Nursing Home Characteristics Associated with Resident Transfers to Emergency Departments

Abstract

This study examined how nursing home facility ownership and organizational characteristics relate to emergency department (ED) transfer rates. The sample included a retrospective cohort of nursing home residents in the Vancouver Coastal Health region (n = 13,140). Rates of ED transfers were compared between nursing home ownership types. Administrative data were further linked to survey-derived data of facility organizational characteristics for exploratory analysis. Crude ED transfer rates (transfers/100 resident years) were 69, 70, and 51, respectively, in for-profit, non-profit, and publicly owned facilities. Controlling for sex and age, public ownership was associated with lower ED transfer rates compared to for-profit and non-profit ownership. Results showed that higher total direct-care nursing hours per resident day, and presence of allied health staff--disproportionately present in publicly owned facilities--were associated with lower transfer rates. A number of other facility organizational characteristics--unrelated to ownership--were also associated with transfer rates.

The Institutional Practice

“…Similarly, findings indicate that for-profit nursing homes hospitalize their residents more often than non-profit nursing homes (Anderson et al 1998, Carter 2003a, Carter & Porell 2003, Konetzka et al 2004, OIG 2013, McGregor et al 2014, Zimmerman et al 2002. A majority, but not all, of chain-affiliated homes are for-profit, hence the division.…”

“…Nursing home size: In many of the research articles nursing home size is said to be more directly correlated to rates of hospitalization (Anderson et al 1998, Barker et al 1994, McGregor et al 2014, OIG 2013; larger nursing homes hospitalize more often than smaller ones. Research articles that analyze a variety of facility specific factors and their respective effect on rates of hospitalization, of which there are several, usually highlight size as the factor with the highest correlation.…”

“…The effect of the number of nurses employed on hospitalization is especially debated. Some state that increasing the number of registered nurses (RNs) decreases hospitalization (Anderson et al 1998, Anderson et al 2003, Carter 2003b, Carter & Porell 2005, Decker 2006, Decker 2008, McGregor et al 2014 or «deficiencies» (Harrington et al 2000), especially if the alternative is licensed practical nurses (LPNs), licensed vocational nurses (LVNs) or similar categories (Anderson 1 See Kayser-Jones´ groundbreaking ethnographic study (1990) for an in-depth analysis of systemic and everyday effects of for-profit ownership, regarding, among other issues, incentives connected to accountability. 2 While prevalent in many countries, advanced directives are not common in Norway.…”

The role of the nurse practitioner in promoting a reduction in the causes and outcomes of problematic polypharmacy among nursing home residents in British Columbia

“…Adverse resident outcomes caused by problematic polypharamacy also increase the use of emergency departments and resulting hospitalizations (McGregor et al, 2014). These consequences are preventable and can be reduced with ongoing and persistent interventions that address problematic polypharmacy among nursing home residents.…”

“…Not-for-profit facilities in BC also demonstrate lower hospital transfer rates (McGregor et al, 2014). Lower hospital transfer rates may be facilitated in not-for-profit facilities by providing more time on direct resident care (McGregor et al, 2005), and connections and collaboration with acute care hospitals and health authorities (McGrail et al, 2007).…”