AVOIDING UNNECESSARY HOSPITALIZATIONS FOR NURSING HOME RESIDENTS

While hospitalizations can be lifesaving, they also pose particular risks for older adults in long-term care. Among other things, frail residents risk exposure to potentially deadly infections, delirium, and functional losses while hospitalized.

Many factors figure into decisions to hospitalize residents. A recent Health Services Research study, in fact, finds that variables such as state Medicaid bed-hold policies and per-diem payments are among these factors. Both lower per-diem payments and policies assuring that nursing home beds are held while residents are hospitalized are associated with significantly higher hospitalization rates, the study shows.

Hospitalizations may be unavoidable but a surprising number are not. According to the same study—which followed more than 570,00 elderly long-stay nursing home residents for 5 months—37.3 % of hospitalizations involved residents with “an ambulatory care sensitive primary diagnosis which, given ideal care, could either have been prevented or treated in the nursing home.”

The study’s lead author, Orna Intrator, PhD, associate professor of Community Health at Brown University, notes that high hospitalization rates for nursing home residents constitute a complex problem, and adds that pay-for-performance policies that reward nursing homes for lowering these rates could be part of the solution.

Several strategies may help long-term care facilities lower rates by preventing unnecessary hospitalizations, say Intrator and others with expertise in the field. Ensuring that there are enough well-trained healthcare providers to go around is likely to help significantly, they note. In fact, Intrator and colleagues reason that their study found lower overall hospitalization rates in states with higher per diem nursing home payments because facilities in these states could better afford to keep more nurse practitioners and other highly trained professionals on staff or available to residents.

“With more staff, and more skilled staff, homes are better able to treat residents on site and they’re better able to practice preventive care to head off problems such as pneumonia, bed sores or urinary tract infections,” says Vincent Mor, PhD, chair of Brown’s Department of Community Health, who led the National Institute on Aging– funded study.

Both careful monitoring and care of chronic conditions such as diabetes, heart failure, and COPD, and consideration of nonhospital treatment of acute infections (with oral antibiotics and supplemental oxygen for residents with pneumonia, for example) can help frail long-term care residents avoid unnecessary hospitalizations, advises study co-author Mark Schleinitz, MD, assistant professor of Community Health at Brown.

For facilities hard-pressed to add permanent staff, services provided by Evercare, a health plan for Medicare-eligible individuals that utilizes nurse practitioners to manage the care of their enrolled beneficiaries (https: //evercarehealthplans. com/index.jsp) and other programs focusing on providing integrated care, such as the Program of All- Inclusive Care for the Elderly ([PACE], https://www.cms.hhs.gov/ pace/), can help. Such programs can ensure that residents are seen more frequently by highly trained nurse practitioners and physicians who can provide urgent and emergent visits, even during weekends and evenings, the researchers add.