This qualitative exploratory study presents new data about small adult care home owners and their experience with health care transitions. Health care transitions are an issue of national concern. The elderly are particularly vulnerable to frequent health care transitions and represent the largest population at risk for rehospitalization, emergency room use, and medication errors resulting from poor care transitions. Small adult care homes are an integral part of the care continuum, yet investigation into health care transition in this setting is scant. Research to date has been focused on medical settings to the exclusion of this provider group suggesting they may be marginalized within this health care continuum. Eight semi-structured interviews were conducted with small care home owners (bed capacity 10 and under) licensed in Maricopa County, AZ over a three month period. Grounded theory methodology was utilized to analyze care home owners experiences.

Findings of this study document the process of care transition as experienced by care home owners upon the hospitalization and discharge of their residents. In managing the transition process, owners developed unique strategies to obtain vital health care information. Strategies documented included proactivity and family relationship building. An emerging model of care transition was identified through the interpretation of purposes for which care home owners developed strategies. The theoretical framework proposes that care home owners manage care transition through relationship and legitimacy building.

Social work implications include a need for better recognition by hospital social workers/discharge planners, case managers, etc. of the positioning of small adult care home owners within the health care continuum. Acting as advocates for the greater inclusion of this provider group may assist in improving care transitions and patient outcomes.