The Kaiser Family Foundation has issued a report on hospitalizations for long-term care facility residents. Nursing homes have become the last living place for millions of Americans. The quality of life is often poor, as it often is for the elderly in any setting, and the quality of medical care is also questionable. Many nursing home residents have very high medical costs and much of this cost can be attributed to hospitalizations and emergency room visits which often don’t seem necessary. The Kaiser report examines the reasons for these trends and what might be done to counter them. (KFF Report) The report is based on a series of interviews with caregivers and family members in four states.
From the interviews, several primary reasons for use of a hospital setting of care instead of dealing with a medical problem at the nursing facility were identified. These included limited medical capacity at nursing homes, physician preference to treat in the hospital setting, financial incentives for both physicians and the nursing home, liability concerns, lack of advance planning and directives, misunderstandings about patient and family preferences and behavioral health issues which nursing home staff don’t want to handle. Reducing inappropriate ER visits and hospitalizations, and the attendant costs, would involve better training and support for the medical staff at hospitals, including more staff at night and on weekends, a focus on avoiding these expensive medical services, better communication and understandings with the patients and family members about the problem, and changing financial incentives.
The consequences of hospitalizations for these residents is not just additional cost. The transition from one care site to another is often poor with little sharing of data and care plans. The residents, who often already have cognitive issues, are easily confused by the movement from one site to another and may even pick up new health problems while hospitalized. Anxiety is undoubtedly caused for family members. While this report is purely qualitative, it helps to identify the parameters of the potential problem. More definitive data collection and analysis, coupled with specific initiatives and incentives to change the care patterns, will be necessary to help reform this area of medical care.