Good nursing homes, she says, "know how to hand feed the patient and know what cues to use to keep the patient eating, but the hospital can't do that."
"It becomes a pathway. The nursing home wants to maximize its money so they send the patient to the hospital," Teno explains. "The hospital wants to get that person out of there quickly so they can have a short stay and be under the number of hospital days they're reimbursed for under that DRG. So the system is not focused on really doing a good job of talking with families about the risks and benefits of these feeding tubes. Instead, there's a rush to put these in, and send the patients back to the nursing home."
"After looking at and writing a number of papers on this for 10 years, I really think we have the wrong financial incentives, and those incentives are doing more harm than good," Teno says. "This is just another example of another intervention that needs to be carefully thought out, to weigh the risks and benefits."
In an invited commentary, Colleen Christmas, MD, and Thomas Finucane, MD, both of the Division of Geriatric Medicine and Gerontology at Johns Hopkins Bayview Medical Center in Baltimore, said Teno's findings "extend and confirm most earlier studies in this area and are now the most rigorous data we have on this subject."
They added, "Teno and colleagues provide sophisticated additional evidence that pressure sore outcomes are not improved, in fact are worsened, among patients with dementia who receive additional nutrition via feeding tubes."