More than half of long-term care residents in skilled nursing facilities made at least one emergency room visit in 2006. A quarter had two or more. Even more troubling, 38 percent were admitted to the hospital at least once that year, and nearly half were admitted twice or more. In all, one-quarter of all hospitalizations for nursing home residents were potentially preventable.
These very troubling statstics are included in a new study released today by the Kaiser Family Foundation. Even more worrisome were the reasons why: Kaiser does not have good statistics on this, but it hired Lake Research Partners, a survey research firm, to ask physicians, nurses, social workers, and family members about these hospital visits. The responses are hair-raising–not because they show uncaring or greedy docs, or sleazy nursing homes, but because they expose the routine systemic problems that drive hospitalizations.
Among the reasons so many nursing home residents land in the hospital:
The Friday effect: Nursing homes don’t have the staff to deal with medical issues, especially on weekends. So they send them to the ER.
Nursing facilities and family members prefer that residents die in the hospital.
Docs would rather care for patients in the hospital, in part because it is more convenient or because they get test results quicker.
Financial incentives: Physicians think they get paid more for caring for a patient in the hospital, and nursing homes may get paid more after a long-term care resident has been hospitalized for at least three days and returns to their facility.
Lack of a relationship between nursing homes staff and residents: It turns out that residents are more likely to get sent to the hospital in the first months of their nursing home stay.
Families consent.They don’t object, perhaps because they believe their loved one will get better care in the hospital. This is especially true if the resident has no advance directive.
Malpractice fears. Docs were afraid they’ll be sued if they don’t hospitalize a sick resident.
Dr, Cheryl Phillips, the immediate past president of the American Geriatrics Society and a member of the panel that discussed the studies at Kaiser today, described a typical situation. Imagine, she says, you are a doctor who has several patients in your waiting room. You see patients at multiple nursing homes and you get a call from a nurse at one. One of your patients–a resident in the facility–“is not doing well,” the nurse says.She doesn’t know quite what’s wrong, but things are not right. You could leave your patients in the waiting room and drive to the nursing home. Or you could say, “Send her to the hospitall.” It isn’t hard to guess what happens.
Thse potentially needless trips to the hospital cost Medicare a bundle, and, most important, hospital stays can be bad for chronically-ill elders. The new health reform law will drive many patients out of the hospital sooner, and many are likely to be cared for in nursing homes. These important studies raise some important questions about whether those facilities are prepared to take on those sub-acute patients.
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