How Can We Keep Nursing Home Residents Out of Hospitals?

One-third of nursing homes residents are admitted to the hospital at least once each year, and half of those admissions could be avoided. Preventing them could protect hundreds of thousands of older adults from potential harm and save Medicare billions of dollars.

The problem is neither new nor surprising. But it is tough to fix. Last week, the federal Centers for Medicare and Medicaid Services (CMS) announced a second stage of what it calls an Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents.

What Medicare and Medicaid’s Ratings Say About Nursing Homes

For all of its flaws, Medicare and Medicaid’s Nursing Home Compare five-star rating system gives consumers a head-start when searching for a facility. Now, the Kaiser Family Foundation has taken a closer look at the ratings, and reached some interesting conclusions:

  • In a system that rates facilities from 1-5 stars, about one-third have low 1 or 2 star ratings, while about 45 percent received 4 or 5 stars.
  • Non-profits, which represent only about one-quarter of nursing facilities, generally get higher ratings than for-profits.
  • Smaller facilities score higher than larger ones.

Nursing Homes Use Too Many Antibiotics, and Residents Are Dying

Infections are all-too-common in nursing homes. And all-too-often facilities treat these conditions with large doses of antibiotics. Now the Obama Administration has announced a major initiative aimed at dramatically reducing the use of these drugs. And the effort has the potential to fundamentally change the way nursing homes operate—and the way residents receive care.

Today, antibiotic use is routine in nursing facilities. The Centers for Disease Control estimates that two-thirds of all residents will be given at least one course of antibiotics this year, and that 25 percent to 75 percent of those prescriptions will be inappropriate. But as a result of the heavy use of antibiotics, 27,000 nursing home residents will suffer from a drug-resistant infection. And many will die.

Looking Beyond Medicare’s Nursing Home Ratings: What You Really Should Know Before Picking a Facility

This week, The New York Times published an investigative report by Katie Thomas on Medicare’s five-star rating system for nursing homes.  Among its findings: Medicare’s Nursing Home Compare tool relies largely on self-reported data by the facilities themselves and is thus unreliable.

On one hand, this is a bit odd, since Medicare’s website explicitly describes these very shortcomings.  On the other hand, the article (which will get a lot of attention because it is The New York Times) may encourage consumers to look beyond Medicare’s rating system. And that would be a good thing.

Frail Seniors Want To Live At Home. But Is it More Dangerous?

Frail seniors getting supports and services at home are more likely to be hospitalized than those living in nursing homes, even though those in nursing facilities are often sicker than those in the community, according to a new study in the June issue of the journal Health Services Research (behind a paywall).

The study finds that seniors receiving care at home face both preventable and non-preventable hospitalizations at significantly higher rates than nursing home residents. These elders were at greater risk of hospitalization for potentially preventable conditions, according to the paper by Andrea Wysocki of Brown University; Bob Kane, Ezra Golberstein, Bryan Dowd, and Tetyana Shipee of the University of Minnesota; and Terry Lum of the University of Hong Kong.  These conditions include congestive heart failure, pneumonia, dehydration, and urinary tract infections.

A Modest Step To Improve Medicare Post-Acute Care

Medicare has a huge and growing problem caring for patients after they have been discharged from the hospital. After years of talk, Congress may be about to take a modest but important first step toward cleaning up the mess, and making sure that patients get care that gives them the best chance to live a healthy and active life after a surgery or acute medical episode such as a stroke.

Where Can You Get the Best Nursing Home Value in America?

A new study by AARP, the Commonwealth Fund, and the SCAN Foundation ranks the quality and affordability of nursing homes by state. It finds wide variation in both cost and quality among states but, at least according to some indicators, you get what you pay for: The states with the most affordable facilities are plagued by many poor performers.

This report, part of a much larger study called Raising Expectations, shows that for middle-income families the typical nursing home is unaffordable in every state. Across the country, the median private pay cost of a year’s stay is more than twice median income of households age 65 or older. But the differences among states are vast.

Want To Know Where Senior Care Is Headed? Keep An Eye On Kindred Healthcare

For an important clue into the future of senior care in the U.S., watch Kindred Healthcare, a $5 billion company that operates in 47 states.  As recently as 2010, half of Kindred’s business was generated by its skilled nursing facilities. This year, only one-fifth of its revenues will come from its nursing and rehab centers. In a major strategic shift, Kindred is betting the company on in-home care, hospice, care management, and fully integrated care services.

In an aggressive effort to expand its homecare business, earlier this month Kindred moved to buy Gentiva Health Services for $1.6 billion. Gentiva, which is fighting the takeover, is a $2 billion home care provider with 47,000 employees in 40 states.

Addressing the Dangers of Nursing Facilities

Earlier this month, the federal department of Health & Human Services concluded that more than one of every five skilled nursing facility (SNF) patients suffered serious harm from events such as medication errors, falls, or infections in 2011. Half were sent to the hospital as a result of these events. Six percent died. And 60 percent of these adverse events were deemed “clearly or likely” preventable by medical experts.

The findings have important implications for a major trend in the care of the frail elderly: the growing partnerships between hospitals and skilled nursing facilities. Increasingly, under financial pressure from Medicare payment rules and through new relationships such as Accountable Care Organizations and bundled payments, hospitals are transferring patients to SNFs faster than ever.

It is Very Hard to Move People Out Of Nursing Homes

It sounds like a great idea: Move people out of long-stay nursing facilities and back into their communities, and give them flexibility to spend government dollars on the care they need. Such a change could make care more person-centered and reduce costs. But a federal/state demonstration aimed at achieving that goal has moved very few people.

For six years, the federal government and state Medicaid officials have been giving people the opportunity to return to their communities through a $4 billion demonstration program called Money Follows the Person. Although 41 states are participating, less than one percent of nursing home residents have successfully made the transition, and most of them were younger people with disabilities.