Nursing homes may replace hospitals as linchpin of senior care

Nursing homes may edge out hospitals as the primary healthcare option for elderly patients, according to the New York Times.

Hospitals often serve as breeding grounds for problems and preventable harms common to senior citizens, such as patient falls and hospital-acquired infections, as well as the risk of unfamiliar surroundings exacerbating issues such as delirium or dementia, the article said. Consequently, "the push is to reduce unnecessary hospitalization for things that can be handled in skilled nursing facilities," David Siskind, the medical director at the Gurwin Jewish Nursing and Rehabilitation Center in Commack, New York, told the Times.

Even though shifting Medicaid and Medicare policies and the rise of accountable care organizations encourage this transition, nursing homes still have adaptations to make. For example, many of the 16,000 nursing homes in the country do not have round-the-clock nursing staff. Hawaii, Maryland, Tennessee, Connecticut and Rhode Island all require 24-7 nurses, and several other states require staffing in proportion to facility size, but there is no requirement for coverage at the federal level.

Lack of 24-hour nursing staff could severely complicate common procedures, such as IV placement, according to the Times. In a facility without round-the-clock nurses, an IV problem would likely mean transferring the patient to a hospital. Complicating the transition even further, Medicare's reimbursement structure provides incentives for that transfer; nursing homes receive fixed reimbursements, even if they need to pay for expensive antibiotics or treatments, so it's easy for a facility to see high-risk patients as cost burdens.

Advocates told the Times that they hope the substantial savings associated with nursing home treatment as opposed to hospital stays will catch the attention of federal agencies; Zachary Palace, M.D., medical director at the Hebrew Home in the Bronx, New York, points to data showing Medicare patients' average length of hospital stay for a blood transfusion in 2012 was 5.3 days, with a mean price tag of $10,399, whereas outpatient transfusions at Montefiore Medical Center cost Hebrew Home only $350 for the same-day procedure and slightly more than $200 for transportation and a unit of blood. Since beginning its effort to reduce hospital transfers, Hebrew Home has cut them in half, Palace told the Times.

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