ED Visits By Nursing Home Residents 'Disproportionately High'

Cheryl Clark, for HealthLeaders Media , October 30, 2013

Of those, 19% were for ambulatory care sensitive conditions, defined by the Agency for Healthcare Research and Quality as pneumonia, urinary tract infections, and other conditions such as asthma, chronic obstructive pulmonary disease, hypertension, appendicitis, congestive hart failure, dehydration, angina, and complications of diabetes.

Hsia says that it's not surprising that the percentage of skilled nursing home patients transported to an ED for care has risen; nursing home patients are sicker than they were 10 years ago, and more resources are available for patients with lower level of illness severity to be cared for in less intense settings such as home or assisted living residences.

Also, with the aging of the population, the number of skilled nursing home beds has outpaced demand, and if patients are not eligible for Medicare SNF coverage, not all patients and their families can afford the expense.

The issue is becoming increasingly important as hospitals struggle to reduce readmissions from skilled nursing facilities, which in 2006 were estimated at 21% and in 2010, rose to 23% according to Momotazur Rhaman, an investigator in health services policy and practice at Brown University.

Additionally, the Medicare Payment Advisory Commission (MedPAC), has been urging the Centers for Medicare & Medicaid Services to impose financial penalties on skilled nursing facilities with higher rates of 30-day hospital readmissions in a manner similar to CMS' up to 3% financial penalty to hospitals with higher rates of readmissions.

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2 comments on "ED Visits By Nursing Home Residents 'Disproportionately High'"

M. Bennet Broner, PhD (10/30/2013 at 12:14 PM)
Years ago, I performed quality assessments of nursing home care for Medicaid and I was surprised at the frequency with which residents were transported to the ED though their conditions could likely have been treated "in-house". Transportation, often by ambulance, occurred for not only suspected UTIs, but also for a minimal spike in temperature, and even for ear wax removal. These facilities had medical directors and many of the patients had personal physicians listed on their charts. Could these professionals not have been consulted first or could they have visited the patient at the home rather than their being transported to overburdened EDs?

Deb Collier (10/30/2013 at 10:08 AM)
SNF medical care is fragmented and limited by the episodic medical oversight provided by the team of medical providers which may change daily. They are not staffed to deliver preventative care through continuous monitoring of chronic conditions. Even when we bring issues to their attention, they are passive and when challenged, call an ambulance. Basic proactive measures are not standard such as a urine dip after treatment for a UTI or removal of a catheter. Is that because CMS does not pay or authorize? It takes over 24 hours to implement any medication or treatment change and then the subsequent aides and nurses do not always follow orders (daily weight - pressure stockings - hydration)because they are short staffed and pressured to care for numerous "guests" simultaneously. Two hospitalizations in three weeks is costly in many terms but of most importance to us, it delays rehab and reduces the chances of any level of recovery. Keep researching this topic. We can do better for our parents and loved ones.




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