Conversion diversion: participation in a social HMO reduces the likelihood of converting from short-stay to long-stay nursing facility placement

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.