TRANSITIONS ACROSS VARIOUS CONTINUING CARE SETTINGS

Purpose: to compare cross-nationally the sources and rates of admissio n and discharge in nursing homes. Methods: data on admission were used from the Minimum Data Set of the Resident Assessment Instrument as co llected in a multi-nation database at the University of Michigan. Addi tional data containing longitudinal episodes were used from databases in the Netherlands, Switzerland and the USA. Results: the sources and rates of admission and discharge in nursing homes vary widely between countries. In Japan 47.5% of the sample was admitted from another long -term care setting, in Italy and the USA 36% and 42% respectively were admitted directly from hospital, while in Denmark and Iceland more th an 60% came from home. The longitudinal data show that in the Netherla nds, residents' return to home was much more likely than in Geneva or the USA (27% vs 5% vs 10%) and that in the USA a relatively large numb er of nursing home residents (>45%) was discharged (intermittently) to a hospital within 180 days after first admission as compared to the N etherlands (10%). Conclusions: there are large differences between cou ntries in admission and discharge to and from nursing homes. Various p olicies, payment schemes, care patterns and routine referrals influenc e this and can be studied with cross-national data now available.