Hospitalizations of nursing home residents: Background and options
Long-stay nursing home residents are frail and have multiple chronic illnesses and high levels of cognitive and functional impairment (Jones, Dwyer, Bercovitz, & Strahan, 2009). More than one-fourth of long-stay nursing home residents are hospitalized each year and hospitalization rates are rising (Grabowski, O’Malley, & Barhydt, 2007). Many of these hospitalizations may be potentially avoidable (Walsh et al., 2010). These potentially avoidable hospitalizations are costly to Medicare and, to a lesser extent, Medicaid. In 2005, $2.6 billion was expended by Medicare and Medicaid on acute hospital costs for potentially avoidable hospitalizations among dual eligible nursing home residents (Walsh et al., 2010). On average, Medicare paid approximately $7,600 and Medicaid paid about $300 for each of these hospital stays.1
These hospitalizations also impose a high personal cost on nursing home residents, causing disruption, risk of complications and infections, and likelihood of reduced functioning on return to the nursing home (Ouslander et al., 2010). Nursing home residents are especially vulnerable to the risks that accompany hospitalizations and transitions of care, including medication errors and hospital-acquired infections. Hospital episodes are even more difficult for patients with dementia, who become disoriented in new, confusing settings. Preventing potentially avoidable hospitalizations of nursing home residents is thus an important quality-improvement initiative from the standpoint of the residents and their families, and also may yield cost reductions.