Housing and Assisted Living Issues for Non-Medicaid Nursing Home Residents Returning to the Community

Heather Davila; Rosalie Kane; Tetyana Shippee; Kathleen Abrahamson

Since 2010, Minnesota's statewide Return to the Community Initiative (RTCI) has provided transition services to non-Medicaid nursing home residents, about 20% of whom were discharged to an assisted living setting. This article reflects on experiences and challenges of private-pay consumers during and after a nursing home stay insofar as they intersect with assisted living and other seniors housing providers. Qualitative data on RTCI, collected over three years, had three components: 1) interviews of RTCI program staff; 2) interviews with nursing home discharge personnel; and 3) case studies. The latter include 30 memorable cases described by RTCI's community living specialists and 24 multiperspective case studies for which the authors interviewed consumers, family members, community living specialists, and others integral to a specific consumer discharge. Interviews were taped and transcribed, and multiple coders identified themes. For this article, the authors analyzed qualitative data from all data sources to identify themes regarding the seniors housing experiences of non-Medicaid seniors and their families. This analysis identifies issues raised by community living specialists but is not an evaluation of RTCI activities or outcomes. Searches for group residential settings were labor intensive and stressful, and exploring options was arduous. Information about this sector, especially small family homes, changes rapidly. Seniors and their families misunderstand the various service levels-even those where they were living-and could conclude, wrongly, that independent living or assisted living was inappropriate and unsafe for them. Professional advisors in nursing homes and family doctors similarly conveyed erroneous information. Professionals often invoked vaguely worded but intensely-felt safety concerns as reasons not to try assisted living or deem an assisted living setting no longer workable. Information supplied by the nursing home was often incorrect or outdated. A subset of the consumers experienced many moves among assisted living settings within periods of a year or two, sometimes punctuated by hospitalizations and additional nursing home stays. The authors identify practice implications for transition advisors and seniors housing providers of many types: nursing homes, assisted living, independent living, and multilevel. They offer provider tips related to clarifying information about their settings, communication with nursing homes, and move-in practices. Also, local collaborative groups of housing providers and other stakeholders (e.g., consumer groups, home care providers, advocates, physicians, municipal officials) could examine gaps, barriers, and possible solutions, and together get beyond vague terms like "need for 24- hour care," to develop a fresh and shared understanding of consumer safety, risk-taking, and choice.

Housing and Assisted Living Issues for Non-Medicaid Nursing Home Residents Returning to the Community

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