Transfer Trauma: Does Moving Between Nursing Homes Increase Hospitalization and Mortality?

Transfer trauma, defined as the negative consequences of moving from one environment to another, can affect some long-term nursing home (NH) residents who are relocated between facilities. However, it remains unclear whether such transfers are associated with serious acute health risks, such as hospitalization or death, and whether these outcomes should be considered indicators of transfer trauma.

We conducted a retrospective cohort study to determine whether long-term NH residents who experience a transfer are at greater risk for hospitalization or death compared to residents who remain in the same facility. We used a 20% national Medicare sample linked to minimum data set (MDS) assessments. Long-term NH residents who underwent a NH-to-NH transfer in 2019 were matched 1:1 with residents from the same facility in the same calendar month who did not transfer. Outcomes were hospitalization and death within 90 days following the transfer. We used conditional logistic regression models, adjusted for demographic variables, dual enrollment status, activities of daily living, cognitive function, and comorbidity scores to assess the association of transfer with outcomes.

A total of 1375 matched resident pairs (n = 2750) were analyzed. The number of hospitalizations did not differ between the transfer and non-transfer groups (173 vs. 160, respectively; p = 0.45). Ninety-day mortality also did not differ between the two groups; however, exact death counts are not reported in accordance with CMS small cell suppression rules. In adjusted analysis, transfer status was not associated with higher odds of 90-day hospitalization (OR = 1.18 [95% CI: 0.91, 1.53]) or death (OR = 1.58 [95% CI: 0.27, 9.40]).

Among long-term NH residents, transfer to another NH was not associated with a higher risk of hospitalization or mortality within 90 days post-transfer. These findings suggest that NH-to-NH transfers, when necessary, may not inherently increase severe acute health risks for this population.