Health Care Transition in Small Adult Care Homes

Background and Purpose: Health care transitions are an issue of national concern. The elderly are particularly vulnerable to frequent health care transitions and represent the largest population at risk for rehospitalization, emergency room use, and medication errors resulting from poor care transitions. Small community-based adult care homes are an integral part of the care continuum, yet investigation into health care transition in this setting is scant. Research on health care transition to date has been focused on medical settings (hospitals, home health agencies, skilled nursing facilities) to the exclusion of this provider group suggesting they may be marginalized within this health care continuum. Investigation into the small community-based care home process of obtaining health care information during hospital transition is critical for understanding the unique challenges and remediation strategies these providers have in obtaining medical information within the health care continuum. The author will present the results of a qualitative exploratory study of small adult care home owners and their experience with health care transitions.

Methods: Semi-structured in-depth interviews were conducted with eight small care home owners (bed capacity 10 and under) over a four month period from 10/2008-2/2009. The sample was recruited by a series of mailings to a random sample of all licensed care home owners in Maricopa County, AZ. Interested care home owners who had a resident hospitalized within the preceding 6 months completed and returned informed consent forms in order to participate. Transcriptions of the interviews were analyzed using the qualitative software ATLAS.ti. Grounded theory methodology was employed to analyze care home owners experiences and processes with health care transition.

Results: Findings indicate no standardized process for care transition with this provider group. Instead, owners develop unique proactive strategies, including development of their own forms, direct in-person contact, family bonding, and relationship building with medical providers to mediate the exchange of health care information. Owners who are more proactive in the development of these strategies report obtaining better and timelier health care information. Factors found to impact owner's utilization of these strategies include length of time in the business and having a medical background.

Conclusions and Implications: This study provides new information to social workers about how small adult care home owners obtain health care information upon resident discharge and admission to a hospital. The findings of this study highlight the challenges and potential areas for remediation with health care transition for case managers and discharge planners working with these settings in the community. Additionally, the results of this study suggest the need for increased training of new care home owners and increased education to medical providers of the rules and regulations that govern their adult care homes locally.