Health Services for Older Adults Clustered in the Wrong Areas, Study Finds

A nationwide look at hospital services for older adults has revealed that most inpatient and post-acute services are concentrated in the northern United States, although older adults tend to live in the central part of the country, in the southwest, and in Florida. The findings appear in the recent Medical Care (2015;53:768-775), a journal of the American Public Health Association.

“The apparent mismatch of hospital services and demographic trends suggests that many US hospitals may not provide a seamless continuum of care for an increasing population of older adults,” researchers wrote.

Researchers came to their conclusions through the development of a Senior Care Services Scale, which was based on data from the 1999 and 2006 American Hospital Association Annual Survey of Hospitals. Each round of the survey included input from nearly 5000 hospitals.

The scale revealed that services for older adults clustered specifically in the northwestern, north central, and northeastern areas of the country, as well as some metropolitan areas elsewhere. Services for older adults were the least concentrated in the southwestern, south central, and southeastern United States, according to the study.

When researchers looked at services by setting type, they found that hospitals, over time, offered more inpatient services and fewer post-acute services, such as skilled nursing, intermediate care, other long-term care, assisted living, retirement housing, adult day care, and home health services. Inpatient services covered by the analysis included geriatrics, palliative care, psychiatric geriatrics, pain management, social work, case management, rehabilitation, and hospice.

The scale provides important information about nationwide services for older adults prior to the passage of the Patient Protection and Affordable Care Act, researchers wrote. Hospitals without adequate post-acute care services today may find themselves unable to participate in accountable care organizations, said study lead author Alicia I. Arbaje, MD, MPH, director of transitional care research at Johns Hopkins Bayview Medical Center and assistant professor of medicine at the Johns Hopkins University School of Medicine (Baltimore, MD).

“If those hospitals are not partnered with post-acute care services providers, or the hospitals lack resources to ensure that older adults have what they need after discharge, then the hospitals are less able to manage the risks they face of what happens to patients after they leave,” said Dr. Arbaje in a press release.—Jolynn Tumolo