Hospitalization and death after nursing home-to-nursing home transfer

TL;DR

This study found that moving nursing home residents to another facility does not increase their risk of hospitalization or death within 90 days.

Contribution

The study provides new evidence that NH-to-NH transfers are not inherently linked to worse health outcomes for long-term residents.

Findings

Hospitalization rates were similar between transferred and non-transferred residents.

Mortality rates did not significantly differ after adjusting for resident characteristics.

Transfers were not associated with increased acute health risks when resident factors were considered.

Abstract

Although some nursing home (NH)-to-NH transfers have been associated with negative outcomes, it is unclear whether they are associated with a higher risk of hospitalization/death among long-term NH residents. Paired cohort analysis was used to evaluate whether long-term residents who experience a transfer are at greater risk for hospitalization or death compared to residents who remain in the same facility. Data: 20% national Minimum Data Set (MDS) assessments linked to Medicare claims. Long-term NH residents who underwent a NH-to-NH transfer in 2019 were matched 1:1 with residents who did not transfer—matching variables included residing in the same NH and month. The primary outcomes were acute care hospitalization and all-cause death within 90 days following the transfer. A total of 1,595 matched resident pairs were analyzed. Hospitalization rates (127.9 vs 126.6 per 1000 residents, p = 0.92) and all-cause mortality (9.4 vs 13.2 per 1000 residents, p = 0.32) did not differ between the transfer and non-transfer groups. After adjusting for demographics (age, sex, race/ethnicity, marital status), dual eligibility status, activities of daily living (ADL) scores, cognitive function scores (CFS) and comorbidity scores, transfer status was not associated with a higher risk of 90-day hospitalization (RR = 0.99; 95%CI [0.82-1.19]) or death (RR = 1.40; 95%CI [0.72-2.72]). Among long-term NH residents, transfer to another NH was not associated with a higher risk of hospitalization or mortality within 90 days post-transfer, after accounting for resident characteristics and comorbidities. These findings suggest that NH-to-NH transfer when necessary, may not inherently increase acute health risks for this population.