Objectives
To determine the effect of a Social Health Maintenance Organization (S/HMO) on diverting
older adults admitted into a nursing facility from converting to long-stay placement.
Design
Members of the SCAN S/HMO and those in Medicare Fee-For-Service were compared on successful
discharge to the community after being admitted to nursing facilities between January
1, 2001, and December 31, 2003.
Setting
Skilled nursing facilities in 4 counties in Southern California (Los Angeles, Orange,
San Bernardino, Riverside).
Participants
Data (N = 4635) were extracted from Minimum Data Set (MDS) 2.0 records for nursing
facility residents in the S/HMO or the Medicare Fee-for-Service 5% sample who were
aged 65 and older with an episode of care greater than 14 days.
Measurements
Predisposing, enabling, and need measures were used to predict successful discharge
to the community within 90 days.
Results
After controlling for selected sociodemographics, comorbidities, behavioral issues,
mental health conditions, and other risk factors, being enrolled in the S/HMO increased
the likelihood of successful discharge by 26%.
Conclusion
With systemic increases in short-stay patients, research on diversion must look past
the avoidance of unnecessary entry to nursing facilities, to the successful transition
of short-stay residents to the community. As described in this study, the S/HMO model
is an important but largely unaddressed method of avoiding the conversion to long-stay.
Keywords
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Article info
Publication history
Published online: April 05, 2010
Footnotes
This research was supported in part by the National Institute on Aging T32 AG000037 and the data were made available through funding from SCAN Health Plan.
Identification
Copyright
© 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
