Teno, a geriatrician who practices in Rhode Island, says that nursing homes and hospitals together have "a strong financial incentive" to deal with patients with dementia by inserting PEGs, or percutaneous gastrostomy tubes rather than hand feeding them, which takes more time and patience.
The majority of the people who get these feeding tubes have already been in a nursing home for a while, she explains. They've exhausted their wealth and now qualify for Medicaid, and then become "dual-eligibles," qualifying for both Medicare and Medicaid. If the patient gets an infection, even a minor one, rather than treating the infection in the nursing home, they send them to the hospital.
The patients then become eligible for skilled nursing facility services for up to 100 days, "which qualifies the nursing home to get paid roughly three to four times what would have been paid if the patient remains at the nursing home on Medicaid," she says.
Because of the setting change, these patients develop disruptive behaviors, which usually leads to physical or pharmacological restraint with neuroleptics. The nutritional supplements they're getting can produce diarrhea. "Now, with the immobility, the incontinence, and diarrhea, they end up with pressure ulcers."