Hospital visits grow too routine for long-term care residents

Hospitalizations for long-term care residents have become too routine, although they could be prevented, according to a report from the Kaiser Family Foundation.

The report, To Hospitalize or Not to Hospitalize, offers insights into factors behind high hospitalization rates and suggests solutions. It is based on interviews with physicians, nurses, social workers and family members of residents of long-term care facilities.

LTC residents account for a disproportionately large share of Medicare spending. According to KFF, 1.7 million Medicare beneficiaries in long-term care for all of 2006--or who died in care before the year's end--cost the program an average of $14,538 per person, more than twice the average expenditure for all Medicare beneficiaries. Medicare covers LTC residents' ER visits, hospitalizations and other medical treatments, but not stays in nursing homes, assisted living facilities or other long-term care programs.

Strategies the report suggests to cut avoidable hospitalizations include beefing up staff with more medical support and a philosophy shift about the appropriateness of hospitalization, instead of viewing it as the path of least resistance.

Among factors that drive hospitalization of LTC residents, interview participants said there were no disincentives to sending an LTC resident to the ER when a medical issue is suspected. Not only does hospitalizing a medically compromised resident reduce liability concerns and allow for more timely diagnostic tests, it also can be more convenient for physicians.

Staff and doctors may assume that the family prefers more aggressive treatment. And a lack of qualified staff, protocols and license restrictions, have further exacerbated the tendency to default to hospitalization. Often the perception of best care is 'Let's send Mrs. M to the emergency room and see what the ER finds,'" Dr. Cheryl Phillips, chief medical officer of the Bay Area nonprofit On Lok Lifeways, told Kaiser Health News. Some of the interviewees noted that residents often return from the hospital disoriented, on different meds and with new infections.

Dr. Donald Berwick, head of the Centers for Medicare and Medicaid Services, told Kaiser Health News that better coordination was needed, saying too many people experience "disintegrated care."

"The goal is to change through redesigning the system," he said.

To learn more:
- read the Kaiser Family Foundation report
- read other related reports from the Kaiser Family Foundation
- read the Kaiser Health News story

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