Transferring Older Adults from Hospitals to Nursing Homes

Ken Covinsky, MD, a geriatrician at the University of San Francisco (UCSF), recently published a blog on GeriPal  addressing an issue that affects many older adults—problems with transfers from the hospital to the nursing home.  Dr. Covinsky worked with Healthinaging.org to include some specific recommendations for caregivers, who can play an active role in helping to ensure safer transfers between sites of care for their older family members and friends.

Recent Study Shows Poor Communication Between Hospitals and Nursing Homes
Huge numbers of older people are transferred from hospitals to nursing homes.  Often, an older hospitalized patient needs skilled nursing care before they are ready to return home.  In other cases, a nursing home resident who needed hospitalization is returning to the nursing home.  Older patients and their families certainly hope that great communication between the hospital and nursing home will ensure a seamless transition in care.

But a recent study in the Journal of the American Geriatrics Society (click here for a copy of the article) suggests that the quality of communication between the hospital and the nursing home can be very problematic.  The study was led by researchers from the University of Wisconsin, including nurse researcher, Dr. Barbara King, and geriatrician, Dr. Amy Kind.

The authors conducted interviews and focus groups with 27 front-line nurses in skilled nursing facilities.  These nurses noted that very difficult transitions from the hospital to nursing home were common.  Sadly, when asked to give the details of a good transition, none of the nurses were able to think of an example.

Most of the nurses felt they were not well informed about what happened to their patient in the hospital.  They also lacked essential information about their patient’s medical status.  The problem was not the lack of paper work that accompanied the patient.  In fact, nurses often received reams of paper work, often over 80 pages.  The problem was that the papers often contained unnecessary details and told them little about what was actually going on with the patient.  Often the transfer information had errors, it conflicted with what the nursing home was told about the patient before they were transferred, and it lacked accurate information about medications.

Essentially, skilled nursing facility nurses found themselves asked to care for patients with little knowledge of what actually happened in the hospital, and little insight into the functional and cognitive status of their patients.  These episodes of poor communication led to a number of problems:

  • Patients were put at risk for medication errors.  In particular, patients were often left in pain while nurses tried to find a physician to write the orders for pain medication that were not included with the transfer orders.
  • Efforts to get patients out of bed or walking were delayed because the transfer information did not say whether the patient was safely sitting or walking while they were in the hospital.
  • Time that nurses could have spent caring for patients was instead spent on trying to piece together the medical records and tracking down primary care providers and hospital providers to learn details about the hospitalization and the patient’s medications.

Drs. King and Kind point to the need for serious efforts to improve the quality of transitions between the hospital and nursing home, including improved communication.

You Can Be Part of the Solution to this Problem
For those of you who may be caring for a family member or friend who is returning to their nursing home residence from the hospital, or who is moving to a nursing home for a short- or long-term stay, it’s helpful to be aware of the problems that can occur during these moves.  You can be an advocate for your family member or friend by asking questions about the above issues before an older person leaves the hospital, and by making sure that this information is communicated to the nurses at the nursing home.  For example:

  • Ask for a written list of medications the patient was taking in the hospital, including the dosages and number of times a day the medication was given.  Make sure the nurses have this information when your family member moves to the nursing home.
  • Share with the nursing home nurses things you know that occurred while your family member was in the hospital.  For example, any tests or procedures you are aware of, any changes in their usual medications, whether they were on a special diet, or whether they were receiving physical therapy.
  • Were they walking and, if so, did they need assistance?  Were they using a cane or walker?  Let the nurses know.

You can become an active partner in an older person’s care, and you can have a positive impact on ensuring that their transfer from one place of care to another is safer and smoother.

The GeriPal blog is a forum for news and discussion.  It is written by healthcare professionals in multiple disciplines with interest and expertise in Geriatrics and Palliative Care.

 

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