Are too many nursing home patients hospitalized?

Study IDs 'dubious' transitions for some patients

About one in five Medicare beneficiaries who are in nursing homes for dementia are hospitalized for questionable reasons during their final months, according to a study in NEJM.

For the study, Brown University, Harvard University, and Dartmouth Medical School researchers analyzed Medicare records for nearly 475,000 nursing home patients from 2000 to 2007 to identify "burdensome" transfer rates. A transfer was considered burdensome if a patient was moved in the last three days of life, moved multiple times in the last three months of life, or moved to a new nursing home after hospital admission.

The findings showed that overall 19% of nursing home patients with advanced cognitive impairment were moved for "dubious" reasons. Patient moved for questionable reasons were more likely to need a feeding tube, spend time in the ICU in the last month of life, develop severe bedsores, or be enrolled in hospice for three days or less before death.

Meanwhile, the study found that many participants were hospitalized for conditions, including dehydration, pneumonia, or urinary infections. However, the researchers note that such transitions "are often avoidable because common complications … can be treated with equal efficacy in the nursing home."

The results also showed a large variation in burdensome transfer rates between states. For example, transfer rates in were 2% in Alaska and more than 37% in Louisiana. Although the study uncovered no definitive evidence that money played a role, the researchers said the variation in rates suggested that financial incentives may be a contributor.

According to AP/Google News, Medicaid pays $175 daily on average for long-term care, but up to three times that amount for skilled nursing care after a patient returns from a more than three-day hospital stay (Barr, Modern Healthcare, 9/28 [subscription required]; Phend, MedPage Today, 9/28; Marchione, AP/Google News, 9/29).

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