THE IMPACT OF THE CLOSING OF 3 MASSACHUSETTS PUBLIC CHRONIC DISEASE HOSPITALS - A MULTIDIMENSIONAL PERSPECTIVE

The closing of three public chronic disease hospitals in Massachusetts in 1991 as a cost-cutting measure sparked renewed attention to the co nsequences of relocation. Massachusetts officials faithfully carried o ut a series of measures to assure that patients would be transferred t o facilities providing high quality care and that the relocation proce ss would be highly sensitive to patient needs. A survey of family repr esentatives revealed that both the relocation process and the outcome tended to be perceived positively. Quasi-experimental studies of healt h and survival outcomes, however, provided less favorable results. On two of three measures of health change, relocation was found to have n o effect. However, relocation was found to increase the likelihood of incontinence. For patients at the hospital with the greatest concentra tion of older patients, relocation lead to heightened mortality rates. Also disappointing for State officials was the fact that the anticipa ted cost savings were less than anticipated. The findings point to the need for renewed efforts to understand the circumstances when relocat ion places institutionalized older people at serious risk, more carefu l cost estimates of the savings to be achieved through proposed cost-s aving policy changes, and more carefully formulated policy guidelines for relocation of the institutionalized elderly that balance the risks associated with relocation against other public policy objectives.