Study questions hospitalization of failing nursing home residents

Nursing home residents close to death and with advanced cognitive and functional impairment often undergo unwanted and burdensome transitions into healthcare facilities, and fewer hospitalizations are part of a possible solution, a new study in the New England Journal of Medicine concludes.

The study of Medicare was conducted to determine how pervasive burdensome healthcare transitions are, given that patients and their families are “especially vulnerable to the adverse consequences resulting from transitions,” the authors wrote.

The study found that among 474,829 nursing home decedents, 19% underwent a burdensome transition, with some rates much higher for individual states, such as 37.5% in Louisiana.

The authors conclude that too many residents may be going into hospitals. “For persons with advanced cognitive impairment, nursing homes are the predominant locus of care,” the authors wrote. “Despite evidence that many infections can be treated in nursing homes without a significant effect on patient outcomes, the current financial incentives are aligned toward hospitalization. Evidence from demonstration programs suggests that rates of hospitalization can be reduced with improved survival and no diminution in the quality of care.”