These transitions are occurring for very high-risk and vulnerable older adults. It is not uncommon to find that a single older individual may move multiple times in the space of several weeks. Within each setting is a new care provider who likely is unfamiliar with the nursing care needs of the older person. The older adult may become confused and distressed in such situations. Even though nursing models such as case management and primary nursing care have been introduced in some settings, evaluation efforts to determine the impact of such models on resident and client outcomes are inadequate.
Hospitals are also a major part of the circle of transfers noted above.
Nursing care provided for older adults in hospitals may make the difference between an uneventful recovery from an acute illness or a recovery slowed by complications and marked by readmissions. Innovative nursing practice strategies need to be developed and evaluated for their effectiveness in reducing or eliminating the negative effects of hospitalization. A wide variety of alternative health care settings and living arrangements for older adults have emerged over the past decade. Although these settings are not seen as the usual arena for nursing practice, most have a health care component, and most of the needed health care is nursing care. Where nursing care is provided, it is important to develop quality indicators to assess the effect of nursing interventions on resident health status.