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Forced relocation between nursing homes: residents' health outcomes and potential moderators

Published online by Cambridge University Press:  19 October 2012

Jacquetta M Holder*
Personal Social Services Research Unit, The University of Kent, Canterbury
David Jolley
Personal Social Services Research Unit, The University of Manchester, Manchester, UK
Address for correspondence: Dr Jacquetta Holder, Personal Social Services Research Unit, University of Kent, Canterbury CT2 7NF, UK. Email:


That transfer of older people from one institution to another is detrimental to well-being, health and survival has been reported for 50 years. This has led to fear, anger and legal challenges when closures occur. Previous reviews identified accounts of relocation followed by adverse outcomes and others where problems were avoided or benefits claimed. This paper reviews the last twelve years of literature on health outcomes following involuntary relocation between nursing homes. Reports of post-move mortality, physical or psychological health suggest and confirm that relocation without preparation carries higher risk of poor outcomes than moves that are orderly and include preparation. The literature on the care home closure process, admissions and individual transfers offers insights into practices that might help minimize adverse outcomes. A number of agencies have produced helpful guidelines. How these are implemented needs to be monitored and linked to in-depth studies of sample closures.

Psychological and social gerontology
Copyright © Cambridge University Press 2012

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1Smith, AE, Crome, P. Relocation mosaic – a review of 40 years of resettlement literature. Rev Clin Gerontol 2000; 10: 8195.CrossRefGoogle Scholar
2Aneshensel, CS, Pearlin, LI, Levy-Storms, L, Schuler, RH. The transition from home to nursing home mortality among people with dementia. J Gerontol B Psychol Sci Soc Sci 2000; 55: S15262.CrossRefGoogle ScholarPubMed
3Laing, W. Care of Elderly People UK Market Survey 2011/12. London: Laing & Buisson, 2012.Google Scholar
4Netten, A, Darton, R, Williams, J. Nursing home closures: effects on capacity and reasons for closure. Age Ageing 2003; 32: 332–37.CrossRefGoogle ScholarPubMed
5Jolley, D, Jefferys, P, Katona, C, Lennon, S. Enforced relocation of older people when Care Homes close: a question of life and death? Age Ageing 2011; 40: 534–37.CrossRefGoogle Scholar
6National Audit Office. Oversight of user choice and provider competition in care markets. HC 1458. Session 2010–2012. London: The Stationery Office, 2011.Google Scholar
7Committee of Public Accounts House of Commons. Oversight of user choice and provider competition in care markets. Fifty-seventh Report of Session 2010–2012. London: The Stationery Office Limited, 2011.Google Scholar
8Shipman, T. Sharks who made a killing out of ‘care’: How City predators destroyed firm caring for 31,000 old people. 2011. Available at: (accessed 7 July 2012).Google Scholar
9Wilson, H. Southern Cross in emergency move to offload 180 homes. 2011. Available at: (accessed 7 July 2012).Google Scholar
10Sutherland, R. Private equity giants filled their boots and walked away. 2011. Available at: (accessed 7 July 2012).Google Scholar
11Riddell, M. The care debacle shows the perils of market solutions to human crisis: so what will Andrew Lansley do now? 2011. Available at: (accessed 14 July 2012).Google Scholar
12Cabinet Office. Open Public Services White Paper. London: HM Government, 2012.Google Scholar
13Department of Health. Oversight of the Social Care Market. Discussion Paper. London: Department of Health, 2011.Google Scholar
14Department of Health. Caring for our future: reforming care and support. White Paper. Cm 8378. London: The Stationery Office, 2012.Google Scholar
15Care Quality Commission. The state of health care and adult social care in England. An overview of key themes in care in 2010/11. HC 1487. London: The Stationery Office, 2011.Google Scholar
16Bäumker, T, Netten, A. Funding: paying for residential care for older people. In Dening, T, Milne, A (eds), Mental Health and Care Homes, pp. 90100. Oxford: Oxford University Press; 2011.Google Scholar
17Comas-Herrera, A, Wittenberg, R, Pickard, L, Knapp, M. Cognitive impairment in older people: future demand for long-term care services and the associated costs. Int J Geriatric Psychiat 2007; 22: 1037–45.CrossRefGoogle ScholarPubMed
18Harrington, C, Carrillo, H, Dowdell, M, Tang, P, Woleslagle Blank, B. Nursing Facilities, Staffing, Residents and Facility Deficiences, 2005 Through 2010. San Francisco: Department of Social Behavioral Sciences, University of California, 2011.Google Scholar
19Organisation for Economic Co-operation and Development. Canada Long Term Care. Paris: OECD, 2011.Google Scholar
20Department of Health and Ageing. Report on the Operation of the Aged Care Act 1997, 2010–2011. Canberra: Australian Government, 2011.Google Scholar
21Lievesley, N, Crosby, G, Bowman, C, with Midwinter, E. The changing role of care homes. London 2011.Google Scholar
22Alzheimer's Society. Dementia UK: a report to Alzheimer's Society by King's College London and the London School of Economics. London: Alzheimer's Society, 2007.Google Scholar
23Thorson, JA, Davis, RE. Relocation of the institutionalized aged. J Clin Psychol 2000; 56: 131–38.3.0.CO;2-S>CrossRefGoogle ScholarPubMed
24Hjaltadóttir, I, Hallbert, IR, Ekwall, AK, Nyberg, P. Predicting mortality of residents at admission to nursing home: A longitudinal cohort study. BMC Health Services Research 2011; 11.CrossRefGoogle ScholarPubMed
25Bebbington, A, Darton, R, Netten, A. Care Homes for Older People: Volume 2. Admissions, Needs and Outcomes. Canterbury: Personal Social Services Research Unit, University of Kent at Canterbury; 2001.Google Scholar
26Forder, J, Fernandez, J-L. Length of stay in care homes. Canterbury: Personal Social Services Research Unit, 2011. Report commissioned by Bupa Care Services. PSSRU Discussion Paper 2769.Google Scholar
27Boockvar, KS, Fridman, B, Marturano, C. Ineffective communication of mental status information during care transfer of older adults. J Gen Intern Med 2005; 20: 1146–50.CrossRefGoogle ScholarPubMed
28Chhabra, PT, Rattinger, GB, Dutcher, SK, Hare, ME, Parsons, KL, Zuckerman, IH. Medication reconciliation during the transition to and from long-term care settings: a systematic review. Res Social Adm Pharm 2012; 8: 6075.CrossRefGoogle ScholarPubMed
29Aminzadeh, F, Dalziel, WB, Molnar, FJ, Garcia, LJ. Symbolic meaning of relocation to a residential care facility for persons with dementia. Aging Mental Health 2009; 13: 487–96.CrossRefGoogle ScholarPubMed
30Davies, S, Nolan, M. ‘Making the move’: relatives’ experiences of the transition to a care home. Health Social Care Commun 2004; 12: 517–26.CrossRefGoogle ScholarPubMed
31Williams, J, Netten, A. English local authority powers, responsibilities and guidelines for managing the care home closure process. Br J Social Work 2005; 35: 924–36.CrossRefGoogle Scholar
32Nay, R. Nursing home residents’ perceptions of relocation. J Clinical Nursing 1995; 4: 319–25.CrossRefGoogle ScholarPubMed
33Morgan, LA, Eckert, JK, Lyon, SM, Mangum, WP. Small board-and-care homes: residential care in transition. Ageing Society 1997; 17: 477–78.Google Scholar
34Peace, S, Kellaher, L, Wilcocks, D. Re-evaluating Residential Care. Buckingham: Open University Press; 1997.Google Scholar
35Nolan, M, Walker, G, Nolan, J, Williams, S, Poland, F, Curran, M, Kent, BC. Entry to care: positive choice or fait accompli? Developing a more proactive nursing response to the needs of older people and their carers. J Advanced Nursing 1996; 24: 265–74.CrossRefGoogle ScholarPubMed
36Nolan, M, Dellasega, C. ‘I really feel I've let him down’: supporting family carers during long-term care placement for elders. J Advanced Nursing 2000; 31: 759–67.CrossRefGoogle ScholarPubMed
37Dellasega, C, Nolan, MR. Admission to care: facilitating role transition amongst family carers. J Clinical Nursing 1997; 6: 443–51.CrossRefGoogle ScholarPubMed
38Reed, J, Morgan, D. Discharging older people from hospital to care homes: implications for nursing. J Advanced Nursing 1999; 29: 819–25.CrossRefGoogle ScholarPubMed
39Ryan, AA, Scullion, HF. Nursing home placement: an exploration of the experiences of family carers. J Advanced Nursing 2000; 32: 1187–95.CrossRefGoogle ScholarPubMed
40Dohrenwend, BS, Dohrenwend, BP (eds). Stressful life events: their nature and effects. New York: Wiley and Son; 1974.Google Scholar
41Boockvar, K, Fishman, E, Kyriacou, CK, Monias, A, Gavi, S, Cortes, T. Adverse events due to discontinuations in drug use and dose changes in patients transferred between acute and long-term care facilities. Arch Intern Med 2004; 164: 545–50.CrossRefGoogle ScholarPubMed
42Crotty, M, Rowett, D, Spurling, L, Giles, LC, Phillips, PA. Does the addition of a pharmacist transition coordinator improve evidence-based medication management and health outcomes in older adults moving from the hospital to a long-term care facility? Results of a randomized, controlled trial. Am J Geriatr Pharmacother 2004; 2: 257–64.CrossRefGoogle ScholarPubMed
43Desai, R, Williams, CE, Greene, SB, Pierson, S, Hansen, RA. Medication errors during patient transitions into nursing homes: characteristics and association with patient harm. Am J Geriatr Pharmacother 2011; 9: 413–22.CrossRefGoogle ScholarPubMed
44Williams, J, Netten, A, Ware, P. Managing the care home closure process: Care managers’ experiences and views. Br J Social Work 2007; 37: 909–24.CrossRefGoogle Scholar
45Castle, NG. Relocation of the elderly. Medical Care Res Review 2001; 58: 291333.CrossRefGoogle ScholarPubMed
46Bourestom, N, Tars, S. Alterations in the patterns following nursing home relocations. Gerontologist 1974; 14: 506–10.CrossRefGoogle Scholar
47Haddad, L. Intra-institutional relocation: Measured impact on geriatric patients. J Am Geriatr Soc 1981; 29: 8688.CrossRefGoogle ScholarPubMed
48Castle, N. Changes in health status subsequent to nursing home closure. Ageing Int 2005; 30: 263–77.CrossRefGoogle Scholar
49Hodgson, N, Freedman, VA, Granger, DA, Erno, A. Biobehavioral correlates of relocation in the frail elderly: salivary cortisol, affect, and cognitive function. J Am Geriatr Soc 2004; 52: 1856–62.CrossRefGoogle ScholarPubMed
50Capezuti, E, Boltz, M, Renz, S, Hoffman, D, Norman, RG. Nursing home involuntary relocation: clinical outcomes and perceptions of residents and families. J Am Med Directors Assoc 2006; 7: 486–92.CrossRefGoogle ScholarPubMed
51Castle, NG, Engberg, JB. The health consequences of relocation for nursing home residents following hurricane Katrina. Res Aging 2011; 33: 661–87.CrossRefGoogle Scholar
52Laughlin, A, Parsons, M, Kosloski, KD, Bergman-Evans, B. Predictors of mortality – following involuntary interinstitutional relocation. J Gerontol Nursing 2007; 33: 2026.Google ScholarPubMed
53Hagen, B, Esther, CA, Ikuta, R, Williams, RJ, Le Navenec, CL, Aho, M. Antipsychotic drug use in Canadian long-term care facilities: prevalence, and patterns following resident relocation. Int Psychogeriatr 2005; 17: 179–93.CrossRefGoogle ScholarPubMed
54Mirotznik, J, Kamp, LL. Cognitive status and relocation stress: a test of the vulnerability hypothesis. Gerontologist 2000; 40: 531–39.CrossRefGoogle Scholar
55Falk, H, Wijk, H, Persson, LO. Frail older persons’ experiences of interinstitutional relocation. Geriatr Nursing 2011; 32: 245–56.CrossRefGoogle ScholarPubMed
56Meehan, T, Robertson, S, Stedman, T, Byrne, G. Outcomes for elderly patients with mental illness following relocation from a stand-alone psychiatric hospital to community-based extended care units. Australian NZ J Psychiat 2004; 38: 948–52.CrossRefGoogle ScholarPubMed
57Mallick, MJ, Whipple, TW. Validity of the nursing diagnosis of relocation stress syndrome. Nursing Res 2000; 49: 97100.CrossRefGoogle ScholarPubMed
58Rahman, A, Applebaum, R. The nursing home Minimum Data Set assessment instrument: manifest functions and unintended consequences – past, present and future. Gerontologist 2009; 49: 727–35.CrossRefGoogle ScholarPubMed
59Medicare. What is Nursing Home Compare? Available at: (accessed 27 June 2012).Google Scholar
60American Health Care Association. What is OSCAR data? Available at: (accessed 24 July 2012).Google Scholar
61Laughlin, A. The impact of involuntary interinstitutional relocation on the physical, psychological, and cognitive functioning of older individuals. Lincoln: University of Nebraska; 2005.Google Scholar
62Parsons, M. The impact of the Eden Alternative on quality of life in nursing home residents. Lincoln: University of Nebraska; 2004.Google Scholar
63Moskowitz, E, McCann, C. Classification of disability in the chronically ill and aging. J Chronic Diseases 1957; 5: 342–46.CrossRefGoogle ScholarPubMed
64Omnibus Budget Reconciliation Act of 1987. Subtitle C. Nursing Home Reform: PL100-203. 1987. Available at: (accessed 24 June 2012).Google Scholar
65Helmes, E, Sapo, C, Short, J. Standardisation and validation of the Multidimensional Observation Scale for Elderly Subjects (MOSES). J Gerontol 1987; 42: 395405.CrossRefGoogle ScholarPubMed
66Mirotznik, J. Does cognitive status moderate the health effects of single-person room transfers on nursing home residents? Gerontologist 2002; 42: 634–42.CrossRefGoogle ScholarPubMed
67Edvardsson, D, Sandman, P, Rasmussen, B. Swedish language Person-Centred Questionnaire – patient version: construction and psychometric evaluation. J Advanced Nursing 2008; 63: 302–9.CrossRefGoogle ScholarPubMed
68Weiner, MF, Martin-Cook, K, Svetlik, DA, Saine, K, Foster, B, Fontaine, CS. The Quality of Life In Late-stage Dementia (QUAL-ID) scale. J Am Med Directors Assoc 2000; 1: 114–16.Google ScholarPubMed
69Falk, H, Persson, L, Wijk, H. A psychometric evaluation of a Swedish version of the Quality of Life In Late-stage Dementia (QUALID) scale. Int Psychogeriatr 2007; 19: 1040–50.CrossRefGoogle ScholarPubMed
70Edberg, A. Assessment by nurses of mood, general behaviour and functional ability in patients with dementia receiving nursing home care. Scand J Caring Sci 2000; 14: 5261.CrossRefGoogle ScholarPubMed
71Folstein, M, Folstein, S, McHugh, P. Mini-Mental-State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–98.CrossRefGoogle ScholarPubMed
72Fleming, R. The psychogeriatric rating scale: a practical tool for assessment, monitoring and programme development. Australian J Aging 1990; 9: 6265.CrossRefGoogle Scholar
73Cohen-Mansfield, J. Agitated behaviours in the elderly: preliminary results in the cognitively deteriorated. JAGS 1986; 34: 722–27.CrossRefGoogle ScholarPubMed
74Flackman, B, Hansebo, G, Kihlgren, A. Struggling to adapt: caring for older persons while under threat of organizational change and termination notice. Nurs Inq 2009; 16: 8291.CrossRefGoogle ScholarPubMed
75Holder, J. Policies and Perspectives on Closing Independent Care Homes for Older People. Unpublished doctoral dissertation. Canterbury: University of Kent; 2008.Google Scholar
76White, C, Seagrave, S. What happens when hospital-based skilled nursing facilities close? A propensity score analysis. Health Services Res 2005; 40: 1883–97.CrossRefGoogle Scholar
77Welsh Assembly Government. Statutory Guidance on Escalating Concerns With, and Closures of, Care Homes Providing Services for Adults. Cardiff: Welsh Assembly Government, 2009.Google Scholar
78Darton, R, Williams, J, Netten, A (eds). Residential and Nursing Home Closures in England: Characteristics of Homes that Closed and the Implications of Closures. [Abstract] The Gerontological Society of America's 56th Annual Scientific Meeting, 21–25 November 2003, San Diego.Google Scholar
79Darton, R, Williams, J, Netten, A. Residential and nursing home closures in England: Characteristics of homes that closed and the implications of closures. Gerontologist 2003; 43: 559.Google Scholar
80Glasby, J, Robinson, S, Allen, K. Achieving Closure: Good practice in supporting older people during residential care closures. Birmingham and London: Health Services Management Centre, University of Birmingham and the Association of Directors of Adult Social Services, in association with the Social Care Institute for Excellence, 2011.Google Scholar
81Social Care Association. Managing Care Home Closure. New Malden: Social Care Association, 2011.Google Scholar
82Scourfield, P. Questions raised for local authorities when old people are evicted from their care homes. Br J Social Work 2004; 34: 501–16.CrossRefGoogle Scholar
83Dubin, S. When the patient suffers: optimization of transitions between care facilities. Geriatr Nurs 2007; 28: 298300.CrossRefGoogle ScholarPubMed
84Coleman, E, Parry, C, Chalmers, S. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med 2006; 166: 1822–28.CrossRefGoogle ScholarPubMed
85Burholt, V, Beech, C, Winter, B. The closure of care homes for older people in Wales: prevalence, process and impact. Health and Social Care Committee Inquiry into residential care for older people. RFS/SC09/09. Swansea: Centre for Innovative Ageing, Swansea University, 2011.Google Scholar
86Davies, S, Sandberg, J, Lundh, U. The Entry to a Nursing Home, Residents’ and Relatives’ Experiences. In Warnes, AM, Warren, L, Nolan, M (editors). pp. 152–70. Care Services for Later Life. London: Jessica Kingsley; 2000.Google Scholar
87Tanner, D. Older people and access to care. Br J Social Work 2003; 33: 499515.CrossRefGoogle Scholar
88Cheek, J, Ballantyne, A, Byers, L, Quan, J. Improving the retirement village to residential aged care transition. Aust Health Rev 2006; 30: 344–52.CrossRefGoogle ScholarPubMed
89Cheek, J, Ballantyne, A. Coping with crisis: how Australian families search for and select an aged care facility for a family member upon discharge from an acute care setting. Contemporary Nurse 2001; 10: 1220.CrossRefGoogle ScholarPubMed
90Cheek, J, Ballantyne, A. Moving them on and in: The process of searching for and selecting an aged care facility. Qualitative Health Res 2001; 11: 221–37.CrossRefGoogle ScholarPubMed
91Parry, C, Coleman, E, Smith, J, Frank, J, Kramer, A. The care transitions intervention: a patient-centered approach to ensuring effective transfers between sites of geriatric care. Home Health Care Services Quarterly 2003; 22: 117.CrossRefGoogle ScholarPubMed
92Johnson, R, Popejoy, LL, Radina, ME. Older adults’ participation in nursing home placement decisions. Clin Nurs Res 2010; 19: 358–75.CrossRefGoogle ScholarPubMed
93Cox, C, Bylina, M, Krogmann, E, Krambeck, H. Facilitating transition from hospital stay to nursing home admission: a hospital-based long-term care ombudsman program. J Gerontol Soc Work 2009; 52: 849–58.CrossRefGoogle ScholarPubMed
94Heliker, D, Scholler-Jaquish, A. Transition of new residents to long-term care: basing practice on residents’ perspective. J Gerontol Nurs 2006; 32: 3442.Google ScholarPubMed
95Kao, HF, Travis, SS, Acton, GJ. Relocation to a long-term care facility: working with patients and families before, during, and after. J Psychosoc Nurs Ment Health Serv 2004; 42: 1016.CrossRefGoogle ScholarPubMed
96Cook, G, Reed, J, Sullivan, A, Burridge, C. Moving In and Moving On: Transition of Older People Between and Within Care Homes. Newcastle upon Tyne: Centre for Care of Older People, University of Northumbria, 2001.Google Scholar
97Lewis, M, Cretin, S, Krane, B. The natural history of nursing home patients. Gerontologist 1985; 25: 382–88.CrossRefGoogle ScholarPubMed
98Hertz, JE, Rossetti, J, Koren, ME, Robertson, JF. Management of relocation in cognitively intact older adults. J Gerontol Nursing 2007; 33: 1218.Google ScholarPubMed
99Coleman, EA, Mahoney, E, Parry, C. Assessing the quality of preparation for posthospital care from the patient's perspective: the care transitions measure. Medical Care 2005; 43: 246–55.CrossRefGoogle ScholarPubMed
100Aminzadeh, F, Dalziel, WB, Molnar, FJ, Garcia, LJ. Meanings, functions, and experiences of living at home for individuals with dementia at the critical point of relocation. J Gerontol Nurs 2010; 36: 2835; quiz 6–7.CrossRefGoogle ScholarPubMed
101Netten, A, Forder, J, Beadle-Brown, Jet al.Adult Social Care Outcomes Toolkit Main Guidance. PSSRU Discussion Paper 2716. Canterbury: Personal Social Services Research Unit, University of Kent, 2010.Google Scholar
102The Information Centre for Health and Social Care. Consultation on Adult Social Care Data Developments: 2012 Short and Long Term Support. London: The Health and Social Care Information Centre, 2012.Google Scholar
103Malley, J, Holder, J, Dodgson, R, Booth, S. Regulating the quality and safety of long-term care in England. In Mor, V, Leone, T, Maresso, A (eds). Regulating Long Term Care Quality: An International Comparison. Cambridge: Cambridge University Press; 2013 (forthcoming).Google Scholar
104Department of Health. Draft Care and Support Bill Cm 8386. London: The Stationery Office, 2012–2013.Google Scholar
105British Geriatrics Society. Quest for Quality. An Inquiry into the Quality of Healthcare Support for Older People in Care Homes: A Call for Leadership, Partnership and Improvement. London: British Geriatrics Society, 2011.Google Scholar
106Picton, C. Keeping patients safe when they transfer between care providers – getting the medicines right. A guide for all providers and commissioners of NHS services. London: Royal Pharmaceutical Society; 2011. Available at: Scholar
107Alzheimer Scotland. Charter of Rights for People with Dementia and their Carers in Scotland. Edinburgh: Alzheimer Scotland – Action on Dementia, 2009.Google Scholar
108The Joint Commission. Long Term Care Accreditation Program. National Patient Safety Goals Effective 1 January 2012. Washington DC: The Joint Commission; 2012.Google Scholar