pre-transfer status, and to describe resident and family perceptions of the transfer. DESIGN: Secondary analysis of a longitudinal, prospective quasi-experimental intervention and a qualitative description of resident and family views. SETTING: The setting was 23 nursing homes in the Philadelphia metropolitan area. PARTICIPANTS: Participants included 120 nursing home residents and 56 family members. MEASUREMENTS: Minimum Data Set (MDS) and data from the Centers for Medicare and Medicaid Services (CMS) Nursing Home Compare Web site RESULTS: There was a statistically significant increase in the number of residents who fell during the post-transfer (76.9%) compared to the pre-transfer (51.2%) period (P = .0001): 76.3% of those with a history of falling prior to transfer fell during the post-transfer period while 77.4% of those without a history of falling prior to transfer fell. Residents were 3.78 times more likely to fall if they required more than supervision while walking (95% confidence interval [CI] 1.57-9.06) and 2.65 times more likely if they required more than supervision while transferring (95% CI 1.09-6.44). Logistic regression demonstrated that the mobility was also associated with falls (odds ratio 1.15, 95% CI 1.05-1.26). Residents did not demonstrate any other significant physical or mental health changes during the 3 months following the involuntary transfer when compared with their pre-transfer status. Residents and family members clearly voiced their dismay over the process of involuntary relocation. CONCLUSION: Relocation is a stressful event; however, a move to a higher quality care environment does not result in any significant physical or mental health changes. The high incidence of falls post-transfer in both those with and without a fall history points to the need for extra fall precautions in newly admitted residents. In particular, frequent reorientation reminders for the cognitively intact and a high level of staff surveillance for all new residents is indicated during the first few weeks of admission.