Transitions to the Community: A Survey of Former Nursing Home Residents Discharged After Community Choice Counseling
EXECUTIVE SUMMARY
OVERVIEW
As part of its evaluation of the New Jersey Senior Initiatives, Rutgers Center for State Health Policy is conducting an evaluation of the Community Choice Counseling Program. An expansion of a pilot project in 1999, this report reflects the findings from the first four months (January 1st and April 30, 2000) of a one-year project. The study entails a telephone survey of all clients who had been counseled through New Jersey's Community Choice Counseling (CCC) program and subsequently discharged. The purpose of the study is to examine the former nursing home residents in terms of their:
• Current living situation
• Use of informal and formal assistance and service deficiencies
• Selected health episodes
• Quality of life, and
• Experience with the CCC program and the transition out of the nursing home
METHODS
The sampling frame consisted of 735 potential respondents discharged from nursing homes between January 1, 2000 and April 30, 2000. We were able to contact and complete surveys with 357 of 587 eligible clients or their proxies, yielding a 61 percent response rate. 1 The survey was administered by telephone and generally lasted 20 minutes. The original questionnaire was developed with input from Community Choice counselors and other program staff, the Advisory Committee of the Senior Initiatives Evaluation, Center for State Health Policy staff and an external reviewer with expertise in long-term care. After pilot testing this instrument in the fall of 1999 with 107 clients, we amended the questionnaire to include more information about quality of life issues, preventive health measures, and more detailed information about selected health episodes.
CONCLUSION
Most former nursing home residents are very satisfied with their current living situation. For the most part, they are receiving the services they need, and have an improved quality of life. Moreover, the Community Choice Counselors (and the program, in general) seem to support and help in the nursing home residents' return to the community. Although the program seems successful from the clients' perspectives, three major conclusions and/or recommendations are:
• Caution should be exercised as to whom is deemed eligible for discharge,
• Clients and their families should be clear as to the level of resources available in the community,
• Clients and their families should be educated to note changes in the client's situation that may warrant a re-examination of whether their setting is the most appropriate.
• While the average client reported about six medications. some reported many more. Efforts to monitor for potentially problematic drug interactions or overusage should be continued in the community.
• Although a significant minority expressed some form of unmet need, the overwhelming majority were satisfied with their current living situation and felt they could do more activities that increased their enjoyment of life.
In conclusion, the Community Choice Counseling program seems to be successfully assisting nursing home seniors return to the community with the appropriate set of services. More importantly, seniors are benefiting from an enhanced quality of life.