FUNCTIONAL AND RESIDENTIAL STATUS TRANSITIONS AMONG NURSING-HOME RESIDENTS

Background. The present study examines transitions in the functional s tatus and discharge destination of new nursing home admissions who rem ain at least 100 days, and ascertains baseline covariates associated w ith transition patterns.Methods. Using a fully observed, continuous-ti me Markov chain model for maximum likelihood estimation of probability intensities, transition processes are characterized. The long-stay co hort (n = 9,541) was derived from a sample of elders newly admitted to 48 National Health Corporation (NHC) nursing homes between 1983 and 1 987. Assessment of functional status, using a modified Katz ADL scale, occurred during the first, second, and third months, and the second, third, and fourth quarters after admission. Four types of residential changes (e.g., mortality) were examined for the latter three quarters. Results. While stability was the predominant pattern during the first 90 days in the nursing home, 51.5% of residents experienced a change in function. The probability of change was higher for modest (one leve l) rather than substantial change, and for such change to represent im provement rather than decline. Over 25% of this long-stay sample exite d in the second quarter, 37% of them returning home. The rates for ret urns to home and for mortality were strongly related to functional lev el. Several sociodemographic variables (e.g., age, source of payment), diagnostic indicators (e.g., cancer), and orientation status were con sistently associated with transition rates within functionally homogen eous groups. Conclusions. Overall, findings underscore the heterogenei ty and complexity of transition patterns for a subgroup historically t reated as likely to decline or remain stable, and viewed as ''permanen t'' residents. The model was useful in describing the volatile transit ion process among older long-stayers.