According to a recent news article from The New York Times, nursing homes are beginning to take the hospital’s place when it comes to basic health care, preventing unnecessary hospitalizations for older adult residents. Not only does this shift in focus allow residents who do not do well in hospital settings to remain in the comfort of their nursing home, it can also prevent unnecessary hazards that could seriously diminish a patient’s quality of life, such as falls, stubborn infections, the development of delirium from unfamiliar environments and pharmaceuticals, and conditional deterioration due to inactivity. Residents can also avoid experiencing functional loss, including cognitive ability that may never be recovered, especially if the resident is already developing dementia.
Hospitalization is a frightening experience for many older adults, causing a lot of anxiety and depressed mood. The article notes that, fortunately, a growing number of nursing home facilities are providing treatment for their residents that would normally occur in the hospital setting. The Hebrew Home at Riverdale is one such nursing home that provides IVs for antibiotics, diuretics and other drugs, or for hydration without having to require residents to leave their rooms. Dr. Zachary Palace, a geriatrician and medical director at the Hebrew Home says that hospitalization for these types of treatments “should be a thing of the past, but it’s not.”
Many still believe that hospitals remain the safest place for older adults when they are ailing. However, more than twenty years of research has reported the risks of hospitalization for older patients, particularly those who are frail or ill enough to require nursing home care. The fact is that in hospitals, older adults fall, contract infections, can develop delirium due to unfamiliar environments and drugs, and pressure ulcers and loss of conditioning from a decrease in activity level.
Changing Medicare and Medicaid policies and incentives, as well as new HMO-like accountable care organizations, are pushing the use of hospital procedures that can be carried out efficiently in the nursing home. Unfortunately, nursing homes are adopting them at a very slow rate. “There’s a mismatch between facilities’ capabilities and what they want to do,” says Dr. Leonard Gelman, the immediate previous president of AMDA – The Society for Post-Acute and Long-Term Care Medicine.
A major problem that is hindering the adoption of more procedures is the fact that many of America’s 16,000 Medicare-certified nursing homes do not employ round-the-clock registered nurses. Federal regulations only mandate eight hours per day. Only five states (Rhode Island, Connecticut, Hawaii, Maryland, and Tennessee) require 24/7 nursing coverage. In other states, staffing levels are determined by facility size.
The Hebrew Home is a nursing home that demonstrates why at-home treatment for older residents makes sense. According to Dr. Palace, residents who needed transfusions previously spent up to four days in the hospital, while specialists performed the usual tests that had not been requested by anyone. He says, “People never came back healthier than when they left us.” Moreover, Dr. Palace recently found that Medicare patients stayed an average of 5.3 days in a hospital for blood transfusions in 2012. The average expense: $10,339. On the other hand, in 2006, Hebrew Home sent approximately 30 to 35 residents to the hospital each month last year, a significant drop from 2006, when the home sent about 70 residents to the hospital, monthly. Dr. Palace says that the nursing home was able to but their hospitalization rate in half due to the increased effort to perform more routine procedures at the facility. He says, “It’s better for your 85-year-old mother to stay here, where she knows us and we know her.”