Nursing Home and Hospital Use by the Elderly

An inevitable focus of efforts to reduce health care spending is the care of those categories of patients who have high costs, particularly those who do so year after year.  One such category is nursing home residents.  A Statistical Brief from the Agency for Healthcare Research and Quality examines hospitalizations and transitions back to nursing homes for the elderly.   (AHRQ Brief)   The Brief is based on data from 2009.  People over 65 represent almost 90% of the nursing home population and account for over a third of all hospital admissions.  Many of these people have cognitive difficulties and transitions from one care setting to another may be particularly destabilizing for them.  A focus on care transitions is one of the core facets of programs to improve coordination across settings in the hope of improving quality and lowering costs.  While elderly nursing home residents have a lower rate of hospitalization, 204 per 1000 versus 311 per 1000 for community dwelling seniors, their length of stay was longer at 6.4 days versus 5.2 days and their stay ended in death much more frequently, 8.1% of the time versus 3.8%.  The most common reason for hospitalization for the nursing home residents was infection, almost 30% of hospitalizations versus 16% for admissions from the community.  This may reflect poor care in the nursing home.  Other common reasons were stroke, heart disease and respiratory problems.  Most nursing home residents were discharged back to the nursing home, but some went to the community, presumably a home.  And some small percent of hospitalizations from the community resulted in discharge to a nursing home.