Preventing Unnecessary Hospitalizations of Nursing Home Residents
Tuesday, April 13, 2010
Hospitalizations can be very difficult for nursing home residents. They can be upsetting and uncomfortable, and can increase risks of medical complications. Spending a lot of time in a hospital bed can result in loss of strength, which can leave an older person more likely to fall. Older adults may also experience temporary confusion or "delirium" when hospitalized. If prescribed additional medications while in the hospital, they may suffer side effects or problems due to interactions between drugs they were already taking and new drugs they've been given in the hospital.
For these reasons, it's extremely important to prevent unnecessary hospitalizations of nursing home residents and, instead, treat them in the nursing home when possible. Avoiding unnecessary hospitalizations can also save money - money that could be spent improving nursing homes so they can better care for sicker residents.
New Research in the Journal of the American Geriatrics Society
To learn more about how often nursing home residents are hospitalized unnecessarily-- and why-- researchers recently took a look at the hospital records of nursing home residents who'd been hospitalized over a 15-month period. The residents lived in 20 different nursing homes in Georgia. Half of the nursing homes had relatively high resident hospitalization rates. The other half had relatively low hospitalization rates. The researchers reviewed a total of 200 records to determine which hospitalizations could have been avoided, and how.
All told, 68% of the hospitalizations probably could have been avoided, the researchers concluded. A number of different things could have prevented these hospitalizations, they report in the Journal of the American Geriatrics Society. Some of these avoidable hospitalizations could have been prevented if the nursing homes did a better job identifying and evaluating major changes in residents' health - something the homes would need more available physicians, nurse practitioners or physician assistants to do. Other hospitalizations could have been prevented if the nursing homes had better access to laboratories that could carry out medical tests, or to X-ray equipment, or to IV fluid services. In other cases, unnecessarily and "futile" hospitalizations -- hospitalizations that did not benefit the resident because he or she was too ill to recover, despite treatment - could have been avoided if more of the nursing home residents had completed "advance directives, " the researchers report. Advance directives are written statements that explain what kind of care you do -- and don't -- want if you become seriously ill or injured and cannot make medical decisions for yourself.
There are other ways nursing homes might lower rates of unnecessary, and additional research exploring these is needed, the researchers write. Because reducing unnecessary hospitalizations of nursing home residents would save money that could help pay for improvements in care, "potentially avoidable hospitalizations of nursing home residents appear to represent an opportunity to improve the quality of nursing home care and lower healthcare expenditures," they conclude.
What Should I Do?
Visit the FHA's expert "tip sheet" offering advice on evaluating a nursing home
The summary above is from the full report titled, "Potentially Avoidable Hospitalizations of Nursing Home Residents: Frequency, Causes, and Costs." It is in the April 2010 issue of the Journal of the American Geriatrics Society (Volume 58, Issue 4). The report is authored by Joseph G. Ouslander, MD; Gerri Lamb, PhD, RN, FAAN; Mary Perloe, MS, GNP; JoVonn H. Givens, MPH; Linda Kluge, RD, LD, CPHQ; Tracy Rutland, MBA, MHA; Adam Atherly, PhD; and Debra Saliba, MD, MPH .