Effect of forced transitions on the most functionally impaired nursing home residents

Abstract

OBJECTIVES:
To examine the hospitalization rate and mortality associated with forced mass transfer of nursing home (NH) residents with the highest levels of functional impairment.

DESIGN:
Retrospective cohort study.

SETTING:
One hundred nineteen Texas and Louisiana NHs identified as being at risk for evacuation for Hurricane Gustav.

PARTICIPANTS:
Six thousand four hundred sixty-four long-stay residents residing in at-risk NHs for at least three consecutive months before landfall of Hurricane Gustav.

MEASUREMENTS:
Using Medicare claims and instrumental variable analysis, the mortality (death at 30 and 90 days) and hospitalization rates (at 30 and 90 days) of the most functionally impaired long-stay residents who were evacuated for Hurricane Gustav were compared with those of the most functionally impaired residents who did not evacuate.

RESULTS:
The effect of evacuation was associated with 8% more hospitalizations by 30 and 90 days for the most functionally impaired residents. Evacuation was not significantly related to mortality.

CONCLUSION:
The most functionally impaired NH residents experience more hospitalizations but not mortality as a consequence of forced mass transfer. With the inevitability of NH evacuations for many different reasons, harm mitigation strategies focused on the most impaired residents are needed.