Transfers among Vulnerable Long-Term Nursing Home Residents

Abstract

Objectives: To determine whether the risk of nursing home-to-nursing home transfer is higher among long-term nursing home residents with intellectual and developmental disabilities (IDD), or serious mental illness (SMI), and/or Alzheimer's disease and related dementias (ADRD), relative to residents without these clinical diagnoses, and to assess the factors associated with transfer overall and for residents with these diagnoses.

Design: Cross-sectional cohort study of nursing home residents in 2019.

Setting and participants: Michigan long-term nursing home residents identified from the Minimum Data Set.

Methods: Residents who had a nursing home-to-nursing home transfer were allocated into 5 groups: IDD, SMI and ADRD, ADRD, SMI, and all others. We examined transfer rates for each group. We assessed the odds of transfer for each group, adjusting for resident and nursing home characteristics, and behavioral issue and clinical indicators. We used stratified logistic regression to determine factors associated with transfers within each group.

Results: Among 37,638 long-term nursing home residents, 2.3% had a nursing home-to-nursing home transfer. Transfers varied across diagnosis groups: 1.9% in IDD, 2.8% in SMI and ADRD, 1.9% in ADRD, 2.6% in SMI, and 2.5% in all others. After adjustment, residents in the SMI and ADRD group were 39% more likely to transfer than those in the all others group (adjusted odds ratio, 1.39; 95% CI, 1.14-1.68). Aged ≥75 years, moderate to severe cognitive impairment, and falls were associated with a lower odds of transfer. Being married and wandering were associated with a higher odds of transfer. Factors associated with transfers varied within each group.

Conclusions and implications: Among Michigan long-term nursing home residents, residents with both SMI and ADRD are at the highest risk for transfer to another nursing home when compared with residents with SMI or ADRD alone and with IDD and none of these diagnoses. Understanding the drivers of transfer of this vulnerable group warrants further investigation.

Keywords: Nursing home; dementia; intellectual and developmental disabilities; serious mental illness; transfers.